Management of premature rupture of membranes before 25 weeks

OBJECTIVES: The aim of our study was to define the benefits and risks related to expectant management in the midtrimester rupture of membranes and to assess the prognostic factors in order to give objective informations to parents facing these obstetrical situations. STUDY DESIGN: We conducted a retrospective study. The study population included 49 patients with premature rupture of membranes at 16-23 weeks' gestation during the period January 1998-June 2003. The main criterion for judgement was neonate survival. Statistical analysis included chi2-test for the qualitative variables and Student's test for the quantitative variables. The threshold for significance was 5%. RESULTS: Twenty couples out of 49 chose medical termination of pregnancy. Among the 29 other pregnancies, the mean latency period was 2.1 weeks. The mean gestational age at delivery was 23.2 weeks. Nineteen patients were delivered after 22 weeks. The main prognostic factors were the initial amniotic fluid index (2.9 cm versus 0.8 cm) (p=0.042) and gestational age at delivery (26.7 weeks versus 22.6 weeks) (p<0.001). About 2% of the pregnancies were complicated by maternal infection. Eighty-three percent of the survivors had neonatal respiratory distress syndrome. 41.2% of them presented sepsis. We observed no cases of severe intraventricular haemorrhage. The number of infants born after 24 weeks of gestation and still alive at 1 week was 12, representing 24% of pregnancies and 63% of the infants born after 24 weeks. CONCLUSION: Expectant management can be widely suggested to patients. However, termination of pregnancy is acceptable, in cases with a poor prognosis including anamnios and premature rupture of membranes before 21 weeks.     

New guidelines for maternal and neonatal resuscitation

New evidence has prompted changes in our national cardiopulmonary resuscitation guidelines for both neonates and adult patients. The purpose of this article is to provide an overview of the changes recommended by the American Heart Association, Academy of American Pediatrics, and the American College of Obstetrics and Gynecology. In addition, a strategy for implementing these guidelines into practice is suggested.     

应用改良方法气管内滴入肺表面活性物质治疗新生儿肺透明膜病的疗效观察

目的：观察改良方法气管内滴入肺表面活性物质（pulmonary surfactant,PS）治疗新生儿肺透明膜病（Neonatal Hyaline Membrane Disease,HMD）的疗效。方法：选取96例新生儿肺透明膜病患儿,按随机数字表法分为治疗组（n=48）和对照组（n=48）,对照组采用传统的多体位间断非密闭式气管内滴入PS;治疗组应用经头皮针气管导管侧壁刺入持续气管内滴入PS,观察比较两组的各观察指标及临床转归情况。结果：治疗组的平均操作时间明显少于对照组,差异有统计学意义（P〈0.05）;且滴药过程中脱管率、管口溢药率、脉搏氧饱和度下降率及呼吸机相关性肺炎（VAP）发病率均明显低于对照组,差异均有统计学意义（P〈0.05）。结论：应用改良方法即经头皮针气管导管侧壁刺入持续气管内滴入PS成功率高,操作简单、快速,注药过程平缓,减少了脱管、药液喷出浪费、一过性缺氧及VAP的发生,是一种更快捷、方便、安全、经济、有效的给药方法,值得推广。     

Ⅰ期修补腹裂的早期转归(附18例报告)

目的 :评价Ⅰ期修补腹裂的早期转归。方法 :回顾分析我院小儿外科 17年间收治的腹裂病历 18份。结果 :产前诊断 16例 (89% )。全部病婴I期修补腹壁缺损。出生至手术的平均时间 5h(0 .5h～ 17h)。 4例合并肠道畸形和 1例并发肠坏死者需要更多的手术和更长的时间达到完全喂养 (P<0 .0 1)。 3例死亡 (16 .6 % ) ,其中 2例死于感染。结论 :我们的经验提示腹裂的死亡率不超过 16 .6 % ,降低死亡率主要是防治感染并发症 ,Ⅰ期修补可改善早期转归。     

血清标志物在需手术治疗的新生儿坏死性小肠结肠炎患儿中的变化

目的 分析C-反应蛋白（CRP）、降钙素原（PCT）、血小板（PLT）及清蛋白等血清标志物在需手术治疗的新生儿坏死性小肠结肠炎（NEC）中的变化情况及临床意义,从而为临床最佳手术时机的选择提供参考。方法 回顾性分析2015年6月至2019年6月在安徽医科大学第一附属医院新生儿科收治的67例确诊为NEC（Bell分期II以上）的患儿病例资料,根据是否经过手术治疗,分为手术组（n=26）与非手术组（n=41）,对两组患儿保守治疗前和保守治疗后（24~48 h）外周静脉血的PCT、CRP、PLT、清蛋白水平进行对比分析。结果 保守治疗后,手术组与非手术组CRP、PCT水平均高于治疗前（P<0.05）,手术组PLT、清蛋白水平均低于治疗前,差异均有统计学意义（P<0.05）;保守治疗后,手术组PCT、CRP水平高于非手术组（P<0.05）,PLT水平低于非手术组,差异均有统计学意义（P<0.05）。保守治疗后的CRP、PCT水平对NEC外科手术具有预测价值,最佳临界值分别为27.685 mg/L、14.675 mg/L,灵敏度和特异度分别为84.6%、68.3%和73.1%、82.9%。结论 PCT、CRP等血清标志物对NEC最佳手术时机的选择具有指导价值,CRP、PCT水平明显升高、PLT及清蛋白水平明显较前降低提示NEC患儿可能需要手术。     

Neonatal education in the North East: A collaborative venture

This article describes a change in the teaching and learning strategy for newly qualified neonatal nurses who wish to become qualified in the speciality (QIS) of neonatal nursing. Two modules have undergone revision in the light of feedback from the Regional Neonatal Network and evaluations from stakeholders. This paper provides the rationale for change and discusses developments in teaching and learning strategies, and the planning and implementing process involved in the change. Factors to take into consideration when evaluating the change and implications for future developments are also briefly discussed.     

持续质量改进在新生儿皮肤护理中的应用效果

目的 分析持续质量改进在新生儿皮肤护理中的应用效果及其对皮肤损伤发生情况的影响。方法 选择2021年3月-2022年3月于我院产科出生的76例新生儿为本次研究对象,采用随机数字表法分为常规组和观察组,各38例。常规组给予常规皮肤护理,观察组给予持续治疗改进皮肤护理,比较两组皮肤损伤发生情况、临床指标、疼痛情况及护理满意度。结果 观察组皮肤损伤发生率为5.26%,低于常规组的23.38%（P＜0.05）;观察组皮肤损伤愈合时间、住院时间、医疗费用均优于常规组（P＜0.05）;两组住院第1、2天的FLACC评分比较,差异无统计学意义（P＞0.05）;观察组住院第3、4天的FLACC评分低于常规组（P＜0.05）;观察组护理总满意度为97.37%,高于常规组的76.32%（P＜0.05）。结论 持续质量改进在新生儿皮肤护理中的应用效果确切,可有效降低新生儿皮肤损伤发生率,缩短治疗时间,减轻治疗费用,同时可有效缓解疼痛,促进损伤愈合,提高了护理满意度,取得了理想的护理效果。     

正常新生大鼠及缺血缺氧性损伤后脑组织铁的组织化学改变

目的：应用大鼠HIE模型了解正常情况下及缺血缺氧损伤后脑组织铁的组织化学改变。方法：实验分正常对照组和HIE组。正常对照组分别于 8 d,10 d,14 d,21 d 龄处死(每时间点3只),HIE组分别于 7 d 龄大鼠(HIE)模型制成后观察 12 h,24 h,3 d,7 d,14 d 处死(每时间点3只)。各组脑组织切片,进行铁Perl's染色和光镜观察。结果：正常大鼠脑组织铁染色阳性细胞较少且主要见于扣带及胼胝体、脑室周围、内囊及外囊的尖部。形态学上铁染色阳性细胞主要与少突神经胶质细胞和小神经胶质细胞相似。HIE组缺血缺氧损伤后 12 h 脑组织铁染色情况与正常对照组无明显差异。缺血缺氧损伤后随时间推移铁染色逐渐增强,1周时为甚,以皮质、内囊及海马回处最明显,铁染色阳性神经胶质的增多程度大于铁染色阳性细胞的增多程度,有明显的傍血管现象。结论：铁染色可作为判断脑组织缺血缺氧中晚期损伤程度的指标之一。     

A Centrifugal Pump Driven Tidal Flow Extracorporeal Membrane Oxygenation System Tested with Neonatal Mock Circulation

In 1993, Chevalier published his experiences with tidal flow venovenous extracorporeal membrane oxygenation (ECMO) featuring a single lumen cannula, non-occlusive roller pump, and alternating clamps. Using a neonatal mock circulation (NMC), which enables different hemodynamic states for neonatal ECMO research, the tested hypothesis was that it is possible to create a centrifugal pump driven tidal flow neonatal venovenous ECMO system. Additionally, the resulting hemodynamic effects in a condition of circulatory impairment were investigated. The ECMO circuit tested was assembled using a pediatric centrifugal pump head, a distensible reservoir, and a rotary clamp separating drainage from the injection phase. Using the NMC, end tidal volumes, mock circulation flow, and arterial and venous pressures were measured at different pump speeds after the drainage and injection phases. Effective venovenous ECMO flow (evvEF) was calculated. Mock circulation baseline values (ECMO clamped) were compared to values during tidal flow ECMO. At 3,000 rpm, a centrifugal pump speed of 75 ml/kg/min evvEF was reached, and it increased with higher pump speeds. At this point, the end tidal mock circulation flow (representing cardiac output) after drainage differed significantly from that during the injection phase (p < 0.01) but not from the baseline value. The end tidal arterial and venous pressures after the drainage phase were found to be significantly decreased compared to the baselines (p < 0.01). In conclusion, a centrifugal pump driven tidal flow venovenous ECMO system can be created enabling sufficient tidal volumes. Tested in the described NMC simulating posthypoxic circulatory impairment, significant hemodynamic effects could be demonstrated. Animal experiments for confirmation are necessary.     

阻塞性黄疸大鼠肝细胞凋亡及蛋白激酶C信号通道的调控作用

目的探讨阻塞性黄疸肝损害的调控机制。方法采用胶原酶原位肝灌注法获取大鼠肝细胞，行原代培养，用蛋白激酶(PK)C激动剂帕斯酶埃(PMA)、拮抗剂切勒斯埃作用于肝细胞，再用50μmol／L甘氨鹅脱氧胆酸钠(GCDC)作用后行流式细胞术(FCM)及用末端脱氧核苷酸转移酶(TdT)介导的脱氧核苷酸(duTP)缺口末端标记技术(TUNEL)检测肝细胞凋亡情况。结扎大鼠胆总管后3、7、14、21d处死大鼠，用TUNEL技术及免疫组织化学方法检测阻塞性黄疸大鼠肝脏组织细胞凋亡状态及PKC蛋白的表达。结果随PMA浓度的增加，肝细胞的凋亡明显增加。随Chelerythrine的增加，肝细胞的凋亡明显减少。大鼠胆总管结扎后随结扎时间的延长细胞凋亡指数(AI)增加，结扎14d后AI达高峰。PKC表达越强，AI就越高。结论PKC信号通道参与了阻塞性黄疸肝细胞凋亡的调节，并在阻塞性黄疸肝损害的发生和发展中起重要作用。