术前地塞米松对预防足月儿呼吸窘迫的临床意义

目的 分析术前地塞米松肌肉注射对择期剖宫产足月新生儿呼吸窘迫综合征的临床意义.方法 回顾性分析解放军第一八一医院产科电子病例系统记录的孕37~38+6周剖宫产病历资料400例;随机挑选术前使用地塞米松6mg肌肉内注射,每12小时1次,共4次的患者200例为研究组,使用0.9%生理盐水10mL注射的200例为对照组.采用单因素方差分析母亲一般情况,采用趋势检验方法 比较两组患者剖宫产出生的新生儿呼吸窘迫综合征的发生等情况.结果 研究组与对照组新生儿Apgar 1分钟评分比较差异有统计学意义(χ2=2.84,P<0.05),而5分钟评分差异无统计学意义(P>0.05).两组的呼吸窘迫综合征发生率和转入重症病房新生儿发生率比较差异均有统计学意义(χ2值分别为13.83、3.55,均P<0.05).结论 对孕37~38+6周择期剖宫产患者施行地塞米松注射可有效降低新生儿呼吸窘迫综合征的发生率.     

Antenatal risk factors and neonatal outcome in meconium aspiration syndrome

Meconium staining of amniotic fluid, present in 10-22% of all live births, has been associated with the subsequent development of meconium aspiration syndrome (MAS). To learn more about the risk factors and outcomes associated with MAS, a retrospective comparison was made of the 187 newborns diagnosed with MAS at the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, India, in 1989-90 and 400 control infants born on the same day with meconium-stained liquor but no MAS. During the 2-year study period, there were 7040 deliveries, of which 790 (11.2%) had meconium-stained liquor. The MAS group contained significantly more post-term babies, primipara and grand multipara, unbooked mothers, mothers with toxemia of pregnancy or prolonged rupture of the membranes, infants with moderate or severe birth asphyxia, and operative deliveries. 80.1% of the 37 neonatal deaths involving MAS infants had a 1-minute Apgar score of less than 3, indicating periods of antepartum and intrapartum asphyxia. Early detection of fetal hypoxia through adequate monitoring and timely delivery could substantially reduce neonatal morbidity and mortality from meconium aspiration.     

择期剖宫产产前使用激素对足月儿呼吸窘迫综合征的影响

目的 探讨择期剖宫产产前使用激素对足月儿呼吸窘迫综合征(respiratory distress syndrome,RDS)发生率及并发症等的影响。 方法 以2010年1月-2011年1月在湖州妇幼保健院择期剖宫产(孕周在37~40周之间)所生足月儿2 606例为对象,根据是否使用激素分为两组,一组其母于分娩24 h前正规使用地塞米松1个疗程,该组为观察组;另一组未使用激素的足月儿为对照组;并把两组根据不同胎龄分别分为3小组,分别为37~37⁺⁶;38~38⁺⁶;39~40周组,比较不同胎龄择期剖宫产RDS发生率的高低,合并并发症情况比较。结果 观察组RDS发生率显著低于对照组,不同孕周发生率亦不同,而且观察组患儿病情较对照组轻。 结论37~38周择期剖宫产产前使用激素值得推广。     

早期足月新生儿的妊娠期因素与并发症分析

目的 分析早期足月分娩的妊娠期因素及新生儿并发症情况.方法 分析130例新生儿及其母亲的临床资料;根据胎龄划分为早期足月儿(61例)、完全足月儿(69例),比较两组孕产妇的基本情况、妊娠期并发症及合并症情况,分析早期足月分娩的危险因素.在早期足月组中进一步分出两个亚组,胎龄37周~37周+6亚组(30例)与胎龄38周~38周+6亚组(31例),比较两组新生儿并发症的发生率.结果 早期足月组孕产妇的高龄状况(≥35岁)、妊娠次数>1次、瘢痕子宫、剖宫产、分娩次数>1次、胎膜早破、羊水异常、胎位异常、妊娠期高血压、多胎妊娠、胎盘异常、子宫肌瘤的比例及新生儿的各种并发症发生率均显著高于完全足月组(P<0.05);早期足月组中37周~37周+6的新生儿重症病房入住率、感染性疾病、脑损伤、高胆红素血症、喂养问题、呼吸窘迫综合征、颅内出血、湿肺比例均显著高于38周~38周+6组(P<0.05).结论 孕产妇高龄、多胎妊娠、妊娠期高血压及瘢痕子宫等可能引起早期足月分娩;相比于完全足月新生儿,早期足月儿有更大几率发生并发症.     

Early onset neonatal infections in the South of the Reunion Island: Incidence and use of 2002 ANAES risk criteria

OBJECTIVES: The aim of this study was to describe the incidence of early onset neonatal infections (EONI) in the southern part of the Reunion Island, and to study the application of ANAES criteria. PATIENTS AND METHODS: A cross-sectional study was made of data collected for all live births having occurred between 1st January 2001 and 31st December 2004. RESULTS: Four hundred and thirty-seven in 16,071 neonates (out of 21,231 live births) presented with a certain or probable EONI, accounting for a regional rate of 20 per thousand (CI95 % 18-23 per thousand). Among 437 EONIs, group B streptococcus (GBS) was reported in 70.5% of the cases (n=308), Gram negative bacteria in 19.9% (n=87), of which nearly two thirds of Escherichia coli (n=56). Applying ANAES criteria led to identify 380 EONIs among 437 proven infections (sensitivity: 87%, specificity: 26%). A logistic regression analysis identified eight EONI predictors for the 7015 neonates for whom the mother GBS screening was documented: GBS positive vaginal culture (OR 4.2; CI95% 3.3-5.4), unexplained preterm birth less than 35 weeks (OR 5.7; CI95% 3.7-8.7), prolonged rupture of membranes greater than or equal to 18 hours (OR 2.1; CI95% 1.4-3.0), maternal fever greater than or equal to 37.8 degrees C (OR 3.2; CI95% 2.3-4.5), fetal tachycardia greater than or equal to 160 ppm (OR 2.7; CI95% 1.8-4.0), and thin (OR 1.6; CI95% 1.2-2.1) or thick meconium-stained amniotic fluid (OR 3.0; CI95% 2.1-4.5) or fetid fluid (OR 14.8; CI95% 4.2-51.8). CONCLUSION: The incidence of EONIS far exceeded that observed in metropolitan France, and the ANAES criteria lack sensitivity and specificity.     

维生素D与早产儿呼吸窘迫综合征的临床分析

目的 分析早产儿血清维生素D[25-(OH)D₃]水平与早产儿呼吸窘迫综合征(RDS)发生的相关性,为早产儿RDS的治疗提供科学依据。方法 选取2018年9月-2019年3月在武汉大学人民医院新生儿科住院的131例RDS早产儿为实验组,29例非RDS早产儿为对照组。收集所有患儿一般临床资料(性别、分娩方式、母孕情况及Apgar 评分等)及血清25-(OH)D₃结果,分析25-(OH)D₃ 水平与RDS发生之间的关系。结果 RDS组25-(OH)D₃水平低于对照组,差异均有统计学意义(t=2.682,P＜0.05),且CPAP时间、吸氧时间、静脉营养天数、住院天数均明显高于对照组,差异均有统计学意义(t=2.969、2.380、2.571、1.999,P＜0.05)。Logistic 回归分析显示:维生素 D 缺乏是早产儿发生RDS 的危险因素(OR=0.050,95%CI:0.013~0.186,P＜0.05)。结论 早产儿更易发生维生素D缺乏,且维生素D缺乏可能是早产儿RDS发生的危险因素,预防维生素D缺乏有重大意义。     

Meconium aspiration syndrome: current concepts

Aspiration of meconium causes considerable perinatal morbidity and mortality. Meconium-stained amniotic fluid (MSAF) is present in 7-22% of all deliveries. Gastrointestinal secretions, bile, bile acids, mucus, pancreatic juice, cellular debris, amniotic fluid, swallowed vernix caseosa, lanuge, and blood comprise meconium. Passage of meconium occurs most often in deliveries after 42 weeks gestation (30%) because of high levels of the hormone motilin. This hormone is responsible for bowel peristalsis, defecation, and maturation of the innervation of the intestinal tract associated with vagal stimulation. It tends to be a marker of pre/intrapartum asphyxia. MSAF is also a sign of fetal hypoxia or acidosis. It appears that meconium aspiration is predominantly an intrauterine event. The definition of meconium aspiration syndrome (MAS) is respiratory distress in a meconium-stained newborn, compatible radiographic findings (e.g., coarse, irregular pattern of increased density throughout the lung), and symptoms that can not otherwise be explained. MAS occurs in 1-4% of infants with MSAF and up to 10% of those with thick meconium. Mortality ranges from 6% to 40%. Initially, meconium particles mechanically obstruct the small airways. Later, chemical pneumonitis and interstitial edema are responsible for small airway obstruction. As many as 66% of persistent pulmonary hypertension of the newborn cases are associated with MAS. Clinical signs and symptoms of MAS include frothy, yellow-green secretions from the mouth; very rapid breathing; intercostal retractions; cyanosis; overinflated chest due to air trapping; rales; and rattling in the throat. Transcervical amnio-infusion of warmed normal saline may be an obstetric intervention in cases of MSAF. Intrapartum oropharyngeal suctioning and postpartum intratracheal suctioning has reduced the incidence of MAS. Routine care of MAS infants includes monitoring and correcting of the thermal environment and blood glucose and calcium levels. Chest physiotherapy, saline lavage, management of hypoxemia, surfactant therapy, and systemic steroid treatment are MAS therapies.     

糖尿病孕妇择期分娩前行羊水泡沫试验的临床价值探讨

目的:探讨妊娠期糖尿病(GDM)孕妇择期终止妊娠前不做羊水泡沫试验测定胎肺成熟度是否会增加新生儿呼吸窘迫综合征(NRDS)的发生率。方法:对52例GDM孕妇于妊娠36~40周在终止妊娠前行羊膜腔穿刺术抽取羊水行羊水泡沫试验,确定胎肺成熟后终止妊娠。64例孕龄准确的孕足月(孕龄>37周)的GDM孕妇作为非穿刺组,在终止妊娠前不予测定胎肺成熟度,比较两组的妊娠结局和NRDS的发生率。结果:两组孕妇的孕周、体重指数(BM I)、剖宫产率及产后出血、羊水过多的发生率无明显差异;两组巨大胎儿、足月低体重儿、新生儿低血糖、新生儿窒息和NRDS的发生率差异无统计学意义。结论:孕龄准确的GDM孕妇妊娠足月后在择期终止妊娠前不需常规行羊膜腔穿刺术做胎肺成熟度的测定。     

持续气道正压通气治疗新生儿暂时性呼吸增快的效果分析

目的 分析鼻塞持续气道正压通气(CPAP)对中晚期早产儿新生儿暂时性呼吸增快(TTN)的治疗效果,为TTN的治疗提供依据。方法 选取2018年3月—2019年2 月在海南医学院第一附属医院新生儿重症监护室(NICU)诊断TTN的中晚期早产儿(32周≤胎龄＜37周)41例,随机分为观察组20例和对照组21例。所有患儿入院后急查肺部超声和胸片,均给予常规治疗,观察组给予鼻塞CPAP通气(FiO₂ 21%,PEEP 4~6 cmH₂O),对照组给予常压空气呼吸,分别记录入院时及治疗后30 min呼吸频率、经皮血氧饱和度、TTN临床评分、住院时间、是否启动应急预案及并发症发生情况。结果 观察组与对照组治疗总有效率、启动应急预案概率、治疗30 min后的TTN临床评分比较,差异有统计学意义(χ²=5.236、8.912,t=-3.042,P<0.05)。观察组与对照组入院时与治疗30 min后呼吸频率、TTN临床评分、经皮血氧饱和度比较,差异有统计学意义(t=5.145、3.608、7.664、5.535、-4.260、-4.891,P<0.05)。两组间并发症发生率比较,差异有统计学意义(P<0.05)。超声诊断TTN的准确率为97.56%。结论 尽早应用CPAP(FiO₂ 21%,PEEP 4~6 cmH₂O)治疗能明显改善TTN患儿的呼吸困难症状,降低用氧概率。超声诊断TTN准确率较高,且安全、无辐射、操作简便,值得在NICU中推广应用。     

深圳16887例不同胎龄单胎新生儿克托莱指数研究

目的 制定不同胎龄单胎新生儿克托莱指数,为评价深圳新生儿出生时身体的匀称性提供参考数据。 方法 采用横断面调查,2013年4月-2015年9月在深圳两家医院整群抽样,完成16 887例(男9 418例,女7 469例)不同胎龄单胎新生儿体重、身长、顶臀长、头围、胸围现场测量,用以制定不同胎龄单胎新生儿克托莱指数。 结果 制定了2015年深圳胎龄27~42周单胎新生儿(男、女、性别混合)三分组的克托莱指数(Quetelet Index, QI)均数及其3^rd~97^th百分位曲线。男、女新生儿的QI数值在胎龄27周最低,随着胎龄增加QI数值不断增大,胎龄42周QI数值最大。胎龄27~42周每个孕周男性QI 的50^th曲线数值都高于女性,增加值范围1.17~1.83,胎龄35~41周增加值差异有统计学意义(t=2.73~8.85,P<0.01~<0.001)。 结论 深圳不同胎龄单胎新生儿QI值随胎龄增加指数值不断增大,提示胎龄增大人体密度和充实度不断提高。QI存在男高女低性别差异。     

胎粪吸引管联用沐舒坦防治胎粪吸入综合征的探讨

目的探讨胎粪吸引管联用沐舒坦防治胎粪吸入综合征(MAS)的疗效。方法回顾性研究我院136例MAS患儿,分为A组76例和B组60例,A组指生后清理口腔和鼻腔黏液后,给予胎粪吸引管行气管内吸引,治疗中给予沐舒坦雾化吸入,保持呼吸道通畅;B组则常规给予清理口腔和鼻腔黏液(必要时气管内冲洗)等治疗措施。结果A组76例全部治愈,并发症明显减少,无1例死亡,治愈率100%;B组治愈52例,家属放弃4例,死亡4例,治愈率86.7%。A组明显优于B组(p<0.05);机械通气、氧疗时间、并发症发生率和住院时间A组明显优于B组(均p<0.05)。结论及时清吸气管内胎粪污染的羊水可以明显提高MAS患儿的治愈率,胎粪吸引管联用沐舒坦雾化吸入是抢救MAS的有效方法之一。     

3447例早期足月产临床分析

目的分析早期足月产的原因、相关因素、不同分娩孕周及妊娠结局。方法将2009年~2013年在无锡市人民医院住院分娩的3 447例早期足月产病例按分娩孕周分为37周和38周两组,对发生原因、不同分娩孕周及新生儿结局进行回顾性分析。结果 (1)早期足月产发生率为28.31%(3 447/12 176)。(2)择期剖宫产原因排在前五位的是社会因素、瘢痕子宫、胎儿窘迫、羊水过少、胎儿臀位。(3)37周组新生儿呼吸系统发病率(4.52%)高于38周新生儿(2.39%),差异有统计学意义(P0.05),其新生儿窒息率两组比较差异无统计学意义(P0.05)。(4)37周择期剖宫产的新生儿呼吸系统发病率(6.32%)高于同期阴道分娩儿(2.37%),差异有统计学意义(P0.05),其新生儿窒息率比较差异无统计学意义(P0.05);38周择期剖宫产新生儿呼吸系统发病率(2.42%)高于同期阴道分娩儿(1.52%),差异有统计学意义(P0.05),其新生儿窒息率比较,差异无统计学意义(P0.05)。结论 37周新生儿呼吸系统发病率高于38周分娩新生儿,择期剖宫产新生儿呼吸系统发病率高于阴道分娩儿,临床工作中应把握择期剖宫产时机,预防不必要的早期足月产。     

Maternal Tdap vaccination and risk of infant morbidity

IntroductionAn increased risk of diagnosed chorioamnionitis in women vaccinated with Tdap during pregnancy was previously detected at two Vaccine Safety Datalink (VSD) sites. The clinical significance of this finding related to infant outcomes remains uncertain.MethodsRetrospective cohort study of singleton live births born to women who were continuously insured from 6 months prior to their last menstrual period through 6 weeks postpartum, with ≥1 outpatient visit during pregnancy from January 1, 2010 to November 15, 2013 at seven integrated United States health care systems part of the VSD. We re-evaluated the association between maternal Tdap and chorioamnionitis and evaluated whether specific infant morbidities differ among infants born to mothers who did and did not receive Tdap during pregnancy. We focused on 2 Tdap exposure windows: the recommended 27–36 weeks gestation or anytime during pregnancy. We identified inpatient diagnostic codes for transient tachypnea of the newborn (TTN), neonatal sepsis, neonatal pneumonia, respiratory distress syndrome (RDS), and newborn convulsions associated with an infant's first hospitalization. A generalized linear model with Poisson distribution and log-link was used to estimate propensity score adjusted rate ratios (ARR) with 95% confidence intervals (CI).ResultsThe analyses included 197,564 pregnancies. Chorioamnionitis was recorded in 6.4% of women who received Tdap vaccination any time during pregnancy and 5.2% of women who did not (ARR [95% CI]: 1.23 [1.17, 1.28]). Compared with unvaccinated women, there were no significant increased risks (ARR [95% CI]) for TTN (1.04 [0.98, 1.11]), neonatal sepsis (1.06 [0.91, 1.23]), neonatal pneumonia (0.94 [0.72, 1.22]), RDS (0.91 [0.66, 1.26]), or newborn convulsions (1.16 [0.87, 1.53]) in infants born to Tdap-vaccinated women.Conclusions and RelevanceDespite an observed association between maternal Tdap vaccination and maternal chorioamnionitis, we did not find increased risk for clinically significant infant outcomes associated with maternal chorioamnionitis.     

Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza Strip

Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths. Yet, despite good access to maternal and newborn care in many transitional countries, perinatal mortality is often not monitored in these settings. The present study identified risk factors for perinatal death and the level and causes of stillbirths and neonatal deaths in the West Bank and Gaza Strip. Baseline and follow-up censuses with prospective monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 randomly selected clusters of 300 households each. A total of 113 of 116 married women 15-49 years old with a stillbirth or neonatal death and 813 randomly selected women with a surviving neonate were interviewed, and obstetric and newborn care records of women with a stillbirth or neonatal death were abstracted. The perinatal and neonatal mortality rates, respectively, were 21.2 [95% confidence interval (CI) 16.5, 25.9] and 14.7 [95% CI 10.2, 19.2] per 1000 livebirths. The most common cause (27%) of 96 perinatal deaths was asphyxia alone (21) or with neonatal sepsis (5), while 18/49 (37%) early and 9/19 (47%) late neonatal deaths were from respiratory distress syndrome (12) or sepsis (9) alone or together (6). Constraint in care seeking, mainly by an Israeli checkpoint, occurred in 8% and 10%, respectively, of 112 pregnancies and labours and 31% of 16 neonates prior to perinatal or late neonatal death. Poor quality care for a complication associated with the death was identified among 40% and 20%, respectively, of 112 pregnancies and labour/deliveries and 43% of 68 neonates. (Correction added after online publication 5 June 2008: The denominators 112 pregnancies, labours, and labour/deliveries, and 16 and 68 neonates were included; and 9% of labours was corrected to 10%.) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery (odds ratio [OR] = 11.9, [95% CI 6.7, 21.2]), antepartum haemorrhage (OR = 5.6, [95% CI 1.5, 20.9]), any severe pregnancy complication (OR = 3.4, [95% CI 1.8, 6.6]), term delivery in a government hospital and having a labour and delivery complication (OR = 3.8, [95% CI 1.2, 12.0]), more than one delivery complication (OR = 4.4, [95% CI 1.8, 10.5]), mother's age >35 years (OR = 2.9, [95% CI 1.3, 6.8]) and primiparity in a full-term pregnancy (OR = 2.6, [1.1, 6.3]). Stillbirths are not officially reportable in the West Bank and Gaza Strip and this is the first time that perinatal mortality has been examined. Interventions to lower stillbirths and neonatal deaths should focus on improving the quality of medical care for important obstetric complications and newborn illnesses. Other transitional countries can draw lessons for their health care systems from these findings.     

高频振荡通气治疗重症新生儿呼吸窘迫综合征疗效分析

目的探讨高频振荡通气治疗重症新生儿呼吸窘迫综合征的疗效。方法将31例选择传统常频机械通气治疗者定为常频组;38例选择高频震荡通气治疗者定为高频组,比较两组的疗效。结果两组治疗48h以上与同组0h各项（氧浓度、平均气道压、动脉血氧分压、动脉二氧化碳分压、经皮血氧饱和度及氧和指数）对比均有显著性差异．常频组χ2值依次为8．68、4．30、9．18、5．62、7．09、2．61;高频组χ2值依次为12．74、10．56、14．43、7．55、5．89、3．07,均P〈0．05;高频组治疗25～48h与0h各项对比均有显著性差异,χ2值依次为5．31、6．94、9．92、4．96、4．45、2．04,均P〈0．05。两组其它时间段各项指标与0h对比差异均无统计学意义（均P〉0．05）。常频组总有效率为87．10％,高频组总有效率为94．74％;无效病例均为出现严重并发症,经抢救无效死亡的患儿;两组总治愈率与死亡率比较均无显著性差异（均P〉0．05）。结论高频振荡通气治疗重症新生儿呼吸窘迫综合征疗效明显优于常频通气,值得,临床推广应用。     

母血、羊水、脐血中白细胞介素-6，-8和血管细胞黏附分子-1联合检测评估胎膜早破及新生儿预后的临床价值

目的探讨母血、羊水、脐血中三种细胞因子白细胞介素-6,-8（interleukin-6,-8,IL-6,-8）和血管细胞黏附分子-1（vascular cell adhesion molecule,VCAM-1）对胎膜早破（premature rupture of membrance,PROM）、绒毛膜羊膜炎和新生儿预后判断的临床意义。方法采用双抗体夹心酶联免疫吸附法,检测58例胎膜早破（PROM组,n=58）及38例正常孕妇（对照组,n=38）母血、羊水、脐血中白细胞介素-6,-8和血管细胞黏附分子-1水平的动态变化,并进行胎膜病理学检查。同时,PROM组按破膜时间分为三组。AI组（n=29）破膜时间为16h,A2组（n=19）破膜时间为（16～24）h,A3组（n=10）破膜时间为〉24h。另外,PROM组与对照组孕妇按病理学检查结果,分为绒毛膜羊膜炎组（n=15）,非绒毛膜羊膜炎组（n=81）。按照PROM组孕妇所产新生儿的Apgar评分,将PROM组分为B1组（n=7,Apgar评分≤7分）和B2组（n=51,Apgar评分≥8分）（分组遵循程序符合扬州大学临床医学院负责人体试验委员会所制定的伦理学标准,并得到该委员会批准,分组征得受试对象的知情同意）。所有个体均无母体疾病、其他产科并发症及胎儿、胎位异常。结果PROM组母血、羊水、脐血中白细胞介素-6,-8和血管细胞黏附分子-1的含量均高于对照组,且含量随破膜时间的延长而升高,尤其破膜时间超过24h（A3组）时,升高更为明显。绒毛膜羊膜炎组患者母血、羊水、脐血中自细胞介素-6,-8和血管细胞黏附分子-1水平明显高于非绒毛膜羊膜炎组患者,两组比较,差异有显著意义（P〈0．05,P〈0．01）。PROM组产妇所生新生儿的Apgar评分≤7分组,其母血、羊水、脐血中自细胞介素-6,-8和血管细胞黏附分子-1含量显著高于Apgar≥8分组（P〈0．05,P〈0．01）。结论白细胞介素-6,-8和血管细胞黏附分子-1三种细胞因子联合检测,可用于对胎膜早破、绒毛膜羊膜炎进行早期诊断,对新生儿预后判断也具有一定的临床价值。     

静脉导管血流变化与慢性胎儿窘迫的关系

目的:探讨静脉导管血流变化与慢性胎儿窘迫的关系。方法:将100例孕周为37～41周的孕妇分为两组:正常妊娠组及怀疑有慢性胎儿窘迫组,每组各50例。测定所有孕妇胎儿静脉导管血流参数(心室收缩期峰值,心室舒张期峰值,心房收缩期峰值,静脉导管的搏动指数、阻力指数),观察所有出生后新生儿1min Apgar评分、脐静脉血pH值、脐动脉血氧饱和度,研究静脉导管血流指数与它们的关系。结果:①慢性胎儿窘迫组静脉导管血流心室收缩期峰值,心室舒张期峰值,心房收缩期峰值均低于正常妊娠组,而静脉导管的搏动指数、阻力指数均高于正常妊娠组,差异具有统计学意义(P<0.05)。②慢性胎儿窘迫组新生儿体重、Apgar评分、脐静脉血pH值及脐动脉血氧饱和度均低于正常妊娠组,差异具有统计学意义(P<0.05)。③静脉导管血流指数与新生儿出生体重,Apgar评分,脐静脉血pH值及脐动脉血氧饱和度之间呈负相关性。结论:慢性胎儿窘迫时胎儿静脉导管血流参数发生变化。监测胎儿静脉导管血流变化可预防不良妊娠结局发生。     

Determinants of caesarean section in Lebanon: geographical differences

This study, based on the Lebanese National Perinatal Survey which included 5231 women, examined the relations between the caesarean section (CS) rate and the characteristics of mothers, children, antenatal care and maternity units in two geographical zones of Lebanon (Beirut-Mount Lebanon and the rest of the country) and then looked at geographical variations. This analysis concerned 3846 women with singleton pregnancies and livebirths at low risk of CS, after exclusion of women with a previous CS, non-cephalic fetal presentations, or delivery before 37 weeks' gestation. The principal end point was caesarean delivery. The relations between the factors studied and CS were estimated by odds ratios (OR), both crude and adjusted, using logistic regression. The rate of CS was higher in the Beirut-Mount Lebanon zone than elsewhere (13.4% vs. 7.6%). After adjustment, several factors remained associated with caesarean delivery in each zone. Common factors were primiparity, gestational age > or = 41 weeks and antenatal hospitalisation. Factors identified only in the Beirut-Mount Lebanon zone were obstetric history and insurance coverage, whereas for the other zones we only found major risk factors for obstetric disease: maternal age > or = 35 years, number of antenatal consultations > or = 4 and birthweight < or = 2500 g. The multivariable analysis of the overall population, adjusting for zone of delivery and other variables, shows that zone was one of the principal factors associated with the risk of caesarean delivery in Lebanon (OR = 1.80 [95% CI 1.09, 2.95]). In conclusion, the CS rates in Lebanon were high, with geographical differences that were associated with access to care and with obstetric practices.     

An outbreak of Serratia marcescens septicaemia in neonatal intensive care unit in Gaza City, Palestine

We performed a case-control study of Serratia marcescens incidence in the neonatal intensive care unit of a governmental Gaza Strip hospital from January to December 2005. S. marcescens was detected in the blood of 159 confirmed nosocomial cases of septicaemia, 70 (44%) neonates died due to S. marcescens infection and 89 recovered. The main clinical symptoms were hypothermia 38%; jaundice 42%; Apgar score 4 at 1min in 29% of neonates; and Apgar score 5 at 5min in 5%. Risk factors significantly associated with S. marcescens infection were birthweight <1500g (OR: 1.7; P=0.026); <37 weeks gestational age (OR: 2.0; P=0.002); and use of mechanical ventilation (OR: 2.3; P=0.001). Agar diffusion susceptibility testing indicated that S. marcescens was generally susceptible to imipenem, followed by ciprofloxacin and ofloxacin. We identified potential risk factors associated with development of neonatal sepsis and highlight the importance of appropriate infection control measures to prevent serious infection.     

A one-year prospective study of nosocomial bacteraemia in ICU and non-ICU patients and its impact on patient outcome

A one-year, prospective, two-observational cohort study was performed to evaluate the incidence and outcome in hospitalized patients (ICU and non-ICU) of nosocomial bacteraemia, and to assess its prognostic value in the ICU group. A group of 18 098 hospitalized patients and a group of 291 consecutive ICU patients were followed. Prognostic factors were determined using single and multivariable analyses. 109 (90 non-ICU and 19 ICU) patients developed 118 nosocomial bacteraemic episodes. The incidence of nosocomial bacteraemia was 6.0 per 1000 admissions (95% confidence interval (CI): 5-7%) and 65 per 1000 admissions in ICU patients (95% CI: 4.5-8.5%). Gram-positive and Gram-negative bacteria were 63/133 (47%) and 70/133 (53%) of the isolated micro-organisms respectively. Crude mortality rates were 41/109 (38%) with adverse outcome associated with mechanical ventilation (OR: 3.6; 95% CI: 1.4-9.2, P =0.01), neutropenia (OR: 7.7; 95% CI: 0.8-73.1;P =0.07) while gastro-intestinal surgery was associated with an improved outcome (OR: 0.4; 95% CI: 0.16-0.96;P =0.04). Of the 291 ICU patients, 19 acquired 22 episodes of nosocomial bacteraemia, and 18 were referred from the wards with documented nosocomial bacteraemia. Of these 37 bacteraemic patients, 17 (46%) died. When adjusting for predictors of death (SAPS II>/=40, cardiac and neurological failure), nosocomial bacteraemia markedly influence the outcome in ICU patients (OR: 3.4; 95% CI: 1.3-8.7;P =0.010). This study suggests that the outcome of nosocomial bacteraemia in hospitalized patients is poor in ventilated and neutropenic patients and that nosocomial bacteraemia per se influenced outcome in ICU patients.