新生儿心脏动脉导管瘤一例

患儿 男,27天,因少吃伴咳嗽20天入院.生后1天发现患儿吸吮无力,少吃,奶量(20～50)ml/天,少哭,间断咳嗽,无口吐白沫、发热、气促、青紫.     

脐动脉血血气分析与Apgar评分评估新生儿窒息的临床意义研究

目的 了解脐动脉血血气分析与Apgar评分在新生儿窒息诊断中的临床意义。方法对广东省江门市新会区妇幼保健院2012年4月至2013年1月出生的足月单胎新生儿采集脐动脉血进行血气分析,结合羊水性状、脏器损害及Apgar评分进行统计分析。结果 研究期间共分娩足月单胎新生儿3958例,成功采集脐动脉血3900例。生后1 min Apgar评分和脐动脉血pH值、PO2均呈正相关,与PCO2呈负相关（r分别为0.334,0.219,-0.227,P均〈0.05）。重度窒息新生儿脐动脉血气pH、PO2、BE、HCO-3均低于轻度窒息组和对照组,PCO2高于轻度窒息组和对照组,差异有统计学意义（P〈0.05）,对照组和轻度窒息组差异无统计学意义（P〉0.05）。pH≤7.2组的新生儿窒息发生率、羊水浑浊发生率及脏器损害发生率均高于pH≥7.25组（7.7%比0.3%,68.0%比9.6%,8.3%比1.0%,P〈0.01）。结论 临床联合Apgar评分和脐动脉血血气分析可早期发现新生儿器官功能损害,是提供支持治疗可靠而简便易行的指标。     

新生儿胆汁性呕吐

第一次查房 主治医师查房,入院当天。 住院医师 汇报病史：患儿,女,1d,因“生后1d,呕吐3次”转诊收治入我院。患儿为G3P2,孕39＋3周,剖宫产,出生体重3530g,出生时无窒息。生后Apgar评分8-9—10分。生后1h开奶,母乳喂养。15h后出现呕吐,先后3次,每次少许2—5ml黄色液体,后逐渐出现腹胀表现,腹围从出生32cm增至36．5cm,上腹部膨隆为主。     

新生儿脐炎74例临床分析

新生儿脐炎是新生儿期常见的感染性疾病之一[1]，常引起新生儿败血症、肺炎、硬肿症导致新生儿死亡。对新生儿的健康危害较大。我科1991年1月－1995年5月共收治新生儿脐炎74例，占同期167例注院新生儿的44％现分析如下：1、临床资料（1）一般资料：本组74例，男48例，女26例。足月儿63例，早产儿11例，日龄＜3天10例，3～7一天18例，8～14天23例，≥15天23例。体重＜3kg19例，3～4kg55例。（2）分娩方式：在家老法接生51例（占69％），接生员接生18例（占24％），在医院分娩5例（占7％）。（3）并发症：本组74例，有72例发生并发症。其中硬…     

新生儿先天性右侧乳糜胸1例

患儿，男，10天，以“生后气促10天”为主诉入院。患儿系G1P1，孕37周在我院出生，足月顺产，出生体重2510g，Apgar评分9’-10’-10’，羊水清，无早破水。生后不久发现气促，无呻吟、发绀、口吐泡沫，但哭声洪亮，未引起家长重视。生后第7天院外行胸片检查发现右侧胸腔积液，给予头孢他啶抗感染治疗无效，遂转入我院。追述病史，其孕母在孕32周做产前B超时即发现胎儿右侧胸腔积液。     

新生儿异戊酸血症一例

患儿男，5d，因早产、自纳奶欠佳1d就诊入院。孕36周阴道分娩，出生体重2550g，Apgar评分8分、9分。生后约3h开始配方奶喂养，吸吮好。生后第4天无明显诱因出现自纳奶差，精神反应欠佳，无烦躁、哭闹等症。其母孕4产4，三姐姐均身体健康。否认家族中有遗传病史。入院查体：T36．5℃，P130次／分，R33次／min，W2600g，BP72／28mmHg（1mmHg=0．133kPa）。发育幼稚，精神反应欠佳，全身皮肤黏膜微黄，头颅五官端正，前囟平软，口唇红润。[第一段]     

新生儿腹水2例

1病例介绍 例1，患儿，女，2天，因“发现腹水2天”入院。该患儿系第2胎第1产，胎龄38。周，有头盆不称、脐带扭转史，剖宫产分娩，出生体重3550g，Apgar评分1min、5min、10min分别为9分、9分、10分。产前B超发现胎儿腹水。查体：体温正常，神志清，     

新生儿肠梗阻1例

1 病历摘要 患儿，女，孕40^＋1周，顺产娩出，出生1min Apgar评分9分，出生时体重3000g，生后因呕吐、腹胀2天入院，生后第2天开始进食少许稀牛奶，第3天开始频繁呕吐，呕吐物为胃内容物及胆汁，呈非喷射状，伴腹胀共2天，并有粪汁排出，体检：体温正常，脉搏145次／min，呼吸48次／min，头围31cm，身长48cm，成熟儿外貌，皮肤无黄染及出血点，心肺听诊正常，腹膨软，肝脾无肿大，肠鸣音存在，四肢肌张力正常。行腹部立位片示：中腹部见多个大小不等液平，提示肠梗阻。请儿外科会诊诊断“不完全性肠梗阻”，治疗予禁食，胃肠减压，上鼻胃管，     

振幅整合脑电图、脐动脉血气及Apgar评分对缺氧缺血性脑病诊断的意义

目的 探讨振幅整合脑电图(amplitude integrated electroencephalogram,aEEG)、脐动脉血气分析、Apgar评分对缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)诊断的意义.方法 选择新生儿HIE 患儿55例为观察对象,观察aEEG异常程度与HIE的关系,同时分析 aEEG 异常程度与脐动脉血气pH和剩余碱的相关性.结果 (1)Spearman等级相关分析表明,aEEG异常程度与HIE临床分度有相关性(Spearman等级相关系数为0.813,P<0.01).(2)aEEG正常组、轻度异常组及重度异常组不同时间Apgar 评分分值比较,差异均有统计学意义(P均<0.05).5 min、10 min Apgar评分异常的新生儿aEEG 异常率高(85.7%,100%),Apgar评分随着时间的推移异常率增加(χ2=13.76,P<0.05);(3)在生后1 min脐动脉血气分析中,aEEG 正常组、轻度异常组、重度异常组3组脐动脉血pH比较差异有统计学意义(P<0.001),剩余碱比较差异无统计学意义(P>0.05).结论 HIE新生儿aEEG异常程度与HIE临床分度密切相关,可作为早期诊断新生儿HIE的依据之一;Apgar评分异常, pH低于7.15的患儿,应常规监测aEEG,及时发现脑电活动异常,及早进行干预.     

Rhombencephalosynapsis: Association with single umbilical artery

A 6-year-old girl who presented with developmental delay and non-progressive ataxia is described. MRI of brain showed agenesis of cerebellar vermis with fusion of cerebellar hemispheres and dentate nuclei. MRI findings were characteristic of Rhombencephalosynapsis. Partial agenesis of corpus callosum and absent septum pellucidum were also seen. The child had also been noted to have a single umbilical artery at birth: a hitherto undescribed association.     

宫内窘迫新生儿脐动脉血乳酸检测与新生儿行为神经测定的临床意义

目的探讨新生儿脐动脉血乳酸水平与宫内窘迫的关系及其对新生儿行为神经表现的影响。方法对160例发生宫内窘迫的足月新生儿(出生时无窒息为窘迫I组,出生时有窒息为窘迫II组)和310例正常足月新生儿(对照组)的脐动脉血进行乳酸测定及血气分析,并在生后4～6d、26～28d进行新生儿20项行为神经测定(neonatal behavioral neurological assessment,NBNA)。结果窘迫I组和窘迫II组脐动脉血乳酸值均较对照组显著升高(P<0.01),两组pH值较对照组明显降低(P<0.01);窘迫II组的乳酸值明显高于窘迫I组,pH值低于窘迫I组,差异均有非常显著性(P<0.01)。脐血乳酸值与pH值呈直线负相关关系(r=-0.53,P<0.01),窘迫II组的脐血乳酸值与NBNA评分也呈直线负相关关系(r=-0.78,P<0.01)。三组NBNA评分随日龄增长均升高,差异有非常显著性(P<0.01)。结论脐动脉血乳酸检测可协助宫内窘迫的诊断,并可望作为评估、预测新生儿窒息损伤的指标之一。     

Structure and closure mechanism of the human umbilical artery

The structure of the fully-patent umbilical artery and rearrangement of its structural elements with postnatal closure were examined in 10 centimeter long umbilical cord segments which were double-clamped at different time intervals after delivery. The fully-patent umbilical artery consists of two main layers: an outer layer of circularly arranged smooth muscle cells and an inner layer which shows rather irregularly and loosely arranged cells embedded in abundant metachromatic ground substance. No predominantly longitudinal arrangements of cells and fibers reported by earlier investigators could be identified in the inner layer. Closure of the umbilical arteries is initiated by numerous localized contractions which are mainly formed by muscle cells of the outer circular layer. Ultimate closure of larger segments of the umbilical arteries is also mainly produced by contractions of the outer layer. In contrast, the inner layer (which is rich in ground substance) seems to serve mainly as a plastic tissue which can easily be shifted in an axial direction and then folded into the narrowing lumen to complete closure. Electron microscopy reveals that the cells of this layer represent rather poorly differentiated smooth muscle cells which contain only a few tiny myofilaments and can therefore hardly contribute actively to the process of closure.     

脐动脉血pH值在新生儿窒息中的意义和价值

目的：由于Apgar评分的局限性,有可能造成新生儿窒息的误诊和漏诊,为弥补其不足,探讨脐动脉血pH值在新生儿窒息诊治中的意义和价值。方法：对经胎心电子监护异常的单胎足月新生儿140例,出生后立即采集脐动脉血进行pH值测定,同时给予生后1 min及5 min Apgar评分,对于62例1 min Apgar≤7分者,窒息复苏后立即转入儿科病房观察治疗,进行血清肌钙蛋白Ⅰ（CTnI）和脏器损伤指标的检测,并进行统计学分析。结果：脐动脉血pH值与出生后1 min和5 min Apgar评分呈正相关(r=0.513和0.478,均P＜0.01),Apgar评分愈低,脐动脉血pH值愈低,各分值组之间差异有显著性（P＜0.01）。出生后1 min及5 min Apgar评分与血清CTnI呈负相关（r=-0.614和-0.569,均P＜0.01）。脐动脉血pH值＞7.20,7.00~7.20,＜7.00相对应的血清CTnI值分别为（31.82±8.63）ng/L,（53.24±11.18）ng/L和（79.36±18.51）ng/L,随脐动脉血pH值的降低, 血清CTnI值明显升高(P＜0.01)。脏器损伤的发生率随Apgar评分的降低而升高（P＜0.05）,两者呈负相关(r=-0.548和-0.496,均P＜0.01)。脐动脉血pH值＞7.2,7.00~7.20,＜7.00相应的脏器损伤发生率分别为36.4％,60.0％及83.3％,脏器损伤的发生率随脐动脉血pH值的降低而升高（P＜0.05）, 两者呈负相关(r=-0.578,P＜0.05)。结论：①脐动脉血pH值和Apgar评分具有相关性,可作为诊断新生儿窒息的敏感指标之一,与Apgar评分相互补充。②脐动脉血pH值对于诊断新生儿窒息,判断病情轻重及预后评估具有重要临床意义。［中国当代儿科杂志,2009,11（7）：521-524］     

Signs of fetal brain sparing are not related to umbilical cord blood gases at birth

Background

Fetal chronic hypoxia leads to centralization of circulation in order to spare the vital organs brain, adrenals and the heart. This can be documented by Doppler ultrasound. Increased blood velocity in the fetal middle cerebral artery (MCA) is an acknowledged sign of centralization of circulation in chronic hypoxia, and is called brain sparing.

Aim

Our aim was to assess the relationship between signs of brain sparing in the MCA and umbilical cord blood gases at birth.

Study design

A prospective study.

Subjects

Singleton 57 high-risk pregnancies (outcome was compared with 21 normal pregnancies).

Methods

MCA Doppler was performed within 24 h of elective caesarean section in high-risk pregnancies. Umbilical cord blood gases were analysed at birth.

Main outcome measures

Cord blood gases were related to signs of centralization of fetal circulation in the MCA.

Results

No correlation between signs of brain sparing in the MCA and cord blood gases. Apgar score at 5′ < 7 was seen in three newborns, but only one of these had antenatal signs of brain sparing. Newborns with antenatal brain sparing were admitted more often (p < 0.04) and had a longer duration of stay in NICU (p < 0.03) compared to newborns without brain sparing.

Conclusion

Decreased pulsatility index in MCA is an acknowledged sign of fetal centralization of circulation during chronic hypoxia. However, signs of brain sparing are not related to cord blood gases at birth, which might suggest that redistribution of fetal circulation can maintain normal blood gases for a long time during chronic hypoxia.     

新生儿窒息血气和电解质变化的临床分析

目的分析新生儿窒息时血气及电解质变化。方法49例窒息新生儿根据Apgar评分分为轻度窒息组(n=20)和重度窒息组(n=29)。采用美国855血气分析仪测定动脉血血气和电解质变化。结果重度窒息组的血pH值、BE值、PaCO2均明显低于轻度窒息组,差异有非常显著性(P<0.01)。窒息新生儿血清K 、Na 均低于正常水平,但轻、重度窒息组间差异无显著性(P>0.05)。重度窒息患儿血清Cl-、Ca2 均明显低于轻度窒息者,差异有非常显著性(P<0.01)。结论新生儿窒息时血气变化以混合性酸碱失衡为主,重度窒息时血清Cl-、Ca2 明显降低,及时监测血气及电解质变化,有助于了解病情变化,指导治疗。     

新生儿出生后24小时内凝血功能检测的临床意义分析

目的探讨不同胎龄以及不同体重新生儿凝血功能指标的差异,为判断凝血功能指标的临床意义提供参考。方法2015年1月至2018年12月期间,在解放军总医院第五医学中心新生儿科住院治疗的新生儿中,纳入170例胎龄28~42周、出生8 h内入院的新生儿,其中男性87例,女性83例。按胎龄分为早期早产儿组、晚期早产儿组和足月儿组。按新生儿出生体重分为正常出生体重组、低出生体重组和极低出生体重组。按是否小于胎龄分为早产适于胎龄儿组、早产小于胎龄儿组、足月适于胎龄儿组、足月小于胎龄儿组。于生后24 h内抽取静脉血,检测活化部分凝血活酶时间(activatedpartial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin,TT)及D-二聚体(D-dimer)。结果早期早产儿组的APTT、PT、D-二聚体水平均高于晚期早产儿组及足月儿组(P值均<0.05),FIB水平低于晚期早产儿组及足月儿组(P值均<0.05);晚期早产儿组的APTT、PT水平均高于足月儿组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。极低出生体重组的APTT、PT、D-二聚体水平均高于低出生体重组及正常出生体重组(P值均<0.05),FIB水平低于低出生体重组及正常出生体重组(P值均<0.05);低出生体重组的APTT、PT水平均高于正常出生体重组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。早产小于胎龄儿组D-二聚体水平高于早产适于胎龄儿组(P<0.05),其余指标比较差异无统计学意义(P值均>0.05);足月适于胎龄儿与足月小于胎龄儿组的凝血指标比较,差异均无统计学意义(P值均>0.05)。早产儿出血发生率高于足月儿[26.6%(29/109)与8.2%(5/61),χ^2=9.019,P=0.003]。结论新生儿凝血指标有胎龄和体重差异,胎龄越小、体重越低的新生儿凝血功能越不完善。     

Effect of delayed sampling on umbilical cord arterial and venous lactate and blood gases in clamped and unclamped vessels

BACKGROUND: Cord blood lactate at birth is a marker of antenatal hypoxia, and is comparable to pH as a prognostic tool. OBJECTIVE: To determine, by a prospective observational study, the effect of delayed sampling from arteries and veins that were double clamped to isolate the blood from the placenta (clamped), and from vessels that were not isolated from the placenta (unclamped). METHODS: Paired samples taken from clamped and unclamped vessels at 0, 20, 40, and 60 minutes were analysed for lactate, base excess, pH, and Pco(2). Data were analysed as the change from time 0 at 20, 40, and 60 minutes. RESULTS: Thirty eight placentas of infants delivered by elective caesarean section were studied. Arterial samples were taken from 20 placentas, and venous samples from 18 placentas. Arterial and venous lactate was significantly higher than at time 0 by 20 minutes in both clamped and unclamped vessels. Changes in unclamped vessels were greater than in clamped vessels. The pH remained unchanged over 60 minutes in clamped vessels, but changed significantly in unclamped vessels. Base excess changed significantly in both clamped and unclamped vessels. CONCLUSIONS: Cord blood samples taken after 20 minutes delay are unreliable for lactate measurement, even if the vessel has been doubly clamped to isolate the blood from the placenta. Current guidelines that state that blood can be sampled from a clamped cord for up to one hour after delivery should not apply to the interpretation of lactate or base excess. Delayed sampling from unclamped cords is very unreliable.