新生儿先天性喉囊肿2例并文献复习

先天性喉囊肿是导致新生儿气道阻塞的原因之一,发病率为1.82/10万～3.49/10万,其中50%是在窒息死亡患儿的尸检中发现的。对本病认识不足可导致病情延误,甚至导致新生儿死亡。报告中国人民武装警察部队特色医学中心分娩的2例新生儿先天性喉囊肿病例。新生儿出生后发生原因不明的窒息、低Apgar评分且复苏效果欠佳时,除外产科因素的同时,还应考虑先天性喉囊肿致新生儿呼吸道阻塞的可能,建议行喉镜检查,紧急情况下可采取囊肿穿刺抽液以在最短时间内缩小囊肿体积,缓解呼吸困难的危重情况,为下一步治疗赢得时机。     

“中国新生儿窒息复苏培训项目”在京开幕

新生儿窒息是导致新生儿死亡、脑瘫和智力障碍的主要原因之一，世界卫生组织1994年的统计数字表明，全球每年500万的新生儿死亡中约有100万死于新生儿窒息，即新生儿窒息导致的死亡已经占到了婴儿死亡的20％～30％。在中国，2002年全国妇幼卫生监测结果显示，婴儿死亡率为29．2‰，新生儿窒息已成为我国5岁以下儿童的第二大致死原因。正确并及时地对有窒息的新生儿进行复苏抢救，是减     

为降低我国新生儿窒息的死亡率和伤残率而努力

新生儿窒息是导致全世界新生儿死亡、脑瘫和智力障碍的主要原因之一。据世界卫生组织2005年的统计数字表明，每年400万的死亡新生儿中约有100万死于新生儿窒息，亦即新生儿窒息导致的死亡已经占到了婴儿死亡的1／4。在中国，根据我国妇幼卫生监测显示：2005年新生儿死亡率为19．0‰。前三位的死因为：早产和低体重、窒息、肺炎，窒息占第2位。[第一段]     

自由呼吸 生命之源——中国新生儿窒息复苏培训项目启动

新生儿窒息是导致全世界新生儿死亡、脑瘫和智力障碍的主要原因之一。世界卫生组织1994年的统计数字表明，全世界每年500万的新生儿死亡中，约有100万死于新生儿窒息。2002年全国妇幼卫生监测结果显示，婴儿死亡率为29．2‰。新生儿窒息已成为我国5岁以下儿童的第二大致死原因。据世界卫生组织1997年报告，大多数新生儿窒息死亡和致残，可以通过出生后第一时间内的适当复苏抢救而减少。     

新生儿窒息复苏及其培训存在问题和防治对策

2000年全球＜5岁儿童死亡1080万，其中＜28d新生儿390万。42个发展中国家占全球＜5岁死亡数的90％，33％(29％～369／5)为新生儿，在经济欠发达国家中新生儿窒息为新生儿死亡第一位原因，占29％。目前新生儿窒息仍是我国围产儿死亡的主要原因，近年来由于产儿科进一步合作，产科     

窒息新生儿细胞因子的变化及其与预后的关系

新生儿窒息及其所引起的缺氧缺血性脑病(hypoxic-is-chemic encephalopathy,HIE)是导致新生儿脑损伤及急性死亡的常见原因,也是造成儿童神经系统损伤的主要原因之一。国内报道新生儿窒息的发病率约为7%~10%[1]。窒息后导致脑损伤的机制尚未完全明确,可能与能量代谢衰竭、氧自由     

新生儿窒息56例分析

目的：探讨新生儿窒息的原因,并寻找预防措施。方法：通过分析我院56例窒息新生儿的临床资料,进行总结。结果：中度窒息50例,占89．3％,重度窒息6例,占10．7％。新生儿死亡3例（5．36％）。胎儿窘迫,脐带因素是导致新生儿窒息的主要原因,其次是羊水过少、巨大儿等。结论：做好孕检,重点监护高危孕妇,适时终止妊娠,胎儿娩出后做好新生儿窒息的急救,可降低新生儿窒息发生率。     

围产期低氧症与新生儿脑病

围产期胎儿、新生儿的低氧症由于低氧状态的程度和持续时间不同,最终可导致脑的微小障碍乃至胎儿、新生儿死亡等多种病症。已知即使在妊娠初期、器官形成期避免流产,仍会造成各种先天性畸形。在妊娠中期以后,会引起胎儿发育障碍、胎儿窒息、胎儿宫内死亡,在分娩期则会引起胎儿、新生儿窒息、胎儿宫内死亡。此外,重症胎儿窒息、新生儿窒息病例和新生儿期的低氧症即使得以救治,还会遗留程度不同的中枢神经系统异常导致的后遗症。     

新生儿窒息复苏后管理

新生儿窒息是当今引起新生儿死亡和影响儿童生存质量的主要因素,是导致全世界新生儿死亡、脑性瘫痪和智力低下的主要原因之一.Ambalavanan 等[1]报道,估计全世界每年400万新生儿死亡中有23%、死亡年龄＜5岁的儿童中有8%与出生时窒息有关.     

围产期窒息

围产期窒息李莪，翁梨驹窒息是造成围产儿死亡及新生儿病率的重要原因之一。可引起新生儿脑瘫及其后智力发育迟缓。窒息及其对器官的损伤可发生在产前及产时，新生儿窒息及并发症为宫内窒息的生后临床表现，因此，提出围产期窒，急（ｐｅｒｉｎａｔａｌａｓｐｈｙｘｉａ）...     

Antenatal detection of a congenital pancreatic cyst.

Congenital pancreatic cyst is very rare. Antenatal detection can potentially decrease the neonatal morbidity because the appropriate preparation can be made in advance of delivery. We report a case of congenital pancreatic cyst detected prenatally by routine obstetric sonography in a fetus at 33 weeks' gestation. The cyst, located at the pancreatic tail, was excised at the age of 10 days. Pathology results confirmed a pancreatic cyst. Differential diagnosis of cystic abdominal lesions occurring in utero should include congenital pancreatic cyst.     

Congenital laryngeal cyst: benefits of prenatal diagnosis and multidisciplinary perinatal management

Congenital laryngeal cysts are rare and can cause upper airway obstruction if they are misdiagnosed. We describe a case of large vallecular cyst diagnosed at 33 weeks of gestation. The purpose of an early diagnosis is to establish a careful perinatal management. If the airway is compromised, a multidisciplinary medical team is necessary to perform emergency immediate tracheostomy. Elective delivery should be always carried out in a tertiary referral center.     

先天性巨细胞病毒感染脑损伤及康复治疗研究

目的探讨先天性巨细胞病毒(CMV)感染对患儿脑功能的影响及脑康复治疗的疗效。方法以2004年1月至2007年11月在中南大学湘雅二医院新生儿科住院的81例先天性CMV感染患儿为研究对象，在用更昔洛韦治疗的同时，对其进行新生儿行为神经测试(NBNA)、头颅CT或MRI检测及听力检查。部分患儿在脑康复治疗后复查了NBNA测试。结果81例患儿中，NBNA评分异常率为43.03%(34/79)；29例患儿康复治疗后NBNA评分提高，差异有统计学意义。头颅影像学检查异常率为46.27%(31/67)，影像学异常表现为脑实质灶性坏死或脑软化灶、脑发育迟缓、脑实质出血、脑室周围钙化及脑积水。听力筛查未通过率为50.68%(37/73)，确诊听力障碍4例。结论先天性CMV感染易导致脑损伤，对患儿早期进行脑功能监测并给予康复治疗有助于改善其预后。     

Obstruction of the neonatal airway from teratomas

Most neonates with cervical or oral-pharyngeal teratomas have airway obstruction and an obvious mass. In previous reports, obstruction of the airway had caused 49 deaths in 164 newborns with cervical teratomas and five deaths in 24 newborns with oral-pharyngeal teratomas. Most were reported before the era of prenatal ultrasound. Cervical and oral-pharyngeal teratomas can now be diagnosed prenatally to allow preparation for the neonatal airway obstruction that so often occurs. Three infants with cervical teratomas, one infant with an oral-pharyngeal teratoma and one with a combined cervical and oral-pharyngeal teratoma were born in Phoenix over a one year period of time, and all had airway obstruction. These five patients demonstrated the value of prenatal planning and prompt postnatal surgical care by an ultrasonographer, a perinatologist, a neonatologist, maternal and pediatric anesthesiologists and a pediatric surgeon.     

Organization of neonatal care services and its importance

Universally 4 million newborns die and another 4 million are stillborn every year. 98% of these neonatal deaths take place in the developing countries. Looking at the state of the world's newborns one can see that neonatal mortality rate is about 4-5 per 1000 in the developed countries and nearly 10 fold this in the developing world. Causes that underlie these newborn deaths differ according to a country's development rank. According to the WHO estimates for the year 2001, newborns die due to infections (32%), birth asphyxia and trauma (29%), prematurity (24%) and congenital anomalies (10%), mostly in the developing countries. When organizing neonatal care services in a country or a region, priorities should be decided by looking at neonatal and perinatal mortality rates and causes of neonatal and perinatal deaths. Causes of neonatal and perinatal deaths in the developing countries have been documented and reflect some common underlying problems in the health systems. Starting points in the organization of neonatal health care services seem to include: improving women's health and social status, family planning practices, antenatal care and safe delivery conditions. Attention should also be paid to neonatal resuscitation, essential newborn care and sick newborn care practices. Communities and health professionals should be advocates of newborn health in order to seek and deliver newborn health care. Existing health systems should be re-organized to host regionalized perinatal care.     

Prenatal diagnosis and management of some fetal intrathoracic abnormalities

Nine cases of fetal intrathoracic anomalies detected in utero and followed to birth are reviewed. There were 6 congenital diaphragmatic hernias (CDH), one congenital pleural effusion and two isolated cysts of the lung. All these conditions were potentially responsible for neonatal respiratory distress and received early intensive treatment after maternal transport and delivery had been arranged in a center with thoracic surgical facilities available. The risks of a delayed or missed diagnosis were thus avoided, especially for CDH. Despite intensive, traditional, respiratory support, started in the delivery room, mortality among prenatally detected cases of CDH was paradoxically high (83%), compared to mortality among 7 cases of CDH not detected in utero, referred in the same period to our Institution, and symptomatic within 6 h from birth (63%). With prenatal diagnosis the total number of CDH cases referred to a surgical center before birth increases. Many cases which would never have been treated in the past because of death before referral and treatment for severe pulmonary hypoplasia not compatible with life are thus observed and sometimes treated. Nevertheless, lung development continues to be a determining factor for survival even when intensive treatment at birth is available. Responsiveness to therapy is unpredictable before birth and proposed antenatal treatment is still far from being a realistic option. For the other three newborns, where a pleural effusion and pulmonary cysts were found, prenatal diagnosis helped to start appropriate treatment and to prevent neonatal hypoxia in two of them. In the third case, with an incommunicant, isolated pulmonary cyst, the outcome would have been favourable even without a prenatal diagnosis.     

Paraurethral Cyst in a Newborn: Case Report and Discussion

BackgroundParaurethral cyst is a rare cause of interlabial mass in neonates with an incidence of 1 in every 2000-7000 live births and represents less than 0.5% of congenital malformations of the urinary tract.CaseWe report the case of a paraurethral cyst in a neonate, which regressed spontaneously during follow-up without complications.Summary and ConclusionParaurethral cyst should be considered in the differential diagnosis of interlabial masses in newborns. Because of the high probability of spontaneous regression, expectant management appears to represent the management of choice.     

先天性畸形的产前诊断、围产期管理及随诊网络的建立与初步实践效果分析

目的 通过先天性畸形的产前诊断、围产期管理和随诊网络的建立,分析初步实践的效果. 方法网络由"产前诊断和分娩中心"与"新生儿治疗及随诊中心"组成.两个中心随时保持业务交流与合作,以实现其网络化功能. 结果网络运行模式:超声科及产科通过超声等影像学检查发现畸形,家长到新生儿外科咨询,新生儿外科与产科、超声科讨论诊断、制定分娩与诊疗计划,按计划分娩,根据病情选择:(1)配有新生儿转运设备的救护车即刻转诊;(2)救护车常规转运;(3)在分娩医院观察及出院后到新生儿外科门诊.转诊患儿进一步检查后根据病情选择急诊手术、择期手术或观察.2003年3月至2007年12月共接诊经产前超声诊断的先天性畸形患儿228例.19例妊娠中期终止妊娠;4例出生后放弃治疗;56例在新生儿期手术,其中51例治愈、5例术后放弃治疗;149例出生后未行手术,仅观察. 结论对先天性畸形的产前诊断、围产期管理及随诊实施网络化管理,进一步加强小儿外科与产科、超声科的密切交流与合作,在实践中逐步建立一套适合我国现实医疗环境、较规范的运作模式,可望进一步提高我国先天性畸形的围产期管理和总体诊治水平.     

Neonatal hepatoblastoma: two cases posing a diagnostic dilemma, with a review of the literature

Hepatoblastoma accounts for less than 1% of all pediatric malignancies. However, it remains the most common malignant tumor of the liver in newborns. Less than 10% of hepatoblastoma cases are diagnosed in the neonatal period. The diagnosis can be very difficult due to the wide spectrum of presentation and differences in the size of the lesion at the time of detection either antenatally or during an infant's neonatal course. In this review, we describe the current investigations used to establish the diagnosis of congenital hepatoblastoma and the role of a nuclear red cell scan as an additional strategy in the evaluation of this malignant condition. The report uses two cases of neonatal hepatoblastoma to highlight both the clinical and pathologic findings, and the problems encountered in the evaluation of this disorder.