Feeding outcomes and influences within the neonatal unit

This study examined the feeding intention of mothers (n = 100), and the factors and beliefs, and changes in those factors or beliefs that influenced their choices, in the challenging environment of the neonatal unit. Mothers' experience and the frequency of nurse-assisted feeding activities were examined in mothers intending and not intending to breast-feed on discharge. Eighty-one per cent of mothers were either partially or fully breast-feeding or intending to do so on discharge. The most important factors identified as influencing this feeding choice included personal choice, with other influences being special benefits, more natural and feeling closer to the baby. Experiences such as infants receiving their first sucking feed from either the breast or bottle (inclusive of breast milk) and mothers expressing breast milk more frequently, were found to be significantly different and increased in frequency, in mothers intending to breast-feed. Differences in the mean weighted total daily nurse-assisted feeding score confirmed that these activities varied with gestational age (< or = 32 weeks [2.57], 32 to less than 35 weeks [3.86], and > or = 35 weeks [4.91]; F = 7.04, d.f. 55, P = 0.002), although there was insufficient power to determine differences between breast-feeding and non-breast-feeding mothers. The use of the Feeding Activities Calendar may have contributed to increased activity and high levels of breast-feeding in this preterm group.     

Association between mechanical ventilation and neurodevelopmental disorders in a nationwide cohort of extremely low birth weight infants

Mechanical ventilation for preterm infants independently contributes to poor neurodevelopmental performance. However, few studies have investigated the association between the duration of mechanical ventilation and the risk for various developmental disorders in extremely low birth weight (ELBW) (<1000 g) infants. Using a large nationwide database, we did a 10-year retrospective follow-up study to explore the effect of mechanical ventilation on the incidence of cerebral palsy (CP), autism spectrum disorder (ASD), intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW infants without diagnoses of brain insults or focal brain lesions in the initial hospital stay were identified and divided into three groups (days on ventilator: ≦2, 3–14, ≧15 days). After adjusting for demographic and medical factors, the infants in the ≧15 days group had higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence interval: 1.50–4.59; p < 0.001) and ADHD (adjusted hazard ratio: 1.95; 95% confidence interval: 1.02–3.76; p < 0.05), than did infants in the ≦2 days group. The risk for ASD or ID was not significantly different between the three groups. We conclude that mechanical ventilation for ≧15 days increased the risk for CP and ADHD in ELBW infants even without significant neonatal brain damage. Developing a brain-protective respiratory support strategy in response to real-time cerebral hemodynamic and oxygenation changes has the potential to improve neurodevelopmental outcomes in ELBW infants.     

Effect of maturation on suprasegmental speech processing in full- and preterm infants: A mismatch negativity study

Infants born prematurely are at higher risk for later linguistic deficits present in delayed or atypical processing of phonetic and prosodic information. In order to be able to specify the nature of this atypical development, it is important to investigate the role of early experience in language perception. According to the concept of Gonzalez-Gomez and Nazzi (2012) there is a special intrauterine sensitivity to the prosodic features of languages that should have a special role in language acquisition. Therefore, we may also assume that pre- and full-term infants having months difference in intrauterine experience show different maturation patterns of processing prosodic and phonetic information present at word level. The aim of our study was to investigate the effect of these differences on word stress pattern vs. phoneme information processing.Two age groups of infants (6 and 10 month-olds) were included in our study. 21 of 46 of the total of infants investigated were prematurely born with low birth weight.We used the mismatch negativity (MMN) event related brain potential (ERP) component, a widely used electrophysiological correlate of acoustic change detection, for testing the assumed developmental changes of phoneme and word stress discrimination. In a passive oddball paradigm we used a word as standard, a pseudo-word as phoneme deviant, and an illegally uttered word as stress deviant.Our results showed no differences in MMN responses in the phoneme deviant condition between the groups, meaning a relatively intact maturation of phoneme processing of preterm infants as compared to their contemporaries. However, the mismatch responses measured in the stress condition revealed significant between-group differences. These results strengthen the view that the total length of intrauterine experience influences the time of emergence of prosodic processing.     

Evaluation of indirect microparticle activity and parameters of thrombin generation test in healthy infants

Introduction

Circulating microparticles support thrombin generation. The aim of this study is to determine the indirect microparticle activity and the parameters of thrombin generation in healthy infants.

Materials and methods

A total of 85 infants who were brought to follow-up visits were taken into the study. Blood samples were collected. Thrombin generation parameters and indirect microparticle activity were measured.

Results

The infants were divided into four groups according to the time of follow-up visits. Mean ages were 1.18 ± 0.19 months in Group 1, 6.15 ± 0.16 months in Group 2, 12.38 ± 0.46 months in Group 3 and 24.53 ± 0.39 months in Group 4, respectively. There was no statistical difference among the age-based groups with respect to the indirect microparticle activity. The lag time and the TTP levels in Group 1 were lower than that found in Group 2. The ETP and peak levels were higher in Group 1 than that of Group 2. The ETP and peak levels in Group 2 were found lower than those found in older children, but the TTP level was found relatively higher. Statistically correlations were found between indirect microparticle activity and all parameters of thrombin generation.

Conclusions

The absence of a difference in terms of age-based microparticle levels may suggest that the features of microparticles in healthy children of this age group are similar. Age-dependent changes in thrombin generation parameters may suggest a regulation mechanism for the thrombin generation system over the first years of life. The results may provide mean values for indirect microparticle activity and thrombin generation in this healthy group.     

Human milk fortifier: An occult cause of bowel obstruction in extremely premature neonates

Background

Human milk fortifier (HMF) is used in neonatal units throughout North America to facilitate growth of preterm infants. Little data is available on the gastrointestinal side effects and potential adverse events. The purpose of this paper was to present a series of infants presenting with bowel obstruction associated with HMF.

Methods

Cases of HMF obstruction were collected between January 2010 and December 2012. Charts were reviewed and relevant data was collected.

Results

During the study period, 7 premature infants presented with bowel obstruction secondary to intestinal concretions of HMF. All babies were premature with gestational ages from 25 to 27 weeks. Birth weight was less than 1000 grams in all patients. Patients presented with feeding intolerance, bilious aspirates, abdominal distension, and obstipation. Four of the patients presented with acute deterioration and required urgent surgical intervention.

Conclusions

HMF is an important source of nutritional support in infants, which is felt to be safe. We present a series of infants where its use has resulted in significant complications. HMF should be used with caution in infants, especially those with a history of necrotizing enterocolitis. Further research should examine the calcium, protein, and fatty acid concentration tolerable in the gastrointestinal tract of infants.     

早产儿视网膜内外层厚度与视力的关系研究

目的　探讨早产儿视网膜内外各层厚度与视力的关系。方法　选取本院2007年1月至2009年1月出生的早产儿60例（120眼）作为早产组,另选取同期在本院出生的足月儿60例（120眼）作为足月组,早产组根据出生时是否有早产儿视网膜病变（retinopathy of prematurity,ROP）、是否接受治疗分为无ROP亚组（32例）、未治疗ROP亚组（20例）和治疗ROP亚组（8例）。测量各组最佳矫正视力（best corrected visualacuity,BCVA）和屈光度,频域光学相干断层扫描(spectral domain optical coherence tomography,SD-OCT)检测视网膜内外各层厚度。比较足月组和早产各亚组间 BCVA及视网膜内外各层厚度,分析早产儿视网膜内外各层厚度与BCVA的关系。结果　足月组BCVA明显优于早产组（P＜0.05）,早产组中治疗ROP亚组BCVA明显弱于未治疗ROP亚组和无ROP亚组（均为P＜0.05）。足月组与早产组年龄、屈光度比较,差异均无统计学意义（均为P>0.05）。早产组各亚组视网膜内层总厚度、视网膜神经纤维层（retinal nerve fiber layer,RNFL）、神经节细胞层（ganglion cell layer,GCL）、内网层（inner plexiform layer,IPL）及内核层（inner nuclear layer,INL）厚度均显著厚于足月组（均为P＜0.05）;未治疗ROP亚组和无ROP亚组视网膜内层总厚度、GCL厚度均显著薄于治疗ROP亚组（均为P＜0.05）。早产组各亚组视网膜外层总厚度、外网层（outer plexiform layer,OPL）和外核层（outer nuclear layer,ONL）、视网膜色素上皮（retinal pigment epithelium,RPE）层厚度均显著厚于足月组（均为P＜0.05）;未治疗ROP亚组和无ROP亚组视网膜外层总厚度、OPL、ONL厚度均显著薄于治疗ROP亚组（均为P＜0.05）。早产组儿童视网膜内层总厚度及GCL厚度与BCVA均呈正相关（均为P＜0.05）,视网膜外层厚度与BCVA无明显相关性（均为P＞0.05）;GCL是影响BCVA的独立危险因素（P＜0.05）。结论　与足月儿相比,早产儿视网膜内外层厚度增加,视力降低,且接受ROP治疗的早产儿视网膜各层厚度和视力所受影响更大,GCL厚度增厚是引起BCVA恶化的独立危险因素。     

Risk factors for acute kidney injury (AKI) in infants with melamine-associated urolithiasis and follow-up: a multi-center retrospective analysis

An epidemic of urinary tract stones was noted among infants in China, 2008. This event was believed to be associated with consumption melamine-contaminated powdered formula. The patients with symptoms and clinical manifests had already been analyzed in our previous studies. In this study, our aim is to investigate the risk factors of melamine-associated acute kidney injury (AKI) and the potential relationship toward children growth in our five years follow-up. A total of 619 infants with melamine-associated urolithiasis were admitted into 20 different hospitals in the Gansu province, China. All clinical data were divided into AKI and control groups according to the occurrence of AKI. Univariate and multivariate analyses were performed with a logistic regression model to assess the independent risk factors of AKI. Logistic regression analysis revealed that the odds ratio (OR) of AKI was 19.62 in the group of infants who consumed Sanlu® milk powdered infant milk formula. A higher prevalence of AKI was observed in infants age of 6–11 months (OR: 9.59, p?p?p?相似文献   

Population pharmacokinetics of theophylline in very premature Japanese infants with apnoea

OBJECTIVE: To estimate the population pharmacokinetics of theophylline in very premature infants using the non-linear mixed effects modelling. METHOD: A total of 167 serum concentration measurements obtained from routine theophylline monitoring of 107 very premature Japanese infants were collected. RESULTS: The final pharmacokinetic parameters were CL (mL/h) = [6.98 . body weight (BW) (kg)(2.17) + 0.244 . post-conceptional age (weeks)] . 1.24(oxygen support), Vd (L) = 0.492 . BW (kg) and F = 0.660, respectively. Clearance was increased by 24% for patients receiving oxygen support. The inter-individual variabilities in clearance and apparent volume of distribution were 15.6% and 80.4%, respectively, and the residual variability was 34.2% as a coefficient of variation. CONCLUSION: Application of the findings in this study to patient care may permit selection of an appropriate initial maintenance dosage to achieve target theophylline concentrations, thus enabling the clinician to achieve the desired therapeutic effect in very premature Japanese infants.