新生儿脐血Toll样受体变化及其意义

目的观察新生儿脐血单个核细胞（MNC）rrLR4、TLR2mRNA的表达。方法将46例无窒息新生儿及40例窒息新生儿根据胎龄分组,分离脐血MNC,测定其TLR4／2mRNA表达及上清中TNF-α水平。另外将TLR4／2mRNA表达水平与TNF-α水平进行相关分析。结果无窒息新生儿中足月儿TLR4／2mRNA及TNF-O／．水平分别为0．75±0．12、0．63±0．08、2502．6±273．1ng／t,胎龄≥32周但〈37周早产儿分别为0．37±0．04、0．32±0．03、1218．8±145．7ng／t,胎龄〈32周早产儿分别为0．26±0．03、0．20±0．03、811．8±105．2ng／t;窒息新生儿中足月儿TLR4／2mRNA及TNF-α．水平分别为0．58±0．07、0．50±0．06、1946．4±244．2ng／t,胎龄≥32周但〈37周早产儿分别为0．29±0．03、0．26±0．03、970．0±94．3ng／t,胎龄〈32周早产儿分别为0．17±0．02、0．14±0．02、652．6±60．3ng／t;成人TLR4／2mRNA及TNF-α水平分别为2．71±0．75、2．61±0．33、9270．1±1098．3ng／t。早产儿、足月儿TLR4／2mRNA及TNF-α水平均低于成人,胎龄越低,TLR4／2mRNA及TNF-α水平越低。窒息新生儿TLR4／2mRNA及TNF-α的表达水平均低于同胎龄无窒息新生儿（P〈0．01）。TLR4／2mRNA表达水平与TNF-O／．水平呈正相关关系。结论新生儿,特别是早产儿,TLR水平低下,可能是新生儿天然免疫能力低下,容易患败血症等严重感染性疾病的重要原因之一。     

早产儿脑反应性及其神经发育的近红外光谱评价研究

目的研究早产儿脑对外界刺激的反应性与神经发育的关系,早期对早产儿进行脑功能的评价,为了解其神经发育水平、估价预后提供客观证据。方法对不同胎龄的早产儿进行声刺激,用近红外光谱技术,观察声刺激后脑反应性的变化,并进行神经发育随访,评价早产儿早期脑反应性与其后神经发育的关系。结果本组早产儿生后对声刺激均显示出不同程度的反应,30~32周的早产儿声刺激后开始反应时间、高峰出现时间、停止刺激后开始恢复时间分别为(278±94)s、(446±67)s、(199±52)s,明显长于足月儿的(107±30)s、(264±51)s、(131±46)s。氧合血红蛋白、还原血红蛋白、脑组织氧饱和度的最大反应值分别为(0.3±0.3)%、(0.7±0.5)%、(0.3±0.3)%,明显低于足月儿的(1.7±0.7)%、(1.7±0.8)%、(1.6±0.7)%。胎龄大于32周的早产儿反应的时间及最大反应值与足月儿相比,差异无统计学意义。围产期脑损伤可影响脑的反应性,早产儿脑反应性与纠正胎龄40周时的神经行为评分及神经发育相关。随访过程中颅脑超声表现为脑发育异常者,其新生儿期对声刺激无反应的比例明显高于脑发育正常者。结论近红外光谱技术能评价新生儿的脑反应性,早产儿具备对声刺激后的脑反应性,早期的脑反应性与神经发育水平有关。     

不同胎龄早产儿生后24 h内血小板及相关参数参考范围

目的 研究不同胎龄早产儿生后24 h内血小板及相关参数参考范围并探讨其临床意义。方法 根据纳入标准和排除标准,收集2018年1~12月入住新生儿重症监护室且出生胎龄为23~36⁺⁶周早产儿1 070例的临床资料进行回顾性分析,观察生后24 h内不同胎龄早产儿血小板参数参考范围。结果 不同胎龄早产儿血小板计数（PLT）及血小板压积（PCT）水平比较差异无统计学意义（P > 0.05）;晚期早产儿组（34~36⁺⁶周,n=667）血小板平均体积（MPV）及血小板体积分布宽度（PDW）均低于极早早产儿组（23~27⁺⁶周,n=36）和早期早产儿组（28~33⁺⁶周,n=367）（P < 0.05）。不同性别早产儿之间血小板及相关参数比较差异均无统计学意义（P > 0.05）。按照不同胎龄来计算早产儿血小板参数的参考范围,23~36⁺⁶周早产儿PLT参考范围为（92~376）×10⁹/L,PCT参考范围为0.1%~0.394%;23~33⁺⁶周早产儿MPV参考范围为9.208~12.172 fl,PDW参考范围为8.390%~16.407%;34~36⁺⁶周早产儿MPV参考范围为9.190~11.950 fl,PDW参考范围为9.046%~15.116%。结论 不同胎龄早产儿生后24 h内MPV及PDW不同,依据胎龄制定早产儿MPV及PDW参考范围更有助于指导临床工作。     

早产儿校正24月龄内生长轨迹研究（英文翻译）

目的分析早产儿校正24 月龄内生长轨迹,以了解早产儿的生长趋势和规律。方法基于互联网+ 随访系统建立早产儿随访数据库,纳入2018 年4 月至2021 年4 月3 188 例早产儿,收集其出生及校正1、3、6、 12、18、24 月龄时的身长、体重、头围数据。按不同的围生期因素分组,绘制生长曲线,并与21 世纪国际胎儿和新生儿生长联合会（International Fetal and Newborn Growth Consortium for the 21st Century,INTERGROWTH-21st）标准和世界卫生组织（World Health Organization,WHO） 标准进行比较。结果按不同的围生期因素分组的各组早产儿体重、身长、头围曲线均在校正6 月龄内快速上升,校正6 月龄后增长速度减缓。按实际月龄比较,各出生胎龄组早产儿（<28 周、28~31⁺⁶周、32~33⁺⁶周、34~36⁺⁶周） 身长曲线在实际9 月龄后逐渐与WHO 曲线重合（P=0.082）,<32 周早产儿的体重和头围则一直落后于WHO 曲线（P<0.001）。校正月龄后,不同出生胎龄组早产儿（<28 周、28~31⁺⁶周、32~33⁺⁶周、34~36⁺⁶周） 的体格生长曲线基本重合（P>0.05）。超低出生体重儿和小于胎龄儿的身长、体重、头围曲线均低于INTERGROWTH-21st 标准和WHO 标准（P<0.05）。结论早产儿在校正6 月龄内体格增长速度较快,校正6 月龄后增长速度减缓。胎龄越小,体重和头围追赶的时间越长。应重点关注超早产儿、超低出生体重儿和小于胎龄儿的体格生长。     

Placental transfer and decay of varicella-zoster virus antibodies in preterm infants

OBJECTIVES: To compare the placental transfer of maternal varicella-zoster (VZV) antibodies to preterm and term infants and to investigate antibody decay during the first 6 months of life in the preterm infants.Study design: Maternal and umbilical cord blood samples were taken from 113 healthy mother-newborn pairs: 64 term (gestational age > or =37 weeks) and 49 preterm (gestational age < or =35 weeks). Premature infants were further tested at 1, 2, and 6 months. Anti-VZV antibody to membrane antigen was measured with the immunofluorescent technique. RESULTS: Preterm infants of gestational age < or =28 weeks had positive cord antibody and a geometric mean titer significantly lower than those in preterm infants of gestational age 29 to 35 weeks and term infants (25% vs 95% and 95%, respectively, P <.001 for each, and 2.5 +/- 2.2 vs 10.5 +/- 2.4 and 12.6 +/- 2.4, respectively, P <.001 for each). There was no difference between the preterm 29 to 35 weeks of gestation and term groups. Fetal-maternal ratios for both preterm groups were <1 and were significantly less than the fetal-maternal ratio in the term infants. The transfer of maternal antibodies to term infants was significantly greater than to the 29- to 35-week preterm infants (P =.01). At 2 months of age, 25% of 29- to 35-week preterm infants and no preterm infant < or =28 weeks had a positive titer. At 6 months of age, all preterm infants were seronegative, and the geometric mean titer in both groups declined to undetectable levels. CONCLUSION: Transplacental transfer of maternal VZV antibodies is diminished in preterm infants. VZV antibody levels are significantly lower in preterm infants born at < or =28 weeks' gestational age compared with those in preterm infants 29 to 35 weeks' gestational age and term infants. Anti-VZV titers decrease to undetectable levels in preterm infants by 6 months of age or earlier; thus these infants appear to be susceptible to chickenpox before the scheduled 12-month vaccination.     

胎龄<32周早产儿中重度支气管肺发育不良危险因素的多中心回顾性分析

目的 分析胎龄<32周早产儿中重度支气管肺发育不良（bronchopulmonary dysplasia,BPD）的危险因素。 方法 回顾性收集2019年1月1日至2020年12月31日江苏省新生儿围产期协作网17家单位新生儿重症监护室收治的胎龄<32周且住院时间≥28 d诊断为BPD早产儿的临床资料,依据胎龄和BPD严重程度分组,采用多因素logistic回归分析不同胎龄段发生中重度BPD的危险因素。 结果 2年间17家协作单位新生儿重症监护室收治的胎龄<32周早产儿共2 603例,诊断BPD的961例,BPD发生率为36.92%（961/2 603）,中重度发生率为8.64%（225/2 603）,24⁺⁰~25⁺⁶周早产儿中重度BPD发生率为56.5%（26/46）,26⁺⁰~27⁺⁶周早产儿中重度BPD发生率为31.0%（66/213）,28⁺⁰~29⁺⁶周早产儿中重度BPD发生率为16.9%（75/445）,30⁺⁰~31⁺⁶周早产儿中重度BPD发生率为22.6%（58/257）。多因素logistic回归分析显示,各胎龄段早产儿中重度BPD危险因素不尽相同：24⁺⁰~25⁺⁶周为需治疗的动脉导管未闭;26⁺⁰~27⁺⁶周为胎膜早破≥18 h、复苏正压通气、临床败血症、机械通气时间≥14 d;28⁺⁰~29⁺⁶周为机械通气时间≥14 d、新生儿肺炎、需治疗的动脉导管未闭;30⁺⁰~31⁺⁶周为复苏正压通气、新生儿肺炎、早产儿贫血（均P<0.05）。 结论 胎龄<32周早产儿中重度BPD是多种因素共同作用的结果,并且每个胎龄段存在不尽相同的高危因素,对不同胎龄段提前采取有针对性举措,将有助于减轻BPD严重程度。     

Neonatal opiate abstinence syndrome in term and preterm infants

Data on 178 term and 34 preterm infants born to methadone-maintained mothers were analyzed to assess the effects of neonatal opiate abstinence in infants of varying gestational ages. More mothers in the term group (79%) than in the preterm group (53%) had abused other drugs during pregnancy (p less than 0.001). Mean (+/- SD) gestational age was 39.5 weeks +/- 1.4 for term infants and 34.3 weeks +/- 2.6 for preterm infants. On the basis of a semiobjective symptom scoring scale, term infants had more severe abstinence symptoms and more prominent central nervous system manifestations than preterm infants. The severity of abstinence symptoms correlated with maternal methadone dosage in both term and preterm infants. Maternal multiple drug abuse (e.g., heroin, cocaine) did not influence severity of abstinence symptoms in either group. More term infants (145/178) than preterm infants (20/34) required treatment for these symptoms (p less than 0.005). In 13 of 178 term infants, compared with 1 of 34 preterm infants, abstinence-related seizures developed. Peak severity occurred 1 to 2 days earlier in term than in preterm infants. A less severe abstinence syndrome in preterm infants may be due to (1) developmental immaturity of either dendritic ramifications, specific opiate receptors, or neurotransmitter function, or (2) reduced total drug exposure during the intrauterine period.     

Early postnatal growth in preterm infants

Changes in weight of 50 preterm infants (gestational age 32.7 +/- 0.3 weeks, birthweight 1772 +/- 49 g) were studied during the period of the 0-4 postnatal weeks. Intrauterine weight gain of fetuses with equivalent gestational age, weight percentile position and sex was calculated and used as a control. Study infants achieved significantly less weight by age of 4 weeks (116.2 +/- 1.2%) than it could have been expected theoretically (144.7 +/- 1.0%). Growth performance did not correlate significantly with calorie intake, but was closely related with gestational age.     

New Ballard Score, expanded to include extremely premature infants

The Ballard Maturational Score was refined and expanded to achieve greater accuracy and to include extremely premature neonates. To test validity, accuracy, interrater reliability, and optimal postnatal age at examination, the resulting New Ballard Score (NBS) was assessed for 578 newly born infants and the results were analyzed. Gestational ages ranged from 20 to 44 weeks and postnatal ages at examination ranged from birth to 96 hours. In 530 infants, gestational age by last menstrual period was confirmed by agreement within 2 weeks with gestational age by prenatal ultrasonography (C-GLMP). For these infants, correlation between gestational age by NBS and C-GLMP was 0.97. Mean differences between gestational age by NBS and C-GLMP were 0.32 +/- 1.58 weeks and 0.15 +/- 1.46 weeks among the extremely premature infants (less than 26 weeks) and among the total population, respectively. Correlations between the individual criteria and C-GLMP ranged from 0.72 to 0.82. Interrater reliability of NBS, as determined by correlation between raters who rated the same subgroup of infants, ws 0.95. For infants less than 26 weeks of gestational age, the greatest validity (97% within 2 weeks of C-GLMP) was seen when the examination was performed before 12 hours of postnatal age. For infants at least 26 weeks of gestational age, percentages of agreement with C-GLMP remained constant, averaging 92% for all postnatal age categories up to 96 hours. The NBS is a valid and accurate gestational assessment tool for extremely premature infants and remains valid for the entire newborn infant population.     

Posthospitalization growth and bone mineral status of normal preterm infants. Feeding with mother's milk or standard formula

The growth and bone mineralization were studied in ten preterm infants fed human milk and 14 preterm infants fed cow's milk-based formula. After discharge from the hospital, at 42, 48, and 56 weeks' postmenstrual age, anthropometric measures of weight, length, occipital frontal circumference, mid-upper arm circumference, triceps, and subscapular skin folds were obtained. Blood was drawn for determinations of serum calcium, phosphorus, 25-hydroxyvitamin D, alkaline phosphatase, and albumin levels. Bone mineral analyses were performed by photon absorptiometry. Mean (+/- SD) gestational ages in nursing and formula-fed infants were similar (32.0 +/- 2.5 vs 31.5 +/- 1.5 weeks), as were their mean (+/- SD) birth weights (1.76 +/- 0.42 vs 1.52 +/- 0.30 kg). After hospitalization, both groups had similar rates of growth in weight, length, head circumference, mid-upper arm circumference, triceps, and subscapular skinfold thickness. The formula-fed group had higher serum phosphorus levels at 42 weeks, higher serum calcium levels at 48 weeks, and higher serum albumin concentrations at 56 weeks than the breast-fed group. By 56 weeks' postmenstrual age, the bone mineral content was higher in the formula-fed group. Our data suggest that after hospitalization, preterm infants fed their own mother's milk have similar growth patterns but a different bone mineralization rate compared with preterm infants fed a standard cow's milk-based formula.     

支气管肺发育不良早产儿振幅整合脑电图的临床意义分析

目的 了解支气管肺发育不良(BPD)早产儿振幅整合脑电图(aEEG)的变化特点及临床意义.方法 回顾性纳入出生胎龄≤32+6周符合BPD诊断的早产儿156例为BPD组,选择同期住院的非BPD早产儿156例为对照组,应用早产儿aEEG评分系统比较两组患儿住院期间的aEEG结果 ,并按检查时间(纠正胎龄≤28+6周、29～...     

Postnatal weight gain and serum total protein and albumin levels in very low birthweight (less than or equal to 1500 g) preterm infants

Postnatal weight gain during the first 8 weeks of life of 20 very low birthweight preterm infants (gestational age: 28.9 +/- 1.7 weeks, birthweight: 1098 +/- 199 g, mean +/- SD) was compared to the in utero weight gain of theoretical control fetuses. By the end of the study period preterm infants gained significantly less weight than their controls (155 +/- 15 vs 221 +/- 16%, p less than 0.001). During the first 6 weeks of life daily additional weight gain of the preterm infants was less than that of the controls, but after that time no significant difference was seen (7th-8th week: 12.0 +/- 3.6 vs 13.7 +/- 3.9 g/kg/day, study infants vs controls, ns). During the 7th-8th weeks of life positive correlation was found between calorie intake and weight gain (r = 0.33, F = 2.17, p less than 0.05). The changes in serum total protein and albumin levels, including an initial increase by the age of 2 weeks, were statistically not significant.     

Duration of ductal shunting in healthy preterm infants: an echocardiographic color flow Doppler study

The purpose of this investigation was to assess the duration of ductal shunting after birth in healthy preterm infants (30 to 37 weeks gestational age) without evidence of respiratory distress. Thirty-six infants were evaluated in the first 12 hours of life by means of two-dimensional echocardiography and color flow Doppler techniques, and then once daily until no ductal flow was detected (defined as functional closure). Preterm infants were subdivided into two groups by gestational age: group 1 = 30 to 33 weeks (n = 12); group 2 = 34 to 37 weeks (n = 24). Sixteen full-term infants (38 to 41 weeks) were similarly evaluated as control subjects (Group 3). One infant from each group had a closed ductus at the time of the first study (performed at a mean of 7.7 +/- 3.2 hours). Subsequent studies for the entire group were performed at a mean of 31.3 +/- 5.4 hours (day 2), 55.0 +/- 4.5 hours (day 3), and 80.3 +/- 6.1 hours (day 4). For the three groups, the rates of ductal closure ranged from 50.0% to 58.3% on day 2 and 81.3% to 87.5% on day 3. For the entire group, all but one infant had demonstrated closure of the ductus arteriosus by day 4. Within the range of gestational ages studied, we conclude that prematurity, in the absence of respiratory distress syndrome, does not prolong the initial duration of physiologic ductal shunting.     

Early postnatal changes of immunoglobulin levels in very low birth weight (less than or equal to 1500 g) preterm infants

Immunoglobulin levels were measured in 16 very low birth weight preterm infants (birth weight: 1091 +/- 221 g, gestational age: 28.8 +/- 1.6 wks, mean +/- SD) at birth and at postnatal ages of 2, 4, 6 and 8 weeks. IgM level increased significantly by the age of 2 weeks (0.26 +/- 0.25 g/l vs 0.76 +/- 0.45 g/l, p less than 0.05), then remained unchanged throughout the study period. IgA level did not change significantly. IgG level decreased significantly by the age of 6 weeks (6.04 +/- 3.8 g/l vs 4.4 +/- 1.4 g/l, p less than 0.05), but after that no further decrease could be detected. The extent of the decrease in IgG level, however, proved to be smaller than expected on the basis of the reference data for term infants. The possibility is suggested that the packed red cell transfusions given to the patients may have resulted in the higher immunoglobulin levels.     

Plasma homocysteine concentrations of preterm infants.

Mild hyperhomocysteinemia in adults is associated with an increased risk of vascular disease. Although information is available about plasma homocysteine concentrations in childhood, data are entirely lacking for preterm infants despite their known abnormalities of sulfur amino acid metabolism. We measured plasma total homocysteine concentrations of 9 preterm infants (gestational age 23-31 weeks) within 48 h of birth and over the subsequent 14 days of life, and 4 term infants (gestational age 36-39 weeks) on a single occasion within 72 h of birth. As measured within 48 h of birth, average plasma homocysteine and cysteine concentrations of the preterm infants were 3.8 +/- 0.3 and 122 +/- 8 microM, both significantly less than those of the term infants (6.1 +/- 1.3 and 187 +/- 39) and of normal adults (8.2 +/- 0.5 and 232 +/- 6). Plasma homocysteine (but not cysteine) appeared to gradually increase during the first 2 weeks of life (p = 0.053). Our results indicate that hyperhomocysteinemia does not normally occur in preterm infants.     

Lower limb standards in newborns

To define standards for lower limb measurements in the newborn, 198 full-term and preterm infants (range, 27 to 41 gestational weeks) were examined. The gestational age was determined chronologically and clinically, and the total length of the lower limb and the leg and foot lengths were measured by two observers with the use of standard measurement techniques. Normal values were determined by plotting the mean +/- 2 SDs for each gestational week v gestational age.     

Sternum length, torso length, and internipple distance in newborn infants

In order to define standards for sternal length, torso length, and internipple distance in the newborn infant, 198 term and preterm infants (27 to 41 gestational weeks) were examined. In every case, the gestational age was determined chronologically and clinically. Sternal and torso length and internipple distance were measured by two observers using standard measurement techniques. Normal values are presented by plotting the mean +/-2 SD for each gestational week v the gestational age.     

深度水解蛋白配方乳对早产儿喂养和生长影响的多中心临床对照研究

目的 通过多中心临床对照研究,观察深度水解蛋白配方乳（eHF）对早产儿喂养和生长的影响。方法 随机选取2012 年2 月至2013 年12 月入住国内8 家三甲医院的早产儿,根据喂养方案分组：（1）胎龄结果 纳入研究的早产儿共328 例。胎龄PPPP>0.05）。胎龄32~34 周的观察组发生喂养不耐受后用eHF,生后第2 周血清总胆红素水平低于其相应的对照组（PPP>0.05）。结论 eHF 可促进早产儿胃肠动力功能、加速胆红素代谢和排泄,且未增加EUGR 的发生。     

Fat absorption in premature infants: medium-chain triglycerides and long-chain triglycerides are absorbed from formula at similar rates

Fat absorption from two different premature infant formulas and one full-term formula containing three different fat blends was investigated in two groups of premature infants. The first group of nine infants (gestational age, 29.1 +/- 0.88 weeks; postnatal age, 3.13 +/- 0.71 weeks) was fed alternately for 1 week each SMA preterm formula containing either high levels (50%) of medium-chain triglycerides (MCT) (6:0, 8:0, and 10:0) or high levels (86%) of long-chain triglycerides (LCT) (greater than or equal to C12). Except for fat blends, the formulas were otherwise identical. The second group of 11 infants (gestational age, 30.5 +/- 0.77 weeks, studied at a postnatal age of 4.33 +/- 0.91 weeks) was fed for 1 week a full-term infant formula, S-26, containing 98% LCT. Fat absorption (studied during a 3-day fat balance period) was similar irrespective of fat blend: 89.08 +/- 2.37% during feeding of preterm SMA, 50% MCT; 87.0 +/- 3.81% during feeding of preterm SMA, 86% LCT; and 83.00 +/- 2.89% during feeding of S-26, 98% LCT. Weight gain (grams per day) and increase in length (centimeters per day) were 23.2 +/- 1.7, 21.20 +/- 1.7, and 14.28 +/- 2.9, and 0.17 +/- 0.06, 0.16 +/- 0.04, and 0.22 +/- 0.07 during feeding of the three fat blends, respectively. Lipase activity levels in fasting gastric aspirates were higher during feeding of the LCT than the MCT formula. The possible stimulation of gastric lipase secretion secondary to long-chain fatty acid stimulation of cholecystokinin secretion might be related to the efficient digestion of formula fat, irrespective of triglyceride-fatty acid chain length.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intrauterine growth and gestational age in preterm infants with cerebral palsy

In a case-control study, gestational age and intrauterine growth of 191 preterm singleton infants 1971–1982 with cerebral palsy were compared to all preterm live-born singletons in Denmark in 1982 (N = 2203). The distribution of gestational age among preterm cases was slightly bimodal with maximum values at 29 and 32 weeks. The risk for cerebral palsy was highest in the infants with gestational age 28–30 weeks (OR = 5.6 (4.0 – 7.8), 95% confidence interval). Birth weight deviation, in the 34–36 weeks infants, expressed as the number of standard deviations from the mean birth weight for gestational age, was more negative in cases than in controls (P < 0.001). The frequency of small for gestational age (SGA) was 13% in cases and 9% in controls (OR = 1.5 (0.96 – 2.3), 95% confidence interval). The odds for cerebral palsy being SGA, was lower in 28–30 weeks (OR = 0.22 (0.06 – 0.86), 95% confidence interval), the same in 31–33 weeks (OR = 0.83 (0.35 – 2.0), 95% confidence interval) and higher in 34–36 weeks (OR = 5.2 (2.9 – 9.5), 95% confidence interval). In conclusion, preterm infants with cerebral palsy are born earlier than other preterm infants. Small for gestational age is associated with cerebral palsy in preterm infants only above 33 weeks.