非糖尿病性巨大儿的相关临床分析

目的:探讨非糖尿病性巨大儿发生的相关因素及临床特点。方法:选择足月出生的巨大儿149例,同时随机选择同期出生的足月正常体质量儿166例作为对照,分析新生儿母亲的年龄、孕次、产次、孕周、孕期增长体质量及孕末期体质指数(BMI)等。结果:非糖尿病性巨大儿的发生以男婴居多,其平均身长、体质量、股骨长、双顶径显著高于对照组(P<0.05);非糖尿病性巨大儿母亲的平均身高、孕期增长体质量、孕末期BMI及围产期发病率、剖宫产率显著高于对照组(P<0.05)。结论:非糖尿病性巨大儿是有别于糖尿病性巨大儿的一种正常儿,其发生除了与遗传因素有关外,与其母亲的营养过量摄入密切相关。     

胎儿宫内窘迫76例临床分析

目的探讨胎儿宫内窘迫与围产儿预后的关系,以供临床参考。方法将我院2009年2月至2010年10月收治的76例发生胎儿宫内窘迫的新生儿与同期正常胎儿80例进行对比,比较2组胎儿出生后发生新生儿窒息、剖宫产率、Apgar评分及羊水污染情况,并将结果进行统计学分析。结果胎儿期发生宫内窘迫的患儿,其发生新生儿窒息例数较多,患儿剖宫产率较高,羊水污染情况更多,Apgar评分较低,与正常胎儿比较,P〈0.05,差异有统计学意义。结论胎儿宫内窘迫可能会出现各种并发症,导致新生儿窒息等情况,严重影响新生儿健康,因此需要医生积极采取措施,早期处理。     

彩色超声多普勒检查预测胎儿宫内缺氧

目的 运用彩色多普勒超声监测胎儿脐动脉血流动力学指标，预测宫内缺氧的临床价值。方法 应用彩色多普勒超声检测128例孕妇胎儿脐动脉血流动力学指标，并进行相关分析。结果 胎儿的脐动脉（UMA）S／D值＞3、PI值＞1．7、RI值＞0．8时，提示宫内缺氧。高危组缺氧发生率与正常组缺氧发生率比较差异有显性（P＜0．001）。结论 产前直接监测胎儿脐血流动力学指标，可以预测胎儿宫内缺氧，及早发现异常，及时治疗，对于降低围产儿死亡率具有临床实用价值。     

Alcohol and the fetus in the west of Scotland

Forty children with the fetal alcohol syndrome were identified in the west of Scotland. All were growth retarded and had abnormal facial features, and all those who were tested were found to have neurological or developmental abnormalities. Two children died of associated physical defects. Most of the mothers were socially deprived, and all had drunk heavily while pregnant. Three women had subsequently died. These findings provide clear evidence that in the west of Scotland maternal alcohol abuse during pregnancy is a significant cause of morbidity and mortality in children.     

Doppler echocardiographic studies of diastolic cardiac function in the human fetal heart

Fetal echocardiography has been used for the noninvasive evaluation of human fetal cardiac anatomy, function, and hemodynamics. The purpose of the present study was to use Doppler echocardiographic methods to measure diastolic flow velocity patterns across the tricuspid and mitral valves in human fetuses during gestation. Fifty normal fetuses, 35 fetuses with intrauterine growth retardation (IUGR), and 30 fetuses of diabetic mothers (DM) were studied. Peak flow velocities during early diastole (peak E wave) and peak flow velocities during atrial contraction (peak A wave) were measured, and the peak E/A ratio was calculated. The peak E/A ratio of the left ventricle in fetuses increased gradually with increasing gestational age (r = 0.57, p < 0.05), and the peak E/A ratio of the right ventricle in fetuses increased linearly with increasing gestational age (r = 0.48, p < 0.05). In early gestational age, the peak E/A ratios of both the left and right ventricle in fetuses with IUGR and of DM were not significantly different from those in the controls. However, in late gestational age, the peak E/A ratios of both the left and right ventricle in fetuses with IUGR and of DM were significantly smaller than those in the controls. This gradual decrease in the peak E/A ratio during gestation may represent the maturational or developmental alteration of diastolic cardiac properties in utero. Fetuses with IUGR and of DM may have abnormal diastolic cardiac function in later gestation.     

脐动脉舒张期血流消失时胎儿生长发育及出生情况分析

目的：分析晚孕期脐动脉舒张期血流信号消失时胎儿生长发育和出生时情况。方法采用彩色超声诊断仪检测脐动脉血流信号,对比分析脐动脉血流正常与脐动脉舒张期血流消失时胎儿的生长发育指标和出生时Apgar评分。结果脐动脉舒张期血流消失的胎儿生长发育小于孕龄的发生率明显高于正常组,出生时宫内窘迫的发生率也明显高于正常组。结论晚孕期脐动脉舒张期血流消失提示胎儿宫内缺氧,胎儿生长发育相对缓慢。     

2～3岁语言发育迟缓儿童的语言能力与父母述情障碍的关系

目的：探究2～3岁语言发育迟缓儿童的语言能力水平与父母述情障碍的关系。方法：选取2021年1月至6月于温州医科大学附属第二医院就诊的59例2～3岁语言发育迟缓儿童和其父母为研究对象,采用一般资料问卷、语言发育迟缓检查法、Gesell婴幼儿发展量表和多伦多述情障碍量表进行调查。结果：Pearson相关分析发现,父母的述情障碍得分与儿童语言发育迟缓（动作课题、符号理解、语言表达）得分呈显著负相关（P<0.05）。回归分析结果显示,父母的述情障碍越高,儿童语言发育迟缓（符号理解能力、动作性课题能力）能力越差（β=0.62,P<0.01;β=-0.60,P<0.01）。结论：父母的述情障碍越严重,儿童的语言发育迟缓程度越高。     

局部应用外源性生长因子对糖尿病创面愈合影响的临床研究

目的 :从临床角度观察局部应用外源性生长因子对糖尿病创面愈合的影响。方法 :局部应用外源性生长因子于糖尿病创面 12例 ,观察术后 3、7、14 d创面上皮葡行后残余面积及肉芽成熟程度 ,同时在同一部位另一创面做空白对照 ,并与非糖尿病创面愈合过程进行比较。结果 :糖尿病创面应用外源性生长因子与未应用生长因子与非糖尿病创面比较 ,其上皮葡行速度在早期未见明显差异 ,在后期其上皮葡行速度由快至慢顺序为非糖尿病创面应用生长因子 >糖尿病创面应用生长因子 >非糖尿病创面未应用生长因子 >糖尿病创面未应用生长因子。局部应用外源性生长因子可促进糖尿病创面上皮化以及肉芽组织的生长 ,但糖尿病创面肉芽组织的生长明显滞后于非糖尿病创面。结论 :局部应用外源性生长因子对糖尿病创面愈合具有促进作用。     

Impact of maternal body mass index on neonatal outcome

Introduction

Maternal body mass index has an impact on maternal and fetal pregnancy outcome. An increased maternal BMI is known to be associated with admission of the newborn to a neonatal care unit. The reasons and impact of this admission on fetal outcome, however, are unknown so far.

Objective

The aim of our study was to investigate the impact of maternal BMI on maternal and fetal pregnancy outcome with special focus on the children admitted to a neonatal care unit.

Methods

A cohort of 2049 non-diabetic mothers giving birth in the Charite university hospital was prospectively studied. The impact of maternal BMI on maternal and fetal outcome parameters was tested using multivariate regression analysis. Outcome of children admitted to a neonatal ward (n = 505) was analysed.

Results

Increased maternal BMI was associated with an increased risk for hypertensive complications, peripheral edema, caesarean section, fetal macrosomia and admission of the newborn to a neonatal care unit, whereas decreased BMI was associated with preterm birth and lower birthweight. In the neonatal ward children from obese mothers are characterized by hypoglycaemia. They need less oxygen, and exhibit a shorter stay on the neonatal ward compared to children from normal weight mothers, whereas children from underweight mothers are characterized by lower umbilical blood pH and increased incidence of death corresponding to increased prevalence of preterm birth.

Conclusion

Pregnancy outcome is worst in babies from mothers with low body mass index as compared to healthy weight mothers with respect to increased incidence of preterm birth, lower birth weight and increased neonate mortality on the neonatal ward. We demonstrate that the increased risk for neonatal admission in children from obese mothers does not necessarily indicate severe fetal impairment.     

正常妊娠中晚期胎儿甲状腺体积的超声检测及分析

目的 利用三维超声检测妊娠中、晚期胎儿甲状腺的体积大小与孕周的关系,以超声辅助判定胎儿甲状腺的生长发育水平.方法 选取进行产前检查的正常妊娠22 ～ 36周的健康孕妇100例,超声检测胎儿一般发育状况的同时应用三维超声计算机辅助分析(3DUS-VOCAL)技术检测胎儿甲状腺体积的大小,并评估胎儿甲状腺体积与孕周的相关性.结果 妊娠中期与妊娠晚期胎儿的甲状腺体积差异有统计学意义,P＜0.01.胎儿甲状腺体积随孕周的增加而增大,两者呈正相关关系,体积=-1.29 +0.08GA(r =0.873,P＜0.01).结论 三维超声检测妊娠中、晚期胎儿甲状腺体积大小有助于评估胎儿甲状腺的发育情况及早期诊断胎儿甲状腺异常,亦可随访判断作为宫内治疗是否有效的依据.     

Outcome at age 4 years in offspring of women with maternal phenylketonuria: the Maternal PKU Collaborative Study

CONTEXT: Untreated maternal phenylketonuria (PKU) increases risk for developmental problems in offspring. The extent to which this risk is reduced by maternal dietary therapy at various stages of pregnancy is not known. OBJECTIVE: To determine whether dietary treatment during pregnancy of women with PKU affects developmental outcomes of offspring. DESIGN: The Maternal PKU Collaborative Study, an ongoing, longitudinal prospective study begun in 1984. SETTING: A total of 78 metabolic clinics and obstetrical offices in the United States, Canada, and Germany. PARTICIPANTS: A total of 253 children of women with PKU (n = 149), with untreated mild hyperphenylalaninemia (n = 33), or without known metabolic problems (comparison group; n = 71) were followed up to age 4 years. INTERVENTION: Women with PKU were offered a low-phenylalanine diet prior to or during pregnancy with the aim of maintaining metabolic control (plasma phenylalanine < or =10 mg/dL [< or =605 micromol/L]). Women with mild hyperphenylalaninemia, who had plasma phenylalanine levels of no more than 10 mg/dL (605 micromol/L) on a normal diet, were not treated. MAIN OUTCOME MEASURES: Children's scores on cognitive and behavioral assessments (McCarthy Scales of Children's Abilities, Test of Language Development, Achenbach Child Behavior Checklist, Vineland Adaptive Behavior Scales, and Home Observation for Measurement of the Environment), compared by maternal metabolic status at 0 to 10 weeks', 10 to 20 weeks', and after 20 weeks' gestation. RESULTS: Scores on the McCarthy General Cognitive Index decreased as weeks to metabolic control increased (r = -0.58; P<.001). Offspring of women who had metabolic control prior to pregnancy had a mean (SD) score of 99 (13). Forty-seven percent of offspring whose mothers did not have metabolic control by 20 weeks' gestation had a General Cognitive Index score 2 SDs below the norm. Overall, 30% of children born to mothers with PKU had social and behavioral problems. CONCLUSIONS: Our data suggest that delayed development in offspring of women with PKU is associated with lack of maternal metabolic control prior to or early in pregnancy. Treatment at any time during pregnancy may reduce the severity of delay.     

胎儿宫内发育迟缓孕妇经高压氧治疗出生后新生儿1年随访结果分析

目的：探讨高压氧治疗胎儿宫内发育迟缓（IUGR）胎儿的远期疗效。方法：经高压氧治疗和正常出生的新生儿48例分二组，分别在出生后3个月，6个月，9个月，12个月为期一年的随访，对照新生儿的身长、体重、智能发育情况。结果：经高压氧治疗后的新生儿发育正常，各观察指标与正常出生的新生儿比较无明显差异。结论：高压氧治疗IUGR孕妇不但宫内治疗疗效可靠，且远期效果好，值得推广使用。     

Neurodevelopment of adopted children exposed in utero to cocaine.

OBJECTIVE: To assess the neurodevelopment of adopted children who had been exposed in utero to cocaine. DESIGN: A case-control observational study. PARTICIPANTS: Twenty-three children aged 14 months to 6.5 years exposed in utero to cocaine and their adoptive mothers, and 23 age-matched control children not exposed to cocaine and their mothers, matched with the adoptive mothers for IQ and socioeconomic status. SETTING: The Motherisk Programme at The Hospital for Sick Children, Toronto, a consultation service for chemical exposure during pregnancy. MAIN OUTCOME MEASURES: Height, weight and head circumference at birth and at follow-up, and achievement on standard tests of cognitive and language development. RESULTS: Compared with the control group, children exposed in utero to cocaine had an 8-fold increased risk for microcephaly (95% confidence interval 1.5 to 42.3); they also had a lower mean birth weight (p = 0.005) and a lower gestational age (p = 0.002). In follow-up the cocaine-exposed children caught up with the control subjects in weight and stature but not in head circumference (mean 31st percentile v. 63rd percentile) (p = 0.001). Although there were no significant differences between the two groups in global IQ, the cocaine-exposed children had significantly lower scores than the control subjects on the Reynell language test for both verbal comprehension (p = 0.003) and expressive language (p = 0.001). CONCLUSIONS: This is the first study to document that intrauterine exposure to cocaine is associated with measurable and clinically significant toxic neurologic effects, independent of postnatal home and environmental confounders. Because women who use cocaine during pregnancy almost invariably smoke cigarettes and often use alcohol, it is impossible to attribute the measured toxic effects to cocaine alone.     

288例发育指标延迟患儿的临床特点分析

目的 对发育指标延迟患儿进行早期诊断、临床特点、高危因素和预后研究分析,为本病的早期诊断及早期干预提供参考。方法 随机选择2014年3月至2015年8月安徽医科大学第一附属医院小儿神经康复科288例发育指标延迟患儿作为研究组,263名正常发育儿童作为对照组,采用问卷形式,对早期诊断、临床特点和危险因素进行分析,采用引导式为主的早期干预措施对治疗组进行干预,并进行6个月的预后随访。结果 发育指标延迟的临床特点以运动发育迟缓最常见（228例,79.1%）,认知/感知发育迟缓次之（31例,10.8%）,情感交流发育迟缓（22例,7.7%）和语言发育迟缓（7例,2.4%）最低。男孩高发,初诊年龄2～36个月,平均（7.80±4.32）个月,高峰为6～12个月。高危因素主要为新生儿缺氧缺血性脑病（HIE）、早产、新生儿窒息、宫内窘迫及妊娠期高血压等。其中222例患儿随访6个月后发现159例进入正常（71.62%）,63例（28.38%）未发育正常,包括发育指标延迟34例（15.31%）,全面性发育落后（GDD）14例（6.30%）,脑性瘫痪（CP）10例（4.50%）和孤独症谱系障碍（ASD）5例（0.23%）。结论 防治HIE、早产、新生儿窒息、妊娠期高血压等可降低发育指标延迟的发生率。有明显运动、认知/感知、语言发育和情感交流发育指标延迟的患儿应早期诊断,引导式为主的早期干预可改善其预后和降低GDD、CP和ASD等的发生率。     

Effect of glycaemic control and duration of disease on overnight albumin excretion in diabetic children

Urine albumin excretion rates were measured in overnight timed samples from diabetic and non-diabetic schoolchildren. The excretion rates in the diabetics were significantly higher than those in the controls and were positively correlated with age, duration of diabetes, and glycaemic control. Diabetic children aged 12 years and older had significantly higher albumin excretion rates than younger diabetic children matched for duration of disease. Among the non-diabetic controls there was no correlation between albumin excretion rate and age and the girls excreted significantly more albumin than the boys. Measurement of the overnight albumin excretion rate may provide a useful early indicator of the progression to clinical proteinuria in diabetes and is free from random variations such as that due to exercise.     

Five-year follow-up of rural Jamaican children whose mothers used marijuana during pregnancy

This research provides data on the development of 59 Jamaican children, from birth to age 5 years, whose mothers used marijuana during pregnancy. Approximately one-half of the sample used marijuana during pregnancy and were matched with non-users according to age, parity, and socioeconomic status. Testing of the children was done at 1, 3, and 30 days of age with the Brazelton Neonatal Behavioral Assessment Scales and at ages 4 and 5 years with the McCarthy Scales of Children's Abilities. Data about the child's home environment and temperament were collected from direct observations as well as from standardized questionnaires. The results show no significant differences in developmental testing outcomes between children of marijuana-using and non-using mothers except at 30 days of age when the babies of users had more favourable scores on two clusters of the Brazelton Scales: autonomic stability and reflexes. The developmental scores at ages 4 and 5 years were significantly correlated to certain aspects of the home environment and to regularity of basic school (preschool) attendance.     

Outcomes after primary coronary intervention with drug-eluting stent implantation in diabetic patients with acute ST elevation myocardial infarction

Background Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction (STEMI) remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts. Methods From December 2004 to March 2006, 56 consecutive diabetic patients (diabetic group) and 170 non-diabetic patients (non-diabetic group) with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event (MACE) including cardiac death, non-fatal recurrent myocardial infarction (re-MI) and target vessel revascularization (TVR) during hospitalization and one-year clinical follow-up were compared between the two groups. Results Patients in diabetic group were more hyperlipidemic (69.6% and 51.8%, P=0.03) and had longer time delay from symptom onset to admission ((364±219) minutes and (309±223) minutes, P=0.02) than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group (82.1% and 51.2%, P&lt;0.001). Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade (TMPG) ≥2 was lower in diabetic group (75.0% vs 88.8% in non-diabetic groups, P=0.02). The MACE rate was similar during hospitalization between the two groups (5.4% vs 3.5%, P=0.72), but it was significantly higher in diabetic group (16.1%) during one-year follow-up, as compared with non-diabetic group (6.5%, P=0.03). The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group (78.6% vs 90.0%, P=0.02). Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively (P=0.19). All of these patients experienced non-fatal myocardial infarction.Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.     

胰岛素样生长因子—I及胰岛素样生长因子结合蛋白—3与 …

目的 检测孕妇静脉血、脐血中胰岛素样生长因子－Ｉ（ＩＧＦ－Ｉ）及胰岛素样生长因子结合蛋白－３（ＩＧＦＢＰ－３）水平,探讨ＩＧＦ－Ｉ、ＩＧＦＢＰ－３与胎儿宫内发育的关系。方法 采用美国ＤＳＬ公司试剂盒。总计８１例孕妇,其中正常孕妇３８例,妊娠糖尿病孕妇２０例,正常妊娠分娩巨大儿孕妇２３例,采用放射免疫方法测定。结果 正常组及巨大儿组孕妇静脉血ＩＧＦ－Ｉ与新生儿体重呈正相关（ｒ＝０．６５３,ｒ＝０．６     

听力障碍婴幼儿语言、语音及认知的早期干预

目的探讨听力障碍婴幼儿语言、语音及认知早期干预的效果和早期干预的临床模式。方法将56例10个月~2岁的听力障碍婴幼儿分为两组,20例配戴助听器并接受系统语言康复的患儿为干预组,36例未接受治疗的患儿为未干预组。采用Gesell发育量表对56例患儿及28例正常对照组儿童进行语言及认知评估;采用普通话语音测试对56例患儿的语音发育状况进行评估,比较干预组、未干预组和正常儿童的语言、语音和认知发育水平。结果(1)干预组患儿的言语能DQ(92.25±17.32)高于未干预组(70.44±29.99),差异有统计学意义(P=0.00),干预组患儿与正常儿童言语能DQ(100.29±8.86)的差异无统计学意义(P=0.07)。未干预组患儿的言语能DQ低于正常儿童,差异有统计学意义(P=0.00)。等级相关分析显示,干预组患儿的语言康复水平与听力损失程度的相关性无统计学意义(P=0.27)。(2)干预组患儿应人能DQ(101.40±7.66)高于未干预组(83.94±22.09),差异有统计学意义(P=0.00),干预组患儿与正常儿童应人能DQ(101.68±13.83)的差异无统计学意义(P=0.93);未干预组患儿的应人能DQ低于正常儿童,差异有统计学意义(P=0.00);粗动作、细动作和应物能DQ3组比较,差异均无统计学意义。(3)干预组除1例极重度听力障碍患儿的/d/发音异常外,其他患儿辅音发音正常。未干预组中重度、重度患儿各有1例表现为/d/发音异常,极重度患儿中/d、m/发音异常6例,其他患儿正常。干预组除2例极重度患儿声调异常外,其他患儿的声调正常。未干预组中度、中重度、重度和极重度患儿中声调异常分别为2例、1例、1例和12例。结论未干预听力障碍婴幼儿的语言、语音和认知水平明显落后于正常儿童,早期干预能显著改善听力障碍患儿的语言、语音和认知能力。已经建立有效的早期干预临床模式。