早产儿母乳主要成分的矿质物动态分析

The content of protein, fat, lactose, potassium, sodium, calcium, phosphorus, magnesium, copper, iron, zinc in preterm human milk was determined from the longitudinal samples during the first 8 weeks of lactation. Changes in content, over time were tested by analysis of variance. Protein, potassium, sodium, copper, iron, zinc content decreased significantly as lactation progressed. Based upon these data, a preterm infant fed 200 ml per kg per day of its own mother's milk would receive an excess of all substrates except calcium, phosphorus and iron over the estimated intrauterine accretion rates. Within 4 weeks the first in the postpartum period, the average intake of calcium, phosphorus, magnesium and copper was lower than the recommended intake. Iron intake is not adequate. After 4 weeks, the average intake of protein, sodium and zinc was lower than the recommended intake. The results may offer a basic datum for establishing premature infant feeding and formulation of human milk fortifiers (HMF).     

Breast milk macronutrient composition and the associated factors in urban Chinese mothers

Background Infancy is a critical period of growth and physiological development,in which breast milk is the best source of nutrients.Compared to western countries,research on breast milk of Chinese population are limited.Thus,it is necessary to measure breast milk energy and macronutrient concentrations of healthy urban Chinese mothers at different lactation stages,to expand the database of milk composition of Chinese population,and to examine whether dietary or other maternal factors can affect the levels of macronutrients in breast milk.Methods Breast milk of full expression of one side breast from 436 urban Chinese lactating mothers at 5-11 days,12-30 days,31-60 days,61-120 days,and 121-240 days postpartum was obtained at 9：00 a.m.to 11：00 a.m.Total energy,lactose,protein,and fat contents were measured.24-hour dietary recall was surveyed,and maternal nutrient intakes were analyzed.Results Milk composition changed over the course of lactation and large individual variations were documented.The concentrations were 61.3 kcal/dl for total energy,7.1 g/dl for lactose,0.9 g/dl for protein,and 3.4 g/dl for fat in mature milk.Stage of lactation was a strong factor affecting milk composition.Minimal evidence was found for associations between maternal current dietary intake and milk macronutrient concentration,consistently with prior research.Maternal body mass index （BMI） was positively associated with milk fat content,to a greater extent than did dietary intake.All other maternal characteristics were not significant for milk composition.Conclusion These findings suggest that milk composition is generally weakly associated with maternal factors except for stage of lactation,and is likely to be more susceptible to long-term maternal nutritional status than short-term dietary fluctuation.     

Experience of early breast milk feeding in preterm very low birth weight infants

Although human milk is generally accepted as the gold standard for the feeding of term infants, its use in the preterm and very low birth weight (VLBW) infants particularly in the initial period of birth has been more controversial. Little is known about the risks and benefits of early introduction of breast feeding on preterm VLBW infants. The primary object of this study was to evaluate the safety and benefit of early breast milk feeding in preterm VLBW newborns during their initial hospitalization periods. Therefore a prospective observational study was conducted among 37 preterm VLBW infants who were admitted to the Neonatal ward of Sir Salimullah Medical College and Mitford Hospital during the period of February 15th to July 25th, 2003. Oral feeding with breast milk was started within one hour of birth, and weight gain, feeding tolerance, nosocomial infection rate as well as other associated problems of pre-maturity, and postnatal growth curve were recorded upto 16th postnatal day. Seventy three percent of the newborns tolerate breast milk well from the very beginning, and the rest did not tolerate initially but all of them tolerate within 24 hours of birth. Infants had less initial weight loss (20 ± 10 gm) and faster recovery of birth weight. They regained their birth weight at 12th postnatal day. Hyper-bilirubinaemia was found in only 22% cases, and was observed in the group who initially didn't tolerate breast milk and was on intravenous fluid. Nobody developed symptomatic hypoglycemia or necrotizing enterocolitis (NEC). Two cases of sepsis and another two cases of minor infection like conjunctivitis and oral thrush have occurred. In conclusion it can be said that early breast milk feeding is safe in preterm VLBW infants and it helps to promote growth and reduce the need for intravenous line.     

妊娠期高血压疾病产妇所生早产儿凝血功能分析

目的 探讨妊娠期高血压疾病产妇所生早产儿凝血功能指标与胎龄的关系及干预措施。方法 选取2017年3月至2018年10月温州市中心医院收治的80例妊娠期高血压疾病产妇所生的早产儿作为观察组,同期选取120例健康产妇所生的早产儿作为对照组,比较两组早期早产儿、中期早产儿和晚期早产儿的凝血功能指标,并分析观察组中凝血指标与胎龄的关系。按照治疗方法不同将观察组分为观察1组（n=46）和观察2组（n=34）。观察1组采用微剂量肝素+常规治疗,观察2组采用常规治疗,比较观察组不同治疗方案患儿凝血功能指标和颅内出血发生率。结果 两组的中期早产儿和晚期早产儿的凝血酶原时间（prothrombin time,PT）、活化部分凝血酶原时间（activated partial thrombin time,APTT）均短于早期早产儿,D-二聚体（D-dimer,D-D）水平均低于早期早产儿,纤维蛋白原（fibrinogen,FIB）水平均高于早期早产儿,差异均有统计学意义（P<0.05）。其中,观察组早期早产儿、中期早产儿、晚期早产儿的PT、APTT均长于对照组,D-D水平均高于对照组,FIB均低于对照组,差异均有统计学意义（P<0.05）。先兆子痫和子痫PT、APTT均长于妊娠期高血压产妇,D-D均高于妊娠期高血压产妇,FIB均低于妊娠期高血压产妇,差异均有统计学意义（P<0.05）;子痫患者的PT、APTT均长于先兆子痫患者,D-D高于先兆子痫患者,FIB低于先兆子痫患者,差异均有统计学意义（P<0.05）。Pearson相关性分析结果显示,观察组中PT、APTT、D-D与胎龄均呈负相关（P<0.05）,FIB与胎龄呈正相关（P<0.05）。治疗前,观察1组和观察2组的凝血功能指标比较,差异均无统计学意义（P>0.05）。治疗后,两组PT、APTT均短于治疗前,D-D水平均低于治疗前,FIB水平均高于治疗前,差异均有统计学意义（P<0.05）。观察2组的PT、APTT均长于观察1组,D-D水平高于观察1组,FIB水平低于高于观察1组,差异均有统计学意义（P<0.05）。观察1组和观察2组颅内出血发生率比较,差异无统计学意义（P>0.05）。结论 妊娠期高血压疾病产妇所生早产儿凝血功能显著改变,且与疾病类型、胎龄有关,给予微剂量肝素联合常规治疗可改善凝血功能且安全性较高,值得临床普及应用。     

极早和超早产儿支气管肺发育不良的回顾性研究

目的：分析并总结本新生儿重症监护室（neonatal intensive care unit,NICU）极早和超早产儿的救治现状及支气管肺发育不良（bronchopulmonary dysplasia,BPD）发病情况。方法：回顾性分析2018年1月—2020年12月南京医科大学附属儿童医院新生儿医疗中心收治的胎龄<32周且出院日龄≥28 d共547例早产儿的临床资料,按临床诊断分为BPD组（n=126）和非BPD组（n=421）,综合比较两组早产儿的情况,并纵向分析、总结3年的临床资料及BPD情况。结果：BPD组胎龄为（28.57±1.49）周,胎龄<28周的超早产儿占31.7%,而非BPD组胎龄为（30.05±1.39）周,超早产儿仅占8.1%(P <0.05)。BPD组出生体重（1 132.18±251.25）g,<1 000 g的超低出生体重儿占28.6%,而非BPD组出生体重（1 384.47±267.44）g,超低出生体重儿仅占6.4%(P <0.05)。BPD组5 min Apgar评分≤7分、产房复苏率均升高（P <0.05）。非BP...     

早产儿NICU中晚期早产儿发生与母亲孕期状况相关性分析

目的分析总结临床资料,探讨引起晚期早产儿发生的母亲孕期风险因素,以期为降低晚期早产儿发生率提供临床指导依据。方法选择2010年10月1日～2011年9月30日人住北京军区总医院附属八一儿童医院的晚期早产儿为研究对象,对母亲孕期状况进行调查问卷,加以总结分析,经多因素相关分析,得出相关因素。结果晚期早产儿以胎龄35周为多,与胎龄34周和36周两组比较,差异有高度统计学意义（P〈0．01）。与晚期早产儿发生密切相关的母亲孕期状况有12种,不同胎龄发生的风险因素不完全相同。胎龄34周者,主要与孕期无明显异常、胎膜早破、妊娠高血压、胎盘早剥密切相关（P〈0．05）。胎龄35周者,主要与孕期无明显异常、胎膜早破、妊娠高血压、官内窘迫、胎盘早剥和羊水异常密切相关（P〈0．05）。胎龄36周者,除了以上6种外,还与感染性疾病、妊娠糖尿病、双胎及多胎妊娠和前置胎盘相关（P〈0．05）。结论影响晚期早产儿发生的母亲孕期状况主要有：孕期无明显异常、胎膜早破、妊娠高血压、胎盘早剥、宫内窘迫、羊水异常、双胎或多胎妊娠、感染性疾病、妊娠糖尿病、前置胎盘、瘢痕子宫和先兆流产史。不同胎龄的母亲孕期相关因素不完全相同,3个胎龄中都包括孕期无明显异常、胎膜早破、妊娠高血压、胎盘早剥因素,相关性最强的前3位是孕期无明显异常、胎膜早破、妊娠高血压。     

乳酸杆菌对不同体质母亲母乳成分的影响

目的 本研究通过给过敏体质孕母、乳母补充益生菌乳酸杆菌,观察乳酸杆菌对母乳成分的影响及其与婴儿过敏性疾病发病的关系.方法 选择过敏体质孕妇(n=60),随机分成两组,一组自孕36周开始口服乳酸杆菌,孩子出生后继续服用直到母乳喂养结束,另一组口服安慰剂,同时选择非过敏体质孕妇(n=30)为对照组 ,生后取母乳测细胞因子及免疫球蛋白(IgA、SIgA、TGF-β1 、sCD14),孩子随访到2岁以确定湿疹及其他过敏性疾病.结果 口服乳酸杆菌的孕妇母乳中TGF-β1、sCD14水平较口服安慰剂低,口服乳酸杆菌的孕妇的孩子2岁内患过敏性疾病率低.口服乳酸杆菌对母乳中IgA、SIgA、水平没有影响.结论 在怀孕晚期及哺乳期口服乳酸杆菌可降低母乳中TGF-β1、sCD14水平,这种细胞因子水平降低与母乳喂养婴儿低敏感性有相关性.     

早产儿生后早期电解质特点

目的分析早产儿生后早期血电解质变化特点,为早产儿正确补充电解质提供理论依据。方法回顾分析2004年1月～2007年12月云阳县人民医院儿科收治的86例小胎龄早产儿（胎龄〈34W）,142例大胎龄早产儿（胎龄34～37W）和110例足月儿生后24h内血清电解质变化特点,采用日立7080全自动生化仪检测。结果两组早产儿组与足月儿组血钠、钾水平比较差异无统计学意义,平均值在正常范围内。而小胎龄早产儿组血钾高于大胎龄早产儿组,差异有统计学意义（P〈0．05）。两组早产儿组与足月儿组血钙水平比较差异有统计学意义∽〈0．05）。血钙的平均值随胎龄的增大而增高。小胎龄早产儿组血钙平均值〈2mmol／L。早产儿组与足月儿组血氮水平比较差异有统计学意义（P〈0．05）。足月儿组的血氟水平低于两个早产儿组,但血氯的平均值都在正常范围内。28％早产儿出现高钾血症。12％早产儿出现低钾血症。22％早产儿出现低钙血症。结论早产儿如出现低渗性脱水症状时应积极补钠,限制水摄入量。出现烦躁、惊厥或反复呼吸暂停时,应常规检查血钙,并静脉补钙。早产儿高钾一般不需处理。     

住院早产儿母亲疾病不确定感现状及影响因素分析

目的 调查住院早产儿母亲疾病不确定感水平并分析其影响因素.方法 以住院早产儿母亲为调查对象,采用一般资料调查表和中文版疾病不确定感父母量表进行问卷调查.评价早产儿母亲疾病不确定感水平,并采用非条件Logistic回归分析法分析其影响因素.结果 共收回有效问卷180份.住院早产儿母亲疾病不确定感总分为(83.92±11.65)分,其中11.7％处于低水平,88.3％处于较高水平.非条件多因素Logistic回归分析显示:不良孕产史(OR=6.357,95％CI:2.890～13.983,P=0.000)、早产儿体质量(OR=3.609,95％CI:1.331～9.787,P=0.012)、婚龄(OR=2.456,95％CI:1.226～4.921,P=0.011)为危险因素,文化程度(OR=0.453,95％CI:0.283～0.723,P=0.001)为保护因素.结论 大多数住院早产儿母亲的疾病不确定感处于较高水平,不良孕产史、早产儿体质量、婚龄、文化程度是住院早产儿母亲疾病不确定感的影响因素.     

Arterial changes in infants of smoking mothers

Examination of umbilical arteries and veins, and vessels in placental villi was carried out by electronmicroscopy in smoking and non-smoking mothers. Severe vascular changes were found in the smoking group. These findings suggest that similar changes may be present in the vessels of the newborn child. Stopping pregnant women from smoking may help to prevent CHD in their children in later life.     

早产儿光疗后低钙血症原因的探讨

目的探讨蓝光治疗早产儿高胆红素血症对血清钙的影响。方法将82例新生儿高胆红素血症患儿按胎龄分为足月儿及早产儿两组,足月儿47例,早产儿35例,测定光疗前后血清钙水平,比较两组低钙血症的发生率。结果足月儿和早产儿光疗后血清总钙和游离钙均下降(P均<0.01),早产儿低钙血症的发生率为63.0%,足月儿为25.5%,两组比较有显著性差异(P<0.01)。结论早产儿接受光疗时比足月儿更易发生低钙血症,光疗时应监测血钙浓度,胎龄<34周的早产儿宜常规补钙。     

早产儿静态骨组织形态学测量

目的：利用早产儿尸检的整块股骨,研究早产儿时期骨形成和吸收静态参数的变化,探讨早产儿代谢性骨病的发病机制。方法：出生后1wk内死亡的早产儿21（男12,女9）例,胎龄25－36wk,出生体质量484－2445g,应用半自动计算机技术对骨皮质、骨小梁进行形态学测量。结果：随着胎龄的增加,骨容积（BV／TV）明显增加,骨表面（BS／BV）,类骨质容积（OV／BV）和静止表面（RS／BS）明显减少;男性较女性的骨皮质形成参数OV／BV,Ob,S/BS,O．Th和骨吸收参数N．Oc／TAr明显增高;随着体质量的增加,Tb．Th,Vd.Th明显增加。结论：早产儿骨吸收增加,骨形成减少,可能是早产儿发生代谢性骨病的主要机制。     

Cow's milk allergy in infants

Cow's milk allergy (CMA) is one of the most common food allergies in young infants affecting up to 7% of children less than six months of age. The clinical presentation of these infants may be very traumatic to their parents, as significant rectal bleeding is the most common symptom in this disease. This article describes our experience treating 44 infants who were diagnosed with CMA in the Pediatric Gastroenterology Clinic at Marshall University. The clinical symptoms, treatment and outcome are presented. To reduce apprehension from the parents, primary physicians should be familiarized with this disease.     

Role of prophylactic surfactant in preterm infants

Background

Respiratory distress syndrome (RDS) in preterm neonates is caused by a deficiency or dysfunction of pulmonary surfactant. The physiological function of surfactant includes the ability to lower surface tension, as well as the ability to rapidly adsorb and spread. A wide variety of surfactant products have been formulated and studied in clinical trials. The present study was designed to find out whether prophylactic administration of surfactant leads to a significant decrease in the risk of neonatal mortality and neonatal morbidity.

Methods

This was an experimental study in which a total of 125 preterm newborns less than 34 weeks gestation were studied. One hundred preterm newborns (controls) less than 34 weeks gestation were managed in the conventional manner as per the existing protocols in the neonatal intensive care unit. Twenty-five consecutively delivered preterm newborns less than 34 weeks gestation were administered surfactant. Data regarding clinical outcomes including mortality and morbidity profile was collected and analysed.

Results

The mean duration of ventilation in the ventilated babies in the control group and the surfactant group was 129.8 ± 43 hours and 85.7 ± 46 hours, respectively; the difference being statistically significant. In the surfactant group, four babies (16%) died and in the control group, 27 babies (27%) died. The difference was not statistically significant. The number of babies developing retinopathy of prematurity and needing laser treatment for retinopathy of prematurity was greater in the surfactant group.

Conclusion

Prophylactic administration of surfactant in preterm newborns of gestational age <34 weeks is associated with a significant decrease in mean duration of ventilation and an increase in the incidence of retinopathy of prematurity.