天津市婴幼儿孤独症患病率与危险因素

目的:探讨天津市婴幼儿孤独症的患病率及相关危险因素,为今后孤独症病因研究提供线索。方法:应用巢式病例对照研究方法,按分层整群抽样的原则随机抽取天津市7 904名1.5～3岁的儿童进行孤独症筛查,对412名筛查阳性儿童进行追踪,年龄满3岁时进行孤独症确诊;每个病例按相同性别月龄匹配4例对照,因素调查表分为四部分,每部分分别进行单因素及多因素条件Logistic回归。结果:22例确诊为孤独症,天津市婴幼儿孤独症患病率及其95%的可信区间为27.83/万(16.22/万～39.44/万),男性孤独症患病率是女性的4倍(P<0.05)。单因素分析时发现孤独症的危险因素总共有8个,各部分多因素分析显示主要危险因素为:父亲有害职业史、母亲人工流产史、被动吸烟、妊娠浮肿、妊娠呕吐、新生儿黄疸。结论:孤独症不应再被认为是极罕见病,环境因素与孤独症发病有一定关系。     

Perinatal and maternal risk factors for autism spectrum disorders in New South Wales, Australia

Background This study was commenced in 1999 with the aim of examining risk factors for autism using established population‐based data for comparison. Methods Cases were ascertained using active surveillance and compared with birth data. Results Four risk factors were found to be significantly associated with autism using binary logistic regression analysis; being male [adjusted odds ratio (OR) 4.7, 95% confidence interval (CI) 3.2–7.0], being born prematurely (adjusted OR 2.2, 95% CI 1.5–3.5), having maternal age ≥35 years (adjusted OR 1.7, 95% CI 1.2–2.4) and having a mother born outside Australia (adjusted OR 1.4, 95% CI 1.0–1.9). For analysis completed for pregnancies, rather than live births, multiple birth was also a significant risk factor for one or more children of the pregnancy to be affected by autism (adjusted OR 2.5, 95% CI 1.1–5.5). There was a statistically significant trend towards increasing risk with increasing risk factor ‘dose’ for gestational age (P = 0.019), multiple birth (P = 0.016) and maternal age (P < 0.001). For mother's country of birth the group with the highest risk were children of mother's born in south‐east or north‐east Asia. There was a non‐significant trend towards a higher proportion of children with developmental disability having risk factors. Conclusion Replication of risk factors from previous studies and a significant risk factor ‘dose’ effect add to growing evidence that maternal and perinatal factors are low magnitude risk factors for autism. The association between developmental disability and autism risk factors warrants further examination.     

Neonatal jaundice: a risk factor for infantile autism?

In a previous study, we found that infants transferred to a neonatal ward after delivery had an almost twofold increased risk of being diagnosed with infantile autism later in childhood in spite of extensive controlling of obstetric risk factors. We therefore decided to investigate other reasons for transfer to a neonatal ward, in particular hyperbilirubinaemia and neurological abnormalities. We conducted a population‐based matched case–control study of 473 children with autism and 473 matched controls born from 1990 to 1999 in Denmark. Cases were children reported with a diagnosis of infantile autism in the Danish Psychiatric Central Register. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals [CI] and likelihood ratio tests were used to test for effect modification. We found an almost fourfold risk for infantile autism in infants who had hyperbilirubinaemia after birth (OR 3.7 [95% CI 1.3, 10.5]). In stratified analysis, the association appeared limited to term infants (≥37 weeks gestation). A strong association was also observed between abnormal neurological signs after birth and infantile autism, especially hypertonicity (OR 6.7 [95% CI 1.5, 29.7]). No associations were found between infantile autism and low Apgar scores, acidosis or hypoglycaemia. Our findings suggest that hyperbilirubinaemia and neurological abnormalities in the neonatal period are important factors to consider when studying causes of infantile autism.     

孤独症、精神发育迟滞的围生期危险因素及家族史的病例对照研究

【目的】 研究孤独症和精神发育迟滞的围生期危险因素及相关家族史之间的差异。 【方法】 分析在复旦大学附属儿科医院诊治的100例孤独症儿童、60例精神发育迟滞儿童以及80例发育正常儿童的围生期及家族史资料,应用方差分析、秩和检验以及χ²检验分析三组儿童围生期危险因素及家族史之间的差异。 【结果】 孤独症及精神发育迟滞儿童有家族史的比例显著高于正常儿童(35.0% vs 6.3%,P＜0.001;31.7% vs 6.3%,P=0.005),而孤独症组和精神发育迟滞组的家族史差异无统计学意义(P=0.362)。三组儿童有孕期疾病史的比例存在差异(28.00% vs 45.00% vs 26.25%,χ²=6.635,P=0.036),但两两比较后发现各组之间差异均不显著。孤独症组母亲的孕龄显著高于正常儿童组(P＜0.001),与精神发育迟滞组差异不显著,而精神发育迟滞组与正常儿童组之间的差异也不显著。三组儿童围生期缺氧或窒息史的比例不存在显著差异(8.00% vs 10.00% vs 2.50%,χ²=3.589,P=0.166)。在胎产次、孕周、生产方式、产重上,三组儿童之间差异也无统计学意义。 【结论】 1)孤独症与精神发育迟滞患儿家族史的阳性率不相上下,但均显著高于正常儿童;2)晚孕可能是孤独症的一个危险因素。     

Perinatal factors and risk of neuroblastoma

Neuroblastoma is a malignancy commonly diagnosed during infancy or early childhood, raising speculation about the role of perinatal factors and risk of disease. Using a case-control design, cases included 155 infants and children aged 0-5 years with histologically confirmed neuroblastoma diagnosed and reported to the New York State Cancer Registry between 1976 and 1987. Controls were randomly selected from the State's Livebirth Registry and were frequency matched to cases on year of birth (n = 310). Medical records of cases were used to verify histology and stage of disease. Data on perinatal factors were ascertained from birth certificates and standardised telephone interviews with mothers. Unconditional logistic regression was used to estimate (un)adjusted odds ratios (OR) and 95% confidence intervals (CI). Both preterm (< 37 weeks) and post-term (> 42 weeks) birth were associated with a reduction in risk (OR = 0.4 [CI = 0.1, 0.9] and OR = 0.3 [CI = 0.1, 0.7] respectively) after controlling for confounders in unconditional logistic regression analysis. Elevated risk factors included: smoking during pregnancy (OR = 1.6; CI = 0.9, 2.8), contracted pelvis (OR = 2.3; CI = 0.6, 9.8), birth injury (OR = 2.9; CI = 0.3, 24.9) and 1-min Apgar Score < or =3 (OR = 6.0; CI = 0.9, 38.6); all confidence intervals included one. These data suggest that extremes in gestation may be associated with a reduced risk, although aetiological mechanisms remain unknown.     

Perinatal factors and the development of autism: a population study

Perinatal factors and the development of autism: a population study . Glasson EJ , Bower C , Petterson B , de Klerk N , Chaney G & Hallmayer JF . ( 2004 ) Archives of General Psychiatry , 61 , 618 – 627 .     

Perinatal risk factors for Wilms tumor in a Swedish national cohort

Perinatal risk factors including high birth weight have been associated with Wilms tumor in case–control studies. However, these findings have seldom been examined in large cohort studies, and the specific contributions of gestational age at birth and fetal growth remain unknown. We conducted the largest population-based cohort study to date consisting of 3,571,574 persons born in Sweden in 1973–2008, followed up for Wilms tumor incidence through 2009 to examine perinatal risk factors. There were 443 Wilms tumor cases identified in 66.3 million person-years of follow-up. After adjusting for gestational age and other perinatal factors, high fetal growth was associated with increased risk of Wilms tumor among girls (hazard ratio per 1 standard deviation (SD), 1.36; 95 % CI 1.20–1.54; P < 0.001), but not boys (1.10; 95 % CI 0.97–1.25; P = 0.14) (P _interaction = 0.02). Among girls, high fetal growth was associated with disease onset before age 5 years (odds ratio per 1 SD, 1.47; 95 % CI 1.28–1.69; P < 0.001), but not beyond (1.00; 95 % CI 0.76–1.31; P = 0.99). No clear associations were found for gestational age at birth or other perinatal factors. In this large cohort study, high fetal growth was associated with Wilms tumor before age 5 years among girls. These findings suggest that early-life growth factor pathways for Wilms tumor may be more common among girls than boys. Further elucidation of these mechanisms may reveal better targets for prevention or treatment of specific subtypes of Wilms tumor.     

Perinatal risk factors for inflammatory bowel disease: a case-control study

To examine perinatal risk factors for Crohn's disease and ulcerative colitis, the authors analyzed birth records for 257 known case participants delivered from 1924 through 1957 at the University Hospital in Uppsala County, Sweden, and compared them with records for 514 controls delivered at the hospital. The two groups were matched by date of birth, sex, and either maternal age or parity. Eleven study variables were abstracted from standard forms that recorded health events during the pregnancy and the delivery hospitalization. Participants were more likely than controls to have a recorded health event (odds ratio (OR) = 4.4; 95% confidence interval (CI) 3.0-6.4). In a multivariate model, this increased risk was evident for infectious (OR = 3.8; 95% CI 2.6-5.8) and noninfectious (OR = 3.5; 95% CI 2.0-6.3) events. Perinatal health events may have contributed to 40% of the inflammatory bowel disease cases in our study. Infants from families with low socioeconomic status had greater risk of inflammatory bowel disease than did infants from families with high socioeconomic status (OR = 3.0, 95% CI 1.5-6.1). Perinatal health events and low socioeconomic status independently increased the risk of inflammatory bowel disease.     

儿童孤独症危险因素分析

目的:探讨儿童孤独症的危险因素。方法: 采用自拟调查表对确诊的149例孤独症患儿进行相关因素的回顾性调查。结果: 在149名患儿中, 43 96%的母亲孕期情绪紧张或抑郁, 母亲孕期和患儿出生时有异常情况者分别为24. 83%和33. 56%; 患儿有家族异常史者占22 .82% (以直系亲属中有孤僻、不合群者居首位), 14. 09%的患儿既往有神经系统疾病史;有18 79%的患儿有寄养史, 48. 12%的患儿家庭教育方式不良。结论: 遗传、孕产期异常和脑部器质性改变等因素可能引起孤独症发病, 通过加强孕产期保健工作, 提高医务人员和家长对儿童孤独症的认知水平及帮助父母正确对待孤独症患儿, 可预防孤独症的发生和改善其预后。     

儿童孤独症发病危险因素的病例对照研究

目的 探讨儿童孤独症发病的相关危险因素, 为孤独症的防治提供理论依据。方法 采用成组病例对照研究, 对165例孤独症儿童和320例正常对照组儿童, 采用自编的孤独症危险因素调查表收集相关危险因素、家庭一般情况等资料, 用χ²检验分析两组儿童之间危险因素的差异。结果 病例组母亲高生育年龄(≥35岁)、有人工流产史、母孕期抑郁情绪史、母孕期被动吸烟史及父亲内向所占比例较正常组高(P<0.05), 进一步进行Logistic 回归分析显示母高育龄、孕期抑郁情绪、孕期被动吸烟、有人工流产史以及父亲性格内向为孤独症的危险因素。结论 母亲高龄生育、有人工流产史、孕期抑郁情绪、孕期被动吸烟以及父亲性格内向均可使儿童孤独症发病风险增高。     

早发型新生儿败血症围生期危险因素及病原菌分布

目的 分析早发型新生儿败血症围生期危险因素及病原菌分布.方法 将2016—2019年某院新生儿重症监护病房(NICU)收治的168例早发型新生儿败血症新生儿作为感染组,并随机选取NICU收治的168例无败血症新生儿作为对照组,收集两组新生儿母亲一般情况、围生期感染情况,以及新生儿的一般情况、侵入性操作及并发症等资料,进...     

Prenatal and postnatal risk factors for infantile pneumonia in a representative birth cohort

Pneumonia is an important cause of mortality and morbidity in infants. However, information of risk factors for pneumonia in children aged <6 months is limited. This study aimed to evaluate the risk factors and their contribution to infantile pneumonia in a large population-based survey. Of 24,200 randomly sampled main caregivers invited, 21,248 (87.8%) participated in this study. A structured questionnaire was used to interview the main caregivers. Information regarding whether hospitalization was required, family environment, and medical history were obtained. The prevalence of pneumonia was 0.62% in our study cohort. Multivariate logistic regression analysis showed that preterm birth, congenital cardiopulmonary disease, antibiotic use during pregnancy, maternal overweight, daily prenatal exposure to environmental tobacco smoke, maternal smoking during pregnancy, and visible mould on walls at home are risk factors associated with infantile pneumonia. Further study is warranted to investigate the causality and mechanisms of these novel factors.     

儿童孤独症的妊娠期和围产期危险因素Meta分析

目的采用Meta分析的方法评价儿童孤独症的妊娠期和围产期危险因素,为儿童孤独症的预防提供科学、客观的参考依据。方法检索PubMed、Embase、Web of Science、中国知网(CNKI)、万方(Wanfang)等数据库,纳入有关病例对照研究,使用Stata14.0软件进行Meta分析。结果母亲年龄>35岁(OR=1.518,95%CI:1.248~1.787)、父亲年龄>35岁(OR=1.180,95%CI:1.083~1.286)、有精神病家族史(OR=3.539,95%CI:2.145~4.934)、妊娠期高血压(OR=1.492,95%CI:1.040~1.910)、妊娠期被动吸烟史(OR=3.035,95%CI:2.040~4.515)、先兆流产(OR=2.201,95%CI:1.355~3.578)、妊娠期并发症(OR=2.673,95%CI:1.620~3.726)、剖宫产(OR=1.290,95%CI:1.118~1.402)、出生时体重<2500g(OR=1.554,95%CI:1.276~1.832)、早产(OR=1.582,95%CI:1.349~1.855)、脐带绕颈(OR=4.876,95%CI:1.058~8.693)、5分钟Apgar评分<7分(OR=1.927,95%CI:1.135~2.719)、新生儿病理性黄疸(OR=4.298,95%CI:2.977~6.162)、儿童性别为男性(OR=3.834,95%CI:2.861~4.808)、先天畸形(OR=1.908,95%CI:1.417~2.569)和未采取母乳喂养(OR=1.713,95%CI:1.250~2.347)是儿童孤独症的危险因素,使用产钳分娩(OR=0.777,95%CI:0.563~0.991)可能是儿童孤独症的保护因素。结论应当做好全孕期的预防保健,尽可能减少妊娠期和围产期高危因素的出现。如果儿童和家庭暴露于危险因素,要密切关注儿童的神经心理发育轨迹。     

新生儿窒息母婴高危因素分析

目的:分析新生儿窒息母婴高危因素,探讨该地区围产期母婴保健重点。方法:采用回顾性资料分析方法对2009年1～12月该院产科分娩的新生儿窒息母婴高危因素进行统计。结果:该年度产科分娩数9 632人,新生儿窒息157例,窒息发生率1.63%。新生儿窒息患儿均有围产高危因素,其中母亲因素占24.84%,胎儿新生儿因素占66.24%,胎盘脐带因素占25.48%,产时因素占24.84%。新生儿窒息中胎儿新生儿病因占第一位,其中早产儿91例、低出生体重儿85例,其他过期产儿、双胎、巨大儿、先天畸形儿共13例。重度窒息7例,发生率0.07%。孕29周3例,孕35周、体重1 300 g 1例,孕34周、胎盘早剥、脐带过细1例,2例先天畸形(先天性肺发育不良、胸腔积液)患儿。结论:早产儿、低出生体重儿已成为该地区新生儿窒息的首要原因,早产儿复苏应成为复苏培训重点。先天畸形为新生儿重度窒息的主要因素,复苏过程中警惕先天畸形的存在可改善预后、防范医疗纠纷。     

孤独症谱系障碍儿童共患睡眠障碍相关危险因素的研究进展

孤独症谱系障碍(ASD)是一组发生于儿童发育早期的神经障碍性疾病,近年来发病率较高。睡眠障碍是ASD儿童常见的一种共患疾病,其严重程度不仅能加重患儿的行为问题,影响学习记忆,降低癫痫阈值,而且增加照顾者的压力。因此,本文将从生物学因素、ASD儿童的核心症状、共患疾病和环境因素进行综述,为更好地理解、预防和早期干预ASD儿童的睡眠问题提供依据。     

Population attributable fractions for three perinatal risk factors for autism spectrum disorders, 2002 and 2008 autism and developmental disabilities monitoring network

PurposeNumerous studies establish associations between adverse perinatal outcomes/complications and autism spectrum disorder (ASD). There has been little assessment of population attributable fractions (PAFs).MethodsWe estimated average ASD PAFs for preterm birth (PTB), small for gestational age (SGA), and Cesarean delivery (CD) in a U.S. population. Average PAF methodology accounts for risk factor co-occurrence. ASD cases were singleton non-Hispanic white, non-Hispanic black, and Hispanic children born in 1994 (n = 703) or 2000 (n = 1339) who resided in 48 U.S. counties included within eight Autism and Developmental Disabilities Monitoring Network sites. Cases were matched on birth year, sex, and maternal county of residence, race-ethnicity, age, and education to 20 controls from U.S. natality files.ResultsFor the 1994 cohort, average PAFs were 4.2%, 0.9%, and 7.9% for PTB, SGA, and CD, respectively. The summary PAF was 13.0% (1.7%–19.5%). For the 2000 cohort, average PAFs were 2.0%, 3.1%, and 6.7% for PTB, SGA, and CD, respectively, with a summary PAF of 11.8% (7.5%–15.9%).ConclusionsThree perinatal risk factors notably contribute to ASD risk in a U.S. population. Because each factor represents multiple etiologic pathways, PAF estimates are best interpreted as the proportion of ASD attributable to having a suboptimal perinatal environment resulting in PTB, SGA, and/or CD.