绒毛膜羊膜炎和脐炎的病理诊断是否与早产儿代谢性酸中毒相关  

Are histopathologic chorioamnionitis and funisitis associated with metabolic acidosis in the preterm fetus?

作　　者：Holcroft C.J. Askin F.B. Patra A. 高雪莲 

出　　处：《世界核心医学期刊文摘（妇产科学分册）》2005年第6期8-9,共2页Core Journal in Obstetrics/Gynecology

摘　　要：Perinatal infection increases the risk of neonatal neurologic injury. Our objective is to determine whether histologically confirmed chorioamnionitis and funisitis is associated with fetal metabolic acidosis. This is a retrospective cohort study of all infants 34 weeks or less born at a single tertiary hospital admitted to the neonatal intensive care unit (NICU) between April 1999 and September 2002. Maternal and neonatal records and placental pathology reports were reviewed. There were 392 infants at 23 to 34 weeks’ gestational age admitted to the NICU during this period of whom 354 had placental pathology reported; 259 infants had umbilical cord gases available. These neonates were placed into 3 groups: group 1 (208 infants) had no signs of placental infection, group 2 (59 infants) had isolated chorioamnionitis, and group 3 (87 infants) had both chorioamnionitis and funisitis. The gestational age (30.2 ± 2.8, 28.3 ± 3.4, 27.8 ± 2.8 weeks, P <. 01) and birth weight (1358 ± 520, 1242 ± 547, 1103 ± 381 g, P <. 01) were significantly higher in group 1. There was an increase in neurologic morbidity in groups 2 and 3 (25.2% , 34.4% , 43.7% ), which was not significant when corrected for gestational age. Groups 2 and 3 had a small but significant increase in umbilical arterial pH (7.25 ± 0.10, 7.29 ± 0.10, 7.30 ± 0.08, P <. 01) and base excess (- 3.5 ± 3.6, - 2.2 ± 3.6, - 2.3 ± 2.7 mmol/L, P =. 02). When a single pathologist reviewed all placentas with any inflammation and staged them on the basis of the degree of the fetal inflammatory response, no relationship was found between the degree of fetal inflammation and umbilical arterial pH (stage 1, 7.27 ± 0.09; stage 2, 7.30 ± 0.09; stage 3, 7.30 ± 0.08; P =. 41) or base excess (stage 1, - 2.82 ± 3.47 mmol/L; stage 2, - 1.95 ± 3.17 mmol/L; stage 3, - 2.23 ± 3.07 mmol/L; P =. 62). When stepwise multiple linear regression was performed, neither histologic chorioamnionitis nor histologic funisitis were associated with a change in umbilical cord pH or bPerinatal infection increases the risk of neonatal neurologic injury. Our objective is to determine whether histologically confirmed chorioamnionitis and funisitis is associated with fetal metabolic acidosis. This is a retrospective cohort study of all infants 34 weeks or less born at a single tertiary hospital admitted to the neonatal intensive care unit (NICU) between April 1999 and September 2002. Maternal and neonatal records and placental pathology reports were reviewed. There were 392 infants at 23 to 34 weeks’ gestational age admitted to the NICU during this period of whom 354 had placental pathology reported; 259 infants had umbilical cord gases available. These neonates were placed into 3 groups: group 1 (208 infants) had no signs of placental infection, group 2 (59 infants) had isolated chorioamnionitis, and group 3 (87 infants) had both chorioamnionitis and funisitis. The gestational age (30.2 ± 2.8, 28.3 ± 3.4, 27.8 ± 2.8 weeks, P <. 01) and birth weight (1358 ± 520, 1242 ± 547, 1103 ± 381 g, P <. 01) were significantly higher in group 1. There was an increase in neurologic morbidity in groups 2 and 3 (25.2% , 34.4% , 43.7% ), which was not significant when corrected for gestational age. Groups 2 and 3 had a small but significant increase in umbilical arterial pH (7.25 ± 0.10, 7.29 ± 0.10, 7.30 ± 0.08, P <. 01) and base excess (- 3.5 ± 3.6, - 2.2 ± 3.6, - 2.3 ± 2.7 mmol/L, P =. 02). When a single pathologist reviewed all placentas with any inflammation and staged them on the basis of the degree of the fetal inflammatory response, no relationship was found between the degree of fetal inflammation and umbilical arterial pH (stage 1, 7.27 ± 0.09; stage 2, 7.30 ± 0.09; stage 3, 7.30 ± 0.08; P =. 41) or base excess (stage 1, - 2.82 ± 3.47 mmol/L; stage 2, - 1.95 ± 3.17 mmol/L; stage 3, - 2.23 ± 3.07 mmol/L; P =. 62). When stepwise multiple linear regression was performed, neither histologic chorioamnionitis nor histologic funisitis were associated with a change in umbilical cord pH or b

关 键 词：绒毛膜羊膜炎 代谢性酸中毒 脐炎 病理诊断 碱剩余 脐血 平均胎龄 感染征象 神经系统疾病 脐动脉血 

分 类 号：R722.6[医药卫生—儿科]