极低和超低出生体重儿颅内出血危险因素Meta分析

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

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1871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>3d(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>3d、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。

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 5.3was used to conduct Meta-analysis.Results Totally 13literatures met the inclusion criteria.The cumulative number of cases was 790,and the number of controls was 1871.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>3days(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<29weeks(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>3days,coagulation mechanism disorder,neonatal necrotizing enterocolitis and gestational age<29weeks are closely related to intracranial hemorrhage in VLBWI and ELBWI.Prenatal glucocorticoids can reduce the incidence of intracranial hemorrhage in VLBWI and ELBWI.