Cerebral blood flow velocity in normal, full-term newborns is not related to ductal closure.

OBJECTIVE--To correlate changes in blood flow velocity in the anterior and middle cerebral arteries with closure of the ductus arteriosus in normal, full-term newborns during the first 2 days following delivery. DESIGN--Survey. SETTING--Large community hospital. PARTICIPANTS--Twenty-three normal, full-term neonates. SELECTION PROCEDURES--Volunteer sample. INTERVENTIONS--None. MEASUREMENTS AND RESULTS--We measured blood flow velocity in the anterior and middle cerebral arteries, cardiac output, and patency of the ductus arteriosus using pulsed Doppler, M-mode, and real-time ultrasound. The initial examination was performed at (mean +/- SD) 7.6 +/- 2 hours and the second examination was performed at 30 +/- 3 hours. The systolic, diastolic, and mean blood flow velocity in the anterior and middle cerebral arteries increased significantly from day 1 to day 2. Cardiac output did not change significantly (252 +/- 49 vs 279 +/- 69 cm3/kg per minute). Thirteen newborns on day 1, but only two newborns on day 2, had echocardiographic evidence of a patent ductus arteriosus. Newborns whose ductus was already closed on day 1 had similar increases in blood flow velocity in the anterior and middle cerebral arteries from day 1 to day 2 compared with newborns whose ductus had closed from day 1 to day 2. CONCLUSION--The normal increase in blood flow velocity in the anterior and middle cerebral arteries in the first 2 days following delivery is not related to changes in cardiac output or ductal closure.     

Necrotizing enterocolitis in full-term newborns

During a 17-month period, 19 full-term newborn infants were hospitalized for necrotizing enterocolitis (NEC). 10 of these infants had no apparent risk factors. Only 7 suffered acute fetal distress. 16 of the 19 infants were born in the same hospital. Toxicological and bacteriological investigations of possible cause revealed no specific agent. Virological analysis of 8 stool samples revealed the presence of corona virus in 5 of the 8.     

Blood pressure and heart rate response to head-up position in full-term newborns

The reactions of heart rate (HR), systolic (sBP) and diastolic (dBP) blood pressure were studied in response to passive head-up tilting (successively to +45 ° and +90 °) in a group of 83 full-term, 1- to 7-day-old newborns who were quiet and awake. A significant mean increase of HR was noted for the whole group, from 121 ± 14 beats/min to 124 ± 15 beats/min at +45 ° and to 127 ± 17 beats/min at +90 °, while sBP rose from 65 ± 9 mmHg to 67 ± 12 mmHg at +45 ° and to 70 ± 13 mmHg at +90 ° tilts, respectively (5th post-tilt min). A negative correlation (r = −0.41, P < 0.01) was found between basal supine values of HR and their post-tilt increments after +45 ° tilting. After +90 ° tilting, dBP correlated negatively (r = −0.33, P < 0.003) with the supine values, as well as HR (r = −0.30, P < 0.01). Breaking down the whole group according to age has shown that in 1-day-old babies (N = 11), the only one significant mean change was an increase of HR by 7 ± 10 beats/min after the +45 ° tilt. At the age of 2 days (N = 36), the group mean values showed a rise of sBP only by 5 ± 12 mmHg after the +90 ° tilt. In 3-day-old babies (N = 18), increased values were noted in both the HR (by 6 ± 18 beats/min) and sBP (by 5 ± 15 mmHg) even after the +45 ° tilt. The increase of all the variables: HR by 7 ± 12 beats/min, sBP by 6 ± 8 mmHg, dBP by 2 ± 4 mmHg after 5 min of +90 ° tilt was present only in 4- to 7-day-old neonates (N = 18). It seems that the evolution of orthostatic circulatory regulation is a component of the evolution in the overall responsiveness of the cardiovascular system to external stimuli and becomes apparent after a relative stabilization of the neonatal blood volume on the 2nd-3rd postnatal day.     

Circadian blood pressure pattern in full-term newborn infants

A fully automatic noninvasive device (Dinamap) was used for monitoring blood pressure (BP) and heart rate repetitively over 48 h in 21 full-term newborn infants (9 males and 12 females), aged 4 days in order to clarify the occurrence of a circadian rhythm (CR). The data collected were analyzed by computer statistical analysis. Mean values and standard error of BP and heart rate measured at hourly intervals in males and females were computed and plotted as chronograms. However, each newborn infant was analyzed for a CR of BP and heart rate by the single cosinor fit of a 24-hour cosine curve. The analysis of the chronograms revealed that the values of systolic and diastolic BP show an hour-by-hour significant fluctuation in male infants, but not in female infants. CR development of BP is present only in a minority of newborn infants and reveals sex and interindividual differences. CR of heart rate is absent in all infants. The physiological significance of these findings was discussed, and the importance of knowing the physiological variances of BP in infants in order to obtain a correct clinical evaluation was stressed.     

极危重新生儿应用外周动静脉同步换血疗法的研究

目的探讨运用外周动静脉同步换血疗法治疗极危重足月新生儿的疗效。方法选择2008年7月至2011年12月在我院新生儿重症监护病房住院的足月危重症新生儿,运用同步换血疗法治疗的患儿为观察组,仅采用常规方法治疗的患儿为对照组。监测并比较观察组治疗前后实验室指标,包括血糖、血清Na+、K+、Ca2+、pH、碱剩余(BE)、凝血酶原时间(PT)、活化部分凝血激酶时间(APTT)、血清尿素氮(BUN)、肌酐(Cr)、白细胞介素-1(IL-1)、IL-6、IL-8和肿瘤坏死因子-α(TNF-α)等炎症因子的变化;比较观察组和对照组病死率和好转率。结果观察组9例,对照组11例。观察组治疗后血清Na+、K+、pH、BE、PT、APTT、IL-1、IL-6、BUN和Cr水平均较治疗前好转,差异有统计学意义(P<0.01或0.05);治疗前后血糖、血清Ca2+、IL-8、和TNF-α差异无统计学意义(P>0.05)。观察组死亡6例,病死率66.7%,对照组死亡7例,病死率63.6%,两组差异无统计学意义(P>0.05)。结论运用外周动静脉同步换血治疗极危重新生儿有助于内环境及凝血功能的稳定,并可致部分炎症因子下降。换血疗法可能是极危重症患儿的有效治疗方法之一。     

Ultrasonic systolic blood pressure gradient between upper and lower limbs in normal term Chinese neonates

The determination of a normal pattern of systolic blood pressure (SBP) gradient between upper limbs (UL) and lower limbs (LL) in neonates is important in the diagnosis of the coarctation syndrome. The scarcity of studies of normal neonates and the conflict of opinion prompted us to evaluate this problem. The UL and LL systolic blood pressures of 100 normal term Chinese neonates were measured by the Doppler Ultrasonic method (Roche Arteriosonde 1020). Under resting condition, the majority (89%) of our neonates had a negative SBP gradient (LL greater than UL). The mean LL SBP (70.1 mmHg) was significantly higher than that of the UL (59.5 mmHg), p less than 0.001. Eleven out of 100 of our neonates had a positive (UL greater than LL) SBP gradient. Eight of these were less than 1 week old. None had a positive gradient of more than 20 mmHg. According to the results of our study, during the first week of life, normal neonates may have upper limb pressure greater than lower limb of up to 20 mmHg.     

正常足月新生儿振幅整合脑电图特点的多中心研究

目的探讨正常足月新生儿生后3 d内振幅整合脑电图（aEEG）的特点,为新生儿临床脑功能监测提供依据。方法选择各参研医院母婴同室或新生儿室的正常足月新生儿为研究对象,依据胎龄分为37周～、38周～、39周～、40周～和41～42周胎龄组。采用首台国产aEEG仪记录正常足月新生儿生后1、2和3日龄的aEEG,每次记录3 h。采用半对数公式计算电压,分析正常足月新生儿aEEG背景波、电压、睡眠-觉醒周期及其影响因素。结果2008年5月至2009年5月纳入116名正常足月新生儿。①正常足月新生儿aEEG背景波呈现连续性波形。905％（105/116名）在生后1日龄出现睡眠-觉醒周期,所有正常足月新生儿在生后2日龄均出现睡眠-觉醒周期;②1个睡眠-觉醒周期的平均持续（699±187）min,其中宽带平均为（220±57）min,窄带平均为（479±171）min;③正常足月新生儿生后1、2和3日龄aEEG背景波最低电压分别为（128±34）、（121±20）和（125±26）μV,最高电压分别为（375±110）、（384±94）和（386±96）μV;④日龄、性别、分娩方式及母亲妊娠并发症对正常足月新生儿aEEG的宽带、窄带电压和时程均无显著影响,37周～胎龄组生后1～3日龄aEEG窄带电压上界较38～42周各胎龄组显著增高（P分别为0014,0001和0000）。结论正常足月新生儿aEEG背景波为连续波形,存在明显的睡眠-觉醒周期;最低电压均＞5 μV,最高电压均＞10 μV。37周～胎龄组的正常足月新生儿生后1～3日龄aEEG窄带电压上界较38～42周各胎龄组正常足月新生儿显著增高。正常足月新生儿的aEEG表现不受日龄、性别、分娩方式及母亲妊娠并发症的影响。     

Adult respiratory distress syndrome in full-term newborns

Since 1984, 11 newborns with severe respiratory distress have been treated whose clinical characteristics appear distinctive. Characteristics of these neonates were as follows: (1) they were full term by obstetric and neonatal criteria, (2) they had diffuse bilateral alveolar opacification on chest radiographs during the acute illness, (3) each had an acute perinatal triggering insult, (4) the neonates required continuous positive pressure ventilation for at least 48 hours with FiO2 greater than 0.50 for at least 12 hours, (5) they needed positive end-expiratory pressure of 6 cm of H2O or greater within three days of the triggering event, (6) there were no other known causes of these clinical conditions. Ten (91%) neonates had evidence of other organ dysfunction in addition to the lungs. Trials of hyperventilation in nine and tolazoline in five failed to improve oxygenation. Ten infants who underwent trials of increased positive end-expiratory pressure greater than or equal to 6 cm of H2O without other concurrent changes in ventilator settings responded with prompt increases in PaO2 (median increase 84 mm Hg, range 22 to 196 mm Hg). All 11 babies survived but required prolonged mechanical ventilation and supplemental oxygen. We suggest that adult respiratory distress syndrome can and does occur in newborns. A trial of positive end-expiratory pressure greater than or equal to 6 cm of H2O should be considered in full-term infants with severe respiratory distress in whom other causes can be excluded.     

Post-natal development of protein C in full-term newborns

The purpose of this study was to determine the concentration of Protein C in the blood of full-term healthy newborns. The levels of Protein C, evaluated by electroimmunoassay, were low in the first 5 days of life and lower than the critical adult thrombotic level. The antigenic activity increased progressively from the 2nd week of life and the adult values were reached after the 6th month. The reduction of Protein C levels may impair the ability of the newborn to control consumptive disorders, thus exposing the infants to the risk of thrombotic conditions in neonatal age.     

Development of the intestinal flora in very low birth weight infants compared to normal full-term newborns

Development of faecal flora was studied in seven very low birth weight (VLBW) infants, who were fed on human milk and whose birth weights ranged from 810–1350 g. The intestine of the VLBW infants was first colonised by enterobacteria and streptococci, as it was in full-term infants. VLBW infants differed, however, from full-term infants in that both types of organism continued to be predominant for a longer period, and establishment of bifidobacterial flora was retarded. Bifidobacteria first appeared in the stools of VLBW infants at a mean age of 10.6±2.7 days and became predominant at a mean of 19.8±8.9 days, in contrast to full-term, breast-fed infants in whom bifidobacterial flora appeared at as early as 4 days of age. The delay seemed to be related to the low milk intake of the VLBW infants.The number of viable staphylococci in the stools of VLBW infants was generally higher than that in full-term infants. Although emergence of Bacteroides, Clostridium and lactobacilli was delayed compared with full-term infants, differences in their occurrence and prevalence between VLBW and fullterm infants were not remarkable.Abbreviation VLBW very low birth weight     

Neurodevelopmental outcome in full-term newborns with refractory neonatal seizures

Aim: This retrospective study describes the prognosis of full‐term newborns with refractory neonatal seizures, comparing the need for treatment with two versus three or more antiepileptic drugs. Methods: We reviewed our database (January 2002–December 2007) to include newborns with refractory neonatal seizures and abnormal electroencephalogram. Group A consisted of 17 newborns with two antiepileptic drugs. Group B consisted of 29 newborns with three or more antiepileptic drugs. Outcome was determined at 2 years of age using the Dutch Bayley Scales of Infant Development or a neurodevelopmental classification scheme. Results: Group A and group B were comparable regarding to a variety of demographic and aetiologic factors. Thirteen newborns died before 2 years of age and one was lost to follow‐up. Normal development at 2 years of age was found in 50% and 5% for group A and B, respectively. Severe neurodevelopmental delay at 2 years of age was found in 30% and 68% for group A and B, respectively. Conclusion: The number of antiepileptic drugs probably reflects increased seizure burden and is – in that way – related to poor outcome. This may be useful information for early prediction of adverse neurological outcome in the first days of life.     

影响足月新生儿脐带脱落时间相关因素的研究

目的：分析影响足月新生儿脐带脱落时间的相关因素。方法：观察337例足月新生儿脐带脱落时间,并对性别、胎龄、体重、脐带结扎位置、脐残端长度、脐带直径、脐带贴卫生、医护人员及家属手卫生、脐部感染等14项相关因素进行单因素分析和多因素非条件logistic回归分析。结果：单因素相关分析发现脐带结扎位置、脐残端长度、脐带直径、脐带贴卫生、脐部感染对脱脐时间有影响（P<0.05）。其中脐带结扎位置、脐残端长度、脐带贴卫生、脐部感染是影响新生儿脐带脱落时间主要因素。结论：脐带结扎位置<0.5 cm、脐带残端保留<0.5 cm、保持脐带贴卫生、预防脐部感染有助于脐带尽早脱落。［中国当代儿科杂志,2010,12(11)：867-869］