SEVERE NEONATAL ASPHYXIA

ABSTRACT. In Sweden during the 1970's the incidence of severe asphyxia (an Apgar score of 3 or less at 5 min) has decreased significantly from 3.22 to 2.56 per 1000 infants. A follow-up study was undertaken concerning 116 infants (40 preterm, 76 full-term) admitted to St. Göran's Children's Hospital during a 7-year period (1973–79). The mortality rate was 48% in preterm and 21% in full-term infants. Significant sequelae were present in 27% of the surviving full-term and 14% of the preterm infants. The three severely-handicapped preterm infants had other serious diseases as well whereas this applied to only one full-term infant. The predictors of sequelae included perinatal complications, late onset of spontaneous ventilation (>20 min) and postnatal symptoms, such as seizures. Only two of 9 infants with regular breathing after 20 min and three of 16 infants with seizures were considered normal at follow-up.     

Jaundice: a 10 year review of 41,000 live born infants

ABSTRACT. A review is presented of jaundiced newborn infants during the 10-year period to 1980. Included are those whose serum bilirubin level was 154 μmol/l or more. Of 41,057 live births, 4,406 (10.7%) infants had hyperbilirubinaemia. The most common (19.9;%) aetiological factor was prematurity, followed by ABO erythroblastosis 7.1%; sepsis 3.4%; Rhesus erythroblastosis 2.7%; bruising 2.2%; multifactorial 1.0% and glucose-6-phosphate dehydrogenase deficiency 0.5%. Treatment was not undertaken in 2,855 (64.7%) infants, but 1,419 (32.2%) received phototherapy alone, 122 (2.7%) infants received both exchange transfusion and phototherapy and 10 (0.2%) infants received exchange transfusion alone. Of the infants requiring exchange transfusion 50.0% had Rhesus erythroblastosis, 28.0% ABO erythroblastosis, 10.6% jaundice of prematurity and the remainder were due to a variety of causes. Sixty-three (1.4%) infants died, with two deaths being related to the hyperbilirubinaemia, as their death was due to necrotizing enterocolitis following exchange transfusion. Phototherapy proved safe with no deaths directly attributable to its use.     

132例新生儿窒息的产科原因分析

目的探讨新生儿窒息的产科原因,提出有效的预防措施.方法对132例新生儿窒息进行回顾性分析.结果新生儿窒息的产科原因中脐带因素、胎位及产程异常为主要原因,分别占35.16%和32.58%;分娩方式中以阴道助产发生率最高,达59.85%,78例为胎儿宫内窘迫的延续.结论做好产前保健,定期产前检查,发现高危妊娠及时处理;避免早产,及早发现胎儿宫内窘迫并进行恰当处理;合理掌握手术适应证,提高产科质量,降低新生儿窒息的发生率.     

新生儿机械通气并发低碳酸血症及其预后的探讨

目的　探讨新生儿机械通气时发生低碳酸血症的病因、危害性及其防治措施。方法选择我院1994年1月-2003年12月10年间,在NICU住院新生儿应用气管插管呼吸机治疗持续时间≥12h者共246例,以发生低碳酸血症的病例为研究对象,未发生者作为对照组,进行临床对照分析。结果低碳酸血症的发病率为14．2％,以早产儿多见,平均发生时间为(31．6±26．9)h,原发病以呼吸窘迫综合征最常见(22．6％),发生低碳酸血症者死亡率(32．9％)和颅内出血发生率(20％)明显高于对照组(P<0．01)。结论新生儿应慎重选择机械通气指征,维持PaO2在正常范围,避免PaCO2<35mmHg,以减少呼吸机合并症,在降低新生儿病死率同时,改善新生儿的预后。     

窒息对新生大鼠肾组织一氧化氮和一氧化氮合酶含量的影响

目的探讨一氧化氮合酶(NOS)和一氧化氮(NO)在窒息后肾损伤中的作用。方法Wistar新生大鼠48只,随机分为对照组、窒息后复氧2h组、24h组和48h组,制备常压窒息模型。窒息30min后在上述时间点处死动物,测定肾脏NOS和NO含量,并在光镜下对肾小管损伤程度进行评分。结果窒息复氧2h肾脏NOS和NO即显著升高,持续时间达24h,肾小管评分在窒息后24h和48h明显增高。结论NOS和NO在新生大鼠窒息后的肾损伤中起重要作用。     

全身亚低温治疗新生儿窒息的安全性评价

目的　探讨全身亚低温治疗对新生儿的不良影响 ,评价亚低温治疗新生儿窒息的安全性。方法　将中重度窒息足月新生儿 2 4例随机分为亚低温治疗组和常规治疗对照组各 12例 ,亚低温治疗组维持肛温在 3 3～ 3 4℃ 72h ,其他治疗措施与对照组相同。两组均连续进行监护和生化指标检测 ,记录临床症状及体征。结果　两组均无出血、严重感染及死亡。亚低温组治疗期间心率平均下降 3 0次 /min ,血压及呼吸未见明显改变 ,未发现与亚低温相关的心律失常及肺动脉高压。其凝血酶原时间及凝血酶时间与治疗前及对照组相比无明显差异。血钠、血钾、血钙在低温治疗后与治疗前及对照组相比无明显差异。窒息新生儿治疗前均有代谢性酸中毒 ,部分患儿有急性肾功能异常 ,治疗后均逐渐纠正 ,亚低温组与对照组相比无明显差异。结论　全身亚低温治疗无严重的不良反应 ,在严密监护下用于足月新生儿窒息的治疗是安全可行的。     

新生儿神经行为测定在高压氧治疗新生儿重度窒息中的效果评价

目的: 为了探讨新生儿神经行为测定(NBNA) 在评价高压氧治疗新生儿重度窒息中的意义。方法: 将新生儿重度窒息的患儿采用随机分组的方法分为高压氧治疗组和对照组, 两组各项指标具有可比性, 同时每例在出生后1 ~7d、12 ~14d、26~28d分别进行新生儿神经行为测定, 将结果进行统计学分析。结果: 出生后1~7d治疗组和对照组NBNA值分别为33 .3±8 .83、32. 7±7. 34, 两组结果经统计学处理无显著性差异。出生后26 ~28d治疗组和对照组NBNA值分别为39. 03±2 .92、37. 72±2. 91, 两组结果经统计学处理有显著性差异。1周内两组NBNA值<35分与>35分的发生率经统计学处理无显著性差异, 26~28d两组NBNA值<35分与>35分的发生率经统计学处理有显著性差异。结论: 高压氧治疗能减轻新生儿重度窒息的后遗症, 改善预后, NBNA对高压氧治疗新生儿重度窒息的疗效具有较好的评价效果。     

围产期窒息后血浆cTnI、CK-MBmass的影响因素及临床应用价值

为探讨围产期窒息后血浆心肌肌钙蛋白I（cTnI）、肌酸激酶心型同工酶质量（CK-MBmass）的影响因素及临床应用价值。对71例围产期窒息新生儿及27例对照组新生儿生后6小时－48时血浆cTnI、CK-MBmass水平进行测定，运用逐步回归等方法进行分析。结果显示：（1）血浆cTnI水平的变化与胎龄、5分钟Apgar评分有关。（2）围产期窒息组足月儿（59例）cTnI明显高于对照组足月儿（19）；重度窒息组（17例）与轻度窒息组（16例）比较，cTnI差异无显著性，而CK-MBmass差异有非常显著性；围产期窒息组的重度心脏损害患儿（8例）cTnI、CK-MBmass水平明显高于无重心脏损害患儿（63例）。表明围产期窒息持续时间越长cTnI的水平越高。相对于CK-MBmass而言，cTnI对心肌损伤的敏感性可能稍差，而且由于cTnI的水平随着胎龄的增加而增加，因此这一指标在判断早产儿心肌损伤时有一定的局限性。     

Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies

Many different systems for the assessment of pain in newborns and infants have been tested for validity, rarely for reliability but never for sensitivity or specificity. We aimed to determine whether the assessment of an analgesic demand in the lower age group during the postoperative period is possible by observational methods only. In an repetitive and sequential prospective process for identifying observationable behaviour and measurable physiological parameters as indicators of a postoperative analgesic demand, 584 newborns, infants and young children were studied (7 prospective studies, 4238 observations). Twenty-six items were selected as suggested by current literature and for reasons of economy and practicability. The factor analyses resulted in a two-factorial solution with the behavioural items loading on one factor and the physiological parameters on the other (principal component analyses). The physiological parameters blood pressure, respiratory rate and heart rate were found to be unreliable and had no discriminant power to detect an analgesic demand during the postoperative period (discriminant analyses, ROC-curves). In newborns and infants, nine observational items were identified as equally selective, reliable, sensitive and specific to the assessment of postoperative analgesic demand, whereas in young children only five items could be identified (discriminant analyses, ROC-curves). For economic reasons, these five items (crying, facial expression, posture of the trunk, posture of the legs, motor restlessness) were chosen as the basis of an additional pain scale ranging from 0=no pain to 10=maximal (Children's and Infants' Postoperative Pain Scale, CHIPPS). Its internal consistency yielded values for Cronbachs' alpha with 0.92 for toddlers and 0.96 for infants. The coefficient for interrater reliability was 0.93. The scale was validated constructively by the intravenous administration of metamizol, tramadol, nalbuphine, piritramide and ketamine (repeated measures analysis of variance). The Toddler-Preschooler Postoperative Pain Scale and CHIPPS equally identified painfree situations or analgesic demand in 87.4%. In cases with definite pain, the score of CHIPPS was never below 4 points. Seventy-one toddlers gave verbal comments on their pain intensity: in 29 painfree situations the CHIPPS score was 3.0 and in 29 painful situations it was 5.7. The values for sensitivity and specificity of CHIPPS were calculated to be 0.92-0.96 and 0.74-0.95, respectively (discriminant analyses). We conclude that it is possible to determine postoperative analgesic demand in the low age group of children by using an observational system such as CHIPPS alone.     

Aminophylline influences cerebral hyperperfusion after severe birth hypoxia

Doppler sonographic investigations have presented cerebral hyperperfusion in neonates after severe asphyxia. Neonates with disturbed cerebral blood flow velocity (CBFV) tend to have poor outcomes. The purpose of this clinical study was to examine the influence of aminophylline on cerebral hyperperfusion. An intravenous bolus of 4 mg/kg aminophylline was given to nine neonates with Doppler sonographic signs of cerebral hyperperfusion. CBFV was determined before, 5 min, 60 min and 120 min after aminophylline administration and on the following day. After aminophylline the mean systolic (56.5 vs. 41.6 cm/s) and end diastolic (21.0 vs. 12.3 cm/s) blood flow velocity decreased and the mean pulsatility index (0.83 vs. 1.1) increased significantly. Repeated measurements showed a decrease in blood flow velocities and an increase in pulsatility index on the following days. Heart rate, mean arterial blood pressure and pCO₂ were not significantly changed. We conclude that aminophylline influences cerebral hyperperfusion in neonates with disturbed autoregulation.