关于低出生体重儿诊疗最优化原则的思考

出生体重及低出生体重发生率是衡量社会发展和妇幼保健状况的重要指标.低出生体重不仅直接增加新生儿和婴儿的患病率和死亡率,而且与儿童的远期预后如生长发育落后、智力低下、脑瘫及成年期胰岛素抵抗密切相关.通过运用诊疗最优化的原则,对低出生体重儿进行预防,及早干预治疗,可提高其生命质量.     

关于低出生体重儿生长模式的思考

低出生体重儿发生率是衡量社会发展和妇幼保健状况的重要指标。低出生体重不仅直接增加新生儿死亡率和儿童早期的患病率,而且与儿童的远期预后密切相关。本文从低出生体重儿的生长特点、生长追赶的利弊以及营养管理等方面,探讨适于低出生体重儿的最佳生长模式,以求改善这一特殊群体的近期健康和远期生活质量。     

关于低出生体重儿生长模式的思考

低出生体重儿发生率是衡量社会发展和妇幼保健状况的重要指标.低出生体重不仅直接增加新生儿死亡率和儿童早期的患病率,而且与儿童的远期预后密切相关.本文从低出生体重儿的生长特点、生长追赶的利弊以及营养管理等方面,探讨适于低出生体重儿的最佳生长模式,以求改善这一特殊群体的近期健康和远期生活质量.     

从家长的角度探讨有关低出生体重儿的生命伦理学问题

为了了解家长关于低出生体重儿医疗救治权的观点,为医疗决策提供伦理学依据,按1：1匹配各选择124例单胎低出生体重儿及正常儿建立队列,调查两组家长对低出生体重儿医疗救治观点的认识。结果显示,两组家长大多认同低出生体重儿应积极救治且医疗救治权应当由医生和家长共同决定。因此,应加强围产期保健教育,积极预防低体重儿出生。     

低出生体重与代谢综合征

低出生体重是发生成年期代谢综合征的高危因素。“代谢程序化”与“营养程序化”概念的提出对人们从多层面认识该现象的内在机制有重要指导作用。随着对发生机制研究的深入,人们终将找到预防低出生体重发生成年期代谢综合征的早期干预措施。     

低出生体重与代谢综合征

低出生体重是发生成年期代谢综合征的高危因素."代谢程序化"与"营养程序化"概念的提出对人们从多层面认识该现象的内在机制有重要指导作用.随着对发生机制研究的深入,人们终将找到预防低出生体重发生成年期代谢综合征的早期干预措施.     

低出生体重儿和小于胎龄儿发生的危险因素分析

比较低出生体重儿和小于胎龄儿发生的影响因素。选择2012年1月1日~2016年12月31日在山东省交通医院分娩的活产单胎新生儿,分析新生儿出生体重的影响因素。Logistic回归分析显示,女婴(OR=2.151,95%CI:1.580~2.927)、出生缺陷(OR=3.325,95%CI:1.444~7.656)、早产(OR=28.548,95%CI:20.460~39.833)是低出生体重儿的影响因素;女婴(OR=1.260,95%CI:1.092~1.455)、产检次数4次(与产检4次~7次者比,OR=1.386,95%CI:1.184~1.623)、产检次数≥8次(与产检4次~7次者比,OR=1.576,95%CI:1.238~2.007)、围孕期未服用营养补充剂(OR=1.379,95%CI:1.109~1.715)是小于胎龄儿的影响因素。低出生体重儿和小于胎龄儿发生的危险因素有所差异,孕妇应采取不同的预防措施,从而减少不良妊娠结局的发生。     

处于生存极限的低出生体重儿该如何决策救治

我国极低及超低出生体重儿的出生比例已接近发达国家。但因为经济、文化、技术及社会保障制度等原因,相当多的患儿得不到合理救治。这与发达国家相比有很大差距。让医护人员做到合理评估和告知,适时放弃治疗,完善社会保障制度,加强社会舆论监督和教育,加快相关制度、法规的建立等措施有望改变这一现状。     

64例中止治疗新生儿引发的伦理思考

1一般资料 对于1998年1月至2002年12月5年中新生儿专科出院的1874名病人进行回顾性调查,其中出院前终止治疗64人.64例新生儿中,男40人,女24人;早产儿17人,低出生体重儿23人(＜2.5kg 15人、＜1.5kg8人);疾病诊断:重度新生儿缺氧缺血性脑病26人,先天畸形26人(其中先天性心脏病11人),宫内感染(包括败血症、巨细胞病毒感染、弓形虫感染等)9人,核黄疸1人,新生儿肺透明膜病2人.终止治疗的原因有:救治无效25人,经济困难14人,严重缺陷14人,担心有后遗症11人.从上述资料可见早产、低出生体重及重度新生儿缺氧缺血性脑病是终止治疗的主要疾病,终止治疗的主要原因是病情严重救治无效.     

早产高胆红素血症患儿脑干听觉诱发电位测听的临床意义

检测分析早产高胆红素血症（HB）患儿脑干听觉诱发电位测听（BAEP）指标。连续选择近期在我院住院的早产HB患儿176例,入选对象治疗前接受了BAEP检测。胎龄较短、分娩体重较轻、日龄较小和血清高浓度早产儿BAEP检测通过耳数、通过率均明显少于胎龄较长、出生体重较重、日龄较大和胆红素较低浓度旱产儿组（P均〈0．05）。不...     

新生儿真菌血症的调查与分析

了解新生儿真菌血症的流行病学特征,为制定有效的预防措施提供科学依据。采取回顾性调查及病例对照研究方法,分析我院2008年~2010年新生儿真菌血症患者及对照的临床资料、实验室检查结果。结果早产儿及极低体重儿易发生真菌血流感染,感染菌株以非白色念珠菌为最常见,预防性抗真菌药的目标人群可定为早产儿、极低体重儿及细菌性菌血症患儿。     

Developmental change in the neuropsychological functioning of very low birth weight infants

Research on very low birth weight (VLBW) infants has not carefully evaluated developmental patterns of neurological and neuropsychological functioning across time. This study reports on a broad range of developmental outcomes for VLBW infants of low (LR, n = 116) and high (HR, n = 84) medical risk compared to full term infants (FT, n = 120) across 6, 12, and 24 months of age. While low risk infants showed initial delays in most areas, faster rates of change in motor and neurological development resulted in catch-up by 2 years of age as compared to the FT infants. The lack of acceleration in development of mental skills demonstrates a persistent lag in this area. In contrast, HR infants showed initial delays in all areas as compared to both LR and FT infants with slower rates of change in mental and expressive language skills. Although faster rates of change were evident for HR infants in motor, neurological, and receptive language skills, scores in these areas remain lower than those for the LR and FT infants. The absence of accelerated rates of development for certain VLBW infants has implications for prognosis and patient access to early intervention services.     

Infant birth weight among women with or at high risk for HIV infection: the impact of clinical, behavioral, psychosocial, and demographic factors.

The purpose of these analyses was to provide a prospective examination of the impact of HIV on birth weight using clinical, behavioral, psychosocial, and demographic correlates. HIV-positive (n = 319) and HIV-negative (n = 220) pregnant women matched for HIV risk factors (i.e., drug use and sexual risk behaviors) were interviewed during the 3rd trimester of pregnancy and 6 weeks postpartum. Medical chart reviews were also conducted for the HIV-seropositive pregnant women to verify pregnancy-related and birth outcome data. In a logistic regression analysis, model chi2(9, N = 518) = 124.8, p < .001, controlling for parity and gestational age, women who were HIV seropositive were 2.6 times more likely to have an infant with low birth weight. In addition, Black women and those who did not live with their partners were more than 2 times as likely to have infants with low birth weight, and those who smoked were 3.2 times more likely to have infants with low birth weight. Knowing that women with HIV, those who are Black, and those not living with a partner are at highest risk for adverse birth outcomes can help those in prenatal clinics and HIV specialty clinics to target resources and develop prevention interventions. This is particularly important for women with HIV because birth weight is associated with risk of HIV transmission from mother to child.     

Influence of infant and child facial cues of low body weight on adults' ratings of adoption preference,cuteness, and health

Infant and child facial cues have been shown to influence decisions and perceptions associated with parental care in adults. Low body weight reflects health problems in infants and children; therefore, facial cues associated with low body weight may influence adult cognitive processes associated with parental care and investment. Facial images of infants and children were digitally manipulated to simulate cues of low body weight and presented to adults using a hypothetical adoption paradigm. Participants' ratings of adoption preference, cuteness, and health were significantly lower for the digitally manipulated low body weight facial images than their unaltered counterparts. These findings support the hypothesis that facial cues of poor health negatively influence adults' responses to infants and children.     

Relation of birth weight, maternal intelligence and mother–child interactions to cognitive and play competence of Jamaican two-year old children

The present study assessed whether birth weight, maternal child rearing behaviors, and maternal intelligence combine in an additive or in a non-linear interactive fashion to influence cognitive performance in a sample of 24-month old full-term appropriate and low birth weight Jamaican children. Child cognitive performance was measured using the Griffiths Scale and a laboratory based assessment of the amount of time the child utilized different levels of play behavior. Mothers were videotaped while playing with their children under different instructional conditions and videotapes were coded for 8 maternal interaction patterns. Maternal verbal intelligence was assessed using the PPVT. Results supported the operation of both additive co-action as well as non-linear interactive processes. Birth weight, maternal behaviors toward her child and maternal intelligence predicted child cognitive performance. In addition, low birth weight infants were either less sensitive to facilitative aspects of maternal behaviors and/or more sensitive to maternal inhibitory behaviors than were appropriate birth weight infants. Further, child rearing behaviors of more intelligent mothers were a stronger influence on their child's cognitive performance than those of less intelligent mothers, even when there were no differences in the level of behaviors of more or less intelligent mothers.     

A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants

Nordhov, S. M., Kaaresen, P. I., Rønning, J. A., Ulvund, S. E. & Dahl, L. B. (2010). A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants. Scandinavian Journal of Psychology, 51, 385–391. The background for this study was that nurturant child‐rearing attitudes are associated with positive development in low birth weight (LBW) infants. The objective was to study child‐rearing attitudes and early intervention (EI) in parents of LBW infants from 12–36 months corrected age. LBW infants (BW < 2000 g) were randomized to an intervention (IG) or a control group (CG). The EI consisted of seven in‐hospital sessions prior to discharge, then four home visits. A Child Rearing Practices Report was administered at 12 (mothers only), 24 and 36 months. A total of 146 infants were randomized. The mean BW in IG was 1396 (SD 429) g and 1381 (436) g in CG. The mean GA was 30.2 (3.1) weeks in IG and 29.9 (3.5) weeks in CG. Mothers in IG reported significantly more nurturant child‐rearing attitudes at 12 and 24 months. There was a significant change in restrictive and nurturant attitudes over time. It was concluded that EI may lead to more nurturant child‐rearing attitudes in mothers of preterms.     

Parenting of low birth weight infants: A review of issues and interventions

Factors that may adversely affect parenting of low birth weight infants, including infant characteristics, parental emotional responses to premature birth, and patterns of parent-infant interaction, are reviewed. In addition, intervention studies designed to improve infant developmental outcomes through influencing parenting behaviors are examined. There was great diversity in theoretical frameworks, in timing of onset and frequency of interventions, and in measurement of outcomes. The interventions that were most effective in influencing behaviors and infant developmental outcomes were those in which there were multiple long-term contacts with parents and/or those that actively involved them in the intervention. The specific theoretical framework upon which the interventions were based appeared to be of less importance in influencing results. In order to increase our knowledge and ability to provide costeffective programs, there is a need to focus attention and data collection efforts on the process and intermediary steps of intervention as well as on outcome measures. There is also a need to improve our ability to recruit and retain those families who are most at risk for parenting and infant developmental problems including those with very low birth weight infants, those whose infants have serious perinatal complications, and those with indications of high social risk such as poverty-level incomes and problems of substance abuse.     

Psychological Sequelae in Parents of Extreme Low and Very Low Birth Weight Infants

The current study evaluated the psychological sequelae in 66 parents of extreme low and very low birth weight infants (mean weight of 842 g). Parents who had given birth within a 3-year period prior to the study were chosen from the archives of a neonatal ward and surveyed regarding posttraumatic stress, coping strategies, and social support. Thirty-five percent of the parents reported that their child had a handicap. Twenty percent of the women met the criteria of posttraumatic stress disorder (PTSD) at the time of the study, and an additional 10% met the criteria for a subclinical PTSD diagnosis. Female gender, handicap of the child, general distress during hospitalization, distressing contact with hospital staff, experienced distress at homecoming, and emotional coping, explained 72% of the degree of traumatization. Psychological support and intervention is recommended during the hospital stay of a premature infant who has a handicap and after the homecoming to prevent the development of chronic PTSD and reduce the associated distress.