低出生体重儿应用母乳强化剂的护理

目的 探讨低出生体重儿使用母乳添加剂的喂养及护理方法.方法 对12例低出生体重儿规范化母乳喂养以及规范化添加母乳添加剂,具体护理内容包括严格掌握开始肠内喂养的时间和喂养方式、制定母乳喂养知情同意书以及母乳宣教手册,对患儿父母进行培训如何收集和运送母乳至病房,培训护士如何储存和配置母乳、如何保存和使用母乳添加剂等.结果 12例体质量增长速率、身长增长速率、头围增长速率均达到正常胎儿在宫内的生长速率.2例出现喂养不耐受等,最终患儿全部治愈出院.结论 临床使用母乳强化剂安全有效,而规范母乳以及母乳强化剂使用和操作流程对早产儿正常的生长发育非常重要.     

喂养延续护理对营养风险早产儿生长发育的影响

目的 对营养风险早产儿进行喂养延续护理管理,促进早产儿生长发育。 方法 将80例存在营养风险的早产儿随机分为对照组和观察组各40例。对照组进行常规护理,观察组采用延续护理喂养方案干预,评估出院早产儿纠正月龄1个月、3个月、6个月体格生长发育情况;进行体格生长发育Z评分;比较两组早产儿家长再入院率及纯母乳喂养情况。 结果 纠正月龄3、6个月观察组身长及其Z评分、体质量及其Z评分显著高于对照组（P＜0.05,P＜0.01）。观察组早产儿再入院率显著低于对照组,母乳喂养率显著高于对照组（P＜0.05,P＜0.01）。 结论 对营养风险早产儿进行喂养延续护理管理,能促进早产儿生长发育及母乳喂养。     

先心病患儿辅食喂养现状及影响因素的多中心研究

目的评价6~12月龄先心病患儿的辅食喂养现状。方法采用自制的先心病婴儿营养管理调查表和婴幼儿喂养指数评价标准(ICFI)收集在5所综合性儿童医院就诊的274名6~12月龄先心病患儿的基本信息和辅食喂养状况,综合评价先心性患儿的营养状况和喂养行为。结果ICFI得分为8.11±4.01,其中6~8月龄(9月龄)患儿得分为6.70±3.72,9~12月龄患儿得分为10.56±3.25;ICFI合格率为9.9%;患儿月龄、母亲学历与ICFI得分显著相关(P0.05,P0.01)。结论先心病患儿的辅食喂养现状堪忧,在较小月龄组患儿中更明显。     

链式早产儿母乳喂养促进方案在NICU的实施

目的探讨链式早产儿母乳喂养促进方案在新生儿重症监护病房(NICU)的实施效果。方法将106例极低出生体重儿(VLBWI)按入院时间分组,2017年3月至2018年2月收治的VLBWI分为对照组(52例),给予常规的爱婴医院母乳喂养策略;2018年3月至2019年2月收治的VLBWI分为观察组(54例),实施链式早产儿母乳喂养促进方案,即组建链式早产儿母乳喂养项目组,建立母乳库并规范管理,规范母乳收集、运送、储存;实行初乳口腔护理,亲母乳、鲜乳优选原则等。结果观察组住院期间母乳喂养率达100%,开始母乳喂养时间、达全肠内喂养时间显著短于对照组,亲母母乳喂养占比及出院后1个月母乳喂养率显著高于对照组,坏死性小肠结肠炎(NEC)和医院感染发生率显著低于对照组(P0.05,P 0.01)。结论对NICU的VLBWI实施链式早产儿母乳喂养促进方案,可以缩短母乳喂养开始时间,提高母乳喂养率和亲母母乳喂养占比,有效降低相关并发症的发生。     

NICU早产儿母乳喂养链式管理效果评价

目的 观察链式管理对NICU早产儿母乳喂养及喂养并发症的影响。方法 将180例NICU早产儿按入院时间分为对照组和试验组各90例。对照组实施常规NICU母乳喂养策略,试验组在对照组基础上进行链式管理,构建并实施产房、产科和NICU间横向管理和各科室内部纵向管理。结果 最终对照组82例、试验组81例早产儿完成研究。干预后,试验组纯母乳喂养率显著高于对照组,试验组早产儿喂养不耐受、坏死性小肠结肠炎、宫外发育迟缓和新生儿高胆红素血症发生率显著低于对照组(均P<0.05),试验组恢复至出生体质量日龄显著短于对照组,出院体质量显著大于对照组(均P<0.05)。结论 链式管理有利于提高NICU早产儿的纯母乳喂养率,降低喂养并发症发生率,促进新生儿生长发育。     

社会支持期望落差及喂养方式对高危妊娠产妇育儿胜任感的影响

目的了解高危妊娠产妇的社会支持期望落差及喂养方式现状,并分析其对产妇育儿胜任感水平的影响。方法对160例高危妊娠产妇于产后6~8周复查时采用中文版育儿胜任感量表(C-PSOC)和中文版产后社会支持量表(C-PSQ)进行调查。结果高危妊娠产妇的育儿胜任感总分68.88±12.75,其中育儿自我效能得分34.17±6.08,育儿满意度得分34.11±8.81;产后社会支持期望落差为27(6.0,54.5)。纯母乳喂养率26.9%,纯母乳喂养产妇的育儿胜任感水平及各维度评分显著高于其他喂养方式的产妇(均P<0.05)。多元线性逐步回归分析显示,纯母乳喂养、产后抑郁得分、信息支持落差是影响高危妊娠产妇育儿胜任感水平的主要因素(调整R^2=0.393)。结论产科工作者应重视高危妊娠产妇抑郁的筛查,提供促进产妇康复、早产儿育儿知识与母乳喂养指导等方面的信息支持,提高早产儿的纯母乳喂养率,以提高高危妊娠产妇的育儿胜任感水平。     

袋鼠式护理改善无创辅助通气超未成熟儿喂养的效果评价

目的探讨袋鼠式护理对无创辅助通气超未成熟儿达到完全肠道内喂养及母乳喂养的影响。方法将NICU体质量低于1 000 g、无创辅助通气的超低出生体质量儿按数字表法随机分为对照组(62例)和干预组(61例)。对照组实施常规护理;干预组在常规护理基础上,入院3周后生命体征平稳即实施袋鼠式护理,每天1次,每次3 h,持续干预2周。结果干预组袋鼠式护理过程中无管道滑脱、呛奶等不良事件发生。干预组达到完全肠内外喂养时间显著短于对照组,出院前24 h纯母乳喂养率显著高于对照组(P0.05,P0.01)。调整性别、孕周和出生体质量、日龄、分娩方式、产前激素应用、试管婴儿、宫内窘迫后,袋鼠式护理干预有助于缩短达到完全肠内喂养时间(P0.01),提高出院前24 h纯母乳率(OR=4.526,P0.05)。结论对无创辅助通气超未成熟儿应用袋鼠式护理,可缩短达到完全肠道内喂养时间,提高纯母乳喂养率。     

仿真婴儿辅食模型的设计与应用

目的探讨应用仿真婴儿辅食模型指导婴儿食物转换的效果。方法将300例4～6月龄足月婴儿按体检时间分为对照组199例、干预组101例。对照组于6月、8月、10月龄体检时按常规进行食物转换指导,干预组采用自行设计制作的仿真婴儿辅食模型进行食物转换指导。随访研究对象至12月龄,比较两组婴儿体格发育、血红蛋白、血清矿物质水平及喂养者对婴儿食物转换的知信行。结果 12月龄时干预组血红蛋白水平显著高于对照组,对婴儿食物转换的认可度、执行度及知信行总分显著高于对照组(均P0.01)。结论应用仿真辅食模型进行婴儿食物转换期辅食指导有利于改善喂养者对婴儿食物转换的信念与行为,合理给予辅食,促进婴儿健康成长。     

母乳哺育支持系统对初产妇产后母乳喂养的影响

目的探讨母乳哺育支持系统对初产妇产后母乳喂养的影响。方法将69例自然分娩的初产妇随机分为观察组35例和对照组34例,观察组新生儿出生后给予持续性母婴皮肤接触1h,由母乳哺育支持团队成员提供母乳喂养护理支持,出院后哺乳顾问持续跟踪并给予帮助;对照组则行皮肤接触至产妇会阴伤口缝合并检查完毕,给予常规产后护理。比较产后不同时间纯母乳喂养率及母乳喂养率。结果观察组出院时、产后7d、4个月及6个月的纯母乳喂养率显著高于对照组(P0.05,P0.01),观察组产后7d、4个月及6个月的母乳喂养率显著高于对照组(均P0.05)。结论医院母乳哺育支持系统能有效提高初产妇产后纯母乳喂养率和母乳喂养率。     

思密达干预母乳性黄疸95例分析

随着母乳喂养率的提高，母乳性黄疸的发病率也越来越高，这有碍于母乳喂养的推广。本院采用思密达干预母乳性黄疸取得满意疗效。现报告如下。资料与方法１．一般资料：收集１９９８年２月至２００１年１２月本院儿科住院母乳性黄疸病例１７８例，归属早发型３７例，晚发型１４１例，诊断标准及分型依据参照《实用儿科学》等犤１，２犦。其中男９３例，女８５例；均为足月儿。出生体重２．３～４．２kg，平均３．１kg。入院日龄５～４３天，平均２２天。血清总胆红素１８０．２～３０７．８umol／L。用随机数码表法分为观察组９５例，对照组…     

Extra-uterine renal growth in preterm infants: Oligonephropathy and prematurity

Background

Nephron number in humans is determined during fetal life. The objective of this study was to investigate the effects of preterm birth on nephron number using renal volume as a surrogate for nephron number.

Methods

This observational study was conducted over 12 months in a tertiary perinatal center. Preterm babies less than 32 weeks of gestation were recruited and followed until discharge. Term infants were recruited for comparison. The babies underwent renal sonography and renal function measurements at 32 and 38 weeks corrected age. The primary outcome measurement was total kidney volume at 38 weeks and the secondary outcome was estimated glomerular filtration rate (eGFR).

Results

Forty-four preterm infants and 24 term infants were recruited. At 38 weeks corrected age, premature infants had lower total kidney volume than term infants (21.6?±?5.7 vs. 25.2?±?5.7 ml; p?=?0.02) and a significantly lower eGFR (73.6 [IQR 68.1–77.6] vs. 79.3 [IQR 72.5–86.6] ml·min^?1·1.73 m^?2; p?=?0.03). There was a significant correlation between total kidney volume and eGFR in premature and term babies.

Conclusions

Premature infants have smaller kidney volume and likely decreased nephron number and lower estimated glomerulofiltration rate relative to infants born at term.     

High Beta-Palmitate Formula and Bone Strength in Term Infants: A Randomized, Double-Blind, Controlled Trial

We aimed to compare the effect of 12-week feeding of commercially available infant formulas with different percentages of palmitic acid at sn-2 (beta-palmitate) on anthropometric measures and bone strength of term infants. It was hypothesized that feeding infants with high beta-palmitate (HBP) formula will enhance their bone speed of sound (SOS). Eighty-three infants appropriate for gestational age participated in the study; of these, 58 were formula-fed and 25 breast-fed infants, serving as a reference group. The formula-fed infants were randomly assigned to receive HBP formula (43 % of the palmitic acid is esterified to the middle position of the glycerol backbone, study group; n = 30) or regular formula with low-beta palmitate (LBP, 14 % of the palmitic acid is esterified to the middle position of the glycerol backbone, n = 28). Sixty-six infants completed the 12-week study. Anthropometric and quantitative ultrasound measurements of bone SOS for assessment of bone strength were performed at randomization and at 6 and 12 weeks postnatal age. At randomization, gestational age, birth weight, and bone SOS were comparable between the three groups. At 12 weeks postnatal age, the mean bone SOS of the HBP group was significantly higher than that of the LBP group (2,896 ± 133 vs. 2,825 ± 79 m/s respectively, P = 0.049) and comparable with that of the breast-fed group (2,875 ± 85 m/s). We concluded that infants consuming HBP formula had changes in bone SOS that were comparable to those of infants consuming breast milk and favorable compared to infants consuming LBP formula.     

早期喂养方式对1岁以下婴幼儿肥胖的影响

目的：探讨早期喂养方式对1岁以下婴幼儿肥胖的影响。方法对462例1岁以下婴幼儿的体格发育资料进行回顾性调查分析,以0～4个月喂养方式的不同分为母乳喂养组298例和人工喂养组164例,比较两组婴幼儿在不同月龄的肥胖及超重＋肥胖的发生率。结果两组在月龄为3个月、6个月时的肥胖率和超重＋肥胖率比较差异均无统计学意义（P＞0.05）;在9、12个月时,母乳喂养组的肥胖率和超重＋肥胖率均较之人工喂养低,两组比较差异有统计学意义（P＜0.05）。结论给予母乳喂养能够预防出现婴幼儿的早期超重和肥胖症,具有显著的保护作用。     

Effects of postnatal interventions for the reduction of vertical HIV transmission on infant growth and non-HIV infections: a systematic review

Introduction

Guidelines in resource-poor settings have progressively included interventions to reduce postnatal HIV transmission through breast milk. In addition to HIV-free survival, infant growth and non-HIV infections should be considered. Determining the effect of these interventions on infant growth and non-HIV infections will inform healthcare decisions about feeding HIV-exposed infants. We synthesize findings from studies comparing breast to formula feeding, early weaning to standard-duration breastfeeding, breastfeeding with extended antiretroviral (ARV) to short-course ARV prophylaxis, and alternative preparations of infant formula to standard formula in HIV-exposed infants, focusing on infant growth and non-HIV infectious morbidity outcomes. The review objectives were to collate and appraise evidence of interventions to reduce postnatal vertical HIV transmission, and to estimate their effect on growth and non-HIV infections from birth to two years of age among HIV-exposed infants.

Methods

We searched PubMed, SCOPUS, and Cochrane CENTRAL Controlled Trials Register. We included randomized trials and prospective cohort studies. Two authors independently extracted data and evaluated risk of bias. Rate ratios and mean differences were used as effect measures for dichotomous and continuous outcomes, respectively. Where pooling was possible, we used fixed-effects meta-analysis to pool results across studies. Quality of evidence was assessed using the GRADE approach.

Results and discussion

Prospective cohort studies comparing breast- versus formula-fed HIV-exposed infants found breastfeeding to be protective against diarrhoea in early life [risk ratio (RR)=0.31; 95% confidence interval (CI)=0.13 to 0.74]. The effect of breastfeeding against diarrhoea [hazard ratio (HR)=0.74; 95% CI=0.57 to 0.97] and respiratory infections (HR=0.65; 95% CI=0.41 to 1.00) was significant through two years of age. The only randomized controlled trial (RCT) available showed that breastfeeding tended to be protective against malnutrition (RR=0.63; 95% CI=0.36 to 1.12). We found no statistically significant differences in the rates of non-HIV infections or malnutrition between breast-fed infants in the extended and short-course ARV prophylaxis groups.

Conclusions

Low to moderate quality evidence suggests breastfeeding may improve growth and non-HIV infection outcomes of HIV-exposed infants. Extended ARV prophylaxis does not appear to increase the risk for HIV-exposed infants for adverse growth or non-HIV infections compared to short-course ARV prophylaxis.     

Influence of nutrition on urinary oxalate and calcium in preterm and term infants

  Few data for normal urinary oxalate (Ox) and calcium (Ca) excretion related both to gestational age and nutritional factors have been reported in preterm or term infants. We therefore determined the molar Ox and Ca to creatinine (Cr) ratios in spot urines from 64 preterm and 37 term infants aged 1–60 days, either fed formula or human milk (HM). Only vitamin D was supplemented; renal or metabolic diseases were excluded. Urinary Ox/Cr ratio was higher in preterm than in term infants, both when formula fed (1st month 253 vs. 180 mmol/mol and 2nd month 306 vs. 212 mmol/mol; P<0.05) or HM fed (206 vs. 169 mmol/mol and 283^* vs. 232 mmol/mol; ^* P<0.05). Ox/Cr was also higher in formula- than HM-fed preterm infants. The ratio increased during the first 2 months of life irrespective of nutrition. Urinary Ca/Cr ratio was comparable in all groups during the 1st month of life, except for a lower (P<0.05) value in term infants fed HM (0.10 mol/mol). It increased in all groups during the 2nd month of life, being highest in HM-fed preterm infants (1.86 mol/mol). In conclusion, urinary Ox and Ca excretion is influenced by both gestational age and nutrient intake in preterm and term infants. Received October 2, 1996; received in revised form and accepted April 24, 1997     

Comparison between a humanized cow's milk and a soy product for premature infants

A soy-based infant feed was compared with a humanized cow's milk product in newborn preterm babies. Forty preterm infants appropriate for gestational age with birth weights of between 1,500 and 1,800 g were randomly allocated, as they were admitted, to either a soy feed or a humanized cow's milk formula--both commercial products. The trial lasted 35 days for each patient. With a formula intake of 180 ml/kg/day, the patients on the soy feed did not progress well, and most had to be withdrawn from the trial, whereas the group fed on cow's milk fared satisfactorily. With formula intakes of 200 ml/kg/d, progress in the group on the soy feed was improved. However, the body weights and serum albumin levels of the babies receiving the soy product were significantly lower than those of babies on the cow's milk formula at the end of the trial. Until more work has been done, we suggest that soy formulas should be employed with caution in the feeding of small preterm infants.     

Effects of Nutrients in Human Milk on the Recipient Premature Infant

As the rate of survival of premature infants isincreasing, more attention is necessarily focused onimproving the quality of survival through optimalnutritional management. The nutritional needs of the premature infant are greater than at any othertime in the life cycle. The benefits of human milk forterm infants are well known. Emerging data suggest thathuman milk may especially benefit the premature infant. The human milk-fed premature infant mayexperience improved health (such as lower rates ofinfection and necrotizing enterocolitis),gastrointestinal function, and neurodevelopment. Thesefactors may outweigh the concerns about adequategrowth, nutrient accretion, and biochemical indices ofnutritional status attributed to the lower nutrientcontent of human milk compared with preterm formula.Some of the nutritional concerns may be met by theuse of multinutrient supplements during the time infantsreceive tube-feeding, generally the time prior toattaining complete oral feeding in-hospital. The available data suggest that the quality ofsurvival of premature infants can be improved, both inthe short-term and long-term, through the feeding ofhuman milk.     

Vascular basis of mucosal color

Background

It has been hypothesized that prematurity and adjunctive neonatal care is 'a priori' a risk for disturbances of palatal and orofacial development which increases the need for later orthodontic or orthognathic treatment. As results on late consequences of prematurity are consistently contradictory, the necessity exists for a fundamental analysis of existing methodologies, confounding factors, and outcomes of studies on palatal development in preterm and low birthweight infants.

Method

A search of the literature was conducted based on Cochrane search strategies including sources in English, German, and French. Original data were recalculated from studies which primarily dealt with both preterm and term infants. The extracted data, especially those from non-English paper sources, were provided unfiltered in tables for comparison (Parts 1 and 2).

Results

Morphology assessment of the infant palate is subject to non-standardized visual and metrical measurements. Most methodologies are inadequate for measuring a three-dimensional shape. Several confounding factors were identified as causes contributing to disturbances of palatal and orofacial development.

Conclusion

Taking into account the abovementioned shortcomings, the following conclusions may be drawn for practitioners and prospective investigators of clinical studies. 1) The lack of uniformity in the anatomical nomenclature of the infant's palate underlines the need for a uniform definition. 2) Metrically, non-intubated preterm infants do not exhibit different palatal width or height compared to matched term infants up to the corrected age of three months. Beyond that age, no data on the subject are currently available. 3) Oral intubation does not invariably alter palatal morphology of preterm and low birthweight infants. 4) The findings on palatal grooving, height, and asymmetry as a consequence of orotracheal intubation up to the age of 11 years are inconsistent. 5) Metrically, the palates of orally intubated infants remain narrower posteriorly, beginning at the second deciduous molar, until the age of 11 years. Beyond that age, no data on the subject are currently available. 6) There is a definite need for further, especially metrical, longitudinal and controlled trials on palatal morphology of preterm and low birthweight infants with reliable measuring techniques. 7) None of the raised confounding factors for developmental disturbances may be excluded until evident results are presented. Thus, early orthodontic and logopedic control of formerly premature infants is recommended up to the late mixed dentition stage.     

母乳喂养中添加辅食的状况及影响过早添加辅食的因素分析

本研究运用对上海两个市区和两个郊县４０３０名产妇产后１５个月的随访资料,探讨婴儿辅食的添加规律（包括时间、原因、建议者）及影响过早添加辅食的可能因素。结果：（１）大部分婴儿在出生后都过早地添加了辅食,出生１～４个月添加辅食的概率分别为６７．００％、７９．２７％、８５．５８％和９２．５８％;（２）在各类辅食中,水和乳类辅食的开始添加时间最早,出生后１个月时已分别高达４５．２６％和４０．７２;（３）大部分辅食（水、果汁类和淀粉类）的添加原因主要是出于婴儿营养和健康的考虑,添加乳类辅食的主要原因则是母乳不足。添加辅食的建议者主要是婴儿的母亲本人,但乳母的父母和医务人员也起着一定的作用;（４）城镇户籍的母亲、接受过哺乳宣教和剖宫产是促使婴儿过早添加辅食的因素;进行哺乳咨询、查阅有关哺乳书籍、无从获得哺乳知识和女性婴儿是防止过早给婴儿添加辅食的因素。提示：纠正人们对添加辅食的错误认识,避免在婴儿未满４个月时过早添加辅食,是母乳喂养工作中的重点。     

Quantitative Ultrasound Measurements in Premature Infants at 1 Year of Age: The Effects of Antenatal Administered Corticosteroids

The aim of this study was to evaluate the effects of antenatally administered glucocorticoids on bone status of preterm infants at 1 year corrected age. The study population consisted of 32 preterm infants with a gestational age of 24-34 weeks. The infants were divided into two groups according to antenatal exposure to corticosteroids. Quantitative ultrasound (QUS) assessment of bone was performed in the study infants at the corrected age of 1 year. Blood levels of carboxy-terminal propeptide of type I procollagen (PICP) and carboxy-terminal telopeptide of type I collagen (ICTP) were measured at birth and at 1 year corrected age. Levels of PICP and ICTP were significantly lower at birth in corticosteroid-exposed neonates (P < 0.05). At corrected age of 12 months ICTP levels remained significantly lower in corticosteroid-exposed infants, but we found no significant difference in levels of the bone-formation marker PICP between corticosteroid-exposed and nonexposed infants. In the majority of participant preterm infants bone speed of sound (SOS) was within age-adjusted normal values of full-term infants. There was no significant difference in bone SOS between exposed and nonexposed infants at corrected age of 12 months. There was no correlation between SOS and levels of bone markers. The results of our study indicate that, despite the suppression of fetal bone turnover at birth in corticosteroid-exposed infants, antenatal glucocorticoid treatment seems to have no long-term impact on bone status of preterm infants assessed by QUS complementary to measurement of bone-turnover markers at 1 year corrected age.