儿童造血干细胞移植后急性肾损伤相关危险因素的回顾性研究

目的 探讨造血干细胞移植(hematopoietic stem cell transplantation,HSCT)后急性肾损伤(acute kidney injury,AKI)的危险因素。方法 回顾性研究2018年1月至2020年1月111例行HSCT患儿的临床资料。采用多因素logistic回归分析筛选出AKI发生的影响因素;采用Kaplan-Meier生存分析比较不同级别AKI患儿生存预后差异。结果 111例HSCT患儿中,AKI发生率为52.3%(58/111)。移植物抗宿主病(Ⅱ～Ⅳ度)(OR=4.406,95%CI:1.501～12.933,P=0.007)、肝小静脉闭塞综合征(OR=4.190,95%CI:1.191～14.740,P=0.026)、血栓性微血管病(OR=10.441,95%CI:1.148～94.995,P=0.037)与HSCT患儿移植后AKI发生密切相关。AKIⅢ期患儿的1年生存率(28.6%±12.1%)低于NAKI (82.8%±5.2%)、AKIⅠ期(81.7%±7.4%)、AKIⅡ期(68.8%±11.6%)患儿(P<0.05)。结论 ...     

Significance of periportal low-attenuation zones following blunt trauma in children

The CT scans of 400 consecutive children evaluated with CT following blunt abdominal trauma were evaluated to determine the frequency of periportal lowattenuation zones, assess patterns of associated intraabdominal injury, and examine clinical outcome. Periportal low-attenuation zones were noted in 60 children (15%). The presence of these zones was associated with a significantly higher incidence of intraabdominal injury (60% versus 11%,p=0.0001). Injuries most frequently associated with zones of periportal low-attenuation included hepatic (n=23,38%), and adrenal (n=14,23%). Children who had periportal low-attenuation zones tended to be more physiologically unstable as evidenced by a lower Trauma Score (diffuse, 11.9; focal, 13.4) than children without the zones (15.1,p=0.0001). The presence of these zones was also associated with a significantly higher mortality rate (13% versus 1%,p=0.0001). Ten children who had periportal low-attenuation zones and no hepatic injury on CT had a normal appearing liver on gross inspection at surgery or autopsy. In conclusion, periportal lowattenuation zones are common in children who have hepatic injury. These zones may be seen in conjunction with non-hepatic visceral injury or in the absence of intraabdominal injury. The presence of zones of periportal lowattenuation is associated with a higher index of physiologic instability, and higher mortality.     

Hepatic Involvement in Dengue Fever in Children

Objective

Hepatic dysfunction is common in dengue infection and the degree of liver dysfunction in children varies from mild injury with elevation of transaminases to severe injury with jaundice. This study was undertaken to assess the spectrum of hepatic involvement in dengue infection.

Methods

110 children with serologically positive dengue fever aged between 2 months - 14 years were studied for their hepatic functions both clinically and biochemically after excluding malaria, enteric fever, Hepatitis A and Hepatitis B with relevant investigations.

Findings

All cases were grouped into DF (Dengue fever), DHF (Dengue hemorrhagic fever) and DSS (Dengue shock syndrome) according to WHO criteria. The spectrum of hepatic manifestations included hepatomegaly (79%), hepatic tenderness (56%), jaundice (4.5%), raised levels of aspartate transaminase (AST)(93%), alanine transaminase (ALT)(78%), alkaline phosphatase (AP) (57%), prolonged prothrombin time (PT) (20%), reduced levels of serum albumin (66%) and abnormal abdomen ultrasound (65%).

Conclusion

Hepatic dysfunction was observed more in DHF and DSS group compared to DF group. About 17.27% of children had >10 fold increase in the liver enzymes. There was no correlation between the degree of hepatic enlargement or hepatic tenderness with the abnormalities of liver functions. Any child with fever, jaundice and tender hepatomegaly in geographical areas where dengue is endemic, the diagnosis of dengue infection should be strongly considered.     

Non-alcoholic fatty liver disease: epidemiology,pathophysiology, diagnosis and treatment

Non-alcoholic fatty liver disease (NAFLD) in most of the world is the most common cause of liver disease in children and adolescents. The term NAFLD includes a spectrum of liver findings with macrovesicular steatosis, either in isolation, or with inflammation and evidence of cellular injury (non-alcoholic steatohepatitis), to cirrhosis. Particular factors responsible for progression of NAFLD from bland to more severe forms remain unknown. Multiple genetic and environmental risk factors are associated with increased risk for NAFLD including obesity, male gender, older age, Hispanic ethnicity or Asian race, and a positive family history. Non-invasive methods of investigation suggesting NAFLD include hepatic ultrasound and MRI, although definitive diagnosis is based on liver biopsy. The current standard of care for treatment of NAFLD is lifestyle modifications in the form of diet and exercise. Rigorous trials of additional treatment modalities such as antioxidants and insulin sensitizers are being explored.     

Protective effects of leflunomide against ischemia-reperfusion injury of the rat liver

Hepatic ischemia-reperfusion (I/R) injury may be developed in some conditions, such as trauma, major hepatic resection, hemorrhagic shock or liver transplantation. I/R injury of the liver causes hepatocellular damage that may lead to hepatic failure. A considerable body of evidence indicates that reactive oxygen species (ROS) and inflammation may contribute to hepatocellular injury in liver I/R. Leflunomide is an isoxazole derivative, and a unique immunomodulatory agent. In the present study, we examined the effects of leflunomide on the neutrophil activation with oxidative stress and some antioxidant enzymes in the reperfusion following I/R in the rat liver. Thirty-two rats divided into four groups: group 1 (control); was given leflunomide 10 mg/kg, i.g.; group 2 (SHAM), animals were only laparotomized; group 3 (liver I/R), and group 4 (liver I/R + Leflunomide). In group 4, rats were pretreated with leflunomide (10 mg/kg, i.g.) two doses prior to experiment. In groups 3 and 4, occluding the hepatic pedicel for 60 min induced ischemia and reperfusion was allowed thereafter for 60 min. At the end of the reperfusion period, rats were sacrificed. superoxide dismutase, catalase, nitric oxide, xanthine oxidase, malondialdehyde, protein carbonyl and myeloperoxidase levels were determined in hepatic tissue as well as histological examination with H and E staining. Group 3 animals demonstrated severe deterioration of liver morphology and a significant liver oxidative stress. Pretreatment of animals with leflunomide markedly attenuated morphological alterations and neutrophil activation, reduced elevated oxidative stress products levels and restored the depleted hepatic antioxidant enzyme. The findings imply that ROS play a causal role in I/R-induced hepatic injury, and leflunomide exerts hepatoprotective effects probably by the anti-inflammatory effect with radical scavenging and antioxidant activities.     

Endoscopic management for hepatic duct injury in children]

Non-operative management of hepatic injury in children with abdominal trauma represents a standard of care. A major duct injury with persistent bile leakage may result from trauma to the liver. This injury is of concern in patients treated non operatively because it generally requires major hepatic surgery. We report on a case of a 13-year-old boy with an hepatic duct injury from trauma in which healing occurred without surgical repair or resection.     

Propylthiouracil hepatotoxicity: two pediatric cases and review of the literature

We have observed isolated hepatotoxicity in two children treated with propylthiouracil (PTU) for hyperthyroidism. Neither patient had risk factors for or clinical evidence of preexisting liver disease. In one patient the drug was promptly discontinued when signs of liver disease were noted. This patient quickly recovered. The second patient continued to receive PTU for several days after developing symptoms. Her illness progressed to fulminant hepatic failure with encephalopathy, and she died. These are the third and fourth pediatric cases reported, and there have been 10 cases reported in adults in the English language literature. Thirteen of the 14 patients are female. The literature regarding all these patients is reviewed. Propylthiouracil may cause lethal hepatic damage. This drug should be discontinued immediately if signs or symptoms of hepatic injury are detected.     

Blunt hepatic and splenic trauma in children: Correlation of a CT injury severity scale with clinical outcome

The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P=0.002 by ²-test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P=0.41 by ²-test) or amount (P=0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury.     

Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury

The medical records of 43 hemodynamically stable children with elevated serum transaminase levels (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) who underwent abdominal computed tomographic (CT) scan for blunt abdominal trauma were reviewed. Nineteen patients (44.2%) had AST levels greater than 450 IU/L and ALT levels greater than 250 IU/L, and 17 of these 19 patients had hepatic injury identified on abdominal CT scan. Of the 43 patients, 25 (58.1%) had AST and ALT levels of less than 450 IU/L and 250 IU/L, respectively, and none of these patients had evidence of hepatic injury on CT scan. Elevated serum transaminase levels (AST greater than 450 IU/L and ALT greater than 250 IU/L) identified all of the patients with hepatic injury visible on abdominal CT scan. The sensitivity and specificity of elevated serum transaminase levels were 100% and 92.3%, respectively, for predicting hepatic injury. It is recommended that hemodynamically stable pediatric patients with blunt abdominal trauma and AST levels greater than 450 IU/L and/or ALT levels greater than 250 IU/L undergo abdominal CT scan to determine the presence and extent of hepatic injury. Children with serum transaminase levels below these values are at decreased risk of liver injury.     

Recurrent early childhood injuries among disadvantaged children in primary care settings.

OBJECTIVE: To examine differences in social risk factors and health care use between young children with and without recurrent injuries. DESIGN: Retrospective cohort study using administrative claims and medical records. Children with no, one, or more than one injury were compared. SETTING: Integrated public healthcare system. SUBJECTS: All children born at Denver Health Medical Center (DHMC) in 1993 who continued care there beyond 15 months of age. Children were followed to 36 months. OUTCOME MEASURES: Sociodemographic information, service use, injury episodes, cause of injury, and social risk factors. RESULTS: 371 injury episodes occurred among 817 children. In the study cohort, 7% had >1 injury episode, 26% had one injury, and 67% had none. Among children with >1 injury episode, 78% had at least one social risk factor compared with 63% of children with one injury and 52% of children with none (p<0.0001). Risk factors for >1 injury included maternal substance abuse (p = 0.0003), maternal age under 18 years (p = 0.04), a primary caregiver who was single (p<0.0001) or mentally ill (p = 0.03), and a history of family violence (p = 0.01). Multiple injury episodes were associated with increased non-injury service use, including primary care visits (p<0.0001), emergency department visits (p<0.0001), and total non-injury encounters (p<0.0001). CONCLUSIONS: Children with recurrent injury were more likely to have social risk factors, and used DHMC more frequently, than children with one or no injuries. Children with risk factors for recurrent injury can be identified and injury prevention counseling can be delivered to their families at their multiple visits to the system.     

Chronic acetaminophen overdosing in children: risk assessment and management

Acetaminophen is currently the pediatric analgesic and antipyretic of choice. Although children appear to tolerate single, high-dose ingestions well, the literature is replete with reports of significant morbidity and mortality after repeated supra-therapeutic dosing. Proposed risk factors for injury with chronic use include age, total dose, duration, presence of intercurrent febrile illness, starvation, co-administration of cytochrome P450-inducing drugs, underlying hepatic disease, and unique genetic makeup. Evaluation of these children should include serum acetaminophen concentration, prothrombin time, and serum bilirubin and transaminase concentrations. The Rumack-Mathew nomogram should not be used to estimate the risk of hepatotoxicity in cases of chronic ingestion. Based on history, clinical examination, and laboratory findings, patients may be placed in three categories: those without hepatic injury and with no residual acetaminophen to be metabolized, those without injury but with some acetaminophen to be metabolized, and those with hepatotoxicity. Those without injury and no residual acetaminophen need not be treated or followed. Patients with hepatotoxicity or potential for hepatotoxicity based on residual acetaminophen should be treated with N-acetylcysteine. Most importantly, because so many parents are unaware of the potential risk of inappropriate dosing, education is the key to preventing future cases.     

The impact of hepatic xanthine oxidase and xanthine dehydrogenase activities on liver function in chronic cholestasis

 Activities of hepatic xanthine oxidase (XO) and xanthine dehydrogenase (XD), serum liver enzymes, and reduced glutathione (GSH) were determined in livers of chronic cholestatic rats. The common bile duct was ligated (CBDL) and rats were randomized to either an untreated group or to treatment with allopurinol, a competitive XO inhibitor, or received a tungsten-supplemented diet to inactivate XO and XD, or received antioxidants vitamin C and vitamin E. One group underwent only sham laparotomy. After 4 weeks, in untreated CBDL animals serum aspartate aminotransferase and bilirubin concentrations were significantly elevated and hepatic GSH was significantly decreased when compared with the sham-operated group. Histochemical and enzymatic determinations of XD and XO showed a significant increase in hepatic XO activity after CBDL. Treatment with allopurinol and a tungsten-supplemented, molybdenum-free diet significantly attenuated serum liver enzymes, hepatic XO activity, and improved hepatic GSH levels, whereas vitamins C and E had a positive effect only on hepatic GSH levels. Our results support the hypothesis that cholestasis-induced hepatocellular injury is partially triggered by oxidative processes derived from increased hepatic XO activity. Inhibition and inactivation of XO exerts a hepatocellular protective effect in chronic cholestasis.     

早产儿胃肠外营养相关性胆汁淤积症的临床特征

目的 分析早产儿胃肠外营养相关性胆汁淤积症(PNAC)的临床特点及影响因素,探讨预后.方法 对2007年7月至2009年6月,我院新生儿监护室的159例接受＞14 d胃肠外营养(PN)的体重＜2000 g和(或)胎龄＜34周的早产儿进行分析,以其中发生PNAC的40例作为PNAC组,另将剩余的119例非胆汁淤积患儿作为对照组.观察PNAC组患儿的胆汁淤积发生时间、持续时间、胆汁淤积程度及肝功能损害情况.分析PANC的相关因素.结果 PNAC平均发生在胃肠外营养后(3.3±1.6)周,一般持续(13.3±5.4)周,其直接胆红素峰值为(135.2±65.5)μmol/L;PNAC患儿中73.7%伴有肝功能损害,肝损一般发生于胃肠外营养后(6.6±3.0)周,常持续(9.5±5.4)周,谷丙转氨酶峰值(121.5±48.4)U/L,谷草转氨酶峰值(239.8±122.3)U/L.对可能的PNAC相关因素进行Logistic回归分析提示开始喂养时间、PN持续时间、窒息、SGA、颅内出血与PNAC的发生相关.结论 PNAC的预后良好.在条件允许下,尽早的肠内喂养、缩短PN时间、避免一些并发症如窒息、败血症、颅内出血等可以减少PNAC的发生.

Abstract：

Objective To analyze the clinical features and influential factors of parenteral nutrition associated cholestasis (PNAC) in preterm infants. Method A total of 159 infants with birth weight less than 2000 grams and/or gestational age less than 34 weeks were exposed to parenteral nutrition for longer than 14 days in NICU during the period from July 2007 to June 2009. Of these infants, 40 cases who had PNAC were aligned into the PNAC group, and the other 119 cases without PNAC were aligned into the nonPNAC group. PNAC occurring time, duration, the degree of PNAC and hepatic injury were observed.Logistic regression analysis was performed to evaluate the correlative factors of PNAC. Result PNAC occurred about (3.3 ± 1.6) weeks after beginning PN, usually lasted for (13.3 ± 5.4) weeks. The maximum direct bilirubin was ( 135.2 ± 65. 5 ) μmol/L. Of the PNAC patients, 73.7% suffered from hepatic injury. Hepatic injury usually occurred ( 6. 6 ± 3.0 ) weeks after beginning PN, and lasted for (9. 5 ±5.4) weeks. The highest alanine aminotransferase (ALT) was ( 121.5 ±48.4) U/L. The logistic regression of the possible correlative factors showed that time to start enteric feeding, persistence time of PN,asphyxia, small for gestational age, intracranial hemorrhage, were related to PNAC. Conclusion The prognosis of PNAC was good. Early enteral feeding, shorter time of PN, avoidance of the complications such as asphyxia and sepsis, were the important measures to lower PNAC.     

Management of blunt hepatic injury in children: usefulness of emergency transcatheter arterial embolization

We reviewed our experience to determine the usefulness of emergency transcatheter arterial embolization (TAE) for severe blunt hepatic injury (BHI) in children. Between 1978 and 2000, 21 children with BHI (14 boys and 7 girls, ranging in age from 2 to 14 years) were managed according to our protocol. The patients who were hemodynamically stable, and had no other associated injury requiring laparotomy, regardless of the hepatic injury grade, were managed nonsurgically. Emergency angiography and TAE performed after a CT scan revealed extravasation of the contrast medium. Of the 21 patients, 3 underwent emergency laparotomy; 2 due to hemodynamic instability despite fluid resuscitation (1 died), and the 3rd patient because of associated injury. The other 18 patients (86%) were initially managed nonsurgically; however, 2 underwent delayed laparotomy because of complications (1 each of suspected delayed hepatic hemorrhage and liver abscess). Nonsurgical management was completed in the remaining 16 (89%) with no morbidity and mortality. Two of the 16 returned to a hemodynamically stable condition with fluid resuscitation, but were compromised with persistent hepatic hemorrhage, and were successfully treated with emergency TAE. We propose that emergency TAE should be considered as an initial treatment for severe BHI in children.     

The epidemiology of injuries in 4 child care centers

OBJECTIVES: (1) To describe the pattern of injury in preschool-aged children in 4 child care centers as compared with the results of other studies; (2) to compare injury rates by sex, age, and child care center; and (3) to examine environmental and child factors contributing to injury severity. DESIGN: A 2-year cohort study of 362 preschool-aged children attending 4 urban child care centers. Teachers completed standardized injury forms on the type of injury, body location, site of injury, and contributing factors. RESULTS: During the 2 years of the study, 1886 injuries were reported. The mean and median child injury rate was 6 and 4 injuries per 2000 exposure hours (equivalent to 1 full-time child care year), respectively. The majority of injuries (87%) were minor, occurred during free play (81%) and on the playground (74%), and were precipitated by child-related factors (59%), such as being pushed. Boys had significantly higher median injury rates than girls. Age-adjusted injury rates for each child care center were significantly different by center (F3 = 61, P<.001). While moderate to severe injuries were more often precipitated by combinations of child and environmental factors (chi2(4) = 20, P<.001), minor injuries were usually precipitated by child-related factors. CONCLUSIONS: Injury data from child care centers are important for identifying common risk factors for frequent or severe injury events and for designing injury prevention programs. More research is needed to identify factors contributing to injuries, such as children's behavior and the child care centers' physical and socioemotional environments.     

Factors affecting the severity of motor vehicle traffic crashes involving young drivers in Ontario.

OBJECTIVES: To assess the factors affecting the severity of motor vehicles traffic crashes involving young drivers in Ontario. POPULATION: Ontario young drivers, aged 16 to 20, involved in traffic crashes resulting in injury, between 1 January 1988 and 31 December 1993, on public roads in Ontario. METHODS: Population based case-control study. Cases were fatal injury, major injury, and minor injury crashes involving young drivers. Controls were minimal injury crashes involving young drivers. Cases and controls were obtained retrospectively from the Canadian Traffic Accident Information Databank. Unconditional logistic regression was used for data analysis. RESULTS: Factors significantly increasing the risk of fatal injury crashes include: drinking and driving (odds ratio (OR) 2.3), impairment by alcohol (OR 4.8), exceeding speed limits (OR 2.8), not using seat belts (OR 4.7), full ejection from vehicle (OR 21.3), intersection without traffic control (OR 2.2), bridge or tunnel (OR 4.1), road with speed limit 70-90 km/hour (OR 5.6) or 100 km/hour (OR 5.4), bad weather (OR 1.6), head-on collision (OR 80.0), and overtaking (OR 1.9). Results of the same model applied to major and minor injury crashes demonstrated consistent but weaker associations with decreasing levels of crash severity. CONCLUSIONS: A casual relationship between crash severity and the risk factors listed above was proposed. Risk factors recommended for preventive intervention include: alcohol consumption, speeding, and use of seat belts. Head-on collisions are of primary concern.     

婴幼儿医源性胆管损伤的外科处理

目的 探讨婴幼儿医源性胆道损伤的手术方式。方法对我院1996年以来4例医源性胆道损伤，分别纵形切开肝总管前壁或左、右肝管汇合部前壁后，行肝肠Roux-Y吻合。结果此组病儿均获随访，无一例发生吻合口狭窄及返流性胆管炎，疗效满意。结论纵形切开肝总管前壁或汇合部前壁，切口大于1．5cm单层内翻缝合的肝肠Roux-Y端侧吻合是治疗医源性胆管损伤的有效方法。     

儿童闭合性肝外伤临床诊治分析

目的探讨儿童闭合性肝外伤的临床特点和诊治方法。方法回顾性分析安徽省儿童医院2012年12月至2018年6月收治的42例肝外伤患儿临床资料,依据治疗方法的不同分为保守治疗组(n=34)和介入治疗组(n=8),依据病史、腹部体征、有无合并伤、收缩压、血红蛋白、谷丙转氨酶、血胆红素、凝血酶原时间、美国创伤外科协会(American Association for the Surgery of Trauma,AAST)肝脏损伤分级等指标进行综合分析,选择恰当治疗方式。结果本组42例闭合性肝外伤患儿中,保守治疗34例,治愈33例,治愈率为97.1%,1例因脑疝死亡。1例包膜下延迟性血肿破裂予介入止血,1例肝右前叶裂伤活动性出血行清创性肝部分切除加肝修补术,2例胆漏和2例肝周脓肿患儿予B超引导下定位穿刺引流,1例肺部感染;除1例死亡外,其余患儿痊愈出院。介入治疗组共8例患儿,治疗成功率100%,其中2例发生胆漏的患儿经B超引导定位穿刺引流,痊愈出院。所有患儿随访未见出血、胆道狭窄的发生。两组患儿治疗前后收缩压、血红蛋白、谷丙转氨酶及血胆红素比较差异有统计学意义(P<0.05),而凝血酶原时间比较差异无统计学意义(P>0.05)。结论大部分Ⅰ、Ⅱ级闭合性肝外伤患儿通过保守治疗可治愈,小部分患儿需要手术治疗;血流动力学稳定的Ⅲ、Ⅳ级肝外伤可首选介入治疗,既能明确诊断,又能及时治疗。     

Hepatic Adenomatosis in a 7-Year-Old Child Treated Earlier With a Fontan Procedure

Patients who undergo a Fontan procedure experience some degree of liver disease. Hemodynamic changes such as central venous hypertension, depressed dynamic cardiac output, and late ventricular dysfunction combined with long-standing hypoxia preceding the Fontan procedure all are recognized risk factors for hepatic injury. The histopathologic changes associated with cardiac hepatopathy include chronic passive congestion, centrilobular necrosis, and cardiac cirrhosis. However, hepatic adenoma and hepatic adenomatosis (HA) are not well-known pathologies during the course of cardiac hepatopathy. This study focused on a 7-year-old girl with chronic hepatic changes and HA who had undergone a Fontan procedure. Hepatic adenomatosis was diagnosed on the basis of magnetic resonance imaging (MRI) and MRI-guided liver biopsy. To the best of the authors’ knowledge, this case involved the youngest patient with hepatocellular adenomatosis documented in the literature. It was a unique case because the patient experienced HA after a Fontan procedure.     

新生儿重度窒息器官损害及死亡危险因素分析(英文)

目的：回顾性分析我院170例新生儿重度窒息的临床情况及各脏器受累损伤程度,了解与死亡有关的危险因素。方法：对1993～2004年我院NICU收治的重度窒息新生儿170例资料进行分析,用SAS软件对与死亡有关危险因素进行OR分析。结果：170例中死亡22例(12.5%),165例(97.1%)出现各脏器的并发症,各脏器受累机会的次序依次为中枢神经系统,肺,代谢系统等;严重程度依次为代谢,肺,中枢神经系统等。与死亡有关的危险因素依次为中枢神经系统严重受累,1个以上脏器严重受损,呼吸衰竭,代谢紊乱,电解质紊乱,血气异常,肺损害,10分钟Apgar评分≤3,胎龄<37周,肝脏损害,心脏损害,PCO2增高和血液系统损伤。结论：器官/系统损害是除HIE外新生儿重度窒息的主要并发症,严重威胁生命并且可以导致死亡;对于一些造成死亡的危险因素应该引起重视和早期干预。