足月选择性剖宫产新生儿呼吸系统疾病发生情况分析

目的：分析选择性剖宫产（ ECD）足月儿的新生儿呼吸系统疾病的发生情况。方法回顾性分析1139例ECD出生的足月新生儿的临床资料,分析其呼吸窘迫综合征（ RDS）、新生儿暂时性呼吸增快（ TTN）、新生儿持续性肺动脉高压（ PPHN）及自发性气胸的发生率,比较胎龄37周、38周、39周及40周新生儿的呼吸系统疾病发生情况。结果 1139例ECD出生的足月儿中,出现新生儿呼吸系统疾病107例（9．39％）;随着胎龄的增加,ECD出生新生儿的呼吸系统疾病发生率呈降低趋势（P＜0．05）。新生儿 TTN 的发生率最高,为6．50％,其次为 RDS（2．90％）、自发性气胸（1．23％）、PPHN （0．88％）。随着胎龄的增加,ECD足月儿的RDS、PPHN及自发性气胸发生率均呈降低趋势（P＜0．05）。结论 ECD足月儿的新生儿呼吸系统疾病发生率较高,最好在胎龄39周后进行ECD。     

Care of very low birthweight infants with limited neonatal intensive care resources

The advanced technology that is available to treat the tiniest infants has raised the legal and moral dilemma of where and how to distribute limited intensive care resources. In one neonatal intensive care unit it was determined that approximately 80% of its resources over a two-year period were utilized by very low birthweight infants, in spite of the fact that these infants comprised less than 50% of the total admissions to the unit. It was not possible to offer all very low birthweight infants full intensive care; to make this possible, it was calculated that resources would have to increase by 26%. In the present economic climate, and with limited numbers of nurses who are skilled in neonatal intensive care, the prospects for extra resources are poor. What action can or should be taken, legally and morally, when no facilities exist to treat a live-born infant who may possibly benefit from intensive care?     

新生儿低血糖病因及临床分析

目的了解高危新生儿低血糖发生情况、探讨低血糖病因和降低低血糖发生率及危害性措施. 方法对597例高危儿进行血糖监测.结果高危新生儿低血糖发生率7.71%;早产儿组较之于足月儿组、低出生体重儿和巨大儿组较之于正常出生体重儿组、小于胎龄儿组较之于适于和大于胎龄儿组,低血糖发生率明显增高(P<0.002 27).结论早产儿、低出生体重儿、巨大儿和小于胎龄儿易发生低血糖;围产期缺氧和应激是引起低血糖的重要原因;出生后3d内尤其1d内易发生低血糖;对高危新生儿进行血糖监测很有必要.     

新生儿早期肺出血诱因分析

目的研究新生儿早期肺出血的诱因.方法回顾性分析66例新生儿肺出血的诱因.结果新生儿早期肺出血34例,后期肺出血32例,早期组窒息、硬肿症、败血症、低出生体重发生率分别为71.4%、28.6%、31.3%、39.1%,后期组分别为28.6%、71.4%、68.8%、60.9%(P<0.05).发生早期肺出血之早产儿组低出生体重、新生儿呼吸窘迫综合征(NRDS)、肺炎、缺氧缺血性脑病(HIE)、循环衰竭发生率为46.7%、46.7%、73.3%、26.7%、13.3%;足月儿组分别为9.1%、4.5%、100%、81.8%、50%(P<0.05).结论新生儿早期肺出血的主要诱因为窒息、HIE,后期肺出血的主要诱因是硬肿症、败血症,早产儿早期肺出血的主要诱因为低出生体重、NRDS,足月儿的主要诱因为肺炎、HIE、循环衰竭.     

The impact of the establishment of a neonatal intensive care unit on the outcome of very low birthweight infants at the University Hospital of the West Indies

A retrospective analysis of the outcome of inborn very low birthweight infants admitted to the neonatal unit of the University Hospital of the West Indies pre- (period 1) and post- (period 2) establishment of a neonatal intensive care unit was conducted. During the study, 250 infants were admitted to the neonatal unit, 132 (53%) during period 1 and 118 (47%) during period 2. There was improved survival during period 2 when 81 (69%) infants survived compared to period 1 when 73 (55%) survived (p = 0.02). This increased survival was due to an increase in survival of infants weighing 750-999g in period 2 when 17 (65%) infants survived compared to 9 (29%) in period 1 (p < 0.05). There was an increase in the number of infants ventilated in period 2, 39 (33%) compared to 12 (9%) period 1 (p < 0.001). Infants who were ventilated in period 2 were less likely to die than those ventilated in period 1 (OR 0.05, CI 0.01, 0.66). After controlling for gender, weight, gestational age and ventilation, infants born in the second time period were less likely to die than those born in the first time period (OR 0.33, CI 0.14, 0.76). The establishment of a neonatal intensive care unit has resulted in improved survival of very low birthweight infants; further improvement in survival of these infants will be dependent on increased accessibility to surfactant therapy, initiation of total parenteral nutrition and availability of trained personnel.     

Outcome of infants of very low birth weight: a geographically based study.

The outcome of 143 live-born infants of very low birth weight (defined as less than 1500 g) who were born in 1980-81 to women resident in Newfoundland and Labrador is described. Sixty-one infants (43%) died during the first year of life. Of the 82 surviving infants 79 were followed for 18 months to 3 years. Eight (10%) were found to have evidence of severe neurodevelopmental abnormality, and nine (11%) were found to have various minor problems, including seizures, developmental delay and behavioural disorders. There was an inverse association between birth weight and mortality. Neonatal pneumothorax, seizures and clinical evidence of intraventricular hemorrhage were more commonly seen among infants who died; these factors also seemed to be predictive of an adverse long-term outcome. Continuous monitoring of the rates of death and disability among infants of very low birth weight born within a defined region should provide the basis for rational planning and delivery of neonatal intensive care.     

Changing overall workload in neonatal units

An epidemiological study was carried out in the current Nottingham health district to determine changes in both neonatal unit workload and in the infants requiring neonatal care during two study periods. All admissions for 1977 and again for the 12 months 1 April 1983 to 31 March 1984 were reviewed. Total numbers of admissions have shown roughly a 50% reduction because of a more rigorous admission policy locally. The admissions of infants of 33 weeks' gestation or less have shown a significant increase, while the overall survival of infants less than 33 weeks' gestation has improved.     

极低出生体重儿支气管肺发育不良高危因素分析

目的研究极低出生体重儿支气管肺发育不良(BPD)的危险因素。方法对四川大学华西第二医院2008年8月～2011年8月收治的241例极低出生体重儿进行回顾性研究,将其分为BPD组(31例)与非BPD组(210例),从产前及出生情况、生后治疗及合并症等方面对照,探讨BPD发生的危险因素。结果极低出生体重儿BPD发生率为12.9%,BPD组出生体重及孕周均较非BPD组低(P<0.001),母亲产前感染史、新生儿呼吸窘迫综合征(NRDS)的发生率、机械通气及用氧时间较非BPD组升高(P<0.01)。BPD组肺出血、颅内出血、早产儿视网膜病(ROP)等合并症的发生率均高于非BPD组(P<0.05)。Logistic回归分析得出孕周<30周(OR 5.033,P<0.01)及NRDS(OR 4.060,P<0.05)是BPD发生的高危因素。结论低胎龄及NRDS是BPD发生的高危因素,而低出生体重、母亲产前感染史、机械通气及用氧时间也与BPD发生有关。提示通过预防早产、预防孕妇感染、采取保护性通气策略可能降低BPD发生率。     

Perinatal asphyxia and outcome of very low birthweight infants

Seventy-eight very low birthweight (VLBW) infants (whose birthweights were 1500 g or less) were admitted to the Neonatal Special Care Unit in 1977. Seventy-two of them required treatment in the intensive care area; these represented 40% of admissions to that area of the Unit. The mortality rate was 20% for infants weighing 1001 g to 1500 g, and 52% for those weighing 501 g to 1000 g. An Apgar score of 0 to 3 at two minutes and five minutes was reported in 34% and 19% of VLBW infants respectively. Although there was no difference in birthweight between the groups with a high or low Apgar score, the mortality rate of infants with a five-minute Apgar score of 0 to 3 was 79% compared to 22% in those with a score of 4 to 10. Over 50% of the infants developed hyaline membrane disease regardless of Apgar score. However, in the infants with a five-minute Apgar score of 0 to 3, the severity of respiratory insufficiency was increased as indicated by increased requirement for high inspired oxygen, and the need for intermittent positive pressure ventilation. The duration of stay in the neonatal intensive care area, and the total length of hospital stay of the 49 VLBW survivors were shorter in the group with higher two-minute and five-minute Apgar scores. Long-term morbidity cannot yet be ascertained. It is likely that prevention, or prompt detection, and appropriate management of perinatal asphyxia would produce a further decline in mortality as well as morbidity for VLBW infants.     

早期营养支持对极低出生体重儿的生长发育及心理行为发育的影响

目的探讨对极低出生体重儿实施早期营养支持的方式,对其生长发育及心理行为发育的影响。方法回顾性分析我院NICU于2015年1月至2017年6月期间收治的符合入院标准的极低出生体重儿102例为研究对象,其中未实施早期营养支持的50例为对照组,实施早期营养支持的52例为观察组,对照组给予延迟营养支持,观察组给予早期肠内外营养支持,对比两组患儿生长发育情况、并发症的发生及神经系统发育指标。结果观察组患儿平均日增长体重高于对照组(P<0.05),且观察组患儿恢复出生体重日龄显著小于对照组(P<0.05);宫外生长迟滞的发生率(以出院体重为参考),观察组为25例(48.1%),对照组为38例(73.10%),两组相比较差异有统计学意义(P<0.05);观察组极低出生体重儿常见并发症呼吸窘迫综合征、新生儿窒息、低血糖、坏死性小肠结肠炎、败血症等的发生率显著低于对照组(P<0.05);纠正胎龄40周时,两组患儿的体质量及身长比较差异有统计学意义(P<0.05),且20项神经评估结果显示观察组较对照组分值高(P<0.05)。结论早期营养支持能够有效解决极低出生体重儿存在的营养和生长发育问题,提高胎儿宫外发育的速度,有效增加患儿的体质量,缩短恢复出生体质量日龄,减少宫外生长迟滞的发生,减少常见并发症的发生,降低了早产儿常见的脑损伤的发生率。     

Epidemiology of respiratory distress and the illness severity in late preterm or term infants: a prospective multi-center study

Background The severity of respiratory distress was associated with neonatal prognosis. This study aimed to explore the clinical characteristics, therapeutic interventions and short-term outcomes of late preterm or term infants who required respiratory support, and compare the usage of different illness severity assessment tools.Methods Seven neonatal intensive care units in tertiary hospitals were recruited. From November 2008 to October 2009, neonates born at ≥34 weeks＇ gestational age, admitted at 〈72 hours of age, requiring continuous positive airway pressure （CPAP） or mechanical ventilation for respiratory support were enrolled. Clinical data including demographic variables, underlying disease, complications, therapeutic interventions and short-term outcomes were collected. All infants were divided into three groups by Acute care of at-risk newborns （ACoRN） Respiratory Score 〈5, 5-8, and 〉8.Results During the study period, 503 newborn late preterm or term infants required respiratory support. The mean gestational age was （36.8±2.2） weeks, mean birth weight was （2734.5±603.5） g. The majority of the neonates were male （69.4%）, late preterm （63.3%）, delivered by cesarean section （74.8%）, admitted in the first day of life （89.3%） and outborn （born at other hospitals, 76.9%）. Of the cesarean section, 51.1% were performed electively. Infants in the severe group were more mature, had the highest rate of elective cesarean section, Apgar score 〈7 at 5 minutes and resuscitated with intubation, the in-hospital mortality increased significantly. In total, 58.1% of the patients were supported with mechanical ventilation and 17.3% received high frequency oscillation. Adjunctive therapies were commonly needed.Higher rate of infants in severe group needed mechanical ventilation or high frequency oscillation, volume expansion,bicarbonate infusion or vasopressors therapy （P 〈0.05）. The incidence of complications was also increased significantly in severe group （P 〈0.05）. The in-hospital mortality in the severe group was significantly higher than other two groups （P〈0.05）. ACoRN Respiratory Score was correlated with Score for Neonatal Acute Physiology-Version Ⅱ （SNAP-Ⅱ） （P〈0.01）. High gestational age, high SNAP-Ⅱ score and oxygenation index （OI）, and Apgar score at 5 minutes 〈5 were independent risks for death.Conclusions Neonatal respiratory distress is still a common cause of hospitalization in China. Illness severity assessment is important for the management. ACoRN Respiratory Score which correlated with SNAP-Ⅱ score is easy to use and may be helpful in facilitating the caregivers in local hospital to identify the early signs and make the transfer decision promptly.     

新生儿脐炎及并发高胆红素血症的临床分析

目的 :了解我院新生儿脐炎的发病率 ,探讨脐炎对黄疸转归的影响。方法 :对我院 2 0 0 3年 1月至 2 0 0 3年 12月出生的 14 6 7例新生儿中所发生的 97例新生儿脐炎患儿及其合并高胆红素血症情况进行回顾性的调查分析。结果 :14 6 7例新生儿中 ,发生脐炎 97人 (6 .6 1% ) ,足月儿组和早产儿组脐炎的感染率分别为 5 .5 1%和 18.4 0 %(χ2 =30 .75 ,P<0 .0 1) ;且有 6 3例并发高胆红素血症 ,足月患儿和早产患儿并发率分别为 6 3.5 0 %和 6 9.6 0 % (χ2 =0 .2 8,P>0 .0 5 ) ;黄疸消退的时间足月儿为 9d～ 16 d,早产儿为 11d～ 2 7d。结论 :早产儿较足月儿易发生脐部感染 ,但都较大程度合并高胆红素血症 ,且黄疸消退时间较正常新生儿延长 ;加强预防措施 ,是减少新生儿脐炎及新生儿病理性黄疸的关键。     

围生期高危儿系统管理12年回顾分析

目的总结我院逐步建立的围生期高危儿系统管理模式的效果。方法回顾性调查实施围生期高危儿系统管理模式前后,在我院出生的新生儿及其相关资料,分析高危儿管理后生活质量的主要指标,如围生期死亡率、窒息发生率、极低出生体质量儿发生率、死亡率和超低出生体质量儿合并症、发生中枢协调障碍的围产因素、干预效果等。结果围生期高危儿管理系统建立前后对比显示,尽管分娩数逐年增加,但围生儿死亡率呈明显下降趋势,窒息率明显下降（P=0．000）;极低和超低出生体质量儿存活率不断提高;发生中枢协调障碍的各种高危因素。依次胎儿宫内窘迫（30．5％）、母亲早期感染史（28．5％）、母亲妊娠糖尿病者（27．8％）、足月小样儿（26．7％）、早产儿（25．8％）、新生儿窒息（25．0％）、新生儿缺血缺氧性脑病（23．1％）、妊娠早期阴道流血史（20．5％）、新生儿高胆红素血症（15．9％）等;实施系统管理高危儿较门诊对照组中中枢协调障碍患儿发现早、疗程短、疗效好。结论围生高危儿系统管理模式的建立,确实能有效提高围生高危儿的生活质量,降低死亡率和伤残率。     

Elective delivery of the term fetus. An obstetrical hazard.

Of 1,020 consecutive admissions to a regional neonatal center, 38 infants were admitted following elective delivery in which no medical condition of the mother or fetus had necessitated immediate delivery. Twenty infants had problems that were not primarily the result of elective delivery, developed in 18. Fifteen of these 18 infants were delivered by cesarean section; in none of the mothers had any assessment of fetal maturity or size (other than the menstrual history and physical examination) been made. The infants remained in the hospital for an average of 12.7 days at a median cost of $2,678 per patient. One infant died. In the absence of pressing medical indications and without an objective assessment of fetal maturity, elective delivery remains potentially hazardous.     

延迟断脐对新生儿黄疸的影响

目的 胎儿娩出后即刻断脐是临床上的一贯做法,而延迟断脐可以使胎盘内的胎儿血充分回流,让新生儿得到更多的血液,对预防新生儿贫血等有积极作用,但是否也增加了新生儿黄疸的风险,临床尚无可靠证据。本研究通过实施早、晚断脐的对比研究,探讨延迟断脐对经阴道分娩足月新生儿黄疸的影响。 方法 选取温州医科大学附属第二医院2017年7-9月足月阴道分娩的延迟断脐的900例新生儿作为观察组,同时选择967例早断脐的新生儿作为对照组,观察组在新生儿娩出后30~180 s之间结扎并截断脐带,对照组在新生儿娩出30 s内结扎并截断脐带,观察2组新生儿每日经皮胆红素平均值、新生儿黄疸发生率、高胆红素血症的发生率、胆红素脑病发生率等指标,并将所得结果进行对比分析研究。 结果 2组新生儿每日经皮胆红素平均值比较,产后1~5 d观察组新生儿黄疸值依次为(3.43±0.76)mg/dl、(7.15±0.85)mg/dl、(11.23±0.74)mg/dl、(12.37±1.04)mg/dl及(13.68±1.49)mg/dl,对照组新生儿黄疸值依次为(3.12±0.43)mg/dl、(7.07±0.74)mg/dl、(11.11±0.68)mg/dl、(12.01±1.13)mg/dl及(12.96±1.58)mg/dl,同一时间相比,新生儿黄疸值观察组均高于对照组,但差异无统计学意义(P>0.05)。对照组中,新生儿病理性黄疸22例(发生率2.28%),观察组中,新生儿病理性黄疸23例(发生率2.56%),2组新生儿病理性黄疸及胆红素脑病发生率比较差异无统计学意义(均P>0.05)。2组新生儿均未发生胆红素脑病。 结论 延迟断脐对新生儿黄疸无明显影响,不增加高胆红素血症发生率。      

Costs and benefits of a community special care baby service

Between January 1981 and December 1986 3829 low birthweight (less than 2500 g) infants and 1980 other high risk infants were cared for at home after they were discharged from hospital by a specialist neonatal nursing service. Of the infants who were referred to this service, 720 (12%) weighed under 2000 g and 1919 (33%) under 2250 g at the time of discharge home. The infants were visited by the community neonatal sisters on an average of 11 occasions, but the number of visits varied from six to over 100 depending on the needs of the child and parents. There was close liaison with other community and hospital staff. Two hundred and thirty (4%) referred infants were readmitted to hospital while under the care of the specialist nursing service. In 1985 the cost of the service was pounds 127,000, or pounds 123 for each infant referred. Providing this specialist support at home allowed much earlier discharge of low birthweight infants from hospital. When compared with the cost of providing continuing inpatient neonatal care earlier discharge was estimated to have saved roughly pounds 250,000 in 1985. Low birthweight infants have an increased risk of serious illness or death that extends beyond the neonatal period. Many are born to young and socially disadvantaged parents who can benefit from expert guidance and support at home. A community neonatal nursing service has advantages for high risk infants and their parents, is cost effective, and allows more efficient use of limited hospital resources.     

东北地区新生儿疾病临床流行病学调查及分析

目的 通过对我国东北地区Ⅲ级医院住院新生儿的调查,以了解东北地区目前住院新生儿的患病情况.方法 回顾性调查了2005年1月1日～2005年12月31日住院的新生儿4 851名.结果 ①男女性别比为1.72∶1.00;②早产儿占住院新生儿的28.5％;③新生儿疾病谱中,发生率最高的前10位的疾病依次为高胆红素血症、肺炎、早产、脓毒症、先心病(含卵圆孔未闭、动脉导管未闭)、窒息、血液系统疾病、颅内出血、HIE、湿肺;④足月儿高胆红素血症、肺炎、胎粪吸入综合征、胆红素脑病、惊厥、先心病、败血症、脐炎和窒息发生率高于早产儿.而早产儿呼吸窘迫综合征、肺出血、呼吸暂停、颅内出血、寒冷损伤综合征、贫血等疾病的发生率高于足月儿;⑤新生儿转归:治愈率占55.6％,好转率占33.5％,死亡率占2.5％,早产儿的治愈率及好转率均低于足月儿,早产儿病死率占4.1％.结论 住院新生儿中早产儿比例明显升高,新生儿疾病病种发生了变化,有关部门应做这方面的预防工作.     

Pattern of proven bacterial sepsis in a neonatal intensive care unit in Riyadh-Saudi Arabia: a 2-year analysis

Bacterial infections are an important cause of neonatal mortality and morbidity. The major pathogens for neonatal sepsis in the neonatal intensive care unit (NICU) vary with geographical area and time. It is therefore important to frequently audit neonatal sepsis in individual NICU, to aid in provision of adequate and appropriate preventive and therapeutic measures. We retrospectively reviewed the medical records of all infants who had positive blood cultures during a 2-year period in the NICU at a university hospital in Riyadh, Saudi Arabia. Overall the incidence of proven-bacterial-sepsis (PBS) was 10.2% of NICU admissions. The incidence of PBS in low-birth-weight (LBW), very low-birth-weight (VLBW), and extremely low-birth-weight (ELBW) infants were 19%, 41%, and 49% respectively. Multiple episodes of bacterial sepsis occurred in 21% of all infants infected. Coagulase negative Staphylococcus (CONS) (50%) was the most common infecting organism causing late onset sepsis (LOS) and Escherichia coli (29%) the most common causing early onset sepsis (EOS). Gram negative bacteria (GNB) were the infecting organisms in 50% of the EOS episodes and 29% of LOS episodes. Only 11% (14) of the PBS were EOS. Only 10 (10.4%) infants had bacterial meningitis. The overall PBS related mortality was 9%, representing 22% of all neonatal deaths.     

A 12-month prospective survey of perinatal outcome of liveborn neonates in Julu County, China

Background Population based epidemiologic study on the main diseases and birth status of liveborn neonates remains scarce in China, especially in rural areas where a large number of neonates are born. The aim of this study was to establish an epidemiological basis of live births in Julu County, a representative of the northern and mid-western parts of China in terms of demography, disease pattern and women and children＇s health care infrastructure.Methods The perinatal data of all live births were prospectively collected in three participating county-level hospitals from September 1, 2007 to August 30, 2008.Results There were 5822 live births in these hospitals. Among all live births, 53.7% were male and 4.5% were bornprematurely. Mean （SD） birth weight （BW） was （3348±503） g. The low （〈2500 g） and very low BW （〈1500 g） infants accounted for 3.8% and 0.5% of the total births, with 6.5% as small for gestational age and 2.8% as multi-births.Cesarean section rate was 30.2%, of which 68.6% were elective. There were 745 infants （12.8% of the live births）admitted to local neonatal wards within 7 days of postnatal life, in which 48.3% and 19.3% were due to perinatal asphyxia and prematurity, respectively. The incidences of perinatal aspiration syndrome, transient tachypnea and respiratory distress syndrome were 4.9%, 0.6% and 0.5%, respectively. Neonatal mortality was 7.6%. （44/5822）, with 16 in delivery room and 28 in neonatal ward before discharge.Conclusions This study provided a population-based perinatal data of live births and neonatal mortality in a northern China county with limited resources. Neonatal disorders related to perinatal asphyxia remain a serious clinical problem,which calls for sustained education of advanced neonatal resuscitation and improvement in the quality of perinatal-neonatal care.     

高危早产儿肠外营养相关性胆汁淤积的危险因素及转归分析

目的 探讨极低和（或）极早早产儿肠外营养相关性胆汁淤积（parenteral nutrition associated cholestasis,PNAC）发生的危险因素及疾病转归。 方法 选择早产儿100例,均于生后24 h内入住新生儿重症监护病房,接受肠外营养（parenteral nutrition,PN）≥14 d,胎龄＜32周和(或)出生体重＜1 500 g。依据实验室结果将其分为PNAC组40例和非PNAC组60例,比较2组临床资料,分析PNAC发生的危险因素。 结果 PNAC组新生儿败血症、NEC发生率、中/长链脂肪乳使用率高于非PNAC组,出生胎龄小于非PNAC组,PN持续时间、脂肪乳使用时间、葡萄糖使用时间、禁食时间、抗生素使用时间长于非PNAC组,葡萄糖累积用量高于非PNAC组,差异有统计学意义（P＜0.05）。多元Logistic回归分析结果显示,新生儿败血症、使用中/长链脂肪乳是PNAC发生的独立危险因素（P＜0.05）。PNAC发生时间为PN后22.0（11.0）d,PN后38.0（21.0）d 血清直接胆红素（direct bilirubin,DBIL）达到峰值,生后47.5（38.0）d后恢复正常,PNAC组发生肝功能损害8例,发生率为20%,无发生肝功能衰竭病例。 结论 PNAC是高危早产儿的常见并发症之一,减少不必要的禁食,缩短PN持续时间,预防感染及NEC发生,优化静脉营养成分对预防PNAC的发生及减轻其严重程度具有积极作用。