极低出生体重儿发生肺出血的危险因素及其临床转归

目的 研究极低出生体重儿(very low birth weight infant,VLBWI)发生肺出血的高危因素及其临床转归。方法 病例来源于2020年1月1日至2021年12月31日江苏省妇幼保健院和南京医科大学附属儿童医院收治的所有活产VLBWI (胎龄<35周),符合纳入和排除标准的574例VLBWI进入研究,其中肺出血组44例,无肺出血组530例。收集2组临床资料进行比较分析,采用多因素logistic回归分析探讨肺出血的危险因素。结果 肺出血组和无肺出血组母亲年龄、正压通气复苏率、气管插管复苏率和生后1h内最低体温的比较差异有统计学意义(P<0.05)。肺出血组Ⅲ～Ⅳ级呼吸窘迫综合征和早发型败血症的比例高于无肺出血组(P<0.05)。生后1h内毛细血管再充盈时间>3 s和生后24 h内最大呼气末正压(positive end-expiratory pressure,PEEP)<5 cm H2O的患儿在肺出血组更常见(P<0.05)。多因素logistic回归分析显示,母亲年龄30～<35岁为肺出血的保护因素(OR=0.115,P&...     

极低体重儿肠道喂养的新进展

本文从喂养时间,营养物的选择,喂养方法,喂养方案及喂养不耐受的处理,非营养性吸吮等角度,阐述了极低体重儿肠道喂养的新进展,对指导临床应用有重要意义。     

极低出生体重儿十二指肠喂养临床探讨

我科自2003年2月至2004年9月对18例极低体重儿（VLBWI）采用了十二指肠喂养与部分肠道外营养相结合的方法，达到了理想生长指标，现报告如下。     

极低出生体重儿颅内出血危险因素的分析

目的：颅内出血是造成极低出生体重（VLBW）儿智力及运动障碍主要原因之一,了解其发病的危险因素、及早预防,可减少残疾、提高生存质量。方法研究169例极低出生体重儿,对产前因素及生后因素进行分析,采用SPSS12.0对数据进行卡方检验,有意义因素再进行logistic回归分析,得出回归方程。结果胎膜早破、1分钟Apgar评分≤7分、使用PS及呼吸机治疗、上机时间＞3 d、入院时PT＞20 s、生后1 d和2 d低钠血症及生后1 d pH值＜7.25为VLBW颅内出血危险因素。结论1分钟Apgar评分≤7分和使用呼吸机治疗是VLBW儿颅内出血的主要危险因素,而凝血功能和内环境紊乱均与缺氧窒息有关。因此,作好产前保健,减少窒息及生后合并症发生,有利于降低VLBW儿颅内出血发生率,提高患儿生存质量。 ［中国当代儿科杂志,2007,9（4）：297-300］     

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。     

极低出生体重儿和超低出生体重儿的神经发育及影响因素

极低及超低出生体重儿生长发育比正常同龄儿童落后，各种疾病发病率较高，体重、身高、头围明显低于同龄儿，神经系统伤残患儿比例较高，这种情况在有合并症的患儿中表现更明显。随着医学的进步，死亡率已呈下降趋势，无伤残存活率增加，同时伤残存活率也增加。目前的研究证实，许多因素可影响这类患儿的预后。低出生体重伴小于胎龄与较差的神经系统发育有关。增加患儿的营养供给，特别是尽早从肠道外提供营养过度到肠道喂养，可明显改善其生长发育。在强调对这类患儿住院期间加强集中管理的同时，要强化院外的生活环境、生活规划及早期教育等方面的管理。加强产前监护，提高父母受教育的水平，给予他们更多的社会支持。     

极低出生体重儿非先天性胆汁淤积发病的危险因素分析

目的 探讨新生儿重症监护病房(NICU)中极低出生体重儿(extremely low birth weiisht infants,ELBWI)非先天性胆汁淤积(简称胆汁淤积)的发生率和相关危险因素.方法 回顾性分析NICU中232例ELBWI的临床资料,对29例胆汁淤积和203例无胆汁淤积ELBWI在胎龄、出生体质量、性别等16项临床因素进行单因素比较,对两组有差异的因素进行多因素Logistic回归分析.结果 ELBWI胆汁淤积的发生率为12.5%(29/232).胆汁淤积组在胎龄、出生体质量、生后1周内胆红素水平、光疗时间、脂肪乳输注量、静脉营养持续时间、开奶时间、生后1周内总奶量、感染发生率、贫血,母亲患妊高征率方面高于对照组(P均<0.05),经Logistic回归分析表明,贫血、母患妊高征、生后1周内最高总胆红素水平和直接胆红素水平、感染5个因素与胆汁淤积的发生有关(P均<0.05).结论 贫血、母患妊高征、感染是ELBWI发生胆汁淤积的危险因素,生后1周内胆红素水平越高,也越容易发生胆汁淤积.     

极低出生体重儿早期喂养的临床观察

目的研究早期微量喂养对极低出生体重儿（VLBWI）的生长发育、胃肠功能成熟及生命体征的影响,为VLBWI的早期微量喂养提供依据。方法将2005年2月至2006年2月北京协和医院NICU住院的符合人选标准的29例VLBWI随机分为早喂组和晚喂组。两组一般情况及合并症差异无统计学意义。对两组的生长发育、胃肠耐受情况、血清胃泌素和胃动素水平、胃肠动力、胃电活动、肠系膜上动脉血流速度、胃食管返流情况进行观察监测。结果研究期间两组生长发育情况、平均肠外营养时间及住院时间差异无统计学意义;喂养耐受性早喂组较晚喂组明显增强（P=0．039）;血清胃动素水平早喂组较晚喂组在第7、14天明显升高;两组血清胃泌素水平差异无统计学意义;第28天时早喂组的胃电图检查更为成熟;早喂组的胎便排完时间更短;卡红胃肠道转运时间第28天早喂组更短;血流动力学参数变化差异无统计学意义。结论早期喂养可以促进VLBWI的胃肠道成熟,改善喂养不耐受,包括减少喂养并发症、促进胃肠激素分泌、促进胃电生理活动成熟、加强胃肠动力。     

机械通气下极低出生体重儿颅内出血的危险因素

文献报告因严重肺部疾病而接受机械通气治疗的新生儿发生颅内出血的危险性增高。本文通过分析机械通气下极低出生体重儿颅内出血的高危因素,以找出降低颅内出血发生率的途径。     

Early enteral feeding in very low birth weight infants

Background/aim

Debate exists about when to initiate enteral feeding (EF) in very low birth weight (VLBW) preterm infants. This retrospective study compared the effectiveness of an education-based quality improvement project and the relationship of time of the first EF to necrotizing enterocolitis (NEC) or death incidence and parenteral nutrition (PN) days in VLBW infants.

Study design/subjects

VLBW infants born in 2 epochs were compared for hour of the first feed, PN days, NEC or death incidence, and feeding type. The 2 epochs were temporally divided by a quality improvement initiative to standardize initiation of EF in postnatal hours 6–24.

Results

603 VLBW infants were included. Median time of feed initiation decreased from 33 (Epoch 1) to 14 h (Epoch 2) (p < 0.0001). Median PN days were 14 vs. 12, respectively (p = 0.07). The incidence of NEC or death was 13.4% vs. 9.5%, respectively (p = 0.14). When controlling for birth weight, gestational age, race, gender, and time period, earlier feed initiation was associated with decreased NEC or death (p = 0.003). Evaluation of the relationship of early EF (defined as within the first 24 h) in Epoch 2 alone showed that early EF was significantly associated with decreased NEC or death (6.3 vs 15.1%) (RR, 95% CI = 0.28, 0.13–0.58) and less PN days (p < 0.0001).

Conclusions

In a VLBW infant cohort, an education-based process improvement initiative decreased time of EF initiation to a median of 14 h with no associated increase in NEC or death. In fact, results suggest that earlier feeding is associated with decreased NEC or death.     

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.     

极低/超低出生体重儿迟发型败血症发生情况及其危险因素分析

目的探讨新生儿重症监护病房(NICU)极低/超低出生体重儿迟发型败血症(LOS)的发生情况及危险因素。方法收集2011年1月至2013年12月入住NICU的极低或超低出生体重儿的临床资料,根据是否合并LOS分为两组:LOS组和无LOS组。回顾性分析LOS的发生率、病死率、常见病原菌及危险因素。结果纳入的226例极低/超低出生体重儿中,117例(51.8%)发生了LOS,其中45例为确诊LOS,72例为临床诊断LOS。LOS组患儿病死率为13.7%(16/117),明显高于无LOS组(5/109,4.6%),差异有统计学意义(P0.05)。共培养出51株病原菌,其中32株(63%)为革兰阴性细菌,16株(31%)为革兰阳性细菌,3株(6%)为真菌。多因素logistic回归分析显示,胎龄、小于胎龄儿、肠外营养持续时间、经外周静脉穿刺中心静脉置管(PICC)、机械通气是极低/超低出生体重儿LOS发生的独立影响因素(OR分别为:0.84、1.59、1.34、3.11、4.55,均P0.05)。结论极低/超低出生体重儿LOS的发生率及病死率较高。LOS常见病原菌为革兰阴性细菌。胎龄低、肠外营养持续时间长、小于胎龄儿、PICC或机械通气的极低/超低出生体重儿LOS的发生危险可能增加。     

Neurodevelopmental outcomes of very low birth weight and extremely low birth weight infants at 18 months of corrected age associated with prenatal risk factors

Background

Very premature infants occasionally have neurodevelopmental disabilities. However, there have been quite limited data on prenatal risk factors associated with their neurodevelopmental outcomes.

Aim

To clarify the relationship between prenatal risk factors and neurodevelopmental outcomes of very premature infants.

Study design

The study design is a retrospective review.

Subjects

One hundred seventy Japanese women with a singleton pregnancy and their infants whose birth weight being less than 1500 g were included. We classified those infants into 118 appropriate for gestational age (AGA) and 52 small for gestational age (SGA) infants.

Outcome measures

Infants' neurodevelopmental outcomes at 18 months of corrected age were evaluated by the Kyoto Scale of Psychological Development 2001 (KSPD). We analyzed and compared the infants' outcomes and prenatal risk factors between two groups.

Results

Mortality and rate of infants unevaluable by KSPD because of severe impairment were not significantly different between those groups. However, the developmental quotient score of the cognitive-adaptive area in SGA infants born between 25 and 31 weeks of gestation was significantly lower than that in AGA infants randomly selected as gestation-matched controls. More advanced gestational age and heavier birth weight protected against adverse neurodevelopmental outcomes in both groups. Moreover, male infants were related to the excess risk of adverse neurodevelopmental outcomes in the SGA group.

Conclusion

In view of the neurodevelopment of the infants, it seems that the most efficient obstetric strategy for improving prognosis of premature infants should be targeted to prolong the pregnancy period as long as the reassuring fetal status and maternal stable health condition are being confirmed.     

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     

极低及超低出生体重儿的预后因素分析

目的 分析极低及超低出生体重儿（出生体重≤ 1 200 g）的临床资料,为其预后及临床干预提供预警指标。方法 回顾性分析108 例极低及超低出生体重儿的母孕期病史、新生儿出生时情况、诊治经过及预后,采用非条件logistic 回归分析筛选预后的影响因素。结果 108 例极低及超低出生体重儿,出生体重范围在结论 极低及超低出生体重儿的病死率较高,且随着日龄的增加,影响早产儿生存的预后因素不同,临床上应针对这些因素制定合理的管理方案,提高早产儿生存率。