Antenatal steroid administration is associated with an improved chance of intact survival in preterm infants

Antenatal steroid administration reduces mortality in preterm infants. We used logistic regression analysis to explore the influence of various factors on intact survival in a population of 798 very low birth weight infants admitted between 1985 and 1992. Antenatal steroid administration (n=87) was associated with an improved chance of normal survival with an odds ratio of 3.0 (95% confidence intervals from 1.5 to 5.9). Other factors associated with improved outcome were a normal cranial ultrasound image or one showing subependymal haemorrhage, female sec, a 5 min Apgar score above 5, low inspired oxygen concentration and higher birth weight. Year of birth was not associated with a consistent trend to improved outcome over this period and surfactant administration rates were constant throughout. These results endorse the current recommendation to increase the use of antenatal steroid therapy.     

Inflammation at birth is associated with subnormal development in very preterm infants

Preterm birth carries a risk for impaired developmental outcome. We have previously described an association between increased levels of proinflammatory cytokines during the first 72 postnatal hours and cerebral damage as detected by ultrasound in a cohort of 74 very preterm infants. Sixty-seven of 71 surviving children with a mean gestational age of 27.1 (2.0) wk were examined at 2 y corrected age with a standardized neurologic examination and with Bayley Scales of Infant Development. We hypothesized that proinflammatory cytokine concentrations at or shortly after birth would be associated with an adverse developmental outcome. Increased concentrations of TNF-alpha in cord blood odds ratio (95% confidence interval) 3.3 (1.1-10.2), p = 0.013 and at 6 h 7.8 (0.9-71.8), p = 0.015 and of IL-6 in cord blood 1.7 (1.0-2.9), p = 0.048 were associated with psychomotor developmental index <85. Increased concentrations of TNF-alpha in cord blood odds ratio (95% confidence interval) 3.6 (1.002-12.8), p = 0.044 and of IL-8 in cord blood 3.5 (1.2-10.6), p = 0.023 were associated with cerebral palsy. Associations of TNF-alpha and IL-8 in cord blood with the respective outcome measures remained significant after adjustment for other clinical variables. Proinflammation at birth is associated with impaired functional outcome at 2 y of corrected age in children with very preterm birth.     

Fortified preterm human milk for very low birth weight infants.

We studied the nutritional effects of two types of human milk fortifiers for very low birth weight infants. These studies suggest that fortified human milk provides nutritional advantages for very low birth weight infants. However, providing calcium and phosphorus with supplementation is necessary for the improvement of bone density.     

采集母乳与母乳库母乳喂养对早产儿生长发育的影响

采集母乳与母乳库母乳可以作为早产儿在无法获得直接母乳喂养时可选择的一种喂养方式.目前文献提示,单纯以采集母乳与母乳库母乳喂养的早产儿生后短期内生长要慢于早产儿配方乳喂养,对早产儿远期生长的影响尚不明确;但采集母乳与母乳库母乳喂养可供给早产儿一定量的人乳特有成分,有利于早产儿神经发育,并减少坏死性小肠结肠炎、喂养不耐受等喂养相关并发症的发生.采集母乳与母乳库母乳的临床广泛应用还面临一些亟待解决的问题,将来的研究应更多关注于对早产儿远期生长发育的影响.     

极/超早产儿的生存现状和呼吸管理进展

极/超早产儿由于肺发育不成熟,病死率和支气管肺发育不良的发生率较高,呼吸管理和患儿的生存率及生存质量密切相关.合理的产前皮质激素促肺成熟、肺表面活性物质(pulmonary surfactant,PS)的应用和机械通气策略有助于改善极/超早产儿的预后.采用无创技术进行呼吸支持,特别是生后立即给予持续气道正压通气而后根据病情选择性给予PS作为预防性给予PS的替代呼吸支持策略已受到普遍推荐.新的机械通气策略与模式如高频振荡通气、神经调节辅助呼吸和目标容量通气是否具有更大的优势仍需要进一步的研究证实.     

Factors associated with successful establishment of breastfeeding in very preterm infants

Aim: To describe feeding practices at hospital discharge in relation to characteristics of the very preterm infants (VPI) and their mothers. Methods: Design. Prospective hospital‐based registration of very preterm infants born with a gestational age ≤32 weeks in Denmark during 2004–2008. Subjects. Healthy mothers and VPI without diseases causing eating disabilities at discharge. Results: A total of 478 VPI were registered. At discharge, 60% were exclusively breastfed, 35% were exclusively bottlefed, and 5% were both breast‐ and bottle‐fed. Mothers of high social class (p = 0.000) and ‘not smoking’ (p = 0.003) were significantly more often breastfeeding their preterm infant(s) at discharge. Single births infants tended more often to be breastfed (p = 0.09). Infant age at discharge and duration of hospitalization did not influence breastfeeding at discharge. Increase in weight z‐score from birth to discharge was largest in the bottlefeeding‐group compared with the breastfeeding‐group (p = 0.000) probably as a result of feeding practice the last week(s) of hospitalization. Conclusion: Breastfeeding can successfully be established in very preterm infants. Mothers of low social classes, smokers, multiple birth and very preterm infants with low weight for age may need extra attention in breastfeeding establishing policies.     

Neonatal hypercalcemia in preterm infants fed with human milk

Hypercalcemia (serum Ca greater than or equal to 2.83 mmol/l) was detected in 10 premature infants (gestational age: 31-37 weeks and birthweight: 1100-1950 g). All were fed with pooled human breast milk. Urinary Ca excretion was high (greater than 0.200 mmol/kg/24 h) in all but one infant while serum phosphorus (P) concentration and urinary P excretion were low. Serum immunoreactive parathyroid hormone and plasma 25-hydroxyvitamin-D concentrations were normal. A significant positive correlation was found between serum Ca concentration and urinary Ca excretion, and a negative correlation between serum Ca concentration and serum P concentration or urinary P excretion. Hypercalcemia disappeared spontaneously in two patients, was corrected by a humanized milk in three patients and by P supplementation in five patients. These data suggest that neonatal hypercalcemia is related to P depletion induced by human breast milk in premature infants.     

Transient hypothyroxinaemia associated with developmental delay in very preterm infants.

In 563 surviving very preterm (less than 32 weeks gestational age) and/or very low birthweight (less than 1500 g) infants the relationship between neonatal thyroxine concentration and psychomotor development at 2 years of age (corrected for preterm birth) was studied. A significant association was found between low neonatal thyroxine concentration and a negative score on the three milestones of development. These findings do not support the view that transient hypothyroxinaemia in preterm infants is harmless.     

Improved growth of preterm infants receiving mother's own raw milk compared with pasteurized donor milk

Aim: To determine whether growth, feeding tolerance and infectious events of preterm infants is related to the proportion of intake of mother’s own raw milk (maternal milk) versus pooled pasteurized banked breast milk (donor milk). Methods: This is a prospective observational study of 55 premature infants born less than 32 weeks of gestational age admitted to the neonatal intensive care unit at the Children’s Hospital of Toulouse during two 6‐month periods from 2003 to 2005. Enrolled infants were exclusively on enteral feeds with maternal milk ± donor milk. Results: Mean gestational age was 28.6 weeks (SD 1.5) and mean birth weight 1105 grams (SD 282). During the time of exclusively breast milk feeds, weight gain (g/kg/day) was correlated to the proportion of maternal milk consumed (p = 0.0048, r = 0.4). Necrotizing enterocolitis was inversely correlated to the amount of maternal milk. The amount of maternal milk did not impact on infectious events. Conclusion: Mother’s own raw milk improves weight gain compared with donor milk in preterm infants. Lactation strategies should be sought that helps mothers to increase their milk production.     

Serial serum 25-hydroxyvitamin D and mineral homeostasis in very premature infants fed preterm human milk

Fourteen very low birthweight infants (mean +/- SD 1,070 +/- 180 g and 29.3 +/- 1.9 weeks gestation) fed their own mother's milk were clinically followed until 3-4 months of age with frequent measurements of serum calcium, phosphorus, magnesium, 25-hydroxyvitamin D (25-OHD), parathyroid hormone, alkaline phosphatase, and albumin, and urine calcium, phosphorus, and magnesium. These infants were matched for birthweight and gestation with 14 infants (1,075 +/- 152 g and 29.0 +/- 1.7 weeks) who had been similarly followed during concomitant studies of infants fed standard formula (Similac 20 cal/oz). Urine phosphorus was markedly lower in the breast milk-fed group from initiation of feedings, and serum phosphorus became significantly lower at and after 6 weeks of age. The fall in serum phosphorus was accompanied by a marked calciuria. Parathyroid hormone was suppressed in the breast milk-fed group, although serum calcium was not elevated and did not differ from formula-fed infants. A high incidence of moderate-severe hypomineralization on radiographs was seen in both breast milk- and formula-fed groups. Six of 14 breast-fed infants required phosphorus supplementation at 8-10 weeks of age because of significant hypophosphatemia, hypercalciuria, and hypomineralization. These infants differed from those not requiring phosphorus supplements by being smaller at birth but not of lower gestation, and having persistently low serum 25-OHD at and after 6 weeks of age.     

早产儿母乳喂养强化方法的探讨

目的通过回顾性队列研究评价早产儿母乳喂养强化时机对早产儿住院期间生长的影响,探讨早产儿母乳喂养强化的最佳时机和进程。方法选择2009年11月至2011年3月在4家三甲医院新生儿重症监护病房住院治疗、住院期间母乳喂养量大于总喂养量50％并应用母乳强化剂的早产儿为研究对象。根据开始添加母乳强化剂的时间分为早强化组[奶量〈90ml／（kg·d）即开始强化]和晚强化纽[奶量≥90ml／（kg·d）开始强化],再根据从开始添加母乳强化剂至足量强化的时间分为快强化组（1～3天完成足量强化）和慢强化组（≥4天完成足量强化）。对不同组间早产儿的合并症、肠内营养情况及生长情况进行比较。结果符合入选标准的早产儿共67例。早强化组32例,晚强化组35例,两组基本情况、坏死性小肠结肠炎（NEC）等合并症发生率、住院期间体重增长速率差异均无统计学意义（P〉0．05）。早强化组出院时小于胎龄儿（SGA）比例与出生时比较差异无统计学意义（P〉0．05）,晚强化组出院时SGA比例较出生时增多（72．7％比42．9％,P=0．013）。快强化组41例,慢强化组26例,两组基本情况、NEC等合并症发生率差异无统计学意义（P〉0．05）。快强化组住院时间更短[（34．0±15．6）天比（43．0-4-13．6）天,P=0．02],住院期间体重增长速率更快[（18．3±5．3）g／（kg·d）vs（15．7±3．7）g／（kg·d）,P=0．03]。快强化组出院时SGA比例与出生时比较差异无统计学意义（P〉0．05）,慢强化组出院时SGA比例较出生时更多（65．4％比30．8％,P=0．012）。结论早产儿母乳喂养晚强化或慢强化均加剧宫外生长迟缓,早强化或快强化对早产儿是安全的。建议在早产儿母乳喂养量达90ml／（kg·d）之前开始添加母乳强化剂;足量强化应尽量在3天内完成。     

捐献母乳喂养对极低出生体重儿院内感染发生的影响

目的 探讨捐献母乳在预防极低出生体重儿院内感染中的作用。方法 将105例极低出生体重住院早产儿纳入研究,根据其所接受的喂养方式分为亲母母乳、捐献母乳、早产儿配方奶喂养组,每组各35例。比较3组院内感染发生率、坏死性小肠结肠炎发生率、喂养不耐受发生率以及达到全肠道喂养时间、早期生长指标。结果 与配方奶组比较,捐献母乳组和亲母母乳组患儿院内感染及坏死性小肠结肠发生率明显降低,且捐献母乳组和亲母母乳组达到全肠道喂养的时间短于配方奶组,差异均有统计学意义（P < 0.05）。3组患儿头围、身长、体重增长速率比较差异无统计学意义。结论 极低出生体重儿在亲母母乳不足时可以采用捐献母乳替代喂养,有助于降低院内感染的发生。