早产儿脑室周围强回声区分度与脑室周围白质囊性变的关系

目的：了解早产儿脑室周围强回声区（PVE）分度与脑室周围白质囊性变发生率及囊性变出现时间的关系。方法：对2005年2月至2008年5月间该院新生儿重症监护室住院超声诊断为PVE的120例早产儿（平均胎龄为32周,平均出生体重2 230 g）进行回顾性单元分析研究。结果：① 诊断为PVEⅠ度52例（43％）,PVEⅡ度42例（35％）,PVEⅢ度26例（22％）,PVE分度与出生体重密切相关,与胎龄无关。②120例早产儿脑白质囊性变发生率24％(29/120),PVEⅢ度囊性变发生率65％,Ⅱ度囊性变发生率21％,PVEⅢ度囊性变发生率明显高于PVEⅡ度。③囊性变出现的时间各不相同,PVEⅢ度组囊性变出现的时间明显早于PVEⅡ度组。结论：PVE分度与脑室周围白质囊性变出现的时间及囊性变发生率密切相关,因此对不同程度的PVE动态监测囊性变有不同的侧重点。［中国当代儿科杂志,2009,11（2）：104-106］     

Twelve‐month neurodevelopmental outcome in preterm infants with and without intrauterine growth restriction

Aim: To evaluate the neurodevelopmental outcome at 12 months’ corrected age in preterm infants with and without severe intrauterine growth restriction. Methods: This prospective follow‐up study included 37 infants with severe intrauterine growth restriction and 36 appropriate‐for‐gestational‐age infants born between 26 and 34 weeks. Neonatal and infant data were prospectively recorded. Infants were assessed at 12 ± 2 months’ corrected age with the Hammersmith Infant Neurological Examination and the Bayley Scale for Infant Development version‐II. Results: Both groups were similar in demographic characteristics and perinatal status. No significant differences in neurodevelopmental performance were found. The mental development index was 98.8 (SD 9.0) vs 98.4 (SD 13.1) (p = 0.9) and the psychomotor development index was 91.7 (SD 9.9) vs 95.5 (SD 13.4) (p = 0.2) for the study and reference groups respectively. Neurological assessment showed no significant differences between the two groups. Conclusion: Although the study group showed a non‐significant trend towards a lower score in the psychomotor development index than the reference group, significant differences at 12 months could not be demonstrated. IUGR infants continued to have significantly lower weight, length and head circumference at 1 year.     

宫内发育迟缓儿的免疫状态研究

宫内发育迟缓是围生期常见的并发症,对胎儿危害很大.近年来的研究发现免疫学机制在宫内发育迟缓的发病中占有重要地位.免疫机制的异常可能通过发育程序化途径影响胎儿宫内以及宫外的免疫机能.     

Correlation of grading and duration of periventricular echodensities with neurodevelopmental outcome in preterm infants

Background Transient periventricular echodensities (PVE) in preterm infants affect neurodevelopmental outcome.Objective To correlate the duration and grading of PVE with neurodevelopmental outcome.Materials and methods A retrospective, single-centre cohort study of infants with PVE diagnosed by ultrasonography from 1995 to 2000 with blinded grading and recognition of duration of PVE.Results A total of 72 infants (median gestational age 32 weeks, median birth weight 1,668 g) were diagnosed as having PVE. Minor neurological abnormalities were diagnosed in seven (10%), cerebral palsy in six (8%), developmental delay in seven (10%), and mild mental retardation in two (3%) of the infants. Differences regarding adverse outcome were not significant between infants with severity grade 1 compared to severity grade 2 (16% and 22%, respectively). There was a significant increase in adverse neurodevelopmental outcome with increasing duration of PVE. Of 33 infants with duration of PVE <7 days, 1 (3%) had an adverse neurodevelopmental outcome, compared to 6 (24%) of 25 infants with a duration of PVE of 7–14 days, and 6 (43%) of 14 infants with a duration of PVE >14 days (P<0.002, RR 7.920, 95% CI 1.017–61.661; P<0.001, RR 14.143, 95% CI 1.871–106.895, respectively).Conclusion The duration, but not the grading, of transient PVE was significantly correlated with neurodevelopmental outcome.     

Impact of intrauterine growth restriction on neurodevelopmental and growth outcomes in very low birthweight infants

The impact of intrauterine growth restriction (IUGR) in very low birthweight preterm infants weighing ≤ 1250g was determined by comparing longitudinal growth and neurodevelopmental outcome to an adjusted age of 36 months in 52 intrauterine growth restricted children, with 55 birthweight-matched and 56 gestational age-matched children. None of these children had chromosomal anomalies, congenital infections, or major congenital malformations. Gestational ages of intrauterine growth restricted, birthweight- and gestational age-matched infants were 30 (± 3), 26 (± 2), 29 (± 2) weeks; birthweights were 842 (± 232), 872 (± 201) and 1094 (± 142) g, respectively. Intrauterine growth restricted children had fewer complications during initial hospitalization ( p < 0.05), and had lower weights and head circumferences at follow-up ( p > 0.05). No significant differences were present in major neurodevelopmental disabilities between the intrauterine growth restricted and two comparison groups. Persistence of microcephaly was associated with adverse neurodevelopmental outcome.     

早产儿脑损伤的危险因素分析

目的 探讨早产儿脑损伤(脑室内出血和脑白质损伤)的危险因素。方法 2014年6月1日至2019年5月31日,在昆明医科大学第一附属医院分娩的出生胎龄28～33+6周的早产儿473例中,入住新生儿科的活产儿443例,排除顽固性低血糖、胆红素脑病、放弃治疗及死亡病例,共纳入392例。结合围产期病史及新生儿早期临床表现,以头颅磁共振成像诊断为主要依据,诊断脑室内出血及脑白质损伤。将患儿分为脑室内出血组(102例)、轻度脑白质损伤组(32例)、中重度脑白质损伤组(31例)及无脑损伤组(227例)。统计学方法采用χ²检验、t检验和Logistic回归模型,分析早产儿不同类型脑损伤的危险因素。结果 392例胎龄28～33+6周的早产儿中,脑损伤发生率为42.1%(165/392),其中脑室内出血发生率为26.0%(102/392),脑白质损伤发生率为16.1%(63/392)。Logistic回归模型显示,脑室内出血的危险因素：重度妊娠期高血压疾病(OR=2.287,95%CI:1.099～4.758,P<0.05)、支气管肺发育不良(OR=2.670,95%CI:1....     

34周以下早产儿宫外生长发育迟缓发生的影响因素

目的　研究34周以下早产儿宫外生长发育迟缓(EUGR)发生的相关因素。方法　选取<34周早产儿694例, 根据出院时体重分为EUGR组和非EUGR组, 回顾性分析两组早产儿的围生期资料、住院期间生长、营养摄入情况及相关合并症等资料。结果　694例早产儿中, 发生EUGR 284例(40.9%)。宫内生长发育迟缓(IUGR)患儿发生EUGR的比例明显高于非IUGR组(P<0.01); 极低出生体重儿发生EUGR比例明显高于非极低出生体重儿(P<0.01)。胎龄越小、出生体重越低的早产儿EUGR的发生率越高(P<0.01)。EUGR组早产儿禁食天数、静脉营养持续天数、首次肠内营养的日龄、全肠内营养的日龄均大于非EUGR组(P<0.01)。EUGR组患儿生后第1周蛋白质累积损失量与热卡累积损失量均大于非EUGR组(P<0.05)。EUGR组生后发生呼吸窘迫综合征、呼吸暂停、坏死性小肠结肠炎、败血症等并发症的比例高于非EUGR组(P<0.05)。Logistic回归分析显示, 出生体重、出生胎龄及IUGR是EUGR发生的独立危险因素。结论 34周以下早产儿EUGR发生率较高, 尤其是已经存在IUGR的早产儿或极低出生体重儿; 生后早期积极的营养支持, 预防呼吸暂停、败血症等并发症将会在一定程度上减少EUGR的发生。     

Endothelin-1 and leptin as markers of intrauterine growth restriction

Objective  To explore the role of endothelin-1 (ET-1) and leptin in intrauterine growth restriction (IUGR) among preeclamptic and non-pre-eclamptic women. Methods  Forty three patients with a pregnancy complicated by IUGR, 23 cases with severe pre-eclampsia and 20 cases of non-pre-eclamptic were enrolled. Control group comprised 15 cases with uncomplicated pregnancy. Blood samples from umbilical artery and maternal venous blood were collected at the time of delivery for analysis of ET-1 and leptin levels. Mode of delivery, birth weight and Apgar score were also recorded. Results  The mean maternal and fetal ET-1 level was significantly higher in pregnancies complicated by IUGR than in control group. The mean maternal leptin level was significantly higher in pre-eclamptic patients when compared to non-preeclamptic and control groups. Mean fetal leptin level was significantly lower in patients compared to control; however, when fetal leptin corrected to fetal weight, it was insignificantly different in the both groups. E-mail: m. alhaggar@yahoo.co.uk. Conclusion  Maternal plasma ET-1 and leptin correlate with the degree of fetal growth restriction originating from deterioration of placental function. Maternal plasma leptin and ET-1 levels may reflect deterioration in fetal growth.     

宫内发育受限新生儿中性粒细胞活性氧代谢的研究

目的　本研究拟通过对宫内发育受限新生儿中性粒细胞受不同刺激后所产生的超氧阴离子水平进行检测 ,并与正常新生儿进行比较 ,以了解宫内发育受限对于新生儿中性粒细胞活性氧代谢水平的影响 ,为进一步研究宫内发育受限对于新生儿整体免疫功能的影响打下基础。方法　选择 15例宫内发育受限新生儿脐静脉血 ,加以乙酸肉豆蔻佛波醇 (PMA)和两种细菌 (金黄色葡萄球菌和大肠杆菌 )刺激 ,用超氧阴离子特异性探针氢化溴乙非啶染色 ,通过流式细胞仪技术以平均荧光强度测定法对中性粒细胞超氧阴离子产生水平进行检测 ,并取正常足月新生儿脐带血 2 3例作为对照。结果　宫内发育受限新生儿中性粒细胞超氧阴离子产生水平 (以平均荧光强度MFI为计量单位 )在不同条件刺激下均与正常足月新生儿中性粒细胞有显著性差异 (PMA :4 4 8± 131vs 314± 89,P <0 .0 1;金黄色葡萄球菌 :4 71± 14 2vs 36 2± 79,P <0 .0 1;大肠杆菌 :5 0 2± 133vs 396± 94 ,P <0 .0 1) ;而其中性粒细胞细菌吞噬能力与正常足月儿相比无明显差异。结论　无明确诱因的宫内发育受限新生儿的中性粒细胞在宫内也可能被某些病理因素所激活 ,导致了细胞活性氧代谢水平的显著增高。     

早产儿宫外生长受限研究进展

随着围生医学的发展和新生儿重症监护病房的建立,早产儿的出生率和存活率均显著提高,但早产儿各组织器官发育不成熟,易合并各种早产相关疾病,加之可能存在能量及营养摄入不足等问题,早产儿宫外生长受限发生率高。宫外生长受限不但与早产儿的生长发育和疾病转归息息相关,还会导致神经系统发育不良、成年期代谢综合征等远期不良结局。文章综述早产儿宫外生长受限的研究进展。     

早产儿脑损伤的相关因素分析

目的 分析早产儿脑损伤的影响因素.方法 对2006年1月至2007年10月我院收治的出生时胎龄小于36周的268例早产儿在生后7 d内行头部B超检查.并分析相关临床资料.结果 130例早产儿存在脑损伤,脑损伤的发生率为48.5%,其中脑室出血116例,发生率为43.3%,脑室周围日质软化38例,占14.2%.轻度和重度脑损伤发生率分别为23.5%、13.6%.脑损伤发生与下列因素有关:胎龄小、低出生体质量、窒息、肺透明膜病、呼吸暂停、呼吸衰竭、肺出血、低血糖、感染、低血压、凝血异常、胎膜早破以及宫内感染.结论 脑室出血以及脑室周围白质软化在早产儿中比较常见,其发生与多种因素有关.临床上应避免或治疗引起脑损伤的因素,头部B超可对早产儿脑损伤做出早期诊断.     

胰岛素样生长因子结合蛋白3在宫内生长受限儿中的甲基化研究

目的：探讨胰岛素样生长因子结合蛋白3（IGFBP3）启动子区甲基化状态在胎儿宫内生长受限（IUGR）中的作用。方法：选取IUGR新生儿50例及正常新生儿30例,应用甲基化特异性PCR（MSP）及高分辨率溶解（HRM）技术检测外周血中IGFBP3基因的甲基化状态。结果：IUGR组中IGFBP3启动子区完全甲基化比例为4%（2/50）,部分甲基化比例为40%（20/50）,未甲基化比例为56%（28/50）;对照组中部分甲基化比例为13%（4/30）,未甲基化比例为87%（26/30）,两组甲基化率差异有统计学意义(P＜0.01)。结论：IGFBP3基因启动子区的甲基化程度与IUGR的发生有关。     

早产儿暂时性低甲状腺素血症与脑损伤及神经行为学相关性研究

目的 通过对早产儿甲状腺素水平测定及脑、神经行为发育测评,分析甲状腺素水平与脑损伤、神经行为学的相关性.方法 选取2009年11月至2010年4月,上海交通大学附属上海市儿童医院新生儿科收治的早产儿52例,生后6 h内留取血清样本,放射免疫法测定T3、T4、TSH值.所有患儿出生后3 d行头颅B超检查,每周复查1次,出院前行头颅MRI检查.根据头颅MRI结果将患儿分为3组:无脑损伤组(33例)、脑室内出血组(10例)、脑白质损伤组(9例).所有患儿于纠正胎龄40±2周时行新生儿20项行为神经测定.结果 3组患儿TSH均正常,排除先天性甲状腺功能减低症;共8例早产儿甲状腺功能正常,占15.4%(8/52);另44例早产儿甲状腺功能均低下,占84.6%(44/52).无脑损伤组T3、T4水平高于脑室内出血组及脑白质损伤组,并以脑白质损伤组T3、T4水平最为低下,3组间比较差异有统计学意义(P＜0.05).无脑损伤组患儿行为能力、被动肌张力、主动肌张力及总分4项得分显著高于有脑损伤的两组患儿,且脑室内出血组患儿得分又高于脑白质损伤组患儿,3组间比较差异有统计学意义(P＜0.05).结论 早产儿脑损伤越严重,甲状腺素水平越低.有脑损伤的早产儿神经行为学评分较无脑损伤的早产儿低.     

早产儿宫外生长发育迟缓的研究进展

早产儿宫外生长发育迟缓(extrauterine growth restriction,EUGR)是由围生期疾病及新生儿期各种并发症、生后营养不足等因素所造成的早产儿生后某个时期体重、身长或头围低于相应生长曲线参考值的一种生长落后状态。EUGR的发生在小胎龄、低体重早产儿中十分普遍,对早产儿的体格发育、神经认知功能、心...     

Neonatal antecedents for cerebral palsy in extremely preterm babies and interaction with maternal factors

BACKGROUND: Preterm delivery is associated with an increased risk of cerebral palsy (CP). The greatest risk is for infants born <28 weeks' gestation. AIMS: To identify significant neonatal risk factors for CP and explore the interactions between antenatal and neonatal risk factors, among extremely preterm infants of 27 weeks' gestation or less. STUDY DESIGN: Nested case control design. METHODS: Infants born between 1989 and 1996, at 24-27 weeks' gestation, were evaluated: 30 with CP at 2 years corrected age and 120 control infants matched for gestation age. Neonatal variables were compared using matched analyses with the interaction between antenatal and neonatal factors being examined using logistic regression analyses. RESULTS: Risk factors for CP on matched analyses included patent ductus arteriosus requiring surgical ligation, peri-intraventricular haemorrhage, moderate to severe ventricular dilatation, periventricular leukomalacia (PVL) and need for home oxygen. Independent neonatal predictors were ventricular dilatation (OR 7.3; 95% CI 1.6, 32.3), PVL (OR 29.8; 95% CI 5.6, 159.1) and home oxygen use (OR 3.4; 95% CI 1.2, 9.4). No interaction terms in the logistic models were significant between the previously identified pregnancy risk factors of absence of antenatal steroids and intrauterine growth restriction and the neonatal risk factors. CONCLUSIONS: PVL is the most powerful independent predictor of CP in extremely preterm infants of 27 weeks' gestation or less and appears to be uninfluenced by antenatal factors.     

Management of preterm infants with intrauterine growth restriction

Preterm intrauterine growth restriction (IUGR) is strongly associated with increased mortality and morbidity. In the management of these infants, complications of preterm birth can be amplified by the effect of suboptimal fetal growth. It is important that pregnancies with IUGR are detected before birth, so that delivery can be arranged in a high-risk maternity unit with the appropriate neonatal staff in attendance. The provision of full support for resuscitation and stabilisation of these infants is crucial to the short-term and long-term health of these infants, who have suffered chronic hypoxia and malnutrition in utero. The long term outcome studies of these infants are retrospective and they include SGA infants. The effects of prematurity affect the outcome of IUGR infants. IUGR is associated with cerebral palsy in those delivered more than 32 weeks gestation. Infants less than 32 weeks of gestation may have poor developmental outcome if the head growth is affected, these infants may have associated cognitive and behavioural problems. Children who fail to grow by 2-4 years are at risk of long term growth problems. This paper outlines the acute and long-term management of these infants.     

Advanced intrauterine growth restriction is associated with reduced excretion of asymmetric dimethylarginine

Background

High blood levels of asymmetric dimethylarginine (ADMA) are associated with future development of adverse cardiovascular events. The ADMA/symmetric dimethylarginine (SDMA) ratio is a marker of ADMA catabolism, with a high ADMA/SDMA ratio being suggestive of reduced ADMA excretion.

Aims

This study aimed a) to verify the presence of a statistically significant difference between ADMA/SDMA ratio levels in a group of young adult subjects who were born preterm with an extremely low birth weight (ex-ELBW) and a group of healthy adults born at term and b) to seek correlations between ADMA/SDMA ratio levels in ex-ELBW and anthropometric and clinical parameters (gender, chronological age, gestational age, birth weight, and length of stay in the Neonatal Intensive Care Unit).

Subjects, study design, outcome measures

Thirty-seven ex-ELBW subjects (11 males [M] and 26 females [F], aged 17–28 years, mean age: 22.2 ± 1.8 years) were compared with 37 controls (11 M and 26 F). ADMA/SDMA ratio levels were assessed for each patient included in the study.

Results

ADMA/SDMA ratio in ex-ELBW subjects was higher compared to controls (1.42 ± 0.31 vs 0.95 ± 0.14, p < 0.002) and inversely correlated with birth weight (r = − 0.68, p < 0.0001) and gestational age (r = − 0.54, p < 0.0005).

Conclusions

ADMA catabolism is significantly decreased in ex-ELBW subjects compared to controls, underlining a probable correlation with restriction of intrauterine growth. These results suggest the onset of early circulatory dysfunction predictive of increased cardiovascular risk in ex-ELBW.