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二级大学医院神经管缺陷的十年回顾性研究。

Neonatal ten-year retrospective study on neural tube defects in a second level University Hospital.

机构信息

Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Piazza delle Cliniche, 2, 90127, Palermo, Italy.

出版信息

Ital J Pediatr. 2020 May 24;46(1):72. doi: 10.1186/s13052-020-00836-1.

Abstract

BACKGROUND

Aim of this retrospective study was to describe clinical characteristics, diagnostic work-up, management and follow-up of newborns with neural tube defects (NTDs), admitted to the Mother and Child Department of the University Hospital of Palermo, in a ten years period.

METHODS

The medical records of 7 newborns (5 males and 2 females) admitted, over a 10-year period from January 2010 to March 2020, to our Department on the first day of life were reviewed. Analyzed data were related to familiar and/or maternal risk factors (consanguinity, maternal preexisting and/or gestational diseases, exposure to teratogen/infectious agents, lack of preconception folic acid supplement), demographic (ethnicity/origin, residence) and clinical features (eventual use of assisted reproduction techniques, prenatal diagnosis, gestational age, fetal presentation, type of delivery, birth weight, preoperative imaging, antibiotics and analgesics use, description of the surgery intervention, length of hospital stay, comorbidities, complications), and follow-up.

RESULTS

In our sample we observed a wide spectrum of NTDs: 3 newborns had open NTDs, namely myelomeningocele (2 lumbosacral, one of which associated with extradural lipoma, and 1 sacral), and 4 closed ones, including 2 with meningocele (occipital), 1 filar lipoma associated with dermal sinus, and 1 terminal myelocystocele. Our patients were discharged between 8 and 22 days of life. The neurodevelopmental follow-up showed a favorable outcome for 4 of the 7 patients, and the appearance over time of neurological impairment (motor and/or autonomic) in the newborns with open NTDs.

CONCLUSIONS

This study describes familiar and/or maternal risk factors and demographic and clinical features of a single-center series of newborns with NTDs. It may provide a further outline of the actual phenotypic spectrum of these malformations, and new insights into epidemiological aspects and comprehensive management of the patients, including diagnostic work-up and follow-up evaluations.

摘要

背景

本回顾性研究旨在描述在十年期间,收治于巴勒莫大学医院妇产科的神经管缺陷(NTD)新生儿的临床特征、诊断评估、治疗和随访情况。

方法

对 2010 年 1 月至 2020 年 3 月期间在我院出生的 7 名新生儿(5 名男性和 2 名女性)的病历进行回顾性分析。分析的数据与家族史和/或母体相关的危险因素(近亲结婚、母体存在和/或妊娠期间的疾病、接触致畸剂/感染性物质、缺乏孕前叶酸补充)、人口统计学特征(种族/原籍、居住地)和临床特征(是否使用辅助生殖技术、产前诊断、胎龄、胎儿体位、分娩方式、出生体重、术前影像学检查、使用抗生素和镇痛药、手术干预的描述、住院时间、合并症、并发症)以及随访情况有关。

结果

在我们的样本中,观察到了广泛的 NTD 类型:3 名新生儿为开放性 NTD,即脊髓脊膜膨出(2 例腰骶部,其中 1 例合并硬膜外脂肪瘤,1 例骶尾部),4 例为闭合性 NTD,包括 2 例脑膜膨出(枕部),1 例伴皮窦的神经纤维脂肪瘤,1 例终丝脊髓脊膜膨出。我们的患者在出生后 8 至 22 天出院。神经发育随访显示,7 名患者中有 4 名预后良好,而开放性 NTD 新生儿则随着时间的推移出现了神经功能损害(运动和/或自主)。

结论

本研究描述了单一中心系列 NTD 新生儿的家族史和/或母体相关危险因素、人口统计学和临床特征。它可能提供了这些畸形实际表型谱的进一步概述,并为这些患者的流行病学特征和综合管理提供了新的见解,包括诊断评估和随访评估。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe01/7247239/03eb255507f0/13052_2020_836_Fig1_HTML.jpg

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