早产儿出生早期粪便钙卫蛋白水平变化及临床意义

目的：探讨早产儿生后早期粪便钙卫蛋白（fecal calprotectin,FC）水平及影响因素,寻找早产儿胃肠道损伤的早期诊断指标。方法：将38例胎龄为29～33周的早产儿按早产原因分为胎膜早破（premature rapture of membrane,PROM）组、自发性早产(spontaneous preterm birth,SPB)组及有医学指征早产(indicated preterm birth,IPB)组,收集出生后第1次胎便及生后第3天最后1次粪便（以下简称为第1次和第2次粪便）,用ELISA法测定FC水平。结果：38例早产儿第1次与第2次FC水平差异无统学计意义（P>0.05）。PROM组第1次FC水平明显高于IPB组（P0.05）。结论：胎膜早破及出生窒息促进早产儿胃肠道分泌FC,生后早期FC水平可反映早产儿早期胃肠道喂养状况,可作为评价早产儿生后早期消化道功能的指标。     

Elevated urinary NT-proBNP after pharmacological closure of patent ductus arteriosus in very low birth weight infants

Background

Hemodynamically significant patent ductus arteriosus (hsPDA) complicates the clinical course of preterm infants and contributes to increased morbidity and mortality. NT-proBNP is indicative of the effects of hsPDA on clinical and cardiac status of patients.

Aims

The aim of this study was to evaluate the value of urinary NT-proBNP and NT-proBNP/creatinine ratio in follow-up of hsPDA.

Study design

Urinary NT-proBNP and NT-proBNP/creatinine ratio (UNBCR) were measured and correlated with the presence of hsPDA. Measurements were performed in 92 neonates on postnatal days 14 and 28 by ELISA methodology. Of 92 neonates, 22 required therapeutic interventions.

Results

Infants treated for hsPDA showed significant higher levels of urinary NT-proBNP and UNBCR on postnatal day 14 whereas similar results were determined on postnatal day 28. Cut-off level of NT-proBNP was 567 pg/mL with a sensitivity of 79% and a specificity of 71%.

Conclusion

Our data showed that NT-proBNP and UNBCR levels as non-invasive and powerful methods in preterm infants may help clinicians to determine the effects of hsPDA on clinical and cardiac status of the patients even with first measurement on day 14.     

乳铁蛋白与早产儿坏死性小肠结肠炎

坏死性小肠结肠炎是早产儿常见主要并发症之一,具有较高的病死率和发病率,可以导致多种远期并发症,如短肠综合征、全身感染、眼部疾病、营养不良和神经系统发育障碍等.乳铁蛋白是母乳中的一种成分,具有抗细菌、抗病毒、抗真菌、增强免疫力等多种作用.新近许多研究评估了乳铁蛋白防治坏死性小肠结肠炎的效果和安全性.应用乳铁蛋白预防和治疗坏死性小肠结肠炎对于提高早产儿的预后具有很重要作用.     

Minimal enteral feeding reduces the risk of sepsis in feed-intolerant very low birth weight newborns

Aims: To evaluate the efficacy and safety of minimal enteral feeding (MEF) nutritional practice in feed-intolerant very low birth weight (VLBW) infants.
Methods: A retrospective design using data reported in the clinical charts of VLBW newborns consecutively observed in neonatal intensive care units (NICU) that presents feed intolerance. During the study period, two feeding strategies were adopted: total parenteral nutrition (PN) (group 1) or PN plus MEF (group 2), for at least 24 h. Primary outcome was the time to reach full enteral feeding; secondary outcomes were the occurrence of sepsis, the time to regain birth weight, the length of hospitalization, the occurrence of necrotizing enterocolitis (NEC) Bell stage >II and death.
Results: In total, 102 newborns were evaluated: 51 in group 1, and 51 in group 2. Neonates in group 2 achieved full enteral nutrition earlier (8 days, interquartile range [IQR] 5) compared with subjects receiving total PN (11 days, IQR 5, p < 0.001). A reduction of sepsis episodes was observed in group 2 (15.7%) compared with group 1 (33.3%, p = 0.038). Additionally, subjects in group 2 regained their birth weight and were discharged earlier. The occurrence of NEC and death were similar in the two groups.
Conclusion: Minimal enteral feeding in very low birth weight infants presenting feed intolerance reduces the time to reach full enteral feeding and the risk of sepsis. This feeding practice does not increase the risk of necrotizing enterocolitis and death.     

极低出生体重儿脑损伤临床及高危因素分析

目的 调查极低出生体重儿(very low birth weight infant,VLBWI)脑损伤发病情况并分析其高危因素,以探讨改善神经发育预后的方法.方法 回顾性分析2007年10月至2014年9月我院NICU收治的326例VLBWI脑损伤发生情况,分析脑损伤组(132例)与无脑损伤组(194例)在一般情况、高危围生因素、早产儿合并症和呼吸支持治疗方面的差异,并对相关危险因素进行Logistic回归分析.结果 326例VLBWI中,发生早产儿脑损伤132例,发生率40.49％;其中出血性脑损伤80例(24.54％,80/326),包括脑室周围-脑室内出血66例(20.25％,66/326)(Ⅰ～Ⅱ级41例、Ⅲ～Ⅳ级25例),非出血性脑损伤52例(15.95％,52/326),包括脑室周围白质软化46例(14.11％,46/326).脑损伤组及无脑损伤组的一般资料显示,除性别外,胎龄、胎数、出生体重等方面差异有无统计学意义(P＞0.05).进一步比较两组间高危围生因素、早产儿合并症及呼吸支持治疗共28个因素的分布,结果提示在窒息、绒毛膜羊膜炎、产前激素使用、新生儿呼吸窘迫综合征、低氧血症、呼吸暂停、肺出血、动脉导管未闭、低血压、酸中毒、低碳酸血症、贫血、高血糖、血小板减少、高频通气、宫外发育迟缓16个方面差异有统计学意义(P＜0.05),进一步二分类Logistic回归分析显示产前激素使用与脑损伤发生呈负相关,绒毛膜羊膜炎、酸中毒和动脉导管未闭与脑损伤发生呈正相关,早产儿脑损伤的危险分别增加了0.108、7.222、3.045和4.565倍.结论 VLBWI的实际病死率及脑损伤发生率仍较高.绒毛膜羊膜炎、动脉导管未闭和酸中毒与早产儿脑损伤的发生密切相关.产前激素可预防早产儿脑损伤的发生.在VLBWI的围生期管理中应高度重视这些影响因素,以降低早产儿脑损伤发生率.     

Transthyretin levels are not related to Apgar score in low birth weight and very low birth weight infants

BACKGROUND: Previous studies have reported an increased incidence of thyroid dysfunction in premature/low birth weight infants. The cord blood concentrations of transthyretin (TTR), a thyroid hormone binding protein, have also been found to be decreased in preterm infants. While thyroid hormone concentrations are decreased in sick infants, it is not known if physical condition influences TTR levels. Serial concentrations of TTR following birth have not previously been reported. AIMS: To measure serial serum concentrations of TTR in premature infants following birth, and determine whether TTR levels are related to physical condition. METHODS: A cohort of 65 premature very low birth weight (VLBW) and LBW infants were studied. Serum samples were obtained on the day of birth, and for 8 weeks following birth. Apgar scores at birth as well as the incidence of respiratory distress syndrome (RDS) were noted. RESULTS: Baseline serum T4 concentrations and Apgar scores were significantly lower in VLBW infants, while the severity of RDS was significantly higher in the VLBW group. Multivariate analyses revealed that T4 levels were negatively associated with RDS, while TSH concentrations were positively related to gestational age. TTR concentrations were not related to gestational age at birth, Apgar score, or RDS, and did not change markedly over 8 weeks. CONCLUSIONS: These findings suggest that serum TTR concentrations are not related to birth weight/gestational age and are not associated with either clinical condition at birth (as assessed by Apgar score) or the occurrence of RDS. Reference values for TTR concentrations in VLBW and LBW infants are provided from birth to 8 weeks of age.     

A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants

This study was carried out to assess the feasibility of late cord clamping of 45 s in preterm infants delivered mainly by caesarean section and the effects on post-partal adaptation and anaemia of prematurity. Prior to delivery, 40 infants of <33 gestational weeks were randomised to either 20 s or 45 s of late cord clamping. After the first shoulder was delivered, oxytocin was given intravenously to the mother in order to enhance placento-fetal transfusion while the infant was held below the level of the placenta. The 20 infants in group 1 (20 s) had a mean birth weight of 1070 g and a mean gestational age of 29 + 4/7 weeks versus 1190 g and 30 weeks in group 2 (45 s). On day 42 of life there were ten infants without transfusions in group 2 versus three in group 1 (P < 0.05). Out of the 20 infants in group 1, 19 and 15/19 in group 2 were delivered by caesarean section. There were no significant differences in Apgar scores, temperature on admission, heart rate, blood pressure and requirements for artificial ventilation. Conclusion Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation. It is possible to perform the procedure at caesarean section deliveries and it should be performed whenever possible. It reduces the need for packed red cell transfusions during the first 6 weeks of life. Received: 10 February 2000 / Accepted: 12 April 2000     

Energy expenditure in very low birth weight newborns: a comparison between small and appropriate‐for‐gestational‐age

Aims: To compare resting energy expenditure (REE) in small‐ and appropriate‐for‐gestational‐age very low birth weight newborns after reaching corrected at‐term age. Methods: Observational study that included all clinically stable very low birth weight newborns admitted to a neonatal intensive care unit. The newborns were classified as small‐for‐gestational‐age (SGA) and appropriate‐for‐gestational‐age (AGA). Resting energy expenditure was measured using indirect calorimetry when the newborns reached at‐term age. Results: A total of 51 newborns, of which 23 were SGA and 28 AGA, were included. There was no statistically significant difference in REE between the two groups, although the observed levels were higher than the reference values. Conclusion: There is no statistical difference in resting expenditure energy between SGA and AGA infants when they reached term. The higher energy expenditure found in both groups may be explained by other factors related to prematurity and its complications and requires further investigation.     

Prevention of necrotizing enterocolitis in extremely low birth weight infants by IgG feeding?

Oral immunoglobulin has been described as preventing necrotizing enterocolitis(NEC) in preterm infants. To prevent NEC in extremely low birth weight infants (ELBW), we have carried out oral IgG prophylaxis since April 1991. The efficacy of this prophylaxis was examined in a study comparing historical cohorts. ELBW infants delivered in the Department of Obstetrics and Gynaecology of the University of Ulm and treated until day 28 in the level III intensive care nursery, Division of Neonatology, University of Ulm were included. Cohort 1, born between 1.1.1988 and 31.3.1991, received no oral IgG and served as a control [n=84, gestational age: median 26 weeks, range 24–34; birth weight: 811 g, 490–990], cohort 2, born between 1.4.1991 and 31.12.1995 [n=137, gestational age: 26 weeks, 22–32; birth weight: 760 g, 362–995], received 6 × 100 mg/kg human IgG (Beriglobin) orally on days 1–28. NEC, stage 2a and higher according to the modified classification of Bell, was observed in 9 of 84 (10.7%) infants of cohort 1 and in 11 of 137 (8%) infants of cohort 2 until day 28. The difference did not reach statistical significance (P=0.63 Fisher's exact test). Conclusion In this historical cohort study, ELBW infants were not protected against NEC by oral IgG. The present published evidence does not allow recommendation of oral human IgG administration in preterm infants as a prophylactic measure against NEC. Received: 8 June 1997 / Accepted in revised form: 1 January 1998     

Feeding and drinking skills in preterm and low birth weight infants compared to full term infants at a corrected age of nine months

Feeding and drinking skills were registered in 47 preterm (< 32 weeks) and/or low birth weight (< 1500 g) infants and compared to 52 healthy full term infants at a (corrected) age of nine months. In the preterm and/or SGA infants a delay was found for sufficient postural balance, drinking independently from a bottle, eating skills and accepting teeth brushing at a corrected age of nine months compared to healthy controls. For tongue position and movement, and choking during drinking no difference was found between both groups.     

Early nasal continuous positive airway pressure treatment reduces the need for intubation in very low birth weight infants

Nasal continuous positive airway pressure (CPAP) applied shortly after birth is said to be an effective treatment of respiratory distress in very low birth weight infants (VLBW). We tested the hypothesis that the use of early nasal CPAP (applied as soon as signs of respiratory distress occurred, usually within 15 min after birth) reduces the need for intubation, the duration of intermittent mandatory ventilation and the incidence of bronchopulmonary dysplasia. All liveborn VLBW infants (birth weight < 1500 g) admitted to our tertiary neonatal intensive care unit in 1990 (historical controls) and in 1993 (early nasal CPAP group) entered the study. The intubation rate was significantly lower after introduction of nasal CPAP (30% vs 53%, P = 0.016). Median duration of intubation was 4.5 days (interquartile range 3–7 days) before versus 6.0 days (2.8–9 days) after nasal CPAP was introduced (P = 0.73). The incidence of bronchopulmonary dysplasia was not reduced significantly (32% vs 30%, P = 0.94). Survival until discharge was 89.5% before versus 92.9% after introduction of nasal CPAP (P = 0.54). Conclusion Early nasal CPAP is an effective treatment of respiratory distress in VLBW infants, significantly reducing the need for intubation and intermittent mandatory ventilation, without worsening other stan dard measures of neonatal outcome. We found no significant decrease in the incidence of bronchopulmo nary dysplasia. Received: 5 February 1996 and in revised form: 12 September 1996 / Accepted: 23 October 1996     

预防性使用益生菌对降低极低出生体重早产儿坏死性小肠结肠炎发病率和病死率的Meta分析

目的 运用循证医学方法,评价益生菌在降低极低出生体重(VLBW)早产儿坏死性小肠结肠炎(NEC)的发病率和病死率方面的安全性和有效性。方法 系统检索PubMed、EMBASE、Cochrane 临床对照试验资料库(CENTRAL)、the ISI Web of Knowledge Databases、中国生物医学文献数据库(CBM)、中文期刊全文数据库(CNKI)和维普中文科技期刊数据库(VIP)、万方数据库,检索时间均为建库至2014年3月,查找所有研究预防性使用益生菌对降低VLBW早产儿NEC的发病率和病死率的随机对照试验。按纳入排除标准进行RCT的筛选、资料提取和质量评价,应用RevMan 5.1软件进行Meta分析。结果 共纳入21项研究(4 607例VLBW早产儿),Meta分析发现预防性使用益生菌能显著降低VLBW早产儿NEC的发病率[RR=0.47;95%CI(0.35~0.62);PRR=0.63;95%CI(0.51~0.78),PRR=0.87;95%CI(0.72~1.06);P=0.17]及NEC相关病死率[RR=0.68;95%CI(0.31~1.48),P=0.33]差异无统计学意义。结论 预防性使用益生菌能降低VLBW早产儿NEC的发病率和病死率,但其对早产儿的长期影响仍需大量的临床研究来评估。     

妊高征对极低出生体重早产儿并发症的影响

目的研究妊娠高血压综合征(妊高征)对极低出生体重早产儿并发症的影响。方法收集极低出生体重早产儿作为研究对象,根据母亲是否患有妊高征分为两组,比较两组患儿主要并发症发生率及住院时间。结果 (1)两组患儿间胎龄、出生体重、性别、母亲糖尿病发生率、产前激素使用率的差异均无统计学意义,妊高征组SGA发生率明显高于非妊高征组。(2)妊高征组支气管肺发育不良(BPD)发生率明显低于非妊高征组,而早产儿呼吸暂停(AOP)、坏死性小肠结肠炎(NEC)、早产儿视网膜病变(ROP)、早产儿颅内出血-脑白质病变(IVH-PVL)发生率及住院天数的差异均无统计学意义。(3)两组间NRDS发生率无差异,但妊高征组NRDS患儿PS使用率明显低于非妊高征组。结论妊高征可减轻早产儿呼吸系统并发症,降低PS使用率,减少BPD发生率。     

Parental psychological well-being and cognitive development of very low birth weight infants at 2 years

Aim: To assess the associations between cognitive development of very low birth weight (VLBW) infants and measures of parental psychological well‐being. Methods: In this prospective cohort study, 182 VLBW infants born 1/2001–12/2006 at the Turku University Hospital, Finland, were followed up. At 2 years corrected age, cognitive development of the child was assessed using the Mental Development Index of Bayley Scales, and both parents filled in validated questionnaires defining parental psychological well‐being (Beck Depression Inventory, Parenting Stress Index and Sense of Coherence Scale). Results: The cognitive delay of the infant was associated with paternal symptoms of depression (p = 0.007) and parenting stress (p = 0.03). Mothers of the infants with cognitive delay reported increased parenting stress related to the difficulty to accept the child (p = 0.001). Weak sense of coherence predicted depressive symptoms in both parents (p < 0.0001). Conclusion: Even if the fathers of VLBW infants experienced depressive symptoms less often than the mothers, the ability of the fathers to cope was significantly associated with the cognitive development of the infant. In addition, the fathers reported more parenting stress if the infant had a cognitive delay. The mothers reported more parenting stress related to accepting the VLBW infant with cognitive delay.     

61例极低出生体重早产儿生后第一年生长发育的随访

目的 探讨极低出生体重早产儿生后第一年生长发育情况及相关影响因素。方法 对61例极低出生体重早产儿进行出生后第一年的生长发育监测。采用Z评分法评价体格指标、丹佛发育筛查测验(DDST)进行发育筛查。结果 61例中小于胎龄儿(SGA)27例(44.3%),适于胎龄儿(AGA)34例(55.7%)。随访1年,年龄别体重(WAZ)、年龄别身长(HAZ)、年龄别头围(HCZ)、身长别体重(WHZ)的Z积分中位数均>-1 SD;年龄别体质指数(BMI)的Z积分(BAZ)以及WHZ的高峰在纠正年龄1个月。纠正胎龄40周时,低体重、生长迟缓、消瘦、小头畸形、超重和肥胖等的生长偏离发生率最高,分别为15%、16%、11%、13%、20%和10%。与纠正胎龄40周比,纠正年龄6个月及9~12个月的超重发生率(3%,3%)明显降低(P P 结论 极低出生体重早产儿在纠正龄3个月以内生长偏离明显。生后第一年DDST筛查异常的比例较高。     

The influence of early postnatal nutrition on retinopathy of prematurity in extremely low birth weight infants

Background

Retinopathy of prematurity(ROP) is the most common serious ophthalmic disease in preterm infants. Human milk may provide a protective effect for ROP; however, beneficial effects of human milk preclude randomized trials. Therefore, we conducted a retrospective analysis comparing early postnatal nutrition with ROP development.

Objective

Evaluate relationship between early postnatal nutriture and ROP surgery.

Design/methods

Nutrition data was collected for inborn AGA infants, BW 700-1000 g. ROP surgery was the primary outcome variable. A single pediatric ophthalmologist supervised examinations. All infants received triweekly IM vitamin A as chronic lung disease prophylaxis (Tyson: NEJM, 1999).

Results

BW and gestational age were 867 ± 85 g and 26.3 ± 1.2 weeks (n = 77, mean ± 1SD). ROP surgery infants(n = 11) received more parenteral nutrition, 1648 mL, and less human milk, 13.8 mL/kg-day, and vitamin E, 1.4 mg/kg-day, during the second postnatal week. Human milk was a negative predictor for ROP surgery, odds ratio = 0.94. Both groups met vitamin A recommendations; however, 74% was administered via IM injections. Neither group met vitamin E recommendations.

Conclusions

Human milk feeding, parenteral nutrition volume and vitamin E intake were predictors for ROP surgery. IM vitamin A injections provided the majority of vitamin A; vitamin E administration was insufficient. Improving human milk feeding rates and vitamin dosing options may affect ROP surgery rates.     

极低/超低出生体重儿晚发败血症的临床分析

目的 分析极低/超低出生体重（VLBW/ELBW）早产儿晚发败血症（LOS）的临床特征及病原菌情况。方法 在2012年1月至2016年12月收治的VLBW/ELBW早产儿（胎龄<32周）中,选取发生LOS的患儿作为LOS组,每例LOS患儿匹配2例非败血症患儿作为对照组。根据是否发生院内死亡,将LOS组分为死亡亚组和存活亚组,分析LOS发生的危险因素、临床特征、病原菌分布、耐药情况及死亡危险因素。结果 共收治VLBW/ELBW早产儿513例,LOS组65例,对照组130例,LOS发生率为12.7%。LOS组死亡6例,存活59例。LOS组出生体重低于对照组（P < 0.05）,LOS组经外周静脉穿刺中心静脉置管（PICC）时间、机械通气时间、住院时间长于对照组（P < 0.05）。LOS组小于胎龄儿（SGA）、机械通气、新生儿坏死性小肠结肠炎、死亡比例高于对照组（P < 0.05）。低出生体重、SGA、PICC时间长为VLBW/ELBW早产儿发生LOS的危险因素（分别OR=1.396、2.550、1.068,P < 0.05）。合并化脓性脑膜炎是VLBW/ELBW早产儿LOS死亡的危险因素（OR=13.443,P < 0.05）。LOS组共培养出65株病原菌,39株（60%）为革兰阴性菌,其中15株为产超广谱β-内酰胺酶（ESBLs）菌,67%（10/15）感染ESBLs菌的LOS患儿发病2周前应用过抗生素,高于非耐药菌（29%,7/24）（P < 0.05）。结论 出生体重低、SGA、PICC时间长为VLBW/ELBW早产儿发生LOS的危险因素,合并化脓性脑膜炎的LOS患儿更容易发生死亡。LOS病原菌以革兰阴性菌多见,发病2周前应用过抗生素可能会增加ESBLs菌感染。     

Timing of surgical ligation of patent ductus arteriosus in very low birth weight infants北大核心CSCD

Objective To study the effect of timing of surgical ligation of patent ductus arteriosus (PDA) on the prognosis of very low birth weight infants (VLBWI). Methods The medical data of VLBWI who underwent transthoracic ligation for PDA from June 2018 to May 2021 were reviewed retrospectively. The infants were divided into early ligation group (≤21 days of age) and late ligation group (>21 days of age) based on the age of ligation. The two groups were compared in terms of perioperative clinical features, complications, and mortality. The risk factors for early surgical ligation were analyzed. Results A total of 72 VLBWI were enrolled, with 19 infants (26%) in the early ligation group and 53 infants (74%) in the late ligation group. There were significant differences in birth weight, gestational age, weight at operation, days of age at operation, rates of preoperative invasive and noninvasive mechanical ventilation, incidence rate of pulmonary hemorrhage, incidence rate of hypotension, preoperative PDA internal diameter (mm/kg), intraoperative PDA external diameter (mm/kg), incidence rate of post-ligation cardiac syndrome, and duration of postoperative invasive mechanical ventilation between the two groups (P<0.05). A binary logistic regression analysis showed that pulmonary hemorrhage was an indication of early surgical ligation of PDA (P<0.05). There were no significant differences in the incidence rates of post-operative complications and the mortality rate between the early ligation and late ligation groups. Conclusions Early surgical ligation may be performed for VLBWI who are experiencing pulmonary hemorrhage and hemodynamically significant PDA confirmed by cardiac ultrasound after birth. However, post-ligation cardiac syndrome should attract enough attention. In addition, early surgical ligation of PDA does not increase the risk of surgery-related and long-term complications or death, indicating that it is a safe and feasible treatment option. © 2022 Central South University. All right reserved.