1，6二磷酸果糖治疗新生儿窒息致心肌损害

目的：探讨1,6二磷酸果糖（FDP）治疗新生儿窒息致心肌损害的疗效和预后,方法：随机分为治疗组和对照组,均予综合治疗,治疗组应用FDP250mg/(kg.d)0.5h内静脉滴入,每日一次,7d一个疗程。两组治疗前后分别做心肌酶谱测定。结果：治疗组临床有效率显著高于对照组（P＜0．05）。治疗后复查心肌酶谱,治疗组心肌酶谱恢复正常病例显著高于对照组（P＜0．01）。结论：外源性FDP能显著改善新生儿窒息致心肌损害患儿的临床表现,并可改善预后,减少后遗症的发生。     

N端脑钠肽原和糖原磷酸化酶同工酶BB在新生儿窒息合并心肌损伤中的变化

目的：探讨N端脑钠肽原(N-terminal pro-brain natriuretic peptide, NT-proBNP )和糖原磷酸化酶同工酶BB (glycogen phosphorylase isoenzyme BB , GPBB)在新生儿窒息合并心肌损伤中的变化及其临床意义。方法：随机选择64例窒息患儿为研究对象（轻度窒息39例,重度窒息25例,其中心肌损伤30例,非心肌损伤34例）,以25例正常新生儿为对照组。采用酶联免疫吸附法（ELISA）测定血浆NT-proBNP 和GPBB水平,同时检测心肌酶、肌钙蛋白I、心电图、X线胸片等。结果：心肌损伤组血浆NT-proBNP 和GPBB水平均明显高于非心肌损伤组和对照组（P<0.01）。重度窒息组血浆NT-proBNP 和GPBB水平明显高于轻度窒息组和对照组（P<0.01）。Spearman秩相关分析显示,窒息患儿血浆NT-proBNP 水平与GPBB、CK-MB、CK、LDH呈显著正相关（P<0.01）;GPBB水平与CK-MB、CK、LDH呈显著正相关（P<0.01）。结论： NT-proBNP 和GPBB均可作为窒息新生儿早期心肌损害的生化标志物,联合检测NT-proBNP 和GPBB对于早期发现窒息合并心肌损伤、判断病情程度、指导治疗具有重要的临床意义。［中国当代儿科杂志,2010,12（4）：252-255］     

窒息新生儿心肌酶谱水平变化的意义

目的探讨窒息新生儿心肌酶谱活性变化的意义。方法窒息新生儿74例。其中轻度窒息29例,重度窒息45例,正常新生儿20例作为对照组,分别测定血清心肌酶活性,并进行对比分析。结果窒息组血清心肌酶谱水平明显高于正常组（P〈0.01）,二者比较有显著性差异;重度窒息组明显高于轻度窒息组（P〈0.01）。结论新生儿窒息后可致心肌损害,心肌酶活性增高为新生儿窒息心肌损害的早期诊断的方法之一。     

心肌酶测定在窒息新生儿心肌损害32例中的应用价值

目的通过对32例窒息后心肌受累的新生儿治疗前后心肌酶谱测定，了解心肌酶谱在窒息新生儿心肌损害诊治中的意义。方法32例均自入院后12h及治疗后5～7天各静脉采血1次，作GOT、LDH、CK、CK-MB检查。结果窒息后心肌损害治疗前后心肌酶谱各项指标比较差异均有显著统计学意义（P〈0．01），出院时心肌酶多恢复正常。结论对窒息新生儿做心肌酶谱检查，有利于早期发现心肌损害并及时治疗，并可作为判断疗效及预后的指标。     

血浆cTnI,CK—MBmass及CK—MBmass／CK比值在围产期窒息后的变化及其比较研究

评价血浆心肌肌钙蛋白I（cTnI)，肌酸激酶心型同工酶质量（CK－MB－mass)肌酸激酶心型同工酶质量／肌酸激酶活性的比值（CK－MBmass/CK)对围产期窒息后心肌损伤诊断价值，对71例围产期窒息新生儿及27例对照组新生儿生后6－48小时血浆cTnI,CK-MBmass及CK水平进行测定并计算CK－MBmass/CK比值，运用Wilcoxon秩和检验等方法进行分析，结果显示：（1）新生儿窒息伴胎儿窘迫组（23例）cTnI,CK-MBmass,CK均显著高于对照组（27例），新生儿窒息伴胎儿窘迫组CK－MB－mass,CK显著高于单纯窘迫组（38例）；单纯窒息组（10例）与对照组相比，仅CK－MBmass/CK明显降低，其它指标差异无显著性。（2）围产期窒息重度心脏损害患儿（8例）cTnI,CK-MBmass,CK均明显高于该组无重度心脏损害患儿（63例），（3）重度窒息组（17）例仅CK－MBmass,CK明显高于轻度窒息组（16例），因此，新生儿严重缺氧时，血浆cTnI-MBmass，CK均明显增高，表明存在心肌伤，CTnI虽对心肌损伤有高度特性性，但敏感性低于CK－MBmass,CK，且受胎龄影响，在判断早产儿心肌损伤时有一定的局限性，CK－MBmass/CK比值不宜作为围产期窒息后心肌损伤的生化指标。     

心肌酶学活性测定评价窒息所致新生儿心肌损害

本文观察窒息新生儿心肌酶谱的动态变化，用以评估窒息对新生儿心肌损害的程度。设对照组15例．窒息组30例，包括宫内窘迫10例（心率＞160次／分），轻度窒息16例，重度室息4例，作心肌酶时间为生后24小时内（30例），3～5天（15例）．＞7天（30例）。结果24小时、3～5天GOT、LDH、CPK、CPK－MB值均明显高于对照组（P＜0．01）。窒息组治疗前后对比呈逐渐下降趋势。CPK的同功酶（CPK－MB）本组窒息组（47.83±21．9）明显高于对照组（12．06±6．42），在心肌损害判断上更有重要意义。有助于早期预测心功能的损害和及对治疗，以免进一步发展为心衰、心源性休克和心肌坏死等不可逆现象。     

新生儿缺氧缺血性心肌损害66例临床分析

目的探讨新生儿窒息心肌损害的状况。方法对82例新生儿窒息患者进行测定心肌酶谱、心电图（ECG）等项目检查，以评价其心肌损害程度。结果82例中并发心肌损害66例，血清心肌酶谱均有不同程度升高，心电图异常48例。结论血清心肌酶谱及ECG可作为早期诊断新生儿缺氧缺血性心肌损害的重要指标。     

新生儿缺氧缺血性脑病心肌酶、肾功能改变的临床意义

目的探讨新生儿缺氧缺血性脑病（HIE）、心肌酶、肾功能改变，并分析临床意义。方法检测42例轻、中、重度HIE患儿的心肌酶（BM、CPK），肾功能（Cr、Uric、Urea），并与40例正常新生儿对照比较。结果HIE组新生儿心肌酶谱均高于对照组，差异有非常显著性（P〈0．01），且均高于对照组（P〈0．01）。结论新生儿HIE除有脑损伤外，常伴有心、肾功能异常。因此，治疗HIE患儿时，应监测心肌酶及肾功能，以便早期发现多脏器损害和及时给予治疗。     

1,6-二磷酸果糖治疗新生儿窒息并心肌损害

目的探讨1,6-二磷酸果糖治疗新生儿窒息后心肌损害的效果。方法新生儿窒息并血清心肌酶谱变化85例患儿,随机分为治疗组45例和对照组40例;二组患儿均采用综合治疗。治疗组予1,6-二磷酸果糖0.10~0.25g/(kg.次),2次/d,快速静脉滴注(10min内滴完),疗程7~10d,入院12h内及治疗后查血清心肌酶谱。结果治疗与对照组治疗后肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(HBDH)比较差异均具有显著性意义(Pa<0.05)。结论1,6-二磷酸果糖对新生儿窒息心肌损害有一定预防及治疗作用。     

新生儿窒息致多脏器损伤临床分析

新生儿窒息是新生儿时期常见病,是围产儿死亡的重要原因之一,窒息缺氧可导致机体内环境发生一系列改变,使心、脑、肾、肝等多脏器产生不同程度的损伤.我科于2005年1月至2007年12月共收治住院新生儿窒息76例患儿,入院后,经临床诊断、心电图检查、心肌酶谱、肝功能、肾功能、头颅CT等检查证实存在窒息后的多脏器产生不同程度损伤,并经临床治疗处理.     

Review of randomized controlled trials on pneumococcal vaccination for prevention of otitis media

BACKGROUND: Increasing resistance to antibiotics of the pathogens causing acute otitis media (AOM) emphasize the need for effective methods to prevent episodes of otitis media in young children. OBJECTIVE: To assess the effectiveness of pneumococcal vaccination for prevention of AOM in children age 12 years and younger. METHODS: Systematic review of 11 randomized controlled trials including 46 074 children in whom pneumococcal vaccination against AOM was compared with a control treatment. Vaccine effect was estimated as a rate ratio (RR): AOM episodes per child month in pneumococcal vaccination group divided by the AOM episodes per child-month in control group. RESULTS: A moderate effect of pneumococcal polysaccharide vaccination was found in children 24 months of age and older [RR 0.78; 95% confidence interval (CI) 0.63 to 0.97]. Pneumococcal polysaccharide vaccine had little effect on prevention of AOM in children without previous documented episodes before vaccination (RR 0.92; 95% CI 0.85 to 0.99). Better efficacy was seen in those children with documented prior AOM before vaccination (RR 0.81; 95% CI 0.72 to 0.91). Pooled results of pneumococcal conjugate vaccine trials in infants vaccinated as early as 2 months of age and in toddlers attending day care showed only a small effect on prevention of AOM (RR 0.92; 95% CI 0.85 to 0.99). CONCLUSION: Based on these results, a large scale pneumococcal vaccination program for a primary indication of preventing AOM in infancy is not indicated. The results of ongoing trials should provide more information whether the conjugate vaccine is effective in high risk (otitis-prone) children after 1 year of age.     

大剂量肾上腺素对于儿童心肺复苏的Meta分析

目的评价大剂量肾上腺素对比标准剂量肾上腺素用于儿童心肺复苏的疗效。方法计算机检索Medline（1966至2006年）、Embase（1974至2006年）、Cochrane图书馆2006年第三期、中国生物医学文献光盘数据库（CBM）（1998至2006年）、中文学术期刊全文数据库（1994至2006年）。按纳入排除标准纳入合格的随机对照研究并对其进行质量评价,Meta分析采用Rev Man4．2．7软件进行。结果共纳入4篇研究包括360例,Meta分析结果表明大剂量肾上腺素与标准剂量的肾上腺素相比用于儿童的心肺复苏在自主循环恢复、24h存活率、出院存活率、神经系统后遗症方面无统计学意义,其RR值和95％CI分别为1．28（0．93,1．77）、1．40（0．43,4．55）、1．78（0．42,7．50）、0．72（0．43,1．19）。结论儿童在进行同等心肺复苏条件下,尚不能认为大剂量的肾上腺素可以增加自主循环恢复率、24h存活率、出院存活率和减少神经系统后遗症。     

亚低温治疗新生儿缺氧缺血性脑病临床效果的Meta分析

目的总结国内外亚低温治疗新生儿缺氧缺血性脑病（HIE）的研究结果,采用Meta分析方法评价亚低温治疗HIE的临床疗效,探讨亚低温治疗HIE的可行性。方法制定原始文献的纳入标准、排除标准及检索策略,检索PubMed、EMBASE、Ovid、Springer、中国期刊全文数据库、万方数据库及维普中文科技期刊数据库等,获得亚低温治疗HIE的相关文献。使用Cochrane中心推荐的方法进行文献质量评价,采用RevMan 4.22软件对满足纳入标准的有关亚低温治疗HIE的RCT文献进行Meta分析。以病死率、严重神经系统发育障碍（脑瘫、发育迟缓、失明和听力损害）发生率和不良反应发生率作为观察指标,进行定性和定量综合评估。结果共检索到846篇文献,符合纳入标准的9项RCT研究（16篇文献）进入Meta分析,纳入研究均未采用盲法,文献质量评价7项RCT研究为A级,2项为C级,漏斗图检验提示无发表偏倚。Meta分析结果显示,亚低温组和对照组比较：病死率显著降低（RR=0.73,95%CI：0.58~0.91）;随访至18月龄时严重神经系统发育障碍发生率显著降低（RR=0.70,95%CI：0.53~0.92）;脑瘫发生率显著降低（RR=0.72,95%CI：0.53~0.98）;发育迟缓（RR=0.73,95%CI：0.53~0.99）、失明（RR=0.57,95%CI：0.30~1.08）和听力损害（RR=1.52,95%CI：0.71~3.25）发生率差异无统计学意义;不良反应发生率：窦性心动过缓（RR=6.35,95%CI：2.16~18.68）和PLT减少（RR=1.55,95%CI：1.14~2.11）发生率升高,需要治疗的心律失常、凝血功能异常导致的血栓或出血、脓毒症和惊厥发生率差异无统计学意义。结论亚低温治疗可降低HIE患儿的病死率,改善神经系统发育障碍,且具有较好的安全性。     

Decreased neonatal serum bilirubin with plain agar: a meta-analysis

Neonatal jaundice is one of the most common problems leading to prolonged hospitalization of the newborn. Therefore, an effective low-risk, low-cost therapy reducing hospitalization is highly desirable. Plain dried agar, an extract of seaweed, is low cost and low risk; it can bind bilirubin in the gut, decreasing its enterohepatic circulation, thereby decreasing serum levels. Because of conflicting conclusions in the studies of agar's effectiveness in the prevention and treatment of neonatal jaundice, a meta-analysis of their methodologies was done. Criteria for assessing prospective controlled therapeutic trials of agar were established in six areas: hypothesis and clinical outcome, patient selection, treatment group allocation, therapeutic maneuver, use of cotherapies, and data analysis. Nine prospective clinical trials of agar therapy were evaluated using these six criteria. The seven studies with negative conclusions regarding agar's efficacy failed to meet the criteria in several categories: patient selection, therapeutic maneuver, use of cotherapies, or data analysis. All of the studies, including the positive studies, were at risk for biased treatment allocation. Although the pooled data analysis suggests that prophylactic agar treatment is associated with reduced peak serum bilirubin levels, this observation must be interpreted cautiously in light of heterogenous patient populations and the methodologic problems described. Based on this meta-analysis, agar therapy for neonatal jaundice can neither be recommended nor rejected. The methodologic analysis gives clear guidance for future research concerning the effectiveness of agar in treating neonatal jaundice and provides a model for meta-analysis of other prospective trials in pediatrics.     

Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials

Aims: To evaluate the benefits and harms of treatments for vesicoureteric reflux in children. Methods: Meta-analyses of randomised controlled trials using a random effects model. Main outcome measures were incidence of urinary tract infection (UTI), new or progressive renal damage, renal growth, hypertension, and glomerular filtration rate. Results: Eight trials involving 859 evaluable children comparing long term antibiotics with surgical correction of reflux (VUR) and antibiotics (seven trials) and antibiotics compared with no treatment (one trial) were identified. Risk of UTI by 1–2 and 5 years was not significantly different between surgical and medical groups (relative risk (RR) by 2 years 1.07; 95% confidence interval (CI) 0.55 to 2.09, RR by 5 years 0.99; 95% CI 0.79 to 1.26). Combined treatment resulted in a 60% reduction in febrile UTI by 5 years (RR 0.43; 95% CI 0.27 to 0.70) but no concomitant significant reduction in risk of new or progressive renal damage at 5 years (RR 1.05; 95% CI 0.85 to 1.29). In one small study no significant differences in risk for UTI or renal damage were found between antibiotic prophylaxis and no treatment. Conclusion: It is uncertain whether the identification and treatment of children with VUR confers clinically important benefit. The additional benefit of surgery over antibiotics alone is small at best. Assuming a UTI rate of 20% for children with VUR on antibiotics for five years, nine reimplantations would be required to prevent one febrile UTI, with no reduction in the number of children developing any UTI or renal damage.     

Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials.

AIMS: To evaluate the benefits and harms of treatments for vesicoureteric reflux in children. METHODS: Meta-analyses of randomised controlled trials using a random effects model. Main outcome measures were incidence of urinary tract infection (UTI), new or progressive renal damage, renal growth, hypertension, and glomerular filtration rate. RESULTS: Eight trials involving 859 evaluable children comparing long term antibiotics with surgical correction of reflux (VUR) and antibiotics (seven trials) and antibiotics compared with no treatment (one trial) were identified. Risk of UTI by 1-2 and 5 years was not significantly different between surgical and medical groups (relative risk (RR) by 2 years 1.07; 95% confidence interval (CI) 0.55 to 2.09, RR by 5 years 0.99; 95% CI 0.79 to 1.26). Combined treatment resulted in a 60% reduction in febrile UTI by 5 years (RR 0.43; 95% CI 0.27 to 0.70) but no concomitant significant reduction in risk of new or progressive renal damage at 5 years (RR 1.05; 95% CI 0.85 to 1.29). In one small study no significant differences in risk for UTI or renal damage were found between antibiotic prophylaxis and no treatment. CONCLUSION: It is uncertain whether the identification and treatment of children with VUR confers clinically important benefit. The additional benefit of surgery over antibiotics alone is small at best. Assuming a UTI rate of 20% for children with VUR on antibiotics for five years, nine reimplantations would be required to prevent one febrile UTI, with no reduction in the number of children developing any UTI or renal damage.     

Neonatal antecedents for cerebral palsy in extremely preterm babies and interaction with maternal factors

BACKGROUND: Preterm delivery is associated with an increased risk of cerebral palsy (CP). The greatest risk is for infants born <28 weeks' gestation. AIMS: To identify significant neonatal risk factors for CP and explore the interactions between antenatal and neonatal risk factors, among extremely preterm infants of 27 weeks' gestation or less. STUDY DESIGN: Nested case control design. METHODS: Infants born between 1989 and 1996, at 24-27 weeks' gestation, were evaluated: 30 with CP at 2 years corrected age and 120 control infants matched for gestation age. Neonatal variables were compared using matched analyses with the interaction between antenatal and neonatal factors being examined using logistic regression analyses. RESULTS: Risk factors for CP on matched analyses included patent ductus arteriosus requiring surgical ligation, peri-intraventricular haemorrhage, moderate to severe ventricular dilatation, periventricular leukomalacia (PVL) and need for home oxygen. Independent neonatal predictors were ventricular dilatation (OR 7.3; 95% CI 1.6, 32.3), PVL (OR 29.8; 95% CI 5.6, 159.1) and home oxygen use (OR 3.4; 95% CI 1.2, 9.4). No interaction terms in the logistic models were significant between the previously identified pregnancy risk factors of absence of antenatal steroids and intrauterine growth restriction and the neonatal risk factors. CONCLUSIONS: PVL is the most powerful independent predictor of CP in extremely preterm infants of 27 weeks' gestation or less and appears to be uninfluenced by antenatal factors.     

Donor human milk versus formula for preventing necrotising enterocolitis in preterm infants: systematic review

OBJECTIVES: To determine if enteral feeding with donor human milk compared with formula milk reduces the incidence of necrotising enterocolitis (NEC) in preterm or low birthweight infants. METHODS: Systematic review and meta-analysis of randomised controlled trials. RESULTS: Four small trials, all initiated more than 20 years ago, fulfilled the prespecified inclusion criteria. None of the trials individually found any statistically significant difference in the incidence of NEC. However, meta-analysis found that feeding with donor human milk was associated with a significantly reduced relative risk (RR) of NEC. Infants who received donor human milk were three times less likely to develop NEC (RR 0.34; 95% confidence interval (CI) 0.12 to 0.99), and four times less likely to have confirmed NEC (RR 0.25; 95% CI 0.06 to 0.98) than infants who received formula milk. CONCLUSIONS: It may be appropriate to consider further larger trials to compare growth, development, and the incidence of adverse outcomes, including NEC, in preterm infants who receive donor human milk versus formula milk.     

血清S100B蛋白在新生儿窒息后脑损伤中的临床意义

目的：S100B蛋白是一种脑特异性蛋白,可反映脑损伤的程度。该研究旨在探讨窒息新生儿脐血及生后血清S100B蛋白的变化及对新生儿窒息诊断和窒息后脑损伤判断的价值。方法：对窒息新生儿的脐血及生后1,3,7d血清S100B蛋白变化进行分析。结果：①窒息新生儿脐血S100B蛋白水平高于正常对照组,差异有显著性(P<0.05),轻度窒息与重度窒息患儿脐血S100B蛋白含量差异无显著性;②出生后1～7d内轻度窒息患儿血清S100B蛋白无明显变化,重度窒息脑损伤患儿血清S100B蛋白呈逐渐增高趋势,生后第7天时重度窒息脑损伤患儿血清S100B蛋白明显高于轻度窒息患儿(P<0.01);③死亡的窒息患儿生后第7天的血清S100B蛋白含量高于存活儿,但差异无显著性(P>0.05);④发生颅内出血和/或脑水肿的患儿生后第3天血清S100B蛋白含量增高,差异有显著性(P<0.05)。结论：血清S100B蛋白检测有助于新生儿窒息的诊断及窒息后脑损伤的判断。     

Changing patterns of perinatal death, 1982-2000: a retrospective cohort study

OBJECTIVE: To describe trends in cause specific stillbirth and neonatal mortality. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 686,860 births in 1982-2000, to mothers resident in the Northern Region of England. MAIN OUTCOME MEASURES: Cause specific stillbirth and neonatal mortality; rate ratios (RR) and 95% confidence intervals (CI) in 1991-2000 compared with 1982-1990. RESULTS: In singletons, rates of stillbirth and neonatal mortality declined over time (RR stillbirths, 0.81 (95% CI 0.76 to 0.87); RR neonatal mortality, 0.76 (95% CI 0.70 to 0.82)). Death from congenital anomalies declined substantially for both stillbirths (RR 0.52; 95% CI 0.40 to 0.68) and neonatal mortality (RR 0.58; 95% CI 0.51 to 0.67). Mortality due to intrapartum hypoxia also fell, by nearly 50% for stillbirths and 30% for neonatal deaths. There was no reduction in stillbirths due to antepartum hypoxia in babies weighing > or = 2500 g, or in mortality attributed to infection. In multiples, the risk of death was higher (RR stillbirths, 4.13 (95% CI 3.68 to 4.64); RR neonatal death, 7.82 (95% CI 7.13 to 8.58)). Stillbirth rates declined significantly (RR 0.71; 95% CI 0.57 to 0.89) but neonatal mortality did not (RR 0.91; 95% CI 0.77 to 1.08). There was no reduction in neonatal mortality resulting from prematurity, or in mortality from congenital anomalies. CONCLUSIONS: There is considerable overlap in the causes of stillbirth and neonatal mortality. Future progress in reducing perinatal mortality requires better understanding of the aetiology of antepartum stillbirth, of the excess risks of prematurity facing multiple births, particularly in the light of their increasing incidence, and of strategies to prevent perinatal infection.