The purpose of this study was to assess whether the duration of labor has any effect on the occurrence of cerebral white-matter damage in very preterm infants who are delivered in the presence of intrauterine infectio...The purpose of this study was to assess whether the duration of labor has any effect on the occurrence of cerebral white-matter damage in very preterm infants who are delivered in the presence of intrauterine infection. Study design: From a cohort of infants who were born spontaneously at < 32 weeks of gestation for whom placental information was available and who survived 7 days from birth, 126 infants had clinical, laboratory, or histologic evidence of intrauterine infection. Among them, variables were compared between those infants with white-matter damage (defined as intraventricular hemorrhage grade 3 plus, periventricular leukomalacia, or ventriculomegaly not associated with hydrocephaly [n = 13]) and those infants without it (n = 113). Comparisons were made with t test, chisquared test, and survival analysis; a probability value of < .05 was considered significant. Results: There were no differences between the 2 groups in gestational age at delivery and rates of labor or cesarean delivery. Duration of active labor (66 ± 45 minutes vs 88 ± 75 minutes; P = .49) and of clinical chorioamnionitis (310 ± 186 minutes vs 529 ± 544 minutes; P = .44) were similar in cases with and without neonatal white-matter damage. Conclusion: In 126 infants who were born at < 32 weeks of gestation with intrauterine infection, we found no correlation between the duration of labor or clinical chorioamnionitis and neonatal white-matter damage.展开更多
OBJECTIVE: To evaluate whether intraventricular hemorrhage and periventricul ar leukomalacia are characterized by different risk factors. METHODS: In a cohort of 653 consecutive singleton neonates born after preterm m...OBJECTIVE: To evaluate whether intraventricular hemorrhage and periventricul ar leukomalacia are characterized by different risk factors. METHODS: In a cohort of 653 consecutive singleton neonates born after preterm membrane rupture, spont aneous preterm labor, or indicated preterm delivery at 24 to 33 weeks of gestati on from January 1, 1993, to December 31, 2002, we evaluated the obstetric and histopathologic pla cental variables in reference to the development of intraventricular hemorrhage (n = 44), periventricular leukomalacia (n = 19), or no ultrasonographic cerebral lesion (n = 589). Excluded were stillbirths and congenital anomalies. Statistic al analysis included Fisher exact test, Student t test, and stepwise logistic re gression analysis with a 2-tailed P < .05 consi-dered significant. RESULTS: Mu ltivariate analysis showed that occurrence of neonatal intraventricular hemorrha ge and periventricular leukomalacia were associated only with spontaneous premat urity (odds ratio = 1.9; 95%confidence interval 1.1-3.4) and gestational age a t delivery in weeks (odds ratio = 0.8; 95%confidence interval 0.7-0.9). Neonat es with intraventricular hemorrhage did not differ from those with periventricul ar leukomalacia in any obstetric or neonatal variable, but there was a higher ri sk of neurodevelopmental delay associated with periventricular leukomalacia. CON CLUSION: Among premature infants born at less than 34.0 weeks of gestation, intr aventricular hemorrhage and periventricular leukomalacia share common clinical c haracteristics, with spontaneous preterm delivery and gestational age at deliver y as the only independent antenatal predictors.展开更多
文摘The purpose of this study was to assess whether the duration of labor has any effect on the occurrence of cerebral white-matter damage in very preterm infants who are delivered in the presence of intrauterine infection. Study design: From a cohort of infants who were born spontaneously at < 32 weeks of gestation for whom placental information was available and who survived 7 days from birth, 126 infants had clinical, laboratory, or histologic evidence of intrauterine infection. Among them, variables were compared between those infants with white-matter damage (defined as intraventricular hemorrhage grade 3 plus, periventricular leukomalacia, or ventriculomegaly not associated with hydrocephaly [n = 13]) and those infants without it (n = 113). Comparisons were made with t test, chisquared test, and survival analysis; a probability value of < .05 was considered significant. Results: There were no differences between the 2 groups in gestational age at delivery and rates of labor or cesarean delivery. Duration of active labor (66 ± 45 minutes vs 88 ± 75 minutes; P = .49) and of clinical chorioamnionitis (310 ± 186 minutes vs 529 ± 544 minutes; P = .44) were similar in cases with and without neonatal white-matter damage. Conclusion: In 126 infants who were born at < 32 weeks of gestation with intrauterine infection, we found no correlation between the duration of labor or clinical chorioamnionitis and neonatal white-matter damage.
文摘OBJECTIVE: To evaluate whether intraventricular hemorrhage and periventricul ar leukomalacia are characterized by different risk factors. METHODS: In a cohort of 653 consecutive singleton neonates born after preterm membrane rupture, spont aneous preterm labor, or indicated preterm delivery at 24 to 33 weeks of gestati on from January 1, 1993, to December 31, 2002, we evaluated the obstetric and histopathologic pla cental variables in reference to the development of intraventricular hemorrhage (n = 44), periventricular leukomalacia (n = 19), or no ultrasonographic cerebral lesion (n = 589). Excluded were stillbirths and congenital anomalies. Statistic al analysis included Fisher exact test, Student t test, and stepwise logistic re gression analysis with a 2-tailed P < .05 consi-dered significant. RESULTS: Mu ltivariate analysis showed that occurrence of neonatal intraventricular hemorrha ge and periventricular leukomalacia were associated only with spontaneous premat urity (odds ratio = 1.9; 95%confidence interval 1.1-3.4) and gestational age a t delivery in weeks (odds ratio = 0.8; 95%confidence interval 0.7-0.9). Neonat es with intraventricular hemorrhage did not differ from those with periventricul ar leukomalacia in any obstetric or neonatal variable, but there was a higher ri sk of neurodevelopmental delay associated with periventricular leukomalacia. CON CLUSION: Among premature infants born at less than 34.0 weeks of gestation, intr aventricular hemorrhage and periventricular leukomalacia share common clinical c haracteristics, with spontaneous preterm delivery and gestational age at deliver y as the only independent antenatal predictors.
