重度窒息新生儿血液流变、血小板活化及止血状态研究

目的 探讨重度窒息新生儿血液流变、血小板活化及止血状态.方法 对60例重度窒息足月儿及20例健康足月儿(正常组)分别测定红细胞滤过指数(IF)、血小板α-颗粒膜蛋白140(GMP-140)、D-二聚体(DD)、血管性假血友病因子(vWF).在此基础上应用PAF拮抗剂EGb761进行早期干预,分为治疗组(30例)及对照组(30例).结果 生后第1天重度窒息儿IF、血浆GMP-140、vWF、DD均明显高于正常组(P＜0.05～0.001).生后第4天治疗组IF、GMP-140、DD均低于对照组(P＜0.05～0.001),两组vWF水平的变化差那里无显著意义(P＞0.05).结论 (1)新生儿重度窒息时,血液流变、血小板活化状态及止血状态发生改变,严重时使微循环血流障碍,器官功能受损.(2)PAF参与了这一病理生理过程,应用PAF拮抗剂可改善重度窒息儿的循环.     

窒息新生儿抗凝血酶Ⅲ血管性假血友病因子及D 二聚体测定及其临床意义

目的探讨窒息新生儿血浆中抗凝血酶Ⅲ(AT Ⅲ)、血管性假血友病因子(VWF)、D 二聚体(D D)的变化及其意义。 方法深圳市人民医院于2002~2004年，采用酶联荧光分析法和发色底物法分别测定39例不同程度窒息新生儿和16名正常新生儿VWF、D D的水平及AT Ⅲ的活性，同时检测血小板计数(BPC)、凝血酶原时间(PT)、纤维蛋白原(Fbg)的变化。 结果重度窒息组的AT Ⅲ明显降低；窒息新生儿血浆的VWF、D D平均值均有不同程度增高，重度窒息组升高更为显著，与正常对照组比较，其差异具有显著性意义(P<0.05，P<0.01)。窒息后并发器官功能损害新生儿较无并发症组血浆的VWF、D D均有不同程度的升高，以颅内出血患儿升高最为明显(P<0.05，P<0.01)。 结论窒息新生儿表现以高凝状态为主的早期DIC、VWF及D D的升高与窒息的程度有关，VWF及D D明显升高者常合并组织器官损害。测定窒息新生儿血浆中AT Ⅲ、VWF、D D等指标对窒息后新生儿临床选用抗凝药物治疗及疗效观察、预后判断,均有一定的指导意义。     

新生儿窒息后对心电图的影响

目的探讨新生儿窒息后对心电图图形的影响.方法收集足月单胎、头先露、阴道分娩新生儿100例,以出生时脐动脉血pH值7.200为截断值将其分为窒息组及对照组,每例新生儿在出生后45 min马上行心电图检测.结果窒息组新生儿心电图ST-T异常的发生率明显高于对照组(P＜0.05).结论围产窒息确实对新生儿心血管系统造成不同程度的影响,应引起国产医学工作者的重视.     

单脐动脉、脐带宫腔内断裂致新生儿重度窒息抢救成功一例

单脐动脉、脐带宫腔内断裂致新生儿重度窒息抢救成功一例张海萍患者，２５岁，因妊娠足月不规则腹痛６小时，于１９９４年３月２日入院，入院时各项检查正常。当日８时３０分开始规律宫缩，１０时宫口开大３ｃｍ，胎心１４０次，１０时３０分胎膜自然破裂，羊水Ｉ°污染，...     

胃液pH检测在窒息新生儿胃肠功能障碍的应用

目的探讨窒息新生儿胃液pH检测的临床意义及与胃肠功能障碍的关系。方法 47例窒息新生儿为观察组,其中重度窒息18例,轻度窒息29例;伴发胃肠功能障碍20例。同期选取健康新生儿40例为对照组。动态观察两组胃液pH值的变化,并分析胃液pH异常与新生儿窒息程度及胃肠功能障碍的关系。结果出生24h内观察组pH值明显低于对照组,差异有统计学意义(P0.05)。伴有胃肠功能障碍患儿胃液pH值明显低于无胃肠功能障碍患儿,差异有统计学意义(P0.05)。随着窒息程度的加重,患儿胃液pH值降低,胃肠功能障碍发生率升高,差异有统计学意义(P0.05)。结论新生儿窒息伴有胃肠功能障碍者胃液pH值明显降低,且与病情程度密切相关,早期检测胃液pH值有助于指导临床的干预,改善预后。     

紧急避孕失败后继续妊娠95例初步临床观察

目的:了解左炔诺孕酮紧急避孕失败而又自愿生育者,其所用药物对妊娠及胎儿有否不良影响。方法:连续3次随访观察95例对象和她们的对照组。随访分别在孕13-15周、孕24周左右和分娩后,用B超作胎儿生长发育监测和胎儿畸形筛查。结果:妊娠15周内研究组自然流产18例(18.95%),对照组11例(11.58%)。第2次随访时2组均发现畸形胎儿1例。最后研究组分娩正常新生儿74例,新生儿畸形和重度窒息各1例。对照组分娩正常新生儿83例,新生儿湿肺症1例。2组在上述各方面的差异均无统计学意义。结论:除自然流产率略高于正常人群外,胎儿和新生儿畸形发生率并未明显升高,所出现重度窒息者与服用左炔诺孕酮间未见因果关系。     

分娩方式与产程对新生儿窒息的影响

新生儿窒息是致新生儿死亡和影响儿童智力发育的主要原因之一 ,会引起很多近、远期并发症。为了探讨预防措施 ,现对 1996年 12月至 2 0 0 0年 1月发生新生儿窒息 141例的有关因素进行回顾性分析。1　资料与方法1.1　新生儿窒息诊断标准与分析方法　新生儿出生后常规于 1、5、10ｍｉｎ各进行 1次Ａｐｇａｒ评分 ,以 3次评分中最低一次为标准 ,评 4～ 7分为轻度窒息 ,0～ 3分为重度窒息 ,≥ 8分为正常。重点分析≤ 7分的新生儿窒息情况 ,以同期≥ 8分的新生儿作为对照组。1.2　新生儿窒息的发生率　从 1996年 12月至 2 0 0 0年 1月在我所共分…     

盐酸纳洛酮在重度新生儿窒息时的应用

盐酸纳洛酮在重度新生儿窒息时的应用１３００２１白求恩医科大学第一临床学院孙玉芝乐杰近期我科在重度新生儿窒息时应用盐酸纳洛酮治疗，取得良好效果，值得推广，现介绍如下。一、抢救方法处理新生儿窒息，除给予保暖、清理呼吸道使之通畅、并不断供氧外，同时给盐酸纳...     

窒息后新生儿胃电活动的研究

目的　利用胃电图探讨窒息对新生儿胃电活动的影响。　方法　采用瑞典 CTd-synec-tics公司生产的便携式胃电图 ( EGG)记录仪对 50例窒息后新生儿和 2 0例正常新生儿进行了喂奶前、后各 3 0 min的胃电活动的检测 ,利用计算机 EGG Version6.4 0软件分析系统分析数据。　结果　 70例新生儿有 3 9例 ( 56% )成功记录到 EGG。轻度窒息组与对照组比较 ,喂奶前胃动过缓 ( <2cpm)百分比增多 ( 7.0± 6.8与 4 .7± 5.4 ) ,差异有非常显著意义 ( P<0 .0 1 )。重度窒息组与对照组及轻度窒息组比较 :喂奶前、后正常慢波百分比明显降低 ( P<0 .0 1 ) ,胃动过速 ( >4 cpm)百分比明显增多 ( P<0 .0 1 )。主功频率不稳定系数 ( DFIC)增高 ( P<0 .0 1 )。　结论　EGG可以用来研究窒息后新生儿的胃电活动 ,进而研究新生儿消化道动力 ;围产期轻度窒息新生儿喂奶前胃动过缓增多 ,重度窒息新生儿喂奶前、后正常慢波百分比明显降低 ,胃动过速百分比明显增多 ,提示围产期窒息的新生儿出现拒乳、腹胀、呕吐等症状 ,可能与其胃电节律异常有关。     

早发型重度子痫前期血清白蛋白水平对母胎结局的影响

目的:探讨血清白蛋白水平与早发型重度子痫前期(sPE)母儿预后的关系。方法:收集单胎早发型sPE患者152例。根据入院时血清白蛋白水平,分为低血清白蛋白组(30g/L)83例和正常血清白蛋白组(≥30g/L)69例。比较两组患者的一般情况,孕产妇并发症:子痫、脑血管意外、HELLP综合征、胎盘早剥、肾功能不全、心功能不全、视网膜剥离、产后出血、腹水的发生率,围产儿一般情况及并发症:新生儿出生体重、出生孕周、Apgar评分,胎儿生长受限(FGR)、胎儿新生儿死亡、新生儿窒息、新生儿呼吸窘迫综合征(NRDS)、新生儿缺血缺氧性脑病(HIE)、新生儿颅内出血、新生儿败血症、新生儿坏死性小肠结肠炎的发生率。结果:低血清白蛋白组的胎盘早剥(12.0%vs 2.9%)、腹水(63.9%vs 34.8%)、FGR(16.9%vs 5.8%)及新生儿窒息(72.9%vs 44.4%)发生率明显高于正常血清白蛋白组,新生儿出生体重、Apgar评分低于正常血清白蛋白组,差异均有统计学意义(P0.05)。多因素二元回归分析提示,胎盘早剥与血清白蛋白水平相关(OR=0.812,P0.05)。结论:早发型sPE合并低血清白蛋白虽不增加胎儿新生儿死亡率,但胎盘早剥、腹水、FGR及新生儿窒息发生率明显升高。低血清白蛋白水平虽不能作为早发型sPE患者终止妊娠的指标,但可作为常规检测指标,合并低血清白蛋白时应警惕胎盘早剥的发生,做好新生儿复苏的准备。     

Neonatal Nucleated Red Blood Cell and Lymphocyte Counts in Fetal Brain Injury

Objective: To determine whether neonatal lymphocyte or nucleated red blood cell (RBC) counts can be used to date fetal neurologic injury.Methods: Singleton, term infants with hypoxic-ischemic encephalopathy, permanent neurologic impairment, and sufficient laboratory data were divided into two groups: infants with preadmission injury, manifested by a nonreactive fetal heart rate (FHR) pattern from admission until delivery; and infants with acute injury, manifested by a normal FHR pattern followed by a sudden prolonged FHR deceleration. Lymphocyte and nucleated RBC values were compared with published high normal counts for normal neonates: 8000 lymphocytes/mm³ and 2000 nucleated RBCs/mm³.Results: The study population consisted of 101 neonates. In the first hours of life, lymphocyte counts were elevated among injured newborns, and then the counts rapidly normalized. Brain-injured neonates were 25 times more likely to have a lymphocyte count greater than 8000 than were normal neonates (54 [62%] of 87 versus 6 [7%] of 84; odds ratio 25.5; 95% confidence interval 8.8, 80.1; P < .001). The mean lymphocyte count tended to be higher in the preadmission-injury group than in the acute-injury group. In comparison, nucleated RBC values were not correlated as strongly with neonatal hours of life; nucleated RBC counts tended to be higher and persist longer among neonates with preadmission injury than among those with acute injury.Conclusion: Compared with normal levels, both lymphocyte and nucleated RBC counts were elevated among neonates with fetal asphyxial injury. Both counts appear to be more elevated and to remain elevated longer in newborns with preadmission injury than in infants with acute injury. However, the rapid normalization of lymphocyte counts in these injured neonates limits the clinical usefulness of these counts after the first several hours of life.     

Abnormal fetal heart rate patterns and percentage of creatine phosphokinase-2

Eighteen term newborn infants who had been evaluated by internal fetal heart rate (FHR) monitoring were studied to correlate fetal monitor tracings with Apgar scores and serum creatine phosphokinase-1 (CPK2) the myocardium-specific isoenzyme of CPK. The percentage of CPK2 at 30 +/- 6 hours did not correlate significantly with Apgar scores. However, values for the percentage of CPK2 at 30 +/- 6 hours were significantly higher in neonates with abnormal FHR tracings than in those with normal FHR tracings (p less than 0.01). These preliminary data suggest that subtle intrapartum asphyxial injury may be present without adversely affecting Apgar scores.     

Comparing the effects of auricular seed acupressure and foot reflexology on neonatal abstinence syndrome: A modified double blind clinical trial

BackgroundThe neonates of addicted women are at risk for neonatal abstinence syndrome. This study aimed to compare the effects of auricular seed acupressure and foot reflexology on neonatal abstinence syndrome among the neonates of addicted women.MethodsThirty one neonates of addicted women were purposively recruited and randomly allocated through coin flipping to receive either foot reflexology then seed acupressure or seed acupressure then foot reflexology. Interventions were performed in two successive days with a 12-h washout interval. Foot reflexology was applied for 15 min to the first horizontal zone of the sole while seed acupressure was applied for 24 h through attaching acupuncture-specific ear seeds to the posterior surface of the auricle on the SJ 17 acupoint. The symptoms of abstinence syndrome were assessed using Finnegan Neonatal Abstinence Scoring System before and after foot reflexology, and before, 15 min, and 24 h after the onset of the seed acupressure intervention. Symptom assessment was done by a research assistant who was blind to the study intervention.FindingsThe mean score of abstinence symptoms for the foot reflexology intervention significantly reduced from 10.32 ± 2.10 at pretest to 7.87 ± 2.04 at posttest (P < 0.001). Moreover, the mean score of abstinence symptoms for the seed acupressure intervention significantly reduced from 9.70 ± 2.10 to 8.70 ± 1.46 at the first posttest (P = 0.007) and 7.32 ± 1.42 at the second posttest (P < 0.001). The change in the mean score of the foot reflexology intervention was significantly greater than the change in the mean score at the first seed acupressure posttest (P < 0.001) but did not significantly differ from the change in the second seed acupressure posttest (P = 0.880).ConclusionBoth foot reflexology and auricular seed acupressure has significant effects on abstinence symptoms. Of course, 15-min seed acupressure is less effective than 15-min foot reflexology, while 24-h seed acupressure is as effective as 15-min foot reflexology in alleviating abstinence symptoms.     

新生儿重度缺氧缺血性脑病预后因素临床分析

目的探讨新生儿重度缺氧缺血性脑病的预后因素。方法 2011年1月至2014年12月湖南省儿童医院新生儿科收治住院的重度新生儿缺氧缺血性脑病患儿131例,对其预后影响因素进行相关和回归分析。结果单因素分析显示5min Apgar评分、惊厥、昏迷、pH值、剩余碱值、脏器损伤是影响重度新生儿缺氧缺血性脑病预后的危险因素;多因素Logistic分析结果表明,5 min Apgar评分3分(OR=4.256,95%CI1.501~15.432)、剩余碱≤-10mmol/L(OR=37.208,95%CI6.053~42.105)是影响重度新生儿缺氧缺血性脑病预后的独立性危险因素(P0.05),入院日龄72h(OR=0.098,95%CI 0.032~0.367)是重度新生儿缺氧缺血性脑病保护因素。结论影响重度新生儿缺氧缺血性脑病预后的因素很多,及时发现这些因素,是预防重度新生儿缺氧缺血性脑病的关键所在,临床医师应该引起重视和早期干预。     

Hemorrheology and microcirculation in women with pregnancy-induced hypertension

Hemorrheologic studies were done in 100 patients with pregnancy-induced hypertension (PIH) and 100 cases of normal pregnancies. The hematocrit values in normal pregnant women and patients with mild and severe PIH were 35.96 +/- 4.92, 36.25 +/- 3.47 and 37.8 +/- 4.32 respectively. The blood viscosity was significantly increased in patients with PIH as compared with that of normal pregnant women. The study of bulbar conjunctive indicates the presence of profound disturbance of microcirculation in patients with PIH. It is suggested that the treatment of PIH should focus on vasospasm relieving, blood volume expansion, reduction of blood viscosity and improvement of microcirculation.     

Neonatal platelet counts in fetal brain injury.

The objective of this study was to determine whether neonatal platelet counts can be used in fetal brain injury. The initial platelet counts, expressed as 1000 per mm3, of singleton term infants with and without permanent asphyxial brain injury were compared. Neonates with encephalopathy were divided into 3 groups: I--nonreactive fetal heart rate (FHR) pattern from admission until delivery; II--reactive FHR pattern on admission followed by nonreactivity, tachycardia, a loss of variability and repetitive FHR decelerations; and III--acute: reactive FHR pattern followed by a sudden prolonged FHR deceleration that lasted until delivery. The neonates and platelet counts for each group were as follows: Control: 104 neonates, mean 281 +/- 56, range 154 to 411; I: 60, mean 185 +/- 80, range 28 to 365; II: 34, mean 251 +/- 66, range 100 to 375; and III: 35, mean 267 +/- 93, range 86 to 569. Platelet counts were significantly lower in neonates with encephalopathy (p <0.001). Group I differed statistically from both Groups II and III (p <0.001). These data suggest an association between the FHR pattern, fetal asphyxial brain injury, and the initial platelet count in singleton term neonates. Further investigation should be pursued to clarify the physiological processes leading to this result.     

A case series of 130 neonates with congenital syphilis: preterm neonates had more clinical evidences of infection than term neonates

Background: The early clinical manifestations of congenital syphilis (CS) vary from asymptomatic to florid lesions, involving multisystem damage. But little is known about the differences of early clinical features between preterm and term neonates with CS. Objectives: To compare the clinical characteristics between preterm and term neonates with CS and analyze the possible underlying reasons for the differences. Methods: Consecutive medical charts of infants at risk for CS from January 1999 to December 2009 were retrospectively reviewed. Neonates with positive 19S-IgM in serum were included in the study. Results: Among the 1,670 cases at risk for CS, 130 neonatal cases with positive 19S-IgM in serum were included in the analysis, including 58 preterm ones and 72 full-term ones. Compared with term neonates with CS, preterm ones were more likely to have characteristic skin rash (36.2 vs. 9.7%, p < 0.001), hepatomegaly (51.7 vs. 25%, p = 0.02), splenomegaly (32.8 vs. 15.4%, p = 0.02), PRP titer ≥1:8 (96.6 vs. 70.8%, p < 0.001), thrombocytopenia (43.1 vs. 23.6%, p = 0.018), elevated CRP (65.5 vs. 36.5%, p = 0.002), and abnormal long bone X-ray results (94.6 vs. 68.1%, p < 0.001). Fewer mothers of preterm neonates with CS received treatment for syphilis (15.5 vs. 40.3%, p = 0.003). The rate of withdrawal of care was higher in preterm neonates with CS (31 vs.12.5%, p = 0.036). Conclusions: Preterm neonates with CS had more clinical evidences and suffered more than term ones.     

Time courses of intrapartum asphyxia: neonatal characteristics and outcomes

We compared neonatal characteristics and adverse outcome rates of neonates with hypoxic-ischemic encephalopathy following (1) prolonged partial asphyxia, (2) acute near-total intrapartum asphyxia, and (3) the two combined. The time course of the insult was determined individually by two authors from obstetric data and neonatal charts. "Severe adverse outcome" was defined as death or severe disability detectable by age 2 years. The asphyxial time course was prolonged partial asphyxia in 167 (45%), acute near-total asphyxia in 96 (26%), combined in 78 (21%), and indeterminate in 34 (8%) patients. Among patients with known time course and outcomes, 212 (67%) had severe adverse outcome and 103 (33%) were free of severe adverse outcome. Severe adverse outcome rates were 61% for prolonged partial asphyxia, 67% for acute near-total asphyxia, and 79% for combined time course asphyxia ( P = 0.025). Long-term outcomes differ according to the time course of the insult; infants with combined time course had the worst outcome.     

Neonatal porencephaly in very low birth weight infants: ultrasound timing of asphyxial injury and neurodevelopmental outcome at two years of age.

OBJECTIVE: To investigate and diagnose the timing of asphyxial injury leading to cerebral cavitation with subsequent developing of neonatal porencephaly in the preterm VLBW infant. All newborns underwent careful neurodevelopmental outcome at 2 years of corrected age. METHODS: 250 consecutive VLBW infants (mean gestational age of 28 weeks and mean birthweight of 1150 g) have been study by means of weekly neonatal transfontanellae ultrasonography. Periventricular white matter necrosis was diagnosed when echolucencies were visible after day 3 from birth. RESULTS: Twelve cases of neonatal porencephaly were diagnosed by ultrasound. The timing of asphyxial insult leading to cerebral cavitation seems to have occurred in 33% of neonates during the antepartum period, in 42% during the peripartum period (antepartum + neonatal period) and 25% in the remaining neonatal period. Periventricular-intraventricular hemorrhage (PVH-IVH) was found in all cases and in 50% a severe IVH (grade III-IV) was diagnosed within 7 days neonatal period. Nine infants had evidence of cerebral palsy at 2 years neurological outcome. CONCLUSIONS: The ultrasound criteria of cerebral cavitation have been priorly selected in order to assure that the damage may have occurred before delivery. A comprehensive prenatal study of fetal brain, integrating ultrasound with high-velocity MRI, is also advocate. This will lead to a more detailed understanding of the underlying cerebral condition that is of critical importance for the clinician in planning the time and mode of delivery and have great deal with further medico-legal consideration.