危重新生儿高渗血症临床探讨

目的观察危重新生儿高渗血症的发生及其临床意义。方法对所有入院的危重新生儿即进行电解质、血糖、尿素氮、血气等测定,按公式计算出血渗透浓度。结果152例危重新生儿发生高渗血症48例,极危重组(新生儿危重症评分≤70分)的高渗血症患儿有19例,一般危重组(新生儿危重症评分70~90分)有29例,极危重组患儿血糖、血渗透浓度和病死率较一般危重组患儿明显升高,P<0.01,而其pH值比一般危重组低,P<0.05,两组比较有统计学意义。血渗透浓度>320 mmol/L组病死率为66.67%,较290~320 mmol/L组明显升高,P<0.01。结论危重新生儿高渗血症有其临床特点,高糖血症参与的高渗血症比例高,极危重组高渗血症及血渗透浓度>320 mmol/L的患儿预后差。     

危重新生儿高渗血症临床探讨

目的 观察危重新生儿高渗血症的发生及其临床意义。方法 对所有入院的危重新生儿即进行电解质、血糖、尿素氮、血气等测定，按公式计算出血渗透浓度。结果 152例危重新生儿发生高渗血症48例，极危重组（新生儿危重症评分≤70分）的高渗血症患儿有19例，一般危重组（新生儿危重症评分70～90分）有29例，极危重组患儿血糖、血渗透浓度和病死率较一般危重组患儿明显升高，P〈0．01．而其pH值比一般危重组低，P〈0．05，两组比较有统计学意义。血渗透浓度〉320mmol／L组病死率为66．67％．较290～320mmol／L组明显升高，P〈0．01。结论 危重新生儿高渗血症有其临床特点，高糖血症参与的高渗血症比例高，设危重组高渗血症及血渗透浓度〉320mmol／L的患儿预后差。     

新生儿颅内出血合并低钠血症25例临床分析

目的探讨新生儿颅内出血合并低钠血症的原因及干预方法。方法回顾性分析25例颅内出血合并低钠血症新生儿的临床资料。结果患儿均表现为血钠下降、尿钠升高、尿比重升高、血浆平均渗透浓度下降。其中20例伴低血容量，在综合治疗基础上予输液、补钠治疗；5例无低血容量表现，予限制液体入量治疗。治疗1～3天血钠恢复正常，治疗1～2周后，治愈7例，好转18例。结论新生儿颅内出血合并低钠血症为脑性耗盐综合征或抗利尿激素分泌异常综合征所致，治疗应针对病因。     

新生儿缺氧缺血性脑病血渗透压改变与合理输液的研究

目的　 观察新生儿缺氧缺血性脑病 (HIE)血渗透压改变 ,确立有无并发抗利尿激素异常分泌综合征 (SIADH) ,并根据其变化进行合理的液体疗法。 方法 　采静脉血做电解质、血糖、尿素氮等测定 ,以公式计算出血渗透压。根据血渗透压的高低确定输液量和张力。 结果 　 5 1例HIE中 ,病程极期有 2 3例发生SIADH(45 0 9%) ,恢复期中 7例血渗透压降低 (13 7%)。均采用适当限制入量 ,提高液体张力的液体疗法。 结论 　HIE极期常并发SIADH ,应合理调整输液成分和液量。     

新生儿缺氧缺血性脑病血渗透压改变与合理输液的研究

目的 观察新生儿缺氧缺血性脑病(HIE)血渗透压改变，确立有无并发抗利尿激素异常分泌综合征(SIADH)．并根据其变化进行合理的液体疗法。方法 采静脉血做电解质、血糖、尿素氮等测定，以公式计算出血渗透压。根据血渗透压的高低确定输液量和张力。结果 51例HIE中，病程极期有23例发生SIADH(45．09％)，恢复期中7例血渗透压降低(13．7％)。均采用适当限制入量，提高液体张力的液体疗法。结论 HIE极期常并发SIADH，应合理调整输液成分和液量。     

新生儿急性肾功能衰竭的液体疗法

新生儿急性肾功能衰竭（下简称肾衰）是指由于各种原因引起的缺氧、低血容量、休克、低体温等多种病理状态下,出现肾功能损害,临床上出现少尿或无尿,体液失衡及电解质紊乱、酸碱失调,血浆中经肾排泄代谢产物浓度升高的一种危重综合征。新生儿急性肾衰的液体疗法,对各...     

高间接胆红素血症新生儿换血前后血生化和渗透浓度及甲状腺素变化的检测及分析

目的 探讨高间接胆红素血症新生儿换血前后血生化、渗透浓度及甲状腺素的变化及其原因。方法 对43例高间接胆红素血症新生儿在换血过程中的血常规、电解质、血糖、渗透浓度、血浆蛋白及甲状腺功能等指标进行测定并分析。结果 ①换血后,血清总胆红素水平明显下降,分别下降了50％(常规法测定)(P<0.01)和47.3%(微量法测定)(P<0.01);②患儿的贫血有所纠正,但白细胞和血小板明显降低(P<0.01);③血Na~+水平明显增高(P<0.05),K~+、Ca~(2+)水平无显著变化;④血清总蛋白和白蛋白分别下降了7.8%(P<0.05)和13.48%(P<0.01),球蛋白无显著变化;⑤血清甲状腺素(T_4)降低(P<0.05),三碘甲状腺原氨酸(T_3)及甲状腺刺激素无显著变化;⑥渗透浓度明显增高(P<0.05),血糖有增高趋势。结论 换血后出现白细胞、血小板、血清蛋白、T_4降低以及血清钠、渗透浓度增高,提示换血后应预防感染、出血和低蛋白血症的发生,避免高渗液体输入,可适当补充甲状腺素。     

小儿恶性肿瘤合并抗利尿激素分泌失调综合征3例

抗利尿激素分泌失调综合征（ Syndrome of Inappropriate Antidiuretic Hormone Secretion, SIADH ）是指内源性抗利尿激素（ADH）分泌异常增多,血浆抗利尿激素浓度呈不适当高水平,导致水潴留、尿排钠增多以及稀释性低钠血症等临床表现的综合征。常见原因有恶性肿瘤、中枢神经系统感染、     

小儿肺炎血渗透压改变与合理输液的临床研究

目的：观察支气管肺炎血渗透压改变,确定有无并发抗利尿激素异常分泌综合征(SIADH),并根据其变化进行合理的液体疗法。方法：采静脉血作电解质、血糖、尿素氮等测定,以公式计算出血渗透压。根据血渗透压的高低确定输液量和张力。结果：200例患儿中重症肺炎32例,病程极期有14例发生抗利尿激素异常分泌综合征(43.8%),普通肺炎中8例血渗透压降低(4.8%)。均采用适当限制入量、提高液体张力而获治愈。结论：支气管肺炎极期常并发SIADH,应合理调整输液成分和液量。     

新生儿术后低钠血症与抗利尿激素异常分泌

对１６例新生儿手术前后血钠、血渗透压、尿渗透压及血浆抗利尿激素（ＡＤＨ）监测：①大手术组患儿术后血钠、血渗透压平均值下降，尿钠、尿渗透压平均值升高，７／１０例发生低钠血症。②４／１６例术后出现抗利尿激素异常分泌综合征，其中隔疝２例，膈膨升１例，肠闭锁１例。③大手术组术后血浆ＡＤＨ明显升高。并且结合文献对新生儿术后低钠血症及ＡＤＨ分泌异常进行讨论。     

Syndrome of inappropriate anti‐diuretic hormone in Kawasaki disease

Background: The pathogenesis of hyponatremia in acute Kawasaki disease (KD) remains unclear. A recent case report of KD complicated by syndrome of inappropriate anti‐diuretic hormone (SIADH) led us to determine the prevalence of SIADH in acute KD patients. Methods: Subjects were 39 Japanese KD patients (2–84 months of age, 25 males and 14 females) treated with intravenous immunoglobulin (IVIG), 2 g/kg/day and oral aspirin. SIADH was defined when hyponatremic patients (serum sodium concentration <135 mEq/L) had decreased serum osmolality <280 mOsm/kg H₂O, elevated urine sodium concentration >20 mEq/L and elevated urine osmolality >100 mOsm/kg H₂O without dysfunctions of renal, thyroid or adrenal gland. We also studied the relation between clinical course of SIADH and the amount of infused fluid during IVIG. Results: Before IVIG, 27 patients (69%) had hyponatremia and 11 (28% of total; 41% of hyponatremic patients) had SIADH while after IVIG, 13 (33%) hyponatremia and four (10%; 31% of hyponatremic patients) SIADH. Among 11 patients with SIADH before IVIG, SIADH improved in 10 after IVIG, but hyponatremia persisted in five. Significant correlation was observed between serum sodium concentration after IVIG and infusion amount in SIADH patients (r=?0.64, P= 0.03), but not in non‐SIADH patients. Conclusions: This is the first report to show that SIADH is common as a cause of hyponatremia in acute KD and hence careful management of water and sodium is warranted.     

Phototherapy-mediated syndrome of inappropriate secretion of antidiuretic hormone in an in utero selective serotonin reuptake inhibitor-exposed newborn infant

Although selective serotonin reuptake inhibitors (SSRIs) have gained wide acceptance in the off-label treatment of mental disorders in pregnant women, there seems to be an increased risk for serotonergic adverse effects in newborn infants who are exposed to SSRIs during late pregnancy. Hyponatremia as a result of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a relatively common serious side effect of the use of SSRIs in (mostly elderly) adults. Severe hyponatremia as a result of an SIADH is proposed here as part of a neonatal serotonin toxicity syndrome in a newborn infant who was exposed prenatally to an SSRI. The definite reversal to normal serum sodium levels after fluid restriction, the lack of any alternative cause for the SIADH, and the positive temporal relation with a high score on a widely used adverse drug reaction probability scale offer solid support for the hypothesis of a causal relationship between the SIADH and the prenatal sertraline exposure in our neonate. Moreover, accumulative data on the acute enhancement of serotonergic transmission by intense illumination led us to hypothesize that phototherapy used to treat hyperbilirubinemia in the newborn infant could have been the ultimate environmental trigger for this proposed new cause of iatrogenic neonatal SIADH. The speculative role of phototherapy as a physical trigger for this drug-related adverse event should be confirmed in other cases by thorough study of the serotonin metabolism, assay of SSRI levels in cord blood, and serial measurement of plasma levels in exposed neonates. As phototherapy is used frequently in jaundiced neonates and an apparently increasing number of infants are born to mothers who take SSRIs, serotonin toxicity in neonates deserves increased attention.     

Acute neonatal respiratory distress in Italy: a one-year prospective study

A prospective multicentre 12-month survey of neonatal respiratory disorders in 63 537 Italian infants was performed to evaluate the incidence of acute neonatal respiratory disorders and of the main related complications. A total of 1427 developed respiratory disorders (2.2%), 208 of whom died (14.6%). The incidence of respiratory distress syndrome was 1.16%, with a case fatality rate (CFR) of 24%; that of transient tachypnoea was 0.93%, with a CFR of 1.3%. The rates of meconium aspiration syndrome, persistent pulmonary hypertension and pneumonia were 0.06%, 0.02% and 0.07%, with CFRs of 10.3%, 38.5% and 21.7%, respectively. The occurrences of the main complications in affected newborns were: bronchopulmonary dysplasia 5.6%, necrotizing enterocolitis 1.7%, patent ductus arteriosus 9.8%, 3^o and 4^o grade intraventricular haemorrhage 6.8% and air leak 4.9%. It was concluded that the incidence of acute neonatal respiratory disorders and the main related complications was lower than that reported two decades ago and that the CFR of acute neonatal respiratory disorders had increased. These results may be the consequences of (i) progress in the management of high-risk pregnancies, (ii) an increased number of viable infants with extremely low birth weight and (iii) diffusion of antenatal treatment with corticosteroids which, in this series, seemed to reduce the morbidity but not the mortality in the high-risk infants.     

足月新生儿颅内出血手术治疗及随诊分析

目的探讨新生儿颅内出血(neonatal intracranial hemorrhage,NICH)的高危因素、临床表现、手术疗效及预后,以提高认识、早诊断、早治疗。方法2012年6月至2014年7月,暨南大学第一附属医院收治的NICH足月患儿中,4例接受手术治疗并定期随诊至学龄前期。采用回顾性分析的方法,记录这4例患儿围产期相关情况、临床表现、实验室检查、手术治疗情况及预后。结果4例患儿均存在围产期相关高危因素(脐带异常、胎心下降、头盆不称、阴道试产失败转剖宫产、羊水污染等);均不以神经系统异常为首发症状。颅脑超声检查均有阳性发现,头颅CT进一步确诊了颅内出血的类型和出血量,病例1双侧侧脑室及第三脑室增宽;病例2头皮下血肿及硬膜下出血,颅骨移位;病例3硬膜外血肿;病例4脑实质内出血脑疝。3例患儿急诊行开颅血肿清除术,1例患儿保守治疗3 d后行侧脑室转孔引流术。4例患儿出院后随访至学龄前,预后均良好。结论足月儿NICH与围产期因素有关,早期临床表现缺乏特异性,建议尽早行头颅超声筛查和CT确诊,及时手术治疗可以改善预后。     

Hyponatraemia in Premature Babies and Following Surgery in Older Children

ABSTRACT. Hyponatraemia implies water retention in excess of sodium with or without increased loss of sodium from the body; extracellular fluid volume may be increased, normal or reduced. It has many causes which are briefly reviewed. Among these is the rare syndrome of inappropriate secretion of antidiuretic hormone (SIADH). It is suggested that SIADH is often diagnosed incorrectly because the raised ADH levels are appropriate for the volume status of the child. Precision in the diagnosis is important because whilst water restriction is necessary for the treatment of SIADH, other measures including the administration of extra fluid are often required if the raised ADH is appropriate. Hyponatraemia in the newborn may be caused by prerenal failure, renal failure or renal sodium wasting which is common in premature infants. Careful control of sodium intake as well as water intake is vital in this age group. Surgery is associated with water retention, but recent studies suggest that ADH levels are raised post-operatively because of volume depletion and that present recommendations for fluid therapy during and following surgery are inadequate. The use of electrolyte-free dextrose solutions should be abandoned and more liberal use of physiological saline or colloid is recommended.     

Hyponatraemia in premature babies and following surgery in older children

Hyponatraemia implies water retention in excess of sodium with or without increased loss of sodium from the body; extracellular fluid volume may be increased, normal or reduced. It has many causes which are briefly reviewed. Among these is the rare syndrome of inappropriate secretion of antidiuretic hormone (SIADH). It is suggested that SIADH is often diagnosed incorrectly because the raised ADH levels are appropriate for the volume status of the child. Precision in the diagnosis is important because whilst water restriction is necessary for the treatment of SIADH, other measures including the administration of extra fluid are often required if the raised ADH is appropriate. Hyponatraemia in the newborn may be caused by prerenal failure, renal failure or renal sodium wasting which is common in premature infants. Careful control of sodium intake as well as water intake is vital in this age group. Surgery is associated with water retention, but recent studies suggest that ADH levels are raised post-operatively because of volume depletion and that present recommendations for fluid therapy during and following surgery are inadequate. The use of electrolyte-free dextrose solutions should be abandoned and more liberal use of physiological saline or colloid is recommended.     

Hyperosmolar solutions in continuous renal replacement therapy for hyperosmolar acute renal failure: a preliminary report.

OBJECTIVE: To demonstrate the efficacy of hyperosmolar dialysis and prefilter replacement fluid solutions for continuous renal replacement therapies in the correction of hyperosmolar disorders in acute renal failure. Data Source: An Institutional Review Board-approved pediatric acute renal failure database at the University of Michigan C. S. Mott Children's Hospital. STUDY SELECTION: Three patients were identified meeting the inclusion criteria. The mean serum sodium concentration and plasma osmolality were 158 mmol/L and 357 mOsm/kg, respectively, at the time of initiation of renal replacement therapy. The sodium and/or dextrose concentrations of the dialysate or replacement fluids initially were increased and subsequently decreased to affect the solutions' calculated osmolalities in an effort to control the rate of decline of the patients' measured plasma osmolalities. DATA EXTRACTION: The case patients' serum sodium concentrations and plasma osmolalities were measured. Additionally, the sodium and dextrose concentrations of the dialysate or replacement fluid were recorded and the solutions' osmolalities calculated. DATA SYNTHESIS: The three patients experienced a mean rate of reduction of their serum sodium concentration and plasma osmolality of 0.5 mmol/L/hr and 1.6 mOsm/kg/hr, respectively. CONCLUSIONS: Hyperosmolar dialysis or prefilter replacement fluid solutions can affect a slow decline in both the serum sodium and plasma osmolality in cases of hyperosmolar acute renal failure.     

Regionalization of neonatal intensive care in Korea

In the current era of low-birth rate in Korea, it is important to improve our neonatal intensive care and to establish an integrative system including a regional care network adequate for both high-risk pregnancies and high-risk newborn infants. Therefore, official discussion for nation-wide augmentation, proper leveling, networking, and regionalization of neonatal and perinatal care is urgently needed. In this report, I describe the status of neonatal intensive care in Korea, as well as nationwide flow of transfer of high-risk newborn infants and pregnant women, and present a short review of the regionalization of neonatal and perinatal care in the Unites States and Japan. It is necessary not only to increase the number of neonatal intensive care unit (NICU) beds, medical resources and manpower, but also to create a strong network system with appropriate leveling of NICUs and regionalization. A systematic approach toward perinatal care, that includes both high-risk pregnancies and newborns with continuous support from the government, is also needed, which can be spearheaded through the establishment of an integrative advisory board to propel systematic care forward.     

Liver fluid collection in neonates and its association with the use of a specific umbilical vein catheter: Report of five cases

In newborns, the presence of liver fluid collection is a rare event. The reported cases are isolated or described over long periods. Within four months, five neonates were diagnosed with liver fluid collection from safety occurrence reports. Clinical, laboratory and radiological data were extracted from medical records. The definite diagnosis was made by ultrasound. Four of the patients were preterm, male and had very low birth weights. The osmolality of the infused solution was within the acceptable range. Investigations revealed that the use of a new brand of umbilical vein catheter introduced in the neonatal intensive care unit, one month before the first case, was associated with this cluster. Low positioning of the umbilical vein catheter tip appeared to be a second contributory factor. Neonatal practitioners may benefit from the present report when facing the occurrence of similar lesions.     

Frequency and significance of electrolyte abnormalities in pneumonia.

To determine the frequency of electrolyte disturbance in pneumonia, we studied 264 hospitalized children with pneumonia for serum sodium and potassium concentration, and plasma osmolality (Posm) on the day of admission. Urine osmalality (Uosm) and urine spot sodium concentration were measured in those who had a serum sodium less than or equal to 130 mEq/L. Hyponatremia was found in 27%, hypernatremia in 3.7%. Hypokalemia (serum potassium less than or equal to 3.5 mEq/L) in 19 and 2% had hyperkalemia (serum potassium greater than or equal to 6.5 mEq/L). Of all the hyponatremia, 68% were secondary to syndrome of inappropriate ADH secretion (SIADH) as suggested by a concomitant lowering of Posm less than or equal to 280 mosm/kg and increased urinary osmolality and sodium excretion. Hyponatremia was associated with 60% longer hospital stay, two fold increase in complications and the 3.5 times higher mortality compared to that of normonatremia. The above variables were affected further, if hypokalemia coexisted with hyponatremia.