ABSTRACT
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.
ABSTRACT
Objective To analyze serum 25(OH)D level and the influence factors in preterm infants. Methods The data of serum 25(OH)D level in preterm infants born from July 2012 to June 2014 were retrospectively analyzed along with gestational age, gender, parity, delivery mode, birth season, birth weight, age of the mother and pregnancy complications. Results Totally 325 cases were included and their average gestational age was 33.41±2.29 week, the ratio of male to female was 1.32?1 and average serum 25(OH)D level was 37.34±16.17 nmol/L. The incidence of vitamin D deficiency and insufficiency in preterm infants was 37.8% and 41.8% respectively. Serum 25 (OH) D levels in preterm infants born in summer and autumn were higher than those born in winter and spring, and there was statistical difference (P<0.05). Logistic regression analysis showed that birth season and the mother's age may be the risk factors that influence serum 25 (OH) D levels in preterm infants. Conclusion The incidence of vitamin D deficiency and insufficiency in preterm infants is high, and the factors affecting the level of vitamin D need to be further studied.
ABSTRACT
Objective To analyze the relationship between serum 25(OH)D level and lung diseases in premature infants. Methods The clinical data and the results of serum 25 (OH) D were collected in the preterm infants admitted to NICU from January 2015 to December 2016. According to the average level of serum 25 (OH) D, the premature infants were divided into low vitamin D group and high vitamin D group, and the differences of lung diseases between two groups were compared. Results A total of 115 premature infants were enrolled. The mean gestational age was (29.9±1.9) weeks, and the mean serum 25(OH)D level was (37.1±16.6) nmol/L. The rates of vitamin D deficiency [25(OH)D<50 nmol/L], vitamin D insufficient [25(OH)D 50-75 nmol/L] , and normal [25(OH)D≥75 nmol/L] were 71.3%, 17.4%, and 11.3%, respectively. The persistent positive airway pressure, oxygen therapy time, the incidences of neonatal respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD), and hospitalization days in the low vitamin D group were significantly higher than those in the high vitamin D group (P all<0.05). Conclusions Preterm infants with low vitamin D levels may increase the incidences of RDS and BPD, and prolong the length of hospitalization.