Meta-analysis of the risk factors for intracranial hemorrhage in very low and extremely low birth weight infants

doi:10.11852/zgetbjzz2020-2101

Abstract

Abstract: Objective To systematically analyze of the risk factors of intracranial hemorrhage in very low birth weight infants(VLBWI) and extremely low birth weight infants(ELBWI), in order to provide reference for early prevention and clinical decision-making. Methods Literatures were searched in China National Knowledge Network, China Biomedical Literature Database (CBM), Wanfang Database, VIP Database, Cochrane Library, PubMed, Web of Science, EMBASE from the establishment of the database to to September 18, 2020. Literatures were retrieved and selected according to the inclusion and exclusion criteria. Finally RevMan 5.3 was used to conduct Meta-analysis. Results Totally 13 literatures met the inclusion criteria. The cumulative number of cases was 790, and the number of controls was 1 871. Meta-analysis showed that the risk factors for intracranial hemorrhage in VLBWI and ELBWI included intrauterine distress or asphyxia(OR=2.52,95%CI: 1.98 - 3.21), application of mechanical ventilation (OR=3.35,95%CI:2.56 - 4.38), mechanical ventilation time ＞3 days (OR=10.29,95%CI:3.69 - 28.66), coagulation mechanism disorder(OR=3.42,95%CI:1.80 - 6.48),neonatal necrotizing enterocolitis (OR=3.79, 95%CI:1.92 - 7.50) and gestational age ＜29 weeks (OR=2.45, 95%CI:1.65 - 3.64), and the protective factor is antenatal use of glucocorticoids (OR=0.35, 95%CI:0.22 - 0.56). It was found that vaginal delivery had no significant influence on ICH of VLBWI and ELBWI. Conclusions Intrauterine distress or asphyxia, application of mechanical ventilation, mechanical ventilation time ＞3 days, coagulation mechanism disorder, neonatal necrotizing enterocolitis and gestational age ＜29 weeks are closely related to intracranial hemorrhage in VLBWI and ELBWI. Prenatal glucocorticoids can reduce the incidence of intracranial hemorrhage in VLBWI and ELBWI.

Key words: very low birth weight infants, extremely low birth weight infants, intracranial hemorrhage

摘要： 目的系统分析我国极低体重儿(VLBWI)和超低出生体重儿(ELBWI)颅内出血(ICH)的危险因素,为早期预防和临床决策提供参考依据。方法通过计算机检索了建库至2020年9月18日在中国知网、中国生物医学文献数据库(CBM)、万方数据库、VIP数据库、Cochrane图书馆、PubMed、Web of Science、EMBASE等数据库发表的文献,并手动检索相关参考文献。按照文献的纳入和排除标准,纳入较高质量文献,最后采用RevMan5.3对其进行Meta分析。结果 13篇文献符合纳入标准,累计ICH人数790例,无ICH人数1 871例,经Meta分析结果显示,VLBWI和ELBWI颅内出血的危险因素为:宫内窘迫或窒息(OR=2.52,95%CI:1.98～3.21)、应用机械通气(OR=3.35,95%CI:2.56～4.38)、机械通气时间＞3 d(OR=10.29,95%CI:3.69～28.66)、凝血机制障碍(OR=3.42,95%CI:1.80～6.48),新生儿坏死性小肠结肠炎(OR=3.79,95%CI:1.92～7.50),胎龄＜29周(OR=2.45,95%CI:1.65～3.64),保护因素为产前应用糖皮质激素(OR=0.35,95%CI:0.22～0.56)。经阴道分娩在本研究结果中无统计学意义。结论宫内窘迫或窒息、应用机械通气、机械通气时间＞3 d、凝血机制障碍、新生儿坏死性小肠结肠炎、胎龄＜29周等因素与VLBWI和ELBWI颅内出血关系密切,产前应用糖皮质激素可以降低VLBWI和ELBWI颅内出血的发生率。

关键词: 极低出生体重儿, 超低出生体重儿, 颅内出血

CLC Number:

R722.1

LI Shang-bin, HAO Ling, LI Jiao, MENG Jin-feng, HUANG Jia-yu, YAN Wei-chen, WANG Jie, REN Chang-jun. Meta-analysis of the risk factors for intracranial hemorrhage in very low and extremely low birth weight infants[J]. Chinese Journal of Child Health Care, 2022, 30(2): 184-188.

李尚彬, 郝玲, 李娇, 孟金凤, 黄嘉瑜, 闫伟宸, 王杰, 任常军. 极低和超低出生体重儿颅内出血危险因素Meta分析[J]. 中国儿童保健杂志, 2022, 30(2): 184-188.

References

[1] Ramenghi LA,Fumagalli M,Groppo M, et al.Germinal matrix hemorrhage: intraventricular hemorrhage in very-low-birth-weight infants: the independent role of inherited thrombophilia[J]. Stroke, 2011,42(7): 1889-1893.
[2] Wilson-Costello D,Friedman D,Minich N, et al., Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s[J]. Pediatrics, 2005,115(4): 997-1003.
[3] Novak CM, Ozen M, Burd I.Perinatal brain injury: Mechanisms, prevention, and outcomes[J]. Clin Perinatol, 2018,45(2): 357-375.
[4] Nehama L,Haskin O,Levit O, et al.Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study[J]. Pediatrics, 2003,111(5):e591-e595.
[5] 柯创宏, 杨天骄, 洪美婷,等.极低和超低出生体重儿并发脑室出血危险因素研究[J]. 中国儿童保健杂志, 2020,28(4): 464-466.
[6] 余在伟, 刘光辉, 张健,等.早产极低出生体质量儿脑室周围-脑室内出血相关因素分析[J]. 安徽医科大学学报, 2018,53(3): 471-475.
[7] 侯莹, 刘莹, 王红宇,等.分析极低出生体重儿发生脑室周围-脑室内出血的危险因素[J]. 航空航天医学杂志, 2018. 29(4): 469-470.
[8] 陈思, 林素, 吴百威,等.极低和超低出生体质量儿脑室内出血的高危因素分析[J]. 中华实用儿科临床杂志, 2014,29(2): 114-119.
[9] 宋振凤, 姜红, 李向红,等.极低出生体重儿颅内出血的高危因素[J]. 中华围产医学杂志, 2011,14(7): 431-433.
[10] 芦起, 余加林.极低出生体重儿脑室周围-脑室内出血相关因素分析[J]. 中国新生儿科杂志, 2011,26(3): 174-176.
[11] 黄芙蓉, 林菊清.极低出生体重儿颅内出血高危因素的分析[J]. 长治医学院学报, 2010,24(5): 355-358.
[12] 梁健, 丁雪明, 李智贤,等.极低体重儿脑室内出血超声表现与临床因素关系探讨[J]. 广西医科大学学报, 2009,26(3): 359-362.
[13] 宋金枝, 赖玉标, 吴本清,等,极低出生体重儿脑室内出血的围产因素分析[J]. 中外医疗, 2009,28(22): 32-34.
[14] 李月凤, 卢光进, 韩玉昆. 极低出生体重儿颅内出血危险因素的分析[J]. 中国当代儿科杂志, 2007,9(4): 297-300.
[15] 袁天明, 顾美虹. 极低出生体重儿脑室内出血危险因素病例对照研究[J]. 浙江预防医学, 2004,16(8): 9-10.
[16] 黄水清, 陈运彬, 吴婕翎. 极低出生体重儿脑室周围-脑室内出血的相关因素[J]. 中华围产医学杂志, 2002,5(2): 32-35.
[17] 钱燕, 张姿英.极低出生体重儿颅内出血诱因及诊治[J]. 新生儿科杂志, 1999,14(2): 3-5.
[18] 中国新生儿重症监护室协作性质量改进研究协作组, 曹云. 极低和超低出生体重儿重度脑室内出血发生情况及其影响因素多中心研究[J]. 中华儿科杂志, 2019,57(4):258-264.
[19] Atienza-Navarro I, Alves-Martinez P, Lubian-Lopez S, et al. Germinal matrix-intraventricular hemorrhage of the preterm newborn and preclinical models: inflammatory considerations[J]. Int J Mol Sci,2020,21(21):8343-8366.
[20] 宋金枝, 文飞球, 黄进洁.机械通气对极低出生体重儿脑室内出血影响的研究[J]. 中国实用儿科杂志, 2008,23(5): 362-364.
[21] Aly H,Hammad TA,Essers J, et al. Is mechanical ventilation associated with intraventricular hemorrhage in preterm infants?[J]. Brain Dev, 2012,34(3): 201-205.
[22] Yang D, Baumann JM, Sun YY, et al. Overexpression of vascular endothelial growth factor in the germinal matrix induces neurovascular proteases and intraventricular hemorrhage[J]. Sci Transl Med,2013,5(193):193-204.
[23] Travers CP, Carlo WA, McDonald SA, et al.,Mortality and pulmonary outcomes of extremely preterm infants exposed to antenatal corticosteroids[J]. Am J Obstet Gynecol, 2018,218(1): 130.e1-130.
[24] Duppré P, Sauer H, Giannopoulou EZ, et al.Cellular and humoral coagulation profiles and occurrence of IVH in VLBW and ELWB infants[J]. Early Hum Dev, 2015,91(12): 695-700.
[25] Korzeniewski SJ, Romero R, Cortez J, et al.A "multi-hit" model of neonatal white matter injury: cumulative contributions of chronic placental inflammation, acute fetal inflammation and postnatal inflammatory events[J]. J Perinat Med, 2014,42(6): 731-743.
[26] Hall N, Hiorns M, Tighe H, et al. Is necrotizing enterocolitis associated with development or progression of intraventricular hemorrhage?[J]. Am J Perinatol, 2009,26(2): 139-143.
[27] Cohen E, Baerts W, Dorado AC, et al.Cerebrovascular autoregulation in preterm fetal growth restricted neonates[J]. Arch Dis Child Fetal Neonatal Ed, 2019,104(5): 467-472.
[28] Gamaleldin I, Harding D, Siassakos D, et al.Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery: a multi-centre retrospective cohort study[J]. J Matern Fetal Neonatal Med, 2019,32(3): 477-482.
[29] Hübner ME, Ramirez R, Burgos J, et al.Mode of delivery and antenatal steroids and their association with survival and severe intraventricular hemorrhage in very low birth weight infants[J]. J Perinatol, 2016,36(10): 832-836.
[30] Humberg A, Härtel C, Paul P, et al.Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network[J]. Eur J Obstet Gynecol Reprod Biol, 2017,212(5): 144-149.
[31] Parodi A, De Angelis LC, Re M, et al.Placental pathology findings and the risk of intraventricular and cerebellar hemorrhage in preterm neonates[J]. Front Neurol, 2020,11(8):761-771.