延长产后母婴皮肤接触时间对母乳喂养的影响

目的 分析产后母婴皮肤接触时间对出院时、产后1月、产后3月母乳喂养情况的影响。方法 选择2018年12月-2019年12月贵州省人民医院符合标准的产妇368例,按实际母婴皮肤接触时间分为<30 min(n=49)、30~<60 min(n=59)、60~<90 min(n=54)、≥90 min(n=206)4组,了解4组纯母乳喂养率、母乳喂养困难情况及远期母乳喂养风险。结果 4组产妇出院时纯母乳喂养率差异无统计学意义(χ²=2.026,P＞0.05),但在产后1月母婴皮肤接触时间≥90 min纯母乳喂养率高于其他3组(χ²=8.755,P＜0.05),产后3月显著升高(χ²=53.000,P＜0.001)。随着母婴皮肤接触时间的延长,中重度母乳喂养困难发生情况显著下降,轻度或无困难比率增加(χ²=19.627,P＜0.05)。产后3月,产妇满意度、婴儿满意度、生活方式持续母乳喂养总分随皮肤接触时间延长得分均增加(F=9.758、15.201、9.025、16.360,P＜0.001)。结论 延长产后母婴皮肤接触时间有助于提高产后纯母乳喂养率及远期母乳喂养结局。     

孤独症鼠模型脑组织CaMKⅡ和ERK表达的相关研究

目的 探讨钙调蛋白激酶Ⅱ(CaMK Ⅱ)和细胞外信号调节激酶(ERK)在孤独症谱系障碍发病中的作用。方法 孕12.5 d Sprague-Dawley孕鼠腹腔注射丙戊酸钠600 mg/kg建立子代孤独症谱系障碍模型大鼠,对照组注射同等剂量生理盐水。利用HE染色、免疫组化和图像分析技术观察比较出生后1、7、14 d和28 d两组大鼠脑部CaMK Ⅱ、ERK表达情况。结果 HE染色:出生后1 d、7 d模型组神经元数量较少,出生14 d后剧增,出生后28 d仍高于对照组。免疫组化:出生后1~14 d两组CaMKⅡ、ERK表达均显著升高(P<0.001),出生28 d后表达趋于稳定(P>0.05);与对照组相比,模型组各日龄大鼠CaMK Ⅱ、ERK表达水平均增高(P<0.001);CaMK Ⅱ、ERK于出生后1 d、7 d表达显著升高(P<0.001),出生后14 d表达量最多(P<0.001),出生28 d后趋于稳定(P>0.05)。结论 孤独症谱系障碍模型大鼠大脑皮层CaMK Ⅱ、ERK的表达增加,尤其是在出生后早期。     

青少年网络成瘾与童年期虐待忽视的相关性研究

目的 了解青少年网络成瘾的流行状况,分析青少年网络成瘾与其童年期虐待忽视的关系。方法 整群抽取安徽省阜阳、铜陵、天长3市5 726名初一~高三学生,使用自编“安徽省青少年健康相关行为问卷”调查研究对象一般情况、网络成瘾、童年期虐待忽视等进行调查。结果 男生网络成瘾检出率为5.41%,女生为2.93%,差异有统计学意义(χ²=47.66,P<0.001)。男生躯体虐待、情感虐待、性虐待、躯体忽视检出率均高于女生,差异均有统计学意义(P均<0.01)。童年期情感虐待、性虐待和躯体虐待是青少年轻度网络成瘾的危险因素(P均<0.05),童年期性虐待是青少年重度网络成瘾的危险因素(P<0.05)。结论 青少年网络成瘾与其童年期虐待忽视密切相关,在探讨青少年网络成瘾影响因素的同时,应关注童年期虐待忽视对网络成瘾的影响。     

肺炎患儿营养状况153例分析

目的 测定肺炎患儿血浆蛋白质及血红蛋白的水平,对患儿的营养状况进行初步分析。方法 根据年龄将153例肺炎患儿分三组:<1岁年龄组;1~<3岁年龄组;3~12岁年龄组。对其血浆总蛋白、白蛋白、前白蛋白、视黄醇结合蛋白、血红蛋白进行检测。结果 153例肺炎患儿的低蛋白血症患病率为25%,<1岁年龄组患儿低蛋白血症患病率为41%,<3岁年龄组为15%,3~12岁年龄组为7%。<1岁年龄组患儿的低蛋白血症患病率高于3~12岁年龄组,差异有统计学意义(P<0.05)。1~<3岁年龄组患儿的低蛋白血症患病率高于3~12岁年龄组,但差异无统计学意义。153例肺炎患儿的贫血患病率为63%,<1岁年龄组患儿的贫血患病率为72%,<3岁年龄组为78%,3~12岁年龄组为28%。<1岁年龄组患儿的贫血患病率高于3~12岁年龄组,差异有统计学意义(P<0.05)。1~<3岁年龄组患儿的贫血患病率高于3~12岁年龄组,差异有统计学意义(P<0.05)。结论 肺炎患儿中,婴幼儿的低蛋白血症及贫血的患病率较大年龄组高。因此,应尽早监测肺炎患儿尤其是婴幼儿营养状况变化,及时进行营养支持,以改善患儿预后。     

中性粒细胞/淋巴细胞比值对新生儿缺氧缺血性脑病早期分度诊断的价值

目的 研究中性粒细胞/淋巴细胞比值(NLR)对新生儿缺氧缺血性脑病(HIE)早期分度诊断的价值。方法 收集兰州大学第二医院新生儿科HIE病例134例,其中轻度HIE组42例,中重度HIE组36例,正常对照组56例。内容包括患儿一般资料,出生分娩情况,第1、3、7天血常规,计算NLR和血小板/淋巴细胞比值(PLR),生后1周内行头颅MRI检查,采用单因素分析、受试者工作特征曲线(ROC)及Kappa一致性检验判断进行统计学分析。结果 单因素分析显示,第1天和第3天白细胞、中性粒细胞、NLR是中重度HIE组的危险因素,第1天中重度HIE组NLR较同期正常对照组明显升高(5.55±1.88 vs 2.63±0.91,P<0.05),轻度HIE组NLR升高不明显(2.71±0.92 vs 2.63±0.91,P>0.05),中重度HIE组NLR明显高于轻度HIE组(5.55±1.88 vs 2.71±0.92,P<0.05);ROC曲线显示第1天NLR效能最高(曲线下面积达0.959),灵敏度高达93.3%,特异度达81.0%,最佳截断点为3.43;Kappa检验显示NLR与1周内头颅MRI结果基本一致。结论 新生儿窒息1周内NLR对HIE早期分度诊断具有一定预测价值。     

脑干听觉诱发电位联合MRI在新生儿胆红素脑病早期诊断中的意义

目的 研究脑干听觉诱发电位(BAEP)和磁共振(MRI)两种检查手段在新生儿高胆红素脑病早期诊断中的价值。方法 回顾性分析137例高胆红素血症患儿临床相关指标。结果 BAEP、MRI异常和有急性胆红素脑病症状组血清总胆红素、血清总胆红素/白蛋白值明显高于BAEP、MRI正常组和无急性胆红素脑病组(P<0.05)。BAEP与MRI异常率呈正相关(r=0.466,P<0.05)。BAEP诊断胆红素脑病的敏感性(87.18%)高于MRI(64.10%),但特异性(78.57%)低于MRI(93.88%)。结论 BAEP和MRI检查在新生儿高胆红素脑病早期诊断中有重要意义。     

不安运动阶段影响婴儿全身运动质量的影响因素分析

目的 分析影响婴儿不安运动阶段全身运动(GMS)质量的相关因素,为临床干预提供理论依据。方法 选取2015年7月-2018年4月接受GMs评估且处于不安运动阶段的高危小婴儿719例,其中,GMs评估正常组571例,异常组148例。对可能会影响小婴儿GMs质量的产前、产时、产后发生的21种危险因素进行调查。结果 单因素分析显示,GMs异常组婴儿出生体重明显低于正常组(P<0.01);而出生胎龄(<30周)、新生儿窒息、缺氧缺血性脑病、新生儿高胆红素血症、颅内出血、新生儿惊厥的比率明显高于正常组(P<0.05)。Logistic回归分析显示,有统计学意义的影响因素有出生体重(OR=0.645,95%CI:0.474~0.878)、出生胎龄(<30周)(OR=4.05,95%CI:1.565~10.484)、缺氧缺血性脑病(OR=3.152,95%CI:1.765~5.629)、新生儿高胆红素血症(OR=5.07,95%CI:3.161~8.132)、新生儿惊厥(OR=3.579,95%CI:1.572~8.146)。结论 出生胎龄(<30周)、缺氧缺血性脑病、新生儿高胆红素血症、新生儿惊厥是影响不安运动阶段婴儿GMs质量的独立危险因素,而出生体重是保护因素;对存在此类高危因素的小婴儿,应给予早期筛查及干预。     

远隔缺血后处理对缺氧缺血性脑病大鼠CaSR表达和Akt/ Pi3k通路的影响

目的 分析远隔缺血后处理对新生大鼠缺氧缺血性脑病(HIE)脑组织钙敏感受体(CaSR)的表达和Akt/Pi3k通路的影响,为新生儿HIE的治疗提供理论依据。方法 7日龄新生Wistar大鼠120只随机分为假手术组(S组)、缺氧缺血性脑病组(HIE组)、远隔缺血后处理5 min组(R1组)、远隔缺血后处理10 min组(R2组)。观察各组大鼠行为表现并称其体重,HE染色观察细胞形态学变化,电镜观察细胞超微结构,免疫组化检测脑组织CaSR、Bax、Bcl-2、p-Akt、Akt蛋白的表达,Western印迹法检测脑组织 p-Akt、Bax、Bcl-2蛋白的表达。结果 与HIE组相比,R1组、R2组大鼠异常行为减少、体重增长率明显增加(P<0.05)。CaSR阳性细胞数R1组(22.00±1.79)与R2组(20.83±2.04)较HIE组(25.67±1.21)减少(P<0.05);p-Akt阳性细胞数R1组(25.00±1.41)与R2组(27.33±1.86)较HIE组(14.33±2.16)增多(P<0.05);p-Akt光密度值R1组(328.33±24.86)与R2组(339.67±23.77)较HIE组(120.83±17.43)增加(P<0.05)。与HIE 组相比,R1组与R2组Bax表达减少(P<0.05),Bcl-2表达增加(P<0.05)。R1组与R2组相比,各项指标差异无统计学意义(P>0.05)。各组间Akt的表达差异无统计学意义(P>0.05)。结论 远隔缺血后处理对新生大鼠脑组织损伤的保护作用可能与脑组织CaSR表达降低和激活Akt/Pi3k通路有关。     

我国西部四省县乡级助产机构新生儿早期基本保健技术能力现状调查

目的 了解我国西部四省县乡助产机构新生儿早期基本保健技术能力现状,为制定有针对性的干预措施提供依据。方法 采用信函调查方式,于2017年6月-2018年9月收集贵州、青海、四川、宁夏4省(区)21个县的助产机构数据,采用描述性统计方法分析各省新生儿早期基本保健干预措施的开展情况,采用χ²检验比较不同级别机构的干预措施实施率。结果 233所县、乡级助产机构参与调查。1)孕产妇相关干预措施:高危孕妇管理率(98.9%)、梅毒孕妇治疗率(97.9%)、孕妇叶酸服用率(88.8%)等均处于较高水平,早产儿胎膜早破母亲使用抗生素治疗的比例较低(60.1%)。2)新生儿分娩后相关干预措施:出生后进行90 min母婴皮肤接触的比例为41.8%,生后1 h内完成首次母乳喂养的比率为77.7%,开展早产儿袋鼠式护理的机构比例为24.7%。3)新生儿疾病相关干预措施:可开展新生儿败血症和新生儿肺炎疾病诊疗的机构分别为33.5%和47.8%,接受肌肉注射维生素K₁的新生儿比例为69.8%。结论 我国西部4省县乡级助产机构的新生儿早期基本保健技术实施现状与世界卫生组织的建议存在差距,应针对这些不足和差距开展干预。     

母源性吸烟对新生儿出生体重、头围、身长及储存铁影响的研究

目的 探讨母源性吸烟对新生儿出生体重、头围、身长及储存铁的影响,为提高我国围产保健水平提供理论依据。方法 以150名产妇及其新生儿为研究对象,按WHO推荐的吸烟频率分类将产妇分为不吸烟组,偶尔吸烟组以及每日吸烟组,于孕晚期进行膳食调查,计算其每日铁摄入量。测量新生儿的出生体重、身长、头围,并采集产妇外周血及新生儿脐带血,检测血清铁蛋白(SF)及血清可溶性转铁蛋白受体(sTfR)水平,计算全身铁(TBI)水平。结果 产妇在孕晚期的每日铁摄入量差异无统计学意义;不吸烟组新生儿出生体重明显高于两个吸烟组(P均<0.05);两个吸烟组新生儿的头围及身长差异无统计学意义(P均>0.05);不吸烟组产妇sTfR水平明显高于两个吸烟组(P均<0.001),SF和TBI水平均低于两个吸烟组(P均<0.05);不吸烟组新生儿sTfR水平明显低于两个吸烟组(P均<0.001),SF和TBI水平明显高于两个吸烟组(P均<0.001)。结论 母源性吸烟可引起产妇自身储存铁升高,而使新生儿出生体重以及储存铁降低。     

新生儿早期基本保健对初产妇泌乳启动的影响

目的 研究新生儿早期基本保健(EENC)技术对初产妇母乳喂养得分、泌乳启动时间及产后前72 h纯母乳喂养率的影响。方法 2018年6-7月随机选取潍坊医学院附属医院自然分娩的89对初产妇及新生儿,分为干预组(n=45)及对照组(n=44)。干预组新生儿实施EENC,对照组进行常规护理。采用母乳喂养测量工具(BAT)进行母乳喂养评分,并在产后24、48、72 h随访记录产妇泌乳启动时间及纯母乳喂养情况。结果 干预组首次母乳喂养评分为(10.84±1.36)分,对照组为(10.23±1.43)分,差异有统计学意义(t=-2.085,P=0.040);干预组产妇泌乳启动时间[(48.51±10.71)h] 早于对照组[(53.66±10.99)h] ,差异有统计学意义(t=2.238,P=0.028);干预组产后24、48、72 h的纯母乳喂养率(33.3%、51.1%、71.1%)均高于对照组(13.6%、29.5%、50.0%),差异有统计学差异(χ²=4.788,4.295,4.155,P<0.05)。但两组首次母乳喂养或成功率和泌乳启动率间差异均无统计学意义(P>0.05)。结论 新生儿早期基本保健对母乳喂养评分及产妇泌乳启动有促进作用,能够提高早期纯母乳喂养率,值得推广。     

Evaluation of the Effects of Skin-to-Skin Contact on Newborn Sucking,and Breastfeeding Abilities: A Quasi-Experimental Study Design

Mother and newborn skin-to-skin contact (SSC) after birth has numerous protective effects. Although positive associations between SSC and breastfeeding behavior have been reported, the evidence for such associations between early SSC and breastfeeding success was limited in high-income countries. This quasi-experimental intervention design study aimed to evaluate the impact of different SSC regimens on newborn breastfeeding outcomes in Taiwan. In total, 104 healthy mother–infant dyads (52 in the intervention group and 52 in the control group) with normal vaginal delivery were enrolled from 1 January to 30 July 2019. The intervention group received 60 min of immediate SSC, whereas the control group received routine care (early SSC with 20 min duration). Breastfeeding performance was evaluated by the IBFAT and BSES-Short Form. Generalized estimating equations (GEEs) were used to evaluate the effectiveness of the intervention. In the intervention group, the breastfeeding ability of newborns increased significantly after 5 min of SSC and after SSC. The intervention also improved the total score for breastfeeding self-efficacy (0.18 point; p = 0.003). GEE analysis revealed that the interaction between group and time was significant (0.65 point; p = 0.003). An initial immediate SSC regimen of 60 min can significantly improve neonatal breastfeeding ability and maternal breastfeeding self-efficacy in the short term after birth.     

Improving breastfeeding outcomes: the impact of tongue-tie

A tongue-tie (ankyloglossia) is defined as a lingual frenulum that is short, tight and restricts normal tongue movement. The tongue-tied newborn baby then has a mechanical difficulty attaching to his mum's breast and maintaining attachment to feed effectively. In the hands of skilled carers, this mechanical problem can be resolved by releasing the frenulum (frenulotomy) and the baby's access to his/her mother's breast milk be preserved. Published research on this subject has undergone justifiable criticism. Robust methodology was lacking in earlier studies. An overview of the course of researchers' response to critique is discussed. The care pathway in place in mid-Norfolk for mother and baby dyads where the baby's tongue-tie compromises efficient breastfeeding is outlined.     

The practice guideline 'Pregnancy and puerperium' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice medicine

The first revision of the Dutch College of General Practitioners' practice guideline about pregnancy and puerperium does not significantly differ from the first edition. The guideline is extensive, is well-worth reading and supports daily practice. There is a greater emphasis on the importance of cooperation and differentiation in primary care (midwifes and general practitioners). During the last decade many general practitioners stopped doing home deliveries and have therefore lost their experience in obstetric care and pathology. The guideline describes the general practitioner's tasks as a preconception counsellor, a professional expert on illnesses during pregnancy and after the delivery, and as the doctor of the newborn baby. It will hopefully stimulate a revived interest of and involvement in pregnancy and post-partum care among general practitioners.     

Determinants of the exclusive breastfeeding abandonment: psychosocial factors

OBJECTIVE

To assess the determinants of exclusive breastfeeding abandonment.

METHODS

Longitudinal study based on a birth cohort in Viçosa, MG, Southeastern Brazil. In 2011/2012, 168 new mothers accessing the public health network were followed. Three interviews, at 30, 60, and 120 days postpartum, with the new mothers were conducted. Exclusive breastfeeding abandonment was analyzed in the first, second, and fourth months after childbirth. The Edinburgh Postnatal Depression Scale was applied to identify depressive symptoms in the first and second meetings, with a score of ≥ 12 considered as the cutoff point. Socioeconomic, demographic, and obstetric variables were investigated, along with emotional conditions and the new mothers’ social network during pregnancy and the postpartum period.

RESULTS

The prevalence of exclusive breastfeeding abandonment at 30, 60, and 120 days postpartum was 53.6% (n = 90), 47.6% (n = 80), and 69.6% (n = 117), respectively, and its incidence in the fourth month compared with the first was 48.7%. Depressive symptoms and traumatic delivery were associated with exclusive breastfeeding abandonment in the second month after childbirth. In the fourth month, the following variables were significant: lower maternal education levels, lack of homeownership, returning to work, not receiving guidance on breastfeeding in the postpartum period, mother’s negative reaction to the news of pregnancy, and not receiving assistance from their partners for infant care.

CONCLUSIONS

Psychosocial and sociodemographic factors were strong predictors of early exclusive breastfeeding abandonment. Therefore, it is necessary to identify and provide early treatment to nursing mothers with depressive symptoms, decreasing the associated morbidity and promoting greater duration of exclusive breastfeeding. Support from health professionals, as well as that received at home and at work, can assist in this process.     

新型冠状病毒肺炎疫情前后个人手卫生状况及影响因素调查

目的 了解新型冠状病毒肺炎疫情发生前、后公众的洗手相关行为及影响因素。 方法 通过中国疾病预防控制中心官方微信公众号平台发放电子调查问卷。 结果 调查期间后台访问13 193次,共收集有效问卷7 011份。日常生活每天洗手>10次的比例从疫情前15.0%提升到疫情后48.3%,洗手次数小于3次的比例从疫情前13.3%下降到疫情后1.5%。每次洗手时间大于20 s的比例疫情前22.2%提升到疫情后51.7%,每次洗手小于10 s的比例疫情前35.3%下降到疫情后4.0%。手消毒液的使用率从疫情前40.6%增至疫情后84.0%。多因素logistic分析结果显示,疫情发生后男性、学生、初中及以下文化程度更有可能在日常生活中洗手次数<3次/d。 结论 新型冠状病毒肺炎疫情后公众对勤洗手预防病毒感染的接受程度高,需要针对性提升男性、学生和初中以下文化程度人群的手卫生教育,认识到洗手的重要性。     

湖南省医疗保健机构新生儿早期基本保健技术服务现状调查

目的 了解湖南省医疗保健机构新生儿早期基本保健服务现状,为开展有针对性的新生儿保健干预提供依据.方法 采用随机抽样方法,于2017年11-12月抽取湖南省长沙市和株洲市各4所助产机构的住院产妇进行问卷调查,收集分娩期间新生儿早期基本保健服务措施的开展情况.采用SPSS 23.0统计软件进行数据分析,比较不同级别医院服务...     

Action of the nurse with peripherally inserted central catheter in the newborn infant

Technological advances in Neonatology have benefited the infant newborn who need a safe venous access. This study aimed at investigating the actions of the nurse regarding Peripherally Inserted Central Catheter (PICC) in the Neonatal Intensive Care Unit in Fortaleza, CE. The sample was composed by 17 nurses; the data were collected from July to August 2004 through a structured questionnaire. In the results, it was verified that 09 nurses reported the basilic vein as the most indicated for puncture; 17 reported the washing the hands before and after handling the catheter and washing it before and after the drug administration as the most important care. It was concluded that handling this device requires knowledge and hability on the part of the professionals.