新生儿抚触联合非营养性吸吮治疗早产儿喂养不耐受39例分析

目的观察新生儿抚触联合非营养性吸吮、口服红霉素或口服西沙必利3种方法治疗早产儿喂养不耐受的疗效比较。方法将2006年5月至2010年5月河南省安阳市人民医院120例喂养不耐受早产儿随机分为红霉素组43例,西沙必利组38例和新生儿抚触联合非营养性吸吮组(简称抚触联合吸吮组)39例。3组均给予保温、体位疗法、部分静脉营养及改善喂养策略等常规治疗。红霉素组在常规治疗基础上加用红霉素每次2.5mg/kg每6h1次口服;西沙必利组在常规治疗基础上加用西沙必利每次0.1mg/kg,每6h1次进食前30min口服;新生儿抚触联合非营养性吸吮组在常规治疗基础上给予新生儿抚触和非营养性吸吮,疗程均为3～5d。结果 3组患儿在病程和呕吐时间、胃残余、平均增加体重、日增加奶量比较,差异无统计学意义(P>0.05)。结论新生儿抚触联合非营养性吸吮组与红霉素组,西沙必利组治疗早产儿喂养不耐受疗效相当,临床可适当减少对早产儿喂养不耐受的药物治疗,为早产儿喂养不耐受的适度医疗提供临床依据。     

非药物治疗缓解新生儿疼痛效果比较

目的 探讨不同干预方法缓解新生儿疼痛的效果.方法 将160例住院新生儿随机分为对照组(未干预组)、拥抱抚触(TTS)组、吸吮8％葡萄糖水(GS)组和非营养性吸吮(NNS)组各40例,在采足跟血疼痛刺激前、刺激后20 s、1min、2 min、3 min分别记录心率、呼吸频率、经皮氧饱和度和哭声持续时间.结果 穿刺后20 s各组心率、穿刺后1 min各组呼吸均较穿刺前增快,差异有统计学意义(P＜0.01);1 min时TTS组心率恢复至穿刺前水平;2 min时TTS组呼吸频率,GS组和NNS组心率和呼吸频率恢复至穿刺前水平;3 min时对照组恢复至穿刺前水平.各组经皮血氧饱和度穿刺前后差异无统计学意义(P＞0.05).穿刺后哭声持续时间TTS组、GS组和NNS组均短于对照组,差异有统计学意义(P＜0.01),且TTS组哭声持续时间短于GS组和NNS组(P＜0.05).结论 新生儿对急性疼痛很敏感,TTS、吸吮GS和NNS对新生儿均有明显止痛作用,可在临床治疗护理中应用,以减轻新生儿操作性疼痛.     

新生儿边缘型维生素A缺乏临床分析

目的分析新生儿与孕妇妊娠晚期维生素A(VA)水平是否具有相关性,对比不同喂养方式的新生儿VA水平状况,探讨边缘型VA缺乏(MVAD)的治疗效果。方法分析2015年5月至2017年5月在沈阳医学院附属中心医院均接受静脉采血行VA检查的妊娠晚期孕妇与新生儿病例各357例,其中MVAD的新生儿251例,VA水平正常的新生儿106例,分析不同喂养方式下MVAD的发病率,随访观察不同喂养方式下MVAD的有效率。结果 (1)妊娠晚期孕妇与新生儿的VA水平具有相关性(r=0.307,P0.01);(2)MVAD新生儿生后1.5个月母乳喂养组中母子同服者治疗有效率为93.75%,人工喂养组为83.33%,单一新生儿给药者为66.67%。(3)血清VA水平正常的新生儿(未干预)生后1.5个月母乳喂养新生儿MVAD发病率为67.34%;人工喂养为33.33%,混合喂养为36.36%,母乳喂养的发病率高于人工喂养,差异具有统计学意义(P0.05)。(4)给予VA口服干预治疗,生后4.5个月总体MVAD发病率明显下降(χ2=9.353,P0.002)。结论新生儿MVAD与妊娠晚期孕妇VA水平密切相关,VA的检测应作为孕妇和新生儿的常规检查;母乳喂养的新生儿MVAD的发病率较高,应作为重点干预对象;尽早给予VA口服可提高MVAD的治疗有效率,降低发病率。     

非营养性吸吮对早产儿营养及胃肠道转运时间的影响

目的　评估非营养性吸吮 (NNS)对早产儿营养、胃肠道转运时间 (WGTT)及喂养相关并发症的影响。方法　将 3 8例需经鼻胃管喂养 (INGF)的健康早产适于胎龄儿 (出生体重 10 5 0～1790g) ,根据是否辅以非营养性吸吮随机分成单纯鼻胃管喂养组和非营养性吸吮组 ,用同一种配方乳喂养。记录喂养 2周的生长发育指标 (体重、身长、头围 )的变化及恢复出生体重的时间 ;入液量、奶量、热能、肠道营养热能达 418 4kJ/(kg·d)的时间、鼻胃管留置时间 ;大便次数、性状 ;喂养相关并发症 ;测定胃肠道转运时间。结果　非营养性吸吮组恢复出生体重时间 [( 8 8± 3 7)d]较单纯鼻胃管喂养组 [( 11 1± 3 0 )d]显著缩短 (P <0 0 5 ) ;喂养前及 2周后体重、身长、头围的变化差异无显著性 (P>0 0 5 )。非营养性吸吮组肠道营养热能达 418 4kJ/(kg·d)的时间 [( 12 3± 5 1)d]较单纯鼻胃管喂养组 [( 15 7± 5 2 )d]明显缩短 (P <0 0 5 ) ;鼻胃管留置时间 [( 13± 10 )d]缩短 4d [( 17± 12 )d],但差异无显著性 (P >0 0 5 )。非营养性吸吮组胃残留的发生率 ( 16 7% )较单纯鼻胃管喂养组 ( 5 0 % )显著减少(P <0 0 5 ) ,两组其他并发症的发生率差异无显著性 (P >0 0 5 ) ;非营养性吸吮组第 2周的全胃肠道转运时间 [( 3 3     

重危早产儿早期间歇胃管喂养的临床观察

目的：探讨重危早产儿早期间歇胃管喂养的临床效果。方法：对96例重危早产儿随机分为对照组(n=46),观察组(n=50),对照组采用静脉补充营养,直至有吞咽功能再用滴管喂养;观察组施行经口插入胃管间歇喂养直至有自行吸吮,并采用放射免疫法对患儿在喂养前后测定血清胃泌素。结果：治疗前后体重增长分别为对照组(490±200) g、观察组(722±165) g,两组比较有显著性差异(t=6.17,P<0.01)。平均每日体重增长对照组为(12.6±7.6) g,观察组(22.2±8.1) g,两组比较有显著性差异(t=5.96,P<0.01)。观察组血清胃泌素显著升高。结论：早期间歇胃管喂养能引起患儿血清胃泌素浓度显著增高,刺激胃肠粘膜的生长,促进胃蠕动。体重增加较对照组明显,可减少并发症的发生,缩短住院日、降低费用。     

出院后喂养方式对早产低出生体重儿生后3个月生长指标增长率的影响

目的：通过研究早产儿出院后配方奶（PDF）与母乳（BM）、足月儿配方奶（TF）等不同喂养方式对早产低出生体重儿（LBWI）出院至生后3个月时的体重、身长、头围等生长指标增长率的影响,为早产LBWI出院后喂养方式的选择提供参考。方法：广东省广州市、佛山市10家医院新生儿科出院的407例早产LBWI按照出院后喂养方式的不同,分为PDF组（n=258）、BM组（n=58）、TF组（n=91）,观察各组在生后3个月时的体重、身长、头围等生长指标值,并计算和比较各生长指标较出生时的增长率。结果：PDF组在生后3个月时的体重、身长和头围分别大于BM组和TF组（P＜0.05）;体重和身长增长率分别大于BM组和TF组（P＜0.05）。结论：出院后予PDF喂养能使早产LBWI在生后3个月时的体重、身长增长率较BM、TF喂养者更大,从而具有较大的体重、身长值,但远期效果有待进一步研究。     

新生儿及新生儿疾病

05 1 3 67　妊娠期肝内胆汁瘀积症对新生儿的影响 /黄英∥临床儿科杂志 .-2 0 0 4,2 2 (7) .-460～ 461将 48例由妊娠期肝内胆汁淤积症 (ICP)产妇所生新生儿与健康产妇所生儿对比。结果 :ICP组新生儿全部为剖宫产儿 ,难产率较对照组明显升高 (P<0 .0 1 ) ,产时窒息率、高胆红素血症率、患病率均高于对照组 (P<0 .0 5 ) ,出生 42 d时 ICP组仍有 1例未通过听力测试。表 1参 1 0(何燕 )0 5 1 3 68　非营养性吸吮改善早产儿胃肠喂养不耐受临床观察 /沈俊海∥临床儿科杂志 .-2 0 0 4,2 2 (7) .-462～4633 8例早产儿喂养办法 :1非营养性吸吮 …     

枸橼酸咖啡因治疗早产儿呼吸暂停临床应用观察

目的探讨枸橼酸咖啡因治疗早产儿呼吸暂停的安全性及有效性。方法回顾性分析我院2012年12月至2014年10月收治的60例胎龄28~32周呼吸暂停早产儿,按治疗方式不同分别纳入枸橼酸咖啡因组和氨茶碱组各30例。对比分析两组呼吸暂停治疗有效率,以及腹胀、心率增快、喂养不耐受、胃潴留、支气管肺发育不良(BPD)发生率。结果枸橼酸咖啡因组治疗有效21例(70.0%),氨茶碱组治疗有效20例(66.7%),差异无统计学意义(P>0.05)。枸橼酸咖啡因组BPD、腹胀、心率增快、喂养不耐受、胃潴留发生率均低于氨茶碱组(16.7%比40.0%、13.3%比36.7%、6.7%比53.3%、10.0%比33.3%、16.7%比43.3%),差异有统计学意义(P<0.05)。结论枸橼酸咖啡因治疗早产儿呼吸暂停临床效果与氨茶碱相似,但其不良反应发生率明显降低。     

非营养性吸吮在机械通气治疗早产儿中的应用

目的：探讨非营养性吸吮在需要机械通气辅助治疗的早产儿中的作用。方法：将68例需要机械通气辅助治疗的早产儿随机分为观察组（n=35）和对照组（n=33）。观察组进行非营养性吸吮,对照组不进行非营养性吸吮。比较两组患儿达全胃肠道喂养时间、恢复至出生体重时间、体重增长速度、住院时间、喂养耐受性、机械通气并发症等。结果：与对照组比较,观察组达全胃肠道营养时间及住院时间缩短（P0.05）。结论：在需要机械通气治疗的早产儿中采用非营养性吸吮可加快其生长发育速度、缩短住院时间,并能提高喂养耐受性,而机械通气并发症发生率没有上升。     

甲状腺功能异常的新生儿寒冷损伤综合征早期干预效果

目的探讨甲状腺素片早期干预治疗新生儿寒冷损伤综合征并甲状腺功能异常的效果。方法将246例患儿随机分为甲状腺素片治疗组(n1=126)和对照组(n2=120),治疗组口服甲状腺素片5mg/(kg·d),分2次口服,持续5d。对照组按常规治疗。所有患儿均采静脉血作甲状腺5项测定。结果两组心率提升、食乳量增长、神经反射灵敏度、硬肿、水肿消退时间、住院天数,经统计学处理,均有显著差异(P均<0.05)。结论早期口服甲状腺素片干预治疗有助于新生儿寒冷损伤综合征并甲状腺功能异常患儿的早日康复。     

Effect of oral glucose on the heart rate of healthy newborns

AIM: Increases in heart rate have been widely utilized as pain responses in different studies. In a previous study, we found an increase in heart rate in newborns when they received glucose as pain relief. Other research groups have shown a smaller increase in heart rate on administration of sweet solutions. We therefore investigated the question as to whether or not oral glucose itself can cause an increased heart rate in healthy infants. METHOD: This was a randomized, controlled, double-blind study comprising 70 healthy newborns. They were randomly allocated to receive 1 ml 30% glucose or 1 ml placebo solution (sterile water) orally without undergoing any painful procedure. The heart rate was recorded during and at different times after this administration. RESULTS: The heart rate was significantly higher in the glucose than in the placebo group (p = 0.020). The highest heart rate was noted during treatment, and the heart rate subsequently decreased in both groups (p = 0.002). CONCLUSION: Oral glucose causes an increase in heart rate in healthy newborns not undergoing any painful intervention.     

Oral glucose and venepuncture reduce blood sampling pain in newborns.

The objectives of this study were to measure pain symptoms in healthy fullterm newborns undergoing routine blood sampling with different methods. The 120 study subjects were randomly allocated to one of four groups with 30 babies in each, namely venepuncture or heel stick, with or without oral glucose administration. Pain was assessed from the duration of crying within the first 3 min, the Premature Infant Pain Profile (PIPP) and changes in heart rate. When the babies received 1 ml 30% glucose prior to skin puncture there was no significant difference between the heel stick and venepuncture group either in mean crying time (12.9 and 11.6 s, respectively) or in PIPP score (3.9 and 3.3). When no glucose was given crying time was 57.3 s in the heel stick group and 26.8 s in the venepuncture group (P = 0.0041) and the mean PIPP scores were 8.4 and 6.0, respectively (P = 0.0458). This study suggests that if oral glucose is given prior to skin puncture the choice of blood sampling method has no impact on the pain symptoms.     

Differentiation of healthy newborns and newborns-at-risk by spectral analysis of heart rate fluctuations and respiratory movements

Neonatal heart rate and its interaction with respiration were computerized by spectral and coherence analysis (FFT) to differentiate healthy newborns (n = 9) from newborns with mild neonatal risk (n = 20). An increased mean heart rate and decreased total variability have been found in newborns-at-risk. Respiratory Sinus Arrhythmia is diminished in newborns-at-risk possibly caused by an impairment of autonomic brain stem function. Furthermore, Respiratory Sinus Arrhythmia holds a central position in differentiating healthy newborns and newborns-at-risk with and without neurological abnormalities during the first year of life. Respiratory Sinus Arrhythmia is diminished in newborns-at-risk showing these abnormalities. None of the parameters discriminates between the two groups of risk infants. The final prognostic value of our results must be confirmed in further clinical follow-up examinations.     

Glucose or sucrose as an analgesic for newborns: a randomised controlled blind trial

BACKGROUND: To evaluate the effect of different oral glucose or sucrose solutions on the pain response to heelstick in newborns. METHODS: DESIGN: randomised double blind placebo controlled trial of water (control) versus one of three solutions of glucose - namely 5, 33 and 50% - or one of two solutions of sucrose (33% and 50%) or nothing. SETTING: postnatal ward. PATIENTS: seven groups of 20 healthy newborns (gestational age 38-41, weighing over 2500 g) were randomised to receive 2 ml of one of the six solutions on the tongue inmediately before heelstick procedure. Main outcome measure: heart rate before, during and three minutes after the procedure. RESULTS: Even if the trend of the cardiac rates did not reach statistic significance, glucose solution 33 and 50% proved to be the most effective in reducing pain response. CONCLUSIONS: Sweet solutions may be an easy, useful, safe and cheap analgesic for minor invasive procedures in newborns.     

A controlled clinical trial of local anesthesia for lumbar punctures in newborns

To evaluate the efficacy of subcutaneous administration of lidocaine for reducing physiologic instability in acutely ill newborns during clinically required procedures, 81 neonates who required lumbar punctures within the first month of life were stratified by birth weight and respiratory support and randomly assigned to an experimental or a control group. The experimental group received an injection of 0.1 mL/kg of 1% lidocaine prior to the lumbar puncture. The control group received a nonanesthetized lumbar puncture without placebo. Changes in heart rate, respiratory rate, transcutaneous oxygen and carbon dioxide tensions, and heart rate variability from baseline, preparatory (positioning/handling), lumbar puncture, and recovery periods were measured. The administration of lidocaine did not minimize physiologic instability in response to the lumbar puncture nor was it associated with any detectable adverse effects other than prolonging the duration of the lumbar puncture. Although significant physiologic changes were observed in response to preparatory procedures, few additional changes beyond those occurred in response to lumbar punctures in either the experimental or control group. It is concluded that local anesthesia failed to influence manifestations of physiologic instability during neonatal lumbar punctures and that preparatory procedures were more destabilizing than either the administration of lidocaine or the lumbar puncture itself. The results suggest that the management of newborns requires emphasis on minimizing the destabilizing effects of required and frequent handling procedures.     

A CONTROLLED TRIAL ON THERAPY FOR NEWBORNS WEIGHING 750-1 250 g

A controlled therapeutic trial was performed in newborns with birthweight of 750-1 250 g. 40 infants (the “treatment” group) received an i.v. infusion with glucose and NaHCO₃ from the 1st to the 4th-7th day of life, and increasing amounts of human milk from the 2nd day of life. They also received, during the newborn period, 3 antibiotics (sodium penicillin G 500 000 U + methicillin 100 mg + colistin sulf. 8 mg per kg/day), a gamma globulin preparation (0.5 ml/day for 3 days) and fresh human plasma (3 ml every 2nd day in the first 5 days of birth). 40 infants (the “control” group) received only oral feeding with 10% glucose and human milk, starting in the 2nd day of life, and i.m. kanamycin (20 mg/kg/day for 5 days). No difference between treated and control babies was observed with respect to the following findings: neonatal mortality rate and survival curve on the whole series; neonatal mortality rate in babies with birthweight above or below 1.04 kg, with gestational age below 28 weeks, with above or below median respiratory rate or arterial pH on admission, with or without marked abnormality on chest film, and in males or females (but, in subjects with gestational age above 27 weeks, a significantly lower mortality rate was found in controls); postmortem findings; incidence of apnoeic spells, tremors and cloni, and pattern of muscular tonus. Bradycardia associated with 2: 1 atrioventricular block was observed in 6 controls in the 2nd day of birth. No adverse effects presumably due to the therapeutic procedures so contrasted were demonstrated. It was concluded that in the present series of newborns with very low weight: (a) the massive anti-infectious therapy was not superior to the administration of a single broadspectrum antibiotic; (b) the administration of fresh human plasma was not effective in preventing hemorrhage (but further evaluation is needed); (c) the routine i.v. infusion with glucose and NaHCO₃ did not improve neonatal survival as compared with oral feeding. However, previous studies, as well as observations on the present series reported elsewhere (11), have shown that several biochemical abnormalities commonly seen in orally fed newborns with very low weight can be prevented or corrected, at least in part, by the early infusion with glucose and NaHCO₃. Since some of these abnormalities are potentially dangerous to the central nervous system, the final evaluation of this therapy must await long-term follow-up studies in survivors. It is therefore suggested that, before such studies are available, the early i.v. infusion with glucose and NaHCO₃ should be given routinely to newborns with very low weight.     

头颅CT影像在判断新生儿缺氧性脑损伤时的作用

目的：围生期缺氧可致新生儿脑损伤。该文探讨头颅CT对新生儿缺氧后脑损伤程度判断的作用。方法：收集有缺氧过程的足月新生儿114例,分为HIE组、窒息组、窘迫组;取同期正常新生儿20例为对照组,于生后2~7d做头部CT检测及NBNA评分。结果：HIE组、窒息组、窘迫组、对照组NBNA评分异常率及组间NBNA评分分值比较差异有显著性(均P<0.05)。4组间CT异常率比较及HIE组与其他3组CT异常率比较差异有显著性(均P<0.01),对照组、窘迫组、窒息组之间两两比较CT异常率没有差异(均P>0.05)。HIE组25例患儿中,临床分度为轻度HIE15例,中度HIE6例,重度HIE4例。CT分度为正常3例,轻度10例,中度7例、重度5例。HIE的CT分度与临床分度不完全吻合。CT对于轻、中、重度HIE诊断的灵敏度分别为47%,33%,50%,特异度为70%,74%,86%,准确度为48%,64%,80%。结论：头颅CT对HIE临床分度的判断存在不确定性,对宫内窘迫、窒息所致轻微脑损伤的判断更无把握。     

Effects of bathing immediately after birth on early neonatal adaptation and morbidity: A prospective randomized comparative study

OBJECTIVE: Because the risks and benefits of early bathing of newborn infants are not well established, we investigated the effects of bathing immediately after birth on rectal temperature, respiratory rate, heart rate, blood pressure, percutaneous arterial blood oxygen saturation (SpO2) and early neonatal morbidity. METHODS: The study was designed as a randomized prospective comparative study in the neonatal care unit of a university hospital. A total of 187 healthy term and near-term newborn infants, who were delivered vaginally without asphyxia, between January and December 1997 were the study subjects. We compared findings in newborns who were bathed 2-5 min after birth (n = 95) with those of a control group (n = 92) who received dry care instead. Groups were comparable with respect to gestational age, birthweight, male: female ratio, Apgar score and umbilical blood pH. Rectal temperature was measured with an electronic thermometer immediately before the intervention bathing or dry care and at 30 min and 1, 2, 3, 8 and 12 h after birth. Heart rate, respiratory rate, systolic and diastolic blood pressure and SpO2 were measured at 1, 2, 8 and 12 h after birth. The incidence of early neonatal morbidity, including hyperbilirubinemia and gastrointestinal and respiratory problems, was also compared. RESULTS: Rectal temperature changed over time postnatally in both groups (P < 0.0001, ANOVA) and there was a significant difference in rectal temperature between groups (P< 0.0001, ANOVA). Mean (+/- SEM) rectal temperature at 30 min after birth (i.e. approximately within 20 min after intervention) was significantly higher in the bathed group than in the control (dry care) group (37.30 +/- 0.06 is 37.00 +/- 0.05 degrees C, respectively; P = 0.000022). Respiratory rate, heart rate, blood pressure and the ratio of the number of infants with SpO2 90-94% and 95-100% did not differ significantly between the two groups. The incidence of early neonatal morbidity, including vomiting, acute gastric mucosal lesion, polycythemia, need for tube feeding, phototherapy and oxygen therapy, also did not differ between the two groups. CONCLUSIONS: Early bathing, minutes after birth, did not appear to adversely affect the adaptation of healthy full-term and near-term newborn infants.     

Gastric emptying in premature newborns with acute respiratory distress

OBJECTIVES: The authors hypothesized that acute respiratory distress (ARD) delays gastric emptying. The objective was to test this hypothesis by assessing gastric emptying on the second and seventh days of life in premature infants with ARD resulting from pulmonary disease. METHODS: Thirty-nine newborns with ARD starting on the first day of life were selected and paired with 39 healthy control newborns matched by weight (within 250 g). Gestational age was 相似文献   

Maternal compliance with nutritional recommendations in an allergy preventive programme

Aims: To assess maternal compliance with nutritional recommendations in an allergy preventive programme, and identify factors influencing compliance behaviour. Methods: Randomised double-blind intervention study on the effect of infant formulas with reduced allergenicity in healthy, term newborns at risk of atopy. Maternal compliance with dietary recommendations concerning milk and solid food feeding was categorised. Results: A total of 2252 newborns were randomised to one of four study formulas. The drop out rate during the first year of life was 13.5% (n = 304). The rates of high, medium, and low compliance to milk feeding during weeks 1–16 were 83.4%, 4.0%, and 7.5%; the corresponding rates to solid food feeding during weeks 1–24 were 60.0%, 12.1%, and 22.9%. In 5.1% of subjects no nutritional information was available. Low compliance was more frequent among non-German parents, parents with a low level of education, young mothers, smoking mothers, and those who weaned their infant before the age of 2 months. Conclusions: Evaluation of allergy preventive programmes should take into account non-compliance for assessing the preventive effectiveness on study outcome.