产科因素与超低出生体重儿

超低出生体重儿（extremely low birth weight infant,ELBWI）是指出生体重低于1000 g的新生儿,大多为胎龄小于32周的极早产儿［1］。伴随围生期医学和新生儿医学的不断发展,ELBWI出生率不断上升,可能存活者的体重和孕周不断降低。但由于体重极低、胎龄极小、各个器官发育极不成熟,ELBWI患病率和死亡率极高,远期发育障碍的发生率远远高于正常发育的新生儿。ELBWI的抢救和治疗过程给家庭和社会带来极其严重的经济负担和社会心理负担,不能不引起人们的重视。了解导致ELBWI的危险因素、提高预防意识、减少其出生率和改善患儿预后是摆在产科和儿科面前的重要课题。本文从产科角度概述引起ELBWI的危险因素,通过加强孕期保健,以强化ELBWI出生的风险意识,早期预防和治疗引起ELBWI出生的妊娠期相关疾病,降低ELBWI的出生率。     

超低出生体重儿救治的国内外近况

近几十年来新生儿医学的快速发展使得超低出生体重儿（ELBWI）病死率和并发症发生率明显下降。然而存活ELBWI发生近远期并发症风险显著增加,包括严重脑室内出血、脑室旁白质软化、院内感染和坏死性小肠结肠炎、支气管肺发育不良、早产儿视网膜病变以及远期神经发育后遗症等。目前国内ELBWI救治水平不断提高,但与国外差距仍较大。本文将近年国内外ELBWI救治存活率、伦理学问题、近远期并发症情况等作一综述。     

母乳喂养超低出生体重儿10例报告

超低出生体重儿(ELBWI)是指出生体重501～1000克的新生儿。合理的营养对于提高ELBWI的存活率及存活质量至关重要。为探讨母乳喂养对ELBWI的临床意义,本文观察了母乳喂养ELBWI存活10例,现报告如下:临床资料自1994年1月至1994年12月,南部非洲博茨瓦纳Nangabgwe医院新生儿科共收治ELBWI31例,占同期新生儿科总住院病人(616例)的5%,住院期间因严重并发症死亡21例(18例于生后7日内死亡)。存活10例几乎纯母乳喂养作为观察对象。10例均在本院产科出生,经阴道分娩;男6例,女4例;胎龄27～31周,平均28.5±1.27周;出生体重800～1000克,平均899…     

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随着我国医学科学的进步和新生儿重症监护水平的提高,超低出生体重儿(extremely low birth weight infant,ELBWI)的抢救成功率也在逐年上升,如何保证ELBWI从宫内至宫外的平稳过渡,适时合理地提供类似于宫内的营养,使其达到理想的生长状态,成为新生儿科医生面临的挑战。     

超低出生体重儿8例治疗体会

超低出生体重儿（ELBWI）是指出生体重501～1000g的新生儿。我院新生儿1992年1月～1995年6月收治8例，现报告如下：临床资料8例ELBWI中男7例，女1例。胎龄28～31周，出生体重900～1000g，均于出生20小时内入院。8例均有三种以上并发症，均合并呼吸暂停及感染。其他并发症有硬肿5例，新生儿中度缺氧缺血性脑病（HIE）3例，RDS1例，先天性心脏病1例。一般治疗包括置温箱保暖，保持呼吸道通畅，供氧，纠正缺氧及高碳酸血症。热卡及液量的供给：1周内均采用全静脉营养，第1日输液用10％葡萄糖60～70ml／kg，第2日用5：1液＜10％葡萄糖：…     

超低出生体重儿43例临床分析

目的 分析我院五年内收治超低出生体重儿（ELBWI）的并发症、死亡原因及相关围产期高危因素.方法 采用回顾性分析的方法,对2008年1月至2012年12月我院出生的ELBWI的临床资料进行分析.结果 五年期间我院共分娩36 991名活产新生儿,出生ELBWI 47例,出生率0.13％;其中4例出生后即转院治疗,故43例纳入研究,胎龄（27.8±2.6）周,出生体重（853±108）g.43例ELBWI中,早期存活并进行救治27例,其中并发新生儿呼吸窘迫综合征20例,发生率74.1％ （20/27）;并发支气管肺发育不良7例,发生率25.9％ （7/27）.43例ELBWI中存活至出院13例,总存活率30.2％（13/43）;30例死亡,其中21例放弃治疗死亡,9例死亡原因分别为呼吸窘迫综合征、重症感染各3例,坏死性小肠结肠炎2例,肺出血1例.死亡婴儿生后1 min Apgar评分及5 min Apgar评分均低于存活者（P＜0.05）.结论 医患同盟积极救治ELBWI,减少出生窒息,积极处理各种并发症,可提高ELBWI存活率及生存质量.     

超低出生体重儿11例临床分析

我院新生儿重症监护室(NICU)1996年1月-2001年10月收治超低出生体重儿(ELBWI)11例，治愈出院7例，存活率63．64％。现将ELBWI治疗经验总结如下。     

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正随着围生医学的发展和新生儿重症监护救治水平的提高,超低出生体重儿(extremely low birth weight infant,ELBWI)的成活率明显提高,但存活的患儿疾病发生率未降低[1],存活者脑瘫和神经发育损害的发生率仍然较高[2-3]。     

极/超低出生体重儿生后早期腹部局部组织氧饱和度变化趋势的前瞻性研究

目的 探讨极/超低出生体重儿（very/extremely low birth weight infant,VLBWI/ELBWI）出生后的腹部局部组织氧饱和度（abdominal regional oxygen saturation,A-rSO₂）变化趋势。 方法 选取2019年9月至2021年5月在新生儿重症监护室住院的VLBWI/ELBWI作为研究对象。利用近红外光谱技术,从出生后第1天开始每天监测A-rSO₂,共监测4周。并根据出生胎龄分为较低胎龄组（<29周组）及较高胎龄组（≥29周组）,对两组VLBWI/ELBWI生后4周内的A-rSO₂进行比较分析。 结果 共纳入VLBWI/ELBWI 63例,其中<29周组30例,≥29周组33例。63例VLBWI/ELBWI生后2周内A-rSO₂呈现波动变化：生后第1天为最低值（47.9%）,后逐渐升高,第4天达最高峰（67.4%）,第5~9天逐渐下降,然后再次上升,至出生2周后趋于稳定。≥29周组出生后第1周及第2周A-rSO2均高于<29周组,差异有统计学意义（P<0.05）。出生第3周及第4周两组A-rSO₂均值比较差异无统计学意义（P>0.05）。 结论 VLBWI/ELBWI的A-rSO₂在出生后最初2周随日龄增加存在波动变化,2周后趋于稳定;生后2周内的A-rSO₂与胎龄相关。     

极低出生体重儿非先天性胆汁淤积发病的危险因素分析

目的 探讨新生儿重症监护病房(NICU)中极低出生体重儿(extremely low birth weiisht infants,ELBWI)非先天性胆汁淤积(简称胆汁淤积)的发生率和相关危险因素.方法 回顾性分析NICU中232例ELBWI的临床资料,对29例胆汁淤积和203例无胆汁淤积ELBWI在胎龄、出生体质量、性别等16项临床因素进行单因素比较,对两组有差异的因素进行多因素Logistic回归分析.结果 ELBWI胆汁淤积的发生率为12.5%(29/232).胆汁淤积组在胎龄、出生体质量、生后1周内胆红素水平、光疗时间、脂肪乳输注量、静脉营养持续时间、开奶时间、生后1周内总奶量、感染发生率、贫血,母亲患妊高征率方面高于对照组(P均<0.05),经Logistic回归分析表明,贫血、母患妊高征、生后1周内最高总胆红素水平和直接胆红素水平、感染5个因素与胆汁淤积的发生有关(P均<0.05).结论 贫血、母患妊高征、感染是ELBWI发生胆汁淤积的危险因素,生后1周内胆红素水平越高,也越容易发生胆汁淤积.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.