极低出生体重儿的治疗体会

我院NICU 3年来共收治出生体重<1500g的极低出生体重儿39例,占同期收治新生儿数的12.8％。体重最低1020g,平均1391±124g。胎龄最小28周,平均31.9±3.1周。新生儿期存活25例,存活率64.1％。平均住院17.6天,出院时平均体重1782±288g。住院期间主要并发症为呼吸暂     

103例超未成熟儿及超低出生体重儿转归及影响因素分析

目的 总结超未成熟儿及超低出生体重儿发生的原因、相关影响因素及转归情况.方法 分析内蒙古医科大学附属医院2009年1月至2015年12月NICU收治的符合条件的103例超低出生体重儿及超未成熟儿的临床资料,包括母孕期病史、新生儿出生时情况、诊治经过及预后.结果 103例患儿存活67例,死亡36例,存活率65.0％ (67/103).妊娠高血压综合征、感染、胎膜早破等为发生超未成熟和超低出生体重儿的主要因素,影响两者的转归因素包括胎龄、性别、出生体重、肺出血、支气管肺发育不良、坏死性小肠结肠炎(P＜0.05).长期住院的存活患儿后期易并发贫血.死亡直接原因前4位包括肺出血、呼吸窘迫综合征、新生儿肺炎及坏死性小肠结肠炎.结论 加强高危妊娠监测管理,预防早产,加强NICU超未成熟儿及超低出生体重儿的监护管理,及早发现、及早处理各种并发症,防止医院感染发生,是提高两者存活率,改善生活质量的根本措施.     

住院早产儿脑室内出血10年回顾性调查及影响因素分析

目的　调查住院早产儿脑室内出血 (IVH)发生率及其影响因素。方法　对 1993～ 2 0 0 2年 10年间入住新生儿病房、曾经头颅B超检查的所有住院早产儿进行分析 ,应用SIGMAB超诊断仪对早产儿进行床边头颅B超检查。结果　 392例早产儿的平均胎龄为 (34 0± 2 1)周 ,平均出生体重为 (2 13± 0 5 3)kg。平均头颅B超初次检查时间为生后 (5 3± 6 3)d ,其中本院出生患儿为 (4 0± 2 0 )d ,外院出生患儿为 (7 0± 8 0 )d ,两者有非常显著性意义。总的IVH发生率为 5 6 6 % (2 2 2 / 392 ) ,重度IVH发生率为 16 3% (6 4 / 392 )。早产儿的胎龄愈小 ,出生体重愈低 ,其IVH发生率愈高 ,出血程度也趋严重。围产期窒息、家中自娩、机械通气、产妇为外来民工等因素与早产儿IVH及其出血程度密切相关。结论　鉴于早产儿IVH的高发生率及约一半IVH早产儿无明显临床症状 ,建议对所有早产儿在生后早期应常规进行床边头颅B超检查     

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目的调查新疆医科大学第一临床学院住院早产儿脑损伤发生率及影响因素。方法对2003-08—2005-10新生儿科收治的404例早产儿应用ABR4000S/LB超诊断仪在生后3~7d内常规进行床边头颅B超检查。结果150例早产儿存在脑损伤,平均胎龄为(33·27±1·99)周;平均出生体重(1992·9±505·2)g。总的脑室内出血(IVH)发生率为35·1%(142/404),脑室周围白质软化(PVL)的发生率为3·5%(14/404),轻度和重度脑损伤发生率分别为23·5%(95/404)、13·6%(55/404)。胎龄越小,体重越低,脑损伤发生率越高,但与颅内出血程度无关。窒息程度与脑损伤程度密切相关。并发症肺透明膜病、呼吸暂停、呼吸衰竭、肺出血、低血糖、多器官功能损害及贫血与脑损伤程度有关。母妊高征、胆汁淤积、胎膜早破、胎龄小、出生体重低及HFOV治疗可使早产儿脑损伤发生率增高。结论早产儿脑损伤的发生及严重程度与多因素有关,头颅B超可对早产儿脑损伤作出早期诊断,为早期干预提供依据。     

新生儿重症监护病房早产儿脑室内出血的临床分析及防治

目的探讨新生儿重症监护病房(NICU)早产儿脑室内出血(IVH)的发病因素及防治。方法回顾分析2000年1月至2006年3月我院NICU早产儿临床资料,生后3～7d内头颅B超检查情况。结果480例早产儿,脑室内出血160例,发生率达33.3%,与出生胎龄、出生体重呈负相关,与窒息、缺氧、感染、贫血等并发症程度呈正相关。结论IVH与胎龄、出生体重、窒息、缺氧、感染、贫血、机械通气密切相关,综合防治可减少IVH发生率,提高早产儿,尤其是极低体重儿的抢救成功率、避免或减少后遗症的发生。     

新生儿脑室内出血血小板参数的动态变化及其临床意义

新生儿脑室内出血 (IVH) ,胎龄愈小 ,发生率愈高 ,文献报道〔1〕 足月儿IVH的发生率为 12 5 %。有关脑室内出血与血小板的关系变化未见报道 ,本文动态观察了 6 9例足月IVH患儿的血小板数、平均血小板体积及血小板体积分布宽度 ,结果报告如下。1　资料与方法1 1　一般资料　IVH组 :6 9例均为2 0 0 1年 1— 6月期间本院新生儿病房住院患儿。其中男 41例 ,女 2 8例 ,平均胎龄 (39± 2 )周 ,出生体重 <2 5 0 0 g4例 ,2 5 0 0～ 40 0 0g 5 9例 ,>40 0 0g 6例。分娩方式 :自然分娩 43例 ,剖宫产2 4例 ,产钳助娩 2例。Apgar评分 :异常者 2 0…     

新生儿重症监护病房早产儿脑室内出血的临床分析及防治

目的 探讨新生儿重症监护病房（NICU）早产儿脑室内出血（IVH）的发病因素及防治。方法 回顾分析2000年1月至2006年3月我院NICU早产儿临床资料，生后3～7d内头颅B超检查情况。结果 480例早产儿，脑室内出血160例，发生率达33．3％，与出生胎龄、出生体重呈负相关，与窒息、缺氧、感染、贫血等并发症程度呈正相关。结论 IVH与胎龄、出生体重、窒息、缺氧、感染、贫血、机械通气密切相关，综合防治可减少IVH发生率，提高早产儿，尤其是极低体重儿的抢救成功率、避免或减少后遗症的发生。     

速尿和利尿酸:婴儿电解质异常及代谢性碱中毒的危险因素

大约25%的新生儿重症监护病房(NICU)患儿因不同情况,如充血性心衰、液体超负荷、早产儿呼吸窘迫综合症(RDS)或支气管肺发育不良(BPD)等接受反复的利尿剂,早期发现并预防继发性电解质失衡对临床结局非常重要。本文研究了接受速尿和利尿酸治疗的新生儿和婴儿电解质和酸碱异常的发病率及危险因素。1977～1982年在蒙特利尔儿童医院NICU 住院的1200名患儿中有142名接受了319次速尿治疗(1次治疗为给与1剂药或多剂药但两剂间隔<3天),其中24次与利尿酸合用。患儿平均出生体重1794.3±1003.3g,胎龄32.1±4.8周,入NICU 时年龄2.42±0.49天。     

出生胎龄≤25+6周超早产儿的救治现状及预后分析

目的探讨出生胎龄≤25+6周超早产儿的救治现状、主要并发症及转归。方法横断面研究, 回顾分析2015年1月至2021年12月入住南方医科大学附属深圳妇幼保健院新生儿科出生胎龄≤25+6周的233例超早产儿的临床资料, 包括围生期因素、治疗、并发症、预后等。根据出生胎龄、入院年份分组, 分析超早产儿的存活率、主要并发症、死因及随访资料。采用χ2检验、Kruskal-Wallis秩和检验等方法进行组间比较。结果 233例出生胎龄≤25+6周的超早产儿中男134例(57.5%)、女99例(42.5%), 出生胎龄为(24.6±0.9)周, 出生体重为710.0(605.0, 784.5)g。总存活率61.8%(144/233), 存活超早产儿中出生胎龄最小为22+2周, 出生体重最低为390 g。因不积极治疗自动出院41例(17.6%);住院积极治疗的192例超早产儿中死亡14例(7.3%), 因合并严重并发症自动出院34例(17.7%), 存活出院144例(75.0%)。7年间超早产儿存活率逐年增高(χ2=26.28, P<0.001), 积极治疗后自动出院和死亡逐年下降(χ2=14...     

未成熟儿脑室内出血的预防(综述)

脑室内出血(IVH)是新生儿期发病率最高的中枢神经系统疾病。妊娠期<34周,出生体重<1500g的未成熟儿,发病率约为40～50%。一旦出血无特异治疗,死亡率可达50%,如能幸存,常有严重后遗症,关键在于预防。现将近年来有关预防未成熟儿IVH的研究介绍如下。     

Dwuletnia ocena rozwoju noworodków urodzonych przedwcześnie i hospitalizowanych w ośrodku III stopnia referencji z rozpoznanym krwawieniem około- i dokomorowym II–IV stopnia

Introduction

Periventricular and intraventricular hemorrhage (IVH) in preterm infants may influence their future development. Although the latest foreign publications indicate changing prognosis at different grades of hemorrhage, Polish literature on this topic is scarce.

Aim

To present relationship between severity of II–IV grade IVH in preterm infants hospitalized in the 3rd level unit and diagnosed with USG, and neurological outcomes at 2 years corrected age.

Material and methods

Ninety eight infants who had been admitted to the NICU at the Institute of Mother and Child in Warsaw and diagnosed with II–IV grade IVH were observed. Motor, language, cognitive, visual and hearing developments were assessed at 2 years corrected age.

Results

Intensity of neurological impairments increased with grade of hemorrhage and presence of accompanying cystic periventricular leukomalacia (PVL). In children with III grade IVH without PVL, cerebral palsy did not occur. Cerebral palsy, including tetraplegia, was diagnosed mostly in children with IV grade IVH.

Conclusions

Short-term evaluation of preterm infants indicates the possibility of occurrence of cerebral palsy in children with II grade IVH. Neurodevelopment of children with III grade IVH is only slightly worse, as long as it is not accompanied by PVL. Prognosis for infants with IV grade IVH is poor in most of the cases and these children should be handled differently from infants with III grade IVH. Brain MRI in selected cases may improve prediction of neurological impairments in this population.     

早产儿动脉导管持续开放相关并发症及预后分析

目的探讨动脉导管持续开放对早产儿的影响和危害。方法采用回顾性调查研究,选择2007—2010年我院新生儿科住院治疗的动脉导管未闭(PDA)早产儿,根据出院时或死亡前动脉导管关闭情况分为动脉导管关闭组和动脉导管持续开放组。比较两组早产儿相关并发症的发生情况、氧疗情况、预后及住院费用等多方面的差异。结果动脉导管持续开放组(59例)发生充血性心力衰竭、喂养不耐受和Ⅲ～Ⅳ级脑室内出血的比例、需要呼吸支持的比例及用氧时间均高于动脉导管关闭组(112例),差异有统计学意义[50.8%比32.1%,33.9%比17.9%,8.5%比0.9%,66.4%比32.1%,7.0天(3.0,13.0)比6.0天(0,9.8),P均<0.05];两组发生NEC、Ⅰ～Ⅱ级脑室内出血、支气管肺发育不良和早产儿视网膜病的比例差异无统计学意义(P>0.05)。导管持续开放组住院时间和住院费用均多于动脉导管关闭组[(26.3±14.9)天比(20.0±12.9)天,(21079±13166)元比(17761±10849)元,P均<0.05]。结论动脉导管持续开放可使早产儿相关并发症增加,对呼吸支持的要求增多,也增加了住院时间和费用。     

Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)

Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004–2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long‐term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage ≥3. Eighty‐five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty‐seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long‐term health of survivors are warranted.     

血氧饱和度对超早早产儿预后影响的Meta分析

目的本研究收集了NeOProM团队发表的比较超早早产儿不同血氧饱和度预后的临床文献,并对其进行系统评价,试图寻找适合超早早产儿的血氧饱和度。方法采用STATA 12.0软件,对NeOProM团队发表的文献进行Meta分析,分别比较在胎龄小于28周的超早早产儿中,高血氧饱和度组(91%~95%)和低血氧饱和度组(85%~89%)在出院前或18月龄前病死率、早产儿视网膜病(ROP)、新生儿坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)、脑室内出血(IVH)、动脉导管未闭(PDA)发生率等方面内容。结果纳入3篇文献,包括4 919名超早早产儿,其中低血氧饱和度组患儿2 460例,高血氧饱和度组患儿2 459例。系统评价显示,与高血氧饱和度组患儿比较,低血氧饱和度组患儿出院前或18月龄前病死率的风险增加(RR:1.19,95%CI:1.05~1.35);ROP发生率降低(RR:0.73,95%CI:0.53~1.00);NEC发生率增高(RR:1.26,95%CI:1.06~1.49);BPD、IVH及PDA发生率两组比较差异无统计学意义。结论维持低血氧饱和度能降低超早早产儿ROP的发生率,但增加了超早早产儿病死率及NEC的发生率。     

Neonatal morbidity and placental pathology

Objective: To investigate the association between gestational age, placental pathology and outcome among preterm births.Methods: Medical records and placental pathology results of 165 preterm infants (gestational age ≤34 weeks) were used to analyze the development of intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis, in association with placental findings in the gestational age categories of 22–27 (n=71) and 28–33 (n=93) weeks.Results: Significant differences were found in placental findings based on gestational age and neonatal morbidity. Lower gestational age was associated with increased infection-related lesions such as chorionic vasculitis (47.9%, P<0.001) and acute chorioamnionitis (67.6%, P<0.001). Placental lesions reflecting disturbances of fetal-placental blood flow (infarction, chorionic plate thrombi and basal perivillous fibrin) were predominantly seen in the 28–33 week gestational age category (P<0.05–0.01). Despite the high prevalence of chorioamnionitis (38.8%), no significant association was found between this lesion and the tested preterm morbidity after controlling for gestational age. Only, villous edema and chorionic vasculitis were identified as independent predictors for the development of IVH (49.2%, OR_A 2.57, 95% CI 1.01, 6.58 and 39.3%, OR_A 1.95, 95% CI 1.01, 4.21, respectively).Conclusion: Villous edema and chorionic vasculitis are significant risk factors for the development of the IVH among neonates born at gestational age ≤34 weeks.     

Short-term outcome of very low birth weight infants in a developing country: comparison with the Vermont Oxford Network

Objectives: To determine the outcome of very low birth weightinfants (VLBWI) admitted to a level III NICU in UAE and comparethe results to percentiles published by the Vermont Oxford Network(VON). Method: Outcome data were collected retrospectively, using standarddefinitions, on a cohort of VLBWI 500–1500 g admittedbetween January 2004 and December 2006. Results: Of the 173 infants weighing 501–1500 g at birth,85.6% survived until discharge, which corresponds to the 50thpercentile (P50) of VON. Chronic lung disease (CLD) occurredin 12.1% (<P25), death or CLD 26.6%, necrotizing enterocolitis(NEC) 5.8% (<P50), intraventricular hemorrhage (IVH) of anygrade 17.5% (P25), grade III or IV IVH in 5% (P25), periventricularleucomalacia (PVL) 2.8% (P50), retinopathy of prematurity stage(ROP) 11.3% (<P10). The mortality and morbidity data forthe subgroups of 501–1000 g and 1001–1500 g birthweight are also reported. Conclusion: We report the outcome of VLBWI born in a developingcountry with high resources. The rates of CLD, IVH and ROP were25th percentile of the VON and mortality, NEC and PVL were inthe 50th percentile.     

早产儿生后补充维生素A可预防支气管肺发育不良:基于6篇随机对照试验的Meta分析

目的系统评价维生素A(Vit A)防治早产儿支气管肺发育不良(BPD)的有效性及安全性。方法计算机检索Pub Med、EMBASE、Cochrane图书馆临床对照试验资料库、中国期刊全文数据库(CNKI)、中国科技期刊数据库(维普)和万方数字化期刊全文数据库,收集已发表的Vit A防治早产儿(胎龄37周)BPD的RCT。检索时间均为建库至2017年10月1日,同时采用主题词和自由词进行检索。主要结局指标为BPD发生率和出院前病死率;次要结局指标包括早产儿视网膜病变(ROP)、动脉导管未闭(PDA)和脑室内出血(IVH)发生率,住院,吸氧,机械通气时间,治疗过程中的不良反应。使用Cochrane手册对纳入研究的RCT进行偏倚风险评估,采用Revman 5.3软件进行统计分析。结果共纳入6篇英文RCT 1 170例早产儿,给药方式5篇为肌肉注射,1篇为胃管给药。6篇均描述了随机序列的产生方法,均提及分配隐藏,均无结局数据缺失和选择性报告结果,5篇采用双盲法。Meta分析结果显示,Vit A组较对照组主要结局指标BPD发生率[RR=0.84,95%CI:0.75~0.94]差异有统计学意义,病死率[RR=1.04,95%CI:0.81~1.34]差异无统计学意义;次要结局指标ROP、PDA、IVH、住院时间、机械通气时间、吸氧时间和不良反应(败血症、呕吐、抽搐)差异均无统计学意义。结论早产儿生后补充Vit A可降低BPD发生率。     

Complications affecting preterm neonates from 1991 to 2006: what have we gained?

Aim: In this study, we determined whether outcome of preterm neonates has improved over a period of 16 years. Study design: Inborn neonates with a gestational age of 25.0–29.9 weeks were included. Patients with severe congenital malformations were excluded. Mortality and morbidity (chronic lung disease; CLD, intraventricular haemorrhage: IVH grade III or IV, cystic periventricular leukomalacia: cPVL, perforated necrotizing enterocolitis: NEC, severe retinopathy of prematurity needing surgery: ROP and cerebral palsy: CP) were compared in three periods (period 1: 1991–1996 n = 434; period 2: 1997–2001 n = 356; period 3: 2002–2006 n = 422). Results: Infant mortality decreased from 15.2% to 10.9%. CLD did not differ significantly between periods (14.1–14.8%). Perforated NEC decreased from 2.8% to 1.6%. IVH grade III and IV both remained at 5.7% in period 3, whereas cPVL decreased significantly from 4.5% to 1.6%. Cerebral palsy decreased from 5.8% to 3.5% in period 3. Two neonates in each period were in need of surgery for ROP. Conclusion: Inborn preterm patients showed an improved survival and a significant reduction in cPVL and CP. Perforated NEC showed a trend to decrease. CLD and IVH grade III and IV remain a matter of concern.     

Short-Term Outcomes of Very Low Birth Weight Infants Born at a Tertiary Care Hospital,Istanbul, Turkey

Objective

To evaluate mortality and short-term outcomes in very low birth weight infants admitted to the tertiary neonatal intensive care unit, Istanbul, Turkey.

Methods

Study data were recorded prospectively from January 1, 2010, to December 31, 2010. The clinical findings in neonates with birth weights <1000g were compared with infants with birth weights of between 1000g and 1499g.

Findings

In the present study, survival rates were 40% and 86.2% for infants weighing <1000g and 1000g to 1499g, respectively. There was no difference between males and females with respect to mortality (P>0.05). The mean (±standard deviation) birth weight was 985.6±150.15 g and mean gestational age was 27.5±2.04 weeks. The antenatal steroid rate was 37.2%, and the Cesarean section rate was 73%. Respiratory distress syndrome was diagnosed in 89% of the infants, with a 69% surfactant administration rate. Severe intracranial hemorrhage (IVH) (grade >II) was 14%. Grade 4 periventricular leukomalacia was 10%. Twelve (24%) infants had evidence of bronchopulmonary dysplasia (BPD). Retinopathy of prematurity (stage >II) was 4%. The correlation between ROP rate and need for ventilation therapy was present (r=0.52). Proven necrotizing enterocolitis (stage >2) was not observed. Patent ductus arteriosus (PDA) was diagnosed in 67% of the neonates. BPD, IVH, and PDA were statistically higher in neonates with a birth weight <1000g.

Conclusion

Survival rate of VLBW infants increased with increasing BW. Sex was not a risk factor for mortality. The need for ventilatory therapy may be an important risk factor for ROP in infants <1500g.     

无创高频振荡通气与经鼻间歇正压通气作为早产儿拔管后呼吸支持疗效比较的Meta分析

目的 系统评估无创高频振荡通气(non-invasive high-frequency oscillatory ventilation,NHFOV)与经鼻间歇正压通气(nasal intermittent positive pressure ventilation,NIPPV)作为早产儿拔管后呼吸支持的有效性及安全性。方法 全面检索中国知网、万方数据库、中国期刊全文数据库、中国生物医学文献数据库、PubMed、Web of Science、Cochrane Library等数据库中关于NHFOV与NIPPV作为早产儿拔管后呼吸支持的文献,检索时间从建库至2022年8月31日。采用RevMan 5.4软件及Stata 17.0软件进行Meta分析,比较NHFOV组和NIPPV组拔管后72 h内再插管率、改无创辅助通气后6～24 h的二氧化碳分压(partial pressure of carbon dioxide,PCO₂)及支气管肺发育不良(bronchopulmonary dysplasia,BPD)、气漏、鼻损伤、脑室周围白质软化(periventricula...