新生儿窒息复苏2min流程图的推广及成效

目的提高新生儿窒息复苏水平，降低新生儿窒息的病死率和伤残率。方法我院制定“新生儿窒息复苏2min流程图”并培训推广应用，并将推广应用前后窒息情况进行对比。结果显示窒息及重度窒息发生率、病死率均显著下降，平均窒息时间由以前的7．2min下降至3．4min，1min评分由3．9分提高到7．0分，5min评分由7．1分提高到9．6分，缺氧缺血性脑病及严重病例明显减少，经统计学处理差异有显著性。结论新生儿窒息复苏2min流程图方便快捷、简单易行，节省了宝贵的抢救时间，符合窒息复苏的病理生理过程，具有重要的推广应用价值。     

陕西省2006-2011年新生儿死亡流行病学调查

目的了解陕西省新生儿死亡的流行病学特征。方法采用城乡分层整群抽样的方法,对全省2006—2011年5岁以下儿童死亡监测点上报的495例死亡新生儿进行统计分析。结果全省新生儿总死亡率由2006年的18.12‰下降到2011年的8.25‰,下降幅度54.47%,农村地区下降幅度60.82%;早期新生儿死亡占新生儿死亡的82.83%,24h内死亡的新生儿占早期新生儿死亡的52.68%;绝大多数新生儿死于医院,占93.94%,家中或途中死亡占6.06%;死因为出生缺陷、出生窒息、早产或低出生体重;农村地区和全省新生儿死亡率呈直线下降趋势。结论陕西省新生儿死亡率总体呈下降趋势,农村地区新生儿死亡率下降幅度较大;早期新生儿死亡所占比重较大;出生缺陷、出生窒息、早产或低出生体重成为新生儿死亡的主要原因。应加强围产期保健、产前诊断及新生儿疾病筛查,减少出生缺陷;强化窒息复苏技术的培训及危重患儿三级转诊制度,开展新生儿死亡评审,以有效降低新生儿死亡率。     

关于我国新生儿新法复苏的现状和建议

自 1 98 3年陕西临潼会议新生儿新法复苏方案[1 ] 的提出 ,1 993年广州会议再次修订[2 ] 并号召推广 ,至今已有 1 8年 ,这期间笔者参加了该项工作 ,不免思考 ,有以下看法和建议。1　对新法复苏现状的估价1 1　成绩巨大　众所周知 ,解放以来 ,我国婴儿死亡率由 2 0 0‰降至目前的 50 1 9‰[3] ,但其中新生儿死亡率的降低并非同等显著 ,导致 2 0世纪 80年代我国新生儿和围产医学的兴起。针对新生儿窒息是主要死因 ,借鉴国外模式要求产科与儿科合作的呼声日高 ,其合作的主要内容当属新生儿新法复苏。 90年代初产、儿科两大学科联合召开了全国…     

87例新生儿颅内出血死亡的病因分析

本院１９８４年１月￣１９９３年１２月十年间住院死亡新生儿２５４例，尸解２４１例，颅内出血８７例，其中直接死于颅内出血４７例，占总死亡数１８．５％，早产儿及窒息儿为易发人群；生后２４小时内死亡占６１．７％，可见重在预防；五种分娩方式中以剖宫产颅内出血死亡率最低，胎头吸引，臀位较高，提示宜放宽臀位剖宫产指症，头吸亦宜慎用。十年中新生儿颅内出血死亡率由８４￣８７年的１．３３２‰下降至８８￣９３年的０．４     

围生期窒息发生率和死亡率近10年变迁及相关因素

目的 分析近10年来围生期窒息发生率和死亡率的变迁，探讨围生期窒息相关因素及开展新法复苏对围生期窒息发生率和死亡率的影响。方法对近10年郑州大学第三附属医院分娩的所有活产新生儿的病历资料进行回顾性分析，计算窒息的发生率、死亡率、病死率，观察上述指标的逐年变化趋势及季节变化的情况，并探讨性别、双／多胎、出生体质量、胎龄分娩方式对这些指标的影响。结果轻度窒息发生率在开展新法复苏后明显下降，并稳定在1．5％左右，而重度窒息的发生率和病死率均无明显变化。窒息儿的发生率以4月份最高，但死亡率和病死率以7月份最高。窒息的发生还与性别、双／多胎、出生体质量、早产以及阴道助产有关。结论围生期窒息的发生与性别、双／多胎、出生体质量、胎龄密切相关；新法复苏能显著降低轻度窒息的发生率，对重度窒息的发生率和窒息病死率无明显影响；窒息儿的死亡率和病死率与季节有关。     

新生儿窒息新法复苏在基层实施的体会

新生儿窒息新法复苏是指采用A、B、C、D、E程序复苏。现将我院取得的很好效果报道如下。临床资料与方法1994年10月1日至1996年9月30日，我院共分娩活产新生儿586例，发生新生儿窒息29例（4．95％），此前全体妇产科医、护人员均经过短期新生儿窒息新法复苏培训，培训新法复苏技术。1995年又接受市、县3次强化培训。对所有新生儿在胎头娩出后20秒种内，都用手法挤出其口、鼻部的羊水；指干身上羊水，保暖，摆好体位，一次性吸管吸净回咽部羊水，再弹拍足底或摩擦儿背的初步复苏处理。结果17例初步复苏后加用气囊面罩复苏器，7例在此基础上…     

新生儿胎粪吸入综合征防治探讨(附44例分析)

新生儿新法复苏自1992年在我国开展以来，对预防胎粪吸入综合征（MAS）的发生起了明显作用，在发达地区由于新法复苏的普及新生儿窒息及MAS的发生率明显下降，死亡率也明显下降。但在三峡库区经济落后地区新法复苏的开展并不令人满意。本文就我院自2000年9月至2004年3月收治的44例来源于不同层次医院的MAS患儿进行了回顾性调查分析，现总结如下：     

甘肃省2004-2007年新生儿死亡监测系统分析

目的 分析新生儿死亡原因,提出预防措施,降低新生儿死亡率.方法 对2004-2007年全省5岁以下儿童死亡监测点上报的893例死亡新生儿进行分析.结果 全省新生儿总死亡率由2004年13.2‰降至2007年10.2‰,早期新生儿死亡占新生儿死亡的83.8%,足月儿死亡占新生儿死亡的67.8%;新生儿死亡率农村高于城市,男性高于女性,多数死亡发生在医院(占82.4%),主要死因为出生窒息、早产低出生体重、出生缺陷;绝大多数新生儿死于医院,家中和途中死亡占17.6%;新生儿死亡各项指标农村均高于城市.结论 加强围生期保健、产前诊断及住院分娩,强化窒息复苏技术的培训及危重患儿三级转诊制度,开展新生儿死亡评审,以有效降低新生儿死亡率.     

中国5岁以下儿童死亡抽样调查

中国５岁以下儿童死亡抽样调查结果表明：１９９１年全国新生儿、婴儿、５岁以下儿童死亡率分别为３３．０７‰、５０．１９‰、６１．０３‰；城市分别为１２．５２‰、１７．３１‰、２０．８６‰；农村分别为３７．９０‰、５８．０２‰、７１．０８‰。农村占全国５岁以下儿童死亡的９３．３０％。婴儿死亡占５岁以下儿童死亡的８０．２０％，新生儿死亡占婴儿死亡的６４．８０％。提示５岁以下儿童死亡的前四位分类死因为新生儿疾病、呼吸系统疾病、意外事故及先天畸形；前四位疾病是肺炎、新生儿窒息、早产、腹泻。     

儿科医生进产房开展新法复苏的体会

自1983年陕西临潼会议提倡儿科医师进产房（1）以来，儿科界号召推行和普及新生儿“新法复苏”（2），以降低新生儿窒息病死率。我院自1994年1月至1997年2月坚持新生儿科医生提前进产房，产儿合作开展新法复苏，取得满意效果，报告如下。材料与方法一、一般资料1994年1月至1997年2月，本院活产分娩7891例，阿氏评分≤7分495例，窒息发生率6．27％，与国内报道的6．39％近似（3）其中0—3分68例，占13．74％。同期新生儿科医师进产房复苏3498例，占活产分娩的44．3％。二、指征与方法凡高危分娩我科医师均在胎儿娩出前提前到达，作好复苏前准…     

关节内侧间隙测量对髋关节脱位术后稳定性的预测

目的探讨关节内侧间隙测量对髋关节脱位术后稳定性的预测意义。方法分析2004～2007年本院10例髋关节再脱位患儿以及随机抽取的50例术后未发生再脱位患儿的影像学资料,对其术后1d、1周、1．5个月、3个月、4个月、5个月、6个月骨盆平片进行患侧髋关节内侧间隙值OA以及泪滴至髋臼外缘的距离OA的测量,并采用D值（D=OA／OA）进行标准化处理。结果无再脱位组D值基本小于0．8。其中30例采用髋关节外展支具,未出现再脱位,D值位于0．66～0．8之间;脱位组在石膏同定期间,D值基本小于0．7,此时股骨头位于髋臼内,未出现脱位;术后6周至3个月拆除石膏后,D值为0．66．0．8,未采取措施,相继出现脱位,此时D值基本大于0．8。结论测量关节内侧间隙对于评价髋关节脱位术后关节的稳定性以及预测早期再脱位有重要意义。D值小于0．66,关节稳定,不会出现再脱位;D值为0．66～0．8,关节稳定性受到影响,可能出现再脱位,需尽早采取干预措施;D值大于0．8,出现再脱位,简单保守治疗措旆失去作用．需再次手术蚕新复位。     

Tacrolimus: the good, the bad, and the ugly

The aim of this study was to evaluate the efficacy and side-effects of tacrolimus in pediatric transplant patients previously receiving cyclosporin A (CsA). This study was a retrospective chart review strengthened by a concomitant patient interview. Eleven pediatric cardiac or renal transplant patients, who had been converted from CsA to tacrolimus from October 1995 to January 1999 at The Cleveland Clinic Foundation, were included; there were six renal and five cardiac transplant patients. Each chart was reviewed to assess transplanted organ function pre- and post-conversion. For the six renal transplant patients, creatinine levels and biopsy findings were evaluated. For the five cardiac transplant patients, cardiac catheterization and routine biopsy data were analyzed likewise. Epstein Barr virus (EBV) status was also evaluated in each patient. In addition, each parent or patient was interviewed to ascertain dates of transplant, current medications, and side-effects. The patients' ages ranged from 6 to 20 yr (mean age 14.6 yr). All patients had been converted to tacrolimus. Eight patients were converted for treatment of refractory rejection, two were converted because of CsA-associated side-effects, and one patient was converted empirically for a history of multiple previous transplant rejections. Seven out of eight patients who received tacrolimus for rejection therapy improved. One patient had complete resolution of gingival hyperplasia. Another patient who previously developed hemolytic uremic syndrome on CsA had no further evidence of hemolysis. Four patients were weaned off steroid therapy. Despite conversion, two renal transplant patients progressed to chronic rejection. Five patients exhibited no side-effects. Side-effects experienced included transient hyperglycemia in conjunction with steroid use, headaches, and tremors that subsided rapidly. Four of 11 patients developed post-transplant lymphoproliferative disease (PTLD). Fortunately, reducing the dose of tacrolimus and/or surgical resection of the mass (if present), eradicated the disease. In conclusion, conversion therapy successfully provides an alternate treatment for acute rejection. It also enabled some patients to discontinue steroid therapy, maximizing growth potential. PTLD is a severe, potentially life-threatening complication that needs to be recognized and monitored closely. In conclusion, tacrolimus has been shown to be a very effective agent for the treatment of refractory organ rejection, but must be used cautiously.     

Neuroimaging in the developmental disorders: the state of the science

The developmental disorders of childhood autistic, developmental language, reading (dyslexia), and attention deficit-hyperactivity disorders-manifest with deficits in the traditional behavioral domains of cognition, language, visual-spatial function, attention, and socialization. However, none of these disorders has been associated with characteristic discrete focal lesions or recognized encephaloclastic processes. Developmental cognitive neuroscientists must therefore begin with the spectrum of sometimes divergent behaviors occurring within these disorders and work backward in an attempt to identify the responsible anomalous neural systems. Since the advent of "brain imaging" two decades ago, much effort has focused on identifying brain-behavior correlates in these disorders. The results of these neuropathologic, structural, and functional neuroimaging studies are presented and the reasons for the often divergent findings are discussed. As we approach the end of the Decade of the Brain, current neuroimaging techniques give us the technology for the first time to apply a fundamental cognitive approach to brain-behavior relationships in the developmental disorders, to eliminate the conglomeration of "apples and camels" phenomenon. Researchers are working together to create comparable protocols and to adhere to methods that can be replicated across sites. The future prospects for a greater understanding of the developmental disorders are now much brighter with neuroimaging technology.     

Flaws in the assessment of the best interests of the newborn

We examined the literature on ethical decisions regarding neonates, to assess whether personal beliefs and prejudices influence end-of-life decisions taken by caregivers. Studies show that religion and familiarity with disability influence caregivers' decisions, whereas the influx of already being a parent, age, sex and professional experience is controverse. Caregivers' attitudes towards end-of-life decisions are also affected by personal concerns about litigation, prejudices and their view of disability. The concept of 'poor quality of life' is widely used as a reference in end-of-life decisions, but this can be interpreted differently, leaving room for a wide range of personal viewpoints. In most cases, parents' opinions are considered important and are sometimes the main determinant in decision making. However, it is unclear whether parents' decisions are based on their own wishes or on the best interests of the newborn.
Conclusion: In neonatal end-of-life decisions, patients may not receive cures based only on their best interests.     

抗癫(癎)药物对骨代谢的影响和防治研究进展

癫痫是神经科常见病,目前控制癫痫发作的主要手段是药物治疗。抗癫痫药物（anti—epileptic drugs,AEDs）对骨骼代谢的影响在上个世纪60年代末就有报道,近年来广大学者对此进行了深入的研究。现就国外关于AEDs对骨代谢的影响、监测和防治的研究作综述如下。     

Effect of the adaptation of the food of the hospitalized child on the cover of the nutritional needs]

AIMS: Denutrition remains a major concern in hospitalized children. Daily experience suggests that the meals proposed by hospital dietetic service, although well-balanced and in accordance with the recommendations, may be poorly accepted and consumed by children. The aims of this study were to assess the effect of modification of foods offer on energy intakes as well as nutriments and minerals and trace elements in hospitalized children. PATIENTS AND METHODS: During a 1-month period, 25 consecutive children (range 4-17 years; 13 girls), hospitalized in our pediatric department were included in the study (reasons for hospitalisation comprised: medical reasons [n=7], orthopedic problem [n=16] or surgery [n=2]). They had no restricted diet and received the usual pediatric hospital feeding according to the French recommended dietary allowances (RDA) (D1). They were compared to 21 children--matched for age, sex, nutritional status and pathology, hospitalized during the following 1-month period--who received a modified diet (D2), elaborated by dieticians according to the child's preference and excluded or limited food usually nonconsumed by the children. Food consumption was prospectively measured for 24h by analysis of the nonconsumed foods, as well as browsing and extra food brought by the family. Analysis of energy, carbohydrate, lipid, protein, iron and calcium intake was made using Bilnut 3 software (Nutrisoft, France). RESULTS: D2 covered 119+/-37% of the median energy needs versus 89+/-37% for D1 (p<0.05). The median energy needs were more often reached with D2 as compared to D1 (62% versus 32%, p<0.05). Protein intake was high in both groups, more importantly with D2 (266+/-111% of RDA versus 193+/-77% with D1, p<0.05). We observed no difference between the 2 diets in regards of fat/carbohydrate balance and iron intake. Calcium intake was increased with the adapted diet: 68+/-26% of RDA with D2 versus 49+/-26% with D1 (p<0.01). CONCLUSION: Adapting food offers to preference influences food and caloric intakes in hospitalized children. This could be an efficient strategy to prevent acute undernutrition in hospital.