低出生体重对婴幼儿听力及言语发育的影响

目的探讨低出生体重儿的听力和言语发育状况,为该类婴幼儿的听力保健提供参考。方法87例极低出生体重儿(very low birth weight infants,VLBWI)、83例超低出生体重儿(extremely low birth weight infants,ELBWI)和90例正常出生体重儿(normal birth weight infants,NBWI)为研究对象,于新生儿出生后出院前一天采用自动听性脑干反应(AABR)进行听力筛查,筛查未通过者于3月龄时进行诊断性听性脑干反应(ABR)检查,ABR异常者进行听力评估,包括耳声发射、声导抗、ASSR、行为测听等检查,同时,对三组婴幼儿采用《婴幼儿听觉及言语发育观察表》及Gesell发育量表评估随访至18月龄,比较各组结果。结果AABR筛查未通过共80例(80/260,30.77%),其中,VLBWI组未通过33例(33/87,37.93%),ELBWI组未通过39例(39/83,46.99%),NBWI组未通过8例(8/90,8.89%),3组结果比较差异有统计学意义(P<0.05);3月龄时诊断性ABR异常8例,其中,VLBWI组3例(3/87,3.45%),ELBWI组5例(5/83,6.02%),NBWI组0例,三组比较差异有统计学意义(P<0.05)。最终确诊5例患儿双耳轻度听力下降,1例双耳中度听力下降,1例左耳重度听力下降、右耳极重度听力下降,1例双耳极重度听力下降。18月龄时VLBWI组发育商(olevelopmental quotieal,DQ)为86.56±4.58,ELBWI组为85.10±4.46,NBWI组94.31±4.57,前两组低于后者,差异有统计学意义(P<0.05)。结论低出生体重是新生儿听力损失的高危因素,可能延迟其言语发育,应加强随访,早发现,早诊治。

中心静脉导管在早产低出生体重儿的应用

目的探讨外周置入中心静脉导管（PICC）在早产低出生体重儿临床应用价值。方法选用美国BD公司生产的1．9Fr型号PICC管对60例早产儿实施PICC置管，回顾性总结置管时机、置管静脉与部位、导管的应用及并发症的发生情况和处理方法。结果60例患儿中1次穿刺成功56例，1次穿刺成功率93．3％，置管长度为9．5-11．5cm，置管时间17-82天，不完全堵管5例，导管异位1例。结论PICC穿刺时机宜选择在病情平稳时，穿刺部位应首选左侧贵要静脉，实际置管长度应比体表测量值小0．5cm，良好的维护能延长置管时间并能减少并发症的发生。

Stage 3B Coats＇ disease in a premature and low-birth-weight infant

Coats＇ disease is characterized by the formation of telangiectatic and microaneurysms changes of theretinal vessels and a large amount of yellowish subretinal exudates but withont appreciable signs of retinal or vitreal traction. It usually occurs unilaterally and mainly in young males. According to the appearance of the fundns, Coats＇ disease has been classified as stage 1-5.z The age at diagnosis has been as young as 3 months m one case,