目的 探讨新生儿父母人口学信息对新生儿窒息的影响因素,为降低甘肃省新生儿窒息发病率提供理论依据.方法 选用2016年1月1日—11月30日间的,甘肃省19家医院的0～28d婴儿,采用病例对照研究进行新生儿窒息危险因素分析.危险因素采用logistic回归分析.结果 单因素logistic回归分析显示母亲及其父亲年龄、职业、文化程度及民族是新生儿窒息的影响因素(P＜0.05),多因素logistic回归分析显示母亲年龄＞40岁(OR=1.191,95％CI:0.820～2.035)、母亲农民(OR=2.441,95％CI:1.705～3.496)、文化程度越低(OR=0.467,95％CI:0.363～0.620)、回族(OR=2.282,95％CI:1.882～2.767);父亲农民(OR=2.319,95％CI:1.772～3.036)、文化程度越低(OR=0.700,95％CI:0.491～0.998)、回族(OR=2.790,95％CI:2.314～3.364)均是新生儿窒息的危险因素.结论 加强孕期保健宣传,预防为主;提高区域经济的发展,提高人口素质,已期降低新生儿窒息的患病率.

Objective:To analyze the distribution of ages at the interhospital transfer of outborn very preterm infants in China and to compare their perinatal characteristics and outcomes at discharge and neonatal intensive care unit (NICU) treatment.Methods:A total of 3 405 outborn very premature infants with a gestational age of 24-31 +6 weeks who were transferred to the NICUs of the Chinese Neonatal Network (CHNN) in 2019 were included in this retrospective study. According to the age at transfer, they were divided into three groups: early transfer (≤1 d), delayed transfer (>1-7 d) and late transfer (>7 d) groups. Analysis of variance, t-test, Chi-square test (Bonferroni correction), Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare the general clinical condition, treatment, and outcomes at discharge among the three groups. Results:The median gestational age was 29.7 weeks (28.3-31.0 weeks) and the average birth weight was (1 321.0 ± 316.5) g for these 3 405 infants. There were 2 031 patients (59.6%) in the early transfer group, 406 (11.9%) in the delayed transfer group and 968 (28.4%) in the late transfer group. Infants who received continuous positive airway pressure ventilation and tracheal intubation in the delivery room accounted for 8.4% (237/2 806) and 32.9% (924/2 805), respectively. A total of 62.7% (1 569/2 504) of the mothers received antenatal glucocorticoid therapy and the ratio in the early transfer group was 68.7% (1 121/1 631), which was higher than that in the delayed transfer group [56.1% (152/271), χ2=16.78, P<0.017] and the late transfer group [49.2% (296/602), χ2=72.56, P<0.017]. The total mortality rate of very premature infants was 12.7% (431/3 405), and the mortality rates in the early, delayed and late transfer groups were 12.4% (252/2 031), 16.3% (66/406) and 11.7% (113/968), respectively ( χ2=5.72, P=0.057). The incidences of severe intraventricular hemorrhage, late-onset sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia at the corrected gestational age of 36 weeks or discharge were all higher in the delayed and late transfer groups than in the early transfer group, respectively. The incidences of retinopathy of prematurity, retinopathy of prematurity requiring treatment and bronchopulmonary dysplasia at the corrected gestational age of 36 weeks or discharge in the late transfer group were significantly higher than that in the delayed transfer group (Bonferroni correction, all P<0.017). In the late transfer group, the median age of very premature infants at discharge was 66.0 d (51.0-86.0 d), and the corrected gestational age at discharge was 38.9 weeks (37.1-41.2 weeks), and both were greater than those in the early transfer [48.0 d (37.0-64.0 d), Z=260.83; 36.9 weeks (35.7-38.3 weeks), Z=294.32] and delayed transfer groups [52.0 d (41.0-64.0 d), Z=81.49; 37.4 weeks (36.1-38.7 weeks), Z=75.97] (all P<0.017). Conclusions:Many very premature infants need to be transferred to higher-level hospitals after birth. The later the very premature infants are transferred, the higher the incidence of complications will be. It is suggested that intrauterine or early postnatal transport may improve the prognosis of very premature infants.

报告我院收治的1例胎龄24周、出生体重370 g的超低出生体重儿，经过产前多学科会诊、围产期专人护理治疗、肺保护策略、营养支持、重度支气管肺发育不良管理、家庭参与式护理及院外随诊，随访至4岁，体格生长、神经系统预后良好。

背景 近年来我国胎儿医学发展迅速,全国各地陆续开展了各种胎儿宫内手术,但目前胎儿医学干预效果评价多基于单中心、小样本数据并局限于围产期结局,缺乏胎儿生后近期和远期预后的多中心、大样本研究.目的 描述2019年中国新生儿协作网(CHNN)57家NICU收治的极早产儿中接受胎儿宫内手术和/或产前侵入性操作者的现状及预后.设计队列研究.方法 以CHNN收录的极早产儿为队列人群,以接受胎儿宫内手术和/或产前侵入性操作(胎儿镜激光凝固术、选择性减胎术、宫内输血、体腔内积液引流术、减羊水术、羊膜腔穿刺或绒毛膜取样术)者为暴露组,采用倾向性评分的方法1:4匹配未接受产前干预的对照组,比较两组间病死率(NICU院内、生后28 d、生后7 d)和主要并发症[严重脑损伤、严重早产儿视网膜病、支气管肺发育不良(BPD)、坏死性小肠结肠炎和败血症]发生率.主要结局指标病死率.结果 2019年CHNN数据库共收治极早产儿9520例,接受胎儿宫内手术和/或产前侵入性操作患儿共187例(2.1％),其中选择性减胎术69例,羊膜腔穿刺或绒毛膜取样术66例,减羊水术42例,胎儿镜激光凝固术20例,宫内输血10例,体腔内积液引流术2例.暴露组极早产儿NICU全因病死率为15.5％(29/187),其中22例死亡发生在生后7 d内;最常见的并发症为BPD(41.7％)、败血症(11.8％)和严重脑损伤(9.4％).匹配后与对照组患儿相比,接受产前干预的极早产儿NICU全因病死率及主要并发症发生率差异无统计学意义,暴露组生后7 d内全因死亡(RR=1.69,95％CI:1.06～2.71),早发败血症(RR=3.20,95％CI:1.28～7.99)发生风险高于对照组.结论 CHNN 2019年NICU入院极早产儿中接受宫内手术和/或产前侵入性操作的患儿占2.1％,接受宫内手术和/或产前侵入性操作并不显著增加极早产儿NICU死亡或并发症的发生率.

胎儿肠扭转及肺栓塞均为新生儿期急危重症，二者同时发生极少见。本文报告我院收治的1例胎龄33周、宫内发现肠扭转、术后合并肺动脉栓塞的病例，以加强临床认识。

目的 探讨促红细胞生成素(EPO)联合亚低温治疗中重度新生儿缺氧缺血性脑病(NHIE)的疗效.方法 选取2017年3月至2019年7月于甘肃省妇幼保健院住院治疗的92例中重度NHIE患儿,根据随机数字表法分为观察组和对照组,各46例.所有患儿均接受亚低温治疗72 h,观察组予重组人促红素注射液静脉滴注,对照组予0.9％氯化钠注射液静脉滴注,均治疗14 d.记录2组基线资料,比较2组出生后24、72、168 h血清超氧化物歧化酶(SOD)水平.治疗14 d后行头颅磁共振成像(MRI)检查,计算并比较2组改良的Barkovich评分.结果 2组胎龄、体质量、男性比例、1 min Apgar评分、惊厥比例、自然分娩比例比较,差异均无统计学意义(均P>0.05).观察组出生后24、72、168 h血清SOD水平逐渐降低[(232±141)、(174±84)、(124±28)kU/L],且观察组出生后72、168 h血清SOD水平均低于对照组[(247±103)、(189±66)kU/L],差异均有统计学意义(t=3.708、6.153,均P<0.001).治疗14 d后观察组18例、对照组21例患儿头颅MRI异常.头颅MRI异常患儿中,观察组改良的Barkovich评分低于对照组[(2.0±1.3)分比(4.0±1.7)分],差异有统计学意义(t=4.014,P<0.001).结论 EPO联合亚低温治疗中重度NHIE能进一步减轻神经系统损伤,改善预后.

Preterm infants constitute an important proportion of neonatal deaths and various complications, and very preterm infants (VPI) are more likely to develop severe complications, such as intraventricular hemorrhage (IVH), anemia, and sepsis. It has been confirmed that placental transfusion can supplement blood volume in infants and reduce preterm-associated complications, which is further conducive to the development of the nervous system and a better long-term prognosis. Based on these advantages, placental transfusion has been widely used in VPI. There are three main types of placental transfusion: delayed cord clamping (DCC), intact umbilical cord milking (I-UCM), and cut umbilical cord milking (C-UCM). However, the optimal method for PTVPI remains controversial, and it is urgent to identify the best method of placental transfusion. We plan to fully evaluate the safety and effectiveness of these three placental transfusion methods in VPI in a 3-arm multicenter randomized controlled trial: Placental Transfusion in Very Preterm Infants (PT-VPI). Trial registration: chictr.org.cn, number ChiCTR2000030953.

Objective: This study aimed to analyze the risk factors of gastroesophageal reflux complicated with pulmonary infections and the characteristics of pathogenic bacteria, and to propose prevention strategies. Methods: A total of 40 patients admitted and definitely diagnosed with gastroesophageal reflux complicated with pulmonary infections in Gansu Provincial Maternity and Child-care Hospital from January 2017 to November 2017 were retrospectively analyzed. Univariate and multivariate logistic analyses were conducted for the evaluation of premature delivery, polyembryony, birth asphyxia and rescue history, birth weight, hyperglycemia, esophageal hiatal hernia and esophageal peristaltic dysfunction. The corresponding intervention measures were proposed, and the types of pathogenic bacteria of pulmonary infections were counted. Results: Premature delivery, birth asphyxia history, birth rescue history, postnatal hyperglycemia, definite esophageal hiatal hernia and esophageal peristaltic dysfunction were independent risk factors for neonatal gastroesophageal reflux complicated with pulmonary infections. Gramnegative (G(-)) bacteria were sensitive to cefepime and ceftazidime, while Gram-positive (G(+)) bacteria were sensitive to ampicillin and cefepime. Conclusion: Our data demonstrate that premature delivery, presence of birth asphyxia and rescue history, hyperglycemia after birth, definite esophageal hiatal hernia and peristaltic dysfunction are independent risk factors for neonatal gastroesophageal reflux complicated with pulmonary infections. G(+) bacteria are the dominant pathogens, suggesting the necessity of cefepime in empirical treatment.

目的 探讨促红细胞生成素(erythropoietin,EPO)联合亚低温治疗中重度新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)的疗效及安全性.方法 选取我院2017年3月至2019年7月收治的满足亚低温标准的中重度HIE患儿92例进行随机对照研究,根据随机数字表法分组,各46例,实验组采用亚低温治疗72 h联合EPO静滴(隔天1次,治疗14 d),对照组给予亚低温治疗72 h及与EPO同等剂量、同样给药方法 的生理盐水.统计对比两组治疗期间安全性、常规生化指标,并对比两组疗效、新生儿行为量表(NBNA)、智能发育(CDCC)评分、后遗症发生率等预后情况.结果 (1)疗效及预后:实验组出生后7、14、28 d NBNA评分呈升高趋势,且均大于对照组(P<0.05);实验组3月龄、6月龄、12月龄的MDI、PDI评分均大于对照组(P<0.05);实验组后遗症发生率(8.70％)与对照组(13.04％)比较,差异无统计学意义(P>0.05);(2)常规生化指标:EPO治疗结束后观察组Hb、RBC、HcT高于对照组,PLT低于对照组,差异有统计学意义(P<0.05);(3)治疗期间安全性:两组治疗期间均无严重不良事件、放弃治疗事件、死亡事件发生,两组一般不良事件发生率对比,差异无统计学意义(P>0.05).结论 EPO联合亚低温治疗HIE能进一步减轻患儿智力、神经损伤,提高预后,且不增加治疗期间不良事件发生风险.

BACKGROUND: Intracranial hemorrhage is a severe cranial disease in the perinatal period. We aimed to explore the feasibility and accuracy of three-dimensional (3D) ultrasonography for the quantitative evaluation of neonatal intracranial hemorrhage.METHODS: A total of 374 neonates with suspected intracranial hemorrhage from January 2017 to December 2019 were selected to be primarily screened by cranial ultrasonography and then diagnosed by cranial CT scan. The examination results were compared to analyze the feasibility and accuracy of 3D ultrasonography in quantifying blood loss.RESULTS: CT scan showed that there were 102 cases of Papile grade I, 106 cases of grade II, 124 cases of grade III and 42 cases of grade IV. 3D ultrasonography showed that there were 108 cases of Papile grade I, 98 cases of grade II, 130 cases of grade III and 38 cases of grade IV. The diagnostic results of these two methods were not significantly different (P>0.05). The accuracies of CT scan for subventricular, intraventricular, subdural, subarachnoid and intraparenchymal hemorrhages were 47.33%, 31.24%, 94.62%, 91.73% and 91.35% respectively, and those of 3D ultrasonography were 98.74%, 96.37%, 91.51%, 90.41% and 97.64% respectively. The accuracies of 3D ultrasonography were significantly superior to those of CT scan for subependymal, intraventricular and intraparenchymal hemorrhages (P<0.05).CONCLUSIONS: Neonatal intracranial hemorrhage can be well diagnosed by cranial ultrasonography which timely provides evidence for clinicians, thereby elevating the cure rate and reducing the mortality rate and incidence rate of sequelae. 3D ultrasonography is feasible and accurate for the quantitative evaluation of neonatal intracranial hemorrhage, thus being of great significance to prognostic determination in clinical practice.

目的 探讨不同保暖措施下,新生儿重症监护中心(NICU)患儿腋窝下温度(腋温)和背部肩胛间温度(背温)的差异及测量体温所需时间,探究适用于NICU的体温测量方式.方法 将303'例入住NICU的患儿根据保暖措施分为暖箱组、辐射床组、婴儿车组,比较3组腋温和背温差异及两种测量方法所需时间.结果 3组背温与腋温比较差异均无显著性(P>0.05),背温测量所需时间少,且差异显著(P<0.05).结论 新生儿背温与腋温均能较准确反映患儿真实体温,且前者测量时间短,既可以减少频繁操作对新生儿的刺激,又可减轻护士工作量,安全有效,方便实用,值得临床推广.

目的:比较枸橼酸咖啡因与氨茶碱治疗早产儿原发性呼吸暂停的并发症及经济学评价.方法:2016年5月-2017年5月收治呼吸暂停早产儿239例,随机分为两组.A组采用枸橼酸咖啡因注射液治疗;B组采用氨茶碱注射液治疗.观察两组并发症情况,并进行经济学评价.结果:A组早产儿支气管肺发育不良(BPD)及败血症发生率均明显低于B组,差异有统计学意义(P<0.05).A组抗生素使用费用明显低于B组,差异有统计学意义(P<0.05).结论:枸橼酸咖啡因治疗呼吸暂停早产儿,安全性较高,并发症少,且不会带来更多的经济负担.

分析神经节苷酯治疗新生儿缺氧缺血性脑病(HIE)对患儿神经相关因子及脑神经损伤程度的影响.选取本院收治的HIE患儿96例,分为两组.对照组患儿采用常规治疗,观察组患儿采用常规治疗联合神经节苷酯治疗,分析两组患儿治疗后的临床疗效.观察组肌张力、原始反射及意识恢复恢复时间短于对照组(P<0.05).治疗后,观察组NGF水平高于对照组,NSE、Caspase3、MBP水平低于对照组,收缩期峰值流速和舒张末期流速快于对照组,但阻力指数与对照组比较.治疗7、28天后,观察组患儿NBNA评分高于对照组.结果说明,神经节苷酯治疗HIE可促进患儿临床症状的恢复,改善神经相关因子表达水平和脑血流动力学参数,减轻脑神经损伤程度.

目的 比较枸橼酸咖啡因与氨茶碱治疗早产儿原发性呼吸暂停的临床效果及安全性.方法 选择2016年5月至2017年5月我院收治的原发性呼吸暂停早产儿为研究对象,随机分为两组,分别采用枸橼酸咖啡因注射液治疗(咖啡因组)以及氨茶碱注射液治疗(氨茶碱组).比较两组患儿的呼吸暂停次数、有创机械通气及无创机械通气时间、吸氧时间以及心动过速血压下降、喂养不耐受、高血糖的发生率.结果 治疗7d后,咖啡因组患儿72 h内平均呼吸暂停次数、无创机械通气时间、有创机械通气时间、吸氧时间显著少于或短于氨茶碱组,差异有统计学意义(P＜0.05).咖啡因组患儿心动过速的发生率(19.2％)显著低于氨茶碱组(30.3％),差异有统计学意义(P＜0.05);两组患儿血压下降、喂养不耐受、高血糖的发生率比较,差异无统计学意义(P＞0.05).结论 枸橼酸咖啡因治疗早产儿呼吸暂停的疗效以及治疗安全性均高于氨茶碱治疗.

Due to the improvement of infant survival rates,Candidas have been proved to be the third most common pathogen of late-onset sepsis in NICU,and invasive fungal infection of high-risk infants is in-creasing attention. As the diagnosis is difficult,treatment is often delayed,high mortality and severe disability are also caused,it's becoming a research hot spot to assess whether antifungal prophylaxis is beneficial. Now a number of studies have been performed to discuss the prophylactic role of fluconazole and nystatin,but has not yet reached a consensus. This review described the influence of chemoprophylaxis on fungal infection, colonization and drug resistance.

Congenital central hypoventilation syndrome,also known as “Ondine′s curse”,is charac-terized by hypoventilation during sleep and impaired ventilatory responses to hypercapnia and hypoxemia. This disorder is associated with a malfunction of the nerves that control involuntary body functions and abnor-mal development of early embryonic cells that form the spinal cord. This review summarized the latest pro-gression in the pathogenesis,clinical symptoms,diagnosis,treatment and prognosis.

患儿,男,生后7d,主因“抽搐2次”入院.G1P1,胎龄40周,于2013年10月12日因“产程延长”于当地医院剖宫产,出生体重4 500 g,有窒息,Apgar评分1min7分,出生后给予吸氧,5min 8分.羊水清亮,无胎膜早破,胎盘脐带未见异常.生后12 h开奶.出生后,当地医院给予“抗感染、输液”治疗.于10月18日出现呛奶2次,家属诉患儿口周发绀,存在抽搐.为求进一步诊治,转入我院.门诊以“新生儿惊厥”入院.母亲24岁,血型A型RH阳性.孕期有感冒,给予药物治疗(具体不详).孕3个月时因阴道流血保胎治疗(口服黄体酮).正规产检.长期接触油漆.无家族性传染病及遗传病病史.

Neonatal fungal infections include superficial skin infections and deep fungal infections.Fungal infection is more common during the neonatal period,which is related with newborns(especially premature children),low birth weight and immune dysfunction.In addition,long-term application of broad-spectrum antibiotics and adrenal corticosteroids also induce fungal infections.Severe or disseminated fungal infection can lead to serious illness and even death.Neonatal fungal infections usually show no special clinical manifestations,and can thus result in the delayed diagnosis and treatment.This article discussed the pathogenic species of fungal infection and the risk factors.

<正>新生儿持续肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)指生后肺血管阻力持续性增高,肺动脉压超过体循环动脉压,使由胎儿型循环过渡至正常"成人"型循环发生障碍,引起

1临床资料患儿,男,生后8d,因"反应欠佳2d"入院.第8胎第7产,胎龄37周,2011年02月04日自然分娩于当地医院.体质量3100 g,无窒息史,Apgar评分不详,胎盘老化,羊水及脐带未见异常.生后10 h开奶,10 mL,混合喂养,二便于生后24h内解.否认家族遗传病史.母亲孕期健康.父母体健、非近亲结婚.第1胎女孩,16岁,健康;第2胎至第5胎均生后10～20 d不明原因死亡;第6胎女孩6岁,健康;第7胎孕7月药流.患儿入院前2d出现反应欠佳,易睡,就诊我院.无发热、无咳嗽、气促、呕吐、腹泻、抽搐等.