极低出生体质量儿支气管肺发育不良发病的危险因素分析

目的探讨影响早产极低出生体质量儿(VLBWI)支气管肺发育不良(BPD)的高危因素,为指导临床预防及治疗BPD提供借鉴。方法回顾性分析2012年5月-2015年4月在苏州市立医院新生儿重症监护病房住院28d以上VLBWI329例临床资料,根据BPD发生与否及BPD严重程度进行分组,采用SPSS22.0统计软件进行BPD危险因素分析。结果BPD93例,BPD发生率28.3%,BPD的发生率随着出生体质量及胎龄的增加而明显降低。多因素Logistic分析结果显示,机械通气时间(OR=1.532,95%CI:1.206~1.946)、肠道外营养时间(OR=1.113,95%CI:1.030~1.203)、胎龄(OR=0.416,95%CI:0.297~0.583)为BPD发生的高危因素;中轻度BPD61例,中重度BPD32例,新生儿呼吸窘迫综合征(NRDS)(OR=3.746,95%CI:1.116~12.576)和新生儿坏死性小肠结肠炎(NEC)(OR=6.563,95%CI:1.415~30.445)是影响BPD病情程度的高危因素。结论BPD的发生随着早产儿胎龄的增加而明显降低;胎龄越小,BPD发生率越高,机械通气时间、肠道外营养时间为BPD发生的高危因素,而NRDS、NEC是影响BPD严重程度的高危因素。     

极低出生体重儿支气管肺发育不良的高危因素分析

目的:探讨极低出生体重儿发生支气管肺发育不良(Bronchopulmonary Dysplasia,BPD)的临床高危因素。方法:回顾性分析NICU收治的极低出生体重儿199例患儿的临床资料,根据是否发生BPD分为BPD组和非BPD组,分析BPD发生的可能危险因素。结果:199例低出生体重儿中有48例发生BPD,发病率为24.1%。与非BPD患儿组相比,BPD组患儿在机械通气时间、总吸氧时间、吸氧浓度>40%时间、宫内感染、合并动脉导管未闭、院内感染等方面比较差异有统计学意义(P<0.05),Logistic回归分析结果显示机械通气时间、宫内感染、吸氧浓度>40%时间为疾病发生的危险因素。结论:预防宫内感染可降低BPD的发生率,长时间机械通气及高浓度吸氧为BPD发生的高危因素。     

极低出生体重儿支气管肺发育不良影响因素分析

目的探讨极低出生体重儿(VLBWI)发生支气管肺发育不良(BPD)的影响因素。方法选择2015年1月至12月,四川大学华西第二医院新生儿重症监护室收治的163例VLBWI为研究对象。按照出院诊断是否包括BPD,将其分为BPD组(n=57)及非BPD组(n=106)。回顾性分析VLBWI临床病例资料,统计学比较下面各项因素对于VLBWI发生BPD的影响。(1)2组VLBWI母亲产前一般临床资料,包括年龄、胎次、是否初产妇、是否多胎妊娠、是否按期规律进行产前检查、分娩时并发症发生情况、分娩方式等12项因素;(2)新生儿情况,包括胎龄,出生体重,性别,出生后1min及5min Apgar评分,出生后肺表面活性物质(PS)使用情况,机械通气使用率及时间,以及生后合并症发生情况等14项因素。根据临床经验及VLBWI发生BPD的单因素分析结果,对其中13项影响因素,进一步进行多因素非条件logistic回归分析,探讨VLBWI发生BPD的独立影响因素。结果 (1)单因素分析结果显示:BPD组VLBWI母亲妊娠期高血压或子痫前期,以及剖宫产比例,均较非BPD组低,而产前出血比例,则较非BPD组高,并且差异均有统计学意义(P0.05);BPD组VLBWI胎龄较非BPD组小,出生体重较非BPD组轻;BPD组VLBWI出生后1 min及5 min Apgar评分≤7分所占比例、PS使用率、机械通气率及时间,以及新生儿呼吸窘迫综合征(NRDS)、动脉导管未闭(PDA)和脑室周-脑室内出血/脑室周围白质软化(PIVH/PVL)发生率,则均较非BPD组高或长,并且上述差异均有统计学意义(P0.05)。(2)VLBWI发生BPD影响因素的多因素非条件logistic回归分析结果显示:胎龄29.5周(OR=3.876,95%CI:1.260~11.924,P0.05),出生体重1 300g(OR=3.983,95%CI:1.165~13.621,P0.05)是VLBWI发生BPD的独立危险因素;机械通气时间7d(OR=0.146,95%CI:0.050~0.424,P0.05)是VLBWI是否发生BPD的独立保护因素。结论避免早产及合理的机械通气策略,可能降低VLBWI的BPD发生率。     

极低出生体重儿急性肺损伤/急性呼吸窘迫综合征的临床观察

目的:总结和分析极低出生体重儿(VLBWI)急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的护理经验。方法:通过对新生儿重症监护室(NICU)的15例极低出生体重儿ALI/ARDS用机械通气治疗,分析呼吸机治疗过程中的护理记录、呼吸机参数和各项监护仪记录,总结VLBWI应用呼吸机治疗肺损伤过程中的护理经验。结果:15例VLBWI的平均出生体重为1200g,平均胎龄30+2周。平均应用呼吸机时间为4.2天,其中≥5天7例。经治疗后痊愈12例,死亡2例,放弃1例。结论:VLBWI患儿ALI/ARDS护理要点是保证观察生命体征及呼吸机参数准确及时、加强气道护理避免患儿呼吸道发生感染、合理充分的胃肠内外营养,正确护理对保证VLBWI存活率及减少后遗症至关重要。     

新生儿呼吸窘迫综合征并发支气管肺发育不良相关影响因素分析

目的 探讨新生儿新生儿呼吸窘迫综合征(NRDS)并发支气管肺发育不良(BPD)影响因素,从而为临床防治提供参考。方法 选取NRDS患儿200例,根据是否合并支气管肺发育不良(BPD)将其分为BPD组和非BPD组。总结患儿临床资料,采用单因素分析和Logistic多因素分析的方法分析BPD危险因素。结果 200例新生儿肺透明膜病(HMD)患儿中,共有BPD患儿48例,患病率为24.00%。随着胎龄的增大,BPD患病率呈下降趋势。随着出生体重的增加,BPD患病率呈下降趋势。单因素分析显示BPD和非BPD患者住院时间、肺出血发生率、出生体重、胎龄、机械通气时间、Apgar评分均有显著差异(P<0.05);多因素分析结果显示胎龄、体重、肺出血是影响BPD的危险因素(P<0.05)。结论 胎龄和体重是BPD的重要危险因素,临床上应给予预防措施,同时治疗肺部原发病对防止BPD有重要意义。     

呼吸窘迫综合征早产儿发生支气管肺发育不良的危险因素分析

目的 分析合并新生儿呼吸窘迫综合征(NRDS)的胎龄＜32周的极低出生体重儿发生支气管肺发育不良(BPD)的危险因素,为临床诊治提供参考依据。方法 选取2019年10月—2020年7月郑州大学第三附属医院新生儿重症监护室收治的合并呼吸窘迫综合征、胎龄＜32周、出生体重＜1 500 g的早产儿138例,根据是否发生BPD,分为BPD组(32例)和非BPD组(106例)。收集所有早产儿的出生与治疗情况、母亲孕期情况,并进行分析。结果 单因素分析显示,BPD组与非BPD组胎龄、出生体重、机械通气应用率、生后糖皮质激素应用率、新生儿感染发生率、产前感染发生率比较,差异有统计学意义(t=3.444、2.912,χ²=24.089、5.208、8.586、9.486,P＜0.05);多因素Logistic回归分析显示:胎龄≥28周是BPD的保护因素(28～周OR=0.143,95%CI:0.035～0.579;30～＜32周OR=0.210,95%CI:0.047～0.939),机械通气(OR=5.459,95%CI:1.991～14.963)、新生儿感染(OR=4.075,95%CI:1.031～16.106)、产前感染(OR=3.375,95%CI:1.051～10.833)是BPD发生的独立危险因素。结论 预防感染、避免早产、减少机械通气是减少合并NRDS、胎龄＜32周、出生体重＜1 500g的早产儿发生BPD的重要措施。     

650例不同胎龄及出生体重双胎早产儿并发症分析

目的探讨不同胎龄及出生体重的双胎早产儿并发症的发生与胎龄、出生体重的关系。方法对本院2010年1月至2015年1月共650例双胎早产儿临床资料进行回顾性分析,,按出生体重分为1 500 g、1 500~2 500 g、≥2 500 g三组,按胎龄分为≤32周、32~≤34周、34~≤37周三组,比较分析各组并发症的发生率,分析双胎早产儿的并发症、结局与其胎龄和出生体重的关系。结果双胎早产儿主要并发症发生率为35.5%,早产儿并发症主要发生于胎龄≤32周和出生体重1 500 g的极低出生体重儿,并发症以感染(8.9%)、颅内出血(5.2%)、血糖异常(4.8%)、高胆红素血症(4.5%)、新生儿呼吸窘迫综合征(NRDS)(2.9%)为主。胎龄≤32周,出生体重1 500 g的双胎早产儿并发症及死亡率明显增高。随着胎龄和出生体重的增加,双胎早产儿的并发症及死亡率下降。结论胎龄越小,出生体重越低,双胎早产儿并发症及死亡率越高。34周后及出生体重≥2500 g者并发症及死亡率均维持在低水平。应加强双胎孕妇产前管理,减少早产尤其是32周以前早产及极低出生体重儿的发生风险。     

极低出生体重早产儿支气管肺发育不良高危因素分析

目的探讨极低出生体重(VLBW)早产儿支气管肺发育不良(BPD)发生情况及其高危因素。 方法选择2014年1月1日至12月31日，于广西壮族自治区妇幼保健院住院治疗的107例出生体重<1 500 g早产儿为研究对象。根据其是否被诊断为BPD，而将其分别纳入BPD组(n＝36)及非BPD组(n＝71)。回顾性分析这107例早产儿的临床病例资料，包括产科因素、早产儿出生时一般情况、治疗经过及住院期间主要并发症发生情况，共计4个方面的26项观察项目。采用t检验及χ²检验，对8项产科因素及10项早产儿出生、治疗相关因素，进行单因素分析；采用单因素logistic回归分析法，对早产儿住院期间发生的8个并发症因素进行分析；再结合已有研究结果及临床经验，以及上述单因素分析结果，将VLBW早产儿发生BPD的13项可能影响因素，进行多因素非条件logistic回归分析，以探讨VLBW早产儿发生BPD的独立影响因素。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求。 结果①对VLBW早产儿发生BPD影响因素的单因素分析结果显示：差异具有统计学意义的因素包括分娩方式、孕产妇宫内感染，早产儿出生体重、胎龄，新生儿窒息、经鼻持续气道正压通气(NCPAP)、有创机械通气、有创机械通气时间、吸入高浓度氧、使用肺表面活性物质(PS)、新生儿呼吸窘迫综合征(NRDS)、动脉导管未闭(PDA)及败血症。②多因素非条件logistic回归分析结果显示：采取有创机械通气(OR＝51.936, 95%CI: 2.395～1 126.182, P＝0.012)，吸入高浓度氧(OR＝76.269, 95%CI: 5.279～1 101.998, P＝0.001)，发生NRDS(OR＝4.497, 95%CI: 1.772～11.415, P＝0.002)及合并败血症(OR＝2.521, 95%CI: 1.006～6.319, P＝0.049)，为VLBW早产儿发生BPD的独立危险因素；剖宫产术分娩(OR＝0.045, 95%CI: 0.003～0.730, P＝0.029)为其独立保护因素。 结论VLBW早产儿若接受有创机械通气、吸入高浓度氧、发生NRDS、合并败血症，则容易发生BPD。临床应针对这些因素，对VLBW早产儿采取相应处理措施，以预防BPD发生。     

极低出生体重早产儿出生时及母亲维生素D缺乏与支气管肺发育不良关系的研究

目的 探讨极低出生体重儿出生时及母亲血液中25-羟基维生素D(25-OHD)的缺乏是否为导致早产儿后期发生支气管肺发育不良(BPD)的一个重要高危因素.方法 以郑州市儿童医院2014年3月至2015年6月收治的新生儿呼吸窘迫综合征并且体重≤1 500g的早产儿为研究对象,入院时留取静脉血(出生3天内)及从出生医院获取母亲分娩后静脉血标本,并进行25-OHD水平测定;按出生后28天后是否合并BPD分为BPD组及未BPD组.结果 80例早产儿有24例(30.00%)合并新生儿BPD,50例未合并BPD,死亡或自动出院6例.BPD组患儿机械通气时间、持续正压通气(CPAP)、总用氧时间、住院天数、PDA患儿数均明显高于非BPD组,差异均有统计学意义(t值分别为9.047、6.275、11.395、15.398,χ2=4.010,均P<0.05).BPD组患儿及母亲血清25-OHD明显低于非BPD组(t值分别为7.003、9.082,均P<0.05);所有BPD组患儿血中25-OHD均<10ng/mL,提示严重缺乏.Logistic回归分析显示出生时25-OHD血清水平是BPD的高危因素,母亲和新生儿血清中25-OHD每增加1ng/mL可能分别使BPD发生率降低24%(OR:0.76,95%CI:68~86,P<0.001)和39%(OR:0.61,95%CI:48~76,P<0.001).结论 通过研究证实极低出生体重早产儿出生时及母亲血清中25-OHD水平较低,是后期发生BPD的一个高危因素.然而仍需进一步研究早期补充足量维生素D是否可以预防BPD及后期其他肺部疾病的发生.     

新生儿呼吸窘迫综合征听力筛查分析

目的 研究新生儿呼吸窘迫综合征(NRDs)对新生儿听力的影响.方法 应用耳声发射仪时71例NRDS惠儿和100名对照组新生儿进行听力筛查.结果 NRDS患几听力筛查通过率明显低于对照组.单因素Logistic回归分析提示胎龄、Apgar评分、出生体重、机械通气是其高危因素.多因素Logistic回归分析提示胎龄、Apgar评分、出生体重是其高危因素.结论 NRDs是导致新生儿听力损伤的原因之一.胎龄、Apgar评分、出生体重、机械通气可能是影响NRDS患儿听力筛查不通过的高危因素.     

The National Weight Control Registry: a critique

This article is a critique of the claim that the National Weight Control Registry provides data showing that a significant number of adults in the United States have achieved permanent weight loss. We believe that promoting calorie-restricted dieting for the purpose of weight loss is misleading and futile. We advocate the adoption of a health-at-every-size (HAES) approach to weight management, focusing on the achievement and maintenance of lifestyle changes that improve metabolic indicators of health.     

Smoking,weight standards and “ideal” weight

DIET AND DOMESTIC LIFE IN SOCIETY. Anne Sharman, Janet Theophano, Karen Curtis and Ellen Messer, Eds. Temple University Press, Philadelphia, 1991, viii +287 pp., $34.85

WITH BITTER HERBS THEY SHALL EAT IT: Chemical Ecology and the Origins of Human Diet and Medicine by Timothy Johns. Arizona Studies in Human Ecology, University of Arizona Press, Tucson, Arizona 85719, USA. US$40.00 clothbound, 356 pages.

MALARIA VACCINE DEVELOPMENT: Pre‐erythrocytic stages. S.L. Hoffmann and L.J. Martinez Eds. Proceedings of a conference held in Bethesda, Maryland, USA. Supplement to Bulletin of the World Health Organization, Vol. 68, 1990. 196 pages, English only. Sw.fr.35.‐/US$31.50. In developing countries Sw.fr.24.50.

STOP THE NONSENSE: HEALTH WITHOUT FADS Ezra Sohar, M.D. Shapolsky Publishers, Inc., New York, 159 pps. $16.95     

博山地区4780名成年人身高、体重调查及体重指数、肥胖发生率的统计分析(人群肥胖症研究之一)

作者采用较准确的方法,对博山地区20岁以上不同职业的4780人(男3216,女1564),进行了年龄、身高和体重的调查,并对调查结果作了性别、年龄、身高与体重之问关系的相关、回归分析,得出推算标准体重的回归方程式、“正常成年男女身高与体重表”。按公式计算出体重指数,并拟定了20岁以上男女体重指数的正常范围(男0.1933～0.2525,女0.1951～0.2563)和体重超重、肥胖的体重指数界限值。按这个体重指数标准,本次调查结果男性属超重者占7.71％,肥胖占5.22％;女性超重占6.96％,肥胖占4.73％。本调查资料所载博山地区20岁以上人群年龄、身高与体重之间的关系及推算标准体重的方法,对国内其它地区也会有一定参考价值。     

Maternal anthropometric measurements and other factors: relation with birth weight of neonates

The objective of this study was to examine the influence of anthropometric measurements of pregnant women, gestational weight gain, fundal height, and maternal factors, namely age, education, family income, parity along with maternal hemoglobin, on birth weight of neonates. A cross sectional study was performed in Khoy City in north west of Iran. Four hundred and fifty healthy pregnant women in the age between 16-40 years were selected for this study from seven health urban centers and one referral hospital. Findings showed that the mean age, height, fundal height, maternal weight, and gestational weight gain during pregnancy were 26.1 years, 159.1 cm, 32.9 cm, 72.0 kg, 11.8 kg respectively. The mean birth weight of neonates was 3.2 kg and 11% of neonates showed low birth weight. Age, family income, maternal height, weight, gestational weight gain and fundal height were significantly associated with birth weight of neonates. Using binary logistic regression analysis, fundal height, maternal hemoglobin, family income and gestational weight gain of pregnant women could be considered as predictive factors of birth weight of neonates.     

An exploration of the experiences and perceptions of people who have maintained weight loss

Background: In clinical weight‐loss trials, the majority of those who lose weight will regain almost all of it within 5 years, yet there is limited evidence about effective strategies to support weight maintenance. The present study aimed to increase understanding of the experiences of those who have been successful at weight maintenance. Methods: This qualitative study used a phenomenological approach. Semi‐structured interviews were undertaken with a purposive sample of 10 participants who had maintained a minimum of 10% weight loss for at least 1 year. Interviews were transcribed and then analysed using a foundational thematic approach based on the Colaizzi method. Results: Participants believed that a more relaxed approach to weight management with realistic, long‐term goals was more appropriate for long‐term control. They had a strong reason to lose weight often with a medical trigger and had elicited support to help them. Most described the presence of saboteurs. Participants took personal responsibility for their weight management and were in tune with their nutrition and activity needs. Self‐monitoring was a strategy commonly used to support this. They described the lack of positive reinforcement in the maintenance phase as a major difficulty. Conclusions: This small‐scale study provides evidence to suggest the importance of a medical prompt to lose weight; planning for how to manage saboteurs and identifying methods of minimising the impact of a reduction in positive reinforcement. It reinforces the importance of many of the strategies known to support the weight‐loss phase.     

Postpartum Weight Change in Relation to Pre-Pregnancy Weight and Gestational Weight Gain in Women in Low-Income Setting: Data from the KITE Cohort in the Northern Part of Ethiopia

(1) Background: Postpartum weight may increase compared to pre-pregnancy due to weight retention or decrease due to weight loss. Both changes could pose deleterious effects on maternal health and subsequent pregnancy outcomes. Therefore, this study aimed to assess postpartum weight change and its associated factors. (2) Methods: A total of 585 women from the KIlte-Awlaelo Tigray Ethiopia (KITE) cohort were included in the analysis. (3) Results: The mean pre-pregnancy body mass index and weight gain during pregnancy were 19.7 kg/m² and 10.8 kg, respectively. At 18 to 24 months postpartum, the weight change ranged from −3.2 to 5.5 kg (mean = 0.42 kg [SD = 1.5]). In addition, 17.8% of women shifted to normal weight and 5.1% to underweight compared to the pre-pregnancy period. A unit increase in weight during pregnancy was associated with higher weight change (β = 0.56 kg, 95% CI [0.52, 0.60]) and increased probability to achieve normal weight (AOR = 1.65, 95% CI [1.37, 2.00]). Food insecurity (AOR = 5.26, 95% CI [1.68, 16.50]), however, was associated with a shift to underweight postpartum. Interestingly, high symptoms of distress (AOR = 0.13, 95% CI [0.03, 0.48]) also negatively impacted a change in weight category. (4) Conclusions: In low-income settings such as northern Ethiopia, higher weight gain and better mental health during pregnancy may help women achieve a better nutritional status after pregnancy and before a possible subsequent pregnancy.     

664例低出生体重儿分析

本文分析１２６２５围产儿中６６４例低出生体重儿（ＬｏｗＢｉｒｔｈＷｅｉｇｈｔＩｎｆａｎｔ，ＬＢＷＩ）的出生体重及产妇情况。     

Self-reported weight and height: implications for obesity research

BACKGROUND: Self-reported weight and height are under- and over-reported, respectively, in epidemiologic studies. This tendency, which may adversely affect study operations, has not been evaluated among subjects being enrolled into a weight-loss program. METHODS: Self-reported weight, height, and body mass index (BMI) were compared to measured values in 97 overweight or obese (BMI>27.3) women being enrolled into a randomized, controlled trial of two behavioral interventions for weight loss. The effects of demographic factors, baseline weight, baseline height, and baseline BMI on weight and height reporting were assessed. RESULTS: There was a significant difference between measured and reported weight (mean difference=-3.75 lb, p=0.0001) and height (mean difference=+0.35 in., p=0.0007). The mean difference between measured and reported BMI was -1.14 kg/m(2) (p=0.0001). Unemployed, retired, or disabled women were more likely to under-report their BMI than employed women (p=0.001). Six percent of subjects who were initially considered eligible for the study on the basis of the self-report were eventually excluded from the study because they did not meet the inclusion criterion for BMI. CONCLUSIONS: Obese women who seek weight-loss assistance tend to under-report their weight and over-report their height, suggesting that self-reported data are likely to be inaccurate. Misreporting is apparently influenced by employment and disability and has the potential to complicate recruitment of subjects for research studies.     

Pregnancy-Associated Obesity in Black Women in New York City

Objective: To determine weight gain during pregnancy and weight changes postpartum in first-time mothers delivering at or near term. Methods: At about 2 weeks after delivery, 47 adult, Black and Hispanic women provided information on their prepregnancy weight and height and maximum pregnancy weight. Women reinterviewed at 2 and 6 months after delivery reported their most recent weight measurement and the date of that measurement. This information was used to compute each woman's prepregnancy body mass index, pregnancy weight gain, and weight loss postpartum. Information on infant feeding was also collected at each postpartum visit. Results: About 2/3 of the women and 100% of the overweight and obese women gained excessive weight during pregnancy. Weight gain was most marked in women who started pregnancy overweight or obese. At 2 months postpartum, women were on average almost 18 lb above their prepregnancy weight. No additional maternal weight was lost by 6 months postpartum. Most infants were started on formula by 2 weeks of age. At 2 months of age, 85% were fed formula only and 91% of the infants were on WIC. Conclusions: Our results demonstrate a need for interventions to help women avoid obesity by regulating their pregnancy weight gain, losing weight for a longer period postpartum, and initiating and maintaining exclusive breast-feeding.     

Objectively Assessed Weight Change and All-Cause Mortality among Community-Dwelling Older People

Later life changes in body weight may be associated with an increased risk of mortality in older adults. The objective of this study was to examine whether weight change over four years was associated with a 17-year mortality risk in older adults. Participants were 1664 community-dwelling adults aged ≥65 years in the longitudinal Enquete de Sante’ Psychologique-Risques, Incidence et Traitement (ESPRIT) study. Outcomes were all-cause mortality, cardiovascular disease (CVD) and cancer mortality. Weight change was defined as difference between weight at baseline and 4 years, categorised into: weight stable (±<5% weight change), weight loss (≥5%) and weight gain (≥5%). Association between weight change and mortality risk was evaluated using Cox proportional hazards models. Over 17 years of follow-up (median 15 years), 565 participants died. Compared to stable weight participants, those with ≥ 5% weight loss had an increased risk of all-cause mortality (HR: 1.24, 95% CI: 1.00–1.56, p = 0.05) and CVD mortality (HR: 1.53, 95% CI: 1.10–2.14, p = 0.01), but not cancer mortality (HR: 0.83, 95% CI: 0.50–1.39, p = 0.49). Weight gain of ≥5% was not associated with increased mortality (HR: 1.05, 95% CI: 0.76–1.45, p = 0.74). Weight monitoring in older adults could help identify weight loss at its early stages to better target interventions to maintain nutritional reserve and prevent premature mortality.