Ursodeoxycholic acid prevention on cholestasis associated with total parenteral nutrition in preterm infants:a randomized trial

Background Preterm infants with long-term parenteral nutrition(PN)therapy are at risk for cholestasis associated with total parenteral nutrition(PNAC).This study examined the safety and efficacy of ursodeoxycholic acid(UDCA)in preventing PNAC in preterm infants.Our research aimed to investigate the prophylactic effect of preventive oral UDCA on PNAC in preterm infants.Methods We compared oral administration of UDCA prophylaxis with no prophylaxis in a randomized,open-label,proof-of-concept trial in preterm neonates with PN therapy.The low-birth-weight preterm infants(<1800 g)who were registered to the neonatal intensive care unit(NICU)within 24 hours after birth were randomized.The main endpoint was the weekly values of direct bilirubin(DB)of neonates during the NICU stay.Results Eventually,a total of 102 preterm neonates from January 2021 to July 2021 were enrolled in this prospective study(42 in the UDCA group and 60 in the control group).Notably,the peak serum level of DB[13.0(12-16)vs.15.2(12.5-19.6)μmol/L,P<0.05]was significantly lower in the UDCA group than that in the control group without prevention.The peak serum level of total bilirubin(101.1±34 vs.116.5±28.7μmol/L,P<0.05)was also significantly lower in the UDCA group than in the control group.Furthermore,the proportion of patients who suffered from neonatal cholestasis(0.0%vs.11.7%,P<0.05)in the UDCA group was significantly lower.Conclusion UDCA prophylaxis is beneficial in preventing PNAC in NICU infants receiving prolonged PN.     

影响早产儿20项行为神经评分的危险因素分析

Objective To analyze the characteristic of twenty-item premature behavioral neurological assessment,and to assess the risk factors of neonatal behavioral neurological assessment(NBNA) in premature infants. Methods Total two hundred and seventy-four premature infants hospitalized in Guangzhou Children's Hospital were assessed with the NBNA after correcting age 40 weeks,premature infants were divided into two groups:normal group (n =221 ) and abnormal group (n =53) according to NBNA. The birth history, mother pregnancy situation, the disease during neonatal period and results in hospital were reviewed,and the risk factors of NBNA in premature infants were assessed. Results There were significant differences in gestational age, birth weight, head circumference, body height, Apgar score, resuscitation time, hospitalization time and total gastrointestinal nutrition time between the two groups( P ＜ 0. 05 ). The incidences of superfoetation,hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease were different between the two groups( P ＜ 0. 05 ). There were no differences in gender, antenatal hormone use, anaemia, hypotension and evoked potential abnormality (P ＞0. 05 ). Multivariate logistic regression analysis showed that the risk factors of NBNA score in premature infants would include low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease. Conclusion Although the premature infants corrected age 40 weeks,but the capability and initiative muscular tension are still lower than term infant. Low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury ,severe infection ,hyperbilirubinemia,hypoglycemia and chronic lung disease are important risk factors related to premature behavioral neurological assessment.     

Influencing factors for the development and severity of bronchopulmonary dysplasia in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g北大核心CSCD

Objective To study the influencing factors for the development and severity of bronchopulmonary dysplasia (BPD) in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g. Methods A retrospective analysis was performed on the medical data of preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g who were admitted to Women and Children's Hospital Affiliated to Xiamen University from January 1, 2017 to December 31, 2021. According to oxygen dependence on day 28 after birth, they were divided into two groups: BPD (n=218) and non-BPD (n=142). According to disease severity based on oxygen concentration required at the corrected age of 36 weeks or at discharge, the infants with BPD were divided into two groups: mild BPD (n=154) and moderate/severe BPD (n=64). Indices such as perinatal data and nutritional status were compared between groups. The multivariate logistic regression analysis was used to determine the influencing factors for BPD and its severity. Results The incidence rate and severity of BPD increased with the reduction in gestational age and birth weight (P<0.05). The multivariate logistic regression analysis showed that a long duration of invasive mechanical ventilation (OR=1.320, P <0.05), hemodynamically significant patent ductus arteriosus (OR=2.032, P<0.05), and a prolonged time to reach oral calorie goal of 110 kcal/(kg·d) (OR=1.041, P<0.05) were risk factors for BPD, while an older gestational age was a protective factor against BPD (OR=0.535, P<0.05). Early-onset sepsis (OR=2.524, P<0.05) and a prolonged time to reach oral calorie goal of 110 kcal/(kg·d) (OR=1.029, P<0.05) were risk factors for moderate/severe BPD, while a high mean weight growth velocity was a protective factor against moderate/severe BPD (OR=0.906, P<0.05). Conclusions The incidence rate and severity of BPD in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g can be reduced by shortening the duration of invasive mechanical ventilation, giving early treatment of early-onset sepsis and hemodynamically significant patent ductus arteriosus, adopting active enteral nutritional strategies, and increasing mean weight growth velocity. © 2022 Xiangya Hospital of CSU. All rights reserved.     

Clinical characteristics and risk factors for early-onset necrotizing enterocolitis in preterm infants with very/extremely low birth weight北大核心CSCD

Objective To investigate the clinical characteristics and risk factors for early-onset necrotizing enterocolitis (NEC) in preterm infants with very/extremely low birth weight (VLBW/ELBW). Methods A retrospective analysis was performed on the medical data of 194 VLBW/ELBW preterm infants with NEC who were admitted to Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. These infants were divided into early-onset group (onset in the first two weeks of life; n=62) and late-onset group (onset two weeks after birth; n=132) based on their onset time. The two groups were compared in terms of perinatal conditions, clinical characteristics, laboratory examination results, and clinical outcomes. Sixty-two non-NEC infants with similar gestational age and birth weight who were hospitalized at the same period as these NEC preterm infants were selected as the control group. The risk factors for the development of early-onset NEC were identified using multivariate logistic regression analysis. Results Compared with the late-onset group, the early-onset group had significantly higher proportions of infants with 1-minute Apgar score ≤3, stage III NEC, surgical intervention, grade ≥3 intraventricular hemorrhage, apnea, and fever or hypothermia (P<0.05). The multivariate logistic regression analysis showed that feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, and hemodynamically significant patent ductus arteriosus were independent risk factors for the development of early-onset NEC in VLBW/ELBW preterm infants (P<0.05). Conclusions VLBW/ELBW preterm infants with early-onset NEC have more severe conditions compared with those with late-onset NEC. Neonates with feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, or hemodynamically significant patent ductus arteriosus have a higher risk of early-onset NEC. © 2023 Xiangya Hospital of CSU. All rights reserved.     

口服氟康唑在预防早产儿深静脉置管时真菌感染中的临床意义

Objective With the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions. Method This study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions ( alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis. Result Except for the proportion of infants bom via vaginal delivery in the control group (56/118, 47. 5% ) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either.Nine infants developed invasive fungal infection in control group (7. 6% ), while no invasive fungal infection was found in prophylaxis group (0%, P=0.01 ). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8. 5%(10/118) and6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks ( P = 0. 47 and 0. 63 ); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5%(9/106) in prophylaxis group after 4 weeks (P = 0. 62 and 0. 15). Conclusion For infants with PICC insertions and gestational ages at birth ≤32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.     

口服氟康唑在预防早产儿深静脉置管时真菌感染中的临床意义

Objective With the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions. Method This study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions ( alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis. Result Except for the proportion of infants bom via vaginal delivery in the control group (56/118, 47. 5% ) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either.Nine infants developed invasive fungal infection in control group (7. 6% ), while no invasive fungal infection was found in prophylaxis group (0%, P=0.01 ). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8. 5%(10/118) and6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks ( P = 0. 47 and 0. 63 ); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5%(9/106) in prophylaxis group after 4 weeks (P = 0. 62 and 0. 15). Conclusion For infants with PICC insertions and gestational ages at birth ≤32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.     

High-mobility group box-1 and receptor for advanced glycation end products in preterm infants with brain injury

Background:High-mobility group box-1 (HMGB1) protein acts as an important pro-inflammatory mediator,which is capable of activating inflammation and tissue repair.HMGB1 can bind to its receptor such as advanced glycation end products (RAGE).RAGE,in turn,can promote the production of pro-inflammatory cytokines.Soluble RAGE (sRAGE) is a truncated form of the receptor comprising the extracellular domain of RAGE and can inhibit RAGE-activation.The objective of this study was to investigate whether HMGB1 and RAGE are involved in the development of brain injury in preterm infants.Methods:In total,108 infants ≤34 weeks gestation at birth were divided into 3 groups according to cranial altrasound scan:mild brain damage (n=33),severe brain damage (n=8) and no brain damage (n=67).All the placentas were submitted for pathologic evaluation.Histological chorioamnionitis (HCA) was defined as neutrophil infiltration of amniotic membranes,umbilical cord or chorionic plate.Expressions of HMGB1 and RAGE proteins were assessed by immunohistochemical analysis.The concentration of HMGB1 and sRAGE in umbilical cord blood were measured by enzyme-linked immunosorbent assay.Results:The frequency of HCA was 30.12％.HCA was associated with elevated concentrations of HMGB1 and decreased sRAGE in umbilical cord blood.The severe brain injury group demonstrated higher cord blood HMGB1 concentrations (P＜0.001) and lower sRAGE concentrations (P＜0.001) than both other groups.Brain injury in the premature infants was linked to intense staining for HMGB1/RAGE,particularly in inflammatory cells.Conclusions:Changes of cord blood HMGB1 and sRAGE of premature infants had direct relationship with the degree of inflammation and severity of brain damage.Monitoring sRAGE and HMGB1 levels may be helpful to predict intrauterine infection and brain injury in premature infants.     

Epidemiology and region-specific risk factors for low Apgar scores in China:a nationwide study

Background Neonatal asphyxia is a serious public health issue.This study aimed to determine the epidemiology and region-specific risk factors for low Apgar scores,an important proxy for neonatal asphyxia,in China from 2015 to 2016.Methods The China Labor and Delivery Survey was a multicenter cross-sectional study including 96 hospitals distributed in 24(out of 34)provinces.Logistic regression analysis was performed to examine the risk factors for a low Apgar score(<7).Correspondence analyses were performed among neonates with low Apgar scores to explore the relationship between risk factors and geographical regions.The population attributable risk percentage(PAR%)was calculated for each region-specific risk factor.Results A total of 72,073 live births,including 320 births with low Apgar scores,were used for the analysis,giving a weighted rate of 3.9/1000 live births.There was a substantial difference in the incidence of low Apgar scores by geographic region,from 2.3/1000 live births in East China to 10.9/1000 live births in Northeast China.Maternal and obstetric factors are the major region-specific risk factors.In Southwest China,hypertensive disorders in pregnancy were more important contributors,with PAR% being 74.47%;in North and Northwest China,pre-pregnancy underweight was a more significant factor,with PAR% of 62.92%;in East China,infants born between 0:00 a.m.and 7:59 a.m.were a key factor,with PAR% of 80.44%.Conclusion Strategies based on region-specific risk factors should be considered to reduce the burden of low Apgar scores in China.     

Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units

Background This study aimed to describe length of stay(LOS)to discharge and site variations among very preterm infants(VPIs)admitted to 57 Chinese neonatal intensive care units(NICUs)and to investigate factors associated with LOS for VPIs.Methods This retrospective multicenter cohort study enrolled all infants<32 weeks’gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network,within 7 days after birth in 2019.Exclusion criteria included major congenital anomalies,NICU deaths,discharge against medical advice,transfer to non-participating hospitals,and missing discharge date.Two multivariable linear models were used to estimate the association of infant characteristics and LOS.Results A total of 6580 infants were included in our study.The overall median LOS was 46 days[interquartile range(IQR):35-60],and the median corrected gestational age at discharge was 36 weeks(IQR:35-38).LOS and corrected gestational age at discharge increased with decreasing gestational age.The median corrected gestational age at discharge for infants at 24 weeks,25 weeks,26 weeks,27-28 weeks,and 29-31 weeks were 41 weeks,39 weeks,38 weeks,37 weeks and 36 weeks,respectively.Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals.Conclusions The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents.Large variation of LOS independent of infant characteristics existed,indicating variation of care practices requiring further investigation and quality improvement.     

早产儿视网膜病1082例筛查报告及诊治分析

Objective To explore the early diagnosis and treatment of retinopathy of prematurity (ROP). Methods Totally premature infants with gestational ages of ＜ 34 weeks or a birth-weight ＜ 2 000 gwho were born in our hospital from July, 2004 to June, 2009, received ROP screen that was carried out by ophthalmologists with particular expertise in ROP using binocular indirect ophthalmoscope. The first screening began at 4 to 6 weeks postnatal age or 32 weeks of postconceptional age. The infants with threshold and prethreshold type Ⅰ ROP(severe) were treated with retinal laser photocoagulation. The infants with immature retinal blood vessels or stage 1 ～ 2 ROP or pre-threshold type Ⅱ ROP (mild) were followed up until retinal vessels are seen in zone Ⅲ or it gets to threshold and pre-threshold type Ⅰ ROP level. All clinical data were analyzed retrospectively. Results 1 082 of total 2 295 premature infants (47. 14% ) received ROP screening ia our department during the past5 years. 14. 23% ( 154/1 082) infants were diagnosed as ROP,the mild and severe ROP accounted for 7.94% (86/1 082) and 6. 28% (68/1 082) respectively. Six infants had to be rehospitalized as they developed into severe ROP during follow-up period. Of all the 68 infants with severe ROP,two infants with severe ROP were confirmed to be bilaterally blind because they had intermitted therapy for one year. Sixty-six infants ( 132 eyes) received various treatments. Sixty-three cases were treated with photocoagulation therapy alone. Of the remaining 3 infants with aggressive posterior ROP, two infants were injected intravitreously with antagonist of vascular endothelial growth factor (Avastin) and photocoagulation,One who was found retinal detachment after photocoagulation therapy alone and then treated with vitrectomy,was blind finally. The eyesight of total 65 infants were saved successfully, the success rate of treatment was 98.48% (65/66). During the surveillance period, none of the infants who had received photocoagulation died,but 10 infants died of the deterioration of the original disease before they were able to receive photocoagulation. Conclusion ROP screening is an effective measure to prevent the progression of ROP. Laser photocoagulation is a safe and effective method for the infants with severe ROP. Photocoagulation combined with Avastin can save the sight of the premature infants with aggressive posterior ROP.     

早产儿肠道外营养相关性胆汁淤积的临床研究

目的 探讨早产儿肠外营养相关性胆汁淤积(PNAC)的相关因素及防治措施.方法 对68例进行静脉营养支持14 d以上的早产儿资料进行分析评价,按是否发生PNAC分PNAC组与非PNAC组.结果 早产儿PNAC发生率为14.7%(10/68),PNAC组的胎龄小于非PNAC组,出生体质量恢复时间长于非PNAC组,而PN持续时间、PN热卡摄入量、脂肪乳最大剂量及累计用量、生后2周时静脉非蛋白热卡所占比例(%)大于非PNAC组.结论 PNAC发生与低胎龄、长PN持续时间、PN提供热卡过高、脂肪乳最大剂量和累计用量、静脉营养中非蛋白热卡所占比例过高相关.防治PNAC的措施包括尽早经口喂养及尽早过渡到全胃肠营养;不过分追求高热卡;调整静脉营养配方,使脂肪乳最大剂量尽量不高于3g/kg.非蛋白热卡的比例尽量不超过85%;双岐杆菌微生态调节剂及腺苷蛋氨酸可以防治PNAC;动态监测直接胆红素(DBIL)、总胆汁酸(TBA)可有助于早期发现PNAC .     

谷草转氨酶与血小板比值指数联合总胆汁酸对胎龄<34周早产儿肠外营养相关性胆汁淤积症的预测价值北大核心CSCD

目的探讨谷草转氨酶与血小板比值指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合总胆汁酸(total bile acid,TBA)对胎龄<34周早产儿肠外营养相关性胆汁淤积症(parenteral nutritionassociated cholestasis,PNAC)的预测价值。方法回顾性分析2019年1月—2022年9月在皖南医学院第一附属医院住院期间接受肠外营养(parenteral nutrition,PN)的270例胎龄<34周早产儿的临床资料,包括PNAC 128例和非PNAC 142例。比较两组的临床资料,通过多因素logistic回归分析探讨PNAC发生的预测因素,并采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价APRI、TBA单独及二者联合预测PNAC的价值。结果PNAC组在PN 1、2及3周后的TBA水平均高于非PNAC组(P<0.05);PN 2、3周后PNAC组APRI均高于非PNAC组(P<0.05)。多因素logistic回归分析显示,PN 2周后APRI和TBA升高是早产儿发生PNAC的预测因素(P<0.05)。ROC曲线分析显示,PN 2周后APRI联合TBA预测PNAC发生的灵敏度、特异度及曲线下面积(area under the curve,AUC)分别为0.703、0.803、0.806;APRI联合TBA预测PNAC发生的AUC高于APRI、TBA单独预测的AUC(P<0.05)。结论在PN 2周后,APRI联合TBA对胎龄<34周早产儿PNAC的预测价值较高。     

早产儿胃肠外营养相关性胆汁淤积综合征的危险因素研究

目的：研究早产儿胃肠外营养相关性胆汁淤积综合征（PNAC）的危险因素。方法：回顾性分析2000年1月至2011年10月静脉营养应用超过14 d的244例早产儿的临床资料,通过病例对照研究调查PNAC发生的危险因素。结果：单因素分析发现,PNAC组（n=23）与非PNAC组（n=221）相比,胃肠外营养（PN）总应用时间更长、氨基酸累计用量及脂肪乳累计用量更大、氨基酸每日最高用量及脂肪乳每日最高用量更高、PN应用第14天时的静脉热卡更多、出生体重更小、贫血及新生儿感染发生率更多（P<0.05）。氨基酸累计用量超过PNAC组氨基酸累计用量的非PNAC组早产儿,脂肪乳累计用量大,PN总应用时间长,机械通气使用情况高, 胎龄更小。脂肪乳累计用量超过PNAC组脂肪乳累计用量的非PNAC组早产儿,胎龄更小。PN总应用时间超过PNAC组PN总应用时间的非PNAC组早产儿,胎龄更小。结论：PN总应用时间、氨基酸累计用量、氨基酸每日最高用量、脂肪乳累计用量、脂肪乳每日最高用量、PN应用14天时的静脉热卡、低体重、新生儿感染及贫血为PNAC的危险因素,其他危险因素需进一步探究。     

极低出生体重儿肠外营养相关性胆汁淤积高危因素分析

目的：胆汁淤积是婴儿肠外营养最常见的并发症,本研究旨在调查极低出生体重儿长期肠外营养相关性胆汁淤积的高危因素。方法：回顾性分析2006年8月至2011年12月在重症监护室住院且肠外营养时间大于2周的极低出生体重儿204例,使用营养液前后定期检测肝功能,发生胆汁淤积的观察组和未发生胆汁淤积的对照组进行单因素及多因素分析。结果：204例极低出生体重儿发生胆汁淤积46例（22.5%）;单因素分析显示经鼻持续正压通气（CPAP）、呼吸衰竭、呼吸窘迫综合征、支气管肺发育不良及早产儿视网膜病在观察组的比例明显高于对照组;另外,与对照组相比,观察组出生体重低、吸氧时间长、第一次开奶时间晚、禁食时间长、肠外营养持续时间长、总氨基酸和总脂肪的摄入量高。Logistic回归分析显示禁食时间（OR:1.115,95%CI： 1.031~1.207）是胆汁淤积的高危因素。结论：胆汁淤积的发生是多因素的,危重儿尽早开展肠内营养,减少肠外营养时间,降低胆汁淤积的发生。     

早产儿肠外营养相关性胆汁淤积防治进展

肠外营养相关性胆汁淤积(PNAC)是早产儿肠外营养(PN)治疗过程中最常见的并发症,其病因及发病机制尚不明确.该文总结了近年来国内外有关早产儿PNAC的研究报道,提出了避免早产、合理喂养、优化PN方案等多种预防措施.熊去氧胆酸是目前治疗PNAC的一线药物.     

早期应用氨基酸对极低出生体重儿胃肠外营养相关性胆汁淤积的影响

目的探讨胃肠外营养（PN）中的主要成分对极低出生体重儿胃肠外营养相关性胆汁淤积（PNAC）的影响。方法 对本中心2004—2008年使用14天以上PN极低出生体重儿中的PNAC病例和配对非PNAC病例资料进行回顾性分析（两组在出生体重、胎龄、窒息程度和PN持续时间方面相匹配）,比较两组发生PNAC相关因素的差异。结果 PNAC组（12例）在PN应用的1周和2周内平均每日氨基酸摄入量明显高于非PNAC组（24例）,分别为（2.5±0.5）g/kg和（2.1±0.4）g/kg（P=0.012）、（2.6±0.4）g/kg和（2.2±0.3）g/kg（P=0.004）,PN应用期间两组平均每日氨基酸摄入量分别为（2.3±0.3）g/kg和（2.0±0.4）g/kg,差异无统计学意义（P〉0.05）;两组在PN应用期间每日平均脂肪和葡萄糖的摄入量差异无统计学意义（P均〉0.05）。结论 极低出生体重儿PNAC的发生可能与应用PN前2周内摄入较高剂量的氨基酸有关,因此有必要进行随机双盲对照试验进一步研究。     

早产儿胃肠外营养相关性胆汁淤积症临床研究

目的 探讨生后早期使用静脉营养的早产儿胆汁淤积症的临床特点,分析胃肠外营养相关性胆汁淤积症(parenteral nutrition associated cholestasis,PNAC)的相关因素及防治措施.方法 回顾性分析2011年1月至2016年4月出生并在盛京医院住院治疗的早产儿,生后均早期使用静脉营养2周,后出现胆汁淤积,共89例,分为两组,PNAC组即符合PNAC诊断(未发现其他导致胆汁淤积原因)41例,多病因组(除胃肠外营养因素还有其他病因)48例.通过病例对照研究分析其临床特点.结果 早产儿胆汁淤积症的男女比例为2.18:1,平均胎龄(31.05 ±2.15)周,平均出生体重(1360.55±421.14)g,静脉营养平均使用时间为(26.22±9.78)d.PNAC组根据丙氨酸氨基转移酶是否升高又分为肝炎组与非肝炎组,两组在胎龄、静脉营养开始时间、生后黄疸出现时间、开奶时间、氨基酸起始剂量及脂肪乳最大剂量方面的差异均有统计学意义,(P＜0.05);根据胃肠外营养时间分为长期组(≥20d)与短期组(＜20 d),长期组的谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素及胆汁酸水平均高于短期组,但P均≥0.05.多病因组患儿多合并感染,依次为细菌感染(75.0％)、真菌感染(20.83％)、巨细胞病毒感染(8.33％)和梅毒感染(2.08％)等.PNAC组和多病因组其他并发疾病的发生率差异无统计学意义.在预后方面,两组患儿经过保肝治疗后肝功能均较前明显好转,PNAC组的各项指标较多病因组降低更为显著(P＜0.05).结论 PNAC是早产儿胆汁淤积症发生的主要因素,PNAC早产儿肝损伤程度与胃肠外营养开始时间、使用时间、肠内喂养时间、氨基酸起始剂量及脂肪乳最大剂量有关.经保肝对症治疗后肝功能可以明显恢复,且效果优于多病因所致的胆汁淤积症.     

极低出生体质量儿肠外营养相关性胆汁淤积危险因素的临床分析

目的 回顾分析极低出生体质量儿(VLBWI)肠外营养相关性胆汁淤积(PNAC)的发病率和危险因素.方法 对2006年1月-2008年12月在南京儿童医院NICU接受肠外营养(PN)支持超过14 d的64例VLBWI的临床资料进行回顾分析,了解PNAC的发病率;并按PNAC的有无进行分组,对2组的临床资料进行分析比较,并应用Logistic回归模型分析PNAC的危险因素.结果 64例VLBWI中10例发生PNAC,发生率15.63%.PNAC组胎龄为(31.54±2.67 )周,体质量增长(12.14±8.44) g·d-1,均小于无PNAC组患儿[(33.30±2.01)周,(17.66±4.36) g·d-1](Pa=0.003).PNAC组患儿住院天数(50.30±32.15) d、PN持续时间(35.00±12.12) d、全静脉营养时间(9.44±8.52) d、氨基酸累计用量(57.62±25.25) g·kg-1、脂肪乳累计用量(55.23±30.60) g·kg-1,均高于无PNAC组.PNAC组先天性心脏病的发病率为30.00%,高于非PNAC组的5.56%,差异有统计学意义(P=0.044).2组患儿的性别、日龄、出生体质量、PN开始日龄、氨基酸和脂肪乳日用量及感染、窒息、颅内出血、机械通气、坏死性小肠结肠炎的发生率比较差异均无统计学意义.Logistic回归分析示:PN持续时间(OR=0.87,95%CI 0.79~0.96,P=0.005)和合并先天性心脏病(OR=39.44,95%CI 2.18~714.24,P=0.013)是PNAC的危险因素.结论 胎龄越小,全静脉营养时间越长、PN持续时间越长,越易发生PNAC.合并先天性心脏病的患儿使用静脉营养时更易发生PNAC.尽早肠内喂养,缩短PN时间,是降低PNAC的重要措施.     

新生儿肠道外营养相关性胆汁淤积的危险因素

肠道外营养（PN）是危重新生儿救治的重要支持、治疗手段,肠道外营养相关性胆汁淤积（PNAC）是其常见合并症。该文从非PN 营养成分及PN 营养成分相关角度综述新生儿PNAC 的危险因素。PNAC 危险因素主要包括早产、小于胎龄、延长的PN、疾病（主要是新生儿败血症及坏死性小肠结肠炎）、延迟喂养或低肠道内营养比例、持续PN 输注,以及氨基酸、脂肪乳种类/用量、能量供给量及部分微量元素含量等。     

胃肠外营养早产儿血清总胆汁酸变化的意义

目的 探讨胃肠外营养(PN)早产儿血清总胆汁酸(TBA)的变化及其与胆汁淤积症的关系.方法 对本院2008-2010年68例应用PN支持治疗2周以上的早产儿(男35例,女33例;胎龄28～36周)进行血清TBA水平检测,比较应用PN前后血清TBA水平的变化,并依据血清TBA水平(TBA<15 μmol·L-1或≥15 μmol·L-1)分为2组[TBA<15 μmol·L-1者30例,TBA≥15 μmol·L-1者38例],比较2组出生2个月时胆汁淤积症的发生率.采用SPSS 13.0软件进行统计学分析.结果 早产儿在PN 2周后的血清TBA水平为(20.17±6.58) μmol·L-1,与PN前[(11.77±1.90) μmol·L-1]比较,差异有统计学意义(t=2.91,P<0.01).当PN 2周后血清TBA水平≥15 μmol·L-1组胆汁淤积症的发生率较TBA<15 μmol·L-1组高(21.05% vs 3.33%,χ2=4.58,P<0.05).结论 血清TBA可作为早产儿PN时胆汁淤积症的早期监测指标.