妊娠期糖尿病患者妊娠晚期血脂水平变化与新生儿出生体重的关系

目的探讨妊娠期糖尿病患者妊娠晚期血脂水平变化与新生儿出生体重的关系。方法采用酶法测定40例妊娠期糖尿病孕妇(妊娠期糖尿病组)、30例1型糖尿病孕妇(1型糖尿病组)、30例2型糖尿病孕妇(2型糖尿病组)及30例正常孕妇(正常妊娠组)妊娠晚期血脂水平。同时测定4组孕妇所分娩的新生儿出生体重。结果(1)妊娠期糖尿病组、1型糖尿病组、2型糖尿病组及正常妊娠组血清甘油三酯水平分别为(40±14)mmol/L、(29±08)mmol/L、(41±25)mmol/L及(27±09)mmol/L;总胆固醇水平分别为(65±30)mmol/L、(62±28)mmol/L、(64±32)mmol/L及(60±31)mmol/L;低密度脂蛋白胆固醇水平分别为(33±13)mmol/L、(32±13)mmol/L、(33±11)mmol/L及(32±10)mmol/L;高密度脂蛋白胆固醇水平分别为(16±05)mmol/L、(14±05)mmol/L、(15±04)mmol/L及(16±04)mmol/L。妊娠期糖尿病组及2型糖尿病组甘油三酯水平明显高于正常妊娠组及1型糖尿病组(P<001)。(2)妊娠期糖尿病组、1型糖尿病组、2型糖尿病组及正常妊娠组的新生儿出生体重分别为(4108±544)g、(3323±457)g、(4111±263)g及(3463±516)g。(3)妊娠期糖尿病组、1型糖尿病组、2型糖尿病组新生儿出生体重,与血清甘油三酯水平呈明显的正相关(r=039,P<001)。结论妊娠期糖尿病及2型糖尿病孕妇     

妊娠中期母体血脂及尿酸水平对子痫前期、妊娠期糖尿病和巨大儿的预测价值

目的 评价妊娠中期母体血脂及尿酸水平对子痫前期、妊娠期糖尿病( gestational diabetes mellitus,GDM)及巨大儿的预测价值. 方法 本研究为前瞻性研究.对2009年6月至2010年1月在南京大学医学院附属鼓楼医院妇产科建卡的单胎初产孕妇,妊娠20周时测定空腹外周血中甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B及尿酸含量,并对其定期产前检查,随访至分娩,收集包括是否发生子痫前期、GDM等并发症、分娩孕周、新生儿体重等母体及新生儿资料.Logistic回归分析血脂及尿酸水平与子痫前期、GDM和巨大儿的相关性,确定是危险因素的指标,再通过受试者工作特性曲线分析其预测子痫前期、GDM和巨大儿的敏感性及特异性. 结果 1000例孕妇参与并完成本研究,其中61例(6.1％)发展为子痫前期,100例(10.0％)发展为GDM.平均分娩孕周为(39.3±1.2)周,早产发生率1.5％ (15/1000).新生儿平均出生体重(3389.6±422.8)g,巨大儿发生率为8.9％(89/1000).妊娠20周时甘油三酯水平升高者发生子痫前期的风险是正常者的3.42倍(95 ％CI:1.88～6.22,P=0.000),GDM风险是其2.12倍(95％CI:1.38～3.35,P=0.001).妊娠20周对尿酸水平升高者发生子痫前期的风险是正常者的2.09倍(95％ CI:1.24～3.53,P=0.005),GDM风险是其2.22倍(95％CI:1.32～3.43,P=0.002).而妊娠20周时高密度脂蛋白胆固醇水平较低者发生子痫前期风险是正常者的2.34倍(95％CI:1.20～4.55,P=0.011),GDM风险是其2.03倍(95％CI:1.33～3.11,P=0.001),巨大儿风险是其1.67倍(95％CI:1.06～2.64,P=0.026).受试者工作特性曲线分析显示,这些预测指标的曲线下面积为0.56～0.65,预测敏感性为28％～82％,特异性为34％～85％. 结论 妊娠中期高甘油三酯、高尿酸及低高密度脂蛋白胆固醇水平使子痫前期、GDM和巨大儿等发生风险增加,但这些代谢指标预测不良妊娠结局的价值有限.     

新生儿胃穿孔的临床特点及影响预后的因素

目的探讨新生儿胃穿孔的临床特点及影响预后的相关因素。方法本研究为回顾性研究。研究对象为山西省儿童医院新生儿外科2008年1月至2017年12月手术治疗的49例新生儿胃穿孔病例。分析这些患儿的临床表现、辅助检查、手术情况及预后等临床资料。根据预后将患儿分为存活组和死亡组,探讨影响患儿预后的相关因素。采用独立样本t检验或连续性校正χ^2检验(或Fisher精确概率法)分析数据。结果(1)49例患儿中,男29例(59.2%),女20例(40.8%);早产儿30例(61.2%),足月儿19例(38.8%);体重(2450±700)g,范围为1010~5000 g。29例(59.2%)为低出生体重儿。11例(22.4%)有围产期不良事件;17例(34.7%)术前合并感染性休克;6例(12.2%)合并其他消化道畸形。2例(4.1%)有生后窒息复苏史,2例(4.1%)合并呼吸窘迫综合征行机械通气,12例(24.5%)有留置胃管或洗胃史。(2)49例患儿的发病时间为(3.8±2.0)d,47例(95.9%)于生后1周内发病,其中36例于生后≤4 d发病;25例(51.0%)发病到手术时间≤12 h。(3)首发症状以单纯腹胀最常见[69.4%(34/49)],12例(24.5%)腹胀伴呕吐,39例(79.6%)患儿术前腹部立位X射线片可见膈下大量游离气体,肝脏受压下移,胃泡影减小或消失。(4)所有患儿入院后均急诊行开腹探查、胃壁一期修补术。术中见27例(55.1%)穿孔位于胃大弯,5例(10.2%)位于胃小弯,14例(28.6%)位于胃前壁,3例(6.1%)位于胃后壁。33例(67.3%)穿孔长径≥3 cm。术后3例(6.1%)发生切口感染,2例(4.1%)吻合口漏;1例术后48 h发现大量气液胸,再次手术证实为食道重复并食道穿孔。(5)49例中,35例(71.4%)的病因为先天性胃壁肌层缺损,4例(8.2%)为损伤,10例(20.4%)为自发性穿孔。(6)49例中,8例(16.3%)死亡,36例(73.5%)存活,5例(10.2%)术后放弃治疗。剔除5例放弃治疗的患儿后,存活组中发病到手术时间≤12 h及穿孔长径<3 cm患儿的比例高于死亡组[61.1%(22/36)与1/8,χ^2=4.404;41.7%(15/36)与0/8];死亡组合并感染性休克的比例高于存活组[6/8与22.2%(8/36),χ^2=6.147](P值均<0.05)。结论新生儿胃穿孔病死率较高,先天性胃壁肌层缺损是新生儿胃穿孔的病理基础和主要病因,突然出现的腹胀是其主要的临床表现。尽早手术有助于提高治愈率。     

产后干预对母乳喂养的影响

母乳喂养是为婴儿生长、发育提供理想食物的一种最好的方法,在生命最初6个月内应对婴儿行纯母乳喂养,以实现最佳的生长、发育和健康[1].随访发现,许多产妇出院后因乳涨、乳头皲裂、乳汁分泌不足、乳腺炎等母乳困难问题而选取了人工喂养或混合喂养方式.2011年10月至2012年10月荣成市妇幼保健院妇幼医师于产后7天、14天进行2次产后家庭访视,针对产妇存在的母乳喂养困难问题进行相关干预,显著提高了产后4～6个月纯母乳喂养率,现报道如下.     

类固醇生成急性调控蛋白基因突变致新生儿先天性类脂质性肾上腺增生症的临床特点及分子遗传学分析

目的探讨类固醇生成急性调控蛋白(steroidogenic acute regulatory protein,StAR)基因突变致新生儿先天性类脂质性肾上腺增生症(congenital lipoid adrenal hyperplasia,CLAH)的临床特征及分子遗传学特点。方法回顾性分析2017年4月我院收治的1例新生儿CLAH病例的临床资料,采用高通量测序及Sanger测序对其StAR基因进行分析。在中国知网、万方数据库、PubMed等数据库中检索,收集StAR基因突变致新生儿CLAH的相关文献。将文献报道的病例进行整理分析。对纳入分析的病例要求同时具备较完整的临床资料、血清相关激素水平检测结果和StAR基因分析结果。结果该例患儿生后不久出现皮肤色素沉着、生长发育迟缓等肾上腺皮质功能减退症状,实验室检查发现低血钠、高血钾、促肾上腺皮质激素明显升高(263.4 pmol/L),17-羟孕酮明显降低(0.16 ng/ml)、脱氢表雄酮明显降低(<0.95μmol/L)、雄烯二酮明显降低(<1.0 nmol/L)、睾酮明显降低(<0.025 ng/ml)、孕酮降低(0.02 ng/ml)、皮质醇降低(1.6μg/ml)。StAR基因分析发现,患儿存在p.Gln258X/p.Thr240fs复合杂合突变,家系分析发现患儿的2个突变分别遗传自其父亲和母亲,确诊为StAR基因突变致CLAH,经激素替代治疗后症状消失、监测电解质正常,随访至2周岁,体格生长和神经发育正常。共检索到中文文献2篇,英文文献11篇,合并本例共报道96例新生儿CLAH,其中42例有较详细资料。CLAH患儿最常见的临床表现依次为皮肤色素沉着(85.7%,36/42)、呕吐(35.7%,15/42)和生长发育迟缓(14.3%,6/42)等;有体检记录的患儿均表现为女性外生殖器(100.0%,35/35);常见的实验室检查包括低钠血症(95.2%,40/42)、高钾血症(88.1%,37/42)、促肾上腺皮质激素升高(100.0%,37/37),17-羟孕酮降低(90.5%,19/21)、皮质醇降低(86.2%,25/29)、睾酮降低(9/10)、脱氢表雄酮降低(14/14);p.Gln258X是包括中国在内的东亚患者中最常见的基因突变位点。及时开始激素替代治疗的患儿,多数预后较好。结论对于新生儿期出现的肾上腺皮质功能减低,尤其是生殖器呈女性外观且17-羟孕酮低的患儿,应考虑CLAH可能。染色体核型分析、基因检测等有助于诊断。及时正确的治疗,可以改善患儿预后。     

缺血缺氧性脑病对新生儿排尿的影响

目的观察新生儿缺血缺氧性脑病（HIE）对患儿排尿的影响。方法将50例HIE新生儿作为观察组,选取同期出生的正常健康新生儿50例为对照组,观察比较两组新生儿上午9~11时排尿情况,包括尿量（尿垫称重法）、排尿次数及余尿量（膀胱容量扫描仪检测）。结果观察组尿量（10.1±6.8）mL,明显少于对照组（18.6±7.9）mL,差异有统计学意义（P〈0.05）。两组排尿次数及余尿量方面比较差异无统计学意义（P〉0.05）。结论 HIE新生儿表现出一定程度的尿量减少,但余尿量与健康新生儿基本相同,说明HIE新生儿的膀胱容量小于健康新生儿,提示HIE可能影响患儿的膀胱发育,值得进一步深入研究。     

孕期膳食营养状况对新生儿出生及母婴血生化指标的影响

目的探讨孕期膳食营养状况对新生儿出生及母婴血生化指标的影响。方法选取454例产前检查的孕妇,对其孕期膳食营养状况进行调查,随访新生儿结局及母婴血生化指标。结果新生儿的体质量与孕期摄入营养物质相关,且其体质量随着摄入量增加而增加,差异有统计学意义（P〈0.05）。脐血脂蛋白α水平较高的孕期脂肪摄入较多,差异有统计学意义（P〈0.05）;脐血胰岛素、C肽较高的孕期总能量及碳水化合物摄入较多,差异有统计学意义（P〈0.05）。结论孕期膳食营养状况对新生儿出生即脐血生化指标产生一定的影响。加强孕妇的营养指导对于促进胎儿正常发育具有重要意义。     

血浆(1-3)-β-D葡聚糖诊断新生儿侵袭性真菌感染的价值

目的 探讨血浆(1-3)-β-D葡聚糖诊断新生儿侵袭性真菌感染的价值.方法 2008年5月至2010年1月在本院新生儿重症监护病房住院的疑似侵袭性真菌感染新生儿,即出现感染症状但抗菌药物治疗效果不明显者,共87例.侵袭性真菌感染诊断标准参考中华医学会儿科学分会呼吸学组制定的"儿童侵袭性肺部真菌感染诊治指南"以及中华医学会重症分会制定的"重症患者侵袭性真菌感染的诊断和治疗指南".检测患儿血浆(1-3)-β-D葡聚糖水平,采用受试者工作特性曲线分析血浆(1-3)-β-D葡聚糖诊断新生儿侵袭性真菌感染的价值及最佳界值,分别计算当(1-3)-β-D葡聚糖取20.0 pg/ml及最佳界值时的敏感性和特异性.结果 87例疑似侵袭性真菌感染新生儿,排除感染59例,诊断侵袭性真菌感染28例,其中确诊5例,临床诊断7例,拟诊16例.确诊5例中血培养4例白假丝酵母菌,1例近平滑假丝酵母菌,有2例同时脑脊液培养白假丝酵母菌阳性.28例诊断侵袭性真菌感染患儿血浆(1-3)-β-D葡聚糖范围为18.6～9999.0 pg/ml,中位数131.6 pg/ml;59例非侵袭性真菌感染患儿血浆(1-3)-β-D葡聚糖范围为5.0～34.6 pg/ml,中位数为8.5 pg/ml,差异有统计学意义(Z=-5.064,P<0.05).血浆(1-3)-β-D葡聚糖用于诊断侵袭性真菌感染的受试者工作特性曲线曲线下面积为0.806(95% CI:0.725～0.886,P<0.05),诊断侵袭性真菌感染的最佳界值为53.7 pg/ml.当界值取20.0 pg/ml时,其诊断侵袭性真菌感染(确诊+临床诊断+拟诊)的敏感性为96.43%,特异性为69.49%;当界值取53.7 pg/ml时,其敏感性为72.22%,特异性为84.21%.结论 血浆(1-3)-β-D葡聚糖可用于诊断新生儿侵袭性真菌感染,但其诊断的界值及假阳性问题尚有待大规模临床试验进一步研究.

Abstract：

Objective To evaluate the diagnostic value of serum (1-3)-β-D-glucan detection for invasive fungal infection (IFI) in neonates. Methods Eighty-seven neonates who were suspected to be IFI cases in neonatal intensive care unit from May 2008 to January 2010 were enrolled into this study. All subjects had infection symptoms, while did no react to the antibiotics treatment. The diagnosis of IFI was made according to Invasive pulmonary fungal infection diagnostic criteria of children set by Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association and Invasive fungal infection diagnostic criteria for critical patients set by the Society of Critical Care Medicine, Chinese Medical Association. Circulating (1-3)-β-D-glucan levels were determined with GKT-5M set kinetic fungus detection kit. Levels of (1-3)-Β-D-glucan in IFI group and that in the control group were compared; optimal cut-off value was established with receiver operating characteristic (ROC) curve; and the sensitivity and specificity at the cut-off value of 20.0 pg/ml and optimal cut-off value were calculated and compared. Results Among the 87 suspected cases, 59 cases were not diagnosed as IFI and 28 cases were diagnosed as IFI finally. Five patients were confirmed to be IFI; seven cases were clinically diagnosed and 16 cases were still suspected IFI. Among the five confirmed cases, four cases were blood culture positive for Candida parapsilosis, one case Candida albicans positive and two cases both cerebrospinal fluid culture and blood culture positive for Candida albicans. The median levels of (1-3)-β-D-glucan of patients diagnosed as IFI (n=28) was 131.6 pg/ml(18.6-9999.0 pg/ml), which was higher than that of the patients without IFI (8.5 pg/ml, 5.0-34.6 pg/ml)(Z=-5.064, P<0.05). Area under ROC curve was 0.806 (95% CI: 0.725-0.886, P<0.05). The sensitivity (96.43% vs 69.49%) and specificity (72.22% vs 84.21%) for (1-3)-β-D-glucan were different as 20.0 pg/ml and 53.7 pg/ml were used as the cut-off values for diagnosing IFI. Conclusions (1-3)-β-D-glucan level could be used to diagnose IFI of neonates, but further studies are needed to evaluate false-positive rates and its cut-off value in IFI diagnosis.     

早期护理干预对新生儿窒息患儿胆红素的影响

目的 探讨早期护理干预对新生儿窒息患儿胆红素的影响。方法 将80例新生儿窒息患儿随机分为观察组和对照组各40例。对照组采用常规护理,观察组予以早期护理干预,用经皮胆红素测定仪连续监测4d患儿胆红素情况。结果 治疗第3天后观察组经皮胆红素测定较对照组低,两组比较差异有统计学意义（P＜0.05）。结论 早期护理干预可明显减低新生儿窒息发生高胆红索血症的风险。     

血清可溶性髓样细胞触发受体-1在足月新生儿细菌感染中的表达及意义

目的 检测感染新生儿血清可溶性髓样细胞触发受体-1(soluble form of triggering receptors expressed on myeloid cell-1,sTREM-1)的水平,探讨sTREM-1在足月新生儿感染中的变化及其意义.方法 以上海交通大学附属儿童医院新生儿科85例足月新生儿为研究对象,根据感染情况分为重症感染组(27例),轻症感染组(28例)和非感染组(30例).感染组患儿在出现感染症状48 h内使用抗生素前采集静脉血1 ml;非感染组患儿在住院期间采集静脉血1 ml.重症感染组中合并器官功能障碍的患儿在出现感染症状的第3和7天再次采集静脉血各1 ml.采用酶联免疫吸附试验测定血清中sTREM-1水平,并采用方差分析进行组间比较.绘制受试者工作特性曲线确定sTREM-1的最佳界值,计算敏感性、特异性、阳性预测值、阴性预测值和约登指数.结果 (1)重症感染组sTREM-1水平为(91.2±47.3)pg/ml,高于轻症感染组[(68.8±30.4)pg/ml],轻症感染组又高于非感染组E(35.5±17.6)pg/ml],差异均有统计学意义(P均=0.000).(2)重症感染组中有17例存活,10例死亡;死亡患儿血清sTREM-1水平为(121.6±49.3)pg/ml,明显高于存活者[(73.1±34.9)pg/ml],差异有统计学意义(t=2.995,P=0.006).(3)重症感染组合并器官功能障碍的13例患儿中,存活者感染第1周内血清sTREM-1水平总体呈下降趋势,死亡患儿sTREM-1水平呈上升趋势,最佳界值为100.6 pg/ml.(4)将sTREM-1≥43.8 pg/ml作为阳性诊断标准,其曲线下面积为0.868,敏感性、特异性、阳性和阴性预测值及约登指数分别为85.5%、80.0%、0.887、0.750和0.655.结论 血清sTREM-1水平在新生儿感染时升高;重症感染患儿血清sTREM-1水平呈动态变化,其变化趋势可能与预后有关.

Abstract：

Objective To observe the changes of serum soluble form of triggering receptors expressed on myeloid cell-1 (sTREM-1) level in full-term newborns with infection and to investigate the relationship between serum sTREM-1 and neonatal bacterial infection.Methods Eighty-five full-term newborns admitted to the neonatal ward of Shanghai Children s Hospital of Shanghai Jiaotong University were selected into this study.According to the locations and severity of infection,patients were divided into 3 groups: severe infection group (n = 27),mild infection group (n = 28),non-infection group (n = 30).The samples of infection groups were collected before using antibiotics and within 48 h after infection symptom occurred; others were collected during hospitalization.For the neonates with organ dysfunction in the severe infection group,samples were also collected at the third and seventh day of infection.Serum sTREM-1 was measured by enzyme-linked immunosorbent assay.Analysis of variance was used to compare the difference between groups.Receiver operating characteristic (ROC) curve was used to calculate the sensitivity,specificity,positive and negative predictive value and Youden index.Results (1) Serum sTREM-1 level of severe infection group[(91.2±47.3) pg/ml] was significantly higher than that of mild infection group[(68.8 + 30.4) pg/ml] and non-infection group[(35.5±17.6) pg/ml],respectively (P＜0.05).(2) Serum sTREM-1 level of the survival newborns (n= 17) in the severe infection group was lower than that of dead ones[(73.1±34.9) pg/ml vs (121.6±49.3) pg/ml,t= - 2.995,P = 0.006].(3) For the survival patients,the serum sTREM-1 level decreased in the first week of infection,while that of dead patients increased,the cut-off value was 100.6 pg/ml.(4) Based on the ROC analysis,43.8 pg/ml was selected as the the cut-off value,area under the curve was 0.868,and sensitivity was 85.5%,specificity 80.0%,positive predictive value 0.887,negative predictive value 0.750,Youden index 0.655.Conclusions Serum sTREM-1 level increases in neonatal infection.The change of serum sTREM-1 level in patients with severe infection is correlated to the prognosis.     

母乳喂养与人工喂养对新生儿免疫功能的影响

应用放射免疫测定法（ＲＩＡ）和酶联免疫吸附实验（ＥＬＩＳＡ）检测８０例分娩前和分娩后６天，母亲血清及新生儿出生时脐血清，新生儿生后３天、６天血清中分泌型免疫球蛋白Ａ（ＳＩｇＡ）、ＩｇＡ、ＩｇＧ、ＩｇＭ和可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平。分为纯母乳喂养组（３０例），混和喂养组（３０例）和人工喂养组（２０例）。结果：３组母亲分娩前后血清中ＳＩｇＡ、ＩｓＡ、ＩｇＧ、ＩｇＭ、ｓＩＬ－２Ｒ水平，差异均无显著性；生后６天新生儿血清与出生时脐血清中ＳＩｇＡ、ＩｇＡ、ＩｇＭ、ｓＩＬ－２Ｒ水平相比，纯母乳喂养组明显高于人工喂养组。提示：纯母乳喂养可以提高新生儿体液免疫和细胞免疫功能。     

Maternal risk factors associated with lead,mercury and cadmium levels in umbilical cord blood,breast milk and newborn hair

Objective: Lead (Pb), mercury (Hg) and cadmium (Cd) are environmental pollutants that are wide spread throughout the world. The present study aimed to investigate the level of exposure to Pb, Hg and Cd during the prenatal period, and the possible routes of maternal exposure to these toxic heavy metals.

Participants: The study included 123 mothers and their newborns. Umbilical cord blood samples were collected immediately after delivery, and breast milk and newborn hair samples were collected between postpartum d 3 and 10.

Results: Among the 121 cord blood samples that were analyzed, Pb was present in 120 (99.2%) and the mean level was 1.66?±?1.60?µg?dL^?1 (range: <detection limit–12.50?µg?dL^?1), whereas Hg was noted in only 2 (1.7%) (15.74 and 33.20?µgL^?1) and Cd was detected in 24 (19.8%) (range: <?detection limit–6.71?µgL^?1). The level of Pb in cord blood was ≥2?µg?dL^?1 in 29% of the samples. Pb, Hg and Cd were detectable in all the newborn hair samples.

Discussion: Among the 107 breast milk samples analyzed, 89 (83.2%) had a detectable level of Pb and the mean level was 14.56?±?12.13?µgL^?1. Detection rate of Cd in breast milk was higher in women who resided near to city waste disposal site. Detection rate of Cd in cord blood was significantly higher in the women who consumed ≥2 servings of fish weekly. Maternal exposure to environmental tobacco smoke (ETS) resulted in elevated levels of Pb and Cd in newborn hair samples.

Conclusion: Most of the study samples had detectable levels of Pb, Hg and Cd, indicating that there was long-term maternal exposure prior to and during pregnancy, and a considerable number of the cord and breast milk samples had levels that exceeded the present accepted safety level.     

Exploring and optimising maternal and infant nutrition in North West Pakistan

Objectives

the aim of this study was to explore and contextualise meanings, beliefs and practices surrounding maternal and infant nutrition in North West Pakistan and to use the findings to inform the development of a nutritional improvement programme adapted to local needs.

Design

the Context-Mechanism-Outcome framework was used to gather contextual data, formulate questions and conduct focus groups to inform the design of a culturally appropriate nutritional health programme with the overall goal of improving practices related to maternal and infant nutrition. Two focus groups were conducted with the team of local lady health workers (n=16), one prior to implementing a nutritional improvement programme and one 6 months after implementation.

Settings

the study was conducted in communities surrounding and served by the Emergency Satellite Hospital (ESH) in Nahaqi in Khyber Pakhtunkhawa (KP) (formally known as the Northwest Frontier Province), Pakistan.

Findings

poverty and specific cultural practices impeded the achievement of optimum maternal and infant nutrition. A nutrition support programme was implemented; it involved cookery demonstration kitchens and free food supplements, coupled with nutrition and health-care information-giving for pregnant and lactating women. Focus group discussions revealed that women had positive perceptions of the impact of the nutritional health improvement programme, feeling that knowledge and practices were enhanced. However, structural and cultural factors continued to have a powerful influence on their practices.

Conclusions and implications for practice

this study highlights that despite structural, cultural and practical barriers, a culturally sensitive health improvement programme has the potential to enhance maternal and infant nutritional practices. However, we should not underestimate the powerful influence of poverty and culturally embedded norms upon women's decisions and practices.     

甲硝唑、替硝唑在乳汁中的含量及其对母乳喂养新生儿的影响

目的　测定产后静脉滴注甲硝唑和替硝唑产妇乳汁中的药物含量 ,了解乳汁中的药物浓度及对婴儿造成的影响。　方法　采用高效液相色谱法测定乳汁药物浓度及新生儿经母乳摄入药物含量。　结果　哺乳妇女单剂量静滴甲硝唑 (2 0 m g/ kg,n=8)、替硝唑 (13m g/ kg,n=7)后 ,其乳汁中甲硝唑达峰浓度时间 (tmax)为 (1.7± 1.0 ) h,甲硝唑含量达峰浓度 (cmax)为 (2 0± 5 ) mg/ L;乳汁中替硝唑其 tmax、Cmax分别为 (1.3± 0 .6 ) h和 (17± 3) m g/ L。由 cmax计算得新生儿每日经母乳摄入的甲硝唑及替硝唑含量分别是 3.0 2 mg/ (kg· d)及 2 .5 8mg/ (kg· d) ,仅仅是甲硝唑用于婴儿治疗剂量的1/ 10～ 1/ 5 ,是替硝唑的约 1/ 8～ 1/ 6。　结论　静滴甲硝唑、替硝唑的乳母 ,即使坚持哺乳对婴儿也是相对安全的。但为了使甲硝唑、替硝唑对乳儿造成的不良反应减至最小 ,建议哺乳时避开母乳中药物峰浓度时间 ,慎重起见 ,早产儿乳母不宜使用替硝唑     

生后0～6月不同喂养方式对7～12月龄婴儿能量摄入和体格发育的影响

目的 探讨在婴儿早期(0～6月龄)采用纯人工喂养、混合喂养、纯母乳喂养3种不同喂养方式对其7～12月龄膳食能量及宏量营养素摄入和体格发育的影响. 方法 对全国8个城市中418例7～12月龄婴儿采用问卷获得其基本情况,采用24 h膳食回顾获得其膳食情况,并测量其身长、体重.将调查的7～12月龄婴儿按生后0～6月喂养方式分为纯人工喂养组、混合喂养组、纯母乳喂养组,采用秩检验和卡方检验比较3组婴儿的膳食能量及宏量营养素摄入与体格发育的差异.结果 男婴的出生体重3组间差异无统计学意义(P＞0.05);但纯人工喂养组、混合喂养组、纯母乳喂养组女婴出生体重的中位数分别为3.10、3.30、3.40 kg,差异有统计学意义(H=12.76,P＜0.05).除女婴的碳水化合物摄入组间无统计学差异外(P＞0.05),男女婴膳食能量、蛋白质、脂肪、碳水化合物摄入量在3组间的差异均有统计学意义(P＜0.05或0.01),其中人工喂养组最高(男婴的能量、蛋白质、脂肪、碳水化合物摄入量的中位数依次为768.61 kJ、24.86 g、27.20 g、106.59 g;女婴依次为884.71 kJ、35.95 g、35.45 g、110.85 g),混合喂养组其次(男婴依次为656.68 kJ、21.84 g、26.03 g、84.54 g;女婴依次为696.38 kJ、20.03 g、26.68 g、77.28 g),母乳喂养组最低(男婴依次为455.88 kJ、17.35 g、15.69 g、71.57 g;女婴依次为562.90 kJ、18.78 g、20.62 g、72.00 g).3组男婴间3种宏量营养素的供能比差异无统计学意义(P均＞0.05).3组婴儿无论男女,其身高别体重z评分、年龄别身高z评分、年龄别体重z评分等级差异均无统计学意义(P均＞0.05).3组女婴间蛋白质供能比差异无统计学意义(H=4.85,P＞0.05),但脂肪、碳水化合物供能比差异有统计学意义(34.58％、36.48％与28.74％,H=2.38;52.67％、51.10％与57.27％,H=2.90;P均＜0.01),纯母乳喂养组脂肪供能比最低,碳水化合物供能比最高.消瘦率、低体重率、发育迟缓率及超重率在男女婴3组间比较差异均无统计学意义(P均＞0.05),人工喂养组超重率最高(男、女分别为25.8％、20.0％).结论 婴儿前0～6个月的采用人工喂养或混合喂养,可能导致其在7～12个月能量及宏量营养素摄入偏高,且体重超重率高.     

强化母乳喂养对住院早产儿生长代谢的影响

目的 回顾性研究强化母乳喂养对早产儿住院期间生长代谢及合并症的影响. 方法 收集中国医学科学院北京协和医院2009年1月1日至2012年12月31日胎龄≤36周且出生体重≤1800 g符合入选条件的早产儿148例,根据喂养方式不同分为强化母乳喂养组(73例)与早产儿配方奶喂养组(75例).比较2组早产儿的生长发育、代谢指标和合并症发生情况.数据采用均数±标准差或中位数和四分位数[M(P25,P75)]表示.采用t检验、x2检验或非参数检验进行统计学分析.结果 强化母乳喂养组和配方奶喂养组早产儿的胎龄、出生体重、出生身长、出生头围、恢复出生体重的日龄及出生时小于胎龄儿、新生儿呼吸窘迫综合征、≥Ⅲ级脑室内出血、窒息的比例差异均无统计学意义(P均＞0.05).强化母乳喂养组早产儿住院期间肠外营养时间为18 d(14 d,25 d),短于配方奶喂养组[24 d(18 d,31 d.),Z=-2.950,P=0.003];奶量达120 ml/(kg·d)日龄为16 d(12 d,23 d),小于配方奶喂养组[22 d(16 d,30 d),Z=-2.895,P=0.004];总热卡达120 kcal/(kg·d)日龄为11 d(8 d,15 d),小于配方奶喂养组[14 d(10 d,18 d),Z=-2.392,P=0.017].强化母乳喂养组住院费用为47 078元(30 802元,67 039元),低于配方奶喂养组[58 400元(38 166元,82 737元)],差异有统计学意义(Z=-1.970,P=0.049).2组早产儿开奶时间、喂养不耐受发生率、恢复出生体重后平均每日体重增长速度、每周身长增长速度、每周头围增长速度、出院时小于胎龄儿发生率、出生体重z评分、出院体重z评分、出院体重、出院身长及出院头围差异均无统计学意义(P均＞0.05).强化母乳喂养组出院前血碱性磷酸酶为(347.7±149.4) U/L,高于配方奶喂养组[(288.6±108.8) U/L,t=2.570,P=0.011],其余生化指标入院时及出院前差异均无统计学意义.强化母乳喂养组败血症的发生率为11.0％(8/73),低于配方奶喂养组[20.0％(15/75)],但差异无统计学意义(x2 =2.30,P＞0.05),视网膜病、支气管肺发育不良及坏死性小肠结肠炎发生率差异均无统计学意义(P均＞0.05). 结论 早产儿强化母乳喂养不仅可达到与配方奶喂养相似的生长速率,且可加速肠内喂养进程,缩短肠外营养时间,减少败血症发生率,降低住院费用.     

孕妇血铅水平测定及对妊娠结局的影响

目的 探讨北京城区孕妇的血铅水平及其与妊娠并发症、新生儿体格发育及神经行为发育的关系。方法 采用石墨炉原子吸收法测定1151例不同孕周孕妇静脉血及434例新生儿脐带血铅水平,同时观察孕妇妊娠及分娩期有无合并症、并发症;并于新生儿出生后24h内测量其体格发育情况(包括体重、身长、头围、胸围、腹围);采用儿童神经行为发育量表,对出生后42d的215例婴儿进行神经行为发育评分。结果 整个孕期血铅中位数为43．4μg／L,孕早期为44．5μg／L,孕中期为37．4μg／L,孕晚期为45．1μg／L。脐血铅中位数为26．4μg／L。孕妇血铅水平与妊娠并发症无明显相关性,但孕妇血铅水平与其血红蛋白水平呈正相关。另外,孕妇血铅水平及脐血铅水平与新生儿体格发育指标及神经行为发育评分,无明显相关性。结论 北京城区孕妇血铅水平对各种孕期并发症及新生儿的体格发育、神经行为发育无明显影响。     

胎儿及新生儿先天性肿瘤15例临床病理分析

分析胎儿及新生儿先天性肿瘤的一般发生情况,及其对胎儿发育的影响和死亡原因。方法 从临床病理学角度,对１５例先天性肿瘤的临床,尸体检查和病理资料进行回顾性分析。结果 先天生肿瘤在胎儿和新生儿期的发生率为７．７／１０万。占围产儿尸体检查总 ０．７％。畸胎瘤最常见,占４６．７％,其次为血管瘤,占２６．７％。本组中,６０．０％的病例在母亲妊娠期有羊水过多表现;     

新生儿疼痛评估及其干预措施探讨

目的 各组哭持续时间及穿刺前后心率、呼吸频率、平均血压、经皮血氧饱和度的变化.采用新生儿急性疼痛评分表(Douleur Aigu(e) Nouveau-néscale,DAN)及早产儿疼痛评分简表(preterm infant pain profile,PIPP)进行疼痛评价.结果 (1)穿刺后15 s,对照[(157.6±14.0)次/min]、安慰剂[(159.2±11.1)次/min]、GS[(146.6±13.0)次/min]、NNS[(148.4±13.3)次/min]、GS+NNS组心率[(147.9±11.8)次/min]均快于穿刺前,分别为(132.1±17.8),(132.8±15.4),(134.2±13.3),(132.0±15.6)和(134.1±17.5)次/min(P＜0.01);穿刺后1 min,对照组和安慰剂组心率仍快于穿刺前(P＜0.05),而GS、NNS和GS+NNS组心率已恢复到穿刺前水平(P＞0.05).(2)穿刺后1 min,对照、安慰剂、GS、NNS、GS+NNS组呼吸频率均快于穿刺前(P＜0.05);穿刺后2和3 min,对照组及安慰剂组呼吸频率仍快于穿刺前(P＜0.05),而GS、NNS、GS+NNS组已恢复到穿刺前水平(P＞0.05).(3)穿刺后GS和GS+NNS组哭持续时间为(1.65±3.12)s和(1.65±5.26)s,均短于对照、安慰剂和NNS组的(21.60±27.49)s、(17.60±17.45)s和(10.20±10.92)s(P＜0.01).(4)GS、NNS和GS+NNS组的DAN和PIPP评分均低于对照组及安慰剂组(P＜0.01). 结论 GS、NNS和GS+NNS均有止痛作用,GS优于NNS,而两者合用疗效更佳.建议在临床治疗和护理中,应采取一些有效干预措施,如给予口服蔗糖、葡萄糖和非营养性吸吮等以减轻新生儿操作性疼痛.