营养强化对出院后早产儿生长及智能发育影响的前瞻性对照研究

目的探讨营养强化对出院后早产儿体格生长及智能发育的影响。方法采用前瞻性随机对照研究方法,选择刚出院的早产儿并随机分为营养强化组(接受营养强化配方奶粉喂养)和对照组(普通配方奶粉喂养)。从出院时干预至矫正年龄9个月。矫正年龄1、3、6、9个月时分别检测体格发育指标,矫正年龄3、9个月时进行儿童智能发育筛查实验(DST)。结果共入组符合入选标准的早产儿80例,最后完成随访的营养强化组早产儿34例,对照组36例。入组时两组早产儿的胎龄、体质量、身长等差异均无统计学意义(P>0.05)。营养强化组早产儿在矫正年龄9个月时体质量、身长及智能发育均优于对照组,差异有统计学意义(P<0.05)。结论营养强化有助于加快早产儿体质量、身长的生长速度,并改善其智能发育。     

早产婴幼儿追赶生长对骨龄发育影响的队列研究

目的了解早产儿在婴幼儿期的追赶生长情况,探索早产儿追赶生长对骨龄发育的影响。方法采用双向队列研究的方法,选取2015年1月1日至12月31日在武汉儿童医院儿童保健科就诊的早产儿为暴露组,按照1∶1的比例选取同年龄、同性别、同种族的足月儿为非暴露组,回顾性收集2组婴儿出生史、既往生长发育史等资料,并随访至3岁。3岁时2组儿童拍摄左腕部X线片进行骨龄评价。结果入组时暴露组和非暴露组研究对象各392例,随访至3岁时暴露组239例,非暴露组247例。随访过程中暴露组儿童的身长、体质量均存在追赶生长的趋势,体质量Z值在2月龄最低,但体质量和身长的总体水平仍落后于非暴露组。体质量的追赶优先于身长,体现在体质量追赶至Z=-2和Z=-1的时间分别为3.78个月、16.18个月,身长追赶至Z=-2和Z=-1的时间分别为7.24个月、22.21个月,身长在5~10月龄和12~21月龄期间追赶速度变缓。2组儿童进行骨龄评价的年龄在2.80~3.20岁(平均3.03岁),暴露组男童骨龄[(3.13±0.61)岁]高于非暴露组[(2.75±0.51)岁],差异有统计学意义(t=-5.52,P<0.01),暴露组女童骨龄[(3.23±0.57)岁]与非暴露组[(3.15±0.54)岁]比较,差异无统计学意义(t=-1.08,P>0.05)。1月龄、2月龄、4月龄、5月龄、6月龄、12月龄的身长Z值和2月龄、3月龄、4月龄体质量Z值是骨龄发育的促进因素,15月龄、18月龄、36月龄的身长Z值和15月龄的体质量Z值是骨龄发育的阻碍因素。结论早产儿在3岁前存在追赶生长趋势,避免1岁前体质量、身长的快速追赶生长可延缓骨龄发育。     

Lack of improved growth outcome related to nonnutritive sucking in very low birth weight premature infants fed a controlled nutrient intake: a randomized prospective study

The effect of nonnutritive sucking during gavage feeding on nutritional outcome and gastrointestinal transit time was evaluated in 18 premature appropriate for gestational age infants whose birth weights were less than or equal to 1,400 g and gestational ages were less than or equal to 30 weeks. Infants were randomized to a treatment (nonnutritive sucking infants received a pacifier for 30 minutes with each feeding, 12 times per day until they reached a weight of 1,500 g, eight times per day thereafter) or control (no pacifier) group. The nine nonnutritive sucking (five girls, four boys) and nine control (five girls, four boys) infants were treated for 14 days. Infants were without medical complications and were fed a single premature formula by intermittent gastric gavage at exactly 120 kcal/kg/d throughout the study period. Weight gain, linear growth, subscapular and triceps skinfold, and arm circumference accretions were assessed weekly. Serum proteins (albumin, prealbumin, retinol-binding protein, and transferrin) were measured weekly. Gastrointestinal transit times were measured weekly using carmine red markers. In contrast to previous studies, these data indicate no apparent effect of nonnutritive sucking on growth outcome, serum proteins, or gastrointestinal transit time in growing, very low birth weight infants when nutrient intake was controlled. In a subgroup of eight boys (four nonnutritive sucking, four control), energy and fat excretions were determined from 72-hour fecal collections and energy expenditure was estimated from six-hour cumulative heart rate measurements. Neither excretion of fat and calories nor estimated energy expenditure was affected significantly by nonnutritive sucking in this subgroup of baby boys. Fat excretion correlated well (r = .987) with energy excretion.     

Elevated serum calcium and osteocalcin levels from calcitriol in preterm infants. A prospective randomized study

The hypothesis of this study was that pharmacologic doses of calcitriol (1,25-dihydroxyvitamin D3) would result in elevated levels of serum osteocalcin, the major noncollagenous bone protein, and calcium in infants of very low birth weight (less than 1500 g). Twenty-four infants of very low birth weight but of the appropriate weight for gestational age were matched in 250-g weight ranges and randomized into calcitriol treatment and control groups on the first day after birth. Treated infants received 4 micrograms/kg of calcitriol intravenously on entry and on the second and third study days. Controls did not receive calcitriol. Four infants from each group were hypocalcemic (serum calcium level, less than 7.0 mg/dL [less than 1.75 mmol/L]) on entry (five to 20 hours after birth) to the study. Seven infants received calcium replacement; data analyses with and without these infants were similar. Of the remaining 17 infants, eight were in the treatment group and nine were in the control group. Calcitriol significantly increased serum calcium and osteocalcin concentrations on days 2, 3, and 4 after birth compared with the control group. None of eight treated infants manifested hypocalcemia after calcitriol vs eight of nine controls. There were no acute changes in heart rate, respiratory rate, systolic blood pressure, or urinary calcium loss nor were there changes at the infusion site, but the diastolic blood pressure increased with treatment. Although high doses of calcitriol may elevate serum calcium concentrations in infants of very low birth weight, we suggest that the long-term or subtle biologic effects of high doses of calcitriol remain to be studied and that its routine use not be recommended at present.     

Sensorial saturation: an effective analgesic tool for heel-prick in preterm infants: a prospective randomized trial

Pain is traumatic for preterm infants and can damage their CNS. We wanted to assess whether multisensorial stimulation can be analgesic and whether this effect is only due to oral glucose or sucking. We performed a randomized prospective study, using a validated acute pain rating scale to assess pain during heel-prick combined with five different procedures: (A) control, (B) 10% oral glucose plus sucking, (C) sensorial saturation (SS), (D) oral water, and (E) 10% oral glucose. SS is a multisensorial stimulation consisting of delicate tactile, vestibular, gustative, olfactory, auditory and visual stimuli. Controls did not receive any analgesia. We studied 85 heel-pricks (5 per baby) performed for routine blood samples in 17 preterm infants (28-35 weeks of gestational age). We applied in random order in each patient the five procedures described above and scored pain. SS and sucking plus oral glucose have the greater analgesic effect with respect to no intervention (p < 0.001). The effect of SS is statistically better than that of glucose plus sucking (p < 0.01). SS promotes interaction between nurse and infant and is a simple effective form of analgesia for the NICU.     

住院极早产儿宫外生长迟缓及相关因素的多中心前瞻性研究北大核心CSCD

目的了解我国住院极早产儿(very preterm infant,VPI)宫外生长迟缓(extrauterine growth restriction,EUGR)的发生率及影响因素。方法采用多中心前瞻性调查研究方法,纳入2019年9月至2020年12月我国7个地区28家医院新生儿科的2514例VPI临床资料,根据纠正胎龄36周或出院时的体重评估是否发生EUGR,分成EUGR组(n=1189)和非EUGR组(n=1325)。比较两组VPI的临床特征,探讨EUGR的发生情况及相关因素。结果以体重评价,EUGR的发生率为47.30%(1189/2514)。多因素logistic结果显示,恢复出生体重后平均体重增长速率快和住院第1周累计热卡高是EUGR的保护因素(P<0.05),小于胎龄儿、达全肠内营养所需时间长、累计禁食时间长、开始添加母乳强化剂时的母乳量少及达到全强化的所需时间长、中-重度支气管肺发育不良是EUGR发生的危险因素(P<0.05)。结论尽早达全肠内营养,及时强化母乳喂养,增加生后第1周的热卡摄入,提高体重增长速率,以及防治中-重度支气管肺发育不良对降低VPI EUGR的发生率至关重要。     

乳糖酶添加剂对早产儿乳糖不耐受有效性和安全性的前瞻性随机对照研究

目的 探讨乳糖酶添加剂对改善早产儿乳糖不耐受的有效性和安全性.方法 选取上海交通大学医学院附属新华医院2018年1月至2019年12月收治的有乳糖不耐受症状的早产儿60例纳入研究,随机分为乳糖酶治疗组和对照组,每组30例.乳糖酶治疗组给予乳糖酶添加剂4滴(180 mg)加入早产儿配方奶或母乳中;对照组给予安慰剂,同时予...     

早产儿维生素D两种补充方案的疗效对比：前瞻性随机对照研究

目的 探讨不同维生素D补充方案对出生胎龄 < 34周早产儿生后第28天维生素D营养状况的影响。方法 将59例2018年10月至2019年10月出生胎龄 < 34周的住院早产儿随机分为肌注组（n=30）和口服组（n=29）。肌注组单次肌内注射维生素D₃注射液（10 000 IU/kg）,口服组口服维生素D₃滴剂（900 IU/d）,持续25 d。采集两组患儿生后48 h内（维生素D₃补充前）及第28天静脉血,检测血清25-羟维生素D[25(OH) D]水平。结果 生后48 h内,59例早产儿维生素D缺乏（≤15 ng/mL）率为78%;两组血清25(OH) D水平及维生素D缺乏率比较差异无统计学意义（P > 0.05）。生后第28天,肌注组血清25(OH) D水平显著高于口服组（P < 0.05）,肌注组维生素D缺乏率显著低于口服组（P < 0.05）,且无维生素D过量或中毒病例。结论 单次肌内注射10 000 IU/kg维生素D₃可显著提升出生胎龄 < 34周早产儿生后第28天血清25(OH) D水平,且能安全并有效地降低维生素D缺乏率。     

早产儿维生素D两种补充方案的疗效对比：前瞻性随机对照研究

目的 探讨不同维生素D补充方案对出生胎龄 < 34周早产儿生后第28天维生素D营养状况的影响。方法 将59例2018年10月至2019年10月出生胎龄 < 34周的住院早产儿随机分为肌注组（n=30）和口服组（n=29）。肌注组单次肌内注射维生素D₃注射液（10 000 IU/kg）,口服组口服维生素D₃滴剂（900 IU/d）,持续25 d。采集两组患儿生后48 h内（维生素D₃补充前）及第28天静脉血,检测血清25-羟维生素D[25(OH) D]水平。结果 生后48 h内,59例早产儿维生素D缺乏（≤15 ng/mL）率为78%;两组血清25(OH) D水平及维生素D缺乏率比较差异无统计学意义（P > 0.05）。生后第28天,肌注组血清25(OH) D水平显著高于口服组（P < 0.05）,肌注组维生素D缺乏率显著低于口服组（P < 0.05）,且无维生素D过量或中毒病例。结论 单次肌内注射10 000 IU/kg维生素D₃可显著提升出生胎龄 < 34周早产儿生后第28天血清25(OH) D水平,且能安全并有效地降低维生素D缺乏率。     

Whole blood ionized magnesium in neonatal acidosis and preterm infants: a prospective consecutive study

The mineral magnesium is a crucial enzymatic cofactor in the cellular bioenergetic process and alternations in magnesium metabolism may be associated with neurological impairment in newborn infants. Therefore, ionized magnesium (IMg) was measured in 14 newborn infants with acidosis [umbilical arterial cord pH 7.00 +/- 0.06, Apgar score 8.3 +/- 1.6 after 5 min, gestational age (GA) 276 +/- 16 d] and 15 premature infants (umbilical arterial cord pH 7.31 +/- 0.07, GA 236 +/- 12 d). Nineteen healthy mature infants served as controls. Arterial umbilical cord samples were taken immediately after delivery and capillary blood samples were taken 2, 6, 12 and 24 h after delivery by heel stick. IMg was measured by NOVA 8. The results showed an increased umbilical cord blood IMg in infants with acidosis compared with both premature and normal infants (0.58 +/- 0.08 mmol l(-1) vs 0.51 +/- 0.03 mmol l(-1) and 0.49 +/- 0.03 mmol l(-1); p < 0.0001). In infants with acidosis IMg declined significantly 2 h after delivery to 0.49 +/- 0.05 mmol l(-1) (p < 0.0001) and did not show any further significant changes during the first day of life. In premature infants and controls IMg levels were constant during the observation period. Conclusion: These findings suggest that elevated IMg is associated with neonatal acidosis.     

晚期早产儿与足月小于胎龄儿生长发育状况比较

目的比较均为低出生体质量的晚期早产与足月小于胎龄(SGA)儿童的生长和发育状况。方法随机选取100例出生体质量<2 500 g的3岁儿童,其中50例为晚期早产儿童,50例为足月SGA儿童,对其进行体格测量及盖赛尔(Gesell)发育量表评估。结果晚期早产和足月SGA儿童的出生体质量、出生身长相近,但3岁时晚期早产儿童的身高、体质量、头围明显优于足月SGA儿童,差异有统计学意义(P<0.05);Gesell发育评估显示,晚期早产儿童的动作能、应物能、语言能、应人能均高于足月SGA儿童,差异有统计学意义(P<0.05)。结论同为低出生体质量,晚期早产儿童的长期生长和发育状况优于足月SGA儿童。     

Early exposure to maternal voice: Effects on preterm infants development

Background

Preterm infants complete their development in Neonatal Intensive Care Unit being exposed to environmental stimuli that lead to the early maturation of the sensory systems. It is known that the fetus perceives sounds and reacts to them with movements since the 26th–28th week of gestational age. Maternal voice represents a source of sensory stimulation for the fetus.

Aims

To investigate the effect of the exposure to maternal voice, administered by bone conduction, on preterm infants autonomic and neurobehavioral development.

Study design

Longitudinal, explorative, case control study.

Subjects

71 preterm infants with birth weight < 1500 g, born adequate for gestational age Outcome measures: vital and neurobehavioral parameters at term, neurofunctional assessment at 3 and 6 months of corrected age.

Results

Infants in the treatment group had lower heart rate values and a higher proportion of stable skin color at each study point as compared to the control group. The scores in the visual attention performance and in the quality of the general movements at term were better in the treatment group than in the control one. Neurofunctional assessment score at 3 months of corrected age was higher in the treatment group whereas no difference between the two groups was detected at 6 months of corrected age.

Conclusions

Early exposure to maternal voice exerts a beneficial effect on preterm infants autonomic and neurobehavioral development.     

晚期早产儿脐血维生素D水平及维生素D3补充对婴幼儿行为发育的前瞻性随机对照研究（英文翻译）

目的 探讨晚期早产儿25-羟维生素D［25-hydroxyvitamin D,25(OH)D］水平及维生素D₃补充对婴幼儿神经行为发育的影响。 方法 前瞻性选取2017年6月—2020年6月收治的晚期早产儿161例为研究对象,根据脐血25(OH)D水平分为充足组（52例）、不足组（53例）、缺乏组（56例）,每组按随机数字法分为A亚组（维生素D₃ 800 IU/d）、B亚组（个体化补充维生素D₃）。分析比较各组生后3个月25(OH)D水平、纠正胎龄10个月及纠正胎龄18个月25(OH)D水平及Gesell发育量表评分的差异。 结果 生后24 h内及3个月时,不足组、缺乏组25(OH)D水平低于充足组（P<0.05）,不足组25(OH)D水平高于缺乏组（P<0.05）;缺乏组生后3个月时B亚组25(OH)D水平高于A亚组（P<0.05）。不足组和缺乏组纠正胎龄10个月、纠正胎龄18个月时Gesell发育量表5个能区得分均低于充足组（P<0.05）;缺乏组纠正胎龄10个月时言语能、纠正胎龄18个月时粗大动作能得分低于不足组（P<0.05）。缺乏组B亚组纠正胎龄10个月时适应能、纠正胎龄18个月时适应能和应物能得分高于A亚组（P<0.05）。 结论 晚期早产儿脐血25(OH)D水平存在明显差异,个体化补充维生素D方案对于纠正维生素D缺乏更为有效。出生时及婴儿早期维生素D水平对神经行为发育有一定影响。     

神经发育损害早产儿肠道菌群变化的前瞻性队列研究

目的 探讨神经发育损害(neurodevelopmental impairment,NDI)与非NDI早产儿的肠道菌群差异。方法 该研究为前瞻性队列研究,以2019年9月1日—2021年9月30日广西壮族自治区妇幼保健院新生儿重症监护室收治的早产儿为研究对象,根据纠正胎龄1.5～2岁时格塞尔发育量表评估的结果分为正常组(n=115)和NDI组(n=100),分别收集早产儿出院前1d、添加辅食前1d和纠正胎龄1岁时的粪便样本,用高通量测序技术分析比较各组肠道菌群组成的差异。结果 NDI组早产儿肠道菌群Shannon多样性指数在纠正胎龄1岁时高于正常组(P<0.05)。主坐标分析显示两组早产儿菌群组成结构在添加辅食前1 d和纠正胎龄1岁时差异有统计学意义(P<0.05)。NDI组肠道内双歧杆菌属丰度在3个时间点均高于正常组,肠球菌属丰度在添加辅食前1 d和纠正胎龄1岁时高于正常组,嗜黏蛋白阿克曼菌属丰度在添加辅食前1d低于正常组(均P<0.05)。结论 NDI与非NDI早产儿的肠道菌群组成存在显著差异。该研究丰富了早产儿NDI的肠菌群特征数据,可为早产儿NDI的微生态治疗...