脐血铅与初乳铅含量与新生儿神经行为发育关系

目的 探讨在宫内低水平铅暴露状态下,新生儿脐血铅含量及初乳铅铅含量与神经行为发育的关系。方法 随机选取南京市妇幼保健院医院产科2010-01/04出生的足月新生儿170例。以脐血铅和初乳铅铅含量作为新生儿铅暴露的指标,新生儿神经行为（NBNA）发育评分作为效应指标,根据初乳铅中位数48.3μg/l,新生儿被分为高低铅两组。结果 高暴露组在新生儿主动肌张力、原始反射,和神经行为发育总评分上低于低暴露组,差异有统计学意义（P〈0.05）,在新生儿行为能力、被动肌张力、一般估价上差异无统计学意义。结论 初乳铅脐血铅水平和与婴儿的早期发育有关,铅可通过乳汁和脐血造成新生儿的铅接触,对新生儿婴儿早期神经行为发育产生不良影响。     

初乳铅与儿童体格和智力发育的关系

目的为了分析产后初乳铅暴露对学龄前期发育智商发育的影响,探讨产后初乳铅影响因素。了解母血、脐血、母乳之间铅、钙含量的相关性,尝试降低人体铅含量的途径方法。方法研究现场选在南京市妇幼保健院医院产科、儿童保建科门诊,2005.10～2006.10共170名孕妇被随机选为研究对象,2010年随访这些孕妇所生子女,通过问卷调查和体格检查分别了解上述儿童的一般状况、生长发育情况。用韦克斯勒氏学龄前儿童智商测量量表测定儿童智商,使用电感耦合等离子体质谱（ICP-MS）检测其中产后初乳铅含量。结果妊娠期产后初乳铅暴露对学龄前期儿童智商发育有显著的影响。产后初乳铅水平影响因素的多因素线性回归分析结果表明,在当地居住时间长短及孕期血铅水平直接影响到产后初乳中的铅含量。通过随访,分析了妊娠期产后初乳铅暴露对学龄前期儿童发育的影响,结果表明低产后初乳铅组儿童总智商评分和操作智商评分均高于高脐血铅水平组（t=2.97,P〈0.01;t=5.79,P〈0.01）。结论产后初乳铅与学龄前期的早期发育有关,铅可通过乳汁造成新生儿的铅接触,对学龄前期儿童早期神经行为发育产生不良影响。     

脐血铅含量与体格发育和智商发育的关系及影响因素分析(英文)

目的探讨在宫内低水平铅暴露状态下,新生儿脐血铅含量与神经行为发育的关系,研究目的是评价脐血铅对孕妇妊娠结局和4岁学龄前儿童的神经发育的影响。课题的研究现场选在南京市妇幼保健院医院产科、新生儿科、儿童保健科门诊。2005年10月至2006年10月共170名孕妇被随机选入我们的研究。所采血液和脐血铅测定使用电感耦合等离子体质谱(ICP-MS)法,106名4岁上面提及孕妇所生的子女被随防,随防率是97.25%。方法通过问卷调查和体格检查分别了解上述儿童的一般状况、生长发育情况。用韦克斯勒氏学龄前儿童智商测量量表测定儿童智商,多元线性回归分析脐血铅和学龄前儿童体格和智商的相关性。同时随机选取南京市妇幼保健院医院产科出生的足月新生儿170例。以脐血铅含量作为新生儿铅暴露的指标,新生儿神经行为(NBNA)发育评分作为效应指标,以脐血铅中位数49.7U/L被分为高低铅组。结果高暴露组在新生儿主动肌张力、原始反射,和神经行为发育总评分上低于低暴露组,差异有统计学意义,在新生儿行为能力、被动肌张力、一般估价上差异无统计学意义。根据智商测定揭示,低铅组的操作智商和言语智商明显高于高铅组(t=2.91,P<0.01;t=5.87,P<0.01)。结论脐血铅水平和与婴儿的早期发育有关,铅可通过脐血造成新生儿的铅接触,对新生儿婴儿早期神经行为发育产生不良影响。随着脐血铅水平的增加,学龄前期儿童总智商评分和操作智商评分下降,妊娠期脐铅暴露水平可能是学龄前期儿童总智商评分和操作智商评分降低的危险因素。     

妊娠晚期孕妇负性认知偏向与新生儿神经行为发育的相关研究

目的:研究妊娠晚期孕妇负性认知偏向与新生儿神经行为发育的相关性。方法:选择1334例在某院出生后3～7天的新生儿,由专人按照婴儿神经国际量表(INFANIB)进行测评了解其神经行为发育状况;并采用负性认知加工偏向量表,对251例妊娠晚期孕妇进行问卷调查,并追踪其分娩的84例新生儿,以婴儿神经国际量表对其进行测评,分析妊娠晚期孕妇负性偏向与新生儿神经行为发育的相关性。结果:①新生儿神经行为发育的异常发生率为44.80%;②不同性别新生儿神经行为发育的异常发生率差异有统计学意义(χ~2=4.573,P0.05),女性患儿阳性率高于男性;③妊娠晚期孕妇负性认知加工得分与临界值以上的新生儿的INFANIB得分具有负相关,并且在注意偏向和沉思偏向两个维度上的相关系数具有统计学意义(P0.05)。结论:新生儿神经行为发育的异常发生率较高,孕妇负性认知加工与新生儿神经行为发育呈负相关。母亲注意与沉思存在负性偏向越多的孕妇,其分娩的新生儿神经行为发育越容易出现异常。     

父母文化和职业因素对婴儿能力发展的影响

目的 :研究父母文化水平及职业对 3 -9月龄婴儿早期能力发展的影响。方法 :采用分层抽样法选取 3、 6、 9月龄婴儿 3 0 0 0名 ,进行能力发展测定。结果 :多因子方差分析及多重比较显示 ,父亲受教育水平不同 ,6月龄婴儿的发育商、智力能区和 9月龄婴儿的DQ分均差异显著 ;父亲职业不同 ,3月龄及 9月龄的婴儿智力能区差异显著。母亲受教育水平不同 ,6、 9月龄婴儿DQ分差异显著 ;母亲职业不同 ,3、 6、9月龄婴儿智力能区差异均显著 ,6月龄婴儿DQ分差异显著 ,9月龄婴儿社会适应能区差异显著。结论 :父母与婴儿的交往、父母文化水平与职业均对婴儿早期能力发展有重要影响     

引导式教育训练对高危儿神经行为发育的影响

目的探究引导式教育训练对高危儿早期神经行为发育的影响。方法将105例1月龄以内的高危患儿随机分为干预组和对照组,对干预组高危儿进行定期随访及引导式教育训练,对照组只接受定期随访。于矫正月龄3月龄、6月龄、12月龄时对两组高危儿进行Gesell发育诊断量表测试评价其神经行为发育。结果干预组的高危儿Gesell发育测试的各项评估明显优于对照组,具有显著的统计学差异(P0.05);在Gesell总发育商异常率方面,干预组发育迟缓患儿比率在3月龄(1.54%)、6月龄(0.00%)和12月龄(0.00%)均低于对照组3月龄(7.50%)、6月龄(5.00%)和12月龄(5.26%),具有显著的统计学差异(P0.05)。结论引导式教育训练可以促进高危儿的神经行为发育,并降低高危儿发育迟缓的发生率。     

对26例窒息儿进行智力监测及早期干预的效果观察

目的 探讨窒息儿智力发育及早期干预的效果。方法 26例窒息儿于出生时进行新生儿神经行为测定,6个月、1岁、1岁半时用0-6岁智能发育筛查测验(DST)随访患儿发育情况。同时教会父母婴儿抚触手法,提供自制的小儿生长各阶段应达到的发育水平评定表和科学育儿资料,并要求家长每日对小儿进行训练。结果 26例窒息儿智能发育水平明显提高。结论 早期干预对窒息儿智力恢复和提高效果明显。     

新生儿神经行为测定在早产儿神经心理发育中的临床探讨

目的：探讨分析新生儿神经行为测定在早产儿神经心理发育中的临床作用。方法抽取在2011年1月~2013年12月在我院分娩的50例早产儿,以及同期在我院分娩的50例足月儿,将50例早产儿作为研究组,50例足月儿作为对照组,早产儿于纠正胎龄40周、足月儿于出生后3d分别进行新生儿神经行为测定,比较两组新生儿的神经行为测定结果,进行前瞻性研究。结果研究组50例早产儿中新生儿神经行为测定<35分的有21例,对照组50例足月儿中新生儿神经行为测定<35分的有5例,差异具有统计学意义(<0.05)。检查出的情况异常的早产儿需要进行早期的干预。结论采用新生儿神经行为测定对早产儿进行神经心理发育方面的检测,能够及早发现中枢神经系统轻微异常情况,值得在临床上推广使用。     

铅对儿童智能发育的影响

测定了160名来自铅作业工厂厂区内幼托儿童血铅水平,均值为227μg/L,血铅≥250μg/L 者占32%。30月龄以下小儿血铅水平与 Bayley 婴儿发育量表中 MDI 和 PDI 无关;可能与铅接触时间短有关;46月龄以上儿童血铅与总 IQ,操作 IQ 和语言 IQ 呈负相关,高铅组儿童各智商均显著低于低铅组,高铅对智能的影响是全面性的。     

早产儿疼痛管理对其远期神经发育、行为及社会情感的影响观察

目的 探讨疼痛管理对早产儿远期神经发育、行为及社会情感的影响。方法 选择2019年1月至2020年1月于我院出生的早产儿共160例,根据护理方法的不同,将所有早产儿分为观察组、对照组2组,每组80例。对照组患儿接受常规护理,观察组在对照组的基础上介入疼痛管理,比较两组早产儿1月龄、6月龄、12月龄时的基本发育情况,神经行为发育（婴幼儿智能综合Gesell发育量表）以及社会情感（婴幼儿社会情感ASQ:SE发育量表）。结果6月龄时以及12月龄时,观察组身长、体质量、头围均明显高于对照组（P<0.05）。6月龄时、12月龄时,观察组粗大运动能力、解决问题能力、个人-社会能力以及言语沟通能力评分均明显高于对照组（P<0.05）。12月龄时,观察组ASQ:SE评分明显高于对照组,ASQ:SE得分>0分例数明显低于对照组（P<0.05）。结论 疼痛管理可有效改善早产儿神经行为、社会情感以及机体生长发育的迟滞现象,具备良好的远期干预效果。     

The sleep of co-sleeping infants when they are not co-sleeping: evidence that co-sleeping is stressful

Co-sleeping proponents consider the practice to be "natural" and a potential protection against sudden infant death syndrome (SIDS); others consider the practice of an infant sleeping in the parents' bed for prolonged periods at night to place an infant at risk for harm or death. For this study, co-sleeping was investigated from a different perspective, that is, as a significant early experience to investigate as it may have implications for the infant's development. The sleep of 101 normal, full-term infants was recorded nonintrusively in the home for 24 hr periods when they were 5 weeks and 6 months old. Infants were assigned to three groups: short-term co-sleepers, long-term co-sleepers, and non-co-sleepers. Their sleep states and wakefulness were compared at the two ages and over age. At 5 weeks and 6 months, the long-term co-sleeping infants differed significantly from the non-co-sleepers on a number of measures: At 5 weeks, they showed more quiet sleep and longer bouts of quiet sleep; and at 6 months, they also showed less active sleep, fewer arousals in active sleep, and less wakefulness. Each of these differences indicates a markedly lower arousal level in the long-term co-sleeping infants. This sleep pattern has been repeatedly found to be an indicator of stress. We infer that a major source of stress for these infants is the experience of sleep disturbance documented for infants when they were co-sleeping. Based on extensive evidence for long-term effects of early stress, we conclude that co-sleeping should have significant implications for infants' neurobehavioral development.     

早期干预对高危儿智能发育影响的研究

目的探讨定期随访高危儿,进行早期发育评价及干预,对高危儿智能发育的影响。方法将82例高危儿随机分成干预组42例和常规组40例,干预组接受早期干预,两组患儿定期随访,以中国婴幼儿发育量表（CDCC）和《Ge-sell发育诊断量表》进行智能发育评估。结果3、6、9月龄时干预组患儿智力发育指数（MD I）和运动发育指数（PD I）均显著高于常规组;1岁时Gesell智能检查,干预组除大运动能区与常规组有显著性差异外（P〈0.05）,其他四大能区均存在非常显著性差异（P〈0.01）。结论早期干预可促进高危儿的智能发育,改善其预后。     

Direct and indirect effects of breast milk on the neurobehavioral and cognitive development of premature infants

Eighty-six premature infants were tested to examine the effects of maternal breast milk on infant development. Infants were classified by breast-milk consumption during the hospitalization period (M = 57.4 days) into three groups: those receiving minimal (<25% of nutrition), intermediate (25-75%), and substantial (>75%) amounts of breast milk. Infants in the three groups were matched for birth weight, gestational age (GA), medical risk, and family demographics. At 37 weeks GA, mother-infant interaction was videotaped, maternal depression self-reported, and neurobehavioral maturation assessed by the Neonatal Behavior Assessment Seale (Brazelton, 1973). At 6 months corrected age, infants were tested with the Bayley II (Bayley, 1993). Infants receiving substantial amounts of breast milk showed better neurobehavioral profiles-in particular, motor maturity and range of state. These infants also were more alert during social interactions, and their mothers provided more affectionate touch. Higher maternal depression scores were associated with lower quantities of breast milk, longer latencies to the first breast-milk feeding, reduced maternal affectionate touch, and lower infant cognitive skills. Maternal affectionate touch moderated the relations between breast milk and cognitive development, with infants receiving a substantial amount of breast milk and frequent touch scoring the highest. In addition to its nutritional value, breast milk may be related to improved maternal mood and interactive behaviors, thereby indirectly contributing to development in premature infants.     

Postnatal lead effects on the development of visual spatial acuity in rhesus monkeys (Macaca Mulatta)

High lead levels adversely affect visual function in humans and laboratory animals. The effects of lower lead levels are less certain. This study compared the development of photopic spatial acuity in rhesus monkeys exposed to lead (n = 43) with monkeys (n = 23) not exposed to lead. Lead exposure began at Day 8 postpartum and continued daily throughout the first 26 weeks of postnatal life achieving target blood lead levels of 35-40 microg/dl by about 15 weeks. Photopic spatial acuity was evaluated by a preferential looking technique used clinically to assess spatial acuity in human infants. Acuity increased rapidly over the first few postnatal weeks achieving the maximum acuity level assessed (26.3 c/deg) by 7 weeks of age for most monkeys. Postnatal lead exposure at the dosages and durations studied did not affect the development of photopic spatial acuity.     

早期应用泡式鼻持续气道正压通气8cmH2O和5cmH2O联合肺表面活性物质防治新生儿呼吸窘迫综合征的临床研究

目的探讨早期应用泡式鼻持续气道正压通气（B—NCPAP）8cmH2O（1cmH2O=0．098kPa）与肺表面活性物质（PS）＋B—NCPAP 5cmH2O防治NRDS的疗效差异。方法B—NCPAP8组选取2007年4月30日至2008年8月30日在中山大学附属第三医院分娩且生后30min内收入新生儿病房的早产儿,胎龄27～37周、羊水泡沫实验（-）～（＋）,生后30min内应用B—NCPAP 8cmH2O,分为B—NCPAP8预防（治疗前未出现呼吸窘迫）和B—NCPAP8治疗亚组（治疗前出现呼吸窘迫,胸部X线检查提示存在不同程度NRDS改变）。Ps＋B—NCPAP5组选取为胎龄27—37周、羊水泡沫实验（一）～（＋）的早产儿,生后6h内气管内注入Ps并给予B—NCPAP5cmH20,分为PS＋B—NCPAP5预防及PS＋B-NCPAP5治疗亚组。结果研究期间,B—NCPAP8预防和治疗亚组分别纳入48和25例;PS＋B—NCPAP5预防和治疗亚组分别纳入36和22例。B—NCPAP8预防亚组41／48例（85．4％）未出现呼吸窘迫;7例在应用B—NCPAP4～6h后出现呼吸窘迫,其中5例为轻度NRDS,继续治疗8h后症状逐渐改善,2例为重度NRDS,在生后8～10h行气管插管注入PS并改用机械通气后存活;应用成功率为95．8％（46／48例）。PS＋B—NCPAP5预防亚组32／36例（88．9％）未出现呼吸窘迫;4例在应用BNCPAP4～6h后出现呼吸窘迫,其中3例为轻度NRDS,继续治疗后症状逐渐改善,应用成功率为97．2％（35／36例）;1／36例（2．8％）为中度NRDS,改用机械通气后死亡。B—NCPAP8治疗亚组24／25例（96．0％）治疗2h后血气分析指标改善,1例改用机械通气。PS＋B—NCPAP5治疗亚组18／22例（81．8％）治疗8h后临床症状及血气指标均改善,1／22例（4．5％）死亡。B—NCPAP8与PS＋B—NCPAP5预防及治疗亚组在防治NRDS的疗效上差异无统计学意义,但B—NCPAP8预防及治疗亚组的肺部感染发生率、住院时间及住院费用较低（P均〈0．05）。结论早期应用B．NCPAP 8cmH2O与PS＋B—NCPAP 5cmH2O预防及治疗NRDS的疗效相近,但前者能减少肺部并发症发生,缩短住院时间,减少住院费用。     

Relationship among maternal blood lead,ALAD gene polymorphism and neonatal neurobehavioral development

Lead is a widely used heavy metal that can affect children’s nervous system development. ALAD gene polymorphism is associated with lead neurotoxicity. This study aimed to clarify the relationship among maternal blood lead, ALAD gene polymorphism, and neonatal neurobehavioral development through detecting maternal blood lead and ALAD gene polymorphism. 198 maternal and neonatal were selected as the research object. Graphite furnace atomic absorption method was applied to detect the maternal blood lead concentration. PCR-RFLP was used to detect ALAD genotype distribution. Neonatal NANB score was treated as effect indicator. SPSS was used for statistical analysis. The ALAD genotype was 181 cases (91.4%) for ALAD₁₁ and 17 cases (8.6%) for ALAD₁₂. ALAD allele frequency distribution accords with genetics Hardy-Weinberg balance (P > 0.05). Blood lead level in maternal with ALAD₁₂ genotype was significantly higher than with ALAD₁₁ genotype (P < 0.01). NANB score in high blood lead neonatal group was obviously lower than the low blood lead group (P < 0.05). Newborn’s NANB score from the maternal with ALAD₁₁ genotype was lower than from the maternal with ALAD₁₂ genotype (P < 0.01). After ruling out the confounding factors influence by multiple linear regressions, ALAD gene polymorphisms had no significant correlation with neonatal NANB score (P > 0.05). ALAD gene polymorphism is associated with the blood lead level. Low level lead exposure in utero may cause newborn early neurobehavioral maldevelopment. Maternal ALAD gene polymorphism can affect early neonatal neurobehavioral development by influencing the blood lead level.     

Longitudinal analyses of prenatal and postnatal lead exposure and early cognitive development

In a prospective cohort study of 249 children from birth to two years of age, we assessed the relation between prenatal and postnatal lead exposure and early cognitive development. On the basis of lead levels in umbilical-cord blood, children were assigned to one of three prenatal-exposure groups: low (less than 3 micrograms per deciliter), medium (6 to 7 micrograms per deciliter), or high (greater than or equal to 10 micrograms per deciliter). Development was assessed semiannually, beginning at the age of six months, with use of the Mental Development Index of the Bayley Scales of Infant Development (mean +/- SD, 100 +/- 16). Capillary-blood samples obtained at the same times provided measures of postnatal lead exposure. Regression methods for longitudinal data were used to evaluate the association between infants' lead levels and their development scores after adjustment for potential confounders. At all ages, infants in the high-prenatal-exposure group scored lower than infants in the other two groups. The estimated difference between the overall performance of the low-exposure and high-exposure groups was 4.8 points (95 percent confidence interval, 2.3 to 7.3). Between the medium- and high-exposure groups, the estimated difference was 3.8 points (95 percent confidence interval, 1.3 to 6.3). Scores were not related to infants' postnatal blood lead levels. It appears that the fetus may be adversely affected at blood lead concentrations well below 25 micrograms per deciliter, the level currently defined by the Centers for Disease Control as the highest acceptable level for young children.     

The use of viral culture and p24 antigen testing to diagnose human immunodeficiency virus infection in neonates. The HIV Infection in Newborns French Collaborative Study Group.

BACKGROUND. Early diagnosis of human immunodeficiency virus (HIV) infection in infants born to infected mothers is important for the infants' medical care, but the presence of maternal antibodies makes serologic tests uninformative. METHODS. In a cohort study of 181 infants born to HIV-infected mothers, we assessed the diagnostic value of HIV viral culture and testing for the presence of p24 antigen. The infants were tested at birth, again during the first 3 months, then followed and tested at the age of at least 18 months. RESULTS. Of the 181 infants, 3 died of HIV infection and 37 were seropositive after the age of 18 months. Viral cultures at birth were positive in 19 of the 40 infected infants and in none of the uninfected infants, yielding a sensitivity of 48 percent (95 percent confidence interval, 32 to 63 percent) and a specificity of 100 percent (95 percent confidence interval, 97 to 100 percent). By the age of three months, 30 of the 40 infants (75 percent) had positive cultures; again, there were no false positive results among the infants who were tested a second time, of the 141 who remained uninfected. The sensitivity of testing for p24 antigen at birth was only 18 percent, with a specificity of 100 percent. The presence of p24 antigen at birth was associated with the development of early and severe HIV-related disease (P less than 0.04). CONCLUSIONS. Viral culture at birth can correctly identify about half of newborns with HIV infection. The fact that this usually sensitive technique fails to identify about half the ultimately infected neonates suggests that vertical transmission of HIV may occur late in pregnancy or during delivery.