早产儿脑室周围-脑室内出血预防的临床证据

目的 寻找与早产儿脑室周围-脑室内出血(PVH-IVH)预防相关的临床证据,并探讨其临床应用价值.方法 检索MEDLINE、EMBASE、Oxford围产新生儿组资料库和Cochrane图书馆关于PVH-IVH危险因素和预防相关的系统评价和随机(半随机)对照研究(randomised or quasi-randomised controlled trials,RCT),并进行分析.结果 产前母亲使用皮质激素、出生时延迟结扎脐带可显著降低早产儿PVH-IVH发生率,出生后预防性使用消炎痛可降低早产儿严重IVH的发生率,但对神经系统远期预后没有影响.结论 推荐产前母亲单次使用皮质激素预防早产儿PVH-IVH的发生,消炎痛和产前多次使用皮质激素尚待更多的前瞻性RCT来证实其安全性和有效性.

Clinical evidence for the prevention of periventricular hemorrhage-intraventricular hemorrhage in preterm infants

Objectives To explore the clinical evidence for the prevention of periventricular hemorrhage-intraventricular hemorrhage(PVH-IVH)in preterm infants,evaluate the importance of its clinical application.Methods Risk factors,meta analyses and randomized(or quasi-randomized)controlled trials(RCT)of preventing PVH-IVH in preterm infants were searched from the database of MEDLINE,EMBASE,Oxford Neonatal Group and Cochrane Library;and the data were analyzed.Results PVH-IVH could be prevented by using corticosteroid antenatally and delaying umbilical cord clamping.Prophylactic indomethacin postnatally could decrease the incidence of severe IVH,with no evidence suggesting prophylactic indomethacin could improve the long-term outcome of nervous system development in preterm infants.Conclusions Single dose of corticosteroid antenatally is recommended for the prevention of PVH-IVH.More RCT are needed to identify the safety and validity of repeated coriticorsteroid and prophylactic indomethacin.