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对"卡泊芬净治疗早产儿霉菌性败血症一例"一文的异议
张晓宁医师(051500河北省南皮县人民医院检验科)问:阅读<中华儿科杂志>2008年第46卷第6期丁晓春等[1]同志撰写的"卡泊芬净治疗早产儿霉菌性败血症一例"后,笔者认为该文文题"卡泊芬净治疗早产儿霉菌性败血症一例"值得商榷.该文称"在气道分泌物、血、大便中先后培养出近平滑假丝酵母菌",而文题却为霉菌件败血症.
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Length and thickness of 152 corpus cal osa were measured in neonates within 24 hours of birth. Using ultrasonic diagnostic equipment with a neonatal brain-specific probe, corpus cal osum length and thickness of the genu, body, and splenium were measured on the standard mid-sagittal plane, and the anteroposterior diameter of the genu was measured in the coronal plane. Results showed that corpus cal osum length as wel as thickness of the genu and splenium increased with gesta-tional age and birth weight, while other measures did not. These three factors on the standard mid-sagittal plane are therefore likely to be suitable for real-time evaluation of corpus cal osum de-velopment in premature infants using cranial ultrasound. Further analysis revealed that thickness of the body and splenium and the anteroposterior diameter of the genu were greater in male infants than in female infants, suggesting that there are sex differences in corpus cal osum size during the neonatal period. A second set of measurements were taken from 40 premature infants whose ges-tational age was 34 weeks or less. Corpus cal osum measurements were corrected to a gestational age of 40 weeks, and infants were grouped for analysis depending on the outcome of a neonatal behavioral neurological assessment. Compared with infants with a normal neurological assessment, corpus cal osum length and genu and splenium thicknesses were less in those with abnormalities, indicating that corpus cal osum growth in premature infants is associated with neurobehavioral de-velopment during the early extrauterine stage.
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早产儿血氧饱和度的监测与视网膜病变
随着围产医学的发展和NICU抢救水平的不断提高,早产儿的存活率逐渐上升,而存活的早产儿发生视网膜病(ROP)也随之增多.国外有报道指出其发病率为11%~60%[1].ROP发病危险因素很多,现在普遍认为长时间吸高浓度氧是主要危险因素.然而,过度限制吸氧会造成一些患儿因缺氧导致的死亡以及出现严重的后遗症--尽管视力得以保存.因此,临床上对于早产儿血氧浓度的监测和寻找早产儿吸氧的安全水平,对降低视网膜病变的发病率,提高早产儿的存活率及以后的生活质量是十分重要的.
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成功救治600g早产超低出生体重儿、小于胎龄儿1例报告
1 临床资料患婴,男,G1P1,出生后10min,因"呼吸困难、呻吟伴发绀10 min",由我院手术室转入NICU.其母孕28周.因重度妊娠高血压综合征,腹水伴昏迷,胎心率162次/min,行急诊剖宫产.羊水清,脐绕颈1周.Apgar评分:1分钟5分,全身青紫,心率140次/min,立即给予气管插管,心肺复苏,并于气管内滴入万分之一肾上腺素针剂0.1 ml;5分钟评7分,急转入NICU.
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沭舒坦预防早产儿呼吸窘迫综合征效果观察
早产儿呼吸窘迫综合征(RDS)是新生儿重症疾病,病死率极高,20世纪80年代以来,广泛采用肾上腺皮质激素产前预防RDS,取得可喜的成绩,但仍有20%左右的早产儿在使用激素后发生RDS[1].自1998年2月本院儿科在产前孕母应用肾上腺皮质激素的基础上,产后早产儿立即加用沐舒坦预防RDS,取得较好疗效.现报道如下.
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Do intra-operative fluids influence the need for post-operative cardiotropic support after a PDA ligation?
Objective To investigate the effect of intra-operative intravenous fluids on post-operative hemodynamic stability. Methods We performed a retrospective cohort study of 98 preterm infants who underwent a patent ductus arteriosus (PDA) ligation in one N1CU between 2001 and 2007. The primary outcome was the need for cardiotropic support within 24 hrs of ligation. Results Twenty-seven infants (28%) required post-operative cardiotropic support. The amount of intra-operative fluids varied between 0 and 50.4 mL/kg (median; 10.2 mL/kg). No intra-operative fluid was recorded in 26 patients. Fluids were not associated with the need for post-operative cardiotropic support (P = 0. 10). Using a multivariate logistic regression model, age at ligation, weight at ligation and pre-operative FiO2 were significant predictors of post-operative cardiotropic support. Conclusions Intra-operative fluids do not appear to be associated with the need for post-operative cardiotropic support. A prospective cohort study may help identify modifiable risk factors and improve outcomes in this population.
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支气管肺发育不良的预防策略
Bronchopulmonary dysplasia (BPD) is one of the few diseases affecting premature infants that have continued to evolve since its first description about half a century ago. The current form of BPD, a more benign and protracted respiratory failure in extremely preterm infants, is in contrast to the original presentation of severe respiratory failure with high mortality in larger premature infants. This new BPD is end result of complex interplay of various antenatal and postnatal factors causing lung injury and subsequent abnormal repair leading to altered alveolar and vascular development. The change in clinical and pathologic picture of BPD over time has resulted in new challenges in developing strategies for its prevention and management. While some of these strategies like Vitamin A supplementation, caffeine and volume targeted ventilation have stood the test of time, others like postnatal steroids are being reexamined with great interest in last few years. It is quite clear that BPD is unlikely to be eliminated unless some miraculous strategy cures prematurity. The future of BPD prevention will probably be a combination of antenatal and postnatal strategies acting on multiple pathways to minimize lung injury and abnormal repair as well as promote normal alveolar and vascular development.
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早产儿肺透明膜病的发病因素分析
肺透明膜病(HMI)是早产儿生后早期出现的严重并发症,也是造成早产儿死亡的常见原因之一.尽管对该病的研究不断深入,但就其发病情况目前国内尚缺乏确切的统计资料.本文对145例早产儿进行了回顾性分析,总结不同孕周HMD的发病情况及HMD发生的高危因素.