目的 探讨新生儿肺出血不良预后的影响因素,为早期识别和提高抢救成功率提供理论依据.方法 搜集2009年1月—2020年12月确诊为新生儿肺出血的143例病例资料进行回顾性分析,根据临床结局分为存活组84例和病死组59例.对与肺出血关系密切的影响因素进行单因素及多因素分析.单因素分析采用t检验与χ2检验,多因素分析应用Logistic回归,计算影响因素OR值以及95％CI.结果 143例中,新生儿肺出血的病死率为41.26％(59/143).两组单因素分析中,胎龄、出生体质量、重度窒息、弥散性血管内凝血(DIC)、多脏器损害、休克、肺出血前血pH值、白细胞计数,差异具有统计学意义(P值均<0.05);多因素Logistic回归分析提示胎龄(OR=0.831,95％CI:0.754～0.915)、休克(OR=8.918,95％CI:3.534～22.506)是新生儿肺出血不良预后的独立危险因素.结论 胎龄、休克是新生儿肺出血不良预后的独立危险因素,对发生休克的肺出血患儿,尤其是胎龄小的患儿应采取更积极的干预措施,以降低病死率.

目的 分析早产儿呼吸窘迫综合征(NRDS)的肺超声表现,探讨不同肺超声表现诊断NRDS的临床应用价值.方法 选取我院收治的疑诊NRDS早产儿109例,于使用外源性肺表面活性物质和持续气道正压通气或常规机械通气治疗前行肺超声检查,同时进行血气分析和胸部X线检查.以临床诊断结果为标准,根据不同肺超声表现制定A、B、C三种诊断标准(胸膜线增厚,至少一个肺野内出现"B"线或"AIS"征为A标准;胸膜线增厚,出现"白肺"征,"A线"征消失为B标准;胸膜线增厚,出现"白肺"征且任一肺野可见"肺实变"征为C标准),分析其对早产儿NRDS的诊断效能.结果 109例NRDS早产儿中,临床诊断NRDS 31例,非NRDS 78例.A标准对NRDS的诊断敏感性和阴性预测值均为100％,B标准的诊断敏感性和阴性预测值均高于C标准(70.96％vs.38.71％,89.66％vs.80.41％,均P<0.05).31例NRDS中,重症NRDS 15例,非重症NRDS 16例.C标准诊断重症NRDS的敏感性、特异性、阳性预测值、阴性预测值分别为73.33％、93.75％、91.66％、78.94％,AUC为0.835,与临床诊断的一致性Kappa值为0.676.结论 "白肺"征是肺超声早期诊断早产儿NRDS的重要影像学特征;"白肺"征合并"肺实变"可初步诊断早产儿重症NRDS.

Background Premature/low-birth-weight infants are at significant risk of metabolic diseases in adulthood, which may be related to the levels of fetal adipokine. Here, we investigated the differences in the levels of umbilical cord blood adiponectin, leptin, insulin, and ghrelin in preterm and term infants and sought to elucidate the link between these hormones and fetal growth. We also evaluated the interrelationship among these metabolic hormones in both groups of newborns. Methods A total of 149 mother–infant pairs (100 in the preterm group and 49 in the term group) were enrolled in the study. The preterm group was further subdivided according to birth weight (≤1,500, 1,501–2,000, 2,001–2,500, and >2,500 g), gestational age (<34 vs. ≥34 weeks), and appropriate for gestational age (AGA) vs. small for gestational age (SGA). The general condition of the mothers and the growth parameters of the newborns at birth were recorded. Results The levels of adiponectin, leptin, and ghrelin were lower in the preterm group than those in the term group ( p < 0.05). In the preterm group, the leptin levels of infants with gestational age ≥34 weeks were significantly higher than those of infants with gestational age <34 weeks (mean ln leptin = 0.63 vs. 0.36 ng/ml, p = 0.009). The levels of adiponectin were lower in the SGA group than those in the AGA group (mean ln adiponectin = 2.26 vs. 2.84 µg/ml, p = 0.001), whereas those of ghrelin displayed the opposite trend (mean ln ghrelin = 6.29 vs. 5.71 pg/ml, p < 0.001). Leptin was significantly correlated with insulin both in preterm infants with birth weight (BW) >2,000 g and in term infants. Umbilical cord blood leptin was positively correlated with the BW, birth length, and head circumference of newborns ( r = 0.460, 0.311, and 0.310, respectively, all p < 0.05), whereas ghrelin was negatively correlated with the same parameters ( r = −0.372, −0.415, and −0.373, respectively, all p > 0.05). Conclusions The lack of maturation of adipose tissue and the gastrointestinal tract by the fetus due to prematurity is associated with changes in the levels of cord blood adiponectin, leptin, and ghrelin. The dysregulation of these hormones in preterm infants may be a risk factor for fetal growth and future metabolic diseases.

目的 探讨新生儿窒息后胃肠道功能损伤的临床表现及相关危险因素.方法 回顾性分析159例新生儿窒息患儿,依据Apgar评分分为轻度窒息组和重度窒息组,比较两组胃肠损伤及喂养不耐受、消化道出血、明显腹胀、肠鸣音减弱的发生情况;并依据胃肠损伤程度分为轻症和重症,采用χ2检验比较其发生率;采用logistic回归分析胃肠道功能损伤的相关危险因素.结果 轻度窒息组136例,重度窒息组23例,两组发生胃肠道功能损伤共60例,其中轻度窒息组44例(32.4％),重度窒息组16例(69.6％),两组差异有统计学意义(χ2=11.59,P<0.01);轻度窒息组发生胃肠损害重症为12例、轻症32例,重度窒息组重症12例、轻症4例,(χ2=12.27,P<0.01);轻度窒息组在24 h和48 h开奶发生喂养不耐受、胃潴留、胃肠出血、腹胀情况均明显低于重度窒息组(χ2分别为3.227、39.380,53.550、30.390,5.118、8.280,14.300、13.440,P值均<0.05)、两组肠鸣音减弱发生率无明显差异(P值均>0.05);轻度窒息组72 h开奶时发生喂养不耐受、胃肠出血发生情况均低于重度窒息组(χ2分别为28.690,5.400,P值均<0.05),两组胃潴留、明显腹胀、肠鸣音减弱发生率均无明显差异(P值均>0.05).窒息程度、Apgar 1 min评分,24、48 h开奶,多脏器功能损伤是发生胃肠道功能损伤的独立危险因素(OR分别为26.267、1.557、4.946、8.132、2.880;P值均<0.05).结论 新生儿窒息后胃肠道功能损伤发生率较高,窒息程度与胃肠道功能损伤呈正相关.

目的 总结5例新生儿脐静脉置管(UVC)相关心包积液的临床特点及诊治方法.方法 回顾性分析5例UVC相关心包积液新生儿的临床资料.结果 本组5例患儿发现心包积液时间为生后44 h～7天6小时,而发生心包积液前0.5～2.5 d均有心源性休克早期的表现,其中3例患儿在上述临床表现基础上进展为心包填塞.5例心包积液患儿中,白细胞计数减低1例,白细胞计数升高1例,血清CRP、PCT水平均有明显增高,诊断为败血症,考虑重症感染,发生心包积液均在生后72 h内;其余3例感染指标均在正常范围,发生心包积液时间均在生后72 h后.本组患儿中5例均采用改善循环、呼吸支持、抗感染、利尿、免中长链脂肪乳的静脉营养等支持对症治疗,1例经上述治疗自行吸收,4例行心包穿刺(1例发生2次心包积液,第2次心包穿刺后随即进行了心包引流);本组5例患儿均治愈.5例心包积液患儿中有3例发生UVC管端异位,1例存在反复操作,二次置管成功.结论 UVC相关心包积液患儿均有心源性休克早期的临床表现,需尽早行心脏彩超及胸片有助于及时明确病因,并及时行心包穿刺或心包引流术,以减少心包填塞发生,降低患儿病死率.管端异位、重症感染、反复操作对血管损伤等是心包积液形成的重要原因,故应该定时监测脐静脉管端位置,积极抗感染控制原发病,UVC的操作过程应尽量轻柔,减少对血管的刺激和损害,以减少心包积液的发生率.

目的 总结哮喘患儿的临床特点,发现诊治过程中新的问题,不断提高临床诊治水平.方法 回顾性分析2017年4月至2021年4月于我院儿童哮喘门诊确诊为哮喘的101例患儿,对其性别、年龄、初次喘息年龄、平均每年喘息次数、既往治疗情况、个人及家族过敏史、过敏原、临床表现、肺功能结果进行描述性分析.结果 101例患儿中,男76例(75.2％),女25例(24.8％);初次喘息年龄≤3岁患儿43例(42.6％);初次就诊6～14岁60例(59.4％);哮喘患儿每年喘息发作次数1～3次40例(39.6％).101例患儿中,有过敏性疾病家族史83例(82.2％),合并过敏性鼻炎81例(80.2％),有慢性咳嗽史70例(69.3％).72例过敏原检测提示,主要以吸入性过敏原为主,其中粉尘螨过敏居首27例(37.5％);肺功能检测结果第一秒用力呼气量(FEV1):(80.9±16.9)％,1秒率(FEV1/FVC):(96.6±10.9)％,用力呼出75％肺活量的呼气流量(FEF75):(56.3±22.6)％,用力呼出50％肺活量的呼气流量(FEF50):(61.2±18.8)％,最大呼气中段流量(MMEF):(61.1±19.5)％.对异常肺功能结果分析能够提示小气道功能异常的主要指标:MMEF、FEF50、FEF75.结论 要重视婴幼儿哮喘,确诊后要尽早治疗,以减少学龄期哮喘发作;反映小气道功能的指标如MMEF、FEF50、FEF75在儿童哮喘的早期诊断中有非常重要的作用,也可作为辅助诊断儿童非典型哮喘的敏感指标.

目的 总结胎儿期心律失常的类型,并观察患儿出生后心律转归.方法 收集32例胎儿期心律失常患儿的临床资料,分析胎儿期心律失常的临床特点、出生后治疗及转归情况.结果 32例患儿中男22例、女10例,发现心律失常时胎龄为(32.7±5.9)周,出生孕周(37.2±2.9)周.32例患儿心律失常类型为房性期前收缩(房早)6例(18.6％),心房扑动、心房颤动9例(28.1％),阵发性室上性心动过速5例(15.6％),室性期前收缩(室早)1例(3.1％),短阵室速2例(6.3％),Ⅲ度房室传导阻滞6例(18.8％),快慢综合征1例(3.1％),长Q-T综合征2例(6.3％).32例患儿12例出生后无需抗心律失常药物治疗,心率及生长发育均正常;20例患儿予抗心律失常治疗,10例出生时口服抗心律失常药物,2例患儿死亡;1例行射频消融术治疗,6例Ⅲ度房传导阻滞患儿植入永久起搏器治疗;30例患儿中28例两岁内停止口服抗心律失常药物,3例继续口服抗心律失常药物治疗.结论 胎儿期心律失常在胎儿出生后多数可自行好转,部分患儿需口服抗心律失常药物治疗,2岁内可治愈,患儿预后较好.存在Ⅲ度房室传导阻滞患儿出生后需放置起搏器治疗.

目的:比较磁共振(MR)检查常规序列同步使用磁敏感加权成像(SWI)和扩散加权成像(DWI)对早产儿不同类型、不同程度颅内出血的预后的评估作用.方法:选取2017年1月至2019年12月期间106例经MR确诊为颅内出血的早产儿作为研究对象,通过常规T1加权像(T1WI)、T2加权像(T2WI)及功能序列将其颅内出血分为脑实质出血、生发基质-脑室内出血、蛛网膜下腔出血、硬膜下出血及混合型出血5组.所有组别按照出血累及范围、中线有无移位及是否合并脑室扩张分为轻度、中度及重度出血.对患儿进行对症康复治疗6个月后记录智能发育指数、运动发育指数并比较所有不同程度颅内出血及各组类型轻度、中度及重度出血预后状况.结果:所有不同程度颅内出血预后比较,存在统计学差异(P<0.05),其中轻、重度出血间差异具有统计学意义(P<0.05),轻、中度及中、重度出血间无统计学差异(P>0.05);5种不同类型出血中的轻度出血的预后,差异无明显统计学意义(P>0.05).由于各组颅内出血中、重度出血例数较少且多数预后不良,故不再进行组间比较.结论:MR早期观察早产儿颅内出血,轻、重度出血间预后存在差别,重度出血预后较差,各类型颅内轻度出血间预后无明显差别,有助于临床做出全面谨慎的预后评估,并针对性采取积极干预措施,减少患儿神经后遗症的发生.

OBJECTIVE To investigate the incidence rate of infectious diseases during hospitalization in late preterm infants in Beijing, China, as well as the risk factors for infectious diseases and the effect of breastfeeding on the development of infectious diseases. METHODS Related data were collected from the late preterm infants who were hospitalized in the neonatal wards of 25 hospitals in Beijing, China, from October 23, 2015 to October 30, 2017. According to the feeding pattern, they were divided into a breastfeeding group and a formula feeding group. The two groups were compared in terms of general status and incidence rate of infectious diseases. A multivariate logistic regression analysis was used to investigate the risk factors for infectious diseases. RESULTS A total of 1 576 late preterm infants were enrolled, with 153 infants in the breastfeeding group and 1 423 in the formula feeding group. Of all infants, 484 (30.71%) experienced infectious diseases. The breastfeeding group had a significantly lower incidence rate of infectious diseases than the formula feeding group (22.88% vs 31.55%, P=0.033). The multivariate logistic regression analysis showed that breastfeeding was an independent protective factor against infectious diseases (OR=0.534, P=0.004), while male sex, premature rupture of membranes, gestational diabetes mellitus, and asphyxia were risk factors for infectious diseases (OR=1.328, 5.386, 1.535, and 2.353 respectively, P < 0.05). CONCLUSIONS Breastfeeding can significantly reduce the incidence of infectious diseases and is a protective factor against infectious diseases in late preterm infants. Breastfeeding should therefore be actively promoted for late preterm infants during hospitalization.

Objective:To study the respiratory morbidity and the risk factors of respiratory complications in late-preterm infants.Methods:The data of 959 late-preterm infants in 21 hospitals in Beijing from October 2015 to April 2016 were collected.These infants were divided into the respiratory morbidity group (237 cases) and the control group (722 cases) according to whether they had short-term respiratory morbidity after birth.Clinical data of the two groups were compared.Results:Among the 959 late-preterm babies, 530 were male and 429 were female.Two hundred and thirty-seven cases (24.7%) developed short-term respiratory morbidity after birth.Infectious pneumonia developed in the most cases (81 cases, 8.4%), followed by transient tachypnea (65 cases, 6.8%), amniotic fluid aspiration (51 cases, 5.3%), and respiratory distress syndrome (24 cases, 2.5%) successively.All the infants recovered and discharged.There were no differences between gender and maternal age between 2 groups (all P>0.05). Compared with the control group, more late-preterm infants were delivered by cesarean section (73.4% vs.59.7%, χ2=14.43, P<0.001) and the 1-minute Apgar score was lower [(9.41±1.66) scores vs.(9.83±0.53) scores, t=5.40, P<0.001] in the respiratory morbidity group.The differences were statistically significant.There were more cases with maternal complications in the respiratory morbidity group that in the control group (66.7% vs.58.6%, χ2=4.877, P=0.027), but no difference in various complications between 2 groups was observed ( P>0.05). In the respiratory morbidity group, the most frequent complications were maternal hypertension and preeclampsia (27.8% vs.22.6%, χ2=2.728, P=0.099). There were no differences between 2 groups in gestational age, birth weight and birth length (all P>0.05). There were more infants small for gestational age and large for gestational age in the respiratory morbidity group than in the control group (18.8% vs.14.1%, 6.3% vs.2.4%, χ2=8.960, P=0.011). The duration of hospitalization of the respiratory morbidity group was significantly longer than that of the control group [(9.00±4.42) d vs.(6.82±4.19) d, t=6.676, P<0.001] since the infants with respiratory morbidity needed to be hospita-lized. Conclusions:Respiratory diseases occur in about 1/4 of late-preterm infants.Infants who are delivered by cesarean section and whose mothers are complicated with the maternal hypertension and preeclampsia should be monitored closely.Respiratory support should be provided for infants not appropriate for gestational age who are more likely to suffer from respiratory diseases, so that they can successfully pass through the transition period.

α-地中海贫血( thalassemia)是一类由于珠蛋白基因缺陷使血红蛋白( Hb)中的珠蛋白肽链有一种或几种合成减少或不能合成的遗传性溶血性疾病,呈常染色体隐性遗传,最为常见的致病原因为位于第 16 号染色体上 a 珠蛋白基因突变或缺失[1-2] ,是世界上最常见的遗传性血液病之一,好发于地中海沿岸,故以此命名,另外多见于美国黑人人群、印度次大陆及东南亚等地区,在我国南方地区(广东、广西、贵州、四川、湖北、湖南、福建、云南、海南、台湾等省)发病率也很高[3] ,是我国长江以南发病率最高、危害最大的一种遗传病.大家知道,遗传性溶血性疾病有其地域特色,一般北方以遗传型球形红细胞增多症为主,南方以地中海贫血、G-6-PD酶缺乏症等多见.目前,随着人口流动性增加,不同种类的遗传性溶血性贫血患儿也打破传统地域限制.我院位于我国华北地区,本文介绍我院发现的首例新生儿α-地中海贫血,并对国内外相关文献进行复习,以引起新生儿医师对此病的重视.

目的 了解新生儿窒息并发医院感染的临床特点,为该病的预防及治疗提供依据.方法 回顾性分析128例新生儿窒息并发医院感染患儿临床资料,对医院感染部位、病原菌及耐药性、相关影响因素进行分析.结果 128例新生儿窒息并发医院感染患儿中呼吸系统感染43例(33.6％)、全身感染38例(29.7％).共培养出病原菌143株主要有肺炎克雷伯菌41株(28.7％),大肠埃希菌39株(27.3％).肺炎克雷伯菌和大肠埃希菌对β-内酰胺类抗菌药物有较高的耐药率,而对碳青霉烯类、加酶抑制剂β-内酰胺类抗菌药物比较敏感.胎龄＜37周、宫内窘迫、出生体质量＜2 500 g、住院时间≥7天、机械通气、肠外营养是医院感染发生的影响因素,除宫内窘迫外其他均为独立影响因素.结论 新生儿窒息并发医院感染主要以呼吸系统及全身感染为主,肺炎克雷伯菌、大肠埃希菌是主要致病菌且多数为多药耐药菌,对β-内酰胺类抗菌药物耐药率高,而对碳青霉烯类及加酶抑制剂的β-内酰胺类抗菌药物敏感.胎龄低(＜37周)、宫内窘迫、出生低体质量(＜2 500g)、住院时间长(≥7天)、机械通气、肠外营养为新生儿窒息并发医院感染影响因素.

目的 探讨晚期早产儿生后早期血液学指标的特点,为早期发现并治疗各种相关疾病,降低晚期早产儿死亡率提供临床依据.方法 收集2014年12月-2016年5月北京地区26家医疗机构新生儿科及儿科新生儿病房住院的875例晚期早产儿临床资料,分析其白细胞计数、血红蛋白含量、血小板计数.结果 白细胞计数平均为(12.27:±:4.81)×109/L,异常提示存在感染性疾病;血红蛋白含量平均为(166.50±27.88) g/L,妊娠期高血压及妊娠期糖尿病为导致红细胞增多的高危因素,贫血发生率随胎龄增长而降低;血小板计数平均为(261.65±89.32)×109/L,增高是由于存在感染性疾病,降低可能与宫内/生后感染、母亲妊娠期高血压及妊娠期糖尿病等有关.结论 对于晚期早产儿尤其是合并各种高危因素的晚期早产儿应密切监测各项血液学指标,以早期发现并治疗各种相关疾病.

[目的]探讨血清胶质纤维酸性蛋白(GFAP)、脂联素(APN)、血液指标与缺血缺氧性脑病(HIE)新生儿脑损伤程度的关系.[方法]选取本院 2015 年 2 月至 2017 年 10 月新生儿科收治的 HIE患儿 112 例(HIE组)及健康新生儿 112 例(对照组)作为研究对象,均于分娩后 24 h内检测有核红细胞(NRBC)数量与GFAP、APN、S100B蛋白、神经元特异性烯醇化酶(NSE)与脑型肌酸激酶同功酶(CK-BB)水平,并对 HIE组进行 APN动态测定.同时分析 GFAP、APN水平、NRBC数量与 S100B蛋白、NSE、CK-BB水平的相关性.[结果]HIE组血清 GFAP及外周血 NRBC数量明显高于对照组,APN水平明显低于对照组(P＜0.05);重度HIE患儿血清 GFAP及外周血 NRBC数量明显高于轻、中度 HIE患儿,APN水平明显低于轻、中度 HIE患儿(P＜0.05);随着治疗时间的推移,HIE组患儿的血清 APN逐渐上升(P＜0.05),治疗 30 d,HIE组与对照组相比,轻、中度组与对照组无统计学差异(P＞0.05),但重度组仍明显低于对照组(P＜0.05);HIE组新生儿血清GFAP、外周血NRBC数量与脑损伤指标S100B蛋白、NSE及CK-BB水平均呈正相关,APN水平与脑损伤指标 S100B蛋白、NSE及CK-BB水平均呈负相关.[结论]血清 GFAP、APN及外周血 NRBC数量能够反映 HIE患儿脑损伤程度,且检测简便,对 HIE早期诊断有一定的临床价值.

Objective To explore the effect of umbilical cord blood acidosis on brain damage in neonates with asphyxia by observing the occurrence of brain damage in neonates with umbilical cord blood acidosis combined with neonatal asphyxia and the changes of routine cranial MRI characteristics and apparent diffusion coefficient (ADC) of sensitive area.Methods A total of 152 neonates with asphyxia were selected from NICU of the First Affiliated Hospital of Tsinghua University from February 2012 to December 2014,then they were divided into asphyxia+acidosis group (82 neonates) and asphyxia group (70 neonates) according to Apgar score at birth and umbilical arterial blood gas.The incidence rates of brain damage,the changes of routine cranial MRI characteristics and ADC of sensitive area in the two groups were compared.Results The incidence rate of brain damage was 68.4％ (104/152).The incidence rate of brain damage in asphyxia+acidosis group was 76.8％ (63/82),which was statistically significantly higher than that in asphyxia group (58.5％,41/70) (x2 =5.826,P =0.016).Routine cranial MRI characteristics:the incidence rates of deep brain white matter damage,basal ganglia thalamus and internal capsule damage,and extensive cerebral edema in asphyxia+acidosis group were 66.7％,49.2％,and 41.3％,respectively,which were statistically significantly higher than those in asphyxia group (46.3％,29.3％,and 21.9％) (x2 =4.231,4.071,4.376,all P＜0.05).ADC values of cranial MRI basal ganglia and thalamus in asphyxia+acidosis group were (0.846±0.214) and (0.907±0.122),respectively,which were statistically significantly lower than those in asphyxia group (1.113±0.130,1.047±0.069) (t =0.009,0.016,P＜0.05).Conclusion Umbilical cord blood acidosis has important predictive value for brain damage in asphyxiated neonates.

Objective To investigate the risk factors of hyperbilirubinemia in late preterm infants. Methods The clinical data of 815 late preterm infants (449 males and 366 females) from 25 hospitals in Beijing were collected from October 2015 to April 2016, including 340 cases(41.7％) with hyperbilirubinemia (hyperbilirubinemia group), and 475 cases without hyperbilirubinemia (control group). The clinical data of two groups were compared, and the maternal factors influencing hyperbilirubinemia in late preterm infants were analyzed with logistic regression. Results There were no significant differences in gender ratio (M:F 1.39 vs. 1.12, t=1.811,P=0.172)and birth weight[(2502.6±439.6)g vs. (2470.2±402.9)g,χ2=2.330,P=0.127)]between two groups. The incidence rates of hyperbilirubinemia in infants of 34 wks, 35 wks and 36 wks of gestational age were 22.9％(87/174), 35％(119/300) and 42.1％(143/341) respectively (χ2=1.218,P=0.544). The multivariate logistic regression analysis indicated that the maternal age(OR=1.044,95％ CI:1.010-1.080,P=0.011)was independent risk factor and multiple births(OR=1.365,95％CI:0.989-1.883,P=0.048), premature rupture of membranes(OR=2.350,95％ CI:1.440-3.833,P=0.001), cesarean section(OR=1.540,95％CI:0.588-4.031,P=0.014)were risk factors for hyperbilirubinemia in late preterm infants. Conclusions The incidence of hyperbilirubinemia in late preterm infants is relatively high. Maternal age, multiple births, premature rupture of membranes and cesarean section are risk maternal factors related to hyperbilirubinemia in late preterm infants.

窒息缺氧胎盘血流阻断时为保证心脑供血会导致心输出量重新分布而引起其他脏器的损害，窒息持续加重时形成严重代谢性酸中毒（pH≤7），并导致心脑损害[1]。窒息酸中毒引起新生儿主动脉舒张压下降，促使冠状动脉收缩使心脏灌注及全身灌注不足，不仅心脏缺血缺氧加重，还进一步累及各器官的灌注压而发生损害[2-6]。但是目前，国内外尚无新生儿窒息多器官损害的多中心研究，更无公认的诊断标准、常规或指南。在清华大学自主科研基金资助下，全国新生儿窒息多器官损害临床诊断多中心研究协作组（简称协作组）成立，提出结合Apgar评分和出生时脐动脉血pH诊断新生儿窒息，及新生儿窒息多器官损害的诊断标准[7]，并根据此标准进行了新生儿窒息多器官损害的多中心前瞻性研究[8-9]。研究结果认为该新生儿窒息多器官损害的临床诊断标准[7]较全面，且更深入，具有较好的临床意义，现对该诊断标准进行解读，以指导临床实施。

目前，国内外尚无新生儿窒息多器官损害的多中心研究，更无公认的诊断标准、常规或指南。在清华大学自主科研基金资助下，全国新生儿窒息多器官损害临床诊断多中心研究协作组成立，制定了本标准。

目的:分析区域新生儿转运网络内不同助产机构转运新生儿特点,探讨提高安全转运救活方法,完善转运网络制度.方法:选择2012年1月至2014年 12月,以我院新生儿重症监护病(NICU为中心,辐射周边20km内12家医院所转运的新生儿,按照医院助产级别的不同分为3组,分析3组新生儿的一般情况,包括转运新生儿数、疾病构成、转运效果及预后;同期开展对网络内医护人员集中培训并考核,参与网络内医院高危孕产妇的全程分娩,指导实施危重患儿救治.结果:①年来共转运新生儿1548例,三级助产机构990例,(占总转运数的63.95％),二级机构505例(32.62％),民营机构53例(3.42％),三级机构转运数多(P=0.000).②转运早产儿664例(42.9％),低体重儿536例(34.6％),孕周多集中在32 ～36周.③转运常见疾病中排名前6位的是:新生儿肺炎、高胆红素血症、贫血、窒息、感染和颅内出血;民营机构以新生 儿肺炎、贫血和低血糖发生比高(P均＜0.05),二级机构以缺氧缺血性脑病发生比高(P＜0.05),三级机构高胆红素血症、感染发生比高(P均＜0.05).④3组好转治愈率、死亡率及转至外科的比例均无差异(P均＞0.05),但来自民营机构患儿的住院天数长于其他两个机构(P＜0.05).⑤对网络内医院产儿科医护集中培训两次,理论考核成绩均较培训前有明显提高(P均＜0.05);参与网络内医院137例高危孕产妇的现场分娩,指导并实施了危重患儿的救治,气管插管、胎粪吸引、PS应用、氧气应用等维持患儿通气措施仍是高危儿需要的,也是各助产机构应熟练掌握和采取的急救手段.结论:区域网络内各级别助产机构对新生儿救治单元均有一定需求;对网络内医护人员集中培训并参与高危产儿现场救治指导是完善院间合作、规范危重儿救治的有效可行方法;通气、供氧、维持血糖稳定是安全转运的前提.

新生儿转运系统最早1950年在美国成立。此后围产保健区域化概念的提出，促进了高危新生儿转运工作的全面发展。我国20世纪80年代后期、90年代初期新生儿转运工作开始启动，并逐渐推广，近年来许多地方已开始创建新生儿转运系统。我国建立的新生儿转运网络是以省会城市和地级市为中心，转运的覆盖面广泛，距离长，花费时间久，难以使危重患儿获得及时高质量救治。2008年，上海市将所有19区县划分区域，组织成立6家新生儿区域急救转运中心，各中心负责转运本区域内危重新生儿，这种划区分片，对口转运，提高了转运效率，但他们采取的转运模式为120与接收医院的联合转运，使转运环节增加，转运耗时延长。我院自2004年开展转运工作以来，转运病人逐渐增多，转运技术的日趋成熟，近3年来，我院将转运模式基本固定为我院独立转运，即转出医院直接与我院NICU联系，我院派人派车接回患儿。转出医院固定为周边十余家医院，具备长期合作关系的至少4家。这样就形成了以我院NICU为中心，辐射周边50公里内的朝阳区东北部地区区域内新生儿转运网络雏形。这种相对固定的对口转运方式不仅保证了转运网络的高效畅通，而且减少了转运中间环节，集中了我院的新生儿急救医疗实力，为患儿争取了宝贵的救治时间。