新生儿重症监护病房侵袭性霉菌感染的临床分析

目的分析新生儿重症监护病房(NICU)侵袭性霉菌感染的发生率、临床表现、治疗及预后,以及引起霉菌感染的危险因素。方法总结1995~2004年10年间我院NICU侵袭性霉菌感染病例,分析霉菌感染发生的危险因素及氟康唑的疗效。结果(1)同期NICU收治的1 854例患儿中32例发生霉菌感染,发生率为1.73%,死亡12例,病死率37.5%;(2)发生霉菌感染的时间平均为入院后(10.4±7.3)d,表现为霉菌性败血症、脑膜炎、腹膜炎、肺炎,症状包括发热(68.8%)、反应差(71.9%)、呼吸增快(81.3%)或呼吸暂停(46.9%)、腹胀(31.3%)、胃肠营养不耐受(25%)、休克(25%)、皮疹(18.8%)、外周血白细胞增高(65.6%);(3)霉菌感染的危险因素中,低出生体重和机械通气是发生霉菌感染的高危因素(χ2=10.68,P<0.005;χ2=36.2,P<0.005);(4)病原学检查结果以白色念珠菌为主,28例(87.5%);(5)接受氟康唑治疗患儿预后优于非氟康唑治疗者(χ2=7.03,P<0.05)。结论霉菌已成为NICU院内感染的一个重要的致病菌;白色念珠菌是主要的致病菌;引起霉菌感染的危险因素有早产、极低出生体重、机械通气;氟康唑是一种有效的抗霉菌药,适用于早产儿及新生儿。     

Primary palliative care in neonatal intensive care

This article explores the 2014 Institute of Medicine׳s recommendation concerning primary palliative care as integral to all neonates and their families in the intensive care setting. We review trends in neonatology and barriers to implementing palliative care in intensive care settings. Neonatal primary palliative care education should address the unique needs of neonates and their families. The neonatal intensive care unit needs a mixed model of palliative care, where the neonatal team provides primary palliative care and the palliative subspecialist consults for more complex or refractory situations that exceed the primary team׳s skills or available time.     

NICU患者的心理分析及对策

目的解除NICU患者的异常心理反应,促进术后康复,提高手术成功率。方法针对718例NICU患者由于环境改变、病情反复变化、手术创伤、经济负担加重,导致不同程度存在焦虑、恐惧、烦躁、抑郁、孤独、悲观、绝望等异常心理反应,采取术前访视,改善NICU环境,重视气管插管期间的非语言交流,维护患者自尊心及给予情感支持6项护理对策,解除患者异常的心理反应。结果718例开颅手术患者入住NICU期间,除19例因其他并发症死亡外,异常的心理反应都得到减轻或解除,其余患者均顺利转出NICU。结论对开颅术后NICU患者进行良好的心理护理,对术后的康复极其重要。     

Platelet transfusions in the neonatal intensive care unit:factors predicting which patients will require multiple transfusions

BACKGROUND: Previous studies suggest that recombinant thrombopoietin (rTPO) will increase platelet production in thrombocytopenic neonates. However, the target populations of neonates most likely to benefit should be defined. Studies suggest that rTPO will not elevate the platelet count until 5 days after the start of treatment. Therefore, the neonates who might benefit from rTPO are those who will require multiple platelet transfusions for more than 5 days. This study was designed to find means of prospectively identifying these patients. STUDY DESIGN AND METHODS: A historic cohort study of all patients in the neonatal intensive care unit (NICU) at the University of Florida who received platelet transfusions from January 1, 1997, through December 31, 1998, was conducted. RESULTS: Of the 1389 patients admitted to the NICU during the study period, 131 (9.4%) received platelet transfusions. Seventeen were treated with extracorporeal membrane oxygenation and were excluded from further analysis. Of the remaining 114 patients, 55 (48%) received one transfusion and 59 (52%) received more than one transfusion (21 had >4). None of the demographic factors examined predicted multiple platelet transfusions. However, two clinical conditions did; liver disease and renal insufficiency. Neonates who received one platelet transfusion had a relative risk of death 10.4 times that in neonates who received none (p = 0.0001). Neonates who received >4 platelet transfusions had a risk of death 29.9 times that in those who received no transfusions (p = 0.0001). CONCLUSION: NICU patients with liver disease or renal insufficiency who receive one platelet transfusion are likely to receive additional transfusions. Therefore, these patients constitute a possible study population for a Phase I/II rTPO trial.     

Kangaroo supported diagonal flexion positioning: Positive impact on maternal stress and postpartum depression risk and on skin-to-skin practice with very preterm infants

Purpose

To test the effects of a new skin-to-skin Supported Diagonal Flexion (SDF) positioning on maternal stress, postpartum depression risk and skin-to-skin daily practice, in comparison with the usual Kangaroo Care in Upright positioning, during the first weeks after very premature birth.

The effect of gestational age on clinical and radiological presentation of necrotizing enterocolitis

Background/purpose

To test the hypothesis that clinical and radiological features of necrotizing enterocolitis vary with gestational age in all neonates with NEC and in subgroup of surgically treated patients.

新生儿重症监护病房护理人员疼痛知识培训的效果分析

目的探讨疼痛知识培训对新生儿重症监护病房(neonatal intensive care unit,NICU)护理人员疼痛管理知识和态度的影响。方法便利抽样选取某三级综合性教学医院的临床NICU护理人员42人,采用自身前后对照的研究设计,使用护理人员疼痛知识和态度(2008)中文版问卷(knowledge and attitudes survey regarding pain,KASRP)评价疼痛知识培训对护理人员疼痛管理知识和态度的影响。结果接受疼痛知识培训后,护理人员KASRP的平均得分从培训前的(16.88±3.05)分增加到(34.68±5.74)分,应用疼痛评估工具的频率显著增加,与培训前比较差异均有统计学意义(均P0.05)。结论疼痛知识培训能显著提高NICU护理人员的疼痛知识水平,改善对疼痛管理的认识,促进其对新生儿疼痛的管理,对及时评估、预防和降低新生儿疼痛具有积极的意义。