新生儿肺透明膜病的特点及影响因素调查分析

目的:分析新生儿肺透明膜病(HMD)特点及影响因素。方法:收集2015年11月—2017年11月本院新生儿科收治的HMD患儿108例为观察组,另选取同期健康新生儿120例为对照组,对两组新生儿资料进行回顾性分析,探究HMD临床特点及影响HMD发生的危险因素。结果:HMD患儿发病时间窗多为0～6h,并发症较多,且观察组pH值、动脉血氧分压(PaO2)、血氧饱和度(SaO2)低于对照组,动脉血二氧化碳分压(PaCO2)高于对照组,男婴、胎龄37周、胎盘早剥、母亲糖尿病、剖宫产、宫内窘迫、先兆子痫发生率均高于对照组,产前使用糖皮质激素、新生儿体重低于对照组(均P0.05);男婴、胎龄37周、体重、胎盘早剥、母亲糖尿病、剖宫产、宫内窘迫、先兆子痫是影响HMD发生危险因素。结论:新生儿HMD发病时间较早,肺泡氧合能力下降,并发症发生率较高,其中性别、胎龄、胎盘早剥、母亲糖尿病、剖宫产、宫内窘迫、先兆子痫等多种因素是HMD发生的危险因素,临床针对上述危险因素应积极采取措施预防HMD发生,并早诊断及早治疗,对改善患儿预后具有重要作用。     

足月剖宫产儿并发新生儿急性呼吸窘迫综合征相关危险因素分析

目的探讨足月剖宫产新生儿并发急性呼吸窘迫综合征的相关危险因素。方法以足月剖宫产新生儿并发急性呼吸窘迫综合征患儿40例为研究对象,同时以40例健康足月生理产新生儿为对照组,应用单因素方差分析选择性剖宫产与非选择性剖宫产发生急性呼吸窘迫综合征有无统计学意义,应用Logistic回归分析两组新生儿在出生体重、产时窒息、胎膜早破、母亲妊娠期合并糖尿病、宫内胆汁淤积症以及哮喘有无统计学意义。结果单因素方差分析提示选择性剖宫产组ARDS发生率明显高于非选择性剖宫产组,差异有统计学意义(P0.05)。Logistic回归分析结果提示出生体重、产时窒息、胎膜早破、母亲妊娠期合并糖尿病、宫内胆汁淤积症以及哮喘与剖宫产儿ARDS的发生密切相关。结论选择性剖宫产是导致足月剖宫产新生儿并发ARDS的重要危险因素。产时窒息、胎膜早破、母亲妊娠合并糖尿病、宫内胆汁淤积症以及哮喘是足月剖宫产新生儿发生ARDS的危险因素,而高出生体重是足月剖宫产儿发生ARDS的保护因素。     

新生儿下呼吸道感染危险因素的病例对照研究

目的探讨新生儿发生下呼吸道感染的危险因素,为临床预防控制新生儿医院感染提供依据。方法采取回顾性调查的方法收集2012年1月—2013年1月入住某妇幼保健院新生儿科的105例下呼吸道感染新生儿的相关信息,并与同时期在该科室住院的无下呼吸道感染的105例新生儿对比,采用单因素和多因素logistics回归分析新生儿下呼吸道感染的危险因素。结果新生儿下呼吸道感染的发生与分娩方式(剖宫产OR=4.89,95%CI:1.60~14.91)、羊水浑浊(OR=4.83,95%CI:1.82~12.80)及侵入性治疗(OR=5.17,95%CI:2.12~12.63)有关。结论剖宫产、羊水浑浊及侵入性治疗是新生儿发生下呼吸道感染的危险因素,应针对这些因素采取相应的干预措施,加强呼吸道管理,降低新生儿下呼吸道感染发生率。     

早产儿肺透明膜病发病及预后的高危因素分析

目的：探讨早产儿肺透明膜病（HMD）发病及影响预后的高危因素,为新生儿肺透明膜病发病提供预防措施。方法：选择67例HMD患儿为研究对象,同期住院的1194例早产儿为对照组,回顾性分析与HMD发病及预后有关的危险因素。结果：围生期窒息、前置胎盘、胎盘早剥、小胎龄、低体重为早产儿HMD发生的高危因素,而胎膜早破及产前使用糖皮质激素对HMD有预防作用。而胎龄越小、体重越低HMD预后越差,早期使用肺表面活性物质明显提高HMD存活率。结论：对孕母特别是高危妊娠孕母重视产前检查,及时发现问题并予以正确处理,减少早产,积极消除HMD高危因素,积极治疗,降低HMD的发病率及病死率。     

肺透明膜病患儿发生支气管肺发育不良的影响因素分析

目的 探讨肺透明膜病（HMD）患儿发生支气管肺发育不良（BPD）的影响因素。方法 回顾性分析2018年1月至2020年12月我院收治的451例HMD患儿的临床资料,根据BPD发生情况分为BPD组与非BPD组,分析HMD患儿发生BPD的影响因素。结果 451例HMD患儿中80例发生BPD,占比为17.74%。Logistic回归分析显示,胎龄≤32周、出生体重≤1.5kg、合并宫内感染、肺出血、机械通气时间>6 d是HMD患儿发生BPD的独立危险因素（P <0.05, OR>1）。结论 胎龄≤32周、出生体重≤1.5 kg、合并宫内感染、肺出血、机械通气时间>6 d是HMD患儿发生BPD的独立危险因素,临床应针对危险因素加强治疗与预防,以降低BPD发生率。     

43例新生儿气胸相关危险因素分析

目的探讨可能导致新生儿气胸发生的主要危险因素及防治策略。方法对2015年1月—2016年10月在遂宁市中心医院新生儿科住院的43例新生儿气胸患儿(气胸组)和随机选取的41例非气胸患儿(非气胸组)对照进行回顾性分析。采用单因素分析和Logistic回归分析的方法,筛选出新生儿气胸发病的危险因素。结果单因素分析显示两组在胎龄、剖宫产、Apgar评分、肺炎、胎粪吸入综合征(MAS)、新生儿呼吸窘迫综合征(NRDS)、持续气道正压通气(CPAP)、有创机械通气等因素上存在统计学差异(P0.05);Logistic回归分析提示胎龄、剖宫产、肺炎、MAS、NRDS、CPAP、有创机械通气是新生儿气胸发生的主要危险因素(P0.05)。结论胎龄、剖宫产、肺炎、MAS、NRDS、CPAP、有创机械通气是新生儿气胸发生的主要危险因素,应采取相应的干预措施避免或减少新生儿气胸的发生。     

高龄产妇产后抑郁症的危险因素调查

目的探讨高龄产妇产后抑郁症的危险因素,为临床诊治及制定干预措施提供参考依据。方法选取2017年7月-2018年3月在孝感市妇幼保健院产后复查的高龄产妇210例,均行爱丁堡产后抑郁量表(EPDS)评分,比较高龄产妇产后抑郁症患者与产后未发生抑郁症患者相关情况,并行Logistic多因素分析。结果高龄产妇产后抑郁症患者年龄>40岁、不良孕产史、婚姻不和谐、婆媳关系差、剖宫产、人工喂养、新生儿健康差、抑郁史及新生儿性别为女性所占比例均明显高于未发生产后抑郁症产妇,差异有统计学意义(均P<0. 05);经Logistic分析,年龄、不良孕产史、剖宫产、抑郁史及新生儿性别为女性为高龄产妇产后抑郁症发生的危险因素,婚姻和谐、婆媳关系好、母乳喂养、新生儿健康为保护因素。结论不良孕产史、抑郁史、年龄、剖宫产等是高龄产妇产后抑郁症发生的危险因素,应强化高龄产妇孕期健康教育及心理辅导等,减少产后抑郁症的发生。     

影响高龄孕妇剖宫产发生产后出血的危险因素探讨

目的:探讨影响高龄孕妇剖宫产发生产后出血的危险因素。方法:选择40例剖宫产产后出血的高龄孕妇为研究组,同期行剖宫产产后非出血的高龄孕妇460例为对照组。对可能造成术后出血的因素进行单因素分析,对于影响显著的因素进行多因素Logistic回归分析。结果:研究组中的妊娠高血压史、流产史、宫缩乏力、巨大儿及前置胎盘的发生率明显高于对照组(P<0.05)。经多因素Logistic回归分析,高龄孕妇剖宫产发生产后出血的高危因素依次为宫缩乏力、前置胎盘、妊娠高血压史、巨大儿、流产史。结论:影响高龄孕妇剖宫产发生产后出血的主要因素为宫缩乏力、前置胎盘、妊娠高血压史,为临床有效预防高龄孕妇剖宫产产后出血提供了理论依据。     

剖宫产产后出血的相关因素病例对照研究

目的:探讨剖宫产产后出血发生的相关危险因素,为剖宫产产后出血的预防提供依据。方法:采用病例对照研究对106例剖宫产产后出血产妇和212例未出血的剖宫产产妇的临床资料进行比较分析。结果:经过单因素和多因素分析显示胎盘因素、巨大胎儿是剖宫产产后出血发生的相关危险因素。结论:胎盘因素、巨大胎儿为剖宫产产后出血发生的相关危险因素,对这两个因素进行控制能预防产后出血的发生。     

新生儿气胸危险因素临床分析及胸腔闭式引流对气胸治疗的影响

目的分析新生儿气胸发生的主要危险因素,并探讨胸腔闭式引流对气胸治疗的影响。方法回顾性分析2013年8月-2017年8月山东大学齐鲁医院新生儿科收治的55例气胸患儿与同期住院的100例非气胸患儿的临床资料。对两组可能影响气胸发生的因素进行单因素分析,对有统计学意义的因素进行多因素Logistic分析。根据是否行胸腔闭式引流将气胸患儿分成两组并采用t检验进行分析。结果多因素Logistic回归分析提示:胎龄、选择性剖宫产、肺炎、窒息后复苏、新生儿呼吸窘迫综合征(NRDS)、胎粪吸入综合征(MAS)、湿肺、机械通气等是新生儿气胸发生的独立危险因素(均P<0. 05)。气胸患儿经胸腔闭式引流的机械通气时间、住院天数均显著高于对照组(均P<0. 05),而撤机后吸氧时间二者差异无统计学意义(P>0. 05)。结论新生儿气胸发生的危险因素是胎龄、选择性剖宫产、肺炎、窒息后复苏、NRDS、MAS、湿肺、机械通气。严重气胸患儿采用胸腔闭式引流及高频机械通气,可促进气胸的治愈。     

围产儿宫内转运与新生儿转运对比分析

目的:通过对比围产儿宫内转运与新生儿转运方式,分析围产儿的结局,探讨对围产儿安全最有利的转运方式。方法:回顾性收集广州市妇女儿童医疗中心2011年1月～2012年1月间可获得完整数据资料的宫内转运孕妇所生新生儿中转入新生儿科的204例与同期由外院转入的出生时间在3日内的新生儿530例。比较两种方式新生儿的出生时胎龄、出生体重、分娩方式、并发症、总住院天数、新生儿结局等,探讨对围产儿安全最有利的转运方式。结果:①宫内转运组平均胎龄和平均出生体重均小于新生儿转运组(P<0.05)。宫内转运组顺产率及足月产率低于新儿转运组,剖宫产率及早产率高于新生儿转运组(P<0.05)。②宫内转运组新生儿窒息(1.96%vs33.77%)、缺血缺氧性脑病(0.5%vs23.58%)、新生儿肺炎(23.53%vs34.33%)的患病率显著低于新生儿转运组(P<0.05)。③宫内转运组肺透明膜病及低血糖的发生率比新生儿转运组高(P<0.05)。④宫内转运组较新生儿转运组治愈率高、死亡率低、住院时间短(P<0.05)。结论:围产儿宫内转运结局优于新生儿出生后转运,应建立和完善围产儿转运体系。     

与早产儿肺透明膜病相关的发病因素分析

[目的 ]　分析与早产儿肺透明膜病 (以下简称HMD)发病相关的诸因素 ,探讨预防的措施。 [方法 ]　对早产儿HMD患者 5 9例 ,就其出生体重、胎龄、分娩方式、阿氏评分和产前激素治疗等情况与HMD的相关性进行分析。[结果 ]　HMD的发病主要在胎龄 <32周、出生体重 <16 0 0克的早产儿 ;与分娩方式无明显相关 ;孕期有促胎肺成熟治疗者其存活率明显高于未进行激素治疗者 ;2 / 3的HMD患儿生后即有呼吸启动困难或窒息。 [结论 ]　加强孕期管理 ,预防早产是关键 ;对于难免早产者应积极进行促胎肺成熟治疗 ,争取保胎至孕周 >32周或出生体重超越 16 0 0克 ;分娩方式视母婴情况而定     

Respiratory distress in newborn

The incidence of neonatal respiratory distress (RD) ranges from 2.2% to 7.6% in developed countries and from 0.7% to 8.3% in India. A study conducted in Pondicherry, India, found the incidence of neonatal RD to be 6.7%. The leading cause of neonatal RD is transient tachypnea (50-60% of RD cases) followed by infections (pneumonia, sepsis, or meningitis), meconium aspiration, and hyaline membrane disease (HMD). Significant predictors of neonatal RD include prematurity, malpresentation, abnormal delivery, premature rupture of membranes, fetal distress, multiple pregnancy, male sex, and low apgar score at birth. The case fatality rate for RD in India is 30-40%. In the Pondicherry study, it was 19%. Case fatality is highest for newborns with HMD (20-40% in developed countries and 50-75% in India). It ranges from 14.3% to 30.37% for meconium aspiration-related RD deaths. RD incidence and subsequent infant mortality can be reduced by improved prenatal care, early detection and referral of high risk pregnancies, closer links between referral hospitals and health centers, close monitoring of labor to detect fetal distress, and early intervention when indicated. In cases of RD, adequate and immediate resuscitation, oxygen supplementation, maintenance of optimal temperature, and time referral if RD lasts beyond two hours will reduce mortality. In cases of HMD and meconium aspiration, adequate ventilatory support and surfactant therapy will reduce mortality.     

Survival and risk factors for neonatal mortality in a cohort of very low birth weight infants in the southern region of São Paulo city, Brazil

Population studies can help identify the complex set of risk factors for neonatal mortality among very low birth weight infants. A cohort (2000-2001) of 213 live newborns with birth weight < 1,500g in the southern region of S?o Paulo city, Brazil, was studied (112 neonatal deaths and 101 survivors). Data were obtained from home interviews and hospital records. Survival analysis and multiple Cox regression were performed. The high mortality in the delivery room and in the first day of life among neonates < 1,000g and < 28 weeks gestational age and the absence of survival in neonates < 700g suggest that care was actively oriented towards newborns with better prognosis. Increased risk of neonatal mortality was associated with maternal residence in slum areas, history of previous cesarean(s), history of induced abortion(s), adolescent motherhood, vaginal bleeding, and lack of prenatal care. Cesarean section and referral of the newborn to the hospital nursery showed protective effects. Birth weight less than 1,000g and Apgar index < 7 were associated with increased risk. The high mortality was due to poor living conditions and to maternal and neonatal characteristics. Improvement in prenatal and neonatal care could reduce neonatal mortality in these infants.     

Optimal gestational age and birth-weight cutoffs to predict neonatal morbidity.

BACKGROUND: Gestational age (GA) and birth weight (BW) criteria are used to identify newborns at risk for neonatal morbidity. Currently, preterm is GA less than 37 weeks; low birth weight is BW less than 2,500 grams; and small for gestational age (SGA) is BW less than the tenth percentile weight for the infant's GA. The optimal classification system balances the misclassification cost of false negatives against the cost of false positives. OBJECTIVE: To calculate the relative misclassification costs implied by the current 37-week and 2,500-gram cutoffs, and to test the validity of the current definition of SGA as a predictor of term morbidities. METHODS: GA, BW, and morbidity information were collected for 22,606 infants born between July 1981 and December 1992. Using this dataset, logistic regression coefficients were obtained modeling GA or BW as predictors of morbidities associated with prematurity. For a subset of 18,813 infants with GAs between 37 and 41 weeks, coefficients were obtained modeling both GA and BW as independent predictors of term morbidities. The logistic regression coefficients were used to calculate optimal birth weight, gestational age, and birth-weight-for-gestational-age cutoffs. RESULTS: The current definitions of low birth weight and preterm imply that it is 18 to 28 times more costly to misclassify a sick infant as low-risk than to misclassify a well infant as high-risk. CONCLUSIONS: Gestational age alone is better than birth weight alone at predicting preterm morbidities. No birth-weight cutoff can adequately predict term morbidities. A single weight-percentile cutoff for all gestational ages should not be used to identify newborns at high risk for neonatal morbidity.     

新生儿低钙血症危险因素分析

目的 分析新生儿低钙血症发病的危险因素,以期为临床诊疗提供理论依据。方法 将162例临床资料完整的患儿纳入研究,根据测定的血钙值将其分为低钙血症组(n=74)和非低钙血症组(n=88),以低钙血症是否发生为因变量,可能的影响因素为自变量,建立Logistic回归模型,采用SPSS17.0软件,进行非条件Logistic回归分析。结果 多因素非条件Logistic回归分析显示,孕周、出生体重、新生儿窒息、新生儿及母孕期维生素D缺乏和母孕期糖尿病与低血钙发生显著相关(P＜0.05),且提示孕周越小、出生体重越低、窒息发生、新生儿及母孕期维生素D缺乏和母孕期合并糖尿病的新生儿,出现低钙血症的危险性越大。29例出现肢体抽搐的患儿行振幅整合脑电图(aEEG)检查,其中aEEG异常的22例患儿低血钙纠正后复查aEEG均正常。结论 新生儿低钙血症的发病与患儿孕周、出生体重、新生儿窒息、新生儿及母孕期维生素D缺乏和母孕期糖尿病有密切的相关性。而且,短暂的新生儿低血钙可引起暂时的aEEG异常。     

Infants of immigrant parents in Italy. A national multicentre case control study

BACKGROUND: The aim of this study was to evaluate health state of newborns of immigrated parents from developing countries. METHODS: Hospital records of 69,605 infants born during 1996/1997 in Italy were reviewed comparing, in a case-control study, each infant of immigrated parents to two infants born immediately before and after to Italian parents. RESULTS: Of the 69,605 newborns 3906 (5.6%) were born to immigrated parents. This prevalence prolongs the increasing trend observed during the last 10 years of infants born to immigrated parents and reduces the fall of the birth rate linked to the few infants born to Italian parents. It was influenced by geographical factors, being higher in Northern-Central Italy (7%) than in Southern and Insular Italy (2.8%), as consequence of more elevated incomes in these Italian regions. The origin countries of immigrated parents were mainly Northern Africa (31.7%), Eastern Europe (18%) and Sub Saharan Africa (11.6%). Infants of immigrated parents showed higher incidences of prematurity, low birth weight, asphyxia and neonatal mortality rate than newborns with Italian parents. These higher incidences appeared related to some risk factors such as higher parity, short gestational age, some maternal infections, maternal drug dependence, maternal age less than 18 years, low familiar income, inadequate obstetric cares, difficulty to accessing the public health services. CONCLUSIONS: The health problems of infants with immigrated parents are mainly related to social disadvantage and can be overcome improving the social state, the lifestyles and the obstetric cares of the immigrated women, so as monitoring their risk pregnancies.     

扬州地区新生儿维生素D水平及影响因素研究

目的 了解扬州地区新生儿血清中维生素D（Vitamin D,VD）水平及其影响因素。方法 选取孕早期在扬州市妇幼保健院建卡且于2014年5月~2015年5月在产科住院分娩的孕妇作为初始研究对象。按照纳入和排除标准选入3 913例健康单胎活产新生儿进入此次研究,并通过自制的问卷收集孕妇及新生儿相关信息。采用酶联免疫吸附法检测孕妇及新生儿血清中的VD浓度,描述并分析新生儿VD的分布特征及影响因素。结果 扬州地区新生儿VD水平为（28.79±8.37）nmol/L,其充足率、不足率、缺乏率分别为2.2%、11.7%、86.1%。多因素Logistic回归模型分析结果显示,孕妇孕中期VD缺乏（OR=3.16,95%CI:2.00~5.00,P<0.001）和不足（OR=1.67,95%CI:1.04~2.67,P=0.033）,孕晚期VD缺乏（OR=8.64,95%CI:5.64~13.24,P<0.001）和不足（OR=1.63,95%CI:1.07~2.49,P=0.024）,胎儿分娩季节为冬春季（OR=1.49,95%CI:1.13~1.97,P=0.004）均是新生儿VD缺乏的危险因素。结论 扬州地区新生儿VD水平普遍缺乏,孕妇孕中期和孕晚期VD状况以及胎儿分娩季节与新生儿VD缺乏均存在关联。     

Risk-approach strategy in neonatal care

This study applied a risk-approach strategy involving extra care to at-risk neonates by optimum utilization of existing resources to a cohort of newborns in rural India. Included in the analysis were all births in the study population of 47,000 people in 22 villages in 1981-82. 5 risk factors were identified (low birth weight and small size, preterm birth, feeding problem, illness, and history of prolonged and difficult labor). A management plan was developed for individual risks, and 40 community health workers were trained to implement these plans. During the 2-year study period, 851 newborns (28%) were designated as at-risk and adequate intervention was possible in 412 cases (48%). Neonatal mortality declined from 51.9 to 38.8/1000 live births between 1981 and 1982. The neonatal mortality rate was significantly higher among the infants designated as at-risk and increased with the number of risk factors present simultaneously. Neonatal mortality was highest among infants with feeding problems (439.2/1000) and illness (471.4/1000). 42% of neonatal deaths were related to low birth weight and associated complications; another 20% resulted from neonatal infections and 18% from asphyxia at birth. The neonatal mortality rate for the adequately intervened group (89.8/1000) was significantly lower than that for the group with inadequate intervention (200.5/1000). 92% of neonatal deaths occurred in 28% of the newborns who formed the at-risk groups. It is concluded that this strategy is effective and could be applied in rural areas with similar problems. Continued training of community health workers, greater cooperation with families through health education, and meetings with local leaders and traditional birth attendants are recommended to facilitate identification of at-risk neonates.