Care of very low birthweight infants with limited neonatal intensive care resources

The advanced technology that is available to treat the tiniest infants has raised the legal and moral dilemma of where and how to distribute limited intensive care resources. In one neonatal intensive care unit it was determined that approximately 80% of its resources over a two-year period were utilized by very low birthweight infants, in spite of the fact that these infants comprised less than 50% of the total admissions to the unit. It was not possible to offer all very low birthweight infants full intensive care; to make this possible, it was calculated that resources would have to increase by 26%. In the present economic climate, and with limited numbers of nurses who are skilled in neonatal intensive care, the prospects for extra resources are poor. What action can or should be taken, legally and morally, when no facilities exist to treat a live-born infant who may possibly benefit from intensive care?     

Long-term follow-up of infants discharged from neonatal intensive care units

A recent review of 20 years' experience with neonatal intensive care for very-low-birth-weight infants provides reassurance that such care saves lives and that an increasing proportion survive free of moderate to severe handicap. However, data on the health status of these survivors largely reflect status in infancy. An increasing literature suggests that such early findings may be insufficient to characterize later outcomes, particularly those problems encountered as the child enters school. Since the specific health and developmental problems that might be encountered are still being defined, a broad conceptual framework is applied to organize a review of the existing literature. Some areas of concern about longer-term outcomes emerge, as well as important areas for which data are lacking. Further definition of longer-term outcomes is critical at the policy level to assess the utility of neonatal intensive care unit interventions and at the individual level for counseling families as to the health and educational needs of these children.     

Mortality in infants discharged from neonatal intensive care units in Georgia

Although neonatal intensive care units (NICUs) have contributed to advances in neonatal survival, little is known about the epidemiology of deaths that occur after NICU discharge. To determine mortality rates following NICU discharge, we used linked birth, death, and NICU records for infants born to Georgia residents from 1980 through 1982 and who were admitted to NICUs participating in the state's perinatal care network. Infants who died after discharge (n = 120) had a median duration of NICU hospitalization of 20 days (range, 1 to 148 days) and a median birth weight of 1983 g (range, 793 to 5159 g). The postdischarge mortality rate was 22.7 per 1000 NICU discharges. This rate is more than five times the overall postneonatal mortality rate for Georgia from 1980 to 1982. The most common causes of death were congenital heart disease (23%), sudden infant death syndrome (21%), and infection (13%). Demographic characteristics commonly associated with infant mortality were not strongly associated with the mortality following NICU discharge.     

The impact of the establishment of a neonatal intensive care unit on the outcome of very low birthweight infants at the University Hospital of the West Indies

A retrospective analysis of the outcome of inborn very low birthweight infants admitted to the neonatal unit of the University Hospital of the West Indies pre- (period 1) and post- (period 2) establishment of a neonatal intensive care unit was conducted. During the study, 250 infants were admitted to the neonatal unit, 132 (53%) during period 1 and 118 (47%) during period 2. There was improved survival during period 2 when 81 (69%) infants survived compared to period 1 when 73 (55%) survived (p = 0.02). This increased survival was due to an increase in survival of infants weighing 750-999g in period 2 when 17 (65%) infants survived compared to 9 (29%) in period 1 (p < 0.05). There was an increase in the number of infants ventilated in period 2, 39 (33%) compared to 12 (9%) period 1 (p < 0.001). Infants who were ventilated in period 2 were less likely to die than those ventilated in period 1 (OR 0.05, CI 0.01, 0.66). After controlling for gender, weight, gestational age and ventilation, infants born in the second time period were less likely to die than those born in the first time period (OR 0.33, CI 0.14, 0.76). The establishment of a neonatal intensive care unit has resulted in improved survival of very low birthweight infants; further improvement in survival of these infants will be dependent on increased accessibility to surfactant therapy, initiation of total parenteral nutrition and availability of trained personnel.     

Treatment choice for infants in the neonatal intensive care unit at risk for AIDS

Many infants admitted to neonatal intensive care units are the children of women infected with the human immunodeficiency virus (HIV); they have approximately a 30% risk of infection. To investigate attitudes surrounding treatment for such newborns, we conducted a survey of professionals at six neonatal intensive care units in New York City. A significant proportion of the 247 respondents recommended less aggressive treatment for non-HIV-related conditions for infants at risk for HIV compared with those not at risk. For example, 97% of respondents recommended open heart surgery for an infant with no known HIV risk but only 77% recommended surgery for an infant whose mother had acquired immunodeficiency syndrome; if certain the infant was infected, 42% of respondents recommended surgery. We conclude that perceived HIV status may influence decision making about treatment for non-HIV-related conditions for critically ill patients, including infants not actually infected. Ethical issues concerning the relevance of HIV status need to be examined.     

Outcome of extremely low birthweight infants at the University Hospital of the West Indies, Jamaica

OBJECTIVE: To describe the early outcome of extremely low birthweight infants delivered at the University Hospital of the West Indies. METHODS: A two-year retrospective review of the charts of all live, inborn extremely low birthweight infants admitted to the neonatal unit between January 1, 2002 and December 31, 2003 was conducted Differences between survivors and non-survivors were determined using analysis of variance and predictors of outcome were determined using multiple regression models. RESULTS: During the study period, 47 extremely low birthweight infants were admitted to the neonatal unit. The mean +/- SD birthweight and gestational age of these infants were 780 +/- 137 g and 27 +/- 2 weeks respectively. Twenty (43%) infants survived Babies (19; 58%) of gestational age > or = 27 weeks had increased survival compared to those < 27 weeks, (1; 7%; p = 0.001) and babies weighing > or = 750 g had increased survival (17, 65%) compared to those weighing < 750 g, (3, 14%; p < 0.001). Infants delivered by Caesarean section had improved survival 15 (58%) over those delivered vaginally (5, 24%; p = 0.02). All six (100%) infants whose mothers did not receive prenatal steroids died while 18 (50%) infants whose mothers received prenatal steroids died (p = 0.02). Significant factors associated with outcome were offered and gender was entered into a multiple regression model; gestational age and female gender remained independent predictors of survival. CONCLUSION: Obstetric measures for the prevention of preterm delivery need to be optimized in order to decrease the morbidity and mortality associated with extremely low birthweight infants.     

新生儿重症监护病房早产儿医院感染情况分析

目的调查新生儿重症监护病房（NICU）早产儿医院感染的发生情况,分析感染特点及危险因素,为有效预防和控制早产儿医院感染提供依据。方法对2009年6月至2011年5月在新乡医学院第一附属医院NICU住院的1685例早产儿医院感染情况进行统计分析。结果1685例早产儿中发生医院感染279例次,发生率为16．56％;住院日相关的医院感染率为46．87／1000住院日;感染部位以肺炎为主（41．85％）,病死率为18．94％。病原菌以革兰阴性菌最多见（57．83％）,主要为肺炎克雷白杆菌,其次是鲍曼不动杆菌、大肠杆菌、铜绿假单胞菌等。医院感染组与非医院感染组比较,胎龄更小,体质量更低。早产儿发生医院感染的危险因素主要有机械通气（OR=6．982）、其他有创操作（OR=5．214）、出生体质量≤1500g（OR=3．265）和胎龄≤32周（OR=2．412）。结论革兰阴性菌是最主要的NICU早产儿医院感染病原菌,其中肺炎克雷白杆菌和鲍曼不动杆菌是主要的病原菌;NICU早产儿医院感染的危险因素众多,需高度重视。     

Late morbidity of very low birthweight infants

The use of hospitals in the first year after term was studied in a geographically based group of 111 very low birthweight infants in Liverpool. This was compared with that of 216 term infants without perinatal complications. Of the group with very low birth weight, 59 (53%) were readmitted, with three deaths, compared with 21 (10%) of the term infants. Of the admissions, 67 (40%) related to sequels of neonatal illness or its management. The admissions were repeated and of long duration, resulting in a 16-fold increased load of inpatients, an eightfold increase in surgical procedures, and a twofold increase in attendance by outpatients at the local children's hospitals compared with the term group. This population of infants after intensive care represented a high risk group with specific problems and requirements in infancy, even when problems were not apparent at discharge from the neonatal unit.     

Vaccination status of infants discharged from a neonatal intensive care unit.

OBJECTIVE: To determine the vaccination rate among infants discharged from a neonatal intensive care unit (NICU) and factors affecting that rate. DESIGN: Cross-sectional survey conducted when the children were 12 to 18 months of age. SETTING: NICU at the Royal University Hospital, Saskatoon, Sask. PARTICIPANTS: All 395 infants discharged from the NICU between Jan. 1 and June 30, 1992. MAIN OUTCOME MEASURES: Vaccination rate, ethnic background (native or non-native), place of residence (urban or rural), health status (number of days spent in the NICU), reasons for delay in or incomplete vaccinations (those involving parents' responsibility, infant illness or contraindications). RESULTS: Of the 395 infants, 20 (5.0%) had died and incomplete information was available for 30 (7.6%). Complete data were available for 345 (87.3%). Of the infants for whom data were available, 8 (2.3%) had never been vaccinated and 142 (41.2%) had a delayed vaccination schedule or had not completed their scheduled vaccinations. Only 195 (56.6%) of the infants had received a full vaccination series. Non-native ethnic background was a predictor of completed vaccinations (odds ratio [OR] 5.40, 95% confidence interval [CI] 3.05 to 9.52). In a univariate model, urban area of residence was not a significant predictor of vaccination status, but when ethnic background was controlled for in a multivariate logistic regression analysis, urban area of residence was found to be inversely associated with completed vaccinations (OR 0.34, 95% CI 0.15 to 0.79). The number of days the child had spent in the NICU was not a significant predictor of vaccination status. CONCLUSION: The vaccination rate of infants discharged from the NICU is not optimal. Urban native children appears to be at risk of not being vaccinated. Non-native infants are five times more likely than native infants to have completed all of their scheduled vaccinations. Methods to improve the rate of completed vaccinations, especially for native children, must be sought and tested.     

Glucose polymer supplementation of feeds for very low birthweight infants

The feeds of 14 very low birthweight infants (birth weight less than 1500 g) were supplemented with a glucose polymer (Caloreen) at the rate of 6 g/kg body weight daily. Seven day periods of supplementation were alternated with seven day periods of normal feeding. Adding the glucose polymer significantly increased the rate of weight gain in these infants from 105 g/week to 140 g/week; growth rates in terms of length and head circumference were not affected. No adverse effects were noted. Glucose polymer is a useful energy supplement for very low birthweight infants.     

新生儿重症监护室早产儿母乳喂养促进策略研究

目的:探讨母乳喂养促进策略对新生儿重症监护室(neonatal intensive care unit,NICU)早产儿住院期间临床结局的影响。方法:制定母乳喂养促进策略,包括建立多学科母乳喂养指导小组、母乳喂养家庭和社会支持、家庭参与式护理、袋鼠式护理、捐赠母乳库等。将2015年11月至2017年2月入住重庆市妇幼保健院NICU的符合纳入标准的胎龄<32周早产儿根据策略实施前后分为对照组和干预组,比较两组早产儿母乳喂养相关指标(开奶时间、开始母乳喂养时间、达完全母乳喂养时间、达完全肠内营养时间、母乳喂养率)、体格发育指标(宫外生长迟缓)、并发症等。结果:纳入研究的早产儿共123例,对照组61例,干预组62例,两组间性别、胎龄、出生体重、宫内生长迟缓、入院疾病状态等方面差异无统计学意义(P>0.05)。干预组与对照组相比,开奶时间[15.37 (10.00, 22.13) h vs. 20.25 (12.88, 26.33) h,P<0.01]、达完全母乳喂养时间[91.00 (69.75, 103.00) h vs. 94.00 (80.37, 118.75) h,P=0.04]、达完全肠内营养时间[12 (11, 15) d vs. 14 (12, 18) d,P<0.01]均显著提前;两组间开始母乳喂养时间、住院时间、体质量宫外生长迟缓发生率、母乳喂养率差异均无统计学意义(P>0.05);两组间喂养不耐受、新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)、支气管肺发育不良(bronchopulmonary dysplasia,BPD)、早产儿视网膜病(retinopathy of prematurity,ROP)等并发症的发生率及死亡率差异均无统计学意义(P>0.05)。结论:母乳喂养促进策略是对常规母乳喂养策略的质量改进,可显著提前NICU早产儿的开奶时间、达完全母乳喂养时间和完全肠内营养时间,但其是否对提高母乳喂养率,降低NEC、BPD、ROP等并发症发生率存在益处,需进一步研究证实。     

重症监护病房新生儿死亡病例分析

目的探讨新生儿重症监护病房（NICU）新生儿死亡的危险因素及变迁。方法回顾性分析我院NICU 2004年1月—2009年12月期间死亡的129例患儿的病历资料,筛选死亡危险因素。结果体重〈1.5 kg新生儿年均病死率9.2%;胎龄≤32周早产儿年均病死率为9.4%;死亡新生儿中出生48 h内病死率达34.9%.2004年—2009年新生儿直接死亡原因排序依次为感染性疾病、窒息及其并发症、先天性畸形、其他疾病。结论胎龄小、出生体重低及母亲高龄始终是新生儿死亡的高危因素,死亡高危时段在出生后48 h内。感染性疾病、窒息及其并发症是最主要的直接死因,先天性畸形致死率增高,疾病谱有扩大趋势。     

新生儿重症监护病房两年院内感染临床分析

目的 比较分析近两年新生儿重症监护病房院内感染发生情况.方法 回顾性分析2010年1月至2012年1月于我院NICU住院期间发生院内感染的110例患儿资料.分为2010年组59例,2011年组51例,比较两组患儿一般资料、院内感染发生的种类,并统计病原学检查情况.结果 两组患儿在较常见的院内感染如呼吸道感染、消化道感染、血液系统感染两组间对比差异无统计学意义(P>0.05);院内感染以条件致病菌为主.结论 近两年新生儿重症监护病房院内感染在发生率及病原菌感染的种类上无显著性变化,院内感染发生率在同等级别的医院中处于较好的水平.     

Very low birthweight and normal birthweight infants. A comparison of continuing morbidity

One hundred and forty-eight (95.5%) of 155 consecutive two-year survivors of 227 very low birthweight (VLBW, less than 1501 g) infants and 50 (83.3%) of 60 infants of normal birthweight who were selected at random, all of whom were born at the Royal Women's Hospital, Melbourne from October 1980 to March 1982, were seen at the age of two years. Social, psychological and health data were compared between the groups. The mean Bayley Mental Developmental Index scores of VLBW children were significantly lower; the prevalence of major handicaps and poor growth (height and weight below the 10th percentile), and the number of hospital readmissions, wheezing episodes, major and minor congenital anomalies and postnatally-acquired malformations (for example, abnormally shaped skull) were significantly greater in VLBW children. There was a trend for a greater number of episodes of otitis media, lower respiratory tract infections and surgical procedures per child in VLBW children. Extremely low birthweight children (birthweight less than 1000 g) contributed significantly to this morbidity. Parents of VLBW children perceived significantly more problems with infant vomiting and behavioural disturbances at two years of age. The children of mothers of limited education, or immigrant status and non-fee paying or lower socioeconomic families had lower mean Bayley Mental Developmental Index scores but similar handicap rates and health status in both weight cohorts.