孕妇在妊娠期间及产后由于体内神经体液调节发生很大变化,其生理生化机制也随之受到影响,当母亲用药时,药物可能在母体内代谢延迟,并可通过胎盘从母体进入胎儿体内或由乳汁进入新生儿体内.该时新生儿的许多器官尚未发育完善,对药物代谢、排泄功能差,体内活性物质和代谢酶尚未形成.因此低浓度也可导致多种不良影响,甚至危及生命.

早产儿是新生儿中的特殊群体,其生理和病理的特殊性表现为一出生就应得到专业性监护、关爱和护理.20世纪80年代初期,早产儿的病死率很高,90年代末期,早产儿的死亡数仍占婴儿死亡数的51.8%.近年来,有资料表明我国早产儿的出生率有上升趋势,从80年代末的4.15%上升到90年代末的5.99%.20年来,NICU的专业医生迅速成长,大中城市NICU的技术和设备不断完善,使早产儿的死亡率大为降低,尤其是超未成熟儿、极低出生体重儿的存活率有了很大提高.救治早产儿的需求也正在逐年增加,使一些超未成熟儿、极低甚至超低出生体重儿得到了及时、成功的救治.

通过总结1997年1月至2001年12月我院儿科NICU极低出生体重儿(VLBWI)的收治情况,并与前5年进行比较,结果显示VLBWI收治数增加;呼吸系统疾病发生率降低,如窒息的发生率自62.1%减少到30%,肺透明膜病的发生率自72.4%减少到58.3%;应用肺表面活性物质、高频振荡通气、中心静脉插管等新技术从17.2%增加到86.7%,从而使治愈率自73.9%提高到89.1%,平均住院日自46.8天缩短到43.3天.治疗体会包括加强孕期保健,产儿科合作进行复苏,积极防治呼吸系统疾病,维持内环境稳定,防治院内感染,保证营养需求和提高医护质量.

Objective To demonstrate the influence of the perinatal factors on neonatal serum bilirubin level in normal neonatal population. Methods Serum bilirubin level of 801 healthy babies were continuously monitored and the perinatal factors related to neonatal jaundice were recorded. 298 newborn with high serum bilirubin level(12. 9 mg/dl) were compared to 298 newborn with low serum bilirubin level randomly selected from the remaining 503 subjects. Results High bilirubin level was significantly associated with brease feeding, pregnancy induced hypertension of mothers, loss of birthweight, and high hematocrit( P0.001 ). There were no significant association of high bilirubin level with maternal age, maternal blood type, oxitocin induction of mothers, the length of the second labor stage, and the route of delivery. Conclusions Breast feeding, pregnancy induced hypertension of the mothers, high hematocrit, and loss of brithweight are important potential factors contributed to serum bilirubin level in early newborn stage.

OBJECTIVETo provide epidemiological data for revising the diagnostic criteria of neonatal hyperbilirubinemia in China.METHODSA survey was performed among full-term infants in multiple centers throughout the country. From less than 24 hours after birth, the infants' bilirubin levels were measured every day until the peak level fell to less than 68.4 mumol/L. Auditory brainstem responses were assessed in 56 infants randomly chosen from those with serum bilirubin levels of higher than 220.5 mumol/L.RESULTSJaundice in most infants was detected at 2-3 days after birth. The bilirubin level usually reached a peak level of 204 +/- 54.69 mumol/L at 5 days after birth and then fell. Among the 875 infants, the serum bilirubin levels in 34.4% of neonates were higher than 220.5 mumol/L. The mean serum bilirubin level of the infants during the first week after birth varied with geography (P < 0.001) and season (P < 0.001). The serum bilirubin level was significantly associated with gestation age (P < 0.01), delivery method (P < 0.01), weight loss (P < 0.001), and PCV elevation (P < 0.001) during the first three days after birth.CONCLUSIONSThe start time of neonatal jaundice was similar to that reported elsewhere, but the mean peak level in our study was higher than the reported. It is suggested that the diagnostic criteria for neonatal hyperbilirubinemia in China should be strict.

进修医生请问低出生体重儿的定义及其病因是什么 ? 教授低出生体重儿是指出生体重不足 2500 g的新生儿，包括早产儿、足月小样儿及过期产儿。发生低出生体重的原因有：①母体因素，例如慢性疾病、外伤、生殖器官异常、妊娠高血压综合征 (妊高征 ) 等；②胎盘因素，例如前置胎盘、胎盘早期剥离、胎膜早破、胎盘或脐血管异常；③胎儿因素，例如双胎、畸形、宫内感染等。

目的 为吸入一氧化氮治疗新生儿肺动脉高压提供实验依据及经验.方法 30只7～10日龄新生兔随机分3组,观察吸入44 ppm浓度一氧化氮对急性低氧和正常新生免肺动脉压的影响.结果 吸入5%低氧气3分钟可使新生兔平均肺动脉压升高36.1±15.9%(-x±s),下同).此时吸入44 ppm一氧化氮,经过3、5、7分钟,分别使平均肺动脉压下降20.3±12.3%、25.5±11.4%、28.4±12.5%(与对照组比较P＜0.01),而对心率、血气性低氧性肺动脉高压.

> 患儿,男,14天。因生后四肢活动少、哭声弱和吸吮差于1987年2月12日入院。患儿生后不哭,周身青紫,经拍打及人工呼吸半小时后出声,但声音低微,不会吸吮,四肢活动少。阿氏评分不详。父母为近亲结婚、体健。其姐4岁,健在。母孕期无特殊病史及服药史。孕4月开始胎动,但较第一胎明显减少。家系调查结果见附图。体检:脉搏100次,呼吸34次,体重2700g。营养一般,反应差。双眼睑无下垂,双眼球有自发性同向水平震颤。眼底:视乳头边

> 患儿男,1987年5月12日出生。生后第7天因拒乳、精神极差、哭声低及阵发性四肢和颈部肌张力增高,由北京协和医院产科转入儿科。母孕三次,第1胎人工流产;第2胎于生后6天出现肌张力增高、拒乳、反应低下、抽搐,死于呼吸衰竭;本例为第3胎,足月剖腹产,无窒息。父母非近亲。体检:足月儿外貌,反应差,哭声弱,四肢肌张力略高。颅脑超声检