早产儿骨代谢的影响因素及实验室评价

体内 99%的钙存在于骨骼中 ,血循环中钙含量不到体内总量的 1 %。胎儿期 ,80 %钙、磷的蓄积出现在孕 2 5周到足月 ,在此期间 ,体内钙以 2 .3～ 2 .98mmol/ ( kg· d)、磷以 1 .9～ 2 .3 9mmol/( kg· d)的速率增加 ,峰蓄积率出现在孕3 6～ 3 8周 ,足月时 ,体内总钙可达 2 8g,磷     

住院早产儿并发症调查及影响因素分析

1999年 1月～ 2 0 0 1年 12月 ,我科收治临床资料较完整的早产儿 155例 ,对其早期常见并发症发生率及影响因素进行回顾性调查 ,分析如下。一、对象和方法1.对象 :男 10 1例 ,女 54例 ;日龄 0 .5～ 48h ;胎龄 2 8～3 6周 ,平均 3 4周 ;出生体重 90 0～ 2 70 0g ,平均 1875g。2 .方法 :按不同胎龄及出生体重调查早产儿早期常见并发症 ,并对其影响因素进行分析比较。常见并发症包括低体温或寒冷损伤 (指体温 <3 5℃ )、呼吸暂停、呼吸窘迫综合征(RDS)、脑室内出血 (IVH )、感染 (肺炎、败血症 ,含院内感染 )、低血糖IVH的诊断均经头颅CT检…     

早产主要因素及对早产儿的影响(附285例临床分析)

目的：探讨早产主要因素及对早产儿的影响。方法：回顾性分析285例早产的主要高危因素，将其分为阴式分娩组和剖宫产组，对不同原因所致早产儿的预后作分析比较。结果：胎膜早破、多胎妊娠及妊高征是引起早产的主要因素；胎龄小死亡率明显增高，特别是胎龄＜32周者；剖宫产组和阴式分娩组中早产儿的存活率及发病率（尤其是颅内出血）有显著性差异（P＜0．05）。结论：早产是新生儿发病和死亡的主要原因，窒息及颅内出血是早产儿死亡的主要原因，早产不是剖宫产的禁忌证。     

新生儿反复低血糖1例

<正>新生儿低血糖是围产期新生儿常见症状之一,如果长期持续低血糖可造成广泛的脑损伤,导致神经系统后遗症,因而早期发现,及时干预极为重要。现对本院双胎新生儿之一反复低血糖1例进行报道,为临床预防及治疗提供参考。1临床资料患儿男36h足月双胎剖宫产。出生体重2000g,脐带绕颈2周,羊水Ⅲ度污染,Apgar评分:1min 8分、5min 10分、10min 10分。出生后     

影响超早产儿不良结局的产科因素分析

目的:探讨超早产儿不良结局的产科影响因素。方法:回顾性收集2012年1月1日至2021年12月31日在北京大学第三医院产科住院分娩，分娩孕周24⁺⁰～27⁺⁶周，复苏后转入本院新生儿科积极救治的超早产儿共196例，按照是否存活和有无严重并发症分为不良结局组(n=154)和非不良结局组(n=42),比较两组孕妇临床资料的组间差异，并使用受试者工作特征(ROC)曲线计算分娩孕周和新生儿出生体质量与不良结局的曲线下面积、选取临界值，转换为二分类变量。将单因素分析有意义的因素，纳入多因素Logistic回归分析，筛选出超早产儿不良结局的相关因素。结果:(1)单因素分析显示孕妇肥胖、产前出血、双胎妊娠、分娩孕周、新生儿出生体质量、1分钟Apgar评分≤7分及新生儿血pH值<7.2与超早产儿的不良结局有关(P<0.05)。(2)ROC曲线分析，取约登指数最大时分娩孕周26.93周、新生儿出生体质量865 g作为临界值将其转为二分类变量。(3)多因素Logistic回归分析显示，超早产儿发生不良结局的独立危险因素是双胎妊娠、新生儿出生体质量&l...     

早产儿假性肠梗阻相关因素的分析

早产儿 ,尤其是极低出生体重儿在住院过程中 ,有时会出现呕吐黄绿色肠道内容物或无粪便排出及腹胀等肠梗阻的临床症状 ,而 X线检查却未发现液平等机械性肠梗阻的征象 ,也不是急性出血性坏死性小肠炎或中毒性肠麻痹 ,考虑与早产儿的神经系统发育不完善有关。分析如下。一、一般资料1997年 3月～ 1999年 1月本院新生儿科住院的 2 8例患儿有明显肠梗阻表现 ,X线检查排除了机械性肠梗阻与急性出血性坏死性小肠炎 ,所有病例均无明显宫内感染或缺氧缺血的病史。其出现症状时间日龄与胎龄、体重的关系见表 1。二、治疗方法所有患儿均给予胃肠道负…     

新生儿反复低血糖1例

新生儿低血糖是围产期新生儿常见症状之一,如果长期持续低血糖可造成广泛的脑损伤,导致神经系统后遗症,因而早期发现,及时干预极为重要。现对本院双胎新生儿之一反复低血糖1例进行报道,为临床预防及治疗提供参考。1临床资料患儿男36h足月双胎剖宫产。出生体重2000g,脐带绕颈2周,羊水Ⅲ度污染,Apgar评分:1min 8分、5min 10分、10min 10分。出生后     

早产儿脑血流的超声多普勒研究

目的　测定正常早产儿和窒息早产儿的颅内动脉血流速度 ,分析影响正常早产儿脑血流的因素及窒息早产儿脑血流的变化规律。　方法　应用超声多普勒测定 2 5例正常早产儿及 17例窒息早产儿脑血流参数。　结果　正常早产儿颈内动脉 (ICA)、大脑前动脉 (ACA)的收缩期峰值血流速度 (Vs)、平均血流速度 (mV )于第 2天以后各组与第 1天比较差异有显著性 ;正常早产儿脑血流速度与胎龄 (GA)、出生体重 (BW )呈正相关 ,ICA、ACA的Vs、舒张末期速度 (Vd)、mV与GA的相关系数 (r)分别为 0 .42、0 .18、0 .17、0 .2 5、0 .17、0 .17;与BW的r分别为 0 .3 8、0 .2 6、0 .2 1、0 .3 5、0 .2 1、0 .2 0。窒息早产儿ICA、ACA的Vs、Vd、mV(cm /s)在生后 2 4h内明显下降 ,分别为 2 8.1± 8.5、5.5±2 .3、12 .6± 4.0、15.4± 5.6、4.2± 3 .0、8.3± 3 .6,与正常组相比P值分别 <0 .0 5、0 .0 1、0 .0 1、0 .0 1、0 .0 1、0 .0 1,第 2天后逐渐升高 ;窒息早产儿的脑血流速度与平均动脉血压 (MABP)呈正相关 ,ICA、ACA的Vs、Vd、mV与MABP的r值分别为 0 .3 3、0 .40、0 .2 8、0 .3 3、0 .3 0、0 .3 9。　结论　在评价早产儿脑血流灌注状态时 ,应注意GA、BW、日龄对其的影响 ;窒息早产儿脑血流改变的主要方式为窒息早期脑血流速度     

早产儿生后早期脑室内出血围产影响因素研究

早产儿脑室内出血（intraventricular hemorrhage。IVH）是早产儿常见围产期脑损伤之一，发病率高达65％以上，是新生儿死亡和存活者预后不良的重要原因之一。本研究旨在采用影像学的方法探讨早产儿IVH的早期发病情况，研究围产因素对早产儿生后早期IVH发病的影响。     

早产儿暂时性甲状腺功能低下研究新进展

早产儿甲状腺激素(thyroid hormone，TH)水平低于足月儿，其低甲状腺素血症的病因较多。早产儿严重低甲状腺素血症与围产期发病及远期发育异常有关。     

早产儿脑室周围白质软化的相关因素研究

摘要：目的　分析导致早产儿脑损伤的相关危险因素。方法　以2006年1月至2009年6月入住安徽省立儿童医院新生儿科的443例早产儿为研究对象,分为脑室周围白质软化（PVL）组（125例）与无PVL组（318例）,按PVL级别分为非囊性PVL组（116例）和囊性PVL组（9例）,采用头颅超声诊断技术早期诊断早产儿PVL,用多因素分析影响PVL及其不同级别的高危因素。 结果　单因素分析显示：胎龄、出生体重、分娩方式、低体温、生后感染、呼吸暂停、血糖、心肌酶谱、C-反应蛋白（CRP）和血清白蛋白在PVL组和无PVL组之间差异有统计学意义（P < 0.05或P < 0.01）。多因素Logistic回归分析显示：出生体重低、母亲低剖宫产率、生后感染及血清白蛋白和心肌酶谱水平高是早产儿发生PVL的危险因素,另外,生后感染是发生囊性PVL的危险因素。结论　出生体重低、母亲低剖宫产率、生后感染及血清白蛋白和心肌酶谱高是早产儿发生PVL的危险因素,另外,生后感染的早产儿发生囊性PVL的风险较高。     

Association between antenatal corticosteroids and neonatal hypoglycemia in indicated early preterm births*

Purpose: We sought to determine if administration of antenatal corticosteroids in early preterm births (<34 weeks) is associated with an increased risk of developing neonatal hypoglycemia (<40?mg/dL) within the first 48?h of neonatal life.

Materials and methods: Retrospective cohort of all indicated singleton preterm births (23?34 weeks) in a single tertiary center from 2011 to 2014. The primary outcome was neonatal hypoglycemia (<40?mg/dL) within the first 48?h of life. The outcome was compared by antenatal corticosteroids received at any point during the gestation, within 2–7 d of delivery, and whether the patient received a partial, full, or repeat course of antenatal corticosteroids. Logistic regression was used to adjust for confounders.

Results: Six hundred thirty-five patients underwent an indicated preterm birth during the study period. Six hundred and four (95%) received antenatal corticosteroids prior to delivery and 31 (5%) did not. The incidence of neonatal hypoglycemia within 48?h of life was not significantly different between those who received any antenatal corticosteroids and those who did not (23.0 versus 16.1%, adjusted odds ratio [OR] 1.3, 95%CI 0.5–3.6). Infants who received a full antenatal corticosteroid course within 2–7 d of delivery had similar incidences of hypoglycemia compared with those who received antenatal corticosteroids more than 7?d before delivery (20.4 versus 25.4%, adjusted OR 1.5, 95% confidence interval(CI) 0.8–2.9). Neonatal hypoglycemia was not increased by the number of antenatal corticosteroid doses (partial, full, or repeat course) administered. There was not a correlation between timing of antenatal corticosteroid administration before delivery, up to 250?h, and the lowest neonatal blood sugar in the first 48?h of life.

Conclusion: Our findings suggest antenatal corticosteroid administration in indicated early preterm infants (<34 weeks) may not increase the risk of developing neonatal hypoglycemia within the first 48?h of life. Further studies should validate our findings.     

Management of patent ductus arteriosus in preterm infants: clinical judgment might be a fair option

Abstract

Objective: The objective of this study was to find out the percentage of preterm infants that needed treatment for patent ductus arteriosus (PDA), when treatment decision was based on clinical signs and symptoms, besides echocardiographic findings.

Methods: Daily echocardiographic evaluation was conducted in 39 preterms ≤29^6/7 weeks’ gestation. Patients with ductus arteriosus were closely followed-up for clinical symptoms of PDA for treatment decision until ductus arteriosus was closed either spontaneously or by treatment.

Results: PDA was found in 25 (64%) infants. Mean gestational age and birth weight (BW) of the patients with PDA were 27.8?±?1.2 and 998?±?221?g, respectively. PDA closed spontaneously or had minimal ductal shunting before any signs and symptoms attributable to PDA were observed in 16 (41%) infants. Mean ductus size/BW ratio and mean left atrial/aortic root ratio were significantly higher in 9 (23%) symptomatic patients (2.06?±?0.75 versus 1.32?±?0.75?mm, p?=?0.012 and 1.31?±?0.52 versus 1.19?±?0.2?mm, p?=?0.043, respectively). PDA closure was observed after the first dose of ibuprofen in six of nine patients.

Conclusion: Correlation of clinical signs with echocardiographic findings for the decision of PDA treatment can be appropriate to prevent unnecessary medical treatments.     

Very low birth weight preterm infants are at risk for hypoglycemia once on total enteral nutrition

Abstract

Objective: To determine the occurrence of hypoglycemic episodes in very low birth weight preterm infants under total enteral nutrition and identify potential risk factors.

Methods: In this single centre cohort study, we analyzed the patients’ charts of preterm infants with a gestational age <32 weeks (n?=?98). Infants were analyzed in two groups (group 1: birth weight <1000?g, n?=?54; group 2: birth weight 1000–1499?g, n?=?44). A total of 3640 pre-feeding blood glucose measurements were screened. Risk factors for the development of hypoglycemia were identified by linear and multiple logistic regression analyses.

Results: In group 1, 44% (24 of 54) of infants experienced at least one asymptomatic episode of blood glucose <45?mg/dl (<2.5?mmol/l) as compared with 23% (10 of 44) in group 2. Regression analysis identified low gestational age and high carbohydrate intake as potential risk factors for the development of hypoglycemia.

Conclusions: Our results indicate that numerous preterm infants experience hypoglycemic episodes once on total enteral nutrition, especially those who are <1000?g at birth and those with a higher carbohydrate intake. Further studies evaluating a possible impact of these common although asymptomatic episodes on later development could help to better define thresholds that should be considered as “hypoglycemia” in this population.     

The INSURE method in preterm infants of less than 30 weeks' gestation

Objectives.?Our aim was to identify the clinical characteristics which could distinguish infants who can be managed with INSURE (intubatio-surfactant-extubation) method for preventing mechanical ventilation (MV) and which could predict INSURE success or failure.

Methods.?Inborn infants with gestational age <30 weeks were Infants were categorised into three groups: (1) infants who needed MV in the delivery room; (2) infants spontaneously breathing who were treated only with NCPAP; (3) infants who were treated with INSURE method.

Results.?We studied 125 infants: 30 (24%) required MV, 75 (60%) received INSURE treatment, and 20 (16%) were treated with NCPAP. Sixty-eight (91%) infants were successfully treated with the INSURE method. Infants in the success group had less severe RDS and less occurrence of sepsis and pneumothorax, lower mortality, and shorter duration of stay in the NICU than infants in the failure group. A birth weight <750?g, pO₂/FiO₂ <218, and a/ApO₂ <0.44 at the first blood gas analysis were independent risk factor for INSURE failure.

Conclusions.?The INSURE method can be applied to the majority of extremely preterm infants and is followed by a high percentage of success.     

Factors influencing language development in preterm infants

OBJECTIVE: To examine factors influencing preterm infant language development. DESIGN: Longitudinal. SETTING: Infants were seen for developmental follow-up at 7, 13, and 26 months corrected age in the school of nursing. PARTICIPANTS: The sample consisted of 43 mothers and their preterm infants who were below 2,000 g and 36 weeks gestation at birth. More than 88% of the sample were from lower social classes. Seventy-three percent of the sample was African American and 27% was White. MAIN OUTCOME MEASURES: Developmental outcome was assessed using the Bayley Scales of Infant Development, and language was assessed using the Reynell Developmental Language Scales. RESULTS: By 26 months corrected age, infant development was within the normal range. Expressive and receptive language was delayed an average of 3 to 5 months. Factors influencing language included length of hospital stay, birth weight, Apgar scores, infant irritability and state regulation at hospital discharge, and maternal sensitivity. CONCLUSION: Language development is delayed in preterm infants. Maternal sensitivity is positively associated with enhanced infant language. Nurses need to utilize opportunities to enhance sensitive mothering to optimize infant outcomes.     

Impact of oral probiotics on neurodevelopmental outcomes in preterm infants

Objective: The aim of the study was to evaluate the neurodevelopment outcomes of very low birth weight (VLBW) preterm infants supplemented with oral probiotics for the prevention of necrotizing enterocolitis (NEC).

Methods: A prospective follow-up study was performed in a cohort of VLBW preterm infants enrolled in a single center randomized controlled clinical trial to evaluate the efficacy of oral probiotics for the prevention of NEC. Cognitive and neuromotor developments were assessed by using the Bayley scales of infant development II. Sensory and neurological performance was evaluated by standard techniques. The primary outcome was neurodevelopmental impairment at 18–24 months’ corrected age.

Results: A total of 400 infants completed the trial protocol. Of the 370 infants eligible for follow-up, 249 infants (124 in the probiotics group and 125 in the control group) were evaluated. There was no significant difference in any of the neurodevelopmental and sensory outcomes between the two groups.

Conclusion: Oral probiotic given to VLBW infants to reduce the incidense and severity of NEC started with the first feed did not affect neuromotor, neurosensory and cognitive outcomes at 18–24 months’ corrected age.     

The effect of topical ointment on neonatal sepsis in preterm infants

Objective: To investigate the effects of topical ointment therapy on neonatal sepsis in premature infants.

Methods: A total of 197 premature infants ≤?34 weeks gestation were randomized to receive topical ointment (Aquaphor Original Emollient) or routine skin care group. Skin cultures were obtained on 3th, 7th and 14th day and blood cultures were obtained if sepsis was suspected clinically. Data included the maternal and neonatal characteristics, factors affecting the risk of sepsis and neonatal outcomes of both groups were collected.

Results: There were no significant differences in terms of gestational age, birth weight, gender, mode of delivery, multiple pregnancy and receiving antenatal corticosteroids between the study and control group. No statistically significant difference was found in the prevalence of sepsis, in the positive skin culture rates at any follow-up and in terms of the neonatal morbidities including patent ductus arteriosus and necrotizing enterocolitis between the groups. Although the rate of death was higher in the topical ointment group, no statistically significant difference was found between the groups.

Conclusions: Our data suggests that applying topical ointment during the first 2 postnatal weeks did not affect the risk of neonatal sepsis in preterm infants, although it changed the bacterial flora on the skin compare to the routine care group.     

Effect of multiple INSURE procedures in extremely preterm infants

Abstract

Objectives.?Our aim was to evaluate whether single and multiple intubation-surfactant-extubation (INSURE) procedures have similar effects on the need of mechanical ventilation (MV) and occurrence of bronchopulmonary dysplasia (BPD) in extremely preterm infants.

Methods.?We studied infants of <30 weeks of gestation with respiratory distress syndrome (RDS) who were treated with single (FiO₂?>?0.30 without need of MV) or multiple (FiO₂?>?0.40 without need of MV) INSURE procedures.

Results.?Seventy-five infants were studied: 53 (71%) received single INSURE and 22 (29%) received multiple INSURE procedures. Infants in the single and multiple groups had similar rates of need of MV (15 vs. 23%) and occurrence of BPD (9 vs. 9%), although the latter were more immature and affected by more severe RDS (higher FiO₂, lower a/ApO₂, and pO₂/FiO₂) than the former.

Conclusions.?Single and multiple INSURE procedures were followed by similar respiratory outcome in a cohort of extremely preterm infants. Further studies are warranted to evaluate whether the multiple INSURE strategy enhances the success rate of INSURE in preventing the need of MV and the occurrence of BPD.