78例小于胎龄儿的临床特点分析

目的分析小于胎龄儿临床基本情况、围生期相关因素和并发症发生情况,为临床预防小于胎龄儿的发生提供参考资料。方法将小于胎龄儿78例和适于胎龄儿120例分为小于胎龄儿组和适于胎龄儿组,统计分析2组新生儿及母亲基本资料、新生儿并发症发生情况。结果 2组新生儿胎龄比较差异无统计学意义(P>0.05);与适于胎龄儿组相比,小于胎龄儿组新生儿女性偏多、住院时间偏长而出生体质量偏低(均P<0.01)。2组胎盘因素、妊娠期糖尿病、母亲内科疾病、高龄产妇比较差异无统计学意义(均P>0.05);与适于胎龄儿组比较,小于胎龄儿组妊娠期高血压、多胎妊娠、羊水过少、胎膜早破和宫内窘迫发生率较高(均P<0.05)。2组新生儿喂养不耐受、颅内出血、呼吸暂停、呼吸窘迫综合征、消化道出血、吸入综合征并发症发生率比较差异无统计学意义(均P>0.05);与适于胎龄儿组比较,小于胎龄儿组新生儿窒息、红细胞增多症、高胆红素血症和低血糖发生率较高(均P<0.05)。结论小于胎龄儿出生体质量低且并发症较多,与母亲健康情况密切相关。加强孕期保健减少小于胎龄儿发生的同时应加强新生儿监护。     

胰岛素样生长因子-1在胎儿生长中的重要作用

目的检测孕产妇、新生儿胰岛素样生长因子-1(Insu lin-like grow th factor-I,IGF-1),探讨小于胎龄儿及宫内发育迟缓儿的发病机制。方法采用放射免疫法检测血清中IGF-1。比较小于胎龄儿与足月胎龄儿,早产孕妇和正常足月孕妇IGF-1含量,了解不同体重、不同胎龄、不同胎盘成熟胎儿及其孕妇母体的IGF-1水平差异。结果IGF-1随胎龄、胎重的增加而增高。表明IGF-1在胎儿生长发育中的重要调节作用。早期改善母体营养,达到改善胎儿宫内营养状况。结论在孕早、中期及时检测IGF-1含量,预防胎儿宫内发育迟缓,产前提高胎儿整体健康水平。     

小于胎龄儿生后3月生长激素和胰岛素样生长因子I变化及临床意义

小于胎龄儿(newborns sm all for gestational age,SGA)是出生体重低于同胎龄正常值的第10百分位数或低于同胎龄正常平均值的2个标准差的一组新生儿,在我国发生率达7.5%,病死率是正常足月儿的8倍[1]。本研究旨在分析小于胎龄儿与适于胎龄儿(newborns appropriate for gestation     

小于胎龄儿出生后血清维生素B12及脑发育水平研究

目的检测小于胎龄儿、适于胎龄儿出生后血清维生素B12(VB12)、同型半胱氨酸(Hcy)水平的差异并对足月儿进行行为神经评定,探讨VB12、Hcy对胎儿发育的影响及小于胎龄儿脑发育水平。方法根据胎龄与出生体质量的关系,将符合入选条件的研究对象分为小于胎龄儿组(早产小于胎龄儿亚组、足月小于胎龄儿亚组)、适于胎龄儿组(早产适于胎龄儿亚组、足月适于胎龄儿亚组),检测其血清中VB12、Hcy水平,分析出生时血清VB12、Hcy水平与出生体质量、胎龄的关系,比较小于胎龄儿、适于胎龄儿组出生时血清VB12、Hcy的水平差异。采用新生儿20项行为神经评定法(NBNA)对生后2~3 d的足月小于胎龄儿亚组、足月适于胎龄儿亚组进行行为神经测定并比较2组差别。结果出生时血清VB12水平与出生体质量呈正相关(r=0.564,P<0.05);血清Hcy水平与出生体质量呈负相关(r=-0.569,P<0.05)。早产适于胎龄儿亚组出生时血清VB12水平高于、Hcy水平低于早产小于胎龄儿亚组[VB12:(262.07±62.25)pg/ml vs(228.21±67.27)pg/ml;Hcy:(8.47±3.81)μmol/L vs(17.53±10.56)μmol/L],差异有统计学意义(P均<0.05);足月适于胎龄儿亚组出生时血清VB12水平高于、Hcy水平低于足月小于胎龄儿亚组[VB12:(431.03±113.82)pg/ml vs(254.80±72.35)pg/ml;Hcy:(4.61±2.88)μmol/L vs(13.60±9.29)μmol/L],差异有统计学意义(P均<0.05)。与足月适于胎龄儿亚组相比,足月小于胎龄儿亚组NBNA总分、行为能力、被动肌张力、主动肌张力评分均明显降低(P均<0.05)。结论出生时血清VB12水平与出生体质量、胎龄呈正相关;血清Hcy水平与出生体质量、胎龄呈负相关;小于胎龄儿出生时血清VB12水平较适于胎龄儿低,Hcy水平较适于胎龄儿高,提示VB12可能影响胎儿生长发育。足月小于胎龄儿早期NBNA评分较足月适于胎龄儿明显减低,说明小于胎龄儿出生时行为神经能力已受到影响。     

小于胎龄儿血中胃肠激素水平对其胃肠道营养影响的研究

目的探讨小于胎龄儿生后血中胃肠激素水平变化及其对胃肠道营养的影响。方法应用放射免疫法监测118例小于胎龄儿（其中早产62例;足月52例）生后喂奶前及第7日胃动素（MOT）、胃泌素（GAS）浓度,并与85例正常足月新生儿作为对照组。结果①小于胎龄儿组生后喂奶前及第7d空腹血浆MOT、GAS均明显低于对照组;但随胎龄、日龄、奶量增加而升高,呈正相关;第7d时已超过足月儿对照组生后开奶前水平;②喂养不耐受组小于胎龄儿生后空腹血中MOT、GAS浓度均较喂养正常组低;③早期喂养能改善小于胎龄儿MOT水平和胃肠道动力,提高肠道喂养的耐受性。结论小于胎龄儿消化道机能适应胃肠道营养,在严密观察下早期喂养,将能促进小于胎龄儿胃肠道的发育和成熟。     

小于胎龄儿与胰岛素抵抗及其相关疾病相关性的研究进展

小于胎龄儿会增加新生儿的死亡率和新生儿的发病率,流行病学和动物实验都证实小于胎龄儿可以造成成年后代谢系统和心血管系统以胰岛素抵抗为病理生理基础的疾病,但是两者之间的关系尚不清楚。此文章主要就这两者之间的关系进行简单的文献综述。目前国内外对预测小于胎龄儿的发生尚没有一个特异性的指标,但是母亲胰岛素敏感性指标结合血糖水平对于小于胎龄儿的预测有一定的价值。更准确更早期预测小于胎龄儿是提高人口质量是提高后代生活质量的重要途径。     

新生儿原发性肾上腺皮质功能不全1例

患儿,男,系第3胎第2产,为双胎之小,胎龄35周,因"双胎妊娠,胎儿宫内发育受限"剖宫产出生,无窒息复苏及抢救史,双胎共用1个胎盘、为帆状胎盘,独立羊膜腔,出生体质量1.85kg,生后以"①早产儿(小于胎龄儿);②低出生体质量儿;③双胎之小"于2011年5月23日入院。父母体健,非近     

小于胎龄儿的认识和管理

小于胎龄儿（small for gestational age infant,SGA）围生期死亡率以及出生后至成人期发病率均明显高于适于胎龄儿（appropriate for gestational age, AGA）。SGA病因具有多样性,混杂了生理性（父母身材矮小）和病理性（母体、胎儿和胎盘）因素。胎儿本身的结构性或染色体异常是SGA的重要病因,5%~20%的SGA是由基因异常引起。小于胎龄儿一旦出生,临床医师需要警惕后续的急性并发症和慢性并发症。急性并发症主要有围生期窒息、红细胞增多、低血糖、宫内感染、低体温、黄疸及喂养困难。SGA长期随访可发现多系统疾病风险,包括生长受限、心血管疾病、肥胖、胰岛素抵抗和2型糖尿病、胃肠道疾病、神经发育和认知障碍等,对于性发育也有一定影响。长期并发症可能导致不良的成人结局。生长激素治疗改善身高安全有效,同时改善身体组分和减少代谢并发症。因此,科学管理SGA需要基于中国SGA病因及生活最佳追赶生长模式的真实世界研究,总结不同类型SGA的最佳成长模式,这将是SGA管理的重要研究方向。     

小于胎龄儿气质和智能发育随访观察

目的初步探讨小于胎龄(SGA)婴儿出生后气质的影响及智能运动发育情况。方法对32例小于胎龄儿(SGA组)及51例适于胎龄儿(AGA组)随访,于6个月龄时采用婴儿气质修订问卷(RITQ)进行气质分析,并于6个月龄及12个月龄对两组采用Gesell婴幼儿发育检查量表评估,对气质类型及发育商(DQ)进行比较。结果小于胎龄儿组和适于胎龄儿组婴儿气质分类比较经χ2检验,两组气质分类差异有显著性(P<0.05)。SGA组D型、I-D型、S型所占比例较高。小于胎龄儿组较适于胎龄儿组DQ低。结论SGA在婴儿期即表现出一定的气质特点,根据其气质特点可指导进行早期干预以提高智能发育水平。     

胃肠激素检测在小于胎龄儿变化中临床意义

应用放射免疫法对68例小于胎龄儿(其中早产36例;足月32例)生后喂奶前及第7日空腹血中生长抑素(soma-tostatin,SS)、胃动素(motilin,MOT)、胃泌素(gastrin,Gas)浓度进行测定,并以30例足月新生儿作为对照组。结果小于胎龄儿组生后喂奶前及第7日空腹血浆胃动素、胃泌素均明显低于对照组,而生长抑素浓度明显高于对照组.并且与胎龄、开始喂养时间及当日进奶等因素相关。结论小于胎龄儿消化道机能适应胃肠道营养,在严密观察下应用合理的喂养方式早日开始胃肠道营养,将能促进小于胎龄儿胃肠道的发育和成熟。     

Intrauterine growth restriction and Doppler ultrasonography.

To clarify the difference between the fetus that is small for gestational age and the fetus with true intrauterine growth restriction, we undertook a retrospective study of singleton fetuses who had fetal weight estimation and umbilical artery Doppler velocity studies within 2 weeks of their delivery. Fetuses were divided into four categories on the basis of sonographic results from their last examination. Statistical comparisons of neonatal outcome were made for the four groups, which totaled 578 fetuses. Increased cesarean section for fetal distress, stays in the neonatal intensive care unit, and increased neonatal morbidity were seen in both small for gestational age and average for gestational age neonates with abnormal Doppler blood flow. The small for gestational age fetuses with normal Doppler studies showed no increased morbidity when compared with their average for gestational age cohorts. Umbilical artery Doppler blood flow studies were a better predictor of neonatal outcome than estimated fetal weight. Small for gestational age fetuses with normal Doppler studies most likely represent constitutionally small, not pathologically growth restricted, fetuses.     

Uterine-umbilical artery Doppler velocimetry in pregnant women with systemic lupus erythematosus.

We evaluated continuous wave uterine-umbilical artery Doppler velocimetry for predicting pregnancy outcome in women with systemic lupus erythematosus (SLE). Lupus anticoagulant (LAC) and anticardiolipin (ACL) antibody status also were correlated with Doppler results and outcome. Three Doppler vascular patterns were identified in 27 pregnancies of 26 women with SLE. Patients with normal flow velocity in both vessels had normal outcomes (n = 18). Reduced flow velocity of the umbilical artery only was present in five women, whose newborn infants were of lesser gestational age and birthweight, two being small for gestational age. In four pregnancies reduced flow velocity was noted in both vessels. These cases had the poorest outcome, with three perinatal losses and all fetuses being small for gestational age. Doppler velocimetry showed 100% sensitivity and negative predictive value in the detection of the small for gestational age fetus and abnormal antepartum fetal heart rate tracing. Fourteen of 18 women with normal Doppler studies did not have preeclampsia or SLE flare-ups, whereas all nine women with abnormal Doppler studies had such complications. In all 27 pregnancies the women were screened for LAC, and 21 women also were tested for the ACL antibody. Poor correlation was found between antiphospholipid antibody status and Doppler results in three of the six pregnancies with positive antibody testing the patients had normal Doppler studies and outcomes. Thus, Doppler velocimetry may help determine when these substances will affect the outcome adversely. In this study the umbilical-placental vascular system was affected more often. Uterine-umbilical arterial Doppler velocimetry uniquely identified the fetus at risk for adverse perinatal outcome in pregnancies complicated by SLE. Thus, it is a potentially valuable tool in clarifying the pathophysiology and in the management of SLE in pregnancy.     

Adverse birth outcomes in relation to prenatal sonographic measurements of fetal size.

OBJECTIVE: To evaluate and quantify the prediction of multiple neonatal outcomes by sonographically estimated fetal weight across a broad range of gestational ages. METHODS: A retrospective cohortanalysis was conducted among women with certain gestational age (n = 1,376) seen at the University of California San Francisco from 1994 through 1997. The relative risks for small size at birth, small (low birth weight) for gestational age, and adverse neonatal outcomes were compared between small and average-sized fetuses. RESULTS: Fetuses with an estimated fetal weight in the 5th percentile or less for gestational age were at increased risk of a birth weight less than 2,000 g (relative risk, 6.5), a birth weight in less than the 3rd percentile for gestational age (relative risk, 10.1), preterm birth (relative risk, 2.2), extreme preterm birth (relative risk, 5.7), prolonged neonatal hospital stay (relative risk, 2.7), neonatal intensive care unit admission (relative risk, 3.2), and stillbirth or neonatal death (relative risk, 7.7) compared with average-sized fetuses (all P < .0001). With intrauterine growth restriction defined as an estimated fetal weight in the 5th percentile or less for gestational age, up to 29% of fetuses with adverse neonatal outcomes were detected, for false-positive rates of only 4% to 5%. After adjusting for confounding variables, low estimated fetal weight remained a significant predictor of neonatal morbidity and mortality. CONCLUSIONS: Morbidity and mortality are significantly increased among fetuses with an estimated fetal weight in the 5th percentile or less for gestational age.     

Prenatal diagnosis of a lean umbilical cord: a simple marker for the fetus at risk of being small for gestational age at birth.

OBJECTIVE: The purpose of this study was to investigate whether the prenatal diagnosis of a 'lean' umbilical cord in otherwise normal fetuses identifies fetuses at risk of being small for gestational age (SGA) at birth and of having distress in labor. The umbilical cord was defined as lean when its cross-sectional area on ultrasound examination was below the 10th centile for gestational age. METHOD: Pregnant women undergoing routine sonographic examination were included in the study. Inclusion criteria were gestational age greater than 20 weeks, intact membranes, and singleton gestation. The sonographic cross-sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. Umbilical artery Doppler waveforms were recorded during fetal apnea and fetal anthropometric parameters were measured. RESULTS: During the study period, 860 patients met the inclusion criteria, of whom 3.6% delivered a SGA infant. The proportion of SGA infants was higher among fetuses who had a lean umbilical cord on ultrasound examination than among those with a normal umbilical cord (11.5% vs. 2.6%, p < 0.05). Fetuses with a lean cord had a risk 4.4-fold higher of being SGA at birth than those with a normal umbilical cord. After 25 weeks of gestation, this risk was 12.4 times higher when the umbilical cord was lean than when it was of normal size. The proportion of fetuses with meconium-stained amniotic fluid at delivery was higher among fetuses with a lean cord than among those with a normal umbilical cord (14.6% vs. 3.1%, p < 0.001). The proportion of infants who had a 5-min Apgar score < 7 was higher among those who had a lean cord than among those with normal umbilical cord (5.2% vs. 1.3%, p < 0.05). Considering only patients admitted in labor with intact membranes and who delivered an appropriate-for-gestational-age infant, the proportion of fetuses who had oligohydramnios at the time of delivery was higher among those who had a lean cord than among those with a normal umbilical cord (17.6% versus 1.3%, p < 0.01). CONCLUSION: We conclude that fetuses with a lean umbilical cord have an increased risk of being small for gestational age at birth and of having signs of distress at the time of delivery.     

Screening for intrauterine growth retardation using the ultrasound biparietal diameter

Fifteen hundred patients were scanned to predict fetal age and weight by biparietal diameter measurement. Three hundred eleven patients had more than one scan. Fortythree small for gestational age (SGA) babies were ultimately delivered in this population. Prenatal ultrasound screening criteria for grouping into appropriate for gestational age (AGA) or small for gestationa1age (SGA) categories were: a only an absolute biparietal diameter below the third percentile for the reference Rochester region population; b only ΔBPD calculated as less than 50 percent of the mean growth rate for the reference population; and c a combination of these two factors. Intrauterine growth retardation was most accurately determined when an absolutely small biparietal diameter was found (at the time of the last ultrasound examination) in a woman with accurate gestational age assessment. Least accurate was the prediction based on one biparietal diameter measurement in a woman with poor clinical dates. A 50 percent false positive detection rate and poor sensitivity to intrauterine growth retardation were found using ultrasound biparietal diameter measurements as a screening test in this manner.     

Performance of Doppler ultrasonography as a screening test in low risk pregnancies: results of a multicentric study.

To assess the efficacy of the Doppler velocimetry of the uterine and umbilical arteries as a screening test for preeclampsia and fetal growth retardation, we studied 916 low risk pregnancies. The S/D ratios of the uterine and umbilical arteries were obtained at 19 to 24 weeks and at 26 to 31 weeks of gestational age. Mean values, receiver operator curves, and the diagnostic accuracy of the tests were calculated for the following end-points: (1) pregnancy-induced hypertension, (2) low birth weight for gestational age, (3) small for gestational age with abnormal outcome, (4) pregnancy-induced hypertension needing preterm delivery. The prevalences for these outcomes were 3.4%, 4.6%, 1%, and 0.7%, respectively. The study was blinded. The umbilical and uterine artery S/D ratios were significantly higher in the abnormal than in the normal outcome group. When uterine arteries were studied at 19 to 24 weeks, sensitivity was 59% in the detection of pregnancy-induced hypertension, 11% in the detection of small for gestational age fetuses, 33% in the detection of small for gestational age fetuses with abnormal outcome, and 83% in the detection of pregnancy induced hypertension needing preterm delivery; the corresponding values for specificity were 69%, 94%, 94%, and 68%. At 26 to 31 weeks the sensitivity values were respectively, 69%, 58%, 75%, and 100% and specificity values were 80%, 59%, 39%, and 79%. When umbilical arteries were studied at 19 to 24 weeks, sensitivity was 38% in the detection of pregnancy-induced hypertension, 46% in the detection of small for gestational age fetuses, 78% in the detection of small for gestational age fetuses with abnormal outcome, and 67% in the detection of pregnancy-induced hypertension needing preterm delivery. The corresponding values of specificity were 74% for all four groups. At 26 to 31 weeks the sensitivity values were 38%, 43%, 87%, and 67%, respectively, and specificity values were 80% for all four groups. We concluded that Doppler examinations of the uterine and umbilical arteries can detect, at midpregnancy, the severe forms of pregnancy-induced hypertension and small for gestational age fetuses but they cannot be used to screen a low risk population in which the prevalence of the disease is low, and hence the positive predictive value is low.     

A possible association between early life factors and burden of functional bowel symptoms in adulthood

ObjectiveThe studies of early life factors and development of functional bowel diseases show inconsistent results. We therefore examined associations between certain early life factors and functional bowel symptoms in adulthood.DesignPopulation-based cross-sectional study.SettingWeight and height were measured and questionnaires were completed at the time point of enrollment in MOS.Subjects1013 participants in the Malmö Offspring Study (MOS) without organic bowel disease with data available from the Swedish Medical Birth Registry.Main outcome measuresAssociations were calculated between gestational age, birth weight, small-for-gestational-age and Apgar score from the Birth Registry, and symptoms according to the visual analog scale for irritable bowel syndrome (VAS-IBS) (abdominal pain, diarrhea, constipation, bloating and flatulence, vomiting and nausea, and symptoms’ influence on daily life) or self-reported IBS using logistic regression.ResultsIn all, 253 (25.0%) participants reported bowel symptoms during the past 2 weeks and 179 (17.7%) self-reported IBS; conditions which were strongly associated (p < 0.001). Female sex and chronic stress were two independent factors more common among participants with bowel symptoms compared with asymptomatic participants (p < 0.001). Early life factors were not associated with presence of overall bowel symptoms (p = 0.080), any specific bowel symptoms or self-reported IBS. Lower birth weight (p = 0.038) and being born small for gestational age (p = 0.043) were associated with severe influence of intestinal symptoms on daily life in adulthood.ConclusionsLower birth weight and small for gestational age are not associated with the presence of overall bowel symptoms but with more pronounced influence of such symptoms on daily adult life.

Key points

• Lower gestational age tended to be associated with functional bowel symptoms in adulthood.
• Lower birth weight and being small for gestational age are associated with increased negative influences of symptoms on daily life in adulthood.
• Patients born preterm or with low birth weights may be at increased risk to develop functional bowel symptoms later in life.

     

A five year survey of small for dates infants for chromosomal abnormalities

Anderson, N. G. (1976). Aust. paediat. J., 12, 19–23. A five year survey of small for dates infants for chromosomal abnormalities. Beginning in February, 1970 and continuing through to January 1975, a period of 5 years, all babies admitted to the Neonatal Unit were assessed for gestational age. Those babies whose weight, when correlated with gestational age, indicated that they were small for dates, had chromosomal analysis. Over this period, 13034 babies were surveyed and 309 were accepted into the small for dates category. Of these, 6 had major chromosomal abnormalities.