静脉用丙种球蛋白治疗新生儿重症感染对细胞免疫功能的影响

应用静脉注丙球(IVIG),配合抗生素(An)治疗重症感染新生儿12例,在观察疗效及不良反应的同时,通过检测患儿治疗前后T细胞亚群及白细胞介素Ⅱ(IL-2)产生水平的变化,观察IVIG对细胞免疫功能的影响。结果显示:患儿CD_3~+、CD_4~+、CD_8~+细胞及IL-2产生水平均明显低于正常同龄新生儿。经IVIG+An及单用An治疗后,T细胞各亚群及IL-2水平均明显增高。IVIG组与An组比较,诒疗后IVIG组CD_4~+细胞明显高于An组,IL-2水平也较An组为高,但无统计学意义。疗效观察,中毒症状及原发病体征好转消失时间IVIG组较An组明显缩短。本文还就IVIG对细胞免疫功能影响的可能机制进行了讨论。     

中国八省市婴幼儿死亡率

根据1985及1987年在上海、北京、辽宁、山东、河北、陕西、甘肃及贵州进行深入的生育力调查中的婴幼儿死亡资料,对中国八省市30年来婴幼儿死亡率作了统计分析。100645名活产婴儿的死亡资料的统计结果表明,30年来婴幼儿死亡率显著下降,从60年代中期到1980～1984年,婴幼儿死亡率降低了62％,婴儿死亡率降低了56％,1～4岁幼儿死亡率降低了76％。1980～1984年八省市平均的婴幼儿死亡率为48‰,婴儿死亡率39‰,幼儿死亡率9‰,新生儿死亡率26‰。据此推算我国婴儿死亡率1975～1979年在50‰左右,1980～1984年在40‰左右。中国婴幼儿死亡率存在明显的地区差异,贵州省与上海市相比,婴幼儿死亡率高3倍,婴儿死亡率高2.4倍,幼儿死亡率高5.1倍。     

Ventriculosubcutaneous shunt for temporary treatment of neonatal post-IVH hydrocephalus: a technical note

A technique for temporary ventricular drainage using a subcutaneous pouch is described for use in neonatal hydrocephalus after intraventricular hemorrhage. The advantages include continuous, valve-regulated ventricular decompression, no exposed tubing, avoidance of electrolyte imbalance and of the loss of CSF, obviation of the need for repeated tapping, and the ability to convert to a peritoneal shunt on an elective basis.     

新生儿窒息合并心肌损害血清心肌酶变化(附12例分析)

目的探讨心肌酶水平对窒息新生儿心肌损害的诊断价值。方法将12例窒息新生儿为实验组,另外收集10例同期正常新生儿作为对照组。两组新生儿经股静脉穿刺采血2 ml,分离血清,在24 h内测定心肌酶活性,同时做心电图检查,统计学处理采用t检验。结果两组血清心肌酶测定结果比较显示两组血清心肌酶均值间的差别有显著性意义。窒息组均出现心电图改变。结论血清心肌酶活性测定及心电图检测可作为新生儿窒息后心肌损害的早期监测和诊断的指标,为早期治疗提供依据。     

The relationship between maternal needs and priorities in a neonatal intensive care environment

AIM: The aim of this study was to investigate the nature and organization of maternal needs and priorities in a neonatal unit. BACKGROUND: The relationship between maternal needs and priorities appears to be an under studied area in neonatal nursing. METHODS: A quantitative survey was carried out based on 209 mothers with premature infants. Two self-assessment schedules were used: critical care maternal needs inventory (J. Leske, Heart and Lung 15, 27-42) and a ranking scale. The data were analysed with multivariate analysis. FINDINGS: Data analysis revealed clear priorities in maternal needs. In particular the need for accurate infant related information was a priority for 93% of the mothers. Good communication practices with professionals were also valued. The mothers displayed altruistic behaviour, and self-related needs took second place. It is proposed that maternal needs demonstrate a hierarchical organization. CONCLUSION: It is important for nurses to consider the individual needs of the mothers, simply because the satisfaction of these needs is essential for maternal well-being.     

重庆市新生儿高胆红素血症患儿G6PD基因突变类型及临床特点

目的研究重庆市新生儿黄疸儿G6PD三种常见基因突变与其临床表现特点之间的关系。初步估计其基因突变频率并探讨其临床意义和遗传学特征。方法应用突变特异性扩增系统(ARMS)法,检测54例重庆市新生儿黄疸儿的G6PD基因突变类型。结果检出G1388A突变39例(72%),G1376T突变8例(15%),未定型者7例(13%)。未检出G95A。结论本研究首次对重庆市新生儿黄疸儿进行G1388A、G1376T和A95G突变检测。提示G1388A和G1376T为重庆市新生儿黄疸儿G6PD缺乏症基因突变的主要类型。ARMS法是一种简便、快速、经济的检测G6PD已知基因突变的方法。本研究发现这两种突变类型仅见于中国人和华裔人群,具有遗传学及临床意义。     

Neurotoxic effects of MDMA (“ecstasy”) administration to neonatal rats

3,4-Methylenedioxymethamphetamine damages fine serotonergic fibers and nerve terminals in adult organisms. Developing animals seem to be less susceptible to this effect, possibly due to a lack of drug-induced hyperthermia. We tested this hypothesis by producing hyperthermia in neonatal rats for 2 h after each of twice-daily MDMA (10 mg/kg s.c.) or saline injections administered from postnatal days 1–4. Other drug-treated and control litters were maintained at normothermic temperatures following injection. Changes in forebrain serotonergic innervation were assessed at postnatal day 25 (serotonin transporter binding and serotonin levels), postnatal day 60 (serotonin transporter binding), and 9 months of age (serotonin transporter immunohistochemistry). We also determined the influence of MDMA treatment on apoptotic activity by means of immunohistochemistry for cleaved caspase-3 at postnatal day 5. The hippocampus showed significant MDMA-related reductions in serotonergic markers at postnatal day 25 and postnatal day 60. At 9 months, there was no effect of prior MDMA exposure on serotonin transporter-immunoreactive fiber density in the hippocampus; however, significant reductions in fiber density were observed in two neocortical areas and a hyperinnervation was found in the caudate-putamen and nucleus accumbens shell. MDMA treatment also produced a two-fold increase in the number of cleaved caspase-3-immunoreactive cells in the rostral forebrain and hippocampus. All of these effects were completely independent of pup body temperature. These findings demonstrate that neonatal MDMA administration exposure stimulates apoptotic cell death in various forebrain areas and also leads to a long-term reorganization of the forebrain serotonergic innervation. Consequently, offspring of MDMA-using women may be at heightened risk for abnormal neural and behavioral development.     

Radioiodinated tracers for the evaluation of dopamine receptors in the neonatal rat brain after hypoxic-ischemic injury

In order to evaluate in vivo single-photon emission tomography (SPET) method of assessing cerebral function after hypoxic-ischemic injury in human neonates, we studied D₁ and D₂ dopamine receptors in a rat model. Seven-day-old rats underwent permanent unilateral common carotid ligation followed by exposure to 8% O₂. Two weeks later, in brains with no visible loss of hemispheric volume, striatal dopaminergic receptors were studied, with [¹²⁵I]TISCH and [1251]IBZM for the D₁ and D₂ dopamine receptors, respectively. Using [¹²⁵I]TISCH, we observed no modifications of D₁ receptors, but in contrast, ex vivo and in vitro autoradiographic experiments showed a 40% decrease in the striatal binding of [¹²⁵I]IBZM on both the ipsilateral and the contralateral side to the carotid ligation. These alterations were detected with IBZM, a D₂ dopamine receptor ligand usable for SPET imaging. Therefore, exploration of D₂ receptors by SPET in human neonates suffering from perinatal hypoxia-ischemia may be valuable for the diagnosis and follow-up of cerebral function damages. Correspondence to: D. Guilloteau     

Rhizomelic Bone Dysplasia with Club-like Femora (Case report and confirmation of a syndrome)

A newborn with rhizomelic bone dysplasia with club-like femora is reported. This is the fourth case Of this easily recognizable, recently reported, congenital bone disease. Maroteaux et al recently reported two patients with rhizomelic bone dysplasia and club-like femora as a distinctive new bone dysplasia. Their observation was confirmed by Gugliantini et al (2) who reported another case. This paper reports a fourth patient with this easily recognisable disorder.