新生儿血浆生长抑素水平的检测

采用放射免疫法检测了４７例新生儿血浆生长抑素（ＳＳ）水平的动态变化，结果显示：足月儿和早产儿血浆ＳＳ水平随日龄增加而上升，早产儿脐血，出生后第１，５ｄ血浆ＳＳ水平明显低于足月儿第９ｄ接近足月儿，新生儿血浆ＳＳ水平与胎龄，日龄呈正相关，与出生体重，性别无相关性，研究认为，血浆ＳＳ水平的检测可为科学喂养新生儿提供一定理论依据。     

早产儿D-二聚体及凝血功能动态变化的临床意义

目的 观察不同日龄正常早产儿D-二聚体(DD)、血浆凝血酶原时间(PT)和活化部分凝血时间(APTT)生理水平及其变化的临床意义.方法 选取日龄1、5、10d的早产儿各20例及1、5、10d正常足月儿各20例(作对照),检测血浆DD、PT、APTT水平,比较各组间凝血、纤溶活性变化及其日龄变化规律.结果 (1)早产儿和足月儿DD在新生儿期较高,尤其是早产儿在生后1周内;DD随日龄增长而降低,早产儿降低较慢.(2)早产儿PT、APTT在第1天与足月儿比较差异有统计学意义(P<0.05),在第5、10天与足月儿比较差异无统计学意义(P>0.05).(3)早产儿PT、APTT随着日龄增长有下降趋势;足月儿第1天的APTT较长,PT则无明显变化.结论 新生儿出生后DD高于正常值,尤其是早产儿DD显著高于正常值,PT及APTT均较高.提示凝血、纤溶活性的增强,对新生儿特别是早产儿临床出现DD高于正常或PT及APTT延长时,应动态观察,诊断DIC要慎重.     

早产儿血清前清蛋白浓度及其血浆蛋白质量分析

目的探讨通过早产儿出生后血清前清蛋白浓度与血浆蛋白质量变化来分析其真实营养水平。方法检测36例早产儿出生时血清前清蛋白浓度,对比44例足月儿;同时追踪出生后第3天的前清蛋白水平及计算其前清蛋白血浆蛋白质量。结果 (1)早产儿较足月儿前清蛋白水平明显下降(P<0.01),胎龄越小,变化越明显;(2)出生后3 d时的前清蛋白的血浆蛋白质量变化低于前清蛋白水平变化。结论前清蛋白能够有效反映出生时早产儿真实营养水平,其血浆蛋白质量的变化更利于出生后监测早产儿营养水平。     

足月儿和早产儿血钙及尿钙水平的测定及分析

目的探讨足月儿和早产儿血钙、尿钙的水平及其相关性。方法选取2009年9月—2011年9月我院新生儿科住院的新生儿63例为研究对象,其中足月儿36例(57.14%),早产儿27例(42.86%)。均留取生后第1、2、3天静脉血标本进行血钙水平检测,留取生后第1、2、3天尿标本进行尿钙水平检测。结果 63例新生儿中,出生第1天发生低钙血症共32例,其中,足月儿13例(36.11%),早产儿19例(70.37%),足月儿与早产儿低钙血症发生率比较,差异有统计学意义(P<0.01)。足月儿与早产儿出生后第1、2、3天血钙水平比较,差异均有统计学意义(P<0.05)。足月儿与早产儿出生后第1、2、3天尿钙水平比较,差异均有统计学意义(P<0.05)。出生后前3d血钙与尿钙水平呈正相关(r=0.891,P<0.01)。结论早产儿由于多种因素影响,导致血钙偏低,但机体代偿性逐步减少尿钙排泄以维持更接近正常的血钙水平。     

血清α1—微球蛋白含量检测对新生儿肾小球功能状况的评估

测定了４０例足月儿，２８例早产儿，９例窒息儿生后３ｄ内血清α１－ＭＧ，β２－ＭＧ，Ｓｃｒ含量。结果早产，窒息两组新生儿血清α１－ＭＧ，β２－ＭＧ均明显高于足月新生儿组（Ｐ〈０．０１），窒息组Ｓｃｒ高于足月儿且；早产儿组与足月新生儿组。窒息组Ｓｃｒ高于足月儿组（Ｐ〈０．０１）；早产儿组与足月儿组无显著性差异。血清α１－ＭＧ与β２－ＭＧ呈正相关关系，α１－ＭＧ在可靠性，灵敏性方面优地β２－ＭＧ。提示α     

尿α_1─M测定对新生儿窒息时肾损害的诊断价值

新生儿窒息可引起多脏器损害，其中肾损害并不少见。现报道40例窒息新生儿的尿α1－M检测结果，并对其在新生儿窒息后反映肾功能损害的价值进行探讨。一、临床资料1．一般资料：本组资料来自本院监护病房和新生儿科。40例窒息新生儿中男29例、女11例；足月儿27例，早产儿13例；生后Apgar评分≤4分17例，5～7分23例；入院日龄平均为15．8小时。正常对照组共32例，男22例、女10例；足月儿20例，早产儿12例；生后Apggr评分8～10分；入院日龄平均为29．2小时。2．方法：均在入院后24小时内采集尿液2ml，－20℃保存。用放射免疫法在一周内测定…     

大剂量丙种球蛋白治疗新生儿败血症29例疗效观察

目的：探讨静脉滴注免疫球蛋白（ＩＶＩＧ）治疗新生儿败血症的临床效果。方法：选用同期住院的新生儿败血症患儿随分为２组：治疗组２９例以ＩＶＩＧ３００－５００ｍｇ．ｋｇ＾－１．ｄ＾－１,用药１－３ｄ;对照组３３例常规治疗。两组间早产儿与早产儿,足月儿与足月儿、发病日龄、临床症状、体征,并发症及用药前血清ＩｇＧ比较无显著差异（Ｐ〉０．０５）。结果：治疗组血培养转阴及患儿体温稳定时间均明显缩短,并发症较少,     

超声流量仪对不同孕周新生儿潮气呼吸正常值的测定

目的：建立正常足月儿及不同孕周早产儿潮气呼吸正常值并分析其差异。方法：对55例足月儿、30例晚期早产儿和25例出生胎龄<34周早产儿,在生后1、14日及28日龄,用超声流量仪进行潮气呼吸检测。结果：新生儿期各孕周潮气呼吸功能参数呈正态分布。在第1、14天及28天呼气达峰时间/呼气时间,呼气达峰容积/呼气量,75%、50%、25%潮气量时呼气流速（tidal expiratory flow at 75% remaining tidal volume,TEF75;tidal expiratory flow at 50% remaining tidal volume,TEF50;tidal expira－tory flow at 25% remaining tidal volume,TEF25）值逐渐升高,而呼吸频率（respiratory rate,RR）值则逐渐下降;RR与TEF75、TEF25的相关性在足月儿组为显著相关（r=0.469,0.539,均P<0.01）,在早产儿组为不相关（r=0.190,0.220,均P >0.05）。而晚期早产儿组则RR只与TEF25有相关性（r=0.231,P<0.05）,而与TEF75无相关性（r=0.130,P >0.05）;纠正胎龄40周时,早产儿组潮气呼吸参数TEF25、TEF50、TEF75、潮气量明显低于足月儿组,RR明显高于足月儿组（均P<0.05）,晚期早产儿组同足月儿比较,上述潮气呼吸参数差别无统计学意义（均P >0.05）。结论：新生儿肺功能参数随日龄逐渐改善,在纠正胎龄40周时,小于34周早产儿潮气呼吸参数仍不能达到足月儿组水平。而RR与TEF25、TEF75在足月儿具有相关性,早产儿则未能体现,新生儿潮气呼吸肺功能的测定及相关性分析有助于评估新生儿特别是早产儿的肺发育。不同孕周新生儿潮气呼吸各项指标可作为临床参考正常值。     

窒息新生儿血浆D-二聚体变化的研究

目的:探讨窒息足月、早产新生儿血浆D-二聚体变化特点,研究其与新生儿DIC的关系。方法:检测10例正常新生儿,44例窒息足月儿,32例窒息早产儿的血浆D-二聚体水平。结果:与对照组比较,窒息足月儿D-二聚体明显升高,且与窒息程度正相关。窒息早产儿与窒息足月儿比较,D-二聚体无明显差异。结论:窒息足月儿大都存有前DIC或DIC早期,而窒息早产儿更易发生DIC。     

新生儿血清瘦素与出生体重关系的研究

目的研究早产和足月新生儿血清瘦素与出生体重的关系。方法共收集143例早产和足月新生儿，按胎龄进行分组，并进行出生测量，于生后第3天检测瘦素水平。结果足月儿血清瘦素浓度显著高于早产儿，瘦素浓度与胎龄的关系按非线性模式增加，胎龄34周以后，瘦素浓度增加明显加快；胎龄32周后血清瘦素浓度与出生体重呈正相关关系。结论胎龄〉32周的新生儿体内可能已开始存在脂肪-胰岛素内分泌轴。     

Measurement and Clinical Significance of Endothelin inNeonatal Urine

Endothelin(ET),a21--aminoacidpeptide,isthemostpotentendogenousvasoconstrictoridentifiedtodate.Itisoriginallyisolatedfromtheculturemediumofporcineaorticendothelialcells[lj.Researchesonithavemadefastprogressinrecentyears,butrarelyinvolvedinurinaryET.ThepresentstudywasdesignedtoexamineurinaryETlevelsinhealthyandasphyxiatedneonates,toelucidatethesourceofurinaryETanditsclinicalsignificance.1PATIENTSANDMETHODS1'1SubjectsForreasonsofconvenientandaccurateurinecollections,onlymaleinfantswere…     

Experience of early breast milk feeding in preterm very low birth weight infants

Although human milk is generally accepted as the gold standard for the feeding of term infants, its use in the preterm and very low birth weight (VLBW) infants particularly in the initial period of birth has been more controversial. Little is known about the risks and benefits of early introduction of breast feeding on preterm VLBW infants. The primary object of this study was to evaluate the safety and benefit of early breast milk feeding in preterm VLBW newborns during their initial hospitalization periods. Therefore a prospective observational study was conducted among 37 preterm VLBW infants who were admitted to the Neonatal ward of Sir Salimullah Medical College and Mitford Hospital during the period of February 15th to July 25th, 2003. Oral feeding with breast milk was started within one hour of birth, and weight gain, feeding tolerance, nosocomial infection rate as well as other associated problems of pre-maturity, and postnatal growth curve were recorded upto 16th postnatal day. Seventy three percent of the newborns tolerate breast milk well from the very beginning, and the rest did not tolerate initially but all of them tolerate within 24 hours of birth. Infants had less initial weight loss (20 ± 10 gm) and faster recovery of birth weight. They regained their birth weight at 12th postnatal day. Hyper-bilirubinaemia was found in only 22% cases, and was observed in the group who initially didn't tolerate breast milk and was on intravenous fluid. Nobody developed symptomatic hypoglycemia or necrotizing enterocolitis (NEC). Two cases of sepsis and another two cases of minor infection like conjunctivitis and oral thrush have occurred. In conclusion it can be said that early breast milk feeding is safe in preterm VLBW infants and it helps to promote growth and reduce the need for intravenous line.     

不同胎龄、不同出生体重新生儿的首次肝功能指标的差异性

  目的  探讨不同胎龄、不同出生体重新生儿的首次肝功能指标的差异变化。  方法  回顾性分析204例不同胎龄早产儿、206例不同出生体重儿的首次肝功能指标总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）、总蛋白（TP）、白蛋白（ALB）、丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰基转移酶（GGT）、总胆汁酸（TBA）、前白蛋白（PA）、胆碱酯酶（CHE）的变化。比较分析各组中和组间生化指标的差异。  结果  不同胎龄、不同出生体重新生儿的首次肝功能指标存在差异:（1）晚期早产儿、中期早产儿、极早产儿中TP、ALB依次递减（P < 0.05）;CHE无统计学意义（P > 0.05）。晚期早产儿、中期早产儿的DBIL、GGT生成、排泄均比极早产儿好（P < 0.05）。（2）与正常出生体重儿比较,低出生体重儿仅TBA增高（P < 0.05）;与极低出生体重儿比较,正常出生体重儿、低出生体重儿DBIL、CHE增高,但仅有低出生体重儿DBIL具有统计学意义（P < 0.05）。  结论  不同胎龄、不同出生体重新生儿随胎龄越小、体重越轻,肝脏功能越差。胎龄对肝脏功能的影响,远大于体重对肝脏功能的影响。     

脐血神经生长因子及新生儿行为神经评分与新生儿窒息的相关性研究

目的探讨新生儿脐血中神经生长因子(NGF)在早期诊断新生儿窒息中的临床价值及其与窒息预后的关系,研究围生期高危因素以及新生儿行为神经评分(NBNA)在新生儿窒息发生发展及预后中的作用。方法 30例正常足月儿作为对照组,57例窒息新生儿作为窒息组,于胎儿娩出后取脐带血,采用酶联免疫吸附试验双抗体夹心法(ELISA)检测NGF,收集并分析两组围生期相关资料,并于新生儿出生后1、3、7 d进行NBNA评分。结果窒息新生儿脐血中NGF水平(185±10)ng/L,低于正常足月新生儿的(228±22)ng/L,差异有统计学意义(P<0.05)。正常足月儿组、Apgar评分正常但有神经系统症状组、轻度窒息组、重度窒息组NGF水平比较差异有统计学意义(P<0.05),其中两两比较差异均有统计学意义(P<0.05),且窒息的程度越重,脐血NGF水平越低。窒息新生儿脐血NGF水平与Apgar评分呈正相关(r=0.410,P=0.002)。生后第1、3、7天正常足月儿组、Apgar评分正常但有神经系统症状组、轻度窒息组、重度窒息组NBNA评分比较差异均有统计学意义(P<0.05),其中两两比较差异均有统计学意义(P<0.05),且病情越严重,评分越低。第7天Apgar评分正常但有神经系统症状组、轻度窒息组、重度窒息组NBNA评分<35分的患儿分别占20.0%、36.7%、94.1%。窒息新生儿NBNA评分与Apgar评分呈正相关(r=0.694,P=0.000)。窒息新生儿脐血NGF水平与NBNA评分呈正相关(r=0.364,P=0.005)。结论检测脐血NGF水平及对新生儿进行动态监测NBNA评分对完善新生儿窒息的诊断及其严重程度的判断,预防新生儿窒息导致的后遗症,如新生儿缺氧缺血性脑病(HIE)、癫痫、脑瘫等起着极为重要的作用。     

早产儿脐血瘦素和血脂水平测定及临床意义

目的通过检测新生儿脐血瘦素和血脂水平,探讨二者对胎儿生长发育的影响,并分析脐血瘦素和血脂之间的相关性。方法根据胎龄和出生体重分为三组：正常足月儿组,早产低出生体重儿组,早产极低出生体重儿组。酶联免疫法检测脐血瘦素,全自动生化分析仪检测脐血TC、TG、HDL-C、LDL-C。结果随着胎儿胎龄及体重的增加,胎儿体内的瘦素水平升高,早产低出生体重儿和早产极低出生体重儿脐血LDL-C水平高于正常足月儿,脐血瘦素与LDL-C呈负相关。结论瘦素可能是胎儿生长发育的重要调控因子之一,早产儿出生时的低瘦素和高LDL-C可能是成人心血管疾病高危因素之一。     

断脐时间对母儿结局的影响

目的:探讨断脐时间对母儿结局的影响。方法:176例产妇随机分为两组,试验组进行晚断脐(等待脐带搏动停止后),对照组按目前临床常规执行早断脐(生后少于10 s),比较两组产后出血量、新生儿脐血血红蛋白、生后最高1次胆红素值、新生儿Apgar评分及是否贫血、是否需要光疗等母儿结局。结果:足月儿127例,早产儿49例,足月儿两组脐血血红蛋白浓度及新生儿1分钟、5分钟Apgar评分均无统计学差异(P>0.05),试验组产后出血量及出生后最高1次胆红素水平明显低于对照组(P<0.05);早产儿两组母儿结局各指标差异均无统计学意义(P>0.05);足月儿和早产儿两组新生儿贫血和需要光疗者所占比例均无统计学差异(P>0.05)。结论:晚断脐(等待脐带搏动停止后断脐)比早断脐(生后10 s)有更少的产后出血量,不增加新生儿胆红素水平,未显示晚断脐对母儿结局有不良影响,分娩应遵循自然规律,等待脐带搏动停止后断脐,以防止过早断脐可能的潜在不良影响。     

早产儿脐血瘦素和胰岛素水平测定及其临床意义

目的:探讨早产儿脐血瘦素和胰岛素水平变化与宫内生长发育状态关系的临床意义。方法:选择无产、儿科合并症的早产儿29例,足月儿41例,于分娩后收集脐静脉血。采用ELISA法和Access免疫分析系统分别测定血清瘦素和胰岛素水平。结果:早产低体重儿瘦素和胰岛素水平明显低于足月儿(P<0.05)。比较胎龄>34周、体重>2000g早产儿的瘦素和胰岛素水平较其以下者均示差异有统计学意义(P<0.01,P<0.05)。结论:脐血胰岛素水平高低与瘦素水平变化在反映早产儿不同时期内的宫内营养状态呈一致性。了解早产儿出生时的瘦素和胰岛素含量对今后早产儿生存质量的监测和易发生的慢性疾病的早期干预有其一定的临床意义。     

Pattern of change of weight following birth in the early neonatal period

Birth weight of new born will vary according to gestational age, maternal, Placental and foetal intrauterine conditions. Postnatal weight change in the first few days of life (early neonatal period) may vary according to gestational age and birth weight. This may create problem in management of these babies. Birth weight and their pattern of change were followed on 105 newborns. Questionnaire and observation charts were the research Instruments and statistical analysis were done by using manual calculator. It was observed that full term newborns had better control on initial weight change following birth than preterm and low birth weight babies. Majority of term newborns loss their weight up to 5 days of life and regained their initial weight by 10 days. Maximum weight loss for longer duration occurred in preterm and very low birth weight babies who regained their initial weight by 10 - 14 days and some required more than 21 days.     

高危早产儿生后1年内生长状况分析

目的 探讨高危早产儿出生至1岁期间的生长发育状况.方法 回顾性分析2009年4月-2010年4月在本院出生并在高危儿门诊随访到1岁的早产儿34例(早产小于胎龄儿9例)与足月儿34例,并用SPSS 16.0软件分别比较出生后12个月内体重、身高、头围的生长速度.结果 早产儿2月、4月龄体重、身高、头围均明显低于正常足月儿...     

Exclusive Breast Feeding in Low Birth Weight Babies

Background

Human milk is the ideal source of nutrition for full term neonates, but there is controversy regarding its use as a nutrition source for preterm and low birth weight infants. However current data supports the use of human milk for low birth weight infants. This study was undertaken to evaluate the growth of both preterm and term small for gestational age infants nursed on exclusive breast milk from birth to four months of age.

Methods

This was a prospective, longitudinal study carried out in a recognized baby-friendly hospital where exclusive breast-feeding is practiced in all neonates. All consecutive low birth weight neonates irrespective of gestational age, born during the study period of two years were included in the study. Assessment of growth parameters included recording of weight (daily when in the hospital and later weekly), length (weekly) and head circumference (weekly) till the age of four months.

Result

Low birth weight infants, both the preterm and the term small for gestational age, on being exclusively breastfed by their own mothers, gained weight and had an increase in their head circumference and length to the levels almost comparable to the standard fetal- infant growth norms.

Conclusion

Exclusive breast-feeding results in adequate growth in low birth weight babies including preterms.Key Words: Breast feeding, Preterm, Low birth weight, Neonates