极低胎龄早产儿低血压研究进展

低血压是极低胎龄早产儿生后早期常见的并发症。目前早产儿低血压定义、治疗及预后缺乏共识,不同NICU治疗差异很大。因此需要进行多中心、大样本的临床前瞻性研究来制定统一的极低胎龄早产儿低血压临床治疗的指南。     

早产儿早期低血压及血流动力学监测

新生儿出生后面临从胎儿循环到成人循环的过渡期,其血流动力学变化复杂。早产儿(尤其是极低/超低出生体重儿)心血管系统发育不成熟,生后早期血压不稳定,易合并低血压,可导致各脏器血流灌注不足、脑损伤,严重者甚至死亡。然而,低血压并不等同于低灌注,临床医生不能仅凭血压值进行干预,需结合血流动力学情况。目前国际上对早产儿低血压的...     

早产儿细菌感染的诊治进展

早产儿细菌感染具有高发病率和高病死率,临床症状缺乏特异性,细菌培养阳性虽是诊断细菌感染的金标准,但阳性率低,诊断需结合病史、高危因素、实验室诊断手段及感染筛查评分进行综合评估,通过提高洗手依从性、早期肠道喂养、静脉丙种球蛋白应用及预防性抗微生物措施降低感染的发生,早期诊断、选择有效抗生素应用是改善预后的关键.     

早产儿低血压对远期预后的影响及其干预措施进展

低血压是早产儿的常见并发症,胎龄愈小,低血压发生率愈高。但到目前为止,有关早产儿低血压的定义和治疗尚未达成共识。研究表明,新生儿重症监护病房（NICU）的早产儿29％一98％接受了针对低血压的治疗,并且治疗方法差异很大,造成这种差异的原因除个体差异以外,更多的是治疗习惯不同。     

低血压对胎龄<32周早产儿近期预后的影响

目的 探讨以平均动脉压(mean arterial pressure,MAP)<胎龄(周)和MAP<30 mmHg定义为低血压的2种定义的早期低血压对胎龄<32周早产儿近期预后的影响。方法 前瞻性纳入华中科技大学同济医学院附属湖北妇幼保健院2020年4月—2021年8月收治的符合纳入标准的早产儿320例,监测生后72 h内血压。低血压的定义与分组采取以下2种方式：(1)连续2次MAP<胎龄者为低血压组(n=104),其余病例为对照组(n=216);(2)连续2次MAP<30 mmHg者为低血压组(n=114),其余病例为对照组(n=206)。收集患儿围生期资料及住院期间的临床资料。近期预后不良定义为住院期间死亡和/或出生1周内发生Ⅲ～Ⅳ度脑室周围-脑室内出血。采用多因素logistic回归分析法评估上述2种定义下的低血压对近期预后的影响。结果 2种定义下的低血压组低灌注临床表现、预后不良、有血流动力学意义的动脉导管未闭、肺出血的发生率均高于对照组,差异有统计学意义(均P<0.05)。此外,MAP<30 mmHg定义下的低血压组脑室周围-脑室内出...     

早产儿喂养不耐受的诊治进展

虽然早产儿喂养不耐受的定义及诊断在不断地修改与完善,但迄今为止,仍缺乏统一的定义及诊断标准.有关其干预措施(包括喂养策略、母乳喂养、药物治疗等)的疗效,尚需要大量的临床随机研究去验证和评估.该文将对喂养不耐受定义、喂养策略,药物治疗等进展进行综述.     

早产儿呼吸暂停诊治进展

新生儿原发性呼吸暂停最主要的原因是早产,即早产儿呼吸暂停(AOP),也是目前新生儿重症监护中面临的主要临床问题之一。AOP的发病机制仍不清楚,目前多倾向于与早产儿呼吸中枢发育尚不完善有关,对低氧、高碳酸血症的呼吸反应不成熟,肺牵张反射过度抑制以及中枢神经介质在AOP的发生发展中起重要作用。而某些中枢神经系统和感染性疾病及早产儿行为状态可能诱发或加重呼吸暂停的发生。俯卧位、甲基黄嘌呤类药物和持续气道正压通气(CPAP)是治疗AOP的主要方法。其他治疗方法包括CO2吸入、输血以及触觉刺激等的临床应用仍需进一步研究。文章就新生儿呼吸暂停的发病机制以及治疗策略的最新研究进展进行综述。     

治疗VLBW早产儿顽固性低血压可用应激量糖皮质激素

香港威尔士王子医院Ng医师等的一项随机双盲对照研究表明，使用“应激量”氢化可的松可治疗极低出生体重（VLBW）早产儿的顽固性低血压和肾上腺皮质功能不全。     

超早产儿生后72 h内低血压发生的危险因素及预后分析

目的 探讨超早产儿生后72 h内低血压的危险因素和预后。方法 回顾性分析2019年1月—2022年4月于浙江大学医学院附属儿童医院收治的超早产儿住院期间的临床资料。根据生后72 h内是否存在低血压,将入选患儿分为低血压组（41例）和正常血压组（82例）,比较2组的临床特征、出生后72 h内的超声心动图参数和早期并发症,并采用多因素logistic回归分析探讨生后72 h内低血压的危险因素。采用受试者操作特征曲线分析评估相关指标预测超早产儿生后72 h内发生低血压的价值。结果 低血压组7 d内药物或手术关闭动脉导管未闭（patent ductus arteriosus, PDA）、≥Ⅲ度脑室内出血和严重肺出血的患儿比例及7 d内病死率显著高于正常血压组（P<0.05）。多因素logistic回归分析显示,出生体重较低、PDA直径较大及有血流动力学意义的PDA是超早产儿生后72 h内发生低血压的危险因素（P<0.05）。受试者操作特征曲线分析显示,出生体重、PDA直径、有血流动力学意义的PDA 3个指标联合预测超早产儿生后72 h内发生低血压的曲线下面积为0.873 (95%C...     

早产儿肺透明膜病诊治进展

早产儿肺透明膜病（HMD）是由于肺表面活性物质（pulmonary surfactant，PS）不足导致弥漫性肺泡不张、水肿及细胞损伤，由于血浆蛋白漏至肺泡腔更抑制了Ps的功能导致肺萎陷，气体交换面积不足出现呼吸困难症状并表现为进行性加剧，近年来对HMD处理的进展方面包括产前对HMD高危儿诊断试验、预防性治疗（包括激素及PS）、围生期处理，尤其呼吸支持的进展及PS的替代性治疗等。     

早产儿肠外营养相关性胆汁淤积防治进展

肠外营养相关性胆汁淤积(PNAC)是早产儿肠外营养(PN)治疗过程中最常见的并发症,其病因及发病机制尚不明确.该文总结了近年来国内外有关早产儿PNAC的研究报道,提出了避免早产、合理喂养、优化PN方案等多种预防措施.熊去氧胆酸是目前治疗PNAC的一线药物.     

早产儿早期应用静脉营养的研究进展

早产儿的营养问题是近年来新生儿科极为关注的问题.对于三大物质(葡萄糖、蛋白质及脂肪)的代谢及利用,早产儿有其自身的特点.经典的静脉营养方案为了避免其对早产儿产生的不良反应,都是循序渐进地给予脂肪乳及氨基酸,但易使早产儿处于营养缺乏状态.近几年的临床研究表明,生后24h内即给予早产儿足量的静脉营养液不仅为早产儿的生长发育...     

早产儿支气管肺发育不良的防治

随着围生医学的发展,早产儿存活率上升,支气管肺发育不良(bronchopulmonary dysplasia,BPD)发病率也逐年增高.BPD是一种由多因素引发的慢性肺疾病,其病因及发病机制复杂,早期病死率高,晚期伴有呼吸系统,甚至神经系统的不良结局,严重影响早产儿存活率及生活质量.该文就BPD的防治进展作一综述.     

早产儿支气管肺发育不良的危险因素研究进展

随着医疗技术水平的快速发展,早产儿的存活率逐步提高,支气管肺发育不良的发生率也随之增加。本文对早产儿支气管肺发育不良的危险因素进行分析阐述。早产、机械通气及吸氧、新生儿呼吸窘迫综合征、感染、动脉导管未闭、贫血及输血是支气管肺发育不良的主要病因和危险因素。     

Prevention and treatment of necrotising enterocolitis in preterm neonates

Prevention and treatment of NEC has become an area of priority for research due to the increasing number of preterm survivors at risk, and the significant mortality and morbidity related to the illness. Probiotic supplementation appears to be a promising option for primary prevention of NEC but further large trials are necessary for documenting their safety in terms of sepsis as well as long-term neurodevelopmental outcomes and immune function. As new frontiers including immunomodulating agents like pentoxifylline continue to be explored, the impact of well-established simple strategies like antenatal glucocorticoid therapy, and early and preferential use of breast milk must not be forgotten. Clinical research on manifestations of ileus of prematurity, and feeding in the presence of common risk factors such as IUGR is needed. Safety of minimal enteral feeds in terms of NEC and benefits of standardised feeding regimens need to be confirmed. Association of common clinical practices such as red cell transfusions, H2 receptor blockade, and thickening of feeds with NEC warrants attention. An approach utilising a package of potentially better practices seems to be the most appropriate strategy for the prevention and treatment of NEC.     

Sleep and aminophylline treatment of apnea in preterm infants

The influence of short-term aminophylline treatment on sleep behaviour was studied in six preterms infants with recurrent apnea. The incidence of apnea, respiratory pauses, and bradycardias which were closely related to the phases of active sleep, decreased during aminophylline treatment. However, the amount of active sleep remained unaffected. The mode of action of aminophylline is discussed in view of the previously proposed neurophysiological concept of apnea of prematurity.Supported by Deutsche Forschungsgemeinschaft SFB 33     

The effects of ibuprofen on sepsis parameters in preterm neonates

Aim

To examine the effects of ibuprofen used for patent ductus arteriosus (PDA) treatment on the production of the proinflammatory cytokines C-reactive protein (CRP) and interleukin 6 (IL-6) in preterm septic newborns.

Methods

Patients with acute phase reactant elevation were divided into two groups according to receiving ibuprofen (Group I, n = 51) or not (Group II, n = 38). Course of sepsis was evaluated by CRP and IL-6 levels.

Results

CRP and IL-6 levels at the time of diagnosis were not different between two groups [16 ± 9.1 vs 16.4 ± 13.2 mg/dL (p = 0.43) for CRP and 124 ± 82 vs 119 ± 73 mg/dL (p = 0.517) for IL-6, respectively]. Similarly, they were statistically insignificant between the groups at the 2nd or 3rd days of ibuprofen treatment [14.3 ± 7.7 vs 13.7 ± 5.9 mg/dL (p = 0.21) for CRP and 83 ± 46 vs 86 ± 37 mg/dL (p = 0.29) for IL-6, respectively]. However, CRP and IL6 levels showed significant difference between groups in the following days; 6.03 ± 3.8 vs 9.1 ± 4.9 mg/dL (p = 0.025) for CRP and 42 ± 33.1 vs 58.9 ± 27.1 mg/dL (0.011) for IL-6 on 4th or 5th days of treatment and 2.3 ± 3.2 vs 4.1 ± 2.3 mg/dL (p = 0.032) for CRP and 16.1 ± 12.4 vs 21.3 ± 16.8 mg/dL (p = 0.016) for IL-6, on 7th to 10th days of treatment, respectively.

Conclusions

IL-6 and CRP may decrease in infants receiving ibuprofen treatment more than infants who do not receive it. This decrease should be considered at the time of caring a preterm infant with both sepsis and PDA after ibuprofen treatment.