Neonatal Resuscitation Guidelines and the Late Preterm Infant

The Neonatal Resuscitation Guidelines have been recently reviewed and released (American Academy of Pediatrics: Neonatal Resuscitation Textbook. 5th edition. Elk Grove, IN: American Academy of Pediatrics; 2006). There are many areas that have applicability to specific populations, such as the infant with meconium-stained amniotic fluid, preterm infants, and infants at the edge of viability. However, there is no specific mention of the late preterm infant. This population does not usually need specific resuscitation measures that are different from other infant populations but may, in fact, require some measure of support after delivery more often than term infants do. The specific changes in the guidelines as well as postresuscitation measures, which are as important as the resuscitation measures themselves, are reviewed in this article. Careful consideration about the best place to provide this increased level of monitoring and intervention, as necessary, is required.     

End Tidal Carbon Monoxide: A New Method to Detect Hyperbilirubinemia in Newborns

Jaundice is the most common medical condition affecting term and preterm infants. Hyperbilirubinemia, if left untreated can have devastating neurological outcomes in the infant. Current methods used to detect hyperbilirubinemia include visual inspection, transcutaneous testing and blood sampling. This article will discuss end tidal carbon monoxide testing and its use in determining hyperbilirubinemia. A brief review of hyperbilirubinemia and bilirubin physiology will be addressed. A review of the literature will examine the accuracy and efficacy of end tidal carbon monoxide testing and its use in the Neonatal Intensive Care Unit (NICU).     

经皮胆红素测定与新生儿高胆红素血症的相关性

目的:评价经皮胆红素测定对诊断、新生儿高胆红素血症中的临床价值。方法:分别测定236例足月新生儿和95例早产儿的经皮胆红素、末梢血胆红素与血清总胆红素浓度。结果:足月新生儿经皮胆红素、末梢血胆红素与血清总胆红素浓度显著相关(r=0.866,P<0.001;r=0.924,P<0.001)。早产儿的经皮胆红素与末梢血胆红素及血清总胆红素浓度无显著相关(r=0.221,P>0.25;r=0.234,P>0.25)。结论:足月新生儿可依据经皮胆红素浓度值进行黄疸筛查,但应建立各实验室参考值或与血清总胆红素浓度的对应关系;早产儿的黄疸判定应以血清总胆红素浓度为依据。     

胆红素吸附术在重症肝炎患者治疗中的应用和护理

重症肝炎是肝炎中最严重的类型,其发病急、发展快、黄疸急剧加深和肝脏迅速缩小,主要临床表现有肝臭、出血、肝性脑病及肝肾综合征等。     

早产儿网络化管理系统的研究和应用

目的 探讨早产儿网络化管理对降低新生儿死亡率、脑瘫发生率的作用。方法 对2004年1月-2005年12月经本院网络转运的356例早产儿进行统计分析。结果 356例早产儿转运途中无1例死亡，转运成功率100％，治愈292例（84．39%），好转36例（10.40％）；因并发症死亡7例，死亡率19．6‰；发生脑瘫3例，脑瘫发生率8．6‰。结论 早产儿网络化管理系统是一种简便、快捷而有效的医学模式，对改善早产儿的远期预后有重要意义。     

极低出生体重儿及极早早产儿1年随访

目的评估极低出生体重儿和极早早产儿随访到1岁时的体格发育状况、呼吸道感染频率及就诊频率等情况。方法将2008年5月至2009年5月四川大学华西第二医院新生儿科收治并存活出院的孕周小于32周或产重小于1500g的72例新生活产婴儿分为3组：第一组26例,孕周〈32周而产重≥1500g;第二组18例,孕周≥32周而产重〈1500g;第三组28例,孕周〈32周且产重〈1500g。于校正胎龄1岁时收集生长状况、呼吸道感染频率及就诊次数等信息。结果出院后随访到1岁时,第三组体重、头围的落后率高于第一组,身长的落后率高于第一组和第二组;第三组的中位呼吸道感染频率（15.5）较第一组（12.5）和第二组（8.5）高,第三组中位就诊次数（27.5）比第一组（17.5）和第二组（15.5）高。结论本研究结果提示,校正胎龄1岁时同是极低出生体重儿和极小胎龄早产儿的随访情况较仅为极低出生体重或极小胎龄的患儿要差,因此,胎龄和产重在评估早产儿预后方面同样重要。     

探讨降低新生儿高胆红素血症的方法

目的　探讨降低新生儿高胆红素血症发病率的方法,促进母乳喂养。方法　实验组新生儿分别采用3种方法降高胆红素血症:1一次性辅乳器添加1 0 %葡萄糖,2脉冲式乳房按摩仪促进乳汁分泌;3食疗法促进胎粪排泄。对照组新生儿采用常规纯母乳喂养。结果　3种方法均有效地降低新生儿高胆红素血症的发病率,与对照组比较差异有显著性(P<0 .0 1 )。结论　3种方法能减少胆红素的肝肠循环,有效降低了新生儿高胆红素血症的发病率,且无明显不良反应。     

新生儿高胆红素血症血清总胆汁酸测定的临床价值探讨

目的探讨血清总胆汁酸(TBA)测定对新生儿高胆红素血症患儿肝功能损伤的临床价值。方法采用循环酶速率法检测187例新生儿高胆红素血症患儿血清TBA水平。结果新生儿高未结合胆红素血症组与对照组差异无显著性;高结合胆红素血症组的血清TBA水平明显高于对照组。回顾性病例分析显示,高未结合胆红素血症患儿无肝功能损伤,病情转归良好(100%痊愈);高结合胆红素血症患儿存在肝功能损伤或胆汁淤积,病情转归不佳,68.18%好转,31.82%未愈。结论当常规肝功能指标改变不明显时,血清TBA检测是一项新生儿病理性黄疸患儿较为灵敏的肝实质损伤的指标。     

经皮测新生儿胆红素在产科的应用

目的：探讨经皮洲胆红素预测新生儿病理性黄疸的意义。方法：经皮测定140例足月新生儿胆红素及抽股静脉血测定血清胆红素，了解两的相关性。结果：经皮测胆红素的数值与血清胆红素数值之间呈高度直线关系，随着经皮测胆红素数值的增加，新生儿病理性黄疸的发生率亦相应增加。结论：动态经皮测新生儿胆红素能早期预测新生儿病理性黄疸，对防止病理性黄疸有一定的指导作用。     

An Analysis of Time to Improvement in Oxygenation in Japanese Preterm and Late Preterm or Term Neonates With Hypoxic Respiratory Failure and Pulmonary Hypertension

PurposeWe analyzed data from an ongoing registry to determine time to improvement in oxygenation in preterm and late preterm or term neonates with hypoxic respiratory failure and pulmonary hypertension receiving inhaled nitric oxide (iNO) in Japan.MethodsRegistry neonates received iNO ≤7 days after birth (February 26, 2010, to October 9, 2012). Efficacy and safety profile data were collected up to 96 h after iNO initiation and, if necessary, every 24 h thereafter and before iNO discontinuation. Patients were stratified by gestational age (GA), oxygenation index (OI), and shunt direction at baseline.FindingsData were evaluated for 1106 neonates (431 with a GA <34 weeks and 675 with a GA of ≥34 weeks). Sixty percent of patients had improved OI; rates were similar for those with GAs of <34 versus ≥34 weeks (61% vs 59%). Overall, mean time to improvement was 11.4 h and tended to be shorter in the groups with a GA <34 weeks versus ≥34 weeks (9.2 vs 12.9 h). Thirty percent of responding neonates required >1 h to achieve improvement in oxygenation. Neonates with higher baseline OI had the greatest decrease in OI during the first hour of treatment. The mortality rate was higher among iNO-treated patients with a baseline OI ≥25 versus those with OI ≥15 to <25 (25% vs 12%; P = 0.0073).ImplicationsiNO treatment provided acute, sustained improvement in oxygenation in neonates with GAs <34 and ≥34 weeks; 70% of patients had improvement within 1 h, but the remaining 30% took >1 h to respond. Initiation of iNO at lower OIs was associated with reduced mortality compared with higher OI.     

先兆早产孕妇自发性早产发生的影响因素

目的:探讨先兆早产孕妇自发性早产发生的影响因素.方法:回顾性分析广州市增城区人民医院2016年1月～2020年12月收治的86例先兆早产孕妇临床资料,统计自发性早产发生情况,并统计孕妇基线资料,分析先兆早产孕妇发生自发性早产的影响因素.结果:86例先兆性早产孕妇中,发生自发性早产42例(纳入发生组,其余未发生自发性早产...     

结合胆红素酶法测定的一种新方法

目的 建立一种特异性更高的酶法血清结合胆红素(CB)测定的新方法。方法 在pH5．5、有氟化钠(NaF)和N—乙酰半肮氨酸(NAC)的存在下，胆红素氧化酶(BOD)选择性氧化CB，引起450nm吸光度下降，计算CB的浓度。结果 批内精密度，n＝20，-↑x＝17．65μmol／L，s＝1．15，CV＝6．52％和-↑x＝301．49μmol/L，s＝1．01，CV＝0．33％；批间精密度，n＝20，-↑x＝31．50μmol／L，s＝3．12，CV＝9．90％和-↑x＝184．12μmol/L，s＝5．01，CV＝2．72％；线性范围至少可达320μmol／L；选择性抑制物的最适浓度，NaF2．5mmol/L，NAC2．5mmol/L；与重氮法的相关性，Y(酶法)＝0．839X(重氮法)—7．965，r＝0．9690。结论 该研究建立的反应条件，能有效地抑制BOD对游离胆红素的“非特异性”氧化，提高CB测定的准确性。     

高未结合胆红素血症新生儿血清肌酸激酶同工酶的测定及意义

目的　探讨肌酸激酶同工酶（ Ｃ Ｋ Ｂ Ｂ） 作为诊断新生儿高未结合胆红素血症合并脑细胞损害的应用价值。方法　采新生儿外周血,连续观察３０ 例高未结合胆红素血症新生儿和５９ 例正常新生儿血清中 Ｃ Ｋ Ｂ Ｂ 水平。结果　高未结合胆红素血症新生儿血清中 Ｃ Ｋ Ｂ Ｂ 明显高于正常对照组,是正常新生儿的２６ 倍, Ｐ＜ ０ ．００１ , Ｃ Ｋ Ｍ Ｂ 组亦明显高于正常组,但其幅度低于 Ｃ Ｋ Ｂ Ｂ 组, Ｃ Ｋ Ｍ Ｍ 组明显低于 Ｃ Ｋ Ｂ Ｂ 组。但高未结合胆红素血症患儿血清中 Ｃ Ｋ Ｂ Ｂ水平与总胆红素相关性差,ｒ＝ ０ ．２２２ , Ｐ＝ ０ ．０５ 。结论　新生儿血清 Ｃ Ｋ Ｂ Ｂ 增高与高未结合胆红素血症造成的脑细胞损害有关, Ｃ Ｋ Ｂ Ｂ 可作为临床监测高未结合胆红素血症新生儿胆红素脑病的一个筛选指标,值得临床推广。     

腺苷蛋氨酸治疗慢性乙型肝炎高胆红素血症

目的 分析腺苷蛋氨酸治疗慢性乙型肝炎高胆红素血症的临床疗效.方法 回顾性分析2010年1 -12月28例接受腺苷蛋氨酸(2 000 mg静脉滴注,1次/d)治疗慢性乙型肝炎高胆红素血症患者的临床资料,并对腺苷蛋氨酸治疗慢性重症乙型肝炎高胆红素血症后症状、体征及实验室检测指标的改变情况进行总结,利用多因素logist...