NBNA评分用于足月小样儿的神经发育评价

目的 了解足月小样儿神经行为特点,比较不同类型足月小样儿神经行为的差异,并探讨其原因.方法 对本院新生儿病房2008年至2012年收治的148例足月小样儿在生后第7天、14天、28天进行新生儿行为神经测定(NBNA)评分,并比较匀称型、非匀称型及混合型足月小样儿的NBNA评分情况.结果足月小样儿NBNA评分低于正常足月新生儿,差异有统计学意义(P＜0.05).三种类型的足月小样儿NBNA评分高低排序为非匀称型＞匀称型＞混合型,组间两两进行比较差异有统计学意义(P＜0.05).结论 足月小样儿的神经活动低于正常新生儿水平,三种类型的足月小样儿神经发育情况为非匀称型高于匀称型高于混合型.     

影响新生儿神经行为测定相关因素的研究

探讨影响新生儿神经行为测定(NBNA)的可能因素，将有助于提高出生人口质量。NBNA是检测新生儿脑损伤的一种实用、经济、有效和无创伤的临床检查方法，是早期发现脑损伤和评估预后的敏感指标。我们将1997年11月-2002年6月所测的NBNA 106例进行相关因素的研究，现将结果报告如下。     

新生儿行为神经测定对高压氧治疗足月窒息儿的评价

本计经过高压氧治疗的４０例足月窒息儿，在治疗前后进行２０项ＮＢＮＡ，并对重度窒丐ＨＩＥ儿在４周，１８月用Ｇｅｓｅｌｌ智能发育一表纵向测试，与对照组比较，表明治疗后两组轻度窒息儿ＮＢＮＡ无显著差异，两组重度窒息并ＨＩＥ儿ＮＢＮＡ差异显著，且智能发育商比较有显著差异。ＮＢＮＡ主分与Ｇｅｓｅｌｌ发育商呈正相关，提示：重度窒息并ＨＩＥ儿加用高压氧治疗意义大，近期疗效好。     

影响足月小样儿神经行为发育的围生期因素分析

目的 探讨影响足月小样儿神经行为发育的围生期相关危险因素.方法 收集2008年4月至2010年4月于烟台毓璜顶医院产科分娩的111例足月小样儿的围生期相关资料,采用新生儿20项行为神经测定法(neonatal behavioral neurological assessment,NBNA)于生后3～7d对其进行评估,采用单因素及多因素Logistic回归分析考察影响足月小样儿神经行为发育的围生期危险因素.结果 足月小样儿行为能力、被动肌张力、主动肌张力及NBNA总分(分别为10.72±1.41,7.13±0.96,7.32±0.74,37.16±1.32)低于正常新生儿(分别为11.27±1.04,7.89±0.72,7.62±0.64,39.12±0.76),差异有统计学意义(P＜0.05).单因素Logistic回归分析提示影响足月小样儿神经行为的因素有分娩方式、胎盘异常、脐带异常、母亲围生期感染、妊娠高血压综合征、双胎妊娠、新生儿期高胆红素血症共7个因素.多因素Logistic回归分析提示母亲围生期感染(OR =2.175,95％CI1.981 ～2.408,P＜0.05)、双胎妊娠(OR=1.936,95％CI 1.517 ～2.368,P＜0.05)、高胆红素血症(OR=1.518,95％ CI1.072～2.149,P＜0.05)是影响足月小样儿NBNA评分的危险因素.结论 足月小样儿神经行为发育较正常新生儿差,母亲围生期感染、双胎妊娠、高胆红素血症是影响足月小样儿神经行为的危险因素.     

足月新生儿早期心功能的动态变化

目的 探讨足月新生儿早期心功能变化的规律。方法 应用彩色多普勒超声心动图动态监测足月新生儿生后d1-7的心功能变化，包括心脏泵血功能指标及各瓣口流速指标。结果 左室射血分数（EF）在生后3d内无明显差异，d4、5呈现上升趋势，d6、7较前3d则明显升高（P〈0．01）；主动脉瓣口峰值流速（AV）和肺动脉瓣口峰值流速（PV）随日龄增加呈上升趋势，前者d3～4处于过渡阶段，而d5—7较d1则明显升高，且相对稳定，后者生后d4明显较前3d升高；三尖瓣口的E／A值d7较d1则明显升高（P〈0．01），而二尖瓣口E／A在生后1周内则未见明显变化。结论 足月新生儿左室泵血功能日渐增强，d6—7达高峰。AV和PV随日龄逐渐增加。右室舒张功能日渐成熟。     

新生儿行为神经测定常规筛查的体会

目的探讨新生儿行为神经测定（NBNA）的可行性、实用性，给予大力推广。方法对我院产科刚出生的足月新生儿进行NBNA评分。结果从中能发现NBNA评分异常的新生儿，为早期于预提供依据。结论NBNA方法容易掌握，工具简单，评分标准实用可靠，可作为产科和新生儿科常规筛查，以便早期发现轻微脑损伤，防治伤残。     

足月小于胎龄儿103例发病因素及神经行为探讨

目的探讨2004年1月～2005年1月出生的103例足月小于胎龄儿的发病因素及生后3～5天与同期足月新生儿神经行为测定比较。方法采用中国新生儿20项神经行为测定法（NBNA）。结果足月小于胎龄儿NBNA总分及行为能力．主动肌张力较正常足月新生儿差异有非常显著性（P〈0．01）。结论足月小于胎龄儿神经行为较正常新生儿落后，应早期干预，促进神经系统发育。     

新生儿高胆红素血症患儿NBNA与BAEP评价

目的　 探讨新生儿高胆红素血症患儿脑损伤的早期预测方法。 方法 　对 38例高胆患儿分别进行新生儿神经行为评分 (NBNA)和脑干听觉诱发电位 (BAEP)检测。 结果 　高胆组BAEP异常率明显高于对照组 (P <0 0 1) ,Ⅰ、Ⅴ波潜伏期与对照组比较差异显著 (P <0 0 1,P <0 0 5 )。高胆组NBNA评分明显低于对照组 (P <0 0 0 1) ,主要失分项目为行为能力和主动肌张力。在血清胆红素≥ 2 0 4μmol/L时 ,胆红素水平与NBNA评分呈显著负相关 (P <0 0 1) ,血清胆红素浓度≤ 2 5 6 5 μmol/L时 ,部分高胆患儿NBNA评分即有降低 ,BAEP异常率增高 ,黄疸消退后NBNA评分全部恢复正常。 结论 　NBNA和BAEP是早期诊断新生儿胆红素脑病敏感而有效的方法 ,有助于判断病情及指导治疗。     

缺氧缺血性脑病足月新生儿的行为神经评定

新生儿行为神经评定（NBNA）可早期判断缺氧缺血性脑病（HIE）患儿的脑功能异常。判断预后敏感性强，特异性高，方便实用。本文对HIE足月儿及健康足月儿进行NBNA评分，报告如下。对象和方法一、对象来自本院新生儿病房的HIE足月新生儿，均符合新生儿缺氧缺血性脑病临床诊断依据     

窒息新生儿抗凝和纤溶的改变及临床意义

目的　研究窒息新生儿抗凝和纤溶系统的变化及其临床意义。方法　采用ELISA法和免疫浊度法测定重度窒息组 2 7例、非重度窒息组 18例和正常对照组 15例足月新生儿的血浆蛋白(PC)、总蛋白S(TPS)、抗凝血酶Ⅲ (AT Ⅲ )、D 二聚体 (D D)、血管性假血友病因子 (vWF)。结果　重度窒息组新生儿血浆PC、TPS、AT Ⅲ低于对照组和轻度窒息组 ,D D、vWF明显高于对照组和轻度窒息组。轻度窒息组和正常对照组各指标均无明显差别。结论　重度窒息新生儿存在抗凝、纤溶系统的激活及血管内皮细胞损伤 ,他们可能是观察早期DIC的重要临床指标     

Effect of hyperbilirubinemia on intestinal permeability in healthy term newborns

We investigated the effect of serum bilirubin (SB) on intestinal permeability (IP) of healthy, term, birth weight appropriate for gestational age neonates before phototherapy. IP was measured by the dual probe (lactulose/mannitol) sugar absorption test (SAT) performed on the third day of life in 12 healthy jaundiced newborns (total bilirubin 249 +/- 39.75 micromol/L) and compared to that of 12 non-jaundiced newborns (total bilirubin 83.79 + 37.62 micromol/L) matched for sex, gestational age, birth weight and Apgar score. Jaundiced newborns have a significantly higher La/Ma ratio than non-jaundiced (0.31 +/- 0.28 vs. 0.053 +/- 0.043; p < 0.0004). A significant correlation was found between serum bilirubin level and La/Ma ratio (r = 0.56 p < 0.006). CONCLUSION: Our study demonstrates a direct effect of UCB on gut epithelial barrier of at-term newborns in whom UCB appears to be responsible for an alteration of IP that theoretically may lead to a passage of macromolecules through the intestinal epithelium increasing the risk of sensitization.     

影响足月新生儿脐带脱落时间相关因素的研究

目的：分析影响足月新生儿脐带脱落时间的相关因素。方法：观察337例足月新生儿脐带脱落时间,并对性别、胎龄、体重、脐带结扎位置、脐残端长度、脐带直径、脐带贴卫生、医护人员及家属手卫生、脐部感染等14项相关因素进行单因素分析和多因素非条件logistic回归分析。结果：单因素相关分析发现脐带结扎位置、脐残端长度、脐带直径、脐带贴卫生、脐部感染对脱脐时间有影响（P<0.05）。其中脐带结扎位置、脐残端长度、脐带贴卫生、脐部感染是影响新生儿脐带脱落时间主要因素。结论：脐带结扎位置<0.5 cm、脐带残端保留<0.5 cm、保持脐带贴卫生、预防脐部感染有助于脐带尽早脱落。［中国当代儿科杂志,2010,12(11)：867-869］     

足月儿重度高胆红素血症不良预后危险因素及评估方法

目的探讨足月重度高胆红素血症患儿发生不良预后的危险因素及评估方法。方法回顾性分析2012年1月至2012年12月间在杭州市儿童医院新生儿科住院的足月重度高胆红素血症患儿的临床资料及随访结果。结果入选326例重度高胆红素血症足月儿,平均胎龄(39.12±1.17)周,男181例、女145例;失访66例,成功随访260例。感染性疾病(74.40%)及新生儿溶血病(51.19%)为足月儿重度高胆红素血症的主要病因。多因素Logistic回归分析显示,血清总胆红素(TSB)峰值升高是不良预后的独立危险因素(OR=2.02,95%CI:1.13~3.62,P=0.018)。BIND评分0~6分组不良预后较轻且有一定可逆性,7~9分组均发生严重不良预后。TSB峰值、血清未结合胆红素(UCB)值、TSB与白蛋白比值(B/A)评价不良预后的ROC曲线下面积分别为0.682、0.671、0.698,TSB=474.50μmol/L,UCB=449.15μmol/L,B/A=0.92 mg/g时约登指数最大。脑干听觉诱发电位(BAEP)、耳声发射(OAE)、颅脑磁共振成像(MRI)、新生儿神经行为评分(NBNA)的异常率在有、无不良预后两组间的差异均无统计学意义(P0.05)。结论 TSB峰值越高,重度高胆红素血症足月儿发生不良预后危险性越大。BIND评分表评估不良预后尤其是严重不良预后有较好价值。TSB峰值、UCB值、B/A值是评估不良预后指标,但诊断价值较低。未发现急性期NBNA、听力筛查结果及苍白球信号改变与远期预后相关。     

Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin contact with different initiation and duration times in healthy, full-term infants

Background

There are few studies that compare the physiological and biological efficacies between different early skin-to-skin contacts (SSC) post birth.

Aim

To investigate physiologically and biochemically how early SSC with different initiation and duration time influence the stress post birth for full-term infants.

Study design

Non-experimental study.

Subjects

Study I; Thirty-two infants who began SSC 5 min or less [birth SSC, mean initiation time (standard deviation): 1.6 (1.1) min] after birth and 36 infants who did so more than 5 min [very early SSC, 26.3 (5.0) min] in heart rate (HR) and oxygen saturation (SpO₂) analysis. Study II; Eighteen infants who underwent SSC for 60 min or less [mean initiation time: 7.5 (12.2) min] and 61 infants who did so for more than 60 min [15.3 (12.5) min] in salivary cortisol analysis.

Outcome measures

HR and SpO₂ measured for 30 min post birth. Salivary cortisol concentration measured at 1 min, 60 min, and 120 min post birth.

Results

Birth SSC group reached HR stability of 120-160 bpm significantly faster than very early SSC group by Kaplan-Meier analysis (P = 0.001 by log-rank test). As for SpO₂ stability of 92% and 96%, no significantly between-group difference was found. Salivary cortisol levels were significantly lower between 60 and 120 min after birth in SSC group, continuing for more than 60 min compared with SSC group for 60 min or less after adjustment for salivary cortisol level at 1 min besides the infant stress factors (P = 0.046).

Conclusions

Earlier SSC beginning within 5 min post birth and longer SSC continuing for more than 60 min within 120 min post birth are beneficial for stability of cardiopulmonary dynamics and the reduction of infant stress during the early period post birth.     

影响早产儿20项行为神经评分的危险因素分析

目的 分析早产儿20项行为神经评分(NBNA)特点,探讨影响早产儿NBNA的危险因素.方法 应用新生儿20项行为神经评价方法对我院274例纠正胎龄40周的早产儿进行评定,按NBNA评分分为NBNA正常组(n=221)和NBNA异常组(n=53).回顾早产儿出生史、母亲孕产期情况、新生儿期原发疾病住院情况及检查结果,分析影响早产儿NBNA评分的可能危险因素.结果 两组患儿在胎龄、出生体质量、头围、身长、Apgar评分,复苏时间、住院时间、达完全胃肠营养时间方面比较差异有统计学意义(P＜0.05);多胎、肺透明膜病、出血性和缺氧性脑损伤、严重感染、低血糖、高胆红素血症、慢性肺疾病的发生率两组比较差异有统计学意义(P＜0.05);而性别、产前使用激素、贫血、低血压及听觉通路异常情况两组比较差异无统计学意义(P＞0.05).窒息、低出生体质量、肺透明膜病、出血性和缺氧性脑损伤、严重感染、高胆红素血症、反复低血糖及慢性肺疾病是影响早产儿NBNA评分的危险因素.结论 早产儿生后虽纠正胎龄足月,但在行为能力和主动肌张力方面得分仍低.低Apgar评分、低出生体质量、肺透明膜病、出血性和缺氧性脑损伤、严重感染、高胆红素血症、反复低血糖及慢性肺部疾病与早产儿NBNA评分密切相关.

Abstract：

Objective To analyze the characteristic of twenty-item premature behavioral neurological assessment,and to assess the risk factors of neonatal behavioral neurological assessment(NBNA) in premature infants. Methods Total two hundred and seventy-four premature infants hospitalized in Guangzhou Children's Hospital were assessed with the NBNA after correcting age 40 weeks,premature infants were divided into two groups:normal group (n =221 ) and abnormal group (n =53) according to NBNA. The birth history, mother pregnancy situation, the disease during neonatal period and results in hospital were reviewed,and the risk factors of NBNA in premature infants were assessed. Results There were significant differences in gestational age, birth weight, head circumference, body height, Apgar score, resuscitation time, hospitalization time and total gastrointestinal nutrition time between the two groups( P ＜ 0. 05 ). The incidences of superfoetation,hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease were different between the two groups( P ＜ 0. 05 ). There were no differences in gender, antenatal hormone use, anaemia, hypotension and evoked potential abnormality (P ＞0. 05 ). Multivariate logistic regression analysis showed that the risk factors of NBNA score in premature infants would include low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease. Conclusion Although the premature infants corrected age 40 weeks,but the capability and initiative muscular tension are still lower than term infant. Low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury ,severe infection ,hyperbilirubinemia,hypoglycemia and chronic lung disease are important risk factors related to premature behavioral neurological assessment.