NEWER CONCEPTS AND MANAGEMENT OF NEONATAL SEPSIS

Despite extensive research into its patho-physiology, investigations and treatment, sepsis remains an important cause of neonatal morbidity and mortality. The incidence in developing countries is 10 times that in the developed world. A large number of pro-and anti-inflammatory cytokines (interleukins, eicosanoids, tumour necrosis factor-alpha, nitric oxide) have been identified, the interplay of which leads to the Systemic Inflammatory Response Syndrome (SIRS) which can have devastating consequences on all systems of the body. In India the common organisms include Staphylococcus, E coli, Klebsiella and Candida. A number of maternal and neonatal risk factors have been identified. The initial signs and symptoms are subtle and can easily be missed. Early investigations and screening tests are important and a promising number of new tests are being studied. The gold standard for diagnosis is a positive culture from a body fluid or local source in the presence of SIRS. The threshold for starting antibiotics should be low in high-risk neonates and broad spectrum antibiotics covering the likely organisms should be given intravenously in all suspected cases in a hospital setting. This should be continued for at least 24-48 hours (till negative reports are available) in suspected cases and for 2-3 weeks in proven cases. Prophylaxis is aimed at preventing nosocomial and cross infections. Strict hand-washing, meticulous asepsis protocols, identification of high risk groups and prompt and better screening tests are essential in controlling this problem.KEY WORDS: Neonate, Sepsis, Systemic inflammatory response syndrome     

ROLE OF TUMOR NECROSIS FACTOR IN NEONATAL SEPSIS

ＲＯＬＥＯＦＴＵＭＯＲＮＥＣＲＯＳＩＳＦＡＣＴＯＲＩＮＮＥＯＮＡＴＡＬＳＥＰＳＩＳＳｈｉＹｕａｎ；（史源）ＳｈｅｎＣｈｉｋａｏ；（沈际臬）ＷａｎｇＪｉａｎｇｈｕａｉ；（汪江淮）ＬｉＨｕａｐｉａｎｇ；（李华强）ＱｉｎＳｈｉｗｅｎ；（覃世文）ａｎｄＬｉｕ...     

新生儿化脓性脑膜炎与败血症相关性分析

对96例新生儿败血症及其中合并化脓性脑膜炎的34例从胎龄、出生体重、日龄、病原菌类型及治疗前病程诸方面进行了回顾性分析,揭示早产儿、低出生体重儿、日龄<7天的新生儿患败血症时更易合并化脑。另外,不同类型病原菌在化脑发生中存在显著性差异。全葡菌和大肠杆菌败血症患儿化脑的发生率高。     

新生儿败血症血小板计数分析(附42例报告)

目的：探讨新生儿败血症患者血小板计数与病情的关系。方法 分析了４２例患儿的临床表现和血小板计数。结果 病情轻重与细菌种类有关,且并发肺炎或肠炎等内部脏器炎症者病情较并发有脓疱疹或脐炎等浅表部位感染者重,并发现血小板随病情轻重而增减,病情重者血小板计数较轻者少（Ｐ〈０．０１）。结论 新生儿败血症病情轻重与病原菌种类及入侵部位有关,血小板计数可作为诊断新生儿败血症的一个辅助标准和病情监测指标。     

严重感染集束化治疗的依从性及对预后的影响

目的评估集束化治疗在ICU实施的依从性及对严重感染和感染性休克患者预后的影响。方法回顾性调查2005年1月—2010年8月宁夏医科大学附属医院ICU收治的149例进行6h、24h集束化治疗严重感染和感染性休克的患者,了解集束化治疗的依从性及对患者28d病死率的影响。结果集束化治疗中早期血清乳酸的监测、EGDT（早期目标化治疗）和血糖控制,依从性偏低,其他各项依从性较好,均在90%以上。6h、24h集束化治疗达标的依从性分别为46.3%和45.2%。6h达标组的患者28d病死率为43.5%,未达标组的患者28d病死率为87.5%,24h达标组的患者28d病死率为45.9%,未达标组的患者28d病死率为78.4%,达标组的患者28d病死率明显比未达标组患者的28d病死率低（P〈0.05）。结论集束化治疗可以更好地改善严重感染和感染性休克患者的预后,应提高感染性休克集束化治疗的依从性。     

脓毒血症时大鼠心肌G 蛋白的变化

目的：研究脓毒血症时大鼠心肌Ｇ蛋白的变化。方法：免疫印迹法测定大鼠心肌细胞膜Ｇｓα、Ｇｉα２和Ｇｉα３的含量，放射免疫法测定各组心肌腺苷酸环化酶的活性。结果：脓毒血症时Ｇｓα表达无明显变化。脓毒血症晚期Ｇｉα２和Ｇｉα３含量分别升高５３．５％（Ｐ＜０．０５）和６３．７％（Ｐ＜０．０１）。基础及Ｇｐｐ（ＮＨ）Ｐ刺激的腺苷酸环化酶活性在脓毒血症晚期明显抑制。结论：大鼠心肌Ｇｉ的增加参与脓毒血症时腺苷酸环化酶信号转导系统功能障碍的发生。     

大鼠实验性败血症后的多器官损伤

用盲肠结扎加穿刺的方法复制大鼠早期多器官衰竭(MOF)模型,作者称其为败血症后多器官损伤。此模型复制后20h,大鼠腹腔器官出现不同程度的形态和功能异常,用激光多普勒微循环血流计测定败血症组及对照组腹腔器官表面血流量的结果表明,败血症组除肝脏外,脾、肾、小肠及尾部微循环血液灌流量均有明显降低。作者介绍了用此方法制作这种动物模型的优点并认为腹腔器官微循环灌流量降低是MOF早期的发病机制之一。     

NEONATAL EPIDEMIC COXSACKIE Bs MENINGITIS

An epidemic of neonatal viral meningitis oc curred in Shanghai from July to September 1984. Cerebrospinal fluid cultures proved that the causative organism was Coxsackie Bs virus. The age at onset of disease was 4-14 days after birth. Symptoms were mild and prognosis was good. The average duration of illness was 10.9士4.1 days. No sequelae were found after one month to oneyear follow-up. The epidemiology, pathogenesis, clinical manifestations, differential diagnosis and treatment are discussed.     

肠外营养在新生儿疾病中的应用

应用肠外营养治疗新生儿疾病１２例。临床观察无任何不良反应，检测未发现代谢并发症。患儿体重平均增加２１６ｇ，血浆白蛋白平均增加４．５７ｇ·Ｌ￣（－１），结果表明，对新生儿进行肠外营养时，应根据新生儿的日龄、体重、疾病计算合理的配方，用脂肪和葡萄糖作为能源底物，脂肪供能占总热量的３０％，最大不超过５０％，氮热卡比值１：１５０～２５０是安全有效的。     

新生儿抚触的临床效果观察和体会

目的探讨抚触对新生儿生长发育的影响.方法 将160例剖宫产儿随机分为2组,抚触组80例,在常规护理的基础上进行抚触,对照组80例行常规护理,将两组新生儿情况进行比较.结果 观察组新生儿在睡眠、哭闹、摄奶量、排便、体重增长和神经行为发育等方面明显优于对照组(均P<0.05).结论抚触护理对新生儿的生长发育有明显的促进作用.     

脓毒症的免疫损伤

目的观察脓毒症小鼠脾淋巴细胞凋亡情况。方法采用盲肠结扎穿孔术复制小鼠脓毒症模型,30只小鼠随机分为假手术组(Sham组)和模型组(CLP组),术后24h取脾组织,行HE染色,观察病理变化,TUNEL法检测细胞凋亡。结果 CLP组脾脏白髓淋巴滤泡内则见大量灶性分布的凋亡淋巴细胞,凋亡的严重程度以凋亡指数(Apoptosis Index,AI)计算,CLP组与Sham组比较差异具有统计学意义(P<0.01)。结论脓毒症脾淋巴细胞凋亡明显增加,成为脓毒症免疫抑制的重要机制。     

CLINICO-PATHOLOGICAL CORRELATION IN NEONATAL AUTOPSIES

Of the 253 neonates admitted to a neonate intensive care unit during the period Jan 91 to Sep 93, 43 neonates died. Autopsy was done in 23 of these (53%). The mean duration of stay of the neonates in the intensive care unit prior to death was 5.6 days (range 2 hours to 10 days). Antemortem diagnoses included asphyxia neonatorum (4), meconium aspiration syndrome (2), septicemia (5), prematurity (3), birth trauma (2), congenital anomalies (2), hypoxic ischemic encephalopathy (1), and non-specific diagnosis (4). There were 6 major autopsy findings that, if known prior to death, would have altered clinical management and might have resulted in cure or prolonged survival. There were 8 additional major findings that, if known prior to death, would not have altered management There were 14 minor findings related to major diagnoses but unrelated to the primary cause of death.KEY WORDS: Autopsy, Cause of death, Perinatal mortality     

新生儿窒息相关因素分析

新生儿窒息是婴儿出生时无呼吸或呼吸抑制而导致的低氧血症和酸中毒,是新生儿死亡和伤残的主要原因之一。2001年1月～2003年1月,在本院分娩后1min Apgar评分≤3分、5min Apgar评分≤7分的重度窒息新生儿188例窒息相关因素进行分析,现报告如下。