Risk Factors for Perinatal Upper Gastrointestinal Bleeding in Full-Term Neonates

足月兒於周產期發生上消化道出血之危險因子

陳銘華(Ming-Hua Chen) ； 陳世傑(Shyh-Jye Chen) ； 楊文理(Winnie Yang)

《北市醫學雜誌》 2卷10期 (2005/10) Pp. 907-914

https://doi.org/10.6200/TCMJ.2005.2.10.04

摘要

目的：發生在健康足月兒之周產期上消化道出血，甚少被報告。本研究的目的，在探討周產期前後，健康足月兒發生上消化道出血的危險因子。方法：符合下列四條件者被納入研究範圍：(1)足月新生兒(2)臨床上，有上消化道出血表徵(3)上消化道出血時間，在出生一星期內者(4)無出血性疾病、早產、或其他胃腸道疾病，如壞死性腸炎、腸扭結等。結果：在1999年至2003年四年間，在本院出生之1230名足月新生兒中，共有9名(9/1230, 0.7%)足月新生兒，以上消化道內視鏡證實有消化性潰瘍疾病。9例中有8例(88.8%)，發生上消化道出血之時間為出生後10.1±6.1小時，這9例經過保守治療法，不需住新生兒加護病房，皆健康出院。出生後，追蹤至一歲大時，皆無復發。每一個病例，皆有7例正常新生兒作為對照組。這7例都是在本院出生，剛好是病例個案出生前後五天的正常足月新生兒。病例組與對照組間，在出生體重、懷孕週數、Apgar score、胎便染色與剖腹產與否，在統計學上皆無差異。結論：多變數迴歸分析發現只有急性胎兒窘迫與產程延長為兩大危險因子。而出生三天內曾經以母乳哺育者，較不易發生上消化道出血，即母乳具保護胃黏膜效益。我們推測，健康足月兒發生上消化道出血，是一個被低估的疾病。國外大規模的報告，發現高達1.23％的足月健康新生兒出生三天內，曾發生上消化道出血。新生兒上消化道內視鏡為一安全的檢查，更積極的內視鏡檢查，可能證實此症並非一罕見的疾病！

關鍵字

週產期 ； 足月兒 ； 上消化道出血

並列摘要

Background and Purpose: Perinatal upper gastrointestinal bleeding (UGI bleeding) is rarely reported, it consists of hemorrhagic or ulcerative lesions in the esophagus, stomach or duodenum, and happened perinatally. The aim of this case-control study was to search for risk factors of perinatal UGI bleeding in full-term neonates. Methods: The enrolled criteria in this study were (1) Full-term neonates (2) Evidence of upper gastrointestinal tract bleeding, even only minimal hematemesis (3) Age of onset ≦1 week (4) No evidence of hemorrhagic disease. Upper gastrointestinal bleeding was confirmed by endoscopy in 9 cases. Each patient case was matched with seven control cases, who were well baby born in the same maternal unit, within 5 days before or after the patient cases. Labor course, mode of delivery, gestational age, body weight, Apgar score, amniotic fluid status and integrity of placenta were recorded. Results: There was no significant difference in gestational age, gender, Apgar score, birth weight, mode of delivery or meconium stain of amniotic fluid between case group and control group. Multivariate logistic regression showed that acute fetal distress (Odds ratio (OR)=18.33. p=0.00389) and protraction disorder (OR=33.0, p=0.005) were significant risk factors associated with perinatal UGI bleeding. On the contrary, breast feeding either exclusive or partial for the initial 3 days after birth had protective effect against upper gastrointestinal bleeding. Conclusion: In conclusion, acute fetal distress and protraction disorder were two significant risk factors and breast feeding either exclusive or partial for the initial 3 days after birth may have protective effect for gastric mucosa. Maternal antacid drug usage during the last month of pregnancy is not a risk factor in this study.

並列關鍵字

risk factors ； perinatal ； upper gastrointestinal bleeding ； neonates