不同胎龄早产儿生后24 h内血小板及相关参数参考范围

目的 研究不同胎龄早产儿生后24 h内血小板及相关参数参考范围并探讨其临床意义。方法 根据纳入标准和排除标准,收集2018年1~12月入住新生儿重症监护室且出生胎龄为23~36⁺⁶周早产儿1 070例的临床资料进行回顾性分析,观察生后24 h内不同胎龄早产儿血小板参数参考范围。结果 不同胎龄早产儿血小板计数（PLT）及血小板压积（PCT）水平比较差异无统计学意义（P > 0.05）;晚期早产儿组（34~36⁺⁶周,n=667）血小板平均体积（MPV）及血小板体积分布宽度（PDW）均低于极早早产儿组（23~27⁺⁶周,n=36）和早期早产儿组（28~33⁺⁶周,n=367）（P < 0.05）。不同性别早产儿之间血小板及相关参数比较差异均无统计学意义（P > 0.05）。按照不同胎龄来计算早产儿血小板参数的参考范围,23~36⁺⁶周早产儿PLT参考范围为（92~376）×10⁹/L,PCT参考范围为0.1%~0.394%;23~33⁺⁶周早产儿MPV参考范围为9.208~12.172 fl,PDW参考范围为8.390%~16.407%;34~36⁺⁶周早产儿MPV参考范围为9.190~11.950 fl,PDW参考范围为9.046%~15.116%。结论 不同胎龄早产儿生后24 h内MPV及PDW不同,依据胎龄制定早产儿MPV及PDW参考范围更有助于指导临床工作。     

Low platelet count is associated with ductus arteriosus patency in preterm newborns

Background/aim

To determine whether there is an association between platelet counts and patent ductus arteriosus (PDA) incidence and/or closure in preterm newborns.

Study design and subjects

Premature infants with hemodynamically significant PDA (n = 154) and a control group without PDA (n = 207) who were hospitalized in the NICU were retrospectively evaluated. Platelet counts and other platelet indices including mean platelet volume (MPV) and platelet distribution width (PDW) of the infants in both groups during the first 3 days of life were recorded. Ibuprofen was started in infants with hemodynamically significant PDA and echocardiography was repeated 48 h thereafter to assess the closure of ductus.

Results

Median gestational age and birth weight of the infants with PDA were 28 (range 26–29) weeks and 1060 (range 892–1250) g respectively. Platelet counts were significantly lower in the patient group than in the control group (p < 0.001). Multivariate analysis including gestational age, presence of RDS, presence of thrombocytopenia and PDW showed that hemodynamically significant PDA was independently associated with platelet count < 150,000 (OR = 2.13, 95% CI 1.26–3.61; p = 0.005), high PDW (> 17) (OR = 2.68, 95% CI 1.41–5.09; p = 0.003) and the presence of RDS (OR = 2.25, 95% CI 1.41–3.59; p = 0.001). Baseline platelet counts of the infants in whom ductus closed or persisted after ibuprofen treatment were similar.

Conclusions

PDA was associated with low platelet count and high PDW but not with other platelet indices in preterm infants. We could not show an association between platelet counts and persistence or closure after medical treatment.     

Platelet parameters and the association with morbidity and mortality in Preterm Infants

BackgroundThere is growing recognition of the role of platelets in inflammation and immune responses, and platelets have been associated with various cardiovascular diseases. It is also known that neonatal morbidities are related to overall platelet activity, and platelet parameters may have the potential to predict morbidities and mortality in preterm infants. This study aimed to assess the initial platelet parameters and the association with major morbidities and mortality in preterm neonates.MethodsWe retrospectively reviewed data from very preterm neonates with a gestational age (GA) <32 weeks who were admitted between June 2020 and May 2021 for platelet parameters (counts, mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (platelet counts x MPV/10000(%)) at birth. Major morbidities included early- onset sepsis (EOS) ≤3 days after birth, severe intraventricular hemorrhage (IVH) grade ≥3, and early or overall mortality.ResultsA total of 197 very preterm neonates were studied. Their mean (±SD) GA was 28.0 ± 2.4 weeks, birth weight was 990 ± 293 g, platelet counts were 245 ± 81 x1000/μL, MPV was 10.0 ± 0.7 fl, PDW was 11.0 ± 1.6 fl, and plateletcrit was 0.24 ± 0.08%. MPV had a weak negative correlation with both GA (r = ?0.234, p = 0.001) and BW (r = ?0.343, p <0.001). A lower plateletcrit was associated with EOS (0.14 (0.04–0.22) % vs. 0.23 (0.19–0.30) %, p = 0.027), severe IVH ≤7 days after birth (0.18 (0.14–0.27) % vs. 0.23 (0.20–0.30) %, p = 0.022), and early and overall mortality (0.15 (0.20–0.30) % vs. 0.23 (0.20–0.30) %, p = 0.049; 0.20 ± 0.09 % vs. 0.25 ± 0.07 %, p = 0.008).ConclusionA lower plateletcrit within 24 hours of birth was associated with EOS, severe IVH ≤7 days after birth, and first-week and overall mortality in very preterm neonates.     

Intestinal permeability in relation to birth weight and gestational and postnatal age

OBJECTIVE: To determine the relation between intestinal permeability and birth weight, gestational age, postnatal age, and perinatal risk factors in neonates. STUDY DESIGN: Intestinal permeability was measured by the sugar absorption test within two days of birth and three to six days later in preterm and healthy term infants. In the sugar absorption test, the urinary lactulose/mannitol ratio is measured after oral ingestion of a solution (375 mosm) of lactulose and mannitol. RESULTS: A first sugar absorption test was performed in 116 preterm (26-36 weeks gestation) and 16 term infants. A second test was performed in 102 preterm and nine term infants. In the preterm infants, the lactulose/mannitol ratio was not related to gestational age (r = -0.09, p = 0.32) or birth weight (r = 0.07, p = 0.43). The median lactulose/mannitol ratio was higher if measured less than two days after birth than when measured three to six days later (0.427 and 0.182 respectively, p<0.001). The lactulose/mannitol ratio was higher in preterm infants than term infants if measured within the first 2 days of life (0.404 and 0.170 respectively, p < 0.001), but not different three to six days later (0.182 and 0.123 respectively, p = 0.08). In multiple regression analysis of perinatal risk factors, only umbilical arterial pH correlated with the lactulose/mannitol ratio in preterm infants less than 2 days of age (T = -1.98, p = 0.05). CONCLUSIONS: In preterm infants (26-36 weeks gestation), intestinal permeability is not related to gestational age or birth weight but is higher during the first 2 days of life than three to six days later. It is higher in preterm infants than in healthy term infants only if measured within two days of birth. This suggests rapid postnatal adaptation of the small intestine in preterm infants.     

Cord prealbumin values in newborn infants: effect of prenatal steroids, pulmonary maturity, and size for dates

We assessed cord prealbumin concentrations in 214 appropriate for gestational age newborn infants, 21 small for gestational age infants, and 27 large for gestational age infants to establish normal values and to assess the effect of intrauterine growth, prenatal steroids, and pulmonary maturity on prealbumin levels. Cord prealbumin values were significantly correlated with increasing gestational age (r = 0.33; P less than 0.001) and birth weight (r = 0.40, P less than 0.001) in the AGA neonates. Neonates born before 37 weeks gestation had significantly lower prealbumin levels than those born at term (P less than 0.001). The SGA infants had significantly lower levels than age-matched AGA controls (P less than 0.01), and LGA infants had significantly higher levels than age-matched AGA controls (P less than 0.001). In preterm infants, those with exposure to prenatal steroids (betamethasone or premature rupture of membranes) had significantly higher prealbumin values than control infants of comparable age and weight (P less than 0.001). Infants without respiratory distress syndrome had higher levels than those of comparable age and weight with hyaline membrane disease (P less than 0.05). This study demonstrates that a correlation of gestational age and birth weight exists with cord prealbumin levels, and that the large variability at each gestational age may be accounted for in part by appropriateness of size for dates, prenatal steroid exposure, and pulmonary maturity.     

新生儿出生后24小时内凝血功能检测的临床意义分析

目的探讨不同胎龄以及不同体重新生儿凝血功能指标的差异,为判断凝血功能指标的临床意义提供参考。方法2015年1月至2018年12月期间,在解放军总医院第五医学中心新生儿科住院治疗的新生儿中,纳入170例胎龄28~42周、出生8 h内入院的新生儿,其中男性87例,女性83例。按胎龄分为早期早产儿组、晚期早产儿组和足月儿组。按新生儿出生体重分为正常出生体重组、低出生体重组和极低出生体重组。按是否小于胎龄分为早产适于胎龄儿组、早产小于胎龄儿组、足月适于胎龄儿组、足月小于胎龄儿组。于生后24 h内抽取静脉血,检测活化部分凝血活酶时间(activatedpartial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin,TT)及D-二聚体(D-dimer)。结果早期早产儿组的APTT、PT、D-二聚体水平均高于晚期早产儿组及足月儿组(P值均<0.05),FIB水平低于晚期早产儿组及足月儿组(P值均<0.05);晚期早产儿组的APTT、PT水平均高于足月儿组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。极低出生体重组的APTT、PT、D-二聚体水平均高于低出生体重组及正常出生体重组(P值均<0.05),FIB水平低于低出生体重组及正常出生体重组(P值均<0.05);低出生体重组的APTT、PT水平均高于正常出生体重组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。早产小于胎龄儿组D-二聚体水平高于早产适于胎龄儿组(P<0.05),其余指标比较差异无统计学意义(P值均>0.05);足月适于胎龄儿与足月小于胎龄儿组的凝血指标比较,差异均无统计学意义(P值均>0.05)。早产儿出血发生率高于足月儿[26.6%(29/109)与8.2%(5/61),χ^2=9.019,P=0.003]。结论新生儿凝血指标有胎龄和体重差异,胎龄越小、体重越低的新生儿凝血功能越不完善。     

Low thymic size in preterm infants in the neonatal intensive care unit,a possible marker of infection? A prospective study from birth to 1 year of age

Aim: To study the growth of the thymus in preterm infants. Methods: Ultrasonographic thymic size (Ti) was studied in 80 preterm infants (gestational age 24–36 weeks) from birth to discharge from the neonatal intensive care unit (NICU). Thirty‐three of these infants were followed to 1 year of age. Results: At birth, the median Ti was 5.2 compared with 11.8 in term infants. At discharge, the median Ti was 10.0 and not significantly different from Ti in term infants at birth (p = 0.22). The size of the thymus was significantly associated with postmenstrual age and weight (both p < 0.01). Infections during admission were negatively associated with the size of the thymus (p < 0.01). During the first 3 months after discharge, preterm infants had a significantly higher frequency of infections than did term infants (p = 0.002); hereafter, the preterm infants had significantly fewer infections than term infants (p = 0.002). The median Ti in preterm infants and term infants at 1 year of age was 21.1 and 17.3, respectively. This difference was not statistically significant (p = 0.41). Conclusions: Growth of thymus was not compromised by preterm birth. Ti is negatively associated with the frequency of infections in preterm neonates submitted to NICU.     

特发性血小板减少性紫癜血小板参数变化及其临床意义

目的探讨特发性血小板减少性紫癜(ITP)时血小板参数的变化及其临床意义。方法对确诊为急性型特发性血小板减少性紫癜患儿67例分别测定其治疗前后的血小板数(PLT)、平均血小板体积(MPV)及血小板分布宽度(PDW)及大血小板比率(P-LCR),同时测定50例健康儿童以上血小板参数作为对照组。治疗前与对照组及与治疗后分别进行比较。并对血小板与血小板参数进行相关性分析。结果(1)ITP患儿治疗前PLT明显低于对照组,而PDW、MPV、P-LCR明显高于对照组,差异均具有极显著性(P<0·001),治疗后PLT上升,PDW、MPV、P-LCR下降,与治疗前比较差异具有极显著性(P<0·001)。(2)ITP轻、中、重度患儿随病情加重PLT进行性下降,而PDW、MPV、P-LCR进行性增大,但极重度患儿MPV反而变小。(3)PLT与MPV呈负相关(P<0·001)。MPV与PDW、PDW、MPV与P-LCR、PDW与P-LCR呈正相关(P<0·05)。结论血小板参数的动态观察有助于ITIP的鉴别诊断、病情判断及疗效观察。     

Serum growth-promoting activity in human newborns. Relationship of thymidine activity with birth weight and the length of gestation

Thymidine Activity (TA) was measured by the effect of serum upon incorporation of 3H-thymidine into human lectin-activated lymphocytes in 54 newborns: 32 full-term, 11 pre-term and 11 with intra-uterine growth retardation (IGR). Capillary blood was collected at 0-6 hours, with routine samplings. TA values were lower in preterm (0.476 +/- 0.079 U/ml) than in IGR (0.910 +/- 0.118 U/ml, p less than 0.01) and in full-term neonates (1.237 +/- 0.60, p less than 0.001), and also in IGR newborns than in newborns of normal weight (p less than 0.025). In preterm neonates TA was significantly correlated with gestational age (r = 0.715, p less than 0.02), but no such correlation existed in IRG and full-term neonates. When TA values were plotted against birth weight, a correlation was found in preterm (r = 0.715, p less than 0.02) and in IGR newborns (r = 0.714, p less than 0.02), but not in full-term neonates. Longitudinal study up to 21 days did not show significant changes in full-term newborns, while in preterm and IGR neonates TA increased progressively to reach normal values at the 21st day. The correlations observed in newborns between TA, birth weight and gestational age, and the postnatal normalization in newborns with low birth weight, show that TA directly reflects the nutritional state of the fetus.     

Determinants of arm muscle and fat accretion during the first postnatal month in preterm newborn infants

We measured arm muscle and fat areas in 22 preterm appropriate for gestational age infants at birth (mean +/- 1 SD birth weight: 1,640 +/- 484 g; gestational age: 31 +/- 2 weeks). Birth arm muscle and fat areas correlated significantly with gestational age (arm muscle: r = 0.86; p less than 0.001; arm fat: r = 0.75; p less than 0.001) and with birth weight. Deviations of birth weights from gestational age means (birth weight z-scores) were related more to variations in arm muscle area (r = 0.69; p less than 0.001) rather than arm fat area (r = 0.44; p = 0.04). Sixteen infants were followed over 4 weeks. They were most physiologically unstable (mean Physiologic Stability Index score = 5.3 +/- 3.5) during the first postnatal week when they also all lost weight. Their mean arm muscle area decreased significantly during the first week by greater than 10%, whereas the mean arm fat area remained unchanged. First week arm muscle losses were directly correlated with the lack of protein intake (r = 0.52; p less than 0.05). The regression equation predicted a protein intake of 4.06 g/kg/day (95% confidence interval: 2.3-6.4) to prevent first week muscle loss. Enteral intake and weight gain were established after week 1, accompanied by a significant reduction in physiologic instability (PSI score = 1.9 +/- 1.9; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum concentration of granulocyte colony stimulating factor in term and preterm infants

We measured serum granulocyte colony stimulating factor (GCSF) concentration and absolute neutrophil count in four groups of infants: (1) 15 healthy term newborn infants; (2) 21 healthy preterm newborn infants, with mean (SD) birth weight 1583 (533) g, and gestational age 32.0 (3.8) weeks; (3) 5 infected newborn infants; (4) 22 6-month-old control infants. Median (range) serum GCSF concentration was 132.2 (41.5–176.0) pg/ml in term infants, 51.5 (1.8–175.7) pg/ml in preterm infants and 138.9 (54.1–449.8) pg/ml in 6-month-old control infants, with a significant reduction in preterm infants, as compared to term and control infants. GCSF levels were significantly higher in the infected infants, as compared to healthy neonates. Conclusion A significant positive relationship was found in term and preterm infants between serum GCSF concentration and gestational age or birth weight. No relationship was found between serum GCSF concen tration and neutrophil count. The low GCSF baseline levels may contribute to the increased incidence and severity of infection in preterm infants. Received: 17 May 1996 and in revised form: 20 July 1996 / Accepted: 29 July 1996     

Developmental patterns of antioxidant defense mechanisms in human erythrocytes

To obtain a profile of erythrocyte antioxidant defense potential during late fetal development, we studied selected antioxidant parameters in blood samples from 65 neonates with birth wt between 520 and 4210 g and from 12 healthy adults. Erythrocyte superoxide dismutase activity did not change significantly with maturation and no significant differences were observed among preterm infants grouped in increasing birth wt categories, term neonates, and adults. Erythrocyte catalase and glutathione peroxidase, as well as plasma vitamin E levels, showed highly significant positive correlations (p less than 0.001) with increasing fetal wt and gestational age; by term, CAT activity reached a level similar to the adult control group, but glutathione peroxidase activity, as well as plasma vitamin E levels, were markedly lower in all the preterm and in the term groups than in adults (p less than 0.01). Erythrocyte glutathione S-transferase activity showed a negative correlation with increasing gestational age (p less than 0.01) and the adult values were considerably lower than any of the neonatal levels (p less than 0.001). The role of glutathione S-transferase in erythrocyte metabolism remains obscure. Maturational changes in the activity of the red cell enzymes that were studied and in the plasma vitamin E level were apparent from about 31-36 wk of gestation, suggesting that the stimulation for these changes may have commenced from about 28-31 wk.     

Thrombocytopenia related neonatal outcome in preterms

Objective To investigate the thrombocytopenia and platelet transfusion related outcome in very preterm infants. Methods Cases (n=94) with at least one episode of thrombocytopenia (platelet counts <150X10⁹/L) and controls (n=70) were identified from a database of 1054 neonates with gestational age ≤32 weeks admitted to a level III NICU. Thrombocytopenia and platelet transfusion related morbidity (IVH, sepsis, NEC, and bleeding) and mortality were analyzed with respect to gestational age (<28 weeks and 28–32 weeks), severity of thrombocytopenia (mild if platelet count ≥ 100 and <150X10⁹/L, moderate if count ≥ 50 and <100X10⁹/L, and severe if platelets <50X10⁹/L), age of thrombocytopenia onset (early <72 hours and late ≥72 hours). Results The majority of thrombocytopenia (67.0%) was diagnosed after 72 hours of age, and was mild in 12.8%, moderate in 36.2% and severe in 51.0% of the cases. Neonates with severe and moderate thrombocytopenia were more frequently born at lower gestational age and birth weight. NEC and sepsis especially that caused by Candida infection, were associated with severe thrombocytopenic events. The development of IVH was strongly associated with lower gestational age but not the severity and age of thrombocytopenia onset. Mucocutaneous bleeding complicated 18.4% of cases with severe and late-onset thrombocytopenia (7/38). Platelets were transfused to 85.4% of infants with severe and 64.7% of infants with moderate thrombocytopenia (P<0.02). The gestational age of the majority of the platelet transfused neonates (49/60, 81.7%) was <28 weeks. Mean gestational age and birth weight, and rates of severe thrombocytopenia, IVH, sepsis and mortality were comparable in transfused vs not-transfused infants with gestational age 28–32 weeks. Platelet transfused neonates with gestational age <28 weeks had lower birth weights, were more often severely thrombocytopenic, and died more frequently than infants of a similar gestational age who were not transfused. Conclusion Platelet transfusions did not lower mortality in very premature born infants with moderate and severe thrombocytopenia during the NICU admission.     

Tissue carnitine reserves of newborn infants

This study assessed the tissue reserves of carnitine at birth in a group of neonates (n = 22) of varying gestational age dying within 24 h of birth, prior to possible changes in carnitine status induced by postnatal intervention. Tissue carnitine concentration was highest in the muscle in each infant. The mean (+/- SD) muscle carnitine concentration of 8.4 +/- 3.6 nmol/mg noncollagen protein (NCP) in very immature infants (less than or equal to 1000 g birth weight) was significantly lower than the corresponding mean (+/- SD) values of 14.0 +/- 3.2 nmol/mg NCP in larger preterm infants (1001-2500 g; P less than 0.01) and 19.4 +/- 2.6 nmol/mg NCP in term infants (greater than or equal to 2501 g; P less than 0.001). Muscle carnitine concentration correlated positively with gestational age (r = 0.832; P less than 0.001) and with body dimensions. Liver and heart carnitine concentrations did not correlate significantly with gestation or body dimensions. The mean (+/- SD) liver carnitine concentration for all the neonates as a group was 4.1 +/- 1.5 nmol/mg NCP. The mean (+/- SD) heart carnitine concentration was 4.7 +/- 1.3 nmol/mg NCP. In comparison to adult controls, tissue carnitine concentrations were markedly lower in neonates, particularly in immature newborns. These data suggest that newborn infants, especially premature babies, are born with limited tissue reserves of carnitine and are therefore at an increased risk for developing carnitine deficiency and its adverse effects in the postnatal period, particularly if maintained on carnitine-free intravenous nutrition for prolonged periods of time.     

Thrombopoietic activity in preterm newborns and infants.

Platelet count and thrombopoietic activity were investigated in preterm infants at birth and during their first four months of life. Thrombopoiesis stimulating factor activity in cord serum was significantly lower than that of adults and of the respective mothers. No difference was noted between thrombopoietic activity in cord serum in the various gestational ages studied--that is, 24 through 39 weeks. Preterm infants followed during their first four months of life showed a mean platelet count significantly higher than that observed in term infants at the respective age. Furthermore, thrombocytosis was found in premature thriving infants at the age of 1 and 2 months. It is suggested that this thrombocytosis is responsible for the low thrombopoietic activity observed in these infants during their first four months of life.     

Nitric oxide levels in preterm and term infants and in premature infants with bacteremia

OBJECTIVE: To determine the serum nitric oxide levels in healthy neonates and in infants with bacteremia. METHODS: We performed a prospective study in a tertiary neonatal intensive care unit. The serum nitric oxide levels were measured in all infants at birth (basal) and in the infected neonates also on the first 2 days of bacteremia. RESULTS: Thirty-three neonates (10 term, 23 preterm) were included. Eleven preterm infants (mean gestational age 27 weeks) had bacteremia. The main blood culture isolates included coagulase-negative staphylococci (n=4), Klebsiella pneumoniae (n=3), and Escherichia coli (n=3). The serum nitric oxide levels increased during infection in 10 infants (p <0.008). The mean nitric oxide level before infection was 44 microM and during infection 96 microM (p=0.008). In the healthy babies, the mean nitric oxide level was 26 microM in those with a gestational age <27 weeks, 44 microM in those born between 28 and 36 weeks of gestation, and 63 microM in term infants. CONCLUSIONS: Bacteremic preterm infants produce significantly higher amounts of nitric oxide. The basal nitric oxide levels at birth may be correlated with gestational age.     

A developmental study on types and frequency distribution of short apneas (3 to 15 seconds) in term and preterm infants

We measured the frequency distribution and the ventilatory correlates of the various types of apneas 3 to 15 s long during sleep in eight term infants (birth weight 3.65 +/- 0.16 kg; gestational age 39.5 +/- 0.3 wk) and eight preterm infants (birth weight 2.07 +/- 0.18 kg; gestational age 34.3 +/- 0.4 wk). Each infant was studied on five to seven occasions from birth to 56 wk of postconceptual age using a modified flow-through system. Sixty-six paired epochs of quiet sleep (1163 min) and rapid eye movement sleep (829 min) were analyzed in term infants and 85 paired epochs of quiet sleep (1553 min) and rapid eye movement sleep (1328 min) in preterm infants. Of the 783 apneas recorded in term infants 82% were central, 1.5% obstructive, 0.5% mixed, and 16% were of the breath-holding type; the corresponding figures for the 4086 apneas recorded in preterm infants were 93, 0.5, 1.0, and 5.5%. This distribution was similar in the two sleep states but term infants had a higher percentage of breath-holding apneas than preterm infants (p less than 0.01). In preterm infants the rate of central apneas decreased with postnatal age (p less than 0.01); in term infants the rate did not change significantly. The duration of apneas showed a modal distribution for central apneas at about 8 s for both groups during the 1st month of life (p less than 0.05). The findings suggest: 1) apneas in the newborn and early infancy are primarily central and are more frequent in preterm than in term infants.(ABSTRACT TRUNCATED AT 250 WORDS)     

妊娠期高血压疾病对胎龄28~34周早产儿外周静脉血细胞计数的影响

目的 探讨母亲妊娠期高血压疾病（hypertensive disorders of pregnancy,HDP）对胎龄28~34周早产儿外周静脉血细胞计数的影响。 方法 选取2020年1~12月昆明医科大学第一附属医院儿科收治的母亲合并HDP的胎龄28~34周早产儿227例为研究组,另选取同期收治的母亲无HDP的胎龄28~34周早产儿227例为对照组。研究组根据母亲妊娠期血压分为妊娠期高血压亚组（75例）、轻度子痫前期亚组（81例）、重度子痫前期亚组（71例）;根据早产儿出生体重分为小于胎龄儿（small for gestational age,SGA）亚组（113例）及适于胎龄儿（appropriate for gestational age,AGA）亚组（114例）。比较研究组和对照组、研究组各亚组间早产儿生后第1天外周血细胞计数的差异。 结果 研究组患儿生后第1天外周静脉血白细胞（white blood cell,WBC）计数、中性粒细胞绝对计数（absolute neutrophil count,ANC）及血小板（platelet,PLT）计数均低于对照组（P<0.05）,白细胞减少症、中性粒细胞减少症发生率高于对照组（P<0.05）。亚组分析中,轻度子痫前期亚组、重度子痫前期亚组WBC计数、ANC、PLT计数均低于妊娠期高血压亚组（P<0.05）;SGA亚组WBC计数、ANC、PLT计数低于AGA亚组（P<0.05）。 结论 HDP可对早产儿外周静脉血细胞计数产生影响,这一影响在母亲子痫前期及SGA早产儿中更为显著。     

早期早产儿动脉导管未闭发生的危险因素的病例对照研究

目的 探讨早期早产儿动脉导管未闭(PDA)发生的危险因素,为进一步减少早产儿PDA 的发生提供临床依据。方法 将2013 年1 月至2014 年12 月住院治疗的136 例诊断为有血流动力学意义的PDA(hs-PDA)的早期早产儿(胎龄≤ 32 周)设为病例组,按1:1 的比例从同期住院的早期早产儿中按匹配病例对照原则抽取136 例无hs-PDA 的早产儿作为对照组,两组匹配因素包括性别及胎龄。收集可能与PDA 发生有关的新生儿基本情况、母亲孕期及围产期情况等资料,应用多因素条件logistic 回归分析筛选PDA 发生的危险因素。结果 单因素分析结果显示:新生儿感染性疾病、新生儿呼吸窘迫综合征(RDS)、生后24 h 内血小板计数减低及低出生体重与hs-PDA 的发生相关(P<0.05)。多因素条件logistic 回归分析显示新生儿感染性疾病(OR=2.368)及生后24 h 内血小板计数减低(OR=0.996)是hs-PDA 发生的独立危险因素。结论 新生儿感染性疾病及生后24 h 内血小板计数减低会增加早期早产儿hs-PDA 的发生风险。     

Measurement of transepidermal water loss in Tanzanian cot-nursed neonates and its relation to postnatal weight loss

In healthy cot-nursed Tanzanian neonates ( n = 92, gestation 26–42 weeks) measurements of transepidermal water loss (TEWL) and weight change were performed during the first 24 h after birth at an average ambient humidity of 70% and an environmental temperature of 32°C. Urine production on day 1 (ml/kg per 24h) was documented for a subgroup of 13 preterm and 8 term infants. In a limited group of preterm infants ( n = 5) TEWL measurements, weight and 24 h urine volume measurements were repeated daily for 7 days. Maximum weight loss was determined in 7 preterm (gestational age 30–36 weeks) and 6 term infants. TEWL was estimated by measuring the evaporation rate at three sites of the body using the water vapour pressure gradient method. On day 1, TEWL was highest in the most preterm infants, whereas TEWL and urine production were higher in large for gestational age infants as compared to appropriate for gestational age (AGA) infants of the same gestational age (31–36 weeks). For the whole group, weight loss on day 1 was correlated with TEWL ( r = 0.49, p <0.05). At follow-up TEWL in preterm infants remained almost constant during the first 4 days and decreased after the fourth day, at which time weight gain commenced. Preterm AGA infants (gestational age 24–37 weeks) showed a mean postnatal weight loss of 4.4% of the birth weight, while in term infants this loss was only 2.6%. A reduced postnatal weight loss as compared to Caucasian infants may be explained by a lower water loss during the first days after birth, through both skin evaporation and urine excretion.