提示: 手机请竖屏浏览!

足月或近足月出生的大脑性瘫痪单胎儿的出生前因素分析
Prenatal Factors in Singletons with Cerebral Palsy Born at or near Term


Karin B. Nelson ... 围产医学和儿科 • 2015.09.03

大脑性瘫痪(脑瘫)是大脑源性先天性运动障碍,是一类终身性运动障碍疾病,每1,000名儿童中约有2人受累。尽管脑瘫被定义为一种运动障碍,但它往往伴有智力缺陷、癫痫和感觉障碍。脑瘫不仅导致身体和精神上痛苦不堪,而且还给家庭和社会带来巨大经济负担。因为目前还没有治愈的方法,所以非常需要有效的一级预防策略,但开发预防策略需要了解致病因素。

出生时的胎龄与脑瘫的关联程度很高,足月儿的患病率约为幸存极早产儿的1/401。因为极早产儿脑瘫的个体风险高,所以脑瘫研究的重点一直是这类婴儿,但存活的脑瘫新生儿中只有不到0.4%是在胎龄28周前出生的1。单胎儿中出生时胎龄至少达到35周的占96%,脑瘫新生儿中有2/3属于这一部分单胎儿,而对这部分新生儿没有深入研究,而且关于他们脑瘫病因的大部分医学和非专业文献重点关注的仍然是出生窒息。

人们寄希望于通过及时干预预防脑瘫,因此在产程期间引入了连续电子胎儿监测以及时发现胎儿窒息。但遗憾的是,这种希望带来的却是失望。尽管对胎儿的监测使手术分娩明显增多,而且风险和花费也随之增加,但过去30年间脑瘫活产儿的数量并未减少(图1)2,3





作者信息

Karin B. Nelson, M.D., and Eve Blair, Ph.D.
From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (K.B.N.); the Department of Neurology, Children’s National Medical Center, Washington, DC (K.B.N); and the Telethon Kids Institute, University of Western Australia, Subiaco, Australia (E.B.). Address reprint requests to Dr. Nelson at nelsonk@ninds.nih.gov.

 

参考文献

1. Watson L, Blair E, Stanley F. Report of the Western Australian cerebral palsy register to birth year 1999. Perth, WA, Australia: Telethon Kids Institute, 2006.

2. Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2013;5:CD006066-CD006066

3. Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2013;55:509-519

4. Eastman NJ, DeLeon M. The etiology of cerebral palsy. Am J Obstet Gynecol 1955;69:950-961

5. Nelson KB, Ellenberg JH. Antecedents of cerebral palsy: multivariate analysis of risk. N Engl J Med 1986;315:81-86

6. Torfs CP, van den Berg B, Oechsli FW, Cummins S. Prenatal and perinatal factors in the etiology of cerebral palsy. J Pediatr 1990;116:615-619

7. Blair E, Stanley F. When can cerebral palsy be prevented? The generation of causal hypotheses by multivariate analysis of a case-control study. Paediatr Perinat Epidemiol 1993;7:272-301

8. Nelson KB, Grether JK. Potentially asphyxiating conditions and spastic cerebral palsy in infants of normal birth weight. Am J Obstet Gynecol 1998;179:507-513

9. Jacobsson B, Hagberg G. Antenatal risk factors for cerebral palsy. Best Pract Res Clin Obstet Gynaecol 2004;18:425-436

10. Stoknes M, Andersen GL, Elkamil AI, et al. The effects of multiple pre- and perinatal risk factors on the occurrence of cerebral palsy: a Norwegian register based study. Eur J Paediatr Neurol 2012;16:56-63

11. McIntyre S, Blair E, Badawi N, Keogh J, Nelson KB. Antecedents of cerebral palsy and perinatal death in term and late preterm singletons. Obstet Gynecol 2013;122:869-877

12. Trønnes H, Wilcox AJ, Lie RT, Markestad T, Moster D. Risk of cerebral palsy in relation to pregnancy disorders and preterm birth: a national cohort study. Dev Med Child Neurol 2014;56:779-785

13. Himmelmann K, Ahlin K, Jacobsson B, Cans C, Thorsen P. Risk factors for cerebral palsy in children born at term. Acta Obstet Gynecol Scand 2011;90:1070-1081

14. Redline RW. Cerebral palsy in term infants: a clinicopathologic analysis of 158 medicolegal case reviews. Pediatr Dev Pathol 2008;11:456-464

15. Moreno-De-Luca A, Ledbetter DH, Martin CL. Genetic [corrected] insights into the causes and classification of [corrected] cerebral palsies. Lancet Neurol 2012;11:283-292[Erratum, Lancet Neurol 2012;11:208.]

16. MacLennan AH, Thompson SC, Gecz J. Cerebral palsy — causes, pathways, and the role of genetic variants. Am J Obstet Gynecol2015May21 (Epub ahead of print).

17. Eastman NJ, Kohl SG, Maisel JE, Kavaler F. The obstetrical background of 753 cases of cerebral palsy. Obstet Gynecol Surv 1962;17:459-500

18. Malamud N, Itabashi HH, Castormessinger HB, Messinger HB. An etiologic and diagnostic study of cerebral palsy. J Pediatr 1964;65:270-293

19. Croen LA, Grether JK, Curry CJ, Nelson KB. Congenital abnormalities among children with cerebral palsy: more evidence for prenatal antecedents. J Pediatr 2001;138:804-810

20. Garne E, Dolk H, Krägeloh-Mann I, Holst Ravn S, Cans C. Cerebral palsy and congenital malformations. Eur J Paediatr Neurol 2008;12:82-88

21. Wu YW, Croen LA, Shah SJ, Newman TB, Najjar DV. Cerebral palsy in a term population: risk factors and neuroimaging findings. Pediatrics 2006;118:690-697

22. Pharoah POD. Prevalence and pathogenesis of congenital anomalies in cerebral palsy. Arch Dis Child Fetal Neonatal Ed 2007;92:F489-F493

23. Rankin J, Cans C, Garne E, et al. Congenital anomalies in children with cerebral palsy: a population-based record linkage study. Dev Med Child Neurol 2010;52:345-351

24. Blair E, Al Asedy F, Badawi N, Bower C. Is cerebral palsy associated with birth defects other than cerebral effects? Dev Med Child Neurol 2007;49:252-258

25. Nelson KB, Dambrosia JM, Grether JK, Phillips TM. Neonatal cytokines and coagulation factors in children with cerebral palsy. Ann Neurol 1998;44:665-675

26. Hong T, Paneth N. Maternal and infant thyroid disorders and cerebral palsy. Semin Perinatol 2008;32:438-445

27. O’Leary CM, Watson L, D’Antoine H, Stanley F, Bower C. Heavy maternal alcohol consumption and cerebral palsy in the offspring. Dev Med Child Neurol 2012;54:224-230

28. Crisham Janik MD, Newman TB, Cheng YW, Xing G, Gilbert WM, Wu YW. Maternal diagnosis of obesity and risk of cerebral palsy in the child. J Pediatr 2013;163:1307-1312

29. Blair E, Nelson KB. Fetal growth restriction and risk of cerebral palsy in singletons born after at least 35 weeks’ gestation. Am J Obstet Gynecol 2015;212:520.e1-527.e1.

30. Hu WF, Chahrour MH, Walsh CA. The diverse genetic landscape of neurodevelopmental disorders. Annu Rev Genomics Hum Genet 2014;15:195-213

31. Kim YS, State MW. Recent challenges to the psychiatric diagnostic nosology: a focus on the genetics and genomics of neurodevelopmental disorders. Int J Epidemiol 2014;43:465-475

32. Decouflé P, Boyle CA, Paulozzi LJ, Lary JM. Increased risk for developmental disabilities in children who have major birth defects: a population-based study. Pediatrics 2001;108:728-734

33. Nelson KB, Ellenberg JH. Predisposing and causative factors in childhood epilepsy. Epilepsia 1987;28:Suppl 1:S16-S24

34. Felix JF, Badawi N, Kurinczuk JJ, Bower C, Keogh JM, Pemberton PJ. Birth defects in children with newborn encephalopathy. Dev Med Child Neurol 2000;42:803-808

35. Bower C, Rudy E, Callaghan A, Quick J, Nassar N. Age at diagnosis of birth defects. Birth Defects Res A Clin Mol Teratol 2010;88:251-255

36. Honein MA, Kirby RS, Meyer RE, et al. The association between major birth defects and preterm birth. Matern Child Health J 2009;13:164-175

37. McIntyre S, Blair E, Goldsmith E, et al. Congenital anomalies in cerebral palsy: where to from here? Dev Med Child Neurol Suppl (in press).

38. Dahlseng MO, Andersen GL, Irgens LM, Skranes J, Vik T. Risk of cerebral palsy in term-born singletons according to growth status at birth. Dev Med Child Neurol 2014;56:53-58

39. von der Hagen M, Pivarcsi M, Liebe J, et al. Diagnostic approach to microcephaly in childhood: a two-center study and review of the literature. Dev Med Child Neurol 2014;56:732-741

40. Mirzaa GM, Millen KJ, Barkovich AJ, Dobyns WB, Paciorkowski AR. The Developmental Brain Disorders Database (DBDB): a curated neurogenetics knowledge base with clinical and research applications. Am J Med Genet A 2014;164:1503-1511

41. Reid SM, Dagia CD, Ditchfield MR, Carlin JB, Reddihough DS. Population-based studies of brain imaging patterns in cerebral palsy. Dev Med Child Neurol 2014;56:222-232

42. Jarvis SN, Glinianaia SV, Torrioli M-G, et al. Cerebral palsy and intrauterine growth in single births: European collaborative study. Lancet 2003;362:1106-1111

43. Stoknes J, Andersen G, Dahlseng M, et al. Cerebral palsy and neonatal death in term singletons born small for gestational age. Pediatrics 2012;130:e1629-e1635

44. Nielsen LF, Schendel D, Grove J, et al. Asphyxia-related risk factors and their timing in spastic cerebral palsy. BJOG 2008;115:1518-1528

45. Sato Y, Benirschke K, Marutsuka K, et al. Associations of intrauterine growth restriction with placental pathological factors, maternal factors and fetal factors; clinicopathological findings of 257 Japanese cases. Histol Histopathol 2013;28:127-132

46. Miquel-Verges F, Mosley BS, Block AS, Hobbs CA. A spectrum project: preterm birth and small-for-gestational age among infants with birth defects. J Perinatol 2015;35:198-203

47. Folkerth RD, Habbe DM, Boyd TK, et al. Gastroschisis, destructive brain lesions, and placental infarction in the second trimester suggest a vascular pathogenesis. Pediatr Dev Pathol 2013;16:391-396

48. Parsa CF, Robert MP. Thromboembolism and congenital malformations: from Duane syndrome to thalidomide embryopathy. JAMA Ophthalmol 2013;131:439-447

49. Weber MA, Sebire NJ. Genetics and developmental pathology of twinning. Semin Fetal Neonatal Med 2010;15:313-318

50. Scher AI, Petterson B, Blair E, et al. The risk of mortality or cerebral palsy in twins: a collaborative population-based study. Pediatr Res 2002;52:671-681

51. Taylor CL, de Groot J, Blair EM, Stanley FJ. The risk of cerebral palsy in survivors of multiple pregnancies with cofetal loss or death. Am J Obstet Gynecol 2009;201(1:41.e1-46.e1

52. Blair E, de Groot J, Nelson KB. Placental infarction identified by macroscopic examination and risk of cerebral palsy in infants at 35 weeks of gestational age and over. Am J Obstet Gynecol 2011;205:124.e1-127.e1

53. Viscardi RM, Sun CC. Placental lesion multiplicity: risk factor for IUGR and neonatal cranial ultrasound abnormalities. Early Hum Dev 2001;62:1-10

54. Lian DWQ, Lam JCM, Aung ACL, Li FX, Chang KTE. Intestinal atresia occurring in association with placental fetal thrombotic vasculopathy: a case report with literature review. Pediatr Dev Pathol 2013;16:28-31

55. Saleemuddin A, Tantbirojn P, Sirois K, et al. Obstetric and perinatal complications in placentas with fetal thrombotic vasculopathy. Pediatr Dev Pathol 2010;13:459-464

56. Kirton A, deVeber G. Cerebral palsy secondary to perinatal ischemic stroke. Clin Perinatol 2006;33:367-386

57. Pinar H, Goldenberg RL, Koch MA, et al. Placental findings in singleton stillbirths. Obstet Gynecol 2014;123:325-336

58. Chisholm KM, Heerema-McKenney A. Fetal thrombotic vasculopathy: significance in liveborn children using proposed society for pediatric pathology diagnostic criteria. Am J Surg Pathol 2015;39:274-280

59. McDonald DG, Kelehan P, McMenamin JB, et al. Placental fetal thrombotic vasculopathy is associated with neonatal encephalopathy. Hum Pathol 2004;35:875-880

60. Takenouchi T, Kasdorf E, Engel M, Grunebaum A, Perlman JM. Changing pattern of perinatal brain injury in term infants in recent years. Pediatr Neurol 2012;46:106-110

61. Hemminki K, Li X, Sundquist K, Sundquist J. High familial risks for cerebral palsy implicate partial heritable aetiology. Paediatr Perinat Epidemiol 2007;21:235-241

62. Tollånes MC, Wilcox AJ, Lie RT, Moster D. Familial risk of cerebral palsy: population based cohort study. BMJ 2014;349:g4294-g4294

63. Khankanian P, Barnaini SE, Johnson BA, et al. Sequencing of the IL6 gene in a case-control study of cerebral palsy in children. BMC Med Genet 2013;14:126-126

64. Segel R, Ben-Pazi H, Zeligson S, et al. Copy number variations in cryptogenic cerebral palsy. Neurology 2015;84:1660-1668

65. Ho NT, Furge K, Fu W, et al. Gene expression in archived newborn blood spots distinguishes infants who will later develop cerebral palsy from matched controls. Pediatr Res 2013;73:450-456

66. McMichael G, Bainbridge MN, Haan E, et al. Whole-exome sequencing points to considerable genetic heterogeneity of cerebral palsy. Mol Psychiatry 2015;20:176-182

67. van Oppenraaij RH, Jauniaux E, Christiansen OB, Horcajadas JA, Farquharson RG, Exalto N. Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Hum Reprod Update 2009;15:409-421

68. Saraswat L, Bhattacharya S, Maheshwari A, Bhattacharya S. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review. BJOG 2010;117:245-257

69. Evrenos AN, Cakir Gungor AN, Gulerman C, Cosar E. Obstetric outcomes of patients with abortus imminens in the first trimester. Arch Gynecol Obstet 2014;289:499-504

70. Montenegro MA, Cendes F, Saito H, et al. Intrapartum complications associated with malformations of cortical development. J Child Neurol 2005;20:675-678

71. Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol 2006;108:1005-1016

72. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013;1:CD003311-CD003311

73. Mcintyre S, Badawi N, Blair E, Nelson KB. Does aetiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy influence the outcome of treatment? Dev Med Child Neurol 2015;57:Suppl 3:2-7

74. Bonnin A, Levitt P. Placental source for 5-HT that tunes fetal brain development. Neuropsychopharmacology 2012;37:299-300

75. Graham EM, Petersen SM, Christo DK, Fox HE. Intrapartum electronic fetal heart rate monitoring and the prevention of perinatal brain injury. Obstet Gynecol 2006;108:656-666

76. Sartwelle TP, Johnston JC. Cerebral palsy litigation: change course or abandon ship. J Child Neurol 2015;30:825-841

77. Nelson KB, Dambrosia HM, Ting TY, Grether JK. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med 1996;334:613-618

78. Dodman N, Natale R. Birth can be a hazardous journey: electronic fetal monitoring does not help. J Obstet Gynaecol Can 2004;26:327-328

79. Neonatal encephalopathy and neurologic outcome. 2nd ed. Washington, DC: American College of Obstetricians and Gynecologists, American Academy of Pediatrics, 2014:88.

80. Hankins GD, MacLennan AH, Speer ME, Strunk A, Nelson K. Obstetric litigation is asphyxiating our maternity services. Obstet Gynecol 2006;107:1382-1385

服务条款 | 隐私政策 | 联系我们