母亲患自身免疫性甲状腺疾病对婴儿的影响

为了解母亲患自身免疫性甲状腺疾病对婴儿的影响，通过浙江省新生儿疾病筛查网络系统，从1999年8月至2001年7月对全省71例有自身免疫性甲状腺疾病史的妊娠妇女及其婴儿进行追踪观察。结果显示，正常58例，新生儿暂时性高TSH血症10例，先天性甲状腺功能减低症2例，婴儿甲状腺功能亢进症1例。3例异常者，其母亲妊娠期甲状腺功能均不正常。提示母亲患自身免疫性甲状腺疾病对婴儿的影响主要决定于母亲妊娠期甲状腺功能状态；因而加强对患自身免疫性甲状腺疾病的育龄妇女及其孩子的管理非常重要。     

窒息和出生低体重新生儿甲状腺功能状态探讨

３８例窒息新生儿和１１例低出生体重新生儿、并与同期健康新生儿５４例作为对照进行血清甲状腺激素测定。三组的各项检测结果在性别上无差异；在窒秘组中血清Ｔ３、Ｔ４、值则明显低于正常对照组，ＴＳＨ值窒息组与正常组无差异；低体重儿组血清Ｔ３、Ｔ４、ＴＳＨ均明显低于正常对照组，提示：窒息缺氧、酸中毒时甲状腺分泌反应低下；低体重我因提前分娩或宫内发育不良使垂体－甲状腺轴功能不成熟、血清Ｔ３、Ｔ４和ＴＳＨ均可出现     

糖尿病母亲的新生儿出生体重和疾病发生率的比较

目的　了解糖尿病母亲的发病孕期对其新生儿出生体重和疾病发生率的影响。方法　应用回顾性对照分析的方法 ,对 9例孕早期发病的糖尿病母亲的新生儿 (NODM) (1组 ) ,32例孕中期发病的NODM (2组 ) ,32例孕晚期发病的NODM(3组 )进行比较。结果　三组出生体重和胎盘重量上无显著差异 ,且出生体重与胎盘重量之间存在正相关 (r >r0 .0 5　　P <0 .0 1 )。新生儿疾病发生率 1组高于 2组和 3组 ,1组与 3组间差异有显著性意义 (χ2 =3 .88　P <0 .0 5)。结论　在现有的干预措施下 ,不同孕期发病的NODM在出生体重上无差别 ,但孕母患病越早、其新生儿的围生期疾病发生率越高     

孕母患自身免疫性甲状腺疾病对婴儿智能发育影响的多因素分析

目的探讨孕母患自身免疫性甲状腺疾病对婴儿智能发育的影响因素。方法对77例孕母患自身免疫性甲状腺疾病的婴儿采用Gesell发育量表进行跟踪调查,采用病例对照研究的方法对可能影响婴儿应人能、应物能、粗动作能、细动作能发育的因素进行非条件Logistic回归分析。结果(1)孕母患自身免疫性甲状腺疾病的婴儿其应人能、应物能、粗动作能、细动作能发育落后,与健康孕母的婴儿比较差异有统计学意义(P<0.01),慢性淋巴细胞性甲状腺炎孕母的婴儿其细动作能、应物能的发育比Graves病孕母的婴儿差,二者比较差异有统计学意义(P<0.05)。(2)经多因素非条件Logistic回归分析筛选出婴儿体内的抗过氧化物酶抗体、母体内的促甲状腺激素受体抗体与婴儿的应物能、应人能,粗动作能有关,而母体内抗过氧化物酶抗体、孕期母亲甲状腺功能则与细动作能有关(P<0.05)。结论孕母患自身免疫性甲状腺疾病对婴儿的智能发育有影响。     

低出生体重儿并甲状腺功能低下早期治疗及随访

目的 探讨低出生体重儿（LBWI）并甲状腺功能低下（甲低）患儿早期治疗及预后。方法 随机将LBWI并甲低96例分为甲状腺片治疗组50例及非治疗组46例；在生后纠正年龄12－30个月时随访，采用婴幼儿发育量表（全国常模）进行智力发育指数（MDI）及运动发育指数（PDI）的测定，同时测量身体生长值。结果 治疗组及非治疗组身高、体重及头围行政管理落后各为5例（10％）及10例（21．7％），MDI及PDI低下各5例（10％）和12例（26．1％）；两组身高、体重及头围落后发生率无差异（P＞0．05）；两组MDI和PDI及其低下发生率比较有明显差异（P＜0．005或P＜0．05）。结论 短期甲状腺片早期治疗有助于改善LBWI并甲低患儿的预后。     

低出生体重对肾脏功能的影响

新生儿由于早产或宫内发育迟缓而造成的低出生体重将会对肾脏的发育产生不良影响。在新生儿期，低出生体重的近期不良效应表现为一过性水电解质失衡，易出现急性肾功能不全。在成人期，低出生体重的远期不良效应与慢性肾脏疾病进展相关。流行病学研究提示低出生体重可能通过影响血压、微血管结构功能、内分泌水平及肾单位的发育而参与了慢性肾脏疾病的发生和进展。     

不同出生体重对新生儿静息能量消耗影响研究

为观察不同出生体重对新生儿静息能量消耗的影响,采用音接能量测定（DeltatracTM II,芬兰产）成功检测180例健康新生儿,其中男孩95例,女孩85例,按出生体重分成3组,即＜3000g组,3000g-3999g组,和≥4000g组,结果显示：体重＜3000g的新生儿能量消耗与体重在3000g-3999g之间的新生儿能量消耗无差异,而体重≥4000g的新生儿能量消耗与他们差异均有显著性,提示出生体重≥4000g的新生儿静息能量消耗明显低于体重在4000g以下的新生儿。     

双胎新生儿与出生体重及胎龄的关系

100例双胎新生儿中,早产52例,低出生体重69例。患病情况以新生儿硬肿症为多,其次是感染性疾病。死亡15例,死亡率15％。其中病死率最高的是RDS,肺出血和颅内出血。指出由于双胎新生儿早产率高,低出生体重发生率高,机体免疫力低下,各器官功能不成熟,易患各种疾病、严重威胁双胎新生儿的生命,对双胎新生儿进行重点监护,早期预防并发症,可望降低其病死率。     

低出生体重新生儿神经行为测定及评价

目的了解低出生体重新生儿的神经行为能力。方法对119例出生体重<2500g 的新生儿分别于出生后2～3d和26～28d时进行新生儿神经行为测定 ,并与142例正常儿进行比较。结果在出生后2～3d和出生后26～28d时 ,低出生体重儿的行为能力、被动肌力、主动肌力、原始反射、一般状态及总评分与对照组比较,差别均有显著性 (P均<0.001) ;出生后26～28d时低出生体重儿的行为能力、被动肌力、主动肌力、原始反射、一般状态及总评分与出生后2～3d比较,差异均有显著性 (P均<0.001)。结论低出生体重儿的新生儿神经行为能力比正常儿弱 ,随着日龄的增加 ,其神经行为能力不断增强。     

产妇高龄对新生儿出生缺陷及生后并发症的影响

目的探讨产妇高龄对新生儿出生缺陷及生后并发症的影响。方法 2014年1月至2015年12月在云南省第一人民医院入住的1 109例新生儿中,选取年龄≥35岁的高龄产妇所产新生儿536例作为高龄组,随机选取同期分娩的年龄35岁的适龄产妇所产新生儿573例作为适龄组。比较两组产妇妊娠期合并症、胎儿宫内窘迫及新生儿出生缺陷、生后并发症等情况;通过单因素logistic回归分析产妇高龄对新生儿围产期合并症的影响。结果高龄组产妇剖宫产率、多胎次、妊娠期糖尿病、妊高症、试管婴儿、胎儿宫内窘迫发生率均显著高于适龄组,差异均有统计学意义(P0.01);高龄组新生儿唇腭裂发生率高于适龄组,骨骼畸形率低于适龄组(P0.05)。高龄是造成胎儿宫内窘迫(OR=2.27;95%CI:1.33~3.88;P=0.003)、新生儿复苏(OR=1.66;95%CI:1.19~2.31;P=0.003)和颅内出血(OR=2.70;95%CI:1.21~6.04;P=0.02)的危险因素。结论高龄产妇妊娠期合并症发生率高于适龄产妇,其所产新生儿唇腭裂发生率高于适龄产妇;产妇高龄会增加胎儿宫内窘迫、新生儿复苏抢救和颅内出血的风险。     

Effect of birth asphyxia on serum calcium levels in neonates

Serum calcium and phosphorus levels were measured at birth, 6 hours, 24 hours, and on 5th day of life in 35 neonates with birth asphyxia (one-minute Apgar score of 6 or less), and in 37 neonates without asphyxia (one-minute Apgar score of 7 or more). Infants were divided into three groups: FT-AGA (n=30, asphyxia=15), FT-IUGR (n=20, asphyxia=10) and PT-AGA (n=22, asphyxia=10). Asphyxiated infants-FT-AGA as well as FT-IUGR-had significantly lower serum calcium levels than control infants during each of the time period studied. In PT-AGA infants with asphyxia, the serum calcium was significantly low only on 5th day of life. Lack of calcium intake, and hyperphosphatemia were identified as possible risk factors for low serum calcium in asphyxiated infants. No change in serum calcium levels was found in bicarbonatetreated asphyxiated infants in comparison to those who did not receive sodium bicarbonate. In view of the high incidence of low serum calcium in asphyxiated infants, serial monitoring of serum calcium levels is recommended in these infants.     

窒息新生儿甲状腺功能测定及临床意义

目的　 探讨新生儿窒息后血清甲状腺激素的变化及其临床意义。 方法 　对 80例新生儿窒息患儿和 40例正常新生儿 ,用放射免疫法测定血中甲状腺激素 ,即游离T3 、T4(FT3 、FT4)及TSH值 ,并进行对比观察。 结果 　窒息新生儿FT3 值显著低于正常对照组 (t=3 90 9,P <0 0 0 1) ,且以重度窒息组更甚 ,FT4及TSH两组无明显差异 (P >0 0 5 )。 结论 　新生儿窒息后可出现甲状腺功能低下 ,窒息患儿血中FT3 显著低于正常新生儿 ,重度窒息患儿血中FT3 更低 ,提示甲状腺激素降低的程度与病情严重程度呈正相关。血清甲状腺激素水平测定可作为窒息新生儿病情判断 ,疗效观察及预后估计的一项参考指标。     

Association between birth weight and birth arm circumference of neonates in rural Egypt

In many developing countries including Egypt, the birth weights (BWs) of most babies go unrecorded because they are born at home. Since it is difficult to record BW in the community setting, birth arm circumference (BAC) has been used as a valid proxy for BW to identify at risk babies with low birth weight (LBW). However, the validity of BAC as an indicator of the actual BW has not been assessed fully. We did this study among neonates in rural Bilbeis, Egypt, to examine the association between BW and BAC, to assess whether BAC can serve as an indicator of the actual BW, and to determine the validity indices of 3 different cut-off levels of BAC as indicators of LBW. During 1987–88, the weights and arm circumference of 148 neonates were recorded within 2 weeks of birth. We observed a strong and highly significant positive linear correlation between BW and BAC (r=0.6188, p=0.0001). The BAC cut-off value of <9.5 cm was associated with the optimal combination of sensitivity (50%) and specificity (88.4%) as an indicator of LBW. In linear regression analysis BAC was found to be a significant (p=0.00001) predictor of BW. The means of the model predicted weights for males, females, and both genders together were identical to the corresponding means of the observed values. In contingency table analysis, for 78 (52.7%) of the 148 neonates studied the observed and predicted BW categories were identical. For another 59 (39.9%) neonates, agreement with the next lower or higher BW category was observed. We feel that BAC can be used as an indicator of the actual BW in settings where routine recording of BW is currently not practicable.     

Risk factors of primary thyroid dysfunction in early infants born to mothers with autoimmune thyroid disease

AIM: To assess whether the state of maternal thyroid function and the pattern of thyroid alterations during gestation would affect the infants' thyroid function and to evaluate the risk factors affecting early infants' thyroid function by means of multiple logistic regression. METHODS: In a cross-sectional study, 78 neonates born to mothers with Graves disease or Hashimoto thyroiditis were examined and followed clinically and biochemically. Neonates born to healthy mothers during the same period were set as controls. Tests of thyroid function, antithyroid peroxidase antibody (TPOAb), antithyroglobulin antibody (TGAb), anti-TSH receptor antibody (TRAb) and antithyroid-stimulating antibody (TSAb) were performed both in early infants and their mothers. All possible maternal and/or infantile risk factors for thyroid dysfunction during early infancy were analysed by means of multiple-factor logistical regression. RESULTS: The overall prevalence of underlying subtle thyroid abnormalities in these 78 infants was 52.6%, which was significantly higher than that witnessed among infants from healthy mothers (5.4 per thousand, p<0.01). By using multiple logistic regression analysis, the state of maternal thyroid function in gestation, the type of autoimmune thyroid disease during pregnancy and the level of TRAb in the newborn were significantly correlated with the early infants' thyroid dysfunction. CONCLUSION: Maternal autoimmune thyroid disease during pregnancy will affect infant thyroid function. Therefore, appropriate management of maternal autoimmune thyroid disease throughout pregnancy is essential in the prevention of undesirable neonatal outcomes.     

系统性红斑狼疮产妇孕期体重增长对新生儿出生体重影响的巢式病例对照研究

目的 考察系统性红斑狼疮(SLE)产妇孕期体重增长(GWG)对新生儿出生体重的影响。方法 以上海交通大学医学院附属仁济医院(我院)产科分娩的SLE产妇及其新生儿为研究对象。采集产妇一般情况(年龄、身高、孕前体重、教育程度、GWG、既往疾病史、分娩孕周)、第一次产检指标(收缩压、舒张压、胆固醇、甘油三酯、空腹血糖)、新生儿性别、Apgar评分及出生体重。根据年龄和教育程度1:3匹配健康产妇及其新生儿作为对照。产妇GWG与新生儿出生体重关系采用一般线性回归分析。结果 共纳入SLE产妇45例和健康产妇135例。所有产妇平均年龄(29.0±3.0)岁,新生儿平均出生体重(3 198.8±501.8)g。SLE组GWG显著低于对照组,(12.4±5.5)kg vs (15.0±5.1)kg, P=0.004,GWG 低于适宜体重增长的比例显著高于对照组(37.8% vs 16.3%, P<0.01)。将所有产妇按GWG进行四分位分组,结果显示随着GWG增长,新生儿出生体重明显增加。与GWG处于最低四分位的SLE产妇相比,处于最高四分位的产妇的新生儿出生体重多(246.4±234.1)g,差异无统计学意义。结论 SLE产妇GWG明显低于正常产妇,随着GWG的增加,新生儿出生体重有增加趋势。     

Effect of birth weight, maternal education and prenatal smoking on offspring intelligence at school age

To examine the combined effect of birth weight, mothers’ education and prenatal smoking on psychometrically measured intelligence at school age 1,822 children born in 1992-1999 and attending the first six grades from 45 schools representing all of the fifteen Estonian counties with information on birth weight, gestational age and mother's age, marital status, education, parity and smoking in pregnancy, and intelligence tests were studied. The scores of Raven's Standard Progressive Matrices were related to the birth weight: in the normal range of birth weight (≥ 2500 g) every 500 g increase in birth weight was accompanied by around 0.7-point increase in IQ scores. A strong association between birth weight and IQ remained even if gestational age and mother's age, marital status, education, place of residence, parity and smoking during pregnancy have been taken into account. Maternal prenatal smoking was accompanied by a 3.3-point deficit in children's intellectual abilities. Marriage and mother's education had an independent positive correlation with offspring intelligence. We concluded that the statistical effect of birth weight, maternal education and smoking in pregnancy on offspring's IQ scores was remarkable and remained even if other factors have been taken into account.     

Vitamin D intake during pregnancy: Association with maternal characteristics and infant birth weight

Background

Vitamin D insufficiency is beginning to be recognized as a public health problem. It is plausible that some portion of the lower Vitamin D levels which characterize minority populations is related to diet.

Aims

We examined and described total Vitamin D intake during pregnancy from the mean of three 24-hour recalls plus use of dietary supplements.

Study design

Prospective cohort.

Subjects

2251 low income, minority gravidae from Camden, New Jersey, USA.

Outcome measures

Differences in total Vitamin D intake by maternal ethnicity. BMI and other factors (age, parity) and associations of total Vitamin D intake with gestation duration and birth weight adjusted for gestation.

Results and conclusions

Total Vitamin D intake was significantly lower for minority gravidae (African American, and Hispanic, mainly Puerto Rican), for parous women, and for women with pregravid BMIs consistent with obesity or being overweight. After control for energy, other nutrients, and other potential confounding variables, total intake of Vitamin D was associated with increased infant birth weight; gravidae below the current adequate intake (< 5 μg/day or 200 IU) had infants with significantly lower birth weights (p < 0.05). Additional intake of Vitamin D may be of importance since higher intake is associated with increased birth weight in a population at risk of adverse pregnancy outcomes.     

出生体重与慢性肾脏病关联性的系统评价和Meta分析

目的系统评价出生体重与慢性肾脏病风险的关联性。方法电子检索The Cochrane图书馆、MEDLINE、OVID数据库、Springer数据库、维普数据库、万方数据库和中国知网,检索时间为建库截止至2016年6月,纳入以BW为暴露因素、评估生后发生CKD或其相关结局变量的观察性研究,文献需对CKD或其他结局变量的诊断标准做出描述并能提取CKD或其相关结局变量的OR值及其95%CI,语种限定为中、英文;排除文献:研究对象生后12个月内肾功能衰竭和死亡、有宫内感染病史或患先天遗传性疾病,母孕期暴露因素有潜在毒性物质接触史,研究人群包括成人和儿童但无法单独提取儿童数据。由两位作者独立检索关于出生体重(BW)对CKD风险相关的观察性研究,病例对照和队列研究采用NOS量表、横断面研究采用AHRQ量表对文献进行偏倚风险评价,提取OR值和95%CI。应用Stata 12.0对文献进行Meta分析,均选用Der SimonianLaird随机效应模型分析。结果 10篇观察性研究纳入本文分析,其中病例对照4篇(3篇8分,1篇7分),队列研究4篇(3篇7分,1篇8分),横断面研究2篇(1篇7分,1篇8分)。慢性肾脏病风险低出生体重(LBW)较正常BW人群高约80%,OR=1.80,95%CI:1.37~2.35;其中蛋白尿、终末期肾脏病和低e GFR在LBW较正常BW人群的OR及其95%CI分别为2.58(1.49~4.46)、1.42(1.22~1.66)和1.87(1.19~2.94)。终末期肾脏病、低e GFR在高出生体重(HBW)中较正常BW人群的OR及其95%CI分别为1.19(0.94~1.49)和1.09(0.93~1.27),HBW与生后慢性肾脏病之间无明显关联;LBW人群作为慢性肾脏病的高危人群仅见于男性人群中,OR=1.83,95%CI:1.10~3.05)。Egger回归提示纳入文献不存在发表偏倚。结论男性LBW是CKD的高危因素,HBW与生后CKD的发生无明显关联。