Safety of magnetic resonance imaging in preterm infants

Aim: As we progress in our knowledge of preterm brain injury, cohort studies are focusing in neuroimaging preterm infants in the first days of life. Magnetic resonance (MR) is the most powerful neuroimaging modality and valuable in understanding perinatal brain injury. The main purpose of the study is to evaluate the safety of MR imaging in very low birth weight (VLBW) infants at our hospital settings where the scanner is located at some distance from the neonatal intensive care unit (NICU). Subjects and methods: This is a prospective study of 33 VLBW infants who underwent early MR imaging (MRI), within 10 days after birth and term corrected age MRI. The study period included June to December 2008. Results: A total of 46 MRI were performed on 33 preterm infants. The mean total time the infants stayed in the bore of the magnet was 13.04 min. No incidences occurred during transfer or during the scans, and no significant changes were found in heart rate, oxygen saturation and temperature. Conclusions: At our hospital settings, the process of transport and MR imaging have been proven to be safe and not to disturb any of the variables measured. MRI should not be restricted to centres with neonatal MR system or MR‐compatible incubator, as long as the process is coordinated and supervised by a multidisciplinary team.     

早产儿应用脂肪乳剂的安全性研究

目的评价２０％英脱利匹特（ｉｎｔｒａｌｉｐｉｄ）在早产儿应用中的安全性。方法４６例早产儿随机分为４组：治疗组分别于生后第１天（Ａ组,１１例）和第３天（Ｂ组,１２例）经外周静脉按０１５ｇ／（ｋｇ·ｈ）输入０５～３５ｇ／（ｋｇ·ｄ）脂肪乳剂１周;Ｃ（１１例）、Ｄ（１２例）组（不用脂肪乳剂）分别与Ａ、Ｂ组对照,并于实验前后监测血气、血生化、脂肪酸生化指标和血糖的变化。结果生后第１,３天治疗组和对照组动脉血氧分压、氧饱和度、胆红素、丙氨酸转氨酶、过氧化脂质、６－酮－前列腺素Ｆ１α、血栓素Ｂ２及血糖浓度差异均无显著性意义（Ｐ均＞００５）。结论自生后第１天或第３天即开始经外周静脉按０１５ｇ／（ｋｇ·ｈ）速率,逐渐增加剂量,从第１天０５ｇ／（ｋｇ·ｄ）,每天增加１ｇ／（ｋｇ·ｄ）,至最大量３５ｇ／（ｋｇ·ｄ）,供给早产儿２０％ｉｎｔｒａｌｉｐｉｄ１周是安全的     

早产儿早期应用静脉营养的研究进展

早产儿的营养问题是近年来新生儿科极为关注的问题.对于三大物质(葡萄糖、蛋白质及脂肪)的代谢及利用,早产儿有其自身的特点.经典的静脉营养方案为了避免其对早产儿产生的不良反应,都是循序渐进地给予脂肪乳及氨基酸,但易使早产儿处于营养缺乏状态.近几年的临床研究表明,生后24h内即给予早产儿足量的静脉营养液不仅为早产儿的生长发育提供了良好的能量基础,而且不会使早产儿出现相关并发症.     

早产儿早期应用静脉营养的研究进展

早产儿的营养问题是近年来新生儿科极为关注的问题.对于三大物质(葡萄糖、蛋白质及脂肪)的代谢及利用,早产儿有其自身的特点.经典的静脉营养方案为了避免其对早产儿产生的不良反应,都是循序渐进地给予脂肪乳及氨基酸,但易使早产儿处于营养缺乏状态.近几年的临床研究表明,生后24h内即给予早产儿足量的静脉营养液不仅为早产儿的生长发育...     

Nutrition and early growth of preterm infants

Recent studies have renewed the controversy over what should constitute the best milk for preterm infants. While pooled human breast milk continues to be widely recommended it seems for reasons poorly understood not to allow adequate early post-natal growth. In view of possible programming of later growth and neuropsychological development by early nutritional experiences there is a need to further research the question of what should consitute optimum nutrition for preterm infants. We suggest that modifying or finding natural modifications in human milk rather than further altering cow's milk might provide some of the answers. Particular attention also needs to be given to long-term neurological, anthropometric and psychological assessment to relate functional outcome to early nutritional experiences.     

Cerebrovascular response in small preterm infants during routine nursery gavage feedings

Although gavage feedings are considered a standard of care, they are often accompanied by hemodynamic changes that may have important effects on the cerebral circulation. In 23 premature infants receiving intermittent bolus gavage feeds, changes in cerebral hemodynamics and oxygenation were studied using near-infrared spectroscopy. Orogastric tube insertion resulted in an increased cerebral blood volume in 73% of the infants and in an increase in reduced hemoglobin and in cytochrome AA(3) oxygenase in approximately 66% of the patients. Within 10 min of initiating a gavage feed, cerebral blood volume, oxygenated hemoglobin, reduced hemoglobin, and cytochrome AA(3) oxygenase decreased from baseline in about 60% of the infants. Towards the end of the study, during the postfeeding period, cytochrome AA(3) oxygenase and oxygenated hemoglobin increased in 60%, while reduced hemoglobin decreased in 78% of the infants.     

Eczema and early solid feeding in preterm infants

Aims: To establish whether development of eczema is influenced by feeding practices in preterm infants, while taking account of confounding factors. Methods: Data were assembled from 257 infants born prematurely and studied to 12 months post-term. Logistic regression analysis was performed to establish the association between feeding practices and eczema, allowing for potential confounding factors including the infants'' gender, parental atopic status, social background, and parental smoking habits. Results: For the development of eczema (with or without other symptoms) by 12 months post-term, the introduction of four or more solid foods by or before 17 weeks post-term was a significant risk (odds ratio 3.49). Male infants were at significantly higher risk (odds ratio 1.84). In addition, having non-atopic parents who introduced solid foods before 10 weeks post-term or having at least one atopic parent represented a significant risk scenario (odds ratio 2.94). Conclusions: Early introduction of a diverse range of solid foods may predispose the preterm infant to eczema development by 12 months post-term. Furthermore, non-atopic parents who practice early as opposed to late introduction of solid foods may be exposing preterm infants to a greater risk of eczema by 12 months post-term.     

Influence of early diet on outcome in preterm infants

Despite intensive research in infant nutrition over the past 50 years, uncertainty exists in nearly every major area of practice. A key factor in this uncertainty has been the lack of knowledge on whether diet or nutritional status in early life has a long-term or permanent influence on health, growth or performance. The possibility that early nutrition has long-term consequences in man has been much debated. There have been limited opportunities to perform formal randomized studies on the effect of early nutrition in humans and many studies have been flawed by problems with study design. Infants born preterm are a special group. At the start of our study in 1982, evidence on which to base choice of diet was inconsistent and related only to short-term outcome, and diets available for such babies differed greatly in nutrient content. In this group it was both ethical and practical to conduct a formal, randomized trial of early diet and outcome and the results were clearly needed for management decisions. We have undertaken a long-term prospective outcome study on 926 preterm infants randomly assigned to the diet received in the neonatal period. Surviving children have been followed at 9 months, 18 months and now 7.5-8 years of age. Our findings suggest that human milk may contain factors which promote brain growth or development and also bone mineralization later in childhood. Outcome data from the randomized trials show that a very brief period of dietary manipulation (on average for the first 4 weeks of life) influences later development.     

The early development of head control in preterm infants

This study documents the longitudinal development of head control in 104 infants born at 25-33 weeks gestation. Protective side turning of the head was found to have a developmental sequence of reducing spinal extension. In the 93 infants with normal motor outcome, individual differences in the rate of development correlated with caudo-cephalic muscle development (P less than 0.001, r = 0.5) but not with the length of extra-uterine experience. As a group, the 11 infants with later motor handicap showed a persistence of the early form of movement at 35-39 weeks post-menstrual age, without a significant correlation with the ratio of upper-lower limb muscle development. Head control, supine to sitting, in the infants with normal motor outcome showed variations in the rate of preterm development. The infants born at less than 31 weeks showed significantly higher scores at 33-35 weeks post-menstrual age than those born at 31-33 weeks (P less than 0.01). There was no difference at later ages. The spinal extension movement accompanying protective side turning of the head is age specific to the preterm infant. Individual rates of normal preterm development can be evaluated by longitudinal standardised examination. As a group, the infants with subsequent abnormal motor development showed delay at preterm age but this was not individually significant.     

���� ��������������������� ���������ۺ����ٴ��ȽϷ���

目的 探讨早期、晚期早产儿与足月儿呼吸窘迫综合征(RDS)的发病趋势和临床特征的差异,为临床合理诊治提供依据。方法 2006年1月至2010年12月在郑州大学第三附属医院住院的963例RDS患儿根据胎龄不同分为早期早产儿组(<34周)679例,晚期早产儿组(34～<37周)204例,足月儿组(≥37周)80例,分别对各组患儿的发病率、入院情况、高危因素、临床诊治、预后及并发症进行比较。结果 RDS的发病率逐年增加,均以早期早产儿占多数,晚期早产儿和足月儿RDS比例有增多趋势;RDS患儿男婴超过女婴(P<0.05),且胎龄和体重越大,男婴比例越高;足月儿RDS组产前糖皮质激素使用率明显低于早产儿组;早产儿发生RDS的高危因素主要有胎膜早破、胎盘异常、母亲妊娠高血压疾病,足月儿发生RDS的高危因素主要是择期剖宫产与感染;晚期早产儿与足月儿RDS的临床诊断和应用肺泡表面活性物质(PS)时间均晚于早期早产儿;足月儿RDS应用机械通气比例明显高于早产儿,其临床治愈率高(P<0.05),在死亡率方面与早产儿组无差别;但并发气胸的比例高于早产儿组(P<0.05)。结论 新生儿呼吸窘迫综合征(NRDS)发病率逐年增高,晚期早产儿和足月儿RDS比例有增多趋势;早期、晚期早产儿与足月儿RDS在性别比例、高危因素、起病特点、治疗反应与并发症方面均存在差异,RDS的诊治需要考虑胎龄因素。足月儿RDS多与择期剖宫产、感染有关,发病相对较晚,容易合并气胸,应引起足够重视。     

Eczema and early solid feeding in preterm infants.

AIMS: To establish whether development of eczema is influenced by feeding practices in preterm infants, while taking account of confounding factors. METHODS: Data were assembled from 257 infants born prematurely and studied to 12 months post-term. Logistic regression analysis was performed to establish the association between feeding practices and eczema, allowing for potential confounding factors including the infants' gender, parental atopic status, social background, and parental smoking habits. RESULTS: For the development of eczema (with or without other symptoms) by 12 months post-term, the introduction of four or more solid foods by or before 17 weeks post-term was a significant risk (odds ratio 3.49). Male infants were at significantly higher risk (odds ratio 1.84). In addition, having non-atopic parents who introduced solid foods before 10 weeks post-term or having at least one atopic parent represented a significant risk scenario (odds ratio 2.94). CONCLUSIONS: Early introduction of a diverse range of solid foods may predispose the preterm infant to eczema development by 12 months post-term. Furthermore, non-atopic parents who practice early as opposed to late introduction of solid foods may be exposing preterm infants to a greater risk of eczema by 12 months post-term.     

Parenting stress in mothers of preterm infants during early infancy

Objective

Mothers of preterm infants during the first year of life may experience stresses greater that those found in mothers of term infants. The aim of the study was to determine the levels of parenting stress and psychological well-being in mothers of very preterm babies in comparison to a control group of term mothers.

Methods

One hundred and five mothers who delivered 124 babies at ≤ 30 weeks gestation were recruited together with 105 mothers who delivered 120 babies at term. At 4 months of age (corrected for prematurity for the preterm babies), the mothers completed the Parenting Stress Index Short Form, the Edinburgh Postnatal Depression Scale (EPDS), the Dyadic Adjustment Scale (DAS) and the Short Temperament Scale for Infants (STSI). The preterm and term groups were compared.

Results

Questionnaires were returned from 86 of the preterm mothers and 97 of the term mothers. The mean Total Stress score for the preterm and term groups was 67.0 and 63.79 respectively (P = 0.32) with 17% of the preterm and 9% of the term group having high scores (P = 0.135). There were no differences of the EPDS and the DAS between the groups. The temperament of the preterm infants was similar to the term infants. For both groups, scores on the EPDS, DAS and the STSI were independent predictors of Total Stress scores on multiple regression analysis.

Conclusion

Parenting stress in mothers of preterm infants during early infancy does not appear to be greater than that in mothers of infants born at term. For both groups of mothers, depression symptoms, marital satisfaction and infant temperament were independent risk factors for high levels of parenting stress.     

The early feeding skills assessment for preterm infants

Preterm infants develop the skills necessary to begin oral feeding as their health stabilizes and as they reach a postconceptional age that supports coordination of breathing and swallowing with oral-motor functioning. The time from initiation of oral feeding to full oral feedings (with adequate intake for growth and maintenance of physiologic stability) can vary from days to months for the preterm infant. The approach to feeding the infant during this transition period must be developmentally supportive and tailored to meet the needs of the individual. To accomplish this, caregivers--notably nurses and parents--need to communicate about the specific skills that the infant has gained, about skills that are emerging, and about skills that the infant has not yet developed. The Early Feeding Skills (EFS) Assessment is a checklist for assessing infant readiness for and tolerance of feeding and for profiling the infant's developmental stage regarding specific feeding skills: the abilities to remain engaged in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. This article introduces the EFS.