Neonatal ventilation strategies and long-term respiratory outcomes

Long-term respiratory morbidity is common, particularly in those born very prematurely and who have developed bronchopulmonary dysplasia (BPD), but it does occur in those without BPD and in infants born at term. A variety of neonatal strategies have been developed, all with short-term advantages, but meta-analyses of randomized controlled trials (RCTs) have demonstrated that only volume-targeted ventilation and prophylactic high-frequency oscillatory ventilation (HFOV) may reduce BPD. Few RCTs have incorporated long-term follow-up, but one has demonstrated that prophylactic HFOV improves respiratory and functional outcomes at school age, despite not reducing BPD. Results from other neonatal interventions have demonstrated that any impact on BPD may not translate into changes in long-term outcomes. All future neonatal ventilation RCTs should have long-term outcomes rather than BPD as their primary outcome if they are to impact on clinical practice.     

Brainstem auditory electrophysiology is supressed in term neonates with hyperbilirubinemia

BackgroundWhether hyperbilirubinemia suppresses electrophysiological activity of the neonatal auditory brainstem remains to be investigated.AimTo determine whether hyperbilirubinemia suppresses the brainstem auditory electrophysiology in term neonates.MethodsMaximum length sequence brainstem auditory evoked response (MLS BAER) was recorded shortly after confirming hyperbilirubinemia in 58 term neonates. Wave amplitudes of the response were analyzed in detail.ResultsCompared with age-matched term controls, the neonates with hyperbilirubinemia showed a significant reduction in the amplitudes of MLS BAER waves III and particularly V at all click rates 91–910/s. The reduction tended to be more significant at higher than lower rates. Wave I amplitude was reduced at 910/s. V/I amplitude ratio was decreased at all click rates. Therefore, the amplitudes of MLS BAER, particularly later, waves were all reduced. The amplitudes of all MLS BAER waves tended to be reduced with the increase in total serum bilirubin level. All wave amplitudes were correlated with the level of total serum bilirubin at some or most click rates.ConclusionsBrainstem auditory electrophysiology is suppressed in neonates with hyperbilirubinemia, which related to the severity of hyperbilirubinemia. Wave amplitudes are valuable BAER variables to detect functional impairment of the brainstem and auditory pathway in neonatal hyperbilirubinemia, and are recommended to be used in assessing bilirubin neurotoxicity to the neonatal brain.     

新生儿低血糖脑损伤早期MRI表现及其演变

目的 通过对低血糖患儿进行低血糖后早期、动态的MRI检查,结合临床特征探讨不同程度低血糖脑损伤患儿的MRI改变。方法 选取我院2005年5月至2013年7月以低血糖收入院,在低血糖后1周内完善首次常规MRI及弥散加权成像（diffusion-weighted imaging,DWI）检查确诊为新生儿低血糖脑损伤的患儿49例。其中34例在低血糖发生后2～3周完善第2次MRI检查,7例完善第3次MRI检查。结果 49例患儿首次MRI均有顶、枕部受累;顶、枕部受累为主33例,顶、枕部合并额叶、颞叶受累6例,弥漫性皮层及皮层下白质受累10例。均表现为受累部位DWI高信号,T1和T2加权像信号改变不明显。部分患儿合并深部脑白质及灰质受累表现。34例患儿第2次MRI检查,有20例表现为损伤部位DWI低信号,T1加权像低信号,T2加权像高信号,3例较前略吸收,11例未见异常信号。7例患儿完善第3次复查,分别出现脑软化,髓鞘发育落后,白质容积减小,胼胝体发育不良。对比不同程度脑损伤患儿的临床症状,发现临床症状较重者脑损伤也较重。结论 低血糖脑损伤具有顶、枕部易损性。低血糖后1周内完善DWI检查对急性期低血糖脑损伤有提示作用。MRI动态观察发现轻症损伤可恢复。损伤较重的患儿可出现坏死及脑软化。部分合并深部白质、灰质损伤的病例,不能除外缺氧缺血所致。     

住院新生儿血清中TORCH感染病原学与临床研究

目的 探讨南宁市住院新生儿TORCH感染病原体情况及临床疾病关系.方法 通过ELISA法对606例住院新生儿检测TORCH-IgM抗体.结果 住院新生儿感染TORCH-IgM总阳性率为5.78％,新生儿TOX(toxoplasma,弓形虫)、RV(rubella virus,风疹病毒)、CMV(cytomegalovirus,巨细胞病毒)、HSVⅠ型和HSVⅡ型(herpes simplex virus,单纯疱疹病毒2型)阳性率分别为0.33％、0.50％、3.47％、0.83％和0.66％,其中CMV感染率最高.且CMV阳性患儿临床以高胆红素血症为主,其次为新生儿肺炎.结论 南宁市住院新生儿CMV感染率最高.新生儿TORCH感染常可引起严重后遗症,因此必须加强新生儿筛查,预防须从育龄妇女防病知识宣传教育开始.     

丙泊酚与硫喷妥钠在产妇全麻诱导中对新生儿影响的Meta分析

目的比较丙泊酚与硫喷妥钠在产妇全麻诱导中对新生儿的影响。方法系统检索:Pubmed、EMBASE、OVID、Cochrane Library、Web of science、万方等数据库及中国知网至2020年2月,收集丙泊酚与硫喷妥钠在产妇全麻诱导中对新生儿影响的随机对照试验,纳入文献质量采用Jadad方法评价,后以RevMan 5.3软件进行Meta分析。结果共纳入11个随机对照试验,共包括669例患者,其中丙泊酚组336例,硫喷妥钠组333例。纳入研究的方法学质量均较高,改良Jadad评分均在4分以上。Meta分析结果显示:与硫喷妥钠组相比,丙泊酚组的脐静脉血pH值稍低[WMD=-0.01,95%CI(-0.02,-0.01),P=0.0005],脐静脉血氧分压无显著差异[WMD=0.07,95%CI(-0.18,0.32),P=0.59],二氧化碳分压无显著差异[WMD=0.12,95%CI(-0.05,0.29),P=0.18];新生儿出生后1分钟及5 min Apgar评分均无显著差异[WMD=-0.10,95%CI(-0.16,0.22),P=0.78]。新生儿出生后15 min,2 h和24 h神经学和适应能力评分(NACS)均无显著差异,WMD=0.19,95%CI(-0.73,1.11),P=0.69。结论丙泊酚与硫喷妥钠用于孕产妇全麻诱导中新生儿的Apgar评分、NACS评分以及脐静脉血血气分析无显著差异。     

母婴血镉含量及其有关因素的影响

目的研究怀孕30周孕妇和其新生儿脐带血镉的含量,分析有关影响因素。方法收集66名孕妇静脉血和其新生儿脐带血各40μl,采用原子吸收光谱仪测定血镉的含量,并分析孕妇家庭和社会环境等有关因素30个项目。结果孕妇和新生儿脐血镉的平均水平分别为(2.38±0.86)μg/L和(1.66±0.62)μg/L。血镉水平≥2μg/L的人数,孕妇为42例,新生儿为17例,各占63.64%和25.76%,二者之间正相关有统计学意义(r=0.58,P<0.01)。结论孕期被动吸烟、孕期喝牛奶、孕龄、新生儿性别对脐血镉水平有显著影响。妇幼工作者应对围生期的镉损伤给予高度重视。     

新生儿窒息血清CK-MB的变化及临床意义

目的 探讨新生儿窒息与血清CK—MB的关系。方法 将66例窒息新生儿按窒息时间分成两组,并设正常足月新生儿40例为对照组,均进行血清CK—MB测定。结果 窒息组66例中,有58例血清CK—MB明显增高,且重度窒息者CK—MB增高更为显著。结论 新生儿窒息常合并有心肌损害,CK—MB可作为心肌损害及其程度的判断指标。     

The maternal experience of kangaroo holding

OBJECTIVE: To describe the maternal experience of kangaroo holding premature infants in the neonatal intensive care unit. Design: Qualitative, naturalistic inquiry design using open-ended, transcribed audiotaped face-to-face interviews. SETTING: Level III 70-bed tertiary care neonatal intensive care unit in Delaware. PARTICIPANTS: Eighteen mothers who kangaroo held their premature infants were interviewed over a 5-month period of time. INTERVENTION: Mothers were interviewed following a 60-minute kangaroo holding session in the neonatal intensive care unit. Additionally, unobtrusive detailed observation of each mother's kangaroo holding experience was recorded and analyzed. MAIN OUTCOME MEASURE: Maternal behaviors and interactions and related nursing and environmental interactions. RESULTS: Triangulation of demographic data, observation data, and themes of the interviews supports the use of kangaroo holding as a method to improve maternal confidence in caring for premature infants. Mothers reported feelings of "being needed" and "feeling comfortable" with the holding experience regardless of the infant's physical health status. CONCLUSIONS: Results identify maternal experiences of and responses to kangaroo holding in the intensive care environment, leading to the increased understanding of the multifaceted advantages of kangaroo holding on maternal attachment behaviors.     

新生儿败血症46例临床特征与病原菌分析

目的探讨新生儿败血症的临床特点、病原菌构成及抗生素耐药性,指导临床诊治。方法对2009—10—2013-01该院1560例住院新生儿中血培养阳性的46例新生儿败血症患儿进行回顾性分析。结果新生儿败血症临床表现缺乏特异性。血培养结果以葡萄球菌为主要致病菌,药敏试验发现大多数菌株对青霉素和氨苄西林耐药,对第一、二代头孢菌素类大部分耐药,对第三代头孢菌素类、舒巴坦、氨基糖甙类和喹诺酮类较敏感,对亚胺培南、万古霉素、替考拉宁高度敏感。结论新生儿败血症临床表现缺乏特异性,病原菌以革兰氏阳性菌为主,监测病原菌耐药性变迁,根据药敏试验结果选用药物,对指导临床防治新生儿败血症具有重要的意义。     

碘伏联合云南白药在新生儿脐炎治疗中的应用

目的:探讨新生儿脐炎的简便、经济、有效的治疗方法。方法:将2000年至2004年在我院确诊为新生儿脐炎的57例患者随机分成两组,治疗组采用碘伏与云南白药进行治疗;对照组采用碘伏进行治疗。将两组的治疗效果进行统计学分析。结果:治疗组中治疗起效快,其中2d有效14例,3d后有效10例;无效5例。对照组中有效16例,2d有效4例,3d后有效12例,无效12例。结论:碘伏与云南白药联合治疗新生儿脐炎,可作为无全身症状新生儿脐炎患者的首选治疗方法。