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Objective:To investigate the short- and long-term outcomes of fetuses with selective fetal growth restriction (sFGR).Methods:A retrospective study was conducted on monochorionic diamniotic (MCDA) twins with sFGR admitted to the Neonatal Intensive Care Unit of Peking University Third Hospital from September 2017 to December 2019. MCDA neonates delivered during the same period without significant complications were selected as the control group. MCDA twins with sFGR were divided into type Ⅰ, Ⅱ, and Ⅲ groups and then further divided into the larger and the smaller fetus subgroups according to the birth weight. These children were followed up by telephone at 2-3 years old. Height-for-age and weight-for-age Z-scores were calculated. Ages and Stages Questionnaire-Third Edition (ASQ-3) was used to determine comprehensive development. Independent sample t-test, one-way analysis of variance, non-parameter test, and Chi-square test (or rank-sum test) were used for statistical analysis. Results:(1) A total of 116 pregnant women with sFGR (232 neonates) were enrolled in this study. There were 43, 40, and 33 mothers and 86, 80, and 66 newborns in type Ⅰ, Ⅱ, and Ⅲ groups, respectively. The control group included 31 pregnant women and 62 neonates. The gestational age at onset of sFGR was younger in the type Ⅱ and Ⅲ groups than in type Ⅰ group [(23.8±4.8) and (24.1±3.1) vs (27.0±6.1) weeks, F=5.19, P<0.05; all P<0.017 during pairwise comparisons]. (2) The incidence of sepsis and treatment abandonment/death in neonates in type Ⅱ and Ⅲ groups were higher than those in type Ⅰ and control groups [neonatal sepsis: 11.3% (9/80) and 6.1% (4/66) vs 2.3% (2/86) and 0.0% (0/62), χ2=6.30, P=0.001; death or treatment abandonment rate:13.8% (11/80) and 10.6% (7/66) vs 3.5% (3/86) and 0.0% (0/62), χ2=4.68, P=0.003; all P<0.017 during pairwise comparisons]. In cases with type Ⅱ or type Ⅲ sFGR, the risk of digestive system diseases was significantly higher in the smaller fetus group than in the larger fetus group [type Ⅱ: 46.2% (37/80) vs 38.7% (31/80), χ2=16.72; type Ⅲ: 47.0% (31/66) vs 34.8% (23/66), χ2=39.69; both P<0.001], while the rate of respiratory system diseases was lower in the smaller fetus group [type Ⅱ: 35.0% (28/80) vs 45.0% (36/80), χ2=36.85; type Ⅲ: 37.9% (25/66) vs 45.4% (30/66), χ2=12.55; both P<0.001]. The incidence of neonatal sepsis in smaller fetuses was higher than that in larger ones in type Ⅱ sFGR [7.5% (6/80) vs 3.7% (3/80), χ2=4.68, P=0.034]. The incidence of neurological complications in larger fetuses was higher than that in smaller ones in type Ⅲ sFGR [15.1% (10/66) vs 4.5% (3/66), χ2=5.72, P<0.001]. (3) In type Ⅱ group, seven neonates died (one case of cerebral hemorrhage, two cases of gastrointestinal perforation, two cases of septic shock, and two cases of necrotizing enterocolitis), and four cases withdrew the treatment. In type Ⅲ group, four neonates died (two cases of necrotizing enterocolitis, one case of gastrointestinal perforation, and one case of cerebral hemorrhage), and three cases withdrew from the treatment. (4) Totally, 71 children in type Ⅰ, 61 in type Ⅱ, and 58 in type Ⅲ group were followed up at the age of 2-3. Children with type Ⅱ or type Ⅲ sFGR lagged behind those in type Ⅰ group and control group in physical growth [ M ( P25- P75), Z-scores:－0.46 (－0.87-0.42),－0.35 (－0.62-0.71), 0.05 (－0.61-0.51), and 0.14 (－0.57-0.75); H=6.20, P=0.001]. In type Ⅱ and Ⅲ groups, the smaller fetuses lagged the larger fetuses in physical growth at 2-3 years of age. ASQ-3 scores in communication, gross motor, fine motor, problem-solving and personal-social areas were all lower in type Ⅱ and Ⅲ groups than in type Ⅰ and control groups. ASQ-3 scores in the five dimensions of the smaller fetuses in the type Ⅱ group were lower than those of the larger fetuses. In the type Ⅲ group, the smaller fetuses had lower ASQ-3 scores in communication and gross motor than the larger ones [communication ability: (42.6±18.8) vs (56.4±9.4) scores, t=19.63, P<0.001; gross motor: (45.5±19.7) vs (54.5±9.7) scores, t=12.64, P=0.003]. Conclusion:The neonatal morbidity is significantly increased in type Ⅱ and Ⅲ sFGR, and babies lagged others in height, weight, and ASQ-3 score at 2-3, which is worthy of early attention.
ABSTRACT
Preterm birth is a major cause of perinatal mortality and long-term morbidity,chorioamnionitis (CAM) is a common cause of preterm birth and characterized by inflammation.CAM produces variety of inflammatory factors in fetal,results in structural and functional impairment,and affects the contractile function of pulmonary blood vessels,so,CAM can have impact on the morbidity of lung disease in premature,and it may even affect the long-term pulmonary function.
ABSTRACT
Preterm birth is a major cause of perinatal mortality and long-term morbidity, chorioamnionitis (CAM) is a common cause of preterm birth and characterized by inflammation.CAM produces variety of inflammatory factors in fetal, results in structural and functional impairment, and affects the contractile function of pulmonary blood vessels, so, CAM can have impact on the morbidity of lung disease in premature, and it may even affect the long-term pulmonary function.
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Objective To investigate the insulin sensitivity in children born small for gestational age without catch-up growth.Methods We investigated 439 outpatients in pediatric department of the Third Hospital of Peking University with diagnosis of short stature from August 2008 to August 2016.Two groups were divided based on their diagnosis as born small for gestational age group(SGA)with 218 patients and idiopathic short stature group(ISS)with 221 patients.Fasting blood-glucose,fasting insulin,fasting insulin/fasting blood-glucose,islet beta-cell function(HOMA%),homeostasis model assessment-insulin resistance(HOMA-IR)were analyzed in two groups.Results Hierarchy based on age and sex in SGA and ISS.No significant difference was observed in preadolescent boys with fasting blood-glucose(4.7±0.6 vs 4.8±0.6,P=0.678),fasting insulin(5.1±4.0 vs 4.3±4.7,P=0.345),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.No significant difference was observed in preadolescent girls with fasting blood-glucose(4.5±0.5 vs 4.6±0.5,P=0.828),fasting insulin(4.7±3.5 vs 4.5±3.3,P=0.603),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.No significant difference was observed in adolescent boys with fasting insulin(5.9±4.3 vs 6.0±4.5,P=0.958),fasting blood-glucose(5.0±0.8 vs 4.9±0.5,P=0.176),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.No significant difference was observed in adolescent girls with fasting blood-glucose(4.9±0.6 vs 4.8±0.4,P=0.141),fasting insulin(7.5±6.4 vs 7.4±8.6,P=0.448),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.Conclusion The insulin sensitivity were in good condition in children born small for gestational age without catch-up growth.
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Objective To study the features and values of ultrasound and Helical computed tomography (CT) in diagnosis of cystic renal cell carcinoma. Methods Twenty patients were preoperatively examined by B-mode ultrasound, color Doppler ultrasound and helical CT. Results All the cases were confirmed by operation and pathology,including 12 cases on the left side and 8 cases on the right side. On B-mode ultrasound images, all lesions appeared as unilocular or multilocular cyst in 5 cases, intratumoral septum in 10 cases,intratumoral nodule in 4 cases,solid-like mass in 1 case. Color blood flow was showed within tumors in 18 patients,in which 17 cases showed the arterial spectrum with a mean resistance index of 0.66. On enhanced CT scans, all the lesions appeared as the early uneven enhancement(19 cases), septal enhancement(6 cases) and mural nodular enhancement(4 cases) respectively. The accuracy of conventional ultrasound combined with color Doppler ultrasound was 85%, while the accuracy of the enhanced CT was 80%.Conclusions Conventional ultrasound combined with color Doppler ultrasound and enhanced CT plays an important role in diagnosis of cystic renal cell carcinoma.