血浆胸腺基质淋巴细胞生成素在毛细支气管炎中的意义

目的 探讨血浆胸腺基质淋巴细胞生成素(thymic stromal lymphopoietin,TSLP)在首次罹患毛细支气管炎患儿发病过程中的意义.方法 首次喘息,临床诊断为毛细支气管炎的患儿共50例,男34例,女16例,平均年龄(7.0±4.8)个月;同期体检健康的婴儿25例,男19例,女6例,平均年龄(7.2±4.0)个月.就诊婴儿分别于就诊当日采集3 ml外周静脉血,分离血浆,并采用ELISA法检测TSLP.结果 毛细支气管炎患儿血浆TSLP为(0.271±0.073) ng/ml,健康婴儿血浆TSLP为(0.211±0.084) ng/ml,差异有统计学意义(P＜0.05).结论 毛细支气管炎患儿血浆TSLP明显升高,TSLP参与毛细支气管炎的发病过程.     

2049名5岁以下婴幼儿体格发育与喂养现状分析

目的分析广西城乡0～5岁儿童体格发育及营养和喂养状况,为提高本地区儿童健康状况提供依据。方法利用卫生部妇社司2004年8省城乡"0～5岁婴幼儿营养状况调查"实施方案,对广西南宁市和玉林市容县2049例0～5岁儿童进行身高、体重、母乳喂养和辅食添加等情况调查。结果城市儿童低体重、发育迟缓、消瘦率分别是4.30%、2.51%、1.93%,均低于2002年全国抽样调查,农村儿童营养不良状况与同地区比较虽然呈逐年下降,但低体重、发育迟缓率仍高达23.74%和20.98%。结论广西农村儿童体格发育与城市相比存在差距,喂养方式上辅食的添加时间和质量不太科学,主要原因是农村家长婴幼儿保健知识缺乏和经济落后等。     

RETRACTED ARTICLE: Perinatal and first year outcomes of spontaneous versus assisted twins: a single center experience

OBJECTIVE: The aim is to compare naturally conceived twins with twins conceived by assisted reproductive techniques (ART) by means of perinatal outcome, behavioural patterns and psychomotor development. MATERIAL AND METHODS: Three hundred and five spontaneous and 119 assisted twins were compared in aspects of behavioural patterns, mental and psychomotor development, as well as maternal and gestational age, foetal presentation, birth weight, sex, Apgar scores, perinatal complications, delivery route, and admission to neonatal intensive care unit (NICU) RESULTS: Although the maternal age was higher in assisted twins, the mean gestational age and birth weight of assisted twins were significantly less than those of spontaneous twins. The assisted twins did not differ from the naturally conceived twins in aspects of presentation, Apgar scores, admission to NICU and perinatal complications. However, caesarean section rate and the delivery rate of male foetuses were significantly higher in assisted twins. During the first year of life, retardation in mental and psychomotor development was more pronounced in assisted twins. Also assisted twins experienced behavioural problems and difficulties in parent-child interactions more frequently. CONCLUSIONS: Although twins born to assisted pregnancies had significantly shorter duration of gestation and thus less birth weight, their perinatal outcome was similar to that of spontaneous twins. The mothers of assisted twins may be keener on getting intensive prenatal care, which might in turn help to diminish any possible maternal and foetal risks. However, assisted twins showed significantly retarded psychomotor and mental development and experienced problems with environmental factors more frequently during their first year.     

A critical analysis on Italian perinatal mortality in a 50-year span

BACKGROUND: Perinatal mortality rate is used as an indicator of reproductive health worldwide. In western countries, national mortality registers are usually accurate and reliable. METHODS AND AIMS: We reviewed the data recorded in the past 50 years in Italy on perinatal and infant mortality. Each single class of mortality rate (according to WHO definitions) was assessed on temporal trends allowing a critical speculative analysis, mainly focusing on the last 20 years, in an attempt to evaluate the impact of prenatal diagnosis. RESULTS: Infant mortality rate (IMR) constantly decreased in the study period whereas early neonatal mortality rate progressively diminished in a 5-year comparison till the early 1990s. Perinatal mortality showed a linear negative trend until the 1980s, after which the decrease steadied at about 23% in the following 5-year period. Infant mortality attributable to congenital anomalies throughout a 20-year span (1980-2000) was steady at about 23% although a progressive reduction in general infant mortality was reported. CONCLUSIONS: A higher reduction in neonatal and perinatal mortality rate was found before the wide availability of the ultrasonographic prenatal diagnosis and the introduction of the law on voluntary abortion in Italy. Given these data, it seems that advances in neonatal care have improved the infant survival rates more than prenatal diagnosis, whereas obstetric care is linked to a reduction of the early perinatal mortality rate.     

The perinatal autopsy: pertinent issues in multicultural Western Europe

Western Europe is in a demographic transition with increasing multicultural societies. Health professionals have to understand the background, religious and cultural aspects of parents to counsel them regarding an autopsy in the event of a perinatal loss. Autopsy rates have declined over the past decades, the major limiting factor being the granting of permission for an autopsy, possibly because of adverse publicity or reluctance of doctors to obtain consent. Autopsy has proved its value in revealing unsuspected findings. The public can be convinced of this utility by means of good information notwithstanding their religious or cultural background.     

妊娠合并先天性心脏病伴肺动脉高压患者的围产结局分析

目的 探讨妊娠合并先天性心脏病（先心病）伴肺动脉高压患者的围产结局。方法 收集1995年4月至2007年5月温州医学院附属第一医院产科收治的45例妊娠合并先心病伴肺动脉高压患者的临床资料,根据肺动脉压力情况分为轻度组29例[30～49mmHg（1mmHg=0．133kPa）],中度组8例（50～79mmHg）,重度组8例（≥80mmHg）,分析各组先心病的种类、心功能级别、终止妊娠孕周和方式、先心病术后妊娠的安全性以及围产结局。结果 （1）先心病种类中以房间隔缺损、室间隔缺损为主,发生率为58％（26／45）。孕前行心脏矫正手术13例（29％,13／45）,以轻度肺动脉高压、心功能Ⅰ～Ⅱ级为主。（2）轻度组心功能Ⅰ～Ⅱ级者28例,中度组心功能Ⅰ～Ⅱ级者6例,重度组心功能Ⅲ～Ⅳ级者7例。（3）轻度组足月分娩27例、难免流产1例、早产1例,新生儿平均出生体重为（3153±399）g;中度组足月分娩5例,早产3例;重度组足月分娩5例,医源性终止妊娠1例,早产2例;中、重度组新生儿平均出生体重明显低于轻度组,差异有统计学意义（P〈0．05）,同时中、重度组胎儿结局不良。（4）妊娠合并先心病伴肺动脉高压患者的分娩方式以剖宫产分娩为主,占78％（35／45）,其中轻度组剖宫产分娩22例（22／29）,中度组6例（6／8）,重度组7例（7／8）。（5）45例患者中有11例于孕前或产后出现心功能衰竭早期表现或心功能衰竭,均分布在中、重度组,且心功能均为Ⅲ～Ⅳ级。其中2例死亡。结论 妊娠合并先心病伴肺动脉高压患者的肺动脉压力越高,围产结局越差;孕前行心脏矫正手术后的先心病患者以轻度肺动脉高压为主,且围产结局良好;以剖宫产术终止妊娠是比较安全的分娩方式。     

The IUGR prognostic scale

OBJECTIVE: Complex evaluation of the functional system "mother-placenta-fetus" in intrauterine growth restriction (IUGR) for the prognosis of risk of perinatal complications and optimization of choice of method of delivery. METHODS: We created an objective scale for the evaluation of pregnancies complicated by IUGR using 19 fetometric, dopplerometric and pulsometric parameters. We prospectively followed 130 fetuses classified into three risk groups determined by our prognostic scale with a control group of 25. Operative method of delivery was recommended for medium and high risk groups. We examined newborns with the help of neurosonography and compared them to 139 retrospective newborns classified into three groups according to severity of IUGR with a control group of 25. RESULTS: C-sections were higher by 27 and 12% in the prospective medium and high risk groups. Ventriculomegaly, brain edema, hemorrhages and pathological vascular pulsation decreased by 9, 27, 12 and 21%. Perinatal mortality decreased by 4%. CONCLUSIONS: The developed IUGR prognostic scale optimized the choice of method of delivery and led to decreased rates of neurological morbidity and mortality in newborns with IUGR.     

Evaluation of pregnant women with scarred uterus in a low resource setting

AIM: Management of post cesarean pregnancy continues to be a dilemma. The present study was undertaken to evaluate the outcome of such pregnancies in a resource constrained setting so that an appropriate management protocol can be decided. METHODS: An observational study was conducted in the Department Of Obstetrics And Gynecology, King George's Medical University, Lucknow, India. The outcome of all of the women admitted with pregnancy with a previous cesarean section was noted. RESULTS: A total number of 447 women with a post cesarean pregnancy underwent delivery. These comprised 13.7% of total deliveries over the same period. 124 women (27.7%) had successful vaginal delivery while 323 (72.3%) had a repeat cesarean section. Maternal morbidity and perinatal mortality were both significantly higher in the vaginal delivery group (P = 0.00211 and P = 0.0426, respectively). CONCLUSIONS: Vaginal birth after cesarean (VBAC) is associated with higher maternal morbidity and perinatal mortality. Therefore the decision for VBAC must be taken only after proper consideration and counseling of the couple.     

早产儿不同食物早期微量管饲的临床观察

目的观察早产儿不同食物早期微量管饲时促胃液素及胃肠道功能变化。方法将33例早产儿随机分为糖水组、牛奶组,分别管饲5%葡萄糖和早产儿奶,每次喂养2 m l/kg,q3h,每12h增加1 m l/kg,同时予静脉营养。糖水组喂养3 d后逐渐添加早产儿奶。分别于喂养前、喂养后d 1、d 3、d 7测空腹血促胃液素(gastrin,Gas),比较血促胃液素、喂养不耐受发生率及达全肠道喂养时间。结果血Gas:糖水组加奶前各时段差异无显著意义(P>0.05);牛奶组逐日增高,同时牛奶组较糖水组明显增高(P<0.05)。喂养不耐受率:牛奶组较糖水组明显降低(P<0.05)。达全肠道喂养时间:牛奶组明显短于糖水组(P<0.05)。结论早期微量管饲时,奶汁能更好地促进Gas分泌,促进胃肠道成熟。     

妊娠期肝内胆汁淤积症患者与正常孕产妇的临床对照研究

目的探讨妊娠期肝内胆汁淤积症对孕妇妊娠及围生儿结局的影响。方法选择我院2009年9月。2010年10月收治的妊娠期肝内胆汁淤积症患者73例作为观察组,选择同期健康孕妇70例作为对照组,比较两组孕妇妊娠及围生儿结局。结果观察组的早产、剖宫产率分别为12．3％、16．4％,均明显高于对照组的1．4％、4．3％,且观察组产后出血量明显多于对照组,组间差异均有统计学意义（P〈0．05）;两组胎儿前置胎盘和脐带绕颈发生率间差异无统计学意义（P〉0．05）,而观察组羊水粪染发生率为15．1％,明显高于对照组的2．9％,组间差异有统计学意义（P〈0．05）;观察组新生儿窒息、低体重儿的发生率分别为11．0％、19．2％,均明显高于对照组的1．4％、2．9％,且观察组新生儿Apgar评分明显低于对照组,组间差异均有统计学意义（P〈0．05）。结论妊娠期肝内胆汁淤积症对孕妇妊娠及围生儿结局均有不良影响,临床应尽早发现并积极治疗,争取获得更好的母婴结局。