极低出生体重儿脑室周围-脑室内出血的相关因素

目的　了解围产因素与极低出生体重儿 (VL BW)脑室周围 -脑室内出血的相关性 ,从而产生预见性价值。　方法　对 4 12例住院的 VL BW定期头颅 B超检查 ,对合并出血进行分级。应用逐步 L ogistic回归分析法寻找脑室周围 -脑室内出血和重度脑室内出血的预测因素。　结果　 4 12例VL BW脑室周围 -脑室内出血发生率为 2 5 .0 % (10 3/ 4 12 ) ,病死率为 39.8% (41/ 10 3)。合理干预后 ,其发生率从 1994年的 32 .0 %逐渐下降 ,2 0 0 0年为 17.6 %。胎龄小、体重低发生率较高。通过对相关因素多变量分析得出导致脑室周围 -脑室内出血独立预测因素分别为围产期窒息 (5 min Apgar评分 <5分 ) :比值比 (OR)为 2 .4 6 ,95 %可信区间为 1.4 8,4 .4 2 ;胎龄小于 2 9周 :OR为 2 .37,95 % ,可信区间为1.35、3.6 8;重度呼吸窘迫综合征 :OR为 2 .16 ,95 %可信区间为 1.34、4 .19;阴道分娩 :OR为 2 .14 ,95 %可信区间为 1.2 5、3.6 8。导致重度脑室内出血的独立预测因素是气胸 :OR为 2 .70 ,95 %可信区间为 1.12、6 .5 7;平均出生体重小于 95 6 g:OR为 4 .0 2 ,95 %可信区间为 1.15、4 .12。　结论　采取合理干预措施有利于避免脑室周围 -脑室内出血的发生和发展     

极低出生体重儿的临床干预和并发症的发生率及病死率研究

目的　探讨极低出生体重儿主要并发症的特点及影响其存活率的相关因素 ,以便改进干预措施 ,进一步降低其病死率。　方法　对 1996年 1月～ 2 0 0 1年 12月于生后 2 4 h内转入 NICU的 12 2例极低出生体重儿的临床资料进行回顾性分析 ,并按出生体重分 3组 ,对其并发症的发生率、转归、主要死因、肠道喂养开始时间及体重变化情况等进行分析比较。　结果　导致极低出生体重的主要原因有多胎妊娠 (30 % )、妊娠合并症 (2 1% )、羊膜早破 (15 % )和原因不明 (30 % )等。所有患儿均有一种或多种并发症 ,主要为高血糖 (5 7% ) ,缺氧缺血性脑病 (46 % ) ,呼吸窘迫综合征 (33% ) ,感染(30 % ) ,低体温 (2 5 % ) ,呼吸暂停 (2 4 % ) ,脑室内出血 (18% )和动脉导管未闭 (18% )等。由于采取预防性干预措施 ,大多数并发症的发生率在不同体重组间的差异无显著性。本组极低出生体重儿存活率为 84 % ,若排除因经济困难或担心后遗症而放弃治疗后死亡的病例 ,则存活率为 91% ;其中出生体重≤ 10 0 0 g者为 5 9%。死亡的主要原因为呼吸窘迫综合征、感染和先天畸形。存活者能耐受经口胃管喂养开始时间为 (6± 4 ) d,不同出生体重之间差异无显著性 (F=1.36 ,P>0 .0 5 ) ;自行吸吮开始时间为 (2 3± 14 ) d,且随出生体重增加而     

The changing pattern of infant mortality in the US: The role of prenatal factors and their obstetrical implications

Infant mortality is one of the leading public health problems in the United States today. During the first half of this century the decline in infant mortality resulted largely from a reduction in postneonatal deaths (2–11 months after birth). Since 1950, two-thirds of all infant deaths have occurred in the neonatal period (1st month after birth). Since 1981, the rate of decline in the infant mortality rate has slowed due to a deterioration in the distribution of birthweights and a slowed improvement in birthweight-specific mortality rates. The role of birthweight is central to this issue, because low birthweight (LBW, < 2500 g) is a major determinant of death in the first year of life, particularly during the neonatal period. Stated another way, less than 0.5% of infants with birthweights > 2500 g die during the first year of life compared to 10.2% of infants with birthweights <2500 g and 45.3% with birthweights < 1500 g (very low birthweight, VLBW). These effects are magnified when evaluated on a race-specific basis: the rate of LBW is twice as high and the rate of VLBW is three times as high for black infants compared to white infants. Reducing the rates of VLBW and LBW, particularly among blacks, holds the greatest potential for future reductions in infant mortality in the United States. The important role of maternal factors in the antecedents of infant mortality (VLBW, LBW, intrauterine growth retardation, preterm birth) have been clearly and repeatedly demonstrated. Some of these factors, such as maternal race, adverse obstetrical history and low level of education, are not amenable to change during pregnancy. Other factors, such as cessation of smoking, higher maternal weight gain and the initiation of early prenatal care have been shown to improve the course and outcome of pregnancy and subsequently result in reduced infant mortality.     

Poor Health‐related Quality of Life After Severe Preeclampsia

Abstract: Background: Preeclampsia is a major complication of pregnancy associated with increased maternal morbidity and mortality, and adverse birth outcomes. The objective of this study was to describe changes in all domains of health‐related quality of life between 6 and 12 weeks postpartum after mild and severe preeclampsia; to assess the extent to which it differs after mild and severe preeclampsia; and to assess which factors contribute to such differences. Methods: We conducted a prospective multicenter cohort study of 174 postpartum women who experienced preeclampsia, and who gave birth between February 2007 and June 2009. Health‐related quality of life was measured at 6 and 12 weeks postpartum by the RAND 36‐item Short‐Form Health Survey (SF‐36). The population for analysis comprised women (74%) who obtained scores on the questionnaire at both time points. Results: Women who experienced severe preeclampsia had a lower postpartum health‐related quality of life than those who had mild preeclampsia (all p < 0.05 at 6 wk postpartum). Quality of life improved on almost all SF‐36 scales from 6 to 12 weeks postpartum (p < 0.05). Compared with women who had mild preeclampsia, those who experienced severe preeclampsia had a poorer mental quality of life at 12 weeks postpartum (p < 0.05). Neonatal intensive care unit admission and perinatal death were contributing factors to this poorer mental quality of life. Conclusions: Obstetric caregivers should be aware of poor health‐related quality of life, particularly mental health quality of life in women who have experienced severe preeclampsia (especially those confronted with perinatal death or their child’s admission to a neonatal intensive care unit), and should consider referral for postpartum psychological care. (BIRTH 38:3 September 2011)     

超低出生体重儿八例临床分析

目的　探讨提高超低出生体重儿（ＥＬＢＷＩ）存活率、降低病残率的办法。　方法　８例ＥＬＢＷＩ平均胎龄２５．６±１．７周,平均体重（７６９±１１３）ｇ,均有一种或多种并发症,经产前胎内运转,产时积极复苏,重视护理、保暖及呼吸管理,积极防治并发症,保持液体、酸碱平衡及合理的静脉营养,防治感染,并早期干预。　结果　８例全部成活,平均住院（４６±１２）天,出院体重（２．１３±０．２４）ｋｇ。随访１年。３个月时智测４例异常,其中３例轻度脑发育不良;１岁时智测１例轻度异常,脑ＣＴ均正常。　结论　正确合理的救治,可提高ＥＬＢＷＩ的存活率,而早期干预,则可降低其病残率     

Sexual Function and Quality of Life for Women with Mild‐to‐Moderate Stress Urinary Incontinence

Introduction: Sexual function is affected by stress urinary incontinence with or without pelvic organ prolapse. The aim of the study was to describe the sexual function of women with mild‐to‐moderate stress urinary incontinence, with or without pelvic organ prolapse (up to stage 2) and examine correlations with symptoms and quality of life. This investigation was part of a large, randomized, clinical trial of women with stress urinary incontinence who participated in an exercise intervention. Methods: Women included in the study suffered from stress urinary incontinence as measured by a pad test and were interested in an exercise intervention. All participants underwent assessment for prolapse staging. Instruments included: the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12), Incontinence Quality of Life Questionnaire (I‐QOL), and a health and urinary leakage questionnaire. Results: One hundred and eighty‐seven ambulatory women, aged 20 to 65 years, had a mean sexual function score of 36.9 (standard deviation [SD] 5.9). No significant correlation was found between the sexual function scores and quantity of urinary leakage. A significant correlation existed between the sexual function and I‐QOL scores (P < .001). An additional finding was that women with urgency symptoms were older (P= .04) and had significantly lower sexual function scores (mean 35.7; SD 6.4) than those who did not report urgency (mean 38.7; SD 4.6; P < .001). Discussion: Women with mild‐to‐moderate stress urinary incontinence, without or with lower stages of pelvic organ prolapse, demonstrated good sexual function, which correlated with physical and psychosocial factors. Health professionals need to perform multifaceted intake assessments on women with urinary leakage to customize their health promotion regimen.     

Prospective Quality of Life Outcomes Following Robotic Surgery in Gynecologic Oncology

Purpose

To characterize the health-related quality of life (HRQL) of patients undergoing robotic surgery for the treatment of gynecologic cancers.

Methods

211 patients completed a quality of life questionnaire before surgery. Postoperative questionnaires, consisting of the same assessment with the addition of postoperative questions, were given at 1 week, 3 weeks, 3, 6, and 12 months after surgery. The Functional Assessment of Cancer Therapy—General (FACT-G) and its subscales were used to evaluate HRQL. Patient-rated body image was evaluated using the Body Image Scale. Statistical significance was measured by the Wilcoxon signed-rank test. Minimally important difference (MID) values were analyzed to evaluate clinical significance.

Results

Overall HRQL and body image decreased at 1 week after surgery and returned to baseline by 3 weeks. Physical and functional well-being decreased at 1 week after surgery and returned to baseline by 3 months after surgery. However, using MID criteria, physical well-being returned to baseline by 3 weeks. Social well-being did not change significantly. Emotional well-being increased immediately by 1 week after surgery.

Conclusion

Patient reported HRQL outcomes following robotic surgery for the treatment of gynecologic cancers suggests a rapid return to pre-surgery values.     

Depression, Anxiety, and Quality of Life in Patients with Epithelial Ovarian Cancer

Objective. The aims of this study were to evaluate psychological distress and quality of life (QOL) in patients with epithelial ovarian cancer (EOC) and to examine the relationship between these problems and health and demographic variables.Methods. Of 344 consecutive patients identified, 246 completed questionnaires. Four dimensions of QOL were assessed including physical, functional, emotional, and social/family well-being, as well as concerns specific to ovarian cancer patients. Depression was measured with the Center for Epidemiologic Studies-Depression (CES-D) scale and anxiety was measured by the State Anxiety Subscale of the Spielberger State–Trait Anxiety Inventory. Performance status was evaluated by the Zubrod score.Results. Sixty-five patients (26%) had early stage disease; 181 (74%) had advanced disease. One hundred twenty-one patients (49%) were under active treatment, while 124 (51%) were seen for posttherapy surveillance. Forty-eight (21%) met CES-D cutoff criteria for a clinical evaluation for depression, and 29% scored above the 75th percentile for anxiety. Performance status was related to depression, anxiety, and QOL problems, except in the domain of social well-being.Conclusions. Clinically significant depression and anxiety may be more prevalent in patients with EOC than previously reported. Future studies of screening for and treating psychological distress are being designed to improve QOL in these women.     

The creation of Adam and God-placenta

Objective. We retrospectively investigated a cohort of very low birthweight infants (VLBWI) by comparing two methods for assessment of albuminuria: nephelometry (standard) and high performance liquid chromatography (HPLC), measuring urinary immunoreactive and non-immunoreactive albumin to evaluate if the latter is more sensitive in identifying childhood onset of albuminuria and hypertension in VLBWI individuals.

Methods. Spot urine samples of a total of 109 subjects (5.3 ± 2.2 years old) who were VLBWI were investigated by HPLC and nephelometry. Twenty-eight subjects were small for gestational age (SGA) and 81 were appropriate for gestational age (AGA). Blood Pressure (BP) was also recorded.

Results. Twelve children (11%) with albuminuria 20 mg/g Cr by nephelometry versus 48 (44.5%) by HPLC (p < 0.001) were identified. The mean ± SD of values in the range of normoalbuminuria was 2.9 ± 5.81 by nephelometry versus 22.6 ± 14 for HPLC (p < 0.001). The values were not statistically different in the two birthweight categories (<1000, 1000–1499 g), in AGA versus SGA and in high BP (>90th percentile) versus normal BP children.

Conclusions. Microalbuminuria by HPLC was more marked in VLBWI than in adults and the difference between values using the two methods was significative.     

极低出生体重儿116例临床分析

目的　探讨影响极低出生体重儿 (verylowbirthweightinfant,VLBWI)存活率的相关因素 ,为降低其病死率和病残率提供依据。　方法　对 1993年 1月～ 1998年 1月收治的 116例VLBWI按体重分三组 ,对其临床资料进行回顾性分析。　结果　VLBWI治愈出院 86例 ,治愈率74 .1% (86 116 ) ;随体重增加而上升 (P <0 .0 5 ) ;治愈者平均住院 (2 7± 13)d ,住院天数随体重增加而缩短 (P <0 .0 5 ) ;病死 15例 ,病死率 12 .9% (15 116 ) ;病死率随体重增加而降低 (P <0 .0 1)。导致VLBWI的主要原因有多胎妊娠 (2 6 .7% ) ,胎膜早破 (2 1.4 % ) ,妊娠并发症 (12 .6 % ) ,习惯性早产(3.1% ) ,妊娠期患内科慢性疾病 (1.3% )和原因不明 (34.9% )。所有住院患儿均有一种以上并发症 ,≤ 10 0 0 g的超低出生体重儿的发生率高达83.3% ,其体重越低 ,并发症的发生率越高 (P <0 .0 1)。存活率 87.1% ,体重≤ 10 0 0 g存活率为 5 6 .3%。死亡的主要原因是肺出血、呼吸窘迫综合征、感染和颅内出血。　结论　提高VLBWI近远期存活率 ,除重视围产期及儿科的处理外 ,VLBWI必须早期发现 ,密切监护 ,及时处理并发症。     

Quality of life in Turkish infertile couples and related factors

Infertility is a major life crisis affecting couples’ psychosocial and physical health. We aimed to assess the quality of life in Turkish infertile couples. This cross-sectional survey was carried out in 127 infertile couples admitted to a University Hospital. The quality of life was measured using the fertility quality of life tool (FertiQoL) scale. Women had lower overall quality of life than men. Women and men who were married for fewer than 10 years had a significantly lower emotional score. Women who had a history of infertility treatment, men who have lived in the town or village men with primary infertility and men who have had primary education or lower, had lower scores for mind/body subscale. Social scores were found lower in women under the age of 30, women with middle or low income, men who were married for fewer than 10 years, men who did not have children for 5 years or more and men with primary infertility. The tolerability and environment scores were significantly higher in women who had been married more than once. We conclude that health care providers should be aware of the factors affecting the quality of life (QoL) and give counselling to improve couples’ quality of life at infertility clinics.     

Effect of Preeclampsia on Blood Pressure in Newborn Very Low Birth Weight Infants

Objective. To test the hypothesis that very low birth infants born to mothers with preeclampsia have higher blood pressure over the first week of life than infants whose mothers did not have preeclampsia. Method. Infants born at < 1,350 g who survived at least one week were stratified by gestational age ( ≤ 28 weeks and ≥ 29 completed weeks) and grouped by the presence or absence of preeclampsia. Highest and lowest systolic and mean and diastolic blood pressures were recorded for each of the first seven days of life. Serial blood pressures were analyzed by repeated measures ANOVA. The presence of hypertension (defined as ≥ 3 days with the highest systolic blood pressure > 90th percentile for gestational age stratum and day-specific range) was analyzed by binary logistic regression. Results. Infants ≥ 29 weeks gestational age born to mothers with preeclampsia had higher blood pressures than did controls. Infants ≤ 28 weeks gestational age born to preeclamptic and nonpreeclamptic mothers had similar blood pressures. In the combined cohort, hypertension was not more prevalent among infants born to women with preeclampsia. Conclusions. Preeclampsia is associated with higher blood pressure in very low birth weight neonates who are ≥ 29 weeks gestation. The long-term significance of this finding is not known.     

Effect of low versus high early parenteral nutrition on plasma amino acid profiles in very low birth-weight infants

Objective: To study the efficacy of early high doses parenteral nutrition (PN) versus early low dose with progressive increments PN regimens, we performed a prospective randomized study in very low birth-weight infants. Study design: Forty-one appropriate gestational age preterm infants with birth weights ranging from 750–1500?g were randomly assigned into two groups. In Group 1, infants started on 3.0?g/kg/day amino acids (AA) and 3?g/kg/day of 20% lipid; in Group 2, AA and lipid were started on 1?g/kg/day, and advanced over 3 days to a maximum 3?g/kg/day. Blood samples were obtained for AA concentrations before starting of the PN, and at the 7th and 14th days. Results: The mean (±SD) birth weight was 1335?g (240), gestational age was 29.7 weeks (1.7) of the study group. The mean body weight and head circumference was similar in the Group 1 and Group 2 at the 14th postnatal days. There was no difference in the blood levels of triglyceride, blood urea nitrogen, creatinine, ammonia, lactat and bicarbonate in the two groups. There was no significant difference in the concentrations of AA except for arginine and asparagine. On day 14, the mean arginine concentrations were significantly higher and asparagine concentrations were lower in Group 2. Conclusion: Although earlier more aggressive administration of AA and fat is not associated with any significant metabolic abnormalities, growth rates and plasma AA concentrations of the infants were similar to infants who AA and lipid given lower in the first day of life.