超低和极低出生体重儿神经发育结局及影响因素分析

目的 评估超低/极低出生体重儿 （ELBWI和VLBWI） 在纠正年龄 （CA） 18月时神经发育结局,探讨影响神经发育结局的因素。方法 收集2013年1月至2014年6月入住新生儿重症监护病房并存活出院的ELBWI和VLBWI病例,在CA40周、1、3、6、12、18月定期随访,评估神经发育结局。按神经发育状况分为神经发育正常组和神经发育异常组,比较两组临床资料的差异,分析ELBWI和VLBWI神经发育的危险因素。结果 共338例ELBWI和VLBWI纳入研究,15例在住院期间死亡。CA18月时,145例 （44.9%） 存活且随访资料完整,75例 （23.2%） 死亡,失访103例 （31.9%）。CA18月时,145例患儿中神经发育损伤71例 （49.0%）,3例 （2.1%） 脑性瘫痪;未发现单眼或双眼失明的视觉损伤及需要助听器的听觉损伤。Logistic回归分析发现BPD和败血症是ELBWI和VLBWI神经发育异常的独立危险因素 （OR=3.530,P < 0.001;OR=2.528,P=0.035）,BPD发生程度越重,神经发育异常的发生率越高。结论 败血症、BPD （尤其是重度BPD） 是ELBWI和VLBWI神经发育异常的危险因素。     

超低出生体重儿的护理方案

超低出生体重儿由于各系统发育极不成熟,临床上病死率很高.提高超低出生体重儿的存活率离不开科学的护理,本文从体温管理、建立静脉、动脉通路、液体疗法护理、呼吸道管理、喂养护理、感染的预防、环境管理、健康教育等方面阐述关于超低出生体重儿的护理方案.     

极低及超低出生体重儿的预后因素分析

目的 分析极低及超低出生体重儿（出生体重≤ 1 200 g）的临床资料,为其预后及临床干预提供预警指标。方法 回顾性分析108 例极低及超低出生体重儿的母孕期病史、新生儿出生时情况、诊治经过及预后,采用非条件logistic 回归分析筛选预后的影响因素。结果 108 例极低及超低出生体重儿,出生体重范围在结论 极低及超低出生体重儿的病死率较高,且随着日龄的增加,影响早产儿生存的预后因素不同,临床上应针对这些因素制定合理的管理方案,提高早产儿生存率。     

超低出生体重儿的营养管理

超低出生体重儿是NICU中最具风险的一组早产儿,除了必要的生命支持技术以外,营养管理成为直接影响到其生存和预后的关键因素.本文从超低出生体重儿的营养需求、肠内外营养和出院后喂养几个方面阐述了其营养管理的特点.超低出生体重儿营养支持的理想目标是使其生长速率及与之相关的功能发育和体重增长的成分接近正常胎儿.     

超低出生体重儿的心血管支持治疗

早产儿循环系统在出生时发育不成熟,常发生早产儿低血压和动脉导管未闭,其处理方法不同,常会影响患儿存活率和预后.扩容药物、血管活性药物、环氧化酶抑制剂以及肾上腺皮质激素等是较常用的药物,但对超低出生体重儿发生的心血管系统问题何时需要处理和如何处理一直困扰着临床医生.     

超低出生体重儿的呼吸支持策略

随着科学知识及技术进步,超低出生体重儿生存率显著提高.这些新生儿出生后常需呼吸支持,合理的肺保护通气策略有助于减轻肺损伤、降低支气管肺发育不良的发生率.呼吸支持形式取决于生后状况,重要的是如何正确应用机械通气,达到理想的气体交换,避免通气损伤.无创性呼吸支持作为出生时最初的干预措施及其在向气管插管或机械通气治疗转变过程中的应用具有较高的研究价值.     

母乳喂养质量改进对极低和超低出生体重儿亲母母乳喂养率的影响

目的 探讨NICU 中母乳喂养质量改进措施对极低和超低出生体重儿亲母母乳喂养率的影响。方法 回顾性调查收集2014 年7 月至2015 年7 月收治的极低和超低出生体重儿（质量改进前组）以及实施母乳质量改进措施后的2015 年8 月至2016 年6 月的极低和超低出生体重儿（质量改进后组）资料。对两组患儿住院期间亲母母乳喂养情况（喂养率、喂养量、喂养时间）、静脉营养持续时间、达到全肠道喂养的时间,喂养不耐受发生率等指标进行比较。结果 实施质量改进后,亲母母乳喂养率和喂养量均明显增高,母乳强化剂添加时间、静脉营养时间、达全肠道喂养时间均较改进前提前,喂养不耐受的发生率较改进前有所改善,差异有统计学意义。结论 亲母母乳喂养质量改进措施可提高NICU 亲母母乳喂养率,改善早产儿消化系统相关并发症。     

103例超未成熟儿及超低出生体重儿转归及影响因素分析

目的 总结超未成熟儿及超低出生体重儿发生的原因、相关影响因素及转归情况.方法 分析内蒙古医科大学附属医院2009年1月至2015年12月NICU收治的符合条件的103例超低出生体重儿及超未成熟儿的临床资料,包括母孕期病史、新生儿出生时情况、诊治经过及预后.结果 103例患儿存活67例,死亡36例,存活率65.0％ (67/103).妊娠高血压综合征、感染、胎膜早破等为发生超未成熟和超低出生体重儿的主要因素,影响两者的转归因素包括胎龄、性别、出生体重、肺出血、支气管肺发育不良、坏死性小肠结肠炎(P＜0.05).长期住院的存活患儿后期易并发贫血.死亡直接原因前4位包括肺出血、呼吸窘迫综合征、新生儿肺炎及坏死性小肠结肠炎.结论 加强高危妊娠监测管理,预防早产,加强NICU超未成熟儿及超低出生体重儿的监护管理,及早发现、及早处理各种并发症,防止医院感染发生,是提高两者存活率,改善生活质量的根本措施.     

Neurodevelopmental outcomes of very low birth weight and extremely low birth weight infants at 18 months of corrected age associated with prenatal risk factors

Background

Very premature infants occasionally have neurodevelopmental disabilities. However, there have been quite limited data on prenatal risk factors associated with their neurodevelopmental outcomes.

Aim

To clarify the relationship between prenatal risk factors and neurodevelopmental outcomes of very premature infants.

Study design

The study design is a retrospective review.

Subjects

One hundred seventy Japanese women with a singleton pregnancy and their infants whose birth weight being less than 1500 g were included. We classified those infants into 118 appropriate for gestational age (AGA) and 52 small for gestational age (SGA) infants.

Outcome measures

Infants' neurodevelopmental outcomes at 18 months of corrected age were evaluated by the Kyoto Scale of Psychological Development 2001 (KSPD). We analyzed and compared the infants' outcomes and prenatal risk factors between two groups.

Results

Mortality and rate of infants unevaluable by KSPD because of severe impairment were not significantly different between those groups. However, the developmental quotient score of the cognitive-adaptive area in SGA infants born between 25 and 31 weeks of gestation was significantly lower than that in AGA infants randomly selected as gestation-matched controls. More advanced gestational age and heavier birth weight protected against adverse neurodevelopmental outcomes in both groups. Moreover, male infants were related to the excess risk of adverse neurodevelopmental outcomes in the SGA group.

Conclusion

In view of the neurodevelopment of the infants, it seems that the most efficient obstetric strategy for improving prognosis of premature infants should be targeted to prolong the pregnancy period as long as the reassuring fetal status and maternal stable health condition are being confirmed.     

超低出生体重儿经幽门喂养的回顾性研究(英文)

目的：反复呼吸暂停和心率减慢是超出生体重儿(ELBWI)特别是有患有慢性肺部疾病的ELBWI的常见问题。胃食道返流是反复呼吸暂停和心动过缓的诱因。本研究的目的是评价持续经幽门喂养对不能耐受胃管喂养的超低出生体重儿的治疗意义,并与间歇经胃管喂养作比较。方法：回顾性分析81例ELBWI的临床资料。分两组：经幽门喂养(TP)组(n=30)及经胃管喂养组(IG组)(n=49)。TP组：比较TP前,与TP期间呼吸暂停及心率减慢的发生情况,喂养耐受性,营养摄入及体重增长速度,并与NG组的患儿做比较。TP组：患儿TP期间与TP前比较,每日呼吸暂停(0.66次vs 1.64次)及心率减慢次数(B1 2.06次 vs 3.32次、B2 1.66次 vs 3.18次)明显减少(P<0.05),未再出现呕吐及腹胀,在摄入蛋白及能量相似的情况下,每日体重增长速度比TP前慢(13.3±2.6 g/kg vs 15.3±3.9g/kg)(P<0.05)。TP组在TP期间与IG组蛋白能量摄入和体重增长速度无显著差异。TP组ELBWI均未发生坏死性小肠结肠炎和肠穿孔。结论：对于不能耐受胃管喂养的超低出生体重儿,经幽门喂养能显著减少呼吸暂停及心率减慢的发生率及改善喂养的耐受性。［中国当代儿科杂志,2004, 6(5): 360-364］     

超低出生体重儿临床诊治的几个问题

本文主要针对超低出生体重儿管理中通常出现的种种问题,包括如何与患儿家属沟通、产儿科间合作、NICU的整体管理、有针对性的专人管理等方面进行讨论,并结合我们这10年中对超低出生体重儿诊疗过程中所积累的经验,如出生时管理、出生后体温、颅内出血的防治、感染的预防和处理、输血的管理、早产儿视网膜病的防治以及出院前及出院后的管理进行概述,以期供临床医生参考.     

极低/超低出生体重儿迟发型败血症发生情况及其危险因素分析

目的探讨新生儿重症监护病房(NICU)极低/超低出生体重儿迟发型败血症(LOS)的发生情况及危险因素。方法收集2011年1月至2013年12月入住NICU的极低或超低出生体重儿的临床资料,根据是否合并LOS分为两组:LOS组和无LOS组。回顾性分析LOS的发生率、病死率、常见病原菌及危险因素。结果纳入的226例极低/超低出生体重儿中,117例(51.8%)发生了LOS,其中45例为确诊LOS,72例为临床诊断LOS。LOS组患儿病死率为13.7%(16/117),明显高于无LOS组(5/109,4.6%),差异有统计学意义(P0.05)。共培养出51株病原菌,其中32株(63%)为革兰阴性细菌,16株(31%)为革兰阳性细菌,3株(6%)为真菌。多因素logistic回归分析显示,胎龄、小于胎龄儿、肠外营养持续时间、经外周静脉穿刺中心静脉置管(PICC)、机械通气是极低/超低出生体重儿LOS发生的独立影响因素(OR分别为:0.84、1.59、1.34、3.11、4.55,均P0.05)。结论极低/超低出生体重儿LOS的发生率及病死率较高。LOS常见病原菌为革兰阴性细菌。胎龄低、肠外营养持续时间长、小于胎龄儿、PICC或机械通气的极低/超低出生体重儿LOS的发生危险可能增加。     

超低出生体重儿胃肠道内喂养24例临床分析

目的 回顾超低出生体重儿(ELBWI)胃肠道内喂养的临床资料,分析影响ELBWI胃肠道内喂养的各种因素.方法 对2000年1月至2010年1月间的24例ELBWI的临床资料进行回顾性分析,根据达到足量胃肠道内喂养的时间分为A组和B组,比较两组之间各项指标的差异.结果 24例ELBWI胎龄为(29.0±1.8)周(26.14～34.43周),出生体重为[(882±67)(730～970)]g,A组11例,达到足量喂养时间为(27±6)d;B组13例,达到足量喂养时间为(46±10)d.生后窒息(18.2%∶61.5%,P=0.047)、脐静脉插管时间长于10 d(18.2%∶61.5%,P=0.047)、机械通气时间长于14 d(27.3%∶76.9%,P=0.038)的比例,以及第21、28天的奶量[(88.9±35.4)ml:(37.4±34.9)ml,P=0.002;(121.1±37.4)ml:(53.2±33.1)ml,P=0.000]在两组间差异有统计学意义.胎龄、出生体重、动脉导管未闭、红细胞增多症、血糖异常、败血症、开奶日龄、开奶量、第1周加奶量、第2周加奶量、第3、7、14天奶量均无统计学差异.结论 窒息、脐静脉插管时间、机械通气时间可能影响ELBWI的胃肠道内喂养,喂养较顺利的ELBWI在生后第3周时即可表现出较好的耐受性.但因ELBWI的胃肠道内喂养可能受到多种因素的影响,在进行喂养时应针对不同情况制定个体化方案.

Abstract：

Objective To review the clinical data of enteral feeding of extremely low birth weight infants (ELBWI), and analyze the influencing factors. Method From Jan. 2000 to Jan. 2010, data of 31 ELBWI from Peking Union Medical College Hospital were retrospectively collected. ELBWI were assigned to different groups according to the time achieving full enteral feeding, comparison was done between two groups for enteral feeding. Result Twenty-four infants were analyzed, their mean gestational age was ( 29. 0 ±1.8) weeks (26. 14-34. 43 weeks), birth weight (882 ±67)g(730-970 g), there were 11 infants in group A, whose time for achieving full enteral feeding was (27 ±6)days, there were 13 infants in group B, whose time achieving full enteral feeding was ( 46 ± 10 ) days. The ratio of asphyxia ( 18.2% vs. 61.5%, P =0. 047 ), duration of umbilical vein catheterization longer than 10 days ( 18. 2% vs. 61.5%, P = 0. 047 ),and duration of mechanical ventilation longer than 14 days(27.3% vs. 76.9% ,P = 0. 038 )in group A was higher than in group B. The milk volume on the 21st and 28th day in group A was much more than that in groupB[(88.9±35.4)mlvs. (37.4±34.9) ml, P=0. 002;(121.1±37.4) ml vs. (53.2±33.1) ml,P =0. 000]. There were no significant differences between the two groups in gestational age, birth weight,patent ductus arterious, erythrocytosis, dysglycemia, sepsis, the time to begin enteral feeding, the beginning milk volume, the adding milk volume in the 1st, 2nd week, and the milk volume on the 3rd, 7th, 14th day.Conclusion Asphyxia, duration of umbilical vein catheterization, and duration of mechanical ventilation are likely to influence the enteral feeding of ELBWI, ELBWI with successful enteral feeding could show good tolerance in the 3rd week. But individual program should be made for enteral feeding of ELBWI, because enteral feeding could be influenced by multiple factors.     

超低出生体重儿救治的国内外近况

近几十年来新生儿医学的快速发展使得超低出生体重儿（ELBWI）病死率和并发症发生率明显下降。然而存活ELBWI发生近远期并发症风险显著增加,包括严重脑室内出血、脑室旁白质软化、院内感染和坏死性小肠结肠炎、支气管肺发育不良、早产儿视网膜病变以及远期神经发育后遗症等。目前国内ELBWI救治水平不断提高,但与国外差距仍较大。本文将近年国内外ELBWI救治存活率、伦理学问题、近远期并发症情况等作一综述。     

Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment

OBJECTIVE: To quantify the effect of grades I-II intraventricular hemorrhage (IVH) on the neurosensory and cognitive outcomes of extremely low birth weight infants. STUDY DESIGN: Of 706 extremely low birth weight infants without major malformations admitted to our center from 1992 to 2000, 537 survived to 20 months' corrected age (CA) and had cranial ultrasound studies performed, of whom 490 (91%) had complete neurodevelopmental assessments. Infants with severe cranial ultrasound abnormalities or meningitis were excluded, leaving a population of 362 infants, 258 of whom had a normal cranial ultrasound and 104 had an isolated grade I-II IVH. The groups had similar birth weight (808 vs 801 grams) and gestational age (26.5 vs 26.3 weeks). Outcomes of infants with normal cranial ultrasound were compared with those with grades I-II IVH at 20 months' CA. Outcomes included the Bayley Scales of Infant Development Mental Developmental Index (MDI) and major neurosensory abnormality. Logistic regression was used to assess the effect of grades I-II IVH on outcomes while adjusting for other risk factors. RESULTS: Extremely low birth weight infants with grades I-II IVH had a significantly lower mean MDI score than infants with normal cranial ultrasound (74 +/- 16 vs 79 +/- 14, P = .006). They had higher rates of MDI <70 (45% vs 25%; OR, 2.00; 95% CI, 1.20 to 3.30; P = .008), major neurologic abnormality (13% vs 5%; OR, 2.60; 95% CI, 1.06 to 6.36; P = .036), and neurodevelopmental impairment (47% vs 28%; OR, 1.83; 95% CI, 1.11 to 3.03; P = .018) at 20 months' CA, even when adjusting for confounding factors. CONCLUSIONS: Extremely low birth weight infants with grades I-II IVH have poorer neurodevelopmental outcomes at 20 months' CA than infants with normal cranial ultrasound. Advanced radiologic imaging may indicate additional brain injury associated with grade I-II IVH, which could explain these outcomes.     

Urinary acidification in extremely low birth weight infants

Premature infants often present metabolic acidosis without protein load in the early neonatal period, around days 4–6. In order to elucidate the cause of acidosis, we investigated urinary acidification of infants in the early neonatal period.

Urine pH, fractional excretion of HCO₃⁻ (FEHCO₃), excretion of HCO₃⁻ and NH₄⁺ of the appropriate-for-date infants were measured on days 0–2 and on days 4–6 of life.

Extremely low birth weight (ELBW) infants showed higher urine pH than more than 1500 g birth weight infants. FEHCO₃ and HCO₃⁻ excretion were of high values in ELBW infants on days 0–2, but decreased on days 4–6. Urine NH₄⁺ excretion rate was lower in ELBW infants than in birth weight more than 1000 g on days 0–2 of life and still remained at a low rate on days 4–6.

These data indicated that insufficiency of NH₄⁺ excretion is the main cause for metabolic acidosis of ELBW infants in the early neonatal period.     

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 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.     

极低和超低出生体重儿生存随访和放弃治疗院内因素分析

目的：总结2000~2008年该院新生儿重症监护室（NICU）住院的极低和超低出生体重儿的生存情况,分析放弃治疗的院内因素。方法：采用回顾性病例对照研究方法,收集148例患儿的临床资料并随访。通过单因素检验和logistic回归对放弃治疗患儿的危险因素进行分析。结果：148例患儿中,院内死亡20例（13.5%）,出院后死亡3例（2.0%）,放弃治疗后死亡19例（12.8%）,出院后失访30例（20.3%）,随访存活病例76例（51.4%）。存活病例中正常47例,先天遗传病2例,不良预后27例。多因素logistic回归分析表明,放弃治疗的院内高危因素主要是新生儿呼吸窘迫综合征（RDS）（P=0.030,OR=11.396,95%CI 1.264~102.701）和住院年限为2004~2006年（P=0.039,OR=9.869,95%CI 1.118~87.140）。结论：极低和超低出生体重儿生存情况不容乐观;减少新生儿RDS的发生率可能有利于减少院内放弃治疗病例。     

Academic achievement of adolescents born with extremely low birth weight

Aim: To assess academic achievement, rates of learning disabilities (LD) and special education in extremely low birth weight (ELBW <1 kg) adolescents relative to normal birth weight (NBW) controls and to identify cognitive weaknesses. Methods: Compared 181 ELBW adolescents born from 1992 to 1995 (mean age 14.8 years, mean BW 809 g, mean GA 26.4 weeks) and 115 NBW term controls. Measures included tests of IQ, reading and math achievement and executive function. Analyses included ANCOVA and logistic and linear regression. Covariates were sex, race and socioeconomic status. Results: Extremely low birth weight adolescents had significantly lower scores on tests of IQ (87.1 vs. 96.4), achievement (88.6 vs. 95.5 reading; 81.3 vs. 93.2 math) and executive function than the NBW group (all p-values <0.001). ELBW also had higher rates of math LD, 51(50%) vs. 26 (28%), OR (95% CI) = 3.10 (1.65, 5.84), p < 0.001, and need for special education, 88 (49%) vs. 11(10%), OR (95% CI) = 11.78 (5.67, 24.47), p < 0.001. Measures of executive function were related to math independent of IQ. Conclusions: Extremely low birth weight adolescents born in the 1990s have poorer achievement and higher rates of math LD than NBW peers. The findings suggest a need for more intensive interventions addressing the specific cognitive vulnerabilities in this population.