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).     

早产儿和足月儿母乳及牛乳铜铁锌含量测定

Sixty-eight samples of preterm human milk and 39 samples of term human milk were obtained during 4 weeks postpartum from 7 mothers delivering prematurely and 9 mothers giving birth at term. Eleven cow's milk samples were obtained at random from 11 healthy cows. Samples were measured by flame method using an atomic absorption spectrophotometer (Type WYX-402). The three trace elements content of PT and FT milks decreased significantly with duration of lactation, and the content of each mineral was higher during the first week than that measured during the fourth week. PT and FT milk did not differ significantly in the content of the three elements during the first month of lactation. Copper content of PT milk at each week, iron content of PT milk at the first week and zinc content of PT milk during the first two weeks of lactation are higher than those of cow's milk respectively. The intake of copper, iron and zinc of the preterm infant fed his own mother's milk or cow's milk was calculated. Comparison of the intake level of copper and zinc of breastfed and cow's milk-fed preterm infant with the recommended intake level of the two minerals was made. The results show PT milk is superior to cow's milk for copper, iron and zinc; may be helpful for promoting breast feeding and feeding the preterm infant with supplemental trace elements.     

早产儿母乳主要成分和矿物质动态分析

纵向动态测定产后8周内早产儿母乳蛋白质、脂肪、乳糖、钾、钠、钙、磷、镁、铜、铁、锌含量。结果:蛋白质、钾、钠、铜、铁、锌含量随周龄增加而显著下降;平均摄入量除钙、磷、铁明显偏低外,其他成分均超过宫内胎儿增积量;产后4周内,钙、磷、镁、铜平均摄入量低于推荐摄入量;4周后蛋白质、钠、锌平均摄入量低于推荐摄入量。     

Comparaison de la réponse métabolique du petit prématuré alimenté parentéralement, puis au lait maternel de prématurité.

The nitrogen retention and plasma amino acid concentration were determined in eight preterm infants (mean birth weight 970 +/- 130 g; mean gestational age 28 +/- 1 weeks) receiving successively total parenteral nutrition and their own mother's milk. The nitrogen retention during both regimens was comparable to the fetal accretion rate. Plasma amino acid concentrations were lower during the enteral phase of the study than during parenteral nutrition. The metabolic response of small preterm infants is related to the quality of amino acids as well as to the route of intake.     

妊娠早期孕母血清高敏C反应蛋白水平特点及临床意义

目的探讨妊娠早期孕母高敏C反应蛋白（hs-CRP）水平特点及其与早产的关系。方法回顾性分析近两年来我院产科住院分娩的220例产妇,以符合早产诊断标准的110例孕妇为早产病例组（〈37wk）,并以110例正常妊娠孕妇为正常对照组,在妊娠早期（9～20孕周）比较两组血清hs-CRP水平,并校正混杂因素后,采用Logistic回归分析计算优势比（OR）及95%可信区间,以评价hs-CRP对早产的预测价值。结果病例组hs-CRP水平高于对照组;通过Logistic回归分析计算出hs-CRP≥7.5mg/L孕妇发生早产的概率是hs-CRP≤2mg/L孕妇的2.04倍;孕周34～37周孕妇与血清hs-CRP水平无明显相关性,但孕周28～34周孕妇与血清hs-CRP水平（≥7.5mg/L）显著相关。结论妊娠早期血清hs-CRP增高可作为监测早产发生的指标。     

足月儿和早产儿母乳中游离和构成蛋白质的氨基酸含量动态比较

目的 了解足月儿和早产儿母乳中游离和构成蛋白质的氨基酸含量的动态变化。方法 采用氨基本自动分析仪对不同泌乳期的足月儿和早产儿母乳中游离和构成蛋白质的氨基酸含量进行测定。结果 牛磺酸、谷氨酸／谷氨酰胺是母乳乳中最丰富的游离氨基酸,而谷氨酸／谷氨酰胺,亮氨酸生门冬氨酸是蛋白质中含量最丰富的氨基酸,提示了其对新生儿的最佳供应,早产儿母乳中氨基酸谱变化与足和母乳有所不同,但更符合于早产儿的需求。结论 从氨     

人奶、牛奶和新生儿配方奶中的表皮生长因子水平

目的　证实母乳EGF分泌量的变化是对早产儿加速生长和成熟的一种适应性反应；比较人乳、新鲜牛奶以及新生儿奶配方中的EGF含量.方法　使用放射免疫分析法,测定了57份人初乳（分别来自分娩早产儿和足月儿的母亲）、4种新鲜牛奶和8种基于牛奶的新生儿配方奶中的EGF含量. 结果　早产儿奶的EGF水平（28.2±10.3?nmol/L）明显高于足月儿奶（17.3±9.6?nmol/L）.母乳EGF含量与其分娩的新生儿胎龄和出生体重呈负相关.新鲜牛奶的EGF水平（13.8-18.2?nmol/L）与足月儿奶相当,但低于早产儿奶.非水解蛋白质配方奶的EGF浓度明显低于人奶和新鲜牛奶.水解蛋白质配方奶的EGF浓度在可测范围之下. 结论　早产儿奶中EGF的高含量可能代表着一种与早产儿加速的生长发育相适应的代偿机制；由于配方奶中的EGF不足甚至缺乏,故应提倡用母乳喂养自己的婴儿.     

Epidermal growth factor concentrations in human milk, cow’s milk and cow ’s milk-based infant formulas

Objective Because maternal epidermal growth factor (EGF)may be an adaptive response to a ccelerate growth and maturation in premature infants, we compared the EGF conten t in fresh cow’s milk and cow’s milk-based infant formulas with full and prete rm mother’s milk. Methods EGF content of 57 human colostrum from mothers delivering prematurely a nd at term, 4 different fresh cow’s milk and 8 different cow’s milk-bas ed infant formulas was determined by radioimmunoassay (RIA). Results Human milk from mothers of premature infants had a higher EGF content compared t o that from mothers of term infants (28.2±10.3nmol/L vs 17.3±9.6nmol/L ). EGF content in human milk negatively correlated with gestational age and bir th weight of neonates. EGF content in fresh cow’s milk (13.8-18.2nmol/L) wa s similar to that in human term milk. EGF levels in non-hydrolyzed protein for mulas were much lower (5.6-8.6nmol/L), and were undetactable in hydrolyzed p rotein formulas. Conclusion The high EGF content in premature milk may represent a maternal compensatory mec hanism to accelerate the growth and development of immature infants. Feeding in fants with breast milk from their own mother should be advocated since there is lack of EGF in cow’s milk-based infant formulas.     

胎儿纤维连接蛋白预测早产的临床观察

目的：研究胎儿纤维连接蛋白（fetalfibronectin,fFN）的检测在早产预测中的临床价值。方法：用fFN快速测试条对有先兆早产症状的孕妇进行阴道后穹窿分泌物中fFN的检测,追踪妊娠结局。结果：（1）共检测191例先兆早产孕妇,临床随访实际发生早产者57例,故从症状判断早产的阳性率29．84％,存在70．16％的误差。（2）191例先兆早产孕妇中72例WN阳性,其中37例发生早产,故fFN阳性者早产的概率为51．39％。（3）阳性孕妇中7d内、14d内、37孕周前分娩率分别为：34．72％、41．67％、51．39％,阴性孕妇中则分别为：9．24％、11．76％、16．81％,对于7d内、14d内、37孕周前分娩的阴性预测值分别为：90．76％、88．24％、83．19％。（4）fEN检测阴性者中有11例在检测结果出现后7d内发生了早产。结论;（1）胎儿纤维连接蛋白的检测提高了从症状及体征来判断早产的阳性率,阴性结果提示短期内不发生早产的价值较大。（2）本研究发现fFN1周内分娩的阴性预测值为90．76％,低于以往研究的报道。可能由于早产并非单一原因引起,如感染、胎窘、妊娠合并症及并发症、子宫畸形等都可诱发早产,因而单一的fFN检测来预测早产便有一定的局限性。在医患关系紧张的当代,对于fFN阴性检测结果不干预治疗是欠妥当的。     

妊娠期血浆促肾上腺皮质激素释放激素水平与分娩时间的关系

目的:研究足月产、早产及过期产孕妇血浆中促肾上腺皮质激素释放激素(CRH)水平的变化,探讨应用CRH预测早产的价值.方法:门诊产科检查孕妇200例,从孕28周起至分娩,每间隔2周取血浆1次,标本用甲醇提取法处理后,通过放免测定观察血浆中CRH水平变化.结果:孕28周起血浆CRH水平[(37.45±8.50) pg/ml]呈进行性升高,孕晚期升高[(160.25±14.59) pg/ml]显著,分娩达最高峰[(570.54±47.91) pg/ml];孕28周起血浆中CRH水平在早产及过期产中即出现异常升高或降低(P<0.01);孕28周时血浆中CRH水平与妊娠持续时间呈负相关.结论:血浆CRH水平是妊娠持续时间的标志,孕28周血浆CRH水平可预测最终早产的发生.     

Facts and artifacts about anemia and preterm delivery

The effect of anemia (hematocrit less than or equal to 0.34) on subsequent preterm birth was prospectively studied in 35,423 pregnancies. The incidence of preterm birth among women with and without anemia at each week during the third trimester was compared. Early in the third trimester, there was a weak association between anemia and preterm delivery. However, anemia early in the third trimester did not account for the substantial increase in preterm birth seen among black women. Anemia after 30 weeks' gestation was not associated with preterm birth. Among women delivering term infants weighing 2500 g or more, the mean hematocrit rose 0.029 among black women and 0.021 among white women from 25 weeks to term. Compared with hematocrits at 40 weeks' gestation, the odds ratios for anemia reached a maximum at 28 weeks and fell sharply as term approached. When the hematocrits of women in term labor were compared with those of women in preterm labor, a spurious dose-response effect for anemia was created. We conclude that anemia is not a strong factor in the pathogenesis of preterm birth and that comparison of hematocrits from women who are in preterm and term labor produces biased results.     

Rate of inactivation of cytomegalovirus in raw banked milk during storage at -20 degrees C and pasteurisation

Samples of milk from 23 mothers attending the department of obstetrics and gynaecology and 36 who donated milk to the department's milk bank were cultured for cytomegalovirus. Virus was isolated from samples from 12 of the milk donors but none of the mothers attending the department; follow-up studies during lactation in seven of these 12 women showed that five continued to excrete the virus. Samples were taken on three occasions from one woman who regularly excreted high titres of the virus. Storage at -20 degrees C for over three days reduced the titre by over 99%; after pasteurisation at 63 degrees C for eight minutes the milk did not contain any viable virus. It is recommended that raw banked milk used for feeding preterm babies should be kept frozen for at least 72 hours before feeding.     

Stripping out pus in lactational mastitis: a means of preventing breast abscess.

OBJECTIVE: To determine whether manual stripping of pus from the breasts of women with lactational mastitis is effective in preventing the formation of breast abscesses. DESIGN: Case series (chart review). SETTING: Family practice in Montreal. PATIENTS: All (475) charts of patients with lactational mastitis were reviewed; 61 women were excluded because they already had a breast abscess. Most of the patients had been referred. OUTCOME MEASURES: Abscess formation, length of illness after treatment, rate of recurrence of mastitis, illness in the mother or infant within the 6 weeks after the mastitis and continuance of breast-feeding. MAIN RESULTS: The duration of symptoms before treatment was 1 to 56 (mean 5.3) days. In 9% of the cases both breasts were affected, and in 23% at least one episode of mastitis had previously occurred. The stripping technique was applied to all the patients. Pus was removed in 210 women; the remaining women were considered to have cellulitis. Only four patients (less than 1%) had breast abscesses. The mean length of illness after treatment was 7.2 days. The rate of recurrence was 14%. In all, 6% of the mothers and 9% of the infants became ill in the 6 weeks after the mastitis. Most (92%) of the patients continued to breast-feed. CONCLUSIONS: The rate of abscess formation was considerably lower than the rates reported in the literature. Therefore, manual stripping of pus from the infected breasts of lactating women appears to be effective in preventing breast abscesses.     

The Impact of Breastfeeding Pattern on the Duration of Lactational Amenorrhoea in Chengdu,China

Objective To determine the relation between infant feeding practices (and other fac-tors) and the duration of postpartum amenorrhoea in a sample of Chinese womendinally in 541 mothers and their infants in Pengxian County Sichuan Province. The,durations of breast feeding and of lactational amenorrhoea were estimated throughsurvival analysis. Cox's non-parametric hazards regression analysis was performed todetermine thevariables associated with the duration of lactational amenorrhoea.Results Mothers breast fed frequently per day, the mean frequency ranging from 6. 4per day at 3 weeks postpartum to 5. 4 per day at 6 months. They breast fed for over18. 3 monthson average. The median duration of lactational amenorrhoea was 9. 3months. Theperiod from birth until the first breast feed was a significant determinantof the duration of lactational amenorrhoea, P = 0. 038. Compared with women whoended full breastfeeding earlier, those who ceased full breast feeding at 120 to 24Cdays returned to menses significantly sooner (risk ratio ＝ 1. 34; 95% CI = 1. 06～1. 69). This finding is probably spurious since no relationship between full breast feed-ing duration and the return of menses was found among women who ended full breast-feeding after 240 days.Conclusion The most important determinant of the return of menses was the delay inthe first breast feed after birth, suggesting that the Ten Steps to Successful Breast feed-ing should be more precisely implemented.     

新生儿神经行为测定在早产儿神经心理发育中的临床研究

目的研究新生儿神经行为测定在早产儿神经心理发育中的作用和意义。方法选择2006年1月至2011年1月在北京市宣武区妇幼保健院产科分娩的早产儿90例,分别于出生后2³ d、123 d、12¹4 d、2614 d、26²8 d(纠正胎龄40周后算起)采用20项新生儿神经行为测定(NBNA)法进行神经行为测定。结果 90例早产儿中,NBNA异常的有21例,出生时伴有不同程度的低体质量、身长与头围不足等现象,经干预后患儿不同时间段的身长、体质量及头围较出生时显著增加(P<0.05);21例NBNA异常患者均进行针对性干预,1228 d(纠正胎龄40周后算起)采用20项新生儿神经行为测定(NBNA)法进行神经行为测定。结果 90例早产儿中,NBNA异常的有21例,出生时伴有不同程度的低体质量、身长与头围不足等现象,经干预后患儿不同时间段的身长、体质量及头围较出生时显著增加(P<0.05);21例NBNA异常患者均进行针对性干预,12¹4 d、2614 d、26²8 d(纠正胎龄至足月后)NBNA评分较纠正胎龄后228 d(纠正胎龄至足月后)NBNA评分较纠正胎龄后2³ d显著上升(P<0.05)。结论 NBNA可及时发现早产儿中枢神经系统功能异常,及时采取有效措施实施干预,对促进早产儿神经功能的恢复,改善预后具有重要意义。     

Quantitative macroscopic study on preterm placenta in gestational diabetes mellitus and pregnancy induced hypertension

Preterm birth is the major cause of perinatal mortality and morbidity. During the last decade, it has become an important issue in public health policies of developing countries. Gestational diabetes mellitus and Pregnancy induced hypertension are two important high-risk factors for preterm birth. The proposed study aimed to make a macroscopic analysis on the functional tissues (Parenchymal tissues) in preterm placenta in respect of Gestational diabetes mellitus (GDM) and pregnancy induced hypertension (PIH). The study was observational and cross sectional. The patients under this study were selected from the Obstetric ward of BSMMU and BIRDEM hospital, from June 2005 to October 2005. Sixty-six samples were collected from women during 28 weeks to 36 weeks of gestation. Among them, twenty-two samples were from gestational diabetic mothers, twenty-two were from pregnancy induced hypertensive mothers and twenty-two were from mothers who were non-diabetic and non-hypertensive in current pregnancy. Placentas were fixed and preserved in 10% formal saline solution. The volume proportions of parenchymal and non-parenchymal components were measured by using a point counting technique on formalin fixed placentas. In this study, the GDM group had significantly more absolute volume and mean proportional volume of the parenchyma but less mean proportional volume of the non-parenchyma when compared with Control and PIH group. However, the PIH group had significantly less absolute volume of the parenchyma than the control group and the mean value of the absolute volume of non parenchyma was also less than control value but did not reach a significant level. The results obtained from diseased and control groups demonstrated a significant change in some events, and some trends were also observed among these groups. However, it could be suggest that, in these two pregnancy-induced disorders, there is placental insufficiency where the placenta tries to exert its reserve capacity by changing its functional structures and consequently overcomes the possible damage to the fetus.     

Pattern of change of weight following birth in the early neonatal period

Birth weight of new born will vary according to gestational age, maternal, Placental and foetal intrauterine conditions. Postnatal weight change in the first few days of life (early neonatal period) may vary according to gestational age and birth weight. This may create problem in management of these babies. Birth weight and their pattern of change were followed on 105 newborns. Questionnaire and observation charts were the research Instruments and statistical analysis were done by using manual calculator. It was observed that full term newborns had better control on initial weight change following birth than preterm and low birth weight babies. Majority of term newborns loss their weight up to 5 days of life and regained their initial weight by 10 days. Maximum weight loss for longer duration occurred in preterm and very low birth weight babies who regained their initial weight by 10 - 14 days and some required more than 21 days.     

不同胎龄不同喂养方式早产儿胃肠激素浓度变化的研究

目的:观察不同胎龄早产儿胃动素(MOT)与胃泌素(GAS)浓度变化及其不同喂养方式对MOT及GAS的影响。方法:80例早产儿按不同喂养方式分为自吸吮组、胃管饲养组、胃管饲养加静脉营养组3组,应用放射免疫法检测其生后12h内开奶前及第7天空腹MOT与GAS的浓度,并以20例足月新生儿作为对照。结果:(1)所有新生儿生后12h的血中MOT、GAS浓度均明显低于生后第7天(P<0.01);早产儿组生后12h内及第7天空腹血中MOT、GAS浓度均明显低于对照组(P<0.05),随胎龄增加其血中MOT、GAS浓度亦升高(P<0.05~0.01);(2)生后第7天自吸吮组早产儿血中MOT、GAS浓度明显高于胃管饲养组、胃管饲养加静脉营养组,差异有统计学意义(P<0.05)。结论:胃肠内分泌细胞功能随胎龄增加逐渐发育成熟,MOT及GAS对未成熟儿胃肠结构和功能完善有促进作用,自吸吮奶汁较胃管饲养有利于胃肠道激素浓度的提高。     

Magnesium sulfate in prevention of preterm labor]

To observe the efficacy of magnesium sulfate in the treatment of preterm labor, 65 uncomplicated cases of preterm labor between 28 and 36 weeks of gestation were studied prospectively during Sep. 1988-May 1991. They were divided into two groups randomly. 30 cases were treated with magnesium sulfate and 35 cases with barbiturates or bed rest. The prevention of delivery for at least 48 hours after the initiation of therapy was achieved in 23 of the 30 cases (76.67%) of the magnesium sulfate group and in 3 of the 35 cases (8.57%) in the control group. Delay of more than 7 days was achieved in 17 of the 30 cases (56.67%) and in 2 of the 35 cases (5.71%). The postponement of delivery between the two groups. There was highly significantly difference (P less than 0.01). There was a significant correlation of cervical dilation at the onset of treatment to success of controlling preterm labor. In the magnesium sulfate group, the mean magnesium level to achieve tocolysis was 2.8 +/- 0.35 mmol/L (mean +/- s). The side effects to the mothers, fetus, and the neonates were mild and not prominent.(ABSTRACT TRUNCATED AT 250 WORDS)     

部分胃肠外营养在早产儿中的应用

目的探讨部分胃肠外营养（partial parenteral nutrition，PPN）在早产儿临床应用中的价值。方法将45例早产儿随机分为两组，治疗组24例，在患儿入院后2—3d内，排除禁忌症后即采用PPN；对照组21例，为同期入院的患儿，按照早产儿的综合性治疗措施处理。两组患儿在治疗的同时尽量早开奶，通过胃肠道进食，尽可能增加喂养奶量。于治疗第3天和第7天分别比较两组患儿的体重和血清前清蛋白（prealbumin，PA）。结果治疗组患儿第3天血清PA水平较对照组增加明显；第7天，治疗组患儿的体重增长和血清PA水平均较对照组明显增加。差异有统计学意义。结论早产儿早期外周PPN可以使患儿获得更多营养支持，并可较早增加体重，改善预后。