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中国新生儿科杂志

中国新生儿科杂志

CSTPCD

Chinese Journal of Neonatology
国家级医学专业学术类期刊。办刊宗旨是为广大围产新生儿医学工作者提供学术交流园地，提高广大儿科医师、特别是新生儿专业医师的学术水平，更好地进行新生儿保健、提高医疗质量，使新生儿茁壮成长。读者主要为儿科医护人员及新生儿专业医护人员。是目前全国唯一的全国性的新生儿专业的医学杂志。
  • 发文量：3220
  • 被引量：1755
  • H指数：1
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  • 万方期刊影响因子：1.75
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  • 国内刊号/CN：11-5424/R
    国际刊号/ISSN：1673-6710
  • 发行周期：双月刊
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  • 主管单位：中华人民共和国教育部
    主办单位：北京大学
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  • 邮箱：cjneo@cmaph.org
  • 地址：北京市西城区西什库大街37号院3号楼4单元地下室 100034
  • 邮编：510150
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中国新生儿科杂志 >2021年第12期

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  • 摘要：目的 探讨重度高未结合胆红素血症新生儿血、尿胱抑素C(Cys C)水平变化及换血疗法对其的影响.方法 选择2013年6月至2014年6月本院新生儿科收治的重度高未结合胆红素血症足月儿为观察组,根据治疗方法分为换血组和非换血组.选取同期我院产科分娩的健康足月儿为对照组.观察组于入院第1、4、7天检测血、尿Cys C水平,对照组于生后10天内检测上述指标,并对各组进行组间及组内比较.结果 共纳入换血组27例,非换血组22例,对照组20例.换血组和非换血组入院第1天血、尿Cys C水平均高于对照组(P＜0.05),3组尿素氮及肌酐水平比较差异无统计学意义(P＞0.05).换血组和非换血组血、尿Cys C水平均随时间变化均呈下降趋势,不同时间点比较差异有统计学意义(P＜0.05);两组间各时间点血Cys C水平差异均无统计学意义(P＞0.05);换血组第4、7天尿Cys C水平低于非换血组,差异有统计学意义(P＜0.05).结论 高未结合胆红素血症新生儿可合并肾功能损伤,换血对改善肾小管功能有一定积极意义.%Objective To study renal function of newborns with severe unconjugated hyperbilirubinemia (TBil≥342 μmol/L) using serum and urine cystatin C (Cys C) as the biomarker and the effects of exchange transfusion (ET) therapy on Cys C level.Methods From June 2013 to June 2014,term infants with severe unconjugated hyperbilirubinemia admitted to the neonatal department of our hospital were recruited as observation group and further assigned to ET group and non-ET group.Clinically well neonates born in the obstetric department of our hospital were recruited as controls.Serum and urine Cys C levels were tested on 1 d,4 d and 7 d of hospitalization in the observation group,while only once in the control group within ten days of hospitalization.The results were then compared.Results A total of 27 neonates enrolled in the ET group,22 non-ET group and 20 the control group.Serum and urine Cys C levels in the observation group on 1 d of hospitalization were significantly higher than control group (P ＜ 0.05).No significant differences of BUN and Scr levels among the three groups (P ＞ 0.05) Serum and urine Cys C in observation group decreased with time (P ＜ 0.05).Urine Cys C levels on 4d and 7d in the ET group were significantly lower than non-ET group (P ＜ 0.05),while no significant difference on the serum Cys C level between the two groups (P ＞ 0.05).Conclusions Renal injury may occur in neonates with unconjugated hyperbilirubinemia and ET may improve the renal tubular function.
  • 摘要：目的 分析新生儿气腹的临床X线表现,探讨气腹发病原因及发生部位,以期为临床治疗提供资料.方法 选择2009年1月至2015年6月本院收治的新生儿气腹患儿临床资料,回顾性分析其临床X线特点,发病原因及转归情况.结果 共纳入新生儿气腹患儿12例,发病日龄3 ～ 15天,其中胃穿孔6例,5例胃泡明显,1例胃泡较小,表现为液体量多,胃泡消失或胃泡瘪小不规则,小肠无或仅有少量气体;肠穿孔6例,2例小肠壁肌层缺损穿孔,1例小肠溃疡穿孔,1例结肠壁肌层缺损穿孔,2例坏死性肠炎导致穿孔,表现为腹腔液体较多、小肠胀气扩张明显,肠壁增厚、可见肠壁积气及肠腔内多发小气液平面.结论 新生儿气腹诊断较容易,根据不同原因导致气腹的临床X线特点,可结合临床表现对发病原因及部位做出初步诊断.
  • 摘要：目的：分析早产儿视网膜病变(ROP)发病率和危险因素随时间的变化情况。方法对2009-2011年,2012-2014年在本院新生儿重症监护病房住院的早产儿进行眼底检查,比较两时间段的 ROP 发病率及其危险因素。结果2009-2011年614例早产儿中 ROP 68例(11.1%),2012-2014年794例早产儿中 ROP 121例(15.2%),差异有统计学意义(P ＜0.05)。2009-2011年3期以上或阈值病变10例,发病率14.7%,2012-2014年12例,发病率9.9%,差异有统计学意义(P ＜0.05)。2009-2011年胎龄、出生体重、吸氧时间、机械通气为早产儿发生 ROP 的独立危险因素,应用肺表面活性物质(PS)为保护性因素；2012-2014年胎龄、机械通气、输血为早产儿发生ROP 的独立危险因素,应用 PS 为保护性因素。2012-2014年早产儿胎龄低于2009-2011年,差异有统计学意义(P ＜0.05),而用氧时间、机械通气、应用 PS、输血比例均高于2009-2011年,差异有统计学意义(P ＜0.05)。结论早产儿 ROP 发病率有升高趋势,降低早产儿发生率,缩短氧疗时间,以及减少机械通气、输血比例对预防该病发生具有重要作用,同时减少有创通气使用、降低吸氧浓度、合理 PS 替代治疗,以及重视早期筛查是预防 ROP 严重病例的重要手段。%Objective To study the incidence and risk factors of retinopathy of prematurity (ROP) in a single tertiary center during different times(Phase 1:2009 to 2011;Phase 2:2012 to 2014). Methods From 2009 to 2014, fundus examinations were performed on premature infants admitted to NICU of our hospital. The incidence and risk factors of ROP were compared between the two phases. Results During Phase 1,68 (11. 1% ) cases were diagnosed with ROP among 614 premature infants. During Phase 2, 121 (15. 2% ) cases were diagnosed with ROP among 794 premature infants. The incidences of ROP between the two phases were significantly different (P <0. 05). During Phase 1 and 2, 10 (14. 7% ) infants and 12 (9. 9% ) infants were diagnosed with Grade 3 and above or threshold ROP, respectively. The incidence of Grade 3 and above or threshold ROP between the two phases were also significantly different (P < 0. 05). Logistic analysis demonstrated that gestational age(GA), birth weight (BW), duration of oxygen therapy and mechanical ventilation(MV) were independent risk factors during hase 1, whereas GA, MV and blood transfusion were independent risk factors during Phase 2. Pulmonary surfactant (PS) was protective factor of ROP in both two groups. GA in Phase 2 was significant lower than Phase 1 (P <0. 05), while duration of oxygen therapy, incidence of MV, PS and blood transfusion were higher in Phase 2 ( P < 0. 05) . Conclusions The incidence of ROP has increased. Reducing the incidence of preterm delivery, duration of oxygen therapy, incidence of MV and blood transfusion has important role in preventing ROP. Reducing the use of MV and the oxygen concentrations, appropriate PS therapy and focusing on early ophthalmic screening are important preventing severe ROP.
  • 摘要：目的：探讨新生儿无脾综合征的临床特点,提高对该病的认识。方法收集2008年6月至2015年7月我院新生儿科收治的无脾综合征患儿资料,回顾性分析患儿的一般特征、临床表现、影像学及实验室检查、治疗及预后。结果共收治8例无脾综合征患儿。8例生后均有不同程度的发绀,5例听诊有心脏杂音,3例心尖搏动位于右侧,2例产前超声检查心脏结构异常,2例合并先天性肛门闭锁伴皮肤瘘；8例心脏彩超检查均提示复杂的先天性心脏病,3例右位心,1例心腔位置异常；8例腹部 B 超均提示无脾、水平肝,1例合并右肾缺如；1例行外周血涂片检查,见豪-周小体。明确诊断后8例均自动出院。随访发现2例存活(1例现19月龄,1例4周岁),失访2例,其余4例死于新生儿期。结论无脾综合征具有脾缺如、内脏反位、严重心血管畸形、易合并其他脏器畸形等特点；临床上若发现持续发绀、心脏杂音、心尖搏动位置异常患儿,应考虑无脾综合征可能,积极完善影像学检查,如胸部 X 线片、B 超、内脏血管造影等。%Objective To summarize the clinical characteristics of neonatal asplenia syndrome to improve the understanding of the disorder. Methods Newborns with neonatal asplenia syndrome admitted to the neonatal department of our Hospital from June 2008 to July 2015 were recruited and their gender, birth weight, gestational age, clinical manifestations, imaging features, laboratory examinations, treatments and prognosis were analyzed. Results A total of 8 newborns with asplenia syndrome were studied. All the patients presented with cyanosis at birth, 5 of them with heart murmur, 3 with apical impulse in the right ( dextrocardia) thorax and complex congenital heart diseases were found in all of them by echocardiogram examinations. 2 of them were diagnosed congenital heart diseases before birth by the fetal ultrasound. 2 cases combined with congenital imperforate anus and cutaneous fistulas. 1 case was found right renal agenesis and Howell-Jolly was seen in another case. All the 8 patientsˊ parents refused medical advices about continuing treatments and left hospital. Among them, 4 patients died in the neonatal period, 2 lost in follow-up and only 2 survived, one for 19 months and the other for 4 years. Conclusions Patients with asplenia syndrome presented absence of spleen, visceral inversion, severe cardiovascular malformations and other malformations. When the cyanosis, heart murmur and abnormal position of apical impulse were found in the newborns, asplenia syndrome should be considered and imaging examinations such as chest X-ray, ultrasound, visceral angiography and more should be ordered immediately, in order to make an early diagnosis of the disease.
  • 摘要：目的：分析重症肺炎合并呼吸衰竭新生儿的肺超声特点，为临床诊治提供参考。方法选择2014年12月至2015年8月入院并确诊为重症肺炎合并呼吸衰竭的新生儿，对患儿双肺十二区进行横向及纵向超声检查，观察患儿肺部超声改变并进行回顾性分析。结果共入选44例患儿。超声检查均有异常，主要表现为肺组织实变(41例)、出现 B 线(44例)、胸膜线异常(44例)、胸腔积液(3例)。双肺受累者32例占73%，十二区每区域均可出现病变，累及肺区数≥6区者(32例，占73%)。41例肺实变中，右后上区肺实变发生率最高(26例，占63%)。结论肺超声检查对新生儿重症肺炎合并呼吸衰竭患儿有重要的诊断价值，对肺实变部位及范围的评估可为临床治疗提供参考。
  • 摘要：Objective To study the pain controlling effects of non-pharmaceutical interventions in neonatal intensive care unit (NICU) setting. Methods Infants who received radial artery puncture were assigned into control group, non-nutritive sucking (NNS) group and NNS plus glucose (NNS + GS) group according to their admission sequences. Each group contained 20 patients. Heart rate ( HR), respiratory rate (RR) and oxygen saturation (SpO2 ) before and after the procedure were monitored using Multi-Parameter Monitor ECG. Neonatal pain was evaluated using the preterm infant pain profile (PIPP). Results Among all three groups, after radial artery puncture, HR and RR were significantly increased, and SpO2 was significantly decreased (P < 0. 01). HR, RR and SpO2 variations in NNS group and NNS + GS group were less significant than the control group (P < 0. 05), and recovered to baseline more quickly. During the radial artery puncture, PIPP scores of infants in NNS and NNS + GS group were significantly lower than the control group (P < 0. 01), with NNS + GS group lower than NNS group (P <0. 05). Conclusions HR, RR and SpO2 can be used as physiological indicators of neonatal pain. PIPP score is simple and practical to be used in NICU setting. Both NNS and NNS + GS can partially relieve neonatal pain, and NNS + GS works better.%目的：通过对新生儿重症监护病房(NICU)接受桡动脉穿刺的新生儿进行疼痛评分,观察其非药物干预的止痛效果。方法将接受桡动脉穿刺的新生儿按入院顺序随机分为3组：(1)对照组；(2)非营养性吸吮组(NNS 组)；(3)非营养性吸吮＋葡萄糖组(NNS ＋ GS 组)。应用多参数心电监护仪监测各组新生儿穿刺前后经皮血氧饱和度(SpO2)、心率和呼吸频率变化及应用新生儿疼痛评分简表(PIPP)对各组新生儿疼痛进行评分。结果各组新生儿在遭受桡动脉穿刺时的心率、呼吸频率均增快,SpO2降低(P 均＜0.01),其中 NNS 组及 NNS ＋ GS 组干预后心率、呼吸频率、SpO2的变化较对照组小(P ＜0.05),且可较快恢复至穿刺前。桡动脉穿刺后行 PIPP 评分,NNS组、NNS ＋ GS 组明显低于对照组,差异有显著统计学意义(P ＜0.01)。 NNS ＋ GS 组 PIPP 评分低于NNS 组,差异有统计学意义(P ＜0.05)。结论(1)心率、呼吸频率、SpO2可作为评价新生儿疼痛的生理指标,PIPP 疼痛评分简便、实用,可在临床推广应用。(2)非营养性吸吮及非营养性吸吮联合葡萄糖均能缓解新生儿疼痛,但非营养性吸吮联合葡萄糖止痛效果更好。
  • 摘要：Objective To study the clinical characteristics and imaging features of perinatal autosomal recessive polycystic kidney disease ( ARPKD) and a systematic review of the literature was performed to improve awareness of the disease. Methods A newborn with infantile ARPKD admitted to the neonatal department of our hospital was studied and her clinical data and imaging features retrospectively reviewed. CNKI, CBMdisc, MEDLINE and Embase databases were searched using autosomal recessive, perinatal and polycystic kidney as keywords. 9 case reports were retrieved from 2005 to 2015 and a total of 9 patients were analyzed. Results The gestational age of patients with infantile ARPKD was from 33 to 37 weeks. 6 of them were diagnosed using prenatal ultrasound and one patient was diagnosed using genetic sequencing. One of 10 infants had a family history, 4 patientsˊ mothers had abnormal pregnancy history (spontaneous abortion or miscarriage) and 7 (70. 0%) patients with respiratory failure needed mechanical ventilation. The ultrasound of all the patients showed enlarged and hyperechogenic kidneys. 9 patients died, and only one patient was alive after renal transplant. Conclusions The characteristics of perinatal APRKD are enlarged and polycystic kidneys, hepatic cysts and liver fibrosis. Infants with this disease have poor outcomes and high mortality rate. Respiratory failure and renal failure are the main causes of death in the neonatal period and early diagnosis and treatment are necessary.%目的：分析常染色体隐性遗传性多囊肾(ARPKD)中围产期婴儿型多囊肾的临床资料及影像学特点,回顾相关文献资料,提高临床医生对新生儿多囊肾的认识。方法回顾性分析我院新生儿科收治的1例围产期婴儿型 ARPKD 患儿临床资料及影像学特点,结合相关文献报道,总结该病的临床诊断思路和治疗方法,并查阅中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、MEDLINE 数据库、医学文摘数据库(Embase),以“常染色体隐形遗传、围产期、多囊肾”为关键词进行检索,检索时间范围2005-2015年,对其中9篇文献报道的9例进行文献复习。结果包括本研究在内共10例围产期婴儿型多囊肾患儿,胎龄33~37周,其中有明确家族史1例,4例患儿母亲有不良孕产史(原因不明),出现呼吸困难需机械通气治疗7例(70.0%),需联合一氧化氮(NO)治疗3例(30.0%),宫内诊断6例(60.0%),10例患儿肾脏 B 超均提示：双肾增大、回声增强。1例患儿行肾移植后存活,死亡9例(90.0%),基因检测确诊1例。结论围产期婴儿型ARPKD 患儿表现为肾脏增大,多发性囊肿、肝囊肿及肝纤维化。本病进展快、预后差、病死率高,生后早期死于肺发育不良或肾功能不全,应早期诊断、早期治疗。
  • 摘要：目的：探讨外周血清 Clara 细胞分泌蛋白(CC16)在支气管肺发育不良(BPD)早产儿早期诊断中的价值。方法选取2014年2月至2014年10月本院产科出生,生后24 h 内入住新生儿重症监护病房(NICU)、胎龄＜32周或体重＜1500 g 的早产儿作为研究对象。采集患儿出生24 h 内(0天)、3、7天血标本,用酶联免疫吸附法检测外周血清 CC16浓度。并根据患儿是否发生BPD 分为 BPD 组和非 BPD 组。结果共纳入56例患儿,其中 BPD 21例,非 BPD 35例。 BPD 组患儿出生体重、胎龄低于非 BPD 组,吸入氧浓度(FiO2)≥40%例数、24 h 内机械通气例数、机械通气时间、吸氧时间高于非 BPD 组,差异均有统计学意义(P ＜0.05)。 BPD 组患儿0天外周血清CC16水平(45.02±10.62)ng / ml,高于非 BPD 组(36.76±10.84)ng / ml,差异有统计学意义(P ＜0.05)；两组间3天及7天血清 CC16水平比较差异无统计学意义(P ＞0.05)。两组内0、3、7天3个时间点血清 CC16水平均逐渐降低(P ＜0.05)。结论 BPD 组早产儿生后24 h 内外周血清CC16水平明显升高,或可为早产儿 BPD 的发生提供早期预测依据；BPD 的发生可能与胎龄、出生体重、FiO2≥40%、24 h 内机械通气、机械通气时间、吸氧时间相关。
  • 摘要：目的：探讨 Caspase-12参与高氧所致新生小鼠胼胝体白质损伤的情况。方法新生6天的 C57BL/6小鼠共12组,随机分为高氧组及对照组。高氧组分别给予高氧24 h 或48 h 以及高氧48 h 后在小鼠日龄的10、12、15、30天(P10、P12、P15、P30)断头取脑,并与相应日龄对照组进行对比。检测不同日龄小鼠胼胝体白质髓鞘碱性蛋白(MBP)表达,检测高氧24、48 h 后小鼠胼胝体白质 Caspase-12 mRNA 及蛋白表达,TUNEL 法检测小鼠胼胝体白质细胞凋亡。结果 P10、P12高氧组 MBP 表达水平低于对照组,差异有统计学意义(P =0.004,0.016)；P15、P30两组比较,差异均无统计学意义(P ＞0.05)。高氧24、48 h 后与对照组24、48 h 比较,Caspase-12 mRNA 相对表达量分别为(1.549±0.098)比(1.080±0.101)和(1.333±0.076)比(1.022±0.089),cleaved-Caspase-12蛋白相对表达量分别为(1.582±0.010)比(0.994±0.078)和(1.370±0.095)比(0.978±0.069),高氧组均高于其对照组,差异有统计学意义(P ＜0.05)。高氧24、48 h 与对照组相比,Caspase-12抗原表达阳性细胞显著增加。 P10、P12高氧组凋亡指数高于对照组(18.742±2.503比4.587±2.353,36.184±3.655比5.351±2.678),差异有统计学意义(P ＜0.05)。结论高氧暴露可导致新生小鼠胼胝体白质损伤,可能通过提高 Caspase-12表达使胼胝体白质细胞过度凋亡,进而导致胼胝体白质损伤。%Objective To study the relationship between Caspase-12 expression and the hyperoxia-induced corpus callosum damage. Methods A total of 12 groups of C57 / BL6 mice were randomly assigned into hyperoxia group (80% O2 ) and control group (21% O2 ) at day 6 after birth (P6). The pups were sacrificed after 24 h and 48 h of hyperoxia exposure and at P10, P12, P15 and P30. Immunohistochemical ( IHC) method was used to detect the expression of myelin basic protein (MBP) in corpus callosum. Real-time PCR, Western Blot and IHC were used to detect the expression of mRNA and protein of Caspase-12 in corpus callosum. The corpus callosum apoptosis was measured using terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling ( TUNEL ) method. Results The expression of MBP in hyperoxia group were significantly lower than the control group at P10 and P12 (P = 0. 004 and 0. 016); however, no significant differences existed between the two groups at P15 and P30 (P > 0. 05). The expression of Caspase-12 mRNA after 24 h and 48 h hyperoxia exposure were significantly higher than the control group [24 h: (1. 549 ± 0. 098) vs. (1. 080 ± 0. 101); 48 h:(1. 333 ± 0. 076) vs. (1. 022 ± 0. 089); P < 0. 05]. The expression of cleaved Caspase-12 protein after 24 h and 48 h hyperoxia exposure were also significantly higher than the control group [24 h: (1. 582 ± 0. 010) vs. (0. 994 ± 0. 078); 48 h: (1. 370 ± 0. 095) vs. (0. 978 ± 0. 069); P < 0. 05] . The Caspase-12 positive cell were significantly increased after 24 h and 48 h hyperoxia exposure comparing with the control group. The apoptosis index in hyperoxia group was significantly higher than the control group at P10 and P12 [P10: (18. 742 ± 2. 503) vs. (4. 587 ± 2. 353); P12 (36. 184 ± 3. 655) vs. (5. 351 ± 2. 678); P < 0. 05]. Conclusions Hyperoxia exposure induces corpus callosum damage in newborn mice. Over-expressed Caspase-12 may induce corpus callosum cell apoptosis excessively.
  • 摘要：标引关键词应针对文章的重点内容，请尽量使用最新版美国国立医学图书馆编辑的《Index Medicus》中的医学主题词表（MeSH）内所列的词。如果最新的MeSH中还无相应的词，处理办法有：①可选用直接相关的几个关键词组配。②如果无法组配，可选用最直接的上位关键词。关键词中的缩写词应按MeSH还原为全称，如“HBsAg”应标引为乙型肝炎表面抗原。
  • 摘要：Objective To study the efficacy and safety of different doses of caffeine citrate and aminophylline treatment for apnea of prematurity. Methods Preterm infants who met the inclusive criteria were admitted to NICU of JingZhou Central Hospital from October 1st, 2013 to October 1st, 2015. They were randomly assigned to three groups. Infants assigned to high dose caffeine group were received a loading dose of 40 mg / kg daily, followed by the maintaining dose of 20 mg / kg daily. Neonates in low dose caffeine group were administered with the loading dose of 20 mg / kg daily, followed by maintaining dose of 10 mg / kg daily. Infants in the aminophylline group received a loading dose of 5 mg / kg, then with maintaining dose of 2 mg / kg every 12 hours. Caffeine citrate or aminophylline therapy were continued until the infants were free from apnea for a period of 7 days or when the gestational age of 34 weeks were reached. Extubation failure rate, frequency of apnea, duration of apnea, mechanical ventilation, as well as oxygen therapy, length of hospital stay, mortality, and the adverse effects were compared among three groups. Results 90 infants were enrolled for study, with 30 in each group. Extubation failure rate, frequency of apnea, apnea duraion and oxygen therapy duration of infants in high dose caffeine groups were all significantly lower than those of infants in low dose caffeine group and aminophylline group (P < 0. 05). The incidence of tachycardia was significantly higher in the high dose caffeine group compared to the other two groups (P < 0. 05). Whereas all these factors between low dose caffeine group and aminophylline group were of no statistical difference (P > 0. 05). Duration of mechanical ventilation and CPAP, length of hospital stay, incidence of complications (BPD, ROP, IVH, PVL, NEC ), mortality were of no significant difference among three groups ( P > 0. 05 ) . Conclusions High dose caffeine therapy for apnea of prematurity is more effective in decreasing incidence of extubation failure and apnea, as well as decreasing duration of apnea and oxygen therapy. Tachycardia is the only adverse effect of high dose caffeine therapy discovered by this study.%目的：分析不同剂量枸橼酸咖啡因和氨茶碱治疗早产儿呼吸暂停的疗效及安全性。方法选择2013年10月至2015年10月本院新生儿重症监护病房(NICU)收治的呼吸暂停早产儿,随机分为大剂量咖啡因组：负荷量40 mg /(kg.d),维持量20 mg /(kg.d),Qd；小剂量咖啡因组：负荷量20 mg/(kg.d),维持量10 mg /( kg.d),Qd；氨茶碱组：负荷量5 mg / kg,维持量2 mg / kg, Q 12 h(持续给药至呼吸暂停停止7天或纠正胎龄34周)。观察患儿拔管失败率、呼吸暂停发生率、呼吸暂停持续时间、机械通气时间、氧疗时间、住院时间、治疗过程中的不良反应、并发症发生率及死亡率。结果大剂量咖啡因组拔管失败率、呼吸暂停发生率、呼吸暂停持续时间、氧疗时间等均低于小剂量咖啡因组和氨茶碱组,心动过速发生率高于小剂量咖啡因组和氨茶碱组,差异均有统计学意义(P ＜0.05)。小剂量咖啡因组与氨茶碱组各项指标比较,差异无统计学意义(P ＞0.05)。各组机械通气时间、持续气道正压通气(CPAP)时间、住院时间及并发症发生率、死亡率等差异无统计学意义(P ＞0.05)。结论大剂量咖啡因可降低拔管失败率和呼吸暂停发生率,减少呼吸暂停持续时间和氧疗持续时间,除心动过速外,未增加其他不良反应。
  • 摘要：Objective To study the value and significance of transcutaneous oxygen saturation monitoring from different parts in early diagnosis of neonatal critical congenital heart disease. Methods The transcutaneous oxygen saturation in right upper extremities and right lower extremities of neonates born in our hospital from July 2010 to July 2015 were detected at 2 hours to 24 hours after birth. If the transcutaneous oxygen saturation ≤ 0. 95 or difference between upper and lower extremities≥0. 03, color doppler ultrasound echocardiography were done. Results There were 24 385 cases of newborns in our study. 1 680 newborns with abnormal transcutaneous oxygen saturation ( ≤0. 95 or difference between upper and lower extremities ≥0. 03) were examined with color doppler ultrasound echocardiography. 204 cases of congenital heart disease (12. 1% ) contain 9 cases of critical congenital heart disease ( 0. 5% ) were detected. The critical congenital heart disease included complete transposition of great artery ( n = 3), tetralogy of Fallot ( n = 4), artery malformation ( n = 1), and pulmonary atresia with right ventricular dysplasia ( n = 1 ) . Conclusions Transcutaneous oxygen saturation monitoring from different parts has a high value for early detection of critical congenital heart disease in the newborn. It is recommended for clinical use in grass-roots hospitals.%目的：探讨经皮血氧饱和度(SpO2)监测在新生儿危急性先天性心脏病(CHD)早期诊断中的价值及意义。方法对我院2010年7月至2015年7月出生的新生儿，于生后2~24 h 进行右上、下肢 SpO2监测。对 SpO2≤0.95和(或)上下肢差异≥0.03者行彩色多普勒超声心动图检查。结果共出生新生儿24385名，其中 SpO2异常患儿1680例，检出 CHD 患儿204例(12.1%)，危急性 CHD 患儿9例(0.5%)。9例危急性 CHD 患儿中完全性大动脉转位3例，法洛四联症4例，大动脉畸形1例，肺动脉闭锁伴右心室发育不良1例。结论经皮 SpO2监测对新生儿危急性 CHD 的早期诊断有一定价值，建议在基层医疗机构普及。
  • 摘要：Objective To study the expression of CD163 in macrophages and sCD163 level in the serum of neonatal rat model of Escherichia coli (E. coli) sepsis. Methods A total of 72 specific-pathogen-free (SPF) neonatal rats (P7) were randomly and equally assigned into experiment group and control group. E. coli was injected peritoneally and the sepsis model was established in the experiential group while normal saline (NS) was injected in the control group. Samples were collected at 2, 4, 6, 12, 24 h and 48 h after the treatment. CD163 expression in macrophages of lung and liver tissues were tested using immunohistochemical(IHC) method, and the dynamic changes of sCD163 concentration in the serum were monitored usingenzyme-linked immunosorbent assay (ELISA) method. Results In the experiment group, CD163 expression in macrophages of lung and liver were gradually decreased at eachtime point (P <0. 001). At 2 h, CD163 expression in macrophages showed no significant differences between the two groups (P >0. 05). At 4 h and later timepoints, the differences were statistically significant (P <0. 001) . Meanwhile, sCD163 in the serum increased gradually (P <0. 01). At 2 h, sCD163 in the serum showed no significant differences between the two groups (P >0. 05). At 4 h and later timepoints, the differences were statistically significant (P <0. 001). Conclusions CD163 plays an important role in sepsis.%目的：探讨 CD163在大肠埃希菌致脓毒症新生大鼠巨噬细胞及血中的表达情况。方法选择72只无特定病原体的7日龄新生大鼠，随机分为实验组和对照组各36只。实验组新生大鼠腹腔注射大肠埃希菌建立脓毒症模型；对照组新生大鼠腹腔注射生理盐水。实验后分别在第2、4、6、12、24、48 h 6个时间点取标本，使用免疫组织化学法动态监测肺脏及肝脏巨噬细胞表面CD163的表达情况，使用酶联免疫吸附法监测血中分泌型 CD163(sCD163)浓度。结果实验组新生大鼠肺脏和肝脏组织中巨噬细胞表面 CD163表达水平随着实验时间延长逐渐降低(P ＜0.001)；2 h 时实验组和对照组肝巨噬细胞表面 CD163表达水平差异无统计学意义(P ＞0.05)；4 h 及以后，实验组肝巨噬细胞表面 CD163表达水平低于对照组，差异有统计学意义(P ＜0.01)。随实验时间延长，实验组血中 sCD163水平呈逐渐上升趋势(P ＜0.001)；2 h 时对照组和实验组血中 sCD163表达水平差异无统计学意义(P ＞0.05)；4 h 及以后，实验组血中 sCD163表达水平高于对照组，差异有统计学意义(P ＜0.001)。结论 CD163在脓毒症发生发展过程中具有重要作用。
  • 摘要：目的：探讨 SP-C 基因外显子5( exon5)区域基因突变与早产儿呼吸窘迫综合征(RDS)的相关性。方法选择2013年1月至2015年1月在我院新生儿病房住院治疗、无血缘关系的汉族 RDS 早产儿(28周≤胎龄＜37周)作为病例组,选择同时间、同民族和同群体中,无血缘关系未发生 RDS 的早产儿为对照组。采集患儿静脉血,采用基因测序方法对 SP-C 基因 exon5区域基因进行测序。结果病例组60例,检测出 SP-C 基因 exon5区域 c.715G ＞ A 位点杂合突变17例(28.3%)；对照组60例,检出 SP-C 基因 exon5区域 c.715G ＞ A 位点杂合突变8例(13.3%),组间比较差异有统计学意义(χ2=4.093,P =0.043)。病例组有、无 c.715G ＞ A 位点杂合突变患儿在 RDS 临床分度、氧疗、肺表面活性物质治疗剂量、治疗结局上比较,差异均无统计学意义(P ＞0.05)。结论 SP-C 基因 exon5区域 c.715G ＞ A 位点杂合突变可能与早产儿 RDS 发生有关。%Objective To study the correlation between the surfactant protein C ( SP-C) gene mutation in exon 5 area and respiratory distress syndrome(RDS) in premature infants. Methods From January 2013 to January 2015, nonconsanguineous premature infants [28 weeks ≤gestational age(GA)< 37 weeks] of Han ethnicity with RDS admitted to our hospital were selected as the RDS group, and nonconsanguineous Han premature infants without RDS as the control group. SP-C gene exon 5 mutation were detected using the gene sequencing method. Results SP-C gene exon 5 region c. 715G > A heterozygous mutations were detected in 17 cases among 60 patients in the RDS group. The mutation frequency was 28. 3% . SP-C gene exon 5 region c. 715G > A heterozygous mutations were detected in 8 cases among 60 patients in the control group. The mutation frequency was 13. 3% . The mutation frequency in the RDS group was statistically significantly higher than the control group (χ2 = 4. 093,P =0. 043) . In RDS group, c. 715G > A heterozygous mutation had no significant correlation with RDS grades, oxygen therapy, pulmonary surfactant dose nor treatment outcome (P > 0. 05). Conclusions A correlation may be existed between SP-C gene exon 5 area c. 715G > A heterozygous mutation and RDS in premature infants.
  • 摘要：目的：比较枸橼酸咖啡因与氨茶碱治疗早产儿原发性呼吸暂停的临床疗效及其对智能发育的影响。方法选择2013年12月至2014年12月在我院珠江新城院区新生儿病房收治的原发性呼吸暂停早产儿，采用枸橼酸咖啡因注射液治疗，治愈出院，并在高危儿门诊随访者为咖啡因组；随机数字法抽取2011年12月至2013年12月同在我院珠江新城院区新生儿病房收治的原发性呼吸暂停早产儿，采用氨茶碱注射液治疗治愈出院，并在高危儿门诊规律随访者为氨茶碱组。比较两组治疗效果及患儿校正月龄6、12月时的智能发育情况。结果两组各纳入150例患儿。咖啡因组吸氧时间[(119.1±100.2) h 比(156.5±134.1) h]、无创机械通气时间[(107.4±100.2)h 比(156.7±139.8)h]、有创机械通气时间[(146.4±122.6) h 比(270.9±257.2) h]短于氨茶碱组，差异均有统计学意义(P ＜0.05)。咖啡因组与氨茶碱组比较，动脉导管未闭(24.0%比45.3%)、支气管肺发育不良(9.3%比21.3%)发生率低于氨茶碱组，差异有统计学意义( P ＜0.05)。校正月龄6月时咖啡因组大运动、精细运动、个人社交发育商均高于氨茶碱组，校正月龄12月时咖啡因组大运动、精细运动、语言、适应性发育商均高于氨茶碱组，差异均有统计学意义(P ＜0.05)。结论枸橼酸咖啡因治疗早产儿原发性呼吸暂停的疗效优于氨茶碱，并有利于促进早产儿的智能发育。%Objective To study the mental development and efficacy of caffeine citrate and aminophylline in treating primary apnea in premature infants. Methods Preterm infants who were diagnosed as primary apnea, received caffeine citrate therapy and recovered in the neonatal ward of our Hospital from December 2013 to December 2014, and followed-up in the high-risk infants outpatient clinic of our Hospital after discharge were recruited in the caffeine group. Preterm infants of aminophylline group were recruited randomly by number method. They were diagnosed as primary apnea, received aminophylline therapy and recovered in our neonatal ward from December 2011 to December 2013, and followed-up regularly in the high-risk infants outpatient clinic of our Hospital after discharge. The treatment effect and mental development at 6 and 12 months of corrected age between the two groups were compared. Results Each group included 150 cases of premature infants. The time (h) of oxygen therapy, noninvasive mechanical ventilation, and invasive mechanical ventilation in the caffeine group were all significantly shorter than that in the aminophylline group [(119. 1 ± 100. 2) vs. (156. 5 ± 134. 1), (107. 4 ± 100. 2) vs. (156. 7 ± 139. 8), (146. 4 ± 122. 6) vs. (270. 9 ± 257. 2), P < 0. 05]. The incidence of patent ductus arteriosus and bronchopulmonary dysplasia in the caffeine group were significantly lower than that in the aminophylline group (24. 0% vs. 45. 3% , 9. 3% vs. 21. 3% , P <0. 05). The scores of gross motor, fine motor and social intercourse in caffeine group were significantly higher than aminophylline group at 6 months of corrected age ( P < 0. 05). The scores of gross motor, fine motor, language and adaptability of infants at 12 months of corrected age from caffeine group were significantly higher than that of infants from aminophylline group ( P < 0. 05). Conclusions Caffeine citrate treatment of primary apnea in preterm infants is more effective than aminophylline. Caffeine citrate treatment can improve mental development of premature infants.
  • 摘要：目的：分析新生儿长期发热病因,以期为早期诊断及早期治疗提供临床依据。方法选择2004年1月至2013年12月本院新生儿中心住院,且符合新生儿长期发热纳入标准,对患儿一般情况及病因进行回顾性分析。结果共纳入患儿238例,男165例,女73例。其中肺炎196例、皮肤黏膜感染67例、败血症46例、脑膜炎/脑炎25例、新生儿坏死性小肠结肠炎24例是最常见病因,尿崩症4例是唯一非感染病因。脑膜炎/脑炎、败血症、尿崩症、免疫缺陷病及泌尿系感染患儿更易出现高热(P ＜0.05)。肺炎患儿热型更易呈稽留热型或其他特殊热型(χ2=4.581, P =0.032)。晚期出现长期发热新生儿更易罹患败血症、感染性腹泻、脑膜炎/脑炎等疾病(P ＜0.05)。结论感染性疾病是新生儿长期发热最主要病因,尿崩症是唯一非感染因素。%Objective To study the etiologies of long duration fever in neonates and to provide clinical evidence for early diagnosis and intervention. Methods From January 1st, 2004 to December 31st, 2013, data from neonates admitted to the Department of Neonatology, Childrenˊ s Hospital of Chongqing Medical University were retrospectively analyzed. Results Among 238 neonates with long duration fever, 165 cases were male and 73 female. Pneumonia(n = 196), skin / mucosa infection (n =67), sepsis (n = 46), meningitis/ encephalitis (n = 25) and neonatal necrotizing enterocolitis (n = 24) were the most common etiologies. Diabetes insipidus was the only noninfectious cause of fever in this study. The incidence of high fever in cases diagnosed with meningitis/ encephalitis, sepsis, diabetes insipidus, immunodeficiency or urinary tract infection were significantly higher than other causes (P <0. 05) . Continuous fever or other special fever types were more common in cases diagnosed with pneumonia ( χ2 = 4. 581, P = 0. 032 ) . Incidences of sepsis, infectious diarrhea or meningitis/encephalitis in late neonates were significantly higher than early neonates ( P < 0. 05 ) . Conclusions Long duration fever in neonates is most likely caused by infectious diseases and diabetes insipidus is the only noninfectious cause of neonatal fever in our study.
  • 摘要：目的：分析近8年住院新生儿败血症构成比、病原菌分布及耐药性特点,为临床治疗提供参考。方法收集2007年1月至2014年12月我院新生儿科收治的败血症患儿临床资料,回顾性分析病原菌分布及耐药情况。结果共收治败血症患儿608例,占同期住院患儿的2.62%(608/23224),其中确诊412例、临床诊断196例。前4年败血症住院构成比为2.29%(225/9805),低于后4年的2.85%(383/13419),差异有统计学意义(P ＜0.05)。共检出病原菌412株,革兰阳性菌(G ＋菌)、革兰阴性菌(G -菌)及真菌分别占62.38%、30.34%和7.28%。前4年检出病原菌155株, G ＋菌、 G -菌及真菌分别为106株(68.39%)、40株(25.81%)、9株(5.81%),其中凝固酶阴性葡萄球菌(CONS)占 G ＋菌的90.57%,肺炎克雷伯菌及大肠埃希菌分别占 G -菌的50.00%和15.00%。后4年检出病原菌257株,G ＋菌、G -菌及真菌分别为151株(58.75%)、85株(33.07%)、21株(8.17%),其中 CONS 占 G ＋菌的74.83%,肺炎克雷伯菌及大肠埃希菌分别占 G -菌的30.58%和35.29%。前、后4年 CONS 及大肠埃希菌构成比比较,差异有统计学意义(P ＜0.05)。 G ＋菌对青霉素 G、苯唑西林及大环内酯类普遍耐药,对哌拉西林他唑巴坦、喹诺酮类抗菌药物敏感性高,未发现万古霉素耐药菌株；G -菌对氨苄西林及头孢菌素类抗菌药物普遍耐药,对β-内酰胺酶抑制剂复方制剂及喹诺酮类较敏感,对碳青霉烯类抗菌药物敏感性高；真菌对康唑类普遍敏感。结论新生儿败血症病原菌以 CONS 为主,其次为肺炎克雷伯菌及大肠埃希菌；主要 G ＋菌及 G -菌对青霉素及头孢类抗菌药物普遍耐药,主要 G ＋菌对万古霉素均敏感,主要 G -菌对碳青霉烯类抗菌药物敏感性高；真菌对康唑类药物普遍敏感。%Objective To study the pathological spectrum of neonatal sepsis and antibiotic resistance of bacteria and fungi isolated from neonatal blood samples. Methods Clinical information of neonates with sepsis admitted to neonatal ward of our Hospital were retrospectively collected from January 2007 to December 2014 and analyzed. Results During the study period, a total of 23 224 infants were admitted to neonatal ward. Among them, 608 were diagnosed with sepsis (2. 62% , 608 / 23 224). Blood culture samples were positive in 412 cases, the rest (196 cases) were diagnosed according to clinical manifestations and laboratory tests. The composition ratio of sepsis during the first 4 years was significantly lower than that of the subsequent 4 years (2. 58% , 225 / 9 805 vs. 2. 85% , 383 / 13 419, P < 0. 05). Of 412 bacterial strains isolated, gram-positive bacteria, gram-negative bacteria and fungi accounted for 62. 38% , 30. 34% and 7. 28% , respectively. For the 155 strains isolated during first 4 years, the number of G + bacteria, G - bacteria and fungi were 106 strains (68. 39% ), 40 strains (25. 81% ), 9 strains ( 5. 81% ), respectively. The coagulase-negative staphylococcus ( CONS ) accounted for 90. 57% of G + strains. Klebsiella pneumoniae and Escherichia coli accounted for 50. 00%and 15. 00% of G - strains respectively. 257 strains were isolated during the subsequent 4 years, of which G + bacteria, G - bacteria and fungi accounted for 151 strains (58. 75% ), 85 strains (33. 07% ), 21 strains (8. 17% ), respectively. CONS accounted for 74. 83% of G + strains, Klebsiella pneumoniae and Escherichia coli accounted for 30. 58% and 35. 29% of G - strains. The composition ratio of CONS and Escherichia coli were significantly different between first and subsequent 4 years (P < 0. 05). G +bacteria were resistant to penicillin, oxacillin and macrolide, sensitive to piperacillin / tazobactam and quinolone. We did not identify any G + strain resistant to vancomycin. In general, G - bacteria were resistant to ampicillin and cephalosporins, sensitive to the beta lactamase inhibitor compound preparation and quinolones, and highly sensitive to carbapenems. Fungi generally were sensitive to conazoles. Conclusions Neonatal sepsis are mainly caused by CONS, Klebsiella pneumoniae and Escherichia coli also play important roles. G + bacteria and G - bacteria in general are resistant to penicillin and cephalosporins. All G + bacterial strains isolated from our cohort are sensitive to vancomycin. G - bacteria are generally sensitive to carbapenems. Fungi generally are sensitive to conazoles.

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