背景:脐带挤奶(UCM)是常规产科实践中延迟脐带夹闭的替代胎盘输血方法,允许婴儿迅速复苏。因此,UCM已在一些三级新生儿中心用于早产儿,以增强胎盘到胎儿的输血。不建议小于28周胎龄的婴儿,因为它与严重的脑出血有关。对于不需要复苏的晚期早产儿或足月儿,脐带管理建议增加铁水平,防止缺铁性贫血的发展,这与受损的运动发育有关,行为问题,和认知延迟。关于UCM是否增加脑室内出血的发生率仍然存在担忧。然而,很少有晚期早产儿在接受UCM后出现新生儿出血性卒中(NHS)和严重凝血病的报道.这里,我们报告一例妊娠34周出生的晚期早产儿。她突然恶化了,在生命的第一天接受UCM后,表现出NHS的体征和症状以及严重的凝血病。
方法:一名妊娠34周出生的女性早产儿在出生后接受UCM。她的胎龄很小,在生命的1分钟和5分钟时,阿普加得分为9分和10分,分别。在新生儿重症监护室住院后,她表现为低血糖和代谢性酸中毒。给婴儿注射葡萄糖和碳酸氢钠。肌内维生素K1也用于预防维生素K缺乏。婴儿在出生后第1天出现脐带出血和胃出血;体格检查显示双侧结膜出血,验血显示血小板减少症,凝血酶原时间延长,活化部分凝血活酶时间延长,低纤维蛋白原,提高D-二聚体水平和贫血。随后的颅骨超声和计算机断层扫描显示左实质脑出血,并延伸到心室和蛛网膜下腔。除了弥散性血管内凝血(DIC)外,该患者还被诊断为NHS。给予新鲜冷冻血浆(FFP)和凝血酶原复合物浓缩物治疗凝血病。为血小板减少和贫血提供红细胞和血小板输注。一团咪达唑仑,静脉注射钙和苯巴比妥钠以控制癫痫发作.婴儿的临床状况在生命的第5天得到改善,婴儿住院46d,恢复良好,无癫痫复发。我们的病例报告表明,接受UCM的早产儿应进行仔细的颅内出血临床评估,NHS和在某些情况下可能发生的严重凝血病。支持性管理,比如重症监护,FFP和输血,当怀疑大规模NHS和相关DIC的发展时,建议。
结论:我们的病例报告表明,对于小于胎龄并接受UCM替代胎盘输血的晚期早产儿,新生儿保健专业人员在评估NHS和严重凝血病的发展时应谨慎.新生儿保健专业人员在接受UCM后评估晚期早产儿的并发症时也应更加谨慎。
BACKGROUND: Umbilical cord milking (UCM) is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice, allowing prompt resuscitation of an infant. Thus, UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion. It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage. For late preterm or term infants who do not require resuscitation, cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia, which is associated with impaired motor development, behavioral problems, and cognitive delays. Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage. However, there are very few
reports of late preterm infants presenting with neonatal hemorrhage stroke (NHS) and severe coagulopathy after receiving UCM. Here, we report a
case of a late preterm infant born at 34 wk of gestation. She abruptly deteriorated, exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.
METHODS: A female preterm infant born at 34 wk of gestation received UCM after birth. She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life, respectively. After hospitalization in the neonatal intensive care unit, she showed hypoglycemia and metabolic acidosis. The baby was administered glucose and sodium bicarbonate infusions. Intramuscular vitamin K1 was also used to prevent vitamin K deficiency. The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life; a physical examination showed bilateral conjunctival hemorrhage, and a blood test showed thrombocytopenia, prolonged prothrombin time, prolonged activated partial thromboplastin time, low fibrinogen, raised D-dimer levels and anemia. A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces. The patient was diagnosed with NHS in addition to disseminated intravascular coagulation (DIC). Fresh frozen plasma (FFP) and prothrombin complex concentrate were given for coagulopathy. Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia. A bolus of midazolam, intravenous calcium and phenobarbital sodium were administered to control seizures. The baby\'s clinical condition improved on day 5 of life, and the baby was hospitalized for 46 d and recovered well without seizure recurrence. Our
case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage, NHS and severe coagulopathy that may develop under certain circumstances. Supportive management, such as intensive care, FFP and blood transfusion, is recommended when the development of massive NHS and associated DIC is suspected.
CONCLUSIONS: Our
case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion, neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy. Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.