A Premature Infant with a Bilateral Thalamostriatal Hemorrhage: Brain Imaging and Pathology

Hemorrhagic areas were seen on ultrasonography and computed tomography in both thalamostriatal regions in a preterm female infant with perinatal asphyxia due to abruptio placentae. At autopsy, marked perivascular bleeding in the thalamus and putamen and eosinophilic neuronal changes in the thalamus and pontine tegmentum were seen. These thalamostriatal and brain stem lesions are thought to have been caused by an acute process causing total asphyxia.     

血浆铁相关抗氧化物对早产儿脑室周围-脑室内出血的预测价值

目的 评估血浆铁相关抗氧化物(铜蓝蛋白、转铁蛋白及铁蛋白)对于早产儿脑室周围-脑室内出血(PVH-IVH)的预测价值.方法 选取2009年8月-2010年10月胎龄≤32周住院早产儿60例,均于出生3～7d行头颅MRI检查,根据头颅MRI检查结果将60例早产儿分为2组:PVH-IVH组(21例)为头颅MRI显示PVH-IVH早产儿,对照组39例为头颅MRI显示无PVH-IVH早产儿.所有早产儿于出生24h内检测血浆铁蛋白、转铁蛋白和铜蓝蛋白,回顾性分析比较2组临床资料及检测结果.应用SPSS 15.0软件进行统计学分析.结果 1.胎龄≤32周早产儿PVH-IVH发生率为35％(21例),按Papile分级法将PVH-IVH进行分级:Ⅰ度5例,Ⅱ度10例,Ⅲ度4例,Ⅳ度2例.2.PVH-IVH组血浆转铁蛋白水平显著低于对照组(P＜0.05);PVH-IVH组血浆铜蓝蛋白水平显著低于对照组(P＜0.05);2组血浆铁蛋白水平比较差异无统计学意义(P＞0.05).结论 早产儿PVH-IVH早期血浆抗氧化物转铁蛋白、铜蓝蛋白水平明显低下,检测血浆抗氧化物转铁蛋白、铜蓝蛋白对预测早产儿PVH-IVH有一定价值.     

早产儿脑室内出血的相关因素

目的探讨早产儿脑室内出血(IVH)发病相关因素及临床特点。方法调查172例早产儿胎龄、体质量、出生情况,通过床旁颅脑彩超确诊早产儿IVH,记录IVH临床表现、彩超结果,并与同期入院无IVH早产儿进行比较。结果1.胎龄与IVH发生有关(χ2=6.40P=0.011);2.出生体质量与IVH发生有关(χ2=26.49P=0);3.早产儿IVH多于生后72h内出现临床症状,生后5d内确诊,且多数早产儿IVH程度较轻,无明显临床症状;4.重度窒息早产儿较轻度窒息早产儿IVH发生率高、程度重。结论胎龄、出生体质量及窒息程度与早产儿IVH的发生呈线性关系;多数早产儿IVH无明显临床表现;床旁颅脑超声是诊断早产儿IVH可靠、敏感和简便的手段。     

Risk Factors of Germinal Matrix Intraventricular Hemorrhage in Premature Infants

Objective

To determine whether some clinical parameters can be used to predict the hemorrhage and whether the relationship between these clinical variables and the grades of hemorrhage is linear.

Methods

A total of 230 premature infants, born at a gestational age less than 34 weeks were retrospectively reviewed. Germinal matrix-intraventricular hemorrhage (GM-IVH), the grade of the hemorrhage, and clinical data were assessed with a checklist. Variables were analyzed by using Mann Whitney U and Fisher’s exact tests and then multiple logistic regression analysis was used to evaluate the independent risk factors.

Findings

Resuscitation, gestational age, hypotension, multiple birth, and birth weight were found to be independent risk factors. We determined non-linear relationship between the grades of hemorrhage and the clinical parameters. But when we classified hemorrhages as grade 1, grade 2-3 and grade 4, the relationships were found linear.

Conclusion

Premature infants who had resuscitation, low gestational age, hypotension, multiple birth, and low birth weight are more likely to have GM-IVH. The relationship between the clinical variables and the grades of GM-IVH does not seem to be linear.     

早产儿脑室周围-脑室内出血继发脑积水的高危因素

目的 探讨早产儿脑室周围-脑室内出血(PVH-IVH)继发脑积水的高危因素,为早产儿PVH-IVH继发脑积水的防治提供依据.方法 2007年6月至2012年6月入住NICU、出生3～7d床旁头颅B超检查结果提示存在PVH-IVH的早产儿214例,根据预后不同分为单纯PVH-IVH组(n=161)和PVH-IVH继发脑积水组(n=53),采用单因素分析和多因素Logistic回归分析调查PVH-IVH后继发性脑积水的高危因素.结果 单因素分析显示,男童、胎龄＜28周、出生体质量＜1000 g、重度窒息、PVH-IVH Ⅲ级或Ⅳ级、代谢性酸中毒、低钠血症、低血糖症或高血糖症等8个因素与早产儿PVH-IVH继发脑积水的发生相关(P均＜0.05);多因素Logistic回归分析显示,男童(OR =3.317)、重度窒息(OR=13.838)、PVH-IVHⅢ级或Ⅳ级(OR=43.281)、低钠血症(OR =2.731)是早产儿PVH-IVH继发脑积水的独立危险因素(P均＜0.05).结论 男童、重度窒息、PVH-IVHⅢ级或Ⅳ级、低钠血症与早产儿PVH-IVH继发脑积水的发生密切相关,早产儿出现PVH-IVH后,应高度重视这些因素,以预防脑积水的发生.     

机械通气早产儿脑室周围-脑室内出血临床高危因素分析

目的：探讨机械通气早产儿脑室周围-脑室内出血（PVH-IVH）的临床高危因素,为早产儿PVH-IVH的防治提供依据。方法：2009年1月至2011年12月入住新生儿重症监护室且应用机械通气的205例早产儿,根据生后3～7 d床旁头颅B超检查结果分为PVH-IVH组（n=84）和无PVH-IVH组（n=121）,采用单因素分析和多因素logistic回归分析调查PVH-IVH发生的高危因素。结果：单因素分析显示,胎龄<32周、出生体重<1500 g、宫内窘迫、重度窒息、自然分娩、孕期感染、胎膜早破≥8 h、机械通气≥7 d、并发呼吸机相关肺炎（VAP）等9个因素与机械通气早产儿PVH-IVH的发生有关（均P<0.05）;多因素logistic回归显示,出生体重<1500 g（OR=2.665）、宫内窘迫（OR=2.177）、重度窒息（OR=5.653）、孕期感染（OR=4.365）、VAP（OR=2.299）是机械通气早产儿PVH-IVH发生的独立危险因素（均P<0.05）。结论：极低出生体重、宫内窘迫、重度窒息、孕期感染、VAP与机械通气早产儿PVH-IVH发生密切相关,在临床工作中应高度重视这些因素,以预防PVH-IVH的发生。     

早产儿的围产因素及防治对策探讨

目的：研究早产的围产因素及寻求相应的预防措施。方法：将我院近5年出生的新生儿2 567例,分为早产儿、足月儿两组,对照分析孕母年龄、胎膜早破、多胎妊娠、前置胎盘、妊高征、胎盘早剥、产前检查等围产因素,同时分析早产儿的并发症。结果：早产儿发生率为6.62%,早产儿组与足月儿组对比,除母亲孕龄差异无显著性外,胎膜早破、多胎妊娠、前置胎盘、妊高征、胎盘早剥,产前检查等因素差异均有显著性(P<0.01 或 0.05)。早产儿的并发症主要是新生儿肺炎、硬肿症、高胆红素血症和颅内出血。胎龄越小,体重越低,死亡率越高。结论：减少早产是降低围产儿死亡的关键,减少早产的发生应加强围产期保健,定期产前检查,对产前并发症采取各种防治措施,提高早产儿的成活率。     

Intrauterine Chlamydia Trachomatis Infection in a Premature Infant

Intrauterine Chlamydia trachomatis infection was strongly suspected in a premature infant born in the 32nd week of gestation. The membranes were artificially ruptured at the time of delivery. This infant showed a high titer of specific IgM antibody to Chlamydia trachomatis at one hour after birth. He showed mild respiratory distress and was treated with oral erythromycin for three weeks. He was discharged home at the age of 46 days.     

Neurological Outcome in Full-Term Infants with Intraventricular Hemorrhage

Eight survivors among 12 full-term infants with intraventricular hemorrhage (IVH) were investigated for neurological handicap. Five patients developed epilepsy during the follow-up period of 4.5 years (range 2.0—6.8 years); four patients had an electroencephalogram (EEG) showing unilateral paroxysmal spikes, mainly in the central region, suggesting ventricular dilatation. The seizures were either partial, evolving to generalized seizures, or were generalized tonic-clonic seizures. Patients with either moderate ventricular dilation and/or grade III IVH with severe asphyxia had a poor developmental and neurological outcome.     

血浆渗透压、血气、血糖变化与早产儿脑室周围-脑室内出血的相关性

目的　研究血浆渗透压、血气和血糖变化与早产儿脑室周围 脑室内出血 (PIVH)的相关性 ,为临床防治提供参考依据。方法　PIVH患儿 173例入院后常规作血生化检测和血气分析 ,并与无PIVH的 164例早产儿比较。结果　低血糖、酸中毒、高碳酸血症和缺氧均与早产儿PIVH密切相关 (P均 <0 .0 5 ) ,两组早产儿血浆渗透压差异不显著 (P >0 .0 5 )。结论　早产儿血浆渗透压与PIVH无相关关系 ,对早产儿要重视纠正低血糖、酸中毒、高碳酸血症和缺氧 ,以降低早产儿颅内出血发生率 ,减少伤残。     

围产期早产儿尿蛋白动态变化

目的：研究早产儿肾功能特点及与胎龄、日龄的关系。方法：利用免疫比浊法、速率法及ELISA法,测定28～31周组(Ⅰ组)、32～34周组(Ⅱ组)、35～37周组(Ⅲ组)早产儿生后第1天、第4天、第7天尿微量白蛋白(mAlb)、视黄醇结合蛋白(RBP)、N-乙酰-β-D氨基葡萄糖苷酶(NAG)值。结果：同一胎龄段尿mAlb随着日龄增加有下降趋势,但差异无显著性(P>0.05);同一日龄mAlb随胎龄增加而降低,差异有显著性(P<0.05 或 0.01)。尿RBP,NAG在Ⅰ组和Ⅲ组随日龄增加而增加,在生后第4天形成峰值,而后明显下降,尤以Ⅰ组不同日龄间RBP和NAG差异有显著性(P<0.01 或 0.05)。同一日龄尿RBP,NAG随胎龄增加而明显降低,尤以生后第4天和第7天不同胎龄间RBP和NAG差异有显著性(P<0.05 或 0.01)。结论： 早产儿肾小球、肾小管尚在发育中,受胎龄日龄影响较大。     

早产儿颅内出血振幅整合脑电图背景模式及睡眠觉醒周期的特点

目的 分析不同程度脑室周围-脑室内出血（PIVH）早产儿振幅整合脑电图（aEEG）背景模式及睡眠觉醒周期的特点。方法 选取56 例胎龄25~33 周的PIVH 早产儿及31 例同胎龄段无PIVH 早产儿,将PIVH 患儿按Papile 分级标准分为轻度出血组（Ⅰ、Ⅱ级）和中重度出血组（Ⅲ、Ⅳ级）,对各组早产儿aEEG的结果进行比较分析。结果 与轻度出血组及对照组比较,中重度出血组患儿的电压连续性降低,睡眠觉醒周期（SWC）缺失率高,aEEG 评分低（P 结论 aEEG 背景活动及SWC 的改变与早产儿PIVH 的严重程度有关。     

Periventricular-Intraventricular Hemorrhage in the Neonate:

Periventricular-intraventricular hemorrhage is a serious problem in the premature infant, and is often associated with poor neurological outcome. The purpose of this paper is to review the literature on the origin, etiology, and incidence of PVH-IVH, to discuss current methods of diagnosis and prevention, and to discuss the neurological outcome of the survivors. Suggestions for additional research are presented.     

Lung Pathology in Premature Infants with Ureaplasma urealyticum Infection

Respiratory tract colonization with Ureaplasma urealyticum in preterm infants has been associated with a higher incidence of pneumonia, severe respiratory failure, bronchopulmonary dysplasia (BPD), and death. In this report, we characterize the lung pathology and expression of tumor necrosis factor-α (TNF-α) associated with U. urealyticum pneumonia in very low–birth weight infants (VLBW; ≤1500 g). Lung pathology of archived autopsy specimens was retrospectively reviewed in three groups of VLBW infants: 5 gestational controls who died from nonpulmonary causes, 13 infants with pneumonia who were culture and/or PCR negative for U. urealyticum, and 5 infants with pulmonary disease and positive for U. urealyticum by tracheal aspirate and/or lung tissue culture or polymerase chain reaction (PCR). Presence and extent of alveolar macrophages and neutrophils, as well as interstitial lymphocytic infiltration and fibrosis were evaluated. PCR was performed on formalin-fixed, paraffin-embedded lung sections. Additional sections were immunostained for TNF-α. The peripheral total white blood cell counts and absolute neutrophil counts were three-fold higher in infants with U. urealyticum pneumonia than cell counts in infants infected with other organisms. There was a trend toward a predominance of neutrophils in alveoli of non-Ureaplasma pneumonia infants, but a trend toward a predominance of alveolar macrophages in U. urealyticum–infected infants. The most striking finding was the presence of increased interstitial fibrosis in all Ureaplasma-infected infants. TNF-α immunoreactive cell density was very low in the gestational controls, but increased in both pneumonia groups. We conclude that persistent lung U. urealyticum infection may contribute to chronic inflammation and early fibrosis in the preterm lung. Received August 6, 2001; accepted October 19, 2001.     

早产儿胃肠功能障碍的临床研究

目的 探讨早产儿胃肠功能障碍的发生率、发病因素及预后.方法 分析206例早产儿不同出生体质量及胎龄与胃肠功能障碍发生率的关系.比较早产儿在合并窒息、感染情况下胃肠功能障碍的发生率.检测早产儿胃肠功能障碍组及非胃肠功能障碍组乳酸(LAC)水平,计算2组病死率.结果 206例早产儿胃肠功能障碍的发生率为21.36%(44/206例).低出生体质量儿与极低出生体质量儿胃肠功能障碍的发生率比较差异有统计学意义(χ2=13.598,P=0.000 2);胎龄≤32周的早产儿与胎龄>32周的早产儿胃肠功能障碍的发生率比较差异有统计学意义(χ2=6.904,P=0.009 0);出生后有窒息史及合并感染的早产儿胃肠功能障碍的发生率均明显升高(Pa<0.01).胃肠功能障碍组早产儿LAC水平明显高于非胃肠功能障碍组(t=32.849,P<0.001),且2组病死率比较差异有统计学意义(χ2=6.032,P=0.014 0).结论 早产儿胃肠功能障碍的发生率较高,尤其是极低出生体质量及胎龄≤32周的早产儿,且与窒息、感染等因素有关.血LAC参数的变化可作为早产儿发生胃肠功能障碍的警示参数及诊断参考指标.早产儿出现胃肠功能障碍病死率明显增加,应重视对其早期干预.     

Neonatal Adrenal Hemorrhage Detected Antenatally

This report describes two cases of neonatal adrenal mass detected antenatally by routine ultrasound (US) examination of pregnant women. Case 1 was recognized by the fetal US at 31 weeks gestation. The mass, located near the right upper pole of the kidney, was echolucent on US examination. A serial US of the mass showed changes of the internal echoes from a cystic lesion to a mixed lesion, and finally to a hyperechogenic lesion due to a neonatal adrenal hemorrhage (NAH). At 33 days, laparotomy was performed, and the pathological finding revealed an NAH owing to the mass bleeding into the adrenal cyst. Case 2 was also detected by fetal US just before birth. The mass of the right upper pole of the kidney was hyperechogenic on US examination. The baby clinically deteriorated after birth because of hypovolemia owing to NAH. A serial US of the mass showed the change from a hyperechogenic to a cystic lesion. Four months later, the mass spontaneously resolved. From the US spectrum, the mass was diagnosed as NAH. These are the second known cases of NAH detected before birth in Japan.     

血小板参数动态变化预测新生儿肺出血

目的 研究血小板参数在新生儿肺出血（PHN）中的动态变化规律。方法人选新生儿肺出血148例，在入院后48h内每3h及肺出血后从末梢动脉部位采取微量血100止送检，应用美国雅培公司CD-3400型全血自动细胞分析仪，动态监测其血小板及其参数的变化。结果血小板计数及血小板比容、血小板体积分布宽度在新生儿肺出血前6h均有明显改变（P均〈0．05）。结论监测血小板参数动态变化有助于PHN的早期预测，可为临床早期诊断提供帮助。     

早产儿脑病相关危险因素回顾性分析

目的 探讨早产儿脑病的发生情况,并分析其相关危险因素,以降低其发病率,改善神经发育预后.方法 对2009年11月1日-2010年10月31日青岛大学医学院附属医院NICU收治的胎龄≤32周的186例早产儿行头颅MRI检查,分析早产儿脑病的发生率,根据头颅MRI表现分为颅内出血组和无颅内出血组、缺血性脑损伤组和无缺血性脑损伤组,头颅MRI未发现异常者设为对照组,详细统计临床资料,应用SPSS 17.0软件进行数据分析,比较2组基本情况、产科病理、生后并发症及治疗措施方面的差异;对相关因素进行Logistic回归分析,筛选出早产儿脑病的高危因素.结果 1.早产儿脑病发生率为36.0%(67/186例),出血性脑损伤发生率为29.0%(54/186例);缺血性脑损伤发生率23.1%(43/186例);缺血性脑损伤中局灶性损伤20例,弥散性损伤23例;67例患儿中同时表现出血及缺血性损伤的发生率16.1%(30/186例);43例缺血患儿中11例表现为神经元轴突损伤.2.脑病组与对照组出生胎龄及第1次MRI检查时间的差异均无统计学意义(Pa>0.05),出生体质量的差异有统计学意义(P<0.05).3.Logistic回归分析:母孕期感染、产道分娩、脓毒症、机械通气是出血性脑损伤的独立危险因素,出生体质量为其保护因素;机械通气、脓毒症、低碳酸血症是缺血性脑损伤的独立危险因素,出生体质量、产前激素为其保护因素.结论 早产儿脑病是多种因素相互作用的复杂结果,母孕期感染等宫内暴露因素、围生期缺氧及出生后感染均为早产儿脑病的危险因素.     

住院早产儿脑室内出血10年回顾性调查及影响因素分析

目的　调查住院早产儿脑室内出血 (IVH)发生率及其影响因素。方法　对 1993～ 2 0 0 2年 10年间入住新生儿病房、曾经头颅B超检查的所有住院早产儿进行分析 ,应用SIGMAB超诊断仪对早产儿进行床边头颅B超检查。结果　 392例早产儿的平均胎龄为 (34 0± 2 1)周 ,平均出生体重为 (2 13± 0 5 3)kg。平均头颅B超初次检查时间为生后 (5 3± 6 3)d ,其中本院出生患儿为 (4 0± 2 0 )d ,外院出生患儿为 (7 0± 8 0 )d ,两者有非常显著性意义。总的IVH发生率为 5 6 6 % (2 2 2 / 392 ) ,重度IVH发生率为 16 3% (6 4 / 392 )。早产儿的胎龄愈小 ,出生体重愈低 ,其IVH发生率愈高 ,出血程度也趋严重。围产期窒息、家中自娩、机械通气、产妇为外来民工等因素与早产儿IVH及其出血程度密切相关。结论　鉴于早产儿IVH的高发生率及约一半IVH早产儿无明显临床症状 ,建议对所有早产儿在生后早期应常规进行床边头颅B超检查