ABSTRACT
Objective To understand the whole situation of neonatal resuscitation in high risk deliveries.Methods Totally,3 420 neonates born from high risk pregnant mothers in Tianjin Central Obstetrics and Gynecology Hospital from September 2013 to November 2014 were recruited and divided into four groups according the needs of resuscitation,including no resuscitation group (Group A),initial resuscitation group (Group B),initial resuscitation plus bag-and-mask or T-piece ventilation (positive pressure ventilation group,Group C),tracheal intubation and/or external chest compression and/or epinephrine administation (tracheal intubation group,Group D).Variance analysis,Chi-square test and Logistic regression analysis were applied to compare the differences of clinical conditions among these groups and to analyze risk factors of tracheal intubation requirement for extensive resuscitation.Results Among the 3 420 newborns,2 360(69.0％) were assigned to Group A,565 (16.5％) to Group B,408 (11.9％) to Group C and 87 (2.5％) to Group D.Statistical differences were shown in the gestational age [(35.5 ± 4.1),(33.0 ± 4.3) and (32.1 ± 4.8) weeks],birth weight [(2 593.8 ± 663.6),(2 063.3 ± 973.9) and (1 839.0 ± 977.9) g],and the incidence of multiple births [66(11.7％),65(15.9％) and 23(26.4％)],abruptio placentae [15(2.7％),35(8.6％) and 9(10.3％)],umbilical cord prolapse [0(0.0％),2(0.5％),and 10(11.5％)],abnormal fetal heart rate in labor [28(5.0％),45(11.0％) and 46(52.9％)],prolonged labor [36(6.4％),35(8.6％),and 20(23.0％)],meconium stained liquor [32(5.7％),0(0.0％),and 8(9.2％)],and congenital anomaly [8(1.4％),12(2.9％) and 7(8.0％)] among Group B,C and D (F or x2=233.188,105.050,14.535,19.934,91.434,149.366,26.525,28.602 and 13.765,all P ≤ 0.05).Multiple regression analysis revealed that gestational age ≤ 28 weeks (OR=1.290,95％ CI:1.167-1.425),abnormal fetal heart rate in labor (OR=1.350,95％CI:1.184-6.862) and meconium stained liquor (OR=1.397,95％CI:1.051-6.825) were independent risk factors for endotracheal intubation requirement (all P ≤ 0.05).Conclusions More newborns born from high risk mothers may need resuscitation,especially for those in small gestational age,with abnormal fetal heart rate during labor and meconium-stained liquor,thus close monitoring and management are necessary.
ABSTRACT
Objective To study the incidence of complications and the influence on early postnatal growth and development in very low birth weight infant(VLBWI) fed by breast milk.Methods From January 1, 2010 to December 31, 2013, 351 VLBWIs, who were appropriate for gestational age and hospitalized in Neonatal Intensive Care Unit of Tianjin Central Hospital of Obstetrics and Gynecology, were included in this study after exclusion of those with small for gestational age, large for gestational age, severe perinatal asphyxia at birth, withdrawing treatment or death, and mixed feeding infants.The group of formula-fed infants (FFI) were 168 VLBWI admitted between January 1, 2010 to December 31, 2011 and the group of breast milk-fed infants (BFI) were 183 VLBWI admitted between January 1, 2012 to December 31, 2013.For BFIs, we added human milk fortifier when oral intake reached 100 ml/kg.All subjects were followed up to 40 weeks of corrected gestational age.We compared the incidence of complications and infantile growth and development from birth to 30 days old between the two groups.Independent sample t-test and Chi-square test were applied for statistical analysis.Results The incidence of feeding intolerance in FFIs was higher than that of the BFIs [27.4％ (46/168) vs 15.3％ (28/183)], so was the incidence of necrotizing enterocolitis [14.9％ (25/168) vs 5.5％ (10/183)] (x2=7.683 and 8.651, both P ＜ 0.05).The incidence of nosocomial infection, retinopathy of prematurity and bronchopulmonary dysplasia in FFI and BFI were 34.5％ (58/168) vs 33.3％ (61/183), 15.5％ (26/168) vs 10.4％ (19/183), and 11.3％ (19/168) vs 9.3％ (17/183), but none of them showed significant difference between the two groups (x2=0.055, 2.033 and 0.388, all P ＞ 0.05).Significant difference was neither found in weight gain from birth to 30 days old [(304± 137) vs (308± 123) g], height growth [(2.6± 1.1) vs (2.7± 1.2) cm] and head circumference growth [(2.5± 1.0) vs (2.4±0.9) cm] between the FFIs and BFIs (t=0.106, 0.614 and 0.485, all P ＞ 0.05).Conclusion Breast feeding is beneficial to VLBWI in decreasing the incidence of feeding intolerance and necrotizing enterocolitis without adverse effect on their early postnatal growth and development.
ABSTRACT
Mechanicalventilation in newborns can be divided into invasive mechanical ventilation and non-invasive me-chanical ventilation. In order to reduce invasive ventilation-induced lung injury, more and more non-invasive ventilation patterns have been used clinically. Early application of nasal intermittent positive pressure ventilation (NIPPV) has become the main mode of non-invasive ventilation in many neonatal intensive care units (NICU). At the same time, the combination with selective pulmonary surfactant can reduce the incidence of chronic lung disease. This article reviews the use and prospect of non-invasive respiratory support modes which include continuous positive airway pressure (CPAP) and bi-level CPAP mode (BiPAP) such as SiPAP and NIPPV. Some modes which are in the research stage were also reviewed including synchronized nasal intermittent positive pressure ventilation, neurally adjusted ventilatory assist and non-invasive high-frequency oscillatory ventilation.