新生儿窒息母儿血浆催乳素水平变化的研究(英文)

目的：目前发现催乳素(PRL)与缺氧缺血性脑病(HIE)的严重程度密切相关，PRL与新生儿窒息的关系较少报道，该文探讨窒息新生儿母儿血浆催乳素(PRL)水平变化与相关性及其意义。方法：采用放射免疫分析法对25例围产期窒息新生儿(窒息组，其中轻度窒息14例，重度窒息11例)及20例正 Ｐ律?对照组)母血、脐血及新生儿血浆PRL水平进行测定并进行动态观察。结果：窒息组母血、脐血及新生儿血浆PRL水平［(362.5±127.1)，(984.6±262.3)，(386.3±216.2)μg/L］均显著高于对照组［(96.4±26.2), (92.3±18.4), (68.7±7.27)μg/L］(P均0.05)。结论：围产期窒息时新生儿血浆、脐血及母血PRL水平显著增高，血浆PRL水平可作为判断新生儿窒息程度的一项参考指标。     

新生儿胃肠道生长发育及胃肠激素的研究

为探讨新生儿胃肠动力学的特点,应用放免分析方法对36例重度窒息新生儿、22例轻度窒息新生儿和24例正常新生儿的血清胃泌素、血浆胃动素进行了检测和对比研究.结果显示重度窒息组血清胃泌素和血浆胃动素水平明显低于正常对照组(t值分别为8.325、3.575,P<0.01);轻度窒息组胃泌素和血浆胃动素与正常对照组相比无显著差异,(t值分别为1.264、0.041、P>0.05).因此,新生儿重度窒息(在围产期)可导致血清胃泌素和血浆胃动素水平明显降低,从而导致喂养不耐受,易合并肠道并发症.     

胎儿窘迫孕妇血及脐血一氧化氮

为了解胎儿窘迫时孕妇血及脐血中一氧化氮(NO)水平的变化及其与胎儿窘迫及新生儿窒息的关系.对42例胎儿窘迫孕妇(胎儿窘迫组)及36例正常晚孕妇女(对照组)母血、脐血中NO代谢产物亚硝酸/硝酸基(NO-2/NO-3)进行测定;以血气分析仪测定脐血pH值.结果显示胎儿窘迫组母血及脐血NO水平均较对照组明显下降(P均＜0.01),胎儿窘迫组与对照组相比脐血pH下降(P＜0.01);新生儿Apgar评分下降(P＜0.01);新生儿一分钟Apar评分≤7分的例数所占比例上升(P＜0.01).母血NO≤2.66umol/L,脐血NO≤2.03umol/L时新生儿窒息率明显上升(P＜0.01),与脐血pH值＜7.20时相比,两者新生儿窒息率无显著差异(P＞0.05).新生儿脐血pH值与脐血NO水平呈高度正相关(r=0.74,P＜0.01).结论母血及脐血NO下降与胎儿窘迫有一定关系;NO水平下降在预测新生儿窒息时与脐血pH值有同等价值;监测母血及脐血NO水平可作为诊断胎儿窘迫的指标之一.指导临床及时处理胎儿窘迫,为减少新生儿窒息的发生起很重要的作用.     

围产期超氧化物歧化酶的测定

本文采用pyrogallol-NBT比色法测定63例产前母血、脐血及35例新生儿末梢血SOD活力。结果:母血SOD活力明显高于脐血;窒息组母血、脐血SOD活力明显低于顺产组;出生后,正常组新生儿末梢血SOD活力明显增高,而窒息组无明显增高。提示:自由基参与分娩的病理生理过程。新生儿窒息时,母血、脐血及新生儿末梢血SOD活力降低。这为应用自由基清除剂预防和治疗新生儿窒息提供了理论依据。     

脐血促红细胞生成素、内皮素与围生儿缺氧的关系

目的探讨脐血促红细胞生成素(EPO)、内皮素(ET-1)与围生期胎儿、新生儿缺氧的关系。方法采用ELISA法检测新出生54例高危儿脐血EPO与ET-1水平,并与正常顺产健康非高危儿进行比较。结果脐血EPO水平羊水Ⅲ度浑浊组及先兆子痫/子痫组分别与对照组相比明显升高(t1=4.842 P1<0.01;t2=3.680 P2<0.01)。新生儿窒息组ET-1水平显著高于对照组(t=9.189 P<0.01)。先兆子痫或子痫组脐动脉血的pH与正常顺产组脐动脉血比较差异显著(t=-9.107 P<0.01)。先兆子痫或子痫组EPO水平与pH水平呈显著负相关(r=-0.984 P<0.001)。新生儿窒息组脐血ET-1水平与5 mim Apgar评分呈显著负相关(r=-0.946,P<0.001)。结论脐血EPO在提示围生儿亚急性、慢性缺氧,ET-1在提示围生儿急性缺氧方面具有重要的作用     

围产期谷胱甘肽过氧化物酶的测定

本文测定54例产前母血、脐血及27例新生儿末梢血GSH-px活力,结果母血GSH-px活力明显高于脐血;出生后新生儿末梢血GSH-px活力明显增高,而窒息组新生儿末梢血酶活力仍低于脐血水平,与顺产组末梢血比较,差异有极显著意义(P<0.001)。提示自由基参与窒息的病理生理过程,为用自由基清除剂预防和治疗新生儿窒息提供了理论依据。     

新生儿缺氧缺血性脑病血浆神经肽Y与催乳素水平变化的研究

目的 探讨新生儿缺氧缺血性脑病(HIE)血浆神经肽Y(NPY)与催乳素(PRL)水平的变化。方法应用放射免疫分析法测定32例新生儿HIE及12例对照组血浆NPY与PRL水平变化。结果 HIE组急性期血浆NPY与PRL水平均显著高于对照组(P均<0.01),中、重度HIE急性期血浆NPY与PRL水平均显著高于恢复期(P均<0.01);HIE惊厥组急性期血浆NPY与PRL水平显著高于非惊厥组(P均<0.01)。病程中NPY与PRL水平变化呈正相关。结论 血浆NPY和PRL水平与HIE脑损伤及其程度密切相关,并与HIE惊厥发作有关,可作为判断新生儿脑损伤程度及惊厥是否发作的指标之一。     

母血及脐血IGF-1、C肽和IGFBP-1质量浓度与新生儿出生体重的关系

目的探讨母体和脐血血清胰岛素样生长因子-1(IGF-1)、C肽(CP)及胰岛素样生长因子结合蛋白-1(IGFBP-1)质量浓度对新生儿出生体重的影响.方法选择12例大于胎龄儿(LGA)、15例适于胎龄儿(AGA)和20例小于胎龄儿(SGA),分为3组,分别抽取脐血和其母外周静脉血,分离血清.采用ELISA法测定IGF-1、CP和IGFBP-1.结果 (1)LGA组脐血IGF-1、CP、IGFBP-1质量浓度(ng·mL-1)分别为59.76±14.50,1.36±0.58,53.78±19.67;AGA组为33.65±12.74,0.90±0.45,104.79±27.60;SGA组为17.05±8.10,0.52±0.22,169.21±55.30;3组间差异有显著性意义(P<0.01).(2)LGA组新生儿母亲血清IGF-1、CP、IGFBP-1质量浓度(ng·mL-1)分别为267.15±99.43,2.84±0.93,158.50±51.25;AGA组母亲分别为237.34±105.56,2.71±0.72,170.78±63.69;SGA组分别为229.53±94.17,2.59±0.83,188.90±74.04;3组间比较差异均无显著性.但同组患儿母血IGF-1、CP及IGFBP-1均显著高于脐血水平(除SGA组母血与脐血IGFBP-1差异无显著性外).(3)新生儿出生体重与脐血IGF-1、CP呈正相关(r分别为0.814、0.654,P<0.01);与IGFBP-1呈负相关(r=-0.759,P<0.01);而与母血IGF-1、CP及IGFBP-1无明显相关性.结论脐血IGF-1、CP及IGFBP-1与胎儿生长关系密切.营养物质-胰岛素-胰岛素样生长因子轴是调节胎儿宫内生长发育的重要因素.     

新生儿缺氧缺血性脑病与血胰岛素样生长因子-1,生长抑素水平的关系

目的观察胰岛素样生长因子-1(IGF-1)、生长抑素(SS)在窒息新生儿脐血中的变化及缺氧缺血性脑病(HIE)各期血液中的变化,探讨IGF-1、SS在HIE发病机制中的作用.方法用放射免疫分析法(RIA)测定新生儿脐血窒息组、正常对照组、HIE极期、恢复期血浆SS水平;用免疫放射分析(IRMA)测定上述标本血清IGF-1水平.结果新生儿窒息时脐血IGF-1、SS均比正常脐血对照组显著下降(t=8.01P＜0.01T=583.0P＜0.01);HIE极期、恢复期与正常对照组IGF-1水平有显著差异(F=78.7P＜0.01),HIE极期IGF-1、SS下降,恢复期IGF-1、SS升高.结论窒息新生儿脐血中IGF-1、SS均下降,提示两者均可能参与新生儿窒息的病理生理过程;HIE极期IGF-1、SS下降,恢复期IGF-1、SS升高,提示IGF-1、SS在HIE的发病机制中可能具有重要作用.     

胎儿窘迫孕妇血及脐血一氧化氮及其与新生儿窒息的相关研究

为了解胎儿窘迫时孕妇血及脐血中一氧化氮 (NO)水平的变化及其与胎儿窘迫及新生儿窒息的关系。对 42例胎儿窘迫孕妇 (胎儿窘迫组 )及 36例正常晚孕妇女 (对照组 )母血、脐血中 NO代谢产物亚硝酸 /硝酸基 (NO- 2 / NO- 3 )进行测定 ;以血气分析仪测定脐血 p H值。结果显示　胎儿窘迫组母血及脐血 NO水平均较对照组明显下降 (P均 <0 .0 1 ) ,胎儿窘迫组与对照组相比 :脐血 p H下降 (P<0 .0 1 ) ;新生儿Apgar评分下降 (P<0 .0 1 ) ;新生儿一分钟 Apgar评分≤ 7分的例数所占比例上升(P<0 .0 1 )。母血 NO≤ 2 .6 6 umol/ L,脐血 NO≤ 2 .0 3umol/ L时新生儿窒息率明显上升 (P<0 .0 1 ) ,与脐血 p H值 <7.2 0时相比 ,两者新生儿窒息率无显著差异 (P>0 .0 5 )。新生儿脐血 p H值与脐血 NO水平呈高度正相关 (r=0 .74,P<0 .0 1 )。结论　母血及脐血 NO下降与胎儿窘迫有一定关系 ;NO水平下降在预测新生儿窒息时与脐血 p H值有同等价值 ;监测母血及脐血 NO水平可作为诊断胎儿窘迫的指标之一。指导临床及时处理胎儿窘迫 ,为减少新生儿窒息的发生起很重要的作用。     

Effect of the adaptation of the food of the hospitalized child on the cover of the nutritional needs]

AIMS: Denutrition remains a major concern in hospitalized children. Daily experience suggests that the meals proposed by hospital dietetic service, although well-balanced and in accordance with the recommendations, may be poorly accepted and consumed by children. The aims of this study were to assess the effect of modification of foods offer on energy intakes as well as nutriments and minerals and trace elements in hospitalized children. PATIENTS AND METHODS: During a 1-month period, 25 consecutive children (range 4-17 years; 13 girls), hospitalized in our pediatric department were included in the study (reasons for hospitalisation comprised: medical reasons [n=7], orthopedic problem [n=16] or surgery [n=2]). They had no restricted diet and received the usual pediatric hospital feeding according to the French recommended dietary allowances (RDA) (D1). They were compared to 21 children--matched for age, sex, nutritional status and pathology, hospitalized during the following 1-month period--who received a modified diet (D2), elaborated by dieticians according to the child's preference and excluded or limited food usually nonconsumed by the children. Food consumption was prospectively measured for 24h by analysis of the nonconsumed foods, as well as browsing and extra food brought by the family. Analysis of energy, carbohydrate, lipid, protein, iron and calcium intake was made using Bilnut 3 software (Nutrisoft, France). RESULTS: D2 covered 119+/-37% of the median energy needs versus 89+/-37% for D1 (p<0.05). The median energy needs were more often reached with D2 as compared to D1 (62% versus 32%, p<0.05). Protein intake was high in both groups, more importantly with D2 (266+/-111% of RDA versus 193+/-77% with D1, p<0.05). We observed no difference between the 2 diets in regards of fat/carbohydrate balance and iron intake. Calcium intake was increased with the adapted diet: 68+/-26% of RDA with D2 versus 49+/-26% with D1 (p<0.01). CONCLUSION: Adapting food offers to preference influences food and caloric intakes in hospitalized children. This could be an efficient strategy to prevent acute undernutrition in hospital.     

Transition to the neonatal nurse practitioner role: making the change from the side to the head of the bed

Role transition is never easy, but is complicated by the experienced neonatal nurse's frustration with reverting to a student role and becoming a novice practitioner, sometimes after years of developing a reputation as an expert nurse. This article discusses this transition, focusing on the skills needed to move successfully from nurse to nurse practitioner. Common to all advanced practice transitions are stages similar to those Benner identifies in her novice-to-expert theory of nursing practice. Feelings of frustration and inadequacy are common during the first year as an NNP. Studies focusing on role transition and role development suggest that a strong nursing identity is important for success in the NNP practice environment. Strategies to enhance the transition are discussed.