新生儿窒息与分娩方式的近年变化

本文对 1998年 10月～ 2 0 0 0年 9月及 1989年 1月～ 1990年 12月在我院产科出生活产新生儿共 5 16 6例进行回顾分析 ,旨在了解新生儿窒息与分娩方式的关系 ,以指导临床工作。对象与方法一、对象　我院产科 1989年 1月～ 1990年 12月出生活产新生儿 2 4 86例 ,男 130 3例 ,女 1183例 ;1998年 10月～ 2 0 0 0年 8月出生的活产新生儿 2 6 80例 ,男 14 4 1例 ,女 12 39例。二、方法　采用回顾性调查 ,根据病历记录的有关内容进行统计分析。新生儿窒息以出生后 1minApgar评分为准[1] ,0～ 3分为重度窒息 ,4～ 7min为轻度窒息。分娩方式分为剖…     

52例窒息新生儿血电解质的变化分析

我们于1997年8月～1999年10月对因窒息住院的52例新生儿及同期住院的30例正常新生儿作血钾、钠、氯、钙检测,观察窒息程度与血清电解质改变的关系。临床资料一、一般资料　围生期窒息的新生儿52例,均符合窒息的诊断标准[1],按窒息程度分为轻度窒息组(1ｍｉｎＡｐｇａｒ评分4～7分)27例,重度窒息组(1ｍｉｎＡｐｇａｒ评分0～3分)25例。男35例,女17例;出生体重3.18±0.35ｋｇ;胎龄36周～42周。对照组30例,为无窒息史及缺氧表现、其母孕健康的正常新生儿。其日龄、胎龄、性别及出生体重与窒息组无显著性差异。二、实验室检查结果　窒息组于治疗…     

窒息新生儿尿视黄醇结合蛋白的动态变化及意义

我院 1998年 6月～ 1999年 8月对 40例足月窒息新生儿进行了尿视黄醇结合蛋白 (ＲＢＰ)的动态监测 ,报告如下。对象与方法一、对象　正常新生儿组 2 0例 ,男 17例 ,女 3例。出生体重平均 32 5 0 ｇ ,胎龄平均 39周 ,出生 1ｍｉｎＡｐｇａｒ评分 8～10分。足月窒息组 40例 ,男 2 2例 ,女 18例。出生体重平均330 0 ｇ ,胎龄平均 39周 ,出生 1ｍｉｎＡｐｇａｒ评分 1～ 7分 ,轻度窒息 14例 ,中重度窒息 2 6例。均未用过肾毒性药物。二、方法　两组均在生后ｄ1、3、7、14各收集一次新鲜尿约 5ｍｌ左右 ,置 - 2 0℃低温保存 ,应用双抗体夹心酶联…     

新生儿窒息尿微量蛋白的检测及临床意义

为了解窒息后肾损害的尿微量蛋白变化 ,我们对 5 6例窒息新生儿进行了尿微量蛋白的检测 ,现报告如下。资料和方法一、检测对象1 窒息组 :出生七天内 ,不分民族、不分性别、孕龄在 32～ 42周 ,出生体重 1 6 5 0～ 40 0 0ｇ ,出生后Ａｐｇａｒ评分均为 7分以下共 5 6例 ,其中重度 1 5例 ,轻度 41例。2 正常对照组 :正常新生儿 40例、年龄为生后 7天内 ,不分性别及民族、孕龄 37～ 41周 ,体重 2 6 0 0～ 380 0ｇ ,Ａｐｇａｒ评分 8～ 1 0分无心、脑、肺、肾及感染性疾病者。日龄与窒息组比较无显著性差异 (Ｐ >0 .0 5 )。二、测定方法全部均…     

气管插管在新生儿重度窒息复苏中的作用

1997年 12月～ 1999年 12月我院采用气管插管抢救 12例重度窒息儿 ,获得满意疗效。现将有关资料报道如下。资料与方法一、一般资料　 1997年 12月～ 1999年 12月在我院分娩新生儿 12 18例 ,其中新生儿窒息 2 2例 ;胎龄 33～ 34周1例 ,～ 37周为 1例 ,～ 4 0周 7例 ,～ 4 2周 3例 (包括 2例低体重儿 )。正常分娩 3例 ,胎吸引产 4例 ,剖宫产 3例 (其中 1例为胎吸失败改行剖宫产 ) ,臀位助产 1例。按新生儿窒息诊断标准[1] ,Apgar评分 0～ 3分为重度窒息 ,本组重度窒息12例 ,占 0 .99%。出生后 1minApgar评分 1分 1例 ,2分 4例 ,3分 7例。二、…     

窒息新生儿血D－二聚体检测及临床意义

本文通过检测窒息新生儿血清Ｄ -二聚体 (Ｄ -Ｄ)水平 ,旨在探讨窒息缺氧对新生儿凝血功能的影响 ,且为临床早期应用抗凝治疗提供理论依据。对象和方法一、对象　正常对照组我院产科生后 2 4小时内健康足月新生儿 2 0例 ,其中男性 11例 ,女性 9例 ;平均日龄 10 4小时 ,出生体重 25 0 0～ 40 35ｇ ,生后 1分钟和 5分钟Ａｐｇａｒ评分为 9～ 10分。窒息组 :本院新生儿科 1997年 6月～ 1999年 9月收治窒息足月新生儿 38例 ,所有研究对象均无家族性出凝血疾病史。新生儿生后及母亲产前、产后均未使用对凝血功能有影响的药物 ,其中轻度窒息组 2 …     

新旧两种复苏方法对新生儿窒息复苏效果的比较

为比较新旧两种复苏方法对新生儿窒息复苏的效果 ,以提高复苏成功率 ,减少死亡率 ,现将我科 1 997年 1月～ 1 998年 1 2月间收治的采用不同方法复苏的新生儿窒息 90例 ,进行回顾性统计分析 ,报告如下。资料与方法一、资料本文新生儿窒息 90例 ,为 1 997年 1月～ 1 998年 1 2月间收住本科的住院患儿。窒息诊断 :依据出生后Ａｐｇａｒ评分 ,1分钟 0～ 3分为重度窒息 ,4～ 7分为轻度窒息。根据复苏方法的不同 ,将患儿分为Ａ、Ｂ两组。Ａ组为本院产科分娩。共 6 0例 ,男 4 2例 ,女 1 8例。Ｂ组 30例 ,院外分娩 2 7例 ,本院 3例。男 1 9例 ,女 1 …     

新旧两种复苏方法对新生儿窒息复苏效果的比较

为比较新旧两种复苏方法对新生儿窒息复苏的效果 ,以提高复苏成功率 ,减少死亡率 ,现将我科 1997年 1月～ 1998年 12月间收治的采用不同方法复苏的新生儿窒息 90例进行回顾性统计分析 ,报告如下。资料与方法一、资料本文新生儿窒息 90例 ,为 1997年 1月～ 1998年 12月间收住本科的住院患儿。窒息诊断 :依据出生后Ａｐｇａｒ评分 ,1分钟 0～ 3分为重度窒息 ,4～ 7分为轻度窒息。根据复苏方法的不同 ,将患儿分为Ａ、Ｂ两组。Ａ组为本院产科分娩 ,共 6 0例 ,男 4 2例 ,女 18例。Ｂ组 30例 ,院外分娩 2 7例 ,本院 3例 ,男19例 ,女 11例。有窒息…     

脐血瘦素水平与婴幼儿体格发育指标的关系

目的　瘦素参与儿童生长发育的调控 ,而宫内生长环境亦可影响生后的生长发育和代谢。该文探讨新生儿出生时脐带血瘦素水平与婴幼儿体格发育指标的关系 ,评价出生时瘦素水平对婴幼儿生长发育的调节作用。方法　采用ELISA方法检测 5 5例新生儿 (男 35例 ,女 2 0例 ,胎龄 31～ 4 1周 )脐血瘦素水平 ,并对其中的 2 5例进行了 1年 7个月至 2年 3个月的随访 ,观察脐血瘦素水平与新生儿胎龄、出生体重、身长、体重 身长2 (BMI)以及生后 1岁 7个月时婴幼儿体重、身长净增长值、BMI的关系。结果　新生儿脐血瘦素水平与胎龄 (r =0 .4 0 9,P<0 .0 1)、出生体重 (r =0 .4 6 3,P <0 .0 1)、身长 (r =0 .36 0 ,P <0 .0 1)、BMI(r =0 .32 8,P <0 .0 5 )均呈正相关 ,与性别无相关性 (P >0 .0 5 )。脐血瘦素水平与 1岁 7个月时婴幼儿体重、身长的净增长值呈显著负相关 (分别为r =- 0 .5 31,P <0 .0 1;r =- 0 .4 4 8,P <0 .0 5 ) ,但婴幼儿BMI与脐血瘦素水平无相关 (P >0 .0 5 )。结论　脐血瘦素水平与新生儿出生体重、身长、BMI有关 ,并对婴幼儿体格发育指标的增长速度具有负性调节作用。早产儿出生时脐血瘦素低水平可能与生后的“生长追赶”现象有关。     

抗凝血酶和纤溶功能的变化在窒息新生儿中的临床意义

新生儿窒息的病理生理基础和本质为缺氧、酸中毒眼1演,缺氧、酸中毒引起的凝血功能紊乱又加重组织缺氧缺血,严重者可导致感染、休克、多器官功能衰竭甚至死亡眼2,3演,故凝血机制在新生儿窒息发生发展及预后中起重要作用眼4演。本研究拟测定窒息患儿的纤维蛋白原(FIB)、抗凝血酶(A T∶A)、D-二聚体(D蛳D)、Ⅷ因子活性(Ⅷ∶C)、血管性血友病因子(V W F)、纤溶酶原活性(PLG∶A)等指标,以探讨抗凝血酶和纤溶变化与病情严重程度及预后关系。1材料和方法1.1研究对象①随机选取2002～2004年入院的窒息新生儿82例,采用A pgar评分标准,分为轻…     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.