气管内冲洗治疗新生儿胎粪吸入综合征疗效观察

胎粪吸入综合征 (ＭＡＳ)是新生儿死亡的主要原因之一。病死率为 7%～ 15 .2 % [1] 。为了探讨气管内冲洗对新生儿ＭＡＳ合并症及预后的影响 ,对我院 1998年 3月～ 2 0 0 2年 2月收治的 6 0例ＭＡＳ患儿进行分析 ,报告如下。资料与方法一、一般资料　我院新生儿科住院的ＭＡＳ患儿 6 0例 ,分非冲洗组 30例 ,男 18例 ,女 12例 ;胎龄 33～ 37周 6例 ,～41周 11例 ,≥ 42周 13例 ;日龄～ 30ｍｉｎ 15例 ,～ 2ｈ 10例 ,～ 6ｈ 5例 ;评分 0～ 1分 7例 ,≤ 3分 2 3例。冲洗组 30例 ,男19例 ,女 11例 ;胎龄 33～ 37周 6例 ,～ 41周 10例 ,≥ 42周14…     

气管内冲洗对新生儿胎粪吸入综合征的疗效观察

我院１９９８年３月～２００１年６月收治新生儿胎粪吸入综合征４２例 ,其中本院分娩３０例 ,外院转入１２例。分为２组 :气管内冲洗组２３例 ,未进行气管内冲洗组１９例 ;两组间在性别、胎龄、出生体重、窒息程度方面差异均无显著性 (Ｐ＞０．０５)。气管内冲洗指征 :①胎粪粘稠 ;②声带或以下有胎粪者 ;③胎粪稀薄 ,Ａｐｇａｒ评分＜７分 ,但呼吸急促。气管内冲洗方法 :喉镜直视下 ,吸净气管口处的胎粪 ,按操作要求经口插入气管导管 ,用直径约为插管直径２／３的吸痰管经插管导管插入气管深部 ,连接吸引器 ,反复吸引多次 ,直到无胎粪吸出 …     

胎粪污染羊水新生儿发生重度胎粪吸入综合征的临床特征及预警因素分析北大核心CSCD

目的探讨胎粪污染羊水(meconium-stained amniotic fluid,MSAF)新生儿发生重度胎粪吸入综合征(meconium aspiration syndrome,MAS)的临床特征及预警因素。方法纳入2018年1月至2019年12月因Ⅲ°MSAF住院的新生儿295例为研究对象,按是否并发MAS分为无MAS组(n=199)、轻度/中度MAS组(n=77)和重度MAS组(n=19),回顾性收集3组患儿一般临床资料、血气分析结果、感染指标、母亲围生期临床资料等进行分析,并比较3组患儿出生后的呼吸支持方案。应用受试者工作特征曲线及多因素logistic回归分析MSAF新生儿发生重度MAS的预警因素。结果295例MSAF新生儿中32.5%(96/295)发生MAS,其中20%(19/96)为重度。重度MAS组出生5min Apgar评分低于轻度/中度MAS组及无MAS组(P<0.05),脐动脉血乳酸水平高于轻度/中度MAS组和无MAS组(P<0.05),生后1h外周血白细胞介素6(interleukin-6,IL-6)水平高于无MAS组(P<0.017)。重度MAS组患儿79%(15/19)出生无活力(其中13例行胎粪吸引术),100%在24h内开始机械通气。生后1 h外周血IL-6水平>39.02 pg/mL及生后1 h白细胞计数>30.345×10^(9)/L为MSAF新生儿发生重度MAS的预警指标(P<0.05)。结论胎粪吸引不能完全阻止MSAF新生儿严重MAS的发生;重度MAS患儿在出生早期即发生严重呼吸窘迫需要机械通气。监测脐动脉血乳酸及生后1 h外周血IL-6水平、白细胞计数有助于预警MAS的发生及严重程度。     

气管冲洗治疗新生儿胎粪吸入性肺炎疗效观察

我科于 1 998年 1月至 2 0 0 0年 1月期间 ,在常规综合治疗的基础上 ,采用气管冲洗治疗新生儿胎粪吸入性肺炎 9例 ,取得了较好的临床效果。报告如下。资料及方法一、临床资料新生儿胎粪吸入性肺炎 1 8例均符合儿科诊疗常规的诊断标准( 1) 。随机分为治疗组和对照组。治疗组 9例 ,其中男 6例 ,女 3例 ,早产儿 1例 ,足月儿 7例 ,过期产儿 1例 ,<2 50 0ｇ 1例 ,2 50 0～ 3 0 0 0ｇ 4例 ,3 0 0 0～ 350 0ｇ 3例 ,3 50 0～ 40 0 0ｇ 1例。轻度窒息 5例 ,重度窒息 4例 ,有宫内窘迫 5例 ,羊水Ⅲ度 7例 ,Ⅱ度 2例 ,缺氧缺血性脑病 2例 ,颅内出血 2例…     

无活力新生儿气管插管吸引胎粪的回顾性队列研究

目的 探讨胎粪污染羊水(meconium stained amniotic fluid,MSAF)无活力新生儿生后立即进行气管插管吸引胎粪的可行性.方法 采用队列研究方法,回顾性收集柘城县人民医院入住新生儿科MSAF无活力病例,2017年7月1日至2018年6月30日无吸引胎粪条件病例为对照组,2018年7月1日至20...     

羊水胎粪污染新生儿复苏的前世今生：过去60年中美两国的演变史

出生于羊水胎粪污染的新生儿可发生新生儿胎粪吸入综合征、持续性肺动脉高压等并发症，甚至死亡。在过去的几十年里，羊水胎粪污染新生儿复苏已发生了几次重要的变革。最初，对于羊水胎粪污染新生儿，通常在其出生后立即采用喉镜直视下吸引声门下胎粪。自2015年起，美国儿科学会新生儿复苏指南不再推荐对羊水胎粪污染无活力新生儿“常规”给予气管插管吸引胎粪，但建议立即给予气囊面罩正压通气复苏。然而，最新版2021年中国新生儿复苏指南仍保留对无活力新生儿进行胎粪吸引的建议。该文旨在探讨过去60年中美两国新生儿复苏指南在羊水胎粪污染新生儿复苏方法中的差异及其原因。     

关于“羊水胎粪污染新生儿复苏的前世今生:过去60年中美两国的演变史”的更正启事北大核心CSCD

由于作者疏忽,《中国当代儿科杂志》2023年第25卷第3期229~237页“羊水胎粪污染新生儿复苏的前世今生:过去60年中美两国的演变史”一文中,文献[58]更正为:苏晋琼,朱小瑜,张谦慎,等.应用胎粪吸引管气管内吸引防治胎粪吸入综合征的临床效果分析[J].中华围产医学杂志,2009,12(1):28-31.DOI:10.3760/cma.j.issn.1007-9408.2009.01.008。特此更正。给读者带来不便,深表歉意。     

胎粪吸入综合征的并发症6年回顾性分析

提高胎粪吸入综合征的存活率，早期认识并发症及时干预为重要，文章总结了６２例胎粪吸入综合征的常见并发症，结果；胎粪吸入综合征的常见并发症依次为气胸，继发感染，肺动脉高压（ＰＰＨＮ）和ＡＲＤＳ，比较呼吸机组和非呼吸机组气胸的发生率无明显的差异（Ｐ〉０．０５），但呼吸机组张力性气胸和继发感染明显增高（Ｐ〉０．０５），提示气胸的发生与胎粪吸入病理变化有关，呼吸机应用加重气胸的发现，应及时的胸腔闭式引流，严     

气管插管冲洗治疗胎粪吸入综合征

目的　观察气管插管冲洗治疗胎粪吸入综合征 (MAS)的临床疗效。方法　回顾分析MAS 6 3例患儿。其中气管插管冲洗 2 4例为治疗组 ;无气道插管冲洗 39例为对照组。两组均在清理呼吸道基础上治疗组用气管插管注射 0 .5～ 1ml生理监水反复冲洗。结果　 1.两组血气分析在 0～ 3h的各项数值无显著性差异 ;但在4～ 2 4h[除 pH、p(CO2 )外 ]p(O2 )、pa(O2 )a/A间均有显著性差异 (P均 <0 .0 5 )。 2 .两组在治愈率、上机人数率、合并症率、死亡率方面均有显著性差异 (P均 <0 .0 5 )。 3.治疗组较对照组明显缩短治愈患儿住院天数 ,两组间有显著性差异 (P <0 .0 5 )。结论　对有黏稠胎粪、并窒息、产前有致窒息高危因素胎儿于吸净气管内分泌物后立即气管插管予气道冲洗 ,可减少MAS发生率     

羊水胎粪污染新生儿脐血IgE水平测定及意义

目的：通过对羊水胎粪污染新生儿脐血IgE水平的检测,探讨羊水胎粪污染及其他高危因素对脐血IgE水平的影响。方法：采用ELISA法测定脐血IgE的含量。结果：①污染组新生儿脐血IgE水平与对照组比较有显著增高,两组间差异有非常显著性意义(t=4.03,P＜0.01）;②Ⅰ,Ⅱ,Ⅲ度羊水胎粪污染组分别与对照组比较,Ⅰ、Ⅲ度组差异有非常显著性意义（F=4.28,P＜0.01）;Ⅰ,Ⅱ,Ⅲ度组间两两比较差异无显著性;③将被检测的660例新生儿脐血IgE值按性别、胎龄、体重、胎次、早破水分组比较,早破水组与对照组比较差异有非常显著性;性别、胎龄、体重、胎次与对照组比较均差异无显著性。结论：羊水胎粪污染新生儿脐血IgE水平显著增高,早破水也是脐血IgE水平显著增高的重要危险因素。对新生儿脐血IgE水平的观察,可作为婴幼儿期过敏性疾病发生的预测的因素之一。［中国当代儿科杂志,2007,9（4）：361-363］     

Feeding problems with the first feed in neonates with meconium-stained amniotic fluid

OBJECTIVE:

To compare the incidence of feeding problems at the first feed between neonates born with meconium-stained amniotic fluid (MSAF) and those born without MSAF.

DESIGN:

A prospective observational study conducted over a one-year period.

SETTING:

A level 2 neonatal unit.

POPULATION STUDIED:

A total of 2828 neonates were studied, including 275 neonates with MSAF. All neonates were born after more than 34 weeks of gestation, and had no birth asphyxia, hemodynamic, respiratory distress or major congenital anomalies. The neonates were offered a feed within 1 h of birth, and the incidence of early feeding problems (ie, retching, vomiting, slow feeding or poor suck) was studied.

RESULTS:

Feeding problems at the first feed developed in 55 infants (13 of 275 with MSAF and 42 of 2533 without MSAF). Feeding problems were more common in infants with MSAF (P=0.001, relative risk=2.8, 95% CI 1.45 to 5.63), regardless of the type of MSAF (thin or thick). Although fetal distress was more frequent in the MSAF group, there were no differences in the 1 and 5 min Apgar scores whether meconium was present. Maternal sedation was not found to be a contributing factor. The mechanical and chemical actions of meconium inside the stomach requires further study.

CONCLUSION:

Feeding problems at the first feed are 2.8 times more frequent in neonates born with MSAF, regardless of the consistency of the amniotic fluid. Mothers of such infants need to be informed and supported during feeding to minimize discouragement. The demands on the nursing staff must be anticipated accordingly.     

Catecholamine levels and associated cardiovascular responses in infants with meconium-stained amniotic fluid

Catecholamine levels and associated cardiovascular responses were determined in 21 control and 30 term infants with meconium-stained amniotic fluid (MSAF). Cord arterial blood was obtained for determination for norepinephrine (NE) and epinephrine (EPI) levels; cardiovascular measurements included heart rate and systolic blood pressure at 30 min. Pregnancy was uncomplicated in all cases. The total length of labor 964±402 versus 555±312 min (P<0.001) and active phase of labor 300±261 versus 135±104 min (P<0.001) were significantly longer in MSAF infants when compared to controls. The 1 min Apgar score was <7 (range 1–6) in 11 of 30 MSAF infants versus 0 of 21 control infants; these 11 infants required positive pressure ventilation for approximately 60 s secondary to transient respiratory depression (RD). The 5 min Apgar score was >7 in 49 of the 51 infants. Infants with MSAF exhibited a higherP _aCO₂ (6.89±1.17 vs 6.24±1.17 mm Hg;P<0.02) and lower pH (7.25±0.06 vs 7.29±0.05;P<0.02) compared to controls. Infants with transient RD demonstrated the most marked arterial blood gas differences, i.e.,PCO₂ 7.41±1.30 mm Hg (P<0.001), pH 7.21±0.07 (P<0.001) and base deficit –6±4 versus –3±2.8 (P<0.001) when compared to controls. NE and EPI levels were significantly higher in MSAF versus control infants, i.e., 12600±3040 versus 3740±1000 pg/ml (SEM) (P<0.02) and 1550±250 versus 620±130 pg/ml (P<0.001) respectively. The highest values were observed in infants with transient RD. NE levels were related to base deficit (r=–0.45,P<0.0001) and the presence of meconium (r=0.26,P<0.05), while EPI levels were related to pH (r=0.44,P<0.001) and meconium (r=0.28,P<0.05). MSAF infants exhibited a higher systolic blood pressure at 30 min, i.e., 59±10 versus 54±8 mm HgP<0.002 when compared to controls. No differences in heart and respiratory rates were noted. These data indicate that infants delivered in the presence of MSAF exhibit significant elevations in catcholamine levels when compared to control infants, which may reflect an adaptive respone to in utero stress.     

Intrapartum and postdelivery management of infants born to mothers with meconium-stained amniotic fluid]

Since a decade, some studies had discussed preventive and curative treatment of infants born to mothers with meconium-stained amniotic fluid. Today amnio-infusion, formerly proposed, is reconsidered in countries where midwives and obstetricians carefully monitor the fetal heart rate tracing during labor. Actually routine intrapartum oropharyngeal and nasopharyngeal suctioning, before and after shoulders delivery, followed by tracheal suction, are not recommended for infants born to mothers with meconium stained amniotic fluid.     

Urinary beta 2-microglobulin in full-term newborns: evidence for proximal tubular dysfunction in infants with meconium-stained amniotic fluid

Urinary concentrations of beta 2-microglobulin (beta 2M) and creatinine were measured in normal term infants and in those born with meconium-stained amniotic fluid. None of the infants or their mothers had conditions known to modify beta 2M excretion. Measurements of beta 2M were made on urines collected by bagging; urines obtained from diapers were not satisfactory. Urinary beta 2M concentrations increased significantly (P less than .02) in the normal infants from the first day (0.36 +/- 0.29 mg/L: n = 29) to the third day (0.60 +/- 0.43 mg/L: n = 21) postpartum. Compared with the normal infants, values for the infants with meconium-stained amniotic fluid were increased significantly on days 1 (1.64 +/- 2.16 mg/L: n = 25: P less than .005) and 3 (2.12 +/- 2.04 mg/L: n = 23: P less than .005). Levels exceeded two standard deviations above the normal mean in 12 of the 26 infants with meconium-stained amniotic fluid on postpartum day 1, and 12 of the 23 infants with meconium-stained amniotic fluid on day 3. Urinary creatinine levels were similar in both the normal infants and those with meconium-stained amniotic fluid. All infants with meconium-stained amniotic fluid with a one-minute Apgar score of 6 or less had an elevated urinary beta 2M concentration. The elevated levels of urinary beta 2M in infants with meconium-stained amniotic fluid indicate the existence of tubular dysfunction, probably mild acute tubular necrosis secondary to hypoxia.     

Early management of infants born to mothers with meconium-stained amniotic fluid: a survey in French delivery rooms]

The meconium aspiration syndrome is the first cause of respiratory distress in full term newborns. At birth, management includes systematical oropharyngeal suctioning, before and after shoulders delivery, followed by tracheal suction. During last 10 years, many trials were published which discuss again the value of this strategy. AIM: To assess practices of the current management of births with a meconial amniotic liquid in the French maternities. METHODS: Observational survey by written questionnaires sent to the 617 French maternities. RESULTS: The rate of answers was of 54.3%. The incidence of the births presenting a meconial amniotic fluid was of 8.2%, complicated of meconium aspiration syndrome in 4.7%. In case of birth with presence of a meconial amniotic liquid, half of the maternities resorted systematically to oropharyngeal suctioning before shoulders delivery. A glottis exposition under laryngoscopy was practiced of principle for half of the newborn. Tracheal suctioning was achieved systematically in a quarter of the establishments. These techniques, with the exception of suctioning before clearing of the shoulders, were especially been achieved in a systematic way in the maternities of I and II A levels. CONCLUSION: This survey shows the necessity of harmonization of the practices in France for the management of the births with a meconial amniotic liquid.