早产孕妇产前应用地塞米松的疗效分析

目的 :了解早产孕妇产前使用地塞米松对早产儿呼吸窘迫综合征 (RDS)的发生率及母儿并发症的影响 ,并探讨不同孕周使用地塞米松的疗效。方法 :对 2 88例早产孕妇及其 32 1例早产儿按产前地塞米松治疗组及对照组进行回顾性分析。结果 :产前使用地塞米松治疗 ,可使早产儿RDS发生率显著降低 ,并且能改善胎龄小于 34周早产儿Apgar评分。结论 :产前地塞米松治疗可促胎肺成熟并改善其换气功能 ,对孕周小于 34周的早产儿尤为重要 ,但不主张产前多疗程应用     

不同胎龄和出生体重早产儿的并发症及其结局探讨

目的 探讨早产儿并发症的发生和结局与胎龄、出生体重的关系.方法 对我院1995年1月至2004年12月共1882例住院早产儿临床资料进行回顾性分析.结果 早产儿死亡率3.3%(62/1882),随胎龄和出生体重的增加,死亡率下降.胎龄《32周者肺透明膜病死亡率高.早产儿并发症发生率为49.5%(932/1882),并发症主要发生于胎龄《32周或出生体重《1500 g的极低出生体重儿,以肺透明膜病、窒息和呼吸暂停为主.胎龄32周以上或出生体重》1500 g的早产儿并发症发生率降低.结论 加强孕期管理降低极低出生体重儿的发生率,对可能早产者积极应用肾上腺皮质激素促胎肺成熟、出生后采取正确有效的复苏抢救措施、预防窒息发生,及早补充肺表面活性物质,将有助于降低早产儿并发婴儿症发病率和死亡率,改善其预后.     

盐酸氨溴索与地塞米松在促胎肺成熟中的临床观察

目的:探讨产前应用盐酸氨溴索与地塞米松在促胎肺成熟中的疗效观察。方法:回顾性分析2005～2010年我院160例早产分娩的孕妇,随机分为两组,即治疗组和对照组,治疗组80例(产前28～34周应用盐酸氨溴索30mg/次,每天两次,5天),b组80例产前用地塞米松8mg/次,每天两次,连用3天,对比产后早产儿呼吸窘迫综合征的发病率。结果:盐酸氨溴索组降低早产儿呼吸窘迫综合征率明显优于地塞米松组,结论:产前应用盐酸氨溴索可以明显促胎肺成熟,降低早产儿呼吸窘迫综合征。提高早产儿存活率及生存质量。     

早产儿呼吸窘迫综合征的早期预防和治疗

早产儿呼吸窘迫综合征(neonatal respiratory distress syndrome, RDS)通常发生于胎龄较小的极低或超低出生体重儿,主要原因是肺表面活性物质合成少和肺发育不成熟。目前外源性肺表面活性物质的替代治疗是防治早产儿RDS的主要手段,此外,产前预防、产房复苏策略以及出生后早期呼吸支持治疗等综合措施也对该病的预防和治疗起着极为重要的作用。本文主要对早产儿RDS的预防及治疗措施进行讨论。     

免疫强化营养治疗对早产极低出生体重儿预后影响的分析

目的观察免疫强化营养治疗对住院早产极低出生体重儿预后的改善作用,以期进一步为早产极低出生体重儿的营养治疗提供指导。方法收集早产极低出生体重儿178例,按采取喂养方式分为观察组（母乳喂养＋母乳强化剂）57例和对照组（早产儿配方奶粉支持）121例,观察两组患儿的基本资料、住院时间、白蛋白水平、出院体质量、感染发生率、胃肠功能紊乱发生率情况。结果观察组早产儿白蛋白水平高于对照组,差异有统计学意义（P〈0．05）。两组在住院时间、出院体质量、感染发生率、胃肠功能紊乱等发生率方面差异无统计学意义（P〉0．05）。结论早期应用母乳与母乳强化剂结合的方式喂养早产极低出生体重儿,可提高体内白蛋白含量,改善营养状况,是一种有效的营养支持方式。     

早产儿临床与死亡相关因素分析

目的 :分析及探讨早产儿的临床与死亡相关因素 ,以利于降低早产儿的死亡率。方法 :对 1 990年 1月至 1 999年 1 2月收治的 1 4 5例早产儿临床资料进行分析 ,对与死亡相关的因素进行 χ2 检验。结果 :1 4 5例早产儿中死亡 2 6例 ,病死率1 7 93 % ;胎龄、出生体重及肺透明膜病、重度窒息的发生与死亡密切相关。结论 :降低早产儿特别是极低出生体重儿的发生率和病死率 ,防治肺透明膜病和重度窒息是降低围产儿死亡率的关键     

重症肺炎对极低出生体重儿血小板及凝血功能的影响

目的探讨重症炎症对极低出生体重儿血小板及凝血功能的影响。方法重症肺炎极低出生体重儿17例为重症肺炎组,选取同期住院的极低出生体重儿12例为对照组,检测凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、血小板,并进行比较。结果重症肺炎组早产儿PT、APTT、TT均高于对照组,血小板低于对照组,差异有统计学意义（P〈0.01）。结论重症肺炎患儿存在凝血系统功能紊乱,对有明显病理性凝血功能障碍者应积极进行病因治疗。     

58例早产儿的护理体会

早产儿又称未成熟儿,指胎龄不足37周的活产婴儿。早产儿各器官组织发育不成熟,生理功能低下,死亡率高,对护理质量提出了较高的要求。我科自2000年7月至2002年1月共收治早产58例。其中极低出生体重儿5例,经过精心治疗护理,治愈56例,总结如下:1临床资料58例早产儿中,男32例,女26例,平均出生体重90g小于1500g5例,胎龄27～36周。平均住院天数15天,治愈56例,1例因先天发育异常后期放弃治疗死亡,另1例极低出生体重儿并发呼吸衰竭死亡,存     

糖皮质激素对早产儿脐血中IGF-1和IGF-2表达的影响

目的:探讨产前单疗程地塞米松注射对早产儿脐血中胰岛素样生长因子1(IGF-1)和胰岛素样生长因子2(IGF-2)表达的影响.方法:将37周前早产的新生儿分为3组,研究组1为接受地塞米松治疗后1周内分娩的新生儿,共48例;研究组2为接受地塞米松治疗后1周后分娩的新生儿,共26例;对照组为未进行地塞米松治疗分娩的新生儿,共19例.出生后分别留取脐血,ELISA法检测脐血中IGF-1和IFG-2水平.结果:(1)3组早产儿的出生体重无显著差异;(2)研究组1 min和5min Apgar评分均高于对照组;(3)IGF-1和IGF-2在研究组1、研究组2以及对照组新生儿中的表达均无显著差异;(4)在3组中的适于胎龄儿中,研究组2和研究组1中IGF-2表达水平均较对照组显著降低(PG1∶G0=0.0423,PG2∶G0=0.0099),IGF-1的表达仍未见显著差异.结论:产前单疗程的地塞米松注射可以改变早产儿脐血中的IGF-2的表达,可能与糖皮质激素导致后代生长潜能变化相关.     

116例极低出生体重儿的临床管理及转归简

目的 分析极低出生体重儿并发症、治疗及预后情况,为极低出生体重儿的防治和管理提供参考.方法 收集116例极低出生体重儿临床资料,对不同胎龄的极低出生体重儿并发症、治疗及预后进行分析.结果 极低出生体重儿的并发症主要有呼吸暂停、肺炎、新生儿呼吸窘迫综合征、贫血、败血症等,治疗措施主要有吸氧治疗、抗生素治疗、输血治疗、肺表面活性物质替代治疗、氨茶碱治疗、鼻塞式持续气道正压通气治疗、全胃肠外营养、布洛芬治疗、第3代SiPAP无创呼吸机治疗、机械通气等.116例极低出生体重儿治愈出院96例（82.76%）,放弃9例（7.76%）,死亡4例（3.45%）,转院7例（6.03%）.结论 极低出生体重儿并发症多,应用肺表面活性物质及机械通气等治疗措施,存活率不断得到提高.     

220例早产原因及对母婴影响的分析

目的探讨早产发生的危险因素及对母儿的影响.方法回顾性分析220例早产的原因及对母儿的影响,并对不同孕龄组28～34周,34+～37周二组作分析比较.结果胎膜早破、臀位、双胎、妊娠高血压综合征(PIH)、妊娠合并肝内胆汁郁积症(ICP)占据早产病因前五位.不同孕周的二组早产对母亲影响无显著差别;在新生儿死亡、新生儿呼吸窘迫综合征(RDS)及低体重儿发生率有显著差别(P＜0.01).结论早产是新生儿发病和死亡的主要原因.胎龄越小、新生儿体重越轻其死亡比越高.提高早产的预防、诊断及治疗水平,对围产医学质量的提高,有着十分重要的意义.     

The corticosteroid therapy of premature rupture of the fetal membranes

Antenatal corticosteroids are now administered for the purpose of hastening maturation of the preterm infant's organs and tissues, thus reducing neonatal mortality and the incidence of respiratory distress syndrome (RDS). Our purpose was to determine the efficacy of maternal corticosteroid therapy on fetal maturation in cases with preterm premature rupture of the membranes. The rates of RDS and survival in low birth weight infants treated with corticosteroids is influenced by the duration of the premature rupture of the membranes and the duration of the corticosteroid therapy, as well as by the gestational age.     

Maternal smoking and infant respiratory distress syndrome

The relationship between maternal smoking and infant respiratory distress syndrome (RDS) was investigated among 550 premature (36 weeks or less) births delivered at the University of Washington Hospital from 1977 to 1980. Forty-five percent of the mothers were smokers. To avoid bias due to the reduced birth weight of infants of smokers, infants of smokers and nonsmokers were compared within small gestational age categories (two-week intervals) and not by birth weight categories. Infants of mothers who smoked had a reduced incidence of RDS for their gestation compared with infants of nonsmokers. The probability of RDS (adjusted for gestational age and method of delivery) was 25% for the infants of smokers versus 38% for the infants of nonsmokers (odds ratio = 0.55, P = .005), equivalent to approximately a 1.5-week acceleration in lung maturity for infants of smokers. The smoking effect was not explained by demographic differences between smokers and nonsmokers, nor by differences in the incidence of pregnancy complications between the two groups. This study adds support to the theory that adverse pregnancy conditions may lead to an acceleration in pulmonary maturity to allow earlier extrauterine adaptation.     

Short-term outcomes in low birth weight infants following antenatal exposure to betamethasone versus dexamethasone

OBJECTIVE: To assess the incidence of short-term outcomes of low birth weight infants ( 24 hours), and the number of women who had received tocolysis. No significant difference was found between the 2 groups with respect to intraventricular hemorrhage and cystic PVL frequencies. No significant differences were found in the incidence of short-term outcomes examined, despite the fact that the dexamethasone group was exposed to a statistically significantly greater number of courses than the betamethasone group. CONCLUSION: There seem to be no advantages to maternal antenatal treatment with betamethasone compared with dexamethasone in reducing the risk of PVL in low birth weight (相似文献   

The hypothalamic pituitary axis in the fetus and newborn

Glucocorticoid receptor activation in the fetal lung triggers maturation necessary for extra-uterine life. Antenatal treatment with betamethasone and dexamethasone has lowered severity of respiratory distress in very low birth weight infants, and dexamethasone given postnatally has resulted in short-term improvement in chronic lung disease. Recently, however, surfactant therapy has diminished the differential benefit of antenatal glucocorticoid treatment, and it has been difficult to show that postnatal dexamethasone therapy improves survival. Treated infants may have reduced weight gain, adrenal suppression, increased incidence of intestinal perforation and infection, and long-term developmental and metabolic problems. Recent data suggest that the fetal hypothalamic/pituitary/adrenal axis is active early and is precisely structured for an intricate sequence of specifically fetal developmental events, which may be deranged by dexamethasone therapy. We consider data suggesting that persistence of the fetal pattern in some premature infants constitutes adrenal insufficiency, and that therapy at stress replacement doses with less potent glucocorticoids might avoid side effects seen with traditional regimens.     

Repeat surfactant therapy for postsurfactant slump.

OBJECTIVE: To evaluate repeat surfactant therapy for the treatment of respiratory failure associated with postsurfactant slump in extremely low birth weight infants (ELBW) by characterizing the population of premature infants who develop postsurfactant slump and measuring their response to a secondary course of surfactant therapy. STUDY DESIGN: A retrospective analysis of a cohort of all patients admitted over a 3-year period with birth weights <1000 g (ELBW infants). Information was collected by chart review and the patients were categorized into three distinct groups for analysis. Initial surfactant only, patients who received surfactant replacement therapy only for respiratory distress syndrome (RDS); repeat surfactant, patients who received both initial surfactant replacement for RDS and repeat surfactant therapy for postsurfactant slump (defined as respiratory failure after 6 days of age), and no surfactant, patients in whom no surfactant was ever administered. A respiratory severity score (RSS) was used to measure the severity of lung disease and response to surfactant therapy. RESULTS: Over 3 years, there were 165 ELBW infants who could develop postsurfactant slump and be eligible for repeat surfactant therapy. There were 39 infants who never received any surfactant therapy estimated gestational age (EGA) 27.7 +/- 1.7, birth weight 856 +/- 109 g) either at birth or after 6 days of life. There were 126 patients treated for RDS with initial surfactant replacement therapy (EGA 25.6 +/- 1.9 weeks, birth weight 713 +/- 179 g). Out of these RDS patients, 101 improved with an initial course of surfactant therapy (EGA 26 +/- 1.8, birth weight 751 +/- 143 g), but 25 (20% of the patients with RDS) developed postsurfactant slump and received a repeat course of surfactant therapy (EGA 24.7 +/- 1.2, birth weight 647 +/- 120 g). The repeat surfactant group (postsurfactant slump) was significantly more premature and had significantly lower birth weights compared to both the initial surfactant only group and the no surfactant ever group. Logistic regression analysis revealed that lack of antenatal steroids, earlier gestational age, and the receiving of 2 or more doses of surfactant to treat the initial RDS were significantly associated with receiving repeat surfactant therapy for postsurfactant slump. Of the 25 patients treated with a repeat course of surfactant therapy more than 70% of patients (n = 18) had an improvement in their lung disease with a 15% reduction in their RSS. This improvement was significant at all time points evaluated (12, 24, and 48 h). CONCLUSION: We found that a repeat course of surfactant therapy, after day of life 6, led to a significant improvement in hypoxemic respiratory failure in premature infants with postsurfactant slump. Infants who received repeat surfactant therapy were born at a significantly earlier gestational age, had significantly smaller birth weight and had significantly worse lung disease. They were significantly less likely to have received antenatal steroids and were significantly more likely to have received multiple doses of surfactant to treat their initial RDS. A repeat course of surfactant therapy for patients with postsurfactant slump appeared beneficial in the short-term. These initial findings would support performing randomized control trials of repeat surfactant therapy for postsurfactant slump.     

The relationship between the time from rupture of the membranes to delivery and the incidence of respiratory distress syndrome in premature newborns

The records of 520 deliveries of low birth weight infants were reviewed. A significantly lower incidence of respiratory distress syndrome was seen in cases where the time interval between rupture of membranes and delivery exceeded 1 h as compared to neonates delivered within 1 h after rupture of membranes. Premature infants born after complicated pregnancies had higher rates of RDS than those delivered after uncomplicated pregnancies. It is concluded that postponement of delivery of premature infants for at least a few hours after ROM can reduce the probability of the development of a RDS.     

Dexamethasone therapy and Candida sepsis in neonates less than 1250 grams.

OBJECTIVE: To determine whether dexamethasone use increases the risk for Candida sepsis (CS) in very low birth weight premature infants (<1250 g). DESIGN: Retrospective chart review of all infants with a birth weight <1250 g, admitted to the neonatal intensive care unit of the MetroHealth Medical Center, Cleveland, Ohio between January 1, 1996 and December 31, 1999. Infant groups with (n=65) and without (n=229) CS were compared. RESULTS: Two hundred and ninety four infants with a birth weight <1250 g were identified. CS was diagnosed at a median age of 18 days, and 6 of 65 (10%) infants died directly from Candida-related complications. Candida albicans (n=30, 60%) and Candida parapsilosis (n=14, 25%) were the predominant isolates. Use of dexamethasone in infants at risk for chronic lung disease before 14 days of age (p=0.001), duration of antibiotics (p=0.001), and total duration of parenteral nutrition and intralipid (p=0.0001) were all significantly greater in infants who developed CS. Regression analysis showed that duration of antibiotics before the diagnosis of Candida infection (r(2)=0.69, p=0.0002) and duration of dexamethasone (r(2)=0.93, p=0.0002) correlated with Candida infection. Early dexamethasone use was also related to the age at diagnosis of Candida infection (r(2)=0.51, p=0.01). CONCLUSIONS: Dexamethasone therapy and prolonged duration of antibiotics are associated with Candida infection in premature infants.