1984年 · 第22卷第01期

This article reports the management of 88 newborn infants with very low body weight (under 1500g) in our neonatal ward from January, 1980 to December, 1981. Out of the 88, 56 survived in neonatal period, showing a survival rate of 63%, among them 750g to 1000g by weight was 5/9 and 1001g to 1500 g was 64.6%.

56 infants were discharged, and 49 were followed up. Of these 19 died, 7 were lost and 30 survived whose age ranged from 12to 31 months. The follow-up survey included measurement of weight, height and the circumferences of head and chest as well as the physical examination and Denver Developmental Screening Test (DDST) . It showed that normal and retardated growth for height was 19/30 (63.3%) and 11/30 (36.7%) , for weight 22/30 (73.3%) and 8/30 (26.7%) respectively. The result of DDST of 30 cases was normal in 16, abnormal in 6 and suspected in 8. Most of the retardation occurred in gross motor development and then in language, fine motor adaptive and personal-social. No neurologic sequel and visual or hearing defect were found.

These data showed that higher survival rate was related to longer gestational age and greater birth weight. Perinatal pathology had great influence on survival. Intrapontum asphyxia, intracranial hemorrhage and aspiration pneumonia accounted for 50% of the total deaths. Proper management was very important for the survival of very low birth weight infants. The authors pointed out that careful feeding, keeping infant's temperature at 36.5-37℃, treatment of jaundice and severe apnea etc., prevention of hypothermia, hypoglycemia, acidosis and hyperbilirubinemia are important for the survival of infants and the reduction of sequelae.

This paper discussed our scheme and result of oxygen therapy in neonatal respiratory dysfunction. Among 76 cases, 65.8% were low or very low weight babies, 41 cases (53.9%) complicated by respiratory failure and in which 90.8%were more than moderately severe. Over 20 types of primary or coexistent diseases were diagnosed in the 76 cases. Besides combined treatment the indications of oxygen therapy are: high concentration oxygen inhalation can be applied in gas exchange dysfunctional patients, but in cases who suffered from ventilatory disturbance only low concentration of oxygen (<30%) was allowed and oxygen intoxication watched for. According to different conditions of hypoxemia proper methods of oxygen therapy were used. In 23 cases, after 4 hours application of open type oxygen hood, PaO₂ elevated, PaCO₂decreased and acidosis improved. Nasal prongs and CPAP with end expiratory pressure of 4-6 cm H₂O were applied to 21 cases. Besides elevation of PaO₂, this method were also effective in apnea, pulmonary hemorrhage and atelectasis, but PaCO₂ was slightly elevated in some cases. Another type of CPAP with closed type oxygen hood was used in 16 cases. Following a short time of high oxygen flow (≥10 liter/minute) , the oxygen flow was decreased gradually and the lower part air leaking hole kept open. 4 hours later, PaO₂ increased, PaCO₂ decreased distinctly together with correction of pH and improvement of general condition. Ventilator was used in 32 patients. PaO₂, PaCO₂ and pH improved in most cases.

32 cases were cured including 5 very critical cases with repeated attacks of apnea. Mortality rate was 30%. The causes of death were severe primary diseases (profuse intracranial hemorrhage, purulent meningitis, sepsis, etc.) , dilayed hospitalization and insufficient experience.

Amniotic fluid was meconium stained in 271 cases out of 2409 live births in 19months. This was a phenomenon of term infants, the average gestational age at birth being 285.3 days. Meconium staining of amniotic fluid may be considered a result of fetal hypoxia.

30 infants, or 1.2% of the total live births had aspiration of the meconium contaminated fluid and developed respiratory distress, cyanosis or pallor, rales in the lungs, twitching, apnea and/or X-ray abnormalities. These were the cases diagnosed as meconium aspiration syndrome (MAS) . X-ray findings included lung patches in 9, atelectasis in 5 and pneumothorax in 2 cases. There were 6 deaths, 3of them were LBWI, weighing 1600-1900g. They all had severe birth asphyxia and the fatal outcome actually was a result of irreversible respiratory failure. These are the cases, fo whom even the most vigorous resuscitation can not be of much help. The other 3 were term babies. Their Ap-gar scores were 4,9,9 respectively. During resuscitation none of them was intubated, but the recovery was fairly good at the delivery room. However, deterioration set in later and eventually led to respiratory failure and deaths. Intubation at the delivery room resuscitation table was, therefore, strongly recommended as a key technique in the management of meconium aspiration. There were 31 infants, who had been intubated during resuscitation. Only 2 of them died of irreversible asphyxia as mentioned above. None of the other 4 infants with severe asphyxia and 25 with mild or no asphyxia died, although 9 of them developed MAS. Pneumothorax is a most serious complication of MAS. One of the fatal cases developed bilateral pneumothorax in spite of an Apgar score of 9. Prevention and proper management of fetal hypoxia and adequate suctioning of the trachea are of paramount importance.

This article reports the results of the investigation of the erythrocyte acetylcholinesterase (AChE) activity and Three Tests (i. e., modified direct Coombs test antiglobulin test, free antibody determination and release test) in newborns with different blood-types who had mothers with blood-type O. In most of infants with feto-maternal ABO incompatibility and negative Three Tests their erythrocyte AChE activity remained in normal range. Whereas the infants with positive Three Tests but normal erythrocyte AChE level, the clinical manifestations could be classified into 3 groups: (1) no hemolysis actually occurred (normal group) , (2) hemolysis did occur but no symptoms were observed (asymptomatic group) , (3) hemolysis might occur eventually (abnormal group) . This study demonstrated that the positive Three Tests and decreased erythrocyte AChE activity might be considered as the clinical characteristics of ABO-in-compatible hemolytic disease. In other words, it showed a significant difference of erythrocyte AChE activities between the normal and abnormal (or asymptomatic) newborn infants. The authors also found that the eventual rate of conformity were only 39.4% in predicting the occurrence of ABO-incom patible hemolytic disease with the determination of the Three Tests and this rate could be raised to 78.9% by the addition of the investigation of the erythrocyte AChE activity. According to these results, the authors considered that the assay of erythrocyte AChE activity would be helpful in studying the mechanism of ABO incompatible hemolytic disease and might be used as new approach for diagnosis of this disease.

The results of the use of ventilator in the treatment of 24 cases of infants and young children are reported. The indications for ventilator requirment include: very faint respiratory movement, severe cyanosis, very weak reactivity to environment and severe bronchial obstruction. Blood gas monitoring is also a helpful device to decide its use. Oral tracheal intubation was used in most of the patients. Four patients had tracheostomy. The mean value of ventilation pressure was 22.8 cm H₂O. The average duration of ventilator treatment was 2 days and 16 hours, the longest being 22 days. Ten of the 24 cases survived. Death was mainly due to uncon-trolleble infections. The change of blood gas parameters after ventilator treatment may reflect the prognosis to certain extent. The efficacy of ventilator treatment in sequence were quite significant in cases of severe bronchial obstruction and respiratory failure of CNS origin, unpromising in cases of diffuse lung damage and poor in adenoviral pneumonia and patients with cardiac arrest.

The changes of amine-mediators in 137 infants with acute pneumonia were studied. The results reveal that blood 5-hydroxytryptamine in acute phase infants, especially in severe ones was lower than that in the control group. It returned normal as the patients were recovering. Comparison of the acute phase results with those of the convalescent phase in 11 patients showed a significant difference. The level of blood histamine and urine catecholamine in patients in both phases and that of the control group were compared, showing no significant difference. It is evident in our study that in infants with acute pneumonia the changes of amine-mediators do exist. These changes may be manifestations of amine-mediator metabolic disorders in the diseased lungs and may play a role in pathophysiology of acute pheumonia.

81 cases of nephrotic syndrome (61simple type and 20 nephritic type) were treated during 1974-1979 with chlorambucil (0.1-0.4 mg/kg/day for 3 months) and prednisone (started with 1.5-2 mg/kg/day, 2 weeks, after remission changed to a tapered course of alternate-day regimen for 6-12 months) 12 steroid resistant cases and 4 cases resistant to cyclophosphamide and prednisone achieved complete remission. Thus the rate of complete remission reached 98.3% in simple type and 85% in nephritic type. During an average of 5.5years follow up, the relapse rate was 20% in simple type and 28.6% in nephritic type of those cases without cyclophosphamide before our treatment. The total relapse rate was 21.9%, much lower than that (57%) with prednisone alone (χ2=23.2, P<0.01) . The difference between the relapse rate of simple type of these cases and that (35%) in cases treated with cyclophosphamide and prednisone is not significant (P>0.05). WBC count<4000was seen in 30 cases (37.8%) during chlorambucil therapy, in order to prevent more serious side reactions of chlorambucil and prednisone, a regimen consisting of chlorambucil (0.2 mg/kg/day for 6 weeks with total dose of 8 mg/kg) and prednisone (dose as stated above for 6-8 months is suggested.

Serum female hormones (FSH, LH, PRL, E₂ &amp; P) were determined in 10 patients with Turner's syndrome. They aged 12-17 years. Among them 6 were X, 45and 4 mosaic. Out of 10 patients 8 showed failure of the ovarian function (increased FSH or LH and decreased E₂, P) . The remaining two were mosaic. Endocrinological evaluation revealed the differences of the ovarian function between X, 45 and mosaic. One of them showed hyperprolactinemia with undeveloped breasts and her tomographic skull films showed evidence of pituitary tumor. The possible relationship between pituitary tumor and Turner's syndrome remains to be studied.

The serum levels of thyroxine (T₄) , triiodothyronine (T₃) , T₃ resin uptake ratio (T₃RU) , free T₄ index (FT₄I) , free T₃index (FT₃I) and thyroid stimulating hormone (TSH) were determined in 120 healthy children of 2 months to 12 years of age, including 56 males and 64 females. They were divided into 4 age groups, namely, 2 months to 3 years, 4-6 years, 7-9years and 10-12 years. It was found that with increase in age the levels of serum T₄, T₃ and FT₃I decreased gradually and the levels of serum T₃RU increased gradually. The FT₄I values were, however, quite similar in the 4 age groups. Serum TSH were lower in age groups 4-6 and 7-9years than in the other 2 groups, giving a saddle-like pattern. The results were briefly discussed.

We investigated 129 children with birth asphyxia (Apgar scores of 7 or less at 1 minute after birth) in order to study the effect of birth asphyxia on mental development of children. There were 83boys and 46 girls, aged from one year to 5 years and 11 months. Their level of development was assessed by Denver Developmental Screening Test (DDST) . Another 137 children with normal birth weight and without history of birth asphyxia were selected at random as controls. The distribution of age of two groups was similar. The results were as follows. Of 129asphyxiated children, 112 were scored as normal (86.8%) , 10 scored as questionable (7.8%) and 7 scored as abnormal (5.4%) ; however, of 137 control children, 132 scored as normal (96.4%) , 4 scored as questionable (2.9%) and 1 scored as abnormal (0.7%) , the difference between these two groups being highly significant (P<0.01) . Further neurological examination in 7 abnormal children of the asphyxiated group, revealed cerebral palsy in 2, epilepsy in 2 and visual defects in 3. Electroencephalogram showed epileptic wave pattern in 3 children and slow basic electrical activity in 4 children. In the asphyxiated group, the mental development of children whose head circumferences were below 3rd percentile was poorer than those above the same percentile.

These results suggested that birth asphyxia might affect the mental development of the children, and have close relation to some of the subsequent neurologic sequelae.