The patent ductus arteriosus in term infants, children, and adults

During fetal life, the ductus arteriosus is a normal and essential structure that connects the pulmonary artery to the distal aortic arch, permitting right ventricular ejection into the aorta. After birth, with commencement of pulmonary blood flow and a 2-ventricle circulation, a variety of physiological and biochemical signals normally result in complete closure of the ductus. Persistent patency of the ductus arteriosus may impair systemic cardiac output and result in deleterious effects on the cardiovascular system and lungs. Although surgery is still the treatment of choice for most premature infants with patent ductus arteriosus (PDA), transcatheter techniques have largely supplanted surgery for closure of PDA in children and adults. This article is a review of the PDA in term infants, children, and adults, with focus on the clinical manifestations and management.     

Photoprotection of solutions of parenteral nutrition decreases the infused load as well as the urinary excretion of peroxides in premature infants

Light exposure and multivitamins are contributing factors to the generation of peroxides in solutions of parenteral nutrition. This article verifies if peroxides infused with parenteral nutrition are of biological significance in neonates. The mechanisms responsible for the generation of peroxides in total parenteral nutrition solutions are reviewed. The consequences of infused peroxides on an index of oxidant stress and on levels of a central antioxidant are evaluated in an animal model. The effect of photoprotection of parenteral nutrition on a biological marker of redox imbalance is evaluated in the urine of premature infants. Parenteral multivitamins produce a drop in glutathione and an oxidant stress similar to peroxides in the lungs of newborn guinea pigs. Infused peroxides elicited an increased urinary peroxide excretion in infants receiving parenteral nutrition exposed to light. Photoprotection reduced levels of infused and excreted peroxides. The results suggest that peroxides infused with total parenteral nutrition are not fully quenched by premature infants.     

The character of premature baby's blood taurine concentration and urinary taurine excretion

The concentration of taurine in fetal blood and in mother's milk is very high. In the present study, in order to elucidate the nutritional role of taurine during fetal and neonatal age we investigated the urinary taurine excretion and the blood taurine concentration change in premature babies. 1. The blood taurine concentration of infants on the first postnatal day decreased along with gestation between 7-10 gestational months. On the other hand, there was no difference in the concentrations of blood total amino acids in infants on the first postnatal day in 7-10 gestational months. 2. The blood taurine concentration of infants decreased remarkably during one week after birth. This tendency to decrease was more prominent in premature infants--those at 8 to 10 gestational months. 3. The urinary excretion of taurine and total amino acids of infants remarkably decreased along with gestation between 7-10 gestational months. This tendency to decrease was the most prominent in infants between 7 and 8 gestational months.     

Late-onset cystic periventricular leukomalacia in premature infants: a threat until term

The purposes of this study are (1) to describe a "late-onset" form of cystic periventricular leukomalacia eventually appearing in premature infants whose neurological assessments were normal in the first month of life; (2) to retrospectively evaluate its incidence among a large population of premature infants; (3) to suggest that a few unexpected complications of prematurity may trigger the development of white matter damage, even several weeks after birth. Retrospective study in a population of 1452 surviving infants after 5 days born before 33 weeks. We identified 10 cases of late-onset cystic periventricular leukomalacia appearing beyond the first 5 weeks of life. In 8 cases, an intercurrent event associated with a systemic inflammatory response preceded the appearance of cysts: necrotizing enterocolitis (n = 5), septicemia (n = 2 cases), strangulated inguinal hernia in one infant. Neurological surveillance should be repeated until discharge in very preterm infants, especially after the occurrence of an intercurrent complication coming along with a systemic inflammatory response.     

Postnatal changes in colloid osmotic pressure in premature infants: in healthy infants, in infants with respiratory distress syndrome, and in infants born to mothers with premature rupture of membranes

Colloid osmotic pressure (COP) of blood plasma during the first 4 days of life was measured in 63 neonates: 16 healthy preterm infants, 36 infants with respiratory distress syndrome (RDS), and 11 infants born to mothers with premature rupture of membranes. The relation between COP and total protein content of blood was significant in all groups over times from 1-3 h to 96 h. COP rose significantly by the age of 3 h compared to COP of umbilical cord plasma in all groups investigated. Infants with RDS showed a significant increase in COP during the investigation period. In healthy preterm infants the increase was less significant. In infants with RDS there was a negative correlation between changes in COP and body weight not seen in the other groups investigated. COP in neonates seems to reflect the compartmentation between vascular and interstitial spaces. Measurement of COP could be clinically useful in assessing hemodynamic adaptation after birth and also in assessing edema formation and water balance in infants with RDS.     

Late preterm infants, early term infants, and timing of elective deliveries

Delivery of infants who are physiologically mature and capable of successful transition to the extrauterine environment is an important priority for obstetric practitioner. A corollary of this goal is to avoid iatrogenic complications of prematurity and maternal complications from delivery. The purpose of this review is to describe the consequences of birth before physiologic maturity in late preterm and term infants, to identify factors contributing to the decline in gestational age of deliveries in the United States, and to describe strategies to reduce premature delivery of late preterm and early term infants.     

早产儿预后研究进展

随着围产医学的发展及危重新生儿救治水平的提高,具有极限生存活力的早产儿存活率和生存质量已达较高水平。但早产儿死亡风险、严重后遗症的发生率与足月新生儿相比,仍存在差异。本文就早产儿的死亡率、死亡原因及远期预后,特别是呼吸系统和神经系统损害的远期预后等问题进行综合阐述。     

关注早产儿的营养与健康

据世界卫生组织统计,全球每年出生1200多万早产儿,占新生儿总数的9.6%.这些早产儿大约85%集中在非洲和亚洲,而早产、窒息和感染性疾病始终是全球新生儿死亡的三大主要原因.按我国目前的出生率和早产发生率计算,每年出生约150万早产儿,占全球早产儿总数的1/10以上.这是一个庞大的群体,已成为备受瞩目的医学和社会问题.而随着早产儿尤其是极低和超低出生体重儿存活率的逐年提高,国际上越来越多的围产、新生儿和营养专家更加关注早产儿的营养与健康.早产儿的营养管理是临床治疗的重要组成部分,是提高早产儿存活率和改善其预后的不可缺少的关键环节之一.