不同病因医源性早产的围生儿结局分析

目的:探讨不同病因医源性早产(IPD)与围生儿结局的关系。方法:回顾性分析2008年1月至2012年12月在我院分娩的医源性早产病例992例,根据剖宫产终止妊娠的IPD的不同病因,分为妊娠期高血压疾病(HDP)组351例,前置胎盘组260例,瘢痕子宫组145例,胎盘早剥组115例,妊娠期肝内胆汁瘀积症(ICP)组78例,羊水过少组43例。比较6组产妇的一般情况、分娩孕周分布、新生儿出生情况及主要并发症的发生率和新生儿出生后第7天存活率情况。结果:各组存活率均随孕周增加而增加,各组存活率比较差异有统计学意义,P0.01。单胎新生儿体重由轻到重依次为:HDP组、羊水过少组(或胎盘早剥组)、ICP组、前置胎盘组(或瘢痕子宫组);黄疸发生率由高到低依次为:ICP组(或瘢痕子宫组或HDP组)、羊水过少组、胎盘早剥组(或前置胎盘组);贫血发生率由高到低依次为:胎盘早剥组、前置胎盘组、瘢痕子宫组,瘢痕子宫组与ICP组、HDP组、羊水过少组比较差异无统计学意义;颅内出血发生率胎盘早剥组高于其他各组,P0.05。双胎各种新生儿主要并发症的发生率均高于单胎,P0.01。结论:不同病因IPD的新生儿存活率显著不同,随孕周增加而增加,但出生情况、主要并发症的发生率不同,双胎新生儿主要并发症的发生率均高于单胎。     

Feeding Preterm Infants

Weight gain, length of hospitalization, and feeding behaviors were compared for preterm infants who were fed on demand (n=15) with preterm infants who were fed on a schedule (n = 14). Weight gain and hospital stays were similar for both groups, and self regulated feeding was found to be safe for physiologically stable infants. Benefits related to feeding behaviors included longer rest periods between interventions and the opportunity for infants to demonstrate bunger cues. The study findings indicate that feeding on demand may enhance contingency interactions between parents and their preterm infants.     

Implications of Epigenetics and Stress Regulation on Research and Developmental Care of Preterm Infants

Epigenetics refers to chemical modifications leading to changes in gene expression without any alteration of the DNA structure. We suggest ways through which epigenetic mechanisms might contribute to alter developmental trajectories in preterm infants. Although theoretical and methodological issues still need to be addressed, we discuss how epigenetics might be an emergent research field with potential innovative insights for researchers and clinicians involved in the neonatal care of preterm infants.     

Factors Influencing Feeding Decisions of Black and White Mothers of Preterm Infants

Objective: To examine the factors involved in mothers' decisions to provide breast milk for their premature infants and to determine if these factors differ between Black and White mothers.
Design: Secondary analysis of data from 2 primary studies at 2 time points within 2 days of hospital admission (T1) and just before discharge (T2).
Setting: Urban level III Neonatal Intensive Care Unit in the eastern United States.
Participants: Convenience sample of 80 mothers, 34 White and 46 Black, who delivered a singleton infant less than 30 weeks' gestation.
Outcome Measures: Mother-focused and infant-focused factors involved in the decision to breastfeed or formula feed as measured by the Preterm Infant Feeding Survey.
Results: Infant-focused scores ranked higher than mother-focused scores at T1. Mother-focused scores ranked higher than infant-focused scores at T2. Between T1 and T2, the increase in mother-focused scores and the decrease in infant-focused scores were significant. There were no significant differences between the Black and White mothers' scores at either time point.
Conclusion: Mothers' focus on factors that impact their feeding decisions change over time from their infant to themselves. Additionally, no differences were noted between the Black and White mothers.     

Oligoamnios and Perinatal Outcome

Objective(s)

We aimed at evaluating the predictive value of amniotic fluid index ≤5 on perinatal outcome in terms of effect on cardiotocography, mode of delivery, meconium in liquor, birth weight, fetal distress, APGAR score at birth and neonatal admission to ICU.

Method(s)

This is a prospective study of 308 antenatal women admitted to labor ward of MIMS during February 2014–December 2015 with gestational ages between 34 and 41 weeks. All women enrolled were subjected to history taking, examination, AFI estimation and compared between those with AFI ≤5 from rest.

Results

The non-reactive CTG, cesarean section rate due to fetal distress, low birth weight, APGAR score <7 and NICU admission were significantly high among those with oligoamnios than the control group.

Conclusion

Oligoamnios has a significant correlation with adverse perinatal outcome.

     

Early Parental Touch and Preterm Infants

Thirty-six parents were videotaped during visits with their preterm infants in a neonatal intensive care unit in order to describe some characteristics of parental touch. Parents most often touched infants' hands, backs, and heads, using stroke, hold, or contact actions of moderate intensity. Mothers and grandmothers provided more touch than fathers, and parents provided less touch to infants at or below a gestational age of 28 weeks. The results can be used as a basis for more controlled experimental studies evaluating preterm infants' physiologic responses to early parental touch.     

Problems of Preterm Infants After Discharge

Preterm infants often experience continuing health problems after discharge and have a higher rate of readmittance to the hospital during the first year. These infants also are at risk for neurodevelopmental problems, such as language, learning, and school difficulties. The continuing health and developmental problems of preterm infants creates stress for the family. Nurses caring for these infants in hospital settings must understand the problems for which preterm infants are at risk after discharge as a basis for appropriate discharge planning and teaching. A similar knowledge base will help nurses working in community settings in assessment and interventions with infants and their families after discharge.     

Teaching Mothers About Their Preterm Infants

The effects of a structured teaching program on 30 mothers' perceptions of and interaction with their premature (between 28 and 35 weeks' gestational age) infants was evaluated. Mothers who agreed to participate in the study were randomly assigned to one of three study groups: control, instruction, and attention. Mothers in the control group received routine care and support from the intensive care nursery staff. Mothers in the instruction group, in addition to the usual intensive care nursery procedures, received instruction about the unique physical and behavioral characteristics of premature infants. Mothers in the attention group were provided with the opportunity to discuss nonmedical concerns about their infants or their situations with the nurse researcher. Measures of maternal perceptions and behaviors were obtained by unbiased observers during home visits two, four, and eight weeks after the infants were discharged from the hospital. No significant differences were found among the groups on maternal perceptions or interaction behaviors.