低体重危重婴幼儿先天性心脏病的早期心内直视手术治疗

目的:回顾性分析低体重婴幼儿危重先天性心脏病早期心内直视手术的效果.方法:对17例出生体重<2 500 g的患儿在中低温体外循环下行心内直视矫治术.结果:手术效果满意,手术成功16例.结论:患先天性心脏病的低体重患儿,若临床心脏症状危重,早期行体外循环心内直视手术可有较满意的效果.     

Cardiac catheterization of low birth weight infants

The increased survival of low birth weight infants means that more of these infants may be candidates for catheter interventions. There are few data on the results of cardiac catheterization in this group. This study aimed to analyze, retrospectively, cardiac catheterization of infants weighing ≤2.5 kg, with emphasis on the results of interventions. The complication rates of interventional and diagnostic procedures were compared. One hundred eleven catheterizations were performed in 107 patients between 1985 and 1998. Thirty-one procedures were interventional. Balloon atrial septostomy (n = 16), balloon pulmonary valvuloplasty (n = 10), balloon pulmonary angioplasty (n = 1), and coil occlusion of collateral vessels (n = 3) were all performed successfully. One infant (3%) died while undergoing myocardial biopsy. The reintervention rate for isolated pulmonary valve stenosis was 25% (2 of 8) at 1 month, 57% (4 of 7) at 6 months, and 71% (5 of 7) at 1 year. Complications were significantly more frequent during interventional (13 of 31, 42%) than during diagnostic (13 of 80, 16%) procedures. The most common complications during interventions were arrhythmias (3 of 31, 10%) and respiratory deterioration (3 of 31, 10%). Cardiac catheterization was technically feasible in all patients. Balloon pulmonary valvuloplasty and atrial septostomy provided good palliation in this patient group. The mortality of interventional procedures was low. The high incidence of respiratory complications suggests that low birth weight infants should undergo elective ventilation for interventional cardiac catheterization.     

低出生体重儿甲状旁腺功能观察

应用放免方法对 110名低出生体重儿生后 1、7、14天血清甲状旁腺素及血钙水平进行检测 ,并与 3 0名足月儿对照。结果表明低出生体重儿中足月小样儿生后甲状旁腺功能是成熟的 ,而早产儿生后甲状旁腺对低血钙反应差 ,但其生后甲状旁腺有逐渐成熟的过程     

Spontaneous desaturations in intubated very low birth weight infants with acute and chronic lung disease.

Patients with chronic lung disease (CLD) have frequent episodes of spontaneous desaturations. Utilizing computerized pulse oximetry (CPO) we quantified the frequency and severity of spontaneous desaturations in very low birth weight (VLBW) infants with CLD. Thirty-four studies by CPO were performed in intubated infants for 4 hours; 17 patients (birth weight, 550-980 g; postnatal age 28-85 days) had CLD, and 17 (birth weight, 520-980 g; postnatal age, 1-7 days) had acute lung disease. Oxygen saturation (SaO2) was measured with the Nellcor N-200 oximeter, its serial output (updated once a second) captured by a computer. Pulse rate, pulse amplitude, and heart rate were also monitored continuously. We measured respiratory system mechanics in 23 patients. Tidal volume (VT), respiratory system compliance (Crs), and resistance (Rrs) were obtained by the PeDS system. Spontaneous desaturation to SaO2 less than 90% occurred for 4.5% of the time in acute patients vs. 27.1% of the time in chronic patients (P less than 0.0001); to SaO2 less than 85%, 0.7% vs. 7.6% of the time in acute vs. chronic patients (P less than 0.002); and to SaO2 less than 80%, 0.4% vs. 2.6% of the time in acute vs. CLD patients (P less than 0.05). Rrs was significantly higher in the ventilated patients with CLD (174 cmH2O/L/s) than in the ventilated patients with acute lung disease (94 cmH2O/L/s, P less than 0.0001). The mean Crs values of the two groups were comparable. Our preliminary data indicate that VLBW infants with CLD receiving assisted ventilation have a greater number of spontaneous desaturation episodes, as compared to patients with acute lung disease.     

Variation of serum ferritin in low birth weight infants with maternal ferritin, birth weight and gestational age.

Serum ferritin measured at birth in 69 low birth weight infants proved to vary with gestational age as well as with weight. The increase with gestational age was even more striking when the infants small for gestational age were excluded. The relation between maternal and infant serum ferritin concentration was investigated for 2 groups of infants and their mothers (*preterm and term infants, respectively). Neither in preterm nor in term infants was the serum ferritin found to vary with that in the respective mothers.     

极低出生体重儿hsPDA的血流动力学变化

极低出生体重儿在出生后1周内动脉导管未闭(patent ductus arteriosus,PDA)或重新开放的发生率高,形成持续性动脉导管(ductusarteriosus,DA)开放,造成血流动力学改变,持续性DA常常需要内科或手术治疗[1].……     

极低出生体重儿45例的临床分析

目的研究极低出生体重儿的临床情况和并发症的防治措施。方法对2008-01～2010-10在新生儿科住院的45例极低出生体重儿(含3例超低出生体重儿)的临床资料进行回顾性分析。结果 45例极低出生体重儿中并发症发生率为100%,共发生并发症175例次,平均3.89例次,排在前5位的依次为低蛋白血症28例(62.22%)、高胆红素血症25例(55.55%)、低血糖症24例(53.33%)、贫血23例(51.11%)、肺透明膜病14例(31.11%)。发生2种以上并发症的43例,占95.55%,发生1、2、3、4、5、6、7、8种并发症的分别为4.44%、24.44%、13.33%、20.00%、20.00%、11.11%、4.44%、2.22%;45例极低出生体重儿中存活34例,存活率为75.56%,死亡2例,放弃治疗9例(于放弃后1～2 d内死亡),病死率为24.44%,在死亡的11例中发生肺透明膜病9例,占81.82%。结论极低出生体重儿生活能力低下,并发症多,病死率较高,其病死原因主要是肺透明膜病,预防肺透明膜病可望降低极低出生体重儿的病死率。     

Thymulin deficiency and low 3,5,3'-triiodothyronine syndrome in infants with low birth weight syndromes

Experimental and clinical evidence indicates that thymic endocrine function is under neuroendocrine control. Recently, a positive correlation was found between plasma thymulin (a major endocrine product of thymus) and serum thyroid hormone concentrations. Low serum thyroid hormone concentrations are frequently found in premature newborn infants. In this study we measured plasma thymulin by bioassay and serum T3 and T4 in a series of healthy fullterm newborns and in premature infants with various disorders. The study subjects were 26 healthy fullterm infants, 23 fullterm small for gestational age infants, 30 preterm appropriate for gestational age (AGA) infants, 22 preterm small for gestational age infants and 30 infants with respiratory distress syndrome, of whom 15 were fullterm and 15 were preterm AGA. Blood samples were obtained 3, 5, 10, 20, and 40 days after delivery. In the healthy fullterm infants plasma thymulin concentrations were low during the first days of life and subsequently increased, reaching normal values for children aged 1-12 months by the 10th day after birth. Persistently low plasma thymulin and serum T3 levels were found in the majority of infants with pathological conditions; the lowest values for both hormones were found in infants with respiratory distress syndrome. A highly significant positive correlation was present in all groups between mean plasma thymulin and serum T3, but not T4. Short term T3 administration in 6 additional preterm AGA infants caused a significant increase in plasma thymulin titers compared to those in 6 untreated infants. We conclude that plasma thymulin is decreased in premature newborns with the low T3 syndrome and that this abnormality may be reversed by administration of T3. These findings indicate that thymic endocrine activity is modulated by thyroid function in early postnatal life.     

Early childhood neurodevelopment in very low birth weight infants with predischarge apnea

Apnea commonly occurs in preterm infants and may persist beyond term. We prospectively investigated the relationship between apnea that persisted beyond 35 weeks post-conceptional age and subsequent neurodevelopment in early childhood. Between January, 1990-November, 1993, we performed predischarge respiratory recordings, using 24-hr, 4-channel pneumography, at 35 weeks or more of postconceptional age in 164 infants (birth weight, <1,250 g; gestational age, < or = 32 weeks), who subsequently underwent multidisciplinary neurodevelopmental assessment at 15-64 (median 24) months of adjusted age. The duration of initial artificial ventilation for respiratory distress syndrome and the grade of intraventricular hemorrhage were independent predictors of neurodevelopmental outcome. Mean oximetry desaturation and frequency of predischarge apnea correlated with mental and motor developmental scores. Mean oximetry desaturation during apnea was an independent predictor for motor score in the total population, and for both mental and motor scores in 50 infants with grade 3 or 4 intraventricular hemorrhage, but not in 114 infants without grade 3 or 4 intraventricular hemorrhage. Despite its limited predictability for early childhood neurodevelopment, predischarge respiratory recordings may be useful in predicting subsequent neurodevelopment of high-risk preterm infants, especially those with severe intraventricular hemorrhage.     

Impaired adrenocortical function in very low birth weight infants after multiple pregnancies

OBJECTIVE: To evaluate the differences in adrenal function between very low birth weight (VLBW) infants from singleton and multiple pregnancies. DESIGN AND METHODS: Forty infants of birth weights less than 1500 g underwent an ACTH test. Thirty infants born from singleton pregnancies (singleton group) and ten born from multiple pregnancies (multiple group) were enrolled. A baseline blood sample was drawn for cortisol measurement and thereafter serum cortisol was measured 1 and 2 h after an i.v. injection of ACTH. RESULTS: In multiple pregnancies, the median basal cortisol level of the infants was significantly lower than that in the singletons. The median cortisol level at 1 and 2 h after administration of ACTH was significantly lower in infants from multiple gestations than in singletons. Of infants from the multiple gestation group six, and of the singleton infants 12, had baseline cortisol levels lower than the reference values (P=0.48). One hour after ACTH stimulation all multiple and 53% of the singleton group infants showed a subnormal (<500 nmol/l, P=0.007) cortisol response. Two hours after ACTH, nine multiple group patients and 43% of the singletons had subnormal (<500 nmol/l, P=0.01) stimulated cortisol levels. CONCLUSIONS: We have concluded that VLBW infants from multiple gestations seem to be at an increased risk of insufficient postnatal adrenocortical function. In the future, specific attention should be paid to evaluate further newborn infants from multiple pregnancies with regard to a possible benefit of hydrocortisone substitution in stressful clinical situations.     

Congenital haemolytic anaemia in a low birth weight infant due to congenital stomatocytosis

A baby girl born at 31 weeks gestation showed severe haemolytic anaemia and hyperbilirubinaemia which led to exchange transfusion within the first 12 hours of life. There was no blood group incompatibility between mother and child but there was a marked stomatocytosis of the baby's red blood cells. Family history revealed a congenital stomatocytosis in the mother. Biochemical characterization of the defect was performed. Phospholipid analysis of the erythrocyte membrane of mother and child showed an increase in phosphatidylserine with a compensatory decrease in phosphatidylcholine and phosphatidylethanolamine. SDS-electrophoresis showed multiple modifications of the protein pattern with a decrease in band 6, an increased content of band 4.1b, a slight decrease in band 7 and a clear change in the shape of the protein band 3 pattern. The results suggest that the basis of the observed abnormalities is a common defect in protein posttranslational modification, rather than multiple genetic defects in the synthesis of several proteins. Haematologic, biochemical and clinical course of the disease in this preterm infant are discussed.     

Respiratory mechanics in very low birth weight infants during continuous versus intermittent gavage feeds.

This study was designed to determine whether respiratory mechanics in stable, very low birth weight infants changed after replacing intermittent feeds with continuous feeding. We measured static respiratory system compliance, respiratory system resistance, functional residual capacity (FRC), and tidal volume immediately before feeds and at 20, 60, and 120 min after feeds, and again the next day on continuous feeds. Patients selected for enrollment into the study needed to fulfill the following criteria: 1) birth weight and postnatal weight < 1,500 g, 2) no need for mechanical ventilation, positive airway pressure, or supplemental oxygen, 3) receiving and tolerating at least 100 mL/kg/day of intermittent gavage feeds, and 4) no change in methylxanthine or diuretic dosage for 3 days before the study. Respiratory mechanics were measured using the SensorMedics 2600 Pediatric Pulmonary Cart (Yorba Linda, CA). We studied 16 infants (gestational age 28.3 +/- 3.7 weeks, mean +/- SD) at a postnatal age of 10-82 days. The average interindividual coefficient of variance was 20 +/- 2% for static compliance, 35 +/- 6% for resistance, 18 +/- 3% for FRC, and 19 +/- 3% for tidal volume. Repeated-measures analysis of variance did not reveal any significant difference in respiratory mechanics with intermittent vs. continuous feeding. The data suggest that static respiratory mechanics in stable, very low birth weight infants are not affected by changing enteral feeds from intermittent gavage to a continuous schedule.     

低出生体质量胆汁淤积儿临床特征和结局随访研究

目的 研究低出生体质量胆汁淤积儿的临床特征和转归情况,为患儿及时合理的诊治提供一个有效的依据。方法 2014年6月～2015年6月在我院治疗的低出生体质量胆汁淤积儿162例,其中由胃肠外营养相关的胆汁淤积（PNAC）患者143例,非PNAC患者19例。比较两组患儿相关临床资料,并分析影响患儿发生PNAC的危险因素。结果 PNAC和非PNAC患者出生体质量分别为【（1237.2±173.3） g和（1377.3±177.9） g,P<0.05】,PNAC组脂肪乳累计用量为（35.7±10.5）g·kg^-1,显著高于非PNAC组【（27.3±12.3）g·kg^-1,P<0.05】,氨基酸累计用量为（36.6±11.2）g·kg^-1,显著高于非PNAC组【（28.2±11.7）g·kg^-1,P<0.05】,PN持续时间为（30.7±14.1）d,显著长于非PNAC组【（22.1±6.2）d,P<0.05】,住院天数为（51.2±11.2） d,显著长于非PNAC组【（37.4±10.5）d,P<0.05】;PNAC患儿贫血发生率为85.3%,显著高于非PNAC组的68.4%（P<0.05）,感染发生率为73.4%,显著高于非PNAC组的42.1%（P<0.05）;多元Logistic回归分析发现,低体质量儿的出生体质量、累计脂肪乳和氨基酸用量和PN持续时间是影响PNAC发生的危险因素。结论 影响低出生体质量患儿发生胆汁淤积的因素繁多,应科学喂养,缩短PN时间,及早恢复肠内营养,防治并发症,以利于其早期康复。     

Effect of dose on response to adrenocorticotropin in extremely low birth weight infants

CONTEXT: Various cosyntropin doses are used to test adrenal function in premature infants, without consensus on appropriate dose or adequate response. OBJECTIVE: The objective of this study was to test the cortisol response of extremely low birth weight infants to different cosyntropin doses and evaluate whether these doses differentiate between groups of infants with clinical conditions previously associated with differential response to cosyntropin. DESIGN: The design was a prospective, nested study conducted within a randomized clinical trial of low-dose hydrocortisone from November 1, 2001, to April 30, 2003. SETTING: The setting was nine newborn intensive care units. PATIENTS: The patients included infants with 500-999 g birth weight. INTERVENTION: The drug used was cosyntropin, at 1.0 or 0.1 microg/kg, given between 18 and 28 d of birth. MAIN OUTCOME MEASURE: We measured the cortisol response to cosyntropin. RESULTS: Two hundred seventy-six infants were tested. Previous hydrocortisone treatment did not suppress basal or stimulated cortisol values. Cosyntropin, at 1.0 vs. 0.1 microg/kg, yielded higher cortisol values (P < 0.001) and fewer negative responses (2 vs. 21%). The higher dose, but not the lower dose, showed different responses for girls vs. boys (P = 0.02), infants receiving enteral nutrition vs. not (P < 0.001), infants exposed to chorioamnionitis vs. not (P = 0.04), and those receiving mechanical ventilation vs. not (P = 0.02), as well as a positive correlation with fetal growth (P = 0.03). A response curve for the 1.0-microg/kg dose for infants receiving enteral nutrition (proxy for clinically well infants) showed a 10th percentile of 16.96 microg/dl. Infants with responses less than the 10th percentile had more bronchopulmonary dysplasia and longer length of stay. CONCLUSIONS: A cosyntropin dose of 0.1 microg/kg did not differentiate between groups of infants with clinical conditions that affect response. We recommend 1.0 microg/kg cosyntropin to test adrenal function in these infants.     

The effects of racemic albuterol versus levalbuterol in very low birth weight infants

Bronchodilators have been used in premature infants. Levalbuterol (LEV) an R‐isomer of Albuterol has fewer hemodynamic side effects than Racemic Albuterol (RAC) in adults and children. In a retrospective study we sought to investigate the effects of LEV (0.31 mg) versus RAC (1.25 mg) in very low‐birth weight infants (VLBW) who were treated with a beta‐2 agonist for ≥2 weeks. Medical records (between January 2001 and December 2006) were reviewed for patients' demographics, medications use, hemodynamic and respiratory parameters, hypokalemia and hyperglycemia. Among 811 VLBW infants who were admitted to our NICU, 16 infants received RAC and 31 infants received LEV for ≥2 weeks. Infants who received RAC were younger, smaller, and received less Ipratropium Bromide (IB) than infants who received LEV [26.1 ± 1.2 weeks vs. 28.1 ± 3.7 weeks (P = 0.01), 817 ± 211 g vs. 1,127 ± 589 g (P = 0.01) and 2/16 (12%) vs. 15/31 (48%; P = 0.01); respectively]. In infants treated exclusively with RAC or LEV without IB, mean arterial blood pressures were lower in the RAC (n = 14) than the LEV group (n = 16, P = 0.05 by general linear model with repeated measures); however there were no differences in daily heart rates, oxygen supplementations, oxygen saturations, or respiratory rates. Also there were no differences between the two groups in hypokalemia or hyperglycemia. We conclude that LEV at a dose of 0.31 mg might have an indication in VLBW infants who are at risk for hemodynamic instability. Pediatr Pulmonol. 2009; 44:778–783. © 2009 Wiley‐Liss, Inc.     

Effect of neck position on endotracheal tube location in low birth weight infants

Neck position can affect the position of the tip of the endotracheal tube (ETT) in normal neonates; this has not been systematically investigated in low birth weight (LBW) neonates. It was our intention to determine the effect of neck flexion and extension on ETT position in LBW infants. Eight LBW orotracheally-intubated infants underwent postmortem anteroposterior chest radiographs with the neck in a neutral position, in 55 degrees flexion, and in 55 degrees extension. Measurements from the thoracic inlet to the ETT were obtained in each position. The ETT always moved caudad with neck flexion (P = 0.001) and cephalad with neck extension (P = 0.001). The mean extent of ETT displacement was 3.1 mm (SD, 1.7 mm) with neck flexion, and 7.4 mm (SD, 5.2 mm) with extension (P < 0.05). We conclude that in LBW infants: 1) the direction of ETT movement with neck flexion and extension is predictable and identical to that seen in term infants and children, and 2) neck flexion should not be a principal consideration in management of ETT location.