小于胎龄儿脐血超敏C反应蛋白水平及意义探讨

目的比较小于胎龄儿（small-for-gestational-age,SGA）与适于胎龄儿（appropriate-for-gestational age,AGA）脐血超敏C反应蛋白（hs-CRP）水平,探索C反应蛋白与心血管病之间的关系。方法检测32例SGA和66例AGA脐血hs-CRP浓度,排除可疑或经证实的宫内感染。结果SGA组hs-CRP浓度显著高于AGA组,中位数（范围）分别为：SGA组0.06 mg/dl（0.02～6.03）、AGA组0.02 mg/dl（0.02～0.61）,P=0.003。hs-CRP浓度高于检测限（0.04mg/dl）分别为：SGA组22例（68.8%）、AGA组26例（39.4%）,（P=0.002）。结论SGA组hs-CRP浓度高于AGA组,提示SGA在胎儿期可能有炎症反应。     

小于胎龄儿发生因素分析

本文对１９９５．４－１９９５．９在我院产科出生的３３例小于胎龄儿以１：１病例－对照方法就其发生因素进行分析（主要分析母亲因素）。所得结论：１．妊娠合并症；２．孕期营养不良；３．胎盘小于正常；４．孕期生活事件发生；５．孕前一年月经不规则，经统计学处理，均证明是小于胎龄儿发生的重要因素。前３个因素是对以往研究结论在我地区进一步地验证，后２个因素是本次调查筛选出的新的值得注意的因素。     

106例小于胎龄儿临床分析与随访

１０６例小于胎龄儿临床分析与随访青岛市第二人民医院儿科（２６６０３３）郑青，齐瑛，栾红，李军军北京儿童医院刘红小于胎龄儿系宫内发育迟缓的胎儿，由于其生后合并症多，病死率高，而且关系着以后的生长发育及智力水平，近年来日益受到重视。本文就近五年来收治的１...     

瘦素与小于胎龄儿的研究进展

小于胎龄儿(SCA)又称胎儿宫内发育迟缓(IUGR),指出生体重低于该孕周平均体重的第10百分位数,发生率国外报告为496～5%,而我国为3.7%～9.2%.SGA死亡率为正常新生儿死亡率的8倍,存活者远期体格、智力、发育障碍发生率较正常儿高,因此,SGA发生因素的研究是当今国内外关注的围产医学的重要课题.     

胃肠激素检测在小于胎龄儿变化中的临床意义

目的:对68例小于胎龄儿(其中早产36例;足月32例)生后喂奶前及第7d空腹血中生长抑素(somatostatin, SS)、胃动素(motilin, MOT)、胃泌素(gastrin, Gas)浓度进行测定,并以30例足月新生儿作为对照组.方法:应用放射免疫分析测定SS、MOT、Gas浓度.结果:小于胎龄儿组生后喂奶前及第7d空腹血浆MOT、Gas均明显低于对照组,而SS浓度明显高于对照组,并且与胎龄、开始喂养时间及当日进奶等因素相关.结论:小于胎龄儿消化道机能适应胃肠道营养,在严密观察下应用合理的喂养方式早日开始胃肠道营养,将能促进小于胎龄儿胃肠道的发育和成熟.     

518例早产低体重儿临床分析

目的 探讨早产低体重儿发病和存活的相关因素,为降低早产儿发生率,提高生存质量。方法 对5年出生518例早产低体重儿按体重和胎龄分3组,并对其临床资料进行回顾分析,对其生存和死亡进行分析比较。结果 早产低体重儿主要发病原因,妊娠并发症42例(占8.1%),多胎妊娠62例(占11.97%),羊膜早破200例(占38.61%),主要并发症依次为高胆红素血症130例,IRDIS 56例,HIE38例,肺炎35倒,应激性溃病15例,贫血35例,窒息25例,体重越低,胎龄越小,并发症的发生率越高,死亡率越高。本组存活率为95.18％,死亡率4.82％,死亡率与出生体重、孕周有明正关系。结论 ①加强围产期保健,提高产科质量,强调产儿科合作。②加强监护,早期发现并发症,及时处理,防止院内感染。     

小于胎龄儿追赶生长特点及影响因素分析

目的探讨中国北方地区小于胎龄儿(SGA)出生后追赶生长特点以及相关影响因素。方法以2012年1月至2013年1月在河北省廊坊市妇幼保健中心出生的新生儿为研究对象,根据出生体质量分为SGA组、适于胎龄儿组(AGA)和大于胎龄儿组(LGA),收集出生时至2岁资料。统计分析SGA出生后追赶生长特点以及相关影响因素。结果研究共纳入SGA、AGA和LGA分别661例(8.3%)、6571例(82.5%)和729例(9.2%)。SGA组2岁时矮小的比例为0.9%,高于AGA组(0.6%)和LGA组(0.3%)(P0.05)。SGA组出生后2年内追赶生长主要出现在1岁以内。相关性分析显示,SGA 1岁内身长增长速度与出生体质量、身长、Apgar评分呈负相关;与胎盘质量呈正相关,而与F/P呈负相关;与喂养方式相关。结论大部分SGA儿童在2岁时完成追赶生长,追赶生长主要出现在出生后1年内,胎盘不适当过重、喂养方式等因素均与SGA追赶生长相关。     

生长激素在小于胎龄儿临床应用的展望

小于胎龄儿(small for gestational age infant,SGA)是指出生体重在同胎龄儿平均体重的第10百分位以下,或低于平均体重2个标准差的新生儿.欧美发达国家的发生率是2.5%,我国的发生率是6.39%,患儿自幼大多生长落后终生身材矮小[1].     

中山地区胎儿宫内发育迟缓338例临床分析

目的探讨孕妇中胎儿宫内发育迟缓的原因及改善其预后的主要环节。方法以回顾性分析方法对我院近5年来9226例新生儿中胎儿宫内发育迟缓的338例（占3．664％）进行分析，并随机抽取同期出生的350例适于胎龄儿为对照，比较相关因素的发生情况，以利于以后及时地发现胎儿宫内发育迟缓，及时地治疗，达到降低围产儿死亡率及患病率的目的。结果胎儿宫内发育迟缓组与对照组在孕期系统管理、分娩方式、围产儿预后及妊高征、多胎、妊娠合并心血管疾患的发生上均有差异显著性（P〈0．05或P〈0．01）。结论加强孕期管理、产前诊断、及时积极治疗各种并发症、采用适当的分娩方式，是减少胎儿宫内发育迟缓的发生，改善其预后的关键。     

小于胎龄儿脐血脂联素水平测定及其临床意义

目的探讨小于胎龄儿（SGA）脐血脂联素（APN）水平变化及其对新生儿的影响。方法研究对象为SGA和适于胎龄儿（AGA）各30例。采用放射免疫分析法测定脐血和产妇血脂联素水平。用免疫比浊法测定三酰甘油（TG）,总胆固醇（TCH）,低密度脂蛋白胆固醇（LDL-C）,高密度脂蛋白胆固醇（HDL-c）水平。并分析脐血脂联素水平与母血脂联素,体质量指数（IBM）,胎盘重量和血脂水平的相关性。结果1.SGA脐血脂联素水平低于AGA差异有显著性（P〈0.01）;SGA血TG,TCH,LDL-c,HDL-c水平与AGA比较差异均无显著性（P〉0.05）。2.SGA血清脂联素水平与新生儿身长,新生儿体质量指数BMI,胎盘重量,脐血TG呈显著正相关（r=0.386,0.431,0.365,0.231,P〈0.05）,与母血脂联素水平,孕前和分娩时产妇IBM无相关性（P〉0.05）。结论小于胎龄儿具有较低血清脂联素水平,测定脐血脂联素水平有助于判断SGA的发展趋势。     

Influence of gestational age and postnatal age on speech sound processing in NICU infants

The study examined the effect of gestational (GA) and postnatal (PNA) age on speech sound perception in infants. Auditory event-related potentials (ERPs) were recorded in response to speech sounds (syllables) in 50 infant NICU patients (born at 24-40 weeks gestation) prior to discharge. Efficiency of speech perception was quantified as absolute difference in mean amplitudes of ERPs in response to vowel (/a/-/u/) and consonant (/b/-/g/, /d/-/g/) contrasts within 150-250, 250-400, 400-700 ms after stimulus onset. Results indicated that both GA and PNA affected speech sound processing. These effects were more pronounced for consonant than vowel contrasts. Increasing PNA was associated with greater sound discrimination in infants born at or after 30 weeks GA, while minimal PNA-related changes were observed for infants with GA less than 30 weeks. Our findings suggest that a certain level of brain maturity at birth is necessary to benefit from postnatal experience in the first 4 months of life, and both gestational and postnatal ages need to be considered when evaluating infant brain responses.     

Maternal and fetal nitric oxide synthesis is decreased in pregnancies with small for gestational age infants

Our purpose was to evaluate whether maternal and fetal nitric oxide synthesis in pregnancies with small for gestational age (SGA) infants are different from those in pregnancies with appropriate for gestational age (AGA) infants. Maternal and fetal circulating nitrate and nitrite concentrations were compared between 30 pregnancies with AGA and 10 pregnancies with SGA at birth. End-products of nitric oxide synthesis were measured in maternal and cord venous blood samples using a fluorometric assay. Umbilical artery blood pH and PO2 were also measured. Maternal circulating nitrite and nitrate concentrations (6.91 +/- 1.27 microM) in pregnancies with SGA were significantly lower than those (11.69 +/- 1.33 microM) in pregnancies with AGA (P = 0.015). Fetal circulating nitrite and nitrate concentrations (7.54 +/- 1.09 microM) in pregnancies with SGA were also significantly lower than those (11.24 +/- 1.08 microM) in pregnancies with AGA (P = 0.024). There were no significant differences in umbilical artery blood pH and PO2 between the two groups. These results suggest that maternal and fetal nitric oxide synthesis are decreased in pregnancies with SGA infants.      

新生儿小脑发育与胎龄的相关性研究

目的　通过颅脑超声检测25~41周新生儿出生时的小脑,分析小脑随胎龄的发育规律,利于临床早期评估小脑发育。 方法　提取318例25~41周适于胎龄儿颅脑超声图像,测量小脑横径,蚓部高度、前后径、周长和面积,作统计学分析。 结果　小脑横径与胎龄最适曲线为直线方程Y=0.1036X+0.1929,R2=0.727(P<0.001)。蚓部高度与胎龄最适曲线为直线方程Y=0.069X-0.3156,R2=0.823(P<0.001);蚓部前后径与胎龄最适曲线为直线方程Y=0.0509X-0.5798,R2=0.735(P<0.001);蚓部周长与胎龄最适曲线为直线方程Y=0.2811X-1.5932,R2=0.782(P<0.001);蚓部面积与胎龄最适曲线为直线方程Y=0.2283X-4.4559,R2=0.817(P<0.001)。其中蚓部高度与胎龄的正相关性最强,相关系数为0.907(P<0.001)。 结论　在适于胎龄儿中,建立出生时小脑横径,蚓部高度、前后径、周长和面积与胎龄之间的宫外参考范围,以此为依据可为临床宫外诊断和评估小脑发育提供参考。     

Frequency of neonatal hypoglycemia in large for gestational age infants of non-diabetic mothers in a community maternity hospital

Large for gestational age (LGA) infants are at increased risk for hypoglycemia. The aim of the study was to determine the frequency of neonatal hypoglycemia in LGA infants of non-diabetic mothers in a Community Maternity Hospital in Gaziantep, Turkey. Hospital records of 5229 infants of non-diabetic mothers were examined retrospectively. Newborns with birth weight more than 4000 g were defined as LGA. The control group consisted of 100 appropriate for gestational age (AGA) newborns. Capillary blood glucose was measured at the second hour of life. Glucose values lower than 40 mg/dL (2.2 mmol/L) were defined as hypoglycemia. Ninety-six (1.8%) of the 5229 infants were found to be LGA. The mean capillary glucose levels of the LGA newborns were significantly lower than those of the AGA newborns (54 mg/dL (3.0 mmol/L) vs. 95 mg/dL (5.2 mmol/L), p < 0.0001). Neonatal hypoglycemia was established in 16 of 96 LGA infants (16.7%). In the control group hypoglycemia was absent. The rate of hypoglycemia in LGA infants was significantly higher than the rate in the AGA infants (p = 0.0000). As hypoglycemia is not rare in LGA infants and can have serious consequences, blood glucose levels should be screened routinely in LGA infants.     

Decreased maternal circulating hepatocyte growth factor (HGF) concentrations in pregnancies with small for gestational age infants

Our purpose was to evaluate whether maternal and fetal hepatocytegrowth factor (HGF) concentrations in pregnancies with smallfor gestational age (SGA) infants are different from those inpregnancies with appropriate for gestational age (AGA) infants.Maternal and fetal circulating HGF concentrations were comparedbetween 55 pregnancies with AGA infants and 16 pregnancies withSGA infants at birth. HGF concentrations were measured frommaternal and cord venous blood samples using an enzyme-linkedimmunosorbent assay. Umbilical artery blood pH and oxidativepressure (PO₂) were also measured. Maternal circulating HGFconcentrations (0.60 ± 0.35 ng/ml) in pregnancies withSGA infants were significantly lower than those (0.91 ±0.44 ng/ml) in pregnancies with AGA infants (P = 0.012). Therewere no significant differences in fetal circulating HGF concentrationsbetween both groups. No significant differences in umbilicalartery blood pH and PO₂ were found between both groups. Theseresults suggest that the maternal serum circulating HGF concentrationhas a significant role in fetal growth during pregnancy.     

新生儿胼胝体大小及形状与胎龄的相关性研究

目的　通过高场MRI检测不同胎龄新生儿出生时胼胝体的面积、偏心率及斜率,为早期评价和改善脑发育提供参考。 方法　从沧州市人民医院提取符合研究条件的新生儿头颅高场MRI图像286例,勾画胼胝体后使用MATLAB R2010a中的图像处理函数进行测量,得到胼胝体面积、偏心率及斜率并作统计学分析。 结果　胼胝体面积与胎龄的相关系数为0.61（P＜0.001）,最适曲线为二次曲线Y=0.132X2-6.179X+141.759,决定系数为0.37（P＜0.001）;偏心率与胎龄的相关系数为0.25（P＜0.001）,最适曲线为直线方程Y=0.009X+0.319,决定系数为0.07（P＜0.001）;后部斜率与胎龄的相关系数为0.27（P＜0.001）,最适曲线为直线方程Y=0.005X+0.349,决定系数为0.07（P＜0.001）。 结论　新生儿胎龄愈小,胼胝体愈小且愈圆。     

Evaluation of nutritional status

The assessment of nutritional status has become very popular, especially for patients undergoing stress (surgery) or potential parenteral nutrition. Evaluation of cancer patients is essentially the same as for other patients. Body fat reserves are approximated by subcutaneous skinfold measurements. Somatic protein (skeletal muscle) mass is decreased in marasmus (protein-calorie malnutrition) and is evaluated by anthropometric determinations, based upon age and sex or both. Instead of using relatively inadequate standards such as the 1959 Metropolitan Life Insurance tables for ideal weight, it is advocated to use the population percentiles derived from the Health and Nutritional Examination Survey (HANES) published in 1979. The visceral protein mass is decreased in kwashiorkor and is approximated by study of the liver transport proteins. A mixed-type of protein-calorie malnutrition may exist, e.g., cancer cachexia, with marked decrease of immunocompetence. A prognostic nutritional index, based on biologic measurements rather than true nutritional assessment, can predict the probability of complications and survival in severely ill patients. All such studies should be used to substantiate good clinical judgement, based on adequate history and physical examination with emphasis on the nutritional aspects.