Objective To investigate the related factors of the retinal hemorrhage in high-risk infants (HRI). Methods Eight hundred and sixty HRI with histories of high-risk pregnancy and/or neonatal asphyxia after 1-5 days of birth were enrolled in this study.In 860 cases of HRI, 498 infants were vaginal delivery and 362 infants were delivered through cesarean sections. Among 498 vaginal delivered infants, 407 infants were eutocia and 91 infants were with forceps delivery; 298 infants were born following normal labor, 102 infants experienced prolonged labor, and 98 infants were urgent birth. The retinal hemorrhages were observed and conditions were graded into three degrees of Ⅰ, Ⅱ, and Ⅲ. Conditions of neonatal asphyxia were evaluated based on criteria of Apgar score. The incidence of retinal hemorrhage in the different types of deliveries and labor processes were compared, and the relationship between degree of retinal hemorrhage and grade of neonatal asphyxia were analyzed. Results In 860 cases of HRI, retinal hemorrhages were found in 202 infants (23.5%). Within these 202 infants, 75 infants (37.1%) were Ⅰ degree retinal hemorrhage, 75 infants (37.1%) were Ⅱ degree retinal hemorrhage, and 52 infants (25.8%) were Ⅲ degree retinal hemorrhage. In these 202 infants of retinal hemorrhage, 172 infants (85.1%) had histories of asphyxia; 119 infants (69.2%) were graded as mild asphyxia-risk, and 53 infants (30.8%) were graded as severe asphyxiarisk. There was a statistical difference of the degree of the retinal hemorrhage between the mild and severe asphyxia-risk infants (chi;2=34.61,P＜0.01). The incidence of retinal hemorrhage after vaginal delivery was higher than cesarean section delivery with significant statistical difference (chi;2=30.73,P＜0.01). The incidence of retinal hemorrhage after forceps delivery was significantly higher than eutocia with statistical difference (chi;2=62.78,P＜0.01). Both prolonged and urgent childbirth had statistically significant higher incidences of retinal hemorrhage compared to normal labor in the process of vaginal delivery (chi;2=45.86, 71.51; P＜0.01). Asphyxia, types of delivery, prolonged and urgent labors were risk factors of retinal hemorrhage for HRI (r=7.46,4.87,15.03,6.47;P＜0.01). Conclusions The incidence of retinal hemorrhage in high-risk infant was 23.5%. And, asphyxia, types of delivery, prolonged and urgent labors may play roles of risk factor in retinal hemorrhage of HRI.
目的 评价不同复苏方法和不同药物、氧疗、物理疗法等对新生儿窒息复苏和复苏后的预防措施的有效性和安全性.方法 计算机检索Cochrane Library(2004年第3期),MEDLINE(1966～2002年) 关于新生儿窒息复苏时不同复苏方法、氧气的应用、以及不同药物、剂量、给药途径治疗和预防新生儿窒息的系统评价、随机和半随机对照试验.结果 正压通气时使用100%氧气和应用室内空气的复苏效果并无差异.胎粪污染羊水(MSAF)与较高的新生儿缺血缺氧性脑病(HIE)的发生率有关,而气管内有胎粪者无论稀稠均与胎粪吸入综合征发生率无关.窒息复苏后预防性给予亚低温疗法、抗惊厥药、纳洛酮、多巴胺等在降低新生儿病死率,继发HIE的严重程度等方面与对照组相比无显著差异.应用肺表面活性物质(PS)预防和治疗新生儿呼吸窘迫综合征(RDS),可减少死亡率和并发症.结论 应用PS预防和治疗RDS可明显减少新生儿死亡率,且胎龄lt;32周的早产儿预防用药比治疗用药效果更好;目前尚无充分证据证明窒息复苏后预防性给予亚低温疗法、抗惊厥药、纳洛酮、多巴胺等治疗的有效性.
ObjectiveTo summarize the experience of surgical treatment of asphyxiating thoracic dysplasia (Jeune syndrome).MethodsA total of 15 patients with asphyxiating thoracic dysplasia from August 2018 to April 2020 in our hospital were retrospectively included. There were 7 males and 8 females, aged 1-25 (8.87±6.71) years. Special steel bars were used to correct the growth direction of the rib and costal cartilage. Meanwhile, the concave and convex deformities of the chest wall on both sides were corrected to increase the chest volume and correct the thoracic deformity.ResultsThe contour appearance of the chest wall of all patients changed after the operation. The shape was close to normal, and the symptoms of hypoxia were improved. The operation time was 147.73±59.78 min, intraoperative bleeding volume was 105.67±91.90 mL, ICU stay time was 14.20±13.54 d and hospital stay time was 26.00±17.87 d. Eleven patients were directly extubated after the operation, 4 patients underwent tracheotomy and received assisted respiration, and the assisted respiration time was 19, 13, 22 and 12 days, respectively. The postoperative chest circumference was significantly increased, and the blood oxygen saturation was significantly improved. There were 5 patients with cardiac insufficiency, and 3 of them were improved by cardiotonic therapy, 2 of them died of heart failure on the 2nd and 31st day after the operation, respectively. Abdominal distention occurred in 10 patients after operation, and 5 of them were obstinate and eliminated by comprehensive treatment. All patients were followed up. The appearance of thorax was improved obviously and there was no sign of compression in lungs. One 13-year-old patient developed respiratory discomfort 3 months after the operation, and the symptoms were relieved after self-administration of oxygen. A 25-year-old patient developed cardiac insufficiency half a month after the discharge, and the symptoms disappeared after cardiotonic treatment. Four patients took out the steel bars in 13, 13, 15 and 17 months after the operation, respectively. The appearance of thorax remained well after the operation. The imaging examination showed that the position of bone structure was normal, the lung field was clear, and there was no sign of chronic inflammation.ConclusionThis technique is a safe and simple operation method. It can not only eliminate the deformity of chest wall, but also increase the volume of chest obviously. However, the long-term effect needs to be further evaluated.