It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several c...It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several causes of perinatal neurological injury and may not be the most common;most neonates diagnosed with hypoxic-ischemic encephalopathy do not have evidence of severe asphyxia. Sepsis, direct brain trauma, and drug or toxin exposure account for some cases, while mechanical forces of labor and delivery that increase fetal intracranial pressure sufficiently to impair brain perfusion may also contribute. Because of bony compliance and mobile suture lines, the fetal skull changes shape and redistributes cerebrospinal fluid during labor according to constraints imposed by contractions, and bony and soft tissue elements of the birth canal as the head descends. These accommodations, including the increase in intracranial pressure, are adaptive and necessary for efficient descent of the head while safeguarding cerebral blood flow. Autonomic reflexes mediated through central receptors normally provide ample protection of the brain from the considerable pressure exerted on the skull. On occasion, those forces, which are transmitted intracranially, may overcome the various adaptive anatomical, cardiovascular, metabolic, and neurological mechanisms that maintain cerebral perfusion and oxygen availability, resulting in ischemic brain injury. Accepting the notion of a potentially adverse impact of fetal head compression suggests that avoidance of excessive uterine activity and of relentless pushing without steady progress in descent may offer protection for the fetal brain during parturition. Excessive head compression should be considered in the differential diagnosis of ischemic encephalopathy.展开更多
目的分析1990—2019年我国出生窒息/创伤所致新生儿脑病的疾病负担水平及其变化趋势。方法从2019年全球疾病负担研究数据库中提取1990—2019年我国出生窒息/创伤所致新生儿脑病的伤残调整寿命年(disability-adjusted life years,DALY)、...目的分析1990—2019年我国出生窒息/创伤所致新生儿脑病的疾病负担水平及其变化趋势。方法从2019年全球疾病负担研究数据库中提取1990—2019年我国出生窒息/创伤所致新生儿脑病的伤残调整寿命年(disability-adjusted life years,DALY)、DALY率、死亡人数、死亡率、危险因素等数据。采用Joinpoint回归分析计算死亡率和DALY率的年度平均百分比变化(annual average percentage change,AAPC)以及95%置信区间(confidence interval,CI)。结果2019年我国出生窒息/创伤所致新生儿脑病死亡率为1139.527人/10万,DALY率为101275.239人年/10万,与1990年相比,均下降了76.23%。其中,男性和女性新生儿的死亡率分别为1230.738人/10万、1033.004人/10万,DALY率分别为109381.824人年/10万、91807.766人年/10万;0~6 d和7~28 d新生儿的死亡率分别为4022.626人/10万、178.166人/10万,DALY率分别为357481.444人年/10万、15844.063人年/10万。1990—2019年出生窒息/创伤所致新生儿脑病死亡率和DALY率的AAPC均为-4.88[95%CI(-5.17,-4.59)]。小于胎龄儿、早产、环境颗粒污染物和固体燃料燃烧的家庭污染是我国出生窒息/创伤所致新生儿脑病的主要危险因素。结论相较于1990年,2019年我国出生窒息/创伤所致新生儿脑病死亡率、DALY率均呈下降趋势,出生早期男性儿童的疾病负担高于女性儿童,因此应针对小于胎龄儿、早产、环境颗粒物污染、固体燃料燃烧的家庭污染等危险因素制定政策,继续重视孕期保健服务,以期进一步降低出生窒息/创伤所致新生儿脑病的疾病负担。展开更多
文摘It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several causes of perinatal neurological injury and may not be the most common;most neonates diagnosed with hypoxic-ischemic encephalopathy do not have evidence of severe asphyxia. Sepsis, direct brain trauma, and drug or toxin exposure account for some cases, while mechanical forces of labor and delivery that increase fetal intracranial pressure sufficiently to impair brain perfusion may also contribute. Because of bony compliance and mobile suture lines, the fetal skull changes shape and redistributes cerebrospinal fluid during labor according to constraints imposed by contractions, and bony and soft tissue elements of the birth canal as the head descends. These accommodations, including the increase in intracranial pressure, are adaptive and necessary for efficient descent of the head while safeguarding cerebral blood flow. Autonomic reflexes mediated through central receptors normally provide ample protection of the brain from the considerable pressure exerted on the skull. On occasion, those forces, which are transmitted intracranially, may overcome the various adaptive anatomical, cardiovascular, metabolic, and neurological mechanisms that maintain cerebral perfusion and oxygen availability, resulting in ischemic brain injury. Accepting the notion of a potentially adverse impact of fetal head compression suggests that avoidance of excessive uterine activity and of relentless pushing without steady progress in descent may offer protection for the fetal brain during parturition. Excessive head compression should be considered in the differential diagnosis of ischemic encephalopathy.
文摘目的分析1990—2019年我国出生窒息/创伤所致新生儿脑病的疾病负担水平及其变化趋势。方法从2019年全球疾病负担研究数据库中提取1990—2019年我国出生窒息/创伤所致新生儿脑病的伤残调整寿命年(disability-adjusted life years,DALY)、DALY率、死亡人数、死亡率、危险因素等数据。采用Joinpoint回归分析计算死亡率和DALY率的年度平均百分比变化(annual average percentage change,AAPC)以及95%置信区间(confidence interval,CI)。结果2019年我国出生窒息/创伤所致新生儿脑病死亡率为1139.527人/10万,DALY率为101275.239人年/10万,与1990年相比,均下降了76.23%。其中,男性和女性新生儿的死亡率分别为1230.738人/10万、1033.004人/10万,DALY率分别为109381.824人年/10万、91807.766人年/10万;0~6 d和7~28 d新生儿的死亡率分别为4022.626人/10万、178.166人/10万,DALY率分别为357481.444人年/10万、15844.063人年/10万。1990—2019年出生窒息/创伤所致新生儿脑病死亡率和DALY率的AAPC均为-4.88[95%CI(-5.17,-4.59)]。小于胎龄儿、早产、环境颗粒污染物和固体燃料燃烧的家庭污染是我国出生窒息/创伤所致新生儿脑病的主要危险因素。结论相较于1990年,2019年我国出生窒息/创伤所致新生儿脑病死亡率、DALY率均呈下降趋势,出生早期男性儿童的疾病负担高于女性儿童,因此应针对小于胎龄儿、早产、环境颗粒物污染、固体燃料燃烧的家庭污染等危险因素制定政策,继续重视孕期保健服务,以期进一步降低出生窒息/创伤所致新生儿脑病的疾病负担。
