Anatomic study of the pre- and neonatal hip. Physiopathologic considerations on dysplasia and congenital dislocation of the hip

Summary Therapeutic success in dysplasia and congenital dislocation of the hip depends on an early diagnosis. The physiopathology remains very debatable and several concepts are propounded. For a better physiopathologic understanding, the authors have carried out a study of the morphology and development of 22 pre- and neonatal hips. At first, the acetabulum is cartilaginous and distorted by the moving femoral head; this acetabulum is histologicaly affected by the femoral pressure.The pathologic hip is characterized by defective posterior bony coverage of the femoral head by the acetabulum. The acetabulum ossifies during the 3 months following birth, forming a cup-like cavity under the pressure of the femoral head. Therefore, neonatal screening tests such as sonography must take place in the first weeks of life.

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Étude anatomique de la hanche antéet néonatale. Réflexions sur la physiopathologie des dysplasies et luxations congénitales de la hanche

Résumé Le succès du traitement des dysplasies et luxations congénitales de hanche est lié à la précocité du diagnostic. La physiopathologie de ces affections reste discutée et plusieurs conceptions ont pu être proposées. Les auteurs ont réalisé une étude structurale et évolutive de 22 hanches anté et néonatales afin de mieux comprendre cette physiopathologie. Dans les périodes anté- et néonatale, l'acétabulum est cartilagineux, déformable sous l'action d'une tête fémorale en mouvement et il est le siège de remainements histologiques dépendant de la pression exercée par l'épiphyse fémorale. L'ossification de l'acétabulum s'effectue lors du ler trimestre postnatal, construisant la cavité articulaire sous l'effet de la pression de la tête du fémur. Dysplasies et luxations apparaissent comme un défaut de couverture postéro-supérieure de l'épiphyse fémorale par l'acétabulum. Le dépistage d'anomalies, notamment par l'échographie, devra donc être réalisé dans les premières semaines de la vie.

     

新生儿窒息史对儿童神经心理发育五项功能的影响

目的：分析有新生儿窒息史儿童五项神经心理发育测查结果，了解新生儿窒息对小儿神经心理发育的影响。方法：对有新生儿窒息史儿童98例分别于6月、12月、24月进行“小儿五项神经心理发育测查”，同时选择50例无新生儿窒息史、无其它重大疾病史儿童于相同月龄进行相同测量作对照，计算测得月龄与实际月龄的相差百分比平均值作标准化对比分析。结果：轻度窒息组57例与对照组无显著性差异，重度窒息组与对照组有显著性差异。结论：新生儿重度窒息对小儿五项神经心理发育有显著性影响。     

苏州市新生儿黄疸初步调查

本文总结分析了 1995年 8月～ 1996年 7月在我院出生的 15 3例正常新生儿血清总胆红素水平。根据本组结果和全国黄疸调查协作组对血清胆红素 >12 .9mg/dl的新生儿作脑干听力诱发电位无异常发现 ,提示正常新生儿高胆红素血症的诊断标准应作适当调整 ,而高胆红素干预标准亦应相应提高     

新生儿窒息与相关疾病心肌酶活性的变化

目的为了探讨新生儿窒息合并新生儿缺氧缺血性脑病(HIE)、新生儿颅内出血和新生儿肺炎时血清肌酸激酶及其同功酶(CK、CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸(α-HBDH)的活性变化及之间关系.方法新生儿窒息32例,其中合并新生儿肺炎15例,合并HIE、新生儿颅内出血17例,分别测定血清中CK、CK-MB、LDH、α-HBDH的活性,并做对比分析.结果两组间CK值合并HIE和新生儿颅内出血组高于合并新生儿肺炎组(P＜0.05),有显著差异,其它心肌酶无显著差异.结论心肌酶活性的增高与HIE、新生儿颅内出血疾病本身无直接关系,其活性增高可能是新生儿窒息的结果.有脑损伤史的患儿CK值增高可能是其同功酶CK-BB活性增高所致.     

单胎初产臀位围产儿预后相关因素分析

目的 探讨臀位新生儿窒息、围产儿死亡的相关因素。方法 回顾分析４７７例单胎初产臀位新生儿Ａpgar评分与孕周、体重、先露类型、分娩方式的关系。结果 臀位早产儿、过期儿、体重〈２kg及阴道分娩的臀位新生儿容易发生窒息（Ｐ〈０．００５,Ｐ〈０．０１）。体重≥２０００g４组间Ａpgar评分较无显著性差异（Ｐ〉０．０５）。结论 臀位选择 在３７～４１＾＋６孕周,估计新生儿体重≥２０００g时分娩较合适;及早发现足先露、     

Age-related differences in sensitivity to organophosphorus pesticides

Organophosphorus (OP) pesticides are used extensively throughout the world to control undesirable pest species. The primary mechanism of action for OP insecticides is inhibition of acetylcholinesterase (AChE), an enzyme dynamically involved in cholinergic neurotransmission. Extensive inhibition of AChE leads to accumulation of acetylcholine in the synapse, disruption of normal impulse flow and subsequent signs of toxicity, including autonomic dysfunction, involuntary movements, muscle fasciculations and a host of others. It is generally believed that young individuals are more sensitive to the neurotoxic effects of these agents relative to adults. Essentially all studies addressing age-related differences in sensitivity to these toxicants have examined responses to acute exposures, however, using acute toxicity (lethality) as the endpoint. As the biochemical mechanism of toxicity for this class of toxicants (inhibition of AChE) is well known and considering that low level, repeated exposures are of great concern to the general public, we propose that evidence of neurochemical alterations, especially when exposures occur during development and maturation, is a more relevant endpoint of toxicity than lethality for estimating susceptibility. This report briefly summarizes previous and ongoing work in our laboratory which examines the relative sensitivity to these toxicants between young and adult rats.     

Povidone-iodine in umbilical cord care interferes with neonatal screening for hypothyroidism

Out of 1346 newborns screened for congenital hypothyroidism, 31 non-hypothyroid infants were summoned because of a thyroid stimulating hormone (TSH) level above 10 U/ml. False-positive TSH levels were significantly more frequent in the babies treated with povidone-iodine (4.6%) than in those treated with either alcohol or triple dye (0.7%).Conclusion Iodine containing solutions should be avoided in umbilical cord care of the newborn     

The effect of polycythemic hyperviscosity on ischemic bowel necrosis

It is known that polycythemia decreases the fluidity of the blood and impairs tissue perfusion due to red-cell sludging in the microcirculation. In this study, the effect of polycythemic hyperviscosity (PH) on bowel necrosis was evaluated in an experimental model of intestinal ischemia. Twenty-eight Wistar albino rats (90–170 g) were divided into two groups: group 1 was transfused to create hyperviscosity and then intestinal ischemia was produced (n = 16); in group 2 ischemia was produced without transfusion (n = 12). Intestinal ischemia was produced by clamping the superior mesenteric artery and the collateral arcades of the right colic artery for 30 min. Gross and histopathologic evaluations were performed by either immediate necropsy or relaparotomy 24 h later. Microscopic findings were graded from 0 to 3 according to the degree of ischemic changes. In group 1, 2 animals (12.5%) died before 24 h postoperatively; coagulation necrosis with grade 2 or 3 ischemic changes was observed in 10 animals (62.5%). In group 2 only a few hypertrophied Peyer's patches and capillary dilation were found, and all histopathologic changes were between grades 0 and 1. The difference between the histopathologic gradings of the two groups was significant (P < 0.001). It appears that in addition to reduced splanchnic blood flow, a secondary effect of PH is needed to induce ischemic coagulation necrosis. PH of the newborn must be considered a risk factor for necrotizing enterocolitis, so-called spontaneous intestinal perforations, and even intestinal atresia.Presented at the 1st European Congress of Pediatric Surgery, Graz/Austria, May 4–6, 1995     

Perinatal mortality trends in a referral hospital

A comparative study of perinatal mortality patterns over a period was conducted at a teaching hospital of South India. Among the 6,048 babies born from January 1984 to December 1985 (Group A), there were 265 (43.8/1000) still births and 127 (22.0/1000) early neonatal deaths. Three hundred and thirty seven (41/1000) babies were still born and 235 (29.8/1000) early neonatal deaths out of 8,215 deliveries during 1992–93 (Group B). The perinatal mortality rate (PMR) in Group A and B were 57.9/1000 and 57.7/1000 respectively. Unbooked cases accounted for the majority (> 75%) of perinatal deaths during both the periods. The overall mortality rates in unbooked cases were three to four times higher than booked cases. Among the various causes of still births, antepartum haemorrhage and uterine rupture had increased. Septicaemia was the major cause of early neonatal deaths in Group A, but in Group B birth asphyxia and prematurity were the leading causes. Effective interventions like creating awareness among the target population to utilise maternal and child health services and early referral of high risk cases with improved intranatal and perinatal care can decrease the perinatal mortality.