Mortality in infants less than 2500 grammes birthweight admitted into a special-care baby unit in Port Harcourt, Nigeria

Physicians studied the mortality rate of low birth weight (2500g) neonates admitted into a special care unit at a hospital in Port Harcourt, Nigeria between January 1984-June 1986. Care consisted of maintaining body temperatures, feeding, and preventing and treating infections. If required, oxygen was only administered in the incubator. 36.3% of all infants admitted to the special care unit during this period weighed 2500g. Those infants that died had lower birth weights, younger gestational age, lower temperatures on admission, and lower temperatures while in the unit than did surviving infants (p.001). Mortality was highest for those infants weighing 1000g (90%) and decreased with increasing birth weight (1000-1500g=51.1%; 1501-2000g=12.4%; and 2001-2499G=3%). In addition, the 1 and 5 minute APGAR scores were significantly lower among neonates who died than those who lived (p0.1 and p.001 respectively). Although infants who died had a significantly lower mean temperature on admission compared to those who survived, there was no significant difference in mean temperatures on admission between those born outside the hospital and those born in the hospital. Another risk factor was place of birth. Neonatal mortality was lower for those infants born in the hospital (9.7%) compared to those not born in the hospital (54%). Since Nigeria does not have specially designed ambulances with sophisticated transport incubators, this high mortality rate could be due to exposure to infection in transport. Nonetheless, it would be easier and cheaper to transfer the mother at risk than her ill neonate. These results demonstrate the importance of prevention of low birth weight rather than improving the facilities for intensive care which is beyond the reach of most developing countries.     

极低出生体重儿45例的临床分析

目的研究极低出生体重儿的临床情况和并发症的防治措施。方法对2008-01-2010-10在新生儿科住院的45例极低出生体重儿（含3例超低出生体重儿）的临床资料进行回顾性分析。结果45例极低出生体重儿中并发症发生率为100％,共发生并发症175例次,平均3．89例次,排在前5位的依次为低蛋白血症28例（62．22％）、高胆红素血症25例（55．55％）、低血糖症24例（53．33％）、贫血23例（51．11％）、肺透明膜病14例（31．11％）。发生2种以上并发症的43例,占95．55％,发生1、2、3、4、5、6．7、8种并发症的分别为4．44％、24．44％、13．33％、20．00％、20．00％、11．11％、4．44％、2．22％;45例极低出生体重儿中存活34例,存活率为75．56％,死亡2例,放弃治疗9例（于放弃后1－2d内死亡）,病死率为24．44％,在死亡的11例中发生肺透明膜病9例,占81．82％。结论极低出生体重儿生活能力低下,并发症多,病死率较高,其病死原因主要是肺透明膜病,预防肺透明膜病可望降低极低出生体重儿的病死率。     

Malformations in infants of very low birth weight

The incidence of lethal, serious and trivial malformations was determined in a consecutive series of 675 infants who weightd 1500 g or less (very low birth weight infants). All patients were born in one maternity hospital. Most of the 169 survivors were followed until at least five years of age. Of these children, 15 had a trivial malformation that either disappeared spontaneously or was corrected surgically. A further five children have a significant or serious residual defect. There were 506 perinatal and infant deaths and 51 of the babies who died had malformations confirmed at necropsy. In 30 of these, death was inevitable. There were 10 seriously malformed infants for whom survival was possible, but in six cases, the diagnosis was obvious at birth. The patients were treated between 1966 and 1970 when techniques of intensive care were evolving. Consequently, some of the infants who died would have survived with the treatment now available. Amongst the perinatal deaths in this report, only 2.0% had a serious malformation compatible with survival.     

体重不足1500g早产儿动脉导管未闭的治疗

目的:通过对体重不足1500g的早产儿接受动脉导管早期结扎术者与仅接受消炎痛(indomethacin)治疗者的临床记录回顾性分析来寻找和确定更适当的治疗方法和方向。方法:我们把1996年7月至2003年12月治疗过的40例体重不足1500g的动脉导管未闭早产儿分为接受消炎痛的治疗者与未给予消炎痛而直接接受外科结扎者,对其结果做了比较分析。结果:消炎痛治疗者与外科手术者中的生存者与死亡者进行比较,二者在患者的体重,孕龄,伴随的心脏畸形,动脉导管的大小,消炎痛治疗并发症,机械辅助呼吸时间,ICU住院时间等均无显著性差异(P>0.05);对消炎痛治疗者与外科手术者进行比较,仅在并发症之间有显著性差异(P<0.05),即消炎痛治疗者有7例出现并发症(36.8%),而外科手术者的5例死亡也与患儿的术前状态密切相关。结论:对体重不足1500g的动脉导管未闭早产儿而言,因受消炎痛用药条件的限制、较高的并发症发生率和失败率,早期行动脉导管结扎术不失为有效的治疗手段。     

Transmission of HIV-1 infections from mothers to infants in Haiti. Impact on childhood mortality and malnutrition. The CDS/JHU AIDS Project Team

Of 4588 pregnant women in a high-risk Haitian population, 443 (9.7%) were serologically positive for the human immunodeficiency virus type 1 (HIV-1). Infants born to women who were HIV-1 seropositive were more likely to be premature, of low birth weight, and malnourished at 3 and 6 months of age than were infants born to women who were HIV-1 seronegative. Increased mortality was observed in infants born to women who were HIV-1 seropositive by 3 months of age. At 12 months of age, 23.4% of the infants born to women who were HIV-1 seropositive had died compared with 10.8% of the infants born to women who were HIV-1 seronegative; at 24 months of age, the mortality rates were 31.3% and 14.2%, respectively. Maternal HIV-1 infections resulted in an 11.7% increase in the overall infant mortality rate in this population. The estimated mother-to-infant HIV-1 transmission rate in these breast-fed infants was 25%, similar to the rates reported for non-breast-fed populations in the United States and Europe.     

486例极低及超低出生体质量儿产科因素分析

 目的探讨极低及超低出生体质量儿的相关产科因素,以降低极低及超低出生体质量儿的出生率。方法回顾性分析于我院分娩的486例极低及超低出生体质量儿和427例孕妇的临床资料。结果早产儿占极低及超低出生体质量儿总数的89.51%,胎龄主要集中在28~32周（62.35%）。极低出生体质量儿的比例（84.16%）远远大于超低出生体质量儿（15.84%）。孕妇剖宫产率为68.15%,初产妇占孕妇总数的77.75%。造成极低及超低出生体质量儿的常见产科因素为子痫前期重度、胎膜早破、胎盘早剥、宫颈机能不全、羊水量异常等。结论28~32周的极低出生体质量儿是产儿科医师工作的重点对象。存在子痫前期重度、胎膜早破、胎盘早剥、宫颈机能不全、羊水量异常等产科因素的初产妇生产极低及超低出生体质量儿的风险较高。     

Maternal fatness and viability of preterm infants

To investigate the effect of maternal fatness on the mortality of infants born preterm up to the corrected age of 18 months 795 mother-infant pairs were studied. Maternal fatness was defined by Quetelet's index (weight/(height] and all infants weighed less than 1850 g at birth. In 771 mother-infant pairs maternal age, complications of pregnancy, mode of delivery, parity, social class, and the baby's sex and gestation were analysed by a logistic regression model for associations with infant mortality (but deaths from severe congenital abnormalities and those occurring during the first 48 hours after birth were excluded). In a subgroup of 284 mother-infant pairs all infant deaths except those from severe congenital abnormalities were analysed in association with the infant's birth weight and gestation and the mother's height and weight; this second analysis included another 24 infants who had died within 48 hours after birth. In the first analysis mortality overall was 7% (55/771), rising from 4% (71/173) in thin mothers (Quetelet's index less than 20) to 15% (6/40) in mothers with grades II and III obesity (Quetelet's index greater than 30). After adjusting for major demographic and antenatal factors, including serious complications of pregnancy, maternal fatness was second in importance only to length of gestation in predicting death of infants born preterm. In the second analysis mortality overall was 15% (44/284), rising from 9% (5/53) in thin mothers to 47% (8/17) in mothers with grades II and III obesity. In both analyses the relative risk of death by 18 months post-term was nearly four times greater in infants born to obese mothers than in those born to thin mothers. In addition, maternal fatness was associated with reduced birth weight, whereas it is associated with macrosomia in term infants. These data differ fundamentally from those reported in full term babies of obese mothers. It is speculated that the altered metabolic milieu in obesity may reduce the ability of the fetus to adapt to extrauterine life if it is born preterm.     

小于胎龄极低出生体质量儿晚发型败血症危险因素分析

目的 探讨新生儿重症监护室小于胎龄极低出生体质量儿(VLBWI)晚发型败血症的危险因素。方法 回顾性分析安徽医科大学第一附属医院新生儿重症监护室2009年1月至2014年12月收治的胎龄<34周、出生体质量<1500 g、住院时间>7 d VLBWI的相关临床资料,分析其中小于胎龄VLBWI晚发型败血症临床特点、实验室结果、危险因素及预后等。结果 296例纳入本研究的VLBWI中,小于胎龄儿组165例,其中发生晚发型败血症者56例,经单因素分析结果显示,小于胎龄VLBWI晚发型败血症危险因素包括极早产(胎龄<32 周)、超低出生体质量(出生体重<1000 g)、胎膜早破>18 h、预防应用抗菌药物>7 d、经外周中心静脉插管>7 d、经鼻持续气道正压通气、机械通气、留置胃管>7 d、静脉营养时间及住院时间长等。有统计学意义的变量进入logistic多元回归分析显示,其独立危险因素为留置胃管>7 d和胎膜早破>18 h。结论 在VLBWI中小于胎龄儿更易发生晚发型败血症,今后临床工作中应对这一特殊群体采取个性化预防措施,凡胎膜早破>18 h者需动态连续监测血象指标,尽早开始经口肠道微量喂养,缩短留置胃管时间。     

Pregnancy outcome in women with sickle cell trait

A prospective study was carried out to discern the outcome of pregnancy and distribution of birth weights of infants delivered of 85 women with sickle cell trait (AS) compared with a control group of 85 women with normal hemoglobin (AA) who were matched for race, age, parity, and sex of offspring. The distribution of birth weight of offspring of primiparous and multiparous women and the proportion of low-birth-weight infants did not differ significantly between infants born to mothers with AS and those in the control group. Similarly, there was no statistically significant difference between the birth weight of infants born to primipara or multipara. Also, the overall incidence of complications among women with AS did not differ from the incidence in the control group. The findings do not support previous reports that there may be definable pathologic correlates of childbearing in women with AS.     

早产低体重儿51例临床管理分析

目的:探讨临床早产低体重儿管理治疗经验,提高其存活率和生存质量。方法:对51例早产低体重儿的临床资料和综合处理进行回顾性分析。结果:治愈30例,占58.8%;好转7例,占13.7%;自动出院8例,占15.7%;死亡6例,占11.8%,其中5例死于呼吸衰竭,肺出血。其中3例有硬肿症,3例为极低体重儿;孕周<32周者3例;1例有宫内发育迟缓,1例有新生儿窒息史,1例有感染史,1例有抽搐史(颅内出血待排)。早产儿死亡率与孕周、体重密切相关,并发硬肿症者死亡率更高。结论:重视早产低体重儿的体温、营养、感染,严密而细致的临床管理,并积极预防及治疗并发症是提高早产低体重儿存活率的关键。     

极低和超低出生体重儿严重脑损伤的高危因素及预后分析

目的:分析极低和超低出生体重儿严重脑损伤的高危因素及预后。方法:以收治的151例极低和超低出生体重儿为研究对象,其中21例严重脑损伤为病例组,其余130例为对照组,比较两组患儿的胎龄、出生体重、窒息、低氧血症、高碳酸血症和机械通气的比例,并比较两组患儿死亡率及脑性瘫痪、癫痫发生率和存活者智测情况。结果:病例组胎龄及出生体重显著小于对照组(P<0.01),窒息、低氧血症、高碳酸血症和机械通气的比例显著高于对照组(P<0.01),死亡率及脑性瘫痪、癫痫发生率显著高于对照组,差异均有统计学意义(P<0.01);病例组存活者NBNA评分、生后6个月及1岁CDCC评分显著低于对照组,差异有统计学意义(P<0.01)。结论:小胎龄和低体重是极低和超低出生体重儿严重脑损伤的高危因素,窒息、低氧血症、高碳酸血症和机械通气均可加重极低和超低出生体重儿脑损伤,严重脑损伤可导致死亡率显著升高,存活者预后不良。     

新生儿住院疾病及死因谱动态分析

目的：探讨降低新生儿死亡率的医疗、保健工作重点，方法：对１４７６９例住院新生儿疾病谱，死因普等进行统计分析。结果：住院男性例数高出女性２．４倍，住院疾病谱９０年代中期和８０年代中期比较一致性差，差异有显著性意义，早产儿、ＬＢＷＩ、出生≤３ｄ者为死亡新生儿中的半数以上，住院病死率由２５．５％下降至１０．８％（Ｐ〈０．０１），９０年代中期与各个分期死因谱比较一致性高，ＨＩＥ、硬肿症、肺炎、腹泻、败血症和溶血症病死率下降，结论：要加强早产低体重儿的监护管理水平，改善女婴、女童的医疗保健服务条件，控制感染性疾病的产伤性疾病。     

低体重儿与优生的临床研究

本文对我院产科住院分娩的孕龄在28周以上、出生体重在1000～2500g之间的低体重儿进行了回顾性研究。分析了低体重儿的相关因素,如早产、妊娠高血压综合征(妊高征)、双胎、前置胎盘等妊娠并发症,内科合并症以及脐带异常、胎盘异常等,同时对低体重儿的产科处理与如何争取优良的结局也进行了探讨。     

1274例体外受精-胚胎移植治疗分娩新生儿结局分析

目的 探讨经体外受精-胚胎移植(IVF-ET)治疗分娩的新生儿的情况,以分析IVF-ET技术对新生儿先天畸形的影响.方法 对我中心经IVF-ET治疗分娩的1274个新生儿结局进行回顾性分析,探讨新生儿出生孕周、体质量、受精方式、母亲年龄、胎数与先天畸形的关系.结果 分娩930例,其中足月产706例(75.91%),早产224例(24.09%).获新生儿1274个,其中低体质量儿363例(28.49%),新生儿畸形13例(1.02%),围产期死亡15例(1.18%).结论 IVF-ET治疗增加了多胎妊娠、早产、低体质量儿等发生率,但未增加新生儿畸形发生率和围产期死亡率,卵母细胞内单精子注射术新生儿畸形率较IVF高,母亲年龄和胎数与先天畸形无明显关系,IVF-ET是治疗不孕症的安全手段.     

极低出生体重儿坏死性小肠结肠炎中胃潴留的研究

目的：研究极低出生体重儿坏死性小肠结肠炎（NEC）中胃潴留的特征,探讨胃潴留在NEC早期诊断中的意义。方法：选取2008年9月～2010年9月我科住院治疗的NEC患儿30例,同期住院的患儿按出生体重、性别、胎龄相当的非NEC患儿30例为对照组配对,记录NEC组患儿出生到确诊当日,胃潴留的液量以及性质的变化,对照组患儿在相同时间段亦进行相应的记录,比较两组间的差异。结果：NEC组胃潴留最大量（5.35±2.14）ml显著高于对照组的（2.38±2.72）ml,以及潴留量所占前次喂养量的最大比率（42.10±14.65）%亦高于对照组的（21.30±7.51）%,差异均有统计学意义（均P〈0.05）;NEC组出血性胃潴留的比例（63.33%）亦显著高于对照组（26.67%）（P〈0.05）。结论：NEC患儿胃潴留明显增加,且易出现出血性胃潴留,提示胃潴留的监测在早期诊断NEC中起着重要的作用。     

极低出生体重儿支气管肺发育不良的高危因素及预防对策

目的:分析极低出生体重儿支气管肺发育不良症(BPD)的高危因素,探讨BPD的预防方法。方法:回顾分析深圳南山医院2006年1月-2009年9月在NICU诊治的极低出生体重儿75例的临床资料。其中13例诊断为BPD(BPD组),而62例为非BPD组,对两组临床资料进行对照研究。结果:极低出生体重儿BPD的总发生率是17.33%,而有机械通气史的极低出生体重儿BPD的发生率高达33.33%,经鼻气道正压通气的极低出生体重儿BPD的发生率较低,为10.34%。BPD组患儿胎龄和产重均较非BPD组低。产前发生绒毛膜羊膜炎、接受机械通气、合并肺部感染、需多次输血的患儿,BPD组较非BPD组明显增高(P<0.05)。生后使用肺表活性物质,限制早期液体摄入量,控制感染,积极纠正贫血,在两组间差异有显著性(P<0.05)。结论:避免早产低体重、肺表面活性物质(PS)联合经鼻气道正压通气治疗肺透明膜病,限制生后前10d的液体摄入、控制肺部反复感染、积极纠正贫血是预防BPD的关键,积极早期综合治疗BPD疗效肯定。     

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.     

Decreased incidence of neurologic disability among neonates at high risk born between 1975 and 1984 in Alberta.

We report the outcome at 2 or 3.5 years of 1463 neonates at high risk born between 1975 and 1984 and cared for in a regional perinatal program in Alberta. Although the number of surviving infants of very low birth weight (1250 g or less) increased over the study period, the incidence rate of neurologic impairment fell significantly, from 19% to 13% (p less than 0.01), so that there was no significant increase in the absolute number of disabled children. This finding remained valid when two other groups of infants at high risk (those weighing more than 1250 g at birth and having a positive neurologic history and those born at term with asphyxial encephalopathy) were included in the analysis, so that over the decade there was a significant decrease in the incidence of disability among the total group of neonates (p less than 0.01) and no increase in the absolute number of disabled children (23 in 1975 and 19 in 1984). We conclude that neonatal intensive care has contributed to improved survival of neonates at high risk without increasing the burden of major neurologic disability.     

Survey of neonatal screening for primary hypothyroidism in England, Wales, and Northern Ireland 1982-4

National screening for congenital hypothyroidism was established in the United Kingdom in 1982. During 1982-4, 488 infants with primary congenital hypothyroidism were detected by the 25 regional screening laboratories in England, Wales, and Northern Ireland. In addition, one infant had signs of cretinism at birth and was investigated before the screening test was done and four infants were known to have been missed by the screening programme; among these four infants the initial thyroid stimulating hormone concentrations were normal in two with inherited defects of synthesis of thyroxine, not measured in one, and false negative in one. The overall incidence of primary hypothyroidism was 1:3937 births (boys 1:6640, girls 1:2756). The incidence seemed to be reduced in infants born to black mothers (two cases only) and increased in those born to Asian mothers (61 cases). Congenital anomalies other than those of the thyroid glands were reported in 36 children (7%), and 15 (3%) died from various causes before the age of 4. Infants who were considered to show unequivocal evidence of hypothyroidism started treatment at a median age of 17 days (5th and 95th centiles 10 and 42 days) compared with a median age of 14 days (5th and 95th centiles 9 and 21 days) for infants with classic phenylketonuria also detected by national screening.     

126 small gestational age infants. Clinical characteristics and long-term observation]

From January 1, 1987 through June 30, 1990, 126 infants of small gestational age (SGA) born in our hospital were studied prospectively. The incidence of SGA infant > or = 37 weeks was 71.4%. The incidence of very low birth weight infants was only 6.3%. The incidence of birth asphyxia in this group (14.9%) was 3 times higher than that in full term infants; this incidence showed negative correlation with gestational age and birth weight. The morbidity rates of hypoglycemia (25.7%) and polycythemia (10.1%) were much higher than those in AGA infants. Malformation was the major cause of death in SGA infants. The mortality rate of SGA infant was 5.6% and the mortality rate of SGA infant > or = 37 weeks was only 1.1%. The results of follow-up showed that the physical development was normal in about 90% of cases at 2 years of age, and only 2 cases had low motor development scale when they were one-year old.