Kangaroo mother care in very low birth weight infants

Objective : This study was conducted (i) to study through a randomized control trial the effect of Kangaroo Mother Care (KMC) on breast feeding rates, weight gain and length of hospitalization of very low birth neonates and (ii) to assess the acceptability of Kangaroo Mother Care by nurses and mothers.Methods : Babies whose birth weight was less than 1500 Grams were included in the study once they were stable. The effect of Kangaroo Mother Care on breast feeding rates, weight gain and length of hospitalization of very low birth weight neonates was studied through a randomized control trial in 28 neonates. The Kangaroo group (n=14) was subjected to Kangaroo Mother Care of at least 4 hours per day in not more than 3 sittings. The babies received Kangaroo Care after shifting out from NICU and at home. The control group (n=14) received only standard care (incubator or open care system). Attitude of mothers and nurses towards KMC was assessed on Day 3 ± 1 and on day 7 ± 1 after starting Kangaroo Care in a questionnaire using Likert’s scale.Results : The results of the clinical trial reveal that the neonates in the KMC group demonstrated better weight gain after the first week of life (15.9 ± 4.5 gm/day vs. 10.6 ± 4.5 gm/day in the KMC group and control group respectively p<0.05) and earlier hospital discharge (27.2 ± 7 vs. 34.6 ± 7 days in KMC and control group respectively, p<0.05). The number of mothers exclusively breastfeeding their babies at 6 week follow-up was double in the KMC group than in the control group (12/14 vs. 6/14) (p< 0.05).Conclusion : KMC managed babies had better weight gain, earlier hospital discharge and, more impressively, higher exclusive breast-feeding rates. KMC is an excellent adjunct to the routine preterm care in a nursery.     

Kangaroo Mother Care in Kangaroo ward for improving the growth and breastfeeding outcomes when reaching term gestational age in very low birth weight infants

Aim: To study the effect of Kangaroo mother care in the Kangaroo ward in comparison with conventional care at neonatal unit on growth and breastfeeding in very low birth weight infants at 40 weeks’ corrected gestational age. Methods: One hundred and forty neonates with birth weight <1500 g were randomized. The primary outcome was the average weight gain (g/kg/day) from the time of randomization to term gestational age. Results: Mean birth weight, age in days and weight at randomization were similar in both the groups. At term gestational age, average weight gain (g/kg/day) post randomization (23.3 ± 8.7 g vs. 22.64 ± 9.1 g, p = 0.67) and breastfeeding rate (85.9% vs. 87.0%) were comparable. There was no difference in weight gain (g/kg/day) from randomization to hospital discharge between the Kangaroo care group and conventional care group (18.01 g vs. 15.64 g, p = 0.12). Mortality, morbidities like sepsis, hypothermia, apnoea, hypoglycaemia and duration of hospitalization were equally distributed. On average, 11.5 days of intermediate care were saved in the kangaroo group. Conclusion: Kangaroo mother care in the Kangaroo ward is as effective as conventional care in the neonatal unit without any increase in morbidity or mortality in stable VLBW infants.     

Earlier versus later continuous Kangaroo Mother Care (KMC) for stable low‐birth‐weight infants: a randomized controlled trial

Aim: The aim of this study was to examine the effectiveness of earlier continuous Kangaroo Mother Care (KMC) for relatively stable low‐birth‐weight (LBW) infants in a resource‐limited country. Methods: A randomized controlled trial was performed in LBW infants at a referral hospital in Madagascar. Earlier continuous KMC (intervention) was begun as soon as possible, within 24 h postbirth, and later continuous KMC (control: conventional care) was begun after complete stabilization (generally after 24 h postbirth). Main outcome measure was mortality during the first 28 days postbirth. This trial was registered with ClinicalTrials.gov, NCT00531492. Results: A total of 73 infants (intervention 37, control 36) were included. Earlier continuous KMC had higher but no statistically different mortality in the first 28 days postbirth (1 vs. 2; risk ratio, 1.95; 95% CIs, 0.18–20.53; p = 1.00). There were no differences in incidence of morbidities. Body weight loss from birth to 24 h postbirth was significantly less in earlier KMC infants compared with later KMC infants. (?34.81 g vs. ?73.97 g; mean difference, 39.16 g; 95% CIs, 10.30–68.03; p = 0.01; adjusted p = 0.02). Adverse events and duration of hospitalization were not different between the two groups. Conclusions: Further evaluations of earlier continuous KMC including measurement of KMC dose, are needed in resource‐limited countries.     

Nosocomial bacterial infections in very low birth weight infants

The occurrence of congenital and nosocomial bacterial septicaemia has been documented by identifying the number of positive blood cultures by reviewing the laboratory and clinical records of 394 very low birth weight infants who were consecutively admitted to a neonatal intensive care unit over a 40-month period. The incidence of congenital septicaemia was 6% and of nosocomial septicaemia 17%. The commonest causes of congenital infection wereStreptococcus agalactiae Staphylococcus epidermidis andEnterococcus faecalis (each in 18% of cases). The commonest cause of nosocomial infection wasS. epidermidis (51% of cases), except in infants of birth weight less than 750 g. Risk factors for nosocomial infection were extremely low birth weight, very preterm birth and prolonged ventilation. Nosocomial infection was associated with significantly lengthened hospital admission.     

Transthyretin levels are not related to Apgar score in low birth weight and very low birth weight infants

BACKGROUND: Previous studies have reported an increased incidence of thyroid dysfunction in premature/low birth weight infants. The cord blood concentrations of transthyretin (TTR), a thyroid hormone binding protein, have also been found to be decreased in preterm infants. While thyroid hormone concentrations are decreased in sick infants, it is not known if physical condition influences TTR levels. Serial concentrations of TTR following birth have not previously been reported. AIMS: To measure serial serum concentrations of TTR in premature infants following birth, and determine whether TTR levels are related to physical condition. METHODS: A cohort of 65 premature very low birth weight (VLBW) and LBW infants were studied. Serum samples were obtained on the day of birth, and for 8 weeks following birth. Apgar scores at birth as well as the incidence of respiratory distress syndrome (RDS) were noted. RESULTS: Baseline serum T4 concentrations and Apgar scores were significantly lower in VLBW infants, while the severity of RDS was significantly higher in the VLBW group. Multivariate analyses revealed that T4 levels were negatively associated with RDS, while TSH concentrations were positively related to gestational age. TTR concentrations were not related to gestational age at birth, Apgar score, or RDS, and did not change markedly over 8 weeks. CONCLUSIONS: These findings suggest that serum TTR concentrations are not related to birth weight/gestational age and are not associated with either clinical condition at birth (as assessed by Apgar score) or the occurrence of RDS. Reference values for TTR concentrations in VLBW and LBW infants are provided from birth to 8 weeks of age.     

Risk factors for low birth weight in Nepali infants

A detailed information on a total of 448 consecutive Nepali births which occurred between January 1, 1985 and December 31, 1994 was collected from the birth registers of the Khasi-Jaintia Presbetyrian Synod Hospital of Shillong, Meghalaya. After the exclusion of still and twin births, and the cases of missing information of birth weight, 418 single live births were considered to find out the distribution of birth weight and the risk factors of low birth weight (LBW) among the Nepali babies of this state. The incidence of LBW was 21.53%. The results of univariate analysis revealed that sex, maternal age, parity, gestation period, economic condition and maternal education were significantly related to the incidence of LBW. Multiple logistic regression analysis revealed that all the above mentioned factors had independent risk for LBW except the economic condition and father’s education. Thus, the present results suggest conducting further studies among other ethnic groups of North-East India to understand the problem of LBW at the population level which may help to formulate an effective maternal and child health care program in this region.     

极低及超低出生体重儿的预后因素分析

目的 分析极低及超低出生体重儿（出生体重≤ 1 200 g）的临床资料,为其预后及临床干预提供预警指标。方法 回顾性分析108 例极低及超低出生体重儿的母孕期病史、新生儿出生时情况、诊治经过及预后,采用非条件logistic 回归分析筛选预后的影响因素。结果 108 例极低及超低出生体重儿,出生体重范围在结论 极低及超低出生体重儿的病死率较高,且随着日龄的增加,影响早产儿生存的预后因素不同,临床上应针对这些因素制定合理的管理方案,提高早产儿生存率。     

Enteral feeding of low birth weight infants

There is sufficient evidence at present to support early enterai feeding of low birth weight (LBW) neonates, including those who are sick or very preterm (< 30 weeks). Trophic feeding with human milk initiated within 48 hours of birth at 10–15 ml/kg/day improves later tolerance to graded increment of enterai feeding volumes without increased risk of necrotizing enterocolitis. Trophic feeding supports increments of feeding volumes by 30 ml/kg/day by intermittent gavage feeding. Non-nutritive sucking and spoon-feeding aid earlier transition to exclusive breast-feeding. Human milk promotes adequate growth of most preterm neonates, though many need multivitamin and mineral supplementation. The role of human milk fortifiers to promote growth appears controversial.     

Long-term effects of earlier initiated continuous Kangaroo Mother Care (KMC) for low-birth-weight (LBW) infants in Madagascar

Aim: To examine the long‐term effects of earlier initiated continuous Kangaroo Mother Care (KMC) for relatively stable low‐birth‐weight (LBW) infants in a resource‐limited country. Methods: A randomized controlled trial with long‐term follow‐up was performed in LBW infants in Madagascar. Earlier continuous KMC (intervention group) was initiated as soon as possible within 24 h postbirth, and later continuous KMC (control group: conventional care) was initiated after complete stabilization. Outcome measures were mortality or readmission, nutritional indicators at 6–12 months postbirth and feeding condition at 6 months postbirth (ClinicalTrials.gov, NCT00531492). Results: A total of 72 infants were followed for mortality or readmission at 6–12 months postbirth. There was no difference between the two groups (7/36 vs. 7/36, Risk ratio (RR), 1.00; 95% CIs, 0.39–2.56; p = 1.00). The proportion of exclusive breast feeding (EBF) at 6 months postbirth was significantly higher with earlier KMC than later KMC (12/29 vs. 4/26; RR 2.69; 95% CIs, 1.00–7.31; p = 0.04). There were no differences in nutritional indicators between the two groups at 6–12 months postbirth. Conclusion: Earlier initiated continuous KMC results in a significantly higher proportion of EBF at 6 months postbirth. Further larger‐scale long‐term evaluations of earlier initiated continuous KMC for LBW infants are needed.     

Feeding of low birth weight infants

Optimal feeding of low birth weight (LBW) infants improves their immediate survival and subsequent growth and development. Being a heterogeneous group comprising term and preterm neonates, their feeding abilities, fluid and nutritional requirements are quite different from normal birth weight infants. A practical approach to feeding a LBW infant including choice of initial feeding method, progression of oral feeds, and nutritional supplementation based on her oral feeding skills and nutritional requirements is being discussed in this protocol. Growth monitoring, management of feed intolerance, and the essential skills involved in feeding them have also been described in detail.     

低出生体质量儿婴儿期食物过敏发生的危险因素

目的 探讨低出生体质量儿食物过敏发生的危险因素.方法 选择2007年1月1日至2011年12月31日在北京大学第三医院NICU住院治疗,出院后在食物过敏门诊就诊且符合食物过敏诊断标准的低出生体质量儿作为食物过敏组(49例),采用分层抽样的方法抽取同期在NICU住院治疗,出院后在儿童保健门诊建档随访但无食物过敏表现的低出生体质量儿作为对照组(49例).采用调查问卷的方法调查2组患儿性别、胎龄、产出方式、出院后喂养方式、父母饮酒、吸烟史、父母变应性疾病史及母孕期每日进食鸡蛋情况和婴儿期鸡蛋添加时间.同时查阅患儿住院期间的病历资料,分析患儿所患疾病、胃肠外营养、PS和呼吸机的应用情况.计数资料比较采用x2检验,计量资料比较采用t检验,多因素分析采用非条件Logistic回归分析.结果 2组患儿出生体质量、性别、产出方式、出院后喂养方式、父母烟酒暴露、母孕期每日进食鸡蛋情况、婴儿期鸡蛋添加时间及其住院期间所患的各系统疾病、胃肠外营养、PS和呼吸机应用情况比较差异均无统计学意义,而胎龄、父母变应性疾病史比较差异有统计学意义.食物过敏组中胎龄33～ 35周、36～37周患儿的比例高于对照组,胎龄29 ～32周患儿的比例低于对照组(x2=10.312,P =0.016;x2 =20.753,P =0.000).非条件Logistic回归分析显示,低出生体质量儿食物过敏的发生仅与父母一方或双方的变应性疾病史有相关性(OR=5.574,P=0.004;OR=14.487,P=0.000).结论 父母双方变应性疾病史与低出生体质量儿食物过敏的发病有关.     

Hepatoblastoma in low birth weight infants: an institutional review

The association between hepatoblastoma and low birth weight documented recently in the literature has yet to be well explained, in particular the suggestion that these patients may have a more aggressive form of the disease. From 1989 to 2003, our institution treated four patients for hepatoblastoma who had birth weights of less than 1,500 g. Notable was 100% patient survival despite bilateral and, in one case, recurrent disease. Speculation regarding the etiology of this subset of hepatoblastoma has included damage to developing hepatocytes induced by oxygen free radicals. Our patients universally had pulmonary disease requiring prolonged supplemental oxygen and ventilatory support. However, our review supports no changes in the standard care of low birth weight infants or in managing those who develop hepatoblastoma.     

益生菌防治低出生体重早产儿喂养不耐受的临床观察

目的：观察益生菌制剂对低出生体重早产儿喂养不耐受的防治作用及其安全性。方法：将60例低出生体重早产儿随机分成益生菌治疗组和常规治疗组,每组30例,两组均治疗原发病,益生菌治疗组在治疗原发病的同时给予益生菌治疗(0.25 g, 每天两次)。比较两组喂养不耐受的发生率、恢复出生体重时间、达全胃肠道营养时间、住院时间;记录不良反应发生情况。结果：益生菌治疗组喂养不耐受的发生率较常规治疗组低(4% vs 14%,P<0.05),恢复出生体重的时间较常规治疗组早（6.8±1.2 d vs 7.7±1.6 d,P<0.01）,且达全胃肠道营养的时间较常规治疗组早（8.0±1.4 d vs 9.0±2.0 d,P<0.05）。益生菌用药中未见不良反应发生。结论：益生菌可降低低出生体重早产儿喂养不耐受的发生率,促进其体重增长,缩短其达全胃肠道营养的时间;且益生菌的应用是安全的。［中国当代儿科杂志,2010,12（9）：693-695］     

Iron status in low birth weight infants on breast and formula feeding

Iron status in 15 low birth weight infants, 1000–2499 g, on breast feeding was studied longitudinally for the first 6 months of age, and the findings compared to those of 30 low birth weight infants receiving a proprietary iron-fortified formula. The two groups received no iron supplement until they developed iron deficiency. The incidence of iron deficiency at 6 months was significantly greater in the breast-fed group than in the formula-fed group (86% v 33%). The breast-fed group had significantly lower serum ferritin and hemoglobin values after 4 months of age. The findings indicate that breast-fed low birth weight infants have a higher risk of developing iron deficiency and should receive iron supplementation from 2 months of age.Abbreviations TIBC total iron-binding capacity - MCV mean corpuscular volume     

Maternal risk factors associated with low birth weight

Maternal factors comprising of social, obstetric and anthropometric are fund to influence LBW. The present study had found association between obstetricrisk factors like age of the mother, parity and gravida with LBW. Similar association was also observed between maternal height, and maternal weight with LBW. However, social factors were not found to be associated with LBW. This could probably be due to RUHSA’s intervention which requires a further inquiry.     

Influence of intrauterine growth retardation on parameters of liver function in low birth weight infants

To establish nutritional management of low birthweight infants according to their individual metabolic situation, hepatocellular partial function was studied in 13 appropriate (AGA) and 11 small-for-gestational-age (SGA) low birthweight (LBW) infants during the first weeks of postnatal life. The concentrations of total bile acids and of alpha-amino-nitrogen in serum, the renal excretion of urea and ammonia and the renal excretion of¹⁵N after enteral administration of 3 mg¹⁵N-labeled methacetin/kg were measured. In comparison to AGA infants, SGA infants had elevated serum concentrations of total bile acids and of alpha-amino-nitrogen, decreased excretion of urea, increased excretion of ammonia in urine, and lower urinary¹⁵N-excretion after enteral administration of¹⁵N-labeled methacetin. The data suggest that hepato-cellular functions are influenced by intrauterine growth retardation resulting in a reduced metabolic capacity in SGA infants. The metabolic differences between SGA and AGA infants should be considered in the nutritional management of LBW infants.     

Epidemiology of low birth weight in Ahmedabad

The study to elucidate epidemiological features of LBW (low birth weight) babies shows incidence of LBW to be 20·37%, out of 481 single births studied in 1982. 6·03% were small for gestational age (SGA). Of LBW babies 61·22% were born preterm (<37 weeks) as compared to 31·85% of normal babies. Of preterm babies 3·3% were SGA, while 7·69% of fullterm babies were SGA. SGA babies were found to be significantly related to parity, being most common in primi, and without antenatal care (ANC). Younger (15–25 years), shorter and primipara mothers were more likely to give birth to LBW babies. Of mothers giving birth to normal babies 85·52% had taken ANC, as compared to 67·34% giving birth to LBW babies. SGA was more common in mothers who had not taken ANC. Young, short and primipara mothers, who are prone to give birth to LBW babies should be detected early and brought under qualitative ANC.     

超低出生体重儿的护理方案

超低出生体重儿由于各系统发育极不成熟,临床上病死率很高.提高超低出生体重儿的存活率离不开科学的护理,本文从体温管理、建立静脉、动脉通路、液体疗法护理、呼吸道管理、喂养护理、感染的预防、环境管理、健康教育等方面阐述关于超低出生体重儿的护理方案.     

极低及超低出生体重儿肺出血的影响因素及预后分析

目的 探讨极低及超低出生体重(出生体重≤1200g)早产儿肺出血的影响因素及预后.方法 回顾性分析2010年1月至2015年12月于中国医科大学附属盛京医院第二新生儿科住院、出生体重≤1200g、住院期间发生肺出血的极低及超低出生体重儿临床资料,同期住院、相同体重范围非肺出血早产儿作为对照组.比较两组母孕期及新生儿期特点,多元回归分析探讨肺出血影响因素,了解肺出血新生儿的近期预后.结果 肺出血新生儿(肺出血组)71例,对照组364例.肺出血发生于 3d 以内者57例(占80.3%),肺出血组胎龄(28.2±1.7)周、出生体重(936±192)g,均明显低于对照组[(29.5±2.1)周,(1033±134)g,t分别为4.776、-5.145,P<0.01].肺出血组呼吸窘迫综合征(RDS)(76.1%)、肺表面活性物质治疗(76.1%,其中≥2次使用率9.9%)、动脉导管未闭(PDA)(66.2%)比例均明显高于对照组[41.2%、30.8%(4.1%)和38.7%,χ2值分别为33.457、28.970(4.074)和32.798,P<0.05].肺出血组产前类固醇激素治疗率(21.1%)亦明显低于对照组(41.2%,χ2=10.177,P<0.01).多因素Logistic逐步回归分析显示,RDS(OR=3.739,95%CI 1.383-10.113,P<0.05)、PDA(OR=2.206,95%CI 1.205-4.093,P<0.05)及5 min Apgar评分<7(OR=2.851,95%CI 1.191-6.828)是肺出血的独立危险因素;出生体重大(OR=0.998,95%CI 0.996-1.000,P<0.05)及母孕期应用激素 (OR=0.432,95%CI 0.224-0.834,P<0.05)是肺出血的保护因素.肺出血组颅内出血、早产儿视网膜病及重度支气管肺发育不良发生率(16.9%、12.7%及18.3%)明显高于对照组(5.8%、4.4%及2.2%,χ2值分别为36.824、7.520及33.568,P<0.01).肺出血组病死率(49.3%)亦明显高于对照组(14.0%,χ2=46.634,P<0.01).结论 多种围生期因素与肺出血有关;预防早产及产前类固醇激素治疗有助于预防肺出血;肺出血新生儿不良预后发生率高.     

极低/超低出生体重儿甲状腺功能减退的临床分析

目的 分析极低/超低出生体重（VLBW/ELBW）患儿甲状腺功能减退的危险因素和治疗情况。方法 选择2018年9月至2019年12月诊断为甲状腺功能减退的VLBW/ELBW患儿为病例组（n=29）,按照1：3比例匹配甲状腺功能正常的VLBW/ELBW患儿作为对照组（n=87）,比较两组患儿的临床特征,分析甲状腺功能与出生胎龄、出生体重的相关性及甲状腺功能减退的危险因素。结果 符合纳入标准的VLBW/ELBW患儿共162例,其中病例组29例,甲状腺功能减退发生率为17.9%。出生体重越低,甲状腺功能减退发生率越高（P < 0.05）;三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（FT3）与出生胎龄呈正相关（P < 0.05）,T3、游离甲状腺素（FT4）与出生体重呈正相关（P < 0.05）。小于胎龄儿、多胎、孕母≥35岁、使用多巴胺是发生甲状腺功能减退的独立危险因素（P < 0.05）。病例组中16例患儿给予左旋甲状腺素（每日5~10 μg/kg）治疗,甲状腺功能在治疗2周后恢复正常。结论 VLBW/ELBW患儿甲状腺功能减退的发生率较高,小于胎龄儿、多胎、孕母高龄、应用多巴胺是其发生甲状腺功能减退的危险因素,应用左旋甲状腺素治疗的患儿需定期随访,以保证用药剂量适宜。