经幽门喂养和经胃管喂养对极低出生体质量儿的喂养耐受性比较

目的通过比较经幽门喂养(TP)和经胃管喂养(IG)对极低出生体质量儿(VLBWI)的喂养耐受性,探讨TP在VLBWI儿胃肠内营养中的应用价值。方法将43例胎龄为28～33周的VLBWI儿随机分为TP组(n=20)和IG组(n=23)。喂养开始于出生2～3d,且生命体征平稳。喂奶量由10～20mL/(kg.d)开始,间断喂养每3～6小时1次,VLBWI儿均同时进行部分外周静脉营养,逐渐过渡到完全肠道内营养。观察二组患儿喂养耐受性、呼吸暂停、体质量增长速度、达出生体质量时间、住院天数、并发症发生情况。结果喂养耐受性中呕吐发生率TP组显著低于IG组(χ2=4.74P<0.05),呼吸暂停发生次数TP组显著低于IG组(t=3.098P<0.05)。二组患儿腹胀、体质量增长速度、达出生体质量时间、平均住院天数经比较均无显著性差异(χ2=0.378;t=1.243,0.388,0.834Pa>0.05),坏死性小肠结肠炎发生率二组比较无显著性差异(χ2=0.027P>0.05),且二组患儿均无肠穿孔发生。结论TP能显著减少VLBWI儿呼吸暂停及呕吐的发生率,改善喂养的耐受性,TP可用于不能耐受IG而反复出现胃食管反流的VLBWI儿。     

早产儿呼吸暂停的防治

呼吸暂停 (apnea)是指呼吸暂停时间 >2 0s,常伴有心率减慢 <1 0 0次 /min或出现青紫、肌张力低下。呼吸暂停是早产儿常见症状之一 ,早产儿呼吸暂停发生率约 2 0 %～ 3 0 %,极低出生体重儿可达 5 0 %,超低出生体重儿则达 90 %。呼吸暂停发作时 ,出现青紫、肌张力低下、心率变慢、血氧饱和度下降、血压降低 ,如不及时发现 ,可致脑缺氧损伤 ,甚至猝死 ,应密切监护 ,及时处理。原发性呼吸暂停主要与早产儿中枢神经和呼吸系统发育未成熟有关 ,呼吸中枢的组织结构及神经元之间的联系不完善 ,神经冲动传出较弱 ,任何细微的干扰均可发生呼吸调节障碍…     

早产极低出生体重儿早期滴服喂养的临床研究

目的观察早期滴服喂养对早产极低出生体重儿的喂养效果及其相关并发症的发生情况,探讨其临床应用价值。方法 2006年6月至2008年12月滨州医学院附属医院新生儿科收治的早产极低出生体重儿45例,分为观察组(早期滴服喂养组)23例,对照组(早期鼻胃管喂养组)22例。观察奶量增加速度、体重增长速度、经奶头喂养时间、达全口喂养时间、恢复出生体重时间、胎粪完全排出时间、累计光疗时间、住院时间及其相关并发症的发生情况。结果与对照组比较,观察组体重增长速度快(P0.05),奶量增加速度明显加快(P0.01),经奶头喂养时间、达全口喂养时间、恢复出生体重时间、胎粪完全排出时间、累计光疗时间及住院时间明显缩短(P0.01)。吸入性肺炎、胃出血及口腔炎的发生率减少(P0.05),呼吸暂停、呕吐及腹胀的发生率明显降低(P0.01)。结论早期滴服喂养能较快提高胃肠道喂养的耐受性、缩短病程、减少并发症,值得临床推广应用。     

超低出生体重儿的临床救治（附3例报告）

目的探讨超低出生体重儿的临床救治方法。方法分析超低出生体重儿（ELBWI）的临床表现，并采取综合治疗措施：全部病例一入院即进入抢救单元（生命岛），特医特护，采用促进肺发育成熟，呼吸管理与氧疗，感染防治极为重要，营养支持包括经皮中心静脉置管（PICC），微量喂养，尤其是当出现早产儿喂养不耐受时，应用生大黄粉治疗，取得了良好的临床疗效。而出院后的专人随访。对预后极为重要。结果3例超低出生体重儿经过10-14周的治疗，2例救治成功，1例于生后103天体重达1400g时死于感染。结论根据临床表现，协调采用多种救治措施，成功救治超低出生体重儿，其抢救治疗技术达到国内先进水平，为超低出生体重儿的救治积累了宝贵的经验。     

抚触对促进极低出生体重儿胃肠道发育的影响

目的：探讨抚触治疗对极低出生体重儿(VLBWI)胃肠道发育的影响。方法：选择42例VLBWI,随机分为抚触组和对照组,观察两组治疗后7,14 d相同时段的喂养不耐受情况及胃排空时间。同时记录达到全肠道喂养的时间并进行比较。结果：抚触治疗后7,14 d,抚触组喂养不耐受的发生率比对照组明显降低(P<0.05);抚触组100％胃排空时间明显快于对照组,7,14 d分别为[(140.8±26.4)min vs(168.6±24.7)min,(122.4±21.3)min vs(141.0±23.1)min](均P<0.01)。抚触组达到全肠道喂养时间明显短于对照组[(14.7±3.9)d vs(19.0±3.3)d](P<0.01)。结论：抚触可刺激VLBWI胃肠道的生长发育并促进胃肠功能成熟。     

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呼吸支持与超低出生体重儿(extremely low birthweight infant,ELBWI)的生存率有关。由于肺保护通气策略的广泛应用,使ELBWI呼吸衰竭死亡率显著下降;随着肺表面活性物质(PS)时代的到来,常规的机械通气呼吸支持手段显得不如20世纪80年代那么重要,但通气模式对于这些非常微小的ELBWI的治疗成功率关系仍然非常密切。     

低出生体重儿不同喂养方法时血清视黄醇结合蛋白的变化

为评估低出生体重儿生后早期间断鼻胃管喂养和鼻十二指肠喂养的效果,将40例低出生体重儿(出生体重1 050～1 920g)随机分为间断鼻胃管喂养组和鼻十二指肠喂养组,两组出生体重、性别、胎龄无显著差异(P＞0.05).用同一种配方乳喂养,记录入液量、热能、蛋白质摄入量、大便性状及喂养相关并发症,喂养前和喂养后1周用ELISA法测血清视黄醇结合蛋白.结果显示,喂养后1周鼻十二指肠喂养组较鼻胃管喂养组奶量、热能、蛋白质摄入量均显著增加(P＜0.001);肠道营养热能达100 kcal/(kg·d)的时间、恢复出生体重时间均明显缩短(P＜0.05).前者较后者血清视黄醇结合蛋白明显增加(P＜0.05).两组均无腹泻、十二指肠穿孔、坏死性小肠结肠炎发生,鼻十二指肠喂养组较鼻胃管喂养组吸入性肺炎、高胆红素血症的发生显著减少(P＜0.01).提示低出生体重儿生后早期鼻十二指肠喂养优于鼻胃管喂养.     

低出生体重儿不同喂养方法时血清视黄醇结合蛋白的变化

为评估低出生体重儿生后早期间断鼻胃管喂养和鼻十二指肠喂养的效果 ,将 40例低出生体重儿 (出生体重 1 0 50～ 1 92 0g)随机分为间断鼻胃管喂养组和鼻十二指肠喂养组 ,两组出生体重、性别、胎龄无显著差异 (P >0 0 5)。用同一种配方乳喂养 ,记录入液量、热能、蛋白质摄入量、大便性状及喂养相关并发症 ,喂养前和喂养后 1周用ELISA法测血清视黄醇结合蛋白。结果显示 ,喂养后 1周鼻十二指肠喂养组较鼻胃管喂养组奶量、热能、蛋白质摄入量均显著增加 (P <0 0 0 1 ) ;肠道营养热能达 1 0 0kcal (kg·d)的时间、恢复出生体重时间均明显缩短 (P <0 0 5)。前者较后者血清视黄醇结合蛋白明显增加 (P <0 0 5)。两组均无腹泻、十二指肠穿孔、坏死性小肠结肠炎发生 ,鼻十二指肠喂养组较鼻胃管喂养组吸入性肺炎、高胆红素血症的发生显著减少 (P <0 0 1 )。提示低出生体重儿生后早期鼻十二指肠喂养优于鼻胃管喂养。     

早产儿早期营养支持策略的临床研究

目的探讨早期积极规范的营养支持策略对早产儿的益处及安全性。方法61例早产儿为研究组,按照尽量早开奶、微量喂养、提倡母乳喂养、提供非营养性吸吮、必要时尽早积极的肠外营养原则提供营养支持;既往收治的61例早产儿作为对照组。结果研究组达到推荐摄入标准、足量喂养、恢复出生体重所需时间及平均住院日均较对照组短(P均<0.05),但两组体重增长速度差异无显著性(P>0.05)。每组中的极低出生体重儿组与较大出生体重儿组比较,达到推荐摄入标准和足量喂养所需时间长,但体重增长速度差异无显著性。研究组无坏死性小肠结肠炎(NEC)发生,对照组发生3例。胆汁淤积发生率两组差异无显著性(P>0.05)。研究组败血症例数少于对照组(P<0.05)。结论早期积极规范的营养支持策略对早产儿是有益且安全的。     

早期滴服喂养在早产极低出生体质量儿的临床应用

目的 观察早期滴服喂养对早产极低出生体质量儿的喂养效果及其相关并发症的发生情况.方法 45例早产极低出生体质量儿随机分为观察组(早期滴服喂养组)23例,对照组(早期鼻胃管喂养组)22例.观察两组奶量增加速度、体质量增长速度、达全口喂养时间、恢复出生体质量时间、胎粪完全排出时间、累计光疗时间、住院时间及其相关并发症的发生情况.结果 观察组体质量增长速度较对照组增快(P<0.05),奶量增加速度较对照组明显增快(P<0.01),达全口喂养时间、恢复出生体质量时间、胎粪完全排出时间、累计光疗时间及住院时间均较对照组明显缩短(P<0.01).观察组无一例发生吸人性肺炎,对照组发生吸人性肺炎4例,2组差异显著(P<0.05).观察组胃出血、口腔炎、呼吸暂停、呕吐及腹胀的发生率均较对照组明显减少(P<0.05).结论 早期滴服喂养能较快提高胃肠道喂养的耐受性,缩短病程,减少并发症,值得临床推广应用.     

Observations on gastro-oesophageal reflux,central apnoea and heart rate in infants

Respiratory movements and heart rate were monitored continuously during the course of 2 h radionuclide studies to detect gastro-oesophageal reflux (GOR) in 22 infants following a milk feed. Twenty infants had GOR, to upper oesophageal/pharyngeal level in 19, and 17 had central apnoea between 3 and 15s. Prolonged central apnoea (greater than 20s) was not observed. Bradycardia, defined as a heart rate less than 80 beats/min for 10s or more, was observed in only 1 infant who did not have GOR. No correlation was found between the number or duration of reflux episodes and the frequency of respiratory pauses between 3 and 17s. When data from individual infants were examined a possible temporal relation between the occurrence of GOR and central apnoea was seen in only two infants; in each case, detailed examination suggested that apnoea was more closely associated with sleep than with GOR. Although the respiratory monitoring system did not include airflow sensors, the almost complete absence of bradycardia suggested that prolonged obstructive apnoeas did not occur. We conclude that any relation between GOR and central apnoeas less than 15 s is not of a direct cause/effect nature.     

Transpyloric feeding in small preterm infants

Wolfsdorf, J., Makarawa, S., Fernandes, C., Fenner, A. (1975). Archives of Disease in Childhood, 50, 723. Transpyloric feeding in small preterm infants. In 20 preterm infants, birthweight ranging from 775 to 1540 g, transpyloric feeding was carried out using expressed human milk as the sole nutrient (study group). 10 further infants, birthweight range 910-1500 g, were also fed with human milk via nasogastric tube (control group). The group fed transpylorically had higher fluid intakes during the early days of life. Body weight loss after birth was similar in both groups, but subsequent weight gain was more rapid in the study group. Thus transpyloric feeding is considered to offer the following advantages in comparison with nasogastric feeding. (1) No danger of aspiration after vomiting. (2) More rapid weight gain.     

Transpyloric feeding in small preterm infants.

Wolfsdorf, J., Makarawa, S., Fernandes, C., Fenner, A. (1975). Archives of Disease in Childhood, 50, 723. Transpyloric feeding in small preterm infants. In 20 preterm infants, birthweight ranging from 775 to 1540 g, transpyloric feeding was carried out using expressed human milk as the sole nutrient (study group). 10 further infants, birthweight range 910-1500 g, were also fed with human milk via nasogastric tube (control group). The group fed transpylorically had higher fluid intakes during the early days of life. Body weight loss after birth was similar in both groups, but subsequent weight gain was more rapid in the study group. Thus transpyloric feeding is considered to offer the following advantages in comparison with nasogastric feeding. (1) No danger of aspiration after vomiting. (2) More rapid weight gain.     

深度水解蛋白配方奶喂养对极低/超低出生体重儿生长发育的影响

目的探讨深度水解蛋白配方奶喂养对极低出生体重(VLBW)和超低出生体重(ELBW)婴儿生长发育的影响。方法选取VLBW和ELBW婴儿375例作为研究对象,根据随机数字表法将其分为观察组(n=187)和对照组(n=188)。观察组给予深度水解蛋白配方奶喂养,当喂养达10 mL/次后,改用标准早产儿配方奶喂养。对照组给予标准早产儿配方奶喂养。两组持续喂养4周,比较两组喂养不耐受发生率、达全肠道喂养时间、胎便排净时间、自主排便次数、生长发育情况、喂养后第4天和第10天胃动素水平以及感染发生情况。结果观察组喂养不耐受率低于对照组(P0.05);观察组达全肠道喂养时间和胎便排净时间均短于对照组(P0.05);观察组平均每日自主排便次数多于对照组(P0.05);观察组婴儿体重、头围和身长均大于对照组(分别是1 793±317 g vs 1 621±138 g、30.5±1.1 cm vs 30.0±1.6 cm和43.9±1.2 cm vs 42.1±2.0 cm;均P0.05);观察组婴儿喂养第4天和第10天胃动素水平均高于对照组(P0.05);观察组婴儿感染率低于对照组(P0.05)。结论深度水解蛋白配方奶可提高胃动素水平,增加胃肠道喂养耐受性,促进VLBW和ELBW婴儿早期生长发育,降低感染发生率。     

Clinical spectrum of neonatal apnoea in very low birthweight infants

This study quantifies apnoea and assesses the response to xanthine derivatives amongst 172 consecutively born, surviving very low birth weight (VLBW) infants, 136 appropriate weight for gestational age (AGA), 36 small for gestational age (SGA). All babies had electronic monitoring of heart and respiratory rates and nursing staff recorded episodes of apnoea (greater than 10 s), bradycardia (less than 100) and cyanosis. Only 42 (24.2%) babies had no episodes recorded. (25 AGA, 17 SGA). Sixty-four (37.2%) received active resuscitation on at least one occasion with six babies ventilated by bag and mask on more than 10 occasions. Apnoea had commenced by day 10 of life in all the babies who had apnoea and persisted beyond day 50 in only six; however four of these infants were still requiring active resuscitation. Apnoea had ceased by 37 weeks post-conceptual age in 88% and by 40 weeks in all but three babies. Risk factor analysis revealed a strong correlation (P less than 0.005) with lower gestational ages and birth weights, respiratory distress syndrome (RDS) and the problems associated with it, such as mechanical ventilation, patency of the ductus arteriosus (PDA) and chronic neonatal lung disease. A single, reversible cause for apnoea was rarely demonstrated. Care must be exercised with feeding, physiotherapy and suctioning the pharynx and trachea of 'at risk' infants. Xanthine derivatives were highly effective in decreasing the frequency of recurrent apnoea from a mean of 10.08 episodes one day before, to 1.83 two days after commencement of treatment.     

Clinical spectrum of neonatal apnoea in very low birthweight infants

Abstract This study quantifies apnoea and assesses the response to xanthine derivatives amongst 172 consecutively born, surviving very low birth weight (VLBW) infants, 136 appropriate weight for gestational age (AGA), 36 small for gestatfonal age (SGA). All babies had electronic monitoring of heart and respiratory rates and nursing staff recorded episodes of apnoea (> 10 s), bradycardia (<100) and cyanosis. Only 42 (24.2%) babies had no episodes recorded. (25 AGA, 17 SGA). Sixty-four (37.2%) received active resuscitation on at least one occasion with six babies ventilated by bag and mask on more than 10 occasions. Apnoea had commenced by day 10 of life in all the babies who had apnoea and persisted beyond day 50 in only six; however four of these infants were still requiring active resuscitation. Apnoea had ceased by 37 weeks post-conceptual age in 88% and by 40 weeks in all but three babies.
Risk factor analysis revealed a strong correlation (P<0.005) with lower gestational ages and birth weights, respiratory distress syndrome (RDS) and the problems associated with it, such as mechanical ventilation, patency of the ductus arteriosus (PDA) and chronic neonatal lung disease. A single, reversible cause for apnoea was rarely demonstrated. Care must be exercised with feeding, physiotherapy and suctioning the pharynx and trachea of 'at risk' infants. Xanthine derivatives were highly effective in decreasing the frequency of recurrent apnoea from a mean of 10.08 episodes one day before, to 1.83 two days after commencement of treatment.     

Gastro-oesophageal reflux and apnoeic pauses during sleep in infancy —no direct relation

We studied the relation of gastro-oesophageal reflux with apnoea during sleep in 24 infants with antecedent respiratory abnormalities and/or proven gastro-oesophageal reflux (GOR), by combined lower oesophageal pH and polygraphic monitoring. GOR, indicated by pH<4, was confirmed in 24 infants. There were no episodes of prolonged (>20s) central apnoea (CA). Fifty-six mixed or obstructive breathing episodes were identified in 12 infants (14 studies), of which 28 lasted between 3 and 6s. Bradycardia (heart rate less than <80 beats/min for 10s was not observed. There were 80 falls in transcutaneous oxygen (PtcO₂>5 mmHg) but only 6 exceeded 10 mmHg and one 20 mmHg. There was no relationship between GOR and obstructive episodes in terms of frequency, duration or temporal occurrence, except in one infant. There were 1276 gross body movements, mainly during active or indeterminate sleep and, of these, 7% were associated with decreases in pH to <4. Movements occurred during the 60s period preceding 83% of pH decreases >1 pH unit compared to only 30% in the 60s succeeding a pH drop. We conclude that, while GOR and obstructive episodes may co-exist in the patient groups studied, decreases in pH in the lower oesophagus do not usually induce either central or obstructive apnoea, and vice versa. Of the variables monitored, only gross body movements were temporally associated with pH drops, and usually preceded them.     

超低出生体重儿大量肺出血高危因素与临床特征分析

目的 探讨超低出生体重儿(ELBW)大量肺出血(MPH)的常见高危因素,并对其临床特点进行分析。方法 211例ELBW患儿分为MPH组(35例)和无肺出血的对照组(176例)。比较两组临床特征、病死率及并发症的差异,并采用多因素logistic回归分析探讨MPH的高危因素。结果 MPH组患儿胎龄、出生体重及5 min Apgar评分均低于对照组(P0.05),而新生儿呼吸窘迫综合征(RDS)、动脉导管未闭(PDA)、早发型败血症(EOS)及颅内出血的发生率、肺表面活性物质(PS)使用率、病死率均明显高于对照组(P0.01)。多因素logistic回归分析显示,5 min Apgar评分是MPH发生的保护因素(OR=0.666,P0.05),而合并PDA和EOS是MPH发生的危险因素(分别OR=3.717、3.276,均P0.05)。在正常出院的患儿中,MPH组的辅助通气时间长于对照组,呼吸机相关性肺炎(VAP)的发生率高于对照组(P0.05)。结论 较高的5 min Apgar评分可降低ELBW患儿MPH发生的危险,而合并PDA和EOS可增加ELBW患儿MPH发生的危险。MPH患儿机械通气时间更长,病死率及VAP、颅内出血的发生率更高。     

Incidence of apnoea and bradycardia in preterm infants following DTPw and Hib immunization: A prospective study

Objective: To evaluate the incidence and severity of apnoea and bradycardia in hospitalized preterm infants following immunization at 2 months of age, and identify risk factors.
Methodology: A prospective study of 98 preterm infants, of gestational age 24–31 weeks, immunized at approximately 2 months post natal age with diphtheria-tetanus-whole cell pertussis vaccine (DTP_w) in the neonatal intensive care unit (NICU) at King George V Hospital Sydney. Half the infants also received Haemophilus influenzae type b conjugate vaccine (Hib) simultaneously. All infants were monitored for apnoea and bradycardia in the 24 h periods pre- and post immunization.
Results: Only one infant had apnoea and/or bradycardia pre-immunization compared with 17 post immunization. For 12 infants these events were brief, self-limiting and not associated with desaturations (oxygen saturation <90%). However, for five infants (30%) these events were associated with oxygen desaturation and two of these infants required supplemental oxygen. The group that had apnoea and/or bradycardia and the group that did not were not significantly different in terms of gestational age, birth weight and other variables. Infants who received Hib together with DTP_w were less likely to have apnoea and/or bradycardia than those given DTP_w alone.
Conclusion: When considering immunization for preterm infants, the benefits of early immunization must be balanced against the risk of apnoea and bradycardia. We recommend that the cardio-respiratory function of hospitalized infants born at less than 31 weeks gestation be monitored for 48 h post immunization.     

不同喂养方式对极低/超低出生体重儿生长发育的影响

目的 探讨极低/超低出生体重（VLBW/ELBW）早产儿纠正年龄6个月内生长发育情况及不同喂养方式对其生长发育的影响。方法 对2016年1月至2017年4月出院并按时完成随访的VLBW/ELBW早产儿109例进行纠正年龄6个月内的生长发育监测。采用Z评分法评价体格指标,并分析不同喂养方式（母乳喂养组：母乳+母乳强化剂;混合喂养组：母乳+早产儿配方奶;人工喂养组：早产儿配方奶）对其生长发育的影响。结果 年龄别体重Z积分、年龄别身长Z积分、身长别体重Z积分、体重指数Z积分的追赶高峰发生于纠正年龄3个月内;年龄别头围Z积分的追赶高峰发生于纠正年龄5个月。VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内。母乳喂养组体重、身长、头围的生长在纠正年龄3个月时均优于混合喂养组和/或人工喂养组（P < 0.05）;母乳喂养组头围、身长的生长在纠正年龄6个月时均优于混合喂养组和/或人工喂养组（P < 0.05）。结论 VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内,提示应加强早期个体化随访及营养指导以减少生长偏离的发生。亲母母乳喂养并添加母乳强化剂是VLBW/ELBW早产儿的最佳喂养方式。