部分静脉营养在低体重儿的临床应用

目的：探讨部分静脉营养（PPN）在低体重儿的临床应用价值。方法：将98例低体重儿分为PPN观察组52例,对照组46例,两组在接受胃肠营养基础上,观察组通过外周静脉输入由脂肪乳剂、氨基酸、葡萄糖、维生素等组成的营养液;对照组以补充葡萄糖为主,同时对有关指标进行监测,两组进行比较,结果：PPN结束后,体重增加、血浆总蛋白、白蛋白增高较对照组差异有非常显著性（P＜0．01）,两组在治疗前后肝功能、血清胆红素、血尿素氮、血脂变化差异无显著性（P＞0．05）。结论以部分静脉营养和胃肠营养结合,再过渡到全胃肠营养,是低体重儿治疗的一种合理有效的支持疗法。     

早期胃肠外营养对早产儿低出生体重儿出院后生长发育的影响

目的研究早期胃肠外营养对早产儿低出生体重儿出院后生长发育的影响。方法选取我院2013年6月至2017年6月120例早产儿低出生体重儿为研究对象,按随机数表法分为早期组与常规组,每组60例。常规组经口或鼻饲早产儿配方奶,适当静脉补充液体;早期组在经口或鼻饲早产儿配方奶基础上给予早期胃肠外营养。检测患儿电解质与生长调节因子,比较两组免疫功能,记录出生时与月龄12个月时生长发育指标,统计胃肠外营养并发症发生率。结果早期组出生后3d血钾显著低于常规组(P <0.05),血钙显著高于常规组(P <0.05)。早期组出生后14d血清瘦素(leptin)、胰岛素样生长因子-1 (IGF-1)、生长激素(GH)分别为5.33±0.96μg/L、66.95±12. 05μg/L、20. 69±3.61μg/L显著高于常规组的4.96±0.89μg/L、62.37±11.22μg/L、18.60±3.35μg/L(P<0.05)。早期组出生后14d CD3^+、CD4^+、CD4^+/CD8^+显著高于常规组(P <0. 05)。早期组月龄12个月时头围、体重、身长分别为44. 90±1.93cm、9. 82±1. 89kg,74. 81±2. 60cm显著高于常规组的43.62±1.88cm、9.15±1. 4kg、73. 06±2.43cm(P <0. 05)。早期组并发症总发生率与常规组比较差异无统计学意义(P>0.05)。结论早期胃肠外营养可以缓解早产儿低出生体重儿电解质紊乱,促进多种生长调节因子分泌,改善患儿免疫功能,有利于患儿出院后生长发育。     

High Incidence of Rickets in Extremely Low Birth Weight Infants with Severe Parenteral Nutrition-Associated Cholestasis and Bronchopulmonary Dysplasia

Risk factors for rickets of prematurity have not been re-examined since introduction of high mineral formula, particularly in ELBW infants. We analyzed the incidence and the risk factors of rickets in extremely low birth weight (ELBW) infants. As a retrospective case-control study from 2004 to 2008, risk factors were analyzed in 24 patients with rickets versus 31 patients without. The frequency of rickets in ELBW infants was 24/55 (44%). Infants with rickets were diagnosed at 48.2 ± 16.1 days of age, and improved by 85.3 ± 25.3 days. By radiologic evaluation, 29% were grade 1 rickets, 58% grade 2 and 13% grade 3. In univariate analysis, infants with rickets had significantly higher incidence of patent ductus arteriosus, parenteral nutrition associated cholestasis (PNAC), severe PNAC and moderate/severe bronchopulmonary dysplasia (BPD). In multiple regression analysis, after adjustment for gestation and birth weight, rickets significantly correlated with severe PNAC and with moderate/severe BPD. Serum peak alkaline phosphatase levels were significantly elevated in rickets (P < 0.001). In ELBW infants, the incidence of rickets of prematurity remains high and the incidence of severe PNAC and moderate/severe BPD was significantly increased 18 and 3 times, respectively.     

胃肠激素检测在小于胎龄儿变化中的临床意义

目的:对68例小于胎龄儿(其中早产36例;足月32例)生后喂奶前及第7d空腹血中生长抑素(somatostatin, SS)、胃动素(motilin, MOT)、胃泌素(gastrin, Gas)浓度进行测定,并以30例足月新生儿作为对照组.方法:应用放射免疫分析测定SS、MOT、Gas浓度.结果:小于胎龄儿组生后喂奶前及第7d空腹血浆MOT、Gas均明显低于对照组,而SS浓度明显高于对照组,并且与胎龄、开始喂养时间及当日进奶等因素相关.结论:小于胎龄儿消化道机能适应胃肠道营养,在严密观察下应用合理的喂养方式早日开始胃肠道营养,将能促进小于胎龄儿胃肠道的发育和成熟.     

早期肠内营养治疗对极低出生体重儿近期预后及hGH、IGF-1的影响

目的 探讨早期肠内营养治疗对极低出生体重儿近期预后的临床影响.方法 将136例极低出生体重儿根据肠内营养开始治疗时间分为A组(≤3d,n =73)、B组(4～6d,n=41例)和C组(≥7d,n=22)三组,比较三组极低出生体重儿的生长速度、消化功能改善情况,并比较三组极低出生体重儿治疗前后生长激素(hGH)、胰岛素样生长因子-1(IGF-1)水平变化情况.结果 三组低出生体重儿消化道症状发生率及头围增长幅度、体重增长幅度比较差异无统计学意义(P＞0.05);第1周时A组奶量均高于B组、C组(P＜0.05),B组奶量高于C组(P＜0.05);第2、3周时A组、B组奶量均高于C组(P＜0.05);A组院内感染发生率低于C组(P＜0.05);第1周时,A组身长增长幅度高于B组和C组(P＜0.05),B组高于C组(P＜0.05);A组达全肠内营养时间低于B组和C组(P＜0.05),B组低于C组(P＜0.05);A组、B组住院时间均低于C组(P＜0.05);A组hGH、IGF-1水平均高于B组和C组,B组高于C组,差异有统计学意义(P＜0.05).结论 早期肠内营养治疗增加了极低出生体重儿喂奶量,缩短了达全肠内营养时间、中心静脉置管时间及住院时间,值得临床重视.     

Neonatal Morbidities Associated with Histologic Chorioamnionitis Defined Based on the Site and Extent of Inflammation in Very Low Birth Weight Infants

Conflicting results on the influences of histologic chorioamnionitis (HC) on neonatal morbidities might be partly originated from using different definition of HC. The aim of this study was to determine the relationship between HC and neonatal morbidities using definition of HC that reflects the site and extent of inflammation. This was a retrospective cohort study of 261 very low birth weight (VLBW) infants admitted at a tertiary academic center. Based on the site of inflammation, HC was categorized: any HC; amnionitis; funisitis; amnionitis+funisitis. The extent of inflammation in each site was reflected by sub-defining high grade (HG). The incidences of morbidities in infants with and without HC were compared. The bronchopulmonary dysplasia (BPD) rate was significantly higher in infants with amnionitis and the severe retinopathy of prematurity (ROP) rate was significantly higher in infants with any HC and funisitis. After adjustment for both gestational age and birth weight, the respiratory distress syndrome (RDS) rate was significantly lower in infants with all categories of HC except for HG amnionitis and HG funisitis, which are not associated with lower RDS rate. HG amnionitis was significantly associated with increased BPD rate but the association of HC with severe ROP disappeared. In conclusion, HC is significantly associated with decreased RDS and HG amnionitis with increased BPD while lacking association with other neonatal morbidities in VLBW infants. The association with HC and neonatal morbidities differs by the site and extent of chorioamnionitis.

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