Enteral nutrition fed to premature and very low birth weight infants with arithmetic progression

目的 探讨不同的肠内营养量对早产儿及极低出生体重儿体格发育的影响.方法 将60例早产儿及极低出生体重儿随机分对照组和观察组各30例,在静脉营养支持的基础上,根据患儿每天的体质量计算所需营养总量(15 mL/kg),对照组采用传统的平均分配营养量的方法即8次/d均分;观察组采用等差递增公式计算每次的营养量.连续14 d后评价效果.结果 患儿体质量显著重于对照组,胎便排尽及黄疸持续时间显著短于对照组,喂养不耐受发生率、胃残留量及每日排便次数显著少于对照组(P＜0.05,P＜0.01).结论 对早产儿及极低出生体重儿采用等差递增肠内营养量的方法可循序渐进地刺激患儿肠道,有利于患儿体格发育,效果优于平均分配营养量法.     

极低出生体重儿临床护理路径在优质护理服务中的应用

目的探讨极低出生体重儿临床护理路径在深化优质护理服务的应用效果。方法将50例极低出生体重儿按出生时间的先后分为观察组26例和对照组24例。对照组采用传统的早产儿护理管理;观察组实施已经融入优质护理服务评价指标的临床护理路径。结果观察组的平均住院时间、基础护理指标、专科护理指标、回院随访率显著优于对照组(P<0.05,P<0.01)。结论开展极低出生体重儿临床护理路径能深化优质护理服务内涵建设,对提高护理质量、促进极低出生体重儿健康成长、提高家属满意度具有重要意义。     

经络抚触对新生儿缺氧缺血性脑病患儿生长发育的影响

目的 探讨经络抚触对新生儿缺氧缺血性脑病患儿神经及体格发育的影响.方法 将120例新生儿缺氧缺血性脑病患儿随机分为观察组和对照组各60例.对照组采用国内改良简易抚触法,观察组在此基础上增加经络抚触,2次/d,每次15 min,连续10 d.结果 观察组体重、身高、摄入奶量、神经行为评分、睡眠时间、恢复出生体重时间、胎粪排尽时间显著优于对照组(P＜0.05,P＜0.01).结论 在国内改良简易抚触法基础上增加经络抚触对新生儿缺氧缺血性脑病患儿神经及体格发育有明显的促进作用.     

发育支持护理对早产极低出生体重儿睡眠和体质量的影响

目的 探讨发育支持护理对早产极低出生体重儿睡眠和体质量的影响.方法 将在我科住院的56例早产极低出生体重儿随机分为干预组和对照组各28例.对照组予以传统常规护理;干预组在此基础上予以发育支持护理,包括同步综合感觉刺激训练、鸟巢式护理、非营养性吸吮等.结果 两组住院第21、28天体质量及睡眠时间比较,差异有统计学意义(P＜0.05,P＜0.01).结论 发育支持护理能促进早产极低出生体重儿生长发育.     

极低出生体重儿喂养方式及相关护理的研究进展

极低出生体重儿(very low birth weigh infant,VLBWI)指出生体重在1 000～1 499g的早产儿。随着围产医学技术的迅速发展,越来越多的低出生体重儿(LBW)、极低出生体重儿(VLBWI)和超极低出生体重儿(ELBW)的生命得到挽救。他们生后所面临的主要问题之一是营养,其中喂养因素在极低出生体重儿(以下简称为VLBWI)存活和正常的生长发     

发育支持护理对早产极低出生体重儿睡眠和体质量的影响

目的探讨发育支持护理对早产极低出生体重儿睡眠和体质量的影响。方法将在我科住院的56例早产极低出生体重儿随机分为干预组和对照组各28例。对照组予以传统常规护理;干预组在此基础上予以发育支持护理,包括同步综合感觉刺激训练、鸟巢式护理、非营养性吸吮等。结果两组住院第21、28天体质量及睡眠时间比较,差异有统计学意义（P〈0．05,P〈0．01）。结论发育支持护理能促进早产极低出生体重儿生长发育。     

水床式鸟巢护理在极低出生体重儿中的应用

目的观察水床式鸟巢护理在极低出生体重儿的应用效果。方法将60例极低出生体重儿随机分为两组各30例。观察组使用改进后的水床式鸟巢护理＋即先做好水床式鸟巢放入温箱并预热至34～35℃,调好温葙湿度,然后将患儿裸体或穿单衣置于水床式鸟巢内;对照组患儿裸体或穿单衣直接置于调节好的温箱内。结果观察组患儿恢复出生体质量时间比对照组显著缩短,体质量增长比对照组显著加快（均P〈0．01）,且并发症（皮肤破溃、呼吸暂停、喂养不耐受、窒息）发生率显著低于对照组（P〈0．05,P〈0．01）。结论水床式鸟巢护理给患儿提供一个母体化环境,安全舒适,有利于生长发育,减少并发症的发生,提高了患儿的存活率和生命质量。     

低出生体重儿家庭发展性照顾的应用研究

目的 探讨家庭发展性照顾对低出生体重儿体格发育和生存质量的影响.方法 将符合入选标准的低出生体重儿100例,随机分为对照组和研究组各50例.对照组行常规出院指导,定期复查;研究组运用发展性照顾的理论对主要照顾者进行培训并由专业人员进行家庭指导.两组均随访至月龄6个月止(早产儿至纠正月龄6个月).比较两组体格发育达标率、常见疾病患病率和住院率.结果 研究组的体格发育达标率、常见疾病发生率、住院率分别为80.0%、16.0%和6.0%,对照组分别为52.0%、34.0%和20.0%.两组比较,差异有统计学意义(P＜0.05,P＜0.01).结论 家庭发展性照顾对促进低出生体重儿体格发育和提高其生存质量具有积极的意义.     

水床式鸟巢护理在极低出生体重儿中的应用

目的 观察水床式鸟巢护理在极低出生体重儿的应用效果.方法 将60例极低出生体重儿随机分为两组各30例.观察组使用改进后的水床式鸟巢护理,即先做好水床式鸟巢放入温箱并预热至34～35℃,调好温箱湿度,然后将患儿裸体或穿单衣置于水床式鸟巢内;对照组患儿裸体或穿单衣直接置于调节好的温箱内.结果 观察组患儿恢复出生体质量时间比对照组显著缩短,体质量增长比对照组显著加快(均P＜0.01),且并发症(皮肤破溃、呼吸暂停、喂养不耐受、窒息)发生率显著低于对照组(P＜0.05,P＜0.01).结论 水床式鸟巢护理给患儿提供一个母体化环境,安全舒适,有利于生长发育,减少并发症的发生,提高了患儿的存活率和生命质量.     

极低和超低出生体重儿脐静脉导管不同固定方法的比较

目的对比分析极低和超低出生体重儿脐静脉导管不同固定方法的效果。方法按入院时间将78例使用脐静脉导管的极低和超低出生体重儿分为两组。对照组(38例)按常规方法固定脐静脉导管;观察组(40例)采用改良法固定脐静脉导管。对比两组脐静脉导管留置时间、置管相关并发症发生率和非计划性拔管率。结果观察组脐静脉导管留置时间为(8.16±0.74)d,显著长于对照组的(6.21±1.02)d;医用粘胶相关性皮肤损伤发生率显著低于对照组(均P0.01);观察组非计划性拔管发生率与对照组比较,差异无统计学意义(P0.05)。结论改良脐静脉导管固定法可有效延长极低和超低出生体重儿置管时间,降低医用粘胶相关性皮肤损伤,且操作简便。     

Caval catheterization in the intensive care nursery: a useful means for providing parenteral nutrition to the extremely low birth-weight infant

We provided parenteral nutrition to 40 very low birth-weight premature infants (birth weight 815 +/- 17 grams, gestational age 27 +/- 2 weeks) with a superior vena cava catheter. To avoid the risk of transport, catheterization was performed under sterile conditions in the intensive care nursery. The central venous catheter facilitated administration of calories to sustain growth, especially in infants whose catheters remained in place for 3 weeks or longer. The overall incidence of catheter related sepsis was high (30%) but the majority of cases were due to Staphylococcus epidermidis and resolved without incident. Other complications of parenteral nutrition were minimal. This approach is a safe and effective means of providing nutrition to the very low birth-weight infant.     

Comparison of oxygen consumption, carbon dioxide production, and resting energy expenditure in premature and full-term infants

A newly developed closed circuit water-sealed infant calorimeter has been used to measure oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory quotient (RQ) and resting energy expenditure (REE) in 31 infants. There were 17 full-term and 14 premature infants. VO2 was measured volumetrically, keeping the inspired oxygen concentration constant. VCO2 was determined by infrared analysis of the mixed expired gases. Values for REE and RQ were calculated from measurements of VO2 and VCO2. All values were normalized for the infants body weight. Our findings demonstrate significant differences in VO2, VCO2, and REE associated with weight, gestational age, postnatal age, activity, feeding, and sex. In addition, VO2, VCO2, and REE were significantly higher for the premature infants. The water-sealed indirect calorimetry system: (a) is safe and noninvasive, (b) does not interfere with infant tube feeding or IV infusion, (c) permits long-term monitoring of metabolic activity, and (d) allows a more exact matching of oral and intravenous feedings to actual energy expenditure. We are finding that indirect calorimetry removes the guess work from writing daily caloric regimens, with potential advantage for the treatment of sick infants.     

Clinical trial of a milk formula for infants of low birth weight

An infant milk formula specially designed to meet the specific needs of the small premature infant was compared with a modified infant milk formula in common use. Healthy infants of very low birth weight were fed with either the specially designed infant milk formula or the standard modified infant milk formula. No statistically significant differences between the two groups of infants were found, although the weight gain, skinfold thickness, serum total protein, albumin and calcium values were marginally better at 28 days in the group fed with the specially designed formula.     

催乳汤对产妇泌乳量及新生儿体重的影响

为观察术后饮食对泌乳量及新生儿体重的影响，将８２例剖宫产产妇随机分为两组。观察组术后６ｈ于饮用催乳汤，辅以主食；对照组按常规饮食护理。结果：观察组产后不同时间段泌乳量均明显多于对照组（均Ｐ〈０．００１），新生儿体重恢复快。提示：加强剖宫产术后营养摄入可使乳母增加泌乳量，促进其肠功能恢复，提高母乳喂养率。     

音乐疗法在早产儿护理中的应用

目的探讨音乐疗法在早产儿护理中的应用效果.方法将50例出生体重1000～2000 g早产儿随机分为观察组和对照组各25例.对照组予以常规护理,观察组在此基础上于出生后72 h内实施音乐干预,3次/d,15 min/次,直至出院前.其他治疗两组相同.观察比较两组体重增长、对疼痛刺激即针刺足跟采血前后心率、呼吸、血氧饱和度的变化恢复时间及住院时间.结果观察组每日体重增长显著高于对照组(P＜0.05);针刺足跟采血后心率、呼吸及血氧饱和度恢复至刺激前的时间显著短于对照组(均P＜0.01);住院时间短于对照组(P＜0.05).结论音乐疗法能促进早产儿体重的增长,缩短机体疼痛刺激阈及住院时间,有利于早产儿的生长发育.     

Rate of change of blood pressure in premature and full term infants from birth to 4 months

Systolic and diastolic blood pressures were evaluated in a cohort of 61 non-hypertensive premature [very low birth weight (VLBW),n=16; low birth weight (LBW),n=22] and full-term [normal birth weight (NBW),n=23] newborn infants admitted to a neonatal intensive care unit (NICU) and followed to their 4-month age-adjusted outpatient examination. All were receiving routine postnatal care by 7 days of age. Blood pressure was measured at 7 days of age, at discharge from the NICU, and at the outpatient examination. Simple linear regression of blood pressure on weight was used to fit a straight line to the three measurements for each infant and the average regression line for each birth weight group was then obtained. There was a significant correlation between systolic blood pressure and both weight and length at each of the measurement points and also between the change in systolic, blood pressure and change in weight from the discharge to the 4-month examination. Diastolic blood pressure tended to follow this same pattern. Gestational age was correlated significantly with the 7-day blood pressure, but postnatal age at the outpatient examination was not correlated with either systolic or diastolic blood pressure. The average slopes of systolic and diastolic blood pressure on weight (mmHg/kg body weight) were virtually identical for the LBW and NBW groups; in constrast, the average slope of the VLBW group was greater than the other two groups, and the difference was statistically significant for diastolic blood pressure. These results show significant group differences in mean blood pressure prior to 4 months of age between VLBW, LBW, and NBW groups and, for the VLBW infants, a steeper slope of the estimated regression line of blood pressure on weight between birth and 4 months.     

Surgical ligation of patent ductus arteriosus in the very-low-birth-weight premature infant

Three recent cases of surgical closure of ductus arteriosus in very low birth weight infants (less than 1 000 g) are reported. The indications of both surgical and pharmacological closure in very low birth weight premature infants are discussed. The necessity of an early closure of a patent ductus arteriosus is now admitted in the very premature infant, but the use of indomethacin in the first days of life is often impossible because of its side-effects. The use of adapted non-invasive monitoring devices during surgery allows a better control of anaesthesia.     

Early peristalsis following epidural analgesia during abdominal surgery in an extremely low birth weight infant

The inhibiting effect of opioids on intestinal motility is a cause of particular concern in extremely low birth weight (ELBW; birth weight <1000 g) infants with decreased peristalsis. An ELBW infant (birth weight 740 g) born after 26 + 1 week of gestation had an uneventful clinical course during the first few days of life. Sudden deterioration occurred on day 8 with metabolic acidosis, hyperglycemia and frequent apnea with secondary bradycardia. A chest X ray demonstrated the presence of air beneath the diaphragm. Intestinal perforation was suspected and the infant was taken to theater for laparotomy. For pain management, a 22 G epidural catheter was inserted via the caudal approach and threaded to a mid-thoracic level. Epidural ropivacaine was administered intraoperatively and for 48 h postoperatively. The infant was extubated on the following day. Opioids were not required or given at any stage during or after surgery. Peristalsis was present on auscultation as early as 3 h after surgery, the first stool was passed on the same day. Enteral nutrition was resumed early and tolerated well, full enteral feeding was rapidly achieved. Our case shows that the technique of caudal anesthesia is feasible in ELBW infants. We speculate that intestinal motility and establishment of full enteral feedings may be achieved earlier by epidural ropivacaine in cases of abdominal surgery in ELBW infants.     

对NICU出院早产儿母亲实施网络支持干预的研究

目的探讨网络支持干预对新生儿重症监护室(NICU)出院早产儿母婴的影响。方法将符合入组条件的早产儿母亲77人按时间分组,2013年6~9月入组的早产儿母亲38人设为对照组,2013年12月至2014年3月入组的早产儿母亲39人设为观察组。对照组接受早产儿常规出院指导,观察组在此基础上实施网络支持干预,持续12周。结果观察组母亲在早产儿出院后4周、12周角色适应评分及育儿胜任感评分显著高于对照组(均P0.01);观察组早产儿出院后12周体质量、身长、头围显著高于对照组(均P0.01),再入院率显著低于对照组(P0.01)。结论网络支持干预能帮助NICU出院早产儿母亲适应母亲角色,提升育儿胜任感,有利于早产儿体格生长发育,降低早产儿再入院率。     

The effect of supplemental parenteral nutrition on outcomes of necrotizing enterocolitis in premature,low birth weight neonates

Background

We hypothesized that supplemental parenteral nutrition (PN) decreases the need for surgery and mortality associated with necrotizing enterocolitis (NEC).

Methods

Single institution retrospective review of all premature, low birth weight infants with NEC from January 2006 to December 2013 was conducted.

Results

NEC was identified in 114 premature, low birth weight infants, 59 (51.8%) of which required surgical management. Surgical NEC infants were born younger (25.8 ± 4.0 vs 27.8 ± 3.3 weeks, P = .005) and weighed less at birth (829 ± 281 vs 938 ± 271 g, P = .038) than those managed medically. There was no difference in the use of PN (37.7% vs 31.4%, P = .541) between surgical and medical NEC patients. There was no statistically significant difference in mortality at discharge between patients who had PN at NEC onset and those who did not (31.4% vs 42.6%, P = .294)

Conclusion

In this single-center study, supplemental PN at NEC onset does not appear to significantly improve outcomes as demonstrated by rates of surgical intervention and in-hospital mortality.