新生儿危重症评分与极低出生体重儿神经预后相关性的研究进展

新生儿危重症评分是一种评估新生儿疾病危重程度、预测死亡风险的评分系统,其对神经预后的评价亦有重要的参考价值。由于各种新生儿危重症评分具有不同的评估内容,对神经预后的评估效能也存在差异。新生儿急性生理学评分、新生儿急性生理学评分-Ⅱ、新生儿急性生理学评分围生期补充-Ⅱ、婴儿神经生物学危险评分等对远期神经预后均有良好的预测价值,而新生儿临床危险指数、新生儿临床危险指数-Ⅱ的预测价值尚未确定。该文对多种新生儿危重症评分与极低出生体重儿(VLBWI)神经预后的相关性研究进行综述,为VLBWI神经损伤的早期识别和预后判断提供参考。     

2015围产期窒息、新生儿复苏和新生儿危重症诊治专题研讨会征文通知

中华医学会围产医学分会新生儿复苏学组定于2015年7月30日至8月1日在广东省深圳市召开"2015围产期窒息、新生儿复苏和新生儿危重症诊治专题研讨会",本次会议将以"围产期窒息、新生儿复苏和新生儿危重症诊治"为主题,邀请我国大陆、港台地区及国外知名专家做专题报告,欢迎围产同道踊跃参加。参会者可获得国家级Ⅰ类继续教育学分。会议征文主要内容:(1)围产期窒息:包括胎儿宫内窘迫、胎儿监护、新生儿窒息的诊断、对Apgar评分的评价等;     

新生儿持续肺动脉高压的诊断与鉴别诊断

新生儿持续肺动脉高压是新生儿期的危重症,正确的诊断和鉴别诊断对临床合理处理有重要意义.本文对新生儿持续肺动脉高压的临床表现与诊断的关系、相关的临床诊断程序、辅助检查方法及常见需要鉴别的疾病等进行介绍,重点对肺动脉高压的超声诊断方法进行了评价.     

危重新生儿动态血小板计数监测

随着小儿急救医学的发展,危重新生儿抢救成功率逐渐提高.但对临床血小板计数的变化在危重症新生儿中是否可作为监测及评分指征存在置疑.2001～2004年我们对新生儿重症监护病房的危重新生儿的血小板计数进行了动态监测.     

96例危重新生儿高血糖症及胰岛素治疗

目的　 观察危重症新生儿高血糖的发生及胰岛素治疗的临床意义。 方法 　对 16 8例危重症新生儿进行血糖监测。轻中度高血糖患儿采用限糖治疗 ,重度高血糖患儿随机分为限糖治疗组 ( 30例 )及小剂量胰岛素治疗组 ( 2 9例 ) ,观察血糖下降速度及预后。 结果 　发生高血糖症 96例 ,患病率为 5 7 1%,且危重症评分越高 ,其血糖值也越高。轻中度高血糖症患儿 ,限糖治疗后第 2天血糖下降正常者达 75 7%,而重度高血糖症患儿应用胰岛素组与未用胰岛素组相比 ,入院 2 4h时血糖控制情况分别为 ( 5 2 3± 1 5 )mmol/L与 ( 7 79± 1 38)mmol/L(P <0 0 1) ,病死率明显下降 ,分别为 13 8%与 40 0 %(P <0 0 5 )。 结论 　危重症新生儿病情越重 ,血糖水平越高。轻中度高血糖症经限糖治疗即可有效控制血糖水平 ,而重度高血糖症应用小剂量胰岛素治疗后可有效阻止血糖的进一步升高 ,减少危重症新生儿的病死率。     

新生儿危重症伴抗利尿激素异常分泌综合征的相关因素分析

目的　探讨新生儿危重症伴抗利尿激素异常分泌综合征 (SIADH)的相关因素。方法　对 16 4例危重新生儿通过监测血钠及血渗透浓度 ,尿钠及尿渗透浓度判断是否存在SIADH ,用Logistic回归方法找出引起新生儿SIADH的相关因素。结果　颅内疾患、肺部疾患和不适当的液体输入是引起新生儿危重症SIADH的危险因素。结论　危重新生儿易发生SIADH ,增加救治难度 ,适当控制危重新生儿液体入量可有效地控制SIADH的发生。     

危重新生儿高渗血症临床探讨

目的观察危重新生儿高渗血症的发生及其临床意义。方法对所有入院的危重新生儿即进行电解质、血糖、尿素氮、血气等测定,按公式计算出血渗透浓度。结果152例危重新生儿发生高渗血症48例,极危重组(新生儿危重症评分≤70分)的高渗血症患儿有19例,一般危重组(新生儿危重症评分70~90分)有29例,极危重组患儿血糖、血渗透浓度和病死率较一般危重组患儿明显升高,P<0.01,而其pH值比一般危重组低,P<0.05,两组比较有统计学意义。血渗透浓度>320 mmol/L组病死率为66.67%,较290~320 mmol/L组明显升高,P<0.01。结论危重新生儿高渗血症有其临床特点,高糖血症参与的高渗血症比例高,极危重组高渗血症及血渗透浓度>320 mmol/L的患儿预后差。     

危重新生儿高渗血症临床探讨

目的 观察危重新生儿高渗血症的发生及其临床意义。方法 对所有入院的危重新生儿即进行电解质、血糖、尿素氮、血气等测定，按公式计算出血渗透浓度。结果 152例危重新生儿发生高渗血症48例，极危重组（新生儿危重症评分≤70分）的高渗血症患儿有19例，一般危重组（新生儿危重症评分70～90分）有29例，极危重组患儿血糖、血渗透浓度和病死率较一般危重组患儿明显升高，P〈0．01．而其pH值比一般危重组低，P〈0．05，两组比较有统计学意义。血渗透浓度〉320mmol／L组病死率为66．67％．较290～320mmol／L组明显升高，P〈0．01。结论 危重新生儿高渗血症有其临床特点，高糖血症参与的高渗血症比例高，设危重组高渗血症及血渗透浓度〉320mmol／L的患儿预后差。     

“2012北大新生儿危重症论坛”通知

为提高危重症新生儿诊断和抢救治疗水平,分享最新学术进展,加强新生儿专业医师间的学术交流,北京大学第一医院(北大医院)儿科重症医学专业将于2012年4月19～22日在北京举办"2012北大新生儿危重症论坛"。论坛期间,北大医院新生儿专业及儿科重症医学专业的     

“2012北大新生儿危重症论坛”通知

为提高危重症新生儿诊断和抢救治疗水平,分享最新学术进展,加强新生儿专业医师间的学术交流,北京大学第一医院(北大医院)儿科重症医学专业将于2012年4月19～22日在北京举办"2012北大新生儿危重症论坛"。论坛期间,北大医院新生儿专业及儿科重症医学专业的     

几种新生儿危重评分的比较

新生儿危重评分是一种评估疾病危重程度,预测死亡风险的评分系统,用以指导新生儿重症监护室的临床工作,对我国日益发展的新生儿医学有其必要性和重要性.该文着重介绍并比较了几种国际上常用的危重评分系统.与新生儿急性生理学评分、新生儿急性生理学评分围生期补充及国内新生儿危重评分相比,新生儿临床危险指数、新生儿急性生理学评分-Ⅱ、新生儿急性生理学评分围生期补充-Ⅱ及新生儿临床危险指数-Ⅱ的变量更精简,分度更科学,评分时间缩短,预测死亡风险的准确性较高,具有更高的实用及推广价值.     

新生儿危重病例评分与临床危险指数评分预测极低出生体重儿死亡风险的比较

目的探讨新生儿危重病例评分(NCIS)与新生儿临床危险指数(CRIB)评分对极低出生体重儿死亡风险评估的价值。方法对93例早产儿按不同胎龄、体重分组进行NCIS,其中42例胎龄<31周或出生体重<1.5kg者再进行CRIB评分,将两种评分结果进行比较。结果①胎龄越小、体重越轻,疾病危重评分分值越低,胎龄<31周或出生体重<1.5kg者明显低于≥31周或出生体重≥1.5kg者,其差异有显著性(P均<0.05雪;②死亡病例NCIS明显低于非死亡病例,CRIB评分明显高于非死亡病例,差异有显著性(P均<0.05雪;③NCIS与新生儿CRIB评分两者间呈负相关,r=-0.383,P<0.01。结论NCIS与CRIB评分均可较好地判断极低出生体重儿的疾病危重度,预测死亡风险,且两者相关性好。     

新生儿危重病例评分与新生儿急性生理学评分围产期补充Ⅱ的应用比较

目的探讨新生儿危重病例评分(NCIS)与新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)两种评分系统预测危重新生儿死亡放弃风险的准确度及临床实用性。方法 269例危重新生儿根据病情转归分为死亡放弃组及好转治愈组,比较两种评分系统预测死亡放弃风险的准确度。结果死亡放弃组患儿的SNAPPE-Ⅱ得分明显高于好转治愈组患儿,差异有统计学意义(P0.001),两组患儿NCIS评分的差异无统计学意义(P=0.091),而符合单项指标的患儿死亡放弃风险明显高于不符合单项指标患儿(P=0.005)。结论 SNAPPE-Ⅱ在危重新生儿死亡放弃风险的早期预测中具有更高的准确性,NCIS中单项指标对预测病情转归有指导意义。     

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目的 比较新生儿危重病例评分(NCIS)与美国新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)在危重新生儿死亡风险预测方面的优越性,探索适合我国新生儿疾病危重度判断的评分系统。方法 对2008年1-12月入住东南大学附属中大医院新生儿重症监护室(NICU)的525例患儿同时采用NCIS和SNAPPE-Ⅱ两种评分系统进行评分,根据评分将入组病例分为极危重、危重、非危重3组,分别对各组病死率进行比较,并描绘受试者工作特征曲线(ROC),比较ROC曲线下面积(AUC),以观察两种评分系统在预测危重新生儿死亡风险的特异度及灵敏度。结果 非危重组、极危重组中,NCIS评分及SNAPPE-Ⅱ的病死率比较,差异无统计学意义(P>0.05);危重组中,两种评分病死率比较,差异有统计学意义(P<0.05);AUC分别为NCIS评分0.934,SNAPPE-Ⅱ评分0.926,两组差异无统计学意义(P>0.05)。结论 NCIS评分对危重新生儿的筛出能力较强,但对临床决策无早期指导作用。SNAPPE-Ⅱ评分能早期、较准确预测患儿死亡风险,临床应用较简便,宜推广使用。     

需要机械通气的极低出生体重儿院内病死率及病死风险因素的前瞻性研究

目的：描述危重极低出生体重儿（VLBWI）的临床特征、接受治疗状况及其转归,评估其病死风险相关因素,评价CRIB、SNAPPE-II评分系统预测我国早产儿病死风险的价值。方法：对2010年1月至2011年10月间新生儿重症监护室（NICU）收治的127例需要机械通气的VLBWI进行前瞻性数据收集。结果：纳入患儿平均胎龄为31±2 周,平均体重为1290±170 g,男女比例为1.23∶1,超低出生体重儿占6.3%。接受肺表面活性剂（PS）治疗者占 48.0%;接受气管插管机械通气的患儿占49.6%。总的院内病死率为41.7%。低出生体重、多胎分娩、剖宫产、低PaO2/FiO2比值是病死的独立风险因素,OR值分别为1.611、7.572、4.062、0.133,P<0.05。SNAPPE-II和CRIB评分系统可较好地预测病死转归,ROC曲线下面积分别为0.806、0.777。结论：VLBWI总的病死率仍处于较高水平;低出生体重、多胎分娩、剖宫产、低PaO2/FiO2比值是VLBWI病死的高危因素。应用新生儿危重评分系统可对研究对象疾病危重程度进行量化。     

Changes in the differential white blood cell count in screening for group B streptococcal sepsis

We compared several previously defined scoring systems using white blood cell indices as part of a retrospective evaluation of infants with early onset Group B streptococcal (GBS) sepsis. Nineteen newborns were diagnosed with GBS sepsis between January, 1988, and April, 1990. Case controls (n = 33) were selected from patients admitted to the Neonatal Intensive Care Unit for suspected sepsis. Complete blood counts obtained at admission and between 12 and 24 hours of age were reviewed. There was a significant change in the ratio of immature to total neutrophils in the GBS group over time. Scoring systems for neonatal sepsis by Manroe et al., Rodwell et al. and Spector et al. had poor sensitivity, specificity, positive predictive value and negative predictive value when initial white blood cell count criteria were used, but scoring systems by Manroe and Rodwell were 100% sensitive and had 100% negative predictive value when applied to the repeat white blood cell count. We conclude that a single early complete blood count may not be an adequate screening tool for early onset GBS sepsis and should not be used to rule out infection. Optimal screening for GBS sepsis requires a repeat complete blood count within the first 24 hours of age.     

Delivery care utilisation and care-seeking in the neonatal period: a population-based study in Vietnam

BACKGROUND: If millions of neonatal deaths each year are to be prevented, one crucial component that must be improved is adequate care-seeking behaviour and effective use of existing health care systems. We have investigated these factors in relation to delivery and the neonatal period in a province in Northern Vietnam, a setting currently in socio-economic transition. METHODS: Information on births and neonatal deaths between January and December 2005 in Quang Ninh province was collected. Narratives of the neonatal deaths were gathered and information about care-seeking in relation to delivery and illness was extracted. This information was then compared with the time and place of delivery and death. RESULTS: We registered 17,519 births and 284 neonatal deaths occurring between January and December 2005. The neonatal mortality rate varied from 7.5/1000 to 38/1000, depending on the place of delivery. A quarter of the neonatal deaths had no contact with the health-care system at the time of death. Neonatal death within 24 hours of birth was more likely when the mother did not seek care at the time of delivery, or did so at the lowest level of the system (chi2=35.5, p<0.001). Mothers of ethnic minorities were more likely to exhibit this care-seeking behaviour at delivery. CONCLUSION: Further improvement in neonatal survival can be achieved by changes in health system utilisation that aim to secure safe delivery for pregnant women. More efforts at local level are needed to encourage adequate care-seeking.     

Growth trajectories of preterm infants: birth to 12 years.

INTRODUCTION: Birth weight often is used to predict how preterm infants will grow, but scant attention has been paid to the effect of neonatal morbidities on growth trajectories. We investigated birth weight and neonatal morbidity in preterm infants' growth to age 12 years. METHOD: A five-group, prospective, longitudinal study was conducted with 194 infants: 46 full term; 29 healthy preterm without morbidity; 56 preterm with medical illness (MPT); 34 preterm with neurologic illness; and 29 preterm small for gestational age (SGA). Height, weight, and body mass index were measured at six ages. RESULTS: The full-term group had greater height than the preterm groups to age 8 years, when healthy preterm and MPT groups caught up. Only the SGA group had smaller height at age 12 years. The MPT, preterm with neurologic illness, and SGA groups had lower weight through age 12 years. Body mass index was appropriate for preterm groups by age 4 years. Across time, neonatal morbidity had a significant effect on height and weight trajectories. Birth weight was significant for weight trajectories only. DISCUSSION: With variation in growth trajectories, details of neonatal morbidity in health history interviews will inform child health assessments.     

Necrotising enterocolitis in older infants.

Thirteen children, ranging in age from 45 days to 2 years, had severe gastrointestinal illness with the features characteristic of neonatal necrotising enterocolitis. All 13 children had preceding gastroenteritis leading to hypovolaemia. Necrotising enterocolitis can occur in children beyond the neonatal age group and it may occur as a sequel to gastroenteritis.     

Necrotising enterocolitis in older infants

Thirteen children, ranging in age from 45 days to 2 years, had severe gastrointestinal illness with the features characteristic of neonatal necrotising enterocolitis. All 13 children had preceding gastroenteritis leading to hypovolaemia. Necrotising enterocolitis can occur in children beyond the neonatal age group and it may occur as a sequel to gastroenteritis.