Aim: To determine the occurrence of intraventricular haemorrhage (IVH) and its association with coagulation factors at birth in preterm neonates born before 30 wk gestation. Methods: 38 neonates (median gestational ag...Aim: To determine the occurrence of intraventricular haemorrhage (IVH) and its association with coagulation factors at birth in preterm neonates born before 30 wk gestation. Methods: 38 neonates (median gestational age 27 wk, range 24-29 wk; median birthweight (BW) 933 g, range 515-1760 g) admitted to the neonatal intensive care unit were studied. Blood samples for coagulation factors were taken within 2 h after birth. The first cranial ultrasonographic examination was performed within the first 3 d. The occurrence of IVH was tested statistically by the Mann-Whitney U-test for association with the activity of coagulation factors and clinical variables. Results: Thirteen IVHs occurred within the first 3 d of life. IVH was associated with BW <1000 g (p = 0.012), low mean blood pressure within the first 2 d (p = 0.026), gestational age <27 wk (p = 0.054), low Apgar scores (<7) at 1 min (p = 0.078) and intrauterine growth restriction (p = 0.072). At birth (samples drawn with a median of first 36 min of life), infants with subsequent IVH had statistically significantly lower prothrombin (factor II) activity (p = 0.024) than infants without IVH. Conclusion: The measured low prothrombin may have been affected by a prior bleeding event. Nevertheless, preterm infants with low prothrombin activity may be susceptible to IVH, or to the progression of it, if left undiagnosed.展开更多
新近研究证实:早产儿慢性肺疾患(CLD)的发生与其体内维生素 A 的低水平有关。对高危婴儿补充维生素 A 能降低月 CLD 发病率。曾有学者提出:继发 CLD 的早产儿,出生时体内缺乏维生素 A,使之容易发生慢性呼吸道疾病。这些婴儿出生一般为...新近研究证实:早产儿慢性肺疾患(CLD)的发生与其体内维生素 A 的低水平有关。对高危婴儿补充维生素 A 能降低月 CLD 发病率。曾有学者提出:继发 CLD 的早产儿,出生时体内缺乏维生素 A,使之容易发生慢性呼吸道疾病。这些婴儿出生一般为过分早产,也许这种不成熟性可以解释体内低维生素 A 水平。关于这一假设。展开更多
Weight, length, and skinfold thicknesses were measured in 4634 term and preter m neonates. Sex and weight/length ratio were important determinants of the amoun t and distribution of the subcutaneous fat store at birth...Weight, length, and skinfold thicknesses were measured in 4634 term and preter m neonates. Sex and weight/length ratio were important determinants of the amoun t and distribution of the subcutaneous fat store at birth. Gestational age, weig ht, length, and other ponderal indices did not explain subcutaneous fat variabil ity.展开更多
The prognostic value of nucleated red blood cell count at birth in relation t o neonatal outcome has been established. However, reference values were needed t o usefully interpret this variable. The normal range of re...The prognostic value of nucleated red blood cell count at birth in relation t o neonatal outcome has been established. However, reference values were needed t o usefully interpret this variable. The normal range of reference values for abs olute nucleated red blood cell count in 695 preterm and term newborns is reporte d.展开更多
Objective This study was undertaken to assess the risk of neonatal morbidity in the second twi ns.Study design We carried out a cohort study of 128,219live born second twins in the United States,1995thro ugh 1997.The ...Objective This study was undertaken to assess the risk of neonatal morbidity in the second twi ns.Study design We carried out a cohort study of 128,219live born second twins in the United States,1995thro ugh 1997.The study subjects were divided into 3groups:second twins delivered by cesarean section after vaginal delivery of the first twin(V -C),both twins delivered vaginally(V -V),and both twins delivered by cesarean section(C -C).Results The rates of low 5-minute Apgar score,me chanical ventila-tion,and seizure were higher in the V-C group(8.27%,13.39%,and 0.31%)than in the V -V(3.07%,7.51%,and 0.08%)and the C -C(2.66%,8.53%,and 0.06%)groups.The V -C associated increase in risk remained after adjustment for confo unding factors and was more evident at term than preterm.Co nclusion The risk of neonatal morbidity is increased in s econd twins who had a cesarean section after vaginal delivery of the first twin,especially at term.展开更多
Cord blood thyroid-stimulating hormone level is elevated in neonates who had undergone more perinatal stresses. The present study aimed to evaluate the cord blood acid-base status in neonates with elevated thyroid-sti...Cord blood thyroid-stimulating hormone level is elevated in neonates who had undergone more perinatal stresses. The present study aimed to evaluate the cord blood acid-base status in neonates with elevated thyroid-stimulating hormone level. Study design: The study population consisted of 2366 singleton, term pregnancies. Subjects were categorized by their cord blood thyroid-stimulating hormone level into four quartiles, and cord blood acid-base parameters were compared among the four groups. The correlations between cord acid-base parameters and thyroid-stimulating hormone level were also studied. Results: Cord blood pH was significantly lower in the highest (arterial, 7.27 ± 0.08; venous, 7.32 ± 0.07) and second highest thyroid-stimulating hormone quartile groups (arterial, 7.29 ± 0.07; venous, 7.34 ± 0.06) compared to the lowest quartile group (arterial, 7.30 ± 0.06; venous, 7.35 ± 0.05). Incidences of cord arterial pH ≤ 7.20 were 4.7% , 6.8% , 10.9% , and 17.3% in lowest to the highest thyroid-stimulating hormone quartile groups, respectively. There was a significant negative correlation between cord blood thyroid-stimulating hormone level and cord arterial and venous pH (r = - 0.26, P < 0.001). When stratified according to the mode of delivery, the negative correlations remained significant in neonates delivered vaginally and by intrapartum emergency cesarean section but not in neonates delivered by elective cesarean section. Conclusion: Incidence of cord blood acidosis is significantly higher in neonates with elevated thyroid-stimulating hormone level. This findings support the postulation that stress-induced elevation of cord blood thyroid-stimulating hormone level may be mediated through intrapartum fetal hypoxia.展开更多
To test whether infants with bronchopulmonary dysplasia (BPD) express the same functional impairments at term as healthy, preterm infants, and whether clinical severity of BPD is qualitatively or quantitatively relate...To test whether infants with bronchopulmonary dysplasia (BPD) express the same functional impairments at term as healthy, preterm infants, and whether clinical severity of BPD is qualitatively or quantitatively related. Prospective measurements on a consecutive sample of 50 infants with BPD and 19 healthy preterm controls in a university hospital. BPD infants were classified as “severe, ”“moderate, ”or “mild, ”according to their need for oxygen. A multiple-breath nitrogen wash-out method was used to assess functional residual capacity (FRC)-and gas mixing efficiency. Mechanical variables were estimated by the occlusion test. Infants with severe BPD had lower FRC, less efficient gas mixing, and higher specific conductance than those with mild and moderate BPD, and the preterm controls. Mild and moderate BPD did not differ in any property from each other but differed from controls in the same variables. The elastic properties of the respiratory system appeared unaffected by BPD. The ventilatory impairments in BPD were of the same nature as in healthy preterm infants when compared with term infants, but their magnitude was related to the clinical severity of the BPD. Gas mixing efficiency together with FRC appears to be useful to assess lung development in BPD.展开更多
The purpose of this study was to assess the risk of neonatal death in the second twin.We carried o ut a retrospective cohort study of 128,219live born sec ond twins in the U-nited States for the years 1995throu gh 199...The purpose of this study was to assess the risk of neonatal death in the second twin.We carried o ut a retrospective cohort study of 128,219live born sec ond twins in the U-nited States for the years 1995throu gh 1997.The study subjects were divided into 3groups:second twins who were delivered by cesarean delivery afte r vaginal delivery of the first twin(group 1),both twins delivered vaginally(group2),and both twins delivered by cesarea n delivery(group3).The risk of asphyxia -related neonatal deaths was in-creased in groups 1and 2;the increased risk in group 1was stronger in term births than in pr eterm births.The risk of neonatal deaths,especially for t erm infants with as-phyxia -related deaths,is increase d for the second twins who are delivered by cesarean delive ry after vaginal deliv-ery of the first twins.展开更多
The aim of this observational study was to assess the long-term growth responses to GH treatment of children born small for gestational age (SGA). GH treatment was begun before puberty and continued to final height (F...The aim of this observational study was to assess the long-term growth responses to GH treatment of children born small for gestational age (SGA). GH treatment was begun before puberty and continued to final height (FH). Seventy-seven short (height SD score below -2) prepubertal children born SGA (below -2 SD for birth weight and/or birth length), with a broad range of GH secretory capacity, were treated with GH in a daily dose of 33 μ g/kg (0.1 U/kg), beginning before the onset of puberty. We observed a difference between adult and pretreatment projected height of 1.3 SD (9 cm) for the entire group. Among the children treated for >2 y before puberty, this mean gain (i.e. difference) in final height was 1.7 SD, whereas the mean gain was 0.9 SD among those in whom treatment was begun < 2 y before puberty. Better catch-up growth was observed in the younger (r = -0.56, p < 0.0001), shorter (r = -0.49, p < 0.0001), and lighter (r = -0.46, p < 0.0001) subjects. We children born SGA. The height gain attained before the onset of puberty is maintained to final height. The younger, shorter, and lighter the child at the start of GH treatment, the better the response. Moreover,most of these SGA individuals treated withGHreach their target height.展开更多
Objective: To investigate whether postnatal allopurinol would reduce free radical induced reperfusion/reoxygenation injury of the brain in severely asphyxiated neonates. Method: In an interim analysis of a randomised,...Objective: To investigate whether postnatal allopurinol would reduce free radical induced reperfusion/reoxygenation injury of the brain in severely asphyxiated neonates. Method: In an interim analysis of a randomised, double blind, placebo controlled study, 32 severely asphyxiated infants were given allopurinol or a vehicle within four hours of birth. Results: The analysis showed an unaltered (high) mortality and morbidity in the infants treated with allopurinol. Conclusion: Allopurinol treatment started postnatally was too late to reduce the early reperfusion induced free radical surge. Allopurinol administration to the fetus with (imminent) hypoxia via the mother during labour may be more effective in reducing free radical induced post- asphyxial brain damage.展开更多
Aims:To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians.Methods:A prospective audit of all ...Aims:To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians.Methods:A prospective audit of all the 14 572 births in a maternity unit only staffed by nurse practitioners between 1996 and 2003. Results:1.2%of all babies born in the unit were found to have a structural defect (as confirmed by echocardiography)within a year of birth. The number not suspected before discharge declined over time,and only 6%were first suspected after discharge in the last four years of this eight year study. Four potentially life threatening conditions initially went unsuspected in 1996-8,but none after that. A policy of referring every term baby with a murmur at 1 day of age that was still present at 7-10 days resulted in 4.2%requiring cardiac referral; 54%of these babies still had a murmur when assesse done to two weeks later,and 33%had a structural defect. Parents said in independent,retrospectively conducted,interviews that they found it confidence building to have any possible heart defect identified early and the cause of any murmur clearly and authoritatively explained. Conclusions:Effective screening requires experience and a clear,structured,referral pathway,but can work much better than most previous reports suggest.Whether staff bring a medical or nursing background to the task may well be of less importance.展开更多
文摘Aim: To determine the occurrence of intraventricular haemorrhage (IVH) and its association with coagulation factors at birth in preterm neonates born before 30 wk gestation. Methods: 38 neonates (median gestational age 27 wk, range 24-29 wk; median birthweight (BW) 933 g, range 515-1760 g) admitted to the neonatal intensive care unit were studied. Blood samples for coagulation factors were taken within 2 h after birth. The first cranial ultrasonographic examination was performed within the first 3 d. The occurrence of IVH was tested statistically by the Mann-Whitney U-test for association with the activity of coagulation factors and clinical variables. Results: Thirteen IVHs occurred within the first 3 d of life. IVH was associated with BW <1000 g (p = 0.012), low mean blood pressure within the first 2 d (p = 0.026), gestational age <27 wk (p = 0.054), low Apgar scores (<7) at 1 min (p = 0.078) and intrauterine growth restriction (p = 0.072). At birth (samples drawn with a median of first 36 min of life), infants with subsequent IVH had statistically significantly lower prothrombin (factor II) activity (p = 0.024) than infants without IVH. Conclusion: The measured low prothrombin may have been affected by a prior bleeding event. Nevertheless, preterm infants with low prothrombin activity may be susceptible to IVH, or to the progression of it, if left undiagnosed.
文摘新近研究证实:早产儿慢性肺疾患(CLD)的发生与其体内维生素 A 的低水平有关。对高危婴儿补充维生素 A 能降低月 CLD 发病率。曾有学者提出:继发 CLD 的早产儿,出生时体内缺乏维生素 A,使之容易发生慢性呼吸道疾病。这些婴儿出生一般为过分早产,也许这种不成熟性可以解释体内低维生素 A 水平。关于这一假设。
文摘Weight, length, and skinfold thicknesses were measured in 4634 term and preter m neonates. Sex and weight/length ratio were important determinants of the amoun t and distribution of the subcutaneous fat store at birth. Gestational age, weig ht, length, and other ponderal indices did not explain subcutaneous fat variabil ity.
文摘The prognostic value of nucleated red blood cell count at birth in relation t o neonatal outcome has been established. However, reference values were needed t o usefully interpret this variable. The normal range of reference values for abs olute nucleated red blood cell count in 695 preterm and term newborns is reporte d.
文摘Objective This study was undertaken to assess the risk of neonatal morbidity in the second twi ns.Study design We carried out a cohort study of 128,219live born second twins in the United States,1995thro ugh 1997.The study subjects were divided into 3groups:second twins delivered by cesarean section after vaginal delivery of the first twin(V -C),both twins delivered vaginally(V -V),and both twins delivered by cesarean section(C -C).Results The rates of low 5-minute Apgar score,me chanical ventila-tion,and seizure were higher in the V-C group(8.27%,13.39%,and 0.31%)than in the V -V(3.07%,7.51%,and 0.08%)and the C -C(2.66%,8.53%,and 0.06%)groups.The V -C associated increase in risk remained after adjustment for confo unding factors and was more evident at term than preterm.Co nclusion The risk of neonatal morbidity is increased in s econd twins who had a cesarean section after vaginal delivery of the first twin,especially at term.
文摘Cord blood thyroid-stimulating hormone level is elevated in neonates who had undergone more perinatal stresses. The present study aimed to evaluate the cord blood acid-base status in neonates with elevated thyroid-stimulating hormone level. Study design: The study population consisted of 2366 singleton, term pregnancies. Subjects were categorized by their cord blood thyroid-stimulating hormone level into four quartiles, and cord blood acid-base parameters were compared among the four groups. The correlations between cord acid-base parameters and thyroid-stimulating hormone level were also studied. Results: Cord blood pH was significantly lower in the highest (arterial, 7.27 ± 0.08; venous, 7.32 ± 0.07) and second highest thyroid-stimulating hormone quartile groups (arterial, 7.29 ± 0.07; venous, 7.34 ± 0.06) compared to the lowest quartile group (arterial, 7.30 ± 0.06; venous, 7.35 ± 0.05). Incidences of cord arterial pH ≤ 7.20 were 4.7% , 6.8% , 10.9% , and 17.3% in lowest to the highest thyroid-stimulating hormone quartile groups, respectively. There was a significant negative correlation between cord blood thyroid-stimulating hormone level and cord arterial and venous pH (r = - 0.26, P < 0.001). When stratified according to the mode of delivery, the negative correlations remained significant in neonates delivered vaginally and by intrapartum emergency cesarean section but not in neonates delivered by elective cesarean section. Conclusion: Incidence of cord blood acidosis is significantly higher in neonates with elevated thyroid-stimulating hormone level. This findings support the postulation that stress-induced elevation of cord blood thyroid-stimulating hormone level may be mediated through intrapartum fetal hypoxia.
文摘To test whether infants with bronchopulmonary dysplasia (BPD) express the same functional impairments at term as healthy, preterm infants, and whether clinical severity of BPD is qualitatively or quantitatively related. Prospective measurements on a consecutive sample of 50 infants with BPD and 19 healthy preterm controls in a university hospital. BPD infants were classified as “severe, ”“moderate, ”or “mild, ”according to their need for oxygen. A multiple-breath nitrogen wash-out method was used to assess functional residual capacity (FRC)-and gas mixing efficiency. Mechanical variables were estimated by the occlusion test. Infants with severe BPD had lower FRC, less efficient gas mixing, and higher specific conductance than those with mild and moderate BPD, and the preterm controls. Mild and moderate BPD did not differ in any property from each other but differed from controls in the same variables. The elastic properties of the respiratory system appeared unaffected by BPD. The ventilatory impairments in BPD were of the same nature as in healthy preterm infants when compared with term infants, but their magnitude was related to the clinical severity of the BPD. Gas mixing efficiency together with FRC appears to be useful to assess lung development in BPD.
文摘The purpose of this study was to assess the risk of neonatal death in the second twin.We carried o ut a retrospective cohort study of 128,219live born sec ond twins in the U-nited States for the years 1995throu gh 1997.The study subjects were divided into 3groups:second twins who were delivered by cesarean delivery afte r vaginal delivery of the first twin(group 1),both twins delivered vaginally(group2),and both twins delivered by cesarea n delivery(group3).The risk of asphyxia -related neonatal deaths was in-creased in groups 1and 2;the increased risk in group 1was stronger in term births than in pr eterm births.The risk of neonatal deaths,especially for t erm infants with as-phyxia -related deaths,is increase d for the second twins who are delivered by cesarean delive ry after vaginal deliv-ery of the first twins.
文摘The aim of this observational study was to assess the long-term growth responses to GH treatment of children born small for gestational age (SGA). GH treatment was begun before puberty and continued to final height (FH). Seventy-seven short (height SD score below -2) prepubertal children born SGA (below -2 SD for birth weight and/or birth length), with a broad range of GH secretory capacity, were treated with GH in a daily dose of 33 μ g/kg (0.1 U/kg), beginning before the onset of puberty. We observed a difference between adult and pretreatment projected height of 1.3 SD (9 cm) for the entire group. Among the children treated for >2 y before puberty, this mean gain (i.e. difference) in final height was 1.7 SD, whereas the mean gain was 0.9 SD among those in whom treatment was begun < 2 y before puberty. Better catch-up growth was observed in the younger (r = -0.56, p < 0.0001), shorter (r = -0.49, p < 0.0001), and lighter (r = -0.46, p < 0.0001) subjects. We children born SGA. The height gain attained before the onset of puberty is maintained to final height. The younger, shorter, and lighter the child at the start of GH treatment, the better the response. Moreover,most of these SGA individuals treated withGHreach their target height.
文摘Objective: To investigate whether postnatal allopurinol would reduce free radical induced reperfusion/reoxygenation injury of the brain in severely asphyxiated neonates. Method: In an interim analysis of a randomised, double blind, placebo controlled study, 32 severely asphyxiated infants were given allopurinol or a vehicle within four hours of birth. Results: The analysis showed an unaltered (high) mortality and morbidity in the infants treated with allopurinol. Conclusion: Allopurinol treatment started postnatally was too late to reduce the early reperfusion induced free radical surge. Allopurinol administration to the fetus with (imminent) hypoxia via the mother during labour may be more effective in reducing free radical induced post- asphyxial brain damage.
文摘Aims:To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians.Methods:A prospective audit of all the 14 572 births in a maternity unit only staffed by nurse practitioners between 1996 and 2003. Results:1.2%of all babies born in the unit were found to have a structural defect (as confirmed by echocardiography)within a year of birth. The number not suspected before discharge declined over time,and only 6%were first suspected after discharge in the last four years of this eight year study. Four potentially life threatening conditions initially went unsuspected in 1996-8,but none after that. A policy of referring every term baby with a murmur at 1 day of age that was still present at 7-10 days resulted in 4.2%requiring cardiac referral; 54%of these babies still had a murmur when assesse done to two weeks later,and 33%had a structural defect. Parents said in independent,retrospectively conducted,interviews that they found it confidence building to have any possible heart defect identified early and the cause of any murmur clearly and authoritatively explained. Conclusions:Effective screening requires experience and a clear,structured,referral pathway,but can work much better than most previous reports suggest.Whether staff bring a medical or nursing background to the task may well be of less importance.
