延迟钳夹脐带对早产儿早期血容量影响的临床研究

目的 探讨延迟钳夹脐带对早产儿早期血容量的影响.方法 将2007年10月至2010年6月在东莞市石龙博爱医院产科经阴道分娩的194例早产儿随机分为两组,即常规钳夹脐带组100例和延迟钳夹脐带组94例.比较分析两组经阴道分娩早产儿的钳夹脐带时间,生后24h、48h、72 h的Hb、RBC、红细胞压积、血压、血氧饱和度和贫血的发生率,以及生后第1天、第2天、第3天和第7天的静脉血胆红素值.结果 延迟钳夹脐带组脐带钳夹时间为(100.14±10.57)s,常规钳夹脐带组脐带钳夹时间为(22.40±5.02)s,两组脐带钳夹时间比较差异有统计学意义(P＜0.005).延迟钳夹脐带组早产儿生后前3 d的Hb及血压均比常规钳夹脐带组高,两组比较差异有统计学意义(P＜0.05).延迟钳夹脐带组94例早产儿中,3 d内发生贫血3例,发生率为3.19%,常规钳夹脐带组100例早产儿中,3 d内发生贫血11例,发生率为11.00%,延迟钳夹脐带组贫血发生率低于常规钳夹脐带组(P＜0.05).两组早产儿出生后7 d内的静脉血胆红素值比较无明显差异(P＞0.05).结论 延迟钳夹脐带对早产儿Hb及血压有明显影响,可提高阴道分娩早产儿早期血容量,减少早产儿早期贫血的发生.     

脐带结扎方式对早产儿并发症的影响

目的 探讨不同脐带结扎方式对早产儿并发症的影响.方法 选择2011年9月至2013年12月本院产科顺产出生的早产儿,分别按挤压脐带、延迟脐带结扎及常规脐带结扎三种方法结扎脐带,每组各纳入100例,对3组早产儿出生12 ～24 h的Hb、Hct和部分并发症发生情况进行比较分析.结果 延迟脐带结扎组Hb(g/L)高于挤压脐带组和常规脐带结扎组[(204 ±25)比(196±16)、(185±12)],挤压脐带组高于常规脐带结扎组;延迟脐带结扎组Hct(％)高于常规脐带结扎组[(67.5±3.0)比(65.9±3.2)],差异有统计学意义(P＜0.05).挤压脐带组和延迟脐带结扎组发生败血症、坏死性小肠结肠炎(NEC)和贫血的比例均少于常规脐带结扎组(败血症:11％、13％比24％,NEC:6％、5％比15％,贫血:21％、12％比37％),差异有统计学意义(P＜0.05),挤压脐带组和延迟脐带结扎组差异无统计学意义(P＞0.05);各组发生RDS、颅内出血、呼吸暂停、红细胞增多症、高胆红素血症、新生儿出血症、早产儿视网膜病(ROP)、支气管肺发育不良(BPD)的比例差异均无统计学意义(P＞0.05).挤压脐带组和延迟脐带结扎组住院时间(天)和住院费用(万元)均低于常规脐带结扎组[住院时间:(28.7±1.5)比(32.4±1.3)、(36.2±1.4),住院费用:(3.1±0.2)比(3.2±0.4)、(3.9±0.3)],挤压脐带组低于延迟脐带结扎组,差异有统计学意义(P＜0.01).结论 挤压脐带和延迟脐带结扎可减少早产儿部分并发症的发生,降低住院时间和费用,易于临床开展,有利于改善早产儿预后.     

脐带延迟结扎和脐带挤压输血对早产儿脑血流动力学的影响：一项随机双盲对照试验

目的 比较脐带延迟结扎（DCC）和脐带挤压（UCM）输血对早产儿脑血流的影响。方法 该试验是一项单中心、前瞻性、双盲、随机对照临床试验。纳入2018年11月2日至2019年11月15日遂宁市中心医院出生、胎龄30~33⁺⁶周早产儿46名,随机分为DCC组（23例）和UCM组（23例）。主要结局指标包括生后0.5~1 h、（24±1）h、（48±1）h、（72±1）h超声多普勒测得的脑血流动力学参数：收缩期峰值流速（PSV）、舒张期峰值流速（EDV）和阻力指数（RI）。次要结局指标包括生后第1天检测的红细胞压积、血红蛋白、红细胞计数和血清总胆红素水平及住院期间颅内出血的发生率。结果 DCC组和UCM组实际进入统计分析的早产儿分别为21例和23例。DCC组和UCM组两组患儿生后各观察时间点PSV、EDV、RI差异无统计学意义（P > 0.05）;两组生后第1天红细胞压积、血红蛋白、红细胞计数和总胆红素水平及住院期间颅内出血发生率的比较差异无统计学意义（P > 0.05）。结论 DCC和UCM对30~33⁺⁶周早产儿脑血流动力学的影响无明显不同。     

Delayed umbilical cord clamping in preterm infants: A feasibility study

Objectives: To assess: (i) the size of placental transfusion following a 30 s delay in cord clamping following vaginal and Caesarean births; and (ii) the feasibility of delaying cord clamping in the labour ward and particularly in the operating theatre.
Methods: Fourty-six infants born at 26–33 weeks gestation were randomized to having the umbilical cord clamped either immediately or 30 s after birth. The venous haematocrit was measured at 1 and at 4 h of age.
Results: There were trends towards higher mean haematocrits in the infants following delayed clamping, but these were not significant either at 1 h (55±7.7 vs 52.9±7) or at 4 h of age (55±7 vs 52.5±7). The trends were more marked in the infants born by Caesarean section, and in those born at 26–29 weeks gestation.
Conclusions: A 30 s delay in cord clamping is feasible at both vaginal and Caesarean births, but does not lead to the predicted difference in infant haematocrit. Although physiological studies suggest that a placental transfusion of 15–20 mL/kg occurs within 30 s of delivery, these data suggest that future trials should either delay cord clamping for more than 30 s, or should alter the position of the infant in relation to the uterus in order to facilitate the transfusion. Delayed cord clamping is feasible at Caesarean section.     

人脐血及脐带间充质干细胞的分离培养及表面标记分析

目的探讨从人脐带血及脐带分离和培养间充质干细胞(MSCs)的方法,并分析MSCs的表面标记。方法人脐带血按常规方法制备单个核细胞,利用MSCs贴壁生长的特性,经培养、换液、传代纯化MSCs;分离脐带华尔通胶(Wharton’s jelly),采用组织块贴壁法获得脐带MSCs并传代。将传代的MSCs冻存,1个月后再复苏,观察复苏后MSCs的生长情况。利用FACScan流式细胞仪检测脐带血及脐带细胞表面抗原。结果经过传代后,贴壁细胞形态趋于同一。人脐血及脐带MSCs体外生长形态相似,类似成纤维细胞,可以稳定增殖和传代。经冷冻保存,复苏后仍能较好生长。人脐血及脐带来源的MSCs表面标记CD29、CD44、CD59高表达,而表面标记CD14、CD33、CD34和CD45低表达。结论人脐带血及脐带均可分离出MSCs,在体外能扩增纯化及冻存复苏,为组织工程提供丰富的细胞来源。     

A new wrinkle: Umbilical cord management (how,when, who)

In the past five years, umbilical cord management in both term and preterm infants has come full circle, going from the vast majority of infants receiving immediate cord clamping to virtually all governing organizations promoting placental transfusion, mainly in the form of delayed cord clamping (DCC). Placental transfusion refers to the transfer of more blood components to the infant during the first few minutes after birth. The different strategies for ensuring placental transfusion to the baby include delayed (deferred) cord clamping, milking of the attached cord before clamping, and milking of the cut cord. In this review, we address the current evidence to date for providing placental transfusion in different circumstances and the methods for implementation. We also highlight the gaps in knowledge and areas for future research.     

Uroguanylin level in umbilical cord blood

BACKGROUND: Uroguanylin is a novel natriuretic and diuretic peptide originally isolated from urine. METHODS: To determine whether uroguanylin has a physiologic role during the perinatal period, uroguanylin levels in umbilical cord plasma obtained at the time of delivery were measured by radioimmunoassay and compared with cord serum osmolality. RESULTS: Mean (+/- SD) cord plasma uroguanylin concentrations (8.8 +/- 2.1 fmol/mL) were higher compared with normal adult values. The extent of maturity, mode of delivery and gender did not appear to influence cord uroguanylin levels. The uroguanylin concentration had a significant positive correlation with cord serum osmolality. Conclusion: These findings support some regulatory role of this peptide in perinatal renal and cardiovascular adaptation.     

脐带挤压与延迟断脐对胎龄<34周早产儿早期预后影响的Meta分析北大核心CSCD

目的分析脐带挤压与延迟断脐对胎龄<34周早产儿早期预后的影响。方法计算机检索PubMed、Web of Science、Embase、Cochrane Library、CINAHL、中国知网、万方数据库、维普数据库和中国生物医学文献服务系统数据库从建库到2021年11月发表的胎龄<34周早产儿脐带挤压与延迟断脐的随机对照试验。由2名研究人员根据纳入和排除标准,独立对文献进行筛选和质量评价,并提取数据,采用Review Manger 5.4进行Meta分析。结果最终纳入11篇文献,共1621例早产儿,其中脐带挤压组809例,延迟断脐组812例。Meta分析结果显示,与延迟断脐相比,脐带挤压提高了早产儿出生后平均血压(WMD=3.61,95%CI:0.73~6.50,P=0.01),但增加了早产儿严重脑室内出血的发生率(RR=1.83,95%CI:1.08~3.09,P=0.02),两者在早产儿出生后血红蛋白水平、红细胞压积、输血率、光疗率、血清胆红素峰值及脑室周围白质软化、坏死性小肠结肠炎等并发症发生的影响差异均无统计学意义(P>0.05)。结论与延迟断脐相比,脐带挤压可能增加胎龄<34周早产儿严重脑室内出血的风险,但仍需更多高质量、大样本的随机对照试验进一步证实。     

Resuscitation of extremely preterm infants - controversies and current evidence

Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable (gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.     

Umbilical cord blood lactate in normal infants: comparison between two methods of measurement

OBJECTIVES: Firstly, to determine the accuracy of the Radiometer ABL 625 lactate electrode (Radiometer Medical Pty Ltd, Nunawading, Victoria, Australia) by comparing the lactate values obtained by this method to those obtained with the Hitachi 917 lactate analyser (Boehringer Mannheim Corporation, Charlottetown, Prince Edward Island, Canada). Secondly, to determine the effect of delay in measurement on blood lactate levels. METHODOLOGY: Umbilical venous (UCV) blood samples were obtained from healthy term infants delivered vaginally. Lactate levels were measured with the Radiometer ABL 625 lactate electrode in the Neonatal Intensive Care Unit, Westmead Hospital and with the Hitachi 917 lactate analyser in 49 paired samples. In addition 26 UCV blood samples were placed in ice slurry and a further 26 samples at room temperature and blood lactate was measured at 5-min intervals for 30 min to determine the change of lactate levels with time. RESULTS: The lactate levels obtained from the Radiometer ABL 625 lactate electrode were consistently lower than the levels obtained from the Hitachi 917 lactate analyser (mean difference - 0.24), but the correlation was high (r = 0.97). The blood lactate levels increased at the rate of 0.012 mmol/L per min if the blood was left at room temperature. The lactate levels remained stable for 20 min if the blood was placed in ice slurry. CONCLUSION: The Radiometer ABL 625 lactate electrode was easy to use and there was high correlation with the values obtained by the standard laboratory method. The blood specimen must be place in an ice slurry if a delay in analysis is anticipated.     

超早产儿出生窒息的危险因素分析

目的 探讨超早产儿发生出生窒息的危险因素.方法 选取2017年1月至2020年6月,解放军总医院第七医学中心儿科医学部超早产重症监护病房收治的超早产儿为研究对象,纳入窒息组184例,对照组153例.回顾性收集超早产儿及其母亲的临床资料,分析超早产儿发生出生窒息的危险因素.统计学方法采用t检验、χ2检验、单自变量和多自变...     

Abnormal fatty acid composition in umbilical cord blood of infants at high risk of atopic disease

It is well known that patients with atopic disease have anomalies of fatty acid composition in their blood. The aim of the present study was to evaluate whether infants from atopic families also have abnormal cord blood levels of long-chain polyunsaturated fatty acids (LC-PUFA) in plasma and red blood cells. The levels of LC-PUFA in umbilical cord blood of 50 healthy, full-term infants with a hereditary risk of atopic disease were analysed and compared with a control group of 50 infants from families without a history of atopic disease. The atopy group was comprised of children from families suffering from atopic dermatitis, allergic rhinitis, asthma bronchiale and food allergy. Within this group, a group (n = 11) was formed in which the risk was determined only by paternal atopy. Fatty acids of plasma and red blood cell phospholipids, triglycerides and sterol esters were separated by high-resolution gas-liquid chromatography. In particular, the levels of arachidonic acid (C20:4n-6) and docosatetraenoic acid (C22:4n-6) were significantly lower in infants at risk of atopic disease than in infants not at risk. Interestingly, there were more significant differences shown between the control group and the paternal atopy group than between the control group and the entire atopy group. Conclusion: The results of this study could be due to a genetic influence of fatty acid metabolism or could reflect the different dietary behaviours of the mothers during pregnancy.     

脐血心钠素在监测高危新生儿水钠平衡中的意义

目的：心钠素(ANP)是一种具有多种功能的内分泌激素,其过度分泌可造成低钠血症。该文探讨脐血ANP测定在监测高危新生儿水钠平衡中的作用和临床意义。方法：选择117例高危新生儿依据Apgar评分的不同分为两大组,即单纯窒息组及评分正常组。单纯窒息组又分为轻度窒息组和重度窒息组,评分正常组又分为感染组和非感染组,另设40例正常新生儿为对照组。各组均在新生儿娩出后立即抽取脐血,应用放射免疫法测定ANP水平,同时抽取静脉血测定患儿的血清钠含量,并分别与对照组比较。结果：高危新生儿的脐血ANP水平明显高于正常新生儿,尤以早产儿1.46±0.39 ng/mL、严重感染新生儿1.16±0.35 ng/mL及重度窒息新生儿2.12±0.46 ng/mL增高最为明显(P<0.01)。而与其相对应的则是血清钠水平的下降,两者呈显著负相关。结论：高危新生儿脐血心钠素增高明显,易致低钠血症,早期测定可对新生儿抢救与治疗起到指导作用。     

Minimizing blood loss and the need for transfusions in very premature infants

Reducing blood loss and the need for blood transfusions in extremely preterm infants is part of effective care. Delayed cord clamping is well supported by the evidence and is recommended for infants who do not immediately require resuscitation. Cord milking may be an alternative to delayed cord clamping; however, more research is needed to support its use. In view of concerns regarding the increased risk for cognitive delay, clinicians should avoid using hemoglobin transfusion thresholds lower than those tested in clinical trials. Higher transfusion volumes (15 mL/kg to 20 mL/kg) may decrease exposure to multiple donors. Erythropoietin is not recommended for routine use due to concerns about retinopathy of prematurity. Elemental iron supplementation (2 mg/kg/day to 3 mg/kg/day once full oral feeds are achieved) is recommended to prevent later iron deficiency anemia. Noninvasive monitoring (eg, for carbon dioxide, bilirubin) and point-of-care testing reduce the need for blood sampling. Clinicians should strive to order the minimal amount of blood sampling required for safe patient care, and cluster samplings to avoid unnecessary skin breaks.     

The water content of the human umbilical cord

105 umbilical cords from 53 term and 52 preterm newborn infants were freeze-dried after removal of the blood vessels, to determine the water content. The mean umbilical cord water content (i.e. mean of water content of fetal and placental ends of the cord), was 88.9% (SD 2.73) for term cords and 91.9% (SD 1.99) for preterm cords. The mean water content fell with increasing gestation. The fetal end of the cord had a significantly higher water content than the placental end. Similarly, the volume of a 4-cm length segment of cord was significantly greater at the fetal than placental end. There was no correlation between cord water content or volume and several other variables including birthweight, size for gestational age and placental weight. These observations suggest a metabolically active role for the umbilical cord.     

更昔洛韦治疗异基因脐血移植术后受者巨细胞病毒抗原血症的研究

目的　 研究更昔洛韦 (丽科伟 )对异基因脐血移植术后受者巨细胞病毒抗原血症的临床疗效和不良反应 ,探讨预防巨细胞病毒相关性间质性肺炎的理想用药时机及方法。 方法 　 12例异基因脐血移植受者 ,在移植后出现CMV Ag阳性 ,即给予更昔洛韦治疗 ,诱导治疗 5mg/ (kg·次 ) ,IV ,q 12h ,用药 2周 ,维持治疗 5mg/ (kg·d) ,IV ,qd ,每周用药 5d ,疗程 2～ 3周。 结果 　对CMV Ag阴转比例 11/ 12 ;不良反应主要有胃肠不适、肝功能轻度异常 ,且不良反应均在停药后顺利恢复 ,无白细胞减少。 2例治疗前白细胞和血小板持续下降 ,在治疗后白细胞和血小板逐渐恢复正常。 结论 　更昔洛韦治疗异基因脐血移植术后受者巨细胞病毒抗原血症的疗效肯定 ,不良反应轻微 ,可作为CMV IP的预防用药。