Reliability of salivary theophylline in monitoring the treatment for apnoea of prematurity.

OBJECTIVE: To evaluate the reliability of salivary levels of theophylline in monitoring therapy of apnoea of prematurity. STUDY DESIGN: Aminophylline was administered intravenously in 13 infants with apnoea, in a loading dose of 5 mg/kg and maintenance dose of 3 mg/kg, every 8 h. The patients were divided into two groups according to their postconceptional age (PCA): group A, of infants with small PCA (32.8+/-2.0 weeks; n=6 cases), and group B, infants with higher PCA (37.1+/-0.8 weeks; n=7 cases). RESULTS: A total of 57 paired samples of serum and saliva were obtained in all 13 infants. The mean serum level of theophylline was 7.8+/-5.8 microg/ml and the ratio between serum and salivary concentration of theophylline was 1.53+/-0.28. A strong correlation between the serum and salivary concentration of theophylline (r=0.973) was found. Infants with small PCA had significant higher serum concentration of theophylline than those with higher PCA (10.6 vs 5.3 microg/ml; P=0.0002). The difference between the mean ratios of serum/salivary theophylline levels in the two groups was low (1.44 vs 1.62; P=0.0155). CONCLUSION: The strong correlation of theophylline in serum and in saliva recommends the salivary levels as a reliable method for monitoring the treatment of apnoea of prematurity.     

Oral Ibuprofen and ductus arteriosus in premature infants: a randomized pilot study

The purpose of this study was to evaluate the feasibility of the use oral ibuprofen suspension (OIS) in the treatment of patent ductus arteriosus (PDA) in premature infants. Premature infants (相似文献   

Effect of dopamine infusion on thyroid hormone tests and prolactin levels in very low birth weight infants

Objective: To evaluate the effect of dopamine on thyroid hormone tests and prolactin (PRL) and to assess requirement for L-thyroxin (LT4).

Methods: The infants (n?=?102) were divided into three groups (Group 1; received no dopamine, Group 2 received ≤25?mg/kg cumulative dose and Group 3; received >25?mg/kg cumulative dose). Blood samples were taken at 6–8 days (timepoint 1), 13–15 days (timepoint 2), and 4–6 weeks of life (timepoint 3).

Results: Respiratory distress syndrome was higher in group 2 and 3. Patnet ductus arteriosus was higher in group 3 than in groups 1 and 2. Duration and cumulative dose in group 3 were higher than group 2. There was no difference between thyroid hormones that were taken after stopping infusion at timepoint 3 among all groups. No therapy with LT4 was needed. PRL levels were higher at timepoint 1 in group 1 than compared to group 2 and 3 (p?p?>?0.05). This difference was disappeared at following timepoints.

Conclusions: The release of TSH, FT3, FT4 and PRL were not inhibited and prophylactic thyroid hormone treatment was not required in VLBW infants receiving dopamine infusions.     

A randomized, controlled, double-blind trial comparing two loading doses of aminophylline.

OBJECTIVE: To compare 8 mg/kg and 6 mg/kg loading doses of aminophylline. STUDY DESIGN: Sixty-one preterm infants weighing <1500 g were enrolled once a decision to administer intravenous aminophylline was made. A standard maintenance dose was used. Serum levels of theophylline were drawn 8 hours after the loading dose and before the fifth maintenance dose. RESULTS: After the initial loading dose, the 8 mg/kg group achieved recommended serum theophylline levels (7-12 microg/ml) more frequently than the 6 mg/kg group (39% vs 3%, p=0.002). Subsequent levels were similar between the groups. There were no increases in side effects with the higher loading dose. CONCLUSION: If a clinical decision to start intravenous aminophylline therapy in preterm infants has been made, the use of an 8 mg/kg loading dose appears to be a better and safe way to quickly achieve serum theophylline levels within the recommended range.     

Ibuprofen use to reduce the incidence and severity of bronchopulmonary dysplasia: a pilot study.

OBJECTIVE: To assess the safety and efficacy of ibuprofen in reducing the incidence and severity of bronchopulmonary dysplasia (BPD) in preterm infants. METHODS: A total of 18 premature infants between 23 and 28 weeks' gestation were studied. Ibuprofen (10 mg/kg of loading dose followed by 5 mg/kg every 12 hours) was administered intravenously or orally to nine infants on respiratory support at > or = 7 days of age and was continued until 28 days of life or until the infants were spontaneously breathing room air, whichever occurred earlier. Ibuprofen levels in plasma were measured in five of these infants. The outcome variables (BPD, ventilatory parameters, and complications) in the study group were compared with those in nine matched controls treated conventionally. RESULTS: The incidence of BPD at 36 weeks postconceptional age was similar in both groups (eight of nine in each group). The percentage of oxygen requirement, the ventilatory efficiency index, and steroid use were also similar in both groups. One infant in the study group, who was also receiving steroids and aminophylline, developed gastrointestinal hemorrhage. Reversible renal failure in one infant and necrotizing enterocolitis in another infant were seen at 4 and 21 days, respectively, after the last dose of ibuprofen. There was no difference in the incidence of intraventricular hemorrhage between the two groups. Plasma levels of ibuprofen at 3 hours after the first dose ranged from 10.3 to 36 mg/liter. Study infants tolerated the feeds better and achieved the full enteral goal earlier than controls (p = 0.04). CONCLUSION: Although a trend toward less ventilator and hospital days in the ibuprofen group was observed in this pilot study, the differences were not statistically significant. The incidence of BPD was similar in both groups. In the study group, two infants developed gastrointestinal complications and a third infant experienced reversible renal failure. The plasma ibuprofen levels were low. Further studies are needed to assess the use of ibuprofen for the prevention and/or treatment of BPD in preterm infants.     

Neither toxicity nor dose intensity of carboplatin is affected by glomerular filtration rate versus body surface area dose calculation in gynecologic malignancy

Twelve patients were given 31 courses of carboplatin using a glomerular filtration rate (GFR)-based area under the curve (AUC) dose schedule, and nine patients were given 35 cycles at a body surface area (BSA) dose of 350 mg m⁻² every 3 weeks. The GFR was determined using technetium-99m-DTPA. The dose given was calculated according to AUC, 5 for previously treated and 7 for previously untreated patients × GFR + 25. Patients treated using the GFR had a 22% lower projected dose intensity (DI) and a 15% lower received DI compared with controls. The percentage difference between the received and projected DI was not different between the two groups of patients. In 11 of 12 patients treated according to the GFR, if the BSA calculation dose had been used it would have resulted in a higher dose of carboplatin. Twenty per cent (six of 30 courses) of GFR-based doses were delayed compared to 29% (10 of 35) of the BSA-calculated control groups. We conclude that giving a dose according to a BSA of 350 mg m⁻² leads to a higher DI and total dose and does not substantially effect toxicity. It is also cost effective as it eliminates the need for unnecessary radiometric GFR determination.     

Dose-range effects of propofol for reducing emetic symptoms during cesarean delivery.

OBJECTIVE: To evaluate the efficacy and safety of propofol at subhypnotic doses for reducing emetic symptoms in parturients undergoing cesarean delivery under spinal anesthesia. METHODS: In a randomized, double-masked trial, 80 patients received lidocaine intravenously 0.1 mg/kg (for injection pain relief) followed by either placebo or propofol at three different doses (0.5 mg/kg per hour, 1.0 mg/kg per hour, 2.0 mg/kg per hour) (n = 20 in each group) immediately after clamping of the umbilical cord. Emetic episodes and safety assessments were performed during spinal anesthesia for cesarean delivery. To estimate a sufficient sample size, it was calculated that 20 patients per group would be required with alpha =.05 and beta =.2. RESULTS: The rate of patients experiencing no emetic symptoms in an intraoperative, postdelivery period was 45% with propofol 0.5 mg/kg per hour (P =.5), 80% with propofol 1.0 mg/kg per hour (P =.011), and 80% with propofol 2.0 mg/kg per hour (P =.011), compared with placebo (40%). No clinically serious adverse events caused by the study drugs were observed. CONCLUSION: Propofol 1.0 mg/kg per hour is the minimum effective subhypnotic dose for reducing emetic symptoms during cesarean delivery. Increasing the dose to 2.0 mg/kg per hour provides no further benefit.     

A randomized, multicenter masked comparison trial of poractant alfa (Curosurf) versus beractant (Survanta) in the treatment of respiratory distress syndrome in preterm infants

We compared the onset of clinical response and safety of two surfactants, poractant alfa (Curosurf, Chiesi Pharmaceuticals, Parma, Italy) and beractant (Survanta, Ross Laboratories, Columbus, OH), for treatment of respiratory distress syndrome (RDS) in preterm infants weighing 750 to 1750 g at birth and <35 weeks gestation. The study was performed as a 20-center prospective, randomized, masked comparison trial. Preterm infants (n = 293) with RDS were randomized to receive an initial dose of either 100 (n = 96) or 200 (n = 99) mg/kg of poractant alfa or 100 ( n = 98) mg/kg of beractant. All repeat dosing was given at 100 mg/kg. The onset of clinical response after the first dose was studied by comparing changes in the fraction of inspired oxygen (F IO(2)) between 0 and 6 hours measured using the area under the curve (F IO(2) AUC (0-6)); other outcomes were assessed for the entire cohort at 28 days and for infants born at < or = 32 weeks gestation at 36 weeks postconceptional age. We found that the mean F IO(2) AUC (0-6) values for the 100 and 200 mg/kg poractant alfa groups were both significantly lower than the mean F IO(2) AUC (0-6) values for the beractant group ( p < 0.005) but were not different from each other. Other outcomes were not different among the three groups for the entire cohort, but in infants born at < or = 32 weeks gestation, mortality up to 36 weeks postconceptional age was significantly less in the 200 mg/kg poractant alfa group than in either the beractant group (3% versus 11%; p = 0.034) or in the 100 mg/kg poractant alfa group (3% versus 11%; p = 0.046). Need for more than one dose of surfactant was significantly lower in infants treated with an initial dose of 200 mg/kg poractant alfa in comparison to the beractant-treated group ( p < 0.002). Treatment with poractant alfa (200 mg/kg initial dose) resulted in rapid reduction in supplemental oxygen with fewer additional doses of surfactant versus treatment with beractant in infants <35 weeks gestation with RDS, and significantly reduced mortality ( p <0.05) than either beractant or poractant alfa (100 mg/kg dosing) in infants < or =32 weeks gestation with RDS.     

Serum ferritin levels in preterm infants after multiple blood transfusions

We have examined the effect on iron stores of blood transfusions given to premature neonates during hospitalization in the neonatal intensive care unit as reflected by serum ferritin levels measured for 6 months after discharge. Premature infants who were transfused with more than 100 ml packed cells (group D; n = 11) had higher ferritin levels for a longer period than premature infants who were transfused with smaller volumes (group c; n = 9) or premature and mature infants who were not transfused at all (group B; n = 24 and group A; n = 21, respectively). At 4-5 months the serum ferritin levels in group D (489.8 +/- 132.1 micrograms/L; mean +/- SEM) were significantly higher (P less than 0.001) than those of the other groups. The level of group A term infants (77.5 +/- 12.5 micrograms/L) was higher than those of group B premature infants who did not receive a blood transfusion (33.0 +/- 7.1 micrograms/L) or group C who received less than 100 ml (36.5 +/- 8.8 micrograms/L packed red blood cells. However, these differences were not statistically significant. Our data demonstrate that very-low-birthweight infants who receive a large volume of packed cells during hospitalization may accumulate iron stores sufficient for red cell production during the first 6 months of life. Administration of large amounts of supplemental iron, in such cases, may be curtailed.     

Effects of dexamethasone on pulmonary function following extubation.

Dexamethasone is often given to intubated neonates to facilitate successful extubation. To study the effects of dexamethasone on pulmonary function immediately following extubation, we conducted a randomized, blinded, placebo-controlled trial in 51 infants. All infants had been intubated for a minimum of 3 days but no more than 30 days. Mean weight at extubation was 2.41 kg in treated infants, 2.25 kg in control infants. When infants were deemed ready for extubation, dexamethasone 0.5 mg/kg/dose or an equal volume of normal saline was given in three doses 8 hours apart. The final dose was given 1 hour before extubation. Esophageal pressure, air flow integrated to tidal volume (Vt), respiratory rate, and heart rate were measured before extubation, immediately following extubation, and every 20 minutes for 80 minutes. Total pulmonary resistance (RTP), dynamic lung compliance (CL), and minute ventilation (VE) were calculated. Forty-two infants completed the study; 19 infants received dexamethasone and 23 received placebo. There was no difference between the two groups in gestational age, weight at study, or length of intubation. Vt, RTP, VE, and CL were not significantly different between the two groups over time; however, RTP increased over time in the placebo group. Heart rate was significantly lower in the dexamethasone group. We conclude that dexamethasone appears to have limited effect on pulmonary function immediately following extubation in the population studied. Further studies should evaluate the drug effect beginning at least 1 hour after extubation.     

Antenatal administration of betamethasone to prevent respiratory distress syndrome in preterm infants: report of a UK multicentre trial

In a prospective, randomized, double-blind, multicentre trial the effect of antenatal treatment with betamethasone phosphate was compared with placebo in the prevention of the respiratory distress syndrome (RDS) in preterm infants. The dose of betamethasone was 4 mg every 8 h for six doses, unless delivery occurred. The 251 women who were enrolled gave birth to 262 liveborn infants, 130 in the beta-methasone and 132 in the placebo group; the two groups were evenly matched in most respects. The diagnosis of RDS in the newborn was confirmed by two independent assessors. Seven of the 130 infants in the betamethasone group and 16 of the 132 in the placebo group developed RDS. In infants whose mothers had received at least three injections, RDS was also less frequent in the steroid group than in the placebo group (3/104 and 10/104 respectively; P less than 0.05). There was a significant reduction of RDS in those born between 24 h and 6 days after entry into the trial (0/30 and 8/45 respectively; P less than 0.05). The largest difference in frequency of RDS occurred in the subgroup of infants born before 34 weeks gestation, within 8 days of trial entry, and whose mothers had received at least three injections (0/27 steroid group and 7/32 placebo group; P = 0.03), and there were also significantly fewer neonatal deaths (2/27 and 13/32, respectively; P less than 0.01) in this subgroup. Betamethasone did not provoke earlier delivery. Premature rupture of the membranes and maternal hypertension did not seem to contraindicate the use of steroids: there was no increase in maternal or neonatal sepsis nor in stillbirth in hypertensive pregnancies in the steroid group. Neonatal jaundice was significantly less frequent in the steroid (55/129) than in the placebo group (81/127; P less than 0.01) but not in the subgroups born before 34 completed weeks gestation.     

叶下珠植物提取物保护盐酸氮芥对小鼠睾丸组织的氧化应激损伤

目的:研究盐酸氮芥(HN2)对青春前期小鼠睾丸组织的氧化应激损伤及叶下珠植物(PU)提取物对损伤的保护作用。方法:将64只小鼠随机分为A组(生理盐水对照组)、B组(1.25mg/kgHN2)、C组(2.5mg/kgHN2)、D组(5mg/kgHN2)、E组(5mg/kgHN2+125mg/kgPU)、F组(5mg/kgHN2+250mg/kgPU)、G组(5mg/kgHN2+500mg/kgPU)、H组(500mg/kgPU),每组8只,按各组PU剂量灌胃,qd×5d,d5一次性腹腔给予相应的HN2。24h后制备各组小鼠睾丸组织匀浆,检测还原型谷胱甘肽(GSH)含量、谷胱甘肽S转移酶(GST)及谷胱甘肽还原酶(GR)酶活性。结果:HN2处理后,睾丸内GSH含量、GST及GR酶活性均随着HN2剂量增加而降低。5mg/kgHN2处理的同时,随着PU剂量增加,睾丸内GSH含量、GST及GR酶活性增加。与PU未干预的高剂量HN2组比较,不同剂量PU干预5mg/kgHN2后,睾丸内GST含量、GST及GR酶活性均显著增加(P<0.01)。与A组比较,F及G组的GSH含量、GST及GR酶活性无显著性差异(P>0.05),H组睾丸内GSH含量、GST及GR酶活性均无显著变化(P>0.05)。结论:HN2通过氧化应激损伤睾丸组织,PU可有效缓解该毒性作用。     

Gentamicin pharmacokinetics in term newborn infants receiving high-frequency oscillatory ventilation or conventional mechanical ventilation: a case-controlled study.

OBJECTIVE: To compare the pharmacokinetics of gentamicin in infants receiving high-frequency oscillatory ventilation (HFOV) with infants receiving conventional mechanical ventilation. DESIGN: A case-controlled study design was used to compare the pharmacokinetics of gentamicin in critically ill infants receiving HFOV and conventional mechanical ventilation. Medical records of all full-term newborn infants (> or =37 weeks gestational age) who received either high-frequency mechanical ventilation or conventional mechanical ventilation between 1991 and 2001 were reviewed and relevant patient demographics, renal function tests and gentamicin administration and plasma concentration data collected. Elimination rate constant, half-life, volume of distribution and clearance for both groups were calculated using standard kinetics equations. SETTING: A tertiary care children's hospital. PATIENTS: Newborn infants, > or =37 weeks gestational age, receiving gentamicin and high-frequency mechanical ventilation or conventional mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: In total, 18 patients were included in the conventional mechanical ventilation group and 15 in the HFOV group. The mean gentamicin dose for conventional mechanical ventilation and HFOV groups infants were 2.52+/-0.07 and 2.5+/-0.07 mg/kg/dose, respectively. Initial dosing interval was 12 hours in all of the conventional mechanical ventilation infants and 13 of the 15 HFOV infants. The dosing interval for the remaining two HFOV infants was 18 hours. No patient in either group demonstrated oliguria. Statistical analysis using the Student t-test for unequal variances yielded significant differences between the two groups with regard to elimination rate constant, half-life, volume of distribution and clearance, with a p value of <0.05 for all the observations. The mean of the highest P(aw) received by each patient in the HFOV group (19.2+/-4.05) was considerably higher than in the conventional mechanical ventilation group (13.4+2.23) (p>0.05). CONCLUSION: Infants receiving HFOV had reduced gentamicin clearance. Full-term infants receiving HFOV should be initiated at gentamicin dosing intervals of 18 hours rather than the traditional 12 hours recommended for this age group.     

壬基酚孕期经口染毒对F1代昆明小鼠卵巢发育的影响

目的:观察壬基酚孕期暴露对F1代昆明小鼠卵巢发育的影响。方法:交配后7d起,对孕鼠分别每日灌胃壬基酚(NP)(分别为1.2mg/kg、12mg/kg、120mg/kg),对照组灌胃花生油,直至交配后17d,每组7只。子代小鼠出生14d时取卵巢组织病理学检查,计数各级卵泡。观察子代雌鼠观察阴道开口时间和规律动情周期出现时间。子代雌鼠成年3月龄后,于动情前期处死,放免法测定血清E2、FSH浓度,酶联免疫吸附法测定血清抑制素B浓度,取卵巢组织行病理学检查,计数各级卵泡。结果:NP低剂量组阴道开口出现时间提前(P<0.05);低、中剂量组规律动情周期出现时间提前并可见动情周期延长(P<0.05);高剂量组性成熟期始基卵泡数减少(P<0.05),血清抑制素B水平降低(P<0.05);各用药组动情前期血清E2水平降低(P<0.05),FSH水平无明显变化。用药组体质量较对照组明显升高(P<0.05)。结论:壬基酚胎仔宫内暴露,在较低剂量时可影响小鼠的动情起始及动情周期,在较高剂量时可降低卵巢储备,并可影响成年后小鼠雌激素水平。     

The efficacy and safety of early supplementation of iron polymaltose complex in preterm infants

The purpose of this study was to examine the efficacy and safety of early nonionic iron supplementation in preterm infants. Infants with gestational age < or = 32 weeks who were fed enriched human milk were assigned concurrently to receive 5 mg/kg/d enteral iron polymaltose complex (IPC) at 2 or 4 weeks of age. The levels of hemoglobin, reticulocytes, serum iron, ferritin, and soluble transferrin receptor were recorded at 2, 4, and 8 weeks of age. The incidence of morbidities associated with prematurity and the need for red blood cell transfusions (RBCTs) were recorded. The 2-week group (n = 32) had a better iron status than the 4-week group (n = 36) at 4 weeks and at 8 weeks of age. The incidence of morbidities associated with prematurity was not different among the groups ( P = 0.26). RBCT was required in one infants of the 2-week group and in 10 infants in the 4-week group ( P = 0.045). The number needed to treat to prevent one RBCT was five. Supplementation of 5 mg/kg/d enteral IPC to preterm infants fed enriched human milk as early as 2 weeks of age was more beneficial to iron status than at 4 weeks of age, and was associated with decreased need for RBCTs and no increase in the incidence of morbidities associated with prematurity.     

Side effects of angiotensin converting enzyme inhibitor (captopril) in newborns and young infants

Abstract Aim: To analyze the side effects of captopril, an angiotensin converting enzyme inhibitor (ACEI) in newborn and young infants. Methods: Retrospective analysis of side effects in 43 patients with congenital heart disease after cardiac surgery treated with captopril for heart failure during a two-year period. Results: Median age of the patients was 26 days (range 6-310 days), median weight 3.5 kg (range 1.9-7.9 kg). Initial median dose of captopril was 0.17 mg/kg/day (range 0.05-0.55 mg/kg/day), slowly increased over 3-33 days to a maximal median dose of 1.86 mg/kg/day (range 0.2-2.3 mg/kg/day). All patients were additionally treated with diuretics. Side effects occurred in 17 patients (renal impairment or failure in 6, low blood pressure in 8, and oxygen saturation deficit in 3) requiring cessation or interruption in seven patients with renal impairment/failure (n=4), hypotension (n=1) and aorto-pulmonary shunting with low pulmonary perfusion (n=2). The six children who developed renal impairment or failure did so following a median delay of nine days after reaching the final dose and weighed on average 500 g less than the other patients (P=0.046). All side effects were fully reversible. Conclusion: Side effects due to captopril were not dose-related in newborns and infants in this study. However, renal side effects occurred more often in smaller infants. Routine monitoring of infants on ACEI should include renal function tests, blood pressure and transcutaneous oxygen saturation measurements.     

不同放化疗方案治疗中晚期宫颈癌的疗效比较

目的比较中晚期宫颈癌不同放化疗方案的疗效和毒性反应,以指导临床。方法2003年1月至2004年12月福州总医院放疗科收治的符合入组标准的ⅡB～ⅢB期宫颈癌患者111例,随机分为顺铂(DDP)+5-Fu组(DF组)、DDP组和DDP周疗组。比较各组患者的5年生存率和毒性反应。结果111例患者的中位随访时间为62个月,DF组、DDP组和DDP周疗组患者5年生存率分别为31.1%、38.4%和41.5%,差异无统计学意义(P=0.772)。DF组Ⅲ～Ⅳ度急性放射性肠炎高于其他两组(P=0.046),3组迟发性毒性反应比较,差异无统计学意义(P=0.953);DF组生存率与DDP组、DDP周疗组比较,差异亦无统计学意义(P=0.111和0.069);DDP组和DDP周疗组合并与DF组比较,5年生存率分别为31.1%和39.5%,差异有统计学意义(P=0.043)。结论每周顺铂同步放化疗方案治疗中晚期宫颈癌,有明显的放疗增敏作用,放射性肠损伤轻,远期疗效较好。     

Cue-based feeding for preterm infants: a prospective trial

We set out to test whether premature infants were able to be fed orally on feeding cues and be discharged home earlier than infants fed by traditional feeding regimens. Attainment of adequate growth, adverse events, and nursing time to provide care were also assessed. After screening, the recruited premature infants (< 36 wks post-conceptual age [PCA]) were divided into two feeding regimens. A control group of 40 infants was fed using an initial combination of scheduled gavage and bottle feeding and then graduating to demand feeds. The intervention group comprised 39 neonates who had gavage feeds discontinued at study entrance and fed orally on cues. Outcomes measured were: weight gain in grams/kg/day, length of stay (in days) after enrollment, PCA on entrance and at discharge, adverse events during feeding, number of cues per feed in the intervention group, and resource utilization using nurse/patient ratios. Differences between groups were evaluated using Mann-Whitney U test, Fisher's exact test, and regression analysis. Two-tailed P values of < 0.05 were considered significant. There was no difference between groups in the mean weight gain; in the control group mean weight gain was 12.5 gm/kg/day and in the intervention group 12.1 gm/kg/day ( P = 0.83). The average length of stay in the control group of 14.5 days was significantly longer than the 10.0 days in the intervention group ( P = 0.009). This difference remained significant after adjusting for gestational age at birth in regression analysis. The average total number of adverse events in the control group (12.5 events) was significantly greater than in the intervention group (3.5 events; P = 0.007). The mean PCA on study entry was 34.4 wks in both groups and on exit 36.5 wks in the control group and 35.8 wks in the intervention group, a significant difference ( P = 0.02), The intervention group elicited 2.8 cues/feed. The nurse to patient ratios was equal in both groups throughout the study period. Cue-based feeding was possible for premature infants with similar weight gain as traditional feeding without affecting workload. Hospitalization and adverse events were decreased.     

Increased immunoreactive erythropoietin in cord plasma and neonatal bilirubin production in normal term infants after labor

The purpose of this investigation was to compare immunoreactive erythropoietin levels in umbilical cord plasma and neonatal bilirubin production in infants born of normal women who delivered with or without labor. Two groups of term (38 to 42 weeks) singleton pregnancies were compared: 1) those delivered by repeat elective cesarean section without prior labor (N = 17), and 2) those delivered vaginally or by cesarean section after labor (N = 24). None of the infants was asphyxiated, and there was no difference in Apgar scores between the no-labor and labor groups. The cord plasma erythropoietin levels were lower in the infants of women who had repeat elective cesarean section without labor than in those whose mothers had labor before delivery (Wilcoxon rank sum test, P less than .025). The median erythropoietin for the no-labor group was 22.9 mU/mL compared with 38.8 mU/mL for the labor group. The pulmonary excretion rate of carbon monoxide (VeCO), an index of bilirubin production, for the no-labor group was 14.3 +/- 6.2 SD microL/kg per hour compared with 18.0 +/- 4.9 SD microL/kg per hour for the labor group (P less than .05). The hemoglobin concentration for the no-labor group was 16.0 +/- 1.5 SD g/dL compared with 17.7 +/- 2.2 SD g/dL for the labor group (P less than .05). The VeCO correlated with the hemoglobin concentration (N = 32, r = 0.37, P less than .05). The results of the present study suggest that labor is normally associated with increases in the cord plasma erythropoietin level.(ABSTRACT TRUNCATED AT 250 WORDS)     

口服布洛芬治疗早产儿动脉导管未闭的前瞻性随机对照研究

目的 研究口服布洛芬在早产儿动脉导管未闭(patent ductus arteriosus,PDA)治疗中的安全性、治疗效果和副作用,以评估其在早产儿PDA治疗中的应用价值.方法 采用前瞻性随机对照研究方法,根据PDA诊断的时间顺序,按随机数字顺序表,将74例PDA早产儿随机分为布洛芬治疗组(36例)与对照组(38例),布洛芬治疗方法为口服布洛芬混悬液每剂10 mg/kg,间隔24 h 1次,共3次;记录并比较2组PDA的关闭率、相关副作用及患儿住院期间的情况.结果 布洛芬治疗组PDA关闭率为52.8%(19/36),高于对照组(18.4%,7/38),差异有统计学意义(χ2=9.575,P=0.002).在口服布洛芬治疗期间,患儿未出现少尿、肾功能损害、出血倾向、胃肠道穿孔、Ⅲ或Ⅳ级脑室内出血或出血加重等严重副作用,布洛芬治疗组和对照组出现腹胀或胃潴留的发生率分别为33.3%(12/36)和26.3%(10/38),差异无统计学意义(χ2=0.436,P=0.509).布洛芬治疗组患儿平均住院(22.8±14.8) d,用氧(8.3±9.3) d,5.6%(2/36)需要机械通气,与对照组[分别为(24.1±17.1) d、(8.8±8.3) d和2.6%(1/38)]比较差异均无统计学意义(P均＞0.05).结论 口服布洛芬对早产儿PDA有较好的治疗效果,且无明显合并症或副作用发生,应用方便,安全性较高.

Abstract：

Objective To assess the safety, efficacy, temporary side effects and feasibility of oral ibuprofen suspension in the treatment of patent ductus arteriosus (PDA) with hemodynamic significance in premature infants. Method A randomized controlled trial including seventy-four premature infants with PDA was performed from February 2007 to May 2008. Infants were randomly assigned to two groups: testing group (36 patients) received three doses of oral ibuprofen suspension (10 mg/kg at 24-hour intervals) and control group (38 patients) did not receive such treatment. The cure rate of PDA, relative side effects of ibuprofen and complications during treatment were recorded.Results The closure rate of ductus arteriosus in the testing group was 52.8% (19/36), which was higher than that of control group (18.4%, 7/38) (χ2=9.575, P=0.002). The severe side effects did not occur in testing group, such as oliguria, renal impairment, prone of bleeding, gastrointestinal perforation and novel appearing or deteriorative of intraventricular hemorrhage (IVH). Compared with the infants in control group (26.3%, 10/38), the morbidity of abdominal distension or gastric retention in testing group (33.3%, 12/36) was higher, while there was no statistically significant difference (χ2=0.436, P=0.509). The hospital stay [(22.8±14.8) d vs (24.1±17.1) d], mechanical ventilation rate [5.6% (2/36) vs 2.6% (1/38)] and oxygen supplement time [(8.3±9.3) d vs (8.8±8.3) d] between the testing and control groups remained no significant difference (P>0.05). Conclusions Oral ibuprofen suspension could be effective in closing PDA of preterm infants; no significant complications and side-effects occurred during oral ibuprofen treatment. It is suggested that oral ibuprofen suspension treatment was safe, effective and well tolerated for preterm infants with PDA.