Newborn health: Everybody's business

Despite advances in issue-attention and in evidence of what works to save newborn lives (e.g., kangaroo mother care, antenatal corticosteroids, immediate and exclusive breastfeeding), we are still falling short on impact. To advance the unfinished newborn survival agenda, newborns must become an integral priority in developing countries where the burden of neonatal mortality is highest. Interventions must be adapted to local contexts and cultures and integrated into packages along the continuum of care delivered through the primary health-care systems that countries have at their disposal.     

Varizellen in der Schwangerschaft und bei Neugeborenen

Varicella belongs to the most common vaccine-preventable diseases in Germany. During pregnancy, varicella may have serious consequences for the pregnant women and for the fetus or newborn. Pregnant women who contract varicella are at risk of pneumonia which must be regarded as a medical emergency. Chicken pox between the 5th and 24th weeks of pregnancy may lead to the congenital varicella syndrome. In case of maternal varicella during the last few weeks of pregnancy or shortly after delivery, the virus can cause chicken pox in the newborn. Life-threaten ing disseminated neonatal varicella must be expected if the mother develops chicken pox between 5 days before and 2 days after delivery. Using currently available diagnostics, immuno-prophylactic and therapeutic opportunities, these serious consequences of varicella during pregnancy can be prevented.     

不典型新生儿颅内出血43例诊断分析

目的分析不典型新生儿颅内出血的临床性质,提高对不典型颅内出血的认识。方法回顾性研究2000-2004年128例头颅CT确诊新生儿颅内出血病例,选取不典型病例进行临床分析。结果不典型颅内出血43例,占新生儿颅内出血33．59％,43例不典型病例中,有窒息史 35例,早产38例,合并缺氧缺血性脑病(HIE)9例,嗜睡并肌张力低下12例,嗜睡并肌张力增高9 例,单纯肌张力降低者8例,单纯肌张力增高者7例,单纯痛苦面容并肌张力增高4例,单纯嗜睡者 2例,无症状体征1例。结论不典型新生儿颅内出血往往临床表现较少,而且表现似乎是轻症, 易漏诊,应引起临床医师重视。     

Previously infertile couples and the newborn intensive care unit

Having a newborn child admitted to a newborn intensive care unit can be a traumatic experience for parents; however, parents who previously have been infertile face unique problems in coping with this situation. The authors discuss the difficulties parents must overcome in resolving their crises and in developing a good relationship with their child, or, in some cases, coming to terms with the child's death or ongoing disability. In addition, the authors offer suggestions for effective social work intervention.     

Newborn blood spot screening in four countries: stakeholder involvement

While newborn blood spot screening has historically been viewed as a public health success, the potential harms and benefits are more finely balanced for new conditions being considered for program expansion. We highlight complex issues that must be addressed in policy decisions, which in turn requires a consideration of many stakeholder perspectives. Using national policy documents from the United Kingdom, the United States, Australia, and Canada, we describe the participation of stakeholder organizations in the newborn screening policy process, how such organizations have incorporated stakeholder views into their own policy writing, and their recommendations for inclusiveness. Stakeholder participation in newborn screening decision-making is widely acknowledged as important, and many methods have been endorsed - consultation as well as direct or indirect input into policy development. Differences across organizations and jurisdictions raise questions about the most effective approaches for facilitating inclusiveness, suggesting a need for formal evaluative research.     

Newborn hearing screening devices: sound advice on choosing the right technology

Infant hearing loss occurs more often than any other problem screened for at birth. Finding such hearing loss helps to prevent early developmental delays that can hinder a child's physical, mental, and emotional growth. To address this public health concern, many hospitals are implementing universal newborn hearing screening (UNHS) programs. They are called "universal" because the objective is to test all newborns. Such programs use auditory brainstem response (ABR), otoacoustic emissions (OAE), or a combination of the two to screen newborn hearing. A goal of any newborn hearing screening program is to reduce the false-positive rates that result in unnecessary referrals. Such rates should be kept low because unnecessary referrals mean personnel must spend extra time scheduling follow-up testing, thus increasing program costs. Therefore, referral rates and costs will be the main factors when hospitals are choosing the appropriate screening technology.     

Attitudes toward defective newborns

The effect of the development of amniocentesis on attitudes toward defective newborns is examined. Before amniocentesis, what is termed the "modern" attitude toward defective newborns had developed whereby more and more parents opted to care for their abnormal children at home rather than to institutionalize them. 3 stages leading to the acceptance of a defective newborn by his parents are described: 1) initial feelings of rejection; 2) a "working through" of guilt and anger against the child and self; and 3) viewing the child, when reasonably possible, as an acceptable substitute for the lost child, with a readiness to accept and raise the child with care. With the development of amniocentesis, the question arises, will the initial tendency to reject the child be reinforced by the knowledge that the child might have (or should have) been prevented? Will the attitudes toward defective children already under care also be changed? Examples of changes in attitude have already appeared in the literature. The author concludes: "We must beware of extending our technical capabilities at the expense of our humanity and hard-won achievements...(We must) guard against arbitrary and unreasonable erosion of the trust which must exist between newborn and parents if the basic moral health of a society is to be maintained."     

Antibiotics and the Newborn

The neonate differs in many critically important ways from older individuals in his susceptibility to infection and his response to antibiotic therapy. Selection and use of antibiotics in the newborn nursery must therefore be based on a body of knowledge different from that applicable to other age groups. Dr. Eichenwald presents detailed guidelines based on this principle.     

The family and neonatal intensive care

The birth of a sick newborn provides great stress for the family. During the illness, the family must face charged issues, including the loss of the perfect child they had anticipated and a fear that their baby may die. Issues related to helping these vulnerable families are examined, including response to the birth of a sick baby, communication with the family, preparation for discharge and long term hospitalization, as well as issues pertaining to the staff of the neonatal intensive care unit.     

THE FAMILY AND NEONATAL INTENSIVE CARE

The birth of a sick newborn provides great stress for the family. During the illness, the family must face charged issues, including the loss of the perfect child they had anticipated and a fear that their baby may die. Issues related to helping these vulnerable families are examined, including response to the birth of a sick baby, communication with the family, preparation for discharge and long term hospitalization, as well as issues pertaining to the staff of the neonatal intensive care unit.     

Revision of the guideline 'Blood transfusion': for the newborn

The large majority (> 90%) of very premature infants and newborn infants with haemolysis receive one or more red blood cell (RBC) transfusions. Up to 35% of newborn infants have thrombocytopenia (platelet count < 150 x 109/l). Following an unambiguous blood transfusion guideline leads to decrease in the number of transfusions given. The necessity for RBC transfusions can be diminished by use of diagnostic tests, micro-analysis techniques and delay of umbilical cord clamping (waiting for 30 seconds to 3 minutes after birth). Newborn infants with a gestational age < 32 weeks or birth weight < 1500 g must receive irradiated and Parvovirus-B19 safe blood products until 6 months post-term. It is still unclear whether lower Hb values and thrombocyte counts can be accepted as a transfusion limit without negative effect on the (neurological) long term outcomes and without increase in risk of intraventricular bleeding.     

Imparting carrier status results detected by universal newborn screening for sickle cell and cystic fibrosis in England: a qualitative study of current practice and policy challenges

Background  

Universal newborn screening for early detection of children affected by sickle cell disorders and cystic fibrosis is currently being implemented across England. Parents of infants identified as carriers of these disorders must also be informed of their baby's result. However there is a lack of evidence for most effective practice internationally when doing so. This study describes current or proposed models for imparting this information in practice and explores associated challenges for policy.     

新生儿Rh溶血病患儿IgG抗G的检测及意义

新生儿Rh溶血病(Rh HDN)是由于孕母体内的IgG类Rh系统抗体经胎盘进入胎儿体内与红细胞结合而引起的免疫性溶血性贫血。引起本病的Rh系统抗体主要有抗D、抗E、抗C、抗c等,以及有抗-Ce、抗-cE等复合抗体参与引起的新生儿溶血病的也时有报道〔1,2〕。然而,有抗G抗体(即抗CD抗体)参与引起的溶血病却少见报道。为此,我们对11例Rh溶血病患儿进行检测分析,现将结果报告如下。1材料与方法1.1标本来源2001年1月~2005年9月本院经新生儿Rh溶血病血型血清学检查确诊为Rh溶血病患儿11例,男5例,女6例,年龄1~7天。1.2试剂与仪器抗D、抗C、抗c、抗…     

窒息新生儿血电解质变化与窒息分度的相关性

目的探讨新生儿窒息后血电解质异常变化与窒息临床分度的关系,为临床治疗提供参考依据,提高抢救成功率及治愈率。方法回顾型分析109例确诊窒息的新生儿入院治疗前的血电解质结果及其与疾病严重程度的关系。结果电解质紊乱以低钠、低钙、低氯血症最为多见,其次为低镁血症,其降低程度与窒息程度呈正相关(p<0.01)。血钾变化不明显。结论窒息可以引起新生儿出现血电解质紊乱;对窒息新生儿要注意监测血电解质变化,可作为分析病情的评价指标,要及时纠正异常,以免加重病情。     

新生儿重症监护病房医院感染监控与管理

目的 加强新生儿神经内科室症监护病房(NICU)的医院感染监控和管理。方法 领导重视，规章制度落实；加强教育增强感染意识；在常规监测的基础上积极开展目标性监测。结果 感染意识提高，消毒隔离制度的落实变被动为主动；NICU空气质量改善，呼吸机相关感染减少。结论 加强NICU的医院感染监控和管理，及时发现和解决感染控制的薄弱环节，控制医院感染的发生，确保医疗安全，提高医疗质量。     

Ethological and methodological considerations in the use of newborn rodents in biomedical research

The use of newborn or immature animals in biomedical research poses certain challenges, in that the ecological niche of immature animals differs from that of adults, and the stimuli provided to immature animals can have profound physiological and behavioural effects through adulthood, even at the cerebral level. In particular, the newborn's behaviour and physiology are regulated by olfactory, thermal, and tactile stimulation supplied by the mother in the nest environment. Thus any disturbance to the mother-offspring relationship in the first two weeks of life can profoundly change the physiological and psychological state of the young. For this reason, research experiments must be adapted to the specific characteristics of the immature animal, to improve not only the quality of the data obtained but also the welfare of the animals. To this end, the present work provides some ethological and methodological considerations in the maintenance, handling, and testing of newborn rats and mice in biomedical research.     

Nursing work force and its insertion in the rooming-in system

A theoretical reflection is developed, featuring the characteristics of the Nursing work force in the rooming-in units. A focus is given, along a leading line, to the importance those workers have in caring for the families of newborn children in hospital facilities. The reference basis, adopted as the argumentative development of the text, centers on previous studies and authors covering the work process in Nursing, as well as on the understanding of nursing as a social and historical practice. Reflection is initially developed along considerations of the organization and division of work in health and in nursing. This study also points out the formal and legal origin of Brazilian nursing workers, in order to characterize this work force specifically in the work process carried out by nursing agents of different levels in rooming-in systems at the maternity facilities. The conclusion reached, showed that the work developed in these units requires from the nursing professionals proper qualification to assist the newborn, the puerpera and also the family. They must also demonstrate theoretical/technical command to operate those instruments (means) which are not usually available in the majority of health services.     

新生儿医院感染相关因素的临床分析

目的降低新生儿医院感染率,提高新生儿病房医院感染的管理质量. 方法 8年来我院加强了医院感染的领导,开展了医院感染的管理工作及有关监控措施,降低了医院感染. 结果新生儿感染率,胎龄出生体重分布,新生儿在消化道和呼吸道常见应该重视的感染部位,合理使用抗生素,医院感染管理是医护人员实施的重要环节. 结论严格监控新生儿医院感染,加强预防是降低新生儿医院感染率的最有效措施.     

许昌地区12972例新生儿听力筛查结果及相关因素分析

目的 分析许昌地区新生儿听力筛查的的现状,为制定合适的听力筛查和干预措施提供依据.方法 对2006年9月-2011年12月本院产科出生的7180例正常新生儿和本科室住院患儿5792例进行瞬态诱发耳声发射（TEOAE）测试,听力初筛、复筛均采用TEOAE,初筛未通过的新生儿42 d进行复筛,复筛未通过新生儿行听性脑干反应（ABR）、40HZ听觉相关电位（40HZ-AERP）和声导抗进行听力损失诊断.结果 可接受筛查的18270例新生儿,初筛率71.11％,初筛未通过618例,初筛未通过率4.77％.复筛率67.96％,复筛未通过率14.7％,影响因素分析结果显示胎龄、体重和新生儿疾病是听力筛查未通过的主要因素.结论 许昌地区新生儿的初筛率和复筛率较低,失访严重,应加强听力筛查的普及工作,完善随访制度,减少致残率.     

新生儿脂质代谢影响因素的探讨

本文检测了174例正常足月儿和40例早产儿的血清总胆因醇(TC)、甘油三酯(TG)、载脂蛋白A_1(ApoA_1)、载脂蛋白B(APoB)及脂蛋白(a)[Lp(a)]的水平,并对其影响因素进行了分析,结果发现除LP(a)外,早产儿脂质及载脂蛋白水平均明显低于足月儿,但男女性别之间,各指标均无显著性差异;经多元线性相关分析发现,TC与TG,ApoA_1与ApoB之间均呈正相关关系,而Lp(a)与各指标间均无相关性,且不受性别、年龄、胎龄及出生体重的影响;ApoB与出生体重成明显正相关。