IGF-I, leptin and active ghrelin levels in very low birth weight infants during the first 8 weeks of life

Aim:  We investigated the relationship between plasma insulin-like growth factor I (IGF-I), leptin, active ghrelin levels, and postnatal growth in very low birth weight (VLBW) infants.
Method:  Plasma IGF-I, leptin, and active ghrelin levels were measured at birth and at 2, 4, 6 and 8 weeks after birth in 61 VLBW infants, including 31 appropriate-for-gestational-age (AGA) and 30 small-for-gestational-age (SGA) infants.
Results:  Insulin-like growth factor I levels were the lowest at birth, but increased gradually over the first 8 weeks of life. IGF-I was positively correlated with body weight, body length and body mass index at all time points. Leptin levels did not change over the study period. Ghrelin levels were significantly lower at birth; however, there were no significant differences between the levels after 2 weeks of age. Leptin and ghrelin levels were not correlated with anthropometrical measures. IGF-I levels at birth were significantly lower in SGA than in AGA infants, but the leptin and ghrelin levels were not significantly different between the two groups.
Conclusion:  Insulin-like growth factor I is related to length and weight gain in the prenatal and the early postnatal periods in VLBW infants, but this does not appear to be the case for leptin and ghrelin.     

Indomethacin therapy on the first day of life in infants with very low birth weight

To investigate the optimal timing for treatment of small premature infants, we performed a double-blind, controlled trial of indomethacin therapy on the first day of life in 104 infants weighing between 700 and 1300 gm. Infants were given indomethacin or placebo at a mean age of 15 hours. Eleven of the 56 infants given placebo developed large left-to-right shunts through a patent ductus arteriosus. In contrast, only two of the 51 infants given indomethacin developed large shunts (P less than 0.025). There were no significant differences in incidence of surgical ligation, duration of oxygen therapy, duration of endotracheal intubation, days required to regain birth weight, or incidence of complications. However, the power of the tests of significance was low because of the small number of patients. Thus, although the incidence of large left-to-right ductus shunts was decreased in the indomethacin group, morbidity was not otherwise altered for the entire group of patients, possibly because of the relatively low incidence (21%) of large shunts in the placebo group. We conclude that although treatment with indomethacin on the first day of life appears to be safe, there is little advantage to its use in centers where the incidence of large shunts through a patent ductus arteriosus is relatively low.     

Passage of the first stool in very low birth weight infants

Times of first stool passage were studied in 171 infants who weighed less than 1,500 g at birth. Delayed passage (greater than 48 hours) was noted in 20.4% of this group. Significant differences were noted between the delayed and nondelayed groups for gestational age, presence of severe respiratory distress syndrome, and the time of the first enteral feeding. In very low birth weight infants, delay in the passage of the first stool is a common occurrence. This delay is probably due to physiologic immaturity of the motor mechanisms of the gut, lack of triggering effect of enteral feeds on gut hormones, and the presence of severe respiratory distress syndrome, which may singly or in concert adversely affect gastrointestinal motility.     

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。     

Time of the first defaecation and urination in very low birth weight infants

The time for passage of the first stool and urine was studied in 111 infants who weighed less than 1500 g at birth. Delayed passage of the first stool (greater than 24 h) was noted in 25 (22.5%) infants of this group, including 7 cases (6.3%) in whom the delay was greater than 48 h (4 on the 3rd day, 2 on the 4th day, 1 on the 6th day of life, respectively). Three (2.7%) cases had delayed passage of the first urine (at 25, 25, and 45 h of life, respectively). Significant differences between the two groups with delayed and nondelayed passage of the first stool were noted in both the gestational age and in the time of the first enteral feeding. In very low birth weight infants, delay in the passage of the first stool is a common occurrence. This delay is probably due to physiological immaturity of the motor mechanisms of the gut, and lack of triggering effect of enteral feeds on gut hormones. As far as passage of the first urine was concerned, there were no significant perinatal factors found between the delayed and nondelayed groups.     

极低出生体重儿院内生长发育状态多中心回顾性研究

目的 研究极低出生体重儿(VLBWI)住院期间的生长发育状态及相关影响因素.方法 回顾性调查广东省珠江三角洲地区9个城市的9家医院新生儿科于2010年7月1日至2011年6月30日,出院的VLBWI的住院资料,根据出生体重,分为宫内生长发育迟缓[IUGR组(n=63)]和非IUGR组(n=120),非IUGR组又根据其出院时是否发展为宫外生长发育迟缓(EUGR)而分为EUGR组(n=71)和非EUGR组(n=49),对比性研究IUGR组和非IUGR组住院期间的日均体重增长速度和出院时EUGR的发生率,及各组的院内营养摄入情况、生长速度和相关疾病因素的影响.结果 (1)出生时IUGR和出院时EUGR的发生率分别为34.4％和72.1％,IUGR组的日均体重增长速度高于非IUGR组[(12.5 ±2.7) g/kg vs (11.3±2.5) g/kg,t=3.068,P=0.002],但IUGR组发展为EUGR的比例明显高于非IUGR组(96.8％vs 59.2％,x2=29.145,P =0.000).(2) IUGR组在生后1、2、4周、达完全经口喂养前和住院期间的日均热卡摄入[62(51,69) kcal/kg vs 56(45,64) kcal/kg、83 (71,94) kcal/kg vs 76(66,88) kcal/kg、107(94,120) kcal/kg vs 95(85,108) kcal/kg; 103(96,110) kcal/kg vs 97(89,106) kcal/kg、121(111,131) kcal/kg vs 111 (101,119) kcal/kg](1 kcal=4.1840 kJ).蛋白质摄入[1.7(1.3,2.0) g/kgvs 1.6(1.2,1.8) g/kg、2.6(2.1,2.9) g/kg vs 2.3(1.9,2.7) g/kg、3.3(2.7,3.6) g/kgvs2.7(2.4,3.2) g/kg、3.1(2.6,3.4) g/kgvs 2.8(2.4,3.3) g/kg、3.4(3.1,3.8) g/kgvs3.1(2.8,3.5) g/kg]均高于非IUGR组(P＜0.05).热卡累积损失[407(360,483)kcal/kg vs 448(393,527) kcal/kg、534(369,689) kcal/kg vs 612(453,758) kcal/kg、367(12,724) kcal/kg vs 718(330,996) kcal/kg、381 (231,609) kcal/kg vs 656(394,959) kcal/kg、0(0,350) kcal/kg vs 387(85,826) kcal/kg].蛋白质累积损失[12.3(10.2,15.5) g/kg vs 13.7(11.7,16.4) g/kg、12.8(7.8,19.4) g/kg vs 17.5(11.9,22.7) g/kg、6.2(0,22.6)g/kg vs 21.7 (7.3,30.3)g/kg、6.6(1.8,23.0)g/kg vs22.1(7.2,32.5) g/kg、1.9(0,16.7)g/kg vs 20.1 (0,32.6) g/kg]则相应低于非IUGR组(P＜0.05).(3)非EUGR组的日均体重增长速度高于EUGR组[(12.7±2.2)g/kgvs (10.3±2.1) g/kg,t=6.137,P=0.000];开始喂养时间[1.0(1.0,3.0)dvs 3.0(2.0,5.0)d]、禁食时间[3.0(1.0,5.5)d vs 4.0(3.0,9.0)d]、最低体重出现时间[4.0(3.0,6.0) dvs6.0(5.0,8.0)d]、恢复出生体重时间[11.0(9.0,14.0) dvs 13.0(10.0,17.0)d]均短于非EUGR组(P＜0.05);需机械通气治疗者比例(70.4％ vs 51.0％)低于非EUGR组(P＜0.05).(4)非EUGR组在生后2周的日均热卡摄入[81(70,91) kcal/kg vs 73(63,85) kcal/kg]和生后1周[1.6(1.4,2.0) g/kgvs 1.4(1.1,1.8) g/kg]、生后2周[2.4(2.1,2.7) g/kg vs 2.1(1.8,2.6) g/kg]、达完全经口喂养前[3.0(2.5,3.4) g/kg vs 2.7(2.3,3.1)g/kg]的蛋白质摄入高于EUGR组(P＜0.05),而生后2周的热卡累积损失[546(403,707) kcal/kg vs 655(494,795) kcal/kg]和生后1周[13.1(10.9,15.1) g/kg vs 14.8(12.0,16.6) g/kg]、生后2周[15.5(11.4,19.8) g/kg vs 20.0(12.1,24.0) g/kg]的蛋白质累积损失低于EUGR组(P＜0.05),在其余各阶段的日均热卡、蛋白质摄入量及累积损失量比较差异无统计学意义(P＞0.05).(5)IUGR组新生儿呼吸窘迫综合征发生率低于非IUGR组(34.9％ vs 56.7％),孕母妊娠期高血压疾病、胎儿窘迫发生率则高于非IUGR组(54.0％ vs 24.2％、25.4％ vs 7.5％),新生儿窒息、坏死性小肠结肠炎、败血症、支气管肺发育不良、缺氧缺血性脑病/颅内出血、胆汁淤积症和孕母胎膜早破、胎盘早剥/前置胎盘的发生率组间比较差异无统计学意义(P＞0.05).(6) EUGR组新生儿败血症发生率(11.3％ vs0％)和孕母妊娠期高血压疾病发生率(31.0％ vs 14.3％)高于非EUGR组(P＜0.05),但新生儿呼吸窘迫综合征、窒息、坏死性小肠结肠炎、支气管肺发育不良、缺氧缺血性脑病/颅内出血、胆汁淤积症和孕母胎膜早破、胎盘早剥/前置胎盘、胎儿宫内窘迫的发生率组间比较差异无统计学意义(P＞0.05).结论 IUGR早产儿发生EUGR的风险远高于非IUGR者;导致非IUGR早产儿发生EUGR的危险因素包括:日均体重增长速度、最低体重出现时间、恢复出生体重时间、开始喂养时间、禁食时间、机械通气治疗、营养摄入与累积损失、疾病等因素.     

Extracellular fluid volume changes in very low birth weight infants during first 2 postnatal months

Serial extracellular volume (ECV) changes were measured in 18 infants of less than 32 weeks gestation. Results were compared with changes in body weight, fluid and sodium intake, urine output, and serum sodium concentration. Mean +/- SD ECV decreased from 550 +/- 116 mL/kg on day 1 to 359 +/- 66 mL/kg on day 14. Thereafter, mean ECV/kg remained between 336 +/- 42 and 349 +/- 54 mL/kg. Clinical hydration and serum sodium concentration usually remained normal during this reduction of stabilization of ECV/kg. Six episodes of hyponatremia occurred at 11 to 31 days of age. Mean ECV/kg was significantly lower in infants with hyponatremia compared with infants of similar age with normal serum sodium concentration (303 +/- 36 mL/kg vs 368 +/- 56 mL/kg, P less than 0.01). Sodium intake in the two groups was similar. We conclude that ECV in the VLBW infant decreases postnatally and is regulated within a range similar to that in older infants, and that postnatal natriuresis in the first 2 weeks of life represents physiologic reduction of the expanded ECV of the fetus. Late hyponatremia may indicate excessive sodium loss and ECV depletion.     

极低体重儿呼吸暂停的有关问题

早产儿呼吸暂停 (ａｐｎｅａｏｆｐｒｅｍａｔｕｒｉｔｙ ,ＡＯＰ)常发生于矛盾睡眠期 ,与呼吸中枢调节功能不成熟有关 ;呼吸暂停发生的频率及严重程度常与胎龄成反比。当呼吸暂停 >15～ 2 0ｓ ,或呼吸显著不规则时 ,可影响组织的氧合状态 ,尤其是在极低体重儿 ,呼吸暂停与发生     

Copper status of very low birth weight infants during the first 12 months of infancy.

The Cu intake and status of 106 very low birth weight (VLBW) infants (birth weight 1152 +/- 251 g, gestational age 29 +/- 3 wk, mean +/- SD) were determined approximately 1 mo before hospital discharge, at discharge (time 0), and at 3, 6, 9, and 12 mo +/- 3 wk corrected for gestational age. Infants were fed either formula plus supplemental Zn/Cu (SUPPL, n = 29); formula plus placebo (PLAC, n = 26); or a low birth weight formula (LBWF, n = 26) or were breast-fed (BRMLK, n = 25). Plasma Cu levels in the formula-fed infants increased significantly at each time period with no significant differences between feeding groups. Hair Cu was significantly higher in the SUPPL group compared to the PLAC, LBWF, and BRMLK groups at 3 and 6 mo. Erythrocyte Cu,Zn-superoxide dismutase (CuZnSOD) activity was lowest in the PLAC group. Cu intake was positively correlated with both hair Cu (r = 0.291, p less than 0.0001) and erythrocyte CuZnSOD activity (r = 0.281, p less than 0.001) but not with plasma Cu. An increasing number of formula-fed infants had very low CuZnSOD activity (less than 2 SD below mean) with increasing age (n = 1, 2, 8, 11, and 13 infants at times 0, 3, 6, 9, and 12 mo, respectively). At 12 mo, approximately one third of the formula-fed VLBW infants in this study had low Cu status as assessed by CuZnSOD activity. Infants with the lowest CuZnSOD activity were those with the largest weight gains from 0 to 6 mo and were observed in all formula-fed groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postural development in very low birth weight and normal birth weight infants

In this study the seven postural responses selected by Vojta to evaluate neuromotor development were applied to 68 very low birth weight (VLBW) (greater than 1500 g) infants and to 28 healthy infants of normal birth weight (less than 2500 g). Of the 68 VLBW infants, 41 were small for gestational age and 27 appropriate for gestational age. All infants were examined between 37 and 40 weeks postmenstrual age. They were all later assessed on the Griffiths Mental Developmental Scale at 12 and 18 months. There were significant differences in postural reactions between the two groups which confirmed the lower tone and greater extension previously described in very low birth weight infants. An important finding in the study was that poor head and trunk righting noted at four months corrected age in very low birth weight infants, was associated with less developed locomotion at 12 and 18 months as assessed by the Griffiths Mental Developmental Scale. Thus, a delay in maturation in very low birth weight infants which was apparent from the assessment of postural responses in early infancy was still identifiable on the locomotor subscales at 12 and 18 months. Five of Vojta's responses were shown to be useful as part of the neurological assessment of high risk infants.     

极低出生体重儿住院期间营养及体重增长状况的观察和分析

极低出生体重儿(Very low birth weight infant．VLBWI）生存率逐年提高,但VLBWI胃肠功能不成熟且常伴随疾病与并发症,而不能得到满意的体重增长。如何给予合适的营养支持促进其生长发育已成NICU的重要问题受到广泛关注。我们总结1999年1月至2003年12月,我院NICU收治的64例VLBWI住院期间的营养及体重增长状况,现分析如下。     

极低出生体重儿临床分析

目的 探讨极低出生体重儿(VLBWI)发生原因及相关并发症,为提高其存活率及生存质量提供临床资料.方法 将6年来收治的218例VLBⅥ按体重分为3组,即≤1 000 g,1 001～1 250 g和1 251～1 500 g.按住院年份分为2001-2003年和2004-2006年2组.对其发生原因、存活率及并发症进行比较.结果 VLBWI发生的主要原因为妊娠期高血压疾病,多胎妊娠及高龄产妇,且2004-2006年所占比例较2001-2003年高,P<0.05.出生体重越低,存活率越低,并发症发生率越高,3组比较P<0.05.后3年存活率较前3年提高,P<0.05,新生儿呼吸窘迫综合征、寒冷损伤综合征及败血症发生率降低,P<0.05,呼吸暂停、动脉导管未闭、早产儿视网膜痛及运动障碍发生率前后3年比较,差异无统计学意义,P>0.05.结论 应加强高危孕妇围产期监测,减少VLBWI发生几率,对VLBWI应预防各种并发症并针对性治疗及随访,以提高其生存率及近远期生存质量.     

Frusemide-induced nephrocalcinosis in very low birth weight infants

Three very low birth weight infants, treated with frusemide for broncho-pulmonary dysplasia are described. They all developed medullary nephrocalcinosis identifiable by real time ultrasound. The sonographic findings of diffuse medullary hyper-echogenicity appears to be specific for nephrocalcinosis.     

极低出生体重儿并发脑室内出血的诊断和治疗

极低出生体重儿 (ＶＬＢＷＩ)并发脑室周围 脑室内出血(ｐｅｒｉｖｅｎｔｒｉｃｕｌａｒｈｅｍｏｒｒｈａｇｅ Ｉｎｔｒａｖｅｎｔｒｉｃｕｌａｒｈｅｍｏｒｒｈａｇｅ ,ＰＶＨ ＩＶＨ)较为常见。根据头颅系列超声检查 ,ＰＶＨ ＩＶＨ发病率约为 40 %～ 5 0 % ,随胎龄及体重降低发病率增加。胎龄 <32周的早产儿约 30 %～ 35 %发病 ,<2 8周者 ,发病率超过 5 0 % ;体重 <5 0 0 ｇ～ 75 0 ｇ者 ,发病率为 6 0 %～70 % ,10 0 0 ｇ～ 15 0 0 ｇ者为 10 %～ 2 0 %。ＰＶＨ ＩＶＨ的发生 ,主要由于ＶＬＢＷＩ室管膜下生发层基质 (尾状核头部脑室周…     

Bronchopulmonary dysplasia in very low birth weight infants

Objective  The developments in newborn care have enabled many more very low birth weight premature infants to live. The aim of our study was to determine the risk factors for bronchopulmonary dysplasia (BPD) development by evaluating mild and moderate/severe BPD in extramural neonates with a birth weight <1501 g. Methods  A case-control study was conducted between January 1, 2004- December 31, 2006 at the Dr. Sami Ulus Children’s Hospital Neonatal Intensive Care Unit. Patients with BPD and without BPD were compared. Bronchopulmonary dysplasia was diagnosed and classified according to the Bancalari criteria. One-hundred and six (106) extramural premature infants with a birth weight <1501 g and admitted to the Neonatal Unit in the first three days of life and survived for more than 28 postnatal days were included. Patients with multiple congenital anomalies and complex cardiac pathologies were excluded. The maternal and neonatal risk factors, clinical features, mechanical ventilation treatment were compared. The principal risk factors for BPD development were analyzed and followed by logistic regression test. Results  The diagnosis was mild BPD in 27 of the 106 patients and moderate/severe BPD in 29. The incidence of BPD was 52.8%. Fifty of 106 patients had no BPD. Analysis of risk factors revealed that gestational age ≤28 weeks (p=0.019), birth weight ≤1000 g (p=0.007), hypothermia (p=0.003), acidosis (p=0.003) and hypotension (p=0.005) at admission, respiratory distress syndrome (RDS) ( p<0.001), mechanical ventilation therapy (p<0.001), surfactant therapy (p=0.005), higher amount of mean fluid therapy on 7^th days (p=0.008), nosocomial infection (p<0.001), higher amount of mean packed red cell transfusions (p<0.001) and more than two packed red cell transfusions (p=0.033) were risk factors associated with the development of BPD. Multivariant logistic regression analysis showed acidosis at admission (OR 5.12, 95%CI 1.17–22.27, p=0.029), surfactant treatment (OR 7.53, 95%CI 2.14–26.45, p=0.002), nosocomial infections (OR 4.66, 95%CI 1.27–17.12, p=0.02) and PDA (OR 9.60, 95%CI 2.23–41.22, p=0.002) were risk factors increasing the severity of BPD. Conclusion  The most important risk factors for BPD development in our study were RDS and nosocomial infections while the presence of acidosis at admission, surfactant administration, nosocomial infections and the presence of PDA were the most important risk factors regarding BPD severity. Presence of acidosis at admission as a risk factor emphasized the importance of suitable transport conditions for premature infants.