早产儿脑损伤的诊断与治疗

脑损伤是导致早产儿远期神经系统伤残和预后不良的主要原因.早产儿脑损伤临床表现不典型、症状缺乏特异性,甚至无明显临床症状,诊断主要依赖颅脑影像学检查和脑功能测定.本文对早产儿脑损伤的诊治要点进行了较为详尽的介绍,以有助于临床医师加强对该病的认识、改善患儿预后.     

Indomethacin Use for the Management of Patent Ductus Arteriosus in Preterms: A Web-Based Survey of Practice Attitudes Among Neonatal Fellowship Program Directors in the United States

The objective of this study was to determine whether neonatal-perinatal fellowship programs (NFTPs) in the United States vary in indomethacin use for the management of patent ductus arteriosus (PDA) in ≤28 week gestational age infants at birth. A 53-item web-based survey was sent to 84 NFTP directors who received prenotification, followed 2 weeks later by a reminder letter. A total of 56 NFTP directors responded (67% maximum response rate). Wide variation exists in the maximum number of indomethacin courses used to close ductus, use of indomethacin for reopened PDA beyond 14 days, ductal closure definition, contraindications before consideration of indomethacin, interventions for contraindications, and reported ductal closer rate after each indomethacin course. Indomethacin therapy for symptomatic PDA and short course of indomethacin are common practices. Indomethacin use for the management of PDA in premature infants varies among NFTP directors. Practice attitudes may explain variations in ductal closure and ligation rates. Because practice variations may have implications for long-term outcome of vulnerable premature infants, studies relevant to the management of PDA in premature infants are needed.     

Pulmonary effects of closure of patent ductus arteriosus in premature infants with severe respiratory distress syndrome

The pulmonary effects of closure of a patent ductus arteriosus (PDA) were investigated in 11 premature infants with severe respiratory distress syndrome. Successful closure of a PDA did not improve the short-term severity of pulmonary disease (24 and 48 h after treatment) as judged by the arterial/alveolar oxygen tension ratio or the amount of ventilatory support. Also, pulmonary mechanics measured 24 h before, 24 and 48 h after treatment, were not statistically different.Conclusion Infants with severe respiratory disease requiring high ventilation pressure and high oxygen concentration, where structural changes in the lungs are already established, will rarely show short-term improvement in pulmonary disease as a result of closure of a PDA. The overall clinical condition may, however, improve as a result of reduced cardiovascular strain. Earlier treatment of a PDA could reduce the ventilation period and the possible risk of developing chronic lung disease.     

室间隔缺损封堵器关闭婴儿大管型动脉导管未闭的初步评价

目的 应用国产室间隔缺损封堵器关闭婴儿大管型动脉导管未闭并对其疗效进行初步评价.方法 2007年5月-2008年2月就诊的10例4～9个月婴儿经主动脉造影确诊为大管型动脉导管未闭,最窄处内径为4.1～7.4 mm,长度7.9～11.9 mm,合并中～重度的肺动脉高压.选用6～12 mnl国产肌部或膜部室间隔缺损封堵器进行介入治疗,术后主动脉造影、术后24 h及1～6个月进行超声心动图随访观察疗效.结果 全组技术成功率100%,术后主动脉造影和超声心动图显示无残余分流.随访超声心动图无明显降主动脉缩窄,1例左肺动脉轻度狭窄.无其他不良并发症.结论 室间隔缺损封堵器可用于关闭婴儿粗大管型的动脉导管未闭,成功率高,近期疗效肯定,中远期疗效需随访观察.     

Recording non-nutritive sucking in the neonate. Description of an automatized system for analysis

A new method for automatic analysis of non-nutritive sucking in newborn infants is described, which uses a specially designed computer program that analyses an analogue signal obtained from a pressure transducer inside a pacifier. Validation is done with four independent methods: electromyogram, visual identification, control of the automatic treatment and comparison of inter-observer results. A high degree of correspondence is shown. The system was applied to 58 healthy full-term neonates. Infants less than 24 h old demonstrated a significantly different sucking pattern compared with the 3-day-old infant. The duration of their bursts was longer (3.7 vs 2.8 s), the frequency of their sucking was lower (1.7 vs 2.0 Hz) and the variability of their sucking pattern was greater. These results also testify to the validity of the method inasmuch as the values for the different sucking parameters are similar to corresponding values presented earlier.     

极低与超低出生体重儿动脉导管未闭管理与支气管肺发育不良发生的关系

早产儿支气管肺发育不良( bronchopulmonary dysplasia,BPD)是早产儿特别是极低和超低出生体重儿常见的并发症之一。 BPD在其发生发展过程中受到多种因素的影响,其中动脉导管未闭( patent ductus arteriosus,PDA)及其临床管理,特别是PDA不同的治疗方案和治疗时机的选择对BPD发生的影响受到广泛关注。本文总结了早产儿PDA管理与BPD发生关系的研究进展,并在此基础上提出可能有利于降低早产儿BPD发生率的PDA管理建议。     

Malignancy in the neonate

From January 1962 to July 1988, 34 infants less than 29 days of age who had cancer were seen at St. Jude Children's Research Hospital (SJCRH). The malignancies in this group consisted of 19 neuroblastomas, 6 leukemias, 3 retinoblastomas, 2 Wilms' tumors, 2 melanomas, and 2 teratomas. Twenty-three patients (68%) are alive and free of disease 2 months to 24 years after diagnosis. We reviewed the presentation and initial symptoms, pathology reports, patient population, associated anomalies, potential genetic influences, and possible perinatal factors. The most common initial symptom was an enlarging abdomen or abdominal mass. Pathological findings were occasionally difficult to interpret; five additional infants who were referred to us did not have malignancies. There was no increased incidence of associated anomalies or perinatal insults. The only genetic factor was retinoblastoma in one parent of each infant diagnosed as having retinoblastoma. The possible etiology of neonatal tumors is discussed.     

The effect of dopamine administration on the activity of the renin-angiotensin-aldosterone system in sick preterm infants

Nine premature infants with birth weight of 1150 to 2500 g and gestational age of 28 to 35 weeks were given dopamine in a dose of 2–4 g/kg/min to treat cardiopulmonary distress.In addition to monitoring of blood gases, blood pressure, acid-base balance, urine flow and urinary sodium excretion, plasma renin activity (PRA) and plasma aldosterone concentration (PA) was also determined prior to and during dopamine therapy.The dopamine-induced increase in urine flow and urinary sodium excretion was associated with a significant increase of PRA from 18.2±5.1 ng/ml/h to 33.0±5.6 ng/ml/h (P<0.025), while PA and blood pressure remained unaltered by dopamine administration.It is suggested that the angiotensin II-stimulated aldosterone production is overridden by the inhibitory effect of dopamine.Abbreviations RAAS renin-angiotensin-aldosterone system - PRA plasma renin activity - PA plasma aldosterone     

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??Abstract??Objective To evaluate the clinical effect of transcatheter closure for ventricular septal defect in infants and young children. Methods Clinical data from 184 children under 3 years old who underwent the transcatheter VSD closure from Jan. 2011 to Dec. 2012 were analyzed. Results Procedure was successful in 176 cases ??95.7%??. No death occurred?? residual shunt in 13 cases?? tricuspid inflow accelerated in 2 cases?? late-onset complete atriovenous block in one case ??6 months after procedure??. All cases had no vascular complications. Conclusion Transcatheter closures for ventricular septal defects are effective in small children. Long-term follow-up is needed to evaluate the safety of this operation. The keys to the success of operation are the proper indications,suitable apparatus,skillful vascular punction and good anaesthetic management.     

Plasma somatostatin concentration in the preterm neonate

Plasma somatostatin concentration was measured by radioimmunoassay in 26 preterm neonates (mean gestational age 34 weeks). None were seriously ill and they were all fed with breast-milk 12 h after birth. In a longitudinal study the concentrations were (mean±SEM): 21±2 pmol/l (n=8) at 2–8 h of age, 24±2 pmol/l (n=11) at the age of 2 days and 25±2 pmol/l (n=15) at the age of 8 days. These levels were significantly higher than in 30 healthy control adults: 11±1 pmol/l (P<0.01). Gavage with breast milk on the 2nd day induced a significant decrease from 21±4 to 15–2 pmol/l in 60 min (P<0.05).This data shows that the high plasma levels in neonates correspond to the high density of somatostatin in the neonatal pancreas and digestive tract. It also indicates that somatostatin is regulated by feeding in the neonate.     

Low biotinidase activity in plasma of some preterm infants: possible source of false-positive screening results

Screening for biotinidase deficiency has been added recently to some national screening programmes. To clarify the problem of false-positive screening tests in premature infants, we have studied biotinidase activities in the plasma of this population in more detail. In 64 newborns (premature and term babies) biotinidase activities correlated positively with gestational age from the 2nd to the 30th day of life. During the 1st–3rd day the activities were below the normal adult range in all 64 infants. In 56 infants the activities subsequently increased gradually and reached the normal adult range during the 4th–40th day of life. In contrast, the biotinidase activities in eight preterm infants dropped during the 3rd–7th day of life. Impaired liver function as a possible cause for this finding could be ruled out in these infants. The lowest activities in these infants were measured during the 4th–6th day of life, i.e. unfortunately at a time when samples for the screening are normally taken. According to our data, 4–8 out of 48 preterm or small-for-date infants with biotinidase activities ranging from 4.7%–26% of the mean adult value would have given false-positive screening tests. A positive screening test was also obtained in a newborn and in an older unrelated child with a partial biotinidase deficiency. In these children the biotinidase activity did not rise but remained slightly below or at the lower range for heterozygotes (at 31% and 38% of the mean adult value). Currently we do not know whether such individuals are heterozygotes, or whether they have a variant of biotinidase deficiency. However, these children have developed normally without biotin therapy.Abbreviations DTT dithiothreitol     

A case control study of necrotizing enterocolitis occurring over 8 years in a neonatal intensive care unit

The perinatal histories of 27 newborn infants with NEC were compared to those of 54 infants of equivalent birth weight who did not have NEC during an 8-year study period to see if possible predisposing factors were independent of the confounding effect of birth weight. No differences were observed in gestational age, degree of intrauterine growth retardation, premature rupture of membranes, perinatal asphyxia, skin temperature at admission, haematocrit, presence or absence of respiratory distress syndrome, umbilical catheter placement, start and type of feeding or presence of positive blood cultures. Prematurity is the greatest risk factor predisposing to the development of NEC and the perinatal problems which precede the onset of NEC are common among all premature infants.Abbreviation NEC necrotizing enterocolitis     

视觉诱发电位在早产儿视网膜病变中的应用研究

目的探讨闪光刺激视觉诱发电位(F-VEP)与早产儿视网膜病变(ROP)的关系。方法2003-01—2006-01对东南大学医学院附属盐城医院儿科采用国际标准法对早产儿对照组33例(66眼)和ROP组36例(72眼)行F-VEP检测,并进行分析。结果P100波潜伏期随眼底病变程度的加重有逐渐延长的趋势,与对照组比较差异有显著性(F=43.5,P<0.001);P100波波幅比较ROP轻度组与对照组差异无显著性(P>0.05),不同程度的ROP各组间的P100波潜伏期及波幅比较差异有显著性(P<0.05);P100波潜伏期与ROP的程度有显著相关性(r=0.648,P<0.05)。结论F-VEP检查可以作为ROP发生和发展过程中的重要监测方法。     

Peabody运动发育量表在早产儿神经发育障碍评估中的应用

随着围生医学的日益发展,早产儿存活率明显提升,其早期严重并发症多有效控制,但部分存活早产儿遗留脑性瘫痪、运动发育迟缓、视听觉损害等神经发育障碍,严重影响了其生存质量.作为新生儿体格检查的一部分,Peabody运动发育量表在了解新生儿的早期智能发育情况、行为能力以及神经发育情况方面发挥越来越重要的作用.本文就Peabody运动发育量表在早产儿神经发育障碍评估中的应用进行综述.     

Treatment of an Aneurysmal Dilatation of the Ductus Arteriosus with Indomethacin in a Premature Infant

A large ductus arteriosus aneurysm can lead to potentially serious and life-threatening complications. We report a case of aneurysmal dilatation of the ductus arteriosus in a premature infant that was successfully treated with indomethacin. Thus, surgical intervention with general anesthesia could be avoided.     

Coexistence of Ductal Constriction and Closure of the Foramen Ovale <Emphasis Type="Italic">in Utero</Emphasis>

We report a fetus with an unusual combination of a narrow ductus arteriosus (DA) and foramen ovale. A pregnant mother was referred at 26 weeks of gestation for fetal pericardial effusion. Fetal echocardiography showed pericardial effusion, right atrial enlargement, right ventricular hypertrophy, and tricuspid regurgitation. The DA looked tortuous with S-shaped kinking. The atrial septum primum bulged into the left atrium. Color Doppler did not show any flow across the atrial septum. Cesarean section was performed at 31 weeks of gestation. Admission to intensive care was required after delivery, but the infant gradually improved and was discharged home without any sequela.     

Catheter closure of the arterial duct in preterm infants

BACKGROUND: When medical treatment of a symptomatic arterial duct in a preterm infant fails, management is surgical. Patients and METHODS: 10 preterm neonates referred to a tertiary cardiac centre for treatment of a symptomatic patent arterial duct who underwent cardiac catheterisation with the intention of device closure. RESULTS: Successful catheter device closure of the arterial duct in nine preterm infants is described. CONCLUSION: In selected cases, catheter device closure may offer an alternative to thoracotomy and surgical ligation.     

Spontaneous DNA synthesis of blood lymphoid cells in premature newborn infants,in older premature infants and in full-term newborn infants

In adults, blood cells which synthesize DNA spontaneously are large, pale lymphoid phagocytes. In fetal blood, transitional cells label spontaneously in addition to the lymphoid phagocytes (Prindull et al., 1975a, b). In the present study, we have measured quantitatively by scintillation counting, spontaneous thymidine incorporation of blood cells from different groups of infants.When compared with the conditions in the normal adult, spontaneous DNA synthesis of peripheral blood lymphoid cells is increased by a factor of 16.4 in premature newborn infants (P<0.002), by a factor of 8.7 in full-term newborn infants (P<0.01), and in older premature infants studied at the time of their calculated birth dates by a factor of 4.3 (P<0.001).Spontaneously labelling blood cells most likely are, at least in part, hematopoietic stem cells from the bone marrow.With technical assistance of Brigitte Prindull.