Influencing factors of the neurodevelopment of high-risk infants

Background High-risk infants refer to newborns exposed to high-risk factors in the prenatal, natal or postnatal period. High-risk infants are at high risk of developmental retardation, and early identification of developmental abnormalities plays a vital role in improving high-risk infants' quality of life.Aims To describe the neurodevelopment of high-risk infants aged less than 1 year old, and to analyse the incidences and influencing factors of neurodevelopmental abnormalities in order to provide a basis for neurodevelopment monitoring and management of highrisk infants.Methods High-risk infants born between January 2016 and December 2016 in the maternity and infant health hospitals of three districts in Shanghai were followed up.The Gesell Developmental Scale was used to assess the neurodevelopmental level at the time of recruitment(0-2 months) and at 9 months. Univariate and multivariate analyses of the influencing factors were conducted.Results 484 high-risk infants(male 51 %, female 49%)with an average gestation age of 36.5±2.2 weeks were recruited. At the time of recruitment, the average age was2.1(0.8) months, and the developmental quotient(DQ)scores of full-term high-risk infants in motor(t=3.542,p=0.001), cognitive(t=3.125, p=0.002), language(t=3.189, p=0.002) and social(t=3.316, p=0.001) areas were higher than those of preterm infants. The incidences of developmental abnormalities of full-term high-risk infants in motor(χ~2 =9.452, p=0.002), cognitive(χ~2=6.258, p=0.012), language(χ~2 =12.319, p =0.001) and social(χ~2 =6.811, p=0.009) areas were lower than the preterm infants. At 9 months, there was no difference in the DQ scores and incidences of developmental abnormalities in four areas between full-term and preterm high-risk infants, and the incidence of developmental abnormalities was around 10%.Conclusion The incidence of neurodevelopmental abnormalities in high-risk infants aged less than 1 year old is high. Preterm birth and parental bad habits are significant factors affecting the neurodevelopment.Monitoring and early interventions help to improve highrisk infants' neurodevelopment.

Achondrogenesis Type II in a Live Term Newborn Infant: A Case Report

Background: Achondrogenesis type II is a lethal form of osteochondrodysplasia characterized by short trunk, disproportionately large head, prominent forehead, micrognathia, extreme micromelia, anasarca, large abdomen and poor ossification of the bones. The children with achondrogenesis are usually born premature, or die in the neonatal period mostly from respiratory failure. We report the case of a live term newborn infant with achondrogenesis type II who died shortly after birth. Methods: We report a case of achondrogenesis type II in a live male newborn. Results: We report the case of a term male infant delivered to a 24-year-old woman with a chondrogenesis type II confirmed radiologically but died at age 5 days. Conclusion: Whenever a skeletal dysplasia in a fetal dwarfism is suspected, a proper work-up plan should be done to evaluate family history. A clinical, radiographic and histopathologic examination, should be done and confirmed by genetic study. Following evidence-based diagnosis, patients could be offered termination of pregnancy after counseling.

Eeffect of super early comprehensive rehabilitationon neurodevelopmental prognosis of high-risk infants

Objective: To observe the effect of super-early comprehensive rehabilitation intervention on neurodevelopmental prognosis of premature high-risk infants;Methods: Premature high-risk infantsmet the inclusion criteria were divided into control group (n=30) and treatment group (n=30) according to parental willingness. The control group was given routine treatment, while the treatment group was treated with comprehensive rehabilitationon the basis of the control group. The course of treatment for both groups was 10 d. The changes of body weight, milk consumption, NBNA score, GMFM score and Gesell score were observed. Results:After treatment, the body weight and milk consumption of the treatment group increased significantly compared with those before treatment (P<0.01), which was significantly better than that of the control group (P<0.01);the NBNA score of the treatment group was higher than that of the control group at 40 weeks of gestational age (P<0.05), and the abnormal rate of NBNA was lower than that of the control group (P<0.01). The GMFM scores of A-energy and B-energy areas and the five dimensions of social adaptation, big exercise, fine exercise, language and personal social interaction in the treatment group increased significantly in 1 month, 2 months and 3 months after birth,which were significantly better than those in the control group (P<0.05 or P<0.01). Conclusion: Super-early comprehensive rehabilitation can improve the physical quality of high-risk infants and promote the development of the nervous system, with remarkable effect.

Transition of Depressive Symptoms and Anxiety Symptoms According to Parity and Associations of These Symptoms with Feelings for Involvement with Newborn Infants during a 6-Month Postpartum Period

Background: Depressive symptoms and anxiety symptoms during the postpartum period affect physical health and child rearing and that these effects are important social issues. Objective: The aims of this study were to clarify the differences in the transition of depressive symptoms and anxiety symptoms according to parity during a 6-month postpartum period and to clarify the differences in associations of depressive symptoms and anxiety symptoms with feelings for involvement with newborn infants in primiparous and multiparous postpartum women. Methods: The design of this study was a longitudinal investigation. This study was conducted from February 2017 to July 2018 in Japan. By using self-administered questionnaires that included questions on psychological symptoms in a standard climacteric scale and questions on feelings for involvement with newborn infants, we collected data at 3 days postpartum, 2 weeks postpartum, one month postpartum, 3 months postpartum and 6 months postpartum. Results: Responses to all of the questionnaires were obtained from 121 (52.8%) of 229 women. The score for depressive symptoms in primiparous women was significantly higher than that in multiparous women at 3 days postpartum. Depressive symptoms and anxiety symptoms showed peaks at 2 weeks postpartum in both primiparous women and multiparous women, but depressive symptoms reoccurred from 3 months postpartum to 6 months postpartum in primiparous women and anxiety symptoms reoccurred from one month to 3 months postpartum in multiparous women. Depressive symptoms and anxiety symptoms were associated with negative feelings for involvement with newborn infants and with mother’s sleeping time. Conclusion: Changes in depressive symptoms and anxiety symptoms were different in primiparous women and multiparous women during a 6-month postpartum period. In addition, depressive symptoms and anxiety symptoms were associated with negative feelings for involvement with newborn infants and with sleeping time in postpartum women.

美国公共图书馆的婴幼儿早期阅读推广——对Born to Read项目的考察

文章通过对美国公共图书馆Born to Read(出生即阅读)婴幼儿早期阅读推广活动的产生背景、服务内容、服务特点及价值内涵进行分析,探讨美国公共图书馆开展婴幼儿早期阅读推广活动的经验和启示。Born to Read早期阅读推广具有主体多元化、关注0岁婴幼儿、以培养阅读能力和阅读兴趣为主等特点,对引导亲子阅读、保障婴幼儿阅读权利、推动婴幼儿早期阅读等具有价值。我国公共图书馆应引导家长开展0岁婴幼儿早期阅读活动,为弱势群体家庭提供早期阅读服务,推广婴幼儿早期阅读的品牌活动。

Early Intervention in the Neurodevelopment of Premature Infants during the First Six Months of Life

Objective: Measure the effects of Early Intervention ad modum Katona (EI-K) in high-risk premature infants by means of clinical, neurobehavioral, and neurophysiologic tests. Method: We used the Amiel-Tison neurologic examination, the Bayley Scale of Infant Behavior, and electroencephalography (EEG) recordings at 42 weeks of conceptional age, and after 6 months of treatment EI-K (n = 14) and compared these results with those of a group of infants without early intervention (nEI) (n = 11). Results: We found better performance of infants in EI-K than nEI group after 6 months of treatment in neurologic and behavioral examination measurements, but found no differences in EEG comparisons. Conclusion: Our data suggest significant benefit of the use of EI-K program over n-EI in the neurologic and neurobe-havior examinations of premature infants after 6 months of age.

护理干预对高危儿母婴分离初产妇社会支持、焦虑和抑郁的影响研究

目的探讨护理干预对高危儿母婴分离初产妇社会支持、焦虑和抑郁的影响。方法对88例高危儿母婴分离初产妇发放社会支持评定量表(SSRS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)。根据调查结果实施护理干预,比较实施护理干预前后其社会支持、焦虑和抑郁有无差异。结果实施护理干预前,中度焦虑57例(64.77%),重度焦虑31例(35.23%);轻度抑郁21例(23.86%),中度抑郁66例(75.00%),重度抑郁1例(1.14%)。实施护理干预后,中度焦虑12例(13.64%),轻度焦虑42例(47.73%);轻度抑郁27例(30.68%),实施护理干预前后其社会支持、焦虑和抑郁经比较,差异均有高度统计学意义(P<0.01)。结论高危儿母婴分离初产妇能获得较高的社会支持,但也存在较高水平的焦虑、抑郁。医护人员采取相应的护理干预措施,才能提高其社会支持,降低其焦虑、抑郁水平,改善情绪,提高其的生活质量。

小儿单纯性肥胖与出生体重

目的:了解出生体重与小儿单纯性肥胖的关系.方法:回顾性研究6～10岁的50例巨大儿与小儿肥胖的关系,并与100例正常儿对照,对身长、体重定期随访,父母进行问卷调查.结果:6～10岁的50例巨大儿肥胖率为24%,高于对照组(7%),并且除外遗传、喂养、代谢性疾病等因素.结论:巨大儿与小儿肥胖有关.

昆明地区正常单胎活产新生儿出生体重十年分析

目的：探讨不同孕龄正常新生儿出生体重经验百分位数,建立新生儿出生体重修匀曲线及百分位数值,获得不同孕龄正常新生儿出生体重标准以及不同孕龄男、女新生儿出生体重标准。方法：回顾分析1999年1月1日2008年12月31日在我院产科住院分娩,母亲无并发症且新生儿存活无畸形的15830例的出生体重。以4次方方程y=a＋bx＋cx2＋dx3＋ex4分别修匀新生儿实际出生体重及男婴、女婴10th、25th、50th、75th、90th百分位数曲线,分别计算修匀后出生体重。结果：（1）获得我院正常妊娠2842周单胎活产新生儿出生体重10th、25th、50th、75th、90th经验百分位数与修匀后百分位数;（2）我院10年间单胎活产中小于孕龄儿和大于孕龄儿的总体发生率分别为10.16%和10.29%;（3）在我院出生的新生儿中男婴的平均出生体重较女婴高104g。结论：（1）我院正常妊娠2842周单胎活产新生儿出生体重修匀曲线为监测评估胎儿生长发育和围产儿结局提供了重要正常参考值;（2）我院小于孕龄儿与大于孕龄儿发生率与国外报道近似;（3）男婴平均出生体重大于女婴。

新生儿接种10ug3针乙型肝炎血源疫苗5年内的...

1986～1958年,对广东3个城市1～5岁儿童乙型肝炎病毒(HBV)感染做横断面调查的基础上,给新生儿普种乙型肝炎血源疫苗。出生后24小时内接种1针,1、6个月接种第、3针,每针10μg,共接种1万余名。免疫后抽查HBsAg阳性母亲新生儿血380人份,HBsAg阴性母亲新生儿血1466人份。同时采集同期出生的未免疫的新生儿血116份作为内对照。以放射免疫法(RIA)检测HBV指在。结果,新生儿免疫后1～5年,标化抗-HBs阳转率为67.3％～79.1％。免疫后1～5年HBsAg阳性率与免前HBsAg阳性率比较,其保护率为65.8％～92.1％;与平行内对照的HBsAg阳性率比较,保护率为58.6％～88.1％。且发现HBsAg阳性母亲的新生儿,随免疫年限延长,HBsAg阳性率有降低趋向。

浙江省0～4岁儿童生存水平的研究

浙江省１７市、县０～４岁儿童连续２年死亡监测，结果：新生儿、婴儿、０～４岁儿童的平均死亡率分别为１５．４０‰、２１．７１‰、２７．３４‰。死亡儿童的年龄主要集中在新生儿期。儿童的主要死因，新生儿组主要为早产和出生窒息，婴儿组为肺炎，１～４岁组为溺水。１９９２年死于感染性疾病的儿童占死亡儿童总数的３５．８０％，１９９３年占２９．２０％，１９９２年城市儿童死于家中的占总死亡数的３５．７０％，农村占４０．２０％，１９９３年前者占４７．５０％，后者占４９．００％。在农村有超过１／４的儿童死前未得到任何医疗保健服务。提示今后儿童保健工作的重点在农村，重点防治疾病为早产、出生窒息、肺炎和溺水，因此重点保健对象为围产儿和新生儿。

肺脏超声在新生儿感染性肺炎诊断及随访中的应用价值

目的:探讨肺脏超声在新生儿感染性肺炎(IPN)诊断及随访中的应用价值。方法:收集120例疑诊为IPN的患儿,行肺脏超声和X线检查,观察2种影像学检查的特点并对比其诊断价值。另对其中102例行肺脏超声随访,观察病情变化。结果:120例,最终临床确诊阳性106例,阴性14例。肺脏超声诊断阳性102例,阴性18例;X线胸片诊断阳性91例,阴性29例。肺脏超声诊断IPN的敏感度、特异度、阴性预测值及准确率均明显高于X线检查(均P<0.05)。102例肺脏超声随访中,最终转为阴性77例;阳性25例中,胸膜线异常15例,B线9例,肺实变10例,胸腔积液1例,肺滑异常及肺搏动征6例。结论:与X线检查相比,肺脏超声对IPN的诊断更具优势,且更适合于该病的随访。

脐血T细胞IL-4基因表达及其调控

目的探讨脐血T细胞中活化T细胞核因子(NF AT)的活性与IL 4基因表达调控的关系。方法采用ELISA和RT PCR法测定受抗CD3 +PMA刺激后 ,18例脐血单个核细胞(CBMC)IL 4基因及其mRNA的表达 ;电泳迁移率转换试验(EMSA) ,测定10例CBMCNF AT的活性。22例成人外周血单个核细胞(PBMC)为对照。结果CBMC培养上清液中IL 4为(12.4±1.5)ng/L ,较PBMC明显低下〔(37.5±5.5)ng/L ,P∨0.01〕 ;CBMCIL 4mR NA的表达较PBMC明显减少 ;PBMC核蛋白内NF AT的活性较强 ,CBMC则几乎测不出NF AT的活性。结论在转录水平缺乏NF AT调控与脐血T细胞IL 4mRNA的转录水平低下有关 ;也是脐血T细胞表达IL 4水平低下的重要原因。

HBV感染者所产新生儿分型免疫研究

目的:探讨乙型肝炎(乙肝)病毒(HBV)感染孕妇分娩的新生儿在宫内从母体获得的HBV标志物和HBVDNA程度分型临床意义,旨在有效地阻断乙肝病毒的母婴传播。方法:检测HBV感染孕妇分娩的831例新生儿产后2h内静脉血中乙肝病毒标志物,根据获得的不同HBV标志物和HBVDNA状态分为5型,各型进行不同剂量的乙肝免疫球蛋白和乙肝疫苗免疫,于产后7～8个月龄时复查。分型免疫组665例,对照组166例。结果:分型免疫组7～8个月复查新生儿HBV感染情况与对照组差别有统计学意义(P<0.05)。结论:分型免疫效果优于一般免疫效果,可进一步降低HBV感染者分娩的新生儿的感染率。

性别价值观与农村出生婴儿性别比失衡

运用综合分析模型对我国农村出生性别比失衡的原因展开专门研究。认为性别选择性生育是农村出生婴儿性别比失衡的直接原因;性别价值观是农村出生婴儿性别比失衡的根本原因。但是农民的性别价值观有其现实的合法基础,调适农村出生婴儿性别比失衡的根本出路,在于改变农民的现实生活条件。

70例婴幼儿先天性肺囊腺瘤样畸形的围术期分析

目的：总结婴幼儿先天性肺囊腺瘤样畸形的诊断和手术治疗方法。方法回顾性分析自2008年8月至2013年7月于本院就诊的70例先天性肺囊腺瘤样畸形患儿临床资料，比较出生后X线检查、CT扫描检查及手术治疗结果，并进行随访。结果70例患儿中，男39例，女31例。入院时最小年龄为30 min，最大年龄为13岁。手术时期：新生儿期40例，1个月至1岁26例，1～13岁4例，平均手术年龄（4.3±0.6）个月。分型：Ⅰ型18例，Ⅱ型35例，Ⅲ型6例，混合型6例，存在大叶性肺气肿5例。4例合并其他畸形，其中2例合并纵隔囊肿；1例混合型合并骶尾部畸胎瘤；1例左侧Ⅲ型合并左侧膈疝。病变位置：1例为双侧，其余均为单侧。右侧21例，左侧18例。术前X线检查均无特异性。70例均采用开胸手术治疗，其中肺叶切除术59例，肺段切除术6例，肺叶＋肺段切除术3例；2例行右肺两肺叶切除术。术后并发症包括气胸、咳嗽、伤口感染、胸腔粘连、膈肌膨升，经治疗后痊愈。随访2个月至5年，均存活，无一例死亡，且无术后复发现象。结论出生后增强CT检查对于先天性肺囊腺瘤样畸形的确诊及手术方案的制定极其重要，建议确诊后早期手术切除。

经颅超声在诊断新生儿缺氧缺血性脑病中的价值

目的研讨新生儿缺氧缺血性脑病超声诊断的意义。方法选取200例临床诊断为缺氧缺血性脑病的新生儿,分析二维超声及大脑中动脉多普勒超声情况。结果 200例临床诊断为缺氧缺血性脑病患儿均有明显二维超声异常表现,可伴有或不伴有大脑中动脉阻力指数异常。结论二维超声对新生儿缺氧缺血性脑病具有直接诊断价值,联合彩色多普勒超声检查可进一步提高早期诊断符合率。

新生儿溶血病早期诊断和防治的研究

为探讨新生儿溶血病早期诊断和防治的有效途径，对１ ４９４ 例夫妻血型不合者进行ＩｇＧ抗Ａ（Ｂ）效价测定，对在孕期诊断母婴血型不合可能产生新生儿溶血而引起不良妊娠结局的妇女进行系统的治疗，服用作者研制的有益于降解免疫性抗体的中药来防治母婴血型不合引起的溶血病，取得良好效果。分析了免疫性抗体效价与新生儿溶血病发病率的关系。

干洗洁肤液对新生儿出生后血液和黏液清洁效果的观察

目的比较干洗洁肤液和石蜡油温水在新生儿出生后血液和黏液清洁的应用效果。方法将2016年1月至3月在本院出生的42例新生儿设为对照组;2016年4月至6月在本院出生的43例新生儿设为观察组,在新生儿出生后首次擦浴中,对照组采用石蜡油温水进行擦浴;观察组采用干洗洁肤液进行擦浴,比较两组新生儿皮肤清洁所用的时间、擦浴前后的肛温、血液和黏液清洁效果和皮肤皮疹发生情况的差异。结果观察组完成擦浴时间较对照组短;擦浴前后肛温差小于对照组,两组比较,差异均有统计学意义(P<0.001)。两组新生儿均无1例发生皮疹。两组新生儿清洁效果满意率比较,差异无统计学意义(P>0.05)。结论在新生儿出生后首次擦浴中应用干洗洁肤液,在有效清洁新生儿皮肤和毛发上的血液和黏液的同时,缩短擦浴时间,缩小新生儿体温差,并且是安全的,值得临床应用推广。

新生儿缺氧缺血性脑病血小板参数的变化及临床意义

目的探讨新生儿缺氧缺血性脑病(HIE)患儿血小板参数的变化及临床意义。方法对确诊为HIE的50例患儿进行临床分度,观察患儿急性期及恢复期血小板数(PLT)平均血小板体积(MPV)及血小板分布宽变(PDW)的变化,并与50例正常足月新生儿作为对照。结果HIE患儿急性期PLT较对照组明显降低(P<0.01),MPV及PDW明显升高(P<0.01),HIE恢复期与对照组PLT、MPV及PDW之间无明显差异(P>0.05),HIE患儿PLT随HIE病情加重而降低(P<0.01),而MPV、PDW则随病情加重而增大(P<0.01)。结论临床上动态观察HIE患儿的血小板参数,可作为判断HIE的严重程度及监测病情变化的指标之一。