Anthropometric and laboratory assessment of very low birth weight infants: the most helpful measurements and why

Very low birth weight (VLBW; < or =1500 g), preterm infants have numerous physiological and developmental concerns, including growth and the provision of adequate nutrients to sustain growth. Growth is an important health care outcome measure for VLBW infants. Provision of energy and nutrients at levels to support growth and development is the goal of nutrition support for VLBW infants. Anthropometry and laboratory data are useful components of growth and nutrition assessment. The objectives of this paper are to describe: 1) the clinical application and interpretation of anthropometric measures of growth, and 2) the utilization and interpretation of laboratory tests of nutritional status in VLBW infants.     

Post-discharge nutrition: what does the evidence support?

Although there are no official recommendations for specific nutrient intakes in premature infants after hospital discharge, it is agreed that the goal should be to achieve the body composition and rate of growth of that of a normal fetus of the same postmenstrual age during the entire first year of life. A general recommendation to use the special formulas designed for preterm infants after hospital discharge in place of the formulas for term infants cannot be made from the available evidence at this time. Infants fed human milk after discharge are of the greatest concern as human milk does not in theory meet the requirements for growth in these infants. Such infants should remain on supplemental vitamins and Fe while breastfeeding, and growth as well as serum levels of phosphorus and alkaline phosphatase should be carefully monitored. The increased risk of preterm infants for obesity and the metabolic syndrome secondary to the metabolic/nutritional events early in life (programming) is likely to be small compared with the contribution of other risk factors, such as parental size, weight as an adolescent, and various lifestyle factors such as physical activity.     

Adequacy of prenatal care and neonatal mortality in infants born to mothers with and without antenatal high-risk conditions

BACKGROUND: Previous studies have found that inadequate prenatal care was associated with increased neonatal mortality in the general pregnant women. AIMS: To examine the association between adequacy of prenatal care and neonatal mortality in the presence and absence of antenatal high-risk conditions. METHODS: We conducted a retrospective cohort study of infants based on 1995-2000 vital statistics data in the USA. The relative risk for neonatal death associated with adequacy of prenatal care was estimated by multivariate logistic regressions with adjustment of confounding factors. RESULTS: Inadequate prenatal care was associated with increased neonatal mortality when pregnancies were complicated by anaemia, cardiac disease, lung disease, chronic hypertension, diabetes, renal disease, pregnancy-induced hypertension, and previous preterm/small-for-gestational-age birth. The observed association also existed in the absence of these antenatal high-risk conditions. Overutilisation of prenatal care was associated with increased risk of neonatal deaths in both the presence and the absence of antenatal high-risk conditions. When gestational age at delivery and birthweight were further adjusted, the observed association between inadequate prenatal care and neonatal mortality was not significant in pregnancies with various high-risk conditions. CONCLUSIONS: Inadequate prenatal care is associated with increased neonatal death in both the presence and the absence of antenatal high-risk conditions. The observed association between inadequate prenatal care and neonatal mortality may be mediated by increased risk of preterm delivery and low birthweight in these pregnancies. Overutilisation of prenatal care is associated with potential risks for fetal and neonatal development, leading to increased neonatal mortality.     

“长颈鹿”多功能培养箱在超低出生体重儿中应用的相关研究

目的初步探讨“长颈鹿”多功能培养箱在超低出生体重儿中的应用效果。方法对2013年入住我院新生儿监护病房（N IC U）经“长颈鹿”多功能培养箱治疗的超低出生体重儿32例（试验组）与2012年入住我院N IC U采用普通温箱治疗的超低出生体重儿15例（对照组）生后体重变化的幅度、医院感染发生率及颅内出血发生率等进行比较分析。结果试验组患儿生理性体重下降幅度较小,体重增长速度较快,缩短了住院天数,与对照组比较差异有统计学意义（P〈0.05）;试验组医院感染发生率为6.25%,对照组医院感染发生率为6.67%,2组比较差异无统计学意义（P〉0.05）;试验组颅内出血发生率为46.88%,对照组颅内出血发生率为80.00%,2组比较差异有统计学意义（P〈0.05）。结论在超低出生体重儿的救治中可优先使用“长颈鹿”多功能培养箱,能够有效降低超低出生体重儿生理性体重下降的幅度,加快体重增长的速度,缩短住院天数,减少超低出生体重儿颅内出血发生率,同时亦不会增加医院感染的发生率,值得临床推广。     

早期血脂代谢指标对不同胎龄早产儿营养评估价值

目的：通过测定不同胎龄、不同相对体质量早产儿早期血脂生化指标,探讨早产儿早期血脂代谢指标对指导早产儿营养支持治疗及预防疾病的临床意义。方法选取2012年9月-2014年4月同期住院的新生儿189例,分为≤28周组16例、28~32周组53例、32~37周组72例、足月儿组48例。于出生后24 h内采集静脉血2 mL,测定总胆固醇及甘油三酯。结果4个胎龄组间比较,总胆固醇水平以28~32周组最高,足月儿组胆固醇代谢水平最低,差异有统计学意义(P<0.05)。4个胎龄组间比较,甘油三酯水平以28~32周组最低,早产儿甘油三酯水平低于足月儿,差异有统计学意义(P<0.05)。28~32周组内AGA较SGA、LGA总胆固醇水平高,差异有统计学意义(P<0.05),余三个胎龄组内SGA、AGA及LGA间总胆固醇差异无统计学意义(P>0.05)。各胎龄组内SGA、AGA及LGA间甘油三酯水平差异无统计学意义(P>0.05)。结论早产儿胆固醇代谢水平高于足月儿,早产儿甘油三酯水平低于足月儿。监测早产儿血脂水平变化,对临床合理营养支持治疗及预防疾病具有指导意义。     

HR-HPV检测与细胞学联合检查在宫颈病变筛查中的应用

目的 评价高危型人乳头状瘤病毒(HPV)DNA检测联合宫颈细胞学检查对宫颈病变筛查的效果.方法 2008年8月～2010年4月,对该院宫颈疾病诊治中心就诊的4144名妇女进行宫颈癌前病变筛查,采用第2代杂交捕获试验(HC-2)检测(HR-HPV检测)联合细胞学检查,同时对其880例细胞学阳性患者进行阴道镜检查,并以宫颈活检的组织病理学结果为确诊标准.比较2种方法在宫颈病变筛查中的意义.结果 4144例研究病例中,细胞学异常(≥ASCUS)占21.24%(880/4144),高危型HPV检测阳性率为32.41%(1343/4144).880例细胞学异常者HR-HPV阳性率为47.84%,其中ASC 34.47%(202/586),LSIL 69.32%(113/163),HSIL89.08%(106/119),SCC100%.880例经病理学诊断为慢性炎症237例、CINI382例、CINI196例、CINIII111例和宫颈浸润癌54例,其HR-HPV阳性率分别为15.19%(36/237)、41.88%(160/382)、80.21%(77/96)、97.30%(108/111)和98.15%;880例细胞学异常中病理学≥CINI者占73.07%(643/880),421例HR-HPV阳性中,病理学≥CINI占91.69%(386/421).对宫颈低度以上病变,细胞学(≥LSIL)、HR-HPV、HR-HPV+细胞学(≥LSIL)3种方法的敏感度分别为45.26%、61.90%、77.14%;特异度分别为98.73%、85.23%、77.14%;不同检查方法差异有显著性(P＜0.05);阴性预测值分别为39.93%、4401%及%44.37%;经统计差异无显著性(P＞0.05).对宫颈高度病变,细胞学(≥LSIL)、HR-HPV、HR-HPV+细胞学(≥LSIL)的敏感性分别为81.23%、93.10%及97.70%;不同方法间差异有显著性(P＜0.05);特异性分别为76.27%、68.50%及64.80%:阴性预测值分别为91.13%、92.35%和99.15%;不同方法间差异无显著性(P＞0.05).结论 高危型HPV-DNA检测在宫颈病变的筛查中具有较高的敏感度和阴性预测值,高危型HPV-DNA检测联合细胞学检查进一步提高其敏感度和阴性预测值,是防治宫颈癌的关键.但特异度未能提高,阴道镜下多点活检术可提高宫颈病变诊断的准确性.     

新疆阿克苏地区库车县乳母口服碘油胶丸前后母子尿碘营养状况调查

目的了解阿克苏地区库车县重点人群的碘营养状况,以及服用碘油丸后的变化情况,为今后在阿克苏地区对重点人群口服碘油胶丸提供指导意见。方法在新疆阿克苏地区库车县牙哈镇的四村选择109名近半年内未服用过碘油丸的19～36岁哺乳期妇女及其子女(20 d～18个月婴幼儿),采用现场干预的方法,并于服药后的第1、3、7、14、30、50、75、100 d分别采集尿样,同时采集婴幼儿干预组及对照组尿样,用过硫酸铵消化—砷铈催化分光光度法分析碘含量。结果阿克苏地区库车县牙哈镇的四村乳母109人,干预组和对照组基础尿碘的中位数为136.54μg/L和114.90μg/L,尿碘含量<100μg/L者分别占39.80%和42.00%,<200μg/L者分别占68.66%和70%。子女109人,干预组与对照组基础尿碘中位数为251.45μg/L和260.75μg/L;<100μg/L者分别占15.30%和10.00%;补碘干预可提高乳母及其子女的尿碘水平。结论通过乳母口服200 mg碘油丸后,以期达到纠正和改善缺碘者的碘营养状况,消除新生儿碘缺乏病的发生,保证脑细胞和智力的正常发育。     

小切口治疗小儿腹股沟斜疝体会

目的:探讨治疗小儿腹股沟斜疝的手术方法。方法:回顾分析某院57例小儿腹股沟斜疝采用腹股沟平行小切口疝囊高位结扎术治疗的临床资料。结果:57例全部治愈。无切口感染、复发等并发症发生。术后随访6个月~1年,无1例复发。结论:小切口疝囊高位结扎术具有损伤小、恢复快、并发症少、复发率低、疤痕小等优点,是一种安全有效的治疗小儿腹股沟斜疝的微创手术方法。     

孕晚期缺铁与婴儿缺铁性贫血相关性分析

目的探讨母亲孕晚期铁元素（Fe）缺乏与婴儿缺铁性贫血的的关系。方法对2007年1月1日-2008年1月1日在秦皇岛市妇幼保健院出生的4个月婴儿进行静脉血常规检查及微量元素检查;孕晚期母亲进行微量元素检查及问卷调查,了解贫血的发生情况。结果母亲孕晚期Fe缺乏101例,4个月婴儿缺铁性贫血93例;母亲孕晚期Fe正常363例,4个月婴儿缺铁性贫血85例,差异有统计学意义（P〈0．05）。结论孕晚期母亲Fe缺乏与婴儿缺铁性贫血有明显的相关性,重视孕晚期母亲Fe的补充可以预防婴儿缺铁性贫血。     

婴儿期引导式家庭教育训练对婴儿认知-运动能力干预效果评估

目的 评估3~12月龄引导式家庭教育训练对早产儿及足月儿认知-运动发育水平的干预效果。方法 选取2014年10月-2015年10月期间来本院儿童保健门诊健康体检的婴儿273例作为干预组研究对象,选取同时期在上海市另外一家妇幼保健院及江苏省某妇保院健康体检的婴儿1 572例为对照组研究对象,对干预组研究对象的家长发放认知-运动发育训练计划并由医生向家长讲解和督促其对婴儿开展训练,对照组研究对象不做任何干预措施。应用“年龄与发育进程问卷(第三版)”(Ages and Stages Questionnaire-Third edition,ASQ-3)作为婴儿认知-运动发育水平的评估工具,通过构建回归方程对干预措施的效果进行评估。结果 在足月儿人群中,干预组和对照组婴儿的ASQ-3总得分差异无统计学意义(P>0.05);而在早产儿人群中,干预组婴儿的ASQ-3总得分较对照组平均高5.554分(P<0.01)。结论 在儿童保健门诊对婴儿家长进行引导式家庭教育训练在提高早产儿认知-运动发育水平方面效果明显。