早产儿脑室周围-脑室内出血预防的临床证据

Clinical evidence for the prevention of periventricular hemorrhage-intraventricular hemorrhage in preterm infants

目的寻找与早产儿脑室周围-脑室内出血(PVH-IVH)预防相关的临床证据,并探讨其临床应用价值。方法检索MEDLINE、EMBASE、Oxford围产新生儿组资料库和Cochrane图书馆关于PVH-IVH危险因素和预防相关的系统评价和随机(半随机)对照研究(randomised or quasi-randomised controlled trials,RCT),并进行分析。结果产前母亲使用皮质激素、出生时延迟结扎脐带可显著降低早产儿PVH-IVH发生率,出生后预防性使用消炎痛可降低早产儿严重IVH的发生率,但对神经系统远期预后没有影响。结论推荐产前母亲单次使用皮质激素预防早产儿PVH-IVH的发生,消炎痛和产前多次使用皮质激素尚待更多的前瞻性RCT来证实其安全性和有效性。

Objectives To explore the clinical evidence for the prevention of periventricular hemorrhage-intra-ventrieular hemorrhage （PVH-IVH） in preterm infants, evaluate the importance of its clinical application. Methods Risk factors, meta analyses and randomized （or quasi-randomized） controlled trials （RCT） of preventing PVH-IVH in preterm infants were searched from the database of MEDLINE, EMBASE, Oxford Neonatal Group and Coehrane Li- brary; and the data were analyzed. Results PVH-IVH could be prevented by using eortieosteroid antenatally and de- laying umbilical cord clamping. Prophylactic indomethaein postnatally could decrease the incidence of severe IVH, with no evidence suggesting prophylactic indomethaein could improve the long-term outcome of nervous system development in preterm infants. Conclusions Single dose of eortieosteroid antenatally is recommended for the prevention of PVH- IVH. More RCT are needed to identify the safety and validity of repeated eoritieorsteroid and prophylactic indomethacin.