早产儿脑损伤的患病率和危险因素

目的 探讨早产儿脑损伤的患病率和危险因素,为预防或降低早产儿脑损伤提供依据.方法 对2005年1月-2006年12月美国圣路易斯华盛顿大学儿童医院NICU收治的胎龄小于37周的早产儿的临床资料进行回顾性分析,按胎龄分组,计算脑损伤的患病率,采用多因素Logistic回归模型确立危险因素.结果 本组早产儿总的脑室内出血(IVH)和脑室周围白质软化(PVL)的患病率分别为17.7%和4.9%,而存活病例的患病率分别为14.4%和4.5%.按胎龄分组,IVH和PVL的患病率分别为:23~<25周龄组48.1% 和14.8%、25~<28周龄组35.2%和11.2%、28~<33周龄组13.8%和3.1%、33~<37周龄组2.8%和1.7%.坏死性小肠结肠炎、PDA、机械通气(MV)是IVH的独立危险因素,而胎龄、5 min Apgar评分为保护因素(负相关);IVH、MV、母亲产前或产时感染是PVL的危险因素,而出生体质量和女性为保护因素.同时IVH是导致早产儿死亡的危险因素.结论 胎龄越小,脑损伤的患病率越高;围生期感染、窒息缺氧以及影响脑血流的因素如PDA和MV等与早产儿脑损伤的发生密切相关.     

促红细胞生成素治疗早产儿脑损伤的效果

目的探讨促红细胞生成素(EPO)在防治早产儿脑损伤中的作用。方法早产儿30例。男23例,女7例;随机分为常规治疗组、EPO治疗组,各15例。EPO治疗组于生后即开始予EPO治疗。所有患儿随诊至1岁,定期行脑电图、脑干诱发电位(ABR)检查及头颅B超等影像学检查,并于纠正胎龄40周行新生儿行为神经检测(NBNA)。结果1.EPO治疗组NBNA评分正常者占73.33%,明显高于常规治疗组(26.67%),差异有显著性(P<0.05);2.纠正胎龄1个月时二组患儿ABR异常率比较差异无统计学意义(P>0.05),随访至3~6个月时,EPO治疗组ABR异常率明显小于常规治疗组(P<0.05)。EPO治疗组后期ABR的异常程度较前明显减轻。结论早期使用EPO可改善早产儿预后,减少或减轻早产儿脑损伤。     

The Incidence of Sleeping Problems in Preterm and Fullterm Infants Discharged from Neonatal Special Care Units: An Epidemiological Longitudinal Study

Abstract— Anecdotal reports have suggested that sleeping problems are a frequent complaint from parents of preterm infants. This prospective epidemiological study examined the incidence and stability of sleeping problems of very preterm (<32 weeks gestation at birth), preterm (32–36 weeks gestation) and fullterm infants, all admitted to special care baby units (SCBU) after birth, in comparison to healthy term infants over the first 5 years of life. Preterm infants were found to have fewer and shorter night-wakings at 5 months. No differences in sleeping behaviour compared with healthy term children were found at 20 and 56 months of age. Similar significant, and moderate, stability of nightwaking from one age to the next were found for exSCBU-graduates and healthy fullterm infants. Parental interventions such as staying the child until asleep and taking the infant into bed at night were related to nightwaking problems and increased parental distress. It is concluded that prematurity, and thus neurological immaturity and special care experience are less important than caretaking bf behaviour in the development of sleeping problems in both preterm and fullterm infants.     

Cerebral Blood Flow in Preterm Infants:

No abstract available for this article.     

Surfactant Replacement Therapy in Preterm Neonates: A Comparison of Postmortem Pulmonary Histology in Treated and Untreated Infants

New histological lesions have been reported in the lungs of preterm neonates treated with surfactant for respiratory distress syndrome (RDS). Globular deposits of hyaline material in parenchymal air spaces, absence of hyaline membranes, and increased interstitial cellularity and edema without associated fibrosis have been described. Fifteen histological findings were assessed in the lung pathology of 76 infants with RDS from three study groups. Group I (24 infants) died in the presurfactant era (before 1982), group II (26 infants) died despite having surfactant treatment, and group III (26 infants) were either untreated controls or did not receive surfactant for other reasons. The three groups were comparable in respect of sex and survival time. All infants were 34 weeks of gestation or less. Infants with a significant congenital abnormality or pulmonary hypoplasia were excluded. The 76 cases were assessed independently and “blindly” by two pathologists. The histological findings assessed were alveolar collapse; epithelial necrosis, proliferation, and metaplasia; hyaline membranes; dilated lymphatics; pulmonary interstitial emphysema; interstitial edema, inflammation, and fibrosis; arteriolar muscular hyperplasia; interstitial and intra-alveolar hemorrhage; massive pulmonary hemorrhage; and pneumonia. No significant differences were found in any of the histological findings between the three groups. The hyaline membranes seen in the surfactant-treated infants were identical to those in the untreated lungs and were of the characteristic linear type. Interstitial fibrosis, inflammation, and edema were present in all three groups. It has also been suggested that surfactant therapy protects preterm infants from interstitial hemorrhage but predisposes them to intra-alveolar hemorrhage. No significant difference in the incidence of intra-alveolar and interstitial hemorrhage in the three groups was identified.     

早产儿和足月儿脑性瘫痪的临床特征

目的探讨早产儿和足月儿脑性瘫痪(CP)的临床特征,确定脑损伤的病因与时间,为病因预防提供依据。方法回顾性分析2005年9月-2007年8月在安徽医科大学第一附属医院小儿神经康复中心住院的267例CP患儿的围生期脑损伤高危因素、临床特点、头颅CT和MRI表现。早产儿组102例。28周≤胎龄<37周;出生体质量1000～4000g,平均2228.82g。足月儿组165例。37周≤胎龄<42周;出生体质量2100～4600g,平均3250.18g。计量资料采用频数分布及中位数,计数资料采用频数分布、百分构成比及χ2检验进行描述与分析。结果早产儿组痉挛型双瘫高于足月儿组(χ2=7.93P<0.01),足月儿组偏瘫型(χ2=8.17P<0.01)和共济失调型(χ2=4.21P<0.05)高于早产儿组。高危因素主要顺位依次为窒息、低出生体质量、黄疸、颅内出血和双胎。早产儿组并2种以上高危因素,病理性黄疸,双胎,低出生体质量的情况较多;而足月儿组并窒息、颅内出血较多。早产儿组癫高于足月儿组(χ2=10.37P<0.01)。除癫癎外,早产儿和足月儿并发症的差异均无显著性意义(Pa>0.05)。头颅影像学方面早产儿组CP集中表现为脑室周围白质软化,足月儿CP影像学异常分布范围较广。结论早产儿和足月儿在CP类型构成、高危因素、并发症和头颅影像学方面均有差异。对早产儿早期随访、早期干预,有利于CP的早期诊断和治疗。     

早产儿脑室周围白质软化发病机制研究进展

脑室周围白质软化是早产儿脑损伤的主要形式之一.近年来,对其发病机制的研究又取得了一些新的进展,包括早产儿脑血管的解剖特点、压力被动型脑循环、血流动力学紊乱、感染、少突胶质细胞前体对各种损伤因素高度敏感、凝血系统的影响及小胶质细胞的毒性作用等.加强对早产儿脑室周围白质软化发病机制的研究,可为临床更有效的预防和治疗提供参考依据,从而进一步改善早产儿预后.     

Macromolecular Absorption in Preterm and Term Infants

ABSTRACT. Human o-lactalbumin (α-LA) has been used as a marker for measuring macromolecular absorption. The serum concentration of human α-LA after a human milk feed has been studied in 32 healthy very low birthweight infants (VLBW), fed human milk (gestational age 26–32 weeks) and in 56 term, breast-fed infants, age 3–140 days. At 31 weeks of gestation the serum concentration of human α-LA was more than 10 times higher (mean value 3000 and median value 2101 μg/1 serum/1 human milk/kg body weight, n = 11) than in the term infants aged 3–30 days (mean value 257 and median value 152, n = 29). The serum concentration of o-LA decreased with increasing maturity in the VLBW-infants. At a postconceptional age of 37 weeks the values were similar (mean value 200 and median value 99, n = 8) to those found for term infants during the first month. In the term infants a decreasing absorption of α-LA was found with increasing postnatal age.     

Serum Immunoglobulin Levels and Incidence of Infection During the First Year of Life in Full-term and Preterm Infants

IgG, IgM, and IgA concentrations from birth to 12 months of age, and the incidence of acute infectious processes were determined in 25 full-term and in 26 preterm infants by the single radioimmunodiffusion technique in a prospective study. Infants born at term showed significantly higher IgG levels than preterm babies up to 2 months of age (P less than 0.05) and the frequency of preterm babies with one or more acute infectious episodes during the same period of time was higher, mainly owing to pulmonary, oral mucosa, and ocular infections. The frequency of children with six or seven infectious episodes was also higher in the preterm group (P less than 0.05). IgM and IgA levels did not differ between groups. Even though preterm infants did not show serious bacterial disease or inability to produce antibodies, the incidence of infectious processes was higher in this group up to 2 months of age, a period during which serum IgG levels were lower than in the group of children born at term.     

Necrotizing Enterocolitis in HIV-Exposed and Nonexposed Infants: Clinical Presentation and Histopathological Features

ABSTRACT Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in neonates and is associated with significant morbidity and mortality. An association between HIV-positive maternal status and increased risk of NEC in preterm infants has been described, and antiretroviral therapy has been proposed as an independent risk factor. Our aim was to compare the clinical presentation and histopathological features of necrotizing enterocolitis in HIV-exposed and unexposed infants. A retrospective study of archival material from the National Health Laboratory Services Histopathology Laboratory in Tygerberg Hospital/Stellenbosch University from 1992 to 2008 was conducted. All surgical specimens from infants who presented to pediatric surgery for a laparotomy and bowel resection for NEC and in whom the HIV status was known were included in the study. In the 37 cases that fulfilled these criteria, male gender was overrepresented in the study population (67%). Nonsteroidal anti-inflammatory drugs appeared to play a significant role in the development of surgical NEC in infants who were not exposed to HIV, but HIV-exposed infants had a significantly poorer survival rate. There was no significant difference in the histopathology between HIV-exposed and nonexposed infants, and Cytomegalovirus infection was not identified in any of the cases studied.     

Surfactant Replacement Therapy for the Prevention of the Neonatal Respiratory Distress Syndrome in Preterm Infants

Objective To study the efficacy of pulmonary surfactant (Exosurf) in the prevention of the neonatal respiratory distress syndrome (RDS) in preterm infants. Methods A prospective clinical trial was conducted. To prevent RDS, a single dose of pulmonary surfactant (Exosurf) was administered intratracheally in 25 preterm infants at a high risk of developing RDS as the prophylaxis group, and another 25 preterm babies who received no surfactant administration formed the control group. Results The preterm infants in the prophylaxis group received a prophylactic dose of surfactant ( 67.5 mg/kg) within 0.25 to 6 hours ( 3.4± 1.9 hours) after delivery. Oxygenation in these babies was markedly improved and their clinical symptoms were relieved after the administration of surfactant. The durations of supplemental oxygen administration, assisted ventilation and hospitalization in the prophylaxis group, were ( 9.5± 6.9) days, ( 2.6± 3.8) days and ( 40.8± 17.8) days respectively, which were significantly shortened compared with those of the control group (P< 0.05). Although the incidence of RDS and mortality in the prophylaxis group (20% and 8%) seemed to be lower than those of the control group (32% and 12%),there was no statistical differenc (P> 0.05). Conclusions Prophylactic administration of surfactant can improve oxygenation, relieve symptoms, and shorten the duration of supplemental oxygen administration, assisted ventilation and hospitalization. It has a relief effect on RDS in preterm infants.     

Surfactant Replacement Therapy for the Prevention of the Neonatal Respiratory Distress Syndrome in Preterm Infants

目的　探讨肺表面活性物质 (PS)预防新生儿呼吸窘迫综合征 (RDS)的有效性及临床价值。方法2 5例高危早产儿气管内滴注单剂预防量PS ,并与 2 5例未用PS的高危早产儿进行前瞻性临床对照研究。结果　预防组早产儿在生后 15min～ 6h ,平均 ( 3 .4± 1.9)h给予预防量PS ,其临床症状及血气指标明显改善 ,氧疗时间、机械通气时间和住院天数分别为 ( 9.5± 6.9)d ,( 2 .6± 3 .8)d和 ( 4 0 .8± 17.8)d。而对照组氧疗时间、机械通气时间和住院天数分别为 ( 13 .1± 6.5 )d ,( 4 .3± 3 .2 )d和 ( 5 3 .8± 2 7.8)d ,两者比较差异具有显著性 (P <0 .0 5 )。预防组RDS发生率 2 0 %、病死率 8%虽较对照组RDS发生率 3 2 %和病死率 12 %低 ,但两者间差异在统计学上无显著性意义 (P >0 .0 5 )。结论　PS预防性给药可改善早产儿临床症状及血气指标 ,缩短氧疗时间、机械通气时间和住院天数 ,对高危早产儿RDS具有减轻病情作用。     

Early Channels of Mother-Infant Communication: Preterm and Term Infants

The impact of prematurity on the responsiveness of mothers and their 4-month-old infants was examined across three channels of communication: attentional, vocal and affective. Log-linear models were used to determine how the behavior of one partner was conditional upon the behavior of the other during home observations of 24 preterm and 24 term infants and their mothers. Visual attention was elicited by vocalization, and the onset of infant gaze was marked by a maternal smile. Mothers and infants responded to vocalizations with vocalizations, and mothers responded to smiles with smiles. Mothers of preterm infants were particularly responsive to their infants' signals within the attentional, vocal and affective channels. Preterm infants demonstrated correspondingly heightened responsiveness within the vocal and affective channels.     

Apoptosis and White Matter Injury in Preterm Infants

White matter injury in premature infants with or without intraventricular hemorrhage (IVH) remains an important cause of neonatal mortality and neurologic morbidity. The contribution of apoptosis to the cellular death in white matter injury in the preterm infant is unclear. The objective of this study was to determine whether apoptosis contributes to the cellular death in premature infants with cranial ultrasound (US) evidence of IVH and asymmetric periventricular echogenicity (PVE). Brain tissue incorporating frontoparietal white matter was obtained from 21 infants: 6 infants with severe IVH and asymmetric PVE (grade 1V IVH) on US (group 1); 9 infants with minimal IVH or normal US who died within 21 days (group II); and 6 infants with minimal IVH or normal US who died later (group III). The presence of DNA fragmentation, typical of apoptosis, was determined using a terminal deoxytransferase-mediated dUTD nick-end labeling (TUNEL) assay. The TUNEL index for group I infants was significantly greater, i.e., 2.75 ± 1.94% versus 0.84 ± 0.70% for group II and 0.42 ± 0.22 for group III infants (P = 0.004). Most cells showing reactivity had morphologic characteristics consistent with astrocytes and oligodendroglia. The number of white matter cells showing morphologic changes consistent with apoptosis, such as nuclear blebs and karyorrhexis, was also quantitated and was significantly more numerous in group I than in group II infants, i.e., 0.51 ± 0.64% versus 0.02 ± 0.05% (P = 0.0005), and group III infants, i.e., 0.10 ± 0.18% (P = 0.03). These findings implicate apoptosis as a contributing mechanism for the cellular death in infants with IVH and asymmetric PVE. Strategies aimed at preventing the white matter injury will need to incorporate methods of inhibiting the ongoing process of apoptosis. Received March 14, 2001; accepted October 25, 2001.