茵栀黄与肝太乐维生素C联合静点治疗新生儿病理性黄疸

新生儿黄疸分为生理性和病理性两大类。产生病理性黄疸的原因很多 ,感染是其中最常见原因之一。我们采用北京万辉业集团第四制药厂生产的茵栀黄及维生素Ｃ注射液及广州名兴制药厂生产的肝太乐注射液联合静点的方法治疗新生儿感染引起的病理性黄疸 ,取得了较好的疗效 ,且没有副作用发生 ,报告如下。1　资料和方法1 1　临床资料　所选 97例患儿为 1995年 6月～ 2 0 0 1年 6月在我科住院的患儿。按《实用新生儿学》第 6版新生儿病理性黄疸诊断标准[1] 确诊为新生儿黄胆。符合下列条件 :(1)新生儿细菌性肺炎合并黄疸 ;(2 )年龄在 14～ 2 8ｄ ;(3…     

脐血胆红素与新生儿黄疸的关系

临床上对新生儿高胆红素血症治疗是有效的,但对新生儿黄疸及胆红素脑损伤仍无可靠的预测方案。为能早期预防黄疸的危险程度,进行早期干预,减少胆红素脑损伤的发生,我们测定脐血胆红素浓度研究其对早期预测新生儿黄疸的意义。     

北海地区新生儿脐血血红蛋白电泳实验结果分析

目的了解北海地区新生儿地中海贫血的发病率,为临床诊断及预防提供依据。方法对本院2006年7月～2010年6月共5766份新生儿脐血标本进行琼脂糖电泳,并对Hb区带进行扫描定量分析。结果在5766份脐血标本中,检出Hb Bart阳性（≥1.0%）437例,阳性率为7.579%。根据Hb Bart含量推算,静止型、标准型α-地中海贫血、HbH病、HbBart胎儿水肿综合征的阳性率分别为2.099%、5.376%、0.087%和0.017%。另外发现异常血红蛋白病共17例,发生率为0.295%,其中HbE11例,HbG2例,HbC-S1例,HbJ 2例,HbK1例。结论北海市属于地中海贫血高发区,使用全自动电泳仪对脐血定量检测分析能早期、方便地对新生儿α-地中海贫血进行筛查。     

思连康联合喜炎平治疗新生儿黄疸临床观察

新生儿黄疸为新生儿常见病,出生后1周内黄疸发生率足月儿为60%,早产儿为80%[1]。若达到病理性黄疸,不及时治疗,往往会给患儿带来不良后果,甚至给患儿神经系统造成永久性损伤,因此早期预防和治疗是降低黄疸发病率的关键。我院儿科2009年4月～2010年12月收治新生儿黄疸80例,应用思连康联合喜炎平治疗40例,取得较好疗效,现报道如下。     

高海拔地区新生儿黄疸的病因特点及评估干预

新生儿黄疸是新生儿时期常见症状 ,对新生儿黄疸进行诊断和治疗时 ,首先要确定是否为病理性黄疸 ,若为病理性黄疸则要找出病因并决定是否治疗。我们在工作中一直延用欧美国家新生儿高胆红素血症的诊断标准 ,即足月儿血清总胆红素超过 2 2 0 .6μｍｏｌ/Ｌ和早产儿超过 2 56.5μｍｏｌ/Ｌ。但近年对是否继续使用上述诊断标准仍存在争议。国内外大量资料已证实生理性黄疸血胆红素有明显的种族、地域差异[1 ] 。我院实行儿科医生进产房 ,产儿科协作 ,孕妇产后母婴在院期间 ,新生儿均由儿科医生独立管理 ,既方便儿科医生掌握第一手资料 ,同时对…     

109例新生儿病理性黄疸病因分析

目的探讨新生儿病理性黄疸的病因。方法对109例新生儿病理性黄疸的临床资料进行回顾分析。结果围产因素37例（33．9％）占首位,其次为感染因素（23．9％）,多因素混合（12．8％）,母乳性黄疸（11．0％）,原因不明（10．1％）,溶血（8．3％）。结论加强国产期保健,防治感染,正确指导母乳喂养,可减少新生儿病理性黄疸的发生。     

新生儿病理性黄疸77例临床分析

新生儿病理性黄疸是新生儿的一种常见疾病。现将我科 1997年以来收治的 77例新生儿病理性黄疸的病因作系统性回顾分析 ,为其临床防治提供依据。1　资料和方法1 1　临床资料　男 4 5例 ,女 32例 ;日龄 1～ 2 8ｄ ,早产儿 2 4例 ,足月儿 5 3例 ,早期黄疸 6 0例 (新生儿日龄 <14ｄ ,足月儿血清胆红素浓度 >2 2 0 6 μｍｏｌ/Ｌ ,早产儿 >2 5 5 μｍｏｌ/Ｌ ,出生后 2 4ｈ出现黄疸者胆红素浓度 >10 2 μｍｏｌ/Ｌ) [1] ,晚期黄疸 17例 (日龄≥ 14ｄ ,德清胆红素浓度 >34 2 μｍｏｌ/Ｌ)。1 2　黄疸的病因　早期黄疸 :母乳性 13例 ;感染 2 2例 ,…     

新生儿急性胆红素脑病临床特点及MRI特征分析

目的探讨新生儿急性胆红素脑病的临床特点及MRI特征。方法选取我院诊治的急性胆红素脑病患儿60例作为观察组,同时选取高胆红素血症患儿60例作为对照组,比较两组患儿的病因及MRI特征。结果ABO血型不合溶血病、葡萄糖-6-磷酸脱氢酶(G6PD)缺乏、感染为观察组的病因前3位;原因不明、母乳性黄疸、ABO血型不合溶血病为对照组的病因前3位;观察组的病因ABO血型不合溶血病、G6PD缺乏、感染明显高于对照组,观察组的病因原因不明、母乳性黄疸明显低于对照组,差异均有统计学意义(P<0.05)。观察组MRI未见异常5例(8.33%),低于对照组57例(95.00%),T1WI苍白球对称性高信号、其他部位高信号分别为46例(76.67%)、9例(15.00%),明显高于对照组的2例(3.33%)、1例(1.67%),差异均有统计学意义(P<0.05)。结论新生儿急性胆红素脑病的主要病因为ABO血型不合溶血病、G6PD缺乏和感染,MRI主要表现为T1WI苍白球对称性高信号。     

黄疸仪对35例新生儿高胆红素血症动态监测的临床观察

新生儿黄疸(neonatal jaundice)是指新生儿时期出现高胆红素血症的症状,是新生儿时期的常见疾病.2013-12月至2014年12月,共出生婴儿1113人,采用JH20-1B经皮黄疸仪行动态黄疸监测,实验证实黄疸仪监测经皮胆红素值(TCB)与微量血胆红素值相关性良好,因此采用日龄或小时龄胆红素值进行评估,动态监测黄疸值变化,是防止新生儿脑病发生及筛选病理性黄疸的关键.     

模拟微重力条件下昆明小鼠早期胚胎体外发育及其G6PD基因表达

目的 研究模拟微重力条件下培养的小鼠早期胚胎体外发育与1g重力条件下体外发育的差异。方法 检测葡萄糖代谢关键酶6-磷酸葡萄糖脱氢酶（G6PD）在昆明小鼠早期胚胎体外不同重力条件下培养各个时期基因的转录与表达。结果 模拟微重力培养条件下,胚胎体外发育受到明显的抑制,模拟微重力不利于小鼠胚胎的体外发育。用CZB＋10％FCS进行培养,2-细胞期培养的囊胚率为零,显著低于常规培养的23．92％;4-细胞期培养的囊胚率为18．44％,显著低于常规培养的80．12％。利用G6PD的内、外两对引物,检测昆明小鼠早期胚胎体外发育各个阶段的G6PD基因的转录与表达。从2-细胞期开始体外常规培养的胚胎,发育至4-、8-细胞胚胎、桑椹胚、囊胚及退化囊胚都有G6PD基因的转录与表达。在模拟微重力条件下,从2-细胞期开始培养的胚胎,发育至4-细胞期、桑椹期、囊胚期胚胎和退化桑椹胚皆有G6PD基因的转录和表达,而退化的2-细胞胚胎没有检测到G6PD基因的转录与表达。结论 两种培养方式之间,G6PD基因的转录与表达不存在差异,说明早期胚胎都存在磷酸戊糖途径。     

北海市10年间儿童贫血病因分析

目的了解北海市儿童贫血的原因。方法收集2001～2011年10年问在我院住院治疗的贫血患儿的病例资料,进行回顾性分析。结果10年间共收住贫血患儿280例,其中红细胞葡萄糖6-磷酸脱氨酶（G-6-PD）缺乏症132例,占47．14％,恶性肿瘤44例,占15．71％,两病在2009年前有增加趋势,但近两年又有所下降;地中海贫血50例,占17．86％,有逐年增加趋势;营养性缺铁性贫血（IDA）34例,占12．14％,发病率逐年减少;再生障碍性贫血8例,占2．86％,出血性贫血12例,占4．29％,变化趋势不明显。结论引起北海市儿童贫血原因的排序已发生了变化,遗传性疾病已成为导致贫血的主要原因,其中G-6-PD缺乏症尤为突出,地中海贫血次之,故应做好产前诊断,减少儿童贫血的发生。     

Prevalence of glucose-6-phosphate dehydrogenase deficiency in U.S. Army personnel

The U.S. Army recently mandated that soldiers undergo glucose-6-phosphate dehydrogenase (G6PD) testing before deployment to malarious regions. We retrospectively characterize the presence and degree of G6PD deficiency in U.S. military personnel by sex, self-reported ethnicity, and World Health Organization deficiency classification through test results obtained October 1, 2004 through January 17, 2005. Data were available for 63,302 (54,874 males and 8,428 females) subjects; 2.5% of males and 1.6% of females were deficient, with most having only moderate enzyme deficiency. African American males (12.2%) and females (4.1%), along with Asian males (4.3%), had the highest rates of G6PD deficiency. Most males were found to have class III variants while most females were class IV variants. The most severely deficient were Asian males (class II). These results suggest that universal screening for G6PD deficiency is clinically warranted, and particularly essential for those male service members who self-report ethnicity as African American, Asian, or Hispanic.     

新生儿黄疸对心率变异性的影响及其临床意义

目的探讨新生儿黄疸对心率变异性的影响及其临床意义。方法应用美国威豪公司CompaxXMHolter分析系统检测12例轻-中度黄疸新生儿、8例重度黄疸新生儿治疗前后和12例正常新生儿的心率变异性。结果轻-中度黄疸患儿即显示有HRV的增高,表现为SNDD、SNDD index、RMSSD、5min total power、HF的升高(P<0.05),而重度黄疸HRV则下降,表现为SNDD、5min total power下降(P<0.05)。经治疗后重度黄疸的HRV增加,表现为交感神经张力的增加,但仍低于对照组(P<0.05)。结论新生儿黄疸可影响心脏自主神经功能,表现为交感神经张力增加。心率变异性判断新生儿黄疸预后的可靠指标。其中SNDDindex、5min total power两项指标反应黄疸新生儿的交感神经张力更敏感。     

Triangular cord sign and ultrasound features of the gall bladder in infants with biliary atresia

The aim of this study was to reassess the accuracy of the triangular cord sign, the triangular cord sign coupled with abnormal gall-bladder length, and an irregular gall-bladder wall in the diagnosis of biliary atresia. The ultrasonograms of 46 infants with cholestatic jaundice were reviewed for the triangular cord sign, gall-bladder length and gall-bladder wall without knowledge of the clinical data. Of the 23 infants with biliary atresia, 22 had the triangular cord sign whereas 17 infants with other causes of cholestatic jaundice did not have the triangular cord sign. The sensitivity, specificity, accuracy and positive predictive value of the triangular cord sign in the diagnosis of biliary atresia were 95.7, 73.9, 84.8 and 78.6%, respectively. The sensitivity, specificity, accuracy and positive predictive value of the triangular cord sign coupled with abnormal gall-bladder length in the diagnosis of biliary atresia were all 95.7%. Gall-bladder wall irregularity was seen in seven of 14 infants (50%) with biliary atresia whose gall bladders contained bile on ultrasound and in two of 22 infants (9.1%) without biliary atresia whose gall bladders contained bile on ultrasound. At the medical centre where this study was performed and where infants present with cholestatic jaundice at an advanced stage, the ultrasonographic triangular cord sign coupled with abnormal gall-bladder length is more reliable than the ultrasonographic triangular cord sign alone or gall-bladder wall irregularity in the diagnosis of biliary atresia.     

早期新生儿黄疸的动态监测及早期干预治疗效果评价

目的观察出生1周内新生儿黄疸的动态变化、高胆红素血症患儿病因分析及早期干预治疗的效果。方法利用经皮胆红素测定仪对我院产科出生的928例新生儿每日进行同一部位的皮肤测定,根据新生儿不同出生情况对超过胆红素值安全范围的及时给予口服药物或转儿科蓝光治疗。结果928例新生儿因高胆红素血症住院156例,高胆红素血症发生率为15.74%,无1例发生胆红素脑病。结论对新生儿黄疸进行监测和早期干预治疗,可大幅度降低高胆红素血症的发病率,从而防止胆红素脑病的发生。     

Echography of the hip in the newborn. 1507 cases

The authors report the data relative to 1507 infants studied with clinical and US examination, in the neonatal period, in order to exclude hip dysplasia or dislocation. US examination was carried out according to Graf's technique and the newborns were classified according to US hip type, to clinical examination and to possible risk factors. The patients were included in a protocol including orthopedic and US controls. Seventeen treated infants were considered as pathologic. Ten of them had IIc or D hips at birth; the other 7, with IIa hips at birth, presented a X-ray pathologic hip after the 4th month of life. At about one year of age all infants could normally walk, except for one who was being treated with harness. No statistically significant differences were observed between the number of pathologic infants in the risk group (1.7%) and that in the no-risk group (0.8%). Clinical examination of the newborn has low sensitivity in detecting pathologic hips. On the basis of their results, the authors believe US examination of the newborn to be a valuable screening method to diagnose hip dysplasia/dislocation. Moreover, Graf's morphologic method is the best one for US screening of the hip in the neonatal period.     

Exercise-induced oxidative stress in G6PD-deficient individuals

PURPOSE: This study was designed to investigate whether individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency can exercise without greater perturbations in their redox status compared with non-G6PD-deficient individuals. METHODS: Nine males with established G6PD deficiency and nine males with normal G6PD activity performed two exhaustive treadmill exercise protocols of different duration (the shorter one lasting 12 min and the longer one 50 min). Several hematological parameters, reduced glutathione (GSH), oxidized glutathione (GSSG), thiobarbituric acid reactive substances (TBARS), protein carbonyls, catalase, and total antioxidant capacity (TAC) were measured in the blood before and after each exercise bout. RESULTS: Both GSH and GSSG were significantly higher in the control group compared with the G6PD-deficient group at baseline (0.404 +/- 0.101 vs 0.195 +/- 0.049 mmol.L(-1) for GSH and 0.047 +/- 0.012 vs 0.012 +/- 0.006 mmol.L(-1) for GSSG; P < 0.05); as a result, their ratio was not significantly different between the two groups (P > 0.05). All other oxidative stress indices were not different between groups at rest (P > 0.05). Exercise of both durations affected significantly (P < 0.05) and similarly the levels of all oxidative stress indices either in the G6PD-deficient group or in the control group. Only the long exercise affected GSH status significantly (P < 0.05), whereas both short and long exercise increased the levels of TBARS, protein carbonyls, catalase activity, and TAC to a similar extent (P < 0.05). CONCLUSION: G6PD-deficient individuals are able to exercise until exhaustion without higher oxidative stress compared with non-G6PD-deficient individuals. Exercise duration is an important determinant of the magnitude of exercise-induced changes for GSH, GSSG, and GSH/GSSG, but not for TBARS, protein carbonyls, catalase activity, or TAC.     

Sonographic diagnosis of biliary atresia in pediatric patients using the "triangular cord" sign versus gallbladder length and contraction

OBJECTIVE: A retrospective review was performed to evaluate the importance of the "triangular cord" sign in comparison with gallbladder length and contraction for the diagnosis of biliary atresia in pediatric patients. MATERIALS AND METHODS: Fifty-five fasting infants with cholestatic jaundice were examined on sonography. The examinations focused on the visualization of the triangular cord sign and assessment of gallbladder length and contraction. The diagnosis of neonatal hepatitis or of other causes of infantile cholestasis was made if symptom resolution occurred during follow-up. RESULTS: A triangular cord sign was found in 27 of 29 infants with biliary atresia and in one of 26 infants with neonatal hepatitis or other causes of infantile cholestasis. The diagnostic accuracy was 95%, sensitivity was 93%, and specificity was 96%. The gallbladder was thought to be abnormal if it was less than 1.5 cm long, was not detectable, or was detectable but had no lumen. The gallbladder was abnormal in 21 of 29 infants with biliary atresia, whereas it was abnormal in eight of 26 infants with neonatal hepatitis or other causes of infantile cholestasis. The diagnostic accuracy was 71%, sensitivity was 72%, and specificity was 69%. The gallbladder was detectable on sonography in 13 infants with biliary atresia and 26 infants with neonatal hepatitis or other causes of infantile cholestasis. Gallbladder contraction was not confirmed in 11 of 13 infants with biliary atresia and seven of 26 infants with neonatal hepatitis or other causes of infantile cholestasis. The diagnostic accuracy was 77%, sensitivity was 85%, and specificity was 73%. CONCLUSION: The triangular cord sign was a more useful sonographic finding for diagnosing biliary atresia than gallbladder length and contraction.