新生儿窒息血清同型半胱氨酸水平的临床研究

同型半胱氨酸(HCY)是含巯基氨基酸,从细胞内蛋氨酸代谢中起源,为蛋氨酸代谢的中间产物。近期研究表明,高同型半胱氨酸血症是冠状动脉疾病、脑血管疾病、外周血管疾病独立的危险因素,也是有效的预测因素。有研究显示,同型半胱氨酸水平的升高及叶酸、维生素B2、维生素B6、维生素B12等缺乏均可增加早产的危险,有些学者认为,高同型半胱氨酸血症与母孕期并发症及不良生产有关。本研究目的为研究与探讨新生儿缺氧性损伤与血清HCY升高之间的相关性。资料与方法我们对2004年1月至2005年1月在我院出生的新生儿进行了血清HCY的检测,其中男28例,女…     

新生儿败血症合并早期弥散性血管内凝血相关因素的临床研究

目的 探讨新生儿败血症合并早期弥散性血管内凝血(DIC)的相关临床因素,为临床早期诊断新生儿败血症合并DIC 提供参考。方法 采用临床回顾研究方法对我院NICU 2012~2013 年确诊为新生儿败血症的100 例患儿进行研究。根据ISTH 显性DIC 评分系统将患儿分为凝血功能正常组、非显性DIC 组(早期DIC 组)及显性DIC 组(晚期DIC 组),对各组临床表现及相关临床因素进行统计分析。结果 100 例败血症患儿中合并早期DIC 者44 例(44%);3 组患儿硬肿的发生率差异有统计学意义(χ2=12.776,P<0.05);窒息、出血及G- 菌感染是败血症合并早期DIC 的独立危险因素。结论 对于临床有窒息、出血及G- 菌感染的新生儿应积极监测凝血功能并采取早期干预措施,预防患儿由早期DIC 进展为晚期DIC,降低新生儿败血症的病死率。     

危重新生儿血清D-二聚体的测定及超小剂量肝素的临床应用

目的　 探讨危重新生儿血清D 二聚体 (D D)水平变化 ,为肝素合理治疗提供理论依据。 方法 　比较正常足月儿3 0例和危重新生儿 42例血清D D检测结果 ;治疗组 2 1例和对照组 2 1例治疗后血清D D变化情况。 结果 　危重组血浆D D(2 45± 0 78)mg/L ,显著高于正常组 (0 48± 0 2 3 )mg/L(P <0 0 1) ;治疗后 ,治疗组血浆D D (0 65± 0 47)mg/L ,较对照组(1 2 1± 0 5 8)mg/L下降显著 (P <0 0 1)。 结论 　危重新生儿血液多呈现高凝状态 ,血清D D水平检测有利于诊断DIC早期。早期肝素治疗 ,不仅可改变血液的高凝状态 ,而且是预测DIC ,提高治愈率的有效途径。     

新生儿窒息血清同型半胱氨酸水平的临床研究

同型半胱氨酸（HCY）是含巯基氨基酸，从细胞内蛋氨酸代谢中起源，为蛋氨酸代谢的中间产物。近期研究表明，高同型半胱氨酸血症是冠状动脉疾病、脑血管疾病、外周血管疾病独立的危险因素，也是有效的预测因素。有研究显示，同型半胱氨酸水平的升高及叶酸、维生素B2、维生素B6、维生素B12等缺乏均可增加早产的危险，有些学者认为，高同型半胱氨酸血症与母孕期并发症及不良生产有关。本研究目的为研究与探讨新生儿缺氧性损伤与血清HCY升高之间的相关性。     

窒息新生儿血清同型半胱氨酸与叶酸的变化

目的：探讨血清中高同型半胱氨酸（Hcy）血症及低叶酸水平与新生儿窒息的发生是否具有相关性,并对性别、胎龄等因素对血清中同型半胱氨酸及叶酸水平是否有一定影响进行分析。方法：应用酶联免疫吸附实验方法检测血清中Hcy水平,应用放射免疫法测定血中叶酸浓度。结果：①与无窒息对照组相比, 新生儿窒息患儿血清Hcy水平显著升高,而叶酸水平显著降低;②窒息组男婴血清Hcy、叶酸水平分别为15.82 ±2.51 μmol/L; 2.49 ±0.19 ng/mL,女婴为10.50±2.19 μmol/L; 2.38±0.40 ng/mL,男、女婴之间比较差异无显著性;③窒息组足月儿血清Hcy、叶酸水平为12.34 ±2. 01 μmol/L,2.58 ±0.19 ng/mL;早产儿为21.25±5.01 μmol/L; 2.14±0.34 ng/mL。早产儿Hcy水平显著高于足月儿（P<0.05）。结论：①新生儿窒息与血清Hcy及叶酸水平具有显著相关性。②血清Hcy及叶酸水平在性别上无显著差异。③缺氧窒息合并早产者血清Hcy水平升高最为显著。     

急危重患儿弥散性血管内凝血的早期监测研究

目的 探讨急危重患儿弥散性血管内凝血(DIC)的监测方法及小儿危重病例评分与DIC的内在关系.方法 随机对我院PICU新入院的急危重患儿在入院24 h内进行首次小儿危重病例评分,根据分值不同依次分成三组:非危重组(＞80分)32例;危重组(71～80分)29例;极危重组(≤70分)23例.评分后按照试验要求应用发色底物法测定抗凝血酶Ⅲ活性(AT-Ⅲ:A);用ELISA法测定D-二聚体和P-选择素水平.结果 三组共收集病例84例,其中22例合并DIC,占26%.危重组和极危重组DIC的发生率明显高于非危重组(x2=6.32,12.82,P值均＜0.05).而且首次小儿危重病例评分值越低,DIC的发生率就越高(x2=27.01,P＜0.01).22例DIC患儿的AT-Ⅲ:A降低,而D-二聚体、P-选择素均显著升高,敏感性高达90%以上,明显高于血小板计数、凝血酶原时间和纤维蛋白原等指标(x2=35.22,P＜0.01).结论 小儿危重病例评分可用于急危重患儿DIC的早期监测,对科学把握DIC早期实验室检测的有利时机有重要的临床意义;D-二聚体、AT-Ⅲ:A、P-选择素作为急危重患儿DIC的早期监测指标,有较高的敏感性和特异性.     

妊娠晚期乙肝孕妇注射乙肝免疫球蛋白对阻断乙肝病毒母婴传播的作用

目的 探讨慢性乙肝病毒感染的孕妇于妊娠晚期注射乙肝免疫球蛋白(HBIG)对阻断乙肝病毒母婴传播的效果.方法 将慢性乙肝病毒携带者或慢性乙肝孕妇及其所生新生儿分为2组,A组孕妇于孕期第28、32及36周时分别肌肉注射HBIG 200 IU;B组孕妇未注射HBIG.分别检测两组孕妇及其所生新生儿血清乙肝病毒标志物(HBVM)及乙肝病毒DNA(HBV DNA).结果 A组孕妇378例,共分娩新生儿378例,其中新生儿血HBV DNA>500 copies/ml 17例,新生儿宫内感染发生率为4.497%;B组孕妇391例,共分娩新生儿391例,新生儿血HBVDNA>500 copies/ml 17例,新生儿宫内感染发生率为4.348%(X<'2>=0.005 6,P>0.05).血清抗-HBs阴性的孕妇所生新生儿中,A组有9例血清抗-HBs阳性,B组未见血清抗-HBs阳性(X<'2>=7.474,P<0.05).结论 给慢性乙肝病毒感染的孕妇于妊娠晚期注射HBIG 3次,每次200 IU不能明显降低新生儿发生乙肝病毒宫内感染的机会,但部分新生儿可获得血清抗-HBs.HBIG在慢性乙肝病毒感染妊娠妇女中的应用尚待进一步探讨.     

黄疸新生儿血清神经元特异性烯醇化酶和脑干听觉诱发电位变化及其临床意义

目的 探讨黄疸新生儿血清神经元特异性烯醇化酶(NSE)与脑干听觉诱发电位(BAEP)的关系,评价NSE在预测黄疸新生儿听力损害的临床意义.方法 抽取119例新生儿外周血1 mL检测其NSE、胆红素/清蛋白质量比值(B/A)及总胆红素(STB)水平,将STB≥171.0 μmol/L患儿89例归为观察组(其中A组171.0～205.2 μmol/L,B组>205.2～256.5 μmol/L,C组>256.5～342.0 μmol/L,D组>342.0 μmol/L),STB<171.0 μmol/L患儿30例为对照组;同期检测并追踪观察组新生儿BAEP,受试者工作特征曲线(ROCC)分析NSE、STB、B/A与BAEP相关性.结果 观察组NSE水平(15.94±4.73)μg/L及异常率(61.8%)明显高于对照组[(8.75±2.71)μg/L,3.3%](Pa=0),随着STB上升,NSE水平逐渐升高(P=0);NSE、STB、B/A的ROCC曲线下面积(AUC)分别为0.844、0.511、0.589,具有显著性差异(Pa=0);以NSE=14.36μg/L作为预测听力损害标准的敏感性为86.0%,特异性为66.7%,明显高于血清STB、B/A(P=0).结论 血清NSE与BAEP异常改变相关性高,具有较好的预测听力损害的临床价值.     

早期应用微小剂量肝素预防危重新生儿并发DIC的临床探讨

DIC在危重新生儿中是极为常见的问题,是危重新生儿及早产儿、低出生体重儿死亡的重要原因之一.将1998年9月至2001年9月收治的危重新生儿43例,随机分为肝素早期预防组22例,对照组21例,并对危重新生儿DIC发生率和原发病治愈率进行疗效观察,现报告如下.     

低蛋白血症与新生儿弥散性血管内凝血预后

目的探讨低蛋白血症与新生儿弥散性血管内凝血(DIC)预后的相关性。方法回顾性分析142例DIC新生儿的临床表现、实验室指标和预后等。依据入院24 h内的血清白蛋白水平分为,正常白蛋白组(≥30 g/L)和低白蛋白组(30 g/L),分析不同血清白蛋白水平与DIC临床表现、实验室指标及预后的关系。结果新生儿DIC中,低蛋白血症的发生率为68.3%(97/142)。低白蛋白组病死率(42.3%)高于正常白蛋白组(22.2%),差异有统计学意义(P0.05)。与正常白蛋白组比较,低白蛋白组休克和多器官功能障碍的发生率升高,凝血酶原时间(PT)、活性部分凝血活酶时间(APTT)延长,血小板计数降低,差异均有统计学意义(P均0.05)。最终死亡新生儿的血清白蛋白水平明显低于存活新生儿,差异有统计学意义(P0.05)。结论低蛋白血症在DIC新生儿中发病率较高,血清白蛋白水平与DIC预后密切相关。     

Evaluation of early detection and management of disseminated intravascular coagulation among Alexandria University pediatric intensive care patients

This prospective study over 24 months aimed to evaluate the outcome of early management of disseminated intravascular coagulation (DIC) among high-risk patients (n = 50) admitted to a pediatric intensive care unit (PICU). It also included all cases presenting with overt DIC (OD) concomitantly (n = 30). The high-risk group (pre-DIC) was subdivided, according to their D-dimer assay, into negative (n = 14) and positive (n = 36) D-dimer groups. All three groups were evaluated, on admission, for their prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen level (Fi), fibrinogen degradation products (FDP), platelet count, and presence/absence of schistocytes in peripheral blood. The combination of D-dimer and FDP assay showed the best correlation for early pre-DIC diagnosis (r = 0.9048). FDP assay was the best parameter for followup of progress of DIC condition in the PICU. The lowest mortality was among negative D-dimer, followed by positive D-dimer and OD groups (28.6 per cent, 77.8 per cent, and 93.3 per cent, respectively). Among the positive D-dimer group the lowest mortality was encountered in the subgroup treated with plasma, heparin and tranexamic acid (33 per cent) while those treated with non-specific therapy, plasma only, or plasma and heparin showed higher mortality (100 per cent, 80 per cent, and 100 per cent, respectively). The deceased subgroup, among positive D-dimer cases showed a significantly higher number of patients presenting with multiple organ failure on admission compared with the discharged group. In summary, early diagnosis and proper management of pre-DIC, before overt bleeding, in high-risk patients admitted to a PICU using combined D-dimer and FDP assays had a positive impact on their prognosis.     

Confirmation of neonatal screening: reference intervals and evaluation of methodological changes in TSH measurement

Neonatal reference values for serum thyrotropin are scarce and comprise only small numbers of patients. During 2006, changes were made in IMMULITE kits for TSH measurement. To validate methodological changes, 80 serum samples from patients were evaluated and to establish reference intervals, 334 neonates and infants were analyzed (divided into 4 groups). Group 1 (G1) (48-72 h of life) (n=153), group 2A (G2A) (7-10 days of life) (n=65), group 2B (G2B) (11-14 days of life) (n=35), group 3 (G3) (28-40 days of life) (n=81). Current kits overestimate TSH results by 26 to 37%; TSH (mIU/L) reference intervals (percentile 2.5-97.5) were G1 (1.1-12.7), G2A (1.8-9.8), G2B (1.1-7.1) (p < 0.03 vs. G2A), G3 (1.2-6.9). We suggest that during the second week of life, reference values should be divided into an early stage and a late stage, at least, for there to be an adequate interpretation of borderline measurements in newborn thyroid screening.     

Anti-Epileptic drug treatment in children: Hyperhomocysteinaemia, B-Vitamins and the 677C→T Mutation of the Methylenetetrahydrofolate Reductase Gene

The aim of the study was to observe the influence of carbamazepine and valproic acid on plasma total homocysteine and B-vitamin status and the gene-drug interaction with the 677C-->T mutation of the methylenetetrahydrofolate reductase (MTHFR) gene. Plasma total homocysteine concentrations were determined in 136 epileptic children taking anti-epileptic drugs as monotherapy. Nutritional (folate, B12 and B6 vitamins) and genetic (MTHFR 677 C-->T) determinants of plasma homocysteine were studied in a random sample of 59 of the 136 epileptic children. Total homocysteine concentrations were significantly increased (p < 0.05) and folate and vitamin B6 levels were significantly decreased (p < 0.01) in the children taking anti-epileptic drugs compared with our reference ranges. In the carbamazepine-treated group, significantly positive correlation was found between duration of treatment and homocysteine concentration (p < 0.01). Homocysteine concentrations showed a significantly negative correlation with vitamin levels (folate: p = 0.002, and vitamin B12: p = 0.017) only in the carbamazepine treated group. In children treated with carbamazepine up to 3 years, total homocysteine concentration correlated negatively only with folate (p = 0.003), while in patients treated for more than 3 years, total homocysteine correlated negatively only with vitamin B12 values (p = 0.007). The lowering action of carbamazepine treatment on folate levels seems to be associated with hyperhomocysteinaemia, which seems to be related to the homozygous condition for the MTHFR 677C-->T mutation. Valproic acid treatment, although also associated with hyperhomocysteinaemia, only shows a lowering effect on vitamin B6 levels, which seems to be independent of the MTHFR genotype.     

围产期窒息后血浆cTnI、CK-MBmass的影响因素及临床应用价值

为探讨围产期窒息后血浆心肌肌钙蛋白I（cTnI）、肌酸激酶心型同工酶质量（CK-MBmass）的影响因素及临床应用价值。对71例围产期窒息新生儿及27例对照组新生儿生后6小时－48时血浆cTnI、CK-MBmass水平进行测定，运用逐步回归等方法进行分析。结果显示：（1）血浆cTnI水平的变化与胎龄、5分钟Apgar评分有关。（2）围产期窒息组足月儿（59例）cTnI明显高于对照组足月儿（19）；重度窒息组（17例）与轻度窒息组（16例）比较，cTnI差异无显著性，而CK-MBmass差异有非常显著性；围产期窒息组的重度心脏损害患儿（8例）cTnI、CK-MBmass水平明显高于无重心脏损害患儿（63例）。表明围产期窒息持续时间越长cTnI的水平越高。相对于CK-MBmass而言，cTnI对心肌损伤的敏感性可能稍差，而且由于cTnI的水平随着胎龄的增加而增加，因此这一指标在判断早产儿心肌损伤时有一定的局限性。     

Hyperhomocysteinemia as risk factor for ischemic and hemorrhagic stroke in newborn infants

We studied the association between plasma total homocysteine concentrations and the occurrence of stroke in newborn infants (n = 24). Newborn infants with stroke had significantly higher mean total homocysteine concentrations compared with 94 healthy newborn infants (9.3 vs 7.4 micromol/L). The odds ratio for neonatal stroke was 3.95 (95" CI 1.53-10.16) at the 80" cutoff level.     

Intracranial hemorrhage in late hemorrhagic disease of the newborn

This study was conducted to evaluate the clinical profile and outcome in late hemorrhagic disease of the newborn (HDN) with particular reference to intracranial hemorrhage. Infants (n = 42) presenting with late HDN from January 1998 to December 2001 were studied. Majority (76%) were in the age group of 1-3 months. All were term babies on exclusive breast-feeding and none received vitamin K at birth. 71% patients presented with intracranial hemorrhage, commonest site being intracerebral and multiple ICH. Visible external bleeding was noted in 1/3rd of patients only. Three patients expired. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. Isolated intracranial hemorrhage is a common mode of presentation.     

Early onset conjugated hyperbilirubinemia in newborn infants

Objectives: To determine the causes and related outcomes of early onset conjugated hyperbilirubinemia in a group of newborn infants, and to determine the incidence of sepsis in these neonates.Methods: The charts of 42 babies with conjugated hyperbilirubinemia were retrospectively reviewed.Results: The mean gestational age was 37 weeks, and the mean postnatal age at presentation was 10 days. Culture-proven sepsis was identified in 15 babies (35.7% of total). Gramnegative bacteria were isolated in 10 cases and E. coli was the most common of these agents (7 cases). Perinatal hypoxiaischemia was the second most frequent etiology (7 patients; 16.7% of total). The other diagnoses were blood group incompatibility (n=5), Down syndrome (n=3), cholestasis associated with parenteral nutrition (n=3), neonatal hepatitis (n=2), metabolic liver disease (n=1), biliary atresia (n=1), portal venous thrombosis (n=1), and unknown (n=4). Thirteen babies with sepsis recovered completely with treatment, whereas the prognosis for those with perinatal hypoxia-ischemia was grave (six of seven died).Conclusions: The findings suggest that early onset cholestatic jaundice in newborn infants is more commonly from non-hepatic causes, so it is reasonable to monitor these infants carefully for a period of time before undertaking time-consuming or invasive investigations towards a primary liver disease.     

Plasma homocysteine and lipoprotein (a) levels as risk factors for atherosclerotic vascular disease in epileptic children taking anticonvulsants

AIM: To assess the effect of anticonvulsant treatment on plasma homocysteine level and lipoprotein (a) in epileptic children. METHODS: Plasma total homocysteine, folate, vitamin B12 and lipoprotein (a) concentrations were measured in 111 epilectic children taking anticonvulsant drugs for longer than 12 mo. Forty-six healthy, sex- and age-matched children served as controls. RESULTS: Patients and controls differed significantly in concentrations of homocysteine (p < 0.05) and lipoprotein (a) (p < 0.001). The number of patients with homocysteine concentrations of >9 microM was significantly higher in the patient group than in the control group. A significant inverse relationship was found between vitamin B12 folate levels and plasma homocysteine levels in the patient group; 28.8% of the patient group had lipoprotein (a) concentrations above the cut-off value (30 mg/dl) for increased risk of early atherosclerosis, whereas none of the control patients had concentrations above this value. CONCLUSION: These data indicate that prolonged anticonvulsant treatment could increase plasma homocysteine and lipoprotein (a) concentrations and that it may be useful to measure the levels routinely in order to prevent atherosclerosis in epileptic children taking anticonvulsant drugs.     

Relationship of prospective diabetes control in pregnancy to neonatal cardiorespiratory function

We evaluated two groups of diabetic women in pregnancy who differed primarily in the time of initiation of careful diabetes management. Group A (early) were entered in the first trimester (n = 35); group B (late) were entered in the late second or early third trimester (n = 28). Normal women delivering at the same period were used as controls (n = 23). All infants were evaluated by a thorough clinical and echocardiographic examination between 24 and 72 hours of life. Both groups of infants of diabetic mothers had mild increase in mean thickness of ventricular and septal walls compared with those of normal newborn infants, and both had a significant percentage with septal hypertrophy (43% vs 39%). None of the infants in the early group had respiratory symptoms requiring oxygen therapy, compared with 19% in the late group. The early group had significantly fewer infants with elevated right ventricular systolic time interval ratios than did the late group (20% vs 50%); none of the normal infants had elevated ratios. We conclude that careful management of diabetes in pregnancy reduces the severity of hypertrophic cardiomyopathy, although no advantage of early vs late management was obvious. Early management does significantly reduce the number of infants of diabetic mothers who develop respiratory symptoms requiring oxygen therapy.     

脑脊液中cAMP浓度与新生儿窒息后脑损伤关系的临床研究

目的：脑细胞能量衰竭被认为是新生儿缺氧缺血性脑病(HIE)的重要发病机制之一,但如何评价其与脑损伤的关系报道较少。本研究通过检测窒息新生儿脑脊液(CSF)中环一磷酸腺苷(cAMP)的浓度变化以探讨其与脑损伤的关系。方法：36例足月新生儿,中 重度HIE 12例,轻度HIE 13例,无HIE(对照组)11例。于生后36～72 h内取CSF和血液,放免法测定cAMP浓度。出院患儿于半岁、1岁时随访,运用贝利婴幼儿发展量表测定其智力发展指数(MDI)及精神运动发展指数(PDI)。结果：中重度HIE组CSF中cAMP浓度［(8.60±2.47) nmol/L］低于轻度组［(14.83±2.84) nmol/L］和对照组［(24.43±2.39) nmol/L］］,差异有显著性意义(P0.05)。中 重度HIE组MDI和PDI分别为 84.79±13.34 和 83.50±13.28,低于轻度HIE组(102.19±7.02,99.94±9.08)和对照组(116.63±12.08,116.69±10.87),差异均有显著性(P<0.01),轻度HIE的MDI和PDI也小于对照组(P<0.05)。CSF中cAMP浓度与MDI及PDI呈高度正相关(r分别为 0.68,0.75,P均<0.01)。结论：CSF中cAMP浓度与缺氧性脑损伤关系密切,可作为新生儿窒息后早期评估脑损伤和评价预后的敏感指标之一。