新生儿重症监护病房死亡危险因素分析

目的 :探讨新生儿重症监护病房 ( NICU )患儿死亡的危险因素。方法 :采用多元 Logistic回归和相关分析 ,回顾性研究各危险因素对死亡的影响。结果 :通过单因素分析 ,低体重、低胎龄、机械通气时机、严重酸中毒、持续高血糖、器官衰竭时间及个数为预测患儿死亡的危险因素。结论 :严重酸中毒、持续高血糖、器官衰竭个数是判断其预后的独立危险因素。     

新生儿重症监护室早产儿母乳喂养促进策略研究

目的:探讨母乳喂养促进策略对新生儿重症监护室(neonatal intensive care unit,NICU)早产儿住院期间临床结局的影响。方法:制定母乳喂养促进策略,包括建立多学科母乳喂养指导小组、母乳喂养家庭和社会支持、家庭参与式护理、袋鼠式护理、捐赠母乳库等。将2015年11月至2017年2月入住重庆市妇幼保健院NICU的符合纳入标准的胎龄<32周早产儿根据策略实施前后分为对照组和干预组,比较两组早产儿母乳喂养相关指标(开奶时间、开始母乳喂养时间、达完全母乳喂养时间、达完全肠内营养时间、母乳喂养率)、体格发育指标(宫外生长迟缓)、并发症等。结果:纳入研究的早产儿共123例,对照组61例,干预组62例,两组间性别、胎龄、出生体重、宫内生长迟缓、入院疾病状态等方面差异无统计学意义(P>0.05)。干预组与对照组相比,开奶时间[15.37 (10.00, 22.13) h vs. 20.25 (12.88, 26.33) h,P<0.01]、达完全母乳喂养时间[91.00 (69.75, 103.00) h vs. 94.00 (80.37, 118.75) h,P=0.04]、达完全肠内营养时间[12 (11, 15) d vs. 14 (12, 18) d,P<0.01]均显著提前;两组间开始母乳喂养时间、住院时间、体质量宫外生长迟缓发生率、母乳喂养率差异均无统计学意义(P>0.05);两组间喂养不耐受、新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)、支气管肺发育不良(bronchopulmonary dysplasia,BPD)、早产儿视网膜病(retinopathy of prematurity,ROP)等并发症的发生率及死亡率差异均无统计学意义(P>0.05)。结论:母乳喂养促进策略是对常规母乳喂养策略的质量改进,可显著提前NICU早产儿的开奶时间、达完全母乳喂养时间和完全肠内营养时间,但其是否对提高母乳喂养率,降低NEC、BPD、ROP等并发症发生率存在益处,需进一步研究证实。     

新生儿重症监护病房早产儿医院感染情况分析

目的调查新生儿重症监护病房（NICU）早产儿医院感染的发生情况,分析感染特点及危险因素,为有效预防和控制早产儿医院感染提供依据。方法对2009年6月至2011年5月在新乡医学院第一附属医院NICU住院的1685例早产儿医院感染情况进行统计分析。结果1685例早产儿中发生医院感染279例次,发生率为16．56％;住院日相关的医院感染率为46．87／1000住院日;感染部位以肺炎为主（41．85％）,病死率为18．94％。病原菌以革兰阴性菌最多见（57．83％）,主要为肺炎克雷白杆菌,其次是鲍曼不动杆菌、大肠杆菌、铜绿假单胞菌等。医院感染组与非医院感染组比较,胎龄更小,体质量更低。早产儿发生医院感染的危险因素主要有机械通气（OR=6．982）、其他有创操作（OR=5．214）、出生体质量≤1500g（OR=3．265）和胎龄≤32周（OR=2．412）。结论革兰阴性菌是最主要的NICU早产儿医院感染病原菌,其中肺炎克雷白杆菌和鲍曼不动杆菌是主要的病原菌;NICU早产儿医院感染的危险因素众多,需高度重视。     

重症监护室中高危新生儿听力状况研究

目的对新生儿重症监护室（NICU）中的高危儿听力状况进行研究分析,完善新生儿听力筛查工作。方法对681例在NICU住院的高危新生儿进行听力筛查和诊断,检查结果运用SPSS18．0统计软件进行分析。结果NICU听力障碍率2．39％,听神经病发病率0．34％;住院期间听力初筛未通过率高,42d复筛通过率高;听损伤的主要高危因素是：早产、高胆红素血症、颅面形态畸形和宫内感染。结论NICU高危儿是听力障碍的高发人群,需重点关注;NICU高危儿的听力状况存在着各种变化;瞬态诱发耳声发射＋快速听性脑干发应是NICU高危儿较适宜的听力筛查模式,42d是联合筛查较适宜的时间。     

重症监护病房新生儿死亡病例分析

目的探讨新生儿重症监护病房（NICU）新生儿死亡的危险因素及变迁。方法回顾性分析我院NICU 2004年1月—2009年12月期间死亡的129例患儿的病历资料,筛选死亡危险因素。结果体重〈1.5 kg新生儿年均病死率9.2%;胎龄≤32周早产儿年均病死率为9.4%;死亡新生儿中出生48 h内病死率达34.9%.2004年—2009年新生儿直接死亡原因排序依次为感染性疾病、窒息及其并发症、先天性畸形、其他疾病。结论胎龄小、出生体重低及母亲高龄始终是新生儿死亡的高危因素,死亡高危时段在出生后48 h内。感染性疾病、窒息及其并发症是最主要的直接死因,先天性畸形致死率增高,疾病谱有扩大趋势。     

Vaccination status of infants discharged from a neonatal intensive care unit.

OBJECTIVE: To determine the vaccination rate among infants discharged from a neonatal intensive care unit (NICU) and factors affecting that rate. DESIGN: Cross-sectional survey conducted when the children were 12 to 18 months of age. SETTING: NICU at the Royal University Hospital, Saskatoon, Sask. PARTICIPANTS: All 395 infants discharged from the NICU between Jan. 1 and June 30, 1992. MAIN OUTCOME MEASURES: Vaccination rate, ethnic background (native or non-native), place of residence (urban or rural), health status (number of days spent in the NICU), reasons for delay in or incomplete vaccinations (those involving parents' responsibility, infant illness or contraindications). RESULTS: Of the 395 infants, 20 (5.0%) had died and incomplete information was available for 30 (7.6%). Complete data were available for 345 (87.3%). Of the infants for whom data were available, 8 (2.3%) had never been vaccinated and 142 (41.2%) had a delayed vaccination schedule or had not completed their scheduled vaccinations. Only 195 (56.6%) of the infants had received a full vaccination series. Non-native ethnic background was a predictor of completed vaccinations (odds ratio [OR] 5.40, 95% confidence interval [CI] 3.05 to 9.52). In a univariate model, urban area of residence was not a significant predictor of vaccination status, but when ethnic background was controlled for in a multivariate logistic regression analysis, urban area of residence was found to be inversely associated with completed vaccinations (OR 0.34, 95% CI 0.15 to 0.79). The number of days the child had spent in the NICU was not a significant predictor of vaccination status. CONCLUSION: The vaccination rate of infants discharged from the NICU is not optimal. Urban native children appears to be at risk of not being vaccinated. Non-native infants are five times more likely than native infants to have completed all of their scheduled vaccinations. Methods to improve the rate of completed vaccinations, especially for native children, must be sought and tested.     

Perinatal risk factors and neonatal complications in discordant twins admitted to the neonatal intensive care unit

Background Many studies have shown a relationship between birth weight discordance and adverse perinatal outcomes.This study aimed to investigate the perinatal risk factors and neonatal complications o...     

Incidence of thrombocytopenia in the neonatal intensive care unit

Background

Thrombocytopenia is the commonest haematological abnormality encountered in the neonatal intensive care unit (NICU). The incidence in neonates varies greatly, depending upon the population studied. The aim of the present study was to study the incidence of thrombocytopenia in the neonates admitted to the NICU.

Method

The study was carried out in 258 consecutive eligible neonates from August 2007 to August 2009. Neonates were placed in two risk groups for thrombocytopenia, viz. high risk and low risk, depending upon the presentation, maternal history and any antenatal/perinatal events. Platelet counts were done on the first, third and fifth day of admission and thereafter every 72 hours till counts were normal. Low counts were collaborated with a peripheral blood smear.

Results and Conclusion

The overall incidence of thrombocytopenia in the study group was 70% (182/258). The incidence in the high-risk group was 93.7% cases (134/143) and in the low-risk group was 41.7% (48/115). This difference was statistically significant. Factors associated with thrombocytopenia were sepsis, extreme low birth weight, intra-uterine growth restriction, birth asphyxia and pre-eclampsia in mothers. The most common severe bleeding manifestation was pulmonary haemorrhage. The overall mortality in babies with thrombocytopenia was 33% despite <90% of these cases having received platelet transfusion. Of these pulmonary haemorrhage was the main cause of death in five cases. It is concluded that thrombocytopenia is very common in the NICU and should be actively looked for so that it can be managed appropriately.     

新生儿重症监护病房医院感染病原菌分布及相关危险因素分析

目的分析新生儿重症监护病房(NICU)的病原学特征,并研究NICU发生医院感染的危险因素。方法回顾性分析2015年8月至2019年8月昆山市第一人民医院发生NICU感染的125例新生儿作为感染组,选取同期未发生感染的新生儿150例作为未感染组,观察细菌种类及其分布情况;采用单因素分析得到具有统计学意义的危险因素,再进行多因素Logistic回归分析NICU医院感染的独立危险因素。结果 NICU医院感染的新生儿主要以呼吸道感染为主,其次为尿路感染;标本中培养出125株病原菌中,革兰阳性菌占61.60%,其中金黄色葡萄球菌(22.40%)和凝固酶阴性葡萄球菌(21.60%)为主要致病菌;革兰阴性菌占37.60%,其中大肠埃希菌(14.40%)和肺炎克雷伯菌(11.20%)为主要病原菌;感染组和未感染组新生儿在胎龄、出生时体质量、抗菌药物使用时间、住院时间、Apgar评分、侵袭性操作方面比较,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,出生时体质量<2 500 g、住院时间≥10 d和侵袭性操作是NICU医院感染的独立危险因素(P<0.05)...     

新生儿重症监护病房中新生儿真菌败血症的临床特点

目的:探讨新生儿真菌败血症的临床特点,并与新生儿细菌败血症的临床特点进行比较,提高对新生儿真菌败血症的认识.方法:选取2011-2016年北京大学第一医院新生儿重症监护病房中收治的新生儿真菌败血症患儿的临床资料进行回顾性分析,同时选取同期住院的新生儿细菌败血症患儿,对两组患儿的临床特点进行比较.结果:共纳入新生儿真菌败血症患儿15例,真菌败血症发生情况为0.52％,极低出生体重儿为2.5％.临床表现非特异,所有患儿应用肠外营养、广谱抗生素,13例患儿留置外周放置中心静脉导管(peripheral inserted central venous catheter,PICC).病原学分析显示,光滑假丝酵母菌(Candida glabrata)占第一位,对二性霉素B均敏感,一株光滑假丝酵母菌对氟康唑耐药.与同期34例新生儿细菌败血症患儿比较,真菌败血症组的血小板计数明显低于细菌败血症组(61×109/L vs.178×109/L,P=0.004),血小板下降比例明显高于细菌败血症组(80.0％vs.29.4％,P=0.001),留置PICC比例高于细菌败血症组(86.7％vs.55.7％,P=0.037).受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析发现,以血小板计数145×109/L为界值时,预测新生儿真菌败血症的敏感度和特异度分别为61.8％和92.9％.经规范的抗真菌治疗后,真菌败血症患儿均治愈,血小板恢复正常,肝、肾功能未见明显变化.结论:新生儿真菌败血症的临床表现呈非特异性,病原以光滑假丝酵母菌占第一位,给予规范治疗疗效较好,血小板降低和留置PICC可能提示真菌感染.     

新生儿重症监护病房实施出院计划对早产儿的有效延续居家护理效果评价

目的 研究新生儿重症监护病房早产儿实施出院计划对于家长抑郁焦虑程度和早产儿6个月内体格发育的影响。 方法 选取在新生儿重症监护病房接受治疗的100例早产儿作为本次研究的对象,按照随机数字表法将其平均分成试验组与对照组,对照组给予常规护理,试验组开展出院计划家居护理,对比分析护理后2组早产儿家长抑郁评分、早产儿3个月以及6个月的身高、体重情况。 结果 试验组早产儿家长护理后抑郁评分为(35.8±4.4)分、焦虑评分为(34.1±0.6)分,与对照组的抑郁评分(42.7±4.8)分、焦虑评分(46.9±0.8)分相比显著较低,差异有统计学意义(P＜0.05)。试验组早产儿3个月、6个月时身高分别为(59.8±8.9) cm、(67.5±6.4) cm,明显高于对照组的身高(49.5±9.5) cm、(55.5±5.6)cm,差异有统计学意义(P＜0.05)。试验组早产儿3个月、6个月时体重分别为(6.8±1.1) kg、(8.1±1.5) kg,明显高于对照组的体重(5.1±0.8) kg、(6.9±1.3)kg,差异有统计学意义(P＜0.05)。 结论 在重症监护室接受治疗的新生早产儿中实施出院计划的效果显著,改善了早产儿家长的抑郁焦虑症状,促进早产儿出院后体格发育。      

Turn-around-time of radiographs in a neonatal intensive care unit

A quality assurance study was carried out prospectively in two phases at the Neonatal Intensive Care Unit (NICU) of Hospital Universiti Kebangsaan Malaysia. The objectives of the study were to determine the turn-around-time (TAT) of radiographs requested for infants undergoing intensive care treatment in the NICU and the effects of a standard operating procedure introduced based on initial findings of first phase of the study on subsequent TAT. The TAT was defined as the time taken for the radiograph to be ready for viewing after the attending doctor had requested for it to be done on an infant. During phase one of the study, none of the requested radiographs was ready to be viewed by the doctors within the standard TAT of 45 minutes. The problems identified were ward staffs delay in sending request forms to the radiology department, radiographers' delay in shooting and processing the films, and delay by NICU porter in collecting the processed films. Based on these findings, a standard operating procedure (SOP) was drawn up jointly by the staff of NICU and Department of Radiology. During phase two of the study conducted at one month after implementation of the SOP, there was a reduction of TAT by 50%. However, only 3 (4.3%) of the radiographs achieved the standard TAT. The main problems identified during phase two were delay in sending request forms and in collecting processed radiographs by the porter system. The dismal TAT of radiographs in NICU was related primarily to human behaviour. Besides continuous staff education, replacement of the porter system with electronic system may improve the TAT.     

纤维支气管镜在新生儿重症监护室的应用分析

 目的  探讨纤维支气管镜在新生儿重症监护室(neonatal intensive care unit,NICU)中的应用指征和安全性。方法  回顾性分析2012年1月至2014年5月在上海市儿童医院NICU住院的35例患儿的纤维支气管镜检查结果及相关临床资料。结果  35例患儿中,31例存在不同程度的气道畸形。20例进行支气管肺泡灌洗液培养,其中14例与痰培养或气管插管尖端培养结果一致。23例患儿在纤维支气管镜检查前后进行影像学检查,16例提示肺部炎症改善。28例好转出院,2例死亡,5例放弃治疗出院。21例在纤维支气管镜检查前后查血气分析提示差异无统计学意义,31例检查后查血常规提示C-反应蛋白下降。结论  纤维支气管镜检对新生儿某些疾病具有诊断和治疗的双重价值,在NICU中应用相对安全。       

Posttransfusion hepatitis A in a neonatal intensive care unit

A single unit of infected blood transfused into 11 neonates resulted in a large multistate outbreak of 55 cases of hepatitis A, 35 of which were symptomatic. The person who donated the blood to the 11 neonates became ill with hepatitis A one week after the donation. Hepatitis A infection was then acquired by nurses and physicians having direct contact with the neonates and by parents and relatives. Three additional newborns who had not received transfusions with the infected unit also acquired hepatitis A. The neonates with hepatitis A were all asymptomatic. The attack rate in susceptible nurses was 16%; in susceptible physicians, 4%. A survey of the relatives of the 11 newborns who received transfusions revealed eight symptomatic cases of hepatitis A in 32 immediate family contacts, ie, mother, father, and siblings, with a resulting attack rate of 25% uncorrected for prior immunity. The setting of the neonatal intensive care unit appears to be ideal for the transmission of hepatitis A.     

重症监护病房机械通气相关肺炎的医源性危险因素研究

机械通气相关肺炎(VAP)是指机械通气(MV)48 h后及停用机械通气去除人工气道48 h内发生的医院内获得性肺炎,是医院内获得性肺炎最常见类型之一,发生率高、死亡率高,医疗成本昂贵.防治VAP的重要一环就是了解其发生的危险因素,采取针对性的预防措施.