影响极低出生体重儿存活率的相关因素

目的　探讨影响极低出生体重儿 (extremelylowbirthweightinfant,ELBWI)存活率的相关因素 ,以采取相应措施。　方法　将 4 2例ELBWI按体重分为三组 ,并对其临床资料进行回顾性分析。　结果　ELBWI出院时存活 2 2例 ,存活率 5 2 % (2 2 /4 2 ) ;死亡 19例 ,病死率 4 5 % (19/4 2 ) ,放弃 1例。存活率随体重增加而增高 (P <0 .0 1) ,病死率则下降 (P <0 .0 1)。存活者平均住院天数 (33.5± 8.3)d ,住院天数随体重增加而缩短 (P <0 .0 1)。引起ELBWI的主要原因是 :多胎妊娠 (4 5 % ) ;胎膜早破 (2 9% ) ;妊娠并发症 (19% ) ,包括妊娠高血压综合征 (17% )、胎盘早剥 (2 % ) ;妊娠期慢性疾病(7% )。全部ELBWI均存在一种以上并发症。其体重越低并发症发生率越高 (P <0 .0 1)。死亡主要原因是 :新生儿呼吸窘迫综合征、颅内出血、肺出血、呼吸循环衰竭、肾功能衰竭等。　结论　加强围产期保健与监护 ,提高儿科对ELBWI管理及并发症的处置水平 ,是提高ELBWI存活率、降低病死率的关键。     

极低出生体重儿的临床干预和并发症的发生率及病死率研究

目的　探讨极低出生体重儿主要并发症的特点及影响其存活率的相关因素 ,以便改进干预措施 ,进一步降低其病死率。　方法　对 1996年 1月～ 2 0 0 1年 12月于生后 2 4 h内转入 NICU的 12 2例极低出生体重儿的临床资料进行回顾性分析 ,并按出生体重分 3组 ,对其并发症的发生率、转归、主要死因、肠道喂养开始时间及体重变化情况等进行分析比较。　结果　导致极低出生体重的主要原因有多胎妊娠 (30 % )、妊娠合并症 (2 1% )、羊膜早破 (15 % )和原因不明 (30 % )等。所有患儿均有一种或多种并发症 ,主要为高血糖 (5 7% ) ,缺氧缺血性脑病 (46 % ) ,呼吸窘迫综合征 (33% ) ,感染(30 % ) ,低体温 (2 5 % ) ,呼吸暂停 (2 4 % ) ,脑室内出血 (18% )和动脉导管未闭 (18% )等。由于采取预防性干预措施 ,大多数并发症的发生率在不同体重组间的差异无显著性。本组极低出生体重儿存活率为 84 % ,若排除因经济困难或担心后遗症而放弃治疗后死亡的病例 ,则存活率为 91% ;其中出生体重≤ 10 0 0 g者为 5 9%。死亡的主要原因为呼吸窘迫综合征、感染和先天畸形。存活者能耐受经口胃管喂养开始时间为 (6± 4 ) d,不同出生体重之间差异无显著性 (F=1.36 ,P>0 .0 5 ) ;自行吸吮开始时间为 (2 3± 14 ) d,且随出生体重增加而     

新技术应用对机械通气极低出生体重儿预后的影响

目的　探讨新的治疗技术如肺表面活性物质 (PS) ,鼻塞CPAP(NCPAP) ,以及开展新生儿转运对需机械通气的极低出生体重儿 (VLBWI)预后的影响。　方法　 73例因呼吸衰竭、反复呼吸暂停、心肺复苏需机械通气的VLBWI按用新技术前后分为A组 3 2例 (1995～ 1998年 )和B组 41例(1999～ 2 0 0 2年 )。B组有 10例用PS(占 2 4% ) ,拔管后改用NCPAP 12例 (占 2 9% ) ,转运的患儿有11例 (占 2 7% )。　结果　两组比较 ,B组存活率明显提高 (3 9%与 71% ,P <0 .0 5) ;机械通气时间缩短 [(8.15± 11.57)d与 (4.59± 3 .50 )d(P <0 .0 5) ] ;院内感染发生率降低 (47%与 2 4% ,P <0 .0 5) ;低体温、代谢性酸中毒B组亦明显减少 ,而慢性肺疾病、颅内出血两组差异无显著性。　结论　VLB WI生后即予PS预防和治疗呼吸窘迫综合征 ;尽早撤离呼吸机 ,改用NCPAP ;开展新生儿转运 ,可能提高VLBWI机械通气的存活率 ,降低病死率     

116例极低出生体重儿的临床管理及转归简

目的 分析极低出生体重儿并发症、治疗及预后情况,为极低出生体重儿的防治和管理提供参考.方法 收集116例极低出生体重儿临床资料,对不同胎龄的极低出生体重儿并发症、治疗及预后进行分析.结果 极低出生体重儿的并发症主要有呼吸暂停、肺炎、新生儿呼吸窘迫综合征、贫血、败血症等,治疗措施主要有吸氧治疗、抗生素治疗、输血治疗、肺表面活性物质替代治疗、氨茶碱治疗、鼻塞式持续气道正压通气治疗、全胃肠外营养、布洛芬治疗、第3代SiPAP无创呼吸机治疗、机械通气等.116例极低出生体重儿治愈出院96例（82.76%）,放弃9例（7.76%）,死亡4例（3.45%）,转院7例（6.03%）.结论 极低出生体重儿并发症多,应用肺表面活性物质及机械通气等治疗措施,存活率不断得到提高.     

极低出生体重儿宫外生长发育迟缓及营养支持分析

目的　评价上海市极低出生体重儿(very low birth weight infant,VLBWI)出生时胎儿生长受限(fetal growth restriction,FGR)和出院时宫外生长发育迟缓(extrauterine growth retardation,EUGR)的发生率并分析营养支持的影响. 方法　收集上海市5家医院126例VLBWI临床资料,分析FGR和EUGR发生率,比较EUGR和非EUGR患儿间的生长发育和营养支持指标.并采用Logistic回归分析EUGR危险因素. 结果 以体重评价,FGR与EUGR发生率分别为53.2%和80.2%,以头围评价为55.6%和46.7%;FGR和EUGR的发生率均随体重减少而增加;以体重评价时,FGR和EuGR发生率随胎龄增加而增加.EUGR组出生胎龄为(32.2±1.8)周,脂肪乳剂为(1.4±0.5)g/(kg·d),高于非EUGR组[分别为(30.9±2.7)周和(0.9±0.2)g/(kg·d)];而出生体重为(1330±156)g,低于非EUGR组[(1380±90)g].Logistic回归分析发现首次应用EN的日龄(OR=0.264,95%CI 0.079～0.876,P=0.04)和PN配方葡萄糖用量(OR=0.029,95%CI 0.001～O.861,P=0.048)是EUGR的危险因素. 结论 出生体重越低,EUGR发生率越高;目前的营养策略仍存在缺陷,不能满足VLBWI生后的营养需求.     

极低和超低出生体重儿出院——生命历程新起点

随着围产医学及新生儿重症监护和治疗技术的发展,近20年来无论经济发达国家还是发展中国家,极低出生体重儿(very low birth weight infant,VLBWI)和超低出生体重儿(extremely low birth weight infant,ELBWI)的存活率都显著提高,远期的生存质量也备受关注.生后早期的监护和治疗与其存活率和生存质量密切相关,而出院后的监护、营养及训练指导同样是保证存活率及促进体格和精神神经发育的重要组成部分.对于VLBWI和ELBWI,出院不是监护和治疗的结束,而是一个新的开始.     

机械通气对新生儿血浆中抗氧化酶活性的影响

目的　探讨机械通气对新生儿血浆中抗氧化酶 (antioxidant enzyme,AOE)活性的影响。　方法　用酶活性测定法检测 72例新生儿机械通气前后血浆中过氧化氢酶 (catalase,CAT)、谷胱甘肽过氧化物酶 (glutathione peroxidage,GPX)和超氧化物歧化酶 (superoxide dism utase,SOD)的活性。　结果　 (1)机械通气前 ,早产儿与足月儿 ,低出生体重儿与正常出生体重儿血浆 GPX分别为(90± 6 1)、(116± 5 1)、(94± 6 1)、(113± 5 2 ) k U/ L,CAT分别为 (6 8± 43)、(82± 43)、(6 9± 41)、(84±43) k U/ L,差异无显著性 (P>0 .0 5 ) ,而 SOD在早产儿和低出生体重儿较低 [分别为 (78± 11)、(84±11) k U/ L(P<0 .0 5 )。(2 )机械通气后 ,各组 GPX、CAT、SOD均随通气时间的延长而下降 ,但足月儿、正常体重儿下降幅度较小 ,而早产儿、低出生体重儿下降幅度较大。通气后 3d GPX、CAT、SOD在早产儿分别为 (72± 47)、(5 1± 33)、(5 3± 9) ,足月儿分别为 (10 2± 49)、(78± 37)、(87± 11) ,低出生体重儿分别为 (70± 48)、(4 9± 31)、(5 1± 9) ,正常出生体重儿分别为 (10 3± 47)、(74± 2 3)、(85± 12 ) k U/L,早产儿低于足月儿 ,低出生体重儿各项均低于正常出生体重儿 (P<0 .0 1)。　结论　机械通气可降低新生     

影响极低出生体重儿早期生长赶超的原因

目的 分析极低出生体重儿（very low birth weight infant，VLBWI）在纠正胎龄40周时的生长赶超情况及影响因素。方法 以50例VLBWI作为研究对象。以40周胎龄健康足月儿和15个城市不同胎龄婴儿出生体重为正常值，比较50例VLBWI在出生、出院时及纠正胎龄40周时的小于胎龄儿（small for gestational age，SGA）发生率；分析喂养方式、并发症、辅助治疗等对VLBWI生长赶超的影响。结果 50例VLBWI在纠正胎龄40周时的体重为（3290±640）g，与同胎龄足月儿比较差异无统计学意义（P〉0．05）。50例VLBWI出院时SGA所占比例为64．0％（32／50），明显高于出生时的24．0％（12／50）和纠正胎龄40周时的32．0％（15／50），P均〈0．05。出生时SGA（OR=0．035，95％CI0．003-0．487）、低T3综合征（OR=0．101，95％CI0．013～0．774）及长期使用静脉营养（OR=0．307，95％CI0．097-0．972）是导致VLBWI生长赶超失败的危险因素，而早期开展肠道喂养（OR=8．241，95％CI1．373～49．470）则有利于VLBWI的生长赶超。并发低T3综合征的VLBWI住院4周期间及出院后平均体重增长速度均低于未并发低T3综合征的VLBWI（P均〈0．05）。结论 合理的营养方案、降低并发症的发生率是VLBWI实现早期生长赶超的关键。     

极低和超低出生体重儿脑损伤的监测

随着产前保健和新生儿医疗护理技术的进步,近20年来极低出生体重儿(very low birth weight infant,VLBWI)的存活率有了显著提高[1-2],但其神经系统伤残如脑性瘫痪及远期神经发育障碍等并没有相应减少[3-4].尤其那些超低出生体重儿(extremely low birth weight infant,ELBWI),其神经系统伤残的风险不但没有降低反在增加,包括住院期间颅脑影像学检查没有异常发现者[5-6];具有高危因素者,如多胎、曾接受产房内复苏、影像学检查存在明显脑损伤、接受呼吸机治疗、出生体重不足750 g者更易发生远期神经系统伤残[6-9].     

新生儿真菌败血症18例分析

随着围产医学的不断发展,早产儿的存活率逐年提高,尤其是许多极早产儿在新生儿重症监护病房(neonatal intensive care unit,NICU)的住院时间较长,早产儿医院感染发生率也随之攀升.美国最近一项涉及6000多例极低出生体重儿(very low birth weight infant,VLBWI)的调查发现,21%经血培养证实发生晚发型败血症(生后3 d以上发生者),其中12%是真菌感染.     

妇科肿瘤转移机制中

SNAIL基因表达异常在妇科肿瘤侵袭和转移中担当了重要的角色。SNAIL基因在细胞水平调节细胞间的黏附,其过度表达会导致上皮细胞-间充质细胞转换,从而引起肿瘤的发生发展、侵袭和转移。各种诱导因子可通过多种信号途径诱导SNAIL的过度表达,顺序激活下游相关靶点,从而引起肿瘤细胞转移。对SNAIL家族成员的深入研究不仅可更进一步阐明SNAIL超家族的作用机制,并且为进一步研究SNAIL与其相关的肿瘤治疗策略提供理论依据。     

The Use of Ritodrine in The Management of The Fetus During the Second Stage of Labour

Summary: A double blind controlled trial was conducted to assess whether maternal intravenous infusion of ritodrine during the second stage benefits the fetus. The pH of both umbilical arterial and umbilical venous blood was increased significantly as a result of the infusion. In addition, the time dependent fall of pH during delivery was abolished. The benefit of ritodrine infusion was therefore demonstrated, and its possible use in women with high risk fetuses should be further tested.     

The Politics of Home Delivery in The Netherlands

ABSTRACT: The Netherlands has been unique among western industrialized countries in having a high proportion of home deliveries and a low infant mortality rate. It is often looked to as an example of a high quality, family-centered system of perinatal care. Recently, with falling birth rates, an imminent oversupply of professionals, removal of financial barriers, and the technologising of medicine, some marked changes have been occurring. Midwives have maintained a constant 40% of the attendance at deliveries, but general practitioners are attending fewer births and obstetricians more. The percent of hospital deliveries has doubled in the last 20 years. Even midwives are coming to be hospital-based. National policy has favoured home delivery, but in practice, a number of professional, financial and political forces are working in the opposite direction. The trend to a reduction of home deliveries seems likely to continue. A stronger voice for consumers and better evaluation of the effects of home delivery are in order if home delivery is to retain a significant place in Dutch perinatal care.     

The essence of nurse-midwifery care The woman's story

The purpose of this qualitative research study was to discover the experience of the woman cared for by a nurse-midwife. Six variously situated and ethnically diverse women were interviewed about their experience with nurse-midwifery care. Using Colaizzi's phenomenological method, the data were analyzed extracting 151 significant statements that were clustered into nine themes. A picture of the essential structure of the women's experience of nurse-midwifery care unfolded and was returned to them for their comments and confirmation. Women talked about a relationship built on respect, trust, and alliance. It was the nurse-midwife herself, her qualities and behaviors, her concern and caring, and her respect for women that laid the foundation for how the women in this study perceived the experience. Repeatedly, women articulated the respect for their time, their families, their fears, and their need for information. Ultimately, it was this respect from the nurse-midwife that empowered the women to determine and direct their care.     

The focus of women in The American Fertility Society

This article reports survey responses from 71 female members of the American Fertility Society during the Society's 1984 annual meeting. Survey questions concern 1) demographic factors such as rank, degree, title, address, and number of children, 2) field of specialization and research interests, and 3) what the Society can do for its meeting participants. The typical respondent is a physician living in the Eastern United States and employed as an assistant professor in an academic setting. In vitro fertilization is the greatest area of interest, followed by general practice, endocrine and male infertility, contraception, and fertility surgery. Survey responses show that women are interested in 1) networking, 2) increased visibility at professional meetings, 3) information about research possibilities and grants, 4) child care provision at Society meetings, and 5) more basic science and physiology oriented presentions in the program. In response to networking interests, the Society will make available information from the surveyed members. Since 16% of respondents have a PH.D., and 77% are employed in academics, the Society should consider more basic presentations. The need for day care indicates changes in Society membership. The Society plans to conduct similar surveys on a regular basis.     

The reliability of perinatal mortality statistics in The Netherlands

All 13 hospitals in the municipality of Amsterdam cooperated in this study; labor ward records for the years 1981 and 1982 were personally searched for cases of perinatal death that corresponded with the World Health Organization definitions of perinatal mortality, presently applied in The Netherlands. The 360 cases that had apparently occurred in the Amsterdam hospitals were individually linked to the cases that had been entered into the national records at the Central Bureau of Statistics. The study established that the magnitude of underregistration of perinatal mortality is considerable (14.3%). Underregistration at the national level is due to underreporting by physicians and not due to errors in statistical bookkeeping. Underreporting is related to birth weight, that is, viability of the infant, and immigrant status of the mother. Recommendations are made to improve uniformity of notification criteria and reliability of perinatal mortality statistics.     

The twentieth century: The century of progress and medicine

The standard criteria for the diagnosis of gestational diabetes (GDM) is based on two abnormal values of a 3-h-100-g oral glucose tolerance test (GTT). Although a markedly elevated 1 h–50-g screen value has been suggested to support a diagnosis of GDM, limited data are available to substantiate this empiric observation. Our purpose was to examine the utility of various 50-g screen cutoff values in establishing the diagnosis of gestational diabetes.

We identified 422 gravidas with a positive 50-g screen (≥135 mg/dl) who underwent additional glucose testing. GDM was defined according to the National Diabetes Data Group (NDDG) standards for the 3-h GTT. An analysis employing the criteria of Carpenter and Coustan was performed for comparison. If a patient had an elevated 50-g value and no 3-h GTT was performed, a fasting serum glucose ≥140 mg/dl was considered evidence of gestational diabetes.

One hundred twenty four (29.4%) had GDM as defined by the NDDG criteria; this increased to 161 (38%) when the diagnosis was based on Carpenter and Coustan's criteria. The mean (≥SD) gestational age at screening was 24 ± 7 weeks. As expected, the prevalence of GDM increased in relation to an increasing 50-g value. All subjects with a 50-g screen < 216 mg/dl had evidence of gestational diabetes and required insulin for glycemic control.

Patients with a 50-g screen ≥220 mg/dl do not all require a 3-h GTT. Those with a fasting serum glucose of ≥140 mg/dl may begin diet therapy, glucose monitoring, and insulin as indicated. If the fasting serum glucose is < 140 mg/dl, a 3-h GTT should be performed for confirmation of GDM. This approach will facilitate rapid therapeutic intervention and reduce the cost of care in this subset of patients. Gravidas with a very high 50-g screen are at significant risk of requiring insulin to maintain euglycemia during pregnancy.