早产因素分析与防治

早产是临床上常见的并发症,这种症状主要发生在28~37孕周(196~258d)分娩产妇中,其发病率占5%~15%,患者发病时婴儿在此期间出生的婴儿体质量为1000~2499g,且新生儿胎龄越小、新生儿体重越小,其死亡率也越高。即使部分早产儿能够幸存,但是很多早产儿智力等存在很多缺陷。根据相关数据结果显示院全球范围内早产发生率达到9.6%。因此,临床上探讨积极有效的方法降低早产率,提高新生儿生存率具有重要的意义。本文将对产妇的早产因素进行分析,并针对这些因素提出合理有效的对策,降低早产率,提高新生儿存活率。     

早产儿视网膜病变发病情况筛查分析

早产儿视网膜病变（retinopthy of premature，ROP）是一种未成熟或低出生体重婴儿的视网膜增殖性病变，主要是由于未成熟儿视网膜发育不完善，在多种因素的影响下，使视网膜缺血，造成新生儿血管形成，导致增殖性视网膜病变，牵引视网膜脱离，可并斜视、弱视、白内障、青光眼、视网膜变性甚至失明，是导致婴儿视力损伤和失明的主要原因，随着我国早产低出生体重儿治疗需求和生存率的不断提高，ROP的发生率及严重程度逐渐上升。约占儿童致盲原因的6％～18％。随着我国早产低出生体重儿治疗需求和生存率的不断提高，ROP的发生率及严重程度逐渐上升．预防和治疗ROP已成为提高早产低出生质量儿生活质量的重要问题。     

胎盘解脲支原体感染PCR检测与母婴的关系

应用PCR检测方法，对291例妊娠晚期分娩产妇的胎盘组织进行解脲支原体（简称UU）检查，其中225例为阴道分娩，66例为剖宫产，并对阳性与阳性者在早产、胎膜早破、足月低体重儿、新生儿窒息和新生儿肺炎病等方面进行比较。结果：33例UU阳性，阳性率为10．3％，阴道分娩中UU阳性者27例，阳性率12．0％，剖宫产中UU阳性者6例，阳性率9．1％，两者差异无显著性（P＞0．05）。UU阳性者中的早产、胎膜早被、足月低体重儿、新生儿窒息和新生儿肺炎发病率明显高于阴性者（P＜0．05）。结果提示：分娩过程产道污染不是导致UU感染的主要因素，胎盘在宫内已感染UU。UU宫内感染与早产、胎膜早破、足月低体重儿、新生儿窒息和新生儿肺炎有关。     

305例低出生体重儿发生的相关因素回顾性分析

目的探讨低出生体重儿发生率及相关因素，为有关部门制定政策和预防措施提供依据。方法对我院2003年1月～2008年12月出生的305例低出生体重儿进行回顾性分析。结果低出生体重儿发生率3．07％（305／9948）。2003年-2008年6年间各年度低出生体重儿的发生率没有明显变化，其中早产发生率36．72％，是低出生体重儿发生的第一因素，而双胎、妊高征、胎盘和胎膜因素等是造成胎儿宫内发育迟缓从而引发低出生体重的重要因素。结论降低早产的发生加强孕晚期保健管理是降低低出生体重儿的发生，提高儿童生命早期质量，降低婴儿死亡率的重要环节之一。     

母亲早产对婴儿的影响及预后

目的 分析研究早产有关的危险因素及早产儿发病及死亡的相关因素。方法 选取我院1995年—2000年12月间早产105例，将早产分为病理性早产(76例)，医源性早产(29例)，与同期足月产对照组110例比较。结果 孕期母亲未作产前检查、胎膜早破、妊高征、胎盘因素、多胎、胎位不正、内外科合并症等同早产有关。早产组产前检查明显低于足月妊娠组(P＜0．05)；早产儿发病率及死亡率明显高于足月儿，早产儿死亡的主要原因是呼吸系统疾患(RDS)、颅内出血、感染。结论 孕期多种因素同早产有关，早产是围产儿发病和死亡的主要原因，提高对早产的认识，倡导围生保健新模式，重视早产的临床相关因素，降低围生儿并发症及死亡率。     

流动人口围生期新生儿死亡影响因素分析

目的 了解省外流动人口围生期新生儿死亡情况.方法对绍兴市2007年52例省外流动人口围生期新生儿死亡情况与本地户籍人口新生儿死亡进行比较.结果省外流动人口围生期新生儿死亡率高于本地户籍人口;前三位死因分别为早产和低出生体重、出生窒息、新生儿破伤风和其它先天异常;流动人口围生期新生儿死亡的影响因素有父母是否有无固定工作、文化程度、母亲年龄、低出生体重、死前未治疗或门诊治疗,与本地户口死亡新生儿相比差异显著.结论省外流动人口围生期新生儿死亡率高于本地户口新生儿,主要死因为早产和低出生体重、出生窒息,影响流动人口围生期新生儿死亡的因素主要有父母无固定工作、文化程度小学及以下、母亲年龄22岁以下或大于35岁、低出生体重、死前未治疗或门诊治疗.     

双胎儿童智能发育的影响因素及预防

目的探讨出生体重及父母文化程度对双胎儿智能发育的影响及预防.方法出生体重及父母文化程度的资料采取复习病案结合随访调查所获得,对每个儿童进行绘人智能测验.结果出生体重＜2500g儿童的绘人能力商明显低于出生体重≥2500g组,P＜0.05.父亲文化程度的高低对子女的智力影响较小,而母亲文化程度的高低对子女的智力有一定影响.结论加强围产期保健,避免早产和降低低出生体重儿出生率,提高母亲的文化素质是预防低智能儿童的重要措施.     

518例早产低体重儿临床分析

目的 探讨早产低体重儿发病和存活的相关因素,为降低早产儿发生率,提高生存质量。方法 对5年出生518例早产低体重儿按体重和胎龄分3组,并对其临床资料进行回顾分析,对其生存和死亡进行分析比较。结果 早产低体重儿主要发病原因,妊娠并发症42例(占8.1%),多胎妊娠62例(占11.97%),羊膜早破200例(占38.61%),主要并发症依次为高胆红素血症130例,IRDIS 56例,HIE38例,肺炎35倒,应激性溃病15例,贫血35例,窒息25例,体重越低,胎龄越小,并发症的发生率越高,死亡率越高。本组存活率为95.18％,死亡率4.82％,死亡率与出生体重、孕周有明正关系。结论 ①加强围产期保健,提高产科质量,强调产儿科合作。②加强监护,早期发现并发症,及时处理,防止院内感染。     

双胎及三胎妊娠的临床特点

探讨双胎及三胎妊娠的临床特点。对 1998年 12月至 2 0 0 0年 12月在我院分娩的双胎及三胎妊娠进行回顾性分析。双胎妊娠的流产率 6 7% ,早产率 5 2 3% ,低出生体重儿 (<2 5 0 0g)约 4 4 5 % ,围产期死亡率 6 8 6‰。三胎流产率 2 8 6 % ,早产率 80 % ,低出生体重儿 (<2 5 0 0g)约 6 6 7% ,均较双胎妊娠升高。双胎体重不均衡、双胎输血综合症是导致双胎流产、早产、围产儿死亡的主要原因。双胎及三胎妊娠早期诊断是影响其围产期管理的重要环节之一。定期产检 ,预防性入院能在很大程度上减少双胎及三胎早产的发生     

1991年广东省5401例婴儿死亡调查分析

本文对广东省２０个市７８个县抽中２７５个调查点，资料按统一表格，统一标准，各市、县抽调医护人员统一培训方法，在全省全面、同时开展，同步进行１９９１年婴儿死亡率回顾性调查。结果：１９９１年共出生活产儿１６８７２８名，死亡５４０１例，死亡率为３２．０１％，其中在新生儿期死亡３７２０名，占婴儿期死亡数的６８．８８％。资料显示婴儿死亡率与城乡、经济条件、地理环境条件等因素密切相关。前三位死因依次是：城市为出生窒息、早产和低出生体重儿、肺炎。农村为肺炎、早产和低出生体重儿、出生窒息。     

早产儿视网膜病发病情况及高危因素的探讨

目的 探讨早产儿视网病（retinopathy of prematurity，ROP）的发病率、高危因素及防治措施。方法对194例早产儿生后72h内及生后4w开始定期检查眼底，发现ROP者密切随访至生后1年。结果72h内早期眼底检查眼底异常包括视乳头水肿、视网膜水肿、视网膜血管改变及出血等。生4w后检出ROP患儿12例（6．2％），高危因素分别为低出生体重，小孕周、长期或高浓度吸氧。结论建议出生体重小于2000g和／或孕周小于35w的早产儿，在生后第3w或胎龄达34w时常规行首次眼底检查，以早期发现ROP并给予及时治疗。     

A population-based study of birth defects in Malaysia

Birth defects are one of the leading causes of paediatric disability and mortality in developed and developing countries. Data on birth defects from population-based studies originating from developing countries are lacking. One of the objectives of this study was to determine the epidemiology of major birth defects in births during the perinatal period in Kinta district, Perak, Malaysia over a 14-month period, using a population-based birth defect register. There were 253 babies with major birth defects in 17?720 births, giving an incidence of 14.3/1000 births, a birth prevalence of 1 in 70. There were 80 babies with multiple birth defects and 173 with isolated birth defects. The exact syndromic diagnosis of the babies with multiple birth defects could not be identified in 18 (22.5%) babies. The main organ systems involved in the isolated birth defects were cardiovascular (13.8%), cleft lip and palate (11.9%), clubfeet (9.1%), central nervous system (CNS) (including neural tube defects) (7.9%), musculoskeletal (5.5%) and gastrointestinal systems (4.7%), and hydrops fetalis (4.3%). The babies with major birth defects were associated with lower birth weights, premature deliveries, higher Caesarean section rates, prolonged hospitalization and increased specialist care. Among the cohort of babies with major birth defects, the mortality rate was 25.2% during the perinatal period. Mothers with affected babies were associated with advanced maternal age, birth defects themselves or their relatives but not in their other offspring, and significantly higher rates of previous abortions. The consanguinity rate of 2.4% was twice that of the control population. It is concluded that a birth defects register is needed to monitor these developments and future interventional trials are needed to reduce birth defects in Malaysia.     

Birth weight in relation to morbidity and mortality among newborn infants

BACKGROUND: At any given gestational age, infants with low birth weight have relatively high morbidity and mortality. It is not known, however, whether there is a threshold weight below which morbidity and mortality are significantly greater, or whether that threshold varies with gestational age. METHODS: We analyzed the neonatal outcomes of death, five-minute Apgar score, umbilical-artery blood pH, and morbidity due to prematurity for all singleton infants delivered at Parkland Hospital, Dallas, between January 1, 1988, and August 31, 1996. A distribution of birth weights according to week of gestation at birth was created. Infants in the 26th through 75th percentiles for weight served as the reference group. Data on preterm infants (those born at 24 to 36 weeks of gestation) were analyzed separately from data on infants delivered at term (37 or more weeks of gestation). RESULTS: A total of 122,754 women and adolescents delivered singleton live infants without malformations between 24 and 43 weeks of gestation. Among the 12,317 preterm infants who were analyzed, there was no specific birth-weight percentile at which morbidity and mortality increased. Among 82,361 infants who were born at term and whose birth weights were at or below the 75th percentile, however, the rate of neonatal death increased from 0.03 percent in the reference group (26th through 75th percentile for weight) to 0.3 percent for those with birth weights at or below the 3rd percentile (P<0.001). The incidence of five-minute Apgar scores of 3 or less and umbilical-artery blood pH values of 7.0 or less was approximately doubled for infants at or below the 3rd birth-weight percentile (P=0.003 and P<0.001, respectively). The incidence of intubation at birth, seizures during the first day of life, and sepsis was also significantly increased among term infants with birth weights at or below the 3rd percentile. These differences persisted after adjustment for the mother's race and parity and the infant's sex. CONCLUSIONS: Mortality and morbidity are increased among infants born at term whose birth weights are at or below the 3rd percentile for their gestational age.     

Obstetrical results after embryonic reductions performed on 34 multiple pregnancies

Thirty-four women with multiple pregnancies (three or more fetuses) underwent embryonic reduction in order to reduce abortions, premature births or fetal growth-retardation by obtention of twins. Four early abortions occurred. Thirty pregnancies reached term and out of 60 fetuses, 58 infants were born alive. Fetal death in utero of one twin occurred in two pregnancies. The mean term until delivery was 36 +/- 2.8 weeks gestation and the prematurity rate was 51.7%. Of 55 neonates, 25 were underweight within the 10th percentile and 10 out of 55 neonates were underweight below the 3rd percentile. There were three deaths in the early neonatal period. The rate of perinatal mortality was 8.3%. Fifty-four children are currently healthy and one child has a mild axial hypotonia. A reduction in prematurity was observed with a gain of 2 weeks on reported data concerning triplet pregnancies. The rate of low-birth-weight infants was high, 63.5% being underweight at birth.     

极低出生体重儿临床相关因素及与预后的关系

目的探讨极低出生体重儿的围产期及临床特点,分析其与预后的关系.方法分析110例极低出生体重儿(含12例超低出生体重儿)的一般情况、产科及母孕期情况、新生儿临床特点.结果胎龄小于32w者占79%,小于胎龄儿占17.3%,41%为多胎;32%有胎膜早破史,18%母亲有妊高征;36%有窒息复苏史;产科异常是胎儿早产的主要原因.呼吸暂停、低体温、高胆红素血症及低血糖是常见的并发症;多胎、围产期异常及小于胎龄儿是极低出生体重儿主要死亡原因,生于院内或转运者死亡率明显低于院外出生者(P<0.01).结论加强对高危孕妇及新生儿的监护,普及新生儿窒息复苏知识,将有助于改善极低出生体重儿的预后.     

Outcomes of extremely-low-birth-weight infants between 1982 and 1988

Infants with birth weights under 750 g are disproportionately represented in perinatal mortality and morbidity rates. We reviewed the outcomes of 98 infants delivered at our perinatal center between July 1982 and June 1985 (period 1) whose lengths of gestation were 20 or more weeks and whose birth weights were under 750 g, and compared them with the outcomes of 129 such infants born between July 1985 and June 1988 (period 2). The frequency of cesarean section increased from 12 to 19 percent between the two periods. During the entire six-year period, 12 percent of the infants with birth weights under 500 g were intubated, as compared with 28 percent of those between 500 and 599 g, 60 percent of those between 600 and 699 g, and 90 percent of those between 700 and 749 g. The frequency of endotracheal intubation increased between the two periods only for infants with birth weights above 500 g (P less than 0.02). Despite more aggressive treatment, survival did not change, although the mean time to death among infants transferred to the neonatal intensive care unit increased from 73 to 880 hours. Among all live-born infants with birth weights under 750 g, the rate of survival was 20 percent during period 1 and 18 percent during period 2, but 48 and 43 percent of those transferred to the neonatal intensive care unit survived in the two periods reviewed. Neonatal morbidity also did not change. Among survivors at a corrected age of 20 months, 4 of 18 born during period 1 and 7 of 14 born during period 2 had moderate-to-severe neurodevelopmental impairment. When all live-born infants of less than 28 weeks' gestation were considered, only 8 percent of those born at 23 weeks survived, as compared with 16 percent of those born at 24 weeks, and 53, 63, and 72 percent of those born at 25, 26, 27 weeks, respectively. Thus, despite a tendency to perform more cesarean sections and active resuscitations, no improvement in the survival of babies with lengths of gestation below 25 weeks or birth weights under 750 g was observed. The probability of survival is very poor if the length of gestation is less than 24 weeks or the birth weight less than 600 g.     

137例重度子痫前期母婴结局临床分析

目的:分析不同孕周重度子痫前期发病与母婴结局的关系,为临床工作提供指导.方法:137例重度子痫前期患者,根据其孕周不同分为A(孕周＜32周)、B(32周≥孕周＜37周)、C(≥37周)三组,比较三组间孕产妇并发症发生情况和围生儿预后情况及分娩方式.结果:A、B、C三组孕产妇并发症发生率分别为59.3%、32.5%和20.3%,A组与B、C两组比较有统计学意义(P＜0.05).三组间孕产妇死亡率比较差异无统计学意义(P＞0.05).A、B、C三组围生儿死亡率分别为48.1%、17.3%和3.2%,三组间比较差异有统计学意义(P＜0.05);三组间胎儿生长受限、胎儿窘迫及新生儿窒息发生率比较,差异均有统计学意义(P＜0.05).三组总剖宫产率92.0%,阴道分娩率8.0%(P＜0.05);产时子痫发生率剖宫产组为0、阴道分娩组为27.3%,两者比较差异有统计学意义(P＜0.05 );两种分娩方式死产发生率比较,差异无统计学意义(P＞0.05).结论:重度子痫前期孕妇严重并发症发生率高和围生儿死亡率高,且发病孕周越小发生率越高.在保证孕妇安全情况下采取保守治疗,适当延长胎龄,促进胎儿成熟,可提高新生儿存活率.分娩方式以剖宫产为最佳选择.     

Perinatal transmission of the human immunodeficiency virus type 1 to infants of seropositive women in Zaire

To examine perinatal transmission of the human immunodeficiency virus type 1 (HIV-1) in Zaire, we screened 8108 women who gave birth at one of two Kinshasa hospitals that serve populations of markedly different socioeconomic status. For up to one year, we followed the 475 infants of the 466 seropositive women (5.8 percent of those screened) and the 616 infants of 606 seronegative women matched for age, parity, and hospital. On the basis of clinical criteria, 85 of the seropositive women (18 percent) had the acquired immunodeficiency syndrome (AIDS). The infants of seropositive mothers, as compared with those of seronegative mothers, were more frequently premature, had lower birth weights, and had a higher death rate in the first 28 days (6.2 vs. 1.2 percent; P less than 0.0001). The patterns were similar at the two hospitals. Twenty-one percent of the cultures for HIV-1 of 92 randomly selected cord-blood samples from infants of seropositive women were positive. T4-cell counts were performed in 37 seropositive women, and cord blood from their infants was cultured. The cultures were positive in the infants of 6 of the 18 women with antepartum T4 counts of 400 or fewer cells per cubic millimeter, as compared with none of the infants of the 19 women with more than 400 T4 cells per cubic millimeter (P = 0.02). One year later, 21 percent of the infants of the seropositive mothers had died as compared with 3.8 percent of the control infants (P less than 0.001), and 7.9 percent of their surviving infants had AIDS. We conclude that the mortality rates among children of seropositive mothers are high regardless of socioeconomic status, and that perinatal transmission of HIV-1 has a major adverse effect on infant survival in Kinshasa.     

Immediate effects of phototherapy on sleep in very preterm neonates: an observational study

Process C (internal clock) and Process S (sleep–wake homeostasis) are the basis of sleep–wake regulation. In the last trimester of pregnancy, foetal heart rate is synchronized with the maternal circadian rhythm. At birth, this interaction fails and an ultradian rhythm appears. Light exposure is a strong factor influencing the synchronization of sleep–wake processes. However, little is known about the effects of phototherapy on the sleep rhythm of premature babies. It was hypothesized that sleep in preterm infants would not differ during phototherapy, but that a maturation effect would be seen. Sleep states were studied in 38 infants born < 32 weeks gestational age and/or < 1 500 g birth weight. Videos of 3 h were taken over the first 5 days of life. Based on breathing and movement patterns, behavioural states were defined as: awake; active sleep; or quiet sleep. Videos with and without phototherapy were compared for amounts of quiet sleep and active states (awake + active sleep). No significant association between phototherapy and amount of quiet sleep was found (P = 0.083). Analysis of videos in infants not under phototherapy revealed an increase in time spent awake with increasing gestational age. The current data suggest that the ultradian rhythm of preterm infants seems to be independent of phototherapy, supporting the notion that sleep rhythm in this population is mainly driven by their internal clock.     

新生儿先天性甲状腺功能异常发病率与胎龄、出生体重关系的研究

目的探讨广西地区先天性甲状腺功能异常（包括先天性甲状腺功能减低症（CH）和高TSH血症）发病率与胎龄、出生体重的关系。方法对2009年9月～2010年12月广西新生儿疾病筛查中心筛查的新生儿,凡滤纸血促甲状腺素（TSH）〉8.0mIU/L者予以召回,进行甲状腺功能检查。结果 2009年9月～2010年12月共筛查220 844人,确诊先天性甲状腺功能异常200人,发病率为1/1104。其中,早产儿（胎龄〈37周）发病率为1/449,足月儿（37≤胎龄≤42周）发病率为1/1189,过期产儿（胎龄〉42周）发病率为1/206,过期产儿发病率高于早产儿及足月产儿（P〈0.05）。低出生体重儿﹙〈2500g）发病率为1/407,正常体重儿（2500～4000g）发病率为1/1236,巨大儿（〉4000g）发病率为1/376,低出生体重儿及巨大儿的先天性甲状腺功能异常发病率明显高于正常体重儿（P〈0.01）。结论先天性甲状腺功能异常的发病率与胎龄、出生体重密切相关,过期产儿、巨大儿、低出生体重儿的发病率较高。注意孕期保健防止过期产儿、巨大儿、低出生体重儿,对降低先天性甲状腺功能异常的发生有重大意义。