窒息对缺氧缺血性脑病新生儿远期神经预后影响的Meta分析

Meta-analysis of the effect of asphyxia on long-term neurological prognosis in neonates with hypoxic-ischemic encephalopathy

目的系统评价窒息对缺氧缺血性脑病新生儿神经系统后遗症发病率的影响。方法检索Pubmed、Embase、Cochrane Library、Web of Science、Google Scholar,收集所有关于窒息导致缺氧缺血性脑病且胎龄≥35周的新生儿在18~24个月神经发育结局的文献,进行率的Meta分析。结果最终纳入8篇文献,共1 554例患者。Meta分析结果显示,总体病死率为29.0%(95%CI:21.4%~36.6%)。在存活者中神经系统发育障碍的发生率为34.1%(95%CI:27.0%~41.2%),其中脑瘫发生率为20.3%(95%CI:16.0%~24.5%),听力损伤发生率为3.1%(95%CI:2.2%~4.0%),视力损伤发生率为5.3%(95%CI:2.3%~8.2%),重度神经运动发育延迟[运动发育指数(PDI)<70)]发生率为21.5%(95%CI:18.7%~24.4%),重度神经发育延迟[智能发育指数(MDI)<70)]发生率为21.7%(95%CI:18.9%~24.5%)。结论窒息导致缺氧缺血性脑病新生儿远期神经预后差,加强围生期窒息的预防及治疗对改善新生儿神经系统发育,降低神经系统后遗症的发生率有重要意义。

Objective To systematically evaluate the effect of asphyxia on the incidence of neurological sequelae in neonates with hypoxic-ischemic encephalopathy.Methods Pubmed、Embase、Cochrane Library、Web of Science、Google Scholar were retrieved. The references on neurodevelopmental outcomes of neonates with asphyxia leading to hypoxic-ischemic encephalopathy and gestational age≥35 weeks at 18 to 24 months were selected, and Meta-analysis of rate was performed.Results Finally, 8 articles were included in the analysis, including 1 554 cases of patients. Meta-analysis results showed that the overall mortality was 29.0%(95% CI: 21.4% to 36.6%). The incidence of neurodevelopmental disability in survivors was 34.1%(95% CI: 27.0% to 41.2%). The incidence of cerebral palsy was 20.3%(95% CI: 16.0% to 24.5%). The incidence of hearing impairment was 3.1%(95% CI: 2.2% to 4.0%). The incidence of visual impairment was 5.3%(95% CI: 2.3% to 8.2%). The incidence of severe neuromotor delay [psychomotor development index(PDI)<70] was 21.5%(95% CI: 18.7% to 24.4%), and the incidence of severe neurodevelopmental delay [mental development index(MDI)<70]was 21.7%(95% CI: 18.9% to 24.5%).Conclusion Long-term neurological prognosis of neonates with hypoxic-ischemic encephalopathy caused by asphyxia is poor. Strengthening the prevention and treatment of perinatal asphyxia is of great significance to improve the development of neonatal nervous system and reduce the incidence of neurological sequelae.