影响新生儿神经行为发育的多因素分析

背景：采用多项有序反应变量的Logistic分析方法。可以从另一个侧面，探讨在子宫内低水平铅暴露状态下，新生儿胎粪铅含量与新生儿神经行为发育之间的关系。 目的：探讨影响新生儿神经行为发育的多种因素及敏感性。 设计：以新生儿神经行为总评分作为因变量，以问卷中的影响因素及脐血铅、胎粪铅等24项指标作为自变量，采用多项有序分类反应型变量的Logistic逐步回归分析方法．在P=0．10水平筛选出相应的影响因素。 单位：武汉科技大学。华中科技大学同济医学院职业病流行病学实验室，中国第一冶金建筑总公司职工医院。 对象：随机选择武汉市新型工业区的青山区一冶职工医院妇产科1999—01／10出生的足月、健康新生儿103例作为观察对象．家属同意参加课题研究并填写问卷调查，提供新生儿胎粪，按时进行新生儿测试。 方法：①在新生儿断脐前采取脐血5mL。于-4℃的冰箱中冷藏保存。收集出生24h内的胎便，用石墨炉原子吸收光谱法测定脐血铅与胎粪铅的含量。②新生儿神经行为的检查：采用新生儿20项神经行为检查法于分娩第3天进行检查。同时采用自行设计的问卷对产妇进行调查。问卷涉及可能影响新生儿神经发育的其他因素，共22项。③对新生儿神经系统发育有影响的家庭、社会、环境、健康状况以及脐血铅含量、胎粪铅含量共24个变量（其中含2个亚变量）作自变量，以新生儿神经行为评分作为反应变量，筛选出相应的影响因素。 主要观察指标：筛选出影响新生儿神经行为发育的因素。 结果：103例新生儿进入结果分析。孕周、孕期服药月份、血红蛋白、孕期情绪、胎粪铅、孕期服药6项因素选入模型。 结论：新生儿神经行为发育受多项因素的影响。孕期营养状况好、孕周长、孕期情绪好有利于新生儿神经行为的发育。孕期服药不利于新生儿神经行为的发育，尤其是妊娠早期用药。胎粪铅含量增高将不利于新生儿神经行为的发育。     

新生儿神经行为发育与脐血及胎粪铅含量的关系

背景以往大量研究都是以生产时一次性脐血铅的浓度来进行研究的,但生产时一次性脐血铅的浓度并不能很好的代表在整个妊娠期间铅对胎儿神经系统的累积损伤.胎粪中的铅主要来源于胎儿消化道分泌的消化液、新生儿肠道脱落的上皮细胞、胎儿吞咽下的羊水、皮脂,是从妊娠一开始直至新生儿出生后24h内排出,它反映的是整个妊娠过程中铅在新生儿胃肠道中的蓄积量.目的探讨在宫内低水平铅暴露状态下,比较新生儿脐血铅含量及胎粪铅含量与新生儿神经行为发育的相关性.设计以脐血铅和胎粪铅含量作为新生儿宫内铅暴露的指标,新生儿神经行为发育评分作为效应指标,采用描述性分析方法评价其相关关系.单位武汉科技大学,华中科技大学同济医学院职业病流行病学实验室,武汉第一冶金建筑总公司职工医院.对象选择武汉市新型工业区的青山区第一冶金建筑总公司职工医院妇产科1999-01/10出生的足月、健康新生儿103例作为观察对象.家属同意参加课题研究并填写问卷调查,提供新生儿胎粪,按时进行新生儿测试.方法①样本的采集及测定采取脐血5 mL,于-4℃冰箱中冷藏保存.收集出生24 h内的胎便,干重5～10 g,用石墨炉原子吸收光谱法测定脐血铅与胎粪铅的含量.②分组以脐血铅0.483 μmol/L为分界值,将新生儿分成高铅组与低铅组.以127.78 mg/kg作为胎粪铅的分界点,并将观察对象分为高铅组与低铅组.③新生儿神经行为发育检查采用新生儿神经行为发育检查法,于分娩第3天进行检查.同时采用自行设计的问卷对产妇进行调查.主要观察指标①新生儿脐血与胎粪中铅含量.②不同浓度脐血铅和胎粪铅的新生儿神经行为发育评分.结果103例新生儿均进入结果分析.①脐血高铅组与低铅组仅在新生儿神经行为发育总评分、生物视听定向反应得分上差异有显著性意义(P＜0.05),但脐血铅含量与新生儿神经行为发育总评分、非生物听定向反应、非生物视定向反应、生物视听定向反应之间不存在等级相关关系.②胎粪高铅组与低铅组在新生儿神经行为发育总评分、非生物听定向反应、非生物视定向反应、生物视听定向反应4项评分上,两组差异有显著性和非常或极显著性意义(P＜0.05～0.01).胎粪铅含量与新生儿神经行为发育总评分、非生物视定向反应、生物视听定向反应3项神经评分有明确的等级负相关关系.结论胎粪铅含量与新生儿神经行为发育评分更为密切,胎粪铅含量可作为妊娠期胎儿体内铅蓄积的指标.     

新生儿神经行为发育与脐血及胎粪铅含量的关系

背景：以往大量研究都是以生产时一次性脐血铅的浓度来进行研究的，但生产时一次性脐血铅的浓度并不能很好的代表在整个妊娠期间铅对胎儿神经系统的累积损伤。胎粪中的铅主要来源于胎儿消化道分泌的消化液、新生儿肠道脱落的上皮细胞、胎儿吞咽下的羊水、皮脂，是从妊娠一开始直至新生儿出生后24h内排出，它反映的是整个妊娠过程中铅在新生儿胃肠道中的蓄积量。目的：探讨在官内低水平铅暴露状态下，比较新生儿脐血铅含量及胎粪铅含量与新生儿神经行为发育的相关性。设计：以脐血铅和胎粪铅含量作为新生儿宫内铅暴露的指标，新生儿神经行为发育评分作为效应指标，采用描述性分析方法评价其相关关系。单位：武汉科技大学，华中科技大学同济医学院职业病流行病学实验室，武汉第一冶金建筑总公司职工医院。对象：选择武汉市新型工业区的青山区第一冶金建筑总公司职工医院妇产科1999—01／10出生的足月、健康新生儿103例作为观察对象。家属同意参加课题研究并填写问卷调查，提供新生儿胎粪，按时进行新生儿测试。方法：①样本的采集及测定：采取脐血5mL，于-4℃冰箱中冷藏保存。收集出生24h内的胎便，干重5-10g，用石墨炉原子吸收光谱法测定脐血铅与胎粪铅的含量。②分组：以脐血铅0．483μmoL／L为分界值，将新生儿分成高铅组与低铅组。以127．78mg／kg作为胎粪铅的分界点，并将观察对象分为高铅组与低铅组。③新生儿神经行为发育检查：采用新生儿神经行为发育检查法，于分娩第3天进行检查。同时采用自行设计的问卷对产妇进行调查。主要观察指标：①新生儿脐血与胎粪中铅含量。②不同浓度脐血铅和胎粪铅的新生儿神经行为发育评分。结果：103例新生儿均进入结果分析。①脐血高铅组与低铅组仅在新生儿神经行为发育总评分、生物视听定向反应得分上差异有显著性意义（P〈0．05）：但脐血铅含量与新生儿神经行为发育总评分、非生物听定向反应、非生物视定向反应、生物视听定向反应之间不存在等级相关关系。②胎粪高铅组与低铅组在新生儿神经行为发育总评分、非生物听定向反应、非生物视定向反应、生物视听定向反应4项评分上，两组差异有显著性和非常或极显著性意义（P〈0．05-0．01）。胎粪铅含量与新生儿神经行为发育总评分、非生物视定向反应、生物视听定向反应3项神经评分有明确的等级负相关关系。结论：胎粪铅含量与新生儿神经行为发育评分更为密切，胎粪铅含量可作为妊娠期胎儿体内铅蓄积的指标。     

东莞市孕产妇血铅锌对孕产妇、胎儿和新生儿发育的影响

目的观察不同孕期孕妇血液及脐血中铅锌水平与不同的妊娠结局及新生儿发育的关系,了解东莞地区的孕产妇的铅污染及锌缺乏程度,判断是否需常规筛查铅锌的水平,用以指导孕产妇优生优育。方法选取早孕期位于2005年5月至2007年12月并在医院分娩的孕产妇500例及其新生儿,进行静脉血和脐带血铅及其他微量元素的分析检测,并采用新生儿20项行为神经测定法进行新生儿神经系统的评分。结果产妇血铅与新生儿脐血铅含量呈正相关。铅锌含量异常均对新生儿的神经系统发育产生影响。结论铅锌对胎儿的神经发育有明显影响,但铅锌的致畸作用在本次实验中尚不能明确体现,有待进一步的研究证实。     

脐血胃动素水平与胎粪排出关系的研究

目的:研究脐血胃动素(Motilin,MTL)水平与胎粪排出的关系.方法:用酶免疫分析法检测并比较足月分娩羊水性状正常(B组,122例)及中重度羊水粪染(A组,62例)的新生儿脐血及其孕母外周血血浆MTL水平.结果:A组新生儿脐血MTL值(343.69 ± 206.73)pmol/L高于B组(139.05 ± 80.06)pmol/L,差异有显著性意义(P ＜0.01),而两组孕妇外周血的MTL值无统计学差异(P ＞ 0.05).羊水中度和重度胎粪污染者的孕妇外周血及脐血的MTL差异均无显著性(P ＞ 0.05).结论:脐血MTL水平升高可能与胎粪排出有关.     

胎儿期低水平铅暴露影响新生儿神经行为发育的量化评估

目的:探讨低水平铅暴露对新生儿神经行为发育的影响。方法:于2004-09/2005-01选择山西省妇幼保健院和山西省介休市妇幼保健院分娩的足月顺产新生儿128例,男76例,女52例,孕期(40.4±1.3)周,出生体质量(3200±430)g,出生身长(50.1±0.4)cm。所有研究对象均无围产期缺血缺氧史。采用新生儿20项行为神经评分法检测神经行为发育。采用石墨炉原子吸收光谱法测定脐带血中铅的含量。根据脐血铅水平,将研究对象分为3组,脐血铅≥0.24μmol/L为高铅组(27例),0.12～0.24μmol/L为中铅组(65例),<0.12μmol/L为低铅组(36例)。结果:纳入新生儿128例,均进入结果分析。①脐血铅≥0.24μmol/L的新生儿其神经行为发育明显落后于血铅<0.24μmol/L者,两者比较差异有显著性意义。②128例新生儿脐血铅水平为(0.17±0.13)μmol/L,男为(0.17±0.12)μmol/L,女为(0.17±0.15)μmol/L,性别差异无显著性意义(t=0.65,P=0.54)。③高铅组新生儿神经行为总得分低于低铅组,差异有非常显著性意义犤(35.2±1.4),(37.9±1.5)分,P<0.01犦。高铅组新生儿头竖立得分低于低铅组犤(1.3±0.5),(1.9±0.4)分,P<0.05犦,头竖立时间较低铅组缩短,差异均有显著性意义犤(1.4±1.5),(3.2±2.2)s,P<0.05犦。结论:胎儿低水平铅暴露仍可对新生儿神经行为发育产生不良影响。     

新生儿铁储备对6月龄婴儿神经发育的影响

目的 探讨新生儿铁储备对6月龄婴儿神经发育的影响。方法 连续性收集2016年11月至2018年1月出生的新生儿及其父母129对。用酶联免疫吸附法测定脐血铁蛋白、C反应蛋白、α1酸性糖蛋白。根据脐血铁蛋白浓度将婴儿分为铁蛋白充足、不足和缺乏3组。采用标准问卷收集研究对象的基本资料，采用Gesell发育诊断量表在婴儿6月龄时行发育评估。比较不同脐血铁蛋白水平婴儿6月龄时在神经发育上的差异。结果 新生儿脐血铁蛋白平均浓度为（75.3±45.0）μg/L，其中铁蛋白缺乏22例（17.1%），铁蛋白不足54例（41.9%）。脐血铁蛋白充足、不足和缺乏3组婴儿6月龄时在适应性及大动作行为评分达标率的差异有统计学意义（P <0.05）。铁蛋白充足组与缺乏组在适应性和大动作行为评分达标率的差异有统计学意义（P <0.05）。结论 铁蛋白不足和缺乏在新生儿中普遍存在，脐血铁蛋白充足的新生儿6月龄时在适应性及大动作行为评分的达标率比脐血铁蛋白缺乏的更高，孕期铁营养及新生儿铁储备状况值得进一步关注。     

胎儿期低水平铅暴露影响新生儿神经行为发育的量化评估

目的：探讨低水平铅暴露对新生儿神经行为发育的影响。方法：于2004—09／2005-01选择山西省妇幼保健院和山西省介休市妇幼保健院分娩的足月顺产新生儿128例，男76例，女52例，孕期（40．4&;#177;1．3）周．出生体质量（3200&;#177;430）g，出生身长（50．1&;#177;0．4）cm。所有研究对象均无围产期缺血缺氧史。采用新生儿20项行为神经评分法检测神经行为发育。采用石墨炉原子吸收光谱法测定脐带血中铅的含量。根据脐血铅水平，将研究对象分为3组，脐血铅≥0．241μmol／L为高铅组（27例），0．12-0．24μmol／L为中铅组（65例），〈0．12μmol／L为低铅组（36例）。结果：纳入新生儿128例．均进入结果分析。①脐血铅≥0．24μmol／L的新生儿其神经行为发育明显落后于血铅〈0．24μmol／L者，两者比较差异有显著性意义。②128例新生儿脐血铅水平为（0．17i-0．13）μmol几，男为（0．17&;#177;0．12）μmol／L，女为（0．17&;#177;0．15）μmol／L，性别差异无显著性意义（t=0.65．P=0.54）。③高铅组新生儿神经行为总得分低于低铅组，差异有非常显著性意义[（35．2&;#177;1．4），（37．9&;#177;1．5）分，P〈0．01]。高铅组新生儿头竖立得分低于低铅组[（1．3&;#177;0．5），（1．9&;#177;0．4）分，P〈0．05]，头竖立时间较低铅组缩短，差异均有显著性意义[（1．4&;#177;1．5），（3．2&;#177;2．2）S，P〈0．05]。结论：胎儿低水平铅暴露仍可对新生儿神经行为发育产生不良影响。     

S100B和脐血铅水平与缺氧缺血性脑病新生儿神经精神运动评分的关系

目的研究S100B和脐血铅水平与缺氧缺血性脑病(HIE)新生儿6月龄神经精神运动评分(DQ)的关系。方法以脐血铅水平60μg/L为标准,将59例中重度HIE新生儿分为低血铅HIE组38例及高血铅HIE组21例,两组分别进行S100B水平及6月龄DQ测定,同时以健康新生儿30例作为对照。结果 HIE组与对照组脐血铅水平差异无统计学意义(P>0.05);HIE组血清S100B水平显著高于对照组(P<0.01);高血铅HIE组与低血铅HIE组S100B水平差异无统计学意义(P>0.05);高血铅HIE组比低血铅HIE组6月龄DQ显著降低(P<0.01)。高血铅HIE组和低血铅HIE组S100B水平与6月龄DQ均呈负相关(r分别为-0.826、-0.729,P均小于0.05)。结论 S100B对HIE患儿病情监测和判断预后有一定的意义。脐血铅含量增高可对婴儿神经行为发育产生不良影响,影响HIE患儿的预后。     

脐带血铅水平与婴儿神经行为及微量元素的关联

铅是一种具有神经毒的重金属元素,由于妊娠期铅暴露可造成胎儿出生后近期及远期的危害,因此,子宫内铅暴露较出生后铅暴露对儿童的发育影响更为重要。为了探讨脐带血铅水平对婴儿神经行为发育的影响及其与相关元素的关系,我们以脐带血铅水平为铅暴露指标,探索能对婴儿发育产生影响的脐血铅水平与婴儿精神发育指数（MDI）和心理运动发育指数（PDI）两发育指标及相关因素的关系。     

袋鼠式护理对早产新生儿神经行为发育及体格发育情况影响分析

目的 探讨袋鼠式护理对早产儿神经行为与体格发育情况的影响。方法 选取2017年8月至2019年12月于南京医科大学附属无锡妇幼保健院出生并入住新生儿科的早产儿100例作为研究对象，按照双色球法将其随机分为对照组（50例）和研究组（50例）。对照组采用常规护理措施，研究组予以袋鼠式护理。两组早产儿均从出生开始进行护理干预直至纠正孕周至40周，比较两组早产儿神经行为发育指标、体格发育指标、喂养指标及家属满意度。结果 护理干预前两组早产儿神经行为各项评分差异无统计学意义（P>0.05）；纠正孕周至40周，研究组早产儿神经行为各项评分均高于对照组（P<0.05）。研究组早产儿头围、身长及体质量增长均优于对照组，达全肠内营养日龄短于对照组，平均加奶速度小于对照组，家属满意度高于对照组，差异均有统计学意义（均P<0.05）。结论 给予早产儿袋鼠式护理干预能够有效促进其神经行为发育与体格发育，提高家属满意度。     

Comparative effects of 2 positional supports on neurobehavioral and postural development in preterm neonates

Preventing abnormal neurobehavioral and postural development requires careful nursing in preterm neonates. The purpose of this prospective study is to assess the effects of 2 different lying-position body supports for physiologic and functional positioning. Thirty preterm neonates were eligible, born between 28 and 35 weeks' gestation. A first sample experimented with a "Home-Cocoon" support made by nurses with rolled sheets, and a second sample provided a "Coconou" support, made with a specifically designed rolled pad. Assessments of body posture and of neurobehavior were administered pretest (on admission without support) and posttest (at discharge). In addition, nurses were asked to answer a questionnaire concerning motor behavior. All preterm neonates showed gains in postural development, but the "Coconou" group performed significantly better than the "Home-Cocoon" group, with fewer cranial deformities, with head positioning, arm relaxation, and better orthopedic leg position. The overall quality of behavior increased for the 2 groups, but visual pursuit was very significantly better for the "Coconou" group. Nurses' assessment was also better for the "Coconou" support. These results point to the benefits of positioning with a specifically designed support like "Coconou," promoting optimal prophylactic neurobehavioral and postural developmental care for preterm neonates.     

204例新生儿死亡临床分析

目的:分析新生儿死亡原因及影响死亡的相关因素,采取相应的干预措施以提高围产保健工作质量,降低新生儿死亡率。方法:对2003～2007年的204例住院死亡新生儿进行回顾性分析。结果:住院新生儿死亡率为2.03%,导致新生儿死亡的主要死因为新生儿感染性肺炎、新生儿窒息、早产儿,产科因素以胎膜早破、宫内窘迫、多胎妊娠为主。结论:加强孕期保健,预防新生儿感染、窒息、早产,防止孕期并发症,是降低新生儿死亡的主要措施。     

Effect of tactile–kinesthetic stimulation on growth,neurobehavior and development among preterm neonates

BackgroundPreterm neonates are at risk of delayed growth and development. Hence, early tactile–kinesthetic stimulation (TKS) is required to improve their growth and development.ObjectiveTo evaluate the effect of TKS on growth, neurobehavior and development among preterm neonates.MethodAn interventional study was conducted from August 2015 to July 2017 in the neonatal unit of Dr. Cipto Mangunkusumo Hospital. Preterm neonates were recruited via random sampling and divided into two groups (the intervention group and control group). TKS was performed for 15 min, three times a day, for 10 days. The anthropometric measurements, neurobehavior (Dubowitz score) and development (Capute Scale score) of neonates in both groups were assessed.ResultsThere were 126 preterm neonates (n = 63 in each group). During the 10-day TKS period, the intervention group had a significant increment in weight and length compared to the control group (p < 0.05) at 11–14 days, at term and 3 months. Moreover, increased tone, reflexes, and improvement in behavior based on the Dubowitz score were observed during monitoring. However, the result did not differ significantly (p > 0.05). There was no significant difference in terms of cognitive and language development in both groups (Developmental Quotient of Clinical Linguistic Adaptive Milestone Scale, Developmental Quotient of Clinical Adaptive Test and Full Scale Developmental Quotient scores, p > 0.05).ConclusionTKS was significantly effective in promoting growth, particularly weight and length, among preterm neonates. However, it did not significantly influence neurobehavior and development at 3 months of chronological age.     

Subhuman Primate Pregnancy Complicated by Streptozotocin-Induced Diabetes Mellitus

Polydipsia, polyuria, polyphagia, and glucosuria followed the administration of streptozotocin to 6 nonpregnant and 15 pregnant monkeys (Macaca mulatta) in the first trimester of pregnancy. The diabetogenic action of the drug was also reflected in an induced but variable deterioration in maternal intravenous glucose tolerance and a marked attenuation of maternal plasma insulin responsiveness to intravenous glycemic stimuli. The products of conception were examined in 29 pregnancies. The neonates and the placentas of the streptozotocin-treated pregnant animals were significantly heavier than average for the period of gestation, polyhydramnios was consistently present, and there was an increase in the incidence of third trimester stillbirths.The fetal and maternal plasma glucose, insulin, and growth hormone concentrations were examined after the intravascular administration of glucose or a solution of mixed amino acids to the fetus in the third trimester. The neonatal plasma responses to similar insulinogenic stimuli were also examined.Fetal and neonatal base line plasma insulin concentrations were significantly elevated compared to those of the controls. The administration of intravascular glucose to the fetus, mother, or neonate was associated with a prompt 2-to 5-fold increase in fetal or neonatal plasma insulin concentrations. These findings contrast to the unresponsiveness of the pancreatic islet tissue we reported in normal subhuman primate pregnancy.The intravascular infusion of a relatively low concentration of mixed amino acids (2 mg/min) to the conceptii from the streptozotocin-treated pregnancies was associated with an elevation in fetal and neonatal plasma insulin levels, whereas normal monkey fetuses and neonates required a 10-fold greater concentration of amino acids in the infusate for similar responses. The induced hyperaminoacidemia or hyperglycemia did not consistently alter plasma growth hormone concentrations in the conceptii from normal or streptozotocin-treated pregnancies.These data provide evidence that maternal glucose intolerance during pregnancy is associated with enhanced fetal and neonatal pancreatic islet cell responsiveness to glucose and mixed amino acids. Although the specific mechanism(s) that alters both the sensitivity and responsiveness of the normal pancreatic fetal islet to insulinogenic stimuli remains unclear, the data do indicate that insulin-dependent maternal hyperglycemia and hyperaminoacidemia, separately or in combination could contribute to the fetal hyperinsulinemia of pregnancies complicated by diabetes mellitus. Moreover, the overall experiences with these streptozotocin-treated animals suggest that a subhuman primate model may be available to examine directly the antenatal pathophysiology of abnormal carbohydrate metabolism.     

先天性小儿脑性瘫痪发病危险因素的多因素条件Logistic回归分析

背景孕期危险因素作用于发育中的胎儿,使得胎儿在出生后出现脑性瘫痪的表现.因此,应把脑性瘫痪病因学的研究转入胚胎发育生物学领域,重视对孕期孕母所处相关的环境、遗传因素及相关疾病等多种因素的分析.目的分析引起小儿脑性瘫痪的主要发病危险因素.设计12配对设计,多因素条件Logistic回归分析.单位佳木斯大学预防医学教研室和哈尔滨医科大学公共卫生学院流行病教研室.对象选择2002-12/2003-09在佳木斯脑瘫疗育中心、沈阳儿童医院及青岛儿童医院收治的103例脑性瘫痪患儿,男68例,女35例.监护人对调查项目知情同意.采用12配对原则,选择同期本院就诊的非患脑性瘫痪及神经系统疾病的患儿和健康儿童206例作为对照.选择对照的匹配条件为同性别,同民族,年龄相差±3个月.方法①自拟脑性瘫痪患儿和健康儿童调查表,调查因素主要包括分娩前因素(遗传因素类似疾病家族史;母亲因素一般情况如职业、学历、分娩时年龄;生育行为因素包括孕次、产次、异常产史;孕期保健和营养如产前检查、各类食物摄入情况;孕期患病或异常表现包括病原体感染、妊娠综合征、阴道出血等;孕期服药情况;胎儿胎盘因素如脐带绕颈、出生质量、双胎妊娠等)、分娩过程因素(产时并发症、分娩方式等)和新生儿期因素(新生儿期所患各类疾病).通过查阅医疗记录和询问知情人来完成调查问卷.②进行单因素、多因素条件Logistic回归分析,对单因素分析具有统计学意义,差异有显著性(P＜0.05)和P值接近于0.05的因素,建立脑性瘫痪主要危险因素的多元Logistic回归模型,进行条件Logistic回归分析.主要观察指标影响脑性瘫痪发病的孕期分娩前、分娩过程和新生儿期因素分析.结果脑性瘫痪患儿103例,健康及非脑性瘫痪患儿206例均进入结果分析.①母亲因素母亲职业因素与脑性瘫痪有联系,母亲职业为工人与年龄≥34岁为脑性瘫痪危险因素(OR=13.333,2.864,P＜0.05).②产前因素孕早期呕吐、孕期吃鱼及海产品、产前体温、出生体质量＞4000g、孕周37～42周为脑性瘫痪保护因素(OR =0.028～0.576,P＜0.05～0.01);异常产史、孕期阴道出血为脑性瘫痪危险因素(OR=2.313～4.095,P＜0.05～0.01).③产时因素Apgar评分和剖宫产是脑性瘫痪保护因素(OR=0.458,0.343,P＜0.01);产钳助产和应用催产素是脑性瘫痪危险因素(OR=16.338,2.116,P＜0.01,0.05).④新生儿期因素缺氧缺血性脑病、新生儿窒息和新生儿颅内出血是脑性瘫痪危险因素(OR=3.586,20.667,32.247,P＜0.01).⑤Logistic回归分析结果产钳助产最危险(OR=70.668),其他危险因素由高到低依次为新生儿窒息、母亲妊娠年龄偏大、孕期阴道出血和出生体质量异常(OR=19.083～4.138,P＜0.05～0.01),孕期吃鱼和海产品与剖宫产是保护因素(OR=0.324,0.262,P＜0.01,0.05).结论脑性瘫痪的危险因素主要集中在孕期和围产期,应积极预防和消除各种产前、产时、产后脑性瘫痪危险因素(如产钳助产、新生儿窒息、母亲妊娠年龄偏大、孕期阴道出血和出生体质量异常),降低脑性瘫痪发病率.     

晚孕期超声指标评估新生儿出生状况的临床价值研究进展

晚孕期超声检查是应用超声的物理属性,对母体内胎儿及其附属物进行影像学检查的方法,是孕妇产前常用、安全、可重复的检查方法。晚孕期超声检查的广泛应用,为临床提供了胎儿的生长发育情况,从而进一步提升出生人口质量。通过对晚孕期(胎心率、脐血流、胎盘成熟度、羊水指数)超声指标与新生儿出生状况的相关性分析,判断超声指标是否影响新生儿出生状况,及其影响程度的分析,以明确相关指标预测新生儿出生状况的意义,为早期临床干预提供重要依据,提高新生儿的出生质量。     

Efficacy and safety of repeated oral sucrose for repeated procedural pain in neonates: A systematic review

BackgroundAlthough sucrose is most extensively examined for its analgesia effect on a single procedural pain, neonates in neonatal intensive care units can be exposed to numerous painful procedures every day requiring multiple doses of sucrose. Some experiments have been performed to examine the efficacy and safety of repeated sucrose administration for repeated procedural pain; however, a systematic review of this topic has not yet been carried out.ObjectiveTo identify and assess the evidence demonstrating the efficacy and safety of repeated sucrose for repeated procedural pain in neonates.MethodA systematic review was conducted using the Cochrane methodology. Pubmed, Cochrane Library, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CBMdisc, CNKI, VIP, and Wanfang databases were searched through December 2015. All related abstracts were reviewed and the full texts of relevant articles were studied. Randomized controlled trials (RCTs) were included. Risk of bias was assessed for RCTs using quality critical appraisal criteria recommended by Cochrane Handbook. A standardised data form was used to extract information.ResultsEight RCTs met our inclusion criteria. Different study designs were used in the included RCTs, which did not allow us to carry out a meta-analysis. The findings from this review indicated that repeated sucrose was effective in reducing both behavioral pain response and composite pain scores during repeated procedural pain. However, as for physiological pain response, one trial found less variability in physiological pain response for term neonates in the sucrose group than the sterile water group, while two trials demonstrated repeated sucrose was inefficacious for preterm neonates. Regarding the clinical outcomes, no study reported adverse effects related to the repeated sucrose administration. Regarding the neurobehavioral development, two trials reported repeated sucrose for repeated procedural pain would not lead to poor neurologic development, while one trial reported that preterm infants <31 weeks’ gestational age who received >10 doses of sucrose per 24 h in the first week of life had poorer neurologic development compared with infants who received fewer sucrose doses. What’s more, no study reported the long-term neurobehavioral development outcome of neonates who repeatedly received sucrose across repeated procedural pain.ConclusionEvidence regarding the efficacy and safety of repeated sucrose across repeated procedural pain for neonates is limited. More prospective, multi-centered, large randomized controlled clinical trials with a standardised study design are required before sucrose can be recommended widely as an analgesia for repeated procedural pain in neonates.