目的 分析支气管肺发育不良(BPD)早产儿的临床特点及高危因素,探讨BPD的防治措施.方法 回顾性分析2009年1月至2012年12月本院NICU收治的极低出生体重早产儿临床资料,最终诊断BPD的早产儿为BPD组,同期未患BPD的早产儿为对照组,比较两组患儿围产期病史、临床表现、治疗、并发症及新生儿期结局.结果 研究期间共收治极低出生体重早产儿227例,159例在本院救治并存活至28天,纳入研究,其中44例早产儿诊断BPD(27.7％),轻度36例(81.8％).单因素分析显示,与对照组比较,BPD组患儿出生胎龄小,出生体重低,男性、宫内感染、新生儿呼吸窘迫综合征(RDS)、动脉导管未闭(PDA)、医院感染比率高,接受辅助通气时间长,差异有统计学意义(P＜0.05);两组以病理学为依据的绒毛膜羊膜炎及胎儿炎症差异无统计学意义(P＞0.05).将出生胎龄＜32周、出生胎龄＜30周、出生体重＜1 000 g、使用呼吸机、RDS及分期、PDA、肺炎、宫内感染、母亲胎盘绒毛膜羊膜炎、医院感染、性别与BPD发生的关系作多因素Logistic回归分析,发现出生胎龄＜30周(OR9.629,95％ CI 2.767～33.513)及男性(OR3.047,95％ CI l.037～8.948)是BPD发生的高危因素.结论 避免早产、合理通气策略、预防和控制感染可能减少BPD发生,远期随访更重要.

胎母输血综合征(fetomaternal hemorrhage,FMH)是指一定量胎儿血液通过破损的胎儿绒毛进入母体血液循环,引起胎儿失血以及母亲和胎儿溶血性反应的临床症候群,是胎儿非免疫性水肿的主要原因之一.由于发病隐匿.多数不能早期诊断,围产儿病死率高;尤其是大量胎母输血,可导致存活者远期神经系统后遗症.本研究回顾性分析近5年在我院分娩新生儿中明确诊断的11例大量胎母输血病例资料,总结如下.

目的总结胎母输血综合征(FMH)的临床特征和诊断治疗方法。方法对10例FMH患儿的临床资料进行回顾性分析。结果10例病例均未产前诊断,5例孕妇分娩前出现胎儿宫内窘迫症状。6例患儿接受了输血治疗,输血次数1~3次,输血总量30~105m l,所有病例治愈7例,转院1例,死亡1例,放弃抢救1例。结论(1)FMH临床症状无特异性,产前诊断困难,多次妊娠可能为FMH发生的诱因。(2)FMH慢性失血者,如重度贫血需积极治疗,仅表现轻度贫血无窘迫者,不需特殊治疗。(3)胎心监护及多普勒超声检查有助于FMH产前诊断。(4)及时发现可疑FMH病例,采取宫内输血或剖宫产结束妊娠,纠正胎儿或新生儿的贫血,有助于提高围产儿的存活率及预后。

Objective To investigate the influencing factors of ghrelin concentration in cord blood and assess the role of ghrelin in fetal growth. Methods Plasma ghrelin concentrations were measured in cord blood of 100 neonates. The relationship between ghrelin and gestational age, gender, delivery mode, birth weight, body length, head circumference and placental weight were analyzed. Results The concentration of plasma ghrelin in cord blood of all 100 neonates was 606.2 (488. 4-914. 4) pg/ml [median (P25-P65]. There was no statistical difference between male and female infants or between neonates underwent cesarean section and vaginal delivery(P>0. 05). Cord blood ghrelin levels were different in different gestational age and birth weight neonates (P < 0.05). Its concentrations were higher in term small for gestational age neonates [1211.7(668. 8-1690. 5) pg/ml] than in term average for gestational age newborns [750. 4(534. 2-1030. 0) pg/ml] and large for gestational age newborns [520. 6(439. 9-773.4) pg/ml] (P<0. 05). Gestational age and birth weight were significant determinants of ghrelin concentrations(β=0. 808,P=0. 000;β=-0. 469, P=0. 020). Conclusions Cord ghrelin concentrations increases with advancing gestational age, but are down-regulated by fetal weight. Ghrelin may play a physiological role in fetal adaptation to intrauterine nutritional environment.

Objective To explore the high risk factor in peripartum and clinical outcome in very low birth weight infant(VLBWI).Me-thods The study was a retrospective analysis of 76 women of preterm labour who delivered 84 VLBWI from Jan.2003 to Dec.2006.The imme-diate neonatal morbidity and mortality were analyzed by dividing patients into 2 groups according to the birth weight,880-1 200 g group and 1 200-1 500 g group.Results Amongst the perinatal high risk factors for preterm labour,pregnancy-induced hypertension(38.2%,n=29),multiple births(22.4%,n=17),premature rupture of membrane(23.7%,n=18),anaemia during pregnancy(18.4%,n=14),abnormal placenta(18.4%,n=14) and in vitro fertilization(11.8%,n=9) were common associations.All VLBWI had at least one complication including jaundice(65.5%,n=55),hemoglobin 100 g/L(46.4%,n=39),asphyxia(34.5%,n=29),apnea(33.3%,n=28),platelet count100×109 L-1(28.6%,n=24),respiratory distress syndrome(21.4%,n=18),feed intolerance(21.3%,n=17),pneumonia(17.9%,n=15),sepsis(8.3%,n=7),bronchopulmonary dysplasia(4.8%,n=4),necrotizing enterocolitis(2.5%,n=2).pulmonary surfactant administration(60.7%,n=51),blood transfusion(39.3%,n=33),mechanical ventilation(28.6%,n=24),resuscitation with endotracheal tube(22.6%,n=19),The survival rate was 90.5% for all VLBWI.The neonatal mortality in babies birth weight 880-1 200 g was significantly higher than that in babies birth weight1 200-1 500 g(P=0.018).Infection and respiratory diseases were the primary causes of death of VLBWI.Conclusions Most VLBWI are able to survive due to timely intervention,appropriate management and neonatal intensive care unit care facility available in our hospital.The prevention of infections and aggressive respiratory support are the key steps for decreasing morta-lity of VLBWI.

Objective To study the risk factors and clinical features of sepsis caused by Klebsiella pneumoniae in neonatal intensive care unit(NICU)and improve the diagnosis and management of this disease.Methods There were 16 cases of Klebsiella pneumoniae sepsis in the Hospital's NICU from January 2005 to May 2008 included in this study,their clinical data and drug sensitivity results were retrospectively analyzed and compared with 32 cases of non-sepsis and 33 cases of sepsis caused by other organisms.Results It was found that the risk factors of Klebsiella pneumoniae sepsis were preterm low birth weight,peripherally inserted central catheter(PICC)placement and prior usage of third generation cephalosporins.It was also found that all the cases of Klebsiella pneumoniae sepsis were nosocomial infection and occurred in premature infants,81.2% of infants were very low birth weights(VLBW);the outcome was poor if it was complicated with infection caused by other organisms.The cultures showed that 93% of the Klebsiella pneumoniae strains were extended spectrum betalactamase producing(ESBLs),it also showed that 100% of Klebsiella pneumoniae was sensitive to imipenem but resistant to penicillin and cephalosporins.Conclusion Klebsiella pneumoniae is the most common bacteria causing nosocomial infection in NICU and it is highly resistant to many antibiotics.The risk factors of Klebsiella pneumoniae sepsis are preterm low birth weight,PICC placement and prior usage of third-generation cephalosporins.Carbapenems are the first line antibiotics to treat such infection.

目的探讨重度子痫前期不同发病孕周与围产儿结局的关系。方法对我院112例重度子痫前期患者以孕34周发病时间为界,分为早发型和晚发型两组,即A组孕妇55例,新生儿59例,B组孕妇57例,新生儿62例,对两组孕妇及分娩新生儿的一般临床资料,新生儿疾病的发生情况及围产结局进行分析比较。结果(1)两组孕妇分娩孕周及早产发生率的比较,有显著统计学差异(P(0.01)。(2)两组新生儿出生时的平均胎龄、平均出生体重、平均身长进行统计学比较,有显著差异(P(0.01)。A组新生儿中低出生体重儿41例(发生率69.49%),B组17例(发生率27.42%),两组统计学比较有显著差异(P(0.01)。A组中小于胎龄儿(SGA)11例(18.64%),适于胎龄儿(AGA)46例(77.97%),大于胎龄儿(LGA)2例(3.39%),B组新生儿中SGA14例(22.58%),AGA40例(65.57%),LGA8例(12.90%),两组比较,差异无统计学意义(P>0.05)。(3)两组新生儿先天畸形,新生儿窒息,呼吸系统疾病,酸中毒及糖代谢混乱的发病率比较,均有统计学差异(P(0.05)。其他各种疾病的发病率比较,无统计学意义。(4)比较两组孕妇妊娠不良结局的发生率,则早发型组为6例,晚发型组为0,两组比较有统计学差异(P值为0.012)。结论重度子痫前期患者的发病孕周直接影响围产结局,且早发型重度子痫前期孕妇早产儿、低体重儿的发生率明显增加,相关新生儿疾病(如RDS、新生儿窒息等)的发病率也明显增加,但SGA及红细胞增多症等疾病的发生率与发病孕周无关。

胎儿生长发育机制目前尚不完全清楚,营养物质(葡萄糖)-胰岛素-胰岛素样生长因子代谢轴可能是调节胎儿和生后早期生长的中心环节[1].

Objective To evaluate the relationship between maternal antepartum fever and early-onset neonatal bacterial sepsis.Methods A retrospective multi-centred clinical study of 404 neonates including 103 new borns with maternal antepartum fever and 311 neonates without was conducted.Results The frequency of early-onset neonatal bacterial sepsis was significantly higher in neonate with maternal antepartum fever than those without(4.9% vs 0.3%,P=0.001).Both maternal antepartum temperature ≥39℃ and maternal postpartum fever lasting several days was higher suggested the possibility of neonatal sepsis.Conclusions The neonates born with high risk factor of early-onset neonate bacterial sepsis require comprehensive lab evaluation including blood culture and uterine culture,clinical observation and aggressive treatment to decrease the mortality.

目的为了探讨母孕期血清抗体与新生儿ABO溶血症程度的关系。方法对夫妇血型不合者在母孕中期曾测定血清IgG抗A、抗B抗体者≥64时追踪其新生儿ABO溶血症发生情况,共50例作了调查分析。结果50例其中有3例抗体很高分别为512、1024、2048均没有发生新生儿ABO溶血症。母子血型相同有14例,母子血型不合有36例。36例母子血型不合中有19例新生儿发生ABO溶血症,发生率为52.78%。母血型不合19例中母产前抗体滴定度≥64者有6例占17.14%,其中新生儿发生ABO溶血症为3例占50%母产前抗体滴定度128-≥256者有30例占83.33%,其中新生儿发生ABO溶血症为16例占53.33%。在母子血型组合中O-A血型组合明显多于O-B血型组合为1.57∶1。结论O-A血型组合较O-B血型组合易发生ABO溶血症,孕母血清抗体水平的高低其新生儿发生ABO溶血症的程度不成正比关系。

目的为了探讨母孕期血清抗体与新生儿ABO溶血症程度的关系.方法对母孕中期曾测定血清IgG抗A、抗B抗体者,共80例,对其中新生儿发生ABO溶血症者53例,观察新生儿ABO溶血症的严重程度,作了回顾性调查分析.结果发病患儿的母产前抗体滴定度≥64者有16例占(30.19%),其新生儿胆红素峰值的均值为18.9mg/dl.母产前抗体效价128～≥256者有34例占(64.15%),其新生儿胆红素峰值的均值为19.6mg/dl.母产前抗体效价512～≥1024者3例占(5.66%),其新生儿胆红素峰值的均值为16.4mg/dl.结论孕母抗体的高低与新生儿ABO溶血症的程度不成正比关系.

目的探讨产前应用地塞米松预防早产儿呼吸窘迫综合征的效果.方法回顾性分析 1999～ 2001年娩出胎龄为 27～ 34周的单胎早产儿病史资料.凡产妇在产前首剂使用地塞米松,至胎儿娩出时间不足 24 h或未使用地塞米松治疗者为对照组;产前首剂使用地塞米松至胎儿娩出时间超过 24 h但不足 7 d者为治疗组.采用 t检验、卡方检验以及 Fisher确切概率法分析数据.结果共有早产儿 106例(治疗组 45例,对照组 61例),两组胎龄分别为( 32.2± 1.6)周和( 31.9± 1.5)周,出生体重分别为( 1918± 421) g和( 1886± 430) g.治疗组 RDS发生率显著低于对照组(0%与14.8%, P<0.05).治疗组孕产妇绒毛膜羊膜炎发生率与新生儿败血症发生率较对照组高(绒毛膜羊膜炎为 6.7%和 1.6 %;新生儿败血症为 2.2%和 1.6%),治疗组新生儿死亡率低于对照组,但差异均无统计学意义.结论对于 <34周的早产儿,产前应用地塞米松可能促进胎肺成熟,进而显著降低 RDS的发生.

Objective There is controversy as to whether vitamin E supplementation is essential for healthy breast-feeding premature infants.This study examined the dynamic changes of the serum vitamin E level in healthy breast-feeding premature infants within 30 days after birth.Methods Thirty-eighty healthy breast-feeding premature infants were randomized to receive vitamin E supplementation(Intervention group,n=20) or without(Control group,n=18).The Intervention group was intramuscularly injected with vitamin E 50 mg daily for 3 days soon after birth.Blood samples were collected at birth(before the first vitamin E injection),and 10 and 30 days after birth.The serum vitamin E level was measured by spectrophotofluorometer.Results The vitamin E level of the Intervention group(1.64±0.68 mg/dL) was no significantly different from that of the Control group(1.76±0.74 mg/dL)(P>0.05) at birth.The Vitamin E level of the both groups increased 10 days after birth,and there was no significant difference between the two groups(2.54±1.23 mg/dL vs 2.64±1.13 mg/dl,P>0.05).On the 30th day after birth,the vitamin E level of the Intervention group remained high but that of the Control group decreased,although there was no significant difference between the two groups(2.77±1.56 mg/dL vs 2.37±1.07 mg/dL,P>0.05).No patient had the serum level of less than 0.5 mg/dL at any time point(reference range(0.59-6.45) mg/dL).Conclusions There was no significant difference in serum vitamin E level between the two groups within 30 days after birth.The healthy breast-feeding premature infants were not vitamin E deficient.Thus Vitamin E supplementation is not necessary for healthy breast-feeding premature infants.

目的探讨胎膜早破对早产儿呼吸窘迫综合征(RDS)发生的影响.方法回顾性分析1997～2000年在我院分娩、胎龄为27～33周的早产儿.依据产妇胎膜早破是否超过24 h,将早产儿分为胎膜早破组44例与对照组99例.采用t检验、χ2检验及Fisher确切概率计算法分析数据.结果两组胎龄分别为(32.30±1.31)、(31.9±1.7)周,出生体质量分别为(1834±378) g、(1838±431) g.两组破膜至胎儿娩出时间分别为(111.9±124.6)、(3.4±6.0) h,经统计分析有显著差异(P<0.001).胎膜早破组RDS发生率显著低于对照组(P<0.05).胎膜早破组孕产妇宫腔内感染率与新生儿败血症发生率较对照组高,但无显著差异.结论对于＜33周的早产儿,胎膜早破超过24 h可能促进胎肺成熟,进而显著降低RDS发生.

在很多医院,产科与新生儿科常因各自医疗的特点,不能互相理解而产生矛盾,尤其目前产妇及家属对医务人员提出过高以至于不合理要求时,会造成产儿科医务人员之间的埋怨情绪,从而使产科及新生儿科的医护人员感到压力很大.如何把握产儿科的结合点,提高围产质量是当前颇为重要的任务.鉴于产科与新生儿科休戚与共,新生儿科是产科的延续,从围产这一整体观点出发,我院自1995年起成立了由产科和新生儿科组成的围产科,产科主任和新生儿科主任共同担任其行政管理.现将我们的点滴体会整理如下,供同仁们探讨.

李斯特菌为革兰阳性杆菌,早在1926年国外已有人报道第1例人类单核细胞性李斯特菌(Listeria monocytogene,LM)感染,至1983年Schlech等报道,加拿大1981年发生的一次LM爆发流行的实验调查中,确是一种极有危害的食物中毒菌的认识,得到了进一步的公认.而我院近几年来发生了5例围产儿LM感染,4例死亡,1例存活,现报道如下.

目的评估正常孕产妇分娩的小于胎龄儿(SGA)的患病率及死亡率.方法回顾分析1998年～2002年在我院分娩胎龄为37～41周的SGA,依据新生儿出生体重的百分位数将SGA分为大于第5百分位,但小于第10百分位SGA(SGA1);小于第5百分位SGA(SGA2).将孕母患妊娠合并症及胎儿畸形者予以剔除.将同期正常孕产妇分娩的适于胎龄儿(AGA)作为对照组.比较3组胎龄、出生体重、身长,入新生儿重症监护病房(NICU)率、低血糖、肺透明膜病(RDS)、吸入性肺炎、机械通气、红细胞增多症、高胆红素血症、败血症及1 min Apgar 评分≤7分、发生率等指标.结果观察对象共4 546例(AGA组4 323例,SGA1组130例,SGA2组93例).3组胎龄相似(P均>0.05);SGA组出生体重、身长均明显低于AGA组(P均<0.001);低血糖、RDS、吸入性肺炎、机械通气、高胆红素血症和败血症3组之间无统计学差异(P均＞0.05).SGA入新生儿重症监护病房率、红细胞增多症和新生儿窒息的发生率显著高于AGA组,且存在出生体重越低危险越大趋势.结论与AGA相比,正常孕产妇分娩足月SGA某些新生儿疾病的发生率显著增加.

VitD是人体中一种主要的维生素,多数主张早产儿在生后2周开始补充VitD.但是有关围产期新生儿特别是早产儿血VitD水平的报道较少,我们对此进行研究,以期能对新生儿补充VitD提供一定的理论依据,并同时观察光疗对血清VitD水平的影响.

目的探讨非蛋白结合铁在新生儿窒息后再灌注损伤中的作用.方法用克服基体效应的Bleomycin方法,分别测定20例窒息新生儿生后6 h内、6～12 h和12～72 h的血浆非蛋白结合铁(NPBI),并取20例正常新生儿于出生6 h内测定其血浆非蛋白结合铁作为对照.结果窒息组NPBI阳性率明显高于对照组(80% vs 20%),P<0.01.窒息组血浆非蛋白结合铁水平在生后6 h内为[(4.14±2.41) μmol/L]、6～12 h为(2.26±2.21) μmol/L,均比对照组[(0.28±0.79) μmol/L]显著升高(P＜0.05),尤以生后6 h内为最高.结论非蛋白结合铁可能在新生儿窒息后再灌注损伤中起着重要的作用.

To study the effect on the infant's early development with baby touch. Ninty nine infants born in our hospital were selected and 51 ones were assigned to the touch group with 48 ones in control group. On the 42 nd day and the 4 th montn after birth the data on physical development and action development were collected separately. Weight and height of the infants in the touch group were better than those in the control group with a significant difference. There was a significant difference in head circle and breast circle in the 4 th month between the two groups. some measurements of action development in the touch group also differed from those in the control group with statistical differences. [Conclusions] Touch can benefit infants' early development in physical and action.