台州地区巨大儿946例临床分析

目的：通过调研和临床研究，阐明巨大儿发生率逐年递增并与孕期管优生和健康教育关系密切。方法：１９９４年１月１日至１９９８年１２月３１日间分娩的９４６例巨大儿体重、产式、窒息发生率和孕妇的相关情况进行回顾性调查和／或现场调查。进行统计分析。结果：巨大儿发率１１.42％，明显高于上海的５.35%，且５年间呈逐年上升趋势。５年间巨大儿平均体重由９４年４.12kg增至９８年的４.26kg，难产率由９４年的３７.73%上升到５０.37%。结论：降低巨大儿发生率，必须加强孕期管理和健康教育。提倡合理营养，适当运动，对高危孕妇防止营养过剩同时，必要时还得控制总热量。     

巨大儿分娩方式及其妊娠结局

目的：探讨巨大儿的分娩方式与妊娠结局的关系;方法：对于１０４例巨大儿进行性分析。结果：巨大儿发生率４．９％（１０４：２１３２）,呈逐年上升趋势,９５年,９６年,９７年,９８年分别为３．２％,２．５％,６．５％,６．７％。     

巨大儿发生的相关因素

巨大儿的定义：胎儿出生体重达到或超过4000g为巨大胎儿。NBW≥相应孕周的第90百分位数为大于孕龄儿。国内资料报道巨大儿占出生总数的5．62％-6．49％。据“国际产科统计组织”104000次分娩的统计，〉4000g者发生率为5．3％，〉4500g的发生率仅为0．4％。新生儿体重超过5000者甚为罕见。巨大男胎多于女胎，并有逐年上升趋势，但产前诊断率普遍较低，母婴并发症高，特别是发生肩难产则危险性更大。     

新生儿窒息的产科原因123例临床分析

目的探讨新生儿窒息的产科原因，找出预防新生儿窒息的方法，降低新生儿窒息发生率。方法对2004年1～5月份在我院分娩的123例新生儿窒息进行回顾分析。结果早产，脐带因素，胎盘功能不全在新生儿窒息中分别占28．32％、22．12％、20．35％。第二产程延长占10．62％。早产重度窒息率最高，占7．96％。阴道助产窒息发生率远高于剖宫产和自然分娩，占18．95％。X^2检验统计P〈0．001。新生儿出生时的体重与新生儿重度窒息有着密切关系，低体重儿重度窒息发生率高，占31，11％（14／45）。结论产前严格掌握好分娩方式，对巨大儿、胎位不正伴脐带绕颈和估计胎儿体重≥3500g的应择期剖宫产。对高危孕妇要严密监测，定期胎心监护，严密观察产程，发现问题积极处理，防止发生新生儿窒息。     

上海浦东地区巨大儿726例临床分析及其与剖宫产关系

本文对我院１９８４年１月至１９９５年１２月住院分娩新生儿１３５５８例，进行了总结分析。结果：巨大儿共７２６例，发生率５．３５％；其中１９８４年－１９８９年共分娩新生儿８８７６例，巨大儿３３４例，发生率３．７６％，１９９０年－１９９５年工分娩新生儿４６８２例，巨大儿３９２例，发生率８．３７％；巨大儿的发生有明显上或。同期剖宫产总数３９０２例，剖宫产率２８７８％，其中巨大儿剖宫产３６２例，巨大儿剖宫产     

新生儿体重与优生─附13140例分析

回顾性分析了１２年来１３１４０例新生儿体重及相关因素。新生儿初生体重由１９８２年的３０５０±５７６ｇ上升至１９９３年的３３１７±４２９ｇ。低体重儿发生率由６．４％降至２．９％。大胎儿的发生率由１７．８％升至３１．８％。大胎儿剖宫产率、产后出血、新生儿窒息及第二产程延长的发生率均明显高于正常体重儿。提出预防低体重儿和大胎儿并重的原则。     

佳木斯地区低出生体重儿684例临床分析及随访

本文对我院１９８５年１月－１９９１年１月分娩的活产婴１５５６４人中低出生体重儿６８４例，发生率为４．４％，其中５２例为早产儿，死亡率为８．３３％。分析结论是孕周越小死亡率越高，体重越小死亡率越高。本组随访率为４７．８８％，智能检查ＤＤＳＴ可疑２０例，均以大的动作能及言语发育迟缓，平均身高，体重，头围接近９市城区男女儿童，略低于北京市儿童保健所１９８６年制定的正常发育的指标。     

信息

巨大儿增多据报道：今年１月２６日苏州医学院二院剖宫产，生一女婴５００ｇ。苏州市妇幼保健所提供情况，建国以来全市分娩超过５ｋｇ者只有３例。据专家介绍仅９７、９８两年娩出巨大儿８８１人，占新生儿总数的７％。据国际通用定义：＜２５００ｇ为低体重儿，＞４００...     

内蒙古地区新生儿出生体重监测报告

９８６年１０月至１９８７年９月内蒙古地区３７所旗县以上医疗保健单位对２９３５９例住院分娩的围产儿进行监测,记录较完整的有２８１６６例,占全部新生儿资料的９５．９４％。新生儿平均出生体重为３２２２．８１±３．４９ｇ;４０孕周出生的平均体重为３２８７．２８±５．２４ｇ,蒙古族新生儿出生体重平均为３２７７．４１±７．９５ｇ,高于本地区汉族新生儿体重。低体重儿及巨大儿的发生率分别为４８．６７‰、６２．８４‰,均高于同期全国平均水平（３５．７７‰、４５．９５‰）。     

母亲孕期的体重增长与巨大儿关系的初步研究

目的;探讨巨大儿的发生与母亲孕期体重增长的关系。方法：对１２８例巨大儿的母亲的孕期体重增长进行回顾性分析,同期１３０例正常出生体重婴儿母亲的孕期体重增长作为对照研究。根据孕前体质指数（ＢＭＩ）将所有研究对象分为四种类型人群即低体重型、正常体重型、超重、胎胖型。结果：巨大儿母亲的孕期理增长比对照组重约２．５ｋｇ。巨大儿组中超重型及胎胖妇女所占的比例对照组为高（１５．６％比２．３％）,但孕期体重增长对     

泸州市近3年出生儿童计划免疫现状分析

目的为了解泸州市近3年出生儿童的计划免疫工作实际情况，找出影响计划免疫的相关因素。方法对泸州市2004—2006出生儿童的建卡、建证、五种疫苗接种等情况进行了调查。结果到2006年底被调查儿童预防接种建卡率98．67％，建证率100．00％，卡证符合率97．00％，儿童五苗合格率和父母文化程度有明显关系，文化程度越高，五苗接种合格率也越高。结论定期进行查漏补种；开展健康教育促进活动，提高家长知晓率，是提高常规免疫接种率的最有效的手段？。     

Birth weights in three Norwegian cities, 1860-1984. Secular trends and influencing factors

Data from birth records from three maternity hospitals in Norway have been used to study the trend in birth weight in this country from 1860-1984. The investigation is based on a sample of 200-300 records taken at random from 2 to 5 years around every 10th year, from each of the three maternity hospitals--amounting to a total sample of 9152 women. Besides describing the trend in birth weight, I have analysed the different factors influencing birth weight--using multivariate linear regression methods. The results show that the mean birth weight has changed remarkably little throughout this period of 120 years. The total increase has only been just below 200 g. From Montreal, Ward and Ward (1984) have reported a decrease in mean birth weight of about 430 g during the second half of the last century. The Norwegian data indicates a simultaneous fall in mean birth weight of about 70 g. This fall is, however, found mainly among unmarried women. Thus, the great decline in birth weight which is found in Montreal, is not apparent in our material from Norway, despite the fact that Oslo was industrialized at approximately the same time as Montreal. Of the various independent variables used in the multiple regression analyses, only the following variables appear to be of any importance: the year when the birth took place, the mother's menarcheal age, her marital status, the sex of the child and the parity number. In this material, I have found a linearly increasing birth weight from birth number 2 up to at least parity 8, and a larger increase from parity 1 to 2. The birth weight shows a significant increase in the case of married women as opposed to unmarried. This effect is most marked before 1900, indicating that the social conditions gradually became less unequal after the turn of the century. The birth weights have a decreasing tendency with higher ages of menarche. This tendency is constant throughout the whole period of time. Boys appear to be about 112 g heavier than girls, this difference being largely the same throughout the investigated period.     

Weight gain velocity in infants with achondroplasia

There are virtually no data regarding appropriate oral intake in infants with dwarfing disorders such as achondroplasia, nor is there clear information regarding appropriate weight gain velocity in this population. Yet, these individuals are at increased risk for both early failure to thrive and, later in life, for obesity. Having appropriate expectations regarding weight gain and reasonable goals in management is imperative. We sought to clarify the rate of weight gain in infants with achondroplasia during the first year of life through analysis of data from 60 infants with achondroplasia seen at least twice during the first year of life in the Midwest Regional Bone Dysplasia Clinic, University of Wisconsin‐Madison between 1998 and 2018. The mean weight gain velocity during the first 3 months was 23 g/day which contrasts with 30 g/day in average statured infants. Mean weight gain from 0 to 12 months of age was 13 g/day. The 3% of weight gain velocity during the first year of life was 8 g/day, and this rate did not differ between 0–3 months and 0–12 months of age. Infants with achondroplasia slightly more than doubled their birth weights by 1 year of age in contrast to averaged statured infants who typically triple birth weights by 1 year. Infants with achondroplasia can be thriving but erroneously assessed as failing to thrive if the incorrect reference values are used. This article describes infant weight gain velocity reference data for this population.     

How the Newcastle Thousand Families birth cohort study has contributed to the understanding of the impact of birth weight and early life socioeconomic position on disease in later life

Much has been made of the potential influence of birth weight and early socioeconomic disadvantage in influencing adult health, but little has been published in terms of how important these associations may be with respect to exposures throughout the lifecourse. The objective of this review is to describe the contributions of the Newcastle Thousand Families Study in understanding the relative impacts of factors in early life, particularly birth weight and socio-economic position at birth, in influencing health in later life. The Newcastle Thousand Families Study is a prospective birth cohort established in 1947. It originally included all births to mothers resident in Newcastle upon Tyne, in northern England, in May and June of that year. Study members were followed extensively throughout childhood and intermittently in adulthood. At the age of 49-51 years, study members underwent a large-scale follow-up phase enabling an assessment of how early life may influence their later health, and also incorporating adult risk factors which enabled the relative contributions of factors at different stages of life to be assessed. While some findings from the study do support birth weight and early socio-economic position having influences on adult health status, the associations are generally small when compared to risk factors later in life. Using path analyses on longitudinal data of this nature enables mediating pathways between early life and later health to be assessed and if more studies were to take this approach, the relative importance of early life on adult disease risk could be better understood.     

早产儿视网膜病发病情况及高危因素的探讨

目的 探讨早产儿视网病（retinopathy of prematurity，ROP）的发病率、高危因素及防治措施。方法对194例早产儿生后72h内及生后4w开始定期检查眼底，发现ROP者密切随访至生后1年。结果72h内早期眼底检查眼底异常包括视乳头水肿、视网膜水肿、视网膜血管改变及出血等。生4w后检出ROP患儿12例（6．2％），高危因素分别为低出生体重，小孕周、长期或高浓度吸氧。结论建议出生体重小于2000g和／或孕周小于35w的早产儿，在生后第3w或胎龄达34w时常规行首次眼底检查，以早期发现ROP并给予及时治疗。     

Polymorphisms in the Angiotensin Converting Enzyme Gene and Growth in the First Year of Life

Abnormal patterns of fetal and infant growth have been associated with an increased risk of cardiovascular disease in adulthood. Catch‐up growth during the first year of life has been associated with a higher prevalence of type 2 diabetes mellitus, whereas a lack of catch‐up growth tracks with a risk of hypertension. The role of genetic factors influencing both growth and blood pressure have not been explored. We genotyped cord blood samples from 530 singleton, Caucasian, uncomplicated pregnancies, drawn from a larger cohort of 1650 pregnancies, and related polymorphism in the angiotensin converting enzyme (ACE) gene (alleles insertion (I) or deletion (D)) with measures of size at birth and at age of 1 year. ACE genotype did not significantly influence size at birth, although there was a greater proportion of individuals with the D/D genotype born with a birth weight less than the 10^th centile (P = 0.004). The ACE I/I genotype was significantly associated with higher weight (p = 0.001), body mass index (p = 0.001) and mid arm circumference (p = 0.001) at 1 year of age compared to the ACE D/D and I/D genotypes. Individuals with the I/I genotype displayed catch‐up (gain from birth size of ≥0.6 Standard Deviation Score) in weight (p = 0.04), body mass index (p = 0.03) and mid arm circumference (p = 0.03) compared to the D/D group, the majority of which showed no change or catch‐down. The I/D genotype was distributed equally across the catch up/catch down/no change categories. The effect was more marked in males, but ACE genotype and sex of the infant contributed independently to mid arm circumference measurements and there was no interaction between the two. There was no effect of maternal or paternal ACE genotype on birth size. In a multiple linear regression model ACE genotype, socioeconomic status and sex of the infant explained 10.9% of the variance in body mass index SDS at 1 year of age. We conclude that the ACE I/I genotype is associated with a higher weight and body mass index SDS at 1 year of age, along with catch‐up in terms of these measures from birth to 1 year. The D/D genotype is associated with a greater proportion of babies, born at term, that at small for gestational age. These results suggest that due consideration should be given to the underlying genotype of an individual when evaluating the association of early human growth with the development of risk factors for cardiovascular disease. The observation of independent effects of genotype, sex of the individual and socioeconomic status on postnatal growth suggests the need to develop methodologies for the integration of genetic and environmental factors in causality modelling.     

1021例体外受精-胚胎移植妊娠结局

目的探讨辅助生殖技术（assisted reproductive technology，ART）后的妊娠结局。方法对1021例通过ART获得的临床妊娠者，通过直接询问或电话随访对其妊娠结局进行回顾性分析。结果1021例妊娠者中，分娩838例（82．08％），单胎642例（76．61％），多胎196例（23．39％），流产132例（12．93％），异位妊娠41例（4．02％），分娩情况失随访10例（0．98％），畸形儿10例（1．19％），分娩男婴540个、女婴495个，新鲜胚胎移植后早期流产率为10．76％，明显高于冻融胚胎移植（FET）后的5．08％（P〈0．01），多胎的早产率、剖宫产率、低体重儿发生率均明显高于单胎（P〈0．01）。结论重视ART技术带来的多胎、早产、流产及异位妊娠等并发症．密切关注ART后代的出生缺陷。     

Genetic and environmental influences on infant weight and weight change: the Fels Longitudinal Study.

Despite significant progress in understanding the mechanisms by which the prenatal/maternal environment can alter development and adult health, genetic influences on normal variation in growth are little understood. This work examines genetic and nongenetic contributions to body weight and weight change during infancy and the relationships between weight change and adult body composition. The dataset included 501 white infants in 164 nuclear and extended families in the Fels Longitudinal Study, each with 10 serial measures of weight from birth to age 3 years and 232 with body composition data in mid-adulthood. Heritability and covariate effects on weight and weight z-score change from birth to 2 years of age were estimated using a maximum likelihood variance decomposition method. Additive genetic effects explained a high proportion of the variance in infant weight status (h2=0.61-0.95), and change in weight z-score (h2=0.56-0.82). Covariate effects explained 27% of the phenotypic variance at 0-1 month of age and declined in effect to 6.9% of phenotypic variance by 36 months. Significant sex, gestational age, birth order, birth year, and maternal body mass index effects were also identified. For both sexes, a significant increase in weight z-score (>2 SD units) (upward centile crossing) was associated with greater adulthood stature, fat mass, and percent body fat than decrease or stability in weight z-score. Understanding genetic influences on growth rate in a well-nourished, nutritionally stable population may help us interpret the causes and consequences of centile crossing in nutritionally compromised contexts.     

Down syndrome birth weight in England and Wales: Implications for clinical practice

The aim of this study was to determine if syndrome‐specific birth weight charts were beneficial for babies with Down syndrome in England and Wales. Birth weights of 8,825 babies with Down syndrome born in England and Wales in 1989–2010 were obtained from the National Down Syndrome Cytogenetic Register. Birth weight centiles for 30–42 weeks gestation by sex were fitted using the LMS method and were compared to those for unaffected babies from the UK‐WHO growth charts. For babies born with Down syndrome the median birth weight from 37 to 42 weeks was 2,970 g (10th–90th centile: 2,115–3,680) for boys and 2930 g (2,100–3,629) for girls, and the modal age of gestation was 38 weeks, 2 weeks earlier than for unaffected babies. At 38 weeks gestation they were only slightly lighter than unaffected babies (159 g for boys and 86 g for girls). However at 40 weeks gestation the shortfall was much greater (304 g and 239 g, respectively). In neonates with Down syndrome there is little evidence of growth restriction before 38 weeks gestation, so up to this age it is appropriate to use the UK‐WHO birth weight charts. Thereafter birth weight is below that of unaffected babies and it should be plotted on the UK Down syndrome growth charts. © 2015 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.     

Attitudes and practices of the primary health care team towards assessing the very elderly.

This paper investigates the attitudes and practices of members of the primary care team towards assessing the very elderly in the community. Using self-completion questionnaires 47 general practitioners, 24 health visitors and 22 community nurses in the Bath health district were asked if they felt over 75 year olds should be assessed, and if so who should do it, and what the assessment should include. A majority of all three groups of professionals considered it important to assess the over 75 year olds and that this should be done at home. They felt that such an assessment should be functionally oriented, that is, should concentrate on the activities of daily living rather than medical problems. None of the groups felt assessment was their sole responsibility but should be undertaken by a combination of members of the primary health care team with the health visitor playing a prominent role. Although 89% of all the respondents felt that health visitors should be involved in assessing the elderly, half of the health visitors felt their work should be mainly concerned with 0-5 year olds. In the absence of any general policy few assessment schemes exist in the district. An overall policy is required and this should be reflected in the training of each of the professional groups.