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Early essential newborn care: a healthy start for every newborn baby in the Western Pacific Region 新生儿早期基本保健:西太平洋区域每个新生儿的健康开端
Q4 Medicine Pub Date : 2019-08-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.08.002
To improve newborn survival and ensure a healthy start for every baby, Member States of World Health Organization endorsed the Action Plan for Healthy Newborn Infants (2014-2020) in the Western Pacific Region in 2013. The focus of which is on implementation of early essential newborn care (EENC). Such items, regional approach to introducing, sustaining and scaling up EENC; progress in EENC implementation; mobilizing social support for newborn care; best practice, lessons learned and future directions, were summarized in this editorial. Efforts are being undertaken in China, which would help to achieve the Sustainable Development Goal targets on maternal and child health and universal health coverage. Key words: Neonatal nursing; Health promotion; Maternal-child health services
为了改善新生儿存活率并确保每个婴儿都有一个健康的开端,世界卫生组织会员国于2013年批准了《西太平洋区域健康新生儿行动计划(2014-2020年)》。其重点是实施新生儿早期基本护理。这些项目,引进、维持和扩大东非经委会的区域办法;EENC实施的进展;动员社会支持新生儿护理;本文总结了最佳实践、经验教训和未来的发展方向。中国正在作出努力,这将有助于实现可持续发展目标中关于妇幼保健和全民健康覆盖的具体目标。关键词:新生儿护理;健康促进;母婴保健服务
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引用次数: 1
Epidemiology and perinatal risk factors of neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture 湖北省恩施土家族苗族自治州新生儿窒息流行病学及围生期危险因素分析
Q4 Medicine Pub Date : 2019-08-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.08.008
Objective To investigate the incidence and risk factors of neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture. Methods Live born infants, including those diagnosed with neonatal asphyxia, were recruited from 16 different hospitals in Hubei Enshi Tujia and Miao Autonomous Prefecture from January to December of 2016. The 16 hospitals included four grade A tertiary hospitals (three general hospitals and one traditional Chinese medicine hospital) and 12 grade A secondary hospitals (eight general hospitals, one maternal and child health hospital and three traditional Chinese medicine hospitals). A retrospective investigation was conducted using questionnaire to analyze the basic information, perinatal risk factors and prognosis of those infants. Chi-square test was used for statistical analysis. Results Among 22 294 recruited live born infants, 733 (3.29%) were diagnosed with neonatal asphyxia on discharge, including 627 (85.54%) mild cases and 106 (14.46%) severe cases. And neonatal asphyxia resulted in deaths of 27 cases (3.68%). The risk factors for neonatal asphyxia included multiple pregnancy, pregnancy conceived with assisted reproductive technology, premature infant, low birth weight infant, fetal malposition, congenital malformation, male infant, born during transfer, mother of Tujia nationality, low educational level (primary school or lower), living in rural area, the number of antenatal visits ≤3, history of early threatened abortion, anemia in pregnancy, hypertensive disorders of pregnancy, chorioamnionitis, abnormal pregnancy history and abnormality of umbilical cord, amniotic fluid or placenta. Conclusions The incidence of neonatal asphyxia in Enshi area is obviously higher than the national average. The main risk factors for neonatal asphyxia in this area are related to maternal background and the living condition of the mother during pregnancy, delivery as well as the newborn at birth. Key words: Asphyxia neonatorum; Incidence; Risk factors; Minority Groups
目的了解湖北省恩施土家族苗族自治州新生儿窒息的发生率及危险因素。方法选取2016年1 - 12月在湖北省恩施土家族苗族自治州16家不同医院出生的新生儿,包括诊断为新生儿窒息的新生儿。这16家医院包括4家三级甲等医院(3家综合医院、1家中医院)和12家二级甲等医院(8家综合医院、1家妇幼保健院、3家中医院)。采用问卷法对患儿的基本情况、围生期危险因素及预后进行回顾性调查。采用卡方检验进行统计分析。结果22 294例新生儿中,出院时诊断新生儿窒息733例(3.29%),其中轻症627例(85.54%),重症106例(14.46%)。新生儿窒息死亡27例(3.68%)。新生儿窒息的危险因素包括:多胎妊娠、辅助生殖技术妊娠、早产儿、低出生体重儿、胎儿位错、先天性畸形、男婴、转产、土家族母亲、文化程度低(小学及以下)、生活在农村、产前检查次数≤3次、早期先兆流产史、妊娠贫血、妊娠高血压疾病、绒毛膜羊膜炎、异常妊娠史及脐带、羊水或胎盘异常。结论恩施地区新生儿窒息发生率明显高于全国平均水平。本地区新生儿窒息的主要危险因素与产妇背景、孕期、分娩及新生儿出生时的生活条件有关。关键词:新生儿窒息;发病率;风险因素;少数民族
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引用次数: 0
Effects of kangaroo mother care during cesarean section on neonatal health parameters of late preterm newborns within "golden hour" 剖宫产术中袋鼠妈妈护理对晚期早产新生儿“黄金小时”内新生儿健康指标的影响
Q4 Medicine Pub Date : 2019-08-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.08.005
Objective To evaluate the effects of kangaroo mother care (KMC) during cesarean section on neonatal health parameters in the "golden hour" of late preterm infants. Methods A total of 120 singleton pregnant women undergoing preterm cesarean section (34-36+6 gestational weeks) from January 1 to December 31, 2018 in Jiaxing Women and Children's Hospital Affiliated to Wenzhou Medical University were prospectively enrolled and divided into two groups (observation and control groups) with 60 cases in each by random number table method. During cesarean section, the both groups received the thorough drying immediately and delayed cord clamping, in addition, the observation group adopted KMC, while the control group received routine maternal and infant care. Several parameters including changes in body temperature, crying, respiration, oxygen saturation and other vital signs, as well as the incidence of hypothermia, transfer to the Department of Neonatology and the success rate of early breastfeeding initiation during the "golden hour" were compared between the two groups. Satisfaction of obstetricians, pediatricians, the pregnant women and their families to KMC and routine maternal and infant care were compared. Two-independent sample t test and Chi-square test were used as statistical methods. Results In total, 113 cases (58 in the observation group and 55 in the control group) were finally analyzed. The body temperature of the late preterm infants at 5 and 10 min after birth in the observation group was higher than that in the control group (36.5 vs 36.0 ℃, 36.4 vs 35.8 ℃, t=11.756 and 7.512, both P 0.05). The observation group had a lower incidence of hypothermia [0% (0/58) vs 15% (8/55), χ2=9.079, P<0.001] and a higher success rate of early breastfeeding initiation [86% (50/58) vs 58% (32/55), χ2=11.137, P<0.001] than the control group. The satisfaction scores of obstetricians (19.3±1.1 vs 13.4±1.9, t=20.517), pediatricians (18.2±1.8 vs 12.6±2.1, t=15.382), gravidas (19.6±0.4 vs 13.6±1.6, t=27.723) and their family members (18.2±0.9 vs 15.3±1.1, t=11.535) were all higher in the observation group than those in the control group (all P<0.001). Conclusions KMC during cesarean section can improve the body temperature of late premature infants in the "golden hour", reduce the occurrence of hypothermia, facilitate early initiation of breastfeeding and improve the satisfaction of doctors and patients on health care. Key words: Cesarean section; Maternal-child nursing; Neonatal nursing; Feasibility studies; Infant, premature
目的评价剖宫产袋鼠妈妈护理(KMC)对晚期早产儿“黄金时段”新生儿健康参数的影响。方法前瞻性纳入2018年1月1日至12月31日在温州医科大学附属嘉兴妇女儿童医院接受早产剖宫产(34-36+6孕周)的120例单胎孕妇,采用随机数表法分为两组(观察组和对照组),每组60例。剖宫产时,两组均立即进行彻底干燥并延迟夹线,观察组采用KMC,对照组采用常规母婴护理。比较了两组之间的几个参数,包括体温、哭闹、呼吸、血氧饱和度和其他生命体征的变化,以及体温过低的发生率、转到新生儿科和在“黄金时段”早期母乳喂养的成功率。比较了产科医生、儿科医生、孕妇及其家属对KMC和常规母婴护理的满意度。采用两个独立样本t检验和卡方检验作为统计方法。结果共分析113例(观察组58例,对照组55例)。观察组晚期早产儿出生后5分钟和10分钟的体温高于对照组(36.5 vs 36.0℃,36.4 vs 35.8℃,t=11.756和7.512,均P<0.05)vs58%(32/55),χ2=11.137,P<0.001)。产科(19.3±1.1 vs 13.4±1.9,t=20.517)、儿科医生(18.2±1.8 vs 12.6±2.1,t=15.382)、,观察组孕妇(19.6±0.4 vs 13.6±1.6,t=27.723)及其家属(18.2±0.9 vs 15.3±1.1,t=11.535)均高于对照组(均P<0.001),促进尽早开始母乳喂养,提高医生和患者对医疗保健的满意度。关键词:剖宫产;母婴护理;新生儿护理;可行性研究;婴儿,早产
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引用次数: 1
Multidisciplinary team building for neonatal resuscitation 新生儿复苏多学科团队建设
Q4 Medicine Pub Date : 2019-08-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.08.003
Multidisciplinary team cooperation was highlighted in Neonatal Resuscitation Program (7th edition), which combining with effective team communication were considered as the essential skills during neonatal resuscitation. The key points of the multidisciplinary team cooperation were the identification of the team leader, mutual support, communication, correct records, and reports after resuscitation. It is of great importance to master the crucial skills, emphasize simulation training of the team cooperation, and strengthen the multidisciplinary team cooperation in decreasing the incidence of neonatal asphyxia. Key words: Asphyxia neonatorum; Infant, newborn; Multidisciplinary team
新生儿复苏计划(第7版)强调了多学科团队合作,结合有效的团队沟通被认为是新生儿复苏过程中的基本技能。多学科团队合作的重点是团队领导者的识别、相互支持、沟通、正确的记录和复苏后的报告。掌握关键技能,重视模拟训练团队协作,加强多学科团队协作,对降低新生儿窒息发生率具有重要意义。关键词:新生儿窒息症;婴儿、新生儿;多学科团队
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引用次数: 0
Meningeal cysts complicated with tethered cord syndrome diagnosed by prenatal ultrasonography: a case report 产前超声诊断脑膜囊肿合并脊髓栓系综合征1例
Q4 Medicine Pub Date : 2019-08-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.08.015
We reported a case diagnosed with meningeal cysts complicated with tethered cord syndrome based on prenatal ultrasound images at 37+5 gestational weeks, which also showed horseshoe kidney and intrahepatic vascular abnormalities (arteriovenous fistula) in the fetus. The gravida had a precipitate delivery at 39+4 gestational weeks. The anus of this newborn was about 1 cm in front of the normal position. Intrahepatic arteriovenous fistula and horseshoe kidney were detected by neonatal ultrasound and CT scan, and spinal cystic occupying lesion was found by lumbar-sacrum MRI. Intraspinal tumors were removed through spinal canal exploration and spinal cord tumor resection and were confirmed as ependymal cysts by pathological analysis, which was consistent with the prenatal diagnosis. Postoperative changes of lumbar spine was reported by CT scan after the operation. The baby received successful anoplasty when five months old and no abnormal growth or development were found when followed up to one year and eight months old. Raising awareness of tethered cord syndrome can help reduce missed diagnosis and misdiagnosis. Key words: Neural tube defects; Ependyma; Cysts; Ultrasonography, prenatal
我们报告了一例37+5孕周的产前超声诊断为脑膜囊肿合并脊髓栓系综合征,同时显示胎儿马蹄肾和肝内血管异常(动静脉瘘)。妊娠39+4周时,孕妇发生沉淀分娩。本例新生儿肛门在正常位置前1厘米左右。新生儿超声及CT检查发现肝内动静脉瘘、马蹄肾,腰骶骨MRI检查发现脊髓囊性占位性病变。经椎管探查及脊髓肿瘤切除术切除椎管内肿瘤,病理证实为室管膜囊肿,与产前诊断一致。术后CT检查腰椎变化情况。婴儿在5个月大时接受了成功的肛门成形术,随访至1岁和8个月时未发现异常生长或发育。提高对脊髓栓系综合征的认识有助于减少漏诊和误诊。关键词:神经管缺损;室管膜;囊肿;超声,产前
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引用次数: 0
Effectiveness and feasibility of early essential newborn care during term cesarean section 足月剖宫产早期新生儿基本护理的有效性和可行性
Q4 Medicine Pub Date : 2019-08-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.08.007
Objective To explore the effects of early essential newborn care (EENC) on short-term maternal and neonatal health and to evaluate the satisfaction and acceptability of both patients and medical staff in the operating room regarding the implementation of EENC during term cesarean section(CS). Methods Two hundred gravidas who underwent CS in Wenzhou Medical University Affiliated Women and Children Hospital from January 2018 to April 2018 were recruited in this prospective study. According to the odd or even number of their medical records, these women were randomly divided into EENC or control group, 100 in each. EENC was offered to those in the EENC group immediately after birth, including drying the newborn immediately and thoroughly, mother–infant skin-to-skin contact at least 90 min and initiating the first breastfeeding, and delayed cord clamping until l-3 min after birth. Routine neonatal care was provided to the control group, including regular drying, insufficient skin-to-skin contact and cord clamping within 1 min after birth. Differences were compared between the two groups in the incidence of abnormal pulse, low oxygen saturation, hypothermia and mild asphyxia from the neonatal aspect and the incidence of postpartum hemorrhage and early initiation of breastfeeding from the maternal aspect. The acceptability and satisfaction of all the participants and the medical staff were also analyzed. t-test and Chi-square test were used as statistical methods. Results All of the 200 participants were finally analyzed. In the EENC group, the incidence of neonatal hypothermia [2% (2/100) vs 13% (13/100), χ2=8.721, P=0.003] and maternal postpartum hemorrhage [1% (1/100) vs 6% (6/100), χ2=5.701, P=0.035] were lower comparing to the control group, while the initiation rate of early breastfeeding was higher [56% (56/100) vs 5% (5/100), χ2=61.352, P 0.05). The scores of maternal satisfaction (24.6±0.4 vs 23.4±1.9, t=6.443, P=0.001) and acceptability (24.3±0.5 vs 23.5±1.4, t=5.436, P=0.001) in the EENC group were also significantly higher than those in the control. For the obstetric operation team, the acceptability scores among obstetricians (22.6±0.8 vs 21.6±1.3, t=2.379, P=0.019), instrument nurses (23.2±0.9 vs 21.3±1.1, t=13.592, P<0.001) and anesthetists (22.6±0.9 vs 21.5±1.7, t=5.625, P=0.001) in the EENC group were higher than those in the control group. However, no significant difference was observed in the acceptability among rounding nurses between the two groups (P=0.086). Conclusions EENC during CS could stabilize the neonatal temperature, reduce postpartum hemorrhage, promote early breastfeeding and improve the maternal satisfaction as well as the acceptability of both obstetric operation team and puerperae. There is a clinical significance to promote EENC during CS. Key words: Cesarean section; Maternal-child nursing; Neonatal nursing; Feasibility studies
目的探讨早期新生儿基本护理(EENC)对产妇和新生儿短期健康的影响,评价患者和手术室医护人员对足月剖宫产术(CS)实施新生儿早期基本护理(EENC)的满意度和接受程度。方法2018年1月至2018年4月在温州医科大学附属妇幼医院行CS的孕妇200例为前瞻性研究对象。根据她们的医疗记录的奇数或偶数,这些妇女被随机分为EENC组和对照组,每组100人。EENC组在出生后立即给予EENC,包括立即彻底擦干新生儿,母婴皮肤接触至少90分钟并开始第一次母乳喂养,延迟脐带夹紧至出生后1 -3分钟。对照组给予常规新生儿护理,包括定期晾晒、皮肤接触不足、出生后1分钟内夹脐带。比较两组新生儿方面脉搏异常、低血氧饱和度、体温过低、轻度窒息发生率的差异,以及产妇方面产后出血、早期开始母乳喂养发生率的差异。分析了所有参与者和医务人员的接受度和满意度。统计学方法采用t检验和卡方检验。结果最终对200名参与者进行了分析。EENC组新生儿低体温发生率[2% (2/100)vs 13% (13/100), χ2=8.721, P=0.003]和产妇产后出血发生率[1% (1/100)vs 6% (6/100), χ2=5.701, P=0.035]低于对照组,而早期母乳喂养起始率[56% (56/100)vs 5% (5/100), χ2=61.352, P 0.05]高于对照组。EENC组产妇满意度评分(24.6±0.4比23.4±1.9,t=6.443, P=0.001)和可接受性评分(24.3±0.5比23.5±1.4,t=5.436, P=0.001)均显著高于对照组。产科手术组产科医师(22.6±0.8比21.6±1.3,t=2.379, P=0.019)、器械护士(23.2±0.9比21.3±1.1,t=13.592, P<0.001)、麻醉师(22.6±0.9比21.5±1.7,t=5.625, P=0.001)的可接受性评分均高于对照组。然而,两组护士的可接受性差异无统计学意义(P=0.086)。结论围产术中EENC能稳定新生儿体温,减少产后出血,促进早期母乳喂养,提高产妇满意度和产褥组及产妇的可接受性。CS术中促进EENC有临床意义。关键词:剖宫产术;妇幼护理;新生儿护理;可行性研究
{"title":"Effectiveness and feasibility of early essential newborn care during term cesarean section","authors":"Jianping Xu, Shuiqin Gu, Qun'e Zhu, X. Cui, Min Zhang, Lianbu Wan, Kaini Lu","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.08.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.08.007","url":null,"abstract":"Objective \u0000To explore the effects of early essential newborn care (EENC) on short-term maternal and neonatal health and to evaluate the satisfaction and acceptability of both patients and medical staff in the operating room regarding the implementation of EENC during term cesarean section(CS). \u0000 \u0000 \u0000Methods \u0000Two hundred gravidas who underwent CS in Wenzhou Medical University Affiliated Women and Children Hospital from January 2018 to April 2018 were recruited in this prospective study. According to the odd or even number of their medical records, these women were randomly divided into EENC or control group, 100 in each. EENC was offered to those in the EENC group immediately after birth, including drying the newborn immediately and thoroughly, mother–infant skin-to-skin contact at least 90 min and initiating the first breastfeeding, and delayed cord clamping until l-3 min after birth. Routine neonatal care was provided to the control group, including regular drying, insufficient skin-to-skin contact and cord clamping within 1 min after birth. Differences were compared between the two groups in the incidence of abnormal pulse, low oxygen saturation, hypothermia and mild asphyxia from the neonatal aspect and the incidence of postpartum hemorrhage and early initiation of breastfeeding from the maternal aspect. The acceptability and satisfaction of all the participants and the medical staff were also analyzed. t-test and Chi-square test were used as statistical methods. \u0000 \u0000 \u0000Results \u0000All of the 200 participants were finally analyzed. In the EENC group, the incidence of neonatal hypothermia [2% (2/100) vs 13% (13/100), χ2=8.721, P=0.003] and maternal postpartum hemorrhage [1% (1/100) vs 6% (6/100), χ2=5.701, P=0.035] were lower comparing to the control group, while the initiation rate of early breastfeeding was higher [56% (56/100) vs 5% (5/100), χ2=61.352, P 0.05). The scores of maternal satisfaction (24.6±0.4 vs 23.4±1.9, t=6.443, P=0.001) and acceptability (24.3±0.5 vs 23.5±1.4, t=5.436, P=0.001) in the EENC group were also significantly higher than those in the control. For the obstetric operation team, the acceptability scores among obstetricians (22.6±0.8 vs 21.6±1.3, t=2.379, P=0.019), instrument nurses (23.2±0.9 vs 21.3±1.1, t=13.592, P<0.001) and anesthetists (22.6±0.9 vs 21.5±1.7, t=5.625, P=0.001) in the EENC group were higher than those in the control group. However, no significant difference was observed in the acceptability among rounding nurses between the two groups (P=0.086). \u0000 \u0000 \u0000Conclusions \u0000EENC during CS could stabilize the neonatal temperature, reduce postpartum hemorrhage, promote early breastfeeding and improve the maternal satisfaction as well as the acceptability of both obstetric operation team and puerperae. There is a clinical significance to promote EENC during CS. \u0000 \u0000 \u0000Key words: \u0000Cesarean section; Maternal-child nursing; Neonatal nursing; Feasibility studies","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"570-574"},"PeriodicalIF":0.0,"publicationDate":"2019-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43026852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Breastfeeding for a good start of life 母乳喂养有利于生命的良好开端
Q4 Medicine Pub Date : 2019-07-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.07.001
Breastfeeding has great benefits for public health and social economy, while the exclusive breastfeeding rate within six months after birth and early initiation rate of breastfeeding in China are lower than the average level of the world. "Early skin to skin contact (SSC), early sucking and early initiation of breastfeeding" is an important start to ensure the success of breastfeeding. SSC between mother and baby is the first key step. Continuous SSC can stabilize the vital signs of newborns, provide the infants with healthy flora from mothers to establish a good micro-ecology and stimulate the rooting reflex of the baby to get colostrum as early as possible to protect them from infections and save their lives. Kangaroo mother care(KMC) for preterm/low birth weight infants can promote breastfeeding, and effectively reduce severe infections and mortality. Early SSC and KMC at the beginning of life are crucial to ensure successful breastfeeding. Key words: Breast feeding; Skin to skin contact; Kangaroo mother care
母乳喂养对公共卫生和社会经济有很大的好处,但中国婴儿出生后6个月内纯母乳喂养率和早期开始母乳喂养率低于世界平均水平。“早期皮肤接触(SSC)、早期吸吮和早期开始母乳喂养”是确保母乳喂养成功的重要开端。母亲和婴儿之间的SSC是关键的第一步。持续的SSC可以稳定新生儿的生命体征,为婴儿提供来自母亲的健康菌群,建立良好的微生态,刺激婴儿的生根反射,尽早获得初乳,保护婴儿免受感染,挽救生命。对早产/低出生体重儿进行袋鼠式母亲护理(KMC),可促进母乳喂养,有效减少严重感染和死亡率。生命初期早期的SSC和KMC对确保母乳喂养成功至关重要。关键词:母乳喂养;皮肤与皮肤接触;袋鼠妈妈看护
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引用次数: 0
Chromosomal anomalies in fetuses with structural malformation detected by ultrasonography at 11-13+6 gestational weeks 11-13+6孕周超声检测结构畸形胎儿染色体异常
Q4 Medicine Pub Date : 2019-07-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.07.012
Objective To investigate the clinical performance of ultrasound screening for fetal structural anomalies at 11-13+6 weeks of gestation and to evaluate the relation of structural anomalies with karyotypes and copy number variations. Methods A retrospective analysis was conducted on fetuses with structural anomalies detected by ultrasound examination at 11-13+6 gestational weeks in First Affiliated Hospital of Sun Yat-Sen University from January 2013 to December 2017. Karyotype and chromosomal microarray analysis(CMA) were offered to these fetuses and ultrasound scans were repeated at 16-18 gestational weeks. All fetuses were followed up to termination or birth. Fisher's exact test was used for statistical analysis. Results A total of 362 fetuses with structural anomalies were studied including 101 (27.9%) fatal malformations, 253 (69.9%) major malformations and eight (0.2%) minor malformations. Cardiac malformation (32.6%, 118/362), central nervous system anomalies (24.9%, 90/362) and anterior abdominal wall defects (20.9%, 76/362) were the three most common abnormalities. Invasive prenatal test was performed in 107 cases including 25 fatal, 79 major and three minor malformations. Thirty (28%) out of the 107 cases had abnormal karyotypes, which were chromosomal aneuploidies (n=28) and chromosomal fragment abnormalities (n=2). Among the 99 cases received CMA, 25 had abnormal karyotypes, and copy number variations were identified in eight [three (4.05%) were pathogenic variations] out of the rest 74 with normal karyotypes. The incidence of chromosomal abnormalities in fetuses with major malformations was higher than that of fetuses with fatal malformation [32.9% (26/79) vs 12.0% (3/25), P=0.045]. Altogether, 117 cases repeated second-trimester ultrasound among which 16 (13.7%) were normal; 19 (16.2%) had cardiac defect which was discordant with the first-trimester evaluation and five (4.2%) were found to have additional malformations. Diagnosis of the other 77 cases were consistent with the first-trimester ultrasound findings. After the second-trimester ultrasound scanning, 49 pregnancies were terminated; 39 twin pregnancies and four triplet pregnancies underwent selective fetal reduction; 25 continued to delivery with good neonatal outcomes. Out of the 23 699 cases without abnormal ultrasound findings at 11-13+6 gestational weeks, 20 182 (85.2%) were successfully followed up, among which structural abnormalities were found in 178 during the second trimester and in 31 after birth. Conclusions A detailed ultrasound examination at 11-13+6 weeks of gestation is important to identify fetal structural defects. However, it could not replace the second-trimester ultrasound. There is a high risk of chromosomal abnormalities in fetuses with early-detected structural defects. CMA is able to identify pathogenic copy number variations with a relatively low detection rate. Key words: Congenital abnormalities; Chromosome aberrations; DNA
目的探讨超声筛查妊娠11~13+6周胎儿结构异常的临床表现,探讨结构异常与核型和拷贝数变异的关系。方法回顾性分析2013年1月至2017年12月在中山大学附属第一医院超声检查发现的11-13+6孕周结构异常的胎儿。对这些胎儿进行核型和染色体微阵列分析(CMA),并在16-18孕周重复超声扫描。对所有胎儿进行随访,直至终止妊娠或分娩。Fisher精确检验用于统计分析。结果共研究了362例结构异常胎儿,其中101例(27.9%)为致命畸形,253例(69.9%)为主要畸形,8例(0.2%)为次要畸形。心脏畸形(32.6%,118/362)、中枢神经系统异常(24.9%,90/362)和前腹壁缺陷(20.9%,76/362)是三种最常见的异常。对107例患者进行了侵入性产前检查,其中25例为致命畸形,79例为严重畸形,3例为轻微畸形。107例病例中有30例(28%)有异常核型,即染色体非整倍体(n=28)和染色体片段异常(n=2)。在接受CMA的99例病例中,25例具有异常核型,在其余74例具有正常核型的病例中,有8例(3例(4.05%)为致病性变异)发现了拷贝数变异。严重畸形胎儿染色体异常的发生率高于致命畸形胎儿[32.9%(26/79)vs 12.0%(3/25),P=0.045];19人(16.2%)有心脏缺陷,这与妊娠早期的评估不一致,5人(4.2%)被发现有其他畸形。其他77例的诊断与孕早期超声检查结果一致。妊娠中期超声扫描后,49例妊娠终止;39例双胎妊娠和4例三胞胎妊娠进行了选择性减胎;25例继续分娩,新生儿预后良好。在11-13+6孕周超声检查无异常的23999例中,成功随访了2182例(85.2%),其中178例在孕中期发现结构异常,31例在出生后发现结构异常。结论在妊娠11-13+6周进行详细的超声检查对识别胎儿结构缺陷很重要。然而,它不能取代妊娠中期的超声检查。早期发现结构缺陷的胎儿染色体异常的风险很高。CMA能够以相对较低的检测率识别致病性拷贝数变化。关键词:先天性畸形;染色体畸变;DNA拷贝数变异;微阵列分析
{"title":"Chromosomal anomalies in fetuses with structural malformation detected by ultrasonography at 11-13+6 gestational weeks","authors":"Ju Zheng, Jie‐Ling Feng, Meifang Lin, T. Lei, L. Du, R. Peng","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.07.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.07.012","url":null,"abstract":"Objective \u0000To investigate the clinical performance of ultrasound screening for fetal structural anomalies at 11-13+6 weeks of gestation and to evaluate the relation of structural anomalies with karyotypes and copy number variations. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on fetuses with structural anomalies detected by ultrasound examination at 11-13+6 gestational weeks in First Affiliated Hospital of Sun Yat-Sen University from January 2013 to December 2017. Karyotype and chromosomal microarray analysis(CMA) were offered to these fetuses and ultrasound scans were repeated at 16-18 gestational weeks. All fetuses were followed up to termination or birth. Fisher's exact test was used for statistical analysis. \u0000 \u0000 \u0000Results \u0000A total of 362 fetuses with structural anomalies were studied including 101 (27.9%) fatal malformations, 253 (69.9%) major malformations and eight (0.2%) minor malformations. Cardiac malformation (32.6%, 118/362), central nervous system anomalies (24.9%, 90/362) and anterior abdominal wall defects (20.9%, 76/362) were the three most common abnormalities. Invasive prenatal test was performed in 107 cases including 25 fatal, 79 major and three minor malformations. Thirty (28%) out of the 107 cases had abnormal karyotypes, which were chromosomal aneuploidies (n=28) and chromosomal fragment abnormalities (n=2). Among the 99 cases received CMA, 25 had abnormal karyotypes, and copy number variations were identified in eight [three (4.05%) were pathogenic variations] out of the rest 74 with normal karyotypes. The incidence of chromosomal abnormalities in fetuses with major malformations was higher than that of fetuses with fatal malformation [32.9% (26/79) vs 12.0% (3/25), P=0.045]. Altogether, 117 cases repeated second-trimester ultrasound among which 16 (13.7%) were normal; 19 (16.2%) had cardiac defect which was discordant with the first-trimester evaluation and five (4.2%) were found to have additional malformations. Diagnosis of the other 77 cases were consistent with the first-trimester ultrasound findings. After the second-trimester ultrasound scanning, 49 pregnancies were terminated; 39 twin pregnancies and four triplet pregnancies underwent selective fetal reduction; 25 continued to delivery with good neonatal outcomes. Out of the 23 699 cases without abnormal ultrasound findings at 11-13+6 gestational weeks, 20 182 (85.2%) were successfully followed up, among which structural abnormalities were found in 178 during the second trimester and in 31 after birth. \u0000 \u0000 \u0000Conclusions \u0000A detailed ultrasound examination at 11-13+6 weeks of gestation is important to identify fetal structural defects. However, it could not replace the second-trimester ultrasound. There is a high risk of chromosomal abnormalities in fetuses with early-detected structural defects. CMA is able to identify pathogenic copy number variations with a relatively low detection rate. \u0000 \u0000 \u0000Key words: \u0000Congenital abnormalities; Chromosome aberrations; DNA ","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"488-494"},"PeriodicalIF":0.0,"publicationDate":"2019-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47699692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Application and evaluation of mobile device-based continuous breastfeeding intervention program 基于移动设备的连续母乳喂养干预方案的应用与评价
Q4 Medicine Pub Date : 2019-07-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.07.008
Objective To investigate the effects of a mobile application-based continuous breastfeeding intervention program for gravidas. Methods Pregnant women who received prenatal care and delivered at First Maternity and Infant Hospital Affiliated to Tongji University were enrolled in this quasi-experiment from April 1 to May 31, 2017. Those women who met the inclusion criteria in the Eastern and Southern campuses of the hospital were recruited as intervention group (n=100) and control (n=100) group, respectively. In addition to the routine breastfeeding support which the control group was offered only, the intervention group also received mobile application-based continuous breastfeeding intervention, namely a questionnaire was sent through WeChat official account where the pregnant women had free access to continuous breastfeeding support based on their survey results, such as understanding the benefits of breastfeeding at the first trimester, relationships between breastfeeding and immunity at the second trimester, breast care at the third trimester, treatment of milk spillage/spit during labor, and iron and vitamin supplementation at puerperium. Basic information about the participants, results of Breastfeeding Knowledge Questionnaires administered at the first, second and third trimesters and during labor and the puerperium, responses to Self-efficacy of Breastfeeding Questionnaires during labor and the puerperium, and exclusive breastfeeding rates at discharge and 42 d postpartum were compared between the two groups using two independent sample t-test and Chi-square test. Results There were 83 and 80 pregnant women in the intervention group and control group finally analyzed, respectively. No statistical difference in the scores of the Breastfeeding Knowledge Questionnaire at the first trimester was observed between the intervention group and control group (13.4±1.9 vs 13.3±1.9, t=0.133, P=0.895). However, the scores at the second and third trimesters and during labor and the puerperium in the intervention group were higher than those in the control group (14.1±1.3 vs 13.5±2.0, 14.7±1.1 vs 14.2±1.3, 15.3±1.7 vs 14.4±1.2 and 15.7±1.5 vs 14.9±1.0; t=2.160, 2.435, 4.104 and 3.946; all P<0.05), respectively. The scores of Self-efficacy of Breastfeeding Questionnaires during labor and the puerperium were also higher in the intervention group (123.5±4.7 vs 118.5±5.7 and 128.4±4.2 vs 119.0±6.5, t=6.170 and 10.959, both P<0.01). Compared to the control group, the intervention group had higher exclusive breastfeeding rate at discharge and on 42 d after delivery [78.3% (65/83) vs 61.2% (49/80), χ2=5.641; 57.8% (48/83) vs 38.8% (31/80), χ2=5.938; both P<0.05]. Conclusions The mobile application-based continuous breastfeeding intervention program may effectively improve breastfeeding outcomes. Key words: Breast feeding; Telemedicine; Clinical protocols; Validation studies
目的探讨基于移动应用程序的孕妇持续母乳喂养干预方案的效果。方法选择2017年4月1日至5月31日在同济大学附属第一妇婴医院接受产前护理分娩的孕妇进行准实验。在医院东部和南部校区符合纳入标准的女性分别被招募为干预组(n=100)和对照组(n=100)。除了对照组仅提供常规母乳喂养支持外,干预组还接受了基于移动应用程序的持续母乳喂养干预,即通过微信公众号发送问卷,根据调查结果,孕妇可以免费获得持续母乳喂养支持,如了解妊娠早期母乳喂养的好处、妊娠中期母乳喂养与免疫力之间的关系、妊娠晚期的乳房护理、分娩期间溢奶/吐奶的处理以及产褥期补充铁和维生素。参与者的基本信息,在第一、第二和第三个月以及分娩和产褥期进行的母乳喂养知识问卷的结果,对分娩和产产褥期母乳喂养问卷自我效能的回答,采用两个独立样本t检验和卡方检验比较两组出院时和产后42天的纯母乳喂养率。结果干预组和对照组分别为83例和80例孕妇。干预组与对照组妊娠早期母乳喂养知识问卷得分无统计学差异(13.4±1.9 vs 13.3±1.9,t=0.133,P=0.895),干预组中晚期、分娩期和产褥期的评分高于对照组(分别为14.1±1.3 vs 13.5±2.0、14.7±1.1 vs 14.2±1.3、15.3±1.7 vs 14.4±1.2和15.7±1.5 vs 14.9±1.0;t=2.160、2.435、4.104和3.946;均P<0.05)。干预组分娩期和产褥期母乳喂养问卷的自我效能感得分也较高(123.5±4.7 vs 118.5±5.7和128.4±4.2 vs 119.0±6.5,t=6.170和10.959,均P<0.01),干预组出院时和产后42d纯母乳喂养率较高[78.3%(65/83)vs 61.2%(49/80),χ2=5.641;57.8%(48/83)vs 38.8%(31/80),两者均P<0.05。关键词:母乳喂养;远程医疗;临床方案;验证研究
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引用次数: 0
Evaluation of continuous quality improvement on breastfeeding in very/extremely low birth weight infants 极/极低出生体重儿母乳喂养质量持续改善评价
Q4 Medicine Pub Date : 2019-07-16 DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.07.005
Objective To implement a continuous quality improvement (QI) initiative to increase the breastfeeding rate of mother's own milk(MOM) in very low birth weight infant (VLBWI) and extremely low birth weight infant (ELBWI) in neonatal intensive care unit (NICU) and to evaluate its impact on the morbidity of these infants. Methods A retrospective analysis was performed to analyze the clinical data of VLBWIs and ELBWIs who were admitted to the Nanjing Maternity Hospital Affiliated to Nanjing Medical University from July 1, 2014 to December 31, 2017 (n=587). The QI initiative was implemented in the hospital on August 1, 2015, the effect was assessed at the end of 2016 and the QI process was adjusted from 2017 to ensure continuous quality improvement of breastfeeding, based on which the 587 infants were divided into three groups: those in pre-QI group admitted from July 1, 2014 to July 31, 2015 (n=141), post-QI group admitted from August 1, 2015 to December 31, 2016 (n=243) and continuous QI group admitted from January 1, 2017 to December 31, 2017 (n=203). Differences in breastfeeding rates of MOM, the time of first breastfeeding of MOM, duration of parenteral nutrition, time to achieve full enteral feeding, average length and costs in NICU stay and the incidence of feeding intolerance, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) were compared between the three groups. Statistical analysis was performed using analysis of variance, rank-sum test, Chi-square test and Bonferroni test. Results Compared with the pre-QI group, both the post-QI and continuous QI groups had significantly increased breastfeeding rates of MOM [0-7 d: 38.2%(0.0%-69.0%) vs 72.8%(42.6%-84.2%) and 75.5%(49.8%-87.2%); 0-14 d: 37.8%(29.9%-80.5%) vs 91.9%(79.1%-96.0%) and 92.0%(71.0%-96.8%); 0-28 d: 58.2%(30.0%-90.1%) vs 96.6%(90.3%-98.9%) and 96.4%(83.1%-98.9%); during hospitalization: 50.0%(30.0%-85.5%) vs 96.6%(89.5%-99.1%) and 96.8% (83.0%-99.3%); all P<0.05] and volume of MOM intake [0-7 d: 31 (0-397) vs 82 (0-506) and 95 (0-510) ml; 0-14 d: 198 (0-1 596) vs 622 (0-1 828) and 717 (0-1 868) ml; 0-28 d: 1 458 (0-4 960) vs 2 707 (0-7 074) and 2 893 (0-10 238) ml; during hospitalization: 2 000 (0-18 767) vs 4 071 (0-22 961) and 3 979 (0-17 260) ml] within 7, 14 and 28 d after birth and during hospitalization. Moreover, the volume of MOM intake in the continuous QI group was higher than that in the post-QI group during the first 7 d after birth (all P<0.05). The time on first MOM breastfeeding in the post-QI and continuous QI groups were earlier than that in the pre-QI group [69 (16-633) and 68 (3-456) vs 73 (8-348) h, P<0.05]. Full enteral feeding was achieved earlier in the continuous QI group than the post- and pre-QI group [14 (5-40) vs 17 (6-53) and 19 (11-56) d, P<0.05]. The length of parenteral nutrition, incidence of feeding intolerance, BPD and LOS and hospital stay in the continuous QI group, post- and pre-QI group
目的实施持续质量改进(QI)计划,提高新生儿重症监护病房(NICU)极低出生体重儿(VLBWI)和极低出生体重儿(ELBWI)的母乳喂养率,并评价其对这两类婴儿发病率的影响。方法回顾性分析2014年7月1日至2017年12月31日南京医科大学附属南京妇产医院收治的VLBWIs和ELBWIs的临床资料(n=587)。该院于2015年8月1日开始实施母乳喂养质量改善倡议,2016年底进行效果评估,2017年开始调整母乳喂养质量改善流程,确保母乳喂养质量持续提升。在此基础上,将587名婴儿分为三组:2014年7月1日至2015年7月31日接受QI前组(n=141), 2015年8月1日至2016年12月31日接受QI后组(n=243), 2017年1月1日至2017年12月31日接受QI持续组(n=203)。比较三组产妇母乳喂养率、产妇首次母乳喂养时间、肠外营养持续时间、实现完全肠内喂养时间、NICU平均住院时间和费用以及喂养不耐受、支气管肺发育不良(BPD)、坏死性小肠结肠炎(NEC)和晚发型脓毒症(LOS)发生率的差异。统计学分析采用方差分析、秩和检验、卡方检验和Bonferroni检验。结果与气胀前组比较,气胀后组和持续气胀组的妈妈母乳喂养率[0 ~ 7 d]分别为38.2%(0.0% ~ 69.0%)、72.8%(42.6% ~ 84.2%)和75.5%(49.8% ~ 87.2%);0 - 14 d: 37.8%(29.9% - -80.5%)和91.9%(79.1% - -96.0%)和92.0% (71.0% - -96.8%);0-28 d: 58.2%(30.0% - -90.1%)和96.6%(90.3% - -98.9%)和96.4% (83.1% - -98.9%);住院期间:50.0%(30.0% - -85.5%)和96.6%(89.5% - -99.1%)和96.8% (83.0% - -99.3%);所有P<0.05]和食用量[0-7 d]: 31 (0-397) vs 82(0-506)和95 (0-510)ml;0-14 d: 198 (0-1 596) vs 622(0-1 828)和717 (0-1 868)ml;0-28天:1 458 (0-4 960)vs 2 707(0-7 074)和2 893(0-10 238)毫升;住院期间:2 000毫升(0-18 767毫升)vs 4 071毫升(0-22 961毫升)和3 979毫升(0-17 260毫升)]在出生后7、14和28天内和住院期间。产后7 d,连续气组的MOM摄入量高于气后组(均P<0.05)。气促后组和持续气促组首次母乳喂养时间均早于气促前组[69(16-633)和68 (3-456)vs 73 (8-348) h, P<0.05]。持续气疗组比气疗后和气疗前更早实现全肠内喂养[14 (5-40)d、17 (6-53)d和19 (11-56)d, P<0.05]。连续气激组、气激后组、气激前组的肠外营养时间、喂养不耐受发生率、BPD、LOS及住院时间分别为13(3-38)、15(8-50)、17(11-39)d;31.5%(64/203)、34.2%(83/243)和47.5%(67/141);8.9%(18/203)、20.1%(49/243)和36.1%(51/141);31.5%(64/203)、35.0%(85/243)和47.5%(67/141);32(1-73)、39(10-93)和34 (1-91)d。持续组的肠外营养时间、喂养不耐受发生率、BPD发生率均低于qi前组,LOS发生率、住院时间均低于qi后组(均P<0.05)。qi组住院时间较qi组长(P<0.05)。结论持续的QI倡议提高了VLBWI和ELBWI的MOM喂养率,降低了喂养不耐受、LOS和BPD的发生率。关键词:母乳喂养;婴儿,出生体重很低;婴儿,出生体重极低;牛奶,人类;质量改进
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引用次数: 0
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中华围产医学杂志
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