匀称型和非匀称型婴儿智能发育观察

目的根据中华儿科杂志小于胎龄儿(SGA)的临床分型对43例SGA进行临床分型并观察其智能发育情况。 方法应用Bayley婴儿发育量表对不同临床分型的SGA婴儿的智能发育进行评价。 结果匀称型SGA其两种临床分型方法的符合率达到72．09％,而体重、头围和身高均在该胎龄值的第10百分位以下婴儿仅占32．56％,其精神发育指数(MDI)和心理运动发育指数(PDI)均较低。匀称型SGA的MDI和PDI高于非匀称型。 结论对目前SGA的临床分型方法尚需商榷。     

Macromolecular Absorption in Infants with Infantile Colic

ABSTRACT. Intestinal absorption of macromolecules, using human α-lactalbumin (α-LA) as a marker, was studied in breast-fed and formula-fed infants with infantile colic. Serum samples taken at 30 and 60 min after an intake of human milk were analyzed for α-LA by a competitive radioimmunoassay technique. Breast-fed infants with infantile colic had significantly higher s-α-LA levels compared with age-matched breast-fed control infants 0-1 month of age: median value 926 μg α-LA/I serum/I human milk/kg bodyweight (n= 11) versus 150 (n= 34); 1–2 months of age: 173 (n= 22) versus 31 (n= 16); 2–3 months of age: 132 (n= 8) versus 11 (n= 16). Similarly, formula-fed colicky infants had significantly higher s-α-LA levels than agematched formula-fed control infants 1-2 months of age: median value 126 (n= 12) versus < 10 (n= 14); 2–3 months of age: 156 (n= 11) versus < 10 (n= 10). The increased absorption of the macromolecule human α-lactalbumin in infantile colic suggests that the gut mucosa is affected in infants with infantile colic.     

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??As a special group of neonates??small-for-gestational-age infants have a higher rate of morbidity and mortality during perinatal period. Even those who have survived also have increased risk of growth and developmental disorders in later life.Recent studies have showed a strong association between being born small for gestational age and increased risk of diabetes mellitus??metabolic syndrome and heart diseases in adulthood. Hence??rational nutritional support is needed for improving the survival rate??promoting growth and reducing the long-term risk of intellectual impairment and metabolic risks.     

Macromolecular Absorption in Preterm and Term Infants

ABSTRACT. Human o-lactalbumin (α-LA) has been used as a marker for measuring macromolecular absorption. The serum concentration of human α-LA after a human milk feed has been studied in 32 healthy very low birthweight infants (VLBW), fed human milk (gestational age 26–32 weeks) and in 56 term, breast-fed infants, age 3–140 days. At 31 weeks of gestation the serum concentration of human α-LA was more than 10 times higher (mean value 3000 and median value 2101 μg/1 serum/1 human milk/kg body weight, n = 11) than in the term infants aged 3–30 days (mean value 257 and median value 152, n = 29). The serum concentration of o-LA decreased with increasing maturity in the VLBW-infants. At a postconceptional age of 37 weeks the values were similar (mean value 200 and median value 99, n = 8) to those found for term infants during the first month. In the term infants a decreasing absorption of α-LA was found with increasing postnatal age.     

Increased protein absorption after acute gastroenteritis in children

We investigated the intestinal absorption of the macromolecule human alpha-lactalbumin during and after an episode of acute gastroenteritis in children. Twenty children were studied in the acute phase and 17 excreted rotavirus. Eleven children were studied again 5-8 weeks later (convalescent phase). Human alpha-lactalbumin serum concentrations in the acute phase were similar but in the convalescent phase they were significantly (p less than 0.001) higher than those in the reference children. The serum concentrations were also higher in the convalescent than in the acute phase (p = 0.021). This study suggests that there is an increased absorption of proteins from the gut into the circulation 5-8 weeks after rotavirus gastroenteritis.     

Body composition in appropriate and in small for gestational age infants

The body composition of 70 appropriate for gestational age newborn infants whose gestational age ranged from 32 to 41 weeks was determined by dual-energy X-ray absorptiometry during the first 48 h of life. The evolution of the bone mineral content, fat and lean mass was well correlated with gestational age ( r = 0.66, r = 0.66 and r = 0.82. respectively) but even more closely with birthweight ( r = 0.85, r = 0.91 and r = 0.97. respectively). The body composition of 20 symmetric small for gestational age infants (mean gestational age ± SD = 38.1 ± 1.2 weeks: mean birthweight ± SD = 2117 ± 183 g) was also studied. The total body fat, the lean mass and the bone mineral content of small for gestational age infants were decreased significantly in comparison with those of appropriate for gestational age infants with the same gestational age ( p ≤ 0.05, p ≤ 0.0001 and p ≤ 0.05) but was not significantly different from those observed in appropriate for gestational age infants of the same birthweight.     

小于胎龄儿血生化营养指标研究

为提高小于胎龄儿今后的生活质量,探讨其出生后即刻血生化指标的变化,以正确评价小于胎龄儿出生时营养状况,对我科2000年1月～2005年5月出生的早产小于胎龄儿、足月小于胎龄儿、足月适于胎龄儿的血生化营养指标进行比较,现将结果总结如下。1资料与方法1.1临床资料早产小于胎龄儿(A组)27例,胎龄30～36(33.04±1.51)周,体重1020～1565(1235.67±145.57)g;足月小于胎龄儿(B组)35例,胎龄37～41(38.33±1.06)周,体重1500～2000(1801.67±123.99)g;足月适于胎龄儿(C组)30例,胎龄37～41(38.87±1.31)周,体重2595～3885(3331.94±363.20)g。出生时…     

晚期早产儿与足月小于胎龄儿生长发育状况比较

目的比较均为低出生体质量的晚期早产与足月小于胎龄(SGA)儿童的生长和发育状况。方法随机选取100例出生体质量<2 500 g的3岁儿童,其中50例为晚期早产儿童,50例为足月SGA儿童,对其进行体格测量及盖赛尔(Gesell)发育量表评估。结果晚期早产和足月SGA儿童的出生体质量、出生身长相近,但3岁时晚期早产儿童的身高、体质量、头围明显优于足月SGA儿童,差异有统计学意义(P<0.05);Gesell发育评估显示,晚期早产儿童的动作能、应物能、语言能、应人能均高于足月SGA儿童,差异有统计学意义(P<0.05)。结论同为低出生体质量,晚期早产儿童的长期生长和发育状况优于足月SGA儿童。     

Intrauterine growth retardation and brainstem auditory-evoked response in preterm infants

Intrauterine growth retardation is frequently associated with intrauterine undernutrition, and can deleteriously affect brain function. Twenty-eight premature small for gestational age infants were compared with 28 premature appropriate for gestational age infants to determine whether intrauterine growth retardation was associated with abnormalities in the auditory pathway in the early neonatal period. The auditory pathway was studied between 4-18 wk of life by analysis of brainstem auditory-evoked potentials elicited by a 10/s 75 decibel above normal adult hearing level (dB nHL) click stimulus presented at the infants' ears. Peak latencies of components I, III and V, and interpeak latencies I-III, III-V and I-V, yielded no statistically significant differences between groups. The present study indicates that intrauterine growth-retarded premature infants may not have abnormalities of brainstem auditory-evoked response in the early neonatal period.     

Factors influencing extrauterine growth retardation in singleton-non-small for gestational age infants in China: A prospective multicenter study

BackgroundThe incidence of extrauterine growth retardation (EUGR) varies considerably in different countries due to the distinct definitions and inclusion criteria of individual studies. Most studies included small for gestational age (SGA) very preterm infants (VPIs), resulting in a higher incidence of EUGR. Experts have suggested the accurate definition of “EUGR” in SGA infants is not “true EUGR”. The postnatal growth curve of multiple premature births also differs from that of singletons. As far as we know, there is no study about relationship between singleton-non-SGA preterm infants and EUGR.ObjectivesTo analyze the factors influencing EUGR among VPIs who were singleton-non-SGA in China.MethodsA prospective-multicenter study was conducted in 28 hospitals distributed through China from September 2019 to December 2020. The clinical data on singleton-non-SGA among VPIs were divided into EUGR group (n = 692) and non-EUGR group (n = 912).ResultsCompared to non-EUGR group, the mean gestational age (GA), mean birth weight (BW) and percentage of BW in Fenton curve in EUGR group were lower (P < 0.001 for all). The incidence of EUGR among distinct GA groups (classifications of GA < 28weeks, 28–28⁺⁶ weeks, 29–29⁺⁶ weeks, 30–30⁺⁶ weeks and 31–31⁺⁶ weeks) and distinct BW groups (classifications of BW<1000 g, 1000–1249 g, 1250–1499 g, 1500–1999g and 2000–2500 g) were statistically significant (P = 0.004 and P <.001). Logistic regression analysis indicated that later addition of human milk fortifier (HMF), later attainment of HMF sufficient fortification, later return to BW, more accumulative days of fasting, longer duration of parenteral nutrition, total duration of oxygen support and moderate/severe bronchopulmonary dysplasia (BPD) were risk factors for the development of EUGR in singleton-non-SGA VPIs (P < 0.001, P = 0.002, P < 0.001, P = 0.002, P = 0.017, P = 0.003 and P = 0.002, respectively). The use of full-course antenatal steroids, greater BW as a percentile of the Fenton curve, breastfeeding initiation and faster average velocity of weight growth effectively protected against EUGR (P = 0.008, P < 0.001, P < 0.001 and P < 0.001, respectively).ConclusionsThe overall incidence of EUGR was 43.1% among singleton-non-SGA VPIs in China. Raising the full-course antenatal steroids usage, reducing the incidence of moderate and severe BPD, attaching importance to the management of enteral nutrition in VPIs and increasing the weight growth velocity can reduce the incidence of EUGR.     

Prediction of early tolerance to enteral feeding by measurement of superior mesenteric artery blood flow velocity: appropriate- versus small-for-gestational-age preterm infants

AIM: To evaluate whether serial Doppler measurements of superior mesenteric artery blood flow velocity could predict early tolerance to enteral feeding in preterm infants. METHODS: In a prospective study, 54 healthy preterm neonates were assigned to one of the following groups: neonates with birthweight appropriate for gestational age (group 1), neonates small for gestational age without (group 2) and with prenatal haemodynamic disturbances (group 3). We studied Doppler blood flow velocity and resistance index before and after the first feed. RESULTS: Contrary to patients of group 3, infants in groups 1 and 2 showed a significant increase in blood flow velocity and a significant decrease in resistance index from the preprandial values after the first feed. At each postprandial time, we found significant differences in all velocity and resistance measurements between patients of group 3 and patients of both groups 1 and 2. In all patients, we found that the value of mean velocity measured 30 min after the first feed was the most predictive of early feed tolerance, with 95% sensitivity and 94% specificity when mean velocity >0.38 m/s. CONCLUSION: Small-for-gestational-age preterm infants with prenatal haemodynamic disturbances have an unusual intestinal haemodynamic response to the first feed. In the whole group of preterm infants, the value of mean velocity measured 30 min after the first feed is a good tool for the clinician in predicting early enteral feeding.     

Lipoproteins in preterm and small-for-gestational-age infants during the first week of life

Plasma lipoprotein levels and composition have been determined in preterm and small-for-gestational-age (SGA) infants, and compared to full-term infants, during the first week of life. Significantly lower levels of HDL and higher levels of VLDL were found in both preterm and SGA infants in comparison to full-term healthy infants. These results suggest a low capacity to metabolize VLDL. Preterm infants showed a behaviour similar to full-term infants with regard to the changes in lipoprotein composition. Small-for-gestational-age infants showed a higher lipoprotein lipid content than preterm infants. A low ratio of cholesteryl ester to free cholesterol (CE/FC) was found in both preterm and SGA infants suggesting a reduced lecithin: cholesterol acyl transferase (LCAT) activity. In preterm infants we observed no changes in the CE/FC ratio during the first week of life, whereas in SGA infants this ratio increased after birth.     

Ventilatory requirements for respiratory distress syndrome in small-for-gestational-age infants

Neonatal ventilatory requirements and outcome were examined in 135 very preterm, small-for-gestational age (SGA) infants to determine whether fetal growth retardation protects against severe respiratory distress syndrome (RDS) in very immature infants. Their results were compared to those from gestational age-and gender-matched controls. Although there was no significant difference in the median duration of mechanical ventilation between the two groups, more SGA infants required ventilation and were ventilated because of RDS. In a subgroup also matched for mode of delivery, there was no significant difference between the proportion of SGA infants requiring mechanical ventilation for RDS compared to their matched controls. The mortality was greater in the SGA group. We conclude that fetal growth retardation does not protect against severe RDS.     

Postnatal intestinal disturbances in small-for-gestational-age premature infants after prenatal haemodynamic disturbances

Uteroplacental insufficiency leads to fetal growth retardation, which is a major cause of perinatal and postnatal morbidity. In the present study we investigated the relationship between prenatal haemodynamic disturbances and postnatal intestinal perfusion and gastrointestinal function in small-for-gestational-age neonates. Prospectively, 114 preterm neonates with a birthweight below 1500 g were assigned to one of two groups according to their prenatal Doppler sonographic measurements: neonates with or without prenatal haemodynamic disturbances. We defined a pathological fetal perfusion by a pulsatility index of uterine arteries, umbilical artery and fetal thoracic aorta above the 90th percentile and by a pulsatility index of middle cerebral artery below the 10th percentile of a normal group. We compared the postnatal respiratory and intestinal adaptation in both groups as well as the blood flow velocity waveforms of the superior mesenteric artery in all neonates. Postnatally, all 36 neonates with prenatal haemodynamic disturbances were classified to be small for gestational age. Thirty-one of these neonates developed abdominal problems with delayed meconium passage, abdominal distension, bilious vomiting and a delay in tolerating in enteral feeding within the first days of life. Six of them needed surgical intervention, but none of these infants revealed typical signs of necrotizing enterocolitis. In contrast, all neonates after normal prenatal perfusion were classified to be appropriate for gestational age. Only 19 of 78 neonates of this group showed signs of intestinal disturbances postnatally. By Doppler sonographic investigations we found significant lower systolic, mean and end-diastolic flow velocities and higher pulsatility indices of the superior mesenteric artery in neonates with prenatal haemodynamic disturbances. This may occur as a result of postnatal persistent redistribution of regional blood flow and results in gastrointestinal problems and may adversely affect gut motility.     

Allergy development and macromolecular absorption in infants with different feeding regimens during the first three days of life. A three-year prospective follow-up

A group of 129 infants were randomly assigned at birth to one of three feeding regimens: human milk (HM), cow's milk formula (CMF) or a casein hydrolysate formula (CHF) during the first 3 days of life. Blood samples were taken on at 4 days and at 2, 4, 8, 12 and 24 months of age. Macromolecular absorption was analysed by measuring the serum concentration of human α-lactalbumin (S-α-LA) with a competitive radioimmunoassay (RIA). Total serum IgE was measured by RIA. A family history of allergy correlated to the proportion of infants with allergic symptoms both at 24 and 36 months of age ( p = 0.03 and p = 0.04 respectively). In none of the three groups did correlation exist between the duration of breastfeeding and serum α-LA, serum IgE, family history of allergy, frequency of allergic symptoms and proportion of infants with infections.     

34 周以下适于胎龄及小于胎龄早产儿出生 2 周内 蛋白质、能量摄入及体质量变化

目的了解34周以下早产适于胎龄儿(AGA)和小于胎龄儿(SGA)生后蛋白质、能量摄入量以及体质量z评分的变化情况。方法回顾收集2012年1月至2014年12月入院的314例早产儿,比较268例AGA和46例SGA早产儿生后2周内蛋白质、能量摄入情况和体质量变化。结果 SGA组住院时间、肠外联合肠内营养时间、全肠内营养时间、达足量喂养时间均较AGA早产儿长,差异有统计学意义(P??0.05);SGA组生后第4、8、12天能量摄入量明显低于AGA组,SGA组生后第6、8天总蛋白质摄入量明显低于AGA组,差异均有统计学意义(P??0.05);SGA组日平均体质量增长量大于AGA组,差异有统计学意义(P??0.05);AGA组与SGA组生后2周内体质量z评分均逐渐远离中位水平,且SGA组2周时体质量z评分低于AGA组(P??0.05)。结论胎龄??34周的SGA早产儿恢复出生体质量后的生长速率快于AGA早产儿,存在一定的追赶生长;但SGA、AGA早产儿的生长均有待提高。     

Prenatal predictors of chronic lung disease in very preterm infants

OBJECTIVE: To identify prenatal risk factors for chronic lung disease (CLD) at 36 weeks postmenstrual age in very preterm infants. POPULATION: Data were collected prospectively as part of the ongoing audit of the Australian and New Zealand Neonatal Network (ANZNN) of all infants born at less than 32 weeks gestation admitted to all tertiary neonatal intensive care units in Australia and New Zealand. METHODS: Prenatal factors up to 1 minute of age were examined in the subset of infants born at gestational ages 22-31 weeks during 1998-2001, and who survived to 36 weeks postmenstrual age (n = 11 453). Factors that were significantly associated with CLD at 36 weeks were entered into a multivariate logistic regression model. RESULTS: After adjustment, low gestational age was the dominant risk factor, with an approximate doubling of the odds with each week of decreasing gestational age from 31 to less than 25 weeks (trend p<0.0001). Birth weight for gestational age also had a dose-response effect: the lower the birth weight for gestational age, the greater the risk, with infants below the third centile having 5.67 times greater odds of CLD than those between the 25th and 75th centile (trend p<0.0001). There was also a significantly increased risk for male infants (odds ratio 1.51 (95% confidence interval 1.36 to 1.68), p<0.0001). CONCLUSIONS: These population based data show that the prenatal factors low gestational age, low birth weight for gestational age, and male sex significantly predict the development of chronic respiratory insufficiency in very preterm infants and may assist clinical decision about delivery.