新生儿常用氧疗方式的安全性评价

目的评价改良鼻导管吸氧、头罩吸氧和暖箱内供氧三种新生儿常用氧疗方式的临床安全性。方法用测氧仪对不同吸氧方式及不同氧流量下患儿的实际吸入氧浓度进行测定。分析氧流量与氧浓度变化的关系。结果改良鼻导管和头罩吸氧时患儿实际吸入氧浓度与氧流量呈正相关。头罩吸氧时低流量（1L／min）即可能对部分新生儿造成过高氧环境（〉50％）；暖箱内供氧在低流量下（1～3L／min）各组之间实际吸入氧浓度无统计学差异。结论现有氧疗方式及常规不完全适用于新生儿，需密切监测实际吸入氧浓度。并应针对新生儿特点进行改进。     

安定治疗新生儿破伤风疗效及安全性探讨

惊厥是新生儿常见急危重的临床症状之一，积极查找病因。及时控制惊厥，是十分必要的。为便于探讨安定在治疗新生儿惊厥过程中的安全性，作者回顾性分析了过去20年中应用安定治疗新生儿破伤风的病例，现将结果报告如下。     

法莫替丁治疗新生儿急性胃黏膜损伤的疗效及安全性观察

急性胃黏膜损伤是新生儿危重疾病常见的并发症。若不及时控制有可能引起消化道大出血，甚至穿孔。目前国外治疗新生儿急性胃黏膜损伤多沿用西咪替丁静脉给．但该药可抑制肝细胞内细胞色素P450氧化酶系统，增加依赖这些酶代谢的药物血清水平和潜在毒性，而法莫替丁的抗H2受体作用较西咪替丁强，对肝脏P450酶系统几     

负荷量苯巴比妥防治新生儿惊厥安全性探讨

苯巴比妥(Phenobarbital,PB)是预防和治疗新生儿惊厥的首选药物。常规剂量PB治疗新生儿惊厥常不能控制发作,近年来国外研究一致认为应给予大负荷量,为探讨PB大负荷量治疗对我国新生儿是否安全、适当,自1986年5月以来我科治疗24例,临床实践表明,PB大负荷量预防、治疗新生儿惊厥是安全的,现报告如下。     

新生儿先天性会厌囊肿2例报告

例1：男、9小时、第一胎第一产，足月顺产儿，出生体重3．2kg，娩出后呈青紫窒息，经清理呼吸道、吸氧治疗紫绀减轻，出现微弱哭声，声音嘶哑，呼吸时可闻及喉鸣伴吸气性呼吸困难，无发热。孕母妊娠8月时，B超发现羊水过多。查休：发育正常，营养一般，颜     

丽珠赛乐在新生儿缺氧缺血性脑病急性期应用的安全性观察

目的观察丽珠赛乐在新生儿缺氧缺血性脑病急性期应用的安全性。方法选取中度缺氧缺血性脑病96例，随机分为观察组和对照组各48例，在进行三支持、三对症基础上观察组于出生后24h即使用丽珠赛乐，5ml／d缓慢静滴，连续使用10～14天；对照组于出生后10—14天使用丽珠赛乐，5ml／d使用10—14天，观察两组用药后相关副反应（抽搐、呕吐、激惹等）。结果观察组患儿使用丽珠赛乐后，无一例发生抽搐等，仅6例发生呕吐，发生率12．5％，对照组有4例发生呕吐，发生率为8．3％，两组呕吐发生率差异无显著性。结论丽珠赛乐在中度缺氧缺血性脑病急性期应用是安全的。     

新生儿高流量鼻导管通气的安全性研究进展

近年来,加热湿化高流量鼻导管通气(HFNC)作为一种无创辅助通气模式越来越多地应用于新生儿重症监护病房,但到目前为止,支持其临床使用安全的相关证据并未充分建立。文章综述影响HFNC安全使用的因素以及相关并发症,为临床应用提供参考。     

积极预防新生儿氧疗并发症

氧疗法是新生儿临床治疗与急救最重要的有效手段之一。新生儿低氧血症是新生儿呼吸功能障碍的常见表现,因肺和/或全身疾病导致通气和/或换气的任何环节障碍所致,严重者伴组织缺氧,进一步引起细胞代谢和器官功能损伤,出现不可逆损伤及严重神经系统后遗症,甚至威胁生命。新生儿出     

法莫替丁治疗新生儿应激性溃疡的疗效及安全性

目的：探讨法莫替丁治疗新生儿应激性溃疡的疗效和安全性。方法：该院2001~2006年共收治新生儿应激性溃疡54例,其中7例经胃镜证实。采用法莫替丁0.5 mg/kg静脉注射,每12 h一次,待止血和胃pH升至4.5~6后改为每天给药1次,连用2 d。同时治疗原发病和合并症以消除应激的病因。监测症状消失的时间和动态监测应用法莫替丁前、后的胃液pH值,统计治愈率;同时监测法莫替丁可能出现的不良反应以及是否增加其他伴用药物的毒性。结果：应用法莫替丁后96.3%的患儿于24 h以内止血、止吐, 100%于48 h以内止血、止吐;胃液pH均值由用药前的2.07±0.22上升并保持在5.01～5.15;用药后呼吸、心率、血压无明显变化,未发现纳差、恶心、呕吐、腹泻、便秘、皮疹等及其他不良反应;用药前、后的白细胞和血小板计数和肝脏酶学检查均无统计学差异;亦未见增加同时应用的其他药物的毒副作用,最后全部治愈。结论：法莫替丁用于治疗新生儿应激性溃疡,疗效好,而且安全。     

围生期常用治疗对新生儿神经发育的影响

新生儿大脑处于不断发育成熟的过程中,围生期的各种干预治疗措施都会直接或间接地影响脑发育过程,糖皮质激素、非甾体类抗炎药、硫酸镁、亚低温治疗、枸橼酸咖啡因、肺表面活性物质、一氧化氮、促红细胞生成素等是围生期的常见药物及治疗,与新生儿的神经发育预后有着密切的关系.该文综述围生期常用治疗是否会直接或间接地对新生儿的神经发育产生不利影响.     

Measurement of systemic oxygen delivery and inotropy in healthy term neonates with the Ultrasonic Cardiac Output Monitor (USCOM)

Introduction

The aim of this study was to assess the normal values for Smith–Madigan inotropy (SMI), Smith–Madigan inotropy index (SMII), oxygen delivery (DO₂) and oxygen delivery index DO₂I in healthy term neonates on the first day of life and during circulatory adaptation over the first three days of life.

Methods

Hemodynamics of the left heart were measured non-invasively in 71 normal full-term neonates over the first three days using the Ultrasonic Cardiac Output Monitor (USCOM). This was combined with hemoglobin concentration from umbilical cord blood and pulse oximetry to calculate DO₂ and DO₂I. Blood pressure was measured using automated oscillometry and combined with the hemodynamic measures and hemoglobin concentration using the Smith–Madigan method to calculate inotropy (SMI) and inotropy index (SMII).

Results

SMI and SMII showed no significant change during the study period, ranging from 154 to 168 mW and 694 to 731 mW/m². Mean (SD) DO₂ and DO₂I showed a significant fall over three days from 131 (63) ml/min and 596 (278) ml/m²/min to 118 (46) ml/min and 517 (173) ml/m²/min (p < 0.01 and < 0.001 respectively) with a corresponding decrease in cardiac output from 758 (143) ml/min to 658 (131) ml/min, (p = 0.002). There was no significant change in stroke volume, heart rate, SMI or SMII within the first day. DO₂ and DO₂I showed small but significant decreases within the first day from 153 (46) ml/min and 699 (174) ml/min/m² to 129 (36) ml/min and 609 (141) ml/min/m² (p = 0.017 and 0.048 respectively).

Conclusions

Normal inotropy of the left heart and systemic DO₂ values in healthy full-term neonates over the first three days of life were assessed using the USCOM. Subjects showed stable myocardial contractility over the first three days with decreasing DO₂ and DO₂I in line with the decrease in cardiac output (CO). DO₂ and DO₂I showed small but significant reductions during the first 24 h. USCOM proved to be a feasible and convenient non-invasive bedside tool to assess inotropy and oxygen delivery in neonates.     

超长期需氧疗新生儿资料分析

目的 了解新生儿重症监护室内新生儿用氧情况及长期需氧疗发生率及临床特点.方法 回顾性分析2009年10月至2011年5月我院新生儿重症监护室收治的12 155例新生儿用氧情况及相关临床资料,并与国内19所医院调查结果进行比较.结果 在纳入的12 155例新生儿中,足月儿4 951例,早产儿7 204例,共有102例用氧超过28 d,发生率为0.84％(102/12 155).102例患儿中,早产儿88例,足月儿14例;出生胎龄(31.16±3.70)周;出生体重(1.60±0.68) kg;用氧时间(40.62±12.25)d;治愈或好转98例,死亡4例.7204例早产儿按持续吸氧超过生后28 d的标准,支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生率为1.22％(88/7204).出生胎龄32周以下的早产儿,如以需氧疗时间超过生后28 d为标准,BPD发生率为4.92％(68/1 381),如以需氧疗时间超过矫正胎龄36周为标准,BPD发生率仅为2.10％(29/1 381),两者BPD发生率比较差异有统计学意义(x2=16.251,P＜0.001).整体比较5 499例不同出生胎龄患儿的用氧比例(x2=119.99)、吸氧持续时间(F=109.27),差异均有统计学意义(P＜0.001),但不同胎龄长期氧依赖患儿的平均用氧和机械通气时间差异无统计学意义(P＞0.05).不同胎龄的长期氧依赖患儿在肺表面活性物质应用、心力衰竭、早产儿视网膜病变、先天性心脏病及其他先天畸形发生率和预后方面差异有统计学意义(x2=8.789,13.538,23.176,7.778,8.842,8.246,P＜0.05).我院与国内19所医院调查数据比较,患儿校正超长期用氧率分别为0.99％ (71/7 204)和1.54％( 190/12 351),差异有统计学意义(x2=10.558,P＜0.001).结论 我院住院早产儿BPD发生率较低.胎龄小、肺发育不成熟及继发的肺损伤可能是需超长期用氧的主要原因.较大胎龄新生儿长期氧依赖应注意除外先天性心脏病、先天畸形等因素.胎龄32周以下早产儿BPD诊断标准仍有待商榷.     

新生儿呼吸衰竭时氧交换指标监测的临床意义

目的探讨新生儿呼吸衰竭时氧交换指标动态监测在临床的意义。方法对新生儿重症监护病房接受呼吸机治疗的120例呼吸衰竭新生儿,予行血气、动脉氧分压与吸入氧浓度之比、动脉/肺泡氧分压比值、肺泡-动脉氧分压差、呼吸指数等指标的动态监测,并根据其病情分组进行对比观察。结果轻度呼吸衰竭组与重度呼吸衰竭组两组间各项氧交换指标均有显著性差异(P<0.05);生存组治疗前与治疗24h后的氧交换指标比较,有非常显著性差异(P<0.001);死亡组治疗前与治疗24h后动脉/肺泡氧分压比值变化差异无显著性(P>0.05)。结论应用氧交换指标对呼吸衰竭的新生儿进行临床评估,对判断病情、指导治疗和估计预后有重要意义。     

新生儿呼吸衰竭时氧交换指标监测的临床意义

目的 探讨新生儿呼吸衰竭时氧交换指标动态监测在临床的意义。方法对新生儿重症监护病房接受呼吸机治疗的120例呼吸衰竭新生儿，予行血气、动脉氧分压与吸入氧浓度之比、动脉／肺泡氧分压比值、肺泡-动脉氧分压差、呼吸指数等指标的动态监测，并根据其病情分组进行对比观察。结果轻度呼吸衰竭组与重度呼吸衰竭组两组间各项氧交换指标均有显著性差异（P〈0．05）；生存组治疗前与治疗24h后的氧交换指标比较，有非常显著性差异（P〈0．001）；死亡组治疗前与治疗24h后动脉／肺泡氧分压比值变化差异无显著性（P〉0．05）。结论应用氧交换指标对呼吸衰竭的新生儿进行临床评估，对判断病情、指导治疗和估计预后有重要意义。     

Arterial oxygen saturation in healthy term neonates

Our objective was to determine arterial oxygen saturation as measured by pulse oximetry (SpO₂) in healthy term neonates during their first 4 weeks of life. Overnight recordings of SpO₂ (Nellcor N200), photoplethysmographic (pulse) wave-forms from the oximeter and breathing movements were performed in 60 term infants. They were studied initially during their 1st week of life (median age 4 days, range 1–7) and then again during their 2nd–4th week (median age 17 days, range 8–27). Median baseline SpO₂, measured during regular breathing, was 97.6% (range 92–100) during week 1 versus 98.0% (86.6–100) during week 2–4 (P>0.05). Episodes of desaturation, defined as a fall in SpO₂ to 80% for 4 s, were found in 35% of recordings obtained in week 1 compared to 60% of those obtained in week 2–4 (P<0.01). Their frequency increased from a median of 0 (0–41) per 12 h of recording at the initial recording to 1 (0–165) at follow up (P<0.01). Analysis of the data by week of life showed a peak in desaturation frequency in the 2nd week of life. The infants with extreme values at follow-up (e.g. a baseline SpO₂ of 86.6%, 5th percentile 91.9%, or a desaturation frequency of 165 per 12 h of recording, 95th percentile 32) had had values well within the normal range during their initial recording (a baseline SpO₂ of 94.4%, or a desaturation frequency of 4). Most of the desaturations in the infants with extreme values were associated with periodic apnoea. These results demonstrate only relatively minor developmental changes in oxygenation in term neonates during the first 4 weeks of life. The clinical significance of outlying values, i.e. a low baseline SpO₂ or a high number of episodic desaturations, remains to be determined.Conclusion These healthy term neonates had values for baseline oxygen saturation and desaturation frequency that were not substantially different from those observed in older infants.     

Enterovirus infections in neonates

Enteroviruses, which include echoviruses, coxsackie A and B viruses, polioviruses and the ‘numbered’ enteroviruses, are among the most common viruses causing disease in humans. A large proportion of enteroviral infections occur in neonates and infants. There is a wide spectrum of clinical manifestations that can be caused by enterovirus infection with varying degrees of severity. In the neonatal age group, enteroviral infections are associated with significant morbidity and mortality, particularly when infection occurs antenatally. This review provides a detailed overview of the epidemiology and clinical features of enterovirus infections in the neonatal period. In addition, laboratory features and diagnostic investigations are discussed. A review of the currently available data for prophylactic and therapeutic interventions, including antiviral therapy, is also presented.     

Assessment of use of spacer devices for inhaled drug delivery to asthmatic children

In the treatment of bronchial asthma, inhaled therapy with both bronchodilators and corticosteroids represents the basis for acute and long-term management. Drug therapy in asthma is predominantly by pressurized metered dose inhalers. The impact of treatment on the disease morbidity and mortality depends to a large extent on appropriate delivery of drug to the lungs by means of a spacer device. We performed an audit on spacer use in 200 children and showed that 99% owned a spacer, 2% owned but did not use their spacer, 11% were using a spacer which was not ideal for their age, 17% had a poor technique, and 24% were not following the recommendations given on previous visits to wash the spacer only with a soapy solution. Although physicians frequently associate poor control of asthma with inadequate doses of drugs, many factors must be considered before increasing the dose of inhaled medications to children. We should all ensure that the drugs we prescribe are delivered in the best possible manner, thus improving control of asthma, reducing side effects and offering a more cost-effective therapy.