极低/超低出生体重儿支气管肺发育不良的危险因素分析

目的 分析极低/超低出生体重儿支气管肺发育不良（BPD）的危险因素。方法 对我院2014年6月至2018年12月新生儿重症监护室收治的胎龄<32周且存活>14 d的278例极低/超低出生体重儿进行回顾性上分析,了解BPD的危险因素。结果 共纳入新生儿278例（BPD组106例,非BPD组172例）,BPD组贫血、输血、生后1 min Apgar评分≤7分、新生儿呼吸窘迫综合征（NRDS）、使用肺表面活性物质（PS）、动脉导管未闭（PDA）、新生儿肺炎、败血症、机械通气≥7 d、持续气道正压通气（CPAP）≥30 d的比例均高于非BPD组。男婴、胎龄、合并NRDS、CPAP≥30 d、机械通气≥7d是发生BPD的危险因素。结论 极低/超低出生体重儿BPD的发生与男婴、胎龄、NRDS、机械通气及CAPA有关,是BPD发生的高危因素。预防早产、减少有创通气时间、合理治疗NRDS、积极控制感染,可能有助于降低BPD的发生率。     

鼻塞持续气道正压通气预防极低出生体重儿原发性呼吸暂停30例

目的了解鼻塞持续气道正压通气(NCPAP)预防极低出生体重儿原发性呼吸暂停疗效。方法回顾性分析我院新生儿科2000~2005年收治的30例极低出生体重儿。结果30例患儿中2例28周患儿应用NCPAP治疗失败,合并严重的频发呼吸暂停,改用呼吸机辅助呼吸,最后家人放弃抢救死亡。余28例未使用呼吸机,均治愈出院。结论鼻塞持续气道正压通气是预防极低出生体重儿原发性呼吸暂停的有效方法。     

N-CPAP模式和NIPPV对呼吸窘迫综合征早产儿心功能的影响分析

目的 分析N-CPAP模式和同步间歇正压通气（NIPPV）对呼吸窘迫综合征（NRDS）早产儿心功能的影响。方法 选取2012年6月~2015年5月在我院出生的90例NRDS患儿,随机分为对照组和实验组各45例。对照组采用N-CPAP（经鼻持续气道正压方法）治疗,实验组采用NIPPV（同步间歇正压通气方法）治疗,对比两组患儿治疗前后氧合指数、血气变化、并发症及总成效。结果 实验组治疗1 h后患儿血气变化和氧合指数明显升高,均大于对照组,实验组在总体疗效（77.78%）比较上也明显高于对照组（55.56%）,差异具有统计学意义（P＜0.05）;两组均未发生并发症。结论 NRDS患儿中用NIPPV进行初始通气治疗总体效果明显优于N-CPAP,值得临床推广。     

早期联合PS＋NCPAP治疗新生儿呼吸窘迫综合征疗效观察

目的探讨肺表面活性物质（Ps）联合鼻塞持续气道正压通气（NCPAP）治疗新生儿呼吸窘迫综合征（NRDS）的疗效。方法对25例NRDS的早产儿早期应用PS联合NCPAP治疗,并对其临床特点、血气分析、X线胸片进行分析。结果25例患儿中20例呼吸困难明显减轻或消失,X线胸片示透亮度明显改善,5例因病情加重改用机械通气,其中2例放弃治疗死亡。结论早期Ps联合NCPAP治疗早产儿呼吸窘迫综合征疗效显著,可有效提高治愈率,减少机械通气使用率。     

预防性应用小剂量氨茶碱及纳洛酮对极低出生体重儿呼吸暂停的影响

目的探讨预防性应用小剂量氨茶碱及纳洛酮对极低出生体重儿呼吸暂停的影响。方法将68例极低出生体重儿随机分为两组,观察组36例,对照组32例。观察组在生后未发生呼吸暂停前即给予静滴小剂量氨茶碱及纳洛酮预防性治疗,对照组在发生呼吸暂停后才开始使用氨茶碱及纳洛酮。观察其在生后10天内两组间呼吸暂停发生率、平均用氧时间和使用呼吸机的百分率。结果观察组出生10d内有7例（19.44%）发生呼吸暂停,对照组21例（65.63%）发生呼吸暂停,观察组平均用氧时间为（2＋0.8）天,对照组（5＋1.8）d,观察组需机械通气比率（5.56%）对照组（28.12%）。结论预防性应用小剂量氨茶碱及纳洛酮能显著降低极低出生体重儿呼吸暂停的发生率,且可缩短其用氧时间,降低需要使用呼吸机的频率。无明显不良反应发生。     

肺表面活性物质联合CPAP治疗NRDS的疗效

目的 观察肺表面活性物质（PS）联合持续气道正压通气（CPAP）治疗新生儿呼吸窘迫综合征（NRDS）的疗效。方法 选择2016年6月~2019年5月我院收治的62例NRDS患儿,按随机数字表法分为对照组和观察组,各31例。对照组接受CPAP治疗,观察组在对照组基础上联合PS治疗。比较两组临床疗效、pH、动脉二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、氧合指数（OI）、住院时间及并发症发生情况。结果 观察组总有效率为93.55%,高于对照组的74.19%,差异有统计学意义（P＜0.05）;观察组pH、PaO2、OI均高于对照组,PaCO2低于对照组,差异均有统计学意义（P＜0.05）;观察组支气管肺发育不良发生率低于对照组,差异有统计学意义（P＜0.05）;两组肺不张、气胸及腹胀发生率比较,差异无统计学意义（P＞0.05）;观察组住院时间短于对照组,差异有统计学意义（P＜0.05）。结论 NRDS患儿接受PS联合CPAP治疗有利于改善动脉血气指标,提升呼吸功能,缩短住院时间,降低相关并发症发生率。     

早期微量滴服喂养和胃管喂养对极低出生体重儿喂养耐受性及并发症的临床观察

目的观察早期微量滴服喂养和胃管喂养对极低出生体重儿喂养耐受性及并发症的发生情况,探讨早期微量滴服喂养的临床应用价值。方法将50例极低出生体重儿随机分成观察组和对照组。观察组25例,早期微量滴服喂养;对照组25例,早期微量胃管喂养。观察两组患儿开始经奶头喂养时间、达全口喂养时间、恢复至出生体重时间、奶量增加速度、住院时间及其相关并发症的发生情况。结果与对照组比较,观察组奶量增加速度快（P〈0.05）,达全口喂养时间及住院时间缩短（P〈0.05）,开始经奶头喂养时间、恢复至出生体重时间明显缩短（P〈0.01）。呼吸暂停、口腔炎和吸入性肺炎的发生率减少（P〈0.05）,腹胀、呕吐的发生率明显降低（P〈0.01）。结论早期微量滴服喂养可有效锻炼早产极低出生体重儿的吸吮及吞咽功能,提高喂养耐受性,减少并发症的发生,值得在临床应用。     

阻塞性睡眠呼吸暂停低通气综合征临床治疗分析

目的：探讨综合治疗对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）治疗的效果。方法：对120例OSAHS病人随机平均分为3组，综合组采用上气道狭窄部位手术加经鼻气道持续正压通气、减肥等行为疗法进行综合治疗，手术组采用上气道狭窄部位手术治疗，通气组采用单纯经鼻气道持续正压通气（NCPAP）治疗。以治疗前后睡眠紊乱指数（AHI）和最低血氧饱和度（ISaO2）等作为疗效判定指标，对比观察3组疗效。结果：综合治疗组有效率87．5％；手术组有效率62．5％；通气组有效率65％。经统计学处理，综合治疗组疗效显著优于手术组和通气组（P〈0．01）。结论：采用手术解除上气道狭窄病变，配合经鼻持续正压通气、减肥等综合治疗OSAHS，可显著提高治疗效果。     

早期应用泡式鼻持续气道正压通气8cmH2O和5cmH2O联合肺表面活性物质防治新生儿呼吸窘迫综合征的临床研究

目的探讨早期应用泡式鼻持续气道正压通气（B—NCPAP）8cmH2O（1cmH2O=0．098kPa）与肺表面活性物质（PS）＋B—NCPAP 5cmH2O防治NRDS的疗效差异。方法B—NCPAP8组选取2007年4月30日至2008年8月30日在中山大学附属第三医院分娩且生后30min内收入新生儿病房的早产儿,胎龄27～37周、羊水泡沫实验（-）～（＋）,生后30min内应用B—NCPAP 8cmH2O,分为B—NCPAP8预防（治疗前未出现呼吸窘迫）和B—NCPAP8治疗亚组（治疗前出现呼吸窘迫,胸部X线检查提示存在不同程度NRDS改变）。Ps＋B—NCPAP5组选取为胎龄27—37周、羊水泡沫实验（一）～（＋）的早产儿,生后6h内气管内注入Ps并给予B—NCPAP5cmH20,分为PS＋B—NCPAP5预防及PS＋B-NCPAP5治疗亚组。结果研究期间,B—NCPAP8预防和治疗亚组分别纳入48和25例;PS＋B—NCPAP5预防和治疗亚组分别纳入36和22例。B—NCPAP8预防亚组41／48例（85．4％）未出现呼吸窘迫;7例在应用B—NCPAP4～6h后出现呼吸窘迫,其中5例为轻度NRDS,继续治疗8h后症状逐渐改善,2例为重度NRDS,在生后8～10h行气管插管注入PS并改用机械通气后存活;应用成功率为95．8％（46／48例）。PS＋B—NCPAP5预防亚组32／36例（88．9％）未出现呼吸窘迫;4例在应用BNCPAP4～6h后出现呼吸窘迫,其中3例为轻度NRDS,继续治疗后症状逐渐改善,应用成功率为97．2％（35／36例）;1／36例（2．8％）为中度NRDS,改用机械通气后死亡。B—NCPAP8治疗亚组24／25例（96．0％）治疗2h后血气分析指标改善,1例改用机械通气。PS＋B—NCPAP5治疗亚组18／22例（81．8％）治疗8h后临床症状及血气指标均改善,1／22例（4．5％）死亡。B—NCPAP8与PS＋B—NCPAP5预防及治疗亚组在防治NRDS的疗效上差异无统计学意义,但B—NCPAP8预防及治疗亚组的肺部感染发生率、住院时间及住院费用较低（P均〈0．05）。结论早期应用B．NCPAP 8cmH2O与PS＋B—NCPAP 5cmH2O预防及治疗NRDS的疗效相近,但前者能减少肺部并发症发生,缩短住院时间,减少住院费用。     

极低体重儿早期营养干预疗效分析

目的早期积极规范的营养干预对极低体重儿的益处。方法观察组20例，出生后48h静脉营养和采用早期建立肠内营养（早期微量喂养、非营养性吸吮、温盐水灌肠）；对照组15例，积极补液和消化道自然复活苏方法。结果观察组体重增长、住院天数较对照组差异有极显著意义（P＜0．01）。胎粪排尽时间、住院费用差异显著（P＜0．05）。结论早期营养干预是极低体重儿管理中行之有效综合措施。     

不同出生体重儿的甲状腺功能检测及分析

目的探讨不同出生体重新生儿的甲状腺功能。方法将盐城市第三人民医院2003年2月~2006年12月收治的不同出生体重的新生儿120例分成4组:A组(出生体重1100g~1499g n1=30),B组(出生体重1500g~1999g n2=30),C组(出生体重2000g~2499g n3=30),D组(出生体重2500g~3750g n4=30),采用放免法测定不同出生体重新生儿出生后第1天及第10天血清FT3、FT4及TSH水平。结果各组血清FT3、FT4、TSH生后1~10天均成下降趋势,FT3、FT4的水平与出生体重成正相关,C组、D组生后第1,10天血清FT3、FT4明显高于A组、B组,B组明显高于A组,C组与D组之间差异无显著性;生后第1天TSH水平C组、D组>A组、B组,生后第10天血清TSH A组、B组>C组、D组,C组与D组之间差异无显著性。结论新生儿的甲状腺功能与出生体重成正相关,出生体重低于1999g的新生儿存在甲状腺功能的暂时性低下。     

Neonatal outcome and congenital malformations in children born after in-vitro fertilization

BACKGROUND: To evaluate the neonatal outcome and the prevalence of congenital malformations in children born after IVF in northern Finland we carried out a population-based study with matched controls. METHODS: Firstly, 304 IVF children born in 1990-1995 were compared with 569 controls, representing the general population in proportion of multiple births, randomly chosen from the Finnish Medical Birth Register (FMBR) and matched for sex, year of birth, area of residence, parity, maternal age and social class. Secondly, plurality matched controls (n = 103) for IVF twins (n =103) were randomly chosen from the FMBR and analysed separately. Additionally, IVF singletons (n = 153) were compared with singleton controls (n = 287). Mortality rates were compared with national figures from FMBR. RESULTS: Most mortality rates were twice as high as national figures in the general population. When compared with the control group representing the general population, the incidences of preterm birth [odds ratio (OR) 5.6, 95% confidence interval (CI) 3.7-8.6], very low birth weight (OR 6.2, 95% CI 2.0-19.0), low birth weight (OR 9.8, 95% CI 5.6-17.3), neonatal morbidity (OR 2.4, 95% CI 1.7-3.4) and hospitalization (OR 3.2, 95% CI 2.2-4.6) were significantly higher in the IVF group. The prevalence of heart malformations was four-fold in the IVF population than in the controls representing the general population (OR 4.0, 95% CI 1.4-11.7). CONCLUSIONS: Neonatal outcome after IVF is worse than in the general population with similar maternal age, parity and social standing, mainly due to the large proportion of multifetal births after IVF. The higher prevalence of heart malformations does not solely arise from multiplicity but from other causes. In order to improve neonatal outcome after IVF, the number of embryos transferred should be limited to a minimum.     

Metabolomic profiling in blood from umbilical cords of low birth weight newborns

ABSTRACT: BACKGROUND: Low birth weight has been linked to an increased risk to develop obesity, type 2 diabetes, and hypertension in adult life although the mechanisms underlying the association are not well understood. The objective was to determine whether the metabolomic profile of plasma from umbilical cord differs between low and normal birth weight newborns. METHODS: Fifty healthy pregnant women and their infants were selected. The eligibility criteria were being born at term and having a normal pregnancy and the pairs were grouped according to their birth weight: low birth weight (LBW, birth weight<10th percentile, n=20) and control (control, birth weight between the 75th-95th percentiles, n=30). Nuclear Magnetic Resonance (NMR) was used to generate metabolic fingerprints of umbilical cord plasma samples. Simultaneously, the metabolomic profiles of the mothers were analysed. The resulting data were subjected to chemometric, principal component and partial least squares discriminant analyses. RESULTS: Umbilical cord plasma from LBW and control newborns displayed a clearly differentiated metabolic profile. Seven metabolites were identified that discriminate the LBW from the control group. LBW newborns had lower levels of choline, proline, glutamine, alanine and glucose than the control newborns, while plasma levels of phenylalanine and citrulline were higher in LBW newborns (p<0.05). No significant differences were found between the two groups of mothers. CONCLUSIONS: Low birth weight newborns display a differential metabolomics profile as compared to those of normal birth weight, something not present in the mothers. The meaning and potential utility of the findings as biomarkers of risk need to be addressed in future studies.     

Obstetric and perinatal outcome of pregnancies after intrauterine insemination.

The main aim of this study was to evaluate the obstetric and perinatal outcome of pregnancies after intrauterine insemination (IUI) with the partner's spermatozoa combined with ovarian stimulation. Information concerning the antenatal care and obstetric and perinatal outcome of IUI pregnancies (n = 111), spontaneous (n = 333) and in-vitro fertilization (IVF) (n = 333) was obtained from the Finnish Medical Birth Register (MBR). The multiple birth rate in the IUI group was 17% (19/111). Significantly less antenatal care was required by the IUI group than the IVF group. The frequency of Caesarean section was 25% for IUI singletons and 58% for IUI multiples, similar to the other groups. The mean (SD) gestational age for IUI singletons at birth was 39.5 (1.8) weeks, with a mean birth weight of 3285 (575) g, compared with 3448 (600) g in non-assisted singletons (P < 0.05). For IUI multiples the mean gestational age at birth was 36.0 (2.8) weeks and the mean birth weight was 2449 (678) g. The incidence of preterm birth, low birth weight or low Apgar scores and the need for neonatal care were similar in all groups. One case of major malformation and two perinatal deaths were recorded in the IUI group. In conclusion, IUI treatment did not appear to increase obstetric or perinatal risks compared with matched spontaneous or IVF pregnancies. Most problems were associated with patient characteristics and multiple pregnancy. Reduction of the high incidence of multiple pregnancies after assisted reproductive technology is essential to improve its outcome.     

Birth weight and age at menarche in patients with polycystic ovary syndrome or diminished ovarian reserve, in a retrospective cohort

BACKGROUND: Few studies have investigated the association between subfertility in women and factors in early life such as birth weight and age at menarche, and most have produced contradictory results. In the present study, this association was investigated among women undergoing artificial reproductive techniques (ART), including IVF for reason of polycystic ovary syndrome (PCOS) or diminished ovarian reserve. Herein, PCOS included oligomenorrhoea and at least one additional symptom such as hyperandrogenism, hirsutism or polycystic ovaries on ultrasound. In most patients this was concomitant with elevated serum LH levels. Diminished ovarian reserve was defined as receiving a donated oocyte or having a low response to ovarian hyperstimulation. METHODS: Among a retrospective cohort of 26 428 women diagnosed with subfertility between 1980 and 1995, three study groups and one reference group were defined using data from medical records. Women were included in the first group if diagnosed as having PCOS (n = 265). In order to define diminished ovarian reserve capacity, two groups were selected: (i) women receiving a donated oocyte (n = 98); and (ii) women having a low response (three follicles or less) to ovarian hyperstimulation in both their first and second IVF cycles (n = 351). Women with tubal obstruction formed the reference group (n = 957). In a logistic regression model, the effect of birth weight and age at menarche was examined. Information on both variables was obtained from mailed questionnaires. RESULTS: Birth weight did not differ significantly between the study groups and the reference group. However, PCOS patients were significantly older at menarche [OR 3.31 (2.18-5.04)]. Women receiving a donated oocyte and low responders were significantly younger at menarche [OR 2.67 (1.35-5.29) and OR 2.01 (1.26-3.20) respectively]. CONCLUSION: The fetal origins hypothesis, the association between intrauterine growth retardation and disease in adult life, could not be confirmed, though a relationship between timing of menarche and PCOS and a diminished ovarian reserve was identified. Further investigation of the effect of birth weight on fertility outcome in a prospective setting is strongly advised.     

Omphalocele, advanced maternal age, and fetal morbidity outcomes

In this study we wanted to determine if the risk for adverse neonatal outcome among omphalocele-affected fetuses is increased among older gravidas. This was a retrospective cohort study on live-born infants with omphalocele delivered in New York State from 1983 through 1999. We compared infants of older (>or=35 years) with those of younger (<35 years) mothers with respect to the following fetal morbidity indices: low birth weight and very low birth weight, preterm and very preterm, and small for gestational age. We used adjusted odds ratios to approximate relative risks. Data on a total of 1,010 infants with omphalocele were analyzed. Mean gestational age and birth weight were similar in both maternal age categories: mean+/-standard deviation (SD) for infants with omphalocele born to older mothers=37.4 weeks+/-3.9 versus 38.0 weeks+/-5.1 for those of younger mothers (P=0.2); mean birth weights+/-SD for infants with omphalocele born to older mothers=2,813+/-871.1 versus 2,958+/-809.9 for those of younger mothers (P=0.08). Also, the two maternal age sub-groups did not differ with respect to the fetal morbidity outcome: low birth weight (OR=0.95; 95% CI=0.60-1.51), very low birth weight (OR=0.78; 95% CI=0.36-1.69), preterm (OR=0.95; 95% CI=0.58-1.57), very preterm (OR=0.73; 95% CI=0.34-1.58), and SGA (OR=1.00; 95% CI=0.44-2.27). Thus, advanced maternal age does not appear to be a risk factor for fetal morbidity outcomes among omphalocele-affected fetuses. This information is potentially useful in counseling affected parents.     

妊娠亚临床甲减患者血清TSH、TPO-AB水平与妊娠结局的相关性研究

目的探讨妊娠期合并亚临床甲状腺功能减退(亚甲减)患者血清促进甲状腺素(TSH),甲状腺过氧化物酶抗体(TPOAb)水平与妊娠结局的关系。方法选取2016年1月至2017年2月在我院定期接受产前检查、定期围产保健且住院分娩的亚甲减患者300例,根据有无接受治疗分为亚甲减治疗组(n=189)和亚甲减未治疗组(n=111);根据血清TSH中位数水平分为高TSH水平组(n=95)和低TSH水平组(n=205);并根据血清TPOAb检测是否为阳性分为TPOAb阳性组(n=182)与TPOAb阴性组(n=118)。另选取同期300例健康孕妇为对照组。对各组妊娠结局进行统计分析。结果亚甲减未治疗组流产、早产、GDM、妊娠期高血压疾病、胎儿生长受限、低出生体重儿发生率均明显高于亚甲减治疗组及对照组(P<0.05)。亚甲减孕妇中,高TSH水平组流产、早产、GDM、妊娠期高血压疾病、胎儿生长受限、低出生体重儿发生率均明显高于低TSH水平组(P<0.05);TPOAb阳性组流产、早产、GDM、妊娠期高血压疾病、低出生体重儿发生率均明显高于TPOAb阴性组(P<0.05)。结论妊娠合并亚甲减可增加流产、早产、GDM、妊娠期高血压疾病、胎儿生长受限、低出生体重儿发生率,且血清TSH水平越高及TPOAb阳性,不良妊娠结局风险越高。     

Late Neuropsychological Outcomes in Preterm Infants of Normal IQ: Selective Vulnerability of the Visual System

Evaluated neuropsychological outcomes in 635 children, ages7 to 10 years, in relation to birth weight group: 1,000 g;1,001–1,500 g; 1,501–2,500 g, and > 2,500 g.The prevalence of low IQ (<85) was related to birth weight.Among children with IQ > 84 (N = 475): (a) Birth weight wasunrelated to Verbal IQ, Performance IQ, Full-scale IQ, or readingachievement; (b) extremely low birth weight (ELBW) childrenachieved more poorly in mathematics than did other birth weightgroups (p < .05); (c) ELBW and very low birth weight childrenperformed more poorly on the Rey-Osterrieth Complex Figure,a complex visual processing task, than did heavier birth weightchildren (p < .05), but performance on the Beery Test ofVisuomotor Integration was not related to birth weight. Resultsare consistent with heightened neurobehavioral vulnerabilityof visual processing to preterm birth.     

延续性护理干预对极低出生体重早产儿婴儿期神经发育的影响

目的:探讨延续性护理干预对极低出生体重早产儿婴儿期神经发育的影响.方法:抽取2015年1至12月自山西省儿童医院出院的符合纳入条件的极低出生体重儿(very low birth weight infant,VLBWI) 174例,随机分为对照组(n=87)和观察组(n=87).对照组采用常规护理,观察组在常规护理基础上开展延续性护理干预;收集两组VLBWI的0,6,9及12月龄体重等指标进行生长发育评价;运用《0～6岁小儿神经心理发育量表》,对大运动、语言等5个能区进行神经发育评价.结果:实验组患儿身长及体重均高于对照组,差异具有统计学意义(P＜0.05),头围与对照组相比无明显改变;实验组患儿的各能区发育商(development quotient,DQ)均高于对照组,差异具有统计学意义(P＜0.001).结论:延续护理干预可促进极低出生体重患儿婴儿期神经发育,是改善其预后和提高生活质量的有效手段.     

Longitudinal changes in family outcomes of very low birth weight

OBJECTIVES: Although children with very low birth weight (VLBW, <1500 g) are at high risk for developmental impairments, we know little about the long-term effects of VLBW on families. This study examined long-term family outcomes and their stability over time. METHODS: Participants were the families of 64 children with <750 g birth weight, 54 with 750-1499 g birth weight, and 66 term-born controls. Family burden and parental distress were assessed annually as part of longitudinal follow-up of the children from mean ages 11-14 years. RESULTS: Family burden and parental distress were higher in the <750 g group than in the term-born group, but differences varied with the child's age and family environment. CONCLUSIONS: The findings document long-term effects of VLBW on families that are moderated by the degree of low birth weight, child's age, and family environment.