Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliv...Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.展开更多
Iris du Pré, a professional pianist, wanted a second child, did not conceive quickly and was injected in 1944 by a doctor in Oxford with pregnant mare serum gonadotropin (PMSG). The doctor joked “This child will...Iris du Pré, a professional pianist, wanted a second child, did not conceive quickly and was injected in 1944 by a doctor in Oxford with pregnant mare serum gonadotropin (PMSG). The doctor joked “This child will be a racehorse winner!” In January 1945, Jacqueline du Pré, the remarkable, world-famous cellist was born. In the 1920's and 1930's, animal experimentation and clinical studies had shown that pituitary glycoproteins stimulated the ovary (follicle-stimulating hormone, FSH) and the corpus luteum (luteal-stimulating hormone, LH) which prepared the human womb for embedding a fertilized ovum and that pregnant mare’s blood and urine contained the glycoprotein, PMSG whose origin was placental cells, but surprisingly in humans had the actions of both FSH and LH. However, the PMSG serum alone did not bring about pregnancy. The doctor did not know that without subsequent injection of another factor in correct sequence and timing, PMSG was pointless. In 1947, a placental glycoprotein, found in the 1920's in urine of pregnant women (human chorionic gonadotropin, hCG), when injected in mice subsequent to PMSG, achieved ovulation but not pregnancy. Human application of those findings was extremely risky due to impurities (up to 95%). The Federal Drug Administration (FDA), established in 1938, requested easily bye-passed marketing safety. Companies offered material “sufficiently” purified;professional bodies negated clinical use, tempting to a few. Evidence also suggests that, to sustain pregnancy the doctor also prescribed the new “eostrogen”, diethyl stilbestrol (DES) of negative fame. In 1947, the Nuremberg Code of ethics demanded human experiments by qualified personnel and trials preceded by adequate animal studies. It is not the case here. From five, du Pré had a most exceptional musical memory, almost obsessive musicality and a very difficult school-time socially. Later history: adult masculine build, awkward gait, tendency to recurrent depressions from mid-adolescence, unbalanced thyroidal metabolism, symptoms of numbness in late teens, long breaks for rest from age 25, MS diagnosis at 28 when unable to play, death aged 42. Yet at sixteen and after, she astounded all with technique, passion and unique musical interpretation. Her husband, an outstanding musician: “She had a capacity to imagine sound such as I never met in any other musician”. A close musician colleague: “... it was done before she was born”;perhaps much closer to the truth than realization, for her history it may suggest a fetal neurodevelopment abused in the womb.展开更多
目的探讨合并脑损伤高危因素的小于胎龄儿的早期运动发育特点。方法回顾性纳入2022年2~10月在西安市儿童医院新生儿随访门诊随访,合并脑损伤高危因素且在校正年龄(corrected age,CA)2~5周或CA14~17周随访并完成一次婴儿运动能力测试(Tes...目的探讨合并脑损伤高危因素的小于胎龄儿的早期运动发育特点。方法回顾性纳入2022年2~10月在西安市儿童医院新生儿随访门诊随访,合并脑损伤高危因素且在校正年龄(corrected age,CA)2~5周或CA14~17周随访并完成一次婴儿运动能力测试(Test of Infant Motor Performanc,TIMP)的小于胎龄儿(small for gestational age,SGA)和适于胎龄儿(appropriate for gestational age,AGA)共81例。CA2~5周随访到SGA 17例(SGA组),AGA 24例(AGA组);CA14~17周随访到SGA 20例(SGA组),AGA 20例(AGA组)。采用两独立样本t检验、秩和检验及χ^(2)检验比较组间的人口学特征、脑损伤高危因素及TIMP各项评分的差异。结果CA2~5周和CA14~17周,SGA组的出生体重均低于AGA组[(1817.1±440.3)与(2630.0±560.9)g,t=-4.98;(1752.0±434.4)与(2226.3±699.8)g,t=-2.58;P值均<0.05],但2组的出生胎龄、脑损伤高危因素差异均无统计学意义(P值均>0.05)。(1)CA2~5周:SGA组TIMP原始总分[(71.6±13.7)与(80.5±11.5)分,t=-2.26,P=0.029]、引出项评分[61.0分(41.0~85.0分)与69.1分(49.0~96.0分),Z=-2.15,P=0.037]和坐位[8.8分(3.0~19.0分)与11.2分(5.0~22.0分),Z=-2.07,P=0.038]、俯卧位评分[(9.8±3.1)与(12.3±3.1)分,t=-2.19,P=0.034]均低于AGA组。(2)CA14~17周:SGA组患儿的TIMP站立位评分低于AGA组[6.5分(4.0~11.0分)与7.7分(2.0~11.0分),Z=-2.05,P=0.040],但原始总分及坐位、仰卧位、俯卧位、翻身、侧方位各体位评分组间差异均无统计学意义(P值均>0.05)。结论5月龄前,SGA的早期运动能力较AGA低,在CA2~5周主要表现为头控能力相对落后,在CA14~17周时头控能力落后延续至站立位。展开更多
文摘Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.
文摘Iris du Pré, a professional pianist, wanted a second child, did not conceive quickly and was injected in 1944 by a doctor in Oxford with pregnant mare serum gonadotropin (PMSG). The doctor joked “This child will be a racehorse winner!” In January 1945, Jacqueline du Pré, the remarkable, world-famous cellist was born. In the 1920's and 1930's, animal experimentation and clinical studies had shown that pituitary glycoproteins stimulated the ovary (follicle-stimulating hormone, FSH) and the corpus luteum (luteal-stimulating hormone, LH) which prepared the human womb for embedding a fertilized ovum and that pregnant mare’s blood and urine contained the glycoprotein, PMSG whose origin was placental cells, but surprisingly in humans had the actions of both FSH and LH. However, the PMSG serum alone did not bring about pregnancy. The doctor did not know that without subsequent injection of another factor in correct sequence and timing, PMSG was pointless. In 1947, a placental glycoprotein, found in the 1920's in urine of pregnant women (human chorionic gonadotropin, hCG), when injected in mice subsequent to PMSG, achieved ovulation but not pregnancy. Human application of those findings was extremely risky due to impurities (up to 95%). The Federal Drug Administration (FDA), established in 1938, requested easily bye-passed marketing safety. Companies offered material “sufficiently” purified;professional bodies negated clinical use, tempting to a few. Evidence also suggests that, to sustain pregnancy the doctor also prescribed the new “eostrogen”, diethyl stilbestrol (DES) of negative fame. In 1947, the Nuremberg Code of ethics demanded human experiments by qualified personnel and trials preceded by adequate animal studies. It is not the case here. From five, du Pré had a most exceptional musical memory, almost obsessive musicality and a very difficult school-time socially. Later history: adult masculine build, awkward gait, tendency to recurrent depressions from mid-adolescence, unbalanced thyroidal metabolism, symptoms of numbness in late teens, long breaks for rest from age 25, MS diagnosis at 28 when unable to play, death aged 42. Yet at sixteen and after, she astounded all with technique, passion and unique musical interpretation. Her husband, an outstanding musician: “She had a capacity to imagine sound such as I never met in any other musician”. A close musician colleague: “... it was done before she was born”;perhaps much closer to the truth than realization, for her history it may suggest a fetal neurodevelopment abused in the womb.
文摘目的探讨合并脑损伤高危因素的小于胎龄儿的早期运动发育特点。方法回顾性纳入2022年2~10月在西安市儿童医院新生儿随访门诊随访,合并脑损伤高危因素且在校正年龄(corrected age,CA)2~5周或CA14~17周随访并完成一次婴儿运动能力测试(Test of Infant Motor Performanc,TIMP)的小于胎龄儿(small for gestational age,SGA)和适于胎龄儿(appropriate for gestational age,AGA)共81例。CA2~5周随访到SGA 17例(SGA组),AGA 24例(AGA组);CA14~17周随访到SGA 20例(SGA组),AGA 20例(AGA组)。采用两独立样本t检验、秩和检验及χ^(2)检验比较组间的人口学特征、脑损伤高危因素及TIMP各项评分的差异。结果CA2~5周和CA14~17周,SGA组的出生体重均低于AGA组[(1817.1±440.3)与(2630.0±560.9)g,t=-4.98;(1752.0±434.4)与(2226.3±699.8)g,t=-2.58;P值均<0.05],但2组的出生胎龄、脑损伤高危因素差异均无统计学意义(P值均>0.05)。(1)CA2~5周:SGA组TIMP原始总分[(71.6±13.7)与(80.5±11.5)分,t=-2.26,P=0.029]、引出项评分[61.0分(41.0~85.0分)与69.1分(49.0~96.0分),Z=-2.15,P=0.037]和坐位[8.8分(3.0~19.0分)与11.2分(5.0~22.0分),Z=-2.07,P=0.038]、俯卧位评分[(9.8±3.1)与(12.3±3.1)分,t=-2.19,P=0.034]均低于AGA组。(2)CA14~17周:SGA组患儿的TIMP站立位评分低于AGA组[6.5分(4.0~11.0分)与7.7分(2.0~11.0分),Z=-2.05,P=0.040],但原始总分及坐位、仰卧位、俯卧位、翻身、侧方位各体位评分组间差异均无统计学意义(P值均>0.05)。结论5月龄前,SGA的早期运动能力较AGA低,在CA2~5周主要表现为头控能力相对落后,在CA14~17周时头控能力落后延续至站立位。
