Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.
摘要:目的:探讨新生儿铜绿假单胞菌肺炎的临床特点及药敏特点,为合理治疗提供依据。方法:对我院新生儿科2006年8月到2008年7月收治新生儿肺炎痰标本进行培养分离鉴定,选择培养结果为铜绿假单胞菌者做药敏及临床分析。结果:铜绿假单胞菌对碳青霉烯类,如:亚胺培南,美洛培南敏感率达100%,对近几年在新生儿较少用的或不用的氨基糖甙类,环丙沙星敏感率为85%～100%,而对常用的氨苄西林+舒巴坦不敏感,对头孢他啶敏感率gt;70%,临床根据药敏结果选择敏感抗生素治疗,疗效满意。结论:近年新生儿铜绿假单胞菌肺炎有上升趋势,病死率极高,故应根据药敏试验结果选择敏感抗生素,以控制疾病发展,降低病死率。
目的 探讨围产期各种相关因素与高间接胆红素血症发病的关系。 方法 选择2011年1月－5月85例产科出生足月高间接胆红素血症患儿血清总胆红素升高(依据其小时龄)达到全国新生儿学组干预推荐方案光疗标准、且结合胆红素＜34 μmol/L，即高间接胆红素血症。同时按同性别同年龄阶段出生抽取85例无高胆红素血症足月儿按1︰1配对作对照组。采用单因素分析和条件logistic回归分析的方法，筛选高间接胆红素血症发病的危险因素。 结果 引起高间接胆红素血症的围生因素包括胎龄、产式、窒息、开奶时间延迟、胎粪排出时间延迟、喂养方式、出血、低血糖、红细胞比容和出生体质量下降。其中引起高间接胆红素血症独立的高危围生因素为胎龄、开奶时间延迟、低血糖、出血、红细胞增多症和出生体质量下降。 结论 临床对具有多种高危围生因素的患儿应提高对其发生高胆红素血症可能的预见性，及早采取预防措施。
摘要:目的:分析高胆红素血症新生儿血清神经元特异性烯醇化酶(NSE)含量和新生儿行为神经能力测评(Neonatal Behavioral Neurological Assessment,NBNA)的变化,探讨高胆红素血症新生儿血清NSE含量变化的临床意义。方法:应用放射免疫分析法分别测定60例高胆红素血症新生儿和20例对照组新生儿血清NSE含量,同步测定血清总胆红素(TSB),进行NBNA评分;高胆红素血症组早期干预后再次测定血清NSE含量。结果: 与对照组比较,高胆红素血症新生儿血清TSB、NSE含量显著升高,而NBNA评分明显降低,差异有显著性意义(Plt;0.01);对照组与高胆红素血症新生儿轻度增高、中度增高、重度增高四组两两比较(均Plt;0.05),存在显著性差异;血清NSE含量与NBNA评分呈明显负相关(r=-0628,Plt;0.01);高胆红素血症新生儿经早期干预治疗后,血清NSE含量均下降(Plt;0.05),差异有显著性。结论: 高胆红素血症可导致新生儿脑损伤,血清NSE含量可以作为脑损伤的监测指标。Abstract: Objective: To analyze levels of neuronspecific enolase(NSE)in serum and neonatal behavioral neurological assessment (NBNA), to study whether NSE in serum can be used as a tool for the early identification of brain damage in neonatal hyperbilirubinemia. Methods: Serum NSE level of 60 full term infants with hyperbilirubinemia and 20 cases as to control group were measured by radioimmunoassay; Also total serum bilirubin (TSB) and NBNA were detected. In the hyperbilirubinemia group,serum NSE level were measured second when TSB were less than 855 μmol/L(5 mg/dL). Results: Compared with control group,the levels of serum TSB、NSE of the hyperbilirubinemia group were significantly higher, but NBNA score was significantly lower. The levels of serum NSE was significantly negative related to NBNA score. In the hyperbilirubinemia group, serum NSE level were significantly lower after treatment. Conclusion: Hyperbilirubinemia in neonates can cause brain damage. Serum NSE level could work as monitoring indexes of this damage.
Objective To explore the feasibility and option of different surgeries for neonates with pulmonary atresia and ventricular septal defect (PA/VSD) through assessing the effect of common surgeries. Methods Fourteen neonates who underwent their first surgery in our center from July 2004 to October 2014 were included. Their basic characteristics, operation and pre- and postoperative clinical information were extracted. Follow up was conducted and the last visit was on October 10, 2016. Short- and midterm survival and total correction rate were compared among different surgeries. Results Among the 14 patients, there were 4 (28.6%) patients, 6 (42.9%) and 4 (28.6%) who underwent one-stage repair, right ventricular outflow tract (RVOT) reconstruction, and systemic to PA shunt operation respectively. The overall in-hospital mortality after the first operation was 28.6% (4/14). At last visit, no death occurred resulting the 5-year survival rate of 71.4% (10/14). The overall total correction rate for all neonates was 64.3% (9/14). Although no statistical difference was found in the mortality among the one-stage repair , RVOT reconstruction and systemic to PA shunt group(50.0% vs. 33.3% vs. 0.0%, P=0.280), the survival and hazard analysis implied better outcomes of the systemic to PA shunt palliation operation. There was no statistical difference in the total correction rate and months from the first palliative operation to correction between those who underwent RVOT reconstruction and systemic to PA shunt (75.0% vs. 50.0%, P=0.470; 32.0 months vs. 18.0 months, P=0.400). Conclusion Performing surgeries for neonates with PA/VSD is still a great challenge. However, the midterm survival rate was optimistic for the early survivors. Systematic to PA shunt seemed to be a better choice with lower mortality for the neonates with PA/VSD who need the surgery to survive.
Objective To identify and quantify independent risk factors for poor perioperative outcomes in neonates with transposition of the great arteries (TGA) and arterial switch operation (ASO), and establish a predictive model for risk stratification and perioperative management optimization. Methods A retrospective analysis was conducted on the clinical data of neonatal TGA patients treated with ASO at Guangdong Provincial People's Hospital from January 1998 to August 2024. The research variables included baseline characteristics, preoperative parameters, surgical variables, and postoperative management indicators. The main outcome was perioperative composite adverse events. Multiple logistic regression was used to screen for independent risk factors and construct a predictive model. Results Finally, 376 patients were enrolled, including 306 (81.4%) males and 70 (18.6%) females, with a median gestational age of 39 weeks and an average age of visit of (3.86±5.76) days. The 167 (44.4%) patients experienced poor prognosis. Low admission length [OR=0.726, 95%CI (0.643, 0.815)], low preoperative oxygen saturation [OR=0.942, 95%CI (0.922, 0.962)], and longer cardiopulmonary bypass time [OR=1.85, 95%CI (1.189, 2.887)] were independent predictive factors of postoperative ASO. The predictive model had good discriminative ability (area under the curve=0.800). Conclusion The short-term poor prognosis of TGA neonatal ASO surgery is highly correlated with admission length, preoperative hypoxia, and longer extracorporeal circulation time. Early risk stratification based on these readily available clinical parameters can aid in individualized perioperative management and improve prognosis.