低体重儿277例眼底筛查结果分析

目的探讨早产儿视网膜病（ROP）及其他常见眼科疾病的发病情况。方法眼科医师使用间接眼底镜对出生体重小于2000g的277例低体重儿进行眼底筛查,并把277例低体重儿按体重分为两组（小于1500g体重组和1500-1999g体重组）,分析ROP、玻璃体混浊及视网膜出血的发病情况。结果277例小于2000g的低体重儿眼底筛查中,发现ROP19例（6.9%）,其中Ⅰ期8例,Ⅱ期7例,阈值病变4例;发现视网膜出血35例（12.6%）,其中3例周边视网膜出血随访证实为早产儿视网膜病变Ⅲ期;发现玻璃体混浊85例（30.7%）。体重〈1500g组发生ROP、玻璃体混浊的几率明显高于1500-1999g组。视网膜出血发生率在不同体重比较无显著性差异,窒息患儿视网膜出血发生率30.51%与无窒息患儿发生率7.80%比较有显著性差异。结论玻璃体混浊成为低体重儿眼底筛查中最常见的问题;体重对ROP、玻璃体混浊的发生有显著影响;窒息与视网膜出血的发生相关;在窒息和低体重儿中开展眼底筛查对提高视力水平极为重要。     

早产儿及低体重儿四种支原体感染状况研究

为了解早产儿、低体重儿人型支原体 (Mh)、解脲脲原体 (Uu)、生殖支原体 (Mg) ,发酵支原体 (Mf)等 4种支原体的感染状况 ,我们于 1997年～ 1998年分别收集了 2 7例早产儿和 2 1例低体重儿的咽拭子标本应用套式PCR (nPCR)法进行上述 4种支原体特异性核酸检测。结果早产儿和低体重儿的Mh阳性率分别为 92 6 %、95 2 % ;Uu阳性率分别为 5 5 5 %、38 1%。Mh Uu合并感染状况严重 ,分别为 5 5 5 %、33 3%。Mg只有 1例阳性 ,Mf无阳性病例发现。无论是早产儿 ,还是低体重儿 ,剖宫产与阴道产的各种支原体检出率无差别 (P均 <0 0 5 )。剖宫产娩出儿咽部查出支原体可确认为宫内感染 ,由此可见 ,支原体宫内感染状况严重。本文并就支原体感染与早产和新生儿出生低体重的发生原因进行了讨论。     

Spectral analysis of heart rate variability using the integral pulse frequency modulation model

Spectral analysis of heart rate variability (HRV) is a widely accepted approach for assessment of cardiac autonomic function and its relationship to numerous disorders and diseases. As a rule, the non-parametric methods for HRV spectral analysis are tested using the integral pulse frequency modulation (IPFM) model. However, published results with simulated HRV signals show differences requiring further development of the existing methods. With the aim of improving estimation accuracy, an entirely IPFM-based method for HRV analysis is investigated. According to this method, the spectra are computed by finding the least squares solution of two matrix equations that are derived using the IPFM model and involve irregular samples of a signal representing the HRV. The method is validated with various synthesised signals (in all tests, the relative errors of the power estimates at the modulating frequencies are within 3%, and the relative power of the spurious terms is less than 0.8% only) and is furthermore applied to the spectral analysis of RR interval series obtained from diabetic children. The results, with simulated and real HRV signals, show that the developed method yields very accurate estimations of the spectral region below half the mean heart rate. Moreover, it allows the detection and assessment of certain genuine modulating components beyond the traditional frequency limit of the HRV spectra.     

Spectral characteristics of heart rate fluctuations during parabolic flight

Parabolic flight is used to create short successive periods of changing gravity in a range between 0 and 1.8 Gz (1 Gz: 9.81 m/s²). The purpose of the present study was to evaluate whether cyclic variations in heart rate during ±20 s periods of stable gravity in parabolic flight reflect autonomic modulation of cardiac chronotropy. During the 29th and 32nd ESA parabolic flight campaign ECG and respiration were recorded in 13 healthy volunteers in both standing and supine postures. We developed and validated a spectral algorithm especially adapted to study frequency components of heart rate among ultrashort (±20 s) stable gravity periods of parabolic flight. A low frequency (LF) component, starting from the lowest measurable frequency (±0.05 Hz) up to 0.15 Hz was distinguished from a high frequency (HF) component, ranging from 0.16 Hz up to 0.4 Hz. Powers were calculated by integration between corresponding limits and represented in normalized units (nu). With our method, we were able to reproduce normal findings in the upright posture at 1 Gz, i.e., less power in the HF component compared to supine (HFnu: 0.18±0.09 vs. 0.40±0.16). These postural related differences are shown to be eliminated at 0 Gz (HFnu: 0.30±0.12 vs. 0.32±0.13) and amplified at 1.8 Gz phases (HFnu: 0.15±0.10 vs. 0.39±0.16) of parabolic flight. In the supine position no coherent differences were shown in the measured variables among different gravity phases. Our observations strongly indicate that spectral characteristics of heart rate fluctuations among stable gravity periods of parabolic flight reflect parasympathetic nervous system control of cardiac chronotropy. At 1 Gz, there is a normal upright situation with less parasympathetic modulation of heart rate compared to supine. This effect is augmented during 1.8 Gz-conditions due to a suppressed parasympathetic control of heart rate in the upright posture. Alternatively, at 0 Gz, increased parasympathetic control in standing position eliminates differences in cardiac chronotropy compared to supine.     

4909例活产儿低体重情况分析

目的通过对4909例活产儿的出生低体重分析，找出影响出生低体重的相关因素，为降低出生低体重儿的发生提供有力数据。方法通过对4902例活产儿中385例出生低体重儿的住院病历及起母亲的住院病历进行详细分析，并进行相关调查。结果出生低体重与母亲居住地区、母亲文化程度等有关。结论提高母亲文化程度，降低母亲并发症，从而降低早产是降低出生低体重的关键。     

极低出生体重儿“鼓励性”喂养的临床观察

目的:观察“鼓励性”喂养对极低出生体重儿的影响。方法:回顾性分析我院3年间收治的29例极低出生体重儿的临床经过。结果:鼓励性喂养组患儿生理性体重下降持续时间短于对照组犤(9.5±3.0)天与(14.0±4.5)天犦(P<0.01),恢复出生体重后的体重增长优于对照组犤(24.5±4.5)g/天与(19.0±4.5)g/天犦,过度至完全经口喂养的时间短于对照组犤(32.5±7.0)天与(4.05±9.0)天犦。结论:鼓励性喂养能促进极低出生体重儿的胃肠道的成熟,改善其临床经过。     

基于多区域分析的非接触式热红外视频心率检测方法

本研究提出了一种基于面部多区域分析的非接触式热红外视频心率检测方法.首先,确定面部3个感兴趣区域(region of interests,ROIs),构建像素均值时间序列.其次,对3个ROIs采用独立成分分析和多变量经验分解算法,分别提取包含心率信息的独立分量和本征模态函数,通过功率谱分析确定最佳独立分量和最佳本征模态...     

Maturational changes in heart rate and heart rate variability in low birth weight infants

To provide insight into the maturation of neural mechanisms responsible for variability in heart rate during quiet and active sleep, 6-hour continuous electrocardiographic recordings and simultaneous minute-by-minute behavioral activity state assignments were performed in 61 healthy, growing low birth weight infants. The infants weighed 795-1600 g at birth and ranged between 31-38 weeks in postconceptional age. During this age interval there was a decrease in heart rate during quiet sleep and an increase in both time domain and frequency domain measures of the variability in cardiac interbeat intervals. In quiet sleep, global variability, measured as SD of R-R intervals, increased in relation to age, as did higher frequency variability, measured as the square root of the mean of squared successive differences in R-R intervals. Developmental changes in the 0.5-2.0 Hz spectral power band of RR-interval variability, another measure of high frequency variability, paralleled the changes seen in the time domain measure. Evaluation of patterns of changes in the magnitude and direction of successive interbeat intervals provided evidence that the incidence of sustained accelerations or decelerations increased whereas the incidence of no change in consecutive RR-intervals decreased as infants matured. Among the various measures of heart rate variability, the incidence of sustained change and no change in successive interbeat intervals were most closely related to postconceptional age in both sleep states. The overall decrease in heart rate, increase in heart rate variability, and increase in the pattern of changes in interbeat interval with postconceptional age are consistent with the maturation of the autonomic cardio-regulatory activity from 31-38 weeks age.     

Mothers of very low birth weight infants have less atopy than mothers of full-term infants

BACKGROUND: Studies on the pregnancy outcome of asthmatic mothers have suggested an increased rate of preterm deliveries. In contrast, our earlier study suggests that mothers of very low birth weight (VLBW) (<1500 g) infants less frequently had atopy than did mothers of full-term infants. METHODS: We inquired about symptoms of atopy and doctor-diagnosed atopy in parents of 370 infants of VLBW (<1500 g) and 544 parents of full-term infants. Odds ratios for atopic symptoms and diagnosed atopy were calculated, and groups were compared with a trend test. RESULTS: Mothers of preterm infants of birth weight (BW) <1000 g significantly less often had physician-diagnosed allergic rhinitis (AR) (P=0.02). Among all the mothers, a trend test showed that maternal AR was significantly (P=0.03) higher in parallel with a higher infant BW. Fathers of infants with different BWs showed no differences in prevalence of atopic symptoms. CONCLUSION: We thus infer that maternal balance between T-helper type 1 (Th1) and Th2 cells, shifted towards Th2 in those with AR, may have a favourable effect on maintenance of pregnancy before gestational week 30.     

Use of the Bayley Infant Neurodevelopmental Screener with low birth weight infants

OBJECTIVE: To examine the utility of the Bayley Infant Neurodevelopmental Screener (BINS) as a screening technique for premature, low birth weight infants. METHODS: One hundred thirty-three preterm infants <1,500 grams received a BINS assessment at mean adjusted age 6.8 months and a Bayley Scales of Infant Development, Second Edition (BSID-II) assessment at mean adjusted age 12.9 months. Infants' BINS scores were compared to their BSID-II Mental Development Index (MDI) and Psychomotor Development Index (PDI) scores. RESULTS: The BINS score showed significant association with the MDI (r =.40, p = <.001) and with the PDI (r =.35, p = <.001). The BINS showed moderate predictive validity (67%-76%) for identifying lower functioning infants. CONCLUSIONS: The BINS is a satisfactory screening tool for low birth weight infants when used in conjunction with other known biologic and social risk factors.     

产妇孕期被动吸烟与低出生体重病例对照研究

为分析母亲孕期被动吸烟与低出生体重的关系,采用群体匹配病例对照研究方法,对1999年3月-2000年4月间在沈阳市妇婴医院等14家医院分娩的非主动吸烟的产妇孕期被动吸烟情况与低出生体重关系进行分析.结果表明孕期被动吸烟可能是低出生体重危险因素,且孕期被动吸烟的时间与低出生体重发生存在剂量反应关系(x2趋势=32.42;P＜0.01).在控制产妇不良孕产史等因素后,被动吸烟孕妇分娩出低出生体重儿的危险性为非被动吸烟孕妇的3.176倍(OR95%,CI,1.868-5.401),且被动吸烟与孕妇文化程度对出生体重可能存在协同作用(协同作用指数为3.16).     

MTHFR和CBS基因多态性与低出生体重的关系研究

目的探讨母亲亚甲基四氢叶酸还原酶（MTHFR）基因C677T、胱硫醚β-合酶（CBS）基因T833C与子代低出生体重发生之间的关系。方法运用聚合酶链反应（PCR）-限制性片段长度多态性与PCR-扩增阻滞突变体系技术分别检测母亲的MTHFR、CBS基因型,对MTHFR基因型、CBS基因型、基因型的交互作用与低出生体重的关系进行分析。结果MTHFR基因突变型、CBS基因突变型对低出生体重影响无统计学意义（P〉0．05）,但MTHFR基因突变型与CBS基因突变型对低出生体重的影响存在交互作用（OR=3．155,95％CI：1．229—8．528）。结论母亲MTHFR基因C677T、CBS基因T833C,与子代低出生体重发生无关,但MTHFR基因突变型与CBS基因突变型存在交互作用,其能增加子代低出生体重发生的危险。     

Periodontitis as a risk factor for preterm low birth weight

PURPOSE: There is growing evidence showing that a number of complex human diseases are caused or are at least influenced by periodontal diseases. Such diseases include cardiovascular diseases, respiratory diseases, diabetes mellitus and osteoporosis. The aim of study was to evaluate periodontal diseases as a risk factor for a preterm low birth weight. MATERIALS AND METHODS: A total of 48 mothers, 20 of who had a preterm low birth weight delivery, were examined in the Clinics of Periodontology, Faculty of Dentistry, Cumhuriyet University. The periodontal exams consisted of a full mouth pocket depth, a Loe and Sillness Gingival index score measurements, and a panoramic radiograph analysis. Information on any other factors that may cause a preterm low birth weight was obtained from the family physician. RESULTS: The study results indicated that periodontitis (OR: 3.6 95% CI: 1.06-12.18) together with bacterial vaginosis (OR: 11.57 95% CI: 1.26-105.7) were independent risk factors of a preterm low birth weight. According to the data obtained from this study, the paternal age, tobacco use and the mothers' height were not significant risk factors for a preterm low birth weight. CONCLUSION: Within the limits of this study, it is concluded that a poor periodontal health status of the mother may be a potential risk factor for a preterm low birth weight.     

New technique for time series analysis combining the maximum entropy method and non-linear least squares method: its value in heart rate variability analysis

A new technique for time series analysis, which is a combination of the maximum entropy method (MEM) for spectral analysis and the non-linear least squares method (LSM) for fitting analysis, is described. In this technique, the MEM power spectral density (MEMPSD) is calculated using a very large lag that could diminish the lag dependence of dominant periods estimated by the MEM analysis. The validity of this large lag is confirmed by the LSM, given that the ten dominant MEM periods are known quantities. To validate the MEM plus LSM technique, it is compared with autoregressive (AR) modelling, by analysing heart rate variability under pharmacological interventions (phenylephrine and trinitroglycerine), using 16 young males. The results indicate that the MEMPSD, when compared with the ARPSD, has numerous periods that could reproduce the original time series much more accurately, as revealed by the LSM analysis. However, both the low- and high-frequency powers with MEMPSD and ARPSDs shift in the expected directions in accordance with the pharmacological effects on the cardiovascular system. The implications of these results are discussed from the theoretical and practical standpoints of the MEM plus LSM technique, compared with AR modelling.     

外周血内皮祖细胞与极低出生体重早产儿并发症发生相关性

目的分析内皮祖细胞（EPCs）与极低出生体重早产儿发生支气管肺发育不良（BPD）、早产儿视网膜病（ROP）和脑室内出血（IVH）并发症的相关性。方法选取于复旦大学附属儿科医院NICU住院的胎龄〈32周、出生体重〈1500g的早产儿,分别于出生时、生后7、14、21和28d及纠正胎龄36周时收集外周血,流式细胞仪检测EPCs水平,酶联免疫法检测血管内皮生长因子（VEGF）、基质细胞衍生因子等水平。结果68例极低出生体重早产儿纳入分析,其中对照组30例,BPD组20例,ROP组10例,IVH组8例。BPD组与对照组出生时EPCs水平差异无统计学意义,生后7d时点EPCs水平较对照组明显降低,CD34＋KDR＋：（0．019±0．009）％伽（0．026±0．012）％,P〈0．05;KDR＋CDl33＋：（0．004±D．002）％傩（0．008±0．004）％,P〈0．01;CD34＋KDR＋CDl33＋：（0．005±0．002）％船（0．008±0．004）％,P〈0．05。从出生时至生后21d,BPD组血浆VEGF水平均明显低于对照组。ROP组出生时至生后28d的EPCs水平与对照组差异无统计学意义,纠正胎龄36周时KDR＋CDl33＋和CD34＋KDR＋CDl33＋EPCs与对照组相比略有升高趋势。与对照组相比,IVH组生后不同时点的EPCs水平差异均无统计学意义。结论生后早期的EPCs和VEGF水平降低可能参与了早产儿BPD的发生,但其具体机制仍需进一步研究。     

极低出生体重儿临床相关因素及与预后的关系

目的探讨极低出生体重儿的围产期及临床特点,分析其与预后的关系.方法分析110例极低出生体重儿(含12例超低出生体重儿)的一般情况、产科及母孕期情况、新生儿临床特点.结果胎龄小于32w者占79%,小于胎龄儿占17.3%,41%为多胎;32%有胎膜早破史,18%母亲有妊高征;36%有窒息复苏史;产科异常是胎儿早产的主要原因.呼吸暂停、低体温、高胆红素血症及低血糖是常见的并发症;多胎、围产期异常及小于胎龄儿是极低出生体重儿主要死亡原因,生于院内或转运者死亡率明显低于院外出生者(P<0.01).结论加强对高危孕妇及新生儿的监护,普及新生儿窒息复苏知识,将有助于改善极低出生体重儿的预后.     

谷胱甘肽硫转移酶M1基因多态性与低出生体重的相关性

目的 为探讨谷胱甘肽硫转移酶M1基因(glutathione S-transferases M1 gene,GSTM1)多态性与低出生体重的关系.方法 采用病例对照研究方法,收集母亲和新生儿资料,用等位基因特异性PCR方法分析母亲GSTM1基因型.应用Logistic回归,对母体GSTM1基因与新生儿低出生体重的相关性进行分析.结果 GSTM1缺失基因型对低出生体重影响未显示显著相关性[OR=1.553,95%CI(0.7052.863);OR=2.016,95%CI(10.961 2.942)].结论 母亲GSTM1基因多态性与低出生体重无相关性.     

A comparison of AmBisome to amphotericin B for treatment of systemic candidiasis in very low birth weight infants

PURPOSE: Amphotericin B is considered the treatment of choice for systemic candidiasis, but adverse effects may limit its use. An alternative option for the treatment of candidiasis includes lipid preparations of amphotericin B. This study investigated the safety and efficacy of AmBisome, a lipid formulation of amphotericin B containing liposomal structures, for the treatment of systemic candidiasis in very low birth weight infants (VLBWI). MATERIALS AND METHODS: Data from 26 VLBWI treated with AmBisome in the study group (AmBisome group) from October 2003 to July 2006 were compared with data from 20 VLBWI treated with amphotericin B as a historical control (Amphotericin group). This study was a prospective, historical control, multi-center trial. RESULTS: Candida spp. was isolated in 73% (19/26) of the cases for the AmBisome group and 90% (18/20) of the cases for the Amphotericin group. The fungal eradication rate and the time to eradication was 84% (16/19) and 9+/-8 days in the AmBisome group, and 89% (16/18) and 10+/-9 days in the Amphotericin group, respectively (p=0.680 vs p=0.712). The major adverse effects were lower in the AmBisome group (renal toxicity, 21% vs 55%, p=0.029; hepatotoxity, 25% vs 65%, p=0.014, AmBisome group vs Amphotericin group, respectively). There was no significant difference in mortality attributed to systemic candidiasis (12% in the AmBisome group, 10% in the Amphotericin group, p=0.868). CONCLUSION: AmBisome is effective and safe for treating systemic fungal infections in VLBWI.     

铁剂在极低出生体重早产儿贫血治疗的意义

目的评价重组人类促红细胞生成素(rhu-EPO)治疗极低出生体重早产儿贫血中补充铁剂的临床意义。方法将56例极低出生体重早产儿按随机抽样原则分为对照组(26例)、治疗组(30例)。治疗组于生后第8天即于rhu-EPO,每次300 IU/kg,皮下注射,每周2次,共4w;第3w开始口服铁剂(力蜚能,每日5~10mg/kg)。两组均于生后7d内口服维生素E(每日5 mg/kg)、叶酸片(5 mg/d)。随访至出生后4个月。结果随年龄增大两组血红蛋白、红细胞数均逐渐下降,在7d,35d,2个月时,治疗组上述指标均较对照组高,差异有显著性意义(P<0.01或0.05);治疗结束后,两组的血清铁蛋白[(103±25μmol/Lvs(123±24)/μmol)差异有显著性(P<0.01);治疗组较对照组出现贫血率低(43%vs89%),两组比较差异有显著性(P<0.01)。结论早期大剂量rhu-EPO治疗极低出生早产儿贫血过程中补充铁剂可提高rhu-EPO的治疗效果,能减轻早产儿贫血的程度,可减少甚至替代输血。同时应延长口服铁剂的时间至出生后第3个月。     

影响极低出生体重儿预后的相关临床因素分析

目的探讨极低出生体重儿围产期及临床影响预后的因素。方法分析234例极低出生体重儿的一般情况、母孕期情况及新生儿临床特点。结果造成极低出生体重儿的主要原因有妊娠并发症（32．5％）、羊膜早破（26．2％）、多胎妊娠（14．9％）、原因不明（12．9％）。呼吸暂停、高胆红素血症、贫血、感染及呼吸窘迫综合征是常见并发症。全组治愈率70．9％，死亡率21．8％。死亡主要原因是颅内出血、感染、呼吸窘迫综合征及肺出血等。结论加强孕期保健及新生儿生命体征的监护，尽早发现并发症并妥善处理，将有助于改善极低出生体重儿的预后。