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Objective To compare the clinical application of FACS analysis indicators and traditional infection indicators in early diagnosis of infection in premature infants .Methods 60 premature infants were divided into the infected group (n=29) and non-in-fected group(n=31) according to their clinical symptoms and laboratory results .BD FACSCanto Flow Cytometry was employed to detect CD11b ,CD64 and CD45RO ,BACTEC 9120 Automated Blood Culture System was used to conduct body fluids and secretions culture .Sysmex XE-5000 Automated Hematology Analyzers and i-CHROMA Reader Immunofluorescence Analyzer were adopted to conduct the complete blood count test and hypersensitive C-reactive protein (hs-CRP) detection ,respectively .Receiver operator characteristic(ROC) curve was used to analyze the diagnostic value of indexes above in preterm infants with infection ,and their sen-sitivity ,specificity ,positive predictive value and negative predictive value were calculated .Results On the first day after birth ,neu-trophil CD11b ,CD64 ,monocyte CD64 and hs-CRP levels of preterm infants in infection group were obviously higher than those in non-infection group(P0 .05) .ROC area under the curve(AUC)>0 .7 was found in Neutrophil CD64 ,monocyte CD64 and hs-CRP ,which had higher value in early diagnosis of infection in premature infants .The highest sensitivity ,specificity ,positive pre-dictive value and negative predictive value were 79 .31% ,96 .78% ,83 .34% and 75 .00% ,respectively .Conclusion FACS analysis indicators has better clinical value in the early diagnosis of infection in premature infants .
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Objective To evaluate nutritional status during hospitalization of very low birth weight infant (VLBWI) and to analyze the risk factors for extrauterine growth retardation (EUGR) at discharge.Methods VLBWIs in neonatal intensive care unit (NICU),＜12 hours after birth on admission and length of hospital stay over 14 days from January 10,2007 to October 1,2011,were retrospectively studied.Relevant information,including perinatal data,weekly nutrition supplements and weight gain,and neonatal complications were collected.Data were analyzed by Chi-square test,t-test and multivariate Logistic regression analysis.Results In all 256 VLBWIs recruited,61 (23.8％) were small for gestational age at birth.One hundred and seventy-two cases,who were EUGR by weight at discharge,were divided into EUGR group.While the other 84cases were divided into non-EUGR group.The mean gestational age and mean birth weight of EUGR infants were (29.3± 1.2) weeks and (1 240± 170) g,among them,53.5％ (92/172) were extreme EUGR.Univariate analysis showed that the total energy intake [(84.9±20.9) kcal/(kg · d)],protein intake [(2.6±0.5) g/(kg · d)] and proportion ofenteral nutrition [(26.1 ± 15.3) ％] on day 7 of EUGR infants were lower than those ofnon-EUGR ones [(92.4±20.2) kcal/(kg · d),(2.8±0.5) g/(kg · d) and (30.2± 13.2) ％,respectively,t=-2.71,P=0.007; t=-2.19,P=0.030; t=-2.10,P=0.037].The enteral nutrition at the time to regain birth weight in EUGR group was lower than those in non-EUGR group [(36.4±21.6) kcal/(kg · d)vs (44.2±24.1) kcal/(kg · d),t=-2.58,P=0.011],the average growth rate after regaining birth weight and enteral nutrition proportion on day 14 were lower [(15.5±4.1) g/(kg · d) vs (17.3±3.3) g/(kg · d),(44.6± 16.6) ％ vs (49.5± 14.4) ％,respectively; t=-3.61,P=0.000; t=-2.42,P=0.016].The duration of parenteral nutrition in EUGR infants was longer than that in the non-EUGR infants [(39.6± 13.8) d vs (34.1 ±8.6) d,t=3.94,P=0.000].Multivariable logistic regression showed that small for gestational age at birth,low protein intake and low enteral nutrition proportion on day 7,low rate of weight gain after regaining birth weight were associated with EUGR on discharge,and small for gestational age at birth was the leading risk factor (OR=42.66,95％CI:9.09-200.23).Conclusions The incidence of EUGR among VLBWIs is high on discharge.Enhancing perinatal health care and early rational nutrition support are critical to reduce the incidence of EUGR and improve the neuro-developmental prognosis of these babies.
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Objective To investigate the short-term clinical outcomes and perinatal risk factors in very low birth weight infants (VLBWI) with delayed enteral feeding (DEF).Methods Three hundred and fifty-five cases of VLBWI admitted to neonatal intensive care unit from Jan 2007 to Oct 2011 served as study objects,and the clinical data of which were analysed retrospectively.According to days to initiate enteral feeding after birth,355 VLBWI were divided into two groups:DEF group (initiate enteral feeds ≥5 days,n =55)and early feeding group (initiate enteral feeds ≤4 days,n =298).The short-term clinical outcomes were compared in 299 cases,including DEF group 44 cases and early feeding group 255 cases,in which cure or improvement were achieved and hospital stay ＞ 14 d.The perinatal risk factors were subjected to univariate and multivariate logistic regression analysis.Results The incidence of DEF was 16.05％ (57/355) in VLBWI.The time to regain birth weight in DEF group was significantly longer than early feeding group [(11.86 ± 3.86) d vs (9.76 ± 3.83) d,P ＜ 0.01],and the incidences of parenteral nutrition associated cholestasis [27.27％ (12/44)] and extrauterine growth retardation at discharge [79.55 ％ (35/44)] in DEF group were also significantly higher than early feeding group respectively [11.76％ (30/255) and 61.57％ (157/255),P ＜ 0.05].Multivariable logistic regression analysis showed that infants born to mother with placental abruption had higher risk of exposure for DEF than those without placental abruption (OR =2.74,95％ CI 1.06 ～7.05,P ＜ 0.05).Similarly,infants with mechanical ventilation had also higher odds of DEF than those with-out mechanical ventilation (OR =3.51,95 ％ CI 1.92 ～ 6.42,P ＜ 0.01).Conclusion Placental abruption and mechanical ventilation are independent risk factors for DEF in VLBWI.Improving neonatal outcome through enhancing obstetric quality and strengthening cooperation between obstetric and neonatology department is still the key to reduce DEF in VLBWI.
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Objectives To investigate the clinical characteristics and prognosis of late-onset group B streptococcal (GBS) sepsis. Methods From Jan. 2007 to Dec. 2011, iffteen neonates diagnosed with late onset GBS sepsis at discharge from NICU were retrospectively analyzed, meanwhile, thirty-four neonates diagnosed with late onset non-GBS Gram-positive bacteria sepsis at discharge were selected as controls during the same period. Results There were signiifcant differences in occurrence rates of shortness of breath, convulsion and apnea between late onset non-GBS sepsis group and late onset GBS sepsis group (P100×106/L, high-sensitivity C-reaction protein (hsCRP)>100 mg/L and glucose in CSF0.05). Conclusions The late onset GBS sepsis is in-sidious, atypical, with many complications and sequelae. It is important for the suspicious neonates to use effective antibiotics as early as possible.
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Objective To study the risk factors of periventricular-intraventricular hemorrhage (PIVH) in extremely low birth weight infants(ELBWI). Methods A retrospective study was performed in 41 ELBWI hospitalized between January 2001 and August 2008. Univariate analysis and Logistic regression analysis were performed to detect the risk factors of PIVH. Results Of 41ELBWI, twenty-three suffered from PIVH with the incidence of 56.1%. Univariate analysis revealed that,in PIVH group,gestational age,mean blood pressure and the minimum values of blood pressure were lower than non-PIVH group[ ( 27.1 ± 1.9 ) weeks vs ( 28. 7 ± 1.6) weeks, t = 2. 834, P ＜ 0. 05 ;(28.9±4.8) mm Hg vs (33.1±4.9) mm Hg, t=-2.747,P＜0. 05; (24.4±4.3) mm Hg vs (31.4 ± 6.6) mm Hg,t= -3. 863, P＜0. 05], while blood pressure fluctuation and the highest values of PaCO2 during the first week of life were higher[(19.0 ± 5.2) mm Hg vs (13.7 ± 4. 8) mm Hg;(60. 2± 19. 4) mm Hg vs (49.5±12.1) mm Hg] (t= 3. 310 and 2. 166, P＜0. 05), the incidence of administration of pulmonary surfactant, neonatal respiratory distress syndrome, shock, hypotension before 4 days of age, hyperglycemia and mechanical ventilation therapy were higher[73. 9 % (17/23) vs 27. 8%(5/18), 60. 9%(14/23) vs 27.8%(5/18),52. 2%(12/23) vs 5.5%(1/18),73. 9%(17/23) vs 33.3%(6/18) ,78. 3%(18/23) vs 44. 5%(8/18),87. 0% (20/23) vs 44. 5% (8/18)]( all P＜0.05).Multivariate Logistic analysis revealed that blood pressure fluctuation (OR = 1. 260, 95% CI: 1. 009-1. 572, P = 0. 041 ) and lowest mean blood pressure(OR = 0. 805,95 % CI: 0. 672-0. 965, P = 0. 019)were risk factors of PIVH. Among twenty-eight ELBWI received mechanical ventilation, only peakinspiratory pressure(OR=- 2. 086,95% CI: 1. 140-3. 819, P= 0. 017) was the risk factor of PIVH by Logistic analysis. Conclusions Low blood pressure and blood pressure fluctuation may be risk factors of PIVH in ELBWI. The high values of peak inspiratory pressure is a risk factor of ELBWI with mechanical ventilation.