三种鼻饲喂养方式在极低出生体重早产儿肠道内营养的应用研究

目的通过研究不同方式鼻饲喂养方法对极低出生体重早产儿(VLBW)喂养耐受性及喂养效果,探讨最适合极低出生体重早产儿的鼻饲喂养方式。方法将77例胎龄在29~33周,出生体重在1000~1400g活产极低出生体重儿,男婴38例,女婴39例,随机分为ABC组。A组:间歇鼻饲注入喂养,起始每次奶量2ml/kg,持续时间3~5min,2h1次,每天递增2ml/kg;B组:持续鼻饲输注喂养,使用电子微量输液泵持续鼻饲输注,奶量1ml/(kg.h),持续时间24h,每天递增1ml/(kg.h);C组:间歇持续鼻饲输注喂养,先采用电子输液泵持续鼻饲喂养2h,奶量2ml/(kg.h),间歇2h后,再继续交替进行,每天递增2ml/kg;所有VLBW均同时进行部分外周静脉营养,逐渐过渡到完全肠道内营养,观察3组患儿喂养过程中体重增长,喂养耐受情况以及黄疸持续时间。结果间歇持续鼻饲输注喂养组喂养不耐受例数最少,黄疸持续时间短,达到完全胃肠道营养时间最少。结论极低出生体重早产儿采用间歇持续鼻饲输注喂养,喂养不耐受发生率最低,达到完全胃肠喂养时间最短,有利于极低出生体重儿的生长发育和胃肠功能完善,优于单纯的间歇或持续鼻饲喂养,值得临床推广。     

持续鼻饲喂养与间断鼻饲喂养对极低出生体重儿的疗效评估

目的评仨对极低出生体重儿(VLBW)进行持续鼻饲喂养(CNG)和间断鼻饲喂养(IBG)的优缺点,找出更适合于VLBW的喂养方法.方法将收住NICU的87例VLBW进行随机分组,分别予CNG(44例)或IBG(43例)喂养.对比VLBW和CNG和IBG的喂养不耐受性(FI)、达到完全喂肠道喂养时间(FEF)(100kcal/(kg·d))、恢复出生体重时间(RBW)、停止静脉补液时间及平均住院日.CNG起始奶量1 ml/h,每持续10 h停止2 h,以后每天增加1 ml/h;IBG组奶量以20ml(kg·d))开始,每天增加20ml/kg;所有VLBW均同时进行部分静脉营养,直至达到FEF.结果CNG组较IBG组出现FI的例数少,分别为7/44和21/43例,P＜0.05;而达到EFE早,(15.8±2.2)d和(19.9±2.3)d;静脉补液时间短,(16.2±3.3)d和(25.2±2.5)d,两组间存在显著性差异,P＜0.01;而RBW(13.3±1.8)d和(13.5±2.3)d及平均住院日(45.7±9.7)d和(46.5±10.8)d,无明显差异,P＞0.05.结论VLBW更耐受CNG喂养,其达到完全胃肠喂养时间及静脉补液时间较IBG短.     

持续鼻饲喂养与间断鼻饲喂养对极低出生体重儿的疗效评估

目的评仨对极低出生体重儿(VLBW)进行持续鼻饲喂养(CNG)和间断鼻饲喂养(IBG)的优缺点,找出更适合于VLBW的喂养方法。方法将收住NICU的87例VLBW进行随机分组,分别予CNG(44例)或IBG(43例)喂养。对比VLBW和CNG和IBG的喂养不耐受性(FI)、达到完全喂肠道喂养时间(FEF)(100kcal/(kg·d))、恢复出生体重时间(RBW)、停止静脉补液时间及平均住院日。CNG起始奶量1ml/h,每持续10h停止2h,以后每天增加1ml/h;IBG组奶量以20ml/(kg·d))开始,每天增加20ml/kg;所有VLBW均同时进行部分静脉营养,直至达到FEF。结果CNG组较IBG组出现FI的例数少,分别为7/44和21/43例,P<0.05;而达到EFE早,(15.8±2.2)d和(19.9±2.3)d;静脉补液时间短,(16.2±3.3)d和(25.2±2.5)d,两组间存在显著性差异,P<0.01;而RBW(13.3±1.8)d和(13.5±2.3)d及平均住院日(45.7±9.7)d和(46.5±10.8)d,无明显差异,P>0.05。结论VLBW更耐受CNG喂养,其达到完全胃肠喂养时间及静脉补液时间较IBG短。     

外周静脉营养在极低出体重儿中的临床应用

目的　探讨外周静脉营养对极低出生体重儿体重增长及其并发症情况。方法将72例极低出生体重儿分成治疗组(42例)和对照组(30例),治疗组在出生后第2-3天开始用外周静脉营养,经微电脑输液泵24h内均匀输入静脉营养液。对照组给予一般综合治疗。二组病情好转后及早开始经口或鼻饲微量喂养,以后逐渐增加奶量。结果治疗组出生后4-7d起体重开始增长,每天增重(20.06±7.64)g,对照组出生后10-15d起体重开始增长,每天增重(11.78±3.36)g。二组比较有显著性差异(P<0.05),治疗组并发症发生率11.9%(5/42),对照组为33.3%(10/30)。治疗组治愈率78.6%,对照组治愈率50.0%,二组比较有显著性差异(P<0.05)。结论外周静脉营养能明显增加极低出生体重儿的体重,合理的营养素有利于减少并发症,提高治愈率,及早经口或鼻饲微量喂养效果好,可缩短静脉营养时间及住院天数。     

极低出生体重儿早期微量喂养深度水解蛋白配方的临床观察

目的 观察早期微量喂养深度水解蛋白配方、早产儿配方奶对极低出生体重儿（very low birth weight,VLBW）的胃肠耐受、生长发育的影响,为VLBW的早期胃肠喂养提供科学依据.方法 将出生体重≤l 500g的126例早产儿分成观察组（63例）和对照组（63例）.在常规综合治疗的基础上,观察组早期微量喂养深度水解蛋白配方,对照组早期微量喂养早产儿配方奶,对两组患儿的胃肠耐受、并发症及生长发育进行监测.结果 观察组恢复出生体重日、达全肠道喂养日龄、住院天数、出院时宫外生长发育迟缓发生率、喂养不耐受发生率、新生儿坏死性小肠结肠炎发生率、喂养消化不良性腹泻发生率分别为12.81 d、25.76 d、37.95 d、23.8％、14.3％、6.3％、3.2％,对照组以上指标分别为16.02 d、27.75 d、45.49 d、42.9％、30.2％、19.0％、12.7％,两组比较差异有统计学意义（P＜0.05）.结论 积极进行早期微量喂养深度水解蛋白,可以降低极低出生体重儿喂养并发症的发生率,对近期生长发育有良好促进作用,适合临床使用.     

极低出生体重早产儿两种肠道外营养方式的对比分析

目的 探讨传统肠道外营养(TTPN)与早期肠道外营养(ETPN)的不同效果.方法 2000年1月至2008年4月我院收治的生后24 h内入院的极低出生体重早产儿,2006年以前入院为TTPN组,2006年以后入院为ETPN组.TTPN组出生24 h后给予氨基酸0.5 g·kg-1·d-1,每日递增0.25～0.5g/kg,出生第3天给予脂肪乳0.5 g·kg-1·d-1,每日递增0.25～0.5 g/kg;ETPN组出生12～24 h给予氨基酸1.0 g·kg-1·d-1,每日递增0.5 g/kg,出生24 h给予脂肪乳0.5～1.0 g·kg-1·d-1,每日递增0.5 g/kg.观察生后1周内非蛋白热卡(不计奶量),生理性体重下降时间、恢复至出生体重时间、体重增长情况、过渡至全肠道营养时间及相关并发症等.结果 共入选58例,TTPN组30例,ETPN组28例.ETPN组较TTPN组非蛋白热卡摄入多,体重下降持续时间短,恢复至出生体重时间短,体重增长快,差异有统计学意义(P＜0.05);后期相关并发症及过渡至全肠道外营养时间差异无统计学意义(P＞0.05).结论 极低出生体重早产儿ETPN比TTPN摄入热量多,体重增长快,可以减少早期营养不良发生,肠道外营养相关并发症无明显增加,对胃肠功能的恢复无明显影响.     

深度水解蛋白配方奶喂养对极低/超低出生体重儿生长发育的影响

目的探讨深度水解蛋白配方奶喂养对极低出生体重(VLBW)和超低出生体重(ELBW)婴儿生长发育的影响。方法选取VLBW和ELBW婴儿375例作为研究对象,根据随机数字表法将其分为观察组(n=187)和对照组(n=188)。观察组给予深度水解蛋白配方奶喂养,当喂养达10 mL/次后,改用标准早产儿配方奶喂养。对照组给予标准早产儿配方奶喂养。两组持续喂养4周,比较两组喂养不耐受发生率、达全肠道喂养时间、胎便排净时间、自主排便次数、生长发育情况、喂养后第4天和第10天胃动素水平以及感染发生情况。结果观察组喂养不耐受率低于对照组(P0.05);观察组达全肠道喂养时间和胎便排净时间均短于对照组(P0.05);观察组平均每日自主排便次数多于对照组(P0.05);观察组婴儿体重、头围和身长均大于对照组(分别是1 793±317 g vs 1 621±138 g、30.5±1.1 cm vs 30.0±1.6 cm和43.9±1.2 cm vs 42.1±2.0 cm;均P0.05);观察组婴儿喂养第4天和第10天胃动素水平均高于对照组(P0.05);观察组婴儿感染率低于对照组(P0.05)。结论深度水解蛋白配方奶可提高胃动素水平,增加胃肠道喂养耐受性,促进VLBW和ELBW婴儿早期生长发育,降低感染发生率。     

不同喂养方式对极低/超低出生体重儿生长发育的影响

目的 探讨极低/超低出生体重（VLBW/ELBW）早产儿纠正年龄6个月内生长发育情况及不同喂养方式对其生长发育的影响。方法 对2016年1月至2017年4月出院并按时完成随访的VLBW/ELBW早产儿109例进行纠正年龄6个月内的生长发育监测。采用Z评分法评价体格指标,并分析不同喂养方式（母乳喂养组：母乳+母乳强化剂;混合喂养组：母乳+早产儿配方奶;人工喂养组：早产儿配方奶）对其生长发育的影响。结果 年龄别体重Z积分、年龄别身长Z积分、身长别体重Z积分、体重指数Z积分的追赶高峰发生于纠正年龄3个月内;年龄别头围Z积分的追赶高峰发生于纠正年龄5个月。VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内。母乳喂养组体重、身长、头围的生长在纠正年龄3个月时均优于混合喂养组和/或人工喂养组（P < 0.05）;母乳喂养组头围、身长的生长在纠正年龄6个月时均优于混合喂养组和/或人工喂养组（P < 0.05）。结论 VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内,提示应加强早期个体化随访及营养指导以减少生长偏离的发生。亲母母乳喂养并添加母乳强化剂是VLBW/ELBW早产儿的最佳喂养方式。     

早产儿先天性幽门肥厚三例

例1患儿男,第1胎第1产,双胎之大,生后因"29周早产、低出生体重"入院,出生体重1450 g,入院诊断:早产儿,极低出生体重儿,呼吸窘迫综合征,呼吸衰竭(Ⅱ型),双胎之大。经持续气道正压通气、胃肠外营养支持,生命体征渐平稳。生后第2天开始鼻饲微量喂养,10天后奶量加至10 ml/次,出生11天后每餐潴留量逐渐增加,约5～10 ml/次,     

早产儿喂养不耐受及处理策略

喂养不耐受(feeding intolerance)指胃肠道不能消化胃肠内食物,表现为胃潴留增加、腹胀和呕吐,主要见于早产儿,尤其极低和超低出生体重(VLBW和ELBW)早产儿,主要与胃肠道发育未成熟有关,但也可为某些疾病的早期表现。临床上,喂养不耐受常常是不能顺利建立肠内营养的重要原因,可导致肠外营养时间延长、早产儿宫外生长迟缓等。一、喂养不耐受的定义[1]早产儿喂养不耐受的定义尚未达成共识。通常     

Current Status and Perspectives in the Kanagawa Birth Defects Monitoring Program (KAMP)*

ABSTRACT The Kanagawa Birth Defects Monitoring Program has been in operation since October 1981 as the first population-based monitoring system in Japan. By the end of 1983, baseline rates of 48 marker malformations were calculated from 100,000 births. Several biological factors increase the incidence of malformations. They include stillbirth, low birth weight, small for gestational age, consanguinity and multiple birth. In the case of obvious deviations from the baseline rates, artificial factors should be ruled out prior to the decision of true deviations. The accuracy of KAMP seems to be high by the monitor of Down syndrome as an indicator. In order to establish the population-based program, covering all or nearly all births in a whole country, the following conditions should be satisfied: 1) the adoption of common marker malformations with clear definitions, 2) the standardization of the systems, 3) the standardized data analysis and the follow up procedures of “alarms,” 4) a better classification system of birth defects, 5) the official government sanction and financial support.     

Bibbulung Gnarneep ('solid kid'): causal pathways to poor birth outcomes in an urban Aboriginal birth cohort

Aim:   To explore the causal pathways leading to poor birth outcomes among a cohort of Aboriginal infants.
Methods:   A cross-sectional study was conducted. Data were collected via face-to-face interviews conducted 6–12 weeks post partum and links to the WA Midwives' Notification System. Two hundred and seventy-three Aboriginal infants and their families from Perth, Western Australia were recruited in the mid to late 1990s.
Results:   Poor birth outcome was defined as low birth weight and/or preterm birth. Criteria for poor birth outcome were met by 12.3% of the cohort. A history of maternal hypertension, vaginal bleeding and consumption of excess spirits in pregnancy were independent predictors of poor birth outcome. Mother being raised on a mission, maternal education, smoking during pregnancy and being exposed to passive smoke during pregnancy were also important risk factors.
Conclusions:   Results indicate that maternal social exposures, maternal ill-health before the index pregnancy and maternal ill-health during the index pregnancy are all important contributors to poor birth outcomes for urban Aboriginal infants. While the causes of poor birth outcomes are complex, the current study highlights several areas where preventive measures may be useful.     

Birth outcomes and risk factors in adolescent pregnancies: Results of a Taiwanese national survey

Background: This study explores birth outcomes and determinants in adolescent pregnancies, using subjects drawn from the Taiwan Birth Cohort Study (TBCS) from 2005. Methods: Through completed interviews and surveys with mothers or other family members, differences in birth outcomes and personal, pregnancy and social profiles of mothers were analyzed. Results: A total of 533 adolescent mothers (<20 years old) and 9347 adult mothers (20–34 years old) were included in our study. There was a significantly higher incidence of low birthweight (LBW) (<2500 g, 10.2% vs 5.6%) and premature birth (<37 weeks, 14.8% vs 8.6%) in the adolescent group. When adjusted for covariates in the multiple‐variable model, youth remained a risk factor for LBW (OR = 1.50, 95%CI 1.09, 2.07) and premature delivery (OR = 1.42, 95%CI 1.07, 1.89). Age, prenatal care and weight gain during pregnancy are important predictors of LBW and premature birth. Conclusion: Adolescent pregnancy carries a high‐risk of LBW and premature birth. Inadequate prenatal care and weight gain during pregnancy are contributing factors that could be improved through strategies of health education, family support and case management.     

Precurrence risk of birth defects in Hawaii

The aim of the investigation was to describe the risk of selected types of birth defects among older siblings of infants and fetuses with specific birth defects. Using data from a population-based birth defects registry in Hawaii for deliveries during 1986-2000, the precurrence risk (risk among older siblings) for any major birth defect, birth defects of the same organ system, and same specific birth defect were calculated for nine major organ systems and 54 specific birth defects. The precurrence risk of any major birth defect (3.5%) was substantially less than the risk of any major birth defect among the entire population (4.7%). The precurrence risk of a birth defect of the same organ system was significantly higher than the reference rate for six (67%) of the major organ systems and eight (15%) of the specific birth defects. The precurrence risk of the same birth defect was substantially elevated for 15 (28%) of the specific birth defects. Precurrence risk of any major birth defect was not elevated, but tended to be lower than expected. However, for several categories, precurrence risk of birth defects of the same organ system or the same specific birth defect was substantially elevated.     

Convulsions following birth asphyxia/birth trauma — are long-term anticonvulsants necessary?

ABSTRACT. A retrospective study of case notes was undertaken at the Royal Children's Hospital Melbourne, over a five-year period 1974–1978 inclusive, to determine the need for long term anticonvulsant medication for infants who had convulsions in the neonatal period following birth asphyxia and/or trauma. Anticonvulsants were generally ceased before discharge from hospital.
Of 38 infants available for follow up, 30 had no recurrence of convulsions by 12 months of age. Of the remaining 8 infants, one had a febrile convulsion, one infant remained on treatment because of a family history of convulsions and later convulsed with fever, one infant who convulsed at six weeks of age and five infants with major neurological sequelae who convulsed beyond the neonatal period, were recommenced on anticonvulsants.
Twenty seven of the 38 infants were developmentally normal, and 11/30 had major neurological sequelae (five of these 11 had subsequent convulsions).
If an infant ceases convulsing, and is behaving normally at discharge, long term anticonvulsants are not necessary.     

Epidemiology of late preterm and early term births – An international perspective

Late preterm (34–36 weeks of gestational age (GA)), and early term (37–38 weeks GA) birth rates among singleton live births vary from 3% to 6% and from 15% to 31%, respectively, across countries, although data from low- and middle-income countries are sparse. Countries with high preterm birth rates are more likely to have high early term birth rates; many risk factors are shared, including pregnancy complications (hypertension, diabetes), medical practices (provider-initiated delivery, assisted reproduction), maternal socio-demographic and lifestyle characteristics and environmental factors. Exceptions include nulliparity and inflammation which increase risks for preterm, but not early term birth. Birth before 39 weeks GA is associated with adverse child health outcomes across a wide range of settings. International rate variations suggest that reductions in early delivery are achievable; implementation of best practice guidelines for obstetrical interventions and public health policies targeting population risk factors could contribute to prevention of both late preterm and early term births.