出生时轻度窒息史对出生七天后新生儿排尿方式的影响

目的 探讨出生时轻度窒息对出生7 d后新生儿排尿方式的影响.方法 选取出生28 d内、无下尿路疾息的34例有轻度窒息病史的新生儿及33例无窒息史新生儿,其中窒息史组正常体重(ANW)16例,体重(2.83土0.31)kg,年龄(11.1±2.7)d;低体重(ALW)18例,体重(1.68±0.54)kg,年龄(14.5±7.6)d.无窒息史组正常体重(NANW)18例,体重(3.24±0.43)kg,年龄(11.8±2.2)d和低体重(NALW)15例,体重(1.88±0.32)kg,年龄(15±8.3)d.各组均进行12 h(9am～9 pm)自由排尿观察,记录排尿频率、每次排尿量、B超测量排尿后残余尿量、排尿时是否处于睡眠状态.结果 共记录排尿533次.ANW组排尿次数(9.5±2.7)次,明显高于NANW组(7.7±2.3)次(P＜0.05),但排尿量和残余尿量差异无统计学意义.ALW组与NALW组排尿次数、排尿量和残余尿量差异无统计学意义.ANW组排尿次数(9.5±2.7)次、排尿量(17.7±5.8)ml,明显高于ALW组(7.7±2.3)次,(13.5±6.1)ml,但残余尿量差异无统计学意义.NANW组排尿量(21.1±11.0)ml明显高于NALW组(13.1±6.2)ml(P＜0.05),但排尿次数和残余尿量差异无统计学意义.膀胱排空率和排尿时清醒百分率在ANW组和NANW组中均较高,二者差异不明显;在ALW组和NALW组中差异也不明显.结论 新生儿出生时轻度窒息史可能对正常体重儿排尿次数有明显影响;对新生儿排尿量和残余尿量影响不大.

Abstract：

Objective The aim of this study was to investigate the effect of mild asphyxiation (A) on voiding pattern of newborns. Methods A total of 67 newborns, 34 cases with mild asphyxiation and 33 cases normal, without low urinary tract pathological abnormalitiesdiseases, single birth,hospitalized in NICU were included in this study. They were divided into 4 groups: 16 cases of asphyxiation with normal weight(ANW), 18 cases of asphyxiation with low weight(ALW), 18 cases of no asphyxiation with normal weight (NANW)and 15 cases of no asphyxiation with low weight (NANW). Each group undertook 12 hours (9:00am ～9:00 pm) free voiding observation. We recorded, recording voiding time, the voiding volume, post-voiding residual urine (PVR) by B ultrasound, empty voiding and awake or sleep percentage at voiding. Results Five hundred and thirty three episodes of voiding were recorded. The voiding frequency in ANW (9. 5 ± 2. 7)times is higher than those of NANW(7. 7 ± 2. 3)times (P＜0. 05), but the voiding volume and PVR are no significant difference (P＞0. 05)between 2 groups. The voiding frequency, volume and PVR in ALW and NALW are no significant difference(P＞0.05). The voiding frequency and volume in ANW(9. 5 ± 2. 7)times, (17. 7± 5. 8)ml respectively is higher than ALW(7. 7 ± 2. 3)times, (13. 5 ± 6. 1 )ml (P＜0. 05), but PVR are no significant difference(P＞0. 05). The voiding volume in NANW (21.1 ± 11.0)ml is higher than NALW( 13. 1 ± 6. 2)ml(P＜0. 05), but the voiding frequency and PVR are no significant difference(P＞0. 05). Voiding empty and awake percentage is higher in ANW and NANW, but no significant difference; voiding empty and awake percentage in LNW and NALW are no significant difference.Conclusions Mild asphyxiation induced more voiding frequencies in ANW newborn but it has little impact on voiding volume, PVR, empty voiding percentage and awake voiding percentage in all newboms. Its mechanism is unclear.     

尿视黄醇结合蛋白和N-乙酰-β葡萄糖苷酶对早产儿肾功能的评价意义

目的 分析尿视黄醇结合蛋白(RBP)、尿N-乙酰-β葡萄糖苷酶(NAG)对评价早产儿肾功能的临床意义.方法 受选新生儿89例,分为早产儿窒息组(18例)、早产儿非窒息组(25例)和足月儿对照组(46例).观察所选对象生后48h内晨尿的RBP和NAG水平,分别与尿肌酐(Cr)相比(以RBP/Cr和NAG/Cr表示);观察血肌酐和血尿素氮,以及非窒息早产儿在生后0~48h,~96h,~168h的RBP/Cr、NAG/Cr变化情况.结果 早产儿窒息组的尿RBP/Cr水平[(0.951±0.629)g/mol]高于非窒息组[(0.389±0.281)g/mol]和足月儿对照组[(0.119±0.081)g/mol],3组间比较差异有统计学意义(P<0.05);非窒息组高于足月儿对照组(P<0.05).早产儿窒息组和非窒息组的尿NAG/Cr比值均高于足月儿对照组,差异有统计学意义(P<0.05),但前两者比较差异无统计学意义(P>0.05).3组间的血肌酐和尿素氮比较差异无统计学意义(P>0.05).早产儿非窒息组尿RBP/Cr与胎龄和日龄均无线性相关(P>0.05),而NAG/Cr与胎龄呈线性负相关(r=-0.625,P<0.05),与日龄呈正相关(P<0.05).结论 尿RBP/Cr和NAG/Cr比值有助于评估早产儿肾功能,前者对窒息损害较后者敏感,后者受胎龄影响更大.

Abstract：

Objective To investigate the clinical value of urinary retinol binding protein(RBP) and N-acetyl-β-glucosaminidase(NAG) for evaluating renal function in preterm neonate.Methods 89 neonates in our NICU were selected,divided into three groups:the asphyxial preterm group (18 cases),the no-asphxial preterm group (25 cases),and the control group (46 term infants without asphyxia).All objects were detected the urinary RBP,NAG and creatinine(Cr).The levels of RBP/Cr and NAG/Cr and blood urea nitrogen(BUN),Cr were observed within 48h after birth after birth.The fluctuations of urinary RBP/Cr and NAG/Cr in no-asphxial preterm group also were observed in 0~48h,~96h,~168h after birth respectively.Results The urinary RBP/Cr levels in asphyxial preterm group [(0.951±0.629)g/mol] were higher than those in no-asphxial preterm group[(0.389±0.281)g/mol] and the control group[(0.119±0.081)g/mol](P<0.05).The urinary RBP/Cr levels in no-asphxial preterm group were also significantly higher than those in the control group(P<0.05).The levels of urinary NAG/Cr in the asphyxial and no-asphxial preterm groups were both higher than those in the control group(P<0.05),but there was no difference betwteen the former two groups(P>0.05).The levels of serum Cr and BUN were no significant difference in the three groups(P>0.05).The urinary RBP/Cr level had non-linear correlation with either postnatal or gestational age in no-asphyxial preterm group.While the urinary NAG/Cr levels negative correlated with the gestational age(r=-0.625,P<0.05).And the correlation between the urinary NAG/Cr and postnatal age was postive(P<0.05).Conclusion The determination of urinary NAG/Cr and RBP/Cr provides a sensitive and reliable method to evaluate the renal function of neonates,especially in preterm infants.The RBP/Cr is affected by asphyxia more than NAG/Cr,which is rather correlated with gestational age.     

呼吸衰竭新生儿肾上腺皮质功能状态分析

Objective To observe the adrenal function in neonates with respiratory failure(neonatal respiratory distress syndrome,pneumonia and severe wet lung),the incidence of adrenal insufficiency,and the relationships between adrenal function and lung diseases.Methods Fifty-five cases of neonates(the preterm group of 33 cases,the term group of 22 cases)were enrolled the study.Serum cortisol values and plasma adrenocorticotropic hormone(ACTH)concentration were detected in the morning.Peak serum cortisol values were detected after 30 minutes low-dose(1 μg/1.73 m2)ACTH stimulation test.Adrenal insufficiency was defined as the peak serum cortisol values ＜ 200 μg/L.Results The mean basal serum cortisol values of the preterm group was significantly higher than that of the term group[(139.2±85.4)μg/L vs(92.1±75.0)μg/L,P=0.0407],and the mean poststimulation increase cortisol level[(122.3±56.4)μg/L vs(198.2±77.9)μg/L,P=0.000 1]and the mean ACTH level[(5.22±2.40)ng/L vs(8.66±5.41)ng/L,P =0.008 4]of the preterm group were significantly lower than that of the term group.The total incidence of adrenal insufficiency in neonates with respiratory failure was 20.0%(11/55),and the incidence of adrenal insufficiency was 21.2%(7/33)in the preterm group and 18.2%(4/22)in the term group.Neonates who had the ventilatory requirements had significantly higher incidence of adrenal insufficiency than neonates who did not have the requirements(29.4% vs 4.8%,P = 0.037).None neonate with adrenal insufficiency died.Conclusion The adrenal and the pituitary function of preterm infants are poor than term infants.The incidence of adrenal insufficiency in neonates with respiratory failure is high,especially in the neonates who have the ventilatory requirements.We do not found relationship between the mortality and adrenal insufficiency.The low-dose ACTH test could be a valuable tool in assessing the function of HPA-axis in neonates with respiratory failure.     

不同性别新生儿排尿参数的差异

目的 了解不同性别新生儿排尿参数的差异.方法 选取2010年3月至2011年3月新生儿室出生3～7d的54例早产儿(男26例,女28例)和48例足月儿(男30例,女18例)作为研究对象,连续观察12 h(9:00 Am-9:00 Pm)的自由排尿情况.记录每次排尿时间、排尿量、残余尿量(PRV)、是否伴排大便、排尿时觉醒状态等参数；并记录液体总入量.比较不同性别新生儿排尿间隔时间、最大膀胱容量、膀胱排空率(BER)等参数.结果 54例早产儿共排尿318次(男156次,女162次),其中排尿时伴排大便40次(男16次,女24次).男女早产儿PRV、BER比较差异均有统计学意义[(1.9±0.9)mL比(0.9±0.8) mL和8.3％比44.1％,P均＜0.01],但排除BER的影响后,男女早产儿PRV为(2.1±0.5)mL比(1.8±0.6) mL,差异无统计学意义；48例足月儿排尿350次(男222次,女128次),其中43次排尿时伴排大便(男32次,女11次).男女足月儿BER比较差异有统计学意义(15.3％比43.0％,P＜0.0001)；排尿伴排大便时,男女早产儿及足月儿BER比较(25.0％比41.7％,28.1％比36.4％),差异均无统计学意义(P均＞0.05).结论 和女童相比,男童新生儿更易发生排尿后膀胱残余尿现象.     

晚期早产儿的临床回顾分析

Objective To analyze if late preterm infants have more postnatal health issues than full term infants.Methods Two thousands four hundreds and ten neonatal records were reviewed from August 31st 2007 to September 1st 2008.There were totally 508 late preterm and 1 514 full term infants were admitted during that time.The incidence of hypothermia,jaundice,hypoglycemia,transient tachypnea of newborn,feeding difficulties,respiratory distress and intracranial hemorrhage was collected.Clinical prognosis was analyzed.Results The incidence of hypothermia was significantly higher in late preterm infants group as compared to full term infants group(13.4% vs 0),same as hypoglycemia(19.9% vs 3.0%,P ＜0.01),respiratory distress(38.6% vs 10.8%,P ＜ 0.01),jaundice(55.0% vs 33.0%,P ＜ 0.01),feeding difficulties (52.4% vs 14.2%,P ＜0.01),transient tachypnea of newborn(31.0% vs 13.1%,P ＜0.01)and intracranial hemorrhage(5.1% vs 2.3%,P ＜0.01).The proportion of ventilation,the usage of surfactant and nasal continuous positive airway pressure were higher in late preterm infants group and the withdrawal rate was also higher as compared to full term infants group.Conclusion Late preterm infants have more complications versus full term infants and it has potential unrecognized risk among neonatal population.     

脑室周围-脑室内出血对早产儿排尿方式的影响

目的 探讨脑室周围-脑室内出血(PIVH)对早产儿排尿方式的影响.方法 31例胎龄在32～36周适于胎龄早产儿分为两组,正常组16例,胎龄(34.2±1.1)周,日龄(11±2)d;PIVH组15例,胎龄(34.1±1.1)周,日龄(11±1)d进行连续8h自由排尿观察,记录每组早产儿在观察时间内的排尿次数、每次排尿量、残余尿量、清醒排尿及间断排尿,对两组早产儿排尿参数进行统计学分析.结果 PIVH组早产儿残余尿量显著高于正常组[(2.4±0.8)ml比(2.0±0.7)ml](P＜0.05),清醒排尿比例显著低于正常组[(35±6)％比(44±8)％](P＜0.05),PIVH组与正常组早产儿在观察时间内的排尿次数[(7.4±1.0)比(7.2±1.0)]、每次排尿量[(15.6±5.7)ml比(16.5±6.0)ml]及间断排尿比例(47％比44％)差异均无统计学意义(P＞0.05).结论 脑室周围-脑室内出血对32～36周胎龄早产儿残余尿量及排尿时意识状态具有显著影响,提示脑室周围-脑室内出血早产儿排尿方式与正常早产儿存在差异.     

Ursodeoxycholic acid prevention on cholestasis associated with total parenteral nutrition in preterm infants:a randomized trial

Background Preterm infants with long-term parenteral nutrition(PN)therapy are at risk for cholestasis associated with total parenteral nutrition(PNAC).This study examined the safety and efficacy of ursodeoxycholic acid(UDCA)in preventing PNAC in preterm infants.Our research aimed to investigate the prophylactic effect of preventive oral UDCA on PNAC in preterm infants.Methods We compared oral administration of UDCA prophylaxis with no prophylaxis in a randomized,open-label,proof-of-concept trial in preterm neonates with PN therapy.The low-birth-weight preterm infants(<1800 g)who were registered to the neonatal intensive care unit(NICU)within 24 hours after birth were randomized.The main endpoint was the weekly values of direct bilirubin(DB)of neonates during the NICU stay.Results Eventually,a total of 102 preterm neonates from January 2021 to July 2021 were enrolled in this prospective study(42 in the UDCA group and 60 in the control group).Notably,the peak serum level of DB[13.0(12-16)vs.15.2(12.5-19.6)μmol/L,P<0.05]was significantly lower in the UDCA group than that in the control group without prevention.The peak serum level of total bilirubin(101.1±34 vs.116.5±28.7μmol/L,P<0.05)was also significantly lower in the UDCA group than in the control group.Furthermore,the proportion of patients who suffered from neonatal cholestasis(0.0%vs.11.7%,P<0.05)in the UDCA group was significantly lower.Conclusion UDCA prophylaxis is beneficial in preventing PNAC in NICU infants receiving prolonged PN.     

早产儿霉菌感染分析

Objective To stuay the features of fungal infection by analyzing the preterm inpatient in our departrment retrospectively.Methods All preterm(1716 babies)inpatient in our department were ealtrolled between April 2005 to January 2008,and the assessment ofinfection was taken by elinical symptom and laratory examillation.The infected babies were give.flueonazol 6mg/(kg·d)by intravenous drip,and amphoteriein B and ganmla globulin would be used for those babies who were still sick.Results A total of 11 cases were diagnod as fungus infection.and another 26 cases of suspected fungus infecdon for a total of37 cases.accounting forthe total number of premature infants 2.16 percents;the death ofthree cases Qfinfection case-fatality rate was 8.1%.The average gestational age was(30.7±2.3)weeks,and 31 cases were less than 32 weeks,aceoundng or 83.78%.The average age ofinfecdon was(19.21±8.02)days;All babies were given two ormoire anubiodes,and used in part ortotal parenteral nutrition,and the number of babies had been conducted with invasive operation was 29.accounting for 78.38%.Conclusion Applicadon of a wide range of broad-spectnlm antibiotie,combined with a variety of antiNodes,invasive treatment in premature infants are nosoeomial fungal infection of the main faetors,the smaller gestational age,the more possibility fungal infoetion.Fluconazole is effective for fungal infection of newborns,and can be comidered as first.line drug.For premature infants,the longer-term(14 days or above)use of antifungal agents may be more appropriate treatment cycle.     

早产儿霉菌感染分析

Objective To stuay the features of fungal infection by analyzing the preterm inpatient in our departrment retrospectively.Methods All preterm(1716 babies)inpatient in our department were ealtrolled between April 2005 to January 2008,and the assessment ofinfection was taken by elinical symptom and laratory examillation.The infected babies were give.flueonazol 6mg/(kg·d)by intravenous drip,and amphoteriein B and ganmla globulin would be used for those babies who were still sick.Results A total of 11 cases were diagnod as fungus infection.and another 26 cases of suspected fungus infecdon for a total of37 cases.accounting forthe total number of premature infants 2.16 percents;the death ofthree cases Qfinfection case-fatality rate was 8.1%.The average gestational age was(30.7±2.3)weeks,and 31 cases were less than 32 weeks,aceoundng or 83.78%.The average age ofinfecdon was(19.21±8.02)days;All babies were given two ormoire anubiodes,and used in part ortotal parenteral nutrition,and the number of babies had been conducted with invasive operation was 29.accounting for 78.38%.Conclusion Applicadon of a wide range of broad-spectnlm antibiotie,combined with a variety of antiNodes,invasive treatment in premature infants are nosoeomial fungal infection of the main faetors,the smaller gestational age,the more possibility fungal infoetion.Fluconazole is effective for fungal infection of newborns,and can be comidered as first.line drug.For premature infants,the longer-term(14 days or above)use of antifungal agents may be more appropriate treatment cycle.     

Therapeutic Effect of Hyperbaric Oxygen on Experimental Piglet Hypoxic Ischemic Brain Damage

OBJECTIVE: To investigate the therapeutic effect of hyperbaric oxygen (HBO) on experimental piglet hypoxic ischemic brain damage (HIBD) and its protective mechanism by using piglets as the animal model for HIBD in newborns. METHODS: Using Levine''s method, thirty 7 day old HIBD piglets were randomly divided into the control group and the HBO treated group in which the piglets were treated with HBO for 3 hours daily. Half of the piglets in each group were sacrificed on the 1st and 7th day after hypoxic ischemic (HI) injury respectively. For these two groups, we observed (1) the mortality and neurological symptoms; (2) the velocity of blood flow in the right carotid artery (rVCA); (3) the brain weight; (4) the quantitative analysis of subdiploid cells in the brain by flow cytometry. RESULTS: The mortality and the incidence of neurological symptoms in the HBO treated group were less than those in the control group (P<0.05). The brain weights in the two groups were not different significantly (P>0.05). The rVCA in the HBO treated group was faster significantly than that in the control group when the first HBO therapy ended ［(146.8±16.8) ml/min vs (123.9±27.6) ml/min］(P<0.01). The ratio of subdiploid cells to all cells in the HBO group was less than that in the control group in the bilateral hippocampus on the 1st and 7th day after HI, and in the left frontoparietal cortex on the 1st day after HI. CONCLUSIONS: HBO therapy is effective on HIBD, and should be recommended as a short term and early treatment.     

Twelve-hour daytime observation of voiding pattern in newborns <4 weeks of age

Aim: To investigate the voiding pattern in <4‐week‐old newborns by 12‐h daytime observation periods. Methods: Twenty‐one healthy 1‐ to 28‐day‐old newborns were included (10 full term, 11 preterm). The 12‐h free voiding parameters, including voiding frequency (VF), voiding volume (VV), post‐voiding residual volumes (PRV) and status at voiding (awake/sleep), were recorded at day 1, 4, 7, 14 and 28 after birth. Results: Voiding was recorded 778 times. VF increased in the full‐term and preterm newborns between day 4 and 7, decreased in preterms between day 14 and 28, but remained higher than in the full terms. VV increased twice in full terms and once in preterms during 28 days and PRV fluctuated. In contrast, VV was higher in the full term than in the preterms at days 4, 7, 14 and 28. PRV was higher at days 4 and 28. Interrupted voiding was less frequent in the full term than in the preterms. Conclusion: Voiding pattern in the preterms differed in many ways from that of the full‐term newborns. Frequent interrupted and incomplete voiding pattern in the preterm newborns indicates a disrupted coordination of the detrusor–sphincter and a delayed maturation of the neural micturition centre.     

新生儿缺血缺氧性脑病对早产儿排尿方式的影响

目的 探讨新生儿缺血缺氧性脑病(HIE)对早产儿排尿方式的影响.方法 选取出生后4～15d确诊为新生儿缺血缺氧性脑病早产儿48例,男34例,女14例,孕(32.1±0.7)周,出生时体重(2.5±0.3)kg.选取同期出生后4～15d无缺血缺氧性脑病的33例早产儿为对照组,男22例,女11例,孕(32.3±1.4)周,出生时体重(2.4±0.5)kg.记录4h(早上8点～10点)排尿情况,包括排尿量、残余尿量、排尿次数等参数,同时记录饮奶量、液体输入量及摄入时间,液体摄入量按标准进行.结果共记录了248次排尿,其中HIE组136次,对照组112次.HIE组排尿量和排空比例分别为(14.8±8.3)ml和11.6％,均显著小于对照组[(16.5±9.2)ml和24.3％];而HIE组的排尿次数、平均残余尿量分别为(2.8±1.1)次、(1.5±1.3)ml,对照组为(3.3±1.2)次、(1.7±0.9)ml,两者之间的差异无统计学意义.结论 缺血缺氧性脑病可使早产儿出现一定程度排空和储尿障碍,表现为每次排尿量及排空比例降低.     

深度水解蛋白配方在早产儿早期喂养中的疗效观察

目的探讨深度水解蛋白配方在早产儿早期喂养中的作用。方法对2010年6月至2011年5月本院儿科新生儿病房住院的早产儿进行研究,将胎龄<34周早产儿及晚期早产儿(胎龄34～36周)分别随机分为深度水解蛋白配方喂养组(观察组)及早产儿配方喂养组(对照组),监测生长发育指标和生后2天内、7～10天、12～15天血清胃泌素和胃动素水平。结果 (1)胎龄<34周早产儿观察组胎便排净时间和达到全肠道喂养时间均较对照组缩短[(4.6±1.5)天比(6.1±2.2)天,(13.6±2.8)天比(16.1±4.0)天],喂养不耐受发生率较对照组低(55.6%比84.6%),自主排便次数较对照组多[(1.8±1.0)次/天比(1.2±0.6)次/天],生后2天内及7～10天胃动素水平(pg/ml)高于对照组[(348.7±177.7)比(245.4±96.6),(493.3±235.9)比(343.2±141.6)],12～15天胃泌素(pg/ml)水平高于对照组[(75.1±21.8)比(59.0±16.6)],差异均有统计学意义,P均<0.05。(2)晚期早产儿观察组和对照组之间各项观察指标差异均无统计学意义,P均>0.05。结论与早产儿配方相比,早期给予深度水解蛋白配方喂养对于胎龄较小的早产儿可降低喂养不耐受的发生率,缩短达到全肠道喂养的时间。     

高胆红素血症新生儿血清S-100蛋白及总胆红素与白蛋白比值的变化及意义

目的 研究高胆红素血症(高胆)新生儿血清S-100蛋白水平和总胆红素(TBC)与白蛋白(B/A)比值的变化,为早期预测胆红素脑损伤提供新的方法.方法 根据胎龄、体质量和是否符合黄疸干预标准将出生7 d内的84例新生儿分为足月高胆组、足月对照组、早产高胆组、早产对照组.检测4组血清S-100蛋白、TBC、白蛋白水平,计算B/A比值.结果 足月高胆组S-100蛋白含量[(0.36±0.14)μg/L]高于足月对照组[(0.25±0.07)μg/L],差异有显著性(P＜0.05),足月高胆组S-100蛋白含量与B/A比值呈正相关性(r=0.509,P＜0.05).早产高胆组S-100蛋白含量[(0.40±0.09)μg/L)高于早产对照组[(0.28±40.05)μg/L],差异有显著性(P＜0.05),S-100蛋白含量与B/A比值无相关性(r=0.356,P＞0.05).结论 血清S-100蛋白和B/A比值可作为早期预测胆红素神经毒性的敏感指标.     

积极的营养支持对住院期间早产儿的影响

目的 探讨生后早期积极的营养支持对住院期间早产儿的影响.方法 研究对象选择胎龄大于28周出生体重1000 g至2000 g、生后12 h内转入我院NICU、住院时间2周以上、无明显畸形且存活出院的早产儿,其中A组(2005年1月1日至2006年6月30日出生)81例,B组(2009年6月1日至2010年11月30日出生)79例.比较营养摄入、早产儿的生长速率及体重Z评分和血生化营养指标的差异.结果 B组生后第3、7天氨基酸用量明显高于A组[2.00(2.00,2.50) g/kg比1.50(1.50,2.00) g/kg,3.00(2.00,3.00) g/kg比2.00(1.80,2.60) g/kg,P均＜0.001].B组第3天奶量和总热卡摄入明显高于A组[9.41(2.66,18.74) ml/kg比14.47(4.23,30.77) ml/kg,P＜0.05,(64.87±16.04) kcal/kg比(55.62±17.68) kcal/kg,P=0.001].两组第1周后总热卡摄入相似.B组母乳强化剂使用率较前升高(62.8％比14.3％,P＜0.005).无论是出生体重1000～1499 g的早产儿,还是出生体重1500～2000 g的早产儿,B组生长速率均更快[(20.6±3.4)g/( kg·d)比(15.4±3.2)g/( kg·d),(20.3±9.1)g/(kg·d)比(14.3±4.9) g/(kg·d),P均＜0.001].A组生长迟缓的比例出院时较出生时增加(65.4％比40.7％,P＜0.05),B组差异无统计学意义.两组出生体重Z评分相似,而B组出院体重Z评分明显高于A组[(-1.24±0.79)比(-1.54±0.84),P＜0.05].出生时血清白蛋白、前白蛋白、尿素水平两组差异无统计学意义,而生后2周和出院前B组明显高于A组.结论 早产儿生后早期营养措施的改善有效促进了早产儿住院期间的生长和营养状况.     

新生儿血清瘦素水平与生长发育关系研究

目的：探讨新生儿血清瘦素与生长发育的关系。方法：采用放射免疫法检测80例新生儿静脉血和脐血瘦素水平,其中66例足月儿分为大于胎龄儿(LGA)组18例,适于胎龄儿(AGA)组32例,小于胎龄儿(SGA)组16例。采用Rohrer’s指数=出生体重(g)×100/身长(cm)~3估测新生儿营养状态。结果：早产儿血清瘦素水平明显低于足月儿[(0.66±1.03)ng/ml vs(3.59±2.16)ng/ml],P<0.01;足月儿中AGA血清瘦素水平[(3.06±0.96)ng/ml]明显低于LGA[(4.03±2.22)ng/ml],而高于SGA[(1.13±1.98)ng/ml];足月新生儿血清瘦素水平与Rohrer’s指数、新生儿体重、胎龄呈显著正相关(r=0.61,0.68,0.62,P均<0.01)。结论：新生儿体内瘦素是反映新生儿的发育和营养状态的有用指标。[中国当代儿科杂志,2003,5(1):29-30]     

Influence of gestational age and intrauterine growth on leptin concentrations in venous cord blood of human newborns

BACKGROUND: The ob gene product leptin is involved in the regulation of body weight and energy expenditure, suggesting a potential role of leptin in embryonal and fetal development and progression of pregnancy. In term infants, leptin concentrations showed a positive correlation with birth weight. We aimed at comparing leptin cord blood levels in AGA (appropriate for gestational age) to SGA (small for gestational age) preterm and term newborns. PATIENTS AND METHODS: Ninety-seven human newborns, 47 females and 50 males, 33 born at term and 64 born before 36 weeks of gestation, were studied prospectively. Leptin concentrations in venous cord blood were determined using a specific RIA (radioimmunoassay). RESULTS: In term newborns, mean gestational age (GA) was 39 weeks (wk) (+/- 0.7 wk) and mean birth weight (BW) was 3316 g (+/- 473 g); in preterm newborns (n = 64), mean GA was 30 wk (+/- 5.0 wk) and mean BW was 1398 g (+/- 505 g). Mean standard deviation score of birth weight (BW SDS) was calculated as - 0.47. Mean leptin concentrations in term newborns differed significantly from those in preterm newborns (9.21 +/- 2.63 ng/ml vs. 1.58 +/- 0.88 ng/ml; p < 0.0001). In preterm and term infants, leptin concentrations showed a linear correlation with BW (r = 0.46; p < 0.0001) and GA (r = 0.48; p < 0.0001), respectively. Leptin levels were best predicted by an exponential regression model with GA (Leptin = exp(- 4.41 + 0.14 x GA); r = 0.61; p < 0.0001). Using multivariate regression analysis (r = 0.57; p < 0.0001), we found significant influences of GA (p < 0.00001) and BW SDS (p < 0.05) on leptin levels. No difference was observed between leptin values in AGA versus SGA preterm infants. CONCLUSION: These data suggest fetal leptin levels to be primarily determined by GA and additionally modulated by growth restriction in term newborns. We found a dramatic increase at weeks 33 to 35 of gestation and no modulation by BW SDS in very preterm infants.     

Cord blood interleukin-10 levels are increased in preterm newborns

Cell-mediated immunosuppression due to interleukin (IL)-10 may contribute to normal pregnancy. By contrast, delivery is associated with a predominance of T-helper-1 (Th1) cytokines (IL-12, interferon-γ) and might be regarded as a graft rejection process. The aim of the study was to assess IL-10 and IL-12 levels in cord blood samples from newborns and their normal mothers in relation to the gestational age and type of delivery. Cord blood and serum samples were obtained from 31 term newborns (gestational age 38–42 weeks) and 40 preterm newborns (mean gestational age 32 weeks). Serum samples were obtained from 26 mothers of term newborns at birth. There were 18 term and preterm infants born by caesarean section. Measurements of IL-10 and IL-12 levels by ELISA were repeated in mothers 15 days after delivery and in 11 preterm infants (median 14 days of age). Cord blood IL-10 levels were significantly higher in preterm than in term newborns (median 17.0 versus 3.2 pg/ml, P = 0.0001), but were similar to term newborns and paired mothers (2.2 versus 1.0 pg/ml). Term and preterm newborns also showed similar cord blood IL-12 levels (median 349 versus 320 pg/ml), and these levels were significantly higher when compared to their paired mothers (median 14.5 pg/ml, P = 0.0003). Cord blood IL-10 levels showed a significant inverse correlation with gestational age (P = 0.0001). When preterm infants, at several weeks post-delivery, were compared to gestational age matched newborns, their IL-10 levels were similar (median 8.3 pg/ml) whereas IL-12 levels were clearly lower(147 pg/ml; P = 0.0007). The type of delivery (vaginal versus caesarean) did not influence cord blood IL-10 and IL-12 results. Conclusion Cord blood IL-10 levels are increased in preterm newborns and may be due to the immunosuppression occurring during pregnancy and to fetal immaturity because these levels are inversely correlated with gestational age. Received: 18 December 1998 and in revised form 12 October 1999 / Accepted: 25 October 1999     

高氧对新生大鼠肺血管发育及肺组织血管生成素1表达的影响

目的 观察持续吸入85％氧气对新生大鼠肺血管发育和肺组织血管生成素1(Ang-1)表达的影响,探讨高氧肺损伤新生大鼠的肺血管发育情况及可能的发生机制.方法 将96只新生SD大鼠在生后6h内,随机分为高氧组和空气组,高氧组将大鼠置于自制密闭氧箱,FiO2=0.85.在实验3、7、14d每组各随机取16只处死,采集标本.采用HE染色进行肺组织形态学分析,放射状肺泡计数评价肺泡化程度,肺动脉钡剂造影及肺动脉密度检测评价肺血管的发育,免疫组织化学法检测肺组织Ang-1的表达,荧光定量PCR和Western blot技术检测肺组织Ang-1的mRNA和蛋白表达水平.结果 (1)新生大鼠高氧暴露14 d,肺组织的病理表现与早产儿支气管肺发育不良(BPD)的病理表现相似.(2)高氧组7 d RAC值显著低于空气组[(10.55±0.13):(11.74 ±0.19),P＜0.05],在14d时差异更显著[(12.47±0.05):( 15.03±0.16),P＜0.01].(3)肺动脉钡剂造影显示,高氧组14 d大鼠肺动脉主干变细,肺小动脉显影减少,肺动脉密度显著低于空气组[(3.55±0.09):(6.03±0.16),P＜0.05].(4)免疫组化染色显示,高氧组7d和14 d,肺组织Ang-1的表达均显著低于同时间点空气组[ (4.27±0.34):(3.10 ±0.29),P＜0.05,(5.65±0.49)∶(3.21±0.28),P＜0.01].(5)荧光定量PCR及Western blot结果显示,高氧组7d和14 d,Ang-1的mRNA水平显著低于空气组[(0.85±0.14)∶(0.44±0.21),P＜0.05,(0.87±0.24)∶(0.24±0.05),P＜0.01],Ang-1的蛋白水平也显著低于空气组[(0.88±0.31)∶(0.41 ±0.12),P＜0.05,(0.90 ±0.29):(0.21 ±0.06),P＜0.01].结论 持续吸入高浓度氧导致新生大鼠的肺血管发育障碍,Ang-1的表达下调可能参与了早产儿BPD血管发育受阻的发生机制.