Neonatal Behavioral Neurological Assessment Research Articles

Different levels of prenatal zinc and selenium had different effects on neonatal neurobehavioral development

Either deficient or excessive of essential nutrients had adverse effects. Effects of different levels of prenatal zinc (Zn) and selenium (Se) on fetal neurobehavioral development remain unclear. To determine the effects of different cord serum levels of Zn and Se on neurobehavioral development in neonates and to explore possible threshold level of Zn and Se based on fetal neurodevelopment, we conducted this epidemiological research. In the multi-center study, we investigated these questions in 927 mother-newborn pairs in Shanghai, China, from 2008 through 2009. Umbilical cord serum concentrations of Zn and Se were measured and Neonatal Behavioral Neurological Assessment (NBNA) tests were conducted. The median cord serum Zn and Se concentrations were 794.3μg/L and 63.1μg/L, respectively. A nonlinear relationship was observed between cord serum Zn and NBNA after adjusting for potential confounders. NBNA score decreased with increasing Zn levels after 794.3μg/L (adjusted β=−3.0, 95% CI: −3.6 to −2.4, p<0.001). Additionally, an invert U-shape with a threshold Se of 100μg/L was observed between cord serum Se and NBNA. The adjusted regression coefficient was 4.4 (95% CI: 3.6–5.2, p<0.001) for Se<100μg/L while −3.6 (95% CI: −6.1 to −1.1, p<0.01) for Se≥100μg/L. Of the 927 infants, 50% had a high level Zn (≥794.3μg/L) and 8.6% had a high level Se (≥100μg/L). High levels of both Zn and Se mainly had adverse effects on behavior and passive tone (p<0.001). Taken together, our study suggested that a threshold of cord blood Zn and Se was existed for fetal neurodevelopment and the prevalence of excessive Zn was high. Thus, the supplementation of Zn during pregnancy should be considered with caution in Shanghai, China.

Clinical significance and outcomes of fetal ventriculomegaly

Objective To evaluate the clinical significance and prognosis of tetus with lateral ventriculomegaly.Methods We retrospectively analyzed 92 singleton pregnant women who were antenatally diagnosed with fetal ventriculomegaly by ultrasound in genetic conselling clinics,Department of Gynaecology and Obstetrics,Nanfang Hospital,Southern Medical University between August 2007 and August 2010.All participants were divided into three groups according to the width of the lateral ventricles:group A (10.0-12.0 mm,n＝50),group B (12.1-14.9 mm,n=38) and severe ventriculomegaly group (≥15.0 mm,n=4).All fetuses were followed up.Chi-square test(or Fisher's exact test),Bonfferoni method,Mann Whitney or Kruskal-Wallis test were used for statistics.Results In group A,B and severe ventriculomegaly group,18％ (9/50),65.8％(25/38)and 3/4 of fetuses were complicated with structural malformation,respectively (x2 =22.934,P =0.000),and statistical significance were found only between group A and B (x2 =20.798,P=0.000).The incidences of fetal chromosomal aberration were 4.0％ (2/50),7.9％ (3/38)and 0/4 in the three groups,respectively (x2＝0.878,P ＝ 0.645).Eventually,all four cases with severe cerebral ventriculomegaly were terminated.Among cases of mild ventriculomegaly,63 women continued the pregnancy (48 in group A and 15 in group B).The intrauterine improvement of group B was poorerthan that of group A (Z=-3.317,P =0.001).Respectively,three,ten and two cases of ventriculomegaly deteriorated,stabilized and regressed in group B,and the corresponding figures were 3,15 and 30 in group A.In group A,the prognosis of fetus with non-isolated ventriculomegaly was poorer than that of fetus with isolated ventriculomegaly (Z=-2.631,P=0.009).For neonates 14 days after birth (n=62),the rates of normal neonatal behavioral neurological assessment (NBNA) scoring were respectively 93.8％ (45/48) and 71.4％ (10/14) for groups A and B with statistical difference (Fisher's exact test,P =0.040).Bayley scales of infant development (BSID) used to evaluate infants at 12-month-old revealed that the psychomotor developmental index (PDI) between group A and group B had statistical difference (8,26 and 1 case of good,moderate and poor development in group A; one,seven and three cases in group B; Z=-2.203,P=0.043).However,the mental developmental index (MDI) between group A and B had no statistical difference.Twenty babies among the survived ones received magnetic resonance imaging (MRI) examination.The results showed that lateral ventricle width regressed in nine babies (45.0％) and progressed in one baby (5.0％).Ten cases (50.0％) did not change.The change of ventriculomegaly after birth was related to BSID evaluation.Better prognosis of fetuses were found in those with regressed ventriculomegaly (P=0.033).Conclusions Fetuses with mild ventriculomegaly (10.0 12.0 mm) have a favorable outcome.Further investigations,such as fetal development,chromosomal examination,intrauterine infection screening and MRI if necessary,are suggested for fetus with ventriculomegaly.Moreover,intensive intrauterine and postnatal follow-up is recommended. Key words: Lateral ventricles ; Dilatation, pathologic ; Ultrasonography, prenatal; Prognosis

Perinatal risk factors associated with neurobehavioral development of full-term small for gestational age newborn infants

Objective To explore perinatal risk factors associated with the neurobehavioral development of small for gestational age (SGA) full-term neonates.Methods This prospective cross-sectional study included 111 full-term newborn infants from Apr 2008 to Apr 2010 born in Yan-tai Yuhuangding Hospital.Detailed clinical data in perinatal period of all subjects were recorded.Infants aged 3 ～ 7 days were assessed with neonatal behavioral neurological assessment (NBNA) for neurobehavioral development.Logistic regression analysis was used to explore risk factors associated with the score of NBNA.Results Significant differences (P ＜ 0.05) were found between full-term SGA (10.72 ± 1.41,7.13 ± 0.96,7.32 ± 0.74,37.16 ±1.32) and normal neonates (11.27 ± 1.04,7.89 ± 0.72,7.62 ± 0.64,39.12 ± 0.76) in terms of capacity,active and passive muscle tension and NBNA score.Full-term SGA neonates had lower score than control.Univariate logistic regression showed that delivery,placenta abnormalities,umbilical cord abnormalities,infection in perinatal period,gestational hypertension,twin pregnancy,hyperbilirubinemia affected neurobehavioral development of full-term SGA infants.Multivariate logistic regression showed that mothers' infection in perinatal period (OR =2.175,95 ％ CI 1.981 ～ 2.408,P ＜ 0.05),twin pregnancy (OR =1.936,95％ CI 1.517 ～2.368,P ＜ 0.05) and hyperbilirubinemia (OR =1.518,95％ CI 1.072-2.149,P ＜ 0.05) were risk factors for neurobehavioral delay of full-term SGA infants.Conclusion Full-term SGA neonates showed poorer quality in neurobehavior.Risk factors associated with neurobehavior of full-term SGA infants included mothers' infection in perinatal period,twin pregnancy and hyperbilirubinemia. Key words: Full-term small for gestational age infant; Neurobehavioral development; Neonatal behavioral neurological assessment; Risk factor

Early intervention and prognosis of neonatal hypoxic iachemic encephalopathy

Objective To explore the optimal timing of prevention and treatment for neonatal hypoxic ischemic encephalopathy ( HIE ) and to provide theoretical and clinical support for the treatment of HIE.Methods 125 neonates with HIE were assessed and divided into control group ( visits within 24 - 72 h after birth ) and study group ( visits within 24h after birth ).The study group was subdivided into intervention group Ⅰ ( 43 neonates,within 6 h ) and group Ⅱ ( 40 neonates,within 6 - 24 h after birth ).Each group received the same treatment.The neonates were assessed by neonatal behavioral neurological assessment ( NBNA )before treatment and 14 days after birth,and determined by DQ 6 months after birth.Results Before intervention,NBNA was ( 34.2 ± 1.64 ) in group 1,( 33.8 ± 1.43 ) in group Ⅱ,and ( 33.3 ± 1.23 ) in the control group,with no significant different among these three groups (P＞ 0.05); 14 days after treatment,it was ( 38.0 ± 1.92 )in group Ⅰ,( 36.9±1.91 ) in group Ⅱ,and ( 36.3 ± 1.88 ) in the control group,with significant difference among these three groups ( P ＜ 0.05 ); although the score was higher in group Ⅱ than in the control group,the difference was not statistically significant ( P ＞ 0.05 ); Only 100 children received DQ at a age within six months,and whose value of DQ was less than 80:3 of 31patients in group Ⅰ or 9.68％,6 of 33 in group Ⅱ or 18.18％,and 7 of 36 in the control group or 19.44％,there was a significant difference between group Ⅰ and Ⅱ group or the control group ( P ＜ 0.05 ),and there was no significant difference between group Ⅱ and the control group ( P ＞ 0.05 ).Conclusions The prognosis of hypoxic ischemic encephalopathy is significantly different with different periods of the early intervention.The NBNA on day 30 DQ at a age within 6 months in the neonates receiving treatment with 2 - 6 h and six months after birth were significandy better than those in the neonates treated 6h after birth,revealing the optimal time to treat hypoxic ischemic encephalopathy may be within 2 - 6h after brith. Key words: Early intervention; Hypoxic ischemic encephalopathy; Neonate; Optimal time

C1inical research of thetherapy of ganglioside combined with high-dose immunoglobulin for neonate with hypoxic-ischemic encephalopathy

Objective To investigate the clinical effect of ganglioside with high-dose immunoglobulin therapy treating on severe neonatal hypoxic-ischemic encephalopathy.Methods 80 severe hypoxic-ischemic encephalopathy neonate were selected and randomly divided into experimental group(42 cases) and control group(38 cases).Control group received conventional treatment,while experimental group received ganglioside with high-dose immunoglobulin therapy.Followed up 1 ～ 2 months,then compared recovery time and neonatal behavioral neurological assessment of two groups.Results The neurological symptoms after treatment,recovery time and NBNA scores of two groups had significant differences(P ＜ 0.05),and the curative effect of experimental group was better than that of control group.Gonclusion The application of ganglioside with high-dose immunoglobulin therapy treating on neonatal hypoxic-ischemic encephalopathy can effectively shorten the course of treatment. Key words: Ganglioside; Immunoglobulin; Moderately severe; Hypoxic-ischemic; Encephalopathy

Transient hypothyroxinemia, brain injury and neuroethology in preterm infants

Objective To analyse the associativity among serum thyroid hormone level,brain injury and neuroethology in preterm infants by testing the thyroid hormone level and neuro-behaviour assessment.Methods Fifty-two preterm infants were continuously admitted in neonatal department of Shanghai Children's Hospital from Dec 2009 to Apr 2010. Radio-immunity was used to determine the serum level of T3,T4, TSH within 6 h after birth. Each case received cranial ultrasonic examination within 3 d after birth and rechecked every week. Before discharge, every infant received a cranial MRI examination. The 52 cases were devided into three groups according to the result of ultrasound and MRI:no brain damage group (33 cases),intraventricular hemorrhage greup (10 cases) ,and white matter injury group (9 cases). At the corrected gestation age 40±2 weeks,every infant received a neonatal behavioral neurological assessment (NBNA). Results The level of serum TSH in all the three groups of preterm infants were normal, which could reject congenital hypothyroidism. Eight preterm infants(15.4% ,8/52) had normal thyroid hormone level,another 44 preterm infants(84. 6% ,44/52) got lower thyroid functions. The levels of T3 and T4 were higher in the no brain damage group than those in intraventricular hemorrhage group and white matter injury group. And the preterm infants who had white mauer injury got the lowest level of thyroine hormone T3 and T4. Thyroxine hormone levels had significant difference among three groups (P ＜ 0. 05). The preterm infants who had no brain damage got higher scores in capability, passive muscle tonus,initiative muscle tonus and total score than the other two groups. Intraventricular hemorrhage group always got higher scores in NBNA than the white matter injury group (P ＜ 0. 05). The NBNA scores had significant difference among three groups (P ＜ 0. 05). Conclusion Premature infant who has more severe brain injury always has lower levels of thyroxine hormone. Premature infants with brain injury get lower scores in NBNA test than those without brain injury. Key words: Transient hypothyroxinemia; Periventricular leukomalacia; Neonatal behavioral neurological assessment ; Premature infants

Research in influence of pain on neonatal early neurobehaviour

Objective To investigate the influences of pain on early neonatal neurobehavioral development Methods 65 newborn infants admitted to the Neonatal Intensive Care Unit( NICU )of our hospital from October,2009 to March,2010 were randomly chosen as the objects of this study.In light of Neonatal Behavioral Neurological Assessment( NBNA) revised by Professor Bao Xiulan,examinations were carried out before and after pain stimulation,and a statistical analysis of the results of the examinations was conducted.Results The total scores of NBNA before and after the pain stimulation were (36.49±1.73) vs.(34.80±1.79) respectively,demonstrating a significant difference.Specifically,after the pain stimulation,the scores of behavioral ability and active muscle tension decreased,with a very significant difference.However,there was no significant difference in terms of the scores of passive muscle tone,primitive reflexes and common reactions.Conclusions Neonatal pain exerts influences on early neurobehavioral development,particularly on behavioral ability and active muscle tension.The training of neonatal health care professionals in the management of and the intervention in neonatal pain should be strengthened in order to decrease the adverse effects of pain on neonates. Key words: Neonates; Pain; Neurobehavior

Risk factors of premature behavioral neurological assessment

Objective To analyze the characteristic of twenty-item premature behavioral neurological assessment,and to assess the risk factors of neonatal behavioral neurological assessment(NBNA) in premature infants. Methods Total two hundred and seventy-four premature infants hospitalized in Guangzhou Children's Hospital were assessed with the NBNA after correcting age 40 weeks,premature infants were divided into two groups:normal group (n =221 ) and abnormal group (n =53) according to NBNA. The birth history, mother pregnancy situation, the disease during neonatal period and results in hospital were reviewed,and the risk factors of NBNA in premature infants were assessed. Results There were significant differences in gestational age, birth weight, head circumference, body height, Apgar score, resuscitation time, hospitalization time and total gastrointestinal nutrition time between the two groups( P ＜ 0. 05 ). The incidences of superfoetation,hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease were different between the two groups( P ＜ 0. 05 ). There were no differences in gender, antenatal hormone use, anaemia, hypotension and evoked potential abnormality (P ＞0. 05 ). Multivariate logistic regression analysis showed that the risk factors of NBNA score in premature infants would include low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease. Conclusion Although the premature infants corrected age 40 weeks,but the capability and initiative muscular tension are still lower than term infant. Low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury ,severe infection ,hyperbilirubinemia,hypoglycemia and chronic lung disease are important risk factors related to premature behavioral neurological assessment. Key words: Behavioral neurological assessment; Risk factors; Infant,premature

Prenatal Exposure to PCBs and OCPs and Neurodevelopment of Newborn: Shanghai Study

PP-31-079 Background/Aims: Research found that prenatal exposure to polychlorinated biphenyls (PCBs) and organochlorine pesticide (OCPs) can affect infant growth and neurodevelopment. But we have not known PCBs and OCPs prenatal exposure levels in Shanghai and whether or not they affect infant health at these levels. This study is to investigate the prenatal exposure levels of PCBs and OCPs to identify the exposing high-risk factors in Shanghai, and to evaluate the effect of the PCBs and OCPs prenatal exposure on the growth and neurodevelopment of newborn infants. Methods: A total of 200 mother–infant pairs were enrolled between October 2008 and September 2009 in Shanghai. General information and risk factors were obtained by questionnaire. Birth weight, length, and head circumference were obtained from medical records. Neonatal neurodevelopment was determined by neonatal behavioral neurological assessment. Cord blood samples were collected during delivery, and PCB and OCP levels in cord serum were determined by gas chromatography-electron capture detector. Results: Among the 21 investigated PCBs and 20 investigated OCPs, p,p'-DDE, HCB, β-HCH are predominant pollutants found in cord serum. The detection rates were 91.4%, 87.8%, 76.6% and the median (range) were about 0.46 (0.34–23.01) μg/L, 0.66 (0.12–2.31) μg/L, 0.42 (0.2–6.81) μg/L, respectively. p,p'-DDE was positively correlated with mothers' age, occupation, education level, and egg and meat consumption frequency. β-HCH was positively correlated with mother's occupation and shrimp consumption frequency. The association between HCB and these factors were not found. We did not find any association between p,p'-DDE, HCB, β-HCH levels and infant birth weight, length, and head circumference. The association between p,p'-DDE, HCB, β-HCH and the results of neonatal behavioral neurological assessment were also not found. But we found HCB was negative when correlated with hand grip and β-HCH was negative when correlated with hand stretch. The detection rates of PCBs ranged from 0% to 38%; related results are not given because of low detection rate. Conclusion: In this research, we found that the predominant contaminant were p,p'-DDE, HCB, β-HCH, and food maybe their major resource. We did not find effects on infant health. This research provided useful information about related study and further research.

Curative effects of nerve growth factor on neonates with moderate and sever hypoxic-ischemic encephalopathy

Objective To observe the curative efects of never growth factor (NGF)on neonates with moderate and severe hypoxic-ischemic encephalopathy (HIE). Methods Eighty-six neonates with HIE were randomly divided into NGF treatment group and control group. The control group (42 cases)were received routine treatment (including cerebrolysin and citicoline) ;the treatment group (44 cages)were given NGF on the basis of routine treatment as early as possible (within 6 hours after birth). Brain CT, neonatal behavioral neuro-logical assessment(NBNA) and children' s development center of China(CDCC) at 3 and 6 months after birth were proformed in both groups. Results Brain CT, NBNA and CDCC markers in treatment group were better than those in control group (P＜ 0. 05). There were great diferences between two groups (P＜ 0. 01). Conclusion Using NGF on the basis of the routine treatment as early as possible after resuscitation can reduce markely the severity of asphyxia induced brain damage in neonates. It is very effective using NGF in treating HIE in neonates. Key words: Hypoxic-ischemic; Brain; Nerve growth factor; Infant; Newborn

Prenatal low-level lead exposure on neonatal neurological, physical, hearing the impact of development

Objective To investigate the prenatal low-level lead exposure neonatal nerve, physical,hearing and development impact. Methods 235 pregnant women in the delivery of umbilical cord blood of 1mL, using graphite furnace atomic absorption spectrometry determination of lead content in umbilical cord blood; on neonatal birth weight, length, head circumference measurements, using 20 neonatal behavioral neurological assessment Detection of neural behavior; teoae methods used to conduct hearing screening for newborns. According to umbilical cord blood lead levels, will study the subjects were divided into low-lead group, in the lead group, the high lead group 3 group, a comparative analysis between the different groups of nerves, physical, hearing and development level. Conclusion prenatal low-level lead exposure on neonatal neurobehavioral development have an adverse effect, but did not result in significant differences; on neonatal physical development and hearing development did not cause significant impact. Key words: Newborn; Umbilical cord blood lead; Neural behavior; Physical development; Hearing development

Efficacy of remifentanil-propofol-atracurium combined anesthesia for caesarean section

Objective To investigate the efficacy of remifentanil-propofol-atracurium combined anesthesia for caesarean section. Methods Forty ASA Ⅰ or Ⅱ patients, aged 24-30 yr, weighing 60-89 kg, at 38-41 week gestation, scheduled for elective cesarean section under general anesthesia, were studied. Remifentanil 1 μg/kg was slowly injected iv and then infused iv at a rate of 0.15 μg·kg-1·min-1 until the end of operation. Propofol 1.5 mg/kg and atracurium 0.6 mg/kg were injected in turn 30 s after remifentauil injection. Mechanical ventilation was performed after tracheal intubation. Atracurium 0.3 mg/kg was intermittently injected iv. Blood samples were taken from umbilical artery (UA) within 1 min after the delivery of the baby for blood gas analysis. Blood samples were simultaneously drawn from UA, umbilical vein (UV), and maternal artery (MA) for determination of plasma remitentanil concentrations (CUA, CUV and CMA) using gas chromatography-mass spectrometry. Systolic blood pressure (SP), diastolic blood pressure (DP), MAP and HR were monitored and recorded before intubation, at the time of inserting the catheter, at skin incision, and at the time of extubation. The analepsia time and satisfactory rate of patients were also recorded. The patient's awareness during operation was noted after operation. Apgar score was performed at 1, 5 and 10 min after the delivery of the newborn. The neonatal behavioral neurological assessment (NBNA) was conducted 1 and 24 h after the delivery of the baby. Results The hemodynamics was stable and varied within the normal range at each time point in all the patients. The analepsia time was (5±4) min and no awareness during operation occurred after postoperative follow-up. The pH value, PaCO2, PaO2 and SaO2 were in the normal range in the neonatal umbilical arterial blood samples. The neonatal Apgar scores at 1, 5 and 10 min after the delivery of the baby were more than 7. NBNA scores were normal. CUV, CUA and CMA were (0.65±0.14), (0.22±0.09) and (0.86±0.25) ng/ml respectively. CUV/CMA and CUA/CUV were 0.7±0.4 and 0.35±0.11 respectively. Conclusion The remifentanil-propofol-atracurium combined anesthesia can produce good anesthetic effect in the patients undergoing cesarean section, with high safety. Key words: Piperidinos; Propofol; Atracurium; Cesarean section

Successful treatment and follow-up of one 500 gram extremely low birth weight infant

Objective To summarize the clinical featurs, experience in diagnosis and treatment and prognosis of the first survival case of an extremely low birth weight infant (ELBWI) with the birth weight of 500 g in China to improve the management of ELBWI. Methods The clinical data and follow up of one neonate with birth weight 500 g, who successfully survived in our hospital in 2006, were collected and analyzed. Results The birth weight of this infant is 500 g. After hospitalization of 139 days, his body weight reached 2710 grams, and the neonatal behavioral neurological assessment scored 38. Physical and intelligence development was good. At the age of 18 months, the physical and intelligence development of this infant became normal. Conclusions There were many complications in ELBWI. Healthy survival of this infant depended on the treatment of neonatal respiratory distress syndrome, chronic lung disease, infection and retinopathy of prematurity necrotizing enterocolitis as well as cystic-periventricular leukomalacia, and early developmental care was also important. Key words: Infant, extremely low birth weight; Infant, premature; Respiratory distress syndrome, newborn; Retinopathy of prematurity; Follow-up studies

Evaluation of Urinary S100B Protein Level and Lactate/Creatinine Ratio for Early Diagnosis and Prognostic Prediction of Neonatal Hypoxic-Ischemic Encephalopathy

Background: Early identification and prevention of hypoxic-ischemic encephalopathy (HIE) in newborns may reduce neonatal mortality and neurological dysfunction. Objective: To analyze the diagnostic and prognostic values of urinary S100B level and lactate/creatinine ratio in newborns with HIE. Methods: Seventy-eight full-term newborns with HIE and 25 normal newborns were enrolled. The Neonatal Behavioral Neurological Assessment (NBNA) and Developmental Screening Test were scored. The concentration of urinary S100B protein was determined using the S100B enzyme-linked immunosorbent assay and the levels of urinary lactate and creatinine were measured with the enzyme colorimetric method. Results: Urinary S100B level on days 1–3 after birth and lactate/creatinine ratio on day 1 were significantly higher in newborns with HIE than those in the control group. Both indexes were positively correlated with the clinical grading of HIE. A cutoff value for the S100B level of 0.47 μg/l on day 3 after birth had a sensitivity of 90% and specificity of 92% for prediction of HIE. A lactate/creatinine ratio of more than 0.55 on day 1 showed the highest sensitivity (92%) and specificity (90%). A combination of both indexes improved the sensitivity and specificity to 99 and 97%, respectively. A negative correlation of both lactate/creatinine ratio on day 1 and S100B level on days 1–3 after birth with the NBNA score was identified on days 3, 7 and 14 after birth. The Developmental Screening Test score of 36 newborns with HIE within 6 months after birth showed that 65% of infants with moderate and high HIE had an abnormal developmental quotient. Conclusion: These data suggest that early measurement of both S100B level and lactate/creatinine ratio in the urine of newborns with HIE is a practical convenient and sensitive way to improve diagnosis on the third day of life and prognostic prediction of HIE.

Placental transfer and neonatal effects of remifentanil as an adjuvant for cesarean section

Objective To investigate the placental transfer and neonatal effects of remifentanil as an adjuvant for cesarean section.Methods Forty ASA Ⅰ parturients at full term aged 26-32 yr weighing 70-90 kg undergoing elective cesarean section under combined spinal epidural anesthesia (CSEA) were randomly divided into 2 groups (n = 20 each): control group (C) and remifentanil group (R). The CSEA was performed at L3-4interspace and the upper spread of sensory block reached T6-8. Group R received TCI of remifentanil (target plasma concentration was set at 1.5 ng/ml) starting from performance of CSEA until blood samples were obtained. In group C equal volume of normal saline was infused instead of remifentanil. MAP, HR, RR, minute ventilation (MV), and OAA/S scores were recorded after the parturients had settled down for 5 min in the operating room (T0), at skin incision (T1), when the baby was being delivered (T2), uterus repaired (T3) and peritoneum closed (T4). Fetal heart rate (FHR) at T0 and immediately before skin disinfection, the duration between uterus incision and delivery of the baby (delivery time), body weight of the newborn, Apgar score at 1 min and 5 min after delivery and neonatal behavioral neurological assessment (NBNA) at 1 h and 24 h after delivery were also recorded.Adverse effects including hypotension, sinus bradycardia, raspiratory depression, muscle rigidity , nausea and vomiting were recorded. The middle segment of umbilical cord (about 10-15 cm long) was clamped at both ends with two clamps at delivery. Umbilical arterial (UA) and venous (UV) blood samples and maternal arterial (MA) blood samples were obtained within 3 min after delivery for blood gas analysis and determination of plasma remifentanil concentration using C,C-MS-SIM method. Results OAA/S scores were significantly lower at T1,2 in group R than in group C. There were no significant differences in MAP, HR, MY, RR, delivery time, FHR, blood gases, bedy weight of the newborn, Apgar scores and NBNA scores between the 2 groups. The plasma concentrations (C) of remifentanil were (0.85±0.31),(0.57±0.12) and (0.22±0.09) ng/ml respectively in maternal arterial, umbilical venous and arterial blood samples, CUV/CMA was 0.67±0.41 and CUA/CUV was 0.39±0.08. Conclusion Remifentanil given by TCI at a target plasma concentration of 1.5 ng/ml has no adverse effects on the newborn because of raid metabolism and redistribution of remlfentanil in the neonate after rapid placental transfer. Key words: Piperidines; Cesarean section; Infant, newborn; Placenta

Clinical observation of the effect of therapeutic touch intervention on neurobehavior in preterm infants

Objective To explore the effect of therapeutic touch(massage)on the neuTobehavior of preterm infants.Methods Sixty preterm infants( gestafional age in 31-36 weeks),through natural delivery or caesarean section were randomly assigned to therapeutic touch group(n=30)and control group(n=30).Both groups re-ceived routine pharmacothempy and nursing care and followed up for half a year from discharge.Touch group re-ceived additional whole-body massage.All subjects were evaluated with neonatal behavioral neurological assessment (NBNA)in one month after birth-and mental development index(MDI), psyehomotor development index(PDI)in 3 months and 6 months after birth.Results The NBNA scores(P<0.01),as well as MDI and PDI(P<0.05)were significantly higher in therapeutic touch group than the control.Conclusion Therapeutic touch intervention im-proves nervous system of preterm infants. Key words: Preterm infants; Touch intervention; Neurobehavioral

Influence factors of the neonatal behavioral neurological assessment in premature infant

Objective To explore the application of neonatal behavioral neurological assessment (NBNA) in premature infant and the influence factors.Methods One handred and twenty-three premature neonates hospitalized in our neonatal department from January 2006 to June 2007 were enrolled in the study.The NBNA was carried out at corrected conceptus age 40w.The influence of conceptus age,birth weight,mechanical ventilation and the ventilation time,high risk factors of brain damage in perinatal period,different delivery methods,and the Apgar score on the outcome of NBNA were analyzed.Results There were significant differences of the NBNA results among the premature infants with different conceptus age (<30w,～32w,and ～34w) and birth weight (<1250g,～1500g,and ～2000g) (P<0.01).The NBNA score was lower as the neonate was younger with conceptus age and lower with birth weight.The NBNA scores in the neonates with ventilation and ventilation time more than 7d were obviously lower than that without ventilation (P<0.01)and ventilation time less than 7d (P<0.05).Furthermore the NBNA scores were markedly lower when the neonates complicated with hemorrhagic and ischemic brain damage,conjugated bilirubin ≥256.5μmol/L,hypoglycemia (<2.6μmol/L) and infection(P<0.01).And the NBNA in neonates with breech position,obstetrical forceps and vaccum extraction delivery was obviously lower than that in the cesarean delivery and spontaneous delivery (P<0.01).The neonate with Apgar score between 0 and 3 has lower NBNA in compared with those with Apgar score 4-7 and ≥8 (P<0.01).Conclusion There are many factors affecting on the NBNA outcome,such as conceptus age,birth weigh,ventilation and ventilation time,abnormal delivery methods,and severe asphyxia.In order to find intracalvarium pathological changes and give early intervention,decrease additional damage and sequelae,the skull ultrasound should be carried out at 3 to 7d after birth for the premature neonate,especially those whose conceptus age less than 32w and birth weight no more than 1500g or with high risk factors of brain damage. Key words: Infant,premature; Neonatal behavioral neurological assessment; Brain damage

Monitoring of lead load and its effect on neonatal behavioral neurological assessment scores in Guiyu, an electronic waste recycling town in China

Guiyu is the major electronic waste (e-waste) recycling town in China. The primary purpose of this study was to measure the lead levels in neonates and examine the correlation between lead levels and neurobehavioral development. One hundred full-term neonates from Guiyu and fifty-two neonates from neighboring towns (control group) in the late summer of 2006 were selected for study. The lead levels in the umbilical cord blood (CBPb) and lead levels in meconium (MPb) of neonates were determined with atomic absorption spectrophotometry. The neonatal behavioral neurological assessment (NBNA) was conducted on all neonates. A questionnaire related to the exposure to lead of pregnant women was used as a survey of the neonates' mothers. Compared with the control group, neonates in Guiyu had significantly higher levels of lead (P < 0.01), and the mean CBPb and MPb were 113.28 microg L(-1) and 2.50 microg g(-1), respectively. The relatively high lead levels in the neonates of the Guiyu group were found to correlate with their maternal occupation in relation to e-waste recycling. Neonates with high levels of lead load have lower NBNA scores (P < 0.01). There was a statistically significant difference in NBNA scores between the Guiyu group and the control group by t test (P < 0.05). No correlation was found between CBPb and NBNA scores; however, a negative correlation was found between MPb and NBNA scores (P < 0.01). There is a correlation between relatively high lead levels in the umbilical cord blood and meconium in neonates and the local e-waste recycling activities related to lead contamination. This study suggests that environmental lead contamination due to e-waste recycling have an impact on neurobehavioral development of neonates in Guiyu.

Clinical evaluation of umbilical artery blood lactate levels and neonatal behavioral neurological assessment in the newborns with fetal distress

目的 探讨新生儿脐动脉血乳酸水平与宫内窘迫的关系及其对新生儿行为神经表现的影响.方法 对160例发生宫内窘迫的足月新生儿(出生时无窒息为窘迫Ⅰ组,出生时有窒息为窘迫Ⅱ组)和310例正常足月新生儿(对照组)的脐动脉血进行乳酸测定及血气分析,并在生后4～6 d、26～28 d进行新生儿20项行为神经测定(neonatal behavioral neurological assessment,NBNA).结果 窘迫Ⅰ组和窘迫Ⅱ组脐动脉血乳酸值均较对照组显著升高(P＜0.01),两组Ph值较对照组明显降低(P＜0.01);窘迫Ⅱ组的乳酸值明显高于窘迫Ⅰ组,Ph值低于窘迫Ⅰ组,差异均有非常显著性(P＜0.01).脐血乳酸值与Ph值呈直线负相关关系(r=-0.53,P＜0.01),窘迫Ⅱ组的脐血乳酸值与NBNA评分也呈直线负相关关系(r=-0.78,P＜0.01).三组NBNA评分随日龄增长均升高,差异有非常显著性(P＜0.01).结论 脐动脉血乳酸检测可协助宫内窘迫的诊断,并可望作为评估、预测新生儿窒息损伤的指标之一。

Evaluation of relationship between early brain response and neurodevelopment in newborns by using near infrared spectroscopy

To study the relationship between early brain response to extrinsic stimulation and neurodevelopment in preterm infants, assess the brain function of preterm infants in the early stage, and thereby to provide objective evidence for the degree of neurodevelopment in preterm infants and to evaluate prognosis. Using near infrared spectroscopy (NIRS), the brain response to sound stimulation of 90 preterm infants at different gestational age was observed and compared with the result obtained from 20 full term infants. The neonatal behavioral neurological assessment (NBNA) was performed at corrected age of 40 weeks, and the infants were followed up for 2 years. The effect of gestational age and brain damage on preterm infants, the relation between early brain response in preterm infants and their neurodevelopment was evaluated. All the preterm infants responded to different degrees to auditory stimulation after birth. The time to beginning to react and the time to appearance of the peak reaction were attained after auditory stimulation and the time to beginning to resume when the auditory stimulation was stopped was (278 +/- 94) s, (446 +/- 67) s and (199 +/- 52) s, respectively, which were significantly longer than those observed in the full term infants (107 +/- 30) s, (264 +/- 51) s and (131 +/- 46) s, respectively. The maximum reactions of hemoglobin, oxyhemoglobin and regional oxygen saturation in the infants after gestational age 32 weeks was (0.3 +/- 0.3)%, (0.7 +/- 0.5)% and (0.3 +/- 0.3)%, respectively, which were significantly lower than those in the full term infants (1.7 +/- 0.7)%, (1.7 +/- 0.8)% and (1.6 +/- 0.7)%, respectively. When the brain response of preterm infants was compared with that in infants without brain damage, the speed of the reaction was slow, the maximum reaction was low. The brain response in preterm infant was correlated with NBNA at corrected age of 40 weeks. It was found during the following-up that abnormal neurodevelopment was associated with poor brain reaction. NIRS can be used to evaluate brain response of infants. Preterm infants display brain response to auditory stimulation. Early brain response is correlated with neurodevelopment.