• 【出生时脑膜脊髓腔积液和高腰截瘫的婴儿的预后。道德工作组的评论。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:
    BACKGROUND & AIMS: :The findings presented in an accompanying paper by Menzies, Parkin, and Hey regarding the survival rates and quality of life of babies with severe spina bifida (Lancet 1985 Nov 2; 2(8462): 993-995) prompt the Working Group to reevaluate the ethical guidelines supporting selective treatment proposed in their 1975 report, "Ethics of Selective Treatment of Spina Bifida" (Lancet 1975 Jan 11; 1(7898): 85-88). Although Menzies, et al., report that survival rates are higher than previously expected and that in most cases the children's and parents' lives appear not to be excessively burdensome, the Working Group contends that there "continues to be ethical justification for selective treatment" of such newborns. Since medical, psychological, and social considerations now seem to be "more complex and less clearcut," the Group emphasizes that judgments regarding treatment should be made on a case-by-case basis.
    背景与目标: :孟席斯(Menzies),帕金(Parkin)和黑伊(Hey)随附的论文中有关严重脊柱裂的婴儿的存活率和生活质量的研究结果(《柳叶刀》 1985年11月2日; 2(8462):993-995)促使工作组重新评估支持选择性治疗的道德准则在其1975年的报告“脊柱裂的选择性治疗伦理”中提出(柳叶刀1975年1月11日; 1(7898):85-88)。尽管孟席斯等人报告说,存活率比以前预期的要高,而且在大多数情况下,儿童和父母的生活似乎并不过分负担,但工作组认为,“继续有道德地为选择治疗提供理由”这样的新生儿。由于现在医学,心理和社会方面的考虑似乎“更加复杂且不那么明确”,专家组强调有关治疗的判断应视具体情况而定。
  • 【Karyomapping:单一中心从应用方法学到持续妊娠和活产率的经验。】 复制标题 收藏 收藏
    DOI:10.1016/j.rbmo.2017.06.004 复制DOI
    作者列表:Ben-Nagi J,Wells D,Doye K,Loutradi K,Exeter H,Drew E,Alfarawati S,Naja R,Serhal P
    BACKGROUND & AIMS: :This study aimed to determine whether karyomapping can be applied to couples requiring preimplantation genetic diagnosis (PGD) for single gene disorder (SGD) and/or chromosomal rearrangement. 75/82 (91.5%) and 6/82 (7.3%) couples were referred for autosomal SGD and X-linked disease, respectively. One couple (1.2%) was referred for SGD and chromosomal rearrangement. Of 608 embryos, 146 (24%, 95% CI 21-28) day-3 and 462 (76%, 95% CI 72-79) blastocyst biopsies were performed. A total of 81 embryo transfers were performed; 16/81 (20%) were following day-3 embryo biopsy, 65/81 (80%) were following blastocyst biopsy and cryopreserved embryo transfer. Of 81 embryo transfers with known pregnancy outcome, 51 (63%, 95% CI 52-73) were on-going pregnancies, 6/81 (7%, 95% CI 3-15) resulted in first trimester miscarriages and 24/81 (30%, 95% CI 21-40) were failed implantations. Of the 51 on-going pregnancies, 15 (29%, 95% CI 19-43) couples had a singleton live birth at the time of write up. There have been no reports of abnormal prenatal, genetic testing or diagnosis of phenotype at birth. Karyomapping is reliable, efficient and accurate for couples requiring PGD for SGD and/or chromosomal rearrangement. Additionally, it provides aneuploidy screening, minimising risks of miscarriage and implantation failure.
    背景与目标: :这项研究的目的是确定是否可以对需要单基因疾病(SGD)和/或染色体重排的需要植入前遗传学诊断(PGD)的夫妇进行核对。 75/82(91.5%)和6/82(7.3%)对夫妇因常染色体SGD和X连锁疾病而被转介。 SGD和染色体重排涉及一对夫妇(1.2%)。在608个胚胎中,第3天进行了146次(24%,95%CI 21-28)CI和462(76%,95%CI 72-79)胚泡活检。总共进行了81次胚胎移植。第3天胚胎活检后为16/81(20%),胚泡活检和冷冻保存的胚胎移植后为65/81(80%)。在有已知妊娠结局的81个胚胎移植中,有51个(63%,95%CI 52-73)正在进行妊娠,6/81(7%,95%CI 3-15)导致早孕流产和24/81 (30%,95%CI 21-40)植入失败。在进行的51次怀孕中,有15对(29%,95%CI 19-43)的夫妇在撰写本文时有单胎活产。没有关于出生前的异常产前,基因检测或表型诊断的报道。对于需要PGD进行SGD和/或染色体重排的夫妇,核定图是可靠,高效和准确的。此外,它还提供了非整倍性筛选,从而最大程度地减少了流产和植入失败的风险。
  • 【社区居民中老年人的脑白质信息完整性和认知能力:Lothian Birth Cohort,1936年。】 复制标题 收藏 收藏
    DOI:10.1037/a0033354 复制DOI
    作者列表:Booth T,Bastin ME,Penke L,Maniega SM,Murray C,Royle NA,Gow AJ,Corley J,Henderson RD,Hernández Mdel C,Starr JM,Wardlaw JM,Deary IJ
    BACKGROUND & AIMS: OBJECTIVE:The present study investigates associations between brain white matter tract integrity and cognitive abilities in community-dwelling older people (N = 655). We explored two potential confounds of white matter tract-cognition associations in later life: (a) whether the associations between tracts and specific cognitive abilities are accounted for by general cognitive ability (g); and (b) how the presence of atrophy and white matter lesions affect these associations. METHOD:Tract integrity was determined using quantitative diffusion magnetic resonance imaging tractography (tract-averaged fractional anisotropy [FA]). Using confirmatory factor analysis, we compared first-order and bifactor models to investigate whether specific tract-ability associations were accounted for by g. RESULTS:Significant associations were found between g and FA in bilateral anterior thalamic radiations (r range: .16-.18, p < .01), uncinate (r range: .19-.26, p < .001), arcuate fasciculi (r range: .11-.12, p < .05), and the splenium of corpus callosum (r = .14, p < .01). After controlling for g within the bifactor model, some significant specific cognitive domain associations remained. Results also suggest that the primary effects of controlling for whole brain integrity were on g associations, not specific abilities. CONCLUSION:Results suggest that g accounts for most of, but not all, the tract-cognition associations in the current data. When controlling for age-related overall brain structural changes, only minor attenuations of the tract-cognition associations were found, and these were primarily with g. In totality, the results highlight the importance of controlling for g when investigating associations between specific cognitive abilities and neuropsychology variables.
    背景与目标: 目的:本研究调查了居住在社区的老年人(N = 655)中脑白质束完整性与认知能力之间的关系。我们探讨了晚年白质物质与认知的关联的两个潜在的混淆:(a)物质与特定认知能力之间的关联是否由一般认知能力(g)解释; (b)萎缩和白质病变的存在如何影响这些关联。
    方法:使用定量扩散磁共振成像体层摄影术(区域平均分数各向异性[FA])确定道的完整性。使用验证性因素分析,我们比较了一阶和双因素模型,以调查特定的道能力关联是否由g解释。
    结果:在双侧丘脑前部辐射中,g和FA之间存在显着相关性(r范围:.16-.18,p <.01),单核(r范围:.19-.26,p <.001),弓状筋膜(r范围:.11-.12,p <.05)和call体脾(r = .14,p <.01)。在双因素模型中控制g之后,仍然存在一些重要的特定认知域关联。结果还表明,控制全脑完整性的主要作用是对g的联想,而不是特定的能力。
    结论:结果表明,g占了当前数据中大部分但并非全部的道认知关联。当控制与年龄相关的整体大脑结构变化时,仅发现了道认知关联的轻微衰减,而这些衰减主要与g有关。总体而言,这些结果凸显了在调查特定认知能力与神经心理学变量之间的关联时,控制g的重要性。
  • 【出生体重很低的婴儿出现贫血的原因。放血损失不是第一被告。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Testa M,Birocchi F,Carta P,Fanos V
    BACKGROUND & AIMS: AIM:The specific aim of the study was to determine the correlation between the severity of pathology, the amount of blood removed for diagnostic purposes in the 1st week of life and the incidence of early anaemia in very low birth weight (VLBW) infants. METHODS:We recorded the level of haemoglobin (Hb) and haematocrit (Ht) in each of the 50 infants entered in the study at their admission in our neonatal intensive care unit (NICU) and at the age of 8 days. We quantified for each infant the blood drawn for clinical purpose during the 1(st)week of life, using microanalytic techniques for all types of analysis performed. Using the neonatal therapeutic intensive score system (NTISS) we divided all patients into 2 groups: group A= mild light pathology; group B= severe pathology. RESULTS:There was statistically significant difference between the percent decrease of Hb and Ht with reference to the birth weight in the 2 groups. Logistic regression analysis indicated a strong correlation (P = 0.009) between higher degree of illness severity and higher percent decrease of Hb and Ht. The difference due to the amount of phlebotomy losses was not significant. CONCLUSIONS:To our knowledge, this study is the first that strongly suggest that phlebotomy losses is not the main cause of anaemia in VLBW preterm infants in the 1st week of life, when a policy of strictly attention to the amount of blood removed is performed.
    背景与目标: 目的:该研究的具体目的是确定病理严重程度,生命的第一周用于诊断目的的采血量与极低出生体重(VLBW)婴儿的早期贫血发生率之间的相关性。
    方法:我们记录了入院新生儿重症监护病房(NICU)以及8天大的50例婴儿中每人的血红蛋白(Hb)和血细胞比容(Ht)的水平。我们使用微分析技术对每位婴儿在生命的第一(st)周内抽取的用于临床目的的血液进行了定量分析,以进行所有类型的分析。使用新生儿治疗密集评分系统(NTISS),我们将所有患者分为两组: B组=严重病理。
    结果:相对于出生体重,两组的Hb和Ht降低百分比存在统计学差异。 Logistic回归分析表明,较高的疾病严重程度与较高的Hb和Ht降低百分比之间有很强的相关性(P = 0.009)。由于放血损失量的差异不明显。
    结论:据我们所知,该研究是第一个强烈建议放血切开不是出生第一周内VLBW早产儿贫血的主要原因,这是一项严格注意采血量的政策。
  • 【孕早期使用选择性5-羟色胺再摄取抑制剂和出生缺陷的风险。】 复制标题 收藏 收藏
    DOI:10.1056/NEJMoa067407 复制DOI
    作者列表:Louik C,Lin AE,Werler MM,Hernández-Díaz S,Mitchell AA
    BACKGROUND & AIMS: BACKGROUND:The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial. METHODS:We assessed associations between first-trimester maternal use of SSRIs and the risk of birth defects among 9849 infants with and 5860 infants without birth defects participating in the Slone Epidemiology Center Birth Defects Study. RESULTS:In analyses of defects previously associated with SSRI use (involving 42 comparisons), overall use of SSRIs was not associated with significantly increased risks of craniosynostosis (115 subjects, 2 exposed to SSRIs; odds ratio, 0.8; 95% confidence interval [CI], 0.2 to 3.5), omphalocele (127 subjects, 3 exposed; odds ratio, 1.4; 95% CI, 0.4 to 4.5), or heart defects overall (3724 subjects, 100 exposed; odds ratio, 1.2; 95% CI, 0.9 to 1.6). Analyses of the associations between individual SSRIs and specific defects showed significant associations between the use of sertraline and omphalocele (odds ratio, 5.7; 95% CI, 1.6 to 20.7; 3 exposed subjects) and septal defects (odds ratio, 2.0; 95% CI, 1.2 to 4.0; 13 exposed subjects) and between the use of paroxetine and right ventricular outflow tract obstruction defects (odds ratio, 3.3; 95% CI, 1.3 to 8.8; 6 exposed subjects). The risks were not appreciably or significantly increased for other defects or other SSRIs or non-SSRI antidepressants. Exploratory analyses involving 66 comparisons showed possible associations of paroxetine and sertraline with other specific defects. CONCLUSIONS:Our findings do not show that there are significantly increased risks of craniosynostosis, omphalocele, or heart defects associated with SSRI use overall. They suggest that individual SSRIs may confer increased risks for some specific defects, but it should be recognized that the specific defects implicated are rare and the absolute risks are small.
    背景与目标: 背景:产前暴露于选择性5-羟色胺再摄取抑制剂(SSRIs)后出生缺陷的风险仍然存在争议。
    方法:我们评估了参加妊娠流行病学中心出生缺陷研究的9849例婴儿和5860例无出生缺陷的婴儿中,孕妇在孕早期使用SSRI与出生缺陷风险之间的相关性。
    结果:在先前与SSRI使用相关的缺陷分析中(涉及42个比较),SSRI的整体使用与颅突狭窄的风险显着增加无关(115名受试者,有2名暴露于SSRI中;比值比为0.8; 95%置信区间[CI] ],0.2到3.5),全卵裂(127名受试者,暴露3;比值比,1.4; 95%CI,0.4到4.5)或整体心脏缺陷(3724名受试者,暴露100,比值比,1.2,95%CI,0.9)至1.6)。对单个SSRI与特定缺陷之间的关联进行的分析显示,使用舍曲林和卵母囊肿(赔率,5.7; 95%CI,1.6至20.7; 3个暴露的受试者)与间隔缺损(赔率,2.0; 95%CI)之间存在显着关联。 ; 1.2至4.0; 13位暴露的受试者)以及在帕罗西汀和右室流出道阻塞缺陷之间的使用(赔率,3.3; 95%CI,1.3至8.8; 6位暴露的受试者)。其他缺陷或其他SSRI或非SSRI抗抑郁药的风险未显着或显着增加。涉及66个比较的探索性分析表明,帕罗西汀和舍曲林可能与其他特定缺陷有关。
    结论:我们的研究结果并未表明与SSRI的使用相关的颅前突增生,卵泡扩张或心脏缺陷的风险显着增加。他们认为,单个SSRI可能会增加某些特定缺陷的风险,但是应该认识到,所涉及的特定缺陷很少,绝对风险也很小。
  • 【极低出生体重婴儿手术干预对神经发育结果的影响:韩国的一项全国队列研究。】 复制标题 收藏 收藏
    DOI:10.3346/jkms.2019.34.e271 复制DOI
    作者列表:Sung SI,Lee NH,Kim HH,Kim HS,Han YS,Yang M,Ahn SY,Chang YS,Park WS
    BACKGROUND & AIMS: BACKGROUND:To investigate the incidence of surgical intervention in very low birth weight (VLBW) infants and the impact of surgery on neurodevelopmental outcomes at corrected ages (CAs) of 18-24 months, using data from the Korean Neonatal Network (KNN). METHODS:Data from 7,885 VLBW infants who were born and registered with the KNN between 2013 to 2016 were analyzed in this study. The incidences of various surgical interventions and related morbidities were analyzed. Long-term neurodevelopmental outcomes at CAs of 18-24 months were compared between infants (born during 2013 to 2015, n = 3,777) with and without surgery. RESULTS:A total of 1,509 out of 7,885 (19.1%) infants received surgical interventions during neonatal intensive care unit (NICU) hospitalization. Surgical ligation of patent ductus arteriosus (n = 840) was most frequently performed, followed by laser therapy for retinopathy of prematurity and laparotomy due to intestinal perforation. Infants who underwent surgery had higher mortality rates and greater neurodevelopmental impairment than infants who did not undergo surgery (P value < 0.01, both). On multivariate analysis, single or multiple surgeries increased the risk of neurodevelopmental impairment compared to no surgery with adjusted odds ratios (ORs) of 1.6 with 95% confidence interval (CI) of 1.1-2.6 and 2.3 with 95% CI of 1.1-4.9. CONCLUSION:Approximately one fifth of VLBW infants underwent one or more surgical interventions during NICU hospitalization. The impact of surgical intervention on long-term neurodevelopmental outcomes was sustained over a follow-up of CA 18-24 months. Infants with multiple surgeries had an increased risk of neurodevelopmental impairment compared to infants with single surgeries or no surgeries after adjustment for possible confounders.
    背景与目标: 背景:使用韩国新生儿网络(KNN)的数据,调查极低出生体重(VLBW)婴儿的外科手术发生率以及18个月至24个月校正年龄(CA)手术对神经发育结局的影响。
    方法:本研究分析了2013年至2016年间在KNN出生和登记的7885名VLBW婴儿的数据。分析了各种外科手术的发生率和相关的发病率。比较了有手术和无手术的婴儿(2013年至2015年出生,n = 3,777)在18-24个月CA时的长期神经发育结局。
    结果:在新生儿重症监护病房(NICU)住院期间,共有7,885例婴儿中的1,509例接受了手术干预。外科手术治疗动脉导管未闭(n = 840),然后进行激光治疗以治疗由于视网膜穿孔而导致的早产儿视网膜病变和剖腹手术。与未接受手术的婴儿相比,接受手术的婴儿死亡率更高,神经发育障碍更大(P值均<0.01)。在多变量分析中,与未进行手术的患者相比,单次或多次手术增加了神经发育障碍的风险,调整后的优势比(OR)为1.6,95%置信区间(CI)为1.1-2.6,2.3为95%CI为1.1-4.9。
    结论:大约五分之二的VLBW婴儿在NICU住院期间接受了一项或多项手术干预。在CA 18-24个月的随访中,外科手术对长期神经发育结局的影响得以持续。与仅接受一次手术或未进行可能的混杂因素调整后不进行任何手术的婴儿相比,进行多次手术的婴儿神经发育受损的风险增加。
  • 【1986年芬兰北部出生队列中出生体重的生态和个体预测因子。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-3016.1997.tb00007.x 复制DOI
    作者列表:Järvelin MR,Elliott P,Kleinschmidt I,Martuzzi M,Grundy C,Hartikainen AL,Rantakallio P
    BACKGROUND & AIMS: This multilevel study of spatial variability in, and determinants of, birthweight was conducted using individual and ecological data in a geographically defined prospective birth cohort for 1986 in northern Finland. The study area comprises three large areas defined by latitudeNorthern Lapland (NL), Southern Lapland (SL) and Oulu province (OP), comprising 74 localities with a total study population of 9216 singleton births. The mean birthweight was 3482 g for NL, 3537 g for SL and 3587 g for OP (NL vs. OP and SL vs.

    OP:P < 0.05). The crude rate for stillbirths was highest in NL. The women in the northernmost area were socially less privileged and the localities less prosperous compared with those in the southernmost area. Significant spatial clustering of mean birthweights was found (P = 0.0016), with highest birthweight in the south-western part of the study area. A variable expressing the wealth of each locality, the financial capacity category (FCC), had its lowest mean value in NL, with a range of one to six for the localities studied here. A multilevel multiple regression model showed that, after allowing for sex, gestational age, mother's age, height and hypertensive disorders, parity, body mass index, previous low birthweight child and smoking as individual determinants of birthweight, part of the residual variation could be explained by the locality wealth parameter. Using the multilevel model, the differences in mean birthweight across the three latitude areas persisted but were reduced (difference OP vs. NL reduced from 105 g to 86.5 g). The relationship between birthweight and FCC was inverse U-shaped with the highest mean birthweight estimated for localities occurring in the middle of the range (FCC = 3). The wealthiest urban localities (FCC = 6) and the most deprived localities (FCC = 1) both had a predicted birthweight about 60 g below the maximum at FCC = 3, if all other factors were held constant. This result, taken together with the spatial clustering of birthweights, suggests that there may be important social and environmental determinants of birthweight that have yet to be identified.

    背景与目标: 这项关于出生体重的空间变异性和决定因素的多层次研究是在1986年芬兰北部一个地理上定义的预期出生队列中使用个体和生态数据进行的。研究区域由北拉普兰(NL),南拉普兰(SL)和奥卢省(OP)定义的三个大区域组成,包括74个地区,总研究人口为9216个单胎出生。 NL的平均出生体重为3482 g,SL的平均出生体重为3537 g,OP的平均出生体重为3587 g(NL vs. OP和SL vs.

    OP :P <0.05)。死产的粗率在荷兰最高。与最南端的地区相比,最北端的地区妇女在社会上的特权较低,而当地的繁荣程度也较低。发现平均出生体重的显着空间聚类(P = 0.0016),在研究区域的西南部具有最高的出生体重。表示每个地方的财富的变量,即财务能力类别(FCC),其平均值在NL中最低,此处研究的地方的范围为1到6。多级多元回归模型显示,在考虑性别,胎龄,母亲的年龄,身高和高血压疾病,均等,体重指数,以前的低出生体重儿童和吸烟作为出生体重的单独决定因素之后,可以解释部分残留变异由当地的财富参数决定。使用多级模型,三个纬度地区的平均出生体重差异持续存在,但有所减少(OP与NL的差异从105 g减少到86.5 g)。出生体重与FCC之间的关系呈倒U形,在该范围的中间(FCC = 3),估计的平均出生体重最高。如果所有其他因素保持不变,则最富裕的城市地区(FCC = 6)和最贫困的地区(FCC = 1)的预测出生体重均比FCC = 3时的最高出生体重低约60 g。该结果与出生体重的空间聚类一起表明,可能还有一些重要的社会和环境决定因素尚未确定。

  • 【1960-93年瑞典的膀胱癌发病率趋势,特别涉及组织病理学,时间段,出生队列和吸烟。】 复制标题 收藏 收藏
    DOI:10.1023/a:1018486111572 复制DOI
    作者列表:Thörn M,Bergström R,Johansson AM,Ramström L,Persson I,Malmström PU
    BACKGROUND & AIMS: This study investigates the incidence trends of urinary bladder cancer in Sweden from 1960 through 1993 (a total of 46,211 cases). Age-standardized incidence rates increased among men from 14.6 per 10(5) in 1960 to 33.5 in 1993 and among women from 4.8 to 8.8, corresponding to an average annual increase of 2.4 percent (95 percent confidence interval [CI]) = 2.0-2.7 percent) and 1.1 percent (CI = 0.9-1.4 percent), respectively. The largest increase occurred in the oldest age-groups. The proportion of patients with transitional cell carcinoma increased in men from 66.0 percent in 1960-64 to 93.6 percent in 1990-93 and in women from 61.0 percent to 89.4 percent. The proportion of patients with papillomas decreased, whereas those with adenocarcinoma and squamous cell carcinoma were stable. Regression modeling (based on the period 1960-89) showed a strong linear effect due to either period and/or cohort. Among men, additional non-linear effects by both period and cohort were obtained. The cohort effects were more important. Cohort data on having smoked daily showed considerable similarities with the estimated cohort-effects. Our findings suggest that the increase of tobacco smoking in successive generations can explain the increase in incidence rates of bladder cancer in Sweden, whereas improved diagnostic activities and registration are less likely to explain fully the changes in incidence rates.

    背景与目标: 这项研究调查了瑞典从1960年到1993年的膀胱癌的发病趋势(共46,211例)。男性的年龄标准化发病率从1960年的每10(5)中的14.6增加到1993年的33.5,女性从4.8增加到8.8,相当于每年平均增长2.4%(95%置信区间[CI])= 2.0-分别为2.7%和1.1%(CI = 0.9-1.4%)。增长最大的是年龄最大的年龄组。男性中移行细胞癌患者的比例从1960-64年的66.0%增加到1990-93年的93.6%,女性从61.0%增加到89.4%。乳头状瘤患者的比例下降,而腺癌和鳞状细胞癌患者的比例稳定。回归建模(基于1960-89年期间)由于周期和/或同类群组而显示出强大的线性效应。在男性中,通过周期和队列均获得了额外的非线性效应。队列效应更为重要。每天吸烟的队列数据显示与估计的队列效应有很大的相似性。我们的发现表明,连续几代吸烟的增加可以解释瑞典膀胱癌的发病率增加,而诊断活动和登记的改善不太可能完全解释发病率的变化。

  • 【子宫颈一致性指数在无症状双胎妊娠中期超声检查中预测自发性早产的预测价值:一项前瞻性队列研究。】 复制标题 收藏 收藏
    DOI:10.3390/jcm9061784 复制DOI
    作者列表:van der Merwe J,Couck I,Russo F,Burgos-Artizzu XP,Deprest J,Palacio M,Lewi L
    BACKGROUND & AIMS: :Novel transvaginal ultrasound (TVU) markers have been proposed to improve spontaneous preterm birth (sPTB) prediction. Preliminary results of the cervical consistency index (CCI), uterocervical angle (UCA), and cervical texture (CTx) have been promising in singletons. However, in twin pregnancies, the results have been inconsistent. In this prospective cohort study of asymptomatic twin pregnancies assessed between 18+0-22+0 weeks, we evaluated TVU derived cervical length (CL), CCI, UCA, and the CTx to predict sPTB < 34+0 weeks. All iatrogenic PTB were excluded. In the final cohort of 63 pregnancies, the sPTB rate < 34+0 was 16.3%. The CCI, UCA, and CTx, including the CL was significantly different in the sPTB < 34+0 weeks group. The best area under the receiver operating characteristic curve (AUC) for sPTB < 34+0 weeks was achieved by the CCI 0.82 (95%CI, 0.72-0.93), followed by the UCA with AUC 0.72 (95%CI, 0.57-0.87). A logistic regression model incorporating parity, chorionicity, CCI, and UCA resulted in an AUC of 0.91 with a sensitivity of 55.3% and specificity of 88.1% for predicting sPTB < 34+0. The CCI performed better than other TVU markers to predict sPTB < 34+0 in twin gestations, and the best diagnostic accuracy was achieved by a combination of parity, chorionicity, CCI, and UCA.
    背景与目标: :已提出了新颖的经阴道超声(TVU)标记来改善自发性早产(sPTB)的预测。子宫颈一致性指数(CCI),子宫颈角(UCA)和子宫颈质地(CTx)的初步结果令人鼓舞。但是,在双胞胎怀孕中,结果并不一致。在这项对18 0-22 0周之间无症状双胎妊娠的前瞻性队列研究中,我们评估了TVU衍生的宫颈长度(CL),CCI,UCA和CTx,以预测sPTB <34 0周。排除所有医源性PTB。在最后63例孕妇中,sPTB率<34 0为16.3%。 sPTB <34 0周组的CCI,UCA和CTx(包括CL)显着不同。 sPTB <34 0周的接收器工作特性曲线(AUC)之下的最佳面积是通过CCI 0.82(95%CI,0.72-0.93)实现的,其次是UCA的AUC 0.72(95%CI,0.57-0.87) 。结合奇偶性,绒毛膜性,CCI和UCA的逻辑回归模型得出的AUC为0.91,对sPTB <34 0的敏感性为55.3%,特异性为88.1%。与其他TVU标记相比,CCI的表现更好,预测sPTB <34在双胎妊娠中为0,并且通过奇偶校验,绒毛膜性,CCI和UCA的组合获得了最佳的诊断准确性。
  • 【在长时间的GnRH激动剂方案中,HP-hMG刺激后的活产率:与卵泡中期hCG和孕激素浓度相关,但与LH浓度无关。】 复制标题 收藏 收藏
    DOI:10.3109/09513590.2012.705379 复制DOI
    作者列表:Arce JC,Smitz J
    BACKGROUND & AIMS: :The aim of this retrospective study was to investigate the impact of endogenous and exogenous luteinizing hormone (LH) activity on treatment outcome, when taking into consideration potential confounding variables. Data were derived from IVF patients (n = 358) stimulated with highly purified menotrophin (HP-hMG) in a long gonadotrophin-releasing hormone (GnRH) agonist protocol. Simple retrospective logistic regression analysis showed that the mid-follicular exogenous concentrations of human chorionic gonadotrophin (hCG) (p = 0.027), provided by the HP-hMG preparation, and female age (p = 0.009) were significantly associated with live-birth rate, while the mid-follicular progesterone concentration (p = 0.075), the estradiol concentration on last stimulation day (p = 0.075) and number of embryos transferred (p = 0.071) were borderline significant. Endogenous LH was not associated with live-birth rate; neither at start of stimulation (p = 0.123), nor in the mid-follicular phase (p = 0.933) or on the last day of stimulation (p = 0.589). In the multiple regression analysis of life birth, mid-follicular hCG (p = 0.016) was identified as a positive predictor, and age (p = 0.004) and mid-follicular progesterone (p = 0.029) as negative predictors. In conclusion, mid-follicular concentrations of exogenous hCG and progesterone, but not endogenous LH, are associated with live-birth rate in IVF patients treated with HP-hMG in a long GnRH agonist cycle.
    背景与目标: :这项回顾性研究的目的是在考虑潜在的混杂变量时,研究内源性和外源性黄体生成激素(LH)活性对治疗结果的影响。数据来自在长期促性腺激素释放激素(GnRH)激动剂方案中受高纯度Menotrophin(HP-hMG)刺激的IVF患者(n = 358)。简单的回顾性Logistic回归分析表明,HP-hMG制剂提供的人绒毛膜促性腺激素(hCG)的卵泡中期外源浓度(p = 0.027)和女性年龄(p = 0.009)与活产率显着相关。 ,而卵泡中期孕酮浓度(p = 0.075),最后刺激日的雌二醇浓度(p = 0.075)和转移的胚胎数(p = 0.071)处于临界水平。内源性LH与活产率无关。在刺激开始时(p = 0.123),卵泡中期(p = 0.933)或刺激的最后一天(p = 0.589)都没有。在生命出生的多元回归分析中,小卵泡中期hCG(p = 0.016)被确定为阳性预测指标,而年龄(p = 0.004)和小卵泡中期孕酮(p = 0.029)被确定为阴性预测指标。总之,在长时间的GnRH激动剂周期中,接受HP-hMG治疗的IVF患者的卵泡中浓度外源性hCG和孕酮(而非内源性LH)与活产率相关。
  • 【英国出生队列中儿童时期和整个成年时期的饮食中钙和维生素D的摄入量以及乳房X线照片密度。】 复制标题 收藏 收藏
    DOI:10.1038/sj.bjc.6604697 复制DOI
    作者列表:Mishra G,McCormack V,Kuh D,Hardy R,Stephen A,dos Santos Silva I
    BACKGROUND & AIMS: :We examined the role of dietary calcium and vitamin D intakes in childhood and throughout adulthood in relation to mammographic density using data from a nationally representative cohort of 1161 women followed up since their birth in 1946. Dietary intakes at the age of 4 years were determined by 24-h recalls and at the ages of 36, 43 and 53 years by 5-day food records. After adjusting for known risk factors and confounders, no evidence of a relationship between dietary calcium or vitamin D intakes and mammographic density approximately at the age of 50 years was found, except for a cross-sectional relationship between dietary calcium intake at the age of 53 years and breast density in women who were post-menopausal at the time of mammography, with those in the top fifth of the distribution of calcium intake having a 0.53 s.d. lower percent breast density than those in the lowest fifth (P-value <0.01 for linear trend).
    背景与目标: :我们使用1161名自1946年出生以来一直接受随访的全国代表性队列研究的数据,研究了儿童期和整个成年期饮食中钙和维生素D摄入量与乳腺摄影密度之间的关系。确定了4岁以下儿童的饮食摄入量通过24小时的召回记录,并通过5天的食物记录分别记录了36岁,43岁和53岁的年龄。在调整了已知的危险因素和混杂因素后,除53岁时饮食钙摄入量之间的横断面关系外,未发现饮食中钙或维生素D摄入量与乳房X线照片密度之间存在关系的证据(约50岁)。乳房X线摄影时绝经后妇女的年数和乳房密度,钙摄入量分布的前五分之一的妇女为0.53 sd相比最低的第五位人群,乳腺密度百分比更低(线性趋势P值<0.01)。
  • 【剖宫产后阴道分娩的预测模型还能预测与分娩试验有关的发病率吗?】 复制标题 收藏 收藏
    DOI:10.1016/j.ajog.2008.06.039 复制DOI
    作者列表:
    BACKGROUND & AIMS: OBJECTIVE:The objective of the study was to determine whether a model for predicting vaginal birth after cesarean (VBAC) can also predict the probabilty of morbidity associated with a trial of labor (TOL). STUDY DESIGN:Using a previously published prediction model, we categorized women with 1 prior cesarean by chance of VBAC. Prevalence of maternal and neonatal morbidity was stratfied by probability of VBAC success and delivery approach. RESULTS:Morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOL (P < .001) but not elective repeat cesarean section (ERCS) (P > .05). When the predicted chance of VBAC was less than 70%, women undergoing a TOL were more likely to have maternal morbidity (relative risk [RR], 2.2; 95% confidence interval [CI], 1.5-3.1) than those who underwent an ERCS; when the predicted chance of VBAC was at least 70%, total maternal morbidity was not different between the 2 groups (RR, 0.8; 95% CI, 0.5-1.2). The results were similar for neonatal morbidity. CONCLUSION:A prediction model for VBAC provides information regarding the chance of TOL-related morbidity and suggests that maternal morbidity is not greater for those women who undergo TOL than those who undergo ERCS if the chance of VBAC is at least 70%.
    背景与目标: 目的:本研究的目的是确定预测剖宫产后阴道分娩的模型(VBAC)是否也可以预测与分娩试验(TOL)相关的发病率。
    研究设计:使用先前发表的预测模型,我们通过VBAC的机会对进行过1次剖宫产的妇女进行了分类。 VBAC成功和分娩方法的可能性对孕产妇和新生儿发病率进行了分层。
    结果:由于接受TOL(P <.001)但非选择性重复剖宫产(ERCS)的女性中VBAC的预测机会增加,因此发病率降低了(P> .05)。当VBAC的预计机会少于70%时,接受TOL的妇女比接受ERCS的妇女更有可能发生孕产妇发病(相对风险[RR]为2.2; 95%可信区间[CI]为1.5-3.1)。 ;当VBAC的预测机会至少为70%时,两组的总产妇发病率没有差异(RR,0.8; 95%CI,0.5-1.2)。新生儿发病率的结果相似。
    结论:VBAC的预测模型提供了与TOL相关的发病率有关的信息,并且表明,如果VBAC的机会至少为70%,接受TOL的女性的产妇发病率并不比接受ERCS的女性高。
  • 【扑热息痛(对乙酰氨基酚)用于早产或低出生体重婴儿的动脉导管未闭。】 复制标题 收藏 收藏
    DOI:10.1002/14651858.CD010061.pub4 复制DOI
    作者列表:Ohlsson A,Shah PS
    BACKGROUND & AIMS: BACKGROUND:In preterm newborns, the ductus arteriosus frequently fails to close and the infants require medical or surgical closure of the patent ductus arteriosus (PDA). A PDA can be treated surgically; or medically with one of two prostaglandin inhibitors, indomethacin or ibuprofen. Case reports suggest that paracetamol may be an alternative for the closure of a PDA. An association between prenatal or postnatal exposure to paracetamol and later development of autism or autism spectrum disorder has been reported. OBJECTIVES:To determine the effectiveness and safety of intravenous or oral paracetamol compared with placebo or no intervention, intravenous indomethacin, intravenous or oral ibuprofen, or with other cyclo-oxygenase inhibitors for treatment of an echocardiographically diagnosed PDA in preterm or low birth weight infants. SEARCH METHODS:We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 10), MEDLINE via PubMed (1966 to 6 November 2017), Embase (1980 to 6 November 2017), and CINAHL (1982 to 6 November 2017). We searched clinical trial databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCT) and quasi-randomised trials. SELECTION CRITERIA:We included RCTs in which paracetamol was compared to no intervention, placebo or other agents used for closure of PDA irrespective of dose, duration and mode of administration in preterm (≤ 34 weeks' postmenstrual age) infants. We both reviewed the search results and made a final selection of potentially eligible articles by discussion. We included studies of both prophylactic and therapeutic use of paracetamol. DATA COLLECTION AND ANALYSIS:We performed data collection and analyses in accordance with the methods of the Cochrane Neonatal Review Group. We used the GRADE approach to assess the quality of evidence for the following outcomes when data were available: failure of ductal closure after the first course of treatment; neurodevelopmental impairment; all-cause mortality during initial hospital stay (death); gastrointestinal bleed or stools positive for occult blood; and serum levels of creatinine after treatment (µmol/L). MAIN RESULTS:We included eight studies that reported on 916 infants. One of these studies compared paracetamol to both ibuprofen and indomethacin. Five studies compared treatment of PDA with paracetamol versus ibuprofen and enrolled 559 infants. There was no significant difference between paracetamol and ibuprofen for failure of ductal closure after the first course of drug administration (typical risk ratio (RR) 0.95, 95% confidence interval (CI) 0.75 to 1.21; typical risk difference (RD) -0.02, 95% CI -0.09 to 0.09); I² = 0% for RR and RD; moderate quality of evidence. Four studies (n = 537) reported on gastrointestinal bleed which was lower in the paracetamol group versus the ibuprofen group (typical RR 0.28, 95% CI 0.12 to 0.69; typical RD -0.06, 95% CI -0.09 to -0.02); I² = 0% for RR and RD; number needed to treat for an additional beneficial outcome (NNTB) 17 (95% CI 11 to 50); moderate quality of evidence. The serum levels of creatinine were lower in the paracetamol group compared with the ibuprofen group in four studies (moderate quality of evidence), as were serum bilirubin levels following treatment in two studies (n = 290). Platelet counts and daily urine output were higher in the paracetamol group compared with the ibuprofen group. One study reported on long-term follow-up to 18 to 24 months of age following treatment with paracetamol versus ibuprofen. There were no significant differences in the neurological outcomes at 18 to 24 months (n = 61); (low quality of evidence). Two studies compared prophylactic administration of paracetamol for a PDA with placebo or no intervention in 80 infants. Paracetamol resulted in a lower rate of failure of ductal closure after 4 to 5 days of treatment compared to placebo or no intervention which was of borderline significance for typical RR 0.49 (95% CI 0.24 to 1.00; P = 0.05); but significant for typical RD -0.21 (95% CI -0.41 to -0.02); I² = 0 % for RR and RD; NNTB 5 (95% CI 2 to 50); (low quality of evidence). Two studies (n = 277) compared paracetamol with indomethacin. There was no significant difference in the failure to close a PDA (typical RR 0.96, 95% CI 0.55 to 1.65; I² = 11%; typical RD -0.01, 95% CI -0.09 to 0.08; I² = 17%) (low quality of evidence). Serum creatinine levels were significantly lower in the paracetamol group compared with the indomethacin group and platelet counts and daily urine output were significantly higher in the paracetamol group. AUTHORS' CONCLUSIONS:Moderate-quality evidence according to GRADE suggests that paracetamol is as effective as ibuprofen; low-quality evidence suggests paracetamol to be more effective than placebo or no intervention; and low-quality evidence suggests paracetamol as effective as indomethacin in closing a PDA. There was no difference in neurodevelopmental outcome in children exposed to paracetamol compared to ibuprofen; however the quality of evidence is low and comes from only one study. In view of concerns raised regarding neurodevelopmental outcomes following prenatal and postnatal exposure to paracetamol, long-term follow-up to at least 18 to 24 months' postnatal age must be incorporated in any studies of paracetamol in the newborn population. At least 19 ongoing trials have been registered. Such trials are required before any recommendations for the possible routine use of paracetamol in the newborn population can be made.
    背景与目标: 背景:在早产新生儿中,动脉导管经常无法闭合,婴儿需要对动脉导管未闭(PDA)进行医学或手术闭合。 PDA可以手术治疗;或在医学上与两种前列腺素抑制剂之一消炎痛或布洛芬合用。病例报告表明,扑热息痛可能是关闭PDA的替代方法。据报道,产前或产后对乙酰氨基酚暴露与自闭症或自闭症谱系障碍后来发展之间存在关联。
    目的:为了确定静脉或口服扑热息痛与安慰剂或无干预措施,静脉消炎痛,静脉或口服布洛芬或与其他环加氧酶抑制剂相比,在早产或低出生体重婴儿中经超声心动图诊断的PDA的有效性和安全性。
    搜索方法:我们使用Cochrane新生儿的标准搜索策略来搜索Cochrane对照试验中央注册簿(CENTRAL 2017,第10期),MEDLINE经由PubMed(1966年至2017年11月6日),Embase(1980年至2017年11月6日),以及CINAHL(1982年至2017年11月6日)。我们搜索了临床试验数据库,会议记录以及检索到的文章的参考文献清单,以进行随机对照试验(RCT)和准随机试验。
    选择标准:我们纳入了RCT,其中对早产(月经后≤34周)婴儿的对乙酰氨基酚与不进行干预,安慰剂或其他用于关闭PDA的药物进行了比较,而与剂量,持续时间和给药方式无关。我们都审查了搜索结果,并通过讨论最终选择了可能符合条件的文章。我们纳入了对乙酰氨基酚的预防和治疗用途的研究。
    数据收集与分析:我们按照Cochrane新生儿评估小组的方法进行了数据收集和分析。当有数据时,我们使用GRADE方法评估以下结果的证据质量:第一疗程后导管闭合失败;神经发育障碍;初次住院(死亡)期间的全因死亡率;消化道出血或大便潜血阳性;治疗后的肌酐水平和血清水平(µmol / L)。
    主要结果:我们纳入了916例婴儿的八项研究报告。其中一项研究比较了扑热息痛与布洛芬和消炎痛。五项研究比较了对乙酰氨基酚与布洛芬对PDA的治疗,并纳入559例婴儿。首次给药后,扑热息痛和布洛芬在导管闭合失败方面无显着差异(典型风险比(RR)为0.95,95%置信区间(CI)为0.75至1.21;典型风险差(RD)为-0.02, 95%CI -0.09至0.09); RR和RD的I²= 0%;证据质量中等。有四项研究(n = 537)报道了对胃肠道出血,对乙酰氨基酚组的胃肠道出血要比布洛芬组低(典型RR 0.28,95%CI 0.12至0.69;典型RD -0.06,95%CI -0.09至-0.02); RR和RD的I²= 0%;达到额外有益结果(NNTB)17所需的人数(95%CI为11至50);证据质量中等。在四项研究中,对乙酰氨基酚组的肌酐水平低于布洛芬组(证据质量中等),两项研究中治疗后的血清胆红素水平也相同(n = 290)。扑热息痛组的血小板计数和每日尿量高于布洛芬组。一项研究报告了对乙酰氨基酚与布洛芬治疗后的18-24个月大的长期随访。在18到24个月时,神经系统结局无显着差异(n = 61)。 (证据质量低)。两项研究比较了80例婴儿中对乙酰氨基酚预防性使用PDA与安慰剂或无干预的情况。与安慰剂或不进行干预相比,对乙酰氨基酚在治疗4至5天后导致导管闭合失败的几率更低,这对于典型的RR 0.49具有重要意义(95%CI为0.24至1.00; P = 0.05)。但对于典型RD -0.21(95%CI -0.41至-0.02)具有显着性;对于RR和RD,I²= 0%; NNTB 5(95%CI 2至50); (证据质量低)。两项研究(n = 277)比较了扑热息痛和消炎痛。关闭PDA的失败没有显着差异(典型RR 0.96,95%CI 0.55至1.65;I²= 11%;典型RD -0.01,95%CI -0.09至0.08;I²= 17%)(低质量)证据)。与扑热息痛组相比,扑热息痛组的血清肌酐水平显着降低,扑热息痛组的血小板计数和每日尿量显着较高。
    作者的结论:根据GRADE的中等质量证据表明,扑热息痛与布洛芬一样有效;低质量的证据表明扑热息痛比安慰剂或无干预措施更有效;低质量的证据表明扑热息痛在关闭PDA方面与消炎痛一样有效。与布洛芬相比,对乙酰氨基酚暴露的儿童神经发育结局无差异。但是,证据质量很低,仅来自一项研究。考虑到对产前和产后对乙酰氨基酚暴露后神经发育结局的担忧,对新生儿对乙酰氨基酚的任何研究都必须纳入对至少18至24个月产后年龄的长期随访。至少有19个正在进行的试验已经注册。在对新生儿人群中可能常规使用扑热息痛提出任何建议之前,需要进行此类试验。
  • 【与传统的培养系统相比,使用延时监视系统进行的胚胎培养可提高活产率:一项前瞻性队列研究。】 复制标题 收藏 收藏
    DOI:10.1080/14647273.2017.1335886 复制DOI
    作者列表:Wu L,Han W,Wang J,Zhang X,Liu W,Xiong S,Han S,Liu J,Gao Y,Huang G
    BACKGROUND & AIMS: :In this prospective cohort study, the effects of a time-lapse monitoring system on embryo quality and clinical pregnancy outcomes were assessed. A total of 608 patients undergoing in vitro fertilization between April 2013 and June 2014 at our institution were recruited for this study and group-matched into a time-lapse monitoring (TLM) (N = 304) or a standard incubator (SI) (N = 304). The patients' characteristics in the TLM and SI groups were not significantly different. The TLM group showed a significantly higher transferable embryo ratio at Day 3 (61.65% vs. 52.87%; p < 0.0010, RR =1.10 [1.02, 1.19]), a higher number of transferable embryos (4.71 ± 2.38 vs. 4.09 ± 2.35; p = 0.0053, SMD =0.26 [0.06, 0.46]) and number of good-quality embryos cryopreserved at Day 3 (2.72 ± 2.35 vs. 2.11 ± 2.33; p = 0.0056, SMD =0.26 [0.06, 0.46]). In addition, the implantation and clinical pregnancy rates were not statistically significant between the TLM and SI groups. However, the TLM group had a higher ongoing pregnancy rate (67.32% vs. 57.22%; p = 0.0410) and live birth rate (65.37% vs. 55%; p = 0.0380) compared with the SI group. The observed beneficial effects could be the result of a more stable environment provided by the TLM system.
    背景与目标: :在这项前瞻性队列研究中,评估了延时监测系统对胚胎质量和临床妊娠结局的影响。招募了2013年4月至2014年6月间在本机构接受体外受精的608位患者进行此项研究,并将其分组配对到延时监测(TLM)(N = 304)或标准培养箱(SI)(N = 304)。 TLM组和SI组的患者特征无显着差异。 TLM组在第3天显示出明显更高的可移植胚胎比例(61.65%对52.87%; p <0.0010,RR = 1.10 [1.02,1.19]),可移植胚胎的数量也更多(4.71±2.38 vs 4.09±2.35) ; p = 0.0053,SMD = 0.26 [0.06,0.46])和在第3天冷冻保存的优质胚胎的数量(2.72±2.35对2.11±2.33; p = 0.0056,SMD = 0.26 [0.06,0.46])。此外,在TLM和SI组之间,植入率和临床妊娠率没有统计学意义。然而,与SI组相比,TLM组的持续妊娠率(67.32%比57.22%; p = 0.0410)和活产率(65.37%vs. 55%; p = 0.0380)更高。观察到的有益效果可能是TLM系统提供的更稳定环境的结果。
  • 【硫酸镁适用于有早产风险的胎儿对胎儿进行神经保护的妇女。】 复制标题 收藏 收藏
    DOI:10.1002/14651858.CD004661.pub2 复制DOI
    作者列表:Doyle LW,Crowther CA,Middleton P,Marret S
    BACKGROUND & AIMS: BACKGROUND:Epidemiological and basic science evidence suggests that magnesium sulphate before birth may be neuroprotective for the fetus. OBJECTIVES:To assess the effectiveness and safety of magnesium sulphate as a neuroprotective agent when given to women considered at risk of preterm birth. SEARCH STRATEGY:We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2006), CENTRAL (The Cochrane Library 2006, Issue 3), MEDLINE (1966 to October 2006), EMBASE (1980 to October 2006), Current Contents (1992 to October 2006), references of retrieved articles, and abstracts submitted to the Society for Pediatric Research (1996 to 2006). SELECTION CRITERIA:Randomised controlled trials of antenatal magnesium sulphate therapy given to women threatening or likely to give birth at less than 37 weeks' gestational age. DATA COLLECTION AND ANALYSIS:We independently extracted data regarding clinical outcomes including paediatric mortality, neurologic outcome of survivors (including blindness, deafness, cerebral palsy and major neurosensory disability), and maternal complications and side-effects. At least two authors assessed trial eligibility and quality, and extracted data. MAIN RESULTS:Four trials (3701 babies) were eligible for this review. No statistically significant effect of antenatal magnesium sulphate therapy was detected on any major paediatric outcome, including mortality (e.g., paediatric mortality relative risk (RR) 0.97; 95% confidence interval (CI) 0.74 to 1.28; four trials; 3701 infants), and neurological outcomes in the first few years of life, including cerebral palsy (RR 0.77; 95% CI 0.56 to 1.06; four trials; 3701 infants), neurological impairments or disabilities. There were also no significant effects of antenatal magnesium therapy on combined rates of mortality with neurologic outcomes. There was a significant reduction in the rate of substantial gross motor dysfunction (RR 0.56; 95% CI 0.33 to 0.97; two trials; 2848 infants). There were higher rates of minor maternal side-effects in the magnesium groups, but no significant effects on major maternal complications. AUTHORS' CONCLUSIONS:The role for antenatal magnesium sulphate therapy as a neuroprotective agent for the preterm fetus is not yet established. Given the possible beneficial effects of magnesium sulphate on gross motor function in early childhood, outcomes later in childhood should be evaluated to determine the presence or absence of later potentially important neurologic effects, particularly on motor or cognitive function. Further information will be available from one of the studies where outcomes are being evaluated again at eight to nine years of age, and from another trial currently in progress.
    背景与目标: 背景:流行病学和基础科学证据表明,出生前的硫酸镁可能对胎儿具有神经保护作用。
    目的:评估硫酸镁作为一种神经保护剂的有效性和安全性,该硫酸镁用于被认为有早产风险的妇女。
    搜索策略:我们搜索了Cochrane怀孕和分娩组的试验登记册(2006年10月),CENTRAL(Cochrane图书馆2006年第3期),MEDLINE(1966年至2006年10月),EMBASE(1980年至2006年10月),当前目录(1992年至2006年10月) (2006年10月),检索到的文章参考和摘要提交给儿科研究学会(1996年至2006年)。
    选择标准:针对威胁或可能在小于孕周出生的妇女进行的产前硫酸镁治疗的随机对照试验。
    数据收集和分析:我们独立提取有关临床结果的数据,包括儿童死亡率,幸存者的神经系统结果(包括失明,耳聋,脑瘫和主要的神经感觉障碍)以及母体并发症和副作用。至少有两位作者评估了试验的资格和质量,并提取了数据。
    主要结果:四项试验(3701例婴儿)符合该评价的条件。在任何主要的儿科预后中,包括死亡率(例如,儿科死亡率相对危险度(RR)0.97; 95%置信区间(CI)0.74至1.28;四项试验; 3701例婴儿),未检测到产前硫酸镁疗法对任何重大儿科结局具有统计学意义的显着影响。生命最初几年的神经系统结果,包括脑瘫(RR 0.77; 95%CI 0.56至1.06;四项试验; 3701婴儿),神经系统障碍或残疾。产前镁疗法对死亡率和神经系统预后的综合率也没有显着影响。严重总体运动功能障碍的发生率显着降低(RR 0.56; 95%CI 0.33至0.97;两项试验; 2848例婴儿)。镁组中较高的次要母亲副作用发生率较高,但对主要的母亲并发症没有显着影响。
    作者的结论:尚未确定产前硫酸镁疗法作为早产胎儿神经保护剂的作用。考虑到硫酸镁对儿童早期的总体运动功能可能产生的有益影响,应评估儿童后期的结局,以确定是否存在后期潜在的重要神经系统作用,尤其是对运动或认知功能的影响。一项研究将在八至九岁时再次评估结局,而目前正在进行的另一项试验将提供更多信息。

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