新生儿窒息513例临床分析

目的 探讨新生儿窒息的相关因素及预防措施。方法 对1995年1月～2004年12月哈尔滨二四二医院住院分娩发生的新生儿窒息513例临床资料进行分析。结果 新生儿窒息与胎儿窘迫高度相关。脐带因素、产程异常、胎盘功能不全是新生儿窒息的主要产科原因。结论 新生儿窒息是胎儿窘迫产程中缺氧在出生后的表现和继续。应以预防为主：要重视产前检查，对高危妊娠进行系统管理，指导胎动计数，加强产程监护，综合判断后选择最佳分娩方式。一旦发生，及时进行复苏术。     

Effects of REM sleep deprivation on cholinergic receptor sensitivity and passive avoidance behavior in clomipramine model of depression

This study investigated the effects of REM (rapid eye movement) sleep deprivation (RSD) on the activity of central cholinergic receptors and passive avoidance retention in rats treated neonatally with clomipramine. Male rat pups treated with clomipramine (15 mg/kg, s.c.) twice daily from postnatal day 5 to 21 were subjected to RSD procedure at three months of age, for 4 days consecutively. In the post-RSD phase, RSD-control rats showed a significantly enhanced cholinomimetic-induced hypothermia and an improved retention in passive avoidance task. However, these measures were not significantly different in RSD-experimental group as compared to rats treated neonatally with saline. These results suggest that RSD reverses the sensitivity of central cholinergic receptors in rats given clomipramine neonatally, and this mechanism may be involved in mediating the antidepressant effects of RSD treatment in clomipramine model of depression.     

广州市产科资源对新生儿窒息的影响

目的 :探讨广州市产科资源对新生儿窒息及重度窒息发生率的影响 ,总结进一步降低新生儿窒息发生率及重度窒息发生率的行政干预措施。方法 :对全市各产科医院的分娩量、产、儿科床位、 MICU、 NICU、产床数、产、儿科技术人才及设备资源等变量进行分层聚类分析 ,将特征相似的产、儿科资源合并 ,最终选择代表产科资源特征的 5类变量 ,将所有产科医院进行样品聚类。结果 :将 14 4所产科医院分 6类 ,描述各类医院特征 ,其中新生儿窒息及重度窒息发生率均最高的一类共 6所产科医院 ,其医院规模最小、技术力量不足、助产技术服务需求低。而新生儿窒息及重度窒息发生率均最低的一类共 6 3所产科医院 ,其产科资源与新生儿窒息发生率高的一组相似。结论 :要进一步降低广州市新生儿窒息发生率 ,可对重点医院进行技术指导 ,进行必要的医疗资源调整及投入。     

茵栀黄注射液治疗新生儿高未结合胆红素血症的150例

目的 :及早有效纠正新生儿高未结合胆红素血症 ,以预防胆红素脑损伤。方法 :在常规治疗的同时 ,加用茵栀黄注射液静脉滴注。结果 :治疗组胆红素日均下降值为 (50 17±25 26) μmol/L ,明显高于对照组的 (37 95±21 58) μmol/L。结论 :茵栀黄注射液治疗新生儿高未结合胆红素血症 ,可迅速降低血胆红素水平 ,明显缩短治疗时间。     

内毒素血症对新生鼠脑一氧化氮合酶表达的影响

目的　在脑的正常发育及一些病理条件下 ,一氧化氮合酶 (NOS)发挥一定作用 ,但不同亚型的NOS作用不同。该研究观察正常新生鼠脑以及内毒素血症时新生鼠脑 3种一氧化氮合酶 (NOS)亚型蛋白的表达 ,并探讨脂多糖 (LPS)和地塞米松 (DXM)对其表达的影响。方法　生后健康 7日龄Wistar大鼠 6 8只 ,随机分为对照组、内毒素血症组 (腹腔内注射E .coliLPS 5mg kg)及DXM组 (LPS 5mg kg +DXM 10mg kg) ,分别于用药后2 ,4 ,6 ,2 4h取脑进行NOS免疫组织化学染色。结果　正常对照组新生大鼠脑神经元型NOS(nNOS)明显表达 ,内皮型NOS(eNOS)微弱表达 ,诱导型NOS(iNOS)无表达。LPS腹腔注射后 4hnNOS表达开始增加 ;eNOS及iNOS表达于 6h开始增加 ,3者表达均于 2 4h时达高峰 ;3种NOS表达阳性细胞主要分布于脑皮质、海马、下丘脑、脑室旁核团、纹状体神经细胞。除此之外 ,nNOS在梨状皮质有较强表达 ,eNOS及iNOS在血管内皮细胞呈微弱表达。3种NOS亚型蛋白表达在DXM注射后 2～ 6h受到明显抑制 ,并持续至用药后 2 4h。结论　正常新生鼠脑表达nNOS及eNOS ,无iNOS表达 ;LPS诱导 3种NOS亚型的表达 ,其表达的部位及受诱导表达的程度亦不同 ,提示NOS在中枢神经系统的正常发育及LPS诱导的内毒素血症脑损伤发病中发挥一定作用 ,DXM具有神     

新生儿脐血红细胞葡萄糖6磷酸脱氢酶缺乏筛查结果分析

目的 了解广东省东莞市莞城地区新生儿脐血红细胞葡萄糖6磷酸脱氢酶(G-6-PD)缺乏的发生率。方法 9676例活产新生儿生后即取脐血，采用定量法测定红细胞G6PD／6PGD的比值。低于1．0者为G-6-PD缺乏。结果 测得G-6-PD缺乏的患儿265例，总发生率为2．74％。其中男230例，发生率为4．07％；女35例，发生率为0．87％。男性发生率明显高于女性(χ^2=90．75，P＜0．001)。结论 脐血G-6-PD活性筛查，能比较准确地检测出G-6-PD缺乏患儿，指导临床对其并发症进行早期干预，避免智力低下等后遗症的发生，提高人口素质。     

两种预防新生儿眼炎的药物体外抗菌活性的比较

目的：测定并比较预防新生儿眼炎的硝酸银滴眼液、聚维酮碘滴眼液的体外抗菌活性。方法：采用肉汤二倍稀释法测定最低抑菌浓度和最低杀菌浓度。结果：硝酸银滴眼液对致新生儿眼炎常见的金黄色葡萄球菌、肺炎球菌的MIC50分别为4，8 μg·mL 1，MBC90分别为8，32 μg·mL 1；聚维酮碘滴眼液对该两菌的MIC50分别为64，128 μg·mL 1，MBC90均为256 μg·mL 1。结论：硝酸银滴眼液和聚维酮碘滴眼液对新生儿眼炎常见致病菌都具有抑菌和杀菌作用，但硝酸银滴眼液更适用于对新生儿眼炎预防。     

前置胎盘的高危因素及围产儿结局

目的探讨前置胎盘发生的高危因素及其对妊娠结局的不良影响。方法回顾性分析6年间分娩的78例单胎前置胎盘病例(前置组)和156例单胎非前置胎盘对照产妇(对照组)的临床资料。结果前置胎盘发生率为0．94%(78/8318例)。前置组产妇年龄大于对照组(≥35岁,OR=8．76,P＜0．001),胎次(≥3次,OR=5．80,P＜0．001)、产次(≥2次,OR=6．87,P＜0．001)、流产次数(≥3次,OR=7．06,P＜0．001)、前次剖宫产史(P＜0．01)均多于对照组。前置组新生儿早产发生率高于对照组(47．44%比7．05%,P＜0．01),早产者1min Apgar评分低于对照组[(7．08±2．08)分比(9．09±0．82)分,P＜0．01],新生儿出生体重低于对照组(P＜0．01)；两组新生儿出生性别的差异无显著性。结论高龄(≥35岁)、多产(≥2次)、多胎(≥3次)、多次流产(≥3次)及前次刮宫产史的孕妇前置胎盘发生率高,且易导致早产和新生儿窒息,是产前重点监护的对象。     

新生儿红细胞葡萄糖-6-磷酸脱氢酶缺乏筛查结果分析

目的:了解广东省肇庆市端州区新生儿脐血红细胞葡萄糖-6-磷酸脱氢酶(G-6-PD)缺乏的发生率。方法:2 236例活产新生儿出生后即取脐血,采用定量法测定红细胞G-6-PD/6-PGD的比值,低于1.0者为G-6-PD缺乏。结果:G-6-PD缺乏的患儿152例,总发生率为6.79%。其中男129例,发生率为10.34%;女23例,发生率为2.32%,男性发生率明显高于女性(2χ=90.03,P<0.001)。结论:脐血G-6-PD活性筛查,能比较准确地检测出G-6-PD缺乏患儿,指导临床对其并发症进行早期干预,避免智力低下等后遗症的发生,提高人口素质。     

The developmental paediatrician and neonatal follow-up

Recent advances in modern perinatal and neonatal intensive care have led to an increase in the survival of premature infants. This increased survival, unfortunately, has not been accompanied by an improvement in neurodevelopmental outcomes. Premature infants, especially those with an extremely low birth weight (less than 1000 g) or those born at less than 28 weeks’ gestation, are at increased risk of major disabilities and complex, ‘low severity’ dysfunctions that have significant, lasting effects on their school function, academic performance and behaviour, as well as on family function. Neonatal follow-up programs provide a number of functions to centres providing neonatal intensive care, including quality assurance and audits, research and follow-up clinical care to neonatal intensive care unit survivors and their families. The challenge for neonatal follow-up programs is to meet the often competing objectives of providing clinical services to children and their families while providing quality assurance and audits, and high-quality long-term outcome research components, given the available resources. There is also a need for ongoing research to develop and evaluate effective postdischarge intervention programs to improve the long-term outcome of prematurity and other neonatal complications. Developmental paediatricians – with their background and training in the provision of specialized health care to children and their care-givers with respect to developmental and psychosocial well-being, and in conducting developmental and behavioural disabilities research – play a valuable role in the follow-up assessment and care of neonatal intensive care unit graduates, and strengthen the multidisciplinary research groups necessary to assess long-term outcomes and the effects of perinatal and postdischarge interventions.