新生儿尸解40例分析

目的　 通过对死亡新生儿的尸体解剖 ,探讨新生儿的主要死因。 方法 　分析 40例死亡新生儿的尸体解剖资料。结果 　 7d以内新生儿的死亡率最高为 5 7 6 %。肺炎是导致新生儿死亡的最主要疾病。 结论 　控制感染 ,提高肺炎诊疗水平及治疗效果是降低新生儿死亡的主要因素 ;降低早产、低体重儿的发生率 ,积极改善窒息情况 ,减少异常分娩是降低新生儿死亡的主要环节 ;加强产前检查 ,避免孕妇对有害物品的接触 ,降低畸形发生 ,也可减少新生儿的死亡率     

新生儿尸解40例分析

目的 通过对死亡新生儿的尸体解剖，探讨新生儿的主要死因。方法 3分析40例死亡新生儿的尸体解剖资料。结果 7d以内新生儿的死亡率最高为57.6%。肺炎是导致新生儿死亡的最主要疾病。结论 控制感染，提高肺炎诊疗水平及治疗效果是降低新生儿死亡的主要因素；降低早产、低体重儿的发生率，积极改善窒息情况，减少异常分娩是降低新生儿死亡的主要环节；加强产前检查，避免孕妇对有害物品的接触，降低畸形发生，也可减少新生儿的死亡率。     

新生儿尸检779例分析

目的　分析新生儿尸检资料 ,总结新生儿的常见死亡原因及死因与日龄、胎龄的关系。方法　分析整理779例新生儿尸检的尸体解剖记录、尸检结果和相关病历资料。结果　新生儿的常见死亡原因依次为窒息性因素、感染、出血性疾病、畸形及产科因素 ,不同日龄与胎龄的新生儿死因排序略有差异。而随着医疗技术水平的提高 ,感染性疾病和畸形在死因中的比例有下降趋势。将临床和病理诊断结果比较 ,误诊率为 15 % ,以窒息性因素最多见。结论　加强产后护理、预防感染、积极防治早产、强化产前检查及孕期保护是降低新生儿死亡率的有效手段。     

早产危险因素的前瞻性队列研究

目的 了解早产的发生情况,并探讨早产发生的危险因素。 方法 以2014年5月至2016年12月在湖南省妇幼保健院首次参加产前检查并决定住院分娩的孕早期孕妇及其配偶为研究对象开展前瞻性队列研究。采用调查问卷收集可能与早产发生相关的暴露信息,并通过医院病历系统完成信息核查,记录妊娠结局。采用多因素logistic回归分析探讨早产发生的危险因素。 结果 共收集6 764例孕妇完整资料,其早产发生率为17.09%。多因素logistic回归分析显示,孕妇有不良妊娠史、孕前进食槟榔、有妊娠并发症史、有肝炎史、孕期未补充叶酸、孕期服药、孕期主动/被动吸烟、孕期饮酒、孕期不均衡饮食、孕期强体力活动、受孕方式为不孕经治疗自然受孕和辅助受孕,以及配偶年龄较大、体重指数较高、吸烟均为早产发生的危险因素（P<0.05）;而孕妇教育水平高、配偶教育水平高、孕次少是早产发生的保护因素（P<0.05）。 结论 早产的危险因素很多,应特别注重孕妇的孕期生活行为,对孕妇及其配偶加强卫生宣教,养成良好的生活习惯,以减少早产的发生。     

孕期烟草暴露与子代肺功能及喘息下呼吸道感染相关性研究

目的研究孕妇烟草暴露对其子女肺功能和喘息、下呼吸道感染疾病发生概率的影响。方法选择2006-01-01至2007-01-01在中山市博爱医院产科出生的新生儿共180例,分为2组。其中母亲孕期有吸烟和(或)被动吸烟史的暴露组90例,并按烟草暴露量分成5层:1～4支/d(16例),5～9支/d(20例),10～15支/d(26例),16～20支/d(14例),>20支/d(14例)。母亲孕期无烟草暴露的对照组90例,对两组新生儿进行肺功能检测并追踪3年,分别在1、2、3岁时复测肺功能,记录生后至3岁发生喘息性疾病及下呼吸道感染疾病的次数,进行统计学分析。结果母亲孕期烟草暴露量低于15支/d的新生儿及生后3年的肺功能指标与对照组相比差异无统计学意义(P>0.05),烟草暴露量在16～20支/d孕妇的子女在新生儿期及生后1岁、2岁肺潮气量与对照组相比差异有统计学意义(P>0.05),达峰时间比较对照组显著降低(P<0.05)。母亲孕期烟草暴露量20支/d以上的婴幼儿在生后3年内喘息性疾病发作次数及发生下呼吸道感染次数远远高于对照组(P<0.05)。结论孕期烟草暴露对子代肺功能有负面影响,主要影响小气道功能,并可导致生...     

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目的统计住院患儿出生缺陷的发生情况及影响因素,为有效预防出生缺陷提供借鉴。方法收集2001-01-01—2010-12-31南京军区福州总医院儿科住院患儿29015例中发生出生缺陷的病例资料,对患儿出生缺陷构成状况、孕妇多种相关暴露因素进行回顾性分析。结果 10年间南京军区福州总医院儿科住院患儿出生缺陷发生率为16.41‰(476/29015)。近4年(2007—2010年)与前6年(2001—2006年)出生缺陷发生率相比(25.24‰对8.83‰),呈明显增高且呈逐年增加趋势,差异有统计学意义(χ2=26.30,P<0.05)。产妇年龄<20岁和>35岁、早产(胎龄<37周)、孕早期患病、孕早期用药、有自然流产史、有家族史为出生缺陷发生的危险因素,而城乡、不同性别间出生缺陷发生率差异无统计学意义(P>0.05)。先天性心脏病占所有缺陷类型之首。结论大力实施围生期新生儿出生缺陷监测与干预工作,开展三级预防措施,能有效降低出生缺陷发生率。     

新生儿窒息278例及相关因素分析

目的探讨新生儿窒息发生的相关高危因素,提高干预措施。方法对我院自2002年1月～2005年12月发生新生儿窒息的278例患者的高危因素进行回顾性分析。结果新生儿窒息为综合因素所致,分娩时高危因素94.24%,胎儿高危因素92.81%,母体高危因素63.31%。结论提高产前检查,对高危孕妇进行产时、产后的监测,综合分析可能发生新生儿窒息的高危因素,适时选择正确分娩方式终止妊娠,加强产、儿科合作,提高新生儿复苏技术,是降低新生儿窒息和病死率的关键。     

北京地区新生儿先天巨细胞病毒感染状况研究

目的评估北京地区新生儿先天性巨细胞病毒(CMV)感染状态及其对新生儿的危害。方法选择2004年11月至2008年3月在北京居住、怀孕12周之内的孕妇,分别于孕早期和孕中期进行血清CMV IgG定量和CMV IgM定性检测;活动感染者接受CMV IgG亲和力、CMV pp65抗原血症和白细胞CMV巢式聚合酶链反应(nPCR)检测;白细胞CMV DNA阳性孕妇接受羊水CMV nPCR检测。所有入选孕妇分娩的新生儿出生后均检测脐血CMV nPCR,阳性者于生后2周内复查尿CMV nPCR。结果本研究共收入孕妇1752例,新生儿1756例;孕期血清学检查CMV活动感染51例,占2.91%(95%CI 2.12%～3.70%),其中原发活动感染2例,占全部孕妇的0.11%(95%CI 0.10%～0.41%);CMV nPCR阳性的孕期活动性感染占0.34%;活动感染孕妇羊水CMV nPCR检测全部阴性;新生儿先天性CMV感染发生率0.23%(95%CI 0.06%～0.58%)。所有先天性CMV感染新生儿出生时均为无症状性感染。结论北京地区CMV感染垂直传播率低,先天CMV感染发生率0.23%,未见到症状性先天性CMV感染患儿。     

2000-2006年北京市宣武区出生缺陷监测结果分析

目的 探讨新生儿出生缺陷的相关因素及干预措施,降低围生儿死亡率及出生缺陷发生率.方法 对2000年1月至2006年12月在北京市宣武区6家医院分娩的22 989名新生儿中341例活产出生缺陷儿进行回顾性分析.结果 出生缺陷儿检出率基本呈上升的趋势.男婴与女婴出生缺陷检出率比较差异无统计学意义.出生缺陷按照病种分类前5位为先天性心脏病、多指并指、唇(腭)裂、隐睾、泌尿生殖器与肛门畸形.孕妇年龄和孕次均与出生缺陷有相关性(P<0.05).结论 开展广泛健康教育,普及婚检、孕检,加强孕产期保健,提高产前筛查质量,加强出生缺陷的三级预防,是降低出生缺陷发生率、减少围生儿死亡率的必要措施.     

新生儿重症监护病房医院感染 临床特点及危险因素分析

目的 探讨新生儿重症监护病房( NICU)医院感染的危险因素.方法 对2005-2010年我院NICU收治的新生儿临床资料进行回顾性分析,根据是否发生医院感染分为病例组和对照组,分析两组患儿的临床特点及发生医院感染的危险因素.结果 纳入的3150例新生儿中发生医院感染256例,发生率8.1％.医院感染与胎龄、出生体重、住院时间、机械通气、外周置入中心静脉导管、胃管留置及胃肠外营养等密切相关（P均＜0.05）,其中住院时间＞14天是医院感染发生的独立危险因素（OR=7.432,95％CI:0.345～6.290）.医院感染病原体以革兰阴性菌为主,其中β-内酰胺酶阳性菌阳性率高(26.2％),耐药性强.结论 医院感染的发生与多种因素有关,住院时间越长,发生率越高,应积极治疗基础疾病,加强管理和防范,降低NICU医院感染发生率.     

The inter-regional epidemiological study of childhood cancer (IRESCC): a case control study of aetiological factors in leukaemia and lymphoma.

The inter-regional epidemiological study of childhood cancer analysed data on 234 children diagnosed with leukaemia or lymphoma and 468 controls matched for age and sex. A wide range of potential risk factors was examined, including prenatal exposure to x rays, maternal drug ingestion and smoking, child''s medical history, and parental medical conditions and occupation. Calculations were completed for leukaemia or lymphoma and diagnostic subgroups, as defined by laboratory confirmed cell type. In utero exposure to narcotic analgesics was weakly associated with leukaemia or lymphoma but no other antenatal factors gave significant risks. New associations were identified for skin diseases in both parents and congenital abnormalities in the mothers of children with leukaemia. For past medical conditions in the child, viral disease occurring under 6 months of age increased the risk for acute lymphoblastic leukaemia. Fewer children in the leukaemia or lymphoma group had been immunised compared with the control groups. Case children diagnosed over the age of 9 years were more likely than controls to have had four or more previous episodes of illness. Overall, these results indicate that prenatal factors may be less important than postnatal or genetic influences in the development of leukaemia or lymphoma in children.     

Congenital malformations in the newborn--a prospective study

In a prospective study of 4098 births the incidence of congenital malformations was 1.464 per 100 births. Major malformations were seen in 1.1% births and minor malformations in 0.4% births. Patterns of congenital anomalies included multiple anomalies (37.68%), CNS malformations (13.33%), alimentary tract anomalies (6.66%), cardiovascular malformations (8.99%), genitourinary malformation (6.66%), limb anomalies (13.33%), and anomalies of skin and appendages (13.33%). Factors like maternal age, hormone testing and drug ingestion during pregnancy, radiation exposure and maternal infections were identified as possible risk factors for congenital malformations in the newborn.     

环境与先天泌尿系统畸形的若干问题

肾脏及泌尿系统的发育受基因-环境-生活方式等多重因素（包括内因和外因）的影响,其中外因主要是指环境因素。该文针对与先天性泌尿系统畸形相关的环境因素进行综述,得出的结论是：先天性泌尿系统畸形的发生与低出生体重、母孕期疾病、胎盘功能不良、母孕期不良药物摄入、母孕期环境杀虫剂暴露、气候等因素相关,并可受到居住环境、家庭收入和教育程度等社会经济因素的影响。     

Effects of maternal medical diseases on the newborn

Summary The effects of maternal diseases on neonates have been analysed. Maternal anaemia leads to an increased incidence of low bith weight and preterm babies. The morbidity rate was high in these newborns with an increased incidence of hypoglycamia and scleraema. The perinatal loss was quite high. Hypertensive mothers as well as mothers suffering from chronic urinary tract infection or tuberculosis or cardiac disease also gave rise to low birth weight and preterm babies in greater proportion as compared to the normal. There was an increased morbidity and high perinatal loss in these groups. An increased awareness of the effects of maternal disease states on foetal growth and development will improve both the ability to make prenatal diagnosis of diseases and to plant for improved antenatal care and appropriant care of those newborns who are at hight risk, which in turn will definitely improve the outcome of the progeny and reduce perinatal loss. From the Dept. of paediatics S.M.S. Medical College and Hospital, Jaipur.     

Congenital syphilis after reactivation of "healed" maternal primary infection

The congenital syphilis is an infectious fetopathy which is able to affect the whole organism. In most cases symptoms are not obvious before week fourth to twelve of life. The infection of the mother is the precondition for the child's disease. The placental transfer takes place after the fifth to sixth month of gestation. We report about an eight week old baby with congenital syphilis. The positive maternal laboratory findings in the 4th month of pregnancy have been interpreted as a completely cured earlier infection causing a sero scar. The diagnosis became evident by serological tests detecting reactivation of maternal infection in late pregnancy and the clinical signs of acute infection of the child. CONCLUSION: There is a high risk of reactivation of maternal syphilis in the third trimenon even if the mother does not show any symptoms. In this case further serological tests in the prenatal care and careful examination of the newborn must be initiated.     

Congenital malformation at Gunung Wenang Hospital Manado: a five-year spectrum.

A five-year evaluation of congenital malformation among newborn infants born at Gunung Wenang Hospital has been evaluated in an attempt to get the picture of the congenital malformation spectrum and the magnitude of its problems in Manado, Indonesia. The total incidence of congenital malformation in this study was 0.9%, of which 0.5% were major types. The most common major malformation were: cleft lip and palate, talipes, multiple malformation, anal atresia, omphalocele and congenital heart diseases. The minor types were: abnormal formation of the ears, incomplete descensus of the testis, hydrocele and finger defects. The risk of having a newborn with birth defects was highest among mother's first pregnancy and among grande multiparity.     

Congenital syphilis: an emerging emergency also in Brazil

OBJECTIVE: To highlight to the fact that some newborns are not identified as having congenital syphilis, and will present to an emergency room within a few months with a severe disease. METHOD: Review of the charts concerning 3 patients with congenital syphilis, as well as review of the literature using Medline and Lilacs databases, covering the period from 1988 to 1999. RESULTS: We describe the case of 3 infants whose diagnosis of congenital syphilis was only established after the neonatal period, when they presented to the emergency room and were admitted to the pediatric intensive care unit. The first patient had neurosyphilis and nephrotic syndrome, the second had neurosyphilis, and the third had hepatitis. We discuss the clinical aspects of the cases, and comment on other clinical manifestations of congenital syphilis that should be within the purview of pediatric emergency medicine. We analyze the reasons for the failure to diagnose syphilis at birth, and describe some risk factors for gestational syphilis. CONCLUSIONS: Considering the rising incidence of syphilis in Brazil, and the possibility that the congenital infections are not recognized at birth, emergency physicians must keep a high degree of suspicion and an awareness of maternal risk factors, prenatal serology pitfalls, as well as of the several clinical presentations of congenital syphilis that can develop in the first months of life.     

Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta-analysis of observational studies

ObjectiveTo identify, using a systematic review and meta-analysis of observational studies, which risk factors are significantly associated with neonatal mortality in Brazil, and to build a comprehensive national analysis on neonatal mortality.SourcesThis review included observational studies on neonatal mortality, performed between 2000 and 2018 in Brazilian cities. The MEDLINE, Elsevier, Cochrane, LILACS, SciELO, and OpenGrey databases were used. For the qualitative analysis, the Newcastle-Ottawa Scale was used. For the quantitative analysis, the natural logarithms of the risk measures and their confidence intervals were used, as well as the DerSimonian and Laird method as a random effects model, and the Mantel–Haenszel model for heterogeneity estimation. A confidence level of 95% was considered.Summary of findingsThe qualitative analysis resulted in six studies of low and four studies of intermediate-low bias risk. The following exposure factors were significant: absence of partner, maternal age ≥35 years, male gender, multiple gestation, inadequate and absent prenatal care, presence of complications during pregnancy, congenital malformation in the assessed pregnancy, Apgar < 7 at the fifth minute, low and very low birth weight, gestational age ≤ 37 weeks, and caesarean delivery.ConclusionThe most significant risk factors presented in this study are modifiable, allowing aiming at a real reduction in neonatal deaths, which remain high in the country.     

围孕期营养因素与先天性心脏病发病的关系

先天性心脏病是人体在胚胎发育时期受各种因素影响导致心脏及血管发育异常的先天性畸形.先天性心脏病是人类最常见的先天畸形,是导致婴儿发病和病死的重要原因.即使可以经过外科手术矫治畸形,先天性心脏病患儿也要面临各种手术并发症甚至疾病复发的风险,给社会带来巨大的经济压力.目前普遍认为先天性心脏病的发生受遗传因素和环境因素的共同影响.近年来围孕期营养因素与先天性心脏病的发病关系成为研究热点.研究结果显示,叶酸及其他围孕期营养素与先天性心脏病的发生有密切关系,围孕期母亲适当补充这些营养素可降低子代先天性心脏病的发生风险.该文就叶酸、维生素A、锌、维生素B、维生素E围孕期关键营养因素与先天性心脏病的关系,从病因、发病机制及预防方面进行综述,为疾病的预防提供基础.     

Congenital heart disease in a Chinese hospital: pre‐ and postnatal detection,incidence, clinical characteristics and outcomes

Background: The pre‐ and postnatal detection rate, incidence, clinical characteristics and outcomes of congenital heart disease (CHD) have been studied in developed countries for many years, but rarely have large‐scale studies been reported in Chinese populations. The aim of the present study was to investigate the pre‐ and postnatal detection rates, incidence, clinical characteristics and outcomes of CHD in a Chinese hospital in order to improve the future screening and treatment of CHD. Methods: Fetuses without risk factors for CHD were screened using basic cardiac ultrasound examination (BCUE). Fetuses with suspected cardiac malformation revealed by BCUE and fetuses with risk factors were screened using extended cardiac ultrasound examination. Outcomes recorded from fetal, neonatal and postmortem records over 4 years (2006–2009) included: therapeutic termination of pregnancy, spontaneous abortions or stillbirths, deaths at birth or in the neonatal period (before 28 days of age), and rate of birth and clinical characteristics of newborns. Results: A total of 34 071 fetuses were screened for CHD during a period of 4 years, of which 173 fetuses were screened for CHD using BCUE and 301 fetuses were screened using extended cardiac ultrasound examination. The incidence of fetal CHD increased from 1.1% in 2006 to 2.4% in 2009 (P < 0.05), yielding an overall incidence of 1.5% (523/34 071). Of the fetuses with CHD, 48.2% (252/523) died before 28 days of age (including intra‐uterine death and termination of pregnancy), 51.8% (271/523) lived more than 28 days and the incidence of live newborns with CHD was 0.80% (271/34071). Conclusions: The prevalence of CHD was quite common in this Chinese hospital. Detailed profiles of CHD suggest that, while training programs in obstetric screening at this hospital were beneficial, prenatal intervention, treatment and care of fetal CHD were inefficient and should be strengthened in China.