Assessment of renal function by estimation of fractional excretion of sodium in asphyxiated newborns

This case control study was conducted in Neonatal unit of Dhaka Shishu (Children) Hospital to assess the validity of fractional excretion of sodium (FENa) as a reliable renal function test in asphyxiated newborns. Seventy five appropriate newborns aged between 0-120 hours were randomized in two groups, (Group I; n=50, cases or study group) and (Group II; n=25, controlled group). Blood urea, serum creatinine, serum electrolytes, urinary electrolytes, creatinine, osmolalities, specific gravity, FENa were estimated. Blood urea, Serum creatinine and FENa are increased in perinatal asphyxia. Controls were selected from newborns who had spontaneous breathing immediately after birth and with Apgar score >8 to 10 at 5 minutes. Mean blood urea and serum creatinine were raised in asphyxiated newborn. Blood urea mean±SD was 7.1±3.1mmol/L and serum creatinine mean±SD was 120.8±73.6μmmol/L. Thirty four percent (34%) patients had raised level of blood urea and serum creatinine both, 18% patients had raised (>2.5%) FENa and 48% patients had raised blood urea in asphyxiated newborns. Hyponatremia was also found in asphyxiated newborns. Urinary sodium and creatinine excretion were also higher in the asphyxiated newborns than non asphyxiated newborns. Urinary volume and osmolality were similar in cases and controls. In this study 24% patients died, of which 62.5% were in HIE stage 3, 4.16% were in HIE stage 2 and 1% was in HIE stage 1. Elevated level of serum creatinine (130.0±60.0) and FENa (2.9±1.4) were found in dead patients. Oliguria (0.99±0.6) was also found in dead asphyxiated newborns. Increase in fractional excretion of sodium (FENa) is shown to be directly related to the degree of renal impairment which is again directly related to the degree of asphyxia in the newborns. FENa can be used as an indicator of renal tubular dysfunction in the asphyxiated newborns.     

新生儿重度窒息96例临床分析

目的　对 96例重度窒息新生儿窒息后器官功能受损进行临床研究。方法　通过临床观察及实验室检查对重度窒息新生儿脑、心、肺、肾及消化道功能受损情况进行评估。结果　 96例重度窒息新生儿共 6 2例 (6 4 .6 % )有不同程度器官功能损害 ,其中 39例 (40 .6 % )合并 2个以上器官损害 ;其中肾功能损失发生最高 ,其次为脑损伤 ,肺功能受损 ,心脏受损及消化道受损 ;死亡原因主要是呼吸衰竭、重度HIE、颅内出血、急性肾功能衰竭。结论　重度窒息新生儿易发生器官功能损害 ,防止新生儿窒息的发生 ,以及窒息后器官功能损害的防治有重要的临床意义。     

PERINATAL ASPHYXIAITS ASSOCIATION WITH COGNITIVE AND BEHAVIORAL DEVELOPMENT OF CHILDREN

The present stLtdy includes 4 groups of children:30 with a history of intrapartum asphyxia, 30 with a history of mild neonatal asphyxia, 15 with a history of severe but transitory neonatal asphyxia, and 30 who had normal deliveries (control group). Psycho logical and neuropsychological assessments were done when the children were 6 years old. There was no significant diffeenrce among the 4 groups in in telligence quotient, social maturity age, most neuro psychological functions and incidence of attention de ficit disorder with hyperactivity. Four test scores in Halstead-Rcitan Battery associated with visual-motor functioning showed backwardness in asphyxiated groups. Behavior problems were more frequently seen in the asphyxiated groups than iri the control Group.     

60例新生儿患者血清磷酸肌酸激酶同功酶测定的临床意义

目的观察有不同程度窒息和羊水吸入的新生儿血清磷酸肌酸激酶同功酶（CK－MB）值的变化并与无窒息无羊水吸入的其他疾病的新生儿比较，判断缺氧对心肌的影响。方法对28例新生儿窒息及4例新生儿羊水吸入患儿在出生3d内测定静脉血CK－MB值，并以28例相同日龄的无窒息无羊水吸入的其他疾病的患儿血清CK－MB值作对照。结果新生儿窒息组CK－MB值非常显著高于无窒息／吸入组，重度窒息组CK－MB值显著高于轻度窒息组，羊水吸入组CK－MB值同样显著高于无窒息／吸入组，在窒息早产儿组，CK－MB值较之窒息足月组升高更为明显。结论围产期缺氧可致新生儿心肌损害，缺氧程度越严重，心肌损害也更严重，对于早产儿更为明显。     

畸变产物耳声发射对窒息新生儿的听力筛查

目的 研究应用畸变产物耳声发射(DPOAE)筛查窒息新生儿听力的基本特征，了解轻度与重度窒息新生儿DPOAE的区别。方法 根据Apgar评分，将42例窒息新生儿分为轻度组及重度组，应用Bio-Logic AuDx耳声发射仪对2组窒息新生儿进行DPOAE听力筛查。采用SPSS l0．0软件进行统计学分析。结果 轻度窒息组新生儿DPOAE检出率高于重度窒息组，窒息新生儿DPOAE DP—NF值存在明显的个体差异，轻度与重度窒息组间DPOAE DP—NP的差异有显著性(P＜0．05)。结论 DPOAE可作为窒息新生儿听力筛查的一种有效方法，DPOAE测试结果与窒息程度密切相关。Apgar评分与窒息新生儿的听力情况有相关意义。     

Status of liver enzymes in babies with perinatal asphyxia

Because of hypoxemia, different organ systems of the body are affected in perinatal asphyxia. In this study, the functional status of liver of the asphyxiated babies was assessed through estimation of liver enzymes to see any correlation existing between enzyme changes and severity of perinatal asphyxia. A total of 70 full-term asphyxiated newborns (study group) were studied during January'2008 to December'2008 in the department of Paediatrics, Mymensingh Medical College Hospital. After enrollment these babies were grouped according to Sarnat & Sarnat stages of Hypoxic-ischemic encephalopathy (HIE) as stage I, II & III. Babies who are small for gestational age, having severe jaundice, sepsis or congenital anomalies of the hepatobiliary system were excluded from the study. Another 50 healthy newborns were also studied as control group. Venous blood was analyzed between 2nd and 5th day of life to estimate serum AST, ALT & alkaline phosphatase (ALP). Unpaired student's 't' test and Spearman's rank correlation was used for data analysis and P value of <0.05 were considered significant. Mean AST, ALT and ALP of the asphyxiated babies were 76.27±37.44, 82.16±48.08 & 369.59±123.05 U/L and that of normal babies were 23.46±8.45, 26.54±7.76 & 208.20±46.95 U/L respectively and these rise were statistically significant (p<0.001). The levels of transaminases and ALP were positively correlated with the severity of asphyxia and these correlations were also statistically significant (p<0.001). So, this study concludes that AST, ALT & ALP significantly elevated in perinatal asphyxia and this elevation was proportional to the severity of hypoxia.     

早发型重度子痫前期期待治疗的临床探讨

目的探讨早发型重度子痫前期期待治疗的适宜时间。方法86例早发型重度子痫前期患者,根据其发病孕龄不同分成3组,A组25例（发病孕龄〈28周）,B组33例（发病孕龄为28～31^＋6周）,C组28例（发病孕龄为32～34周）。比较3组患者并发症的发生率、围产儿死亡率、新生儿窒息率及期待治疗时间等。结果3组患者并发症的发生率比较,差异无统计学意义（P〉0．05）;3组围产儿死亡率及新生儿窒息率比较,差异有统计学意义（P〈0．05）,C组〈B组〈A组（P〈0．05）。B组期待治疗时间明显长于其他两组（P〈0．05）。结论孕28周前发病的患者,采取期待治疗时应慎重考虑;孕28～31柏周发病患者,可以在严密监测下积极期待治疗,适当延长孕周,改善围产儿结局。     

围生期窒息新生儿血清IL-6，sICAM-1水平的动态变化及其临床意义

【目的】了解围生期窒息新生儿血清IL 6、sICAM 1水平的动态变化。【方法】采用双抗体夹心ELISA方法 ,检测 41例围生期窒息新生儿及 11例正常新生儿生后出生时、第 3天、第 7天血清IL 6、sICAM 1的水平。【结果】 41例围生期窒息新生儿中 2 6例合并缺氧缺血性脑病 ,其中轻度 12例 ,中度 8例 ,重度 6例。对照组血清IL 6的水平生后 1周内无明显变化 ,缺氧缺血性脑病 (HIE)组血清IL 6水平呈先升后降的趋势 :生后第 3天达高峰 ,第 7天下降 ,较出生时水平低 ,随着HIE程度的加重 ,IL 6水平呈上升趋势。对照组血清sICAM 1水平随日龄增加呈上升趋势 ,重度HIE组各天的水平均显著高于对照组、单纯窒息组及轻度、中度HIE组各天的水平 (P <0 0 5或 0 0 1) ,其余 4组间各天的水平差异无显著性。围生期窒息新生儿的血清IL 6水平与血清sICAM 1水平无相关关系。【结论】血清IL 6、sICAM 1水平与脑损伤的程度及预后密切相关。     

妊娠期肝内胆汁淤积症与围产儿的预后

目的:探讨妊娠期肝内胆汁淤积症(ICP)对围产儿预后的影响.方法:收集2004年1月至2005年10月在我院分娩的ICP孕妇48例为ICP组,设观察同期分娩的48例正常孕妇为对照组,比较两组间胎儿窘迫、羊水粪染、新生儿窒息、新生儿肺炎、早产的发生率.结果:ICP组胎儿窘迫、羊水粪染、新生儿窒息、早产的发生率分别为43.75%、25%、8.33%、27.08%,与对照组相比差异有显著性(P＜0.05 或P＜0.01),新生儿肺炎差异无显著性(P＞0.05).结论:ICP可导致胎儿窘迫、羊水胎粪污染、新生儿窒息、早产.     

脐带绕颈阴道试产对围产期结局的影响

目的 分析足月妊娠妇女脐带绕颈时,阴道试产对围产期结局的影响.方法应用彩超确诊为脐带绕颈,并测定脐动脉收缩期最大血流速度（S）和舒张末期血流速度（D）的比值（S/D值）,比较分析246例脐带绕颈者（观察组）和260例无脐带绕颈的足月妊娠妇女（对照组）阴道试产的分娩结局.结果观察组胎儿宫内窘迫率明显高于对照组（P＜0.05）,且急诊剖宫产率明显升高（P＜0.01）,但两组新生儿重度窒息发生率差异无显著性（P＞0.05）.结论脐带绕颈足月妇女,在彩色多普勒超声和胎心监护下可行阴道试产.     

早发型重度子痫前期的期待治疗临床观察

目的探讨早发型重度子痫前期期待治疗对母儿结局的影响及其期待治疗效果。方法对52例早发型重度子痫前期病例进行回顾性分析,按发病孕龄分为3组:即A组9例(孕周<28 W),B组15例(28 W≤孕周<32 W),C组28例(32 W≤孕周<34 W)。结果早发型重度子痫前期发病孕周越早,患者并发症的发生率越高,但3组患者并发症发生率无统计学意义(P>0.05);3组间新生儿窒息率和围产儿死亡率均有统计学意义(P<0.05);B组期待治疗时间均明显长于其他两组(P<0.05)。结论早发型重度子痫前期新生儿窒息和围生儿死亡率随发病孕周延长而降低,适当期限内的保守治疗有助于改善母儿结局。     

Thyroid hormone status in apparently healthy elderly persons

Thyroid disorders are frequent in elderly population and difficult to recognize because of their atypical presentation, and the absence of classic signs and symptoms. Nonspecific symptoms, even in the absence of thyroid dysfunction, are common in this age group, including fatigue, anorexia, weight loss, failure to rehabilitate, and difficult to concentrate. Symptoms of aging can be confused easily with hypothyroidism. The interpretation of thyroid function tests is also cumbersome in aged individuals because of the difficulty in differentiating physiologic age-associated changes from alterations secondary to acute or chronic non-thyroidal illness. In the present study, a total 100 subjects were included. Subjects were divided into two groups: Group I - Control (n=50) and Group II - Case (n=50). Fifty apparently healthy young adults were taken as control (Group I) and 50 apparently healthy elderly subjects were included in case (Group II). Group I was subdivided into two groups- Group IA: young male (n=25) and Group IB: young female (n=25). Group II was also subdivided into two groups - Group IIA: elderly male (n=25) and Group IIB: elderly female (n=25). All the subjects were selected from the local community of Mymensingh Sadar, Mymensingh Medical College, Mymensingh and Community Based Medical College, Bangladesh, Mymensingh. In the present study, the difference of mean serum T3 concentration between Group I (control) and Group II (elderly subjects) was not found to be significant (p>0.05). Significant difference in serum TSH concentration between Group IA and Group IIA was to be found (p<0.001). The difference of mean serum T4 concentration between Group IB and Group IIB was not found significant (p>0.05). Significant difference in mean serum TSH concentration between Group IB and Group IIB was to be found (p<0.001).     

剖宫产率及指征变化与新生儿窒息、围生儿死亡率的关系

目的 探讨剖宫产率及指征变化与新生儿窒息、围产儿死亡率关系。方法 对我院近10年产科分娩病例进行回顾性分析,了解其剖宫产率,剖宫产指征及新生儿窒息、围生儿死亡率。结果 1993-1997年(A组)剖宫产率25.77％,而1998-2002年(B组)剖宫产率48.62％,B组明显高于A组(P<0.01)。在剖宫产指征中,社会因素剖宫产从A组第6位升到B组第2位,从5.83％上升到26.30％,而难产、胎儿窘迫及疤痕子宫指征相对下降。两组新生儿窒息、围生儿死亡率比较无明显差异(P>0.05)结论 社会因素是剖宫产率升高的重要原因;随着剖宫产率的进一步上升,围生儿的病死率并未相应降低;必须正确掌握剖宫产指征,普及产科知识,降低剖宫产率及新生儿窒息、围生儿死亡率。     

支原体感染及产褥感染与新生儿窒息关系的研究

目的　研究围生期孕妇支原体感染与产褥感染及新生儿窒息的关系。方法　采用支原体培养法检测围生期孕妇阴道解脲支原体 (Uu)和人型支原体 (Mh) ,根据检测的结果将 2 480例孕妇分为支原体阳性组和支原体阴性组 ,观察两组产褥感染及新生儿窒息发生率。结果　支原体阳性组 110 0例 ,产褥感染发生率为4.4% (4 8/ 110 0 ) ,阴性组 1380例 ,产褥感染发生率为 3.2 % (4 4/ 1380 ) ,两组间差异无显著性 (P >0 .0 5 ) ;进一步分组研究发现Mh(+)Uu(+)亚组产褥感染发生率显著高于支原体阴性组 (RR3.78,95 %CI 2 .13～ 6 .6 9,P<0 .0 5 ) ,各亚组间新生儿窒息发生率差异无显著性 (P >0 .0 5 )。结论　提示围生期生殖道支原体混合感染可能导致产褥感染     

早发型与晚发型重度子痫前期对围生儿结局的影响

目的了解重度子痫前期不同孕周对围生儿结局的影响。方法回顾性分析88例重度子痫前期患者的临床资料,按照34孕周为界分为早发型重度子痫前期组(A组)、晚发型重度子痫前期组(B组)。对其一般资料、分娩孕周、早产、胎儿生长受限发生率、新生儿窒息发生率、围生儿死亡发生率、新生儿体重等进行比较。结果①两组患者一般资料中,分娩孕周、早产发生率、规律产检率差异有统计学意义(P<0.05),其余差异均无统计学意义(P>0.05)。②围生儿结局中,各项差异均有统计学意义(P<0.05),存活新生儿中,新生儿体重比较差异也具有统计学意义(P<0.05)。结论重度子痫前期患者的发病孕周直接影响围产结局,且早发型重度子痫前期孕妇早产儿、低体重儿、围生儿死亡的发生率明显增加,相关新生儿疾病(如新生儿窒息等)的发病率也明显增加。     

围产期窒息新生儿脐血中血气分析及电解质的变化

目的：观察围产期窒息新生儿脐血中血气分析及电解质的变化。方法：根据诊断标准将新生儿分为围产期窒息组和对照组。在新生儿娩出后,胎盘未娩出前从近胎盘侧抽取脐动脉血约0．5ml,采用美国I－STAT公司生产的血气分析仪,在抽取脐血3min之内检测血气及电解质。结果：围产期窒息组与对照组相比pH值、PO2明显降低,而PCO2则显著增高,差异有统计学意义（P＜0．01）;与此同时两组相比K、Na、Ca^2 差异均无统计学意义（P＞0．05）。结论：脐动脉血血气分析结合Apgar是判断胎儿新生儿缺氧缺血的敏感的客观指标。     

早发性羊水过少与妊娠并发症的关系及对围生儿的影响

目的探讨早发性羊水过少与妊娠并发症的关系及对围生儿的影响。方法将2017年1月~2018年1月在我院进行定期产检并在我院分娩的60例孕产妇纳入本研究。按照孕产妇羊水情况分为羊水过少组(9例)、羊水偏少组(14例)和羊水正常组(37例)。对于所有羊水减少的患者予饮水疗法及静脉补液法。观察阴道分娩、剖宫产、产后出血、围生儿羊水粪染、胎儿宫内窘迫、新生儿窒息、出生低体重儿、羊水指数和脐血流检测结果。结果三组产妇阴道分娩、剖宫产、产后出血发生率比较,差异有统计学意义(P0.05);三组产妇AFI、S/D、RI、PI、FVR比较,差异有统计学意义(P0.05);三组围生儿羊水粪染、胎儿宫内窘迫、新生儿窒息、出生低体重儿比较,差异有统计学意义(P0.05)。结论早发性羊水过少会增加妊娠并发症的风险,围生儿发生羊水粪染、胎儿宫内窘迫、新生儿窒息、出生低体重儿的几率增加,临床需引起足够的重视。     

早发型重度子痫前期终止妊娠时机及分娩方式与围生儿结局的关系研究

目的:探讨早发型重度子痫前期终止妊娠时机和分娩方式对围生儿结局的影响。方法:随机抽取在2005年1月～2010年12月这6年时间里,在我院就诊的早发型重度子痫前期的患者中抽取病例200例,将其分为A、B组,平均每组100例。A组患者为<34周终止妊娠的孕妇,B组为≥34周终止妊娠的孕妇。按分娩方式分为两组:阴道分娩组和剖宫产组。对两组的产妇并发症发生率及围生儿结局进行比较分析。结果:研究结果显示,A组孕妇的围生儿病死率都明显高于B组患者,有显著的统计学差异(P<0.05);两组产妇的并发症情况基本相同,没有显著的统计学差异(P>0.05)。结论:对于患有早发型重度子痫的患者来说,将孕周延长至34以上再终止妊娠,其围生儿的结局会比较理想,患者也不会出现特有的并发症现象,值得在今后对该类患者进行治疗的过程中予以使用和推广。     

新生儿窒息心脏收缩功能损害的超声心动图观察及临床意义

目的观察窒息新生儿心脏解剖及主、肺动脉血流参数的变化,探讨窒息对心脏收缩功能影响的特点及其意义。方法利用二维及多普勒超声对27例轻度窒息和18例重度窒息及14例正常新生儿进行二维超声及主、肺血流参数测定,并分析其与临床表现和预后的关系。结果和正常新生儿比较,轻、重度窒息组心脏的腔室大小和室壁厚度无显著差异(P>0.05)。急性期重度窒息组主动脉最大射血速度(PV)较正常新生儿和轻度窒息组降低(P<0.01),主动射血加速时间(AT)重度窒息组较正常新生儿延长(P<0.05);肺动脉射血加速时间(AT)及与射血时间(ET)的比值(AT/ET)轻度窒息组较正常组,重度窒息较轻度窒息及正常组缩短或降低(P<0.01或<0.05)。恢复期除主动脉最大射血速度(PV)和肺动脉AT/ET仍低于正常外,余参数各组间无差异。以急性期肺动脉AT/ET低于正常新生儿95%可信区间的下限0.26为标准,其估测窒息新生儿预后不良的敏感性、特异性及准确性分别为66.66%、79.66和77.77%。结论窒息对新生儿的主、肺动脉血流参数均有影响,急性期肺动脉AT/ET的改变与患儿的预后有一定关系。     

窒息新生儿血中胰岛素样生长因子-1和表皮生长因子的研究

目的 观察窒息后新生儿血中胰岛素样生长因子-1（IGF-1）、表皮生长因子（EGF）的变化,探讨出生窒息对新生儿胃肠激素的影响。方法 用放射免疫分析法（RIA）测定48例窒息新生儿和36例正常足月儿生后1、3、7天血中IGF-1、EGF的变化。结果 窒息新生儿血中IGF-1、EGF均比正常对照组显著下降,P〈0．01;窒息新生儿恢复期IGF-1、EGF升高。结论 窒息新生儿血中IGF-1、EGF的水平下降,表明窒息新生儿胃肠激素水平异常,可能是造成患儿消化功能紊乱的因素之一。