胎膜早破后残余羊水量与宫内感染和新生儿发病率的相关性

目的探讨胎膜早破后残余羊水量与宫内感染和新生儿发病率的相关性。方法175例胎膜早破患者在破膜后均行超声检测羊水指数(AFI),根据残余AFI将孕妇分成3组羊水过少组(AFI≤50mm)22例、羊水量偏少组(50mm<AFI≤80mm)24例、羊水量正常组(AFI>80mm)129例,分析胎儿宫内感染、胎儿窘迫和新生儿发病等指标在3组之间的差别。结果羊水残余量少者,破膜时孕周和分娩孕周均明显比残余量多者短,胎儿宫内感染率和新生儿发病率明显增加。胎儿窘迫的发生与羊水残余量无明显相关性,孕妇的年龄、孕次、产次、破膜后继续妊娠的时间、分娩方式和胎儿的出生体重等在3组之间无明显差别。结论胎膜早破后,羊水残余量的减少可能与宫内感染和新生儿发病率升高等有关,可作为临床监测胎儿宫内安危的指标。

胎膜早破残余羊水量与孕妇宫内感染和新生儿发病率的关系

目的探讨胎膜早破后残余羊水量与胎儿宫内感染和新生儿发病率的相关性。方法604例胎膜早破患者在破膜后均行超声检测羊水指数(AFI),根据残余羊水指数分成3组:羊水量过少组(AFI≤5 cm)79例,羊水量偏少组(5 cm<AFI<8 cm)166例,羊水量正常组(AFI≥8 cm)359例,分析胎儿宫内感染、胎儿窘迫和新生儿发病等指标在3组之间的差别。结果羊水残余量少者,破膜时孕周和分娩孕周均明显比残余量多者短,胎儿感染率和新生儿发病率明显增加。胎儿窘迫的发生与羊水残余量无明显相关性,3组孕妇破膜后继续妊娠的时间、孕次、产次、分娩方式、胎儿出生体重等比较,差异无统计学意义(P>0.05)。结论胎膜早破后,羊水残余量的减少可能与胎儿和新生儿发病率升高有关。

胎膜早破与宫内感染和新生儿发病率的相关性分析

目的通过探讨胎膜早破与宫内感染和新生儿发病率的相关性,旨在为预防宫内感染、提高新生儿出生质量提供理论依据。方法分娩的胎膜早破产妇67例作为研究组,再选择同期分娩的正常产妇67例作为对照组,对患者临床资料进行统计分析,记录两组产妇宫内感染率、新生儿肺炎率、新生儿窘迫率及高胆红素血症率,同时应用实验室检查羊水残余量、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)水平。结果研究组患者宫内感染率、新生儿肺炎率、新生儿窘迫率及高胆红素血症率均显著高于对照组,且羊水残余量、IL-6、IL-8及TNF-α水平两组差异有统计学意义(P<0.05)。结论胎膜早破与宫内感染和新生儿发病率密切相关。

早产儿脐血IL-6浓度和新生儿发病率的关系

This study was undertaken to evaluate the association between umbilical cord interleukin- 6 (IL- 6) levels and neonatal morbidity in infants born at less than 32 weeks gestation. Umbilical cord plasma IL- 6 levels and neonatal outcomes were assessed in 309 infants born between 24 weeks and 0 days and 31 weeks and 6 days gestation. Mean IL- 6 levels were higher in spontaneous (n = 193, 355 ± .1822 pg/mL) compared with indicated preterm births (n = 116, 37 ± 223 pg/mL, P <. 0001). Adjusting for gestational age, a progressive relationship was noted between increasing IL- 6 levels and increased risk of neonatal systemic inflammatory response syndrome (SIRS). IL- 6 levels beyond the 90th percentile (≥ 516.6 pg/mL) were also significantly associated with periventricular leukomalacia (PVL; odds ratio 15, 95% CI 2- 149) and necrotizing enterocolitis (NEC; OR 6, 95% CI 1.1- 33). In the multivariate analysis, an IL- 6 level 107.7 pg/mL or greater (determined by receiver operating curve analysis) remained a significant independent risk factor for PVL (OR 30.3, 95% CI 4.5- 203.6). Umbilical cord IL- 6 levels are higher in preterm infants born after spontaneous preterm labor or premature rupture of membranes. Elevated IL6 levels are associated with an increased risk for SIRS, PVL, and NEC in infants born at less than 32 weeks gestation.

胎膜早破保守治疗并于孕34周分娩的新生儿发病率(法)

Objective. To evaluate the neonatal morbidity and its risks factors in case of uncomplicated preterm rupture of membranes managed conservatively with subsequent planned delivery at 34 weeks of gestation. Patients and methods. We studied retrospectively 42 consecutive neonates systematically delivered at 34 weeks of gestation after more than 48 hours of conservative management for uncompli-cated preterm rupture of membranes. Conservative management was conducted in a single tertiary care center and consisted in corticotherapy and in antibiotherapy (amoxycilline during 7 days). We evaluated the neonatal mortality rate, the incidence of infection, respiratory distress, neurological disorders, and we looked for their prenatal risks factors. Results. Forty-two neonates were included. The median gestational age at rupture was 31.1 weeks of gestation (from 25 to 33.9 weeks). The median duration of expectant management was 20 days (from 2.4 to 65 days). We observed 7 cases of neonatal infection but no septic failure, 18 cases of respiratory distresses among which 9 required a tracheal intubation for a mean duration of 3.7 days, no perinatal encephalopathy (5 cases of subependymal haemorrhage) and no neonatal death. We isolated one single risk factor that was the lowest gestational age at rupture in case of subsequent respiratory distress (29.6 vs 31.9 weeks; P = 0.02). Discussion and conclusion. Neonatal morbidity in this population consisted mainly in respiratory distresses with an increased incidence when gestational age at rupture decreased.

对早产胎膜早破患者行积极保胎治疗不能延长孕周及降低新生儿发病率

Objective This study was undertaken to evaluate whether aggressive to colysis i mproves pregnancy outcome after preterm premature rupture of the membranes (PPRO M). Study design Retrospective case-control study of patients with PPROM before 34 weeks of gestation, followed by a prospective cohort study with historical c ontrols. The retrospective phase covered 1995 through 1999 when we used tocolysi s aggressively. With the use of survival analysis, we compared latency in our ca ses with 4 published control series in which tocolysis was never used. On the ba sis of the results, we adopted a new protocol in mid-2000 limiting tocolysis to 48 hours after betamethasone dosing and we conducted a 2-year prospective eval uation of this new protocol. Results In the retrospective phase, tocolysis was u sed in 94%of 130 cases and maintained during 84%of 1162 total antenatal patien t-days. There was no difference in latency between our cases and the published controls. One or more complications of tocolysis occurred in 18%. In the prospe ctive study, 43%of 63 patients received tocolytics, but these were used at lowe r doses and were given during only 7%of 770 patient-days. Latency with this ve ry limited tocolytic regimen (median 4.5 days, interquartile range 2.3 to 14.0) was not significantly different than during the last 24 months of aggressive toc olysis (median 3.8 days, 1.8 to 14 days, P=.16) and there were no differences in neonatal morbidity. Conclusion Aggressive tocolysis after PPROM causes significant maternal morbidity, but does not incr ease latency or decrease neonatal morbidity compared with either very limited to colysis or no tocolysis at all.

低危人群的剖宫产分娩率及新生儿发病率

OBJECTIVE: To estimate the relationship between case-mix adjusted cesarean delivery rates and neonatal morbidity and mortality in infants born to low-risk mothers. METHODS: This retrospective cohort study used vital and administrative data for 748,604 California singletons born without congenital abnormalities in 1998-2000. A total of 282 institutions was classified as average-, low-, or high-cesarean delivery hospitals based on their cesarean delivery rate for mothers without a previous cesarean delivery, in labor at term, with no evidence of maternal, fetal, or placental complications. Neonatal mortality, diagnoses, and therapeutic interventions determined by International Classification of Diseases, 9th Revision, Clinical Modification codes, and neonatal length of stay were compared across these hospital groupings. RESULTS: Compared with average-cesarean delivery-rate hospi tals, infants born to low-risk mothers at low-cesarean delivery hospitals had increased fetal hemorrhage, birth asphyxia, meconium aspiration syndrome, feeding problems, and electrolyte abnormalities (P <.02). Infused medication, pressors, transfusion for shock, mechanical ventilation, and length of stay were also increased (P <.001). This suggests that some infants born in low-cesarean delivery hospitals might have benefited from cesarean delivery. Infants delivered at high-cesarean delivery hospitals demonstrated increased fetal hemorrhage, asphyxia, birth trauma, electrolyte abnormalities, and use of mechanical ventilation (P <.001), suggesting that high cesarean delivery rates themselves are not protective. CONCLUSION: Neonatal morbidity is increased in infants born to low-risk women who deliver at both low-and high-cesarean delivery-rate hospitals. The quality of perinatal care should be assessed in these outlier hospitals.

胎膜早破后羊水残余量与宫内感染和新生儿发病率的相关性分析

目的:探讨胎膜早破后残余羊水量与宫内感染和新生儿发病率的相关性。方法:根据产妇胎膜早破后残余羊水指数(Amniotic Fluid Index,AFI)的监测结果,将本组120例产妇分为三组:羊水量正常组82例;羊水量较少组20例;羊水量过少组18例。所有产妇入院后行胎膜早破常规处理,回顾分析并统计三组产妇宫内感染率,胎儿窘迫率和新生儿发病率。结果:在宫内感染发生率上,三组比较,差异具有显著性,羊水量较少组、羊水量过少组宫内感染的发生率明显高于羊水量正常组(P<0.01)。在胎儿窘迫发生率上,三组比较,差异无统计学意义(P>0.05)。在新生儿发病率上,三组比较,差异具有显著性,羊水量较少组、羊水量过少组新生儿的发病率明显高于正常组(P<0.01)。Logistic回归分析发现羊水量、产妇基础性疾病和分娩孕周为孕产妇宫内感染和新生儿发病的关键影响因素。结论:胎膜早破后残余羊水量过少与宫内感染和新生儿发病率的升高密切相关,产妇于胎膜早破后应加强残余羊水量的监测,以采取有效措施降低宫内感染和新生儿发病的发生率。

大剂量吲哚美辛治疗动脉导管未闭可能增加新生儿发病率

有症状的动脉导管未闭(patent ductus arteriosus,PDA)是早产儿最常见的心脏畸形。治疗PDA最理想的疗程和药物剂量目前仍不明确。Waldvogel等进行了一项研究,目的在于观察用大剂量吲哚美辛治疗PDA的动脉导管关闭率和不良反应。该研究于2019年12月30日在线发表于《美国围产医学杂志》上。

家庭访视对新生儿期发病率的影响

目的 探讨家庭访视对新生儿期发病率的临床效果.方法 对笔者所在医院2010年1～10月分娩的600例足月、单胎、顺产的市内七区的新生儿随机分为两组.对观察组在出生后7、14、28 d进行家庭访视,给予家长卫生、喂养、常见疾病等方面的指导及相关处理,并向家长宣传科学儿科知识.最终对两组新生儿在1个月后复查时对各种新生儿疾病发病率进行对比分析.结果 实验组新生儿发病率较对照组显著降低（P＜0.01）.结论 家庭访视有利于降低新生儿期发病率.

医院产科质量管理指标与孕妇、新生儿发病率的相关性

为了研究医院产科质量管理指标与孕妇、新生儿发病率的相关性，2010年Howell等收集了纽约市41家医院住院分娩病例资料，共纳入孕产妇115742例，足月正常新生儿103416例，对2项产科质量管理指标：37～39周无医学指征选择性剖宫产和孕妇存在低危因素行剖宫产进行研究分析。孕妇严重发病者指发生威胁生命的合并症或需施行挽救措施者，新生儿发病者指发生产伤、低氧血症、住院时间延长等合并症。

脐动脉血pH、PO_(2)、PCO_(2)水平与足月新生儿综合发病率指数的相关性分析及临床意义

目的:探究脐动脉血酸碱度(pH)、氧分压(PO_(2))、二氧化碳分压(PCO_(2))水平与足月新生儿综合发病率指数的相关性及临床意义。方法:选取2021年1月~2022年6月于暨南大学附属顺德医院产科经阴道分娩的新生儿100例,根据新生儿有无发生综合疾病分成病发组和非病发组,其中病发组患儿39例,非病发组新生儿61例,统计病发组足月新生儿的综合发病率情况,并比较两组足月新生儿的脐动脉血气指标水平,且采用Pearson相关性分析pH、PO_(2)、PCO_(2)与病发组新生儿综合发病率指数的相关性。结果:两组新生儿的一般资料在孕妇年龄、新生儿性别、新生儿平均孕周、新生儿出生时体重、新生儿居住地等方面比较差异无统计学意义(P>0.05)。病发组足月新生儿中呼吸窘迫15例,机械通气13例,胎粪吸入综合征8例,心肌损害25例,新生儿窒息8例,缺氧缺血性脑病2例,新生儿肺炎8例,体温过低治疗、新生儿死亡、脑室出血、癫痫为0例;病发组足月新生儿PO_(2)、PCO_(2)高于非病发组,pH明显低于非病发组,差异均有统计学意义(P<0.05)。根据Pearson相关性分析结果显示,PO_(2)、PCO_(2)与病发组新生儿综合发病率指数呈正相关(r=0.598,P=0.001;r=0.615,P=0.002),pH与病发组新生儿综合发病率指数呈负相关(r=-0.625,P=0.000)。结论:脐动脉血pH、PO_(2)、PCO_(2)水平与足月新生儿综合发病率指数的Pearson相关性分析显示,pH与病发组新生儿综合发病率指数呈负相关,PO_(2)、PCO_(2)与病发组新生儿综合发病率指数呈正相关,对于新生儿常见疾病的预测、降低新生儿死亡率具有重要意义。

无高血压或糖尿病的产妇肥胖也是导致新生儿发病增加的独立危险因素

近日,妇产科权威杂志Obstetrics and Gynecology上发表了一篇研究文章,研究人员旨在比较没有高血压或糖尿病的肥胖和非肥胖女性的子女之间新生儿发病率的独立风险。该研究是对2010—2014年期间妊娠37周或以上单胎分娩的前瞻性单中心队列研究进行的二次分析。

新生儿期和婴儿期的保健重点

新生儿期保健重点 新生儿期,特别是生后1周内的新生儿发病率和死亡率极高,婴儿死亡中约2/3是新生儿,〈1周的新生儿的死亡数占新生儿期死亡数的70%左右。故新生儿保健是儿童保健的重点,而生后1周内新生儿的保健是重中之重。因此,在2005年的世界卫生组织（WHO）年度报告中,把过去的儿童保健,改为新生儿及儿童保健,突出新生儿保健的重要性。

全科医生新生儿家庭访视(一)

新生儿期是〈5岁儿童死亡发生率最高的时期。家庭访视能够早期发现异常或疾病，早期进行干预，从而减少新生儿发病率或死亡率。根据国家基本公共卫生服务规范（2009年版）0～36个月儿童健康管理服务规范的要求，社区医生要对辖区内居住的所有0～36个月儿童进行新生儿家庭访视。服务内容包括：新生儿出院后1周内，医务人员到新生儿家中进行，同时进行产后访视。了解出生时情况、预防接种情况，在开展新生儿疾病筛查的地区了解新生儿疾病筛查情况等。

25例先天性梅毒新生儿的护理

近年来我国先天性梅毒新生儿发病率明显呈上升趋势。为了强调先天性梅毒患儿在临床工作中护理的重要性和特殊性。2006年10月-2008年10月期间．我科共收住25例先天性梅毒新生儿，通过一系列有效的护理对策，取得良好效果，现将护理体会报道如下。

关于罕见病的定义和发病率

据《中国医学论坛报》2013年3月28日A9版刊登对上海医学会罕见病专科分会主任委员、新华医院内科主任李定国教授的专访,中国目前对罕见病的定义是：发病率为万分之一（指新生儿发病率）或患病率为50万分之一的疾病。共四大类43种。目前估计有1 000万～2 000万病例。我国从20世纪90年代后期开始关注罕见病防治。2008年起政府对罕见病防治越来越重视。媒体（报刊）报道罕见病690次,2010年为2 600余次,2012年已达6 500余次。目前65%的医生对罕见病知识有限,很多罕见病也缺乏有诊断价值的实验室检测指标。

加强新生儿外科无陪病房护理管理提高院感质控效果

由于新生儿免疫功能发育尚不完善,出生后,外界环境和宫腔环境有很大差异,且自我调节功能也较差,此外,新生儿入院后存在较多和医疗护理相关的感染因素[1],体质量低,病情重,抵抗力差,急诊手术、污染手术多,有创操作多,抗生素耐药等多种原因,导致患儿院内感染发生率高[2]。因此对于病房医院感染预防与控制已成为病区管理工作的重点。其中,新生儿外科无陪病房在医院感染方面的问题尤其值得注意。出现医院感染将会直接对新生儿发病率、病死率以及住院时间的增长造成直接影响。2018年3月至2019年2月,我们在新生儿外科无陪护病房院感防控护理工作中加强管理,取得了满意效果,现报告如下。