新生儿急性肾功能衰竭的早期诊断

新生儿急性肾功能衰竭 (ＡＲＦ)是由各种病因致肾功能减退甚至停滞 (肾小球滤过及肾小管排泄障碍 )伴或不伴尿量变化的一种综合征[1～ 4] 。发病率随统计方法 (前瞻、回顾 )应用标准不一、结果不全一致。一、目前ＡＲＦ应用标准[5]1.出生后 4 8ｈ无尿、或出生后少尿 (每小时 <1ｍｌ/ｋｇ)或无尿 (每小时 <0 .5ｍｌ/ｋｇ)。2 .氮质血症 :血清肌酐 (Ｓｃｒ)≥ 88～ 14 2 μｍｏｌ/Ｌ ,血尿素氮 (ＢＵＮ)≥ 7.5～ 11ｍｍｏｌ/Ｌ。或Ｓｃｒ每日增加≥ 4 4 μｍｏｌ/Ｌ ;ＢＵＮ每日增加≥ 3.5 7ｍｍｏｌ/Ｌ。除上述指标外 ,常伴电解质紊乱及其他…     

新生儿意外损伤218例

意外损伤已成为当代发达国家威胁儿童健康及生命的主要问题，成为儿童死亡的主要原因，也是导致疾患及残疾的主要因素之一。儿童意外损伤问题越来越受到人们关注。但对新生儿意外伤害报告较少，现就我院5年间诊治的新生儿意外损伤218例报告如下。     

新生儿先天性鼻后孔闭锁5例临床分析

新生儿先天性鼻后孔闭锁 (Congenitalatresia of the posterior naves)是鼻腔狭窄或闭锁使气流与外界不通的一种疾患。最早由Roedever1 75 5年加以描述 ,Dtto1 892年在尸检中证实 ,分为单侧、双侧 ,完全性、部分性 ,骨性、膜性或混合性多种类型 ,其中 80 %～ 90 %为骨性 ,并以完全性闭锁居多。其临床特点是新生儿出现阵发性紫绀或窒息 ,即闭口时呼吸困难 ,乃至紫绀、窒息 ,张口啼哭时症状消退或缓解 ,进乳时症状加重。由于缺乏鼻呼吸功能 ,困此本病患儿常因肺炎而夭折。本文对本院新生儿病房 1 990年 1月～ 1 999年 8月共收治的 5例先天性…     

足月新生儿生后呻吟紫绀

第一次查房主治医师、主任医师查房,入院后第1天。 住院医师汇报病史。患儿,男,14h,主因“呻吟14h,面色紫绀2h”入院。患儿生后即有呻吟,无紫绀,产院未予处置,生后12h呻吟无好转并出现面部轻度紫绀转来我院。患儿系第2胎第1产,孕38周剖宫产,羊水早破7h,出生体重4500g。     

新生儿重度硬肿症并急性肾功能衰竭诊治体会

我科于96年1月～3月间收治了4例新生儿重度硬肿症并急性肾功能衰竭（ARF）。现就诊治体会报告如下：临床资料一、一般资料一般情况：男3例，女1例。平均日龄4天。早产儿2例，足月儿2例。入院平均体重2250g。硬肿原因：窒息2例、感染及寒冷损伤2例。平均出现硬肿时间3．8天。硬肿面积均达80～90％，其中2例皮肤硬肿呈木僵状，肤色苍白。另2例皮肤呈暗红色。2例体温不升，2例体温正常。2例于入院第3天发现少尿。1例于重度硬肿后12小时出现无尿。1例于硬肿前即有少尿。2例合并肺炎、败血症。2例并消化道出血。实验室检直：BUN均＞9mmol／L，…     

新生儿生后结扎脐带的时间

在19世纪50年代中期之前,“早期结扎”意味着生后1 min内结扎脐带,而“晚期结扎”意味着出生5 min后结扎脐带.瑞典、美国、加拿大对新生儿生后血容量的改变进行了一系列实验研究,结果发现,健康足月儿在最初的几次呼吸后已获得90％以上的血容量.基于上述发现以及当时缺少专门的指南,从出生到结扎脐带之间的时间开始缩短.大多数情况下,维持婴儿于胎盘水平或以下,并于生后15 ～20 s内结扎脐带.尽管许多关于早产儿和足月儿的随机对照实验评估了生后立即结扎和延迟结扎脐带（生后30～60 s）的利弊,但是,结扎脐带的最佳时机尚不确定,且一直存在争议.     

局部脑组织氧饱和度监测在新生儿生后早期的应用价值

局部脑组织氧饱和度(regional cerebral oxygenation,rSO2)监测的应用范围很广,不受温度和搏动血流影响,是一种监测脑组织氧合状态的新方式,但目前在新生儿方面的研究较少.本文针对不同病理状况对新生儿生后早期rSO2的影响进行综述,阐明新生儿rSO2监测的重要临床意义并对其未来应用范围进行展望.     

新生儿休克与胃肠功能衰竭30例

休克等危重症可由不同原因所致，若继续发展，则导致多系统器官功能衰竭，合并有胃肠衰竭者更为严重，本文通过病例分析，进一步认识危重病症的发展过程。临床资料一、对象与方法选择我院新生儿病房危重新生儿30例．新生儿休克诊断参照新生儿循环功能不全评分表。男21例，女9例     

新生儿意外伤害五年回顾

随着计划生育国策的落实，优生优育已被人们广泛关注，但在基层尤其是经济欠发达地区，新生儿意外伤害还屡有发生，直接影响到新生儿的健康，并成为新生儿疾患、残疾及死亡的主要原因之一。现将我院近5年收治的75例新生儿意外伤害予以回顾性分析，并讨论防止新生儿意外伤害的方法。     

新生儿急性肾功能衰竭39例

本文对３９例新生儿急性肾功能衰竭进行分析，认为有窒息，硬肿症等原发病因存在时，应检测肾功能以早期发现ＡＲＦ，Ｃｃｒ，ＲＦＩ是鉴别新生儿肾前性和肾性ＡＲＦ的指标。     

Unsupervised breastfeeding was related to sudden unexpected postnatal collapse during early skin-to-skin contact in cerebral palsy cases

Aim

This study aimed to identify the clinical features of infants who were healthy at birth, but developed sudden unexpected collapse and were then diagnosed with cerebral palsy before 5 years of age.

Methods

We retrospectively analysed 1182 records from the no-fault Japan Obstetric Compensation System for Cerebral Palsy database up to 2016. This identified 45 subjects (3.8%) who were subsequently diagnosed with severe cerebral palsy due to sudden unexpected postnatal collapse (SUPC). They were all healthy at birth, based on the criteria of five-minute Apgar scores of seven or more, with normal umbilical cord blood gases and no need for neonatal resuscitation within five minutes of birth.

Results

The median birth weight of the 45 subjects (26 males) was 2770 g (range 2006-3695 g). Of these, 10 developed SUPC during early skin-to-skin contact (SSC). Medical personnel were not present in all 10 cases: nine were being breastfed at the time and eight of the mothers did not notice their infant's abnormal condition until medical staff alerted them.

Conclusion

This national study of children with cerebral palsy who appeared healthy at birth found that unsupervised breastfeeding was a common factor in cases of SUPC during early SSC.

     

Sudden unexpected infant death in Auckland: a retrospective case review

Aim: To review autopsy reports of all SUDI deaths in the Auckland region, New Zealand, from October 2000 to December 2009. Methods: Information on all SUDI cases from 2000 to 2009 was extracted from autopsy and police reports from the National Forensic Pathology Service at Auckland Hospital. Results: Of the 332 post‐mortems in this period, 221 were classified as SUDI. Of these, 83% were Māori or Pacific infants. The median age at death was 11 weeks and 11% occurred in 7‐ to 28‐day‐olds. At the time of death, 64% overall were bedsharing; this was more common in 7–28 day olds (92%). Bedsharing infants were significantly younger at death than non‐bedsharing infants (p = 0.008). Where sleep position was known, 57% were placed in non‐supine at the last sleep. There was no evidence of diagnostic shift and the prevalence of bedsharing did not change over the decade. Conclusions: Bedsharing was associated with a high proportion of SUDI cases, especially in the youngest infants, and non‐supine sleep positions were common. There is a need to enhance SUDI prevention messages and consider innovative ways of promoting safe sleeping environment and supine sleep position in Māori and Pacific communities.     

Unexpected collapse of healthy newborn infants: risk factors,supervision and hypothermia treatment

Aim

To determine the occurrence and risk factors of sudden unexpected postnatal collapse (SUPC) in presumably healthy newborn infants.

Methods

All live‐born infants during a 30‐month period, in five major delivery wards in Stockholm, were screened, and possible cases of SUPC thoroughly investigated. Infants were ≥35 weeks of gestation, had an Apgar score >8 at 10 min and collapsed within 24 h after birth. Maternal, infant, event characteristics and outcome data were collected.

Results

Twenty‐six cases of SUPC were found among 68 364 live‐born infants, an incidence of 38/100 000 live births. Sixteen of these cases of SUPC required resuscitation with ventilation >1 min, and 14 of these remained unexplained (21/100 000). Fifteen of the 26 children were found in a prone position, during skin‐to‐skin contact, 18 were primipara, and 13 occurred during unsupervised breastfeeding at <2 h of age. Three cases occurred during smart cellular phone use by the mother. Five developed hypoxic–ischaemic encephalopathy (HIE) grade 2, and 4 underwent hypothermia treatment. Twenty‐five infants had a favourable neurological outcome.

Conclusion

SUPC in apparent healthy babies is associated with initial, unsupervised breastfeeding, prone position, primiparity and distractions. Guidelines outlining the appropriate monitoring of newborns and safe early skin‐to‐skin contact should be implemented.

     

Sudden unexpected death in epilepsy in children

Sudden unexpected death in epilepsy (SUPEP) is the commonest cause of seizure‐related mortality in people with intractable epilepsy. The incidence of SUDEP varies in different epilepsy populations, with lower rates in population‐based studies, higher in referral populations and clinical trials of adjunct drugs for complex partial epilepsy, and highest rates for surgical series. Certain risk factors for SUDEP have been identified, with seizure activity being one of the strongest risk factor for SUDEP. Suspected underlying mechanisms include cardiac dysrhythmias, seizure‐related apnoea and postictal respiratory arrest. Prevention of SUDEP has centred on seizure control, and SUDEP incidence has been reduced by epilepsy surgery in some studies. In this review, we present epidemiological data, and discuss risk factors and underlying pathophysiological mechanisms that are associated with SUDEP in children.     

Sudden unexpected death in infancy: A historical perspective

Epidemiological, developmental and pathological research over the last 40 years has done much to unravel the enigma of sudden unexpected death in infancy (SUDI) and sudden infant death syndrome (SIDS) that has afflicted the human condition for millennia. Modifications in infant care practices based on the avoidance of risk factors identified from a consistent epidemiological profile across time and multiple locations have resulted in dramatic reductions in the incidence of SUDI and SIDS in particular. The definition of SIDS (or unexplained SUDI) has been continually refined allowing enhanced multidisciplinary research, results of which can be more reliably compared between investigators. These latter expanded definitions mandating death scene investigations, evaluation of the circumstances of death and more comprehensive autopsies including additional ancillary testing have illuminated the importance of life‐threatening sleep environments. The triple‐risk hypothesis for SIDS has been increasingly validated and formulates an inextricable relationship between an infant's state of development, underlying pathological vulnerability and an unsafe sleep environment for sudden infant death to occur. Today, the major risk factors for SUDI are maternal smoking and bed sharing, and the challenge is to implement effective strategies that will reduce the exposure to such risks as was done with prone sleeping position. The challenges ahead include development of clinical methods and/or laboratory testing that will accurately identify which infants are at particularly high risk of SIDS but also means by which their deaths can be prevented.     

Very early neonatal apparent life-threatening events and sudden unexpected deaths: incidence and risk factors

Aim: To evaluate the incidence of neonatal apparent life‐threatening events and sudden unexpected deaths during the first 2 h after birth. Methods: A prospective study was conducted over a 1‐year period in all the maternities of the French region of Provence, Alpes, Côte d'Azur, which included all presumably healthy full‐term neonates. Twenty‐three previously published cases were also studied in order to identify possible risk factors. Results: Sixty two thousand nine hundred sixty‐eight live births were recorded over the study period. There were two neonatal apparent life‐threatening events and no neonatal sudden unexpected death. The overall rate of neonatal apparent life‐threatening events and unexpected deaths was thus 0.032 per 1000 live births. Three potential risk factors were identified: skin‐to‐skin contact, primiparous mother and mother and baby alone in the delivery room. Conclusion: A neonatal apparent life‐threatening event or sudden unexpected death during the first 2 h of life is very uncommon. Skin‐to‐skin contact between mother and infant left alone in the delivery room may constitute the main risk situation. This must not lead to reconsider skin‐to‐skin contact that has been proven beneficial and seems per se almost safe, but must induce maternity staff to pay particular attention to a skin‐to skin infant when left alone with its mother.