宫内缺氧对胎儿、新生儿及成年子代心脏功能的影响及相关研究进展

宫内缺氧是胚胎发育中的常见综合征,多见于产前期病理生理高危妊娠,或由于血管病变使子宫血流减少,使宫内胎儿供氧减少,引起胎儿生长迟缓,严重的可引起胎儿死亡。妊娠期间慢性宫内缺氧可抑制胎儿心脏功能,改变心脏基因表达,增加心肌程序性细胞死亡,还可导致心肌细胞过早退出细胞周期和心肌肥厚,这些改变不仅在围生期表现明显,而且可能通过生理和代谢的程序化控制,引起成年子代心脏结构和功能的改变,造成成年心脏对缺血-再灌注损伤的易感性增加。现就宫内缺氧对胎儿、新生儿及成年子代心脏功能的影响及相关研究进展进行综述。

胚胎期、新生儿和儿童期HBV感染后免疫耐受研究进展

乙型肝炎病毒(HBV)可导致急性和慢性肝炎,急性乙型肝炎可以自愈,而慢性HBV感染进一步可发展为肝硬化或肝癌。这些临床和病毒学特征不仅与不同个体的遗传背景有关,也与患者的年龄有关。HBV感染后HBV复制水平高而肝脏无明显炎症,这一时期称为免疫耐受期。导致免疫耐受的原因是多方面的,免疫耐受主要与Th1/Th2细胞因子的不平衡应答、树突状细胞的抗原提呈功能缺陷以及细胞毒性T淋巴细胞的功能不足和耗竭等有关。从出生至儿童时期免疫耐受机制尚未明确,本文总结了这一时期HBV感染后机体免疫和免疫耐受变化的研究进展。

妊娠肝内胆汁淤积综合征相关新生儿肺损伤的危险因素分析

目的探讨妊娠肝内胆汁淤积综合征孕妇所娩新生儿发生肺损伤的危险因素。方法将我院妇产科诊断妊娠期肝内胆汁淤积症的产妇及其新生儿30例(ICP组)与同期正常分娩之孕妇及新生儿40例(对照组)列为研究对象,分析新生儿发生肺损伤的发病率及临床特点,比较母亲血清和羊水中总胆汁酸、甘胆酸及其与新生儿肺损伤之间的关系。结果 ICP组新生儿肺损伤发病率增加,新生儿肺损伤以暂时性呼吸过快、新生儿肺炎及新生儿呼吸窘迫综合征为主要类型;孕妇血清与羊水甘胆酸水平在一定范围内相关,且与新生儿肺损伤发病率相关性较好。血清甘胆酸上升至40μg/ml,或当血清总胆汁酸上升至30μmol/L时,羊水甘胆酸及总胆汁酸异常率超过75%,此时新生儿发生肺损伤的概率明显增加。结论母亲患妊娠肝内胆汁淤积综合征可增加新生儿肺损伤的发病机会,母亲血清及羊水中高胆酸(甘胆酸)水平可能是导致新生儿肺损伤的原因。

胎毒清、早期游泳加抚触减轻新生儿黄疸的临床研究

60%的新生儿可出现黄疸,大部分新生儿黄疸均较轻微,但由于胆红素毒性严重,高胆红素血症可导致胆红素脑病或核黄疸[1],为减少严重胆红素血症及胆红素脑病或核黄疸的发生,本文通过300例健康新生儿应用胎毒清、游泳、抚触,观察新生儿的黄疸发生率,旨在研究胎毒清、游泳抚触对新生儿黄疸的干预效果。1资料与方法1.1一般资料选择2010年1月至2011年11月于辛集市妇幼保健院、辛集市第一医院足月、单胎、初产、无妊娠合并症及并发症,自然分娩或择期剖宫产的新生儿病例1863例,新生儿评分9～10分,均无ABO血型不合。

CPAP结合肺泡表面活性物质治疗新生儿呼吸窘迫综合征的疗效观察

目的分析CPAP结合肺泡表面活性物质治疗新生儿呼吸窘迫综合征的临床疗效。方法选取我院2016年2月—2017年4月收治的新生儿呼吸窘迫综合征患儿40例作为研究对象。通过抽签法,将其均分为观察组和对照组,每组各20例患儿。对照组患儿采用肺泡表面活性物质进行治疗,观察组患儿采用CPAP结合肺泡表面活性物质进行治疗。结果治疗前,观察组和对照组患者PaO_2、PaCO_2、PaO_2/FiO_2和pH值比较,差异无统计学意义(P>0.05)。治疗后,观察组患者PaO_2、PaCO_2、PaO_2/FiO_2和pH值与对照组比较,差异具有统计学意义(P<0.05)。结论新生儿呼吸窘迫综合征经CPAP结合肺泡表面活性物质治疗疗效确切。

新生儿溶血病筛查送检标本的分析

应用微柱凝胶血型检测卡及新生儿血型卡,对本院临床送检的新生儿溶血病筛查标本及其母亲的血标本,进行血型鉴定(ABO+RhD)及新生儿溶血病三项检验。结果在247例新生儿溶血病筛查的标本中,母婴ABO+RhD血型相合、相容的标本38例,占送检标本的15.38%(38/247);38例血型相合、相容的标本中游离、放散试验均为阴性。在送检的新生儿溶血病筛查的标本中,含有一定比例的母婴ABO+Rh血型相合、相容的标本,为避免多次抽取新生儿血液、盲目送检标本,作者建议可用脐带血直接进行新生儿ABO血型鉴定(Rh阴性产妇对其新生儿加做Rh血型鉴定),同时结合产妇产前的抗筛结果,这是尽早决定是否送检新生儿溶血病筛查标本的关键,也是对Rh阴性产妇是否进行免疫球蛋白注射治疗的有效依据。

两种非药物性镇痛方法在新生儿疼痛中的应用分析

目的:分析两种非药物性镇痛方法在新生儿疼痛中的应用效果。方法:选取2017年1月~2019年1月370例新生儿作为研究对象,根据镇痛方式不同分为两组,对照组180例予以口服甜味剂联合非营养吮吸,实验组190例予以襁褓包裹、音乐和非营养性吮吸,对比两组新生儿穿刺操作NFCS评分、穿刺操作NIPS评分、疼痛HR变化以及疼痛性啼哭发生率。结果:实验组NFCS穿刺中(t=3.4918,P=0.0007)、穿刺后3min(t=4.9060,P=0.0000)评分低(P<0.05)。实验组NIPS穿刺中(t=5.2003,P=0.0245)、穿刺后3min(t=4.2536,P=0.0052),评分低(P<0.05)。实验组HR采血前(t=2.2534,P=0.7412)、采血后(t=11.5236,P=0.0052)、上升程度(t=9.5723,P=0.0027)均低于对照组(P<0.05)。实验组疼痛性啼哭(x^(2)=21.5236,P=0.0000)发生率低(P<0.05)。结论:新生儿疼痛治疗中采用襁褓包裹、音乐和非营养性吮吸,可有效降低新生儿痛感,减少疼痛性啼哭发生率。

新生儿耳聋基因筛查的发展现状

先天性聋是我国新生儿最常见的出生缺陷之一,也是一种早期干预可以得到较好康复效果的先天性疾病。耳聋不尽早干预,会导致儿童听力障碍,语言障碍。对孩子的成长发育、学习生活、社会交往产生巨大的影响,成为一个家庭沉重的负担。自2000年国家将听力检测列入妇幼保健的常规检测项目中,之后历经了多年发展,对婴幼儿的听力检测才开始获得更全面的使用。随着技术的发展和对新生儿耳聋预防及治疗的进一步关注和完善,我国目前在各地已经逐步开始普及听力及耳聋基因联合筛查。但由于我国各地技术水平、经济水平及受教育水平的不同,导致各地发展进度差异较大。而各地耳聋基因检测的结果具有一定的地域特异性,因此非常值得研究对比。本文将通过对我国各地听力及基因联合筛查的进展和差异性进行阐述,为我国新生儿听力及耳聋基因联合筛查机制的建立和完善提供有效的参考。

Analysis of TORCH results of retinal exudative changes in neonates

AIM:To explore the relationship between retinal exudative changes in neonates and perinatal toxoplasmosis,others,rubella,cytomegalovirus,and herpes simplex virus(TORCH)infections,as well as the characteristics of TORCH infection in neonates with retinal exudative changes.METHODS:Retrospective study.A total of 612 neonates with retinal exudative changes detected during ophthalmic screening in our hospital from May 2019 to March 2023 were selected.TORCH tests were performed on these neonates,and the results were subjected to statistical analysis to determine the infection characteristics.The neonates with retinal exudative changes were grouped by sex and age,the characteristics of TORCH infection were analyzed,and the positive rates were compared.RESULTS:Among the 612 neonates with retinal exudative changes,the highest positive rate was observed for cytomegalovirus(CMV-IgG)(96.7%),followed by rubella virus(RV-IgG)(73.9%).Mixed infections with two or three viruses were also observed,with the highest positive rate for mixed infection of RV-IgG and CMV-IgG reaching 71.2%.There was no statistically significant difference in TORCH infection among neonates of different sex(P>0.05).However,there were statistically significant differences in RV-IgG and CMV-IgM infections with retinal exudative changes among neonates of different age groups(P<0.05).CONCLUSION:Perinatal TORCH infection may be an important factor causing retinal exudative changes in neonates.The differences in various infections are not related to sex but are related to different age groups.

医院重点科室院感监测及管理对策

目的:探讨手术室、产房、新生儿病区医院感染管理控制方法。方法:对手术室、产房、新生儿病区医院感染质量进行全面监测,采样检测物表、医护人员手、使用中消毒剂、无菌物品后分析原因,制定和实施手术室、产房、新生儿病区感染管理控制措施。结果:物表、医护人员的手、使用中消毒剂、无菌物品合格率在实施院感控制管理措施后得到显著效果。结论:加强重点科室感染质量监测与管理,有效预防院内感染发生。

茵陈退黄汤治疗母乳性黄疸120例疗效观察

目的:观察茵陈退黄汤治疗母乳性黄疸的疗效。方法:120例母乳性黄疸患儿随机分为两组,对照组60例,采用蒙脱石散和双岐四联活菌治疗;观察组60例,给予茵陈退黄疸治疗。结果:观察组在胆红素下降程度及总有效率方面均优于对照组,差异有统计学意义。结论:茵陈退黄汤治疗母乳性黄疸疗效好,无毒副作用。

维生素D缺乏诱导小儿呆小病与血液微量元素的关系研究

目的探讨维生素D缺乏诱导呆小病新生儿血液中微量元素含量的变化。方法采用微分电位溶出法测定维生素D缺乏诱导呆小病的新生儿与健康新生儿血液中微量元素的含量。结果呆小病组血清锌、镁、铁、钙均低于正常,全血铅、血清铜均高于正常。结论小儿维生素D缺乏诱导呆小病新生儿血液微量元素存在一定的失衡,与感染所造成的机体伤害有一定的关系,因此需要及时补充和调理微量元素,对疾病的治疗和恢复有重要意义。

5年控制剖宫产临床措施探讨

目的：在保证母子平安的前提下,努力降低剖宫产率。方法：回顾性分析2002年1月1日-2006年12月31日分娩7260例的资料,其中剖宫产1351例,死产新生儿死亡4例。结果：5年间剖宫产率分别为27.4%、18.5%、22.4%、19.6%、16.8%;5年间剖宫产指征一直以难产为第一位,社会因素为最后一位。结论：只要严格掌握剖宫产指征,剖宫产率可以控制,死产、新生儿死亡也可以稳定在正常范围内。

孕妇血氧自由基与胎儿窘迫的关系研究

目的分析孕妇血氧化应激指标活性氧簇(ROS)和超氧化物歧化酶(SOD)的水平,探讨其与胎儿窘迫和新生儿窒息的关系。方法选取临产时出现胎儿窘迫的产妇为研究组,共纳入40例,另选取同期分娩时无胎儿窘迫者60例为对照组,检测两组产妇血清SOD和ROS水平,对比两组产妇氧化应激指标的差异,并采用Spearman相关分析产妇血SOD和ROS水平与新生儿出生后的体质量和Apgar评分的关系。结果研究组血清ROS和SOD水平明显高于对照组,与对照组比较差异具有统计学意义(P<0.05),ROS/SOD比值与对照组比较差异亦具有统计学意义(P<0.05);研究组因胎儿窘迫导致新生儿窒息中,轻度窒息组中产妇血SOD水平高于重度窒息组,而重度窒息组ROS水平高于轻度窒息组(P<0.05)。相关分析显示,随着ROS/SOD比值下降,Apgar评分升高,两者呈正相关(OR=0.631,P<0.05),但与新生儿出生后的体质量未见明显相关性(P>0.05)。结论胎儿窘迫与孕妇血清SOD和ROS水平相关,通过检测两项指标,有助于评估胎儿窘迫和新生儿窒息的程度。

早教新型护理模式在新生儿期的应用方法及价值分析

探讨早教新型护理模式在新生儿期的应用方法及价值。方法 于2021年1月至2022年10月期间在我院选取新生儿分析,共643例,分为实施传统的护理(对照组,n=322)与实施早教新型护理模式(观察组,n=321)。比较两组效果。结果 观察组对护理服务的认知高于对照组,新生儿体重、身长增长与头围高于对照组,新生儿NBNA评分高于对照组,新生儿常见疾病发生率低于对照组,满意度高于对照组,(p<0.05)。结论 通过临床实施早教新型护理模式,不但能开发新生儿智力发育,而且促进新生儿体格的发育,降低新生儿常见疾病发病率,值得推广。

Transformation of hepatitis B serologic markers in babies born to hepatitis B surface antigen positive mothers

AIM:To better understand the clinical significance of hepatitis B seroiogic markers in babies born to hepatitis B surface antigen (HBsAg) positive mothers, the incidence of maternal seroiogic markers of hepatitis B via placenta and its transformation in these babies were investigated. METHODS: Mothers with positive HBsAg were selected in the third trimester of pregnancy. Their babies received immunoprophylaxis with hepatitis B immunoglobulin and hepatitis B vaccine after birth, and were consecutively followed up for hepatitis B seroiogic markers and HBV DNA at birth, mo 1, 4, 7, 12, and 24. RESULTS: Forty-two babies entered the study, including 16 born to hepatitis B e antigen (HBeAg)-positive HBsAg carrier mothers and 26 to HBeAg-negative HBsAg carrier mothers. Apart from four babies born to HBeAg-positive carrier mothers and demonstrated persistent positive HBeAg eventually became HBV carriers, all other babies developed anti-HBs before 12 mo of age. Among the other 12 babies born to HBeAg-positive carrier mothers, HBeAg was detected in 7 at birth, in 4 at mo 1, and in none of them thereafter. No antibody response to the transplacental HBeAg was detected. Among the babies born to HBeAg-negative carrier mothers, anti-HBe was detected 100% at birth and mo 1, in 88.5% at mo 4, in 46.2% at mo 7, in 4.2% at mo 12 and none in mo 24. Among all the immunoprophylaxis-protected babies born to either HBeAg-positive or HBeAg-negative carrier mothers, anti-HBc was detected in 100% at birth, mo 1 and mo 4, in 78.9% at mo 7, in 36.1% at mo 12 and in none at mo 24. CONCLUSION: HBeAg can pass through human placenta from mother to fetus and become undetectable before 4 mo of age, but no antibodies response to the transplacental HBeAg can be detected till mo 24 in the immunoprophylaxis-protected babies. The sole existence of anti-HBe before 1 year of age or anti-HBc before 2 years of age in babies born to HBsAg carrier mothers may simply represent the transplacental maternal antibodies, instead of indicators of HBV infection status.

Biochemical characteristics of neonatal cholestasis induced by citrin deficiency

AIM:To explore differences in biochemical indices between neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) and that with other etiologies. METHODS:Patients under 6 mo of age who were referred for investigation of conjugated hyperbiliru-binaemia from June 2003 to December 2010 were eligible for this study. After excluding diseases affecting the extrahepatic biliary system, all patients were screened for the two most common SLC25A13 mutations; the coding exons of the entire SLC25A13 gene was sequenced and Western blotting of citrin protein performed in selected cases. Patients in whom homo-zygous or compound heterozygous SLC25A13 mutation and/or absence of normal citrin protein was detected were defined as having NICCD. Cases in which no specific etiological factor could be ascertained after a com-prehensive conjugated hyperbilirubinaemia work-up were defined as idiopathic neonatal cholestasis (INC). Thirty-two NICCD patients, 250 INC patients, and 39 infants with cholangiography-confirmed biliary atresia (BA) were enrolled. Laboratory values at their first visit were abstracted from medical files and compared. RESULTS:Compared with BA and INC patients, the NICCD patients had significantly higher levels of total bile acid (TBA) [all measures are expressed as median (inter-quartile range):178.0 (111.2-236.4) μmol/L in NICCD vs 112.0 (84.9-153.9) μmol/L in BA and 103.0 (70.9-135.3) μmol/L in INC, P = 0.0001]. The NICCD patients had significantly lower direct bilirubin [D-Bil 59.6 (43.1-90.9) μmol/L in NICCD vs 134.0 (115.9-151.2) μmol/L in BA and 87.3 (63.0-123.6) μmol/L in INC, P = 0.0001]; alanine aminotransferase [ALT 34.0 (23.0-55.0) U/L in NICCD vs 108.0 (62.0-199.0) U/L in BA and 84.5 (46.0-166.0) U/L in INC, P = 0.0001]; aspartate aminotransferase [AST 74.0 (53.5-150.0) U/L in NICCD vs 153.0 (115.0-239.0) U/L in BA and 130.5 (81.0-223.0) U/L in INC, P = 0.0006]; albumin [34.9 (30.7-38.2) g/L in NICCD vs 38.4 (36.3-42.2) g/L in BA and 39.9 (37.0-42.3) g/L in INC, P = 0.0001]; glucose [3.2 (2.0-4.4) mmol/L in NICCD vs 4.1 (3.4-5.1) mmol/L in BA and 4.0 (3.4-4.6) mmol/L in INC, P = 0.0014] and total cholesterol [TCH 3.33 (2.97-4.00) mmol/L in N ICCD vs 4.57 (3.81-5.26) mmol/L in BA and 4.00 (3.24-4.74) mmol/L in INC, P = 0.0155] levels. The D-Bil to total bilirubin (T-Bil) ratio was significantly lower in NICCD patients [all measures are expressed as median (inter-quartile range):0.54 (0.40-0.74)] than that in BA patients [0.77 (0.72-0.81), P = 0.001] and that in INC patients [0.74 (0.59-0.80), P = 0.0045]. A much higher AST/ALT ratio was found in NICCD patients [2.46 (1.95-3.63)] compared to BA patients [1.38 (0.94-1.97), P = 0.0001] and INC patients [1.48 (1.10-2.26), P = 0.0001]. NICCD patients had significantly higher TBA/D-Bil ratio [3.36 (1.98-4.43) vs 0.85 (0.72-1.09) in BA patients and 1.04 (0.92-1.14) in INC patients, P = 0.0001], and TBA/TCH ratio [60.7 (32.4-70.9) vs 24.7 (19.8-30.2) in BA patients and 24.2 (21.4-26.9) in INC patients, P = 0.0001] compared to the BA and INC groups. CONCLUSION:NICCD has significantly different bio- chemical indices from BA or INC. TBA excretion in NICCD appeared to be more severely disturbed than that of bilirubin and cholesterol.

Comparison of different diagnostic methods in infants with Cholestasis

AIM: To evaluate different methods in differentiating idiopathic neonatal hepatitis from biliary atresia. METHODS: Sixty-five infants with cholestatic jaundice and final diagnosis of idiopathic neonatal hepatitis and biliary atresia were studied prospectively from September 2003 to March 2006. A thorough history and physical examination were undertaken and the liver enzymes were examined. All cases underwent abdominal ultrasonography, hepatobiliary scintigraphy, and percutaneous liver biopsy. The accuracy, sensitivity, specificity and predictive values of these various methods were compared. RESULTS: There were 34 girls and 31 boys, among them 46 subjects had idiopathic neonatal hepatitis (age, 61 ± 17 d) and 19 had biliary atresia (age, 64 ± 18 d). The mean age at onset of jaundice was significantly lower in cases of biliary atresia when compared to idiopathic neonatal hepatitis cases (9 ± 13 d vs 20 ± 21 d; P = 0.032). The diagnostic accuracy of different methods was as follows: liver biopsy, 96.9%; clinical evaluation, 70.8%; ultrasonography, 69.2%; hepatobiliary scintigraphy, 58.5%; and liver enzymes, 50.8%.CONCLUSION: Our results indicate that clinical evaluation by an experienced pediatric hepatologist and a biopsy of the liver are considered as the most reliable methods to differentiate idiopathic neonatal hepatitis and biliary atresia.

Role of neuronal nitric oxide synthase and inducible nitric oxide synthase in intestinal injury in neonatal rats

AIM： TO investigate the dynamic change and role of neuronal nitric oxide synthase （nNOS） and inducible nitric oxide synthase （iNOS） in neonatal rat with intestinal injury and to define whether necrotizing enterocolitis （NEC） is associated with the levels of nitric oxide synthase （NOS） in the mucosa of the affected intestine tissue. METHODS： Wistar rats less than 24 h in age received an intraperitoneal injection with 5 mg/kg lipopolysaccharide （LPS）. Ileum tissues were collected at 1, 3, 6, 12 and 24 h following LPS challenge for histological evaluation of NEC and for measurements of nNOS and iNOS. The correlation between the degree of intestinal injury and levels of NOS was determined. RESULTS： The LPS-injected increase in injury scores pups showed a significant versus the control. The expression of nNOS protein and mRNA was diminished after LPS injection. There was a negative significant correlation between the nNOS protein and the grade of median intestinal injury within 24 h. The expression of iNOS protein and mRNA was significantly increased in the peak of intestinal injury. CONCLUSION： nNOS and iNOS play different roles in LPS-induced intestinal injury. Caution should be exerted concerning potential therapeutic uses of NOS inhibitors in NEC.

Usefulness of a scoring system in the interpretation of histology in neonatal cholestasis

AIM:To ascertain the usefulness of a histological scoring system devised to assist in the interpretation of liver histology in neonatal cholestasis(NC) .METHODS:Liver biopsy specimens obtained from infants with NC referred to a tertiary pediatric unit in Malaysia were prospectively studied.The first author,blinded to the final diagnosis,devised the histological diagnosis based on a 7-feature(portal ductal proliferation,bile plugs in portal ductules,portoportal bridging,lymphocytic infiltration in portal region,multinucleated hepatocytes,neutrophilic infiltration,hepatocellular swelling) ,15-point(0 to 15) scoring system.The author classified the histological diagnosis as either biliary atresia(BA) or neonatal hepatitis(NH,all other diagnoses) ,and subsequently compared the author's diagnosis with the final diagnosis.RESULTS:Eighty-four biopsy specimens obtained from 78 patients were reviewed.Without the scoring system,BA was correctly diagnosed by the author histologically in 30 cases,labelled as NH in 3.For other diagnoses,BA was excluded correctly in 33 cases and mislabeled as BA in 2 cases.The overall sensitivity for BA was 91%,specificity 86% and accuracy 88%.With the scoring system,a score of ≥ 7 had the best diagnostic utility to differentiate BA from other intrahepatic cholestasis histologically(sensitivity 88%,specificity 94%,accuracy 92%) .Four patients with a score < 7 had BA,and 3 patients with a score ≥ 7 had NH.CONCLUSION:A 7-feature,15-point histological scoring system had good diagnostic accuracy in the interpretation of liver histology in neonatal cholestasis.