Effect of breastfeeding versus formula milk feeding on preterm infants in the neonatal intensive care unit / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the importance of breastfeeding in preterm infants with various gestational ages.</p><p><b>METHODS</b>A total of 639 preterm infants with a gestational age of 28-36weeks were enrolled, and according to the feeding pattern, they were divided into exclusive breastfeeding group (n=237) and formula milk feeding group (fed with liquid milk for preterm infants; n=402). These two feeding patterns were compared in terms of their effects on weight gain, laboratory markers including albumin (Alb) and alkaline phosphatase (ALP), incidence rate of feeding intolerance, and incidence rates of complications including necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP).</p><p><b>RESULTS</b>Compared with the formula milk feeding group, the breastfeeding group had a significantly faster increase in body weight, a significantly lower incidence rate of NEC, a significantly higher ALP level, and a significantly lower Alb level in the preterm infants with a gestational age of 28-30 weeks (P<0.05); there were no significant differences between the two groups in the incidence rates of anemia, ROP, bronchopulmonary dysplasia (BPD), and nosocomial infection and length of hospital stay (P>0.05). For the preterm infants with a gestational age of 31-33 weeks, the breastfeeding group had a significantly faster increase in body weight, a significantly lower incidence rate of feeding intolerance, a significantly shorter length of hospital stay, and a significantly higher ALP level (P<0.05); there were no significant differences between the two groups in the incidence rates of NEC, anemia, ROP, BPD, and nosocomial infection and the Alb level (P>0.05). For the preterm infants with a gestational age of 34-36 weeks, there were no significant differences in these indices between the two groups (P>0.05).</p><p><b>CONCLUSIONS</b>Breastfeeding plays an important role in increasing body weight, reducing the incidence rates of feeding intolerance and NEC, and shortening the length of hospital stay in preterm infants with a gestational age of 28-33 weeks.</p>

Background patterns and sleep-wake cycles on amplitude-integrated electroencephalography in preterm infants with periventricular-intraventricular hemorrhage / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the background patterns and sleep-wake cycles (SWC) on amplitude-integrated electroencephalography (aEEG) in preterm infants with different grades of periventricular-intraventricular hemorrhage (PIVH).</p><p><b>METHODS</b>Fifty-six preterm infants with a gestational age between 25 and 33 weeks who were diagnosed with PIVH and 31 gestational age-matched normal preterm without ICH were enrolled. According to Papile staging criteria, the infants with PIVH were subdivided into mild group (grades I and II) and moderate-severe group (grades III and IV). The results of the aEEG were compared between groups.</p><p><b>RESULTS</b>The moderate-severe PIVH group showed a decreased continuity of the voltage, an increased loss rate of SWC, and a lower aEEG score than the mild PIVH and control groups (P<0.017). There were no significant differences in these parameters between the mild PIVH and control groups.</p><p><b>CONCLUSIONS</b>The changes of background patterns and SWCs may be associated with the severity of PIVH in preterm infants.</p>

Value of abdominal ultrasound in the diagnosis of neonatal necrotizing enterocolitis and evaluation of disease severity / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the value of abdominal ultrasound in diagnosing neonatal necrotizing enterocolitis (NEC) and its significance in evaluating the disease severity.</p><p><b>METHODS</b>The clinical data of 84 neonates who were diagnosed with NEC between July 2013 and January 2015 were analyzed retrospectively. According to the modified Bell-NEC staging criteria, these neonates were divided into a suspected NEC group (n=44) and a confirmed NEC group (n=40); according to clinical prognosis, they were divided into a medical treatment and full recovery group (n=58) and a surgery/death group (n=26). The changes in the results of abdominal ultrasound and abdominal X-ray plain film were compared between groups.</p><p><b>RESULTS</b>In the confirmed NEC group, abdominal ultrasound showed significantly higher detection rates of portal venous gas and dilatation of the intestine than abdominal X-ray plain film (P<0.05). Compared with the medical treatment and full recovery group, the surgery/death group had significantly higher detection rates of dilatation of intestine, bowel wall thickening, peritoneal effusion and free intraperitoneal air (P<0.05). Dilatation of the intestine and free intraperitoneal air shown by abdominal X-ray plain film were more common in the surgery/death group.</p><p><b>CONCLUSIONS</b>Abdominal ultrasound is useful for the diagnosis of NEC. Ultrasonic findings can contribute to the prediction of the severity of NEC.</p>

Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China: A Multi-center Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>With the progress of perinatal medicine and neonatal technology, more and more extremely low birth weight (ELBW) survived all over the world. This study was designed to investigate the short-term outcomes of ELBW infants during their Neonatal Intensive Care Unit (NICU) stay in the mainland of China.</p><p><b>METHODS</b>All infants admitted to 26 NICUs with a birth weight (BW) < l000 g were included between January l, 2011 and December 31, 2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors.</p><p><b>RESULTS</b>A total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age (GA) was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants (23.3%) died and another 69 infants (26.7%) died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas (53.6% vs. 35.3%, P = 0.019). BW < 750 g and GA < 28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization.</p><p><b>CONCLUSIONS</b>Our study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries.</p>

Early complications and treatment outcomes in test-tube premature infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the incidence of early complications and treatment outcomes in premature infants conceived via test tube.</p><p><b>METHODS</b>A retrospective analysis and comparison was conducted on the clinical data of 122 test-tube premature infants and 183 naturally conceived premature infants (control group), including maternal complications, birth conditions and early complications.</p><p><b>RESULTS</b>There was no statistically significant difference in maternal complications between the two groups (P > 0.05). The incidence of respiratory distress syndrome (25.4% vs 12.0%; P < 0.05) and malformations (3.3% vs 0%; P < 0.05) in the test-tube group was statistically higher than in the control group. The mortality rate in the test-tube group was statistically higher than in the control group (9.0% vs 2.2%; P < 0.05).</p><p><b>CONCLUSIONS</b>Test-tube premature infants are more likely to suffer from respiratory distress syndrome and have higher incidences of congenital malformations and mortality. Asisted reproductive technique should therefore be chosen cautiously, and enhanced assessment and monitoring is needed during pregnancy.</p>

Mortality and morbidity of acute hypoxemic respiratory failure and acute respiratory distress syndrome in infants and young children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute hypoxemic respiratory failure (AHRF) often develops acute respiratory distress syndrome (ARDS), and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively. This study aimed at prospectively investigating incidence, causes, mortality and its risk factors, and any relationship to initial tidal volume (V(T)) levels of mechanical ventilation, in children £5 years of age with AHRF and ARDS.</p><p><b>METHODS</b>In 12 consecutive months in 23 pediatric intensive care units (PICU), AHRF and ARDS were identified in those requiring > 12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge. ARDS was diagnosed according to the American-European Consensus definitions. The mortality and ventilation free days (VFD) were measured as the primary outcome, and major complications, initial disease severity, and burden were measured as the secondary outcome.</p><p><b>RESULTS</b>In 13 491 PICU admissions, there were 439 AHRF, of which 345 (78.6%) developed ARDS, resulting in incidences of 3.3% and 2.6%, and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia (62.9%) and sepsis (33.7%) as major underlying diseases respectively. No association was found in V(T) levels during the first 7 days with mortality, nor for V(T) at levels < 6, 6 - 8, 8 - 10, and > 10 ml/kg in the first 3 days with mortality or length of VFD. By binary Logistic regression analyses, higher pediatric risk of mortality score III, higher initial oxygenation index, and age < 1 year were associated with higher mortality or shorter VFD in AHRF.</p><p><b>CONCLUSIONS</b>The incidence and mortalities of AHRF and ARDS in children £5 years were similar to or lower than the previously reported rates (in age up to 15 years), associated with initial disease severity and other confounders, but causal relationship for the initial V(T) levels as the independent factor to the major outcome was not found.</p>

Discussion on the clinical indications for blood transfusion in anemia of prematurity / 中华血液学杂志

<p><b>OBJECTIVE</b>To compare the effect of different indications of blood transfusion on the treatment and complications in anemia of prematurity, and to investigate the suitable and reasonable indication of blood transfusion for our country.</p><p><b>METHODS</b>Ninety six hospitalized premature infants with birth weight less than 1500g and stay in hospital equal or more than 2 weeks were enrolled in the retrospective study and divided into two groups according to different indications of blood transfusion. There are 54 cases in observation group 1 (with strict indications for transfusion) and 42 cases in observation group 2 (with loose indications for transfusion).</p><p><b>RESULTS</b>In the observation group 1, the total amount of blood transfusion \[M(P25, P75):71.0(43.25, 107.25) ml\] and the times of blood transfusion \[3.00 (2.00, 4.00) times\] are both higher than those of the observation group 2 \[36.0 (29.50, 56.25) ml and 1.50 (1.00, 2.25) times, respectively, P = 0.00 1\]. The days of mechanical ventilation and the days of continuous positive airway pressure were more in the observation group 1, but oxygen supplement in the two groups had no significant difference. In observation group 1, the incidence of intracranial hemorrhage, fungal infection rate and mortality were higher than those of the observation group 2 (P < 0.05).</p><p><b>CONCLUSIONS</b>Anemia of prematurity easily led to the complications, and had obvious influence on the survival of premature infants. Clinician should consider concrete conditions of every patient before blood transfusion. It has positive significance on the survival of premature infants to loosen the indication properly and make the use of blood scientifically and rationally.</p>

Risk factors for capillary leak syndrome in neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the risk factors for capillary leak syndrome (CLS) in neonates.</p><p><b>METHODS</b>The clinical data of 52 neonates with CLS (case group) were retrospectively reviewed. Fifty hospitalized neonates without CLS were used as the control group. The possible factors for the development of CLS were identified by univariate analysis. The independent risk factors for CLS were determined by multivariate logistic regression analysis.</p><p><b>RESULTS</b>The univariate analysis showed that the incidences of hyperglycemia, respiratory distress syndrome (RDS), sepsis and cold injury syndrome in the case group were significantly higher than those in the control group (P<0.05). The logistic regression analysis showed that sepsis (OR=5.004, P=0.001), RDS (OR=3.880, P=0.013) and cold injury syndrome (OR=3.207, P=0.023) were the independent risk factors for the development of CLS.</p><p><b>CONCLUSIONS</b>RDS, sepsis and cold injury syndrome are independent risk factors for CLS in neonates. Hyperglycemia may be associated with the development of CLS.</p>

Digital retinal camera for screening of retinopathy of prematurity / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the practicability and efficacy of digital retinal camera (RetCam) as a method for early diagnosis of retinopathy of prematurity (ROP).</p><p><b>METHODS</b>One hundred and twelve preterm infants admitted to the First Hospital of Jilin University from June 2007 to March 2008 were enrolled. Fundus examinations were performed by indirect ophthalmoscope and RetCam respectively. The results from RetCam were compared with those from indirect ophthalmoscopy which was a "gold standard" for ROP screening.</p><p><b>RESULTS</b>ROP was identified in 46 eyes by RetCam, and in 43 eyes by indirect ophthalmoscope. The sensitivity of RetCamII was 97.7% (43/44) and the specificity was 98.3% (177/180), and the positive and negative predictive values were 93.5% and 99.4%, respectively. The concordance rate for identification of ROP between RetCam and indirect ophthalmoscopy was 97.3%.</p><p><b>CONCLUSIONS</b>RetCam is an effective method for the identification of ROP and is worth recommending.</p>

Epidemiology of respiratory distress and the illness severity in late preterm or term infants: a prospective multi-center study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The severity of respiratory distress was associated with neonatal prognosis. This study aimed to explore the clinical characteristics, therapeutic interventions and short-term outcomes of late preterm or term infants who required respiratory support, and compare the usage of different illness severity assessment tools.</p><p><b>METHODS</b>Seven neonatal intensive care units in tertiary hospitals were recruited. From November 2008 to October 2009, neonates born at ≥ 34 weeks' gestational age, admitted at < 72 hours of age, requiring continuous positive airway pressure (CPAP) or mechanical ventilation for respiratory support were enrolled. Clinical data including demographic variables, underlying disease, complications, therapeutic interventions and short-term outcomes were collected. All infants were divided into three groups by Acute care of at-risk newborns (ACoRN) Respiratory Score < 5, 5 - 8, and > 8.</p><p><b>RESULTS</b>During the study period, 503 newborn late preterm or term infants required respiratory support. The mean gestational age was (36.8 ± 2.2) weeks, mean birth weight was (2734.5 ± 603.5) g. The majority of the neonates were male (69.4%), late preterm (63.3%), delivered by cesarean section (74.8%), admitted in the first day of life (89.3%) and outborn (born at other hospitals, 76.9%). Of the cesarean section, 51.1% were performed electively. Infants in the severe group were more mature, had the highest rate of elective cesarean section, Apgar score < 7 at 5 minutes and resuscitated with intubation, the in-hospital mortality increased significantly. In total, 58.1% of the patients were supported with mechanical ventilation and 17.3% received high frequency oscillation. Adjunctive therapies were commonly needed. Higher rate of infants in severe group needed mechanical ventilation or high frequency oscillation, volume expansion, bicarbonate infusion or vasopressors therapy (P < 0.05). The incidence of complications was also increased significantly in severe group (P < 0.05). The in-hospital mortality in the severe group was significantly higher than other two groups (P < 0.05). ACoRN Respiratory Score was correlated with Score for Neonatal Acute Physiology-Version II (SNAP-II) (P < 0.01). High gestational age, high SNAP-II score and oxygenation index (OI), and Apgar score at 5 minutes < 5 were independent risks for death.</p><p><b>CONCLUSIONS</b>Neonatal respiratory distress is still a common cause of hospitalization in China. Illness severity assessment is important for the management. ACoRN Respiratory Score which correlated with SNAP-II score is easy to use and may be helpful in facilitating the caregivers in local hospital to identify the early signs and make the transfer decision promptly.</p>

Efficacy and safety of recombinant human growth hormone solution in children with growth hormone deficiency in China: a multicenter trial / 中华儿科杂志

<p><b>OBJECTIVE</b>Human growth hormone (hGH) is an essential therapeutic drug for the treatment of growth hormone (GH) deficiency (GHD). However, the process of dissolving hGH of the powder form is complicated and potentially hazardous. In the present study, we evaluated the efficacy and safety of preparation in the replacement therapy for children with GH deficiency.</p><p><b>METHODS</b>A 12-month randomized, open-label, multicenter trial was conducted in 31 previously untreated children with growth failure secondary to GH deficiency [20 boys and 11 girls, mean age (10.5 +/- 4.1) years]. An recombined human growth hormone (rhGH) solution (Iintropin AQ) was given via subcutaneous injection daily in every evening at a weekly dose of 0.25 mg/kg. The patients were followed up at 3, 6, 9, and 12 months of the treatment, and the course of treatment was 12 months. Body height was measured 3-monthly and height velocity (HV) and mean height standard deviation score (HT SDS) were calculated. Serum Insulin-like growth factor I (IGF-1), Insulin-like growth factor binding protein 3 (IGFBP-3), GH antibodies and safety parameters were assessed at the baseline and at 3-month intervals. Bone age (BA) was assessed at the baseline and the rate of skeletal maturation (DeltaBA/DeltaCA) was calculated after 6 and 12 months of rhGH treatment by a central bone age reader. Moreover, the safety of rhGH solution treatment was assessed.</p><p><b>RESULTS</b>After 12 months of liquid rhGH therapy, growth parameters were significantly increased over baseline. (1) The mean (+/- SD) height increment DeltaHT (cm) was 4.0 +/- 1.3, 7.0 +/- 2.0, 10.3 +/- 2.6 and 12.9 +/- 3.3 after 3, 6, 9, and 12 months of treatment, respectively (P < 0.01), which indicated linear growth after treatment. The GV (cm/years) was 2.7 +/- 0.9 before treatment and increased to 16.0 +/- 5.1, 14.1 +/- 4.0, 13.7 +/- 3.5, and 12.9 +/- 3.3 after treatment, suggesting that catch-up growth was significant after treatment as compared to the pre-treatment status (P < 0.01). Accordingly, post-treatment catch-up growth was obvious, significant differences were observed in HT SDS, which was -4.62 +/- 1.46 at the onset of therapy and increased significantly after the treatment to -3.80 +/- 1.53, -3.28 +/- 1.60, -2.86 +/- 1.75 and -2.47 +/- 1.86, respectively (P < 0.01). The height difference between GH deficient children and unimpaired children of the same age and gender gradually decreased after treatment, which was significantly different from that seen before treatment (P < 0.01). (2) The levels of serum IGF-1 and IGFBP-3 were increased comparably for the treatment. IGF-1 level (microg/L) was 41 +/- 64 at baseline and increased to 179 +/- 155, 202 +/- 141, 156 +/- 155 and 159 +/- 167 after 3, 6, 9, 12 months of treatment. IGFBP-3 level (mg/L) was 1540 +/- 1325 at baseline, and increased to 3891 +/- 1815, 4051 +/- 1308, 3408 +/- 1435 and 3533 +/- 1413, respectively, suggesting that with the increases in height, IGF-1, and IGFBP-3 were significantly activated to relatively high levels by the medication and reached peak values between 3 and 6 months of treatment. The levels of IGF-1 and IGFBP-3 were significantly different before and after treatment (P < 0.01). The IGF-1/IGFBP-3 molar ratio significantly increased during GH therapy (0.143 +/- 0.013 pre-therapy up to 0.240 +/- 0.055 post-therapy, P < 0.01). The IGF-1/IGFBP-3 molar ratio tended to stabilize after 3-month GH therapy. (3) The bone age assessment carried out 6 and 12 months after treatment showed that the bone maturity (DeltaBA/DeltaCA) was 1.01 +/- 0.57 and 1.07 +/- 0.75, respectively, suggesting that there was no speed-up development in the bone age. No severe adverse events were observed during the trial and the most frequent accompanying event was mild hypothyroidism.</p><p><b>CONCLUSIONS</b>rhGH solution (Iintropin AQ) is a safe and effective preparation in the replacement therapy for children with GH deficiency.</p>

Permeability and Protective Effect of Nerve Growth Factor by Periphery in Neonatal Rats with Hypoxic-Ischemic Brain Damage / 实用儿科临床杂志

Objective To explore the permeability of nerve growth factor(NGF)through blood brain barrier and protective effect of NGF by periphery in neonatal rats with hypoxic-ischemic brain damage(HIBD).Methods The models with HIBD were established and NGF 5 ?g/kg was injected intravenously with 125I,and the permeability of NGF was observed by periphery through blood brain barrier of neonatal rats.Then apoptosis in each group was examined in tissues,samples of frontal cortex and CA1 district in cornu ammonis by TUNEL method.Results The contents of 125I-NGF in neonatal rats and ratio with blood content was higher than those of adult rats,then contents of 125I-NGF in neonatal rats with HIBD and ratio with blood content were higher than those of the neonatal rats(Pa

Absorption of Radioiodinated Nerve Growth Factor in Hypoxic Neonatal Rats Brain / 实用儿科临床杂志

Objective To observe absorption of exogenous nerve growth factor(NGF) between normal newborn rats and newborn rats with hypoxidosis.Methods Thirty-two healthy newborn rats(7 days of age) were divided into experiment group and normal group.Experiment rats were made into hypoxic-ischemic brain damage(HIBD) model.NGF labeled with()~(125)I or()~(125)I was injected into the rats abdominant.All of the rats were killed and brain was removed after 30 minutes.The brain was dissected into basal forebrain,forehead cortex,hippocampus,thalamus,cerebellum,smellorb,pituitary tissue samples were assayed for radioactivity in a two-channel gamma counter.Results Absorptions of two groups(()~(125)I-NGF) were significantly higher than those of()~(125)I in basal forebrain,cortex,hippocampus,cerebellum.Absorptions of hypoxic group were significantly higher than those of control group in cortex,hippocampus,cerebellum.Conclusions NGF can penertrate blood brain barrier of newborn rats into brain regions by means of peripheral administration.Early application of NGF for treating hypoxic-ischemic encephalopathy(HIE) is feasible.