廊坊地区79450例新生儿听力筛查结果分析

目的:了解该地区新生儿听力障碍的发病情况。方法:回顾性分析2010年10月～2011年10月廊坊地区出生的79 450例新生儿听力筛查的结果。采用畸变产物耳声发射(DPOAE)进行初筛,初筛阳性者及高危儿42天后采用DPOAE联合自动听性脑干诱发电位(AABR)进行复筛,复筛阳性者采用AABR+ABR+DPOAE+声导抗等听力测试做最后确诊,确定听力障碍的程度和性质。结果:新生儿听力筛查79 450例,初筛率92.5%;初筛通过69 122例,通过率87.0%;复筛8 125例,未通过975例,阳性率12.0%;确诊201例,总发病率2.5‰,其中轻度听力损伤108例,中度听力损伤56例,重度37例。结论:对新生儿进行听力普遍筛查,可早期发现听力异常,及时给予干预,减少听力损害的发生,促进言语发育,提高人口素质。     

326例30个月以下婴幼儿乙肝标志物模式的调查分析

目的:探索新生儿乙肝标志物模式和接种乙肝疫苗后的免疫状态,分析新生儿免疫状态在30个月以内的变化和影响因素。方法:选取326例30个月以内婴幼儿,188例7～30个月完成初次全程免疫接种婴幼儿。采用酶联免疫法对各年龄段婴幼儿乙肝5项指标进行测定。同时对0～1个月新生儿母亲的孕期检查进行回顾性分析。结果:受检婴幼儿的乙肝五项指标中,单纯抗-HBs的阳性率在7～12个月达高峰,为93%,25～30个月时下降至65.3%。抗-HBc阳性所占比例在0～1个月的新生儿中最高,随年龄的增长比例降低。0～1个月的新生儿与母亲乙肝5项模式中各抗体的阳性率比较差异无统计学意义,其中母亲为HBsAg阳性的新生儿,抗-HBc的阳性率为100%。结论:全程接种乙肝疫苗结束后1个月及在25个月后都应及时检测乙肝标志物,提高乙肝疫苗接种失败率及抗-HBs水平衰减的检出,以便及时复种。对于母亲是乙肝病毒携带者的婴幼儿,应在出生时、全程免疫后1个月、25个月时进行乙肝标志物的检查,以检测新生儿阻断的效果及乙肝标志物的动态变化。     

新生儿黄疸与患儿心肌损伤之间的关联

目的探讨新生儿黄疸与患儿心肌损伤之间的关联。方法选择生理性黄疸患儿59例(生理性黄疸组),病理性黄疸患儿33例(病理性黄疸组)为研究对象。观察两组新生儿血清肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)、心肌肌钙蛋白I(cTnI)水平,心电图校正Q-T间期(QTc)、校正Q-T间期离散度(QTcd)以及心脏超声检查左室射血分数(EF)和二尖瓣口舒张早期峰值流速/舒张晚期峰值流速(E/A)的结果,并统计分析。结果病理性黄疸组患儿CK、CK-MB、LDH显著高于生理性黄疸组,差异有统计学意义(P0.05);cTnI高于生理性黄疸组,但无统计学差异(P0.05)。两组QTc、QTcd、EF、E/A无统计学差异(P0.05)。结论新生儿病理性黄疸患者存在一定程度的心肌损伤,应谨慎分析与处理。     

The challenge to identify the global neonatal workforce needed to meet the millennium developmental goals

Millennium Development Goal (MDG) # 4 targets a 2/3 reduction of under 5 years of age deaths by 2015 (United Nations, 2013). However, preventable neonatal deaths which constitute nearly half of this under 5 years of age mortality hinder the achievement of MDG. Strategic implementation of programs and initiatives to improve neonatal outcomes relies on effective utilization of neonatal workforce at the regional, national, and global level. The Council of International Neonatal Nurses (COINN), Inc. identified as the only international neonatal nursing organization recognizes the need for an updated data which is not only updated but neonatal specific, in order to identify the gaps in care providers compared to neonatal outcomes.Neonatal nurse workforce shortages and how it relates to the quality or the availability of care is reported widely, however, in a fragmented manner.This article will describe the significance of the neonatal workforce to the neonatal health and neonatal nursing by reporting the existing evidence related to the neonatal workforce and the current efforts being made globally.     

经引流管超声造影在经皮经肝胆道置管引流术中的应用

目的探讨经引流管超声造影在梗阻性黄疸患者行经皮经肝胆道置管引流术(PTCD)中的应用价值。方法 54例梗阻性黄疸患者(肝内胆管内径≥0.5 cm),使用Sono Vue经引流管超声造影指导PTCD过程。结果 PTCD置管成功51例,成功率94.4%,效果良好且未见明显并发症;其中肝内置引流管1根46例,置引流管2根5例。置管失败3例。结论经引流管超声造影能有效提高梗阻性黄疸患者PTCD的成功率。     

产ESBLs细菌对哌拉西林/他唑巴坦的耐药性分析

目的了解哌拉西林/他唑巴坦对医院新生儿病房分离的产超广谱β-酰胺酶(ESBLs)细菌的体外抗菌活性,合理指导临床用药。方法使用Phoenix 100全自动微生物分析仪检测2007年1月-2010年12月新生儿病房患儿各类临床标本中分离的产ESBLs菌对哌拉西林/他唑巴坦的药物敏感性。结果共分离出产ESBLs菌135株,包括肺炎克雷伯菌83株,占61.5%,大肠埃希菌40株,占29.6%,奇异变形菌9株,占6.7%,阴沟肠杆菌3株,占2.2%;产ESBLs细菌对哌拉西林/他唑巴坦耐药率为12.6%,其中肺炎克雷伯菌和大肠埃希菌对哌拉西林/他唑巴坦耐药率分别为14.5%和12.5%;未出现奇异变形菌、阴沟肠杆菌对哌拉西林/他唑巴坦耐药株。结论新生儿病房检出产ESBLs细菌以肺炎雷伯菌和大肠埃希菌为主,哌拉西林/他唑巴坦对产ESBLs菌具有较强的抗菌活性,其中对大肠埃希菌的抗菌活性高于肺炎克雷伯菌。     

NICU医院感染分析及预防治疗措施

目的 了解某医院新生儿重症监护病房(NICU)医院感染现状,以加强前瞻性监控,减少NICU医院感染发生.方法 采取回顾性和前瞻性相结合的调查方法,对NICU 2007-2010年4811例出院患儿的临床资料进行调查分析.结果 4年中发生医院感染101例、106例次,感染率为2.10％、例次感染率为2.20％;2007-2010年感染率分别为2.28％、3.14％、1.61％、1.62％;不同年份NICU部位感染率不同,4年平均感染部位中以呼吸系统发生率最高,其中下呼吸道占25.47％,上呼吸道占17.92％;4年平均季度感染率中,第四季度最高、第三季度最低,分别为3.07％、0.95％.结论 加强前瞻性监测并采取一系列控制措施可有效降低医院感染的发生.     

怀化市新生儿先天性甲低的筛查与治疗评估

目的 探讨先天性甲状腺功能减低症的筛查、治疗方法、随访以及疗效评价. 方法 筛查采用时间分辨荧光免疫法进行TSH水平检测,对召回的可疑患儿采用全自动化学发光分析仪检测甲状腺功能,确诊后给予左旋甲状腺素钠4～10 μg/kg·d治疗,治疗2～3年后,停药观察,结合甲状腺B超、体格发育评价、骨龄评定和智力检测进行综合评估. 结果 筛查了活产新生儿153951人,检出甲低60例,发病率0.39‰.54例坚持治疗的患儿体格发育正常,智力发育与正常对照组比较差异无统计学意义,48人做了甲状腺B超,其中1例甲状腺缺如,4例甲状腺小,29人甲状腺肿大或稍大,14人甲状腺正常.27人进行了疗效评估,14例为暂时性甲低,11人为原发性甲低,2人为亚临床甲低. 结论 开展新生儿疾病筛查,结合早期安全有效的治疗和长期随访,可避免先天性甲低智残的发生,保障儿童体格和智能发育正常.     

Cost-effectiveness of neonatal ECG screening for the long QT syndrome.

AIMS: A significant number of preventable cardiac deaths in infancy and childhood are due to long QT syndrome (LQTS) and to unrecognized neonatal congenital heart diseases (CHDs). Both carry a serious risk for avoidable mortality and morbidity but effective treatments exist to prevent lethal arrhythmias or to allow early surgical correction before death or irreversible cardiac damage. As an electrocardiogram (ECG) allows recognition of LQTS and of some of the CHDs that have escaped medical diagnosis, and as LQTS also contributes to sudden infant death syndrome, we have analysed the cost-effectiveness of a nationwide programme of neonatal ECG screening. Our primary analysis focused on LQTS alone; a secondary analysis focused on the possibility of identifying some CHDs also. METHODS AND RESULTS: A decision analysis approach was used, building a decision tree for the strategies 'screening'-'no screening'. Markov processes were used to simulate the natural or clinical histories of the patients. To assess the impact of potential errors in the estimates of the model parameters, a Monte Carlo sensitivity analysis was performed by varying all baseline values by +/-30%. Incremental cost-effectiveness analysis for the primary analysis shows that with the screening programme, the cost per year of life saved is very low: 11,740 euro. The cost for saving one entire life of 70 years would be 820,000 euro. Even by varying model parameters by +/-30%, the cost per year of life saved remains between 7400 euro and 20,400 euro. These figures define 'highly cost-effective' screening programmes. The secondary analysis provides even more cost-effective results. CONCLUSION: A programme of neonatal ECG screening performed in a large European country is cost-effective. An ECG performed in the first month of life will allow the early identification of still asymptomatic infants with LQTS and also of infants with some correctable CHDs not recognized by routine neonatal examinations. Appropriate therapy will prevent unnecessary deaths in infants, children, and young adults.     

内镜下鼻胆管引流加口服吡喹酮治疗重症华支睾吸虫病

目的 了解十二指肠镜下放置鼻胆管引流加口服吡喹酮治疗重症华支睾吸虫病的疗效。方法 内镜下鼻胆管引流组58例，手术T管引流组26例，两组在年龄、性别、病情等方面有可比性，均于术后8～48h口服吡喹酮驱虫(1．2g／次，每日3次，连服2d)。结果 鼻胆管引流组腹痛、发热、黄疸等症状迅速改善，与手术T管引流组比较，鼻胆管引流症状缓解快、创伤小、术后恢复快、并发症少及治疗费用低。结论 内镜下放置鼻胆管引流加口服吡喹酮治疗重症华支睾吸虫病，是有效、安全的。