ABSTRACT
Objective:To summarize the survival rate, complications, and outcomes of 32 periviable extremely preterm infants (PEPIs) born at ≤23 gestational weeks.Methods:This was a retrospective observational study involving PEPIs born at the Shenzhen Maternity & Child Healthcare Hospital from January 1, 2015, to December 31, 2021. Clinical data of all subjects were collected and analyzed. The survival rates of PEPIs born from 2015 to 2019 and 2020 to 2021 were compared. Chi-square (or Fisher's exact) test was used for statistical analysis. Results:(1) During the study period, 32 PEPIs were admitted, accounting for 0.024% (32/132 534) of all newborns born in the same hospital during the study period. The median gestational age of the 32 PEPIs was 23 weeks (21 +4-23 +6 weeks), and the birth weight was 480 g (350-720 g). (2) The survival rate of PEPIs born between 2020 and 2021 was 10/19, which appears to be a trend higher than that between 2015 and 2019 (3/13, χ2=2.79, P=0.095), while the rate of withdrawal of treatment was 8/13 and 3/19, respectively, with a statistically significant difference ( χ2=7.16, P=0.007). (3) Thirteen of the 32 PEPIs survived on discharge, including four born at 22 weeks and nine at 23 weeks. The birth weights of these surviving infants were 300-<400 g in one case, 400-<500 g in five cases, 500-<600 g in four cases, 600-<700 g in one case, and ≥700 g in two cases. (4) The most common complication was moderate and severe bronchopulmonary dysplasia (10/13), followed by retinopathy of prematurity requiring surgical intervention (5/13), patent ductus arteriosus requiring ligation (4/13), late-onset sepsis (2/13), necrotizing enterocolitis (stage Ⅱa or above) (2/13) and grade Ⅲ-Ⅳ intraventricular hemorrhage or periventricular leukomalacia (2/13). The median duration of follow-up was ten months (6-69 months), and motor retardation occurred in three infants. Conclusions:The overall survival rate of PEPIs in our hospital is relatively high, with a lower incidence of complications during hospitalization and relatively better outcome. However, further studies are required for the long-term prognosis in this group of infants.
ABSTRACT
Objective:To study the early use of inhaled nitric oxide (iNO) as a rescue therapy in extremely premature infants (EPIs) with refractory hypoxic respiratory failure (HRF).Methods:Between January 2021 and December 2021, EPIs with refractory HRF receiving iNO within the first week of life in our NICU were enrolled. Their clinical characteristics and outcomes were retrospectively analyzed.Results:A total of 11 EPIs were included with 5 males and 6 females. The median gestational age (GA) was 24(22.6, 25.2) weeks. The median birth weight (BW) was 580(490, 770) g. The most common primary diagnoses were moderate/severe respiratory distress syndrome (RDS) (5/11) and early-onset sepsis (3/11). The median age starting iNO therapy was 6.5(4.5, 34.0)h and the median duration of iNO was 24(12, 36)h. The median iNO starting dose was 5(5, 8) ppm and the therapeutic range was 5-20 ppm. Therapeutic efficacy was defined as ≥30% FiO 2 reduction after 6 h of iNO treatment. The treatment was effective in 8 cases. The oxygenation index (OI) decreased more than 10% from baseline 1 h after initiation in 9 patients and in all 11 patients after 12 h of iNO. The reduction of OI was more prominent in EPIs with a higher OI at baseline. Of the 11 patients, 8 survived, 1 died and 2 abandoned further treatments. Conclusions:As an early rescue therapy for EPIs with refractory HRF, iNO can improve oxygenation without obvious short-term adverse effects.
ABSTRACT
Objective:To study the effects of breastfeeding within 2 weeks after birth on late-onset sepsis in very low birth weight infants (VLBWI).Methods:From July 2018 to June 2019, clinical data of VLBWI (birth weight <1 500 g) born in our hospital were retrospectively reviewed. According to the proportion of breastfeeding volume in total feeding volume within 2 weeks after birth, the infants were assigned into high-proportion breastfeeding group (breastfeeding >50%), low-proportion breastfeeding group (breastfeeding ≤50%) and formula group. The incidences of late-onset sepsis among the three groups were compared using the chi-square test or Fisher's exact probability method. Logistic regression was used to analyze the effects of breastfeeding within 2 weeks after birth on late-onset sepsis.Results:The incidences of late sepsis in high-proportion breastfeeding group, low-proportion breastfeeding group and formula group were 0.4% (1/216), 8.1% (5/62) and 8.0% (2/25), respectively ( P<0.001). Logistic regression analysis showed that compared with the high-proportion breastfeeding group, the low-proportion breastfeeding group ( OR=17.844, 95% CI 2.005~158.775) and the formula group ( OR=23.261, 95% CI 1.916~282.350) had increased risks of late-onset sepsis. Conclusions:For VLBWI, high proportion breastfeeding (breastfeeding >50%) within 2 weeks after birth may reduce the risk of late-onset sepsis.
ABSTRACT
Objective:To study the incidence and risk factors of periventricular- intraventricular hemorrhage (PIVH) in extremely preterm infants (EPI) with gestational age (GA)<28 weeks.Methods:A retrospective study was performed in 304 cases of EPI hospitalized between January 2016 and December 2018. The infants were assigned into two groups according to whether PIVH occurred. Univariate analysis and Logistic regression analysis were used to determine the risk factors of PIVH.Results:Among the 304 cases,101 (33.2%) developed PIVH and 44 (14.5%) developed severe PIVH.The incidences of PIVH and severe PIVH in EPI with birth weight (BW) <750 g were 50.6% and 31.0%. The incidences of PIVH and severe PIVH in EPI with GA<26 weeks were 51.4% and 27.5%. Logistic regression analysis revealed that advanced GA ( OR=0.697, 95% CI 0.543~0.895, P=0.005) decreased the risk of PIVH. Prolonged invasive mechanical ventilation ( OR=1.121, 95% CI 1.007~1.249, P=0.037) and use of vasoactive drugs ( OR=1.373, 95% CI 1.040~1.812, P=0.025) within the first week of life increased the risk of PIVH. Conclusions:The incidences of PIVH and severe PIVH in EPI are quite high. Smaller GA, longer use of invasive mechanical ventilation and vasoactive drugs within the first week will increase the risk of PIVH in EPI.
ABSTRACT
Objective:To analyze the cases referred to a higher-level hospital from the Department of Neonatology in a primary hospital, and evaluate the efficiency of clinical works related to the referrals.Methods:Data of neonates admitted to the Department of Neonatology at Maternal and Child Health Hospital of Dabu County from January 2018 to December 2020 and referred to the superior hospital were retrospectively analyzed.Results:A total of 1 670 neonates were included and 128 neonates were referred.The median age of the neonates referred was 0.5 hours(0 hours, 25 days), the median gestational age was 38 + 3(29 + 1, 42 + 4) weeks, the median weight was 3 000(1 250, 4 800) g, and the transport distance was 78 km.Twenty-four cases were assessed as critical cases before the referral, 125 cases were improved and discharged after treatment in the superior hospital, and three cases died.The referral rate in 2018, 2019 and 2020 showed a downward trend year by year (10.3%, 7.6% and 4.0%, respectively), and the difference was statistically significant( χ2=14.362, P=0.001). The proportion of critical cases in referral cases increased year by year (9.4%, 23.9% and 38.9%, respectively), and the difference was statistically significant( χ2=9.289, P=0.010). The incidence of critical case was higher in those whose mothers didn′t have regular prenatal examination during pregnancy( χ2=5.129, P=0.032). Conclusion:The ability of neonatal treatment in primary hospitals has been improved.The neonates need to be referred and critical cases are not rare in primary hospitals.More attention should be paid to the safety and effectiveness of the regional transport network.Also, enhancing the health awareness of residents and improving the primary medical technics are important to maximize the life safety and optimal transition of newborns.
ABSTRACT
Objective:To review the treatment experience of extremely premature infants (EPIs) with gestational age (GA) <23 weeks.Methods:From January to November 2021, EPIs with GA<23 weeks treated in our hospital was retrospectively analyzed.Results:A total of 3 patients with GA of 22 weeks were reviewed, including 2 boys and 1 girl. Their birth weight (BW) was 450~498 g. The duration of hospitalization was 112~126 d. The treatment included early "gentle" management strategies, respiratory management, anti-infection, patent ductus arteriosus treatment and parenteral + enteral nutrition. All 3 infants were discharged from the hospital without further oxygen therapy. All had satisfying oral feeding with no neurological sequelae on follow-up.Conclusions:Early "gentle" management is the key to successful treatment and good prognosis for EPIs with GA<23w
ABSTRACT
Objective:To study the effect of oropharyngeal colostrum administration on salivary secretory IgA (sIgA) levels in extremely/very low birth weight preterm infants fed by gastric tube.Methods:Preterm infants with birth weight <1 500 g ( n=90) hospitalized in neonatal intensive care unit of the Affiliated Shenzhen Maternity & Child Healthcare Hospital of Southern Medical University from August 2020 to January 2021 were enrolled as research subjects. They were assigned into observation group and control group. The observation group accepted oropharyngeal administration of colostrum before being fed by gastric tube once every 3 hours for 7 days. The control group was given normal saline before each feeding. Other nursing interventions were consistent with the observation group. Saliva samples were collected at the 2 hour and 7 day after birth and the levels of slgA were tested. SPSS 26.0 statistical software was applied to analyse the data. Results:A total of 81 preterm infants completed this study. The content of salivary sIgA in observation group (42 cases) on 7 day after birth were significantly higher than those on the 2 hour after birth [15.4 (0.6, 106.7) μg/ml vs. 0.6 (0.0, 5.3) μg/ml] ( P<0.05). There was no statistically significant difference between the sIgA levels in the saliva of the control group (39 cases) at the 7 postnatal day and 2 hour after birth [0.0 (0.0, 1.4) μg/ml vs. 0.0 (0.0, 5.2) μg/ml] ( P>0.05). The content of salivary sIgA in observation group were significantly higher than those in control group on the 7 day after birth, the difference was statistically significant ( P<0.05). The salivary sIgA levels in the observation group were negatively correlated with the starting time of oropharyngeal administration of colostrum ( r=-0.330, P<0.05), and positively correlated with the total number of oropharyngeal administration of colostrum ( r=0.388, P<0.05). Conclusions:Oropharyngeal colostrum administration can improve the levels of salivary sIgA of extremely/very low birth weight preterm infants fed by gastric tube.
ABSTRACT
Objective:To study the trends and ranges of blood pressure in extremely premature infants (EPIs) during the first 7 days after birth.Methods:From January 2016 to December 2020, EPIs born in our hospital were retrospectively analyzed. Their blood pressure were monitored using umbilical arterial catheters and no patients needed anti-hypotension treatment. The clinical data of the infants and their mothers, blood pressure data during the first 7 days after birth, clinical outcomes and complications were collected. The trends of blood pressure in untreated EPIs were analyzed and the blood pressure ranges of EPIs of different gestational ages (GA) were established.Results:A total of 145 cases of EPIs were included and their systolic pressure, diastolic pressure and mean blood pressure showed upward trends during 2~168 h after birth ( P<0.001). The diastolic pressure increased significantly within 24 h after birth ( P<0.05), systolic pressure and mean blood pressure increased significantly within 72 h after birth ( P<0.05). Blood pressure increased with age and GA. Conclusions:The blood pressure of EPIs will increase spontaneously during 7 days after birth. The ranges of blood pressure are measured for infants with different GA to provide clinical evidence for blood pressure management of EPIs during early postnatal period.
ABSTRACT
Bronchopulmonary dysplasia is a common respiratory complication in premature infants.With the improvement of neonatal treatment, premature infants are surviving more than ever.However, the incidence of bronchopulmonary dysplasia remains high, which seriously affects the outcomes of premature infants.The immature lung of preterm infants are susceptible to damage from a variety of factors, which are modifiable by the early use of lung-protective strategies of respiratory support.This review focused on summarizing the research progress of early lung-protective ventilation techniques for preventing bronchopulmonary dysplasia in premature infants.
ABSTRACT
Objective:To investigate the clinical and genetic characteristics of Simpson-Golabi-Behmel syndrome (SGBS) type Ⅰ caused by glypican-3 ( GPC3) gene mutations. Methods:Data of one neonate with SGBS type Ⅰ from Shenzhen Maternity and Child Healthcare Hospital Affiliated to Southern Medical University was reviewed retrospectively. Literature was retrieved to summarize the clinical and genetic characteristics of SGBS type Ⅰ caused by GPC3 mutations, using terms of "Simpson-Golabi-Behmel type Ⅰ", "GPC3" and "glypican-3" from China National Knowledge Infrastructure, VIP database, Wanfang database, and PubMed from January 2010 till April 2021. Results:The male infant was admitted to the hospital at 4 h after birth due to "abdominal distension for 1 h", presenting with dysmorphic facial features, including macrocephaly, coarse face, broad nasal bridge, macrostomia, tongue with a groove in the middle, as well as macrosomatia, supernumerary nipples, and hypospadias. Whole exome sequencing revealed a novel frameshift mutation (c.720delC) in GPC3 gene of the patient and his mother for hemizygous and heterozygous variation, respectively, based on which SGBS type Ⅰwas confirmed. During the follow-up, overgrowth, neuroblastoma, and motor development retardation were found in the boy. In addition to the index patient, 92 cases of SGBS type Ⅰ reported in 31 articles were analyzed, including 89(95.7%) males and 4(4.3%) females. The main clinical features were craniofacial dysmorphism, pre/postnatal overgrowth with multiple congenital anomalies. Most patients were combined with language disorders, motor retardation, and various degrees of dysnoesia, and were more likely to develop embryonic tumors. Among the 93 cases, 11(11.8%) suffered from tumors. Apart from 21 cases of termination, 63 cases were born alive and nine cases died after birth. Pathogenic variants in GPC3 gene were reported in 80 cases, which were nonsense mutation in 25 cases (31.2%), DNA fragment deletion in 21 cases (26.2%), frameshift mutation in 16 cases (20.0%), large duplications in eight cases (10.0%), missense mutation in five cases(6.2%), and splice site mutation in five cases(6.2%). Conclusions:SGBS type Ⅰ is an X-linked recessive genetic disease with various phenotypes. Patients with postnatal craniofacial dysmorphism, overgrowth, and multiple congenital anomalies should be highly suspected of SGBS type Ⅰ. Genetic testing is conducive to its early diagnosis. Treatment requires multidisciplinary cooperation and long-term follow-up, especially for those with tumors.
ABSTRACT
Objective:To study the risk factors of hypotension after ligation of patent ductus arteriosus (PDA) in very/extremely low birth weight infants (VLBWI/ELBWI).Method:From March 2016 to January 2021, preterm infants with birth weight <1 500 g receiving bedside PDA ligation in the neonatal intensive care unit (NICU) of our hospital were enrolled in the study. According to the occurrence of hypotension within 72 hours after ligation, the infants were assigned into non-hypotension group and hypotension group. The general status and perioperative conditions of the two groups were analyzed. Multivariate Logistic regression was used to analyze the risk factors of hypotension.Result:A total of 44 cases were enrolled, including 33 in non-hypotension group and 11 in hypotension group. Univariate analysis showed that hypotension group had significantly more cases with body weight <1 100 g during surgery and receiving preoperative high frequency oscillatory ventilation (HFOV) than non-hypotension group ( P<0.05). Multivariate Logistic regression analysis showed that weight <1 100 g during surgery ( OR=12.045, 95% CI 1.351~107.394, P=0.026) and receiving preoperative HFOV ( OR=27.832, 95% CI 1.363~568.292, P=0.031)were independent risk factors of hypotension. Conclusion:Hypotension is one of the common complications of PDA ligation in VLBWI/ELBWI. The infant's body weight during ligation and receiving preoperative HFOV are independent risk factors of hypotension.
ABSTRACT
Objective:To study the effects of early breastfeeding volume on neonatal necrotizing enterocolitis (NEC) and feeding intolerance in very low birth weight infants.Methods:This study retrospectively analyzed the clinical data of 275 cases of very low birth weight infants (birth weight<1 500 g) born in Shenzhen Maternity & Child Healthcare Hospital from June 2017 to May 2018. Based on whether breastfeeding or not and the ratio of breast milk intake over the total volume of intake within two weeks after birth, they were divided into three groups: breast milk intake>50% group (>50% group, n=199), breast milk intake≤50% group (≤50% group, n=55) and formula group ( n=21). Differences in the incidence of NEC and feeding intolerance among the three groups were analyzed using Chi-square test (or Fisher's exact test). Effects of breast milk intake on the incidence of NEC and feeding intolerance were evaluated using univariate and multivariate logistic regression analysis. Results:The incidence of NEC in the >50% group, ≤50% group and formula group was 1.5% (3/199), 27.3% (15/55) and 9.5% (2/21), respectively ( P<0.01), and the incidence of feeding intolerance was 17.6% (35/199), 56.4% (31/55) and 28.6% (6/21), respectively ( χ2=34.826, P<0.01). Univariate logistic regression analysis showed that compared with the >50% group, the risk of NEC in the≤50% and formula group increased ( OR=24.500, 95% CI: 6.755-85.594; OR=6.877, 95% CI: 1.081-43.744); that of feeding intolerance increased in the≤50% group ( OR=6.316, 95% CI: 3.293-12.113). Multivariate logistic regression analysis showed that compared with the >50% group, the risk of NEC in the≤50% and formula groups increased ( OR=28.452, 95% CI: 7.280-111.195; OR=8.610, 95% CI: 1.262-58.766); that of feeding intolerance increased in the≤50% group ( OR=7.207, 95% CI: 3.601-14.425). Conclusions:Breastfeeding accounting for more than half of the total volume of intake within two weeks after birth may reduce the incidence of feeding intolerance and NEC in very low birth weight infants.
ABSTRACT
Objective@#To investigate the correlation of early incubator temperature fluctuation on intraventricular hemorrhage (IVH) in very/extremely-low birth weight infants (E/VLBW).@*Methods@#From July 2015 to September 2016, 270 patients of hospitalized E/VLBW were included in this study. Temperature changes including incubator temperature and abdominal temperature within 72 hours after admission and routine clinical data were collected,the E/VLBW were divided into IVH group and non-IVH group, as well as the occurrence and grading of IVH. Chi-square test, t test and nonparametric test and logistic regression analysis were used to explore the effect of early incubator temperature fluctuations in E/VLBW on IVH.@*Results@#Of the 270 V/ELBW studied, the incidence of IVH was 24.4% (66/270) , severe IVH(grade Ⅲ and Ⅳ) was 5.2% (14/270) . Univariate analysis showed that in addition to common IVH risk factors such as gestational age, body weight, 1/5 min Apgar score, sex, delivery, hyperglycemia, prenatal steroid and mechanical ventilation, fluctuations of body temperature and incubator temperature were relevant for IVH in E/VLBW (P<0.05) . Logistic regression analysis of the above relevant risk factors showed fluctuations of temperature (OR=1.10) was also an independent risk factor for IVH in E/VLBW(P<0.05) , in addition to sex(OR=0.42) , 1 min Apgar score (OR=0.71) , and hyperglycemia (OR=3.67) .@*Conclusion@#Fluctuation of incubator temperature is an independent risk factor for IVH in V/ELBWI. During centralized nursing and nursing operations, the operating time should be shortened as much as possible to reduce the number of fluctuations of incubators and body temperature to reduce the incidence of IVH and improve the quality of life.
ABSTRACT
Objective@#To investigate the efficacy and adverse effects of sustained lung inflation (SLI) combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS).@*Methods@#This prospective randomized controlled trial included 124 premature infants (gestational age <34 weeks and birth weight <2 000 g) diagnosed with NRDS and in need of PS treatment in Shenzhen Maternity & Child Healthcare Hospital affiliated to Southern Medical University from July 1, 2016 to October 31, 2018. They were randomly divided into experimental or control group, with 62 cases in each. Infants in the experimental group were treated with SLI using T-piece and intratracheal PS, while those in the control group were given PS only. Blood gas analysis and measurement of fraction of inspiration O2 (FiO2) and ratio of partial pressure of oxygen (PO2) over FiO2 were performed before and 1 h after PS injection. Results of the treatments and incidence of complications were compared. Paired samples t-test, two independent samples t-test, rank-sum test and Chi-square test were used for statistical analysis.@*Results@#There were 56 participants in the experimental group and 54 in the control group who were eventually analyzed. In the experimental group, the pH value, partial pressure of carbon dioxide (PCO2), FiO2 and PO2/FiO2 at 1 h after PS injection were all improved compared with those before treatment [pH value: 7.26±0.09 vs 7.19±0.09, t=3.814; PCO2: (51.5±12.6) vs (59.8±16.3) mmHg (1 mmHg=0.133 kPa), t=2.610; FiO2: 26.0 (21.0-31.5)% vs 40.5 (38.5-51.5)%, U=392.000; PO2/FiO2: (284.6±117.9) vs (173.4±59.7) mmHg, t=6.427; all P<0.05]. The overall decrement of FiO2 after PS injection in the experimental group was more significant than that in the control group [-10.0 (-15.0 to -5.0)% vs -5.0 (-8.0 to 0.0)%, U=706.500, P<0.001]. The experimental group had a higher rate of extubation within 24 h than the control group [80% (45/56) vs 71% (32/54), χ2=5.830, P=0.016]. However, no significant differences were shown in total mechanical ventilation time, non-invasive/high-flow nasal cannula ventilation time, the ratio of re-intubation within 72 h, or the incidence of air leak, bronchopulmonary dysplasia, periventricular-intraventricular hemorrhage, necrotizing enterocolitis or patent ductus arteriosus between the two groups (all P>0.05).@*Conclusions@#SLI combined with PS for NRDS babies can increase the rate of extubation within 24 h and promote the down-regulation of FiO2 without causing significant complications.
ABSTRACT
Objective To explore the clinical characteristics, treatment and prognosis of bronchopulmonary dysplasia (BPD) in extremely preterm infants. Method The clinical data of extremely preterm infants with gestational age ＜ 28 weeks hospitalized between August 2014 and August 2017 were retrospectively analyzed. According to oxygen inhalation and BPD clinical grading at 28 days after the birth, extremely preterm infants were divided into non-BPD group, mild, moderate and severe BPD groups, and their clinical characteristics, treatment and prognosis were discussed. Results A total of 205 extremely preterm infants were enrolled, with an average gestational age of (26.2±1.2) weeks and an average birth weight of (0.87±0.19) kg. Among them, 46 infants were gave up treatment, 15 died, and 144 (70.3％) were discharged eventually. There were statistically significant differences in the rates of patent ductus arteriosus (PDA) and infection among groups with different degrees of BPD (P＜0.01) . The incidence of PDA was higher in the moderate and severe BPD groups, and the infection rate was higher in the severe BPD group. The oxygen use time, length of stay, hospitalization cost, glucocorticoid treatment rate and incidence of pulmonary sequelae among groups with different degrees of BPD were significantly different (P＜0.01) . With oxygen use time, length of hospital stay and hospitalization cost increased gradually over the aggravation of BPD. Glucocorticoids were used in all moderate and severe children, and the incidence of pulmonary sequelae was higher. Conclusion BPD still is an important complication affecting the prognosis of extremely preterm infants. Early prevention and systematic treatment can alleviate severe sequela.
ABSTRACT
Objective To analyse the risk factors associated with spontaneous intestinal perforation (SIP) in extremely premature infants/extremely low birth weight infants. Method From January 2015 to December 2018, infants with gestational age (GA)<28 weeks or birth weight (BW)<1000 g admitted to our neonatal intensive care unit were enrolled to the retrospective nested case-control study.The clinical data of SIP infants (SIP group) and infants with the same GA but without SIP (control group) were randomly selected and compared. Multivariable Logistic regression was used to analyse the risk factors of SIP. Result A total of 409 extremely premature infants/extremely low birth weight infants were born during the study period. Among them, 25 SIP infants and 55 controls were enrolled. The incidence of SIP in infants with GA 22～25 weeks was 11.8％(16/136), which is higher than infants with GA 26～27 weeks (2.0％, 5/247) (χ2=16.057, P<0.001). The incidence of SIP in infants with BW 400～749 g was 13.0％(14/108), which is higher than infants with BW 750～999 g (3.4％, 8/236) (χ2=11.343, P=0.001). Multivariate Logistic regression analysis showed that twins (OR=4.153, 95％CI 1.392～12.384, P=0.011), umbilical veins catheterization (OR=15.942, 95％CI 1.026～247.789, P=0.048) and ibuprofen use within 3 days after birth (OR=15.387, 95％CI 1.519～155.883, P=0.021) were independent risk factors of SIP. Conclusion The smaller the GA and BW, the higher the incidence of SIP. Twins,umbilical veins catheterization and ibuprofen use early after birth may be independent risk factors of SIP.
ABSTRACT
Objective To investigate the correlation of early incubator temperature fluctuation on intraventricular hemorrhage (IVH) in very/ extremely-low birth weight infants (E/VLBW). Methods From July 2015 to September 2016, 270 patients of hospitalized E/VLBW were included in this study. Temperature changes including incubator temperature and abdominal temperature within 72 hours after admission and routine clinical data were collected,the E/VLBW were divided into IVH group and non-IVH group, as well as the occurrence and grading of IVH. Chi-square test, t test and nonparametric test and logistic regression analysis were used to explore the effect of early incubator temperature fluctuations in E/VLBW on IVH. Results Of the 270 V/ELBW studied, the incidence of IVH was 24.4%(66/270), severe IVH(gradeⅢandⅣ) was 5.2%(14/270). Univariate analysis showed that in addition to common IVH risk factors such as gestational age, body weight, 1/5 min Apgar score, sex, delivery, hyperglycemia, prenatal steroid and mechanical ventilation, fluctuations of body temperature and incubator temperature were relevant for IVH in E/VLBW (P＜0.05). Logistic regression analysis of the above relevant risk factors showed fluctuations of temperature ( OR=1.10)was also an independent risk factor for IVH in E/VLBW( P＜0.05), in addition to sex( OR=0.42), 1 min Apgar score ( OR=0.71), and hyperglycemia ( OR= 3.67). Conclusion Fluctuation of incubator temperature is an independent risk factor for IVH in V/ELBWI. During centralized nursing and nursing operations, the operating time should be shortened as much as possible to reduce the number of fluctuations of incubators and body temperature to reduce the incidence of IVH and improve the quality of life.
ABSTRACT
Objective To evaluate the value of monitoring non-invasive cardiac output parameters in medical treatment of patent ductus arteriosus (PDA) in premature infants.Method Premature infants with PDA diagnosed three days after birth (gestational age:28 ～ 31 weeks or birth weight of 1 000 ～ 1 799 g) admitted to the neonatal intensive care unit (NICU) of our Hospital from February 2016 to August 2016 were enrolled in the study.These premature infants were assigned into treated PDA group (the treatment group) and untreated PDA group (the observation group) based on results of non-invasive cardiac output parameters CI and MD,with aorta CI ≥2.95 L/(min · m2),MD ≥21.50 m/min and pulmonary artery CI ≥4.55 L/(min · m2),MD ≥26.50 m/min as cut-off values.Statistical analysis was carried out using t test,x2 test.The closure rate of arterial duct of two groups and changes in non-invasive cardiac output parameters before and after the closure of arterial duct in the treatment group were compared.Result The overall closure rate of arterial duct was 85.1％ (57/67).The closure rate of arterial duct of the treatment group was 70.8％ (17/24),that of the observation group was 93.0％ (40/43),and the difference had statistical significance (P ＜ 0.05);Comparing the following parameters before and after ductal closure in the treatment group,the difference of pulmonary artery flow time (FT),aorta stroke volume index (SVI) and the integral of the flow profile (Vti) had statistical significance (P ＜ 0.05) [(217.6±19.3) ms vs.(235.8 ±21.4) ms,(22.4±6.0)ml/m2 vs.(25.2 ±7.7)ml/m2,(15.1 ± 4.1) cm vs.(17.2 ±5.3) cm].In the treatment group,after arterial duct was closed,aorta and pulmonary artery CI,MD decreased to some degree,but the difference had no statistical significance (P ＞ 0.05).Conclusion Non-invasive cardiac output parameters including aorta and pulmonary artery CI,MD have certain guiding significance for PDA drug treatment among premature infants;after PDA drug treatment,arterial duct closure condition cannot be judged simply by the changes of aorta and pulmonary artery CI,MD,ultrasonic cardiogram examination results should also be considered.
ABSTRACT
Objective To investigate the preventive and adverse effects of postnatal inhalation of Budesonide in early stage on bronchopulmonary dysplasia (BPD) in very low birth weight infants.Methods A total of 105 cases of high risk premature infants with BPD,who were born in the Neonatal Intensive Care Unit (NICU) from Shenzhen Maternity and Child Healthcare Hospital from July 15,2015 to December 25,2016,and their gestational age ≥ 27 weeks and ＜ 32 weeks or birth weight ≥ 1 000 g and ＜ 1 500 g were collected for a prospective randomized controlled trial,and were randomly divided into 3 groups:early inhalation group(34 cases),late inhalation group(34 cases) and non-inhalation group(37 cases).The oxygen time,and the incidence of BPD,periventricular-intraventricular hemorrhage (IVH),retinopathy of prematurity (ROP),necrotizing enterocolitis of the newborns (NEC),patent ductus arteriosus in preterm infants (PDA),sepsis and hyperglycemia of infants in 3 groups were compared.Results The average oxygen time in early inhalation group was 9 days,while in late inhalation group and the non-inhalation group was 15 days and 18 days,respectively.The average oxygen time in early inhalation group was significantly lower than that in the late inhalation group and the non-inhalation group,with the difference being statistically significant (H =6.09,P ＜ 0.05).The noninvasive ventilation time in early inhalation group was 3 days,while both the late inhalation group and non-inhalation group were 6 days.The noninvasive ventilation time in early inhalation group was significantly lower than that in the late inhalation group and non-inhalation group,with the difference being statistically significant (H =6.17,P ＜0.05).The incidence of BPD in the early inhalation group,late inhalation group and non-inhalation group were 14.7％ (5/34 cases),20.6％ (7/34 cases) and 37.8％ (14/37 cases),respectively.The incidence of BPD in non-inhalation group was significantly higher than that in the early inhalation group and late inhalation group,with the difference being statistically significant (x2 =12.017,P ＜ 0.05).There were no significant differences in IVH,ROP,NEC,PDA,sepsis and hyperglycemia among the 3 groups (all P ＞ 0.05).Conclusions Postnatal inhalation of Budesonide in early stage in high risk very low birth weight infants can reduce the incidence of BPD and the oxygen time,and the adverse reactions are not obvious.
ABSTRACT
Application of sustained lung inflation (SLI)during neonatal resuscitation can increase alveolar opening,promote lung fluid absorption and maintain the appropriate functional residual capacity (FRC) which can complete the transition from fetal phase of respiratory system to neonatal period.In recent years,SLI has also been confirmed by a large number of animal experiments and clinical studies,and it is expected to be practically applied in the resuscitation of newborns.However,more randomized controlled trials with a large number of samples is required for exploring suitable populations,methods of operation,and recent or long-term effects on newborns.Now,the application and research of SLI in neonatal resuscitation are described.