183例早产儿围产期高危因素及并发症分析

目的：探讨早产儿发生的围产期高危因素及并发症。方法：收集我院2006．1—2009．12出生的早产儿183例的临床资料,总结其早产的相关围产期高危因素及并发症。结果：胎膜早破、多胎妊娠、妊娠高血压综合征是早产发生的主要原因;早产儿的主要并发症为肺炎和颅内出血等。结论：加强围生期保健,早期干预各种围产期高危因素,积极防治早产儿各种并发症,是提高早产儿存活率降低致残率的关键。     

早产儿发生原因及并发症临床分析

目的:回顾分析以往早产儿的临床资料,总结经验,以改善早产儿的生存质量,提高医疗水平.方法:对2006年1月至2008年12月在我院出生的1080例早产儿进行回顾性分析,按不同孕周分为35～37周组、32～35周组以及＜32周组,对3组早产儿的早产原因,合并症的情况进行回顾性分析.结果:胎膜早破是引起早产最主要的原因,其他依次为妊娠期感染,不明原因的自然早产,妊娠期高血压疾病、多胎、胎盘因素及胎儿宫内窘迫.早产儿的并发症中以高胆红素血症,贫血,肺炎,低血糖为主,胎龄＜32周组出现各种合并症的概率＞35～37周组和32～35周组,差异有统计学意义.结论:加强围产期保健指导工作,积极防治早产高危因素,提高早产儿的救治水平,可以改善早产儿的生存质量.     

儿童癫痫的围产期高危因素分析

目的:研究儿童癫痫相关的围产期高危因素。方法:随访16986例新生儿后期癫痫的患病情况,分为儿童癫痫组与非癫痫组,比较两组各项围产期高危因素,进行单因素与多因素统计分析。结果:随访期内儿童癫痫的发病例数为118例(6.95‰),癫痫的发病率在1岁以下的儿童最高(27.12%)。儿童癫痫的发生与孕周、高龄产妇、低出生体重、流产史、宫内窘迫、喂养方式、孕期感染、子痫、胎盘早剥、新生儿惊厥都有相关性,并且孕周、子痫和新生儿惊厥是儿童癫痫发生的独立危险因素。结论:儿童癫痫的发生与围产期高危因素密切相关,这对临床儿童癫痫的诊疗可能有提示作用。     

重症医学病房中早产儿死亡危险因素的单变量logistic 回归 分析研究

目的:探讨重症医学病房内早产儿的相关性危险因素对其死亡的影响.方法:回顾性收集我重症医学病房从2008年6月1日至2011年8月31日收治的早产患儿共45例,分组后,对相关死亡危险因素进行logistics回归分析研究.结果:45例早产儿死亡的相关危险因素为出生体重(OR=4.157),体重越低,死亡率越高.结论:加强孕期保健,优化围产期管理,促进胎儿成熟,加强对低出生体重儿的管理,可提高早产儿的存活率和存活质量.     

301例早产儿视网膜病变筛查结果及其高危因素分析

目的:调查早产儿视网膜病变(ROP)的发生情况并分析其高危因素。方法:选取2017年6月至2018年6月在我院进行眼底检查的301例早产儿,依据《早产儿治疗用氧和视网膜病变防治指南》和《中国早产儿视网膜病变筛查指南》对早产儿进行筛查和随诊,同时收集早产儿及其母亲的相应病历信息,采用多因素Logistic回归分析分析ROP的高危因素。结果:301例早产儿中,共检出ROP患儿43例,其中须接受治疗的患儿13例,所有患儿经过2-6个月的治疗和随诊后均好转。围产因素中,胎龄小、出生体重低、吸氧、输血、有急性呼吸窘迫综合征(ARDS)的早产儿ROP检出率更高(均P0.05);母体因素中,多胎分娩的早产儿ROP检出率高于单胎分娩的早产儿(P0.05)。Logistic回归分析显示,胎龄小、出生体重低、吸氧、输血和有ARDS为早产儿ROP的高危因素(P0.05)。结论:早产儿ROP发病率较高,胎龄小、出生体重低、吸氧、输血和有ARDS是其高危因素,在临床实践中应给予重视,及早发现ROP并规范治疗,以降低早产儿ROP的发病率。     

早产病因及发病机制的研究现状

早产在妇产科临床上比较常见,其作为围生医学当中的一类重要而复杂的妊娠并发症,对早产儿的预后具有较大危害,严重时可能直接导致早产儿死亡。通常而言,早产患者的临床表现主要是子宫收缩,初期表现为不规律的宫缩,并伴有少量的阴道出血亦或是血性分泌物,进而发展成规律性的宫缩,此过程中宫颈管先发生消退,而后扩张。早产儿的体重大多数低于2500 g,且头围小于33 cm,部分胎儿的器官功能及适应能力与足月儿相比明显较差,常需给予特殊的处理。因此,及时梳理导致早产的原因并分析其发病机制,有利于早期掌握防治早产的基础要点。本文就此展开综述,以期为改善母婴妊娠结局提供理论支持。     

新生儿低血糖症的发生原因及临床疗效分析

目的探讨新生儿低血糖症的发生原因以及临床治疗措施。方法对我院收治的80例低血糖新生儿的临床资料进行回顾性分析。结果胎龄37周的新生儿较易发生低血糖,小于胎龄儿、围产期窒息、喂养延迟、母体糖尿病等是导致新生儿发生低血糖的高危因素。经治疗后,全部患儿血糖均恢复正常。结论新生儿发生低血糖的原因较多,对有低血糖高危因素的新生儿应常规监测血糖,及早诊断,及早治疗,避免引起严重的并发症。     

胎膜早破早产的临床分析

目的:探讨胎膜早破早产的临床处理方法及其对新生儿的影响.方法:以2009年3月至2012年1月在我院产科住院的妊娠满28～36+6周的205例胎膜早破早产患者为研究对象,针对不同孕周,采用相应的治疗方法,并对其妊娠结局和早产儿的状况进行观察和分析.结果:胎龄28～34+6周的早产儿并发症的发生率和死亡率分别为52.2％和10％,胎龄35～35+6周的早产儿并发症的发生率和死亡率分别为32.3％和4.8％,分别明显高于胎龄＞36周出生的早产儿(1.6％和0),差异具有统计学意义(P＜0.05);但孕周在36周以上出生的新生儿的并发症的发生率和死亡率与足月出生的新生儿相比无明显差异(P＞0.05).结论:胎膜早破早产是新生儿患病和死亡的主要原因,胎龄越小新生儿的患病率和死亡率越高,对于胎膜早破早产的孕妇,应针对不同孕周采用不同的治疗方法,以延长孕周以降低早产儿的患病率和死亡率.     

新生儿低血糖症的高危因素及临床防治探讨

目的：探讨新生儿低血糖症的高危因素及临床防治。方法：对2010年1月．2012年8月我院收治的有低血糖高危因素的267例新生儿的临床资料进行回顾性分析。结果：检出低血糖83例,无特异性临床症状;惠有新生儿窒息、新生儿缺氧缺血性脑病、早产儿及小于胎龄儿及糖尿病母亲娩出的新生儿发生低血糖症的发生率较高。早产儿、低出生体重儿、巨大儿低血糖症的发生率显著高于正常胎儿,P〈0．05。结论：对于有低血糖症的高危因素的患儿应严密监测血糖情况,尽早进行防治,避免因低血糖造成脑损伤。     

儿童癫痫的围产期高危因素分析

目的：研究儿童癫痫相关的国产期高危因素。方法：随访16986例新生儿后期癫痫的患病情况,分为儿童癫痫组与非癞痫组,比较两组各项围产期高危因素,进行单因素与多因素统计分析。结果：随访期内儿童癫痫的发病例数为118例（6．95‰）,癫痫的发病率在1岁以下的儿童最高（27．12％）。儿童癫痫的发生与孕周、高龄产妇、低出生体重、流产史、宫内窘迫、喂养方式、孕期感染、子痫、胎盘早剥、新生儿惊厥都有相关性,并且孕周、子痫和新生儿惊厥是儿童癫痫发生的独立危险因素。结论：儿童癫痫的发生与围产期高危因素密切相关,这对临床儿童癫痫的诊疗可能有提示作用。     

Genetic polymorphisms for vascular endothelial growth factor in perinatal complications

Low birth weight (LBW) infants have increased susceptibility to perinatal complications. An immature and impaired vascular system may possibly participate in these complications. There is evidence that supports the notion that vascular endothelial growth factor (VEGF), which is an essential regulator of embryonic angiogenesis, plays a central role in the pathogenesis of perinatal complications. We aimed to test whether functional genetic polymorphisms of VEGF are associated with the risk of preterm birth or perinatal morbidity. We enrolled 128 LBW infants (< or = 1500 grams). VEGF T-460C, VEGF C-2578A and VEGF G+405C polymorphisms were determined by real-time PCR or PCR-RFLP, respectively. Their genotypes were compared with VEGF genotypes of 200 healthy, term neonates. The prevalence of the VEGF+405 C allele was higher in LBW infants than in healthy, term neonates (OR [95% CI]: 1.29 [1.01-1.65]). Carrier state for the VEGF -2578A allele was an independent risk factor for enterocolitis necrotisans (NEC) (adjusted OR [95% CI]: 2.77 [1.00-7.65]). The carrier state for the VEGF -2578AA genotype was associated with a decreased risk of acute renal failure (ARF) (adjusted OR [95% CI]: 0.2 [0.05-0.78]). These results suggest that VEGF G+405C polymorphism might be associated with a higher risk of preterm birth and that VEGF C-2578A polymorphism may participate in the development of perinatal complications such as NEC and ARF.     

Risk Factors and Adverse Perinatal Outcomes among Term and Preterm Infants Born Small-for-Gestational-Age: Secondary Analyses of the WHO Multi-Country Survey on Maternal and Newborn Health

Background

Small for gestational age (SGA) is not only a major indicator of perinatal mortality and morbidity, but also the morbidity risks in later in life. We aim to estimate the association between the birth of SGA infants and the risk factors and adverse perinatal outcomes among twenty-nine countries in Africa, Latin America, the Middle East and Asia in 359 health facilities in 2010–11.

Methods

We analysed facility-based, cross-sectional data from the WHO Multi-country Survey on Maternal and Newborn Health. We constructed multilevel logistic regression models with random effects for facilities and countries to estimate the risk factors for SGA infants using country-specific birthweight reference standards in preterm and term delivery, and SGA’s association with adverse perinatal outcomes. We compared the risks and adverse perinatal outcomes with appropriate for gestational age (AGA) infants categorized by preterm and term delivery.

Results

A total of 295,829 singleton infants delivered were analysed. The overall prevalence of SGA was highest in Cambodia (18.8%), Nepal (17.9%), the Occupied Palestinian Territory (16.1%), and Japan (16.0%), while the lowest was observed in Afghanistan (4.8%), Uganda (6.6%) and Thailand (9.7%). The risk of preterm SGA infants was significantly higher among nulliparous mothers and mothers with chronic hypertension and preeclampsia/eclampsia (aOR: 2.89; 95% CI: 2.55–3.28) compared with AGA infants. Higher risks of term SGA were observed among sociodemographic factors and women with preeclampsia/eclampsia, anaemia and other medical conditions. Multiparity (> = 3) (AOR: 0.88; 95% CI: 0.83–0.92) was a protective factor for term SGA. The risk of perinatal mortality was significantly higher in preterm SGA deliveries in low to high HDI countries.

Conclusion

Preterm SGA is associated with medical conditions related to preeclampsia, but not with sociodemographic status. Term SGA is associated with sociodemographic status and various medical conditions.     

Role of omega-3 fatty acids in brain development and function: potential implications for the pathogenesis and prevention of psychopathology

The principle omega-3 fatty acid in brain, docosahexaenoic acid (DHA), accumulates in the brain during perinatal cortical expansion and maturation. Animal studies have demonstrated that reductions in perinatal brain DHA accrual are associated with deficits in neuronal arborization, multiple indices of synaptic pathology including deficits in serotonin and mesocorticolimbic dopamine neurotransmission, neurocognitive deficits, and elevated behavioral indices of anxiety, aggression, and depression. In primates and humans, preterm delivery is associated with deficits in fetal cortical DHA accrual, and children/adolescents born preterm exhibit deficits in cortical gray matter maturation, neurocognitive deficits particularly in the realm of attention, and increased risk for attention-deficit/hyperactivity disorder (ADHD) and schizophrenia. Individuals diagnosed with ADHD or schizophrenia exhibit deficits in cortical gray matter maturation, and medications found to be efficacious in the treatment of these disorders increase cortical and striatal dopamine neurotransmission. These associations in conjunction with intervention trials showing enhanced cortical visual acuity and cognitive outcomes in preterm and term infants fed DHA, suggest that perinatal deficits in brain DHA accrual may represent a preventable neurodevelopmental risk factor for the subsequent emergence of psychopathology.     

Induced abortion as a risk factor for perinatal complications: a review.

Past and continuing studies of the influence of a prior induced abortion on subsequent perinatal complications are reviewed. Many definitive conclusions are precluded because of design problems in the extant studies and these methodological issues, therefore, form the focus for the current review. The available studies do suggest that abortion by vacuum aspiration is not a risk factor for complications of subsequent pregnancies, labor, delivery, or of newborns. Abortion by dilatation and curettage, however, may increase the risk of subsequent spontaneous abortion, low birth weight, and prematurity but these findings need to be confirmed. The impact of other abortion techniques or perinatal complications has not been studied. The more common design problems in the extant literature include: (1) failure to control for confounding maternal factors; (2) problems in reliability of reporting previous abortion; and (3) nonspecific measurement of abortion techniques. Since approximately three-quarters of all abortions performed annually in the United States are on young never-married women who may eventually wish to bear children, further rigorous research to define the risks of induced abortion is urgently required.     

Perinatal mortality in eastern Uganda: a community based prospective cohort study

Background

To achieve a child mortality reduction according to millennium development goal 4, it is necessary to considerably reduce neonatal mortality. We report stillbirth and early neonatal mortality risks as well as determinants of perinatal mortality in Eastern Uganda.

Methods

A community-based prospective cohort study was conducted between 2006 and 2008. A total of 835 pregnant women were followed up for pregnancy outcome and survival of their children until 7 days after delivery. Mother''s residence, age, parity, bed net use and whether delivery took place at home were included in multivariable regression analyses to identify risk factors for perinatal death.

Results

The stillbirth risk was 19 per 1,000 pregnancies and the early neonatal death risk 22 per 1,000 live births. Overall, the perinatal mortality risk was 41 [95%CI: 27, 54] per 1,000 pregnancies. Of the deaths, 47% followed complicated deliveries and 24% preterm births. Perinatal mortality was 63/1,000 pregnancies among teenage mothers, 76/1,000 pregnancies among nulliparous women and 61/1,000 pregnancies among women delivering at home who, after controlling for potential confounders, had a 3.7 (95%CI: 1.8, 7.4) times higher perinatal mortality than women who gave birth in a health facility. This association was considerably stronger among nulliparous women [RR 8.0 (95%CI: 2.9, 21.6)] than among women with a previous live birth [RR 1.8 (95%CI: 0.7, 4.5)]. All perinatal deaths occurred among women who did not sleep under a mosquito net. Women living in urban slums had a higher risk of losing their babies than those in rural areas [RR: 2.7 (95%CI: 1.4, 5.3)].

Conclusion

Our findings strengthen arguments for ensuring that pregnant women have access to and use adequate delivery facilities and bed nets.