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。     

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。     

法安明联合维生素E对胎儿生长受限高危患者早期干预的临床研究

目的:探讨法安明联合维生素E对胎儿生长受限高危患者进行早期干预的临床疗效。方法:选择存在胎儿生长受限高危因素的孕妇共156例,研究组86例,每天皮下注射一次法安明5000U,同时给予天然维生素胶丸E0.1g,每天口服3次,可根据D-二聚体结果调整法安明用量直至降至正常,孕中期开始补钙。对照组70例,孕早期不干预,孕中期开始补钙。比较两组妊娠结局。结果:研究组分娩孕周、新生儿出生体重明显高于对照组,胎儿生长受限、羊水过少、妊娠期高血压疾病、新生儿窒息的发生率明显低于对照组,两组比较差异有统计学意义(P0.05);两组宫内死胎、围产儿死亡的发生率无差异(P0.05)。结论:法安明联合维生素E对胎儿生长受限高危患者进行早期干预,可减少胎儿生长受限、羊水过少、妊娠期高血压疾病及新生儿窒息等的发生,改善妊娠结局及围生儿预后。     

复杂性热性惊厥脑电图特征与癫痫发生的相关性

目的：探讨复杂性热性惊厥脑电图特征与癫痫发生的相关性。方法：2012年3 月到2014 年5 月选择在我院诊治为复杂性热 性惊厥的呼吸道感染患儿86 例作为观察组,同期选择在我院诊治的非热性惊厥的呼吸道感染患儿86 例作为对照组,两组都进 行脑电图监测与认知功能判定,对癫痫发生情况进行判定与分析。结果：观察组的言语智商、行为智商与总智商评分都明显低于 对照组(P<0.05)。观察组的癫痫发生率为9.3 %,脑电图异常率为8.1 %;而对照组的癫痫发生率为1.2 %,脑电图异常率为2.3 %, 对比差异都有统计学意义(P<0.05)。在观察组患儿中,Spearman 相关性分析显示脑电图异常与癫痫发生存在明显正向相关性(r=0. 349,P<0.05)。结论：复杂性热性惊厥伴随有脑电图异常,与癫痫发生存在明显正向相关性,损害患儿的认知功能。     

围产期孕妇生殖道B族链球菌感染高危因素分析及母婴结局探讨

目的调查沈阳地区围产期孕妇生殖道B族链球菌(group B streptococcus,GBS)定植率和感染高危因素及对母婴结局的影响,以便预防和控制围产期妇女GBS感染,优化母婴结局。方法对2017年9—11月在医院作孕期检查的31～40周孕晚期孕妇691例取阴道拭子及直肠拭子进行GBS培养、分离鉴定,分析GBS定植率;采用卡方检验进行GBS感染的单因素分析,采用多因素二元Logistic回归进行GBS感染的高危因素分析;对比两组孕妇及新生儿结局。结果沈阳地区孕晚期孕妇生殖道GBS定植率为7.67%(53/691),其中阴道试子阳性率为4.63%(32/691),直肠试子阳性率为6.22%(43/691);孕妇GBS感染的危险因素显示,在教育程度、生产史、分娩方式、甲状腺异常、妊娠期高血压、妊娠期贫血和妊娠期糖尿病,组间差异均无统计学意义(P>0.05);孕妇GBS感染危险因素,年龄、体质量、流产史和生殖道感染,组间比较,差异均有统计学意义(P<0.05);经多因素二元Logistic回归分析结果显示,年龄、体重、流产史和生殖道感染为影响GBS感染发生的独立危险因素,两组比较差异均有统计学意义(P<0.05);感染组孕妇胎膜早破、早产发生率高于对照组,经比较差异有统计学意义(P<0.05);产后出血发生率经比较差异无统计学意义(χ2=0.624,P>0.05);感染组新生儿胎儿窘迫、绒毛膜羊膜炎、新生儿黄疸发生率高于对照组,经比较差异有统计学意义(P<0.05)。结论沈阳市孕妇生殖道GBS定植率较高,建议对孕晚期孕妇开展GBS常规筛查。年龄、体重、流产史和生殖道感染为GBS感染发生的独立危险因素,有必要对本地区的围产期孕妇进行健康宣教,减少GBS感染的发生,进而改善母婴结局。     

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     

44例不同孕周脐带脱垂患者的临床资料分析

目的:探讨不同孕周脐带脱垂患者相关因素的差异。方法:回顾性比较分析2012年01月至2017年12月我院收治的44例脐带脱垂患者的临床资料。将患者按照脐带脱垂发生的孕周分为足月组、早产组及流产组,使用SPSS18.0统计软件处理数据。结果:我院近六年脐带脱垂总的发病率为1.829/1000。44例患者中,足月组7人,占15.91%;早产组22人,占50%;流产组15人,占34.09%。三组患者的年龄、产次及孕次均无显著统计学差异(P0.05)。足月组新生儿apgar评分最高,与其它两组相比均有统计学差异(P0.05),早产组apgar评分显著高于流产组(P0.05);足月组剖宫产率为100%,早产组为63.64%,流产组则为13.13%,三组患者剖宫产率比较存在统计学差异(P=0.000),足月组剖宫产率与早产组比较无统计学差异(P=0.075),足月组剖宫产率与流产组比较有统计学差异(P=0.000),早产组剖宫产率与流产组比较有统计学差异(P=0.003)。足月组异常胎方位的发生率显著低于早产组(P=0.038)。早产组胎儿数(单胎、双胎)与足月组及流产组相比均有统计学差异(P0.05),而足月组与流产组胎儿数则无统计学差异(P0.05)。早产组双胎妊娠占比例更高。三组患者发生脐带脱垂的地点比较无统计学差异(P=0.256)。结论:不同孕周是否发生脐带脱垂与患者的年龄、产次、孕次及地点无关。脐带脱垂较多发生于早产者,且早产患者中双胎、异常胎方位发生率更高。一旦发生脐带脱垂,尤其是有机会存活的胎儿,应以最快的方式娩出胎儿,提高新生儿存活几率。     

早产妇女妊娠期阴道微生物群落分析

目的检测早产妇女妊娠期阴道微生物群落情况。方法选择2016年1月至2018年1月在我院妇产科住院的孕妇,根据妊娠结局将产妇分为早产组(186例)和足月产组(114例)。早产组中孕龄28周的20例,28周≤孕龄32周的62例,32周≤孕龄37周的104例。研究患者基本资料,包括年龄、孕前体重指数(BMI)、是否吸烟、既往史、分娩时孕龄、新生儿体重、性别、Apgar评分和新生儿是否进入重症监护病房(NICU)。检测患者阴道菌群情况。结果全部的早产孕妇孕早期和孕中期阴道大肠埃希菌以及孕龄28周产妇孕中期阴道肺炎克雷伯菌检出率明显高于足月产孕妇。全部的早产孕妇孕早期和孕中期阴道乳杆菌检出率明显低于足月产孕妇。孕龄28周和28周≤孕龄32周的早产孕妇新生儿出生体重和Apgar评分明显低于足月产产妇。全部的早产孕妇早产新生儿NICU入院率明显高于足月产新生儿,孕龄28周早产新生儿死亡率明显高于足月产新生儿。阴道大肠埃希菌、肺炎克雷伯菌和乳杆菌与产妇是否早产存在相关性,其中大肠埃希菌和肺炎克雷伯菌检出率与早产成正相关,乳杆菌检出率与早产成负相关。结论阴道肺炎克雷伯菌和大肠埃希菌检出率增加与早产存在相关性,可能成为早产的预测指标。     

产后出血的危险因素分析与防控策略探讨

为了分析导致产后出血的主要危险因素,并提出有效的防控策略来降低产后出血发生率。本研究以104例发生产后出血的孕产妇和649例未发生产后出血的孕产妇为研究对象,利用单因素分析和二元Logistic回归分析方法考察孕周、年龄、产次和分娩方式等因素,并对新生儿质量、贫血、妊娠高血压、脐带异常情况、宫缩乏力、是否应用镇痛药物、肝肾功能等情况进行分析。研究显示,两组孕产妇在年龄、孕周、产次、分娩方式、产检次数、新生儿质量以及是否应用分娩镇痛药物等方面的比较无明显差异(p0.05);观察组孕产妇妊娠期高血压、中重度贫血、宫缩乏力、脐带异常以及临产前肝肾功能异常产妇所占比例明显高于对照组(p0.05)。Logistic二元回归分析显示,孕产妇发生产后出血的主要危险因素包括妊娠期高血压、中重度贫血、宫缩乏力、脐带异常、临产前肝肾功能异常。本研究认为,加强孕期产检、针对危险因素做好产妇围产期保健工作、积极治疗中重度贫血和妊高症、对仍有出血倾向的产妇积极做好抢救准备等措施可有效保证孕产妇的生命安全。     

子痫前期发病相关高危因素的Logistic回归分析

目的:采用单因素和多因素Logistic回归方法分析本地区子痫前期发病相关高危因素。方法:选择2014年1月到2017年4月在我院进行分娩的子痫前期产妇78例作为观察组及同期在我院进行分娩的正常产妇78例作为对照组,比较两组产妇的一般情况、婚姻生育史、孕期保健情况、既往史、家族史、本次妊娠情况等。结果:两组产妇的年龄、孕次、产次、初检孕周、产前检查次数等比较差异无统计学意义(P0.05)。观察组子痫前期首次发生的平均孕周为38.26±2.63周。单因素分析显示自然流产史、子痫前期家族史、妊娠高血压、孕前BMI、孕期尿路感染与子痫前期发病明显相关(P0.05);非条件Logistic回归多因素分析结果显示自然流产史、子痫前期家族史、妊娠高血压、孕前BMI为导致子痫前期发病的主要独立危险因素(P0.05)。观察组以剖宫产为主要分娩方式,分娩孕周也明显长于对照组(P0.05);两组产妇都无死亡情况发生,但观察组的产后出血、胎盘早剥、心肝肾功能不全等并发症发生率明显高于对照组(P0.05)。结论:自然流产史、子痫前期家族史、妊娠高血压、孕前BMI为导致子痫前期发病的主要独立危险因素,可导致不良妊娠结局的增加。     

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。     

Clinical Characteristics of Children with Autism Spectrum Disorder and Co-Occurring Epilepsy

Objectives

To estimate the prevalence of epilepsy in children with Autism Spectrum Disorder (ASD) and to determine the demographic and clinical characteristics of children with ASD and epilepsy in a large patient population.

Methods

Cross-sectional study using four samples of children with ASD for a total of 5,815 participants with ASD. The prevalence of epilepsy was estimated from a population-based sample. Children with and without epilepsy were compared on demographic and clinical characteristics. Multivariate logistic regression was used to examine the association between demographic and clinical characteristics and epilepsy.

Results

The average prevalence of epilepsy in children with ASD 2–17 years was 12.5%; among children aged 13 years and older, 26% had epilepsy. Epilepsy was associated with older age, lower cognitive ability, poorer adaptive and language functioning, a history of developmental regression and more severe ASD symptoms. The association between epilepsy and the majority of these characteristics appears to be driven by the lower IQ of participants with epilepsy. In a multivariate regression model, only age and cognitive ability were independently associated with epilepsy. Children age 10 or older had 2.35 times the odds of being diagnosed with epilepsy (p<.001) and for a one standard deviation increase in IQ, the odds of having epilepsy decreased by 47% (p<.001).

Conclusion

This is among the largest studies to date of patients with ASD and co-occurring epilepsy. Based on a representative sample of children with ASD, the average prevalence of epilepsy is approximately 12% and reaches 26% by adolescence. Independent associations were found between epilepsy and older age and lower cognitive ability. Other risk factors, such as poor language and developmental regression, are not associated with epilepsy after controlling for IQ. These findings can help guide prognosis and alert clinicians to patients with ASD who are at increased risk for epilepsy.     

Exposure to Pre- and Perinatal Risk Factors Partially Explains Mean Differences in Self-Regulation between Races

Objectives

To examine whether differential exposure to pre- and perinatal risk factors explained differences in levels of self-regulation between children of different races (White, Black, Hispanic, Asian, and Other).

Methods

Multiple regression models based on data from the Early Childhood Longitudinal Study, Birth Cohort (n ≈ 9,850) were used to analyze the impact of pre- and perinatal risk factors on the development of self-regulation at age 2 years.

Results

Racial differences in levels of self-regulation were observed. Racial differences were also observed for 9 of the 12 pre-/perinatal risk factors. Multiple regression analyses revealed that a portion of the racial differences in self-regulation was explained by differential exposure to several of the pre-/perinatal risk factors. Specifically, maternal age at childbirth, gestational timing, and the family’s socioeconomic status were significantly related to the child’s level of self-regulation. These factors accounted for a statistically significant portion of the racial differences observed in self-regulation.

Conclusions

The findings indicate racial differences in self-regulation may be, at least partially, explained by racial differences in exposure to pre- and perinatal risk factors.     

结节性硬化症伴癫痫患儿临床特征和基因型分析

摘要 目的：探讨结节性硬化症（TSC）伴癫痫患儿的临床特征和基因型特点,旨在了解 TSC伴癫痫患儿的临床表现,以及表型与基因型的相关性,为临床诊治提供更有效的方案。方法：回顾性分析 2019年 12月至 2021年 1月安徽省儿童医院神经内科收治的 10例 TSC伴癫痫患儿的临床表现,采用芯片捕获高通量测序以及 Sanger测序验证,对 TSC伴癫痫患儿及父母进行基因检测,分析其临床及遗传变异的特征。结果：10例中男性 4例,女性 6例,首次发作痉挛 3例,局灶性 7例,70.00%首发年龄小于 1岁。临床表现：90.00%皮肤病变,80.00%心脏横纹肌瘤,20.00%眼底异常,未见肾脏、肝脏、肺脏病变。视频脑电图显示 60.00%痫样波位于额颞区,100.00%伴神经影像学皮层 /皮层下异常,90.00%双侧室管膜 /室管膜下异常,10.00%室管膜下巨细胞星形细胞瘤。研究患儿均完善基因检测,3例为 TSC1基因突变,7例为 TSC2突变,包括错义、移码及剪接位点突变,2例检测出家族变异,7例均未检测出家族变异。结论：TSC伴癫痫患儿男女发病无明显差异性,散发病例多见,发病年龄多为 1岁内,首次发作常为局灶性。视频脑电图痫样波额颞区为主,头颅影像学多为皮层 /皮层下及双侧室管膜 /室管膜下异常。TSC2突变较 TSC1突变常见,临床表现严重,痉挛发生率高,发病年龄小,多控制不佳。早期基因检测,对于发病年龄小,疗效欠佳患儿尤为重要。     

唑尼沙胺单药治疗儿童癫痫疗效及骨代谢的影响

目的:探讨唑尼沙胺(Zonisamide ZNS)对儿童癫痫疗效及骨代谢的影响。方法:选择2013年3月至2014年3月到河北省儿童医院神经内科门诊及病房就诊的新诊断癫痫患儿,其中男性36名,女性24名,年龄在2-14岁,给予唑尼沙胺单药治疗,分别于服药前、服药后6月查血甲状旁腺素、血钙、磷、碱性磷酸酶和骨密度测定,并与对照组进行对比。对照组选择就诊于儿保科年龄、性别相匹配的正常儿童。并分析癫痫患儿发作频率及严重程度,评估疗效。结果:唑尼沙胺治疗53例癫痫患儿中,42例(79.2)无发作,8例(15%)有效,3例(5.7%)无效。且对骨代谢相关血清学指标、骨密度无明显影响。结论:ZNS对儿童癫痫有显著疗效,是一种广谱、耐受良好的抗癫痫药。     

Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study

Objectives To investigate whether age at onset of epilepsy, type of epilepsy, family history of psychosis, or family history of epilepsy affect the risk of schizophrenia or schizophrenia-like psychosis among patients with epilepsy.Design Comparison of population based data.Setting Danish longitudinal registers.Subjects The cohort comprised 2.27 million people.Main outcome measures Epilepsy, psychosis, personal birth data.Results We found an increased risk of schizophrenia (relative risk 2.48, 95% confidence interval 2.20 to 2.80) and schizophrenia-like psychosis (2.93, 2.69 to 3.20) in people with a history of epilepsy. The effect of epilepsy was the same in men and in women and increased with age. Family history of psychosis and a family history of epilepsy were significant risk factors for schizophrenia and schizophrenia-like psychosis, and the effect of epilepsy, both in cases and families, was greater among people with no family history of psychosis. In addition, the increased risk for schizophrenia or schizophrenia-like psychosis did not differ by type of epilepsy but increased with increasing number of admissions to hospital and, particularly, was significantly greater for people first admitted for epilepsy at later ages.Conclusions There is a strong association between epilepsy and schizophrenia or schizophrenia-like psychosis. The two conditions may share common genetic or environmental causes.     

肺炎支原体肺炎患儿发生心血管系统损害的危险因素分析

目的:探讨肺炎支原体肺炎(MPP)患儿并发心血管系统损害的危险因素。方法:选取我院收治的241例MPP患儿为研究对象,收集患儿入院时的一般临床资料及实验室检查指标,按照是否并发心血管系统损害将患儿分为两组:心血管损害组和非心血管损害组,比较两组相关指标的差异,并对相关危险因素进行Logistic回归分析。结果:241例MPP患儿中有51例发生心血管系统损害(发生率21.2%);单因素分析提示:两组在年龄、急性期MP-Ab、胸腔积液、热程、血沉(ESR)、血清C反应蛋白(CRP)、白细胞计数(WBC)、血清CD4+/CD8+比值、发病7 d内应用大环内酯类药物、发病10 d内用药糖皮质激素存在统计学差异(P0.05);二分类非条件Logistic回归分析提示:年龄、热程、胸腔积液、CRP是MPP患儿发生心血管系统损害的独立危险因素(P0.05);血清CD4+/CD8+比值、发病7 d内应用大环内酯类药物则为保护性因素。结论:年龄、热程、胸腔积液、CRP是MPP患儿发生心血管系统损害的独立危险因素,而早期应用大环内酯类药物、及高CD4+/CD8+比值则为保护性因素,应当引起临床注意。     

Disproportionate Fetal Growth and the Risk for Congenital Cerebral Palsy in Singleton Births

ObjectiveTo investigate the association between proportionality of fetal and placental growth measured at birth and the risk for congenital cerebral palsy (CP).ResultsWe identified 503,784 singleton births, of which 983 were confirmed cases of CP. Head/ abdominal circumference ratio (aHR:1.12; 95%CI:1.07-1.16) and cephalization index (aHR:1.14; 95%CI:1.11-1.16) were associated with the risk of CP irrespective of gestational age. Birth weight-placental weight ratio was also associated with CP in the entire cohort (aHR:0.90; 95%CI:0.83-0.97). Ponderal index had a u-shaped association with CP, where both children with low and high ponderal index were at higher risk of CP.ConclusionsCP is associated with disproportions between birth weight, birth length, placental weight and head circumference suggesting pre and perinatal conditions contribute to fetal growth restriction in children with CP.