足月妊娠脐动脉血流S／D值介于2．5～3．0间的围产儿结局分析

目的研究足月妊娠胎儿脐动脉血流S／D值介于2．5～5．0间的围产儿结局。方法将360例足月妊娠妇女根据分娩前脐动脉血流S／D值分成两组，即S／D值介于2．5～3．0的42例为研究组，S／D值〈2．5的318例为对照组，记录分娩结局：新生儿Apgar评分、羊水粪染、新生儿体重及脐带绕颈等指标。结果围产儿不良结局（羊水11度以上，Apgar评分低于7分，出生体重〈2500g）发生率，研究组59．52％（25／42），对照组22．33％（71／318），两组比较差异有显著性（χ^=26．25，P〈0．005）；研究组的新生儿出生体重（3105±578）g显著低于对照组（3350±475），（t=2．84，P〈0．005）。结论对于足月妊娠脐动脉血流S／D值介于2．5～3．0的胎儿，要加强监护，动态观察，避免围产儿不良结局的发生。     

小胎龄早产儿宫外生长发育迟缓的临床分析

目的 了解小胎龄早产儿宫外生长迟缓（EUGR）发生率及高危因素。方法 回顾性分析2012年1月～2013年12月在淮安市妇幼保健院新生儿医学中心住院治疗且存活出院的胎龄≤32周早产儿资料。根据出院时体重是否标低于校正年龄体重的第10百分位（P10）诊断EUGR,分为EUGR组61例和对照组118例。分析EUGR发生情况和相关因素,应用Logistic多元回归分析EUGR的高危因素。结果 ①179例小胎龄早产儿中,宫内发育迟缓（IUGR）发生率为4．5％（8／179）,EUGR发生率为34．1％（61／179）。②早产儿随胎龄和出生体重降低IUGR发生率明显增加,各胎龄组的早产儿严重IUGR（χ^2=7．313）和IUGR（χ^2=7．083）发生率及各体重组之间的早产儿严重IUGR（χ^2=15．819）和IUGR（χ^2=37．160）发生率比较,差异均有统计学意义（P〈0．05或P〈0．01）。早产儿随胎龄和出生体重降低EUGR发生率明显增加,各胎龄组早产儿严重EUGR（χ^2=10．265）和EUGR（χ^2=7．320）发生率及各体重组之间早产儿严重EUGR（χ^2=22．959）和EUGR（χ^2=50．264）发生率比较,差异均有统计学意义（P〈0．05或P〈0．01）。③两组胎龄、出生体重、出院体重、出生Z评分、住院天数、首次胃肠喂养时间、达到全胃肠喂养时间、达最大静脉营养时间、女性、感染、IUGR、新生儿呼吸窘迫综合症（NRDS）、动脉导管未闭、支气管肺发育不良、母亲妊娠高血压综合征、插管机械通气和重度贫血等单因素比较,差异均有统计学意义（P〈0．05或P〈0．01）。Logistic回归分析发现低出生体重、低胎龄、NRDS和女性为小胎龄早产儿发生EUGR的高危因素（均P〈0．05）。结论 小胎龄早产儿EUGR发生率较高,其发生的高危因素为低出生体重、低胎龄和NRDS和女性。     

不同分娩方式对足月小样儿合并症的影响

孕周37～42周,出生体重＜2500g的新生儿称足月小样儿.足月小样儿出生后可能出现一系列并发症,直接影响出生人口的素质.现将1994年1月～2003年12月在本院出生的257例足月小样儿的资料进行小结,比较不同分娩方式对足月小样儿合并症的影响.     

加强低体重儿管理降低死亡率的调查分析

随着围产医学的发展,低体重儿的成活率已有了明显的提高。但仍是新生儿死亡的重要原因之一。我院产科加强对低体重儿的系统管理．使死亡率逐年下降．现将三年来低体重儿的情况分析如下：1临床资料11一般资料自1993年至1995年三年中共出生新生儿7互17名;低体重儿（＜2500g）564人,占7.92%其中早产儿394例（69.84％）．足月小样儿170例（30.14％）体重最小950g．胎龄最小为28周．三年共死亡新生儿89人新生儿死亡率12.5%．其中低体重儿62人,占696.6%。1.2三年中低体重儿死亡率的比较1993年出生低体重儿175人,死亡30人,死亡率为171．4‰,…     

奥美拉唑联合莫沙必利治疗反滤眭食管炎的临床疗效

目的探讨奥美拉唑联合莫沙必利治疗反流性食管炎（RE）的疗效。方法将浙江省东阳市横店医院2012年1～12月期间62例RE患者分为两组,对照组32例应用奥美拉唑,治疗组30例在此基础上加用莫沙必利。结果治疗组烧心、反酸等症状改善情况比对照组更为明显（P〈0．05）;治疗组治愈率和总有效率（73．33％、96．67％）显著高于对照组（46．88％、71．88％）（χ^2=4．50,P〈0.05;χ^2=5．32,P〈0．05）;胃镜下疗效治疗组治愈率和总有效率（76．67％、93．33％）显著高于对照组（40．63％、68．75％）（χ^2=8．26,P〈0．01;χ^2=6．00,P〈0．05）。结论奥美拉唑联合莫沙必利治疗RE效果优于单用奥美拉唑。     

宫颈环形电切术对妊娠结局的影响

目的探讨宫颈环形电切术（LEEP）对妊娠结局和分娩方式的影响。方法采用回顾性病例对照研究,选择因宫颈上皮内瘤变（CIN）1I～III而行宫颈环形电切术,于术后妊娠并分娩的31例产妇为研究组。按年龄、孕次、产次、经济收入相匹配的原则,选取同期分娩且孕前未行任何宫颈手术的产妇62例为对照组,2组均无并发症,观察2组间的早产儿发生率、胎膜早破发生率、分娩方式及新生儿体重等指标的差异。结果研究组早产率9．68％、胎膜早破发生率6．45％、剖宫产发生率41．94％、新生儿出生体重〈2500g者发生率6．45％;对照组早产率8．06％、胎膜早破发生率4．84％、剖宫产发生率38．71％、新生儿出生体重〈2500g者发生率4．84％,2组比较差异无统计学意义（P〉0．05）。结论LEEP可能对妊娠结局无不良影响。     

极低出生体重儿的临床管理

极低出生体重儿（very low birth weight infants,VLBWI）是指出生体重〈1500g的早产儿。由于器官组织发育不成熟,生理功能低下,在新生儿中以VLBWI的病死率为最高,国内目前VLBWI的存活率为60％～82％。2000年1月～2006年12月唐都医院新生儿重症监护室共收治VLBWI38例,存活率为89．5％,疗效满意。     

340例新生儿中早产儿视网膜病变临床分析

目的 了解早产儿视网膜病变（ROP）的发生状况及影响因素,为下一步防治和筛查工作提供依据。方法 收集2011年至2012年在我院新生儿科、新生儿监护室以及眼科门诊就诊的新生儿共计358名。运用间接检眼镜进行早产儿视网膜病变筛查。结果 随访至视网膜完全血管化或病变退化新生儿340例,失访18例。340例新生儿中有29例发生早产儿视网膜病变,发生率为8.5%。ROP的发生与出生体重和孕龄有关,差异具有统计学意义（χ^2体重=257.3,P体重〈0.01;χ^2孕龄=164.2,P孕龄〈0.001）。而且出生体重越低,出生孕龄越小,ROP的发生率和病变程度越高（χ^2体重=17.04,P〈0.01,χ^2孕龄=17.38,P〈0.01）。结论 早产儿视网膜病变易发生在出生体重低或孕龄短的新生儿,相关部门应该采取早期的干预性措施。     

新生儿游泳与抚触临床观察研究

目的：探讨新生儿游泳与抚触对新生儿生理指标的影响及临床效果。方法：选择2007年11月至2008年9月在我院剖宫产的足月新生儿300例，按分娩的时间顺序及家长的意愿随机分成观察组（游泳与抚触组）与对照组（单纯沐浴组）各150例。新生儿体重2500～4000g，Apgar评分≥8分，出生后24h进行沐浴、抚触、游泳。对住院期间相同时间段内的新生儿吃奶量、睡眠、胎便变化、体重增长等指标进行临床观察及统计分析。结果：观察组新生儿生后6天内吃奶量多（P〈O．05）；睡眠时间长（P〈0．05）；睡眠质量好（P〈0．05）；新生儿排便次数增加（P〈O．05）；胎便转黄时间提前（P〈0．05）；出院时体重增加（P〈0．05）。结论：新生儿游泳与抚触是一项全新的健康保健运动，有益于新生儿生长发育。     

妊娠期高血压疾病对妊娠结局的影响

目的探讨不同程度妊娠期高血压综合征（妊高症）疾病对妊娠结局的影响。方法回顾性分析我院住院分娩的170例妊娠期高血压疾病的临床资料,选取同期住院分娩的正常妊娠孕妇340例作为对照组,分析两组孕妇分娩方式、并发症的发生情况及其对围生儿的影响。结果170例妊高症产妇中,妊娠期高血压和子痫前期（包括轻度和重度）分别占70．6％、29．4％。子痫前期的新生儿窒息、胎儿窘迫、产后出血、围生儿死亡、早产儿、剖宫产及低出生体重（体重〈2500g）的发生率明显高于妊娠期高血压患者,不同指标在各组间的差异均有统计学意义（P〈0．05）。妊高症组的新生儿窒息、胎儿窘迫、胎盘早剥、产后出血、围生儿死亡、早产儿、剖宫产及低出生体重（体重〈2500g）的发生率明显高于对照组,不同指标在各组间的差异均有统计学意义（P〈0．05）。结论妊高症对母婴危害严重,应通过科学有效管理和预防,降低妊高症的发生率,尤其是子痫的发生率。     

Mortality in infants less than 2500 grammes birthweight admitted into a special-care baby unit in Port Harcourt, Nigeria

Physicians studied the mortality rate of low birth weight (2500g) neonates admitted into a special care unit at a hospital in Port Harcourt, Nigeria between January 1984-June 1986. Care consisted of maintaining body temperatures, feeding, and preventing and treating infections. If required, oxygen was only administered in the incubator. 36.3% of all infants admitted to the special care unit during this period weighed 2500g. Those infants that died had lower birth weights, younger gestational age, lower temperatures on admission, and lower temperatures while in the unit than did surviving infants (p.001). Mortality was highest for those infants weighing 1000g (90%) and decreased with increasing birth weight (1000-1500g=51.1%; 1501-2000g=12.4%; and 2001-2499G=3%). In addition, the 1 and 5 minute APGAR scores were significantly lower among neonates who died than those who lived (p0.1 and p.001 respectively). Although infants who died had a significantly lower mean temperature on admission compared to those who survived, there was no significant difference in mean temperatures on admission between those born outside the hospital and those born in the hospital. Another risk factor was place of birth. Neonatal mortality was lower for those infants born in the hospital (9.7%) compared to those not born in the hospital (54%). Since Nigeria does not have specially designed ambulances with sophisticated transport incubators, this high mortality rate could be due to exposure to infection in transport. Nonetheless, it would be easier and cheaper to transfer the mother at risk than her ill neonate. These results demonstrate the importance of prevention of low birth weight rather than improving the facilities for intensive care which is beyond the reach of most developing countries.     

LOW BIRTH WEIGHT BABIES : INCIDENCE AND RISK FACTORS

In a prospective hospital based study, during the period from Jan 95 to Dec 96, 3100 consecutively delivered live newborns were studied for the incidence of low birth weight neonates and to evaluate the associated risk factors. One thousand fourteen newborns were classified as low birth weight babies. The incidence expressed per 1000 live births was 327 (32.7%). Of these, 815 (80.4%) were small for gestational age neonates and 199 (19.6%) were preterm neonates. Five hundred seventy small for gestational age neonates (70%) were weighing between 2001 to 2500 gms. Mothers belonging to the age group of 19-25 years delivered the maximum number of low birth weight babies (618/1014) and of these 82.8% were small for gestational age neonates. There were 48 neonates with low birth weight born to mothers below the age of 18 years. Primiparous mothers were found to contribute higher number of low birth weight neonates (414/1014). Spacing as a factor did not show any major difference. Two hundred sixty two low birth weight neonates were born to mothers with significant obstetrical problems such as pregnancy induced hypertension, bad obstetrical history and premature rupture of membranes. The incidence of 32.7% of low birth weight babies is high enough to ring alarm bells.     

Patent ductus arteriosus in infants of low birth weight.

Patent ductus arteriosus was diagnosed in 239 neonates of low birth weight (less than 2500 g) referred to the Hospital for Sick Children in a 21/2-year period. The respiratory distress syndrome was present in 77% of the group and congestive heart failure in 50%. Spontaneous closure of the defect was more frequent in those without congestive heart failure. In 48 patients whose heart failure could not be controlled by other medical therapy indomethacin was given, and in 20 (42%) it was judged successful. Surgical ligation of the ductus was performed at a median age of 30 days in 33 infants who either failed to respond to indomethacin or in whom its use was contraindicated; there were no intraoperative deaths, but 11 (33%) of the infants died 4 days to 6 months after the operation.     

早产儿视网膜病变高危因素的多因素分析

目的 探讨早产儿视网膜病变(ROP)的发生及其危险因素.方法 对2006年7月1日～2007年2月1日期间在北京军区总医院收治的125例早产儿和20例足月新生儿定期进行眼底检查,根据ROP国际分期标准进行ROP的诊断和分期.结果 125例早产儿中ROP的患病率为6.4%,对照组足月新生儿未发生ROP.出生体质量≤2000 g的早产儿ROP患病率显著高于出生体质量＞2000 g的早产儿(x2=6.42,P=0.01),孕周≤32周组的早产儿ROP患病率(17.5%,7/40)显著高于孕周＞32周的早产儿(1.1%,1/85,x2=9.52,P=0.002).孕周(OR=0.865,P=0.038)和出生体质量(OR=0.768,p=0.042)与ROP的发生相关性最高,未发现吸氧、机械通气、使用消炎痛、输血和母亲病情与ROP发生有相关性.结论 早产儿ROP的患病率高于正常足月新生儿,孕周越短、出生体质量越低,ROP患病率越高.应定期检查早产儿眼底可早期发现ROP.     

Mid-arm and chest circumferences at birth as predictors of low birth weight and neonatal mortality in the community

In developing countries, where about three quarters of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. A study was performed to see whether other simpler measurements could be substituted for weight to identify neonates of low birth weight and those at risk. A study of 520 hospital births showed a strong correlation (p less than 0.001) between other anthropometric variables and birth weight, but the correlation was maximum for chest circumference (r = 0.8696) and mid-arm circumference (r = 0.8110). A mid-arm circumference of less than or equal to 8.7 cm and a chest circumference of less than or equal to 30 cm had the best sensitivity and specificity for identifying neonates with a birth weight of 2500 g or less. Measurements on 501 consecutive live births in the community were recorded and the infants followed up at specified ages. Mid-arm circumference was again significantly correlated to birth weight (r = 0.6918). Neonatal mortality showed an inverse relation but postneonatal mortality an inconsistent relation with mid-arm circumference. A mid-arm circumference of less than or equal to 8.7 cm and a birth weight of less than or equal to 2500 g were equally useful in predicting neonatal outcome. Mid-arm and chest circumferences are simple, practicable, quick, and reliable indicators for predicting low birth weight and neonatal outcome in the community and can be easily measured by paramedical workers in developing nations.     

不同体质量早产儿早期合理营养与体质量变化关系探讨

目的探讨不同体质量早产儿早期合理营养与体质量变化关系。方法随机选取2011年1月至2012年1月广东医学院附属南山医院新生儿重症监护室(NICU)收治的184例胎龄在28～37周的早产儿作为研究对象,按体质量分为两组:<2000 g组和≥2000 g组,比较两组早产儿早期的肠外营养及胃肠营养对体质量的影响。结果两组早产儿在出生后第2周肠外热量及蛋白质摄入有明显差异(P<0.05),且两组早产儿在开奶日龄、体质量开始增长日龄、回到出生体质量日龄方面有明显差异(P<0.05)。结论早产儿早期热量及蛋白质的摄入对出生后体质量的变化有明显影响,对早产儿,尤其是出生时体质量较低的早产儿,应及时给予合理的营养,以满足其生长发育的需要。     

Anthropometric measurements in the detection of low birth weight infants in Lagos

The present study was undertaken to determine the anthropometric risk indicators in the detection of infants with low birth weight. A total of 788 consecutive, singleton, live born infants had anthropometric measurements determined within 24 hours of life using standard methods. There were 389 (49.37%) males and 399 (50.63%) females; 136 (17.56%) of the infants were of low birth weight (LBW). Birthweight was significantly correlated with occipitofrontal circumference (OFC; r = 0.66), length (r = 0.86), mid-arm circumference (MAC; r = 0.88) and maximum thigh circumference (MTC; r = 0.95) (p < 0.001). Furthermore, OFC of 33.6 cm and 32.3 cm, length of 47.7 cm and 45.5 cm, MAC of 9.6 cm and 9.1 cm, and MTC values of 15.5 cm and 14.9 cm were the corresponding cut-off values with the best combination of sensitivity, specificity and predictive values (p < 0.001) for identifying infants with birth weights of < 2500 g and < 2000 g respectively. The use of these risk indicators would help to identify newborns for close supervision and care, as well as prevent mortality and postnatal developmental retardation.     

早产儿视网膜病变的筛查与高危因素

目的探讨早产儿视网膜病变(ROP)的发生及其危险因素。方法对2003年5月1日~2004年11月30日北京协和医院172例胎龄小于37周,或胎龄大于37周、但出生体重低于2500g的早产儿定期检查眼底。根据ROP国际分期标准进行诊断、分期。同期住院的20例正常足月新生儿作为对照组。结果172例早产儿中,放弃治疗或死亡12例,检查并随访完全160例。早产儿ROP的患病率为19·4%,对照组新生儿未发生ROP。出生体重≤2000g组的ROP患病率(28·4%)显著高于出生体重>2000g组(8·3%)(χ2=10·217,P=0·001)。孕周≤32周组的ROP患病率(42·5%)显著高于孕周>32周组(11·7%)(χ2=18·258,P=0·000)。胎龄(OR=0·959,P=0·036)和出生体重(OR=0·999,P=0·026)与ROP的发生相关性最高;输血(OR=0·076,P=0·029)和Apgar评分(OR=23·62,P=0·012)与ROP的发生具有负相关性。未发现吸氧方式、表面活性物质、多巴胺和出生前地塞米松的使用、输血和母亲病情与ROP的发生具有相关性。结论早产儿ROP的患病率高于正常足月新生儿。孕周越短、出生体重越低,ROP患病率越高。应定期检查早产儿眼底,早期发现ROP。     

莫沙必利及妈咪爱防治早产儿喂养不耐受的疗效评价

目的:研究莫沙必利及妈咪爱防治早产儿胃肠喂养不耐受疗效.方法:2004~2005年住院早产儿107例(未给药组),未给予莫沙必利及妈咪爱预防早产儿喂养不耐受;2006~2008年住院早产儿260例(给药组),入院后即给予莫沙必利及妈咪爱预防早产儿喂养不耐受.观察2组早产儿喂养不耐受发生率及喂养不耐受患儿恢复出生体重时间及达到全胃肠道喂养时间.结果:给药组、未给药组发生喂养不耐受分别为65例、38例,发病率分别为24.07%、35.51%;喂养不耐受患儿恢复出生体重时间分别为(11.17±3.87)d、(12.92±3.91)d,达到全胃肠道喂养时间分别为(9.05±3.26)d、(11.76±6.28)d;2组差异均有统计学意义(P<0.01).结论:莫沙必利及妈咪爱可有效防治早产儿喂养不耐受.     

极低出生体质量和极早早产与新生儿生存状况的关系

目的 探讨极低出生体质量和极早早产与新生儿的生存状况及相关影响因素.方法 选取2012年4月至2016年1月该院收治的极低出生体质量儿(VLBWI)和极早早产儿(VPI) 142例,选取同期出生的非VLBWI和非VPI 140例,比较入组新生儿的生存状况及远期预后,根据生存状况将VLBWI与VPI分为死亡组和存活组,对两组患儿的临床资料进行单因素和多因素Logistic回归分析.结果 出生体质量小于1 500、1 500～2 500、＞2 500 g新生儿的预后不良发生率比较,差异有统计学意义(P＜0.05).胎龄小于32周、32～37周、≥37周新生儿的预后不良发生率比较,差异有统计学意义(P＜0.05).死亡组新生儿的胎龄、出生体质量和产前使用地塞米松的比例明显低于存活组,母亲年龄、窒息、胎粪吸入、妊娠高血压综合征和机械通气比例明显高于存活组,两组比较差异有统计学意义(P＜0.05).≤28周胎龄、≤1 000 g出生体质量、窒息是影响VLBWI与VPI生存状况的独立危险因素(P＜0.05).结论 VLBWI与VPI的生存状况及远期预后不佳,易发生智力和运动障碍.