新生儿缺氧缺血性脑病诊断标准

Diagnostic criteria for neonatal hypoxic-ischemic encephalopathy

摘要:

新生儿缺氧缺血性脑病(HIE)是指围产期窒息导致脑的缺氧缺血性损害,临床出现一系列中枢神经异常的表现。其诊断根据临床表现,同时具备以下4条者可确诊,第4条暂时不能确定者可作为拟诊病例:①有明确的可导致胎儿宫内窘迫的异常产科病史,以及严重的胎儿宫内窘迫表现(胎心<100次,持续5min以上;和/或羊水III度污染),或者在分娩过程中有明显窒息史;②出生时有重度窒息,指Apgar评分1min≤3分,并延续至5min时仍≤5分;或者出生时脐动脉血气pH≤7. 00;③出生后不久出现神经系统症状、并持续至24h以上;④排除电解质紊乱、颅内出血和产伤等原因引起的抽搐,以及宫内感染、遗传代谢性疾病和其他先天性疾病所引起的脑损伤。本诊断标准仅适用于足月新生儿HIE的诊断。

Abstract:

Hypoxic-ischemic encephalopathy (HIE) in the newborn is a cerebral hypoxi-ischemic injury caused by perinatal asphyxia. It presents with various clinical manifestations of central nervous system. Diagnosis of HIE may be confirmed based on the following four criteria: A) Well-defined episode of fetal distress and evidence of severe fetal distress before delivery with fetal heart rate of < 100 beats per minute lasting for over 5 minutes and with or without severe meconium stained amniotic fluid, or an evidence of obvious asphyxia history during delivery. B) Severe birth asphyxia, defined as an Apgar scores of ≤ 3 at 1 minute and ≤ 5 at 5 minutes or an umbilical arterial pH of ≤7.00. C) Onset of abnormal neurological symptoms and signs in immediate newborn period and persisting for longer than 24 hrs. D) Exclusion of convulsions caused by electrolyte disturbances, intracranial hemorrhage and birth trauma, as well as the exclusion of brain injury resulted from intrauterine infection, genetic metabolic diseases, and other inborn errors of diseases. The infants who met the first three criteria but did not necessarily exhibit the fourth one may be diagnosed as suspected HIE. The diagnostic criteria for HIE are only suitable for term infants.［Chin J Contemp Pediatr, 2005, 7(2): 97-98］