足月低体重儿92例分析

目的探讨足月低体重儿围产影响因素。方法对92例足月低体重病例资料进行回顾性分析。结果双胎妊娠、子痫前期、妊娠期肝内胆汁淤积症是引起足月低体重的主要因素,足月低体重儿与正常体重足月儿相比,胎儿窘迫的发生率明显升高,差异有显著性意义（P〈0.05）。结论足月小样儿是围生期的重要并发症,不仅影响胎儿的发育,远期也影响儿童期及青春期的体能与智能发育,加强产前检查是减少低体重儿出生的关键。     

足月低体重儿回顾分析

目的　分析有关因素对足月低体重儿的影响从而能及时干预。方法　比较分析 110例足月低体重儿与 10 0例正常体重儿在性别、孕妇年龄、妊娠合并症及并发症、分娩方式等的差异。结果　足月低体重儿在性别比例无明显差异 ,而孕妇年龄、妊娠合并症及并发症、分娩方式及预后与正常体重儿存在显著差异 (P <0 .0 5 )。结论　足月低体重儿受孕妇年龄、妊娠合并症及并发症影响明显     

低出生体重儿78例住院情况分析

目的探讨低出生体重儿的临床管理。方法将78例低出生体重儿分为2组,对其临床资料进行分析。结果低出生体重儿的高危因素有胎膜早破、妊娠期高血压、双胎、母亲贫血、子宫因素、胎盘早剥、原因不明。足月小样儿组的并发症主要是感染、病理性黄疸;早产低出生体重儿组的并发症主要是呼吸困难、感染、病理性黄疸和早产儿脑损伤。结论低出生体重儿中的足月小样儿和早产低出生体重儿并发症和转归有很大的不同,管理上要有不同的侧重点,及早发现并发症,对症处理,可有效降低病死率,提高生存质量。孕期提高产检率,及时发现并治疗母亲原发病是减少低出生体重儿的关键。     

321例低出生体重儿的高危因素及并发症的临床研究

目的:分析总结低出生体重儿的高危因素及并发症,为指导产科临床工作,降低LBWI发生几率提供依据.方法:对我院收治的低出生体重儿321例进行临床资料收集及整理分析.结果:低出生体重儿高危因素主要是:妊娠期高血压疾病、胎膜早破、双胎、自发早产、前置胎盘等.并发症主要是:贫血、低蛋白血症、病理性黄疸、NRDS、肺炎、败血症、新生儿窒息、脑白质病变、湿肺、先天性心脏病、低血糖、颅内出血、BPD、HIE、NEC.且<34周早产儿发生几率明显升高.结论:通过对低出生体重儿的高危因素及并发症的分析,临床工作中需重视高危人群、提高产检质量、加强危重早产儿的抢救水平以达到早发现、早干预,降低低出生体重儿的并发症,提高存活率.     

新生儿肺出血与早产儿低体重的关系

目的 探讨新生儿肺出血病变与早产低体重儿之间的关系。方法 对36例新生儿肺出血患者的临床资料进行分析。结果 36例新生儿肺出血患者,早产儿占66.7%（24例）,低体重儿占69.4%（25例）,足月正常体重儿占30.5%（11例）。早产儿、低体重儿肺出血的发病率明显高于足月正常体重儿（P＜0.01）。结论 早产儿、低体重是发生肺出血的高危因素。     

足月低体重儿100例临床分析

本文对１００例足月低体重儿进行临床分析，发现宫内窘迫、新生儿窒息、新生儿死亡率明显高于正常儿，发育及智商低于正常儿．提出预防足月低体重儿出生是优生优育的一项重要措施。     

早产低体质量儿气管支气管异物的治疗

目的探讨早产低体质量儿气管支气管异物的治疗方法。方法选择新乡医学院第一附属医院耳鼻喉科120例气管支气管异物患儿,其中足月正常体质量儿102例,早产低体质量儿18例,对其临床资料进行回顾性分析。结果 120例患儿中术前伴并发症33例,其中32例经积极对症治疗及手术治疗治愈出院,1例死亡;33例出现并发症的患儿中,早产低体质量儿15例(83.33%),足月正常体质量儿18例(17.65%),早产低体质量儿患气管支气管异物后并发症发生率显著高于足月正常体质量儿(P<0.05)。1例(5.56%)早产低体质量儿气管支气管异物取出术中出现双侧气胸和纵隔气肿,压迫心脏,出现心跳停止,经抢救无效死亡;而足月正常体质量患儿无死亡病例,足月正常体质量儿病死率显著低于早产低体质量儿(P<0.05)。结论早产低体质量儿气管支气管异物患儿并发症发生率及病死率较足月正常体质量儿支气管异物患儿高,临床上应高度重视,术前充分准备,术中谨慎小心,掌握常规的急救技能,可有效降低其并发症发生率及病死率。     

足月低体重儿172例母婴并发症临床分析

足月低体重儿的管理是围产期保健工作的重点之一,新生儿期疾病对远期预后影响较大,所以加强管理是预防和减少并发症、降低围产儿发病率的关键。本文对1997年1月～2000年12月我院分娩的172例足月低体重儿母婴并发症进行临床分析,现报道如下:     

低出生体重儿296例临床分析

本文对296例低出生体重儿进行分析,发生率为4.48％,死亡28例,死亡率为9.5％。本组资料显示农村产妇出生的低出生体重儿显著高于城区产妇。早产儿死亡率高于足月小样儿。胎龄越短,体重越低,死亡率越高。低出生体重儿的直接死因为各种并发症,多数死于呼吸衰竭。本文还对其发生率及发生因素,死亡率及死亡因素以及并发症进行探讨。     

巨大胎儿相关因素及分娩结局的临床分析

目的 分析巨大胎儿的相关因素及分娩方式,降低母婴并发症。方法 回顾性分析152例巨大胎儿的临床资料,并抽取同期分娩正常体重儿的足月孕妇作为对照组。结果 巨大胎儿的发生与孕期孕妇体重超重,妊娠合并糖尿病,遗传因素,孕妇饮食摄入过多而活动太少有关。巨大胎儿组较对照组易发生难产,巨大胎儿剖宫产较阴道分娩产时出血、新生儿窒息及产伤发生率均明显减少（P〈0．01,0．05）。结论 关注巨大胎儿的发生相关因素,预防其发生,适时采取适当的分娩方式,避免困难的阴道手术助产。     

运用多元Logistic回归模型分析影响新生儿低血糖的危险因素

目的 探讨影响新生儿低血糖的危险因素。方法 回顾性分析了2013年7月~2015年7月入住本院的340例新生儿的临床资料,根据新生儿血糖浓度进行分组,将血糖浓度＜2.2 mmol/L为低血糖组,其中新生儿低血糖组32例,正常新生儿组308例。分别采用Pearson单因素与多元Logistic回归模型分析影响低血糖新生儿的相关危险因素。结果正常新生儿组与低血糖新生儿组在新生儿出生情况(出生体重、早产儿、足月小于胎龄儿)、母亲围生期情况(母亲年龄、妊高症)及新生儿合并症(合并呼吸系统疾病、新生儿窒息、先心病、出血性疾病、感染性疾病、高胆红素血症、甲减)方面的差异均具有统计学意义(P＜0.05)。影响新生儿低血糖相关危险因素:新生儿出生情况(出生体重、早产儿、足月小于胎龄儿)、母亲围生期情况(母亲年龄、妊高症)、新生儿合并症(新生儿窒息、先心病、高胆红素血症)。结论影响新生儿低血糖相关危险因素为:出生体重、早产儿、足月小于胎龄儿、母亲年龄、妊高症、新生儿窒息、先心病、高胆红素血症,控制这些因素为有效预防新生儿低血糖提供科学依据。     

STUDY OF LOW BIRTH WEIGHT NEONATES

Low birth weight neonates with 2000g or less birth weight constitute about 10% of live births with perinatal mortality as high as 32.4%. Perinatal morbidity is 19.3% with asphyxia neonatorum and neonatal jaundice heading the list. Epidemiological maternal factors include extremes of age and parity, lack of antenatal care, low socioeconomic status, illiteracy and underweight short women. Etiologic factors are obstetric complications, hypertensive disorders, systemic diseases or idiopathic. The scope of preventive measures include improvement of economic status and education about health and safe pregnancy. Proper antenatal care for early detection of high risk cases, adequate and timely management of complications and adequate facilities for neonatal care can reduce the perinatal morbidity and mortality.KEY WORDS: Low birth weight neonates, Perinatal mortality     

Discriminant function of perinatal risk that predicts early neonatal morbidity: its validity and reliability

BACKGROUND: This study aimed to identify significant perinatal risk factors associated with neonatal morbidity to construct a scoring system to aid in distinguishing between healthy and ill neonates. Validity and reliability of the scoring system were determined. METHODS: We conducted a screening test and used logistic regression to analyze data from a cohort of 387 neonates and to determine the relationship between risk factors and morbidity. Twenty nine factors of perinatal risk were studied. Logistic regression and discriminant analysis were performed to assess risk for morbidity. This system was developed and validated prospectively on 238 new neonates. RESULTS: Risk factors that demonstrated association with morbidity by logistic regression were chronic maternal illness, premature rupture of membranes (PROM), amniotic fluid, low Apgar score at 5 min, obstetric trauma, hypertension, neonatal resuscitation, breathing pattern at 6 h after delivery, birth weight, and gestational age. Discriminant function obtained from discriminant analysis had sensitivity of 68% and specificity of 93%, while positive and negative predictive values were 88 and 86%, respectively. Area below receiver operating characteristic (ROC) curve was 0.86 (standard error [SE]: 0.02). In the validity study, these values were maintained without significant differences. Kappa statistic between two physicians was calculated at 0.84 (p < 0.001). CONCLUSIONS: Evidence indicated that discriminant function is a useful tool to assess initial neonatal risk, allowing pediatricians to predict morbidity prior to discharge of neonates.     

小于与适于胎龄的极低出生体重儿患肺透明膜病差异的探讨

目的 探讨极低出生体重儿(VLBWI)中小于胎龄儿(SGA)与适于胎龄儿(AGA)患肺透明膜病(HMD)的差异。方法 将VLBWI72例按出生体重与胎龄关系及是否患HMD分组，从围产因素、胎龄、出生体重、患病率、起病时间、病情及3d内病死率等因素分析比较。结果 在VLBWI中，围产因素如窒息、剖宫产、前置胎盘等可增加患HMD的危险，尤其在SGA是主要致病因素；AGA胎龄越小，越易患HMD，而SGA此种关系不明显；出生体重近似的SGA与AGA患病率无明显差异；患病的SGA与AGA病情及3d内病死率均无明显差异，起病时间则SGA较晚。结论 VLBWI在胎龄、围产因素等影响下，体重近似的SGA和AGA的HMD患病率、病情等可无明显差异；要降低HMD发病率，除了延长患儿胎龄外，还应尽量减少围产期各危险因素。     

Predictors of mortality in very low birth weight neonates in India

INTRODUCTION: Very low birth weight (VLBW) neonates constitute approximately 4-7 percent of all live births and their mortality is very high. The objective of the present study was to determine the predictors of mortality in VLBW neonates. METHODS: A retrospective cohort of VLBW neonates admitted over three years was studied. Exclusion criteria were: (1) neonates weighing less than 500 g and with gestational age less than 26 weeks; (2) presence of lethal congenital malformations; and (3) death in the delivery room or within 12 hours of life. The outcome measure was in-hospital death. Medical records were reviewed and data was analysed. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. RESULTS: A total of 260 cases were enrolled, of which a total of 96 (36.9 percent) babies died. The survival rate was found to increase with the increase in birth weight and gestational age. Univariate analysis showed maternal per vaginal bleeding, failure to administer steroid antenatally, Apgar score less than or equal to 5 at one minute, apnoea, gestational age, neonatal septicaemia and shock are the factors directly responsible for neonatal mortality. Logistic regression equation showed maternal bleed (1.326), apnoea (3.159), birth weight (0.037), gestational age (0.063), hypothermia (1.132) and shock (3.49) predicted 65 percent of mortality in VLBW babies. CONCLUSION: Common antenatal and perinatal predictors of mortality in VLBW infants in India include maternal bleed, failure to administer antenatal steroids, low Apgar score, apnoea, extreme prematurity, neonatal septicaemia and shock.     

A survey on the constitutional status of perinates in China

Data of all categories of birth defects among live and still births from 28 weeks of gestation to a period within 7 days after delivery were collected. During a period of 12 months (1986.10-1987.9), there were 1,243,284 perinates monitored in 945 hospitals of 29 provinces, cities and autonomous regions. Among these, 16,172 perinates were with birth defects. Altogether, 101 categories of birth defects were noted. The total incidence of the 101 categories of birth defects in China was 130.1 per 10,000. The 5 leading categories of major birth defects by frequency were: anencephaly, hydrocephaly, spina bifida, cleft lip with cleft palate, and congenital heart diseases. Perinatal deaths totaled 33,137 and the perinatal mortality was 26.7 per 10,000. Among the causes of perinatal death, congenital malformation accounted for 17.8%. There were 44,469 births (35.8%) of full-term low birth weight infants, and 1,748 of them were with birth defects. The incidence of birth defects in full-term low birth weight infants was 393.1 per 10,000.     

孕早期行减胎术对胚胎移植助孕患者围产期母婴的影响

目的 探讨胚胎移植三胎妊娠后于孕早期行不同减灭数目减胎术对围产期母婴的影响。 方法 回顾性分析胚胎移植后三胎妊娠患者于孕早期行多胎妊娠减胎术后保留单胎和保留双胎共282例孕妇的资料,依据保留胎儿数将减胎组分为减至单胎组28例、减至双胎组254例。同时采用倾向性评分匹配法(PSM)与同期胚胎移植后未行减胎的单胎或双胎妊娠研究对象分别进行1∶3匹配。匹配完成后,共846例作为对照组,其中单胎对照组84例、双胎对照组762例。对4组患者的一般资料、妊娠结局、新生儿体质量及围产期并发症进行比较,并采用Logistic回归进一步做敏感性分析。 结果 (1)减胎组的流产率、晚期流产率、围产期并发症发生率高于对照组(P均<0.01),平均分娩孕周短于对照组(P=0.01),平均足月产儿体质量(P<0.01)、足月产率(P=0.016),剖宫产率(P=0.037)低于对照组;(2)减至单胎组剖宫产率低于减至双胎组(P=0.001),平均分娩孕周长于减至双胎组(P<0.01),平均足月产儿体质量高于减至双胎组(P<0.01);单胎对照组流产率、早期流产率、足月产率、足月产儿及早产儿体质量高于双胎对照组(P均<0.01),早产率低于双胎对照组(P<0.01)。 结论 妊早期行多胎妊娠减胎术并未增加早产、出生缺陷风险,但流产、围产期并发症及低体质量儿的发生风险增加。三胎妊娠后行多胎妊娠减胎术保留至单胎者比保留至双胎者,有更好的妊娠结局。     

新生儿高胆红素血症的病因及危险因素分析

目的探讨新生儿高胆红素血症的病因及临床危险因素。方法对2005年1月—2010年12月的560例高胆红素血症新生儿临床资料,采用多因素Logistic回归分析其临床危险因素。结果 560例高胆红素血症新生儿的病因主要为母乳性黄疸（37.7%）、ABO血型不合溶血（16.4%）、感染相关因素（15.2%）、围产期相关因素（12.1%）、胆汁排泄障碍（6.3%）、红细胞增多症（5.0%）和先天性因素（4.5%）。母乳性黄疸、ABO血型不合溶血、感染相关因素、围生期相关因素、胆汁排泄障碍、红细胞增多症、先天性因素和其他不明原因为危险因素（P〈0.05）,而与性别无关（P〉0.05）。围生期的危险因素有孕母年龄、胎龄、出生体质量、1 min Apgar评分、产式、宫内窘迫、催产素、出血、开奶时间、胎粪排出时间和喂养方式（P〈0.05）,而性别和胎次则不是危险因素（P〉0.05）。结论母乳性黄疸为新生儿高胆红素血症的主要原因,危险因素主要包括母乳性黄疸和ABO血型不合溶血等;围生期危险因素为孕母年龄、胎龄和出生体质量等。     

138例孕妇早产高危因素及母婴结局

【目的】探讨早产的常见危险因素与母婴结局的关系。【方法】回顾性分析138例早产的临床资料,与同期足月分娩的138例相比较,分析引起早产的危险因素,并对不同孕周组的母婴结局进行比较。【结果】胎膜早破、未作产前检查和妊娠期高血压疾病是造成早产的高危因素,与足月组比较差异均有统计学意义（ P ＜0．05）。不同孕周早产组在低体质量儿、新生儿呼吸窘迫综合征、Apgar评分＜7分的比率及新生儿病死率方面比较差异具有显著性（P＜0．05）;而对母亲的影响差异不显著（P＞0．05）。【结论】早产的发生与多种因素相关,胎龄越小、体质量越轻,其病死率和并发症越高;加强孕期保健,重视产前检查对新生儿结局意义重大。     

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic.

CONTEXT AND OBJECTIVE: Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING: Retrospective study at a multidisciplinary reference center, Embu, S?o Paulo. METHODS: All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mothers age < 18 years, congenital infections, malformations and low mothers education level. Developmental abnormalities were defined according to developmental tests and assessments by the clinics professionals. The statistical analysis consisted of the chi-squared test for comparing categorical variables and a logistic regression model for multivariate analysis. RESULTS: 211 children were followed up for more than three months. Developmental abnormalities occurred in 111 (52.6%). Univariate analysis showed significant relationships between developmental abnormality and low birth weight, perinatal asphyxia, length of stay > 5 days, prematurity and mothers age 18 years and older. Low birth weight, history of perinatal asphyxia and mothers age continued to be significant in multivariate analysis. CONCLUSIONS: Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.