超低和极低出生体重儿神经发育结局及影响因素分析

目的 评估超低/极低出生体重儿 （ELBWI和VLBWI） 在纠正年龄 （CA） 18月时神经发育结局,探讨影响神经发育结局的因素。方法 收集2013年1月至2014年6月入住新生儿重症监护病房并存活出院的ELBWI和VLBWI病例,在CA40周、1、3、6、12、18月定期随访,评估神经发育结局。按神经发育状况分为神经发育正常组和神经发育异常组,比较两组临床资料的差异,分析ELBWI和VLBWI神经发育的危险因素。结果 共338例ELBWI和VLBWI纳入研究,15例在住院期间死亡。CA18月时,145例 （44.9%） 存活且随访资料完整,75例 （23.2%） 死亡,失访103例 （31.9%）。CA18月时,145例患儿中神经发育损伤71例 （49.0%）,3例 （2.1%） 脑性瘫痪;未发现单眼或双眼失明的视觉损伤及需要助听器的听觉损伤。Logistic回归分析发现BPD和败血症是ELBWI和VLBWI神经发育异常的独立危险因素 （OR=3.530,P < 0.001;OR=2.528,P=0.035）,BPD发生程度越重,神经发育异常的发生率越高。结论 败血症、BPD （尤其是重度BPD） 是ELBWI和VLBWI神经发育异常的危险因素。     

Is phototherapy exposure associated with better or worse outcomes in 501‐ to 1000‐g‐birth‐weight infants?

Aim: To compare risk‐adjusted outcomes at 18‐ to 22‐month‐corrected age for extremely low birth weight (ELBW) infants who never received phototherapy (NoPTx) to those who received any phototherapy (PTx) in the NICHD Neonatal Research Network randomized trial of Aggressive vs. Conservative Phototherapy. Methods: Outcomes at 18 to 22‐month‐corrected age included death, neurodevelopmental impairment (NDI) and Bayley Scales Mental Developmental Index (MDI). Regression models evaluated the independent association of PTx with adverse outcomes controlling for centre and other potentially confounding variables. Results: Of 1972 infants, 216 were NoPTx and 1756 were PTx. For the entire 501‐ to 1000‐g‐BW cohort, PTx was not independently associated with death or NDI (OR 0.85, 95% CI: 0.60–1.20), death or adverse neurodevelopmental endpoints. However, among infants 501–750 g BW, the rate of significant developmental impairment with MDI < 50 was significantly higher for NoPTx (29%) than PTx (12%) (p = 0.004). Conclusions: Phototherapy did not appear to be independently associated with death or NDI for the overall ELBW group. Whether PTx increases mortality could not be excluded because of bias from deaths before reaching conservative treatment threshold. The higher rate of MDI < 50 in the 501‐ to 750‐g‐BW NoPTx group is concerning and consistent with NRN Trial results.     

Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g: 1992-1995

OBJECTIVE: To examine the neurosensory and cognitive status of extremely low-birth-weight (ELBW; < 1,000 g) children born from January 1, 1992, through December 31, 1995, and to identify the significant predictors of outcome. DESIGN: An inception cohort of ELBW infants admitted to the neonatal intensive care unit (NICU) and observed to 20 months' corrected age. SETTING: A tertiary level urban NICU and follow-up clinic at a university hospital. POPULATION: Of 333 ELBW infants without major congenital malformations admitted to the NICU, 241 (72%) survived to 20 months' corrected age. We studied 221 children (92%) at a mean of 20 months' corrected age. The mean birth weight was 813 g; mean gestational age, 26.4 weeks. MAIN OUTCOME MEASURES: Assessments of cognitive and neurosensory development. RESULTS: Major neurosensory abnormality was present in 54 children (24%), including 33 (15%) with cerebral palsy, 20 (9%) with deafness, and 2 (1%) with blindness. The mean (+/- SD) Bayley-Mental Developmental Index (MDI) score was 74.7 +/- 17. Ninety-two children (42%) had a subnormal MDI score (<70). Neurodevelopmental impairment (neurosensory abnormality and/or MDI score <70) was present in 105 children (48%). Multiple stepwise logistic regression analysis that considered sex, social risk, birth weight, and neonatal risk factors revealed significant predictors of a subnormal MDI score to be male sex (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.52-4.92), social risk (OR, 1.48; 95% CI, 1.09-2.00), and chronic lung disease (OR, 2.18; 95% CI, 1.20-3.94). Predictors of neurologic abnormality were a severely abnormal finding on cerebral ultrasound (OR, 8.09; 95% CI, 3.69-17.71) and chronic lung disease (OR, 2.46; 95% CI, 1.12-5.40); predictors of deafness were male sex (OR, 2.79; 95% CI, 1.02-7.62), sepsis (OR, 3.15; 95% CI, 1.05-9.48), and jaundice (maximal bilirubin level, >171 micromol/L [>10 mg/dL]) (OR, 4.80; 95% CI, 1.46-15.73). CONCLUSION: There is an urgent need for research into the etiology and prevention of neonatal morbidity.     

Outcome of extremely low birth weight survivors at school age: the influence of perinatal parameters on neurodevelopment

Extremely low birth weight (ELBW) is associated with impaired neurodevelopmental outcome in infancy. Information on the long-term cognitive and neurological consequences of ELBW is scarce. We aimed to identify the perinatal and neonatal factors of ELBW infants associated with adverse cognitive and neurological outcome at school age. A regional cohort of 135 ELBW infants born between 1993 and 1998 was prospectively evaluated at 3, 6, 12, and 18 months postmenstrual age and at yearly intervals up to age 10 years. The comprehensive follow-up programme for high-risk infants included neurological examinations and psychometric evaluations. According to the overall results of these tests, children were classified as either being normal or having minor or major impairment. At a mean age of 8.4 (SD: 1.6) years, 43% of children had survived without any impairment. Minor impairment was diagnosed in 39% and major impairment in 18% of assessed children. The proportion of disabled school children rose with decreasing gestational age. The following neonatal complications were significant risk factors for developing major or minor impairment at school age: an increase in head circumference <6 mm per week (OR 4.0, 95% CI: 1.1–14.8), parenteral nutrition ≥6 weeks (OR 2.5, 95% CI: 1.1–6.0), and mechanical ventilation >14 days (OR 2.3, 95% CI: 1.0–5.1). High-grade intraventricular haemorrhage (IVH) and/or PVL (OR 13.3, 95% CI: 4.0–44.9), neonatal seizures (OR 5.2, 95% CI: 1.2–22.4) and bowel perforation, and/or necrotizing enterocolitis (OR 4.4, 95% CI: 1.1–17.0) were significant risk factors for developing major impairment. In spite of the relatively large proportion of normal children, ELBW remains an important risk factor for neurodevelopmental impairment at school age. Thus, measures to prevent complications such as necrotizing enterocolitis, cerebral haemorrhage, and undernutrition remain important goals for neonatal intensive care.     

极低出生体重早产儿143例结局

目的 分析我院近两年内出生体重小于1500 g早产儿的死亡率和并发症.方法 2009-2010年本院共出生12907名活产新生儿,选取出生体重小于1500 g的早产儿,通过登记表获取患儿基本信息,进入电子病历,核对并登记新生儿性别、胎龄、出生体重、住院经过、呼吸支持、吸氧时间、眼底筛查、头颅超声等信息,进行统计学分析.结果 共纳入143例出生体重小于1500 g的早产儿,死亡34例,死亡率23.8%.胎龄和出生体重与死亡率呈负相关(胎龄:r=-0.93,P=0.002;出生体重:r=-0.92,P=0.01).存活的109例婴儿中,中-重度支气管肺发育不良16例,发生率14.7%;早产儿视网膜病38例,发生率34.9%,需要激光治疗11例;脑室内出血(Ⅰ～Ⅲ级)15例,发生率13.8%,存活者中无Ⅳ级脑室内出血者;坏死性小肠结肠炎4例,发生率3.7%.存活者中至少有一种严重并发症(支气管肺发育不良、需要激光治疗的早产儿视网膜病、脑室内出血或坏死性小肠结肠炎)37例,占所有存活婴儿的33.9%.体重低于1000 g者16例,死亡或合并严重并发症15例(93.8%);体重大于1000 g者127例,死亡或合并严重并发症56例(44.1%),两组差异有统计学意义(P<0.05).结论 极低出生体重儿死亡率和严重并发症的发生率较高,提高对并发症的管理有助于改善该类新生儿的生存质量.     

Risk factors for intraventricular hemorrhage in very low birth weight infants in Tehran, Iran

Intraventricular hemorrhage (IVH) is an important cause of morbidity and mortality in very low birth weight (VLBW) infants; 80-90% of cases occur between birth and the third day of life. In a retrospective case control clinical study, files of all premature infants with birth weights <1500 grams admitted between April 2004 and October 2005 to the Neonatal Intensive Care Unit (NICU) of Akbar Abadi Hospital were reviewed. We determined risk factors that predispose to the development of high-grade IVH (grades 3 and 4) in VLBW infants. Thirty-nine infants with IVH grade 3 and 4 were identified. A control group of 82 VLBW infants were also selected. Prenatal data, delivery characteristics, neonatal course data and reports of cranial ultrasonography were carefully collected for both groups. Those variables that achieved significance (p<0.05) in univariate analysis were entered into multivariate logistic regression analysis. A total of 325 VLBW infants were evaluated. Mortality rate was 21.5%. Multivariate logistic analysis showed that the following factors are associated with greater risk of high-grade IVH occurrence: lower gestational age (OR: 3.72; 95% CI: 1.65-8.38), birth weight (OR: 3.42; 95% CI: 1.65-8.38), mechanical ventilation (OR: 4.14; 95% CI: 1.35-12.2), tocolytic therapy with magnesium sulfate (OR: 4.40; 95% CI: 1.10-24.5), hyaline membrane disease (HMD, OR: 3.16; 95% CI: 1.42-7.45), symptomatic hypotension (OR: 2.32; 95% CI: 1.06-5.42), hypercapnia (OR: 1.9; 95% CI: 1.1-3.4) and Apgar score at 5 minutes (OR: 1.58; 95% CI: 1.59-6.32).     

Academic achievement of adolescents born with extremely low birth weight

Aim: To assess academic achievement, rates of learning disabilities (LD) and special education in extremely low birth weight (ELBW <1 kg) adolescents relative to normal birth weight (NBW) controls and to identify cognitive weaknesses. Methods: Compared 181 ELBW adolescents born from 1992 to 1995 (mean age 14.8 years, mean BW 809 g, mean GA 26.4 weeks) and 115 NBW term controls. Measures included tests of IQ, reading and math achievement and executive function. Analyses included ANCOVA and logistic and linear regression. Covariates were sex, race and socioeconomic status. Results: Extremely low birth weight adolescents had significantly lower scores on tests of IQ (87.1 vs. 96.4), achievement (88.6 vs. 95.5 reading; 81.3 vs. 93.2 math) and executive function than the NBW group (all p-values <0.001). ELBW also had higher rates of math LD, 51(50%) vs. 26 (28%), OR (95% CI) = 3.10 (1.65, 5.84), p < 0.001, and need for special education, 88 (49%) vs. 11(10%), OR (95% CI) = 11.78 (5.67, 24.47), p < 0.001. Measures of executive function were related to math independent of IQ. Conclusions: Extremely low birth weight adolescents born in the 1990s have poorer achievement and higher rates of math LD than NBW peers. The findings suggest a need for more intensive interventions addressing the specific cognitive vulnerabilities in this population.     

Postnatal growth in VLBW infants: significant association with neurodevelopmental outcome

OBJECTIVE: To study the significance of growth status at birth and postnatal growth on neurodevelopmental outcome in very low birth weight (VLBW) infants. STUDY DESIGN: Growth and neurodevelopment were examined in 219 VLBW (<1250 g) children, 94 small for gestational age (SGA) (<10th percentile) and 125 appropriate for gestational age (AGA) (>10th percentile). Outcome at age 2 was assessed with the Bayley Scales of Infant Development (Mental Developmental Index [MDI], Psychomotor Developmental Index [PDI]) and a standardized neurologic examination. RESULTS: SGA status was not associated with poor neurodevelopmental outcome. However, after adjustment for covariables including cerebral palsy (CP), SGA children with weight <10th percentile at age 2 had lower mean PDI than SGA children with catch-up growth to weight >10th percentile (mean [SD], 89.9 [17.4] versus 101.8 [14.5]; P<.001). AGA children with catch-down growth (weight <10th percentile at age 2) were, independent of CP, more likely to have lower mean MDI (94.9 vs 101.7, P=.05) and PDI (81.9 vs 95.1; P<.001) than AGA children remaining >10th percentile at age 2. They also more frequently had severe CP (22.9% vs 1.2%; P=.008). CONCLUSIONS: In VLBW children, the course of postnatal growth rather than the appropriateness of weight for gestational age at birth determines later neurodevelopmental outcome.     

Neonatal cranial ultrasound screening for intraventricular haemorrhage

The cost effectiveness of performing routine neonatal cranial ultrasound scans to diagnose intraventricular haemorrhage (IVH) on cohorts of high risk infants is in question. In the early 1980s cranial ultrasound scans were performed on preterm infants to expand knowledge of the incidence, aetiology, pathogenesis and evolution of IVH. In many neonatal units high risk infants are scanned on days 5–7 and 10–14 and prior to discharge for extremely low birthweight (ELBW) infants. Cranial ultrasound scanning is often used as a surrogate for assessment of neurodevelopmental outcome with information from meta analyses used to counsel parents about the likelihood of subsequent neurosensory disability.     

Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome

OBJECTIVE: To determine if postnatal growth failure exerts an adverse effect on subsequent growth and neurodevelopment. STUDY DESIGN: A secondary analysis of 1018 infants who were enrolled in a randomized, clinical trial of glutamine supplementation was performed to determine whether early provision of parenteral amino acids (AA) is associated with better growth and neurodevelopmental outcomes. Infants were stratified by whether they were provided > or =3 g/kg per day of AA at < or =5 days of life (early; n = 182) or not (late; n = 836). RESULTS: At 36 weeks' postmenstrual age, significant differences were found in weight, length, and head circumference in favor of the infants who received early AA; the odds of having weight less than the 10(th) percentile for age was 4-fold higher for infants in the late group. At 18 months' CA, there were no differences in weight, length, or measures of neurodevelopment between the groups; however, male infants in the late group were twice as likely to have head circumference less than the 10(th) percentile. CONCLUSIONS: Early AA were associated with significantly better growth outcomes at 36 weeks' postmenstrual age, and fewer infants who received early AA were found to have suboptimal head growth at 18 months' CA.     

Neurodevelopmental sequelae of intraventricular haemorrhage at 8 years of age in a regional cohort of ELBW/very preterm infants

BACKGROUND: Major grades of intraventricular haemorrhage (IVH) are associated with adverse neurodevelopmental sequelae in early childhood but the extent of problems in specific cognitive areas, such as executive function, and the contribution of lesser grades of IVH to neurodevelopmental problems at school age are not well described. AIMS: To determine the neuromotor, cognitive and educational outcome of extremely low birthweight (ELBW, birthweight <1000 g) or very preterm (<28 weeks) infants at 8 years of age related to the severity of IVH diagnosed in the newborn period. DESIGN: Regional cohort study. PATIENTS: Consecutive surviving children of either birthweight <1000 g or gestational age <28 weeks born in the state of Victoria in 1991 or 1992. MAIN OUTCOME MEASURES: Neurological impairments and disabilities, cognitive function and academic progress. RESULTS: Of 298 consecutive ELBW/very preterm survivors 270 (90.6%) with cranial ultrasound data were assessed at 8 years of age. Cerebral palsy, poor motor performance and major neurosensory disability were more prevalent with increasing severity of IVH. Cognitive functioning across domains was worse with increasing severity of IVH. Most of the differences were attributable to the few (n=6) survivors who had grade 4 IVH; there were few substantial differences between survivors with lesser grades of IVH. CONCLUSIONS: Neurodevelopmental dysfunction at school age in ELBW/very preterm survivors varies little with increasing severity of IVH, with the exception of grade 4 IVH.     

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.     

Grade and laterality of intraventricular haemorrhage to predict 18-22 month neurodevelopmental outcomes in extremely low birthweight infants

Aim: To determine whether extremely low‐birthweight (ELBW) infants with bilateral compared to unilateral intraventricular haemorrhage (IVH) have worse neurodevelopmental outcomes at 18–22 months. Methods: A total of 166 ELBW infants (<1000 g) admitted to a Cincinnati NICU from 1998 to 2005 with a head ultrasound showing Grade I–IV IVH and neurodevelopmental assessment at 18–22 months corrected age were included. Multivariable linear and logistic regression models were developed to determine the impact of laterality and grade of IVH and other clinical variables to predict scores on the Bayley Scales of Infant Development, Second Edition, Mental Development Index and Psychomotor Development Index and the combined outcome of neurodevelopmental impairment (NDI). Results: Infants with bilateral grade IV IVH had lower adjusted mean Bayley scores compared with infants with unilateral grade IV IVH. For grades I, II and III IVH, bilaterality of IVH was not associated with lower mean Bayley scores. Infants with grade IV IVH had the highest odds of NDI. The probability of NDI increased with sepsis and postnatal steroid use. Conclusion: ELBW infants with bilateral compared to those with unilateral grade IV IVH had worse neurodevelopmental outcomes. Infants with grades I–III IVH had similar outcomes whether they had unilateral or bilateral IVH.     

The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants

OBJECTIVE: To determine whether extremely low birth weight infants (ELBW) transfused at lower hemoglobin thresholds versus higher thresholds have different rates of survival or morbidity at discharge. STUDY DESIGN: Infants weighing <1000 g birth weight were randomly assigned within 48 hours of birth to a transfusion algorithm of either low or high hemoglobin transfusion thresholds. The composite primary outcome was death before home discharge or survival with any of either severe retinopathy, bronchopulmonary dysplasia, or brain injury on cranial ultrasound. Morbidity outcomes were assessed, blinded to allocation. RESULTS: Four hundred fifty-one infants were randomly assigned to low (n = 223) or high (n = 228) hemoglobin thresholds. Groups were similar, with mean birth weight of 770 g and gestational age of 26 weeks. Fewer infants received one or more transfusions in the low threshold group (89% low versus 95% high, P = .037). Rates of the primary outcome were 74.0% in the low threshold group and 69.7% in the high (P = .25; risk difference, 2.7%; 95% CI -3.7% to 9.2%). There were no statistically significant differences between groups in any secondary outcome. CONCLUSIONS: In extremely low birth weight infants, maintaining a higher hemoglobin level results in more infants receiving transfusions but confers little evidence of benefit.     

Obstetrical and neonatal risk factors in very low birth weight infants related to their neurological development

An analysis of pre- and perinatal risks in very low birth weight (VLBW) infants showed that children later suffering from severe neurodevelopmental sequelae were exposed to a significantly higher number of risk factors compared to normally developed VLBW controls. This was not only due to a higher incidence of specific risks, but to the accumulation of risk factors, which consequently made an ischaemic or haemorrhagic brain lesion more likely to occur. This result suggests that brain lesions in VLBW infants are essentially multifactorial. The improved outcome of VLBW infants cared for in the NICU of the Children's Hospital of Tübingen during 1977–1983 was accompanied by a decreasing incidence of obstetrical and neonatal risks. This was mainly due to more frequent transport in utero, earlier obstetrical intervention, and immediate postnatal stabilization of the infant's condition. These changes in perinatal care strategy evidently favoured the postnatal course and thus also improved the neurodevelopmental outcome.Abbreviations VLBW very low birth weight - NICU neonatal intensive care unit - ICH intracranial haemorrhage - IVH intraventricular haemorrhage - CSF cerebrospinal fluid     

Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome

OBJECTIVE: To describe mortality, morbidity at discharge and neurodevelopmental outcome at 2 years corrected age in extremely low birth weight infants with systemic Candida infection during intensive care stay. METHOD: We identified all extremely low birth weight (birth weight <1000 g) infants diagnosed with Candida sepsis and/or meningoencephalitis between 1988 and mid-1996 in the tertiary neonatal intensive care centers of Toronto. The outcome of the infected infants at discharge and at 2 years corrected age was compared with a cohort of 470 extremely low birth weight infants born between 1990 and 1994. RESULTS: Forty-six extremely low birth weight infants with systemic Candida infection, mean (+/-SD) gestational age of 24.7 +/- 1.6 weeks and birth weight 699 +/- 135 g, were identified. Case fatality rate was 37% (17 of 46), not significantly different from the control group (35%). Data on 27 infected survivors were available at discharge. All had chronic lung disease compared with 33% in the control cases (P = 0.0001), a high incidence of periventricular leukomalacia (26% vs. 12%, P = 0.06) and an increase in severe retinopathy of prematurity (22% vs. 9%, P = 0.04); 60% had adverse neurologic outcomes at 2 years corrected age compared with 35% in the control group, and 41% vs. 12% had severe disabilities (P = 0.005). Cranial ultrasound examination was the only diagnostic modality in 5 of 13 (38%) cases with central nervous system Candida involvement. All infants with brain parenchymal lesions detected by cranial ultrasound had poor outcome. Early diagnosis and commencement of antifungal treatment favorably affected the outcome. CONCLUSIONS: Systemic Candida infection is associated with increased short and long term morbidity in extremely low birth weight infants. Candida infection of the central nervous system has a significant impact on long term neurodevelopmental outcome. Performance of cranial ultrasound examination is recommended as a part of the diagnostic investigation in these infants. Detection of brain parenchymal involvement might provide further information to predict outcome.     

Comparison of morbidities in very low birthweight and normal birthweight infants during the first year of life in a developing country

Objective : To compare the morbidities in the very low birthweight (VLBW; < 1500 g) and normal birthweight (NBW; ± 2500 g) Malaysian infants during the first year of life.
Methodology : Prospective observational cohort study of consecutive surviving VLBW infants and randomly sampled NBW infants born in the Kuala Lumpur Maternity Hospital between 1 December 1989 and 31 December 1992. Infants were followed up regularly during the first year of life, after correction for prematurity.
Results : Compared with NBW infants ( n = 106), VLBW infants ( n = 127) had significantly higher risk of failure to thrive (odds ratio [OR] = 8.0, 95% confidence intervals [Cl]: 1.1 to 354.3), wheezing (OR = 3.7, 95% Cl: 1.6 to 9.3), rehospitalization (OR = 2.3, 95% Cl: 1.1 to 5.0), cerebral palsy (OR = 8.6, 95% Cl: 2.0 to 77.6), neurosensory hearing loss (OR = 12.0, 95% Cl: 1.7 to 513.6) and visual loss (7.9 vs 0%, P = 0.002). The mean mental developmental index (MDI) and mean psychomotor developmental index (PDI) at 1 year of age were significantly lower among VLBW infants (MDI 99 [SD = 28], PDI89 [SD = 25]) than NBW infants (MDI 106 [SD = 18], PDI 101 [SD = 18]) (95% Cl for difference between means being MDI: -14.1 to -1.7; and PDI: -17.6 to -6.0). Logistic regression analysis showed that among VLBW infants: (i) male sex, Malay ethnicity and bronchopulmonary dysplasia were significant risk factors associated with wheezing; (ii) longer duration of oxygen therapy during the neonatal period, seizures after the post-neonatal period and wheezing were significant risk factors associated with rehospitalization; and (iii) longer duration of oxygen therapy during the neonatal period was a significant risk factor associated with adverse neurodevelopmental outcome during the first year of life.
Conclusions : Compared with NBW infants, VLBW Malaysian infants had significantly higher risks of physical and neurodevelopmental morbidities.     

外周血内皮祖细胞与极低出生体重早产儿并发症发生相关性

目的 分析内皮祖细胞（EPCs）与极低出生体重早产儿发生支气管肺发育不良（BPD）、早产儿视网膜病（ROP）和脑室内出血（IVH）并发症的相关性。方法 选取于复旦大学附属儿科医院NICU住院的胎龄<32周、出生体重<1 500 g的早产儿,分别于出生时、生后7、14、21和28 d及纠正胎龄36周时收集外周血,流式细胞仪检测EPCs水平,酶联免疫法检测血管内皮生长因子（VEGF）、基质细胞衍生因子等水平。结果 68例极低出生体重早产儿纳入分析,其中对照组30例,BPD 组20例, ROP组 10例,IVH组 8例。BPD组与对照组出生时EPCs水平差异无统计学意义,生后7 d时点EPCs水平较对照组明显降低,CD34+KDR+: (0.019 ±0.009) % vs (0.026±0.012)%, P<0.05; KDR+CD133+: (0.004±0.002)% vs (0.008±0.004)%, P<0.01; CD34+KDR+CD133+: (0.005±0.002)% vs (0.008±0.004)%, P<0.05。从出生时至生后21 d,BPD组血浆VEGF水平均明显低于对照组。ROP组出生时至生后28 d的EPCs水平与对照组差异无统计学意义,纠正胎龄36周时KDR+CD133+和CD34+KDR+CD133+ EPCs与对照组相比略有升高趋势。与对照组相比, IVH组生后不同时点的EPCs水平差异均无统计学意义。结论 生后早期的EPCs和VEGF水平降低可能参与了早产儿BPD的发生,但其具体机制仍需进一步研究。     

极低出生体重儿血小板参数与脑室内出血的关系探讨

目的　 探讨极低出生体重儿血小板参数与脑室内出血 (IVH)的关系。 方法 　将 84例极低出生体重儿分为无IVH组、轻度IVH组和重度IVH组 ,分析比较其生后 2 4h内的血小板参数。 结果 　血小板计数重度IVH组低于无IVH组 (P <0 0 1)及轻度IVH组 (P <0 0 5 ) ,轻度IVH组低于无IVH组 (P <0 0 1) ;血小板压积重度IVH组低于无IVH组 (P <0 0 1) ;血小板体积分布宽度 ,重度IVH组高于无IVH组 (P <0 0 5 )。血小板减少症发生率重度IVH组高于轻度IVH组 (P <0 0 5 )及无IVH组 (P <0 0 1) ,轻度IVH组高于无IVH组 (P <0 0 5 )。 结论 　血小板参数与极低出生体重儿IVH密切相关 ,可能参与了IVH的病理过程。     

The effect of neonatal maternal milk feeding on the neurodevelopmental outcome of very low birth weight infants

The effect of maternal milk feeding during the first 4 weeks of life on neurodevelopmental outcomes at 20 months corrected age (CA) of singleton very low birth weight (VLBW) (< 1.5 kg) infants was examined. Ninety-eight VLBW infants born from January 1997 to February 1999 were followed to 20 months CA (mean birth weight, 1012 g; gestational age, 27 weeks). Maternal milk intake was calculated as both mean milliliters per kilogram per day and graded doses. Outcomes included the Bayley Mental Development Index (MDI) and Psychomotor Development Index (PDI), and rates of cerebral palsy (CP) and of overall neurodevelopmental impairment. After adjusting for neonatal and social risk, results revealed no effect of maternal milk on outcomes. MDI was predicted by both social and neonatal risk, and PDI, CP, and neurodevelopmental impairment were predicted by neonatal risk. In this small, high-risk group of VLBW infants, the effects of social and neonatal risk appear to outweigh any possible benefits of maternal milk on neurodevelopmental outcome.