足月儿与早产儿排尿方式的比较研究

目的 探讨足月儿与早产儿出生后排尿方式的不同.方法 选取2010年3月至5月人住郑州大学第一附属医院新生儿室的出生后3～7d足月儿12例与早产儿14例作为研究对象,足月儿孕(38.3±1.1)周,体重(3.1±0.4)kg,早产儿孕(32.5±1.6)周,体重(1.7±0.4)kg.观察新生儿在12 h内(上午9点至晚上9点)的自由排尿情况,记录每次排尿量、残余尿量、排尿时的意识状态(清醒/睡眠)、排尿次数及排尿时间等参数,同时记录饮奶量、液体输入量及摄入时间,液体摄人量按标准进行.每次排尿量等于排尿后尿垫重量减去排尿前尿垫重量,残余尿量由超声检测仪测得.共观察记录了220例次.结果 每次排尿量、残余尿量、排尿次数、排尿时意识清醒状态百分比在足月儿分别为(19.8±10.9)ml、(1.55±1.01)ml、(7.2±1.9)次、(43.5±26.8)%,而在早产儿则分别为(11.1±7.5)ml、(1.82±0.88)ml、(9.6±2.5)次、(24.7±19.1)%.二组数据相比,早产儿的每次排尿量及排尿时意识清醒状态百分比小于足月儿,残余尿量及排尿次数大于足月儿,均具有统计学差异(P＜0.05).结论 足月儿与早产儿排尿方式明显不同,提示足月儿膀胱功能的发育优于早产儿,早产儿膀胱功能及其受控制的神经系统发育较足月儿明显延迟.

Abstract：

Objective To study the voiding patterns of term and preterm newborns.Methods Between March 2010 and May 2010,26 hospitalized newborns aged 3 to 7 days at this center were recruited in this study.In these patients,12 were term newborns,with an average gestational age of (38.3 ± 1.1 ) weeks,weight of (3.1 ± 0.4) kg,14 were preterm newborns with an average gestational age of (32.5 ± 1.6) weeks,and weight of (1.7 ± 0.4) kg.The voiding volumes (VV),post-void residual volumes (PRV),state of consciousness at voiding,voiding time (VT),voiding frequency (VF)in 12 hours as well as the volume of milk and liquid fed in the same time frame were recorded and analyzed retrospectively.Results In the term newborns,the VV and consciousness voiding rate were significantly higher compared with the preterm newborns [VV and consciousness voiding rate,( 19.8 ±10.9) ml (43.5 ± 26.8%) vs (11.1 ± 7.5) ml (24.7 ± 19.1 %),P＜0.05].However,the PRV and VF were significant lower in term newborns [PRV and VF,(1.55 ± 1.01 ) ml (7.2 ± 1.9) times vs (1.82 ± 0.88) ml (9.6 ± 2.5) times,P＜0.05].Conclusions Incomplete voiding pattern exists in term and preterm newborns.The better urodynamic parameters of the term newborns indicate the term newborns have better mature bladder function than preterm newborns.     

Voiding pattern of term newborns with hyperbilirubinemia

目的 探讨不同程度高胆红素血症对新生儿排尿方式的影响.方法 选取出生后4～15d确诊为高胆红素血症新生儿33例,根据不同血清总胆红素(Tbil)水平,分为轻中度高胆组(mild to moderate hyperbilirubinemia,MHB)和重度高胆组(severe hyperbilirubinemia,SHB).其中MHB组18例,胎龄(38.6±2.1)周,体重(3.1±0.3)kg; SHB组15例,胎龄(38.9±1.8)周,体重(3.4±0.4) kg.连续4h观察新生儿排尿,记录排尿次数、每次尿量、残余尿量、排尿时觉醒状态.同时选取胆红素水平正常新生儿19例为对照组.比较各组参数的差异.结果 SHB组排尿次数和残余尿量分别为(3.3±1.1)次和(1.8±0.5) ml,显著高于正常组[(2.7±0.8)次和(1.3±0.8)ml]和MHB组[(2.7±0.8)次,(1.4±(0.7) ml],(P＜0.05);平均每次排尿量(23.1±8.3)ml明显低于正常组(27.8±7.3) ml和MHB组(26.9±5.6) ml,(P＜0.05).排尿时清醒状态百分比在三组之间无统计学差异(P＞0.05).结论 SHB新生儿排尿方式明显改变.排尿方式的改变是否与重度高胆红素血症影响新生儿排尿中枢有关有待进一步研究.     

不同性别新生儿排尿参数的差异

目的 了解不同性别新生儿排尿参数的差异.方法 选取2010年3月至2011年3月新生儿室出生3～7d的54例早产儿(男26例,女28例)和48例足月儿(男30例,女18例)作为研究对象,连续观察12 h(9:00 Am-9:00 Pm)的自由排尿情况.记录每次排尿时间、排尿量、残余尿量(PRV)、是否伴排大便、排尿时觉醒状态等参数；并记录液体总入量.比较不同性别新生儿排尿间隔时间、最大膀胱容量、膀胱排空率(BER)等参数.结果 54例早产儿共排尿318次(男156次,女162次),其中排尿时伴排大便40次(男16次,女24次).男女早产儿PRV、BER比较差异均有统计学意义[(1.9±0.9)mL比(0.9±0.8) mL和8.3％比44.1％,P均＜0.01],但排除BER的影响后,男女早产儿PRV为(2.1±0.5)mL比(1.8±0.6) mL,差异无统计学意义；48例足月儿排尿350次(男222次,女128次),其中43次排尿时伴排大便(男32次,女11次).男女足月儿BER比较差异有统计学意义(15.3％比43.0％,P＜0.0001)；排尿伴排大便时,男女早产儿及足月儿BER比较(25.0％比41.7％,28.1％比36.4％),差异均无统计学意义(P均＞0.05).结论 和女童相比,男童新生儿更易发生排尿后膀胱残余尿现象.     

脑室周围-脑室内出血对早产儿排尿方式的影响

目的 探讨脑室周围-脑室内出血(PIVH)对早产儿排尿方式的影响.方法 31例胎龄在32～36周适于胎龄早产儿分为两组,正常组16例,胎龄(34.2±1.1)周,日龄(11±2)d;PIVH组15例,胎龄(34.1±1.1)周,日龄(11±1)d进行连续8h自由排尿观察,记录每组早产儿在观察时间内的排尿次数、每次排尿量、残余尿量、清醒排尿及间断排尿,对两组早产儿排尿参数进行统计学分析.结果 PIVH组早产儿残余尿量显著高于正常组[(2.4±0.8)ml比(2.0±0.7)ml](P＜0.05),清醒排尿比例显著低于正常组[(35±6)％比(44±8)％](P＜0.05),PIVH组与正常组早产儿在观察时间内的排尿次数[(7.4±1.0)比(7.2±1.0)]、每次排尿量[(15.6±5.7)ml比(16.5±6.0)ml]及间断排尿比例(47％比44％)差异均无统计学意义(P＞0.05).结论 脑室周围-脑室内出血对32～36周胎龄早产儿残余尿量及排尿时意识状态具有显著影响,提示脑室周围-脑室内出血早产儿排尿方式与正常早产儿存在差异.     

出生1～7 d早产儿12 h自由排尿观察

目的 探讨出生7 d内早产儿的自由排尿特点.方法 选取2010年3-5月在本院NICU住院的113例出生7 d内无疾病的单胎早产儿.男60例,女53例;胎龄32～36周[(34.0±1.9)周];体质量1.16～2.07 kg[(1.48±0.34) kg].据日龄分为7组(第1天组～第7天组).第1天组6例,第2天组11例,第3天组11例,第4天组18例,第5天组18例,第6天组26例,第7天组23例.每组均进行12 h(900-2100)自由排尿观察,记录排尿时间、每次排尿量, B超测量排尿后残余尿量,排尿时觉醒状态.结果 113例早产儿12 h共观察排尿745次.第1天组6例早产儿观察时段位于出生0.5～12.5 h,12 h内排尿1～4次[(2.8±1.2)次],其中5例出生4 h内无排尿.第3天组开始发现早产儿排尿前有手臂或大腿微动或排尿后啼哭现象.第2、3、4天组平均2.5 h排尿1次.第5、6、7天组平均不到2 h排尿1次.第1天组、第4天组、第7天组排尿次数、排尿量比较差异均有统计学意义(Pa<0.05).各组残余尿量比较差异均无统计学意义(Pa>0.05),膀胱排空率均低于30%.总体27.39%(204/745次)的排尿发生在清醒状态.间断排尿(10 min内排尿次数≥2)见于第2天组以后的早产儿,达70%(522/745次).结论 出生7 d内的早产儿中枢神经系统参与排尿不明显.每次排尿量及排尿次数变异较大,但有随日龄增加的趋势.     

出生时轻度窒息史对出生七天后新生儿排尿方式的影响

目的 探讨出生时轻度窒息对出生7 d后新生儿排尿方式的影响.方法 选取出生28 d内、无下尿路疾息的34例有轻度窒息病史的新生儿及33例无窒息史新生儿,其中窒息史组正常体重(ANW)16例,体重(2.83土0.31)kg,年龄(11.1±2.7)d;低体重(ALW)18例,体重(1.68±0.54)kg,年龄(14.5±7.6)d.无窒息史组正常体重(NANW)18例,体重(3.24±0.43)kg,年龄(11.8±2.2)d和低体重(NALW)15例,体重(1.88±0.32)kg,年龄(15±8.3)d.各组均进行12 h(9am～9 pm)自由排尿观察,记录排尿频率、每次排尿量、B超测量排尿后残余尿量、排尿时是否处于睡眠状态.结果 共记录排尿533次.ANW组排尿次数(9.5±2.7)次,明显高于NANW组(7.7±2.3)次(P＜0.05),但排尿量和残余尿量差异无统计学意义.ALW组与NALW组排尿次数、排尿量和残余尿量差异无统计学意义.ANW组排尿次数(9.5±2.7)次、排尿量(17.7±5.8)ml,明显高于ALW组(7.7±2.3)次,(13.5±6.1)ml,但残余尿量差异无统计学意义.NANW组排尿量(21.1±11.0)ml明显高于NALW组(13.1±6.2)ml(P＜0.05),但排尿次数和残余尿量差异无统计学意义.膀胱排空率和排尿时清醒百分率在ANW组和NANW组中均较高,二者差异不明显;在ALW组和NALW组中差异也不明显.结论 新生儿出生时轻度窒息史可能对正常体重儿排尿次数有明显影响;对新生儿排尿量和残余尿量影响不大.

Abstract：

Objective The aim of this study was to investigate the effect of mild asphyxiation (A) on voiding pattern of newborns. Methods A total of 67 newborns, 34 cases with mild asphyxiation and 33 cases normal, without low urinary tract pathological abnormalitiesdiseases, single birth,hospitalized in NICU were included in this study. They were divided into 4 groups: 16 cases of asphyxiation with normal weight(ANW), 18 cases of asphyxiation with low weight(ALW), 18 cases of no asphyxiation with normal weight (NANW)and 15 cases of no asphyxiation with low weight (NANW). Each group undertook 12 hours (9:00am ～9:00 pm) free voiding observation. We recorded, recording voiding time, the voiding volume, post-voiding residual urine (PVR) by B ultrasound, empty voiding and awake or sleep percentage at voiding. Results Five hundred and thirty three episodes of voiding were recorded. The voiding frequency in ANW (9. 5 ± 2. 7)times is higher than those of NANW(7. 7 ± 2. 3)times (P＜0. 05), but the voiding volume and PVR are no significant difference (P＞0. 05)between 2 groups. The voiding frequency, volume and PVR in ALW and NALW are no significant difference(P＞0.05). The voiding frequency and volume in ANW(9. 5 ± 2. 7)times, (17. 7± 5. 8)ml respectively is higher than ALW(7. 7 ± 2. 3)times, (13. 5 ± 6. 1 )ml (P＜0. 05), but PVR are no significant difference(P＞0. 05). The voiding volume in NANW (21.1 ± 11.0)ml is higher than NALW( 13. 1 ± 6. 2)ml(P＜0. 05), but the voiding frequency and PVR are no significant difference(P＞0. 05). Voiding empty and awake percentage is higher in ANW and NANW, but no significant difference; voiding empty and awake percentage in LNW and NALW are no significant difference.Conclusions Mild asphyxiation induced more voiding frequencies in ANW newborn but it has little impact on voiding volume, PVR, empty voiding percentage and awake voiding percentage in all newboms. Its mechanism is unclear.     

新生儿呼吸暂停与缺氧性脑损伤关系的研究

目的　探讨新生儿反复呼吸暂停与缺氧性脑损伤的关系。方法　对 78例反复呼吸暂停新生儿进行头颅CT扫描 ,其中足月儿 2 8例 ,早产儿 5 0例。观察缺氧性脑损伤的发生情况。结果　蛛网膜下腔出血 (SAH)2 5例 ,脑室内出血 (IVH) 10例 ,缺氧缺血性脑病 (HIE) 6例 ,HIE +SAH 8例 ,总阳性率为 6 2 .8%。早产儿组阳性率为 74% ,以颅内出血为主 ,足月儿组阳性率为 42 .8% ,以HIE及SAH为主。早产儿组与足月儿组比较差异有显著性意义 (P <0 .0 1)。结论　新生儿反复呼吸暂停 ,是新生儿出生后缺氧性脑损伤的早期表现之一。对此类新生儿尤其是早产儿进行头颅CT扫描 ,有助于脑损伤的早期诊断与治疗。     

新生儿排尿特性及血浆尿液渗透压变化

目的：探讨新生儿昼夜排尿特性、膀胱容量及血浆、尿液渗透压变化。方法：42例新生儿(男22例,女20例),根据日龄分为A,B,C 3组,3组日龄分别为～3 d,～7 d,>7d。记录昼夜排尿时间、尿量,以膀胱B超机测量膀胱残余尿量,以FM-6型全自动冰点渗透压仪测量血浆、尿液渗透压。结果：①A组昼夜尿量,排尿次数与B,C组比较,差异有显著性意义(P0.05)。③以逐步回归分析法建立估测膀胱最大容量的最优回归方程,膀胱最大容量=42±0.17X(ml),X为10 AM～6 PM尿量,F=15.561(P<0.01)。结论：正常新生儿膀胱稳定,几乎完全排空。新生儿肾脏浓缩功能无昼夜差异。     

新生儿缺氧缺血性脑病血清生长激素动态变化及临床意义研究

目的：探讨新生儿缺氧缺血性脑病(HIE)对生长激素(GH)的影响。方法：采用放射免疫法,检测40例窒息后新生儿缺氧缺血性脑病(HIE)及36例正常新生儿在生后2～4,24,48,96 h及7 d血清生长激素浓度。结果：轻度、中度HIE足月儿生后2～4 h GH水平分别为(49.536±11.068) ng/ml,(61.805±8.433) ng/ml明显高于对照组(22.409±11.360) ng/ml (P<0.01),重度HIE后2～4 h GH水平为(17.186±11.675) ng/ml明显低于对照组(P<0.01)。早产儿HIE生后2～4,24 h GH水平分别为(58.733±15.372) ng/ml,(38.919±10.286) ng/ml明显高于对照组(37.998±19.901) ng/ml,(24.072±14.697) ng/ml (P<0.01)。结论：早期测定血清GH水平对判断HIE程度具有重要意义。     

新生儿败血症血清降钙素原的动态改变

目的：探讨新生儿败血症患儿血中降钙素原(procalcitonin PCT)的改变。方法：以放免方法检测24例新生儿败血症患儿血中PCT的改变,同时检测20例缺血缺氧性脑病(HIE)以及16例正常足月儿作为正常对照。结果：新生儿败血症患儿在急性期PCT较正常对照组明显升高［(112.23±10.13) μg/L vs (8.65±2.14) μg/L］, (P0.05);而HIE组患儿PCT与正常对照组比较无明显的差别。结论：新生儿败血症患儿在急性期血中PCT明显增高,对败血症的早期诊断有一定的价值。     

积极的营养支持对住院期间早产儿的影响

目的 探讨生后早期积极的营养支持对住院期间早产儿的影响.方法 研究对象选择胎龄大于28周出生体重1000 g至2000 g、生后12 h内转入我院NICU、住院时间2周以上、无明显畸形且存活出院的早产儿,其中A组(2005年1月1日至2006年6月30日出生)81例,B组(2009年6月1日至2010年11月30日出生)79例.比较营养摄入、早产儿的生长速率及体重Z评分和血生化营养指标的差异.结果 B组生后第3、7天氨基酸用量明显高于A组[2.00(2.00,2.50) g/kg比1.50(1.50,2.00) g/kg,3.00(2.00,3.00) g/kg比2.00(1.80,2.60) g/kg,P均＜0.001].B组第3天奶量和总热卡摄入明显高于A组[9.41(2.66,18.74) ml/kg比14.47(4.23,30.77) ml/kg,P＜0.05,(64.87±16.04) kcal/kg比(55.62±17.68) kcal/kg,P=0.001].两组第1周后总热卡摄入相似.B组母乳强化剂使用率较前升高(62.8％比14.3％,P＜0.005).无论是出生体重1000～1499 g的早产儿,还是出生体重1500～2000 g的早产儿,B组生长速率均更快[(20.6±3.4)g/( kg·d)比(15.4±3.2)g/( kg·d),(20.3±9.1)g/(kg·d)比(14.3±4.9) g/(kg·d),P均＜0.001].A组生长迟缓的比例出院时较出生时增加(65.4％比40.7％,P＜0.05),B组差异无统计学意义.两组出生体重Z评分相似,而B组出院体重Z评分明显高于A组[(-1.24±0.79)比(-1.54±0.84),P＜0.05].出生时血清白蛋白、前白蛋白、尿素水平两组差异无统计学意义,而生后2周和出院前B组明显高于A组.结论 早产儿生后早期营养措施的改善有效促进了早产儿住院期间的生长和营养状况.     

托特罗定在小儿神经原性膀胱的应用评价

目的 评价托特罗定治疗小儿神经原性膀胱的有效性和安全性.方法 随访126例2002年1月至2009年9月收治的神经原性膀胱患儿,男71例,女55例,年龄(6.2±3.1)岁,全部病例行清洁间歇导尿,81例同时服用托特罗定(0.1 mg·kg-1·d-1,2次/d),45例未服用托特罗定.就诊时和治疗3个月后分别行尿动力学和临床评价.结果 导尿+药物组中8例因副作用终止治疗,其中3例出现口干,2例头晕,3例便秘加重,73例坚持服用托特罗定.就诊时导尿组膀胱容量、膀胱顺应性、逼尿肌压分别为(119.3±19.6)ml、(4.0±1.1)ml/cmH2O、(56.7±10.4)cmH2O.3个月后膀胱容量、膀胱顺应性、逼尿肌压压分别为(122.0±20.1)ml、(4.1±1.1)ml/cmH2O、(55.8±10.9)cmH2O,无明显变化.11例(24.4%)逼尿肌过度活动减轻,13例(28.9%)漏尿分数下降.药物+导尿组就诊时膀胱容量、膀胱顺应性、逼尿肌压分别为(119.8±17.6)ml、(4.4±1.3)ml/cmH2O、(55.1±11.7)cmH2O,3个月后膀胱容量、膀胱顺应性、逼尿肌压分别为(149.6±23.1)ml、(7.5±2.3)ml/cmH2O、(38.4±11.6)cmH2O,膀胱容量、膀胱顺应性明显增加,膀胱内压降低.58例(79.5%)逼尿肌过度活动减轻,53例(73%)漏尿分数下降及家长表示满意.结论 托特罗定可抑制逼尿肌过度活动,降低膀胱内压,增加膀胱顺应性和膀胱容量,较少有副作用,有利于保护上尿路功能,并可减轻尿失禁的程度,对于反射亢进型小儿神经原性膀胱的治疗是安全、有效的.

Abstract：

Objective To evaluate the efficacy and safety of tolteroding to treat neurogenic bladder in children. Methods 126 patients (71 boys and 55 girls of 6. 2 ± 3. 1 years old) with hyperreflexia neurogenic bladder who were treated during January 2002 to September 2009 were followed up. All patients were performed clean intermittent catheterization. 81 patients took tolterodine(0. 1mg· kg-1 ·d-1 ,2 times/d) and 45 patients did not use tolterodine. Urodynamic and leakage score were evaluated before the treatment and 3 months later. Results 8 patients stopped tolterodine due to side effect,such as dry mouth in 3, dizziness in 2, sever constipation in 3. 73 patients took tolterodine all the time. Before treatment, the bladder volume, compliance and detrusor pressure in catheterization group were 119. 3 ± 19. 6 ml、4. 0 ± 1. 1ml/cmH2O 、56. 7 ± 10. 4 cmH2O, respectively. Three months after the treatment, bladder volume, compliance and detrusor pressure were 122. 0 ± 20. 1 ml、4. 1 ± 1. 1ml/cmH2O 、 55. 8 ± 10. 9 cmH2O, respectively. There was no significant difference. Detrusor overactivity in 11 patients(24. 4％)and leakage score in 13 patients (28. 9％)decreased. Bladder volume, compliance and detrusor pressure in catheterization + tolterodine group in the beginning were 119. 8 ± 17. 6ml、4. 4 ± 1.3ml/cmH2O 、 55. 1 ± 11.7 cmH2O, respectively. 3 months later, bladder volume, compliance and detrusor pressure were 149. 6 ± 23. 1 ml、7. 5 ± 2. 3ml/cmH2O 、38. 4 ± 11.6 cmH2O, respectively. Bladder volume and compliance increased and detrusor pressure decreased significantly. Detrusor overactivity in 58 patients(79. 5％)and leakage score in 53 patients(73％)decreased. The parents satisfied with this result. Conclusions Tolterodine could inhibit the detrusor overactivity, so it could decrease detrusor pressure and increase bladder volume and compliance and protect kidney. It was effective to the children with hyperreflexia nerurogenic bladder.     

Characteristics of the bladder in infants with urinary tract infections: an ultrasound study

BACKGROUND: Patients with urinary tract infection (UTI) are known to have impaired bladder function as demonstrated by urodynamic (UD) studies. UD is rarely performed in infants. OBJECTIVE: To evaluate bladder function in infants with UTI using a dynamic US protocol. Maximal bladder volume (MaxBV), residual volume (RV) and bladder wall thickness (BWT) were measured and compared with values from normal controls. MATERIALS AND METHODS: A total of 57 consecutive infants (47 males, 10 females; mean age 0.48+/-0.30 years) with proven UTI, and 63 age-matched normal controls (37 males, 26 females; mean age 0.47+/-0.37 years) were recruited. MaxBV was determined just before voiding, and RV and BWT were measured after spontaneous voiding. RESULTS: Infants with UTI had smaller MaxBV (34.89 vs. 42.91 ml), larger RV (3.46 vs. 1.51 ml) and greater BWT (4.21 vs. 3.68 mm) than normal infants (P<0.05, Mann-Whitney test). CONCLUSION: Smaller bladder volume, larger residual volume and thicker bladder wall in infants with UTI can be explained by bladder instability, hypercontractility and infection-induced oedema of the bladder wall during UTI. The US measurement of bladder parameters might serve as an objective guide for clinical diagnosis and allow objective evaluation of bladder function during posttreatment follow-up.     

Incomplete bladder emptying is associated with febrile urinary tract infections in infants

ObjectiveTo investigate lower urinary tract dysfunction in pre-toilet trained infants with and without history of febrile UTI (f-UTI).Materials and MethodsPre-toilet trained infants with f-UTI (Group 1) from pediatric nephrology and urology clinics, and those without f-UTI (Group 2) from infant-care centers were enrolled for the present study. Infants in Group 1 underwent four-hourly (4-H) observations for at least one month after treatment for UTI. Voided volume (VV) and post-void residual urine (PVR) were measured by weighting diaper and suprapubic ultrasound after finishing voiding, respectively. Average PVR was defined as the mean value of PVR during 4-H observation. Interrupted voiding was defined as two or three voidings within 10 min. Voiding efficiency was defined as VV/(VV + PVR).ResultsThe mean ages of Group 1 (n = 64) and Group 2 infants (n = 56) were 10.6 ± 7.5 months vs 10.2 ± 5.1 months, respectively (p = 0.70). Group 1 infants had significantly higher voiding frequency (3.0times ± 1.2 vs 2.6times ± 0.9, p = 0.04), average PVR (14.5 ml ± 14.2 vs 8.9 ml ± 8.8, p < 0.01) and lower voiding efficiency (71.2% ± 20.5 vs 80.2% ± 18.5, p = 0.01) than Group 2. ROC curve analysis showed that the optimal cutoff values for PVR and voiding efficiency to differentiate Group 1 and Group 2 infants were 10 ml and 80%, respectively. Group 1 infants had significantly more repeat elevated PVR (≧ 10 ml) and repeat low voiding efficiency (≦ 80%) than Group 2 (44.8% vs 22.4%, p = 0.03; 62.0% vs 28.6%, p < 0.01, respectively).ConclusionPre-toilet trained infants with f-UTI were associated with elevated PVR and lower voiding efficiency than normal controls.     

早期营养支持策略对早产儿生长和代谢的影响

目的 探讨早期营养支持策略对早产儿生长和代谢的影响.方法 回顾性分析我院2005-2007年(A组82例)和2008-2010年(B组82例)出生体重≤1800 g、无先天畸形、住院2周以上、存活出院早产儿的临床资料,比较两组出生时一般情况、肠内外营养摄入、体格增长及血生化指标.结果 与A组相比,B组早产儿应用氨基酸、脂肪乳剂更早[氨基酸:(1.8±0.4)天比(2.1±0.9)天,脂肪乳:(2.2±0.6)天比(2.6±1.6)天],起始剂量更高[氨基酸:(1.4±0.5)g/(kg·d)比(0.8±0.3)g/(kg·d),脂肪乳:(0.9±0.2)g/(kg·d)比(0.6±0.3)g/(kg·d)],且开奶时间早(1天比2天),肠内热卡达到100 kcal/(kg·d)的日龄更早(20天比25天),第7天摄入奶量明显增多(45 ml/天比22 ml/天),母乳喂养及混合喂养率明显增加(56.1%比40.0%),肠外营养时间缩短(24天比27天),体重和身长增长速度更快[体重:(22.6±3.3)g/(kg·d)比(18.6±4.4)g/(kg·d),身长:(1.1±0.6)cm/周比(0.8±0.4)cm/周],出院时宫外生长迟缓发生率降低(58.5%比72.0%),住院时间缩短(30天比35天),血白蛋白、前白蛋白、尿素氮、血磷水平明显增高[白蛋白:(34.2±2.8) g/L比(31.8±2.9)g/L,前白蛋白:(112.0±25.0)mg/L比(89.0±19.0)mg/L,尿素氮:(4.1±2.1)mmol/L比(3.3±1.8)mmol/L,血磷:(2.0±0.5) mmol/L比(1.8±0.5)mmol/L],总胆汁酸和碱性磷酸酶明显降低[总胆汁酸:(25.1±19.7)μmol/L比(38.6±25.2)μmol/L,碱性磷酸酶:(315.4±120.0)U/L比(471.1±202.3)U/L],差异均有统计学意义(P<0.05).结论 早期更积极的营养支持策略能促进早产儿的生长,减少宫外生长迟缓的发生,缩短住院时间,改善营养状况.     

Superior vena cava flow in newborn infants: a novel marker of systemic blood flow

BACKGROUND: Ventricular outputs cannot be used to assess systemic blood flow in preterm infants because they are confounded by shunts through the ductus arteriosus and atrial septum. However, flow measurements in the superior vena cava (SVC) can assess blood returning from the upper body and brain. OBJECTIVES: To describe a Doppler echocardiographic technique that measures blood flow in the SVC, to test its reproducibility, and to establish normal ranges. DESIGN: SVC flow was assessed together with right ventricular output and atrial or ductal shunting. Normal range was established in 14 infants born after 36 weeks' gestation (2 measurements taken in the first 48 hours) and 25 uncomplicated infants born before 30 weeks (4 measurements taken in the first 48 hours). Intra-observer and interobserver variability were tested in 20 preterm infants. RESULTS: In 14 infants born after 36 weeks, median SVC flow rose from 76 ml/kg/min on day 1 to 93 ml/kg/min on day 2; in 25 uncomplicated very preterm infants, it rose from 62 ml/kg/min at 5 hours to 86 ml/kg/min at 48 hours. The lowest SVC flow for the preterm babies rose from 30 ml/kg/min at 5 hours to 46 ml/kg/min by 48 hours. Median intra-observer and interobserver variability were 8. 1% and 14%, respectively. In preterm babies with a closed duct, SVC flow was a mean of 37% of left ventricular output and the two measures correlated significantly. CONCLUSIONS: This technique can assess blood flow from the upper body, including the brain, in the crucial early postnatal period, and might allow more accurate assessment of the status of systemic blood flow and response to treatment.     

A comparative study of cells and anti-microbial proteins in colostrum of mothers delivering pre- and full-term babies.

The different anti-infective factors in the colostrum of 25 mothers delivering pre-term (33.04 +/- 2.18 weeks gestation) and 10 mothers full delivering term (39.1 +/- 0.87 weeks gestation) babies were measured. The mothers of both the groups were comparable with respect to age, parity, nutrition, and haemoglobulin levels. Although the mean volume of colostrum (12 hours) was significantly lower in pre-term (32.28 +/- 7.92 ml) than in full term (44 +/- 4.83 ml) colostrum (P less than 0.05), the concentrations of total protein, sIgA, lysozyme, and lactoferrin were significantly higher in preterm than in full-term colostrum. IgG and IgM levels were similar in both the groups of colostrum. In both the groups, s-IgA was the predominant immunoglobulin. Moreover, the absolute counts of total cells, macrophages, lymphocytes, and neutrophils were significantly higher in pre-term compared to full-term colostrum. Macrophage were the predominant cells. Degree of prematurity has been found to have profound influence on the volume, protein concentration, and cell and macrophage counts of colostrum. Thus, more pre-term the newborn was, the mother produced less amount of colostrum. Total protein concentration and absolute cell count were significantly higher in the colostrum samples of mothers delivering between 28 and 32 weeks as compared to those delivering between 33 and 36 weeks. It is concluded that the colostrum of mothers delivering pre-term, though less in amount, is rich in soluble anti-infective agents and cells. The higher concentration of protective factors compensates for the limited capacity of milk intake in the pre-term infant.