阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

Objective To discuss the clinical value of fetal fibronectin (fFN) and cervical length in predicting preterm birth. Methods Totally, 511 pregnant women at 22-35 weeks of gestations were enrolled from Dec. 2006 to Dec. 2007 at 4 tertiary hospitals in Beijing, and all with either symptoms or high risk factors of preterm birth, but without preterm premature rupture of membrane or vaginal bleeding. Cervical fFN were determined and cervical length of each subjects were measured by ultrasound. The pregnancy outcomes were compared. Results The sensitivity, specificity and negative predictive value (NPV) of fFN in predicting preterm birth within 7 d were 77.4%, 69.4% and 97. 9%, respectively; and 70.5%, 70.0% and 96.2% for deliveries within 34 weeks. The above figures changed to 54.8%, 66.3%, 95.8% for deliveries within 7 d and 59.1%, 67.2%, 94.6% for those within 34 weeks, respectively, when cervical length ≤3 cm was applied to predict preterm birth. When fFN and cervical length were combined, the sensitivity, specificity and NPV were 51.6%, 87.1%, 96.5% for deliveries within 7 d, and 45.5%, 87.60/00, 94.5% for those within 34 weeks, respectively. Conclusions FFN has higher NPV and specificity than cervical length in predicting preterm birth within 7 d and 34 weeks, and the positive predictive value and specificity can be improved when combined with cervical length.     

Measurement of albumin and low molecular weight proteins in the urine of newborn infants using a cotton wool ball collection method

Objective : The aim of this study was to investigate the inter-relationship between urinary excretion of alpha-1-microglobulin (AIM), retinol-binding protein (RBP) and albumin in term and premature neonates, with urine collected into cotton wool balls and extracted by a novel method. Subjects and methods : Sixty-four infants were studied on the first day of life; 26 had been born at term (37–42 weeks gestation) and 38 prematurely (24–28 weeks n = 16, 29–36 weeks n = 22). Urine collected into cotton wool balls was analysed following a new detergent extraction method, which resulted in a recovery rate of 94–107% for albumin, AIM, RBP and creatinine. Results : Urinary protein excretion, expressed as a ratio to urinary creatinine, decreased significantly with increasing gestational age (24–28 weeks, 29–36 weeks, 37–42 weeks: albuminxreatinine ratio mg/mmol mean 96.9, 31.7, 19.3; AIM: creatinine ratio mg/mmol mean 99.3, 37.0, 7.8; RBP: creatinine ratio mg/mmol mean 16.2, 3.8, and <0.01, below the limit of detection, respectively). When results were corrected for birthweight, this gestation-associated effect was still present for A1M and RBP, but not for albumin. In premature infants there was a significant positive correlation between AIM: creatinine ratio and RBP: creatinine ratio ( r = 0.85), and also between albumin and both AIM and RBP ( r = 0.82 and 0.77). Conclusion : Increased excretion of AIM, RBP and albumin at earlier gestational ages is probably due to proximal tubular immaturity, although tubular damage and also glomerular dysfunction cannot be excluded as possible explanations.     

Interaction between mothers and infants born at risk during the first six months of corrected age

Abstract The effects of preterm birth and the perinatal infant health condition on mother-infant interactions were analysed in 278 mother-infant pairs, divided into four groups according to infants' gestational age at birth: group 1. 23–31 weeks; group 2,32–36 weeks; group 3, 37–42 weeks; and group 4, a control group of healthy full-term infants. The methodological approach was based on observation of the pairs at 2,4 and 6 months of infants" corrected age (± 1 week) during undressing of the infant and face-to-face interaction. It was found that mother-infant pairs with preterm infants (groups 1 and 2) did not differ in interactional variables from those of the control group. On the other hand, the birth of a full-term infant in need of neonatal intensive care (group 3) affected maternal and infant interactive behaviour. Additionally, infants from group 3 did not show stability in their interactive behaviour between any ages of measurement. This result suggests that interactive behaviour of full-term infants in need of neonatal intensive care are rather unpredictable during their first 6 months of life, which might have contributed to the less optimal interactive pattern observed for their mothers compared with mothers of the control group.     

Delayed umbilical cord clamping in preterm infants: A feasibility study

Objectives: To assess: (i) the size of placental transfusion following a 30 s delay in cord clamping following vaginal and Caesarean births; and (ii) the feasibility of delaying cord clamping in the labour ward and particularly in the operating theatre.
Methods: Fourty-six infants born at 26–33 weeks gestation were randomized to having the umbilical cord clamped either immediately or 30 s after birth. The venous haematocrit was measured at 1 and at 4 h of age.
Results: There were trends towards higher mean haematocrits in the infants following delayed clamping, but these were not significant either at 1 h (55±7.7 vs 52.9±7) or at 4 h of age (55±7 vs 52.5±7). The trends were more marked in the infants born by Caesarean section, and in those born at 26–29 weeks gestation.
Conclusions: A 30 s delay in cord clamping is feasible at both vaginal and Caesarean births, but does not lead to the predicted difference in infant haematocrit. Although physiological studies suggest that a placental transfusion of 15–20 mL/kg occurs within 30 s of delivery, these data suggest that future trials should either delay cord clamping for more than 30 s, or should alter the position of the infant in relation to the uterus in order to facilitate the transfusion. Delayed cord clamping is feasible at Caesarean section.     

Infants born to narcotic dependent mothers: Physical growth patterns in the first 12 months of life

Objectives: To describe the physical growth patterns of infants born to narcotic dependent mothers (INDM) over a 12 months period and, if possible, to relate the growth to drug taking patterns during pregnancy.
Methodology: The growth of a cohort of 43 INDM was measured during the first 12 months of life. Weight and length measurements were compared with percentile charts and converted to Z scores. Questionnaire data about drug taking practices, demographic variables and the neonatal period (including withdrawal scores) were obtained.
Results: Twenty-four (55.8%) of INDM had evidence of neonatal drug withdrawal requiring treatment with phenobarbitone. At birth, Z scores for weight and length indicated relative intrauterine growth retardation. By 12 months, there had been some catch up growth, but Z scores for weight and length were still below zero. Persistent weight retardation at 12 months was correlated with methadone dosage during pregnancy, but not the need for phenobarbitone therapy.
Conclusions: The growth patterns of INDM in the first 12 months of life indicated that at birth there was evidence of intrauterine growth retardation, but by 12 months the growth was little different from the rest of the community. There appears to be some influence of narcotic agents taken while pregnant on subsequent growth of INDM.     

A national study of risk factors associated with mortality in very low birthweight infants in the Malaysian neonatal intensive care units

To determine the risk factors associated with mortality in very low birthweight (VLBW) infants admitted to the neonatal intensive care units (NIUC) in Malaysia.

Method:

A prospective observational study of outcome of all VLBW infants born between 1 January 1993 and 30 June 1993 and admitted to the NICU.

Results:

Data of 868 VLBW neonates from 18 centres in Malaysia were collected. Their mean birthweight was 1223 g (95% confidence intervals: 1208–1238 g). Thirty-seven point four per cent (325/868) of these infants died before discharge. After exclusion of all infants with congenital anomalies ( n =66, and nine of them also had incomplete records) and incomplete records ( n =82), stepwise logistic regression analysis of the remaining 720 infants showed that the risk factors that were significantly associated with increased mortality before discharge were: delivery in district hospitals, Chinese race, lower birthweight, lower gestation age, persistent pulmonary hypertension of the newborn, pulmonary airleak, necrotizing enterocolitis of stage 2 or 3, confirmed sepsis, hypotension, hypothermia, acute renal failure, intermittent positive pressure ventilation, and umbilical arterial catheterization. Factors that were significantly associated with lower risk of mortality were: use of antenatal steroid, oxygen therapy, surfactant therapy and blood transfusion.

Conclusion:

The mortality of VLBW infants admitted to the Malaysian NICU was high and was also associated with a number of preventable risk factors.     

Infant influenza

Reports on the symptoms of infant influenza (less than 1 year of age) are very few. From 1989 to 1996, 105 infants with influenza were examined. The symptoms, nutrition and source of infection of the 105 patients were investigated in Sakuma Pediatric Clinic and viral studies were performed at the Kitakyushu City Institute of Environmental Sciences. The symptoms of patients under 6 months old are very mild, with a low maximum body temperature and a short duration of fever. Other complications are few. The symptoms gradually become more severe with each month of age. The ratio of patients displaying a diphasic fever with two peak temperatures increases with each month of age. Over 50% of patients over 9 months old have this diphasic fever with two peak temperatures. It is inconclusive whether an anti-infective factor in human milk exists or not. Of the 105 patients in this study, 28 were under 4 months of age; of these 28, all but 3 were infected by family members.     

Three cases of pyogenic sacro-iliitis,and factors in the relapse of the disease

Pyogenic sacro-iliitis (PS) is a rare disease in childhood. Three cases of PS are reported that were difficult to diagnose. Scintigraphy and magnetic resonance imaging (MRI) were useful for diagnosis. One patient suffered from an episode of relapse. Seventeen other cases of PS were reviewed in the literature to investigate the incidence of abnormal imaging findings and various factors in disease relapse. It was found that the incidence of abnormal findings by scintigraphy was significantly higher than that by computed tomography (P = 0.0057). The duration of intravenous antibiotic administration of the relapse group (14.7 ± 4.7 days) was significantly shorter than that of the non-relapse group (24.3 ± 10.7 days; P = 0.0376). The statistical analysis suggested that intravenous antibiotic administration is necessary at least for 20 days to prevent a relapse of PS.     

Ureaplasma urealyticum, erythromycin and respiratory morbidity in high-risk preterm neonates

We investigated colonization with Ureaplasma urealyticum (Uu) in infants <30 weeks gestation and assessed the relationship to other risk factors influencing respiratory morbidity, plus the effect of treatment with erythromycin. Ventilated preterm infants [ n = 155; median GA 26 (23–29) weeks] were cultured for Uu in endotracheal aspirate and nasopharynx. Colonized infants were randomly assigned to treatment with erythromycin 40mg/kg/d, intravenously or orally. The rate of colonization was 29/155 (19%) and the Uu-colonized infants had lower mean gestational ages than the culture-negative infants (25 vs 26 weeks). For the colonized infants PROM (48% vs12%), chorioamnionitis in the mother (46% vs 17%) and vaginal delivery (71% vs 29%) were more common. More colonized infants needed supplemental oxygen at 36 weeks'postconceptual age ( p < 0:05). Erythromycin treatment was effective in reducing colonization with negative control cultures in 12/14 (86%) of treated infants. No significant differences were found between the colonized treated infants ( n = 14) and those not treated ( n = 14) in time with supplemental oxygen. Oxygen requirement at 36 weeks was related to lower gestational age, late appearance of PDA, late onset sepsis and signs of chorioamnionitis in the mother. We conclude that the Uu colonization is related to increasing immaturity, the presence of prolonged rupture of membranes, signs of chorioamnionitis and vaginal delivery. Treatment with erythromycin reduced colonization but did not significantly alter length of time with supplemental oxygen.     

Neurodevelopmental outcome after prenatal exposure to opiates

To study the developmental effects of prenatal exposure to opiates, a prospective follow up study of 34 drug-exposed (opiates and nicotine) and 42 reference infants (nicotine exposure only) was conducted from January 1992 to September 1995. At the time of delivery, 12 of 34 mothers used opiates without medical control. Twenty-two mothers participated in a methadone maintenance programme. At 1 year, the average Griffiths Developmental Quotient (DQ) was lower in the drug-exposed group (mean: 100.5 vs. references 107.9; P < 0.001). This difference was mainly due to lower subscales “locomotor” (mean 100.8 vs. 111.4; P < 0.05) and “intellectual performance” (mean 100.8 vs. 108.5; P < 0.05) in the drug-exposed group. Severe developmental retardation mean DQ (−2 SD) was diagnosed in 2 drug-exposed infants. Mild developmental retardation (mean DQ: 1 SD– > 2 SD) was found in 7 drug-exposed and in 3 reference infants (P < 0.05). Neurological abnormalities were found more frequently in the drug-exposed group (11 vs. 3 infants; P < 0.01). Among the opiate-exposed infants, the subscales “hearing and speech” and “intellectual performance” were lower in the uncontrolled drug-using than in the methadone group. The 17 fostered infants showed no difference in developmental outcome compared with the 10 infants living with their biological parents (mean DQ: 100.0 versus 101.3). Conclusions At 1 year infants prenatally exposed to opiates are at risk for mild psychomotor developmental impairment. Received: 1 August 1997 / Accepted in revised form: 15 January 1998