新生儿窒息临床分析

目的 探讨新生儿窒息的相关因素及防治措施.方法 对我院收治的90例窒息新生儿的病因、临床表现、实验室检查等情况进行综合分析.结果 新生儿窒息为羊水粪染,脐带因素,胎后(横)位,活跃期延长,第二产程延长,低体重(M ＜2500 g)等因素所致.结论 产前做好充分抢救准备,及时判断新生儿窒息的发生并及时采取积极有效的复苏手段,可有效地降低新生儿窒息的病死率.     

尿微量蛋白在新生儿窒息肾损害早期诊断中的意义

目的探讨尿微量蛋白测定在新生儿窒息早期肾损害的临床意义。方法63例窒息足月新生儿（窒息组）,平均日龄（1±1．8）d,其中轻度窒息36例,重度窒息27例,于出生后第2d及第5d检测尿中尿清蛋白（ALB）、α1微球蛋白（α1—MG）、转铁蛋白（TRF）、β2微球蛋白（β2-MG）的水平及尿常规,同时查血尿素氮（BUN）及肌酐（Cr）。30例正常足月新生儿用作对照组。结果窒息组新生儿出生后第2d的尿ALB、（α1—MG、TRF、β2-MG均显著高于对照组,均P〈0．01,第5d尿ALB、TRF、α1-MG、β2-MG仍显著高于对照组,P〈0．05,0．05,0．01,0．01。重度窒息组生后第2d的尿ALB、α1-MG、TRF、β2-MG均显著高于轻度窒息组,均P〈0．01,第5d的尿ALB、TRF、α1—MG、β2-MG仍显著高于轻度窒息组,P〈0．05,0．05,0．01,0．01。尿ALB、α1—MG、TRF、β2-MG的高低与窒息的程度呈正相关,均P〈0．05。结论联合检测尿ALB、α1-MG、TRF、β2-MG能更敏感地评估新生儿窒息早期。肾损伤的程度及肾脏功能,为临床诊疗提供依据。     

窒息新生儿脐血D-二聚体水平和红细胞膜Na~+-K~+-ATP酶活性变化

目的:分析窒息新生儿脐血pH、D-二聚体水平及红细胞膜Na+-K+-ATP酶活性变化。方法 :选择临产过程出现急性胎儿窘迫孕妇40例,其剖宫娩出新生儿以1min Apgar评分确定为正常者20例(窘迫组),出现窒息者20例(窒息组);另选无急性胎儿窘迫、同样剖宫娩出的正常新生儿20例作为对照组。取各组脐动脉血,血气分析仪检测pH值,免疫比浊法检测D-二聚体水平,定磷法检测红细胞膜Na+-K+-ATP酶活性。比较各组上述指标的差异。结果:方差分析显示,各组脐动脉血pH值、D-二聚体水平和红细胞膜Na+-K+-ATP活性差异均有统计学意义(P0.05)。窒息组脐动脉血pH值明显低于对照组和窘迫组(P均0.05),D-二聚体水平显著高于对照组和窘迫组(P均0.05),红细胞膜Na+-K+-ATP酶活性显著低于对照组与窘迫组(P均0.05);窘迫组pH值和红细胞膜Na+-K+-ATP酶活性显著低于对照组(P均0.05)。结论 :窒息新生儿纤溶和红细胞膜泵功能检测结果,可为新生儿窒息治疗措施的选择提供实验依据。     

Fetal asphyctic preconditioning in rats results in a preserved placental inflammatory phenotype at birth

IntroductionPerinatal asphyxia (PA) is a major cause of neonatal mortality and morbidity. Research has shown that in rats fetal asphyxia (FA) can provoke neuroprotection against a subsequent more severe perinatal asphyctic insult. This is called fetal asphyctic preconditioning (PC). Our objective was to investigate alterations in the placental inflammatory phenotype associated with PC.MethodsFA was induced in the rat at embryonic day 17 by reversibly clamping the uterine circulation and PA was induced at birth by submersion of the uterine horns in a saline bath for 19 min. The effect of PC was studied by inducing FA at E17, followed by PA at E21. Placental TNF-α, IL-1β, IL-6 and IL-10 mRNA and protein levels were measured by qPCR and ELISA.ResultsIL-1β mRNA increased in the labouring FA group, but IL-1β protein decreased after both FA and PA. In the PC group, IL-1β mRNA and protein levels were similar to controls. IL-6 protein increased 6 h after FA, however decreased 24 h after FA. IL-6 mRNA was higher in the labouring PA group. IL-10 protein decreased 24 h after FA. At birth, IL-10 mRNA increased in the PA group; however, IL-10 protein decreased in both the PA and the FA group. In the PC group, IL-10 mRNA and protein were similar to control levels.DiscussionDepleted protein concentrations of IL-10 and IL-1β after one single asphyctic insult were reversed after fetal asphyctic PC. In addition, PC placentas showed less up-regulation of IL-6 mRNA compared to the PA ones. This modulated placental inflammatory phenotype might contribute to the improved neonatal outcome showed after fetal asphyctic PC.     

Correlation of cardiac troponin T levels with inotrope requirement,hypoxic-ischemic encephalopathy,and survival in asphyxiated neonates

BACKGROUNDCardiac involvement in neonates with perinatal asphyxia not only complicates perinatal management but also contributes to increased mortality. AIMTo assess cardiac troponin T (cTnT) levels in asphyxiated neonates and their correlation with echocardiography findings, inotrope requirement, hypoxic-ischemic encephalopathy (HIE) stages, and mortality.METHODScTnT levels, echocardiographic findings, the requirement of inotropes, HIE stages, and outcome were studied in neonates of gestational age ≥ 34 wk with perinatal asphyxia.RESULTSAmong 57 neonates with perinatal asphyxia, male gender, cesarean section, forceps/vacuum-assisted vaginal delivery and late preterm included 33 (57.9%), 23 (40.4%), 3 (5.3%), and 12 (21.1%) respectively. The mean gestational age was 38.4 wk (1.6 wk). HIE stages I, II, and III were observed in 7 (12.3%), 37 (64.9%), and 9 (15.8%) neonates respectively. 26 (45.6%) neonates had echocardiographic changes and 19 (33.3%) required inotropes. cTnT levels were elevated in 41 (71.9%) neonates [median (IQR); 0.285 (0.211-0.422) ng/mL]. The Median cTnT level showed an increasing trend with increasing changes in echocardiography (P = 0.002). Two neonates with mitral regurgitation and global hypokinesia had the highest cTnT levels (1.99 and 0.651 ng/mL). Of 31 neonates with normal echocardiography, 18 (58.06%) showed elevated cTnT. cTnT levels were significantly higher in those who required inotropic support than those who did not (P = 0.007). Neonates with HIE stage III had significantly higher cTnT levels compared to those with HIE stage I/II (P = 0.013). Survivors had lower median cTnT levels [0.210 (0.122-0.316) ng/mL] than who succumbed [0.597 (0.356-1.146) ng/mL].CONCLUSIONcTnT levels suggestive of cardiac involvement were observed in 71.9% of asphyxiated neonates. cTnT levels correlated with echocardiography findings, inotrope requirement, HIE stages, and mortality.     

Effect of perinatal asphyxia on thyroid-stimulating hormone and thyroid hormone levels

AIM: To compare serum concentrations of thyroid hormones--T4, T3, free T4 (FT4) and reverse T3 (rT3)--and thyroid-stimulating hormone (TSH) found in the umbilical cord blood of term newborns with and without asphyxia and those found in their arterial blood collected between 18 and 24 h after birth. A further aim of the study was to assess the association between severity of hypoxic-ischemic encephalopathy and altered thyroid hormone and TSH levels, and between mortality and FT4 levels in the arterial blood of newborns between 18 and 24 h of life. METHODS: A case-control study was carried out. The case group comprised 17 term newborns (Apgar score < or = 3 and < or = 5 at the first and fifth minutes; umbilical cord blood pH < or = 7.15) who required bag and mask ventilation for at least one minute immediately after birth. The control group consisted of 17 normal, term newborns (Apgar score > or = 8 and > or = 9 at the first and fifth minutes; umbilical cord blood pH > or = 7.2). Cord blood and arterial blood samples were collected immediately after birth and 18 to 24 h after birth, respectively, and were used in the blood gas analysis and to determine serum concentrations of T4, T3, FT4, rT3 and TSH by radioimmunoassay. All newborns were followed-up until hospital discharge or death. RESULTS: Gestational age, birthweight, sex, size for gestational age, mode of delivery and skin color (white and non-white) were similar for both groups. No differences were found in mean levels of cord blood TSH, T4, T3 and FT4 between the groups. In the samples collected 18 to 24 h after birth, mean levels of TSH, T4, T3 and FT4 were significantly lower in the asphyxiated group than in the control group. Mean concentrations of arterial TSH, T4 and T3 between 18 and 24 h of life were lower than concentrations found in the cord blood analysis in asphyxiated newborns, but not in controls. In addition, asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy presented significantly lower mean levels of TSH, T4, T3 and FT4 than those of controls. None of the asphyxiated newborns with FT4 > or = 2.0 ng/dl died; 6 out of the 11 asphyxiated newborns with FT4 < 2.0 ng/dl died. CONCLUSIONS: Serum concentrations of TSH, T4, T3 and FT4 are lower in asphyxiated newborns than in normal newborns between 18 and 24 h of life; this suggests central hypothyroidism secondary to asphyxia. Asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy present a greater involvement of the thyroid function and consequently a greater risk of death.     

新生儿窒息后心肌肌钙蛋白Ⅰ与心肌酶活性的时相变化及其意义

目的：探讨新生儿窒息后心肌肌钙蛋白Ⅰ(CTnⅠ)及心肌酶活性的时相变化。方法：化学发光法和全自动生化分析仪测定新生儿窒息组26例(轻度窒息16例，重度窒息10例)和对照组10例生后0 h，6 h，12 h，24 h，72 h，10 d血清CTnI水平、肌酸激酶(CK)、肌酸激酶心型同工酶(CK-MB)、乳酸脱氢酶(LDH)及天门冬酸氨基转移酶(AST)活性。结果：窒息组0 h血清CTnI水平，CK，CK-MB和LDH活性明显高于对照组，均P<0.01；其中CTnI峰值在12 h，48 h开始下降；CK活性峰值为6 h，而CK-MB活性于12～24 h达高峰，均于72 h后下降；LDH活性于12 h达高峰，AST活性则于6 h开始升高，24 h后降低。结论：窒息新生儿生后早期动态监测血清CTnI与心肌酶活性有助于及时诊断和治疗心肌损害。     

纳洛酮对窒息新生儿血浆β内啡肽及血管活性肠肽的影响

目的　探讨新生儿窒息后血浆 β内啡肽 (β EP)和血管活性肠肽 (VIP)的变化 ,及纳洛酮治疗后对其的影响。方法　围产期窒息新生儿 44例 ,其中重度窒息 1 9例 ,轻度窒息 2 5例。将 44例窒息新生儿中的 32例设为实验组 (重度窒息 1 4例 ,轻度窒息 1 8例 ) ,在生后第 1天及用纳洛酮治疗后1h和 3d分别取血 ,用放射免疫技术测定血浆 β EP及VIP。另 1 2例为窒息对照组 (重度窒息 5例 ,轻度窒息 7例 )。正常对照组 1 6例。结果　生后 2 4h内窒息组患儿 β EP及VIP明显高于对照组 ,且窒息程度越重 ,两者水平越高 ,两组比较差异有显著意义 (P <0 .0 5)。重度窒息、轻度窒息 ,及非窒息对照组患儿血浆 β EP及VIP水平分别为 (1 65± 61 ) ,(91± 45) ;(1 0 1± 2 9) ,(73± 1 4 ) ;(67± 1 6) ,(64± 1 1 )ng/L。应用纳洛酮 1h后实验组患儿血浆 β EP及VIP水平均下降 ,连续用药 3d后 ,实验组 β EP[(58± 1 8)ng/L]及VIP[(50± 1 3)ng/L]明显低于窒息对照组 [分别为 (77± 1 5)、(70± 1 2 )ng/L] ,两组比较差异有显著意义 (P <0 .0 5)。而与同日龄非窒息对照组水平差异无显著意义。结论　血浆 β EP及VIP浓度与围产期窒息缺氧密切相关 ,窒息程度越重 ,β EP及VIP水平越高 ,而纳洛酮可有效降低 β EP及VIP水平     

窒息新生儿尿视黄醇结合蛋白水平的变化及意义

目的探讨尿视黄醇结合蛋白（RBP）的变化在新生儿窒息后肾小管损伤中的意义及不同窒息程度新生儿尿RBP值随日龄的动态变化特点。方法对132例足月窒息新生儿（轻度窒息67例，重度窒息65例）和48例足月正常新生儿（对照组）在生后1、3、7、10天用酶联免疫吸附法监测尿RBP。结果①生后d．与对照组相比，窒息组尿RBP值显著升高（P〈0．001）。②重复测量资料方差分析显示，不同组别之间存在差异（P〈0．01），进一步用SNK检验，得出两两间的差异均有意义（P〈0．05）。③不同日龄3组新生儿尿RBP值变化的趋势不同（P〈0．01）。④重度窒息组尿RBP，、RBP，。值与对照组和轻度窒息组均有差异（P〈0．05）。结论①生后7天内新生儿肾小管功能发育不完善。对窒息新生儿应监测肾功能，特别是重度窒息需7—10天以上的肾功能随访。