Expert consensus on nutritional management of preterm infants with bronchopulmonary dysplasia / 中国当代儿科杂志

Inadequate nutrition supply in the early stage after birth is a risk factor for the development of bronchopulmonary dysplasia (BPD) in preterm infants, and it is also closely associated with the progression and clinical outcome of BPD. Optimized nutritional support is of great importance to reduce the incidence and severity of BPD and promote lung development and neurological prognosis. Based on the relevant studies in China and overseas, the expert consensus on BPD nutrition management is developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. The consensus includes the following seven aspects: the importance of nutrition in BPD, fluid intake, energy intake, enteral nutrition, parenteral nutrition, post-discharge nutrition, and nutrition monitoring and evaluation.

Analysis of In-hospital Neonatal Death in the Tertiary Neonatal Intensive Care Unit in China: A Multicenter Retrospective Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Globally, the proportion of child deaths that occur in the neonatal period remains a high level of 37-41%. Differences of cause in neonate death exist in different regions as well as in different economic development countries. The specific aim of this study was to investigate the causes, characteristics, and differences of death in neonates during hospitalization in the tertiary Neonatal Intensive Care Unit (NICU) of China.</p><p><b>METHODS</b>All the dead neonates admitted to 26 NICUs were included between January l, 2011, and December 31, 2011. All the data were collected retrospectively from clinical records by a designed questionnaire. Data collected from each NICU were delivered to the leading institution where the results were analyzed.</p><p><b>RESULTS</b>A total of 744 newborns died during the 1-year survey, accounting for 1.2% of all the neonates admitted to 26 NICUs and 37.6% of all the deaths in children under 5 years of age in these hospitals. Preterm neonate death accounted for 59.3% of all the death. The leading causes of death in preterm and term infants were pulmonary disease and infection, respectively. In early neonate period, pulmonary diseases (56.5%) occupied the largest proportion of preterm deaths while infection (27%) and neurologic diseases (22%) were the two main causes of term deaths. In late neonate period, infection was the leading cause of both preterm and term neonate deaths. About two-thirds of neonate death occurred after medical care withdrawal. Of the cases who might survive if receiving continuing treatment, parents' concern about the long-term outcomes was the main reason of medical care withdrawal.</p><p><b>CONCLUSIONS</b>Neonate death still accounts for a high proportion of all the deaths in children under 5 years of age. Our study showed the majority of neonate death occurred in preterm infants. Cause of death varied with the age of death and gestational age. Accurate and prompt evaluation of the long-term outcomes should be carried out to guide the critical decision.</p>

Characterization of acid-and pepsin-soluble collagens from spines and skulls of skipjack tuna (Katsuwonus pelamis) / 中国天然药物

Acid-soluble collagen (ASC) and pepsin-soluble collagen (PSC) from the spine (ASC-SP and PSC-SP) and skull (ASC-SK and PSC-SK) of the skipjack tuna, Katsuwonus pelamis, were successfully isolated and characterized. The yields of ASC-SP, PSC-SP, ASC-SK and PSC-SK were (2.47 ± 0.39)%, (5.62 ± 0.82)%, (3.57 ± 0.40)%, and (6.71 ± 0.81)%, respectively, on the basis of dry weight. The four collagens contained Gly (330.2-339.1 residues/1 000 residues) as the major amino acid, and their imino acid contents were between 168.8 and 178.2 residues/1 000 residues. Amino acid composition, SDS-PAGE, and FTIR investigations confirmed that ASC-SP and ASC-SK were mainly composed of type I collagen, and had higher contents of high-molecular weight cross-links than those of PSC-SK and PSC-SP. The FTIR investigation also certified all the collagens had triple helical structure. The denaturation temperatures of ASC-SK, PSC-SK, ASC-SP, and PSC-SP were 17.8, 16.6, 17.6, and 16.5 °C, respectively. All isolated collagens were soluble at acidic pH (1-5) and lost their solubilities when the NaCl concentration was above 2% (W/V). The isolated collagens from the spines and skulls of skipjack tuna could serve as an alternative source of collagens for further application in food, cosmetic, biomedical, and pharmaceutical industries.

Clinical review of enteral feeding of extremely low birth weight infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To review the clinical data of enteral feeding of extremely low birth weight infants (ELBWI), and analyze the influencing factors.</p><p><b>METHOD</b>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.</p><p><b>RESULT</b>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 group B [(88.9 ± 35.4) ml vs. (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.</p><p><b>CONCLUSION</b>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.</p>

Clinical characteristics and long-term follow-up analysis of three cases with newborn aristolochic acid nephropathy / 中华儿科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics and prognosis of newborn aristolochic acid nephropathy induced by akebia.</p><p><b>METHOD</b>Retrospective analysis of clinical manifestations, therapy and prognosis was made upon data of 3 newborn infants with renal function lesion induced by akebia.</p><p><b>RESULT</b>Three infants who were fed with Chinese herbal medicines containing akebia trifoliate suffered from acute renal failure, renal glomerular and tubular injury, with symptoms of vomiting, diarrhea, and oliguria. Laboratory tests manifested hyperpotassemia, hyponatremia, elevation of serum creatinine and urea nitrogen, and metabolic acidosis. Renal glomerular lesion was mild, presented with proteinuria and increased serum β(2) microglobin. Renal dysfunction was manifested with alkaline urine, glucosuria, positiveness of urine glucose, ketone and aminoaciduria, and increased urine β(2) microglobin excretion. After symptomatic treatment for 3 to 4 weeks, the renal function of these infants recovered. Proteinuria, aminoaciduria and glucosuria turned negative within 5 to 8 months, 3 months to 1 year, and 9 months to 3 years, respectively. Urine pH decreased to 7.0 after 5.0 - 5.5 years. All cases took citric acid mixtures for 5.5 to 6 years. A 12-years follow-up demonstrated that serum creatinine of 3 cases were within normal range during the first 11 years of life, however recent follow-up showed increased serum creatinine of case 1 and case 2, except for serum creatinine of case 3 remained normal. The estimated glomerular filtration rate (eGFR) of all the 3 cases decreased. Among which, eGFR of case 1 and case 2 were lower than 90 [ml/(min·1.73 m(2))], and decreased 1.1 [ml/(min·1.73 m(2))] and 0.6 [ml/(min·1.73 m(2))] per year during recent six years, respectively. No obvious decrease of eGFR was observed in case 3. Blood gas analysis and urine routine were normal, yet blood and urine β(2) microglobin excretion were still high. Urinary N-acetyl-β-D-glucosaminidase increased again after having returned to normal.</p><p><b>CONCLUSION</b>Newborn aristolochic acid nephropathy induced by akebia might induce acute renal failure and renal tubules injury. Renal function could recover after symptomatic treatment in short-term. Nevertheless, glomerular filtration rate presents a slow descending tendency and renal tubules lesion lasted for many years, which requires a long-term follow-up.</p>

Early diagnosis of the premature infant nosocomial infection by clinical assessment / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the possibility of bacterial infections in the hospital among the premature and low birth weight newborns by scoring their clinical assessments and laboratory examinations.</p><p><b>METHODS</b>From January 2002 to January 2003, 62 newborns with birth-weight less than 2,000 g were divided into two groups, infected group and control group, based on the current diagnostic standards for newborns. We scored the newborns according to the severity of their illnesses based on their clinical manifestations and laboratory examination, and compared the scores obtained before and after effective antibiotic treatment.</p><p><b>RESULTS</b>It was found that the scores were significantly different (P < 0.01) between the infected group and the control group before treatment; while after antibiotic treatment, the difference was no longer significant (P > 0.05). In the infected group, the scores obtained pre- and post-treatment were significantly different (P < 0.01). In the control group, in those with the scores >or= 11 before antibiotic treatment, the scores significantly decreased (P < 0.01) after-treatment; but in those with the scores < 11, the score did not decrease (P > 0.05). These results indicate that the current diagnostic criteria for newborns may not be sensitive enough for premature infants, low birth weight infants and very low birth weight infants.</p><p><b>CONCLUSION</b>Scoring the low birth weight premature infants with their clinical manifestations has the advantages in judging the possibility of infection and monitoring the effectiveness of the anti-infection treatment.</p>

The enteral feeds in very low birthweight infants / 中华儿科杂志

<p><b>OBJECTIVE</b>The study aimed to investigate the clinical characteristics of enteral feeding in very low birthweight infants (VLBWI), to determine the risk factors associated with feeding intolerance, and to analysis the beneficial factors in order to improve gut motility and maturation.</p><p><b>METHODS</b>The study was carried out in 38 VLBWI, birthweight (1,314 +/- 180) g, in the NICU of authors' department. They were divided into feeding tolerance and intolerance groups, and earlier enteral feeding and later groups. Comparison was made between two groups about the associate factors.</p><p><b>RESULTS</b>The incidence of feeding intolerance was 55 per cent. There was a significant difference in two groups about the clinical factors (gestational age, birth weight, the age of the first feeding, time of full enteral feeding and the hospitalized days). The significant risk factors associated with feeding intolerance were the smaller gestational age, umbilical catheterization, theophylline therapy, and delay of the time when the first feed was commenced.</p><p><b>CONCLUSION</b>If vital signs are stable, trophic feeding in VLBWI should be commenced as soon as possible during the first 6 days of life. Early trophic feeding, slowly increase the feeding volume, carefully fast, and moving bowel were suggested and will improve feeding tolerance and gastrointestinal maturation.</p>