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Objective To investigate the influence of early skin-to-skin contact (SSC) after cesarean section on maternal psychological status and the rate of exclusive breastfeeding.Methods This was a prospective randomized controlled study enrolling 221 singleton pregnant women who underwent elected caesarean section at term in Shenzhen Nanshan Maternity and Child Healthcare Hospital from August 1 to December 31,2017.They were randomly divided into SSC group and control group.In the SSC group,naked infants were placed on the mothers' chests within 1 h after delivery for 1-2 h,while those in the control group received standard care.Clinical outcomes were compared between two groups,including the rate of exclusive breastfeeding and score of Breastfeeding Self-Efficacy Scale (BSES) and Edinburgh Postnatal Depression Scale (EPDS) at 72 h and 42 d after delivery,scores of Breastfeeding Assessment Tool (BAT) for the first breastfeeding,time to lactogenesis and successful rate of first breastfeeding.Two-independent sample t test,Chi-square test and binary logistic regression analysis were used as statistical methods.Results Eventually,210 puerperae were analyzed with 105 in each group.Twenty in the SSC group and 17 in the control group were lost to follow-up 42 d after delivery.The successful rate of first breastfeeding [77.1％ (81/105) vs 59.1％ (62/105),x2=7.913,P=0.005],BAT scores (9.5± 1.7 vs 8.6± 1.4,t=4.115,P＜0.001),the rate of lactation initiation ≤ 24 h after birth [41.0％ (43/105) vs 12.4％ (13/105),x2=23.205,P＜0.001],and exclusive breastfeeding rates [36.2％ (38/105) vs 22.9％ (24/105),x2=4.486,P=0.034;76.5％ (65/85) vs 60.2％ (63/88),x2=5.261,P =0.022] and BESE scores (117.5± 12.0 vs 111.8±22.3,t=2.100,P=0.037;124.3± 11.6 vs 113.1 ± 19.0,t=4.710,P＜0.001) at 72 h and 42 d after delivery were all higher in the SSC group than those in the control group.However,no statistically significant difference in EPDS scores was observed between the two groups at either 72 h or 42 d after delivery (5.4±3.5 vs 5.9±4.0,t=0.937,P=0.350;7.0±3.7 vs 8.1 ±4.0,t=0.905,P=0.058).Binary logistic regression analysis showed early SSC was a protective factor for successful exclusive breastfeeding 42 d after delivery (OR=2.359,95％CI:1.173-4.743,P=0.016).Conclusions Early SSC after caesarean should be recommended as a usual clinical practice because it can improve maternal confidence on breastfeeding,shorten the time to lactogenesis and increase the successful rate of first breastfeeding and exclusive breastfeeding rate during puerperium.
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Objective To explore the analgesic efficacy and stability of oral sucrose for the treatment of procedural pain in preterm infants,then to evaluate the effect of repetitive oral sucrose on glucose metabolism.Methods Eighty-two preterm infants (gestational age ≤34 weeks,birth weight ≤2 000 g)who were admitted to Neonatal Intensive Care Unit in Shenzhen Nanshan Maternity and Child Health Care Hospital between January 2014 and October 2016 were randomized into an intervention group (n =42) and a control group (n =40).The intervention group received a pretreatment with 0.3-0.5 mL of 120 g/L sucrose solution bemore a painful procedure was executed.But the control group only received usual care.The two groups were compared for the changes in heart rate (HR),blood pressure (BP),percutaneous oxygen saturation(SPO2) in pre-and post-painful procedure and the duration of the HR recovering to pre-procedure level.The variations of Neonatal Infant Pain Scale (NIPS) of pre-and post-painful procedure were compared in each group and between 2 groups during the first 4 weeks of life.Finally,the concentrations of fasting blood glucose,the level of insulin,and glucose-to-insulin ratio were compared between the 2 groups on the day of discharge.Results The variations in HR,BP,NIPS and SPO2 between pre-and post-painful procedure were lower in the intervention group than those in the control group [(10.59 ± 5.50) times/min vs.(20.75 ± 14.18) times/min;(1.86 ± 2.45) mmHg vs.(3.64 ± 1.78) mmHg (1 mmHg =0.133 kPa);(2.11 ± 0.93) scores vs.(3.25 ± 1.21)scores;(0.71 ± 0.53) ％ vs.(1.03 ± 0.54) ％],and the differences were statistically significant (t =-3.298,-3.008,-4.084,-2.195;P =0.002,0.004,0.001,0.033).Meanwhile,there was a shorter duration of the HR recovery to pre-procedure level in intervention group compared with the control group[(36.27 ±9.86) s vs.(54.72 ±26.43) s,t =-3.093,P =0.004].The variations in NIPS of pre-and post-procedures showed no significant difference in the 2 groups during the first 4 weeks (F =0.188,P =0.904).The concentrations of fasting blood glucose,the level of insulin,and glucose-to-insulin ratio were similar between the 2 groups when the infants were discharged [(4.73 ± 0.85) mmol/L vs.(4.96 ± 0.83) mmol/L,P =0.411;(6.30 ± 13.65) mU/L vs.(6.44 ± 8.60) mU/L,P =0.969;0.069 ± 0.135 vs.0.096 ± 0.108,P =0.567].Conclusions Oral sucrose (120 g/L) has an effective and stable analgesic effect on preterm neonates pain stimulation,but no significant effect on glucose metabolism.
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Objective To study the impact of sucrose analgesia on pain response and salivary cortisol levels in preterm infants.Method Preterm infants admitted to our hospital between January 2014 and October 2016 with gestational age ＜ 34 weeks,birth weight ＜ 2 000 grams,and length of hospital stay ≥ 14 days were prospectively assigned into two groups.The intervention group received 0.3 ～ 0.5 ml of 12％ sucrose solution two minutes before each painful procedure,while the control group received none.At time of discharge and at 8 months of corrected age (CA),pain response was measured,saliva samples were collected and salivary cortisol levels were assayed using Enzyme Immunoassay Kit before and after pain stimulus.Result A total of 82 infants were included in our study,42 in the intervention group,and 40 in the control group.There were no statistically significant differences between two groups in pain response at discharge and 8 months of CA.At time of discharge and at 8 months of CA,infants in intervention group had higher salivary cortisol levels than in control group at time of discharge and 8 months of CA after pain stimulus [6.8 (5.6,11.7) ng/ml vs.5.4 (2.6,10.8) ng/ml,5.0 (3.3,5.6) ng/ml vs.4.8 (3.0,5.5) ng/ml] after log transformation,two groups were statistically significant (P ＜ 0.05).However,before the pain stimulus,no differences were found between two groups.Multiple stepwise regressions analysis showed that salivary cortisol level post pain stimulus was negatively related to the total number of pain stimulus,and positively related to sucrose analgesia at discharge and 8 months of CA.Conclusion Sucrose analgesia may mitigate the negative effect of repeated pain stimulus on cortisol regulation in preterm infants,however,may have no influence on pain response of them.
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Objective To study the constituent ratio and antimicrobial susceptibility patterns of pathogenic bacteria in patients with urinary tract infection (UTI) in NICU. Methods Data were collected retrospectively of neonates who admitted to NICU in St. Louis Children' s Hospital in Washington University School of Medicine between Jan 1 ,2005 and Dec 31,2006. Results The prevalence of UTI in NICU was 6. 5%. Gram-negative organisms were the most common agents of UTI in NICU,of which Ecoli ranked highest ,followed by Klebiella and Enterobacter cloacae. Of gram-positive organisms Enterococcus species and Coagulase-negative Staphylococci were the most common agents. Cefepime and gentamycin showed high activity against gram-negative organisms. Overall, non-E. coli microorganisms showed more resistances compared with Escherichia coli. The best susceptible antibiotics for gram-positive organisms were vancomycin and rifampin. Almost all gram-negative bacteria showed resistant to ampicillin and all of gram-positive bacteria resistant to penicillin and oxacillin. Conclusion Gram-negative organisms were the most common agents of UTI in NICU in this study. The drug resistance of bacteria is severe,especially to ampicillin and penicillin,which will be no longer the first choice clinically. So urine culture should be examined when initiating antibiotics treatment for UTI.
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Objective To determine the prevalence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in neonates. Methods Data were collected retrospectively among neonates admitted to NICU in St. Louis Children's Hospital in Washington University School of Medicine between January 1,2005 and December 31,2006. Results A total of 682 patients were mechanically ventilated and 79 episodes of VAP occurred in 527 patients who were mechanically ventilated for more than or equal to 48 h. VAP prevalence were 6. 3,5. 8,5.6, and 3.6 per 1 000 ventilator days for patients with birth weight ≤1 000 g, 1 001～1 500 g, 1 501～2 500 g, and＞2 500 g, respectively. By multivariate logistic regression analysis, smaller gestational age and longer duration of mechanical ventilation were found to be predictive of VAP (odds ratio:0. 886 and 1. 037;95% confidence interval:0. 839～0. 943 and 1.027～1.046). Patients with VAP had prolonged length of stay in NICU [ (103.6 4±69. 1) d vs (42. 8 ±46. 5) d]. Gram-negative bacilli were the most commonly isolated organisms (86. 09%). Conclusion VAP occurred at higher rates in neonates with smaller gestational age and might be associated with increased length of stay. Developing a standardized assessment of readiness to wean mechanical ventilatory support would be useful in this patient population.
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0.05); the level of leptin in cord blood were (6.79?4.59)?g/L and (16.30?11.61)?g/L ( P
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Objectives To determine the influence of total parenteral nutrition(TPN)and partial parenteral nutrition(PPN)on gut hormones in preterm infant.Methods The levels of gastin,motilin and vasoaetive intestinal polypoptide of 31 TPN and 33 PPN preterm infants were measured by RIA at ages of 1,3,7,and 10 days.Results On 7th and 10th day,three gut hormones were all significantly higher in preterm infant of PPN than those in preterm infant of TPN(P