新生儿惊厥161例临床分析

目的 总结新生儿惊厥的发生率、病因及临床特点.方法 回顾性分析161例惊厥新生儿临床资料.结果 惊厥发生率12.4%;男女之比为2.2:1;惊厥首发时间为生后51.6 h,13.0%的患儿足量苯巴比妥不能控制.治疗后85.7%治愈出院,10.6%有症状出院,3.1%死亡,1.16%自动出院.围产期窒息(47.2%)是引起惊厥的首要病因,其次是糖及电解质紊乱(13.0%)、感染性疾病(16.2%)、各类遗传代谢病(6.8%).发作类型以微小性发作为主(26.7%),其次为阵挛性发作(23.0%).结论 (1)窒息是导致新生儿惊厥发生的主要原因.(2)发作形式以微小性发作最多见.(3)苯巴比妥仍是抗新生儿惊厥的一线药,少数患儿应用该药后惊厥不能控制,制定一套安全有效的抗新生儿惊厥治疗方案迫在眉睫.     

新生儿气胸的病因及救治策略

目的 探讨新生儿气胸发生的病因、诊断及救治措施.方法 回顾性分析2005年3月至2010年3月收住我院新生儿科的98例新生儿气胸的病因、诊治手段及预后.结果 98例气胸患儿中,足月儿71例,早产儿27例;自发性气胸10例,非自发性气胸88例,分别给予原发病治疗、胸腔穿刺排气、胸腔闭式引流及机械通气等救治措施后,治愈88例,好转8例,死亡2例.结论 新生儿气胸与剖宫产、窒息复苏时正压通气过度、胎粪吸入、早产儿肺透明膜病应用肺表面活性物质及机械通气等因素有关,绝大部分继发于肺部疾病.预防早产和窒息,避免错误的气道加压,可减少气胸的发生.     

出生24h内新生儿肺出血病因与死因分析

目的 探讨出生24h内新生儿肺出血的病因与死因,并推测其与胎儿肺出血的关系.方法 选择114例出生24h内即发生肺出血的新生儿,根据临床与病理资料进行分析.结果 114例患儿的肺部病理检查结果,点状肺出血6例,局灶性肺出血印例,弥漫性肺出血48例.28例于生后0～6h,71例于生后7～12h,15例于生后13～24h内发病.肺出血病因中缺氧因素110例,包括吸入性肺炎62例、呼吸窘迫综合征24例、青紫型复杂心脏畸形7例、肺膨胀不全7例、新生儿窒息7例、其他原因缺氧3例;感染因素4例,病因均为宫内感染所致败血症.肺出血患儿死亡因素中缺氧因素113例,包括肺出血74例、吸人性肺炎15例、呼吸窘迫综合征12例、青紫型复杂心脏畸形7例、肺膨胀不全2例、颅内出血2例、新生儿窒息1例;感染因素I例,为宫内感染所致败血症.82例有宫内窘迫史,在直接死于肺出血的74例中,3例有宫内窘迫史,且出生数分钟即死亡.结论 出生24 h内新生儿肺出血病因及死因均以缺氧因素为主,大多有宫内窘迫.其中3例弥漫性肺出血患儿于出生数分钟即死亡,从而推测出生24h内新生儿肺出血,有相当部分可能为胎儿肺出血的延续.     

新生儿惊厥病因分析

新生儿惊厥是新生儿疾病常见的症状，病因复杂病死率高。我院新生儿病区2000年9月～2002年9月共收住新生儿1255例，其中发生惊厥者138例，现将该组病例的病因及临床表现特点分析如下。     

新生儿脑水肿的病因与早期诊断探讨

为了降低新生儿脑水肿（NBE）的病死率与伤残率，对其病因与早期诊断作探讨以利防治。资料分析方法：1.回顾性分析，尸检证实NBE583例（1962～1998年）。2.对生后3～7天经头颅CT检查确诊NBE的63例症侯分析（1998～1999年）。资料显示：1.583例NBE的原发病依次：脑267例，肺223例，感染52例，心35例，畸形6例。2.63例CT扫描结果SAH60例，HIE48例，IPH、脑积水各2例，SDH、IVH、脑梗塞各1例。3. 临床表现：以兴奋或抑制、呼吸改变、青紫或苍白、肌张力异常、反射异常为明显。可以认为：1.本组NBE的病因以缺氧为主。2.当患儿具有窒息，异常分娩史，母为高危妊娠，产前、产时有合并症和生后具有上述症侯者，应作头颅CT或超声，可早期诊断脑水肿。     

新生儿脑水肿的病因与早期诊断探讨

为了降低新生儿脑水肿(NBE)的病死率与伤残率,对其病因与早期诊断作探讨以利防治.资料分析方法1.回顾性分析,尸检证实NBE 583例(1962～1998年).2.对生后3～7天经头颅CT检查确诊NBE的63例作症候分析(1998～1999年).资料显示1.583例NBE的原发病依次脑267例,肺223例,感染52例,心35例,畸形6例.2.63例CT扫描结果SAH60例,HIE48例,IPH、脑积水各2例,SDH、ⅣH、脑梗塞各1例.3.临床表现以兴奋或抑制、呼吸改变、青紫或苍白、肌张力异常、反射异常为明显.可以认为1.本组NBE的病因以缺氧为主.2.当患儿具有窒息,异常分娩史,母为高危妊娠,产前、产时有合并症和生后具有上述症候者,应作头颅CT或超声,可早期诊断脑水肿.     

新生儿心律失常的临床特点及预后

目的 探讨新生儿心律失常的临床特点及预后.方法 对2004年1月-2006年12月在本院新生儿病房住院经体检或心电监测发现心律失常80例患儿进行24 h动态心电图的检查,分析其临床资料,并进行横断面随诊.结果 80例患儿中男52例,女28例;足月儿68例,早产儿9例,过期产儿3例;心律失常诊断时日龄平均4 d.心律失常以室上性占多数,共45例(56.3%);临床表现不典型,缺氧、感染及电解质紊乱、代谢紊乱为主要原因;急性期经病因或抗心律失常药物治疗,25例房性期前收缩患儿18例痊愈;21例审性期前收缩患儿10例痊愈;4例室性心动过速患儿2例治愈,1例死亡;3例阵发性室上性心动过速药物转复后1例复发2次,2例末财发作;5例房室传导阻滞患儿3例治愈.急性期预后室上性好于室性,二者远期预后无明显差别.其中61例随诊(1.2±0.7)a,室上性和室性心律失常的痊愈率无显著差异.结论 新生儿心律失常以室上性占多数,多为功能性、暂时性,预后较好,室上性心律失常转归更好,只有少数严重心律失常需药物治疗.     

婴儿病理性黄疸的病因及预后因素

本文对128例婴儿病理性黄疽分析显示，乙肝病毒及巨细胞病毒感染是主要病因，且与明道闭锁形成密切相关。黄疸程度、病因等影响预后。重症肝炎、胆道闭锁预后极差。故认为早诊断、早治疗可大大改善领后。     

新生儿气腹症72例临床特点及预后分析

目的 探讨新生儿气腹症的临床特点和影响其预后的相关因素,以指导临床对新生儿气腹症的救治.方法 回顾性分析本院2000年1月至2009年6月新生儿气腹症的临床资料.对早产、原发疾病、就诊时间、手术时间等与预后相关的因素进行Logistic回归分析.结果 共72例气腹症,腹胀、呕吐为其早期和常见症状,腹壁发红及红肿高度提示气腹症,及时腹部直立住X线检查和腹腔穿刺有助诊断;手术治疗64例,其中62例为消化道穿孔,2例为非消化道穿孔,8例放弃治疗出院;手术患儿中治愈37例,治愈率57.8%;死亡27例,病死率42.2%.不同原发疾病痛死率不同,以坏死性小肠结肠炎病死率最高,达78.3%.对死亡的危险因素进行Logistic多元回归分析,手术时间(P<0.05)、早产(P<0.05)、多脏器功能受损(P<0.01)、坏死性小肠结肠炎(P<0.01)是死亡的相关危险因素.发病24 h内手术者疗效较佳(P<0.01).结论 新生儿气腹症中绝大多数为消化道穿孔性气腹,病死率高,死亡危险因素包括手术时间、早产,坏死性小肠结肠炎、多脏器功能受损等,早期诊断和早期治疗可改善预后.     

婴儿痉挛伴局灶性发作的病因、临床和脑电图特征及转归

目的探讨婴儿痉挛（IS）伴局灶性发作（FS）的病因、临床和脑电图（EEG）特征及转归。方法通过临床观察、神经影像学（CT和MRI），视频EEG监测和随访，根据黔出现的早晚与痫性痉挛（ES）发作的关系，将12例IS患儿分为A、B、C3组。探讨12例Is患儿发生胯的起始时间、发作形式与变化、病因和EEG特征及病情转归与ES之间的相互关系和临床意义。结果10例具有局灶性皮质发育不良、结节性硬化、颞叶囊肿或硬化和缺氧缺血性病变等病因。临床表现主要为不对称性痉挛或强直痉挛发作时或前后伴头眼部分旋转发作、无动性凝视或局灶性肢体抽动等FS；其中，同一次ES成串发作中FS与ES发生的先后关系：FS→ES（6例），ES→FS→ES（1例），ES→FS（3例）。A组和B组早期FS发作频繁、症状不典型（眼、面、口咽部和全面性发作）、游走发作或交替发作为主，FS的痫性放电主要集中于后顶枕和颞顶枕区；B组后期和C组FS频率相对较少、以复杂局灶性发作或继发全面发作多见，EEG提示以局灶性额叶及周围前头区放电为主。自然转归过程中，2例由FS发作转变为IS；6例Is转变为Lennox—Gastaut综合征或症状性全面性癫痫，4例转变为FS，1例维持FS伴ES2种发作形式的特殊病理状态，1例不确定。结论IS伴FS是一种年龄相关性FS继发全面性癫痫脑病。其为多种病因，临床发作形式，脑电图变化及病情演变过程，提示了本病特定年龄期未成熟皮层与皮层下痫性放电的复杂性及由此表现出的特殊临床癫痫综合征形式。     

Management of Neonatal Seizures

Seizures in the newborn period constitute a medical emergency. Subtle seizures are the commonest type of seizures occurring in the neonatal period. Myoclonic seizures carry the worst prognosis in terms of long-term neurodevelopmental outcome. Hypoxic-ischemic encephalopathy is the most common cause of neonatal seizures. Multiple etiologies often co-exist in neonates and hence it is essential to rule out common causes such as hypoglycaemia, hypocalcemia, and meningitis before initiating specific therapy. A comprehensive evidence based approach for management of neonatal seizures has been described in this protocol.     

Recent Advances in Neonatal Seizures

Neonatal seizures are the most important indicators of underlying brain injury. Seizures in a neonate are different from seizures in older children in many aspects including clinical presentation and etiology. The neonatal brain is immature and tends to have a decreased seizure threshold. Neonatal seizures are classified, based on their presentation as, clinical seizures, electroclinical seizures and electroencephalographic seizures; based on the pathophysiology as epileptic and nonepileptic seizures; and also on the basis of the etiology. Hypoxic ischemic encephalopathy is the leading cause of neonatal seizures, followed by intracranial hemorrhage, metabolic causes such as hypoglycemia and hypocalcemia, intracranial infections and strokes. Neonatal epilepsy syndromes are rare. Electroencephalography (EEG) is the gold standard for diagnosis. Amplitude integrated EEG (aEEG) is also used for continuous monitoring. The approach to management consists of initial stabilization of the neonate followed by treatment of potentially correctable injurious processes such as hypocalcemia, hypoglycemia and electrolyte disturbances, etiology specific therapies and antiepileptic drug (AED) therapy. Phenobarbital remains the first line AED therapy. Pharmacokinetic data on newer drugs is limited. Prognosis depends on the etiology, seizure type, neurological examination at discharge and EEG. Long term neurodevelopmental follow up is essential for babies with neonatal seizures.     

Etiology and Diagnosis of Neonatal Conjunctivitis

ABSTRACT. Chlamydia trachomatis was isolated from the most inflamed eye of 13 of 107 (12%) infants with neonatal purulent conjunctivitis and from none of 100 healthy infants ( p <0.01). Staphylococcus aureus was recovered from 49 (46%) inflamed eyes and from 8 (8%) healthy eyes ( p <0.01). Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catar-rhalis, Escherichia coli and Klebsiella pneumoniae were isolated from very few infants with conjunctivitis but not from controls. No organisms could be recovered from 23 (22%) infants with conjunctivitis and from 60 (60%) healthy infants (p<0.01). The incidence of neonatal purulent conjunctivitis was 107 (2%), of 5924 births. Eyes infected with C. trachomatis were significantly more inflamed than eyes from which S. aureus or no organisms could be isolated. Furthermore, conjunctival "psendomembranes" were associated with C. trachomatis. The age at onset of the chlamydial conjunctivitis was higher compared to the age at onset of conjunctivitis in which S. aureus or no organisms were isolated.     

Advances in Management of Neonatal Seizures

Seizures are more common in the neonatal period than any other time in the human lifespan. A high index of suspicion for seizures should be maintained for infants who present with encephalopathy soon after birth, have had a stroke, central nervous system (CNS) infection or intracranial hemorrhage or have a genetic or metabolic condition associated with CNS malformations. Complicating the matter, most neonatal seizures lack a clinical correlate with only subtle autonomic changes and often no clinical indication at all. Over the last three decades, several tools have been developed to enhance the detection and treatment of neonatal seizures. The use of electroencephalography (EEG) and the later development of amplitude-integrated EEG (aEEG), allows for Neurologists and non-Neurologists alike, to significantly increase the sensitivity of seizure detection. When applied to the appropriate clinical setting, time to diagnosis and start of therapy is greatly reduced. Phenobarbital maintains the status of first-line therapy in worldwide use. However, newer anti-epileptic agents such as, levetiracetam, bumetanide, and topiramate are increasingly being applied to the neonatal population, offering the potential for seizure treatment with a significantly better side-effect profile. Seizures in premature infants, continue to confound clinicians and researchers alike. Though the apparent seizure burden is significant and there is an association between seizures and adverse outcomes, the two are not cleanly correlated. Compounding the issue, GABA-ergic anti-epileptic drugs are not only less effective in this age group due to reversed neuronal ion gradients but may cause harm. Selecting an appropriate treatment group remains a challenge.     

新生儿肠闭锁的诊治与预后

目的 探讨新生儿肠闭锁(IA)的诊断、治疗与预后,以进一步提高治愈率.方法 对本院2004年4月-2008年11月行手术治疗的29例先天性IA患儿临床资料进行回顾性分析.本组29例生后均有呕吐,15例有正常胎粪排出史,19例腹上区可见胃肠型,腹部立位平片示21例可见胃宽大液平面及数个扩张小肠液平、余8例仅见胃内的宽大液平,余部位无气体.术中见回肠闭锁16例,十二指肠闭锁7例,空肠闭锁6例;闭锁类型:Ⅰ型、Ⅱ型、Ⅲa型各9例,Ⅲb型(Apple-peel)、Ⅳ型各1例;行IA近远端修剪端斜吻合术17例,IA隔膜切除纵切横缝术9例,IA近远端切除端端吻合术3例.术后29例均予全静脉营养支持.结果 29例全部存活.其中治愈28例,1例术后放弃治疗.28例均未发现吻合口瘘及切口裂开等并发症.术后发生吻合口梗阻1例,经保守治疗后痊愈.26例术后获随访3个月～4 a,生长发育良好,无腹胀、腹痛.2例失访.结论 早期诊断、合理的术式选择及围术期处理是提高IA治愈率的关键.