Abstract： Objective To analyze the early outcomes of open heart surgery for congenital heart diseases in sixty low birth weight infants and premature infants. Methods Sixty low birth weight infants （body weight＜2 500 g） and premature infants with congenital heart diseases undergoing surgical repair from May 2003 to October 2011 were studied retrospectively in Guangdong Cardiovascular Institute. There were 43 male patients and 17 female patients with their mean gestational age of 33.5±4.1 weeks （ranging from 26 to 42 weeks） and mean age at operation of 24.9±12.5 d（ranging from 4 to 55 d）. Among them there were 47 premature infants with their mean birth weight of 1 729.3±522.5 g（ranging from 640 to 2 500 g）and mean weight at operation of 1 953.2±463.6 g （ranging from 650 to 2 712 g）. All the patients received preoperative treatment in newborn intensive care unit（NICU） and underwent surgical repair under general anesthesia, including 29 patients without cardiopulmonary bypass （CPB）and 31 patients with CPB . All surviving patients received postoperative monitoring and treatment in NICU, and their postoperative complications and in-hospital death were reported. Results A total of 13 patients died during hospitalization with a total in-hospital mortality of 21.7%（13/60）, including 4 intra-operative deaths, 6 early deaths （within 72 h postoperatively） and 3 patients giving up postoperative treatment. CPB time was 121.0±74.7 min, aortic clamp time was 74.8±44.7 min, and postoperative mechanicalventilation time was （136.9±138.1）h. Thirteen patients underwent delayed sternal closure. Eight patients underwentreexploation for postoperative bleeding. Ten patients had severe pneumonia, 2 patients had pulmonary hypertensive crisis, and 8 patients had low cardiac output syndrome. All the postoperative complications were resolved or improved after proper treatment. Follow-up was complete in 47 patients from 2 to 12 monthes, and all the patients were alive during follow-up. Conclusion Early surgical repair for low birth weight infants and premature infants with congenital heart diseases is safe and effective.
Objective To discuss how is the perinatal infant’s prognosis influenced by different cardiac function and types of heart disease in pregnant women with heart disease, and to check the importance of antenatal examination. Method Retrospective analyses were conducted on the clinical records of 102 pregnant women hospitalized due to heart disease from February 2002 to February 2011 in the First Affiliated Hospital of Xinjiang Medical University. According to the level of cardiac function, 61 patients were divided into the Level I-II group and the other 41 patients were in the Level III-IV group. Results Of all cases, 38 were congenital heart disease (37.25%), followed by 22 arrhythmia (21.57%), 17 rheumatic heart disease (16.67%), 15 perinatal cardiomyopathy (14.71%), 7 hypertensive heart disease and 3 other types of heart disease. The average gestational weeks were shorter and the neonate’s weight was lower in the Level III-IV group than the Level I-II group, with a significant difference (Plt;0.05); the incidence of premature delivery, low birth weight infant at normal gestational age, neonatal asphyxia and perinatal mortality was higher in the Level III-IV group than the Level I-II group, with a significant difference (Plt;0.05); the rate of regular antenatal examination was higher in the Level III-IV group than the Level I-II group, with a significant difference (P=0.008); and there were significant differences between the regular and irregular examination groups in the incidence of premature delivery and low birth weight infant at normal gestational age (Plt;0.05), but no significant differences were found in the incidence of asphyxia and perinatal mortality (Pgt;0.05). Conclusions Congenital heart disease is the most commonly-seen type in the pregnant women with heart disease. The maternal cardiac function directly impact the prognosis of perinatal infant, and the regular antenatal examination, timely diagnosis and treatment can improve pregnancy outcome.
Objective To assess the growth station, the upper respiratory infection frequency and consultation frequency of the geographically defined high risk neonatal population at 1-year-old based on both birthweight and gestational age. Methods All infants admitted in our hospital from May in 2008 to May in 2009 were divided into three groups according to gestational age and birth weight, that were, group 1: born lt;32 completed gestational weeks and weighing ≥1 500 g; group 2: born after 32 completed gestational weeks and weighing lt;1 500 g; and group 3: born lt;32 completed gestational weeks and weighing lt;1 500 g. Information at 12 months corrected age about growth, the upper respiratory infection frequency and consultation frequency was collected. Results The growth rate of weight and head circumference in group 3 were lower than that in group 1, and the length growth rate was lower than that in group 1 and group 2. Infants in group 3 suffered from more airway infections (median: 15.5) than in group 1 (12.5) and group 2 (8.5). Infants in group 3 needed more medical consultations (median: 27.5) than those in group 1(17.5) and group 2 (15.5). Conclusions This study gives estimates for growth outcome, airway infection and consultation frequency at 12 months corrected age for very low birthweight infants (lt;1 500 g) and for very preterm infants (lt;32 completed gestational weeks). Gestational age and birth weight are the same important for predicting infants’ outcome and should therefore be integrated into clinical statistics.
Objective To investigate the role of low-dose heparin added to total nutrient admixture (TNA) solutions in the prevention of catheter related infections (CRIs). Methods One-hundred three newborn infants with periph-erally inserted central catheter (PICC) were divided into heparin group (n=63) and control group (n=40). The patients in the heparin group received TNA with 0.5 U/ ml heparin. The patients in the control group received TNA without heparin. We retrospectively analyzed the incidence of CRTs in the two groups. Results We found that the incidence of CRIs was 0 in the heparin group and 12.5% (5/40) in the control group. The incidence of catheter obstruction was 6.3% (4/63) in the heparin group and 20% (8/40) in the control group. The incidence of catheter-tip colonization was 1.58% (1/40) in the heparin group and 17.5% (7/40) in the control group. The incidences of CRIs, catheter obstruction, and catheter-tip colonization were signiicantly lower in the heparin group than those in the control group (Plt;0.05). Conclusion TNA solutions with 0.5U/ml heparin have decreased catheter obstruction and CRIs.
Objective To evaluate the maternal satisfaction and the clinical effect of kangaroo mother care (KMC) in preterm infants. Methods We searched PubMed, EMBASE, Ovid, Springer, CNKI, CBM and Taiwan Database of Journal Fulltext (from establishment to September 2007) and hand searched relevant conference proceedings to identify randomized controlled trials on kangaroo mother care. The quality of included trials was assessed. Meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2 software. Results A total of 5 eligible studies were included. No significant differences were observed in infant mortality, incidence of severe infections, and psychomotor development at 12 months (corrected for age) between the KMC group and the routine therapy group (Pgt;0.05). Compared to the routine therapy group, the KMC group had lower incidences of nosocomial infection, upper respiratory tract disease at 6-month follow-up and not exclusively breastfeeding at discharge (Plt;0.05). KMC could improve mother’s sense of competence during her baby’s stay in hospital and NICU, increase infant weight at discharge, relieve mother’s feelings of worry and stress during her baby’s stay in hospital (Plt;0.05). Conclusions The currently published evidence from randomised trials supports the use of KMC in preterm infants, which is a scientific, effective and humanistic nursing model. Further multicentre and large-scale randomized controlled trials of KMC are still needed to evaluate its potential influence on infant mortality and psychomotor development.
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.
Objective To explore the effectiveness of passive immunization of fetus via mother on preventing the transmission of HBV from mother to infant. Methods A prospective randomized controlled study was designed. Fifty-two HBeAg positive pregnant women were randomly allocated to two groups, of which 28 women were allocated to trial group, and injected with 200 IU of hepatitis B immune globulin (HBIG) for 1 injection at the 28th, 32nd and 36th weeks of pregnancy respectively, 24 women allocated to control group were given no injection of HBIG. The samples of cord blood from the newborns in two groups were collected and tested for HBeAg and HBV-DNA by ELISA and FQ-PCR. Results The rates of HBeAg positive in the newborns were 21.4% in trial group, 79.2% in control group. There was statistically significant difference between two groups ( χ2=17.26, Plt;0.01, RR=0.27). The rates of HBV-DNA positive in newborns were 25.0% in trial group, 83.3% in control group, showing statistically significant difference between the two groups (χ2=17.62, Plt;0.01, RR=0.30). In the trial group, there were 21 newborns with HBV-DNA negative, 7 with HBV-DNA positive. HBV-DNA quantities were significantly lower in 7 newborns than in their mothers (T=28, P=0.02, Wilcoxon test). Conclusions Multiple injections of HBIG to pregnant women with HBeAg positive before labor could greatly reduce mother-infant transmission of HBV.
摘要:目的: 探讨如何提高早产儿存活率和生存质量。 方法 :对我院新生儿病房收治的228例早产儿的临床资料进行了回顾分析。 结果 :引起早产的母亲因素以胎膜早破、妊娠期胆汁淤积综合征及妊娠合并高血压综合征为早产的重要因素,而引起早产儿常见疾病的是新生儿肺炎,高胆红素血症及新生儿窒息等。而呼吸衰竭、新生儿休克、多器官衰竭则是引起早产儿预后不良的重要因素。 结论 :早产原因以母体因素为主,故加强孕期保健,积极防治母亲的有关并发症,同时提高新生儿急救水平,早期干预,以提高早产儿的生存质量。Abstract: Objective: To exploere the ways of promoting the survival rate and the quality of life in premature infants. Methods :The clinical data on 228 cases of premature infants treated by neonatal wards were analyzed retrospectivelly. Results : The important factors of premature are cholestasis of pregnancy syndrome, premature rupture of membbranes, and hypertemsion in prefnancy. The commom diseases in premature infants are neonatal pnecemonia, hyperbilirubinemia and asphxia, the major factors in poor prognasis are caused by neonatal shock, multiple organ failure in premature infants. Conclusion :The main reasons of premature is maternal factors. It is important to strengthen the health care during pregnancy, control the complications of mothers actively, at the same time, improve the level of neonatal first aid, intervent early, so as to imprive the quality of life in preterm infants.
摘要:目的：观察小儿反复性肺炎的发生与血微量元素的关系。方法:选择56例反复性肺炎患儿为观察组，与60例健康儿童作对照，分别测定血镉、铅、铜、锌、钙、镁、铁含量。结果:56例反复性肺炎患儿血锌、铁含量较对照组减低，差异有统计学意义（Plt;0.05）。结论:部分反复性肺炎的发生与血微量元素锌、铁缺乏有关。应对反复性肺炎患儿常规行血微量元素检测，对血微量元素缺乏者应予相应补充治疗。Abstract: Objective: To observe the relationship to the occurrence of repeated pneumonia and the microelement in blood. Methods: We chose the 56 infant patients who suffered from repeated pneumonia as the observe group while the 60 health infants as the comprise group, then test the content of cadmium， plumbum， cuprum， zinc， calcium， magnesium and ferrum in blood. Results: The content of zinc and ferrum in the patient’s blood was lower than the comparison group, and the P value was Plt;0.01 and Plt;0.05 respectively, there was obvious differentiation between the two groups. Conclusion: Occurence of part repeated pneumonia is related to the deficiency of the microelements zinc and ferrum in blood. We should detect the common content of microelement to the infant patients who suffer the repeated pneumonia, and give a complement treatment to the microelements’ deficiency infant patients.
ObjectiveTo explore the related factors for the influences and outcomes of mothers and infants, and further provide a basic reference for reducing maternal and prenatal mortality caused by central placenta previa, through the analysis of its clinical characteristics. MethodsWe retrospectively analyzed the clinical data of 89 patients with central placenta previa treated from January to August 2012. ResultsThere were 89 patients with central placenta previa, and the average age of these patients was (29.6±11.4) years, and the average number of pregnancy among the patients was 3.17. Nine patients had scar uterus; 8 had pernicious placenta previa (9%); 34 had prenatal anemia symptoms; 44 had prenatal vaginal bleeding with the bleeding volume ranged from 2 to 500 mL; 40 were treated before delivery. The average gestational age was 36 weeks ±4.2 days, and 28 of them were readmitted. The intraoperative bleeding in such patients as had placenta located in the anterior wall, placenta adhesion or implantation, history of uterine cavity operation or multipara was more than other patients. The postpartum hemorrhage of patients with the gestational age of 36 weeks or more was more than that of patients with the gestational age shorter than 36 weeks. The incidence of fetal distress in patients with the gestational age of 36 weeks or more is lower and the neonatal 1-minute Apgar score was higher than that in patients with the gestational age shorter than 36 weeks (P<0.05). ConclusionThe treatment of central type of placenta previa should be more active to prolong the gestational week. Patients with placenta adhesion or implantation, caesarean, multipara and placenta in the anterior wall are susceptible to intraoperative bleeding during the termination of pregnancy. Termination of pregnancy in these patients with central placenta previa should be carried out by cesarean section when gestation is more than 36 weeks to reduce postpartum hemorrhage and complications.