Neurodevelopmental Outcome of Very-Low-Birth-Weight Infants with Chorioamnionitis

合併有絨毛膜羊膜炎之極低體重早產兒神經心智發展之結果分析

穆淑琪(Shu-Chi Mu) ； 林姃慧(Cheng-Hui Lin) ； 宋增銓(Tseng-Chen Sung) ； 陳怡伶(Yi-Ling Chen) ； 林依潔(Yi-Chieh Lin) ； 李進成(Chin-Cheng Lee) ； 陳東榮(Tong-Jong Chen) ； 林明益(Ming-I Lin) ； 卓貴美(Guey-Mei Jow)

《Acta Paediatrica Taiwanica》 48卷4期 (2007/08) Pp. 207-212

https://doi.org/10.7097/APT.200708.0207

摘要

背景：絨毛膜羊膜炎(Chorioamnionitis(CAM))是造成早產的主要原因之一，也與早產兒出生後的不利結果有關。
目的：此研究的目的是要評估病理診斷有或沒有CAM之極低體重早產兒(very low birth weight infants)，於矯正年齡6、12、18、24個月在貝氏測驗發展指標分數上是否有所差異。
方法：本研究中95位個案均為出生體重小於1500克之早產兒，有CAM診斷為54人，無CAM之診斷為41人，有CAM之診斷的比率為56.8%。
結果：在週數、分娩方式、產前類固醇的使用上，兩組間有統計上的意義，而在有慢性肺、支氣管生成不良、使用呼吸器、接受氣管插管的比例上，有CAM組人數顯著較多，且呼吸器的使用天數也明顯較長。但在早產兒視網膜病變、腦室內出血、嚴重腦室內出血（第三級及第四級）、開放性動脈導管，住院天數部份貝氏兩組結果相似。於矯正年齡6、12、18、24個月時心智及動作發展指標分數兩組無明顯差異。
結論：有絨毛膜羊膜炎之極低體重早產兒兩歲以前之神經心智發展與無絨毛膜羊膜炎者比較並無明顯差異。

關鍵字

極低體重早產兒 ； 絨毛膜羊膜炎 ； 早期破水 ； 貝氏嬰幼兒發展測驗

並列摘要

Background: Chorioamnionitis (CAM) is one of the main causes of preterm labor and has been associated with an adverse perinatal outcome in preterm infants.
Objective: The specific aim of our study was to evaluate whether there is significant difference in the Bayley developmental index scores at 6, 12, 18 and 24 months of corrected age for very-low-birth-weight (birth body weight ＜1500 gm, VLBW) infants with or without placental CAM.
Methods: Ninety-five cases (54 in CAM and 41 in non-CAM groups) available for the study were all VLBW infants with adequate histologic placental material for analysis. Neonatal characteristics and morbidities were recorded. The infants were followed up prospectively with Bayley Scales of Infant Development in the Neonatal Follow-up Clinic for 2 years. Results: We found that 56.8% of placentas presented a picture of CAM. In comparison of the neonatal characteristics, VLBW infants with CAM had shorter gestational age (27.9±2.8 vs. 30.0±3.7 weeks, p=0.003), lower Cesarean delivery rate (48.1% vs. 73.2%, p=0.011), more maternal steroid use (44.4% vs. 12.2%, p=0.004) and higher incidence of preterm premature rupture of membrane (PPROM, 37.0% vs. 12.2%, p=0.009). In comparison of neonatal outcomes, the CAM group had higher incidence of bronchopulmonary dysplasia (BPD, 40.7% vs. 19.5%, p=0.044), more mechanical ventilation (87.0% vs. 27/41, p=0.023) and intubation (68.5% vs. 46.3%, p=0.049), and more median days of ventilation (23.1±29.1 vs. 7.8±13.7 days, p=0.001). As for the follow-up, at any test age, either the mean (Mental Development Index (MDI)/(Psychomotor Development Index (PDI) scores of Bayley test or the incidence of score below 85, there was no significant difference in both groups.
Conclusions: The VLBW infants with histologic chorioamnionitis were not associated with an increased risk of lower MDI or PDI scores at the corrected ages of 6, 12, 18 and 24 months compared with the non-CAM control group.

並列關鍵字

very-low-birth-weight ； chorioamnionitis ； preterm premature rupture of membrane ； Bayley scales of infant development