新生儿室管膜下囊肿的影像表现分型及危险因素分析

目的 探讨新生儿室管膜下囊肿(SEC)的影像表现分型及危险因素.方法 回顾性分析经MR检查(16例)或超声检查(26例)诊断为新生儿SEC的临床资料共42例(SEC组),并选择健康新生儿42名作为对照组.根据SEC发生位置进行分型,并进行统计学分析.结果 根据SEC发生位置可分为前角型、体旁型(包括凸向室内及室外脑白质)及后角型3型,其中体旁型25例,前角型15例,后角型2例.缺氧缺血及感染是新生儿发生SEC的有统计学意义的危险因素(P均<0.05).前角型缺氧缺血的发生率明显高于体旁型[86.67%(13/15), 52.00%(13/15), χ²=4.95, P=0.03] ;前角型及体旁型中感染因素发生率差异无统计学意义[60.00%(9/15), 44.00%(11/25), χ²=0.96, P>0.05].2例后角型均存在缺氧缺血及感染因素.结论 围生期缺氧缺血及感染是新生儿SEC形成的主要诱发因素,且缺氧缺血与前角型的发生密切相关.     

颅脑超声评价新生儿脑发育与孕周、出生体质量的相关性

目的 探讨颅脑超声评价新生儿脑发育的价值。方法 选择我院新生儿重症监护室的135例新生儿,均于出生当天行颅脑超声检查,测量胼胝体矢状长度和小脑蚓部矢状长度,分析孕周和出生体质量对新生儿胼胝体及小脑蚓部发育的影响。结果 早产儿、足月儿出生时平均胼胝体矢状长度分别为（39.18±2.53）mm、（41.62±3.28）mm,差异有统计学意义（t=4.87,P<0.05）;小脑蚓部矢状长度分别为（19.03±2.00）mm、（20.91±2.29）mm,差异有统计学意义（t=5.05,P<0.05）。新生儿胼胝体矢状长度与孕周、出生体质量均呈正相关（r_s=0.45、0.51,P均< 0.05）;小脑蚓部矢状长度与孕周、出生体质量均呈正相关（r_s=0.42、0.46,P均< 0.05）;胼胝体矢状长度与小脑蚓部矢状长度呈正相关（r_s=0.43,P<0.05）。结论 颅脑超声可动态观察新生儿颅内结构及胼胝体和小脑蚓部发育情况,为临床干预提供可靠依据。     

高危新生儿脑室周围-脑室内出血的超声诊断与分析

目的 观察高危新生儿脑室周围-脑室内出血(PIVH)的超声表现与相关临床因素,评价颅脑超声诊断PIVH的价值。方法 对1768例高危新生儿进行床旁颅脑超声检查,对影像资料进行分析。结果 检出91例PIVH患儿,其中早产儿占68.13%(62/91),低体质量儿占53.85%(49/91)。早产儿中,胎龄32~37周者重度PIVH(Ⅲ级及Ⅳ级PIVH)占13.33%(6/45),胎龄<32周者重度PIVH占41.18%(7/17),二者比较,差异有统计学意义(P=0.04)。低体质量儿中,出生体质量1.5~2.5 kg者重度PIVH占8.82%(3/34);出生体质量<1.5 kg者重度PIVH占40.00%(6/15),二者比较,差异有统计学意义(P=0.03)。结论 胎龄越小、出生体质量越低,重度PIVH发生率越高。对高危新生儿进行常规颅脑超声筛查是一项有效、可行的检查手段。     

腹部X线检查在新生儿坏死性小肠结肠炎分型及预后中的价值

目的 探讨腹部X线检查在新生儿坏死性小肠结肠炎（NEC）分型及预后中的价值。方法 收集58例确诊新生儿NEC的患儿，根据临床转归将患儿分为轻症组（n=31）和重症组（n=27）。比较2组患儿腹部X线影像表现。结果 2组间胎龄、患病日龄、性别、胎数、生产方式的差异均无统计学意义（P均>0.05）；重症组出生体质量低于轻症组（P<0.05），极低体质量儿例数多于轻症组（P<0.05）；患儿门静脉积气和固定肠袢发生率均高于轻症组（P均<0.05）；2组间肠壁积气形态差异有统计学意义（P<0.05）。结论 腹部X线检查可有效辅助诊断NEC、分型；尤其对肠坏死和肠穿孔的判定及治疗具有指导价值。     

新生儿体质量对初产妇耻骨直肠肌弹性和形态的影响

目的 探讨新生儿体质量对初产妇耻骨直肠肌（PR）弹性和形态的影响。方法 收集产后6~8周的65名足月单胎且经阴道自然分娩的初产妇,根据新生儿出生体质量将其分为新生儿体质量正常组（A组,新生儿体质量为2.5~<4.0 kg,n=50）和巨大儿组（B组,新生儿体质量≥ 4.0 kg,n=15）。收集同期健康未育女性60名为对照组。分别于静息及最大收缩状态下以腔内超声测量PR前部的厚度,以剪切波弹性成像技术（SWE）测量PR前部的杨氏模量,并分别计算差值。比较3组间PR厚度和杨氏模量的差异。结果 A组、B与对照组间静息和最大收缩状态下双侧PR厚度及收缩前后差值、杨氏模量及收缩前后差值总体差异均有统计学意义（P均<0.05）,且对照组、A组、B组依次减低,两两比较差异均有统计学意义（P均<0.05）。结论 初产妇产后PR的弹性和形态同步改变;妊娠和分娩巨大儿更易造成初产妇PR弹性降低,厚度变薄,收缩功能减低。     

床旁肺部超声诊断新生儿胎粪吸入综合征

目的 观察床旁肺部超声检查（LUS）诊断新生儿胎粪吸入综合征（MAS）的价值。方法 收集56例MAS新生儿（MAS组）和70名健康新生儿（对照组）,对比2组临床资料及床旁LUS表现。结果 MAS组与对照组新生儿性别、年龄、体质量及出生情况差异均无统计学意义（P均>0.05）。对照组新生儿LUS示胸膜线呈光滑清晰的线状强回声,随呼吸运动而水平滑动;A线呈线状强回声,彼此平行、间隔相等;每个肺野未见或仅见1~2条B线;未见胸腔积液或肺实变等异常征象。MAS组LUS均见双肺散在大小不等、边界不清的中低回声及点状或线状高回声,即肺实变伴支气管充气征;部分患儿胸膜线消失或增厚、模糊,肺部实变区未见A线,非实变区可见多条B线;8例（8/56,14.29%）可见肺实变伴肺搏动征,8例（8/56,14.29%）存在胸腔积液。结论 床边LUS可用于诊断新生儿MAS;超声发现双肺实变伴支气管充气征高度提示新生儿MAS。     

1H-MRS评价新生儿缺氧缺血性脑病

目的 探讨¹H-MRS评价新生儿缺氧缺血性脑病（HIE）的价值。方法 收集经临床确诊的足月HIE患儿30例（HIE组）和无神经系统异常新生儿16例（对照组）。于出生后22天内行头颅¹H-MRS扫描,分别计算胆碱/肌酸（Cho/Cr）、N-乙酰天门冬氨酸/肌酸（NAA/Cr）、N-乙酰天门冬氨酸/胆碱（NAA/Cho）、乳酸/肌酸（Lac/Cr）比值,并进行统计学分析。结果 与对照组比较,HIE组Lac/Cr升高（P<0.05）,NAA/Cr,NAA/Cho均降低（P均<0.05）,Cho/Cr差异无统计学意义（P>0.05）。多因素Logistic回归分析结果示NAA/Cr、Lac/Cr是HIE的独立危险因素（P均<0.05）。结论 ¹H-MRS可客观反映HIE患儿缺氧缺血后代谢变化,更好地评价脑损伤的严重程度,有助于HIE的早期诊断及治疗。     

对比不同超声估重公式预测巨大胎儿体质量

目的 观察不同超声估重（SFEW）公式预测巨大胎儿的准确率，分析其影响因素。方法 回顾629例巨大儿，根据体质量分为A组和B组；将产前超声所测双顶径（BPD）、头围（HC）、腹围（AC）及股骨长（FL）代入不同公式，比较SFEW预测值与出生后实测值的差异。结果 不同估算公式SFEW测值均明显低于实测值（P均<0.001），其中Hadlock公式预测值与实测值的差异最小；产前超声生物学测值与出生后实测体质量及身长低度相关（r_s<0.50）。B组身长、体质量指数（BMI）及各超声生物学测值均明显大于A组（P均<0.05）；不同公式计算B组误差均明显大于A组（P均<0.05）。结论 SFEW有效可行，但易低估胎儿体质量，各公式参数不能充分体现巨大胎儿躯干外脂肪分布差异对体质量的影响可能是原因之一。     

高频超声诊断婴儿发育性髋关节发育不良

目的 探讨高频超声对发育性髋关节发育不良（DDH）的诊断价值,并分析DDH发生的相关影响因素。方法 对3个民族（汉族、回族、维吾尔族）共1 674例临床疑诊DDH婴幼儿的双侧髋关节行临床和超声检查,比较其对DDH的检出率,分析患儿相关资料,包括性别、民族、侧别、分娩方式、胎方位、羊水量、胎次、出生体质量、胎龄、首次超声检查月龄、母亲妊娠年龄等因素与DDH发生的相关性。结果 超声对DDH的检出率为12.39%（415/3 348）,临床检查的检出率为11.47%（384/3 348）,差异有统计学意义（χ²=2 510.037,P<0.001）。左侧髋关节（13.38%）与右侧髋关节（11.41%） DDH发生率差异有统计学意义（P=0.047）。多因素关联性分析结果显示,侧别、分娩方式、胎方位、羊水量、出生体质量、孕周、首次超声检查时间、母亲妊娠年龄均与DDH发生具有相关性（P均<0.05）,其中羊水量与DDH发生呈中等程度相关（φ=0.469）,而民族、性别和胎次与DDH发生无明显相关（P均>0.05）。结论 高频超声有助于早期评估和随访婴幼儿髋关节发育状况,对临床早期诊断、治疗DDH有重要作用。     

产前超声评估先天性膈疝预后

目的 探讨产前超声在先天性膈疝预后评估中的应用价值。方法 分析65例出生后经手术或随诊证实为先天性膈疝的胎儿的产前超声声像图特征,测量胎儿健侧肺的肺头比（LHR）、与该孕周正常胎儿的LHR进行比较,计算O/E LHR,探讨其与新生儿预后的关系。结果 65例中,45例出生后行手术治疗后存活,8例手术后死亡,12例未行手术即死亡,总死亡率30.77%（20/65）。肝上型膈疝死亡率66.67%（8/12）;肝下型膈疝死亡率22.64%（12/53）。合并其他结构异常共9例,死亡8例,其中6例合并胸腔内结构异常。LHR为0.40~2.72,平均1.59±0.69;不同LHR膈疝胎儿出生后死亡率差异有统计学意义（χ²=19.360,P<0.001）,LHR≤1.0的膈疝胎儿出生后死亡率高于LHR>1.0的膈疝胎儿。O/E LHR为23%~90%,平均（58.25±17.61）%,不同O/E LHR膈疝胎儿出生后死亡率差异有统计学意义（χ²=15.261,P=0.002）,O/E LHR≤45%的膈疝胎儿出生后死亡率高于O/E LHR>45%的膈疝胎儿。结论 产前超声可用于诊断胎儿先天性膈疝,并评估健侧肺的发育情况及患儿预后。     

Adrenomedullin increases in term asphyxiated newborns developing intraventricular hemorrhage

OBJECTIVES: Adrenomedullin (AM) is a newly discovered vasodilator peptide that participates in the regulation of cerebral blood flow. The aim of this study was to investigate whether circulating AM was increased in infants with prenatal asphyxia who developed intraventricular hemorrhage (IVH). DESIGN AND METHOD:: A case-control study was performed on 40 full-term asphyxiated newborns: 20 developed IVH (group A) and 20 did not (group B). Forty term healthy newborns represented the control group. Biochemical laboratory parameters, neurological patterns, cerebral ultrasound scanning, and Doppler velocimetry were assessed at 12 and 72 h from birth. Plasma AM concentration was measured at 12 h from birth by means of a specific RIA. RESULTS: AM levels were significantly higher in group A (20.2 +/- 5.2 fmol/ml) than in group B (8.4 +/- 2.1 fmol/ml) or controls (9.3 +/- 2.6 fmol/ml). In asphyxiated newborns, AM concentration was correlated with middle cerebral artery PI value only in group B. CONCLUSIONS: Increased concentration of AM at 12 h from birth in asphyxiated newborns who later developed IVH suggests that this peptide may participate in the loss of cerebral vascular autoregulation in response to hypoxia and could be useful to discriminate, among newborns at risk, those with an adverse neurological outcome.     

Increased plasma concentrations of activin a predict intraventricular hemorrhage in preterm newborns

BACKGROUND: Intraventricular hemorrhage (IVH) is a major cause of neurologic disabilities in preterm newborns. We evaluated the use of plasma activin A concentrations to predict the development of perinatal IVH. METHODS: We measured nucleated erythrocyte (NRBC) counts, plasma activin A, hypoxanthine (Hyp), and xanthine (Xan) in arterial blood samples obtained from 53 preterm infants during the first hour after birth. Cerebral ultrasound was performed within 48 h of birth and repeated at 5- or 6-day intervals until the age of 4 weeks. RESULTS: Grade I or II IVH was detected during the first 10 days of life in 11 of 53 patients (21%). Activin A, Hyp, and Xan concentrations and NRBC counts were higher in preterm newborns who subsequently developed IVH than in those who did not (P<0.0001, except P=0.019 for Xan). Neonatal activin A was correlated (P<0.0001) with Hyp (r=0.95), Xan (r=0.90), and NRBC count (r=0.90) in newborns without later IVH and in those who developed IVH (Hyp, r=0.89, P=0.0002; Xan, r=0.95, P<0.0001; NRBC count, r=0.90, P=0.0002). At a cutoff of 0.8 microg/L activin A, the sensitivity and specificity were 100% [11 of 11; 95% confidence interval (CI), 71%-100%] and 93% (39 of 42; 95% CI, 81%-98%), and positive and negative predictive values were 79% (95% CI, 61%-100%) and 0% (95% CI, 0%-2%), respectively. The area under the ROC curve was 0.98. CONCLUSIONS: Activin A concentrations at birth are increased in preterm newborns who later develop IVH and may be useful for early identification of infants with hypoxic-ischemic brain insults who are at high risk for IVH.     

产前超声诊断胎儿冠状动脉代偿性扩张

目的 探讨产前超声诊断胎儿冠状动脉代偿性扩张（CACD）的临床价值。方法 回顾性分析经出生后超声心动图检查或引产后尸检证实的17胎CACD胎儿，观察其产前超声声像图特征，随访妊娠结局。结果 17胎CACD左右CA均受累，15胎于晚孕期、2胎于中孕期获得诊断，均伴不同程度血流动力学异常；其中10胎存在不同程度水肿，7胎伴Galen静脉瘤；8胎生长发育受限；8胎伴结构畸形。17胎中，8胎引产，3胎胎死宫内；6胎经紧急剖宫产出生，其中2例早产儿于出生1周内夭折，4名为健康足月儿。结论 产前超声可诊断胎儿CACD，并及时预警胎儿宫内缺氧。     

High maternal blood S100B concentrations in pregnancies complicated by intrauterine growth restriction and intraventricular hemorrhage

BACKGROUND: Intrauterine growth restriction (IUGR) is associated with perinatal mortality and with neurologic damage from intraventricular hemorrhage (IVH). We investigated whether S100B, a neural protein found in high concentrations after cell injury in the nervous system, is increased in serum of women whose pregnancies are complicated by IUGR and whose newborns develop IVH. We also explored the prognostic accuracy of maternal serum S100B for IVH in the newborn. METHODS: We conducted a case-control study of 106 pregnancies complicated by IUGR, including a subgroup (n = 26) who developed IVH after birth, and 212 unaffected pregnancies matched for gestational age. Ultrasound examination, Doppler velocimetry patterns (in the utero-placental vessels and middle cerebral artery), and maternal blood collection were performed before birth; cerebral ultrasound and neurologic examinations were performed after birth. RESULTS: S100B was higher (P <0.001) in IUGR pregnancies complicated by IVH than in those that were not and in controls. At a cutoff of 0.72 microg/L, sensitivity was 100% [95% confidence interval (95% CI), 87%-100%] and specificity was 99.3% (97.5%-99.9%) for prediction of IVH (area under the ROC curve, 0.999). The prevalence of IVH was 8.2% in the whole study population, 93% (95% CI, 83.6%-100%) in those with maternal S100B >0.72 microg/L, and 0% (0%-2.5%) in those with maternal S100B <0.72 microg/L. CONCLUSION: For prediction of IVH, measurements of maternal S100B may be useful at times before clinical, laboratory, and ultrasound patterns can identify risk of IVH.     

超声心动图评估新生儿出生72 h内肺动脉压力生理性变化

目的 采用超声心动图评估新生儿出生后72 h内肺动脉压力的生理性变化。方法 对76名正常新生儿分别于出生后2、6、12、24、48、72 h进行超声心动图检查,并于各时间点超声检查后测量新生儿上肢肱动脉血压。采用大血管压差法估测肺动脉收缩压（PASP）、肺动脉舒张压（PADP）,计算平均肺动脉压（PAMP）,并确定其出生后各时间点PASP的95%参考值范围上限。结果 出生24 h后,76名新生儿开始出现动脉导管生理性闭合,至72 h时72名闭合,4名未闭。出生后2 h动脉导管内均为双向分流;24 h后均为单纯左向右分流。新生儿出生后随时间延长,肺动脉压力逐渐降低,各时间点PASP、PADP、PAMP差异均有统计学意义（P<0.05）。各时间点PASP的95%参考值范围上限分别为：出生后2 h 88.52 mmHg,6 h 80.70 mmHg,12 h 67.38 mmHg,24 h 57.25 mmHg,48 h 49.20 mmHg,72 h 43.15 mmHg。结论 正常新生儿出生后肺动脉压力呈进行性下降趋势,72 h仍超出成人正常水平（PASP<30 mmHg）。     

Factors associated with low fifth minute Apgar score in term and preterm singleton live births in a Ghanaian hospital

IntroductionApgar score remains the most effective measure of newborn health outcomes in the first few minutes of delivery and it is useful in diagnosing perinatal asphyxia and metabolic acidosis.MethodsThis retrospective cross-sectional study was conducted on 3011 women at the Baptist Medical Centre in the North East Region of Ghana. Binary logistic regression models were used to determine the factors associated with low fifth minute Apgar score.ResultsThe majority of the newborns weighed 2.5 kg or more at birth (90.7%), were delivered through the vagina (79.8%), and a little over half of them (51.40%) were males. We found evidence that delivery at less than 37 weeks gestation, birth weight of less than 2.5 kg, and caesarean delivery were associated with increased odds of low fifth minute Apgar score. For infants born at term, being born to a multigravid mother was protective against low fifth minute Apgar score while delivery through caesarean section increased the odds of low fifth minute Apgar score among this group of newborns. Among preterm infants, our study found strong evidence that those born with low birth weight (<2.5 kg) had about 4 times the odds of suffering low fifth minute Apgar score compared to those with normal birth weight.ConclusionIn designing interventions to improve the survival and the Apgar score of newborns, measures to properly diagnose and prevent preterm delivery and low birth weight should be of great concern.     

Chemokine CCL18 predicts intraventricular hemorrhage in very preterm infants

Abstract

Background. Intraventricular hemorrhage (IVH) in very preterm infants is a common disease associated with long-term consequences. Risk factors of IVH remain to be further defined.

Aims. To determine whether specific immunoproteins at birth predict the risk of IVH and whether their receptors are localized at the bleeding site.

Methods. A prospective cohort consisted of 163 infants born before 32 weeks of gestation. Altogether 107 cord blood immunoproteins and 12 cytokines from peripheral blood obtained 1 and 7 days after birth were analyzed. Serial brain ultrasounds were assessed. Immunohistochemistry of a chemokine receptor from 14 autopsies was studied.

Results. Low levels of cord chemokine CCL18 (chemokine (C-C motif) ligand 18) robustly predicted the risk of IVH grade II–IV when ante- and neonatal risk factors were considered. Cord CCL18 increased from 32 weeks to term. During the first week after very preterm birth CCL18 increased as the risk of new IVH cases decreased. CCL18 receptor, CCR3, was detectable in choroid plexus, periventricular capillary endothelium, ependymal cells, and in germinal matrix.

Conclusion. Low cord blood CCL18 is an independent risk factor of IVH. CCL18 may inhibit signal transduction of its receptor in periventricular cells. Defining the function and regulation of CCL18 may help to decrease the risk of IVH.     

乙型肝炎病毒感染母亲的新生儿免疫预防后远期保护效果

目的:探讨母亲感染乙型肝炎病毒(HBV)后,新生儿免疫预防措施及远期保护效果。方法:选择2013年1月至2014年12月定期产检并顺利分娩的240例HBV感染孕产妇及其新生儿(240例)作为研究对象。将接受免疫预防措施的120例孕产妇及其新生儿作为观察组,将未接受免疫预防措施的120例孕产妇及其新生儿作为对照组。比较2组新生儿HBV感染率,出生时、出生1年后乙型肝炎表面抗体(HBsAb)阳性率。随访5年,根据新生儿免疫预防效果,将母亲分为免疫成功组和失败组,分析影响免疫预防效果的因素。结果:观察组新生儿HBV感染率为0,低于对照组的16.67%(P0.05);出生时、出生1年后,观察组新生儿HBsAb阳性率分别为22.50%、96.67%,高于对照组(5.00%、78.33%,P0.001);观察组5年内加强接种乙肝疫苗率为26.67%,低于对照组(55.00%,P0.001)。免疫成功组与失败组母亲血清乙型肝炎病毒e抗原(HBeAg)滴度、HBV-DNA浓度、是否使用抗病毒药物、病毒变异情况差异均有统计学意义(P0.05)。结论:同时给予HBV感染孕产妇及其新生儿乙型肝炎免疫球蛋白(HBIg)、乙肝疫苗预防HBV母婴传播,可有效降低新生儿感染HBV风险,提高HBsAb阳性率,获得远期保护效果。     

早产儿脑室内出血的超声诊断

目的探讨早产儿脑室内出血（IVH）发生的影响因素,以及床旁颅脑超声检查对IVH的诊断价值。方法对171例早产儿进行床旁头颅超声检查,IVH的轻重程度按照Papile分级法分级,将胎龄、出生体重、Apgar评分等因素与总IVH发生率以及出血程度进行相关对比研究。结果早产儿IVH的发生率为61．4％,胎龄≤32周的总IVH发病率以及重度IVH发生率明显高于胎龄〉32周的患儿（P〈0．05）。出生体重≤1500g的患儿重度IVH发生率明显增高（P〈0．05）。Apgar评分与总IVH发生率以及出血程度组间比较无明显差异,但总IVH及重度IVH发生率随评分增高有递减趋势。结论早产儿IVH发生率较高,胎龄越小,出生体重越轻,IVH发生率越高,出血程度越重。早产儿在出生3d内常规进行床旁颅脑超声检查十分必要,利于早期诊断和及时治疗。     

Delayed diagnosis of critical congenital heart defects predicting risk factors and survival rate in newborns in Beijing: a retrospective study

ObjectiveTo assess the prevalence and survival rate of newborns with a delayed diagnosis of critical congenital heart defects (CCHD) in Beijing.MethodsThis retrospective study analysed data from births between 2010 and 2017 from the Birth Defects Monitoring Network in Beijing. Newborns with CCHD were analysed according to seven categories. Statistical analyses were used to calculate the mortality rate within the first week (days 0–6) after live birth. Multivariate logistic regression analysis of survival was performed to analyse the potential risk factors for newborn mortality.ResultsA total of 1 773 935 perinatal newborns were screened in Beijing and 1851 newborns were diagnosed with CCHD, showing a prevalence of 10.43 per 10 000. Among the total 1851 CCHD patients, the majority (1692 of 1851; 91.41%) were identified through prenatal diagnosis, 104 of 1851 (5.62%) were diagnosed before obstetric discharge/transfer and 55 of 1851 (2.97%) were identified through delayed diagnosis. The prevalence of CCHD in newborns was 1.96 per 10 000 births. Multivariate logistic regression analysis of survival demonstrated that gestational age at delivery was the only risk factor for death within the first week after birth.ConclusionsWithin the first week after birth, gestational age was the only risk factor for death in newborns with CCHD.