不同出生体重与性别的新生儿脐血中黄体生成素、卵泡刺激素及睾酮水平的变化

近期研究发现，脐血中多种激素水平与母血中相应的激素含量之间无明显相关性，说明脐血中激素含量更能反应胎儿的生长发育情况。至今为止，有关新生儿脐血中黄体生成素（LH）、卵泡刺激素（FSH）、睾酮（T）的变化国内外报道甚少。为此，我们检测上述激素水平，以探讨它们与新生儿出生体重、性别的关系。     

不同出生体质量、性别新生儿脐血黄体生成素、卵泡刺激素、睾酮的水平变化

目的探讨脐血黄体生成素（LH）．卵泡刺激素（FSH）和睾酮（T）在不同出生体质量、性别新生儿脐血中的差异及其对胎儿生长发育的影响。方法根据新生儿出生体质量分为3组，其中巨大儿组28例，官内发育迟缓儿（IUGR）组31例；正常新生儿组71例。采用放射免疫分析法检测3组新生儿脐血LH,FSH和T水平。结果1．男性新生儿脐血LH、FSH和T水平均显著高于女性者（P〈0．001，0．05）；2．IUGR组脐血LH水平显著高于正常新生儿组（P〈0．05），而FSH水平显著低于正常组（P〈0．01）。结论脐血LH、FSH和T水平与胎儿性别有相关性，脐血LH与IUGR的发生有关。     

蓝光照射降低足月儿血清FSH和LH水平的研究

用放免法连续测定50例光疗组和55例对照组足月儿生后5周内血清促性腺激素浓度。结果:(1)对照组男女嬰血清卵泡刺激素(FSH)水平的变化相似,第1周偏低,第2～3周明显升高,其后下降。女婴的水平略高于男嬰,但统计学上无显著性意义。黄体生成素(LH)水平的变化不同,男嬰维持在较高水平,而女嬰除第1周外,均处于低水平且显著低于男嬰。(2)光疗组男女婴血清FSH和LH第1周均显著低于对照组,其后显著回升。女婴的变化较男婴明显而持久。提示:(1)生理性黄疸足月儿血清促性腺激素水平与性别、日龄相关;(2)光照可能影响足月儿下丘脑——垂体——性腺轴的功能。     

血清促性腺激素基础值在性早熟女童诊断中的价值

目的：探讨血清促性腺激素基础值在性早熟女童诊断中的价值。方法：以促性腺激素释放激素（GnRH）激发试验结果作为性早熟诊断的金标准,将77例性早熟女童分为中枢性性早熟（CPP,n=45）和单纯性乳房早发育（IPT,n=32）两组,分别比较两组黄体生成素（LH）、卵泡刺激素（FSH）基础值及LH/FSH比值的差异;并采用受试者工作特征（ROC）曲线分析LH、FSH基础值及LH/FSH比值诊断性早熟的准确性。结果：CPP组患儿血清基础LH、FSH水平及LH/FSH比值均高于IPT组（P<0.01）;两组患儿LH基础值与GnRH激发试验中LH峰值存在正相关;LH、FSH和LH/FSH比值诊断CPP的曲线下面积（AUC）进行比较,AUCLH大于AUCFSH和AUCLH/FSH（均P＜0.05）,而AUCFSH和AUCLH/FSH之间比较差异无统计学意义。当血清LH基础值为0.62 IU/L时,敏感度为0.778,特异度为0.906,Youden指数最大（0.684）;当切割值为1.5 IU/L时,诊断敏感度下降为0.311,但特异度为1.0。结论：血清LH基础值诊断CPP的价值优于LH/FSH比值及FSH基础值,可用于性早熟女童门诊的初步诊断,但存在一定的误诊和漏诊率;对于LH基础值大于1.5 IU/L的患儿,结合临床表现可明确诊断,无需另行GnRH激发试验。     

定量测定尿促性腺激素判断女童性发育程度应用价值研究

目的 探讨定量测定尿促性腺激素（UGn）,包括尿黄体生成素（ULH）、尿卵泡刺激素（UFSH）在女童性发育中的应用价值。方法 以2013年10月至2015年2月在上海交通大学附属瑞金医院儿内科因乳房发育就诊的109例女童作为研究对象。109例均诊断为性早熟或青春发育提前。收集其就诊第1、2日晨尿,检测UGn浓度。就诊第2日晨采血,行促性腺激素释放激素（GnRH）激发试验,并收集试验后4 h内总尿,测UGn。结果 （1）连续2日晨尿UGn浓度差异无统计学意义,与血Gn基础值显著相关。（2）GnRH激发试验后4 h总尿UGn浓度与血Gn峰值呈显著相关,激发试验后血和尿的LH/FSH比值也呈显著相关。（3）尿、血Gn水平评估Tanner Ⅱ期与Tanner Ⅲ期的价值相似。（4）晨尿ULH、激发后4h总ULH及ULH/UFSH比值有助于临床鉴别乳房早发育（PT）和中枢性性早熟（CPP）。结论 检测UGn对于判断女性儿童性发育程度有一定意义,可作为一种无创而灵敏的诊断方法。     

不同出生体重与性别的新生儿脐血中黄体生成素、卵泡刺激素及睾酮水平的变化

近期研究发现,脐血中多种激素水平与母血中相应的激素含量之间无明显相关性,说明脐血中激素含量更能反应胎儿的生长发育情况。至今为止,有关新生儿脐血中黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)的变化国内外报道甚少。为此,我们检测上述激素水平,以探讨它们与新生儿出生体重、性别的关系。对象与方法一、研究对象2003年7月至2004年7月常熟市妇幼保健院产科住院待产的产妇130例,其中巨大儿组(出生体重≥4000g)28例,男19例,女9例;宫内发育迟缓儿(IUGR)组(出生体重<2500g31例,男12例,女19例;正常组(2500g≤出生体重<4000g)71例,男35例,…     

双胎新生儿与出生体重及胎龄的关系

100例双胎新生儿中,早产52例,低出生体重69例。患病情况以新生儿硬肿症为多,其次是感染性疾病。死亡15例,死亡率15％。其中病死率最高的是RDS,肺出血和颅内出血。指出由于双胎新生儿早产率高,低出生体重发生率高,机体免疫力低下,各器官功能不成熟,易患各种疾病、严重威胁双胎新生儿的生命,对双胎新生儿进行重点监护,早期预防并发症,可望降低其病死率。     

中国不同胎龄新生儿出生体重曲线研制

目的 调查我国新生儿出生体重状况,制定新的新生儿出生体重标准,绘制不同出生胎龄新生儿出生体重曲线.方法 在全国范围内建立新生儿协作网,收集产科出生的新生儿数据.在全国七大区域23个省、市、自治区,共有63家医院设立监测点.研究对象为2011-2014年各监测点出生的单胎活产儿,采用连续收集的方法收集产科出生新生儿的胎龄和出生体重数据.新生儿生后2h内用电子秤进行裸身体重测量,胎龄判断为母亲末次月经、孕早期超声检查和出生后胎龄评分相结合的方法.出生体重曲线拟合方法采用LMSP方法,利用R2.11.1软件中的基于位置、尺度、形状的广义可加模型(GAMLSS) 1.9-4软件包进行曲线绘制和检验.结果 共收集单胎新生儿159 334名,其中男84 447名,女74 907名,平均出生体重(3 232±555)g,其中男性平均体重(3 271±576)g,女性平均出生体重(3 188±528)g.对新生儿出生体重数据的正态分布进行检验,结果提示胎龄和体重数据分布均不符合正态分布,BCT分布拟合度最优.用虫形图检测和拟合模型残差图检验,提示本曲线较好拟合了本研究的数据分布.采用同样的方法分别绘制男性新生儿和女性新生儿出生体重曲线.结论 对我国不同出生胎龄新生儿出生体重参考值进行了更新,使用GAMLSS方法建立新生儿出生体重曲线,分性别制定不同参考曲线,制定的出生体重曲线经统计学检验提示较为准确拟合实际情况.     

中国15城市不同胎龄男女新生儿出生体重值修正报告

本文报告中国15城市28～44周不同胎龄男女新生儿出生体重值。为了与国际上同类研究进行比较,作者采用美国CDC 研制的概率图的方法,对新生儿出生体重实测值进行修正,以供国内外同道参考应用。     

Correlation between umbilical cord blood lipid profile and neonatal birth weight

Introduction and aim: The aim of this study was to investigate the relation between birth weight and neonatal umbilical cord serum lipid levels.     

Growth hormone levels in relation to birth weight and gestational age

Growth hormone levels were measured in 33 umbilical cord blood samples collected from babies born at JIPMER Hospital during April and May-1998. The study was done to evaluate the growth hormone profile in relation to birth weight and gestational age. There was statistically significant difference in the cord blood growth hormone levels between babies weighing > 2500 gms (28.1 ± 12.83 ng/dl) and low birth weight babies (76.8 ± 55.7 ng/dl). The difference in growth hormone levels between term babies weighing >2500 gms and preterm babies (72.5 ± 29.4 ng/dl) was also statistically significant. However, there was no significant difference in the cord blood growth hormone levels between term low birth weight and preterm babies. Growth hormone levels were higher in preterm babies and low birth weight babies as compared to term babies weighing >2500 gms indicating that growth hormone has an important role to play in intrauterine growth along with other growth promoting factors.     

Association between birth weight and birth arm circumference of neonates in rural Egypt

In many developing countries including Egypt, the birth weights (BWs) of most babies go unrecorded because they are born at home. Since it is difficult to record BW in the community setting, birth arm circumference (BAC) has been used as a valid proxy for BW to identify at risk babies with low birth weight (LBW). However, the validity of BAC as an indicator of the actual BW has not been assessed fully. We did this study among neonates in rural Bilbeis, Egypt, to examine the association between BW and BAC, to assess whether BAC can serve as an indicator of the actual BW, and to determine the validity indices of 3 different cut-off levels of BAC as indicators of LBW. During 1987–88, the weights and arm circumference of 148 neonates were recorded within 2 weeks of birth. We observed a strong and highly significant positive linear correlation between BW and BAC (r=0.6188, p=0.0001). The BAC cut-off value of <9.5 cm was associated with the optimal combination of sensitivity (50%) and specificity (88.4%) as an indicator of LBW. In linear regression analysis BAC was found to be a significant (p=0.00001) predictor of BW. The means of the model predicted weights for males, females, and both genders together were identical to the corresponding means of the observed values. In contingency table analysis, for 78 (52.7%) of the 148 neonates studied the observed and predicted BW categories were identical. For another 59 (39.9%) neonates, agreement with the next lower or higher BW category was observed. We feel that BAC can be used as an indicator of the actual BW in settings where routine recording of BW is currently not practicable.     

Transthyretin levels are not related to Apgar score in low birth weight and very low birth weight infants

BACKGROUND: Previous studies have reported an increased incidence of thyroid dysfunction in premature/low birth weight infants. The cord blood concentrations of transthyretin (TTR), a thyroid hormone binding protein, have also been found to be decreased in preterm infants. While thyroid hormone concentrations are decreased in sick infants, it is not known if physical condition influences TTR levels. Serial concentrations of TTR following birth have not previously been reported. AIMS: To measure serial serum concentrations of TTR in premature infants following birth, and determine whether TTR levels are related to physical condition. METHODS: A cohort of 65 premature very low birth weight (VLBW) and LBW infants were studied. Serum samples were obtained on the day of birth, and for 8 weeks following birth. Apgar scores at birth as well as the incidence of respiratory distress syndrome (RDS) were noted. RESULTS: Baseline serum T4 concentrations and Apgar scores were significantly lower in VLBW infants, while the severity of RDS was significantly higher in the VLBW group. Multivariate analyses revealed that T4 levels were negatively associated with RDS, while TSH concentrations were positively related to gestational age. TTR concentrations were not related to gestational age at birth, Apgar score, or RDS, and did not change markedly over 8 weeks. CONCLUSIONS: These findings suggest that serum TTR concentrations are not related to birth weight/gestational age and are not associated with either clinical condition at birth (as assessed by Apgar score) or the occurrence of RDS. Reference values for TTR concentrations in VLBW and LBW infants are provided from birth to 8 weeks of age.     

Postnatal thyroid function in low birth weight infants: A cross-sectional assessment of free thyroxine and thyroid hormone binding globulin

To investigate the significance of low serum thyroxine in premature infants, serum FT4, T4, TSH and TBG were measured in 7 infants with BW<1000 g, 8 infants with BW 1001 to 1350 g, 9 infants with BW 1351 to 2499 g, and 11 full-term infants.FT4 concentrations were lower in the LBW infants than in the FT infants. Percent FT4 values in the infants with BW<1000 g were the highest in the groups studied, so that FT4 concentrations in those infants did not fall proportionally with the marked T4 decrease. TBG concentrations were lower in the VLBW infants (相似文献   

三种鼻饲喂养方式在极低出生体重早产儿肠道内营养的应用研究

目的 通过研究不同方式鼻饲喂养方法对极低出生体重早产儿（VLBW）喂养耐受性及喂养效果,探讨最适合极低出生体重早产儿的鼻饲喂养方式。方法 将77例胎龄在29～33周,出生体重在1000～1400g活产极低出生体重儿,男婴38例,女婴39例,随机分为ABC组。A组：间歇鼻饲注入喂养,起始每次奶量2ml/kg,持续时间3～5min,2h1次,每天递增2ml/kg;B组：持续鼻饲输注喂养,使用电子微量输液泵持续鼻饲输注,奶量1ml/（kg.h）,持续时间24h,每天递增1ml/（kg.h）;C组：间歇持续鼻饲输注喂养,先采用电子输液泵持续鼻饲喂养2h,奶量2ml/（kg.h）,间歇2h后,再继续交替进行,每天递增2ml/kg;所有VLBW均同时进行部分外周静脉营养,逐渐过渡到完全肠道内营养,观察3组患儿喂养过程中体重增长,喂养耐受情况以及黄疸持续时间。结果 间歇持续鼻饲输注喂养组喂养不耐受例数最少,黄疸持续时间短,达到完全胃肠道营养时间最少。结论 极低出生体重早产儿采用间歇持续鼻饲输注喂养,喂养不耐受发生率最低,达到完全胃肠喂养时间最短,有利于极低出生体重儿的生长发育和胃肠功能完善,优于单纯的间歇或持续鼻饲喂养,值得临床推广。     

三种鼻饲喂养方式在极低出生体重早产儿肠道内营养的应用研究

目的通过研究不同方式鼻饲喂养方法对极低出生体重早产儿(VLBW)喂养耐受性及喂养效果,探讨最适合极低出生体重早产儿的鼻饲喂养方式。方法将77例胎龄在29~33周,出生体重在1000~1400g活产极低出生体重儿,男婴38例,女婴39例,随机分为ABC组。A组:间歇鼻饲注入喂养,起始每次奶量2ml/kg,持续时间3~5min,2h1次,每天递增2ml/kg;B组:持续鼻饲输注喂养,使用电子微量输液泵持续鼻饲输注,奶量1ml/(kg.h),持续时间24h,每天递增1ml/(kg.h);C组:间歇持续鼻饲输注喂养,先采用电子输液泵持续鼻饲喂养2h,奶量2ml/(kg.h),间歇2h后,再继续交替进行,每天递增2ml/kg;所有VLBW均同时进行部分外周静脉营养,逐渐过渡到完全肠道内营养,观察3组患儿喂养过程中体重增长,喂养耐受情况以及黄疸持续时间。结果间歇持续鼻饲输注喂养组喂养不耐受例数最少,黄疸持续时间短,达到完全胃肠道营养时间最少。结论极低出生体重早产儿采用间歇持续鼻饲输注喂养,喂养不耐受发生率最低,达到完全胃肠喂养时间最短,有利于极低出生体重儿的生长发育和胃肠功能完善,优于单纯的间歇或持续鼻饲喂养,值得临床推广。     

T-tube ileostomy for intestinal perforation in extremely low birth weight neonates

To evaluate the results of use of T-tube ileostomy in selected cases of intestinal perforation in extremely low birth weight (ELBW) neonates. The records of 288 ELBW neonates treated at author’s institution, from 1998 to 2003 were retrospectively reviewed to identify neonates operated for intestinal perforation with T-tube placement. T-tube was inserted into the bowel through the site of perforation or proximally to the perforated gut via separate stab incision. T-tubes were used in five ELBW neonates (BW 600–900 g, gestational age 25–27 weeks) with intestinal perforation, in four of them at the time of primary surgery and in one neonate 8 days after primary anastomosis. All patients survived and there were no serious complications related to the T-tube insertion. Median duration of T-tube placement was 4 weeks (range 3–8 weeks), full enteral feeding after T-tube insertion was achieved in 4 weeks (range 1–6 weeks). All sites of T-tube insertion closed spontaneously. T-tube ileostomy is an effective and safe technique for treatment of selected cases of intestinal perforation in ELBW neonates. With respect to the hypoperistalsis of immature bowel, we recommend the use of T-tube in all cases of isolated intestinal perforation in ELWB neonates.