生长激素抑制素治疗先天性乳糜性胸水可导致新生儿—过性甲状腺功能减退

Aim: To describe a group of neonates with congenital, non-traumatic chylothorax, one of whom developed transient hypothyroidism following treatment with somatostatin. Methods: The charts of seven infants with congenital chylothorax were reviewed in terms of their clinical presentation, the severity of their disease, the complications they presented and the duration of their hospitalization. Their pituitary-thyroid axis function was monitored in particular. Results: The seven infants, all preterm (32-34wk), suffered from congenital chylothorax and hydrops fetalis diagnosed during the prenatal period. Four were treated by intrauterine drainage, and four had congenital malformations. Hospitalization lasted from 32 to 120 d. Three of the infants suffered from thrombocytopenia, three had chronic lung disease, and one suffered from Gram-negative sepsis. The infant treated with somatostatin initially had normal thyroid function, but later developed primary transient hypothyroidism and was treated with L-thyroxine. The thyroid screening tests for the infants who were not treated with somatostatin were all normal. Conclusions: Repeated doses of somatostatin were effective in reducing chylus production. Administering this treatment earlier should be considered in order to minimize known complications. The only potential side effect observed was primary transient hypothyroidism. Therefore, careful monitoring of the pituitary-thyroid axis is advised.

产前暴露于倍他米松与地塞米松的低体重新生儿近期不良结局的比较

OBJECTIVE: To assess the incidence of short-term outcomes of low birth weig ht infants (≤1,750 g) exposed prenattally to either dexamethasone or betamethaso ne. METHODS: We retrospectively analyzed a cohort comprising 550 infants who wer e born alive at our center during the period January 1999 through December 2001, who weighed 1,750 g or less at birth, and who were exposed to prenatal steroid treatment. We compared brain ultrasound findings, such as intraventricular hemor rhage and cystic periventricular leukomalacia (PVL), as well as other clinical f indings, including respiratory distress syndrome (RDS), necrotizing enterocoliti s, retinopathy of prematurity, and bronchopulmonary dysplasia, for all premature infants whose mothers received either dexamethasone (from January 1, 1999 to Ju ne 30, 2000, n = 263) or beta-methasone (July 1, 2000 to December 31, 2001, n = 287). RESULTS: Patient characteristics (mothers and infants) were the same in b oth groups, with the exception of the number of steroid courses administered, th e number of women with premature rupture of membranes (defined as >24 hours), an d the number of women who had received tocolysis. No significant difference was found between the 2 groups with respect to intraventricular hemorrhage and cysti c PVL frequencies. No significant differences were found in the incidence of sho rt-term outcomes examined, despite the fact that the dexamethasone group was ex posed to a statistically significantly greater number of courses than the betame thasone group. CONCLUSION: There seem to be no advantages to maternal antenatal treatment with betamethasone compared with dexamethasone in reducing the risk of PVL in low birth weight (≤1,750 g) infants. Both drugs have the same effect on all short-term outcome parameters checked.

新生儿听力筛查监测到极低出生体重儿中听力损害流行率较低

Objectives:To (a) study the prevalence of hearing impairment in a cohort of very low birthweight (VLBW) infants and (b) evaluate the effectiveness of transient evoked otoacoustic emissions(TEOAE) as a first stage in-hospital hearing screening tool in this population. Study design:The study group was a cohort of 346 VLBW infants born in 1998—2000 at The Sheba Medical Center. The prevalence of hearing impairment in the study group was compared with that of all other newborn infants participating in a universal newborn hearing screening programme during the same period. To evaluate the effectiveness of TEOAE,a control group of 1205 healthy newborns who had no known risk factors for hearing impairment was selected. The results and follow up of hearing screening for these infants were examined retrospectively. Results:Only one VLBW infant (0.3%) was diagnosed with bilateral sensory-neural hearing loss. In addition,nine infants (2.7%) were diagnosed with conductive hearing loss. Bronchopulmonary dysplasia and low Apgar score were the most significant factors for predicting the occurrence of conductive hearing loss. The percentage of VLBW infants who successfully passed the in hospital TEOAE screening was 87.2,compared with 92.2%in the full term control group. No false negative cases were detected on follow up. Conclusions:The study shows a low incidence of sensory-neural hearing loss in a cohort of VLBW infants and a relatively high incidence of conductive hearing loss. TEOAE screening was found to be an effective first stage in-hospital hearing screening tool in this population.