高胆红素血症对新生儿神经行为及智能发育的影响

目的探讨高胆红素血症(HB)对新生儿神经行为及智能发育的影响。方法选取轻中度非结合性HB新生儿57例为治疗组,同期正常足月新生儿53例为对照组。观察2组干预前、干预后1 d及出生后7、14 d时血清总胆红素(TSB)水平及神经行为的变化,比较出生后6、12个月智能发育情况,并分析新生儿神经行为测定(NBNA)评分与TSB水平的相关性。结果干预前及干预后1 d,出生后7、14 d,治疗组TSB水平显著高于对照组(P0.05或P0.01),而NBNA评分显著低于对照组(P0.01);治疗组出生后14 d NBNA评分恢复至正常范围,但仍低于对照组(P0.01)。出生后6个月,治疗组智能发育指数(MDI)及运动发育指数(PDI)均显著低于对照组(P0.01);出生后12个月,2组MDI及PDI无显著差异(P0.05)。TSB水平与NBNA评分呈显著负相关(r=-0.969,P=0.031)。结论 HB对新生儿神经行为及智能发育均有一定影响,及早进行干预能有效逆转胆红素对中枢神经系统的损伤,加速神经行为恢复。     

新生儿缺氧缺血性脑病治疗的相关进展

新生儿缺氧缺血性脑病(HIE)是造成新生儿死亡和儿童神经系统功能障碍的常见疾病.HIE在新生儿中的发病率和致残率相对较高,特别是中重度HIE患儿,常伴有各种严重并发症,威胁患儿生命安全,严重影响生活质量.本研究对亚低温、干细胞移植、远隔缺血后处理、高压氧及相关药物治疗HIE的最新进展进行综述,以期在HIE治疗中提高治愈...     

The activity of the von Willebrand factor cleaving protease ADAMTS-13 in newborn infants

Summary.  Background : Unusually large von Willebrand factor (VWF) multimers have been observed in patients with thrombotic microangiopathies (TMA), and absence of the VWF cleaving protease ADAMTS-13 activity is considered to be involved in the etiology of TMA. Increased amounts of large multimers of VWF have also been identified in neonates. Objective : We assessed ADAMTS-13 activity in healthy neonates, children and adults to establish baseline levels. Patients and methods : Cord blood was collected from 38 full-term newborns; venous samples were taken from 15 neonates on day 2–3 of life. Seventeen children, 24 healthy adults and seven patients with TMA were studied as well. ADAMTS-13 activity was quantified by the binding of the subjects' plasma VWF to collagen before and after enzyme activation. The multimer distribution of VWF was also determined. Results : Neonates and children had percentage ADAMTS-13 activity similar to adults. However, two groups were apparent in the cord blood samples: while 28/38 newborns had percentage activity within the normal range of healthy adults (102 ± 3.0%), 10 had significantly lower percentage activity (53 ± 1.1%; P  < 0.0001) that normalized by day 2–3. The VWF multimer distribution was the same in all cord blood samples and was not different compared with children and adults. High-molecular-weight VWF multimers were significantly increased in the 2–3-day-old neonates and in TMA patients. Conclusions : Although ADAMTS-13 activity was similar in neonates compared with adults, 26% of neonates had mildly reduced activity. Further studies are needed to investigate the complex interaction of VWF production and secretion with its size control by ADAMTS-13 in different age groups.     

Scenario-based clinical simulation: Bridging the gap between intern-students’ anxiety and provision of holistic nursing care for preterm neonates

AimThis study aimed to determine the effect of Scenario-Based Clinical Simulation (SBCS) on nursing students’ anxiety and skills related to providing holistic nursing care for preterm neonates.BackgroundNursing students who are caring for preterm neonates experience high level of anxiety that might negatively influence their clinical performance. Clinical nurse educators face the challenge of preparing skilful and competent students within the constraints of limited orientation time in the Neonatal Intensive Care Unit (NICU). The application of SBCS provides students with opportunities to practice critical thinking, problem-solving and communication skills, pose questions and remediate their clinical deficiencies in non-threatening learning enviroment.DesignA quasi-experimental, two groups, pre-post test study was carried out in the NICU of Specialized Hospital at Smouha, Alexandria.MethodSixty students completed a baseline skills assessment, as students' clinical skills were scored on a 148-item checklist and participants rated their anxiety. All participants received a didactic lecture and demonstrated nursing procedures. Research team facilitated an interactive SBCS session for the intervention group focused on the holistic care of preterm neonates and the common health problems affecting them. Two weeks later, two independent raters re-assessed the students' skills on the admitted preterms, and participants completed the anxiety questionnaire again.ResultsIt is revealed that all participants in the intervention group (100%) had good skills after two weeks of SBCS compared to 20% of the control group (P < 0.001). Moreover, 43.3% of the nursing students in control group experienced severe anxiety compared to only 6.7% of those in the intervention group who attended the SBCS (P < 0.001).ConclusionThe application of SBCS in NICU provided an interactive learning experience, improved and sustained students' clinical skills. They reflected on their performance and remediated their skills in a conducive environment. So, they encountered less anxiety while providing holistic care for preterm neonates.     

产时母体脐部血糖与新生儿生后48小时血糖监测的相关性研究

目的 探讨产时母体脐部血糖与新生儿48小时血糖动态变化的相关性,为临床早期干预提供依据 方法 选取2017年2月～2017年12月于上海市第一人民医院产科阴道分娩的200例孕妇及其分娩新生儿为对象,孕妇产时母体脐部血糖及新生儿出生后1h、3h、6h、12h、24h和48h这6个时间段的血糖进行监测,研究新生儿血糖48小时的动态变化及与母体脐部血糖的相关性。结果 新生儿出生3小时血糖妊娠糖尿病孕妇组新生儿血糖显著低于正常孕妇组新生儿血糖（P＜0.05） 差异有统计学意义 ;母体脐部血糖与新生儿血糖在新生儿出生1小时、3小时血糖呈正相关（P＜0.05）,差异有统计学意义 结论 1、重视新生儿血糖监测,特别是妊娠糖尿病孕妇分娩新生儿3h的血糖监测,及早发现低血糖情况并及时干预 2、母体脐部血糖对新生儿生后3小时内血糖水平有预测的价值     

高胆红素血症新生儿β2-微球蛋白的变化及临床应用

目的探讨血、尿β2-微球蛋白在高胆红素血症新生儿的变化及临床应用。方法对临床确诊的73例高胆红素血症新生儿进行血、尿β2-微球蛋白含量测定，并与27例健康新生儿进行对比分析。结果高胆红素血症新生儿血、尿β2-微球蛋白含量明显增高，且胆红素水平越高，血、尿β2-微球蛋白含量也明显增高，胆红素水平的高低与血、尿β2-微球蛋白含量呈正相关。结论血、尿β2-微球蛋白在新生儿高胆红素血症时与胆红素水平呈正相关，提示临床在治疗高胆红素血症患儿的同时，应加强肾脏的保护治疗。     

Experience with the Platelia Candida ELISA for the diagnosis of invasive candidosis in neonatal patients.

This preliminary study evaluated the use of the Platelia Candida antigen kit for the diagnosis of invasive candidosis in 70 of 184 pre-term infants admitted to a neonatal intensive care unit between March 2004 and March 2006. The frequency of confirmed candidaemia was 6.5%. The sensitivity and specificity of the assay were 94.4% and 94.2%, respectively, with a positive predictive value of 85% and a negative predictive value of 98%. These results suggest that the inclusion of regular serological surveillance for mannanaemia in some pre-term infants would complement blood cultures for the early detection of candidosis.     

新生儿继发于筛窦炎的眼眶脓肿(英文)

骨膜下脓肿是眼眶蜂窝织炎的一种,以脓和渗出液汇集在眼眶内骨膜下为特点。对于新生儿,眼眶脓肿非常罕见。我们报告1例年龄为26d的右眼患有严重眼眶蜂窝织炎的女患儿。眼眶和副鼻窦CT扫描显示右眼眶蜂窝织炎并内侧骨膜下和眼眶后部脓肿。眼分泌物培养见葡萄球菌生长,经用先锋霉素和甲硝唑静脉注射和经内窥镜鼻窦手术行急诊脓肿引流,恢复良好。通过内窥镜的鼻窦引流手术是预防更严重的并发症的首选治疗。     

Lymphocyte phenotypes and infection incidence in transfused preterm neonates1

SUMMARY. The immunomodulating effects of repeated exposure to blood from multiple donors coupled with an immature immune system may predispose the preterm neonate to an increased incidence of infection in his first few months of life. To test this hypothesis, we compared lymphocyte phenotypes, serum IgG concentrations, and histories of infection and rehospitalization in neonates at 4 months corrected age. Two of the study groups were preterm infants who had been transfused with either frozen, deglycerolized or CMV-negative, γ-irradiated blood. Control groups consisted of nontransfused term and preterm infants. There were no differences found in lymphocyte phenotypes or serum IgG concentrations of controls or transfused infants. No differences were found in the infection or rehospitalization incidence in the transfused infants as compared with nontransfused preterm neonates. We failed to show differences in immune parameters or in infection and rehospitalization rates of the preterm infants analysed. Alongside previously published reports, our data suggest that red cell transfusions have a minimal impact on the immature immune system of the neonate.