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.     

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.     

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.     

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。     

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.     

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。     

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。     

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...     

The influence of prematurity,maternal anxiety,and infants' neurobiological risk on mother–infant interactions

In this study, we investigated how the birth of a very low birth weight preterm (VLBW) infant influences the mother–infant interaction at 3 months. We also focused on the impact of the infant's neurobiological risk and maternal anxiety, and their interaction. The comparison of the VLBW preterm sample (n = 79) with an external full‐term sample (n = 35) showed mother–infant interactions of the families with the preterm infant to be more vocally responsive during the interaction, but less facially responsive during the interaction. Additionally, higher levels of maternal anxiety were associated with preterm infants being less facially responsive in interaction with their mother. While neurobiological risk of the infant played a part in this association, with higher risk infants also being less facially responsive, the relationship with maternal anxiety and the mother–child interaction was stronger. How these findings may influence therapeutic interventions is discussed.     

Mutual touch during mother–infant face-to-face still-face interactions: Influences of interaction period and infant birth status

Contact behaviours such as touch, have been shown to be influential channels of nonverbal communication between mothers and infants. While existing research has examined the communicative roles of maternal or infant touch in isolation, mutual touch, whereby touching behaviours occur simultaneously between mothers and their infants, has yet to be examined. The present study was designed to investigate mutual touch during face-to-face interactions between mothers and their 5½-month-old fullterm (n = 40), very low birth weight/preterm (VLBW/preterm; n = 40) infants, and infants at psychosocial risk (n = 41). Objectives were to examine: (1) how the quantitative and qualitative aspects of touch employed by mothers and their infants varied across the normal periods of the still-face (SF) procedure, and (2) how these were associated with risk status. Mutual touch was systematically coded using the mother–infant touch scale. Interactions were found to largely consist of mutual touch and one-sided touch plus movement, highlighting that active touching is pervasive during mother–infant interactions. Consistent with the literature, while the SF period did not negatively affect the amount of mutual touch engaged in for mothers and their fullterm infants and mothers and their infants at psychosocial risk, it did for mothers and their VLBW/preterm infants. Together, results illuminate how both mothers and infants participate in shaping and co-regulating their interactions through the use of touch and underscore the contribution of examining the influence of birth status on mutual touch.     

Corrected and uncorrected Bayley scores: Longitudinal developmental patterns in low and high birth weight preterm infants

In this study, we longitudinally investigated developmental changes in very low birth weight (VLBW, less than 1500 gms), in higher birth weight (HBW, 1500–2000 gms) preterm, and in full-term (FT) infants. We also investigated changes in their caretaking home environment. The subjects were 20 VLBW, 39 HBW, and 24 FT infants who participated in an intervention study. Blind independent assessments were performed at 4, 8, 12, and 16 months corrected age using the Bayley mental and motor scales, both corrected for prematurity and uncorrected, the Infant and Toddler temperament questionnaires, and the Caldwell Home Observation for Measurement of the Environment inventory (HOME). The VLBW infants obtained the lowest mental (77) and motor (77) uncorrected scores, which were significantly different from the mental and motor scores of the HBW (94 and 89, respectively) and of the FT (115 and 109, respectively) infants. Mental and motor uncorrected scores were significantly lower at 4 months than at 8, 12, and 16 months. By 12 months, the uncorrected scores of the HBW infants no longer differed from the FT ones, and by 16 months only the difference between the FT and the VLBW was significant. The corrected mental and motor scores yielded no significant group or age differences. Post hoc analysis of an interaction in the motor scores yielded significantly higher scores for the FT than for the VLBW group at the last assessment. Overall, the VLBW infants were more passive and less intense than were either HBW or FT infants. In general, the home environment of the VLBW infants was significantly less stimulating and responsive than was the home environment of the FT and HBW infants. These results are discussed in terms of vulnerability of the VLBW preterm infants to developmental deficits and the difficulties their parents experience in their caretaking role.     

Early receptive and productive language skills in preterm and full-term 8-month-old infants

Early receptive and productive language skills were examined for preterm low birthweight infants and full-term normal birthweight infants from middle-class homes. Nineteen preterm infants and 19 full-term infants were observed in a laboratory setting at the gestationally corrected age of 8 months. To avoid the frequent confound between prematurity and low socioeconomic status, mothers of the two groups of infants were matched on educational levels. Regression analyses were used to assess the relative influence of infant cognitive skills, infant sociability, infant birth status, and the mothers' language input as possible predictors of infant receptive language and vocal behavior. Receptive language skills were associated with higher cognitive performance, greater sociability, and preterm birth. Productive language skills were associated with higher cognitive performance. On the basis of this research, the prognosis for language development in preterm infants raised in middle-class homes appears to be excellent.This research was aided by Social and Behavioral Sciences Research grant No. 12-11 from the March of Dimes Birth Defects Foundation and supported by DHHS Grant HD03352. Computing was provided by the Waisman Center Computing Facility at the University of Wisconsin-Madison. Donna Boylan, Sue DaPra, Maria Kleczewski, Michal Rubin, Susan Silverber, and Paula VanLaanan assisted with data collection.     

Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother–infant interaction: The case of preterm birth

Preterm birth may represent a traumatic situation for both parents and a stressful situation for the infant, potentially leading to difficulties in mother–infant relationships. This study aimed to investigate the impact of an early intervention on maternal posttraumatic stress symptoms, and on the quality of mother–infant interactions, in a sample of very preterm infants and their mothers. Half of the very preterm infants involved in the study (n = 26) were randomly assigned to a 3-step early intervention program (at 33 and 42 weeks after conception and at 4 months’ corrected age). Both groups of preterm infants (with and without intervention) were compared to a group of full-term infants. The impact of the intervention on maternal posttraumatic stress symptoms was assessed 42 weeks after conception and when the infants were 4 and 12 months of age. The impact of the intervention on the quality of mother–infant interactions was assessed when the infants were 4 months old. Results showed a lowering of mothers’ posttraumatic stress symptoms between 42 weeks and 12 months in the group of preterm infants who received the intervention. Moreover, an enhancement in maternal sensitivity and infant cooperation during interactions was found at 4 months in the group with intervention. In the case of a preterm birth, an early intervention aimed at enhancing the quality of the mother–infant relationship can help to alleviate maternal post-traumatic stress symptoms and may have a positive impact on the quality of mother–infant interactions.     

Public health issues related to infection in pregnancy and cerebral palsy

Cerebral palsy is the most common neuromotor developmental disability of childhood, affecting as many as 8,000 to 12,000 children born in the U.S. each year (corresponding to a prevalence rate of between 2 and 3 per 1000 children). Recent improvements in neonatal care have not resulted in a decline in the overall prevalence of cerebral palsy and, in fact, greater numbers of very preterm/very low birth weight infants are surviving with cerebral palsy and other developmental problems. Infection in pregnancy may be an important cause of the disorder. In preterm infants, there appears to be about a 2-fold increased risk for cerebral palsy from chorioamnionitis, and in term infants the estimated increased risk is about 4-fold. Provisionally, chorioamnionitis might account for 12% of spastic cerebral palsy in term infants and 28% of cerebral palsy in preterm infants. Studies of biochemical markers of fetal inflammation typically associated with infection also suggest that an inflammatory response may be an important independent etiologic factor. If a substantial proportion of cerebral palsy is attributable to acute amnionitis infection and/or neonatal sepsis, cerebral palsy should have decreased in the United States after administration of intrapartum antibiotics became widespread in response to publication of public health consensus guidelines for Group B streptococcus in 1996. However, failure to detect declines could have a number of explanations and these explanations illustrate the many public health challenges related to intrauterine infection and cerebral palsy. Given the gaps in our current knowledge about intrauterine infection and cerebral palsy, public health recommendations for timely and specific prevention activities are limited at this time.     

Dynamics of oralrespiratory coordination in full-term and preterm infants: II. Continuing effects at 3 months post term

Thirty-two infants participating in a longitudinal study of the effects of premature birth on sucking and breathing were tested at 3 months post term. They were assigned at a previous test to either a healthy full-term, healthy preterm, or high risk preterm group on the basis of birth weight, postconceptional age at birth, and perinatal medical status. Positive and negative sucking pressure as well as chest and abdominal breathing movements were recorded during nutritive sucking. The high risk preterms used a simpler and more stable pattern of coordination between sucking and breathing, were more likely to interrupt breathing at milk onset, and produced longer phase lags between positive and negative sucking pressure.     

The effect of preterm birth on infant negative affect and maternal postpartum depressive symptoms: A preliminary examination in an underrepresented minority sample

ObjectiveTo examine the effect of preterm birth on maternal postpartum depressive symptoms and infant negative affect in an underrepresented minority sample.MethodParticipants were 102 mothers and their 3- to 10-month-old infants. Mothers completed the Edinburgh Postnatal Depression Scale and the Infant Behavior Questionnaire-Revised.ResultsRelative to normative samples, the current underrepresented minority sample of mostly Hispanics and Blacks displayed high rates of preterm birth (30%) and maternal postpartum depressive symptoms (17%). Preterm birth had a significant direct effect on postpartum depressive symptoms and infant negative affect. Additionally, there was an indirect effect of postpartum depressive symptoms on the relation between preterm birth and infant negative affect. Specifically, lower birth weight and gestational age predicted higher levels of depressive symptoms in the mother, and higher levels of depressive symptoms in the mother, in turn, predicted higher levels of infant negative affect.ConclusionFindings emphasize the importance of screening for postpartum depressive symptoms and infant negative affect among mothers and their preterm infants, especially among families from underrepresented minority backgrounds.     

Early interactive behaviours in preterm infants and their mothers: Influences of maternal depressive symptomatology and neonatal birth weight

The study evaluated the quality of preterm infant–mother interactions, considering severity of birth weight (ELBW and VLBW) and maternal depression, compared to full term babies. 69 preterm infants (29 ELBW and 40 VLBW) and 80 full-term (FT) infants and their mothers were recruited. At 3 months of corrected age, the quality of mother–infant interaction was evaluated through Global Rating Scales; moreover, infant level of development and maternal depression were assessed through Griffith Development Mental Scales and Edinburgh Postnatal Depression Scale. Results showed adequate sensitivity in preterm infants’ mothers and higher involvement with their infants, compared to full term mothers, but ELBW ones exhibited an intrusive interactive pattern and a higher prevalence of depressive symptoms. The study underlined the relevance of paying special attention to both ELBW infants and their mothers, in order to support the parenting role and the co-construction of early interactions.     

Immediate Effect of Training at the Onset of Reaching in Preterm Infants: Randomized Clinical Trial

The authors' aim was to investigate the immediate effect of a single specific training session (serial varied practice), of short duration on the kinematic parameters of reaching, in the period of the emergence of the skill in preterm and low birth weight infants. The study included 16 infants of both sexes, born at a mean gestational age of 32.13 (±1.36) weeks and mean birth weight of 1720.94 (±358.46) g. The infants were randomly divided into 2 groups: experimental and control. The experimental group was given a 5-min training session in reaching, while the control group received no training. The results showed significant differences in peak velocity in the intra (Z = –2.10, p = .036) and intergroup (U = 9.00, p = .016) evaluations, which decreased in the experimental group after training. Cohen's d test for clinical relevance suggested that the specific, short duration training proved effective in promoting slower reaches, with greater adjustment and lower number of units of movement. These results are positive for preterm infants given that these parameters more closely resemble the typical development of mature reaching behaviors in term infants, which suggests that this protocol of reaching training (serial varied practice) could be used as an evidence-based intervention strategy.