新生儿高胆红素血症对其神经行为及预后的影响

目的　探讨新生儿高胆红素血症 (高胆 )对神经行为及预后的影响。方法　对 38例高胆新生儿及2 4例健康新生儿均行新生儿神经行为评分 (NBNA)和脑干听觉诱发电位 (BAEP)检测 ,幼儿期用婴幼儿智力发育量表 (CDCC)测定智力发育。结果　高胆组BAEP异常率明显高于对照组 (P <0 .0 1) ,两组Ⅰ、Ⅴ波潜伏期比较差异显著 (P <0 .0 1,P <0 .0 5 )。高胆组NBNA评分明显低于对照组 (P <0 .0 0 1) ,血清胆红素 (≥ 2 0 4 μmol/L)与NBNA评分呈显著负相关 (P <0 .0 1) ,围生因素、溶血、感染在黄疸高峰期NBNA评分明显低于对照组 (P <0 .0 1)。高胆组智力发育指数 (MDI)、心理运动发育指数 (PDI)与对照组比较差异显著 (P <0 .0 1,P <0 .0 5 ) ,智能分级比较 ,对照组明显优于高胆组 (P <0 .0 0 1)。结论　不同程度高胆均可影响新生儿神经行为能力和智能发育。新生儿高胆均应积极治疗 ,尽量减少后遗症的发生     

高胆红素血症对新生儿神经行为及其预后的影响

探讨高胆红素血症对新生儿神经行为及其预后的影响,通过对38例高胆患儿在新生儿期进行神经行为评分(NBNA)检测、婴幼儿期用婴幼儿智力发育量表(CDCC)测定智力发育.结果显示高胆组NBNA评分明显低于对照组(P＜0.001),主要失分项目为行为能力和主动肌张力.在血清胆红素≥204 μmol/L时,胆红素水平与NBNA评分呈显著负相关(P＜0.01);围产因素、溶血、感染组在黄疸高峰期NB-NA评分低于对照组(P＜0.01).高胆组MDI、PDI与对照组比较差异显著(P＜0.001),智能分级比较,对照组优于高胆组(P＜0.01,P＜0.05).结果提示,不同程度高胆红素血症无论是不同龄别生理性特点或为不同而更较复杂的病理特异,均可能影响新生儿神经行为能力和智能发育.对新生儿高胆红素血症,无论其程度和病因如何均应积极治疗,尽量减少后遗症的发生.     

高胆红素血症对新生儿神经行为及其预后的影响

探讨高胆红素血症对新生儿神经行为及其预后的影响,通过对38例高胆患儿在新生儿期进行神经行为评分(NBNA)检测、婴幼儿期用婴幼儿智力发育量表(CDCC)测定智力发育。结果显示:高胆组NBNA评分明显低于对照组(P<0.001),主要失分项目为行为能力和主动肌张力。在血清胆红素≥204μmol/L时,胆红素水平与NBNA评分呈显著负相关(P<0.01);围产因素、溶血、感染组在黄疸高峰期NB-NA评分低于对照组(P<0.01)。高胆组MDI、PDI与对照组比较差异显著(P<0.001),智能分级比较,对照组优于高胆组(P<0.01,P<0.05)。结果提示,不同程度高胆红素血症无论是不同龄别生理性特点或为不同而更较复杂的病理特异,均可能影响新生儿神经行为能力和智能发育。对新生儿高胆红素血症,无论其程度和病因如何均应积极治疗,尽量减少后遗症的发生。     

新生儿行为神经评价与高胆红素血症的关系

目的 探讨２０项新生儿行为神经测定（ＮＢＮＡ）与高胆红素血症的关系,了解高胆红素血症对新生儿行为神经的影响。方法 对６２例高胆红素血症患儿运用ＮＢＮＡ。结果 ①当血清胆红素水平≥２０５μｍｏｌ／Ｌ,对ＮＢＮＡ即有显著影响（Ｐ〈０．０１）,血清胆红素≥３４２ｕｍｏｌ／Ｌ,则与ＮＢＮＡ评分呈明显直线负相关关系（ｒ＝－０．８４１,Ｐ〈０．０１）;②溶血感染所致高胆红素血症ＮＢＮＡ评分均低于对照组,差异有     

新生儿行为神经评价与高胆红素血症的关系

目的　 探讨 2 0项新生儿行为神经测定 (NBNA)与高胆红素血症的关系 ,了解高胆红素血症对新生儿行为神经的影响。 方法 　对 62例高胆红素血症患儿运用NBNA。 结果 　①当血清胆红素水平≥ 2 0 5 μmol/L ,对NBNA即有显著影响 (P <0 0 1) ,血清胆红素≥ 3 4 2 μmol/L ,则与NBNA评分呈明显直线负相关关系 (r =-0 841,P <0 0 1) ;②溶血感染所致高胆红素血症NBNA评分均低于对照组 ,差异有显著意义 (P <0 0 5 ) ;母乳性黄疸NBNA评分与对照组无显著差异 ;③高胆红素血症主要影响患儿的视听定向能力。 结论 　提示高胆红素血症影响新生儿行为神经 ,对血清胆红素≥ 3 4 2 μmol/L ,应采取积极有效措施 ,以减少胆红素脑病的发生。     

高胆红素血症与20项新生儿行为神经评价的关系

为了探讨新生儿高胆红素血症与２０项新生儿行为神经测定ＮＢＮＡ）的关系，将２０项ＮＢＮＡ应用于本院８２例高胆红素血症患儿。结果显示：（１）当血清胆红素水平≥２０５ｕｍｏｌ／Ｌ对２０项ＮＢＮＡ即有显著影响，血清胆红素≥３４０ｎｍｏｌ／Ｌ，则与ＮＢＮＡ评分呈明显直线负相关关系。（２）溶血、感染所致高胆红素血症ＮＢＮＡ评分均你芋对照组。差异有显著意义；母乳性黄疸儿ＮＢＮＡ评分与对照组无显著差异。（３）高胆     

新生儿高胆红素血症的远期随访观察

为探讨新生儿期血清胆红素水平对远期预后的影响,对126例高胆红素血症患儿在5－8岁时进行智力、听力及神经系统随访检查。结果发现,33例患儿有程度不等的智力缺陷,25例有听力损失,6例有神经系统的改变。智力、听力及神经系统异常率与血清总红素峰值无显著相关性（P＞0．05）。溶血组与非溶血组间异常率无显著性差异（P＞0．05）。结果提示,除重度高胆红素血症外,轻、中度高胆红素血症（无论是否溶血）也可对新生儿产生永久性神经损害,致精神神经发育异常,仅凭血清胆红素水平并不能确切预测远期预后。对所有高胆红素血症新生儿均应积极治疗,尽量减少后遗症的发生。     

高胆红素血症新生儿智能及社会生活能力追踪

对41例高胆红素血症新生儿进行追踪，结果显示随访组智能明显低于对照组（P＜0.05），智能迟缓程度与胆红素浓度值不呈线性关系，围生期高危因素对智能有一定影响。强调患此症的婴儿应定期监测。     

新生儿高胆红素血症患儿神经行为变化临床观察

新生儿高胆红素血症（简称高胆）的主要危害是引起胆红素中毒性脑病——核黄疸，造成中枢神经系统损害而致残。然而，临床上未发生核黄疸的高胆红素血症这部分患儿，高胆红素血症对脑的发育是否有影响？为此，我们对高胆患儿进行了新生儿行为神经评分法（NBNA）测定，及早发现不同程度高胆对中枢神经系统的损害，为临床治疗提供依据，以减少伤残。     

Behavior of Human Neonates*

ABSTRACT Clinical methods of neonatal neurobehavioral evaluation are outlined, and the conceptual basis and the procedures of Brazelton's Neonatal Behavioral Assessment Scale (NBAS) which is most widely used is described in detail. The studies which have been conducted to date using the NBAS are reviewed, and future directions in the assessment of neonatal behavior are explored. Infants showed following behavioral characteristics: Healthy Japanese infants show higher habituation and orientation scores with lower motor activity score than American Caucasian counterparts. Japanese infants with intra-uterine growth retardation (IUGR) show mild deviation of Apgar score, and maternal toxemia has an effect on the neonatal behavior as well as neurological signs. In Japanese infants, the mental-motor development during infancy is significantly correlated with the neonatal behavior and family environment. Studies of normal and high-risk infants revealed that both perinatal complications and cultural background affect the neonatal behavior.     

新生儿佝偻病骨代谢转换生化标志物检测的意义

目的探讨骨代谢转换生化标志物血清β胶原分解片断（β-CTx）、骨碱性磷酸酶（BALP）和骨钙素（BGP）测定在新生儿佝偻病诊断中的意义。方法选取30例佝偻病新生儿（病例组）和30例健康新生儿（健康对照组）,每例儿童均采集空腹静脉血2mL,电化学发光免疫分析法检测血清β-CTx,ELISA法测定BALP和BGP水平,并对这三项测定指标的灵敏度、特异度、漏诊率、误诊率、诊断符合率、Youden指数、阳性预测值和阴性预测值进行计算和分析,同时测定其血清钙、磷和AKP水平,并进行左手腕关节X线摄片。结果病例组血清β-CTx、BALP和BGP水平分别为（1.58&#177;0.49）μg/L、（291.5&#177;78.4）U/L和（15.2&#177;5.9）μg/L,健康对照组分别为（1.16&#177;0.38）μg/L、（137.1&#177;64.7）U/L和（10.1&#177;4.3）μg/L,病例组明显高于对照组,二组比较均有极显著性差异（Pa〈0.001）。病例组血清β-CTx、BALP和BGP水平异常者分别为28例（93.3%）、26例（86.7%）和24例（80.0%）,明显高于对照组[2例（6.7%）、2例（6.7%）和3例（10.0%）]（Pa〈0.001）。血清β-CTx的灵敏度、特异度、诊断符合率、Youden指数、阳性预测值和阴性预测值均高于血清BALP和BGP,但无统计学意义,其漏诊率和误诊率显著低于血清BALP和BGP（χ^2=9.7124,11.2913,16.9212,18.3671Pa〈0.01）。结论血清BALP和BGP水平测定是准确反映骨代谢转换的生化标志物,也是诊断新生儿佝偻病特异而敏感的指标;血清β-CTx水平测定是诊断新生儿佝偻病、反映骨吸收活动特异性很高的敏感指标。     

危重新生儿弥散性血管内凝血前期的监测与治疗

目的探讨监测危重新生儿血浆凝血酶原片段F1＋2、凝血酶抗凝血酶复合物（TAT）及D-二聚体等凝血及纤溶因子水平对弥散性血管内凝血前期（pre-DIC）的诊断及治疗意义。方法对NICU收治的96例危重症及36例正常新生儿检测F1＋2、TAT及D-二聚体水平，对30例诊断pre-DIC的患儿予抗凝治疗，并监测治疗后F1＋2、TAT及D-二聚体水平。结果危重症组与对照组相比，F1＋2、TAT、D-二聚体水平均增高，差异有极显著性（P均〈0．01）。TAT对pre-DIC诊断的敏感性较高，F1＋2特异性强；三者在抗凝治疗后均明显下降。F1＋2与TAT、D-二聚体三者之间均呈直线正相关，F1＋2与TAT、D-二聚体的相关系数分别为r=0．70P〈0．01；r=0.42 P〈005；TAT与D-二聚体呈正相关（r=0．35 P〈0．05）；F1＋2、TAT、D-二聚体与危重评分呈直线负相关（r=-0．68、-072、-054P均〈0.01）。结论检测TAT、F1＋2、D-二聚体水平监测危重新生儿的血液高凝状态，有助于pre—DIC的诊断，并可协助判断抗凝治疗的效果。     

Development of Personality and Intelligence in Children with Congenital Heart Disease

One hundred and twenty-eight children with congenital heart disease (CHD) and 89 healthy controls were compared according to their development of personality and intelligence. Presence of physical disability in daily life was the independent variable for dividing children with CHD into two groups: children with physical handicap due to CHD (n = 77) have lower IQ scores than healthy children. Unexpectedly, in the parents' opinion they show no difference in behaviour patterns. On introspective examination, these cardiac patients showed an increased feeling of inferiority and of basic anxiety and a more impetuous behaviour as their way of self-protection, but a reduced need for independence due to parental overprotection was not confirmed. None of these observations could be detected in children with CHD who are physically fit (n = 51).     

营养与小儿智能发育的关系

营养素可通过参与神经细胞的构成或促进神经递质代谢2种途径影响小儿智能发育。前者如蛋白质、核苷酸、长链多不饱和脂肪酸等；后者如5-羟色胺、去甲肾上腺素、多巴胺、谷氨酸、牛磺酸、维生素B1、B6、B12,烟酸、胆碱及微量元素铁、锌、碘等。多种营养素合并使用，对改善智能的效果更为明显。     

Development of Histidinemic Patients: Follow-Up Study of Five Cases with Neuropsychological Symptoms

We described the general clinical course of histidinemia in a previous report. Here, we report on five patients having particular problems in the developmental aspects. Case 1 was found to have histidinemia at the age of 3 years during a clinical survey of the nature of his neurological symptoms. He has been followed up for seven years. He developed poorly in verbal expression. Case II was detected by newborn mass screening. The psychomotor development was apparently normal, but in detail, the development of fine motor and cognitive function was insufficient during the follow-up period. Consequently, a developmental lag in visual perception, visual motor perception and spatial perception were noted in this case. Cases III, IV and V were each 3 years old, and were also diagnosed as histidinemic by newborn mass screening test; scanty attachment and various kinds of autistic behavior were noted during their clinical course. These five cases were clinically different from other non-symptomatic patients with histidinemia. It is important to study the pathogenesis of such psychomotor abnormalities from the viewpoint of psychological care for the children.     

新生儿胃肠外营养相关性肝胆并发症研究进展

目前胃肠外营养在新生儿已得到广泛应用,但其引起的肝胆并发症仍未完全解决。研究表明,早产与低出生体重、缺乏肠道刺激、感染、静脉供给过高热卡、静脉营养成分失衡、胃肠外营养的毒性成分等因素均可能与发病有关,由此提出了一些综合性防治措施。该文就其病因学研究及治疗进展作一综述。