目的 探究S100B蛋白、神经元特异性烯醇化酶与新生儿低血糖脑损伤的诊治相关性。方法 收集2014年1月—2016年12月来我院就诊出现低血糖脑损伤的新生儿116例,设为患病组,首先根据临床表现,分为两组,有低血糖症状组(n=54)和无低血糖症状组(n=62)。两组患儿均给予常规药物治疗,有效患者82例,为有效组,无效患者34例,为无效组。同期收集健康足月的新生儿53例,为健康对照组。患儿均于治疗前、后检测血清S100B蛋白、神经元特异性烯醇化酶水平,健康对照组新生儿也于同一时间点进行相同检测。观察各组新生儿血清S100B蛋白、神经元特异性烯醇化酶水平变化,并探究其水平变化与诊断及治疗效果的相关性。结果 低血糖症状组和无低血糖症状组患儿的血糖水平均低于和健康对照组(P<0.05);低血糖症状组患儿的低血糖扶持续时间高于无低血糖症状组(P<0.05)治疗后,各组的NSE和S100B的蛋白水平差异无统计学意义(P>0.05)。患儿血清NSE和S100B与血糖水平呈负相关(r=-0.131、-0.124、P<0.05),与低血糖持续时间呈正相关(r=0.135、0.129,P<0.05)。结论 血清NSE及S100B与患儿血糖水平相关,可作为新生儿低血糖脑损伤的早期诊断指标。血清NSE及S100B水平与治疗效果存在相关性并为负相关,血清水平越低,患者治疗效果越好。

目的 根据巨脑回畸形的病理特点,对比其它影像检查,研究该病的超声特点,探讨新生儿期巨脑回畸形的超声诊断价值。方法 对5例新生儿巨脑回畸形的患儿的超声资料进行分析。结果 5例超声检查均表现为大脑脑回明显宽大,脑沟、脑回稀少,皮层明显增厚,大脑表面光滑,且5例均伴有不同程度的其它颅脑畸形。结论 新生儿巨脑回畸形具有一定的超声特征,超声检查在新生儿巨脑回畸形的诊断中具有重要的价值。

目的 游泳抚触操对新生儿神经行为及体格发育影响的研究。方法 将76例正常新生儿随机分为观察组(游泳加抚触操)31例,对照组(常规沐浴)45例,两组新生儿分别于出生后第5天、14天、42天对两组新生儿进行新生儿行为神经评分(NBNA),新生儿生后睡眠情况比较,胎便初排,胎便转黄时间比较,新生儿体重,身长比较。结果 两组新生儿神经行为及体格发育各项指标与对照组相比,差异有统计学意义,(P＜0.01)。结论 游泳抚触操对新生儿神经行为及体格发育有促进作用,临床值得推广应用。

目的 研究音乐疗法对新生儿喂养不耐受的保护作用,以及对胃动素和胃泌素水平的影响。方法 将2013年3月—2015年6月在我院新生儿科住院治疗的40例喂养不耐受新生患儿随机分为音乐治疗组和常规治疗组,治疗干预后,比较两组的喂养不耐受情况以及GAS和MOT水平。结果 音乐治疗组腹胀缓解时间、吸吮吞咽功能建立时间、达足量喂养时间、静脉营养应用时间明显的短于常规治疗组,体重增加量明显的高于常规治疗组(P＜0.05);治疗后,音乐治疗组的GAS和MOT水平明显的高于常规治疗组(P＜0.05)。结论 音乐疗法可以促进新生儿喂养不耐受症状改善,提高患儿血清GAS和血浆MOT水平,促进其生长发育。

Objective To study music therapy for neonatal feeding intolerance protection, and the effects of levels of gastrin and motilin. Methods From March 2013 to June 2015 in newborn Department of Pediatrics in our hospital 40 cases feeding tolerance of newborns were randomly divided into music therapy group and routine treatment group, after treatment, compared feeding tolerance and GAS and MOT level in the two groups. Results Abdominal distension relieving time, sucking and swallowing function establishment time, full enteral feeding time, use of the parenteral nutrition in the music therapy group was fewer than the conventional therapy group. Weight gain was higher than that in the conventional treatment (P<0.05). After the treatment, GAS and MOT levels in the music therapy group were higher than conventional treatment group, the difference is statistical significant (P<0.05). Conclusion Music therapy may promote neonatal feeding intolerance symptoms and improve patients serum GAS and plasma MOT levels, promote their growth and development.

目的 探讨颅脑超声在高危新生儿颅内疾病的诊断应用。方法 2010年7月—2014年6月间在我院新生儿重症监护室(NICU)813例新生儿应用百胜Mylab Five型彩色多普勒超声诊断仪,探头频率5～7.5 MHz,进行常规颅脑超声检查。患儿取仰卧位,经前囱作矢状切面及冠状切面按顺序扫查,重点扫查几个标志性切面。头皮留置针遮盖前囟者先予拔除,以保证检查顺利进行。结果 超声异常者85.73%(697/813)。其中颅内出血45.62%(318/697)。早期脑室周围—脑室内出血(PIVH)88.05%(280/318),以I级和II级为多;大脑出血4.40%(14/318);丘脑出血2.22%(7/318);小脑出血1.89%(6/318);蛛网膜下腔出血1.89%(6/318);硬膜下出血1.57%(5/318)。缺氧缺血性脑损伤(HIHB) 36.01%(251/697)。足月儿缺氧缺血性脑病(HIE)67.33%(169/251),轻度HIE52.59%(132/251),中重度HIE14.74%(37/251)。早产儿缺氧缺血性脑病(PVL)33.67%(82/251),化脓性脑膜炎3.30%(23/697)。脑积水15.06%(105/697),以外围性脑积水多见。出院前复查: I度及II度PIVH大部分吸收,III级及IV级PIVH可见侧脑室扩大、脑实质液化性囊腔。大脑出血、丘脑出血、小脑出血均有不同程度吸收,严重者遗留液化性囊腔,蛛网膜下腔出血及硬膜下出血亦有不同程度地吸收。轻度HIE大部分恢复正常,中重度HIE 均有脑室扩大、脑萎缩、液化性囊腔。PVL后期见囊泡性改变。化脓性脑膜炎后期可见硬膜下积液及梗阻性脑积水。结论 颅脑超声便携,可床边,价廉,可重复,具有较实用临床应用价值。适用于新生儿颅内疾病的筛查及诊断。对脑中线部位脑室周围—脑室内出血,对脑积水的程度、预后具有特异性诊断价值。它可提示颅内病变类型、程度、部位及动态监测病情进展情况。对某些颅内病变如蛛网膜下腔出血,硬膜下腔出血,小脑出血则需要结合CT、MRI等其它影像技术,为临床诊断提供依据。

目的 通过听力筛查,了解新生儿听力障碍的发病状况,探讨新生儿听力损失的危险因素。方法 采用耳声发射仪(OAE)和听觉脑干诱发电位仪(ABR)进行听力筛查,收集听力损失患儿,采用1:2配对的χ²检验和多因素Logistic回归分析筛选新生儿听力损失的危险因素。结果 20661例新生儿进行了听力损失初筛,初筛通过率88.99%(18386/20661);2231例进行了复筛,复筛通过率96.51%(2153/2231);对78例复筛未通过者进行ABR检查,确诊听力损失59例,听力损失发病率为2.86‰。多因素Logistic回归分析显示,新生儿头颅五官先天畸形(OR=3.435,95%CI:1.473~8009,P=0.004)和听力损失家族史(OR=2.681,95%CI:1.107~8.083,P=0.009)是新生儿轻中度听力损失的危险因素;新生儿头颅五官先天畸形(OR=2.213,95%CI:1.322~3.712,P=0.003)、NICU监护史(OR=1.524,95%CI:1.358~1.714,P=0.005)和听力损失家族史(OR=8.954,95%CI:1.783~45.128,P=0.008)是新生儿重度和极重度听力损失的高危因素。结论 母亲羊水异常、新生儿头颅五官先天畸形、NICU监护史和听力损失家族是新生儿听力损失的高危因素,应采取普遍筛查措施早期发现并给予相应干预,减少新生儿听力损失的发生率。

Objective To explore the influencing factors of hearing loss in newborns. Methods through screening, screening, diagnostic evaluation of 3 procedures to collect hearing loss in children, with 1:2 matching test and multivariate Logistic regression analysis in screening neonatal hearing loss risk factors. Results 20,661 cases of hearing loss in newborn screening, screening pass rate 88.99% (18386/20661); 2231 cases were re-screened for rescreening pass rate 96.51% (2153/2231); 78 patients who did not pass for rescreening ABR examination, diagnosed 59 cases of hearing loss, hearing loss incidence rate 2.86 ‰. Logistic regression analysis showed that neonatal facial congenital malformations (OR=3.435, 95%CI: 1.473~8009, P=0.004) and a family history of hearing loss (OR=2.681, 95%CI: 1.107~8.083, P=0.009) neonates with mild to moderate hearing loss is a risk factor; Neonatal facial congenital malformations (OR=2.213, 95%CI: 1.322~3.712, P=0.003), NICU care history (OR=1.524, 95%CI:1.358~1.714, P=0.005) and a family history of hearing loss (OR=8.954, 95%CI: 1.783~45.128, P=0.008) in neonates with severe and very severe hearing loss risk factors. Conclusion amniotic fluid anomalies neonatal cranial features mother, congenital malformation, NICU care history and hearing loss family is newborn hearing loss risk factors, should be taken to universal screening for early detection and appropriate intervention measures, reduce the incidence of neonatal hearing loss.

目的 探讨赛肤润与局部氧疗对新生儿臀红皮肤的疗效,总结防治新生儿臀红的护理方法。方法 选择66例患有臀红的新生儿随机分成对照组和实验组,对照组给予臀部清洁并吸干水分,对潮红及尿液刺激处皮肤涂搽赛肤润处理;实验组在给予臀部清洁,吸干水分,对臀红皮肤行吹氧气治疗5分钟后给潮红及尿液刺激处范围的皮肤涂搽赛肤润,并加强护婴者婴儿臀部护理知识宣教。结果 实验组新生儿臀红处皮肤红斑消退时间比对照组短;实验组新生儿臀红和皮肤红疹发生率比对照组减少18.33%;实验组新生儿臀部皮肤红疹治愈率比对照组高22.61%(P<0.05)。结论 加强臀部护理知识宣教,赛肤润与局部氧疗联合干预在降低新生儿臀红发生率,缩短新生儿臀红消退时间、提高新生儿臀红治愈率比单纯赛肤润治疗效果明显,值得临床推广应用。

目的 比较3种常见MRI序列对于新生儿臂丛神经损伤的显示率。方法 采用1.5TMR对两组共25名受试对象进行双侧臂丛神经扫描,扫描序列包含单方向背景抑制弥散加权成像序列(DWIBS)、重T2脂肪抑制序列(STIR/long TE)和脊髓造影序列(MYELO-3D),各序列所用扫描层厚、层间距、扫描范围均相同。分别统计出3种序列单独、3种序列进行两两组合运用和3种序列共同运用的诊断效能。结果 DWIBS序列对于新生儿臂丛神经损伤无诊断作用。MYELO-3D序列优于STIR/long TE序列,而MYELO-3D序列与STIR/longTE序列联合应用优于3种序列单独运用。结论 MYELO-3D序列与STIR/longTE序列联合应用对于显示新生儿臂丛神经损伤效果较佳。

目的 探讨新生儿早发型B族链球菌(GBS)败血症的临床特点,提高对本病的认识。方法 选取我院2010—2012年我院新生儿重症监护病房(NICU)收治的新生儿资料,回顾性分析GBS的临床表现、实验室检查、治疗和转归。结果 早发型GBS败血症8例,占住院患儿的6.28‰,均为足月儿,生后24小时内发病,以气促、发绀等呼吸系统症状为主,其中4例出现感染性休克表现;实验室检查提示血常规WBC:2.07~14.1×10⁹/L,＜5×10⁹/L 5例,中性粒细胞绝对值0.54~8.32×10⁹/L。胸部X线提示:肺部纹理粗乱,渗出增多。1例需机械通气辅助呼吸。青霉素联合头孢三代或万古霉素治疗有效,重症感染者需加强支持治疗。结论 应重视新生儿早发型无乳链球菌败血症早期呼吸系统症状,尽早诊断和治疗,降低病死率。

Objective To investigate the clinical features of early-on set neonatal Group B Streptococcal (GBS)septicemia in order to guide the clinical diagnosis and treatment. Methods Retrospectively analysing the clinical presentation, laboratory examination, treatment and prognosis of the 8 cases of all newborns from 2010 to 2012 in our hospital. Results The incidence of neonatal early-on set Group B Streptococcal septicemia was 6.28‰.8 cases were full-term infants in this study.Respiratory symptoms such as anhelation and cyanosis were first signs of early-on set Group B streptococcal septicemia within 24 hours after birth; 4 cases of septic shock. Results of laboratory tests included WBC:2.07~14.1×10⁹/L, in which 5 cases were ＜5×10⁹/L, N 0.54~8.32×10⁹/L. Chest X-ray: lung texture showed coarse and disorderly, leakage was increased. One case needed respiratory support with mechanical ventilation. Intravenous treatment of neonatal GBS with penicillin combined with Vancomycin was effective. Patients of serve infections should be provided supportive care. Conclusion Patients of serve early symptom of respiratory system should be paid attention. Early diagnosis and treatment should be as soon as possible to reduce fatalities.

目的 了解惠州市新生儿眼病的发病状况,探讨新生儿眼病筛查的临床模式。方法 回顾分析我院在2014年1月—2015年3月950例(1900只眼)高危新生儿的眼病筛查资料。结果 950例(1900只眼)新生儿中,检查出新生儿眼病10种,共200例,检出率21.05%;其中家族性渗出性视网膜病变(FEVR)5例(0.526%)、永存原始玻璃体增生症(PHPV)1例(0.105%)、先天性白内障1例(0.105%)、视网膜出血55例(5.789%)、生理性大视杯3例(0.316%)、新生儿鼻泪管阻塞5例(0.526%)、新生儿结膜炎100例(10.53%)、皮样脂肪瘤2例(0.211%)、新生儿泪囊黏液囊肿2例(0.211%)、早产儿视网膜病变26例(2.737%)。结论 新生儿眼病在临床中并不少见,而且部分眼病是可以早期筛查、早期治疗以避免盲的。

Objective To study the incidence of newborn eye diseases and to explore the clinical strategies for the screening of newborn ocular diseases. Methods A retrospective analysis was conducted on 950 newborns from January 2014 to March 2015. Results Among the 950 newborns who were enrolled the screening program,10 different eye diseases(involving 200 cases)were detected,with a prevalence of 21.05%. The eye diseases included familial exudative vitreoretinopathy in 5 cases(0.526%),persistent hyperplastic primary vitreous in 1 case(0.105%),congenital cataract in 1 case(0.105%),retinal hemorrhage in 55 cases(5.789%), physiologic large cup in 3 cases(0.316%),congenital lacrimal duct obstruction in 5 cases(0.526%),neonatal conjunctivitis in 100 cases(10.53%),dermolipoma in 2 cases(0.211%),congenital lacrimal sac mucocele in 2 cases(0.211%),retinopathy of prematurity in 26 cases(2.737%). Conclusion Neonatal eye diseases are not uncomon in clinical, and a part of the eye diseases can be early screening and early treatment to avoid blindness.