使用双胞胎与单胞胎生长图表识别出小到妊娠年龄的双胞胎新生儿不良后果:系统性审查和元分析
S Sorrenti1, D Di Mascio1, A Khalil2,3
1Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.
概括
双胞胎生长图表提高了特异性,但降低了识别怀孕年龄小 (SGA) 双胞胎的敏感性. 然而,它们更好地检测出具有较高新生儿不良后果风险的双胞胎,指导必要的干预措施.
科学领域:
- 周围生理学 周围生理学
- 新生儿科学 新生儿科学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
背景情况:
- 准确检测小到妊娠年龄 (SGA) 双胞胎对于识别有不良新生儿结果风险的胎儿至关重要.
- 目前双胞胎的生长图表并未被普遍采用,导致了各种各样的诊断实践.
- 双胞胎与单胞胎生长图在预测新生儿发病率方面的比较有效性仍然是积极研究的领域.
研究的目的:
- 评估双胞胎与单胞胎生长图的诊断性能,以识别有不良新生儿结果风险增加的SGA双胞胎.
- 为了比较双胞胎和单胞胎生长图表在检测SGA胎儿时的灵敏度和特异性.
- 用不同的生长图表和特定的新生儿不良结果来评估SGA诊断之间的关联.
主要方法:
- 一个系统的审查和对比双胞胎和单胞胎生长图表用于双胞胎怀孕中SGA检测的研究的元分析.
- 电子数据库搜索 (MEDLINE,EMBASE,CINAHL,Cochrane,Scopus) 进行至2024年5月.
- 主要结局:SGA胎儿的综合不良新生儿结局. 二次结局包括NICU入院,呼吸支持和死亡率. 采用了随机效应的元分析.
主要成果:
- 五项涉及10,554例双胞胎怀孕的研究被纳入了元分析.
- 与单个图表相比,双胞胎图表显示SGA胎儿的不良结果风险明显更高 (OR 3.11).
- 与单个图表相比,双子图表的敏感性较低 (14%),但对不良结果的特异性更高 (95%),敏感性为32%,特异性为71%.
结论:
- 双胞胎生长图表增加了特异性,但与单独图表相比,在检测SGA胎儿时降低了灵敏度.
- 尽管灵敏度较低,但双胞胎图表识别SGA病例具有较高的新生儿不良后果风险,可能表明需要干预的病例.
- 这些发现表明,双胞胎特异性生长图表可能对双胞胎怀孕中针对性的新生儿风险评估有价值.
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