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Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d<DOT≤15.0 d), Q 3 (15.0 d<DOT≤27.0 d) and Q 4 (DOT>27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%<breast milk intake ratio≤50%), medium-ratio breastfeeding group (50%<breast milk intake ratio≤75%) and high-ratio breastfeeding group (breast milk intake ratio>75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.
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OBJECTIVE@#To review the clinical features of a male twin affected with glutaric academia type I (GA-I) and analyze the variations of glutaryl-CoA dehydrogenase (GCDH) gene.@*METHODS@#Clinical data of the pair of twins and their parents were collected. Genomic DNA was extracted from peripheral blood samples, and variants of GCDH genes were detected by capture sequencing using a customized panel. Variants of the twins and their parents were verified by Sanger sequencing.@*RESULTS@#The level of glutaric acyl carnitine (C5DC + C6OH) was 3.26 μmol/L in the male twin. The relative level of glutaric acid in urine was 547.51 by gas chromatography mass spectrometry analysis. Cerebral ultrasonography showed that the patient had subependymal hemorrhage, but no serious clinical manifestation was noted. After treating with special formula milk powder and L-carnitine, the boy showed good growth and development. Two heterozygous variants of the GCDH gene were detected in the patient, among which c.416C>G was suspected to be pathogenic, while c.109_110delCA was unreported. The variants were respectively inherited from his parents. The twin girl only carried the c.416C>G variant.@*CONCLUSION@#GA-I can be diagnosed by mass spectrometry, urine gas chromatographic mass spectrometry, imaging as well as genetic diagnosis. Early diagnosis and intervention is important.
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Female , Humans , Male , Amino Acid Metabolism, Inborn Errors , Genetics , Brain Diseases, Metabolic , Genetics , Glutaryl-CoA Dehydrogenase , Genetics , Mutation , PhenotypeABSTRACT
Objective To investigate the influences of maternal gestational diabetes mellitus (GDM) on amino acid levels in neonates.Methods From June 2016 to May 2017,393 pregnancies diagnosed with GDM in Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University and 3 924 normal pregnancies were enrolled in this study.Clinical data of the gravidas and their newborns were collected.Heel blood samples were collected at 72 to 96 hours after birth.Tandem mass spectrometry was performed to detect the levels of 11 amino acids including alanine,arginine,citrulline,glycine,leucine/ isoleucine/hydroxyproline,methionine,ornithine,phenylalanine,proline,tyrosine and valine in neonatal heel blood.Differences in amino acid levels between the two groups were compared by t test.Influences of GDM on neonatal amino acid levels were analyzed by multivariate linear regression.Results Compared with the healthy pregnancy group,neonates in the GDM group had higher levels of methionine [(21.01 ±6.30) vs (19.93±6.47) μmol/L,t=3.159,P=0.002] and phenylalanine [(47.19±9.19) vs (45.78±8.58) μ mol/L,t=3.076,P=0.002],but lower levels of alanine [(280.51 ±64.54) vs (290.15±68.40) μ mol/L,t=2.678,P=0.007],proline [(147.64±30.64) vs (152.36±33.57) μ mol/L,t=2.680,P=0.007],tyrosine [(85.21 ±29.50) vs (90.60± 33.32) μ mol/L,t=3.089,P=0.002] and ornithine [(101.22±28.79) vs (105.83±30.10) μmol/L,t=2.906,P=0.004].Multivariate linear regression analysis showed that GDM was responsible for the increase of methionine (β=0.69,95％CI:0.02 to 1.37,P=0.044) and phenylalanine (β=1.60,95％CI:0.69 to 2.51,P=0.001),and the decrease of tyrosine (β=-4.98,95％CI:-8.42 to-1.54,P=0.005) and ornithine (β=-3.16,95％CI:-6.30 to-0.02,P=0.048) in neonates.Conclusions GDM neonates has increased of methionine and phenylalanine levels and decreased tyrosine and omithine levels.
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Objective To investigate the effect of intensive follow-up on the correction of mild anemia among infants in the community. Methods Eighty four infants aged 6-12 months with mild anemia managed systematically in the child health clinic of Changzhou Lanling Community Health Service Center were enrolled from April 2016 to January 2017. Seventy five cases completed the study, including 36 cases managed with intensive follow-up (study group) and 39 cases managed with routine procedure (control group). The hemoglobin(Hb) levels, Hb changes, the rates of correction and closure of anemia and the medication of iron treatment were compared between two groups during the 2 and 6 month-follow-up. Results The Hb value, Hb changes, the rate of correction in study group were significantly higher than those in control group after 2 monthsof treatment [(113.50 ± 5.40)g/L vs. (109.13 ± 7.91)g/L, t=2.772, P=0.007;(13.22 ± 4.56)g/L vs. (7.54 ± 6.75)g/L, t=4.240, P<0.001;77.8％(28/36) vs. 46.2％(18/39),χ2=6.617, P=0.010, respectively]. In 6 month-follow-up, the Hb value, the rate of correction and closure rate in study group were significantly higher than those in control group [(116.22±3.72)g/L vs. (112.23±5.90)g/L, t=3.471, P=0.001;88.9％(32/36) vs. 66.7％(26/39),χ2=4.082, P=0.043;77.8％(28/36) vs. 41.0％(16/39),χ2=8.967, P=0.003, respectively]. For infants receiving iron treatment, the proportion of standardized medication in study group was significantly higher than that in control group after 2 months (14/14 vs. 4/8, χ2=5.525, P=0.019); the Hb values in study group were significantly higher than those in control group after 2 months[ (109.93 ± 3.51)g/L vs. (102.88 ± 2.88)g/L, t=4.820, P<0.001)and 6 months[(114.50±4.00)g/L vs. (108.55±5.04)g/L, t=3.297, P=0.003] of follow-up. Conclusion The intensive follow-up management can significantly improve the Hb values, the rates of correction and closure rate of infants with mild anemia in the community.
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Objective To study the effects of family integrated care ( FIcare ) in the neonatal intensive care unit ( NICU) on preterm infants and their mothers′physical and mental health.Method From Jan 2016 to Dec 2016, preterm infants(birth weight 1000~2000 g;gestational age 26~34 weeks stabilized in NICU were randomly assigned into two groups:FIcare group and control group .The incidences of major diseases in infants , their mothers′depression score and anxiety score were studied .Result A total of 40 infants were assigned into two groups respectively .No significant differences existed between the two groups in gender , gestational age , brith weight , age, breastfeeding rate and their mothers′depression score and anxiety score (P>0.05).At discharge, the breastfeeding rate (90.0%vs.52.5%) and weight gain [(2258 ±112) g vs.(2105 ±103) g] of the FIcare group were significantly higher than the control group, and the hospital stay duration [(42.0 ±15.7) d vs.(43.5 ±14.3) d], hospitalization expenses [(40,000 ±18,000) RMB vs.(44,000 ±19,000) RMB], oxygen therapy duration [(10.4 ±5.7) d vs. (11.7 ±7.9) d], CPAP duration [(7.2 ±4.3) d vs.(8.1 ±5.0) d], mothers′depression score [(48.7 ±3.0) vs.(57.6 ±2.7)] and anxiety score [(49.4 ±1.1) vs.(61.1 ±1.9)]of the FIcare group were significantly lower than the control group ( P <0.05 ) . Conclusion Family-integrated care is beneficial for the recovery of preterm infants and their mother′s physical and mental health .
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Objective Follow-up monitoring was carried out in infants infected with cytomegalovirus (CMV) so as to find out whether breastfeeding could bring about changes of CMV viral load.Methods Saliva of the neonates born in Changzhou Maternal and Child Health Hospital from Nov.2010 to Feb.2012,was collected for CMV screening.Premature infants,or the infants with seriously infectious diseases and deformities were excluded,such as severe intrauterine infection,congenital immune deficiency disease and so on.The full-term infants with aymptomatic infection were divided into the artificial feeding group and the breastfeeding group,and followed up for 6 months.During the 1st,the 3rd and the 6th month after their birth,their saliva and their mother's breast milk were collected.The method of realtime fluorescent quantitative PCR was adopted to test the changes in the viral load of CMV-DNA in the saliva and breast milk.Meanwhile,head B-ultrasound test,otoacoustic emission hearing screening,liver function test,blood routine analysis and so on were performed.Results Among infants from both artificial feeding group and breastfeeding group,during the 1 st,the 3 rd and the 6th month after birth,no significant changes in the DNA viral load of saliva and breast milk cytomegalovirus were found (t =2.832,3.161,3.475,all P ＞ 0.05).And in breastfeeding group,the cytomegalovirus DNA viral load in breast milk were 3.125 × 103 ±2.017 × 102 (the 1st month),2.688 × 103 ±2.251 × 102 (the 3rd month),3.016 × 103 ±2.613 × 102 (the 6th rmonth),also no significance during the time (F =1.725,P =0.667).Meanwhile,the head B-ultrasound,otoacoustic emission hearing screening,liver function test,blood routine analysis,etc showed no clinical significance (F =1.725,P =0.667).Conclusions In the CMV-infected neonates,even if CMV in breast milk is tested to be positive,breastfeeding can continue without causing secondary symptoms of infection.
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Objective To investigate the feasibility of congenital cytomegalovirus (CMV)infection screening by saliva polymerase chain reaction.Methods From November 1,2010 to February 29,2012,6733 newborns born in Changzhou Maternal and Child Health Care Hospital were enrolled.Saliva samples (0.2 ml) were collected within 3 days after birth,CMV-DNA was detected by real time-polymerase chain reaction and hearing screening was done with EroScan transient-evoked otoacoustic emissions at the same time.The positive rate of congenital CMV infection screening was calculated and clinical manifestations were analyzed.Chi square test was applied to statistical analysis.Results Totally 6733 newborns were screened and 107 of them were found to be positive with CMV DNA,the positive rate was 1.59％ (107/6733),among which 88 were asymptomatic (82.2％) and 19 were symptomatic (17.8 ％).The major clinical manifestations of the neonates with positive CMVDNA were pathological jaundice (13 cases),hepatomegaly (5 cases),granulocytopenia,thrombocytopenic purpura,anemia and small for gestational age (two cases each).Fourteen newborns had only one major clinical manifestation,three newborns had two major clinical manifestations and two newborns had three major clinical manifestations.There was no statistical difference between newborns with positive and negative CMV DNA on hearing screening [hearing loss in one ear:8.4％ (9/107) vs 5.8％ (382/6626); hearing loss in two ears:3.7 ％ (4/107) vs 2.4 ％ (159/6626),x2 =2.776,P=0.241].Conclusion It is feasible to screen congenital CMV infection with saliva sample.
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Objective To investigate the role of serum S-100B of umbilical cord blood in the early diagnosis of newborn hypoxic ischemic encephalopathy(HIE).Methotis 307 full-term newborns with asphyxia were selected as subiects and 43 normal full-term newborns delivered during the corresponding period were selected as controls.The umbilical cord blood sample was acquired.46 cases of 307 subjects with asphyxia developed into HIE,31 cases with mild HIE and 15 cases with moderate and severe HIE.The serum S-100B concentration of umbilical cord blood was detected by ELISA analysis.Results ①There was no significant difference in the serum S-100B concentration of umbilical cord blood between the male sub-group and female sub-group in normal group;②The concentration in control group and HIE group were(1.03±0.32)μg/L and(2.53±1.1)μg/L respectively(t=8.848,P＜0.05＝;③The concentration in mild HIE group and moderate to severe HIE group were(1.03±0.32)μg/L nd(3.49±1.23)μg/L respectively,which were significantly different with control group(F=79.6909,P＜0.01).Conclusion Sex has no significant relation to the serum S100B concentration.Serum S-100B concentration of umbilical cord blood can be biomarkers for early diagnosis of newborn HIE.