围生期窒息新生儿血清IL-6，sICAM-1水平的动态变化及其临床意义

【目的】了解围生期窒息新生儿血清IL 6、sICAM 1水平的动态变化。【方法】采用双抗体夹心ELISA方法 ,检测 41例围生期窒息新生儿及 11例正常新生儿生后出生时、第 3天、第 7天血清IL 6、sICAM 1的水平。【结果】 41例围生期窒息新生儿中 2 6例合并缺氧缺血性脑病 ,其中轻度 12例 ,中度 8例 ,重度 6例。对照组血清IL 6的水平生后 1周内无明显变化 ,缺氧缺血性脑病 (HIE)组血清IL 6水平呈先升后降的趋势 :生后第 3天达高峰 ,第 7天下降 ,较出生时水平低 ,随着HIE程度的加重 ,IL 6水平呈上升趋势。对照组血清sICAM 1水平随日龄增加呈上升趋势 ,重度HIE组各天的水平均显著高于对照组、单纯窒息组及轻度、中度HIE组各天的水平 (P <0 0 5或 0 0 1) ,其余 4组间各天的水平差异无显著性。围生期窒息新生儿的血清IL 6水平与血清sICAM 1水平无相关关系。【结论】血清IL 6、sICAM 1水平与脑损伤的程度及预后密切相关。     

新生儿脓疱疮医院感染聚集发病的监测与控制

目的加强产房环境和人员的监测,降低新生儿脓疱疮的发病率。方法实时监测新生儿脓疱疮发生率,聚集发病时进行临床资料和环境卫生学流行病学调查。结果 2013年12月发生新生儿脓疱疮4例,发病率为0.97%,明显高于其他月份。患儿分泌物分离出金黄色葡萄球菌。从助产士鼻腔和手,沐浴室洗澡网托和护士工作服中分离出金黄色葡萄球菌,药敏结果与患儿分泌物分离菌株药敏谱一致。采取了将带菌助产士调离直接接触婴儿的岗位,取消洗澡用网托等一系列干预措施。连续监测3个月,无新感染病例发生。结论助产士鼻腔携带致病菌,环境、物品和设备消毒不到位,医护人员手卫生依从性差是造成感染发生的重要原因。应加强产科病区的环境和物品的消毒工作,加强工作人员鼻腔和手携带病原菌情况检测,以便及时采取干预措施。     

绒毛膜羊膜炎与早产儿并发症的相关性分析

目的探讨绒毛膜羊膜炎与早产儿并发症的关系。方法选择在产科分娩的早产儿（≤34周）108例,按是否存在绒毛膜羊膜炎分为绒毛膜羊膜炎组（病例组）50例和非绒毛膜羊膜炎组（对照组）58例,比较2组以下并发症的发病率：窒息、早发型败血症、呼吸窘迫综合征（RDS）、坏死性小肠结肠炎（NEC）、脑室旁白质软化（PVL）、脑室内出血（IVH）、支气管肺发育不良（BPD）,分析绒毛膜羊膜炎与上述并发症的相关性。结果病例组窒息、早发型败血症、IVH、PVL、BPD的发病率均高于对照组（P均＜0.05）;RDS和NEC的发病率2组差别无统计学意义（P＞0.05）。结论绒毛膜羊膜炎与早产儿的并发症关系密切,可导致窒息、早发型败血症、PVL、IVH、BPD的发病率升高。     

窒息新生儿血清神经元特异性烯醇化酶浓度动态变化与脑损伤的相关性研究

目的 探讨血清神经元特异性烯醇化酶（NSE）在窒息新生儿中的动态变化及其与脑损伤的关系.方法 收集2005年1月至2012年12月住院治疗的足月窒息新生儿75例（窒息组）和健康足月新生儿30例（对照组）,采用酶联免疫吸附试验法检测两组新生儿出生后1,3,7d时血清NSE浓度变化,并分析其变化与窒息后脑损伤的关系.结果 出生后1,3,7d,窒息组轻度窒息新生儿和重度窒息新生儿血清NSE浓度均明显高于对照组[（29.85±8.53）、（59.26±15.75） μg/L比（15.59±6.25） μg/L,（23.69±6.54）、（47.28±12.46） μg/L比（15.38±5.84） μg/L,（18.95±5.37）、（62.57±19.62） μg/L比（13.92±5.37）μg/L],重度窒息新生儿明显高于轻度窒息新生儿,差异有统计学意义（P＜0.05）.出生后1,3,7d,脑损伤新生儿25例血清NSE浓度逐渐升高,而CT正常新生儿50例血清NSE浓度逐渐下降,脑损伤新生儿血清NSE浓度均明显高于CT正常新生儿[（37.48±12.09） μg/L比（30.95±11.86） μg/L、（51.84±14.21）μg/L比（21.73±6.15） μg/L、（68.25±18.69）μg/L比（15.62±5.94）μg/L],差异有统计学意义（P＜0.05）.结论 监测血清NSE浓度动态变化有助于早期辅助判断窒息新生儿脑损伤.     

The influence of maternal glucose metabolism on fetal growth,development and morbidity in 917 singleton pregnancies in nondiabetic women

Summary To study the effects on the fetus of variations in maternal glucose tolerance, a 25 g rapid intravenous glucose tolerance test was performed at or about 32 weeks gestation in 917 randomly selected nondiabetic women with singleton pregnancies. The results were withheld from the patients and their obstetricians and paediatricians, and no treatment or advice was offered. Fasting plasma glucose and indices of glucose disposal (including a new index which we have termed summed glucose) were distributed unimodally, with no evidence of a separate pathological group towards the diabetic end of the distributions. Significant associations were found between maternal glucose metabolism and var ious measures of neonatal nutrition and morbidity, including the incidence of congenital malformations and morbidity related to asphyxia, suggesting that variations within the normal range in maternal glucose metabolism can influence growth and development in the fetus. These relationships were continuous throughout the range of maternal glucose tolerance and were not of predictive value in individual cases.     

The impact of an intervention package promoting effective neonatal resuscitation training in rural China

Objective

To evaluate an intervention package promoting effective neonatal resuscitation training at county level hospitals across China.

Methods

The intervention package was implemented across 4 counties and included expert seminars, training workshops, establishment of hospital-based resuscitation teams, and supervision of training by national and provincial instructors. Upon completing the activities, a survey was conducted in all county hospitals in the 4 intervention counties and 4 randomly selected control counties. Data on healthcare providers’ knowledge and self-confidence, and incidence of deaths from birth asphyxia from 2009 to 2011 in all hospitals were collected and compared between the two groups.

Results

Eleven intervention and eleven control hospitals participated in the evaluation, with 97 and 87 health providers, respectively, completing the questionnaire survey. Over 90% of intervention hospitals had implemented neonatal resuscitation related practice protocols, while in control hospitals the proportion was less than 55%. The average knowledge scores of health providers in the intervention and control counties taking a written exam were 9.2 ± 1.2 and 8.4 ± 1.5, respectively (P < 0.001) out of maximum possible score of 10, and the average self-confidence scores were 57.3 ± 2.5 and 54.1 ± 8.2, respectively (P < 0.001). Incidence of birth asphyxia (defined as 1-min Apgar score ≤ 7) decreased from 8.8% to 6.0% (P < 0.001) in the intervention counties, and asphyxia-related deaths in the delivery room decreased from 27.6 to 5.0 per 100,000 (P = 0.076). There was no difference over time in asphyxia rates for the control counties.

Conclusions

The intervention has not only improved skills of health providers, decreased the mortality and morbidity of birth asphyxia, but also resulted in effective implementation of guidelines and protocols within hospitals.     

围生期窒息新生儿心功能的二维及多普勒超声观察

目的探讨反映围生期低氧对新生儿心功能损害的敏感超声诊断指标。方法将我院45例窒息新生儿分为轻度窒息组和重度窒息组，采用二维及多普勒超声进行心功能测定，并以14例正常新生儿作对照。结果重度窒息组主动脉最大射血速度（PV）为（0．54±0．12）m／s，与正常组比较明显降低（F=3．551，t=6．787，P〈0．05）；射血加速时间（AT）为（77．33±12．34）ms，与正常组比较明显延长（F=3．390，t=4．404，P〈0．05）。肺动脉PV为（O．71±0．10）m／s，与正常组比较差异无显著性（P〉O．05）；AT为（38．33±12．34）ms，显著低于正常组（F=3．451，t=2．433，P〈0．05）。结论围生期低氧能引起心脏血流参数的改变，而且这种改变在临床出现心力衰竭症状之前即已显现，AT及PV敏感性较高。     

Pustulöse Hauterkrankungen des Neugeborenen

In the newborn, there exists a wide spectrum of pustular skin diseases. These range from transitory, benign adaptation disorders up to systemic, life threatening illnesses. In 30 – 60 % of newborns pustules are observed in association with the relatively harmless Erythema toxicum, the origin of which is still unknown today. It is necessary to differentiate this from the pustular diseases which may be of infectious or non‐infectious nature and which require therapy. Typical pathogens include Malassezia furfur, Staphylococci, Streptococci, Candida spp. and the herpes virus group.     

羊水过少83例临床分析

目的:探讨羊水过少对母婴的影响.方法:采用回顾分析方法,对羊水过少组83例及同期羊水量正常(对照组)100例的临床资料进行对比分析.结果:羊水过少组胎儿窘迫51例(61.4%)、胎儿宫内发育迟缓7例(8.4%)、羊水粪染32例(38.6%)、新生儿窒息30例(36.1%),其发生率均明显高于对照组.结论:羊水过少对母婴危害较大,对羊水过少者应加强监护,及时行剖宫产术.