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Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.
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Objective:To determine the gestational weight gain and its risk factors and adverse effects among pregnant women in Beijing.Methods:Between June 2018 and June 2019, all registered infants and their mothers in a child care center of a third-tier-class hospital in Beijing were selected. A self-made questionnaire was used to collect the basic information of the maternal mothers. Chi-square test and analysis of variance were used to describe the basic characteristics of the study subjects and clarify the harmful effect of gestational weight gain for maternal and infant health. Multiple logistic regression analysis was used to analyze the risk factors of both insufficient and excessive weight gain during pregnancy.Results:A total of 3732 maternal mothers and their babies were included. The average weight gain of maternal mothers during pregnancy was 13.0 kg. The results of this study showed that the proportion of insufficient weight gain during pregnancy was 31.8% and the proportion of excessive weight gain was 24.1%. It was further found that young age, pre-pregnancy body mass index indicating overweight and obesity, primipara, and low education were independent risk factors for excessive weight gain during pregnancy. The risk of excessive weight gain of pre-pregnancy overweight and obesity was 2.40 times ( OR=2.40, 95% CI=1.91-3.03, P<0.001) and 2.90 times higher, respectively, ( OR=2.90, 95% CI=1.59-5.27, P<0.001) when compared with that of pre-pregnancy normal weight. In addition, our results suggested that excessive weight gain significantly increased the risk of macrosomia for the infant and the risk of cesarean section, gestational hypertension, and postpartum weight retention for maternal mothers. Conclusions:Age, pre-pregnancy BMI, primipara, and education level were the influencing factors for gestational weight gain. Considering the serious harmful effects of both insufficient and excessive weight gain for maternal and infant health, weight management during pregnancy should be strengthened for these high-risk populations in the future.
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Objective:To investigate the clinical features and risk factors of feeding intolerance in premature infants.Methods:This is a retrospective study involving premature infants who were hospitalized in Peking University Third Hospital from January to December 2017. Those in the feeding intolerance group (FI group) were further divided into subgroups of gestational age (GA) < 31 weeks group and GA ≥ 31 weeks group, as well as birth weight (BW)<1 250 g group and BW≥1 250 g group. Medical records of all subjects were reviewed to retrieve relevant clinical information. Independent-samples t-test, Chi-square test, and logistic regression tests were used for statistical analysis. Results:There were 612 eligible subjects with 182 (29.7%) in the FI group and 430 (70.3%) in the feeding tolerance (FT) group. (1) In the FI group, there were 103 (56.6%) males and 79 (43.4%) females with an average GA of (30.6±2.3) weeks and BW of (1 298±417) g, and 134 (73.6%) were very low birth weight premature infants. Among the patients with FI, there were 93 in the GA<31 weeks group and 89 in the GA≥31 weeks group, and 93 in the BW<1 250 g group and 89 in the BW≥1 250 g group. The FI infants accounted for 63.2% of very low birth weight premature infants in the same period. (2) The age at diagnosis was (2.7±0.9) d and (13.2±6.9) d at recovery. And the duration of FI was (10.5±6.7) d. The main symptoms were gastric retention (100.0%, 182/182), abdominal distention (54.4%, 98/182) and vomiting (17.0%, 31/182). (3) FI in preterm infants with GA <31 weeks or BW <1 250 g occurred and disappeared later [GA subgroups: (2.4±0.8) vs (2.9±0.9) d, t=3.977 and (10.4±5.2) vs (16.0±7.3) d, t=5.935; BW subgroups: (2.5±0.9) vs (2.8±0.9) d, t=2.540 and (10.0±4.5) vs (16.3±7.4) d, t=6.951; all P<0.05] and had a longer duration than those with GA≥31 weeks or BW≥1 250 g [GA subgroups: (8.0±5.0) vs (13.0±7.3) d, t=5.450; BW subgroups: (7.5±4.3) vs (13.5±7.3) d, t=6.690; both P<0.05]. Premature infants with smaller GA took longer time to regain their birth weight [(9.4±4.1) vs (12.0±5.1) d, t=3.672, P<0.05] and those with lower BW were less likely to have symptom of vomiting [23.6% (21/89) vs 10.8% (10/93), χ2=5.308, P<0.05]. (4) Multivariate logistic regression analysis showed that BW was a protective factor for FI in premature infants ( OR=0.998, 95% CI: 0.997-0.998, P<0.001) and the independent risk factors for FI were neonatal respiratory distress syndrome ( OR=2.129, 95% CI: 1.163-3.897, P=0.014), multifetation ( OR=1.812, 95% CI: 1.116-2.941, P=0.016), caffeine citrate exposure within 48 h after birth ( OR=2.663, 95% CI: 1.619-4.381, P<0.001), continuous positive airway pressure (CPAP) treatment within 48 h after birth ( OR=5.211, 95% CI: 2.861-9.489, P<0.001) and intrauterine infection ( OR=1.988, 95% CI: 1.060-3.728, P=0.032). Conclusions:The incidence of feeding intolerance in premature infants is high. Premature infants with GA <31 weeks or BW <1 250 g may develop FI and recover at an older age, and suffer longer. Low BW, neonatal respiratory distress syndrome, multifetation, caffeine citrate exposure, or CPAP treatment within 48 h after birth and intrauterine infection are risk factors for FI in premature infants.
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Objective To investigate the relationships between low one-minute Apgar score and the prognosis of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI). Methods Altogether 50 EPI and ELBWI who had a low one-minute Apgar score ( ≤ 7) and were admitted to the Neonatal Intensive Care Unit (NICU) of Peking University Third Hospital from January 1,2010 to December 31, 2015 were enrolled in this study. All of them were divided into two groups according to their Apgar score: mild group (4-7) and severe group (0-3). Medical records of the subjects were reviewed and an at least 18 months follow up study was conducted. Conditions of all subjects during perinatal period and hospitalization were summarized. Outcomes and follow-up results were compared between the two groups by using Fisher exact test. Results (1) General information: Fifty infants were involved, among which 37 had a mild low Apgar score and 13 had a severe low Apgar score. The mean gestational age was (27.7±2.1) weeks and the mean birth weight was (884.4±174.3) grams. (2) Main complications (some infants with more than one complication): There were 42 cases of neonatal respiratory distress syndrome, 12 cases of pulmonary hemorrhage, 21 cases of bronchopulmonary dysplasia, 31 cases of patent ductus arteriosus, 36 cases of intraventricular hemorrhage, 22 cases of white matter damage and six cases of retinopathy of prematurity. (3) Outcomes: The survival rate was 48% (24/50) and the mortality rate was 52% (26/50). Among the 26 infants, five died despite treatment and 21 died within 72 hours after their parents giving up treatment. There were no significant differences in the survival rates, mortality rates and rates of abandon treatment between the two groups [43% (16/37) vs 8/13; 11%(4/37) vs 1/13; 46% (17/37) vs 4/13; Fisher exact test, all P>0.05]. (4) Follow-up results: Twenty-one infants were followed-up to at least 18 months of age, among which four were normal, 10 had growth retardation and recurrent respiratory tract infection and seven had motor development retardation. The incidence of motor development retardation in severe group was higher than that in mild group, and the difference between them was statistically significant (5/8 vs 2/13, Fisher exact test, P=0.046). Conclusions EPI or ELBWI with a low one-minute Apgar score have many nosocomial complications, resulting in high mortality and high incidence of motor development retardation.
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Objective To examine the effectiveness of simulation newborn simulator in neona-tal resuscitation training for pediatric residents. Methods From June 2011 to June 2012, 11 residents working in neonatal ward of the Third Hospital of Peking University were enrolled into the study. Eval-uation on the residents was made before the training. Training of simulated teaching using simulation newborn simulator was conducted and evaluation was made after the training. SPSS 18.0 was used for statistical analysis. Comparison was made between pre- and post-training test by paired t test. P<0.05 was considered statistical significant. Questionnaire survey was conduct to acquire residents' feedback. Results A total of 11 participants completed the training and finished the questionnaire. The score of pre-training was 37.82±1.17 versus that of post-training 39.18±0.87(t=4.89, P<0.01). All residents were satisfied with the simulation-based training. Conclusion Simulation training can improve pedi-atric residents' knowledge and skills in neonatal resuscitation.
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Objective To investigate the epidemiological and clinical characteristics, risk factors, outcome and prevention strategy of very low birth weight infant (VLBWI) with nosocomial infection in neonatal intensive care unit (NICU). Methods The VLBWIs whose birth weight were less than 1500 g and hospital stays were more than 48 hours in NICU of Peking University Third Hospital from January 1, 1998 to December 31, 2008 were selected in this study. They were divided into nosocomial infection group and non-infection group. The clinical features and outcomes of nosocomial infection were summarized and the risk factors of which were analyzed with Logistic regression. Results There were 158 VLBWIs who fit for the criteria of our study during the eleven years, the mean birth weight was (1263.8± 155.5) g and the mean gestational age was (30.4±2.1) weeks. There were 70 times and 56 cases suffered from nosocomial infections. The incidence of nosocomial infection was 35.4% and hospital stay-related incidence was 14.4‰. Among 70 times of infections, there were 40(57.1%) pneumonia, 22(31.4%) septicemia, 4(5.8%) thrush, 1(1.4%)conjunctivitis, 1 ( 1.4%) upper respiratory tract infection and 2 (2.9%) unknown site infections.Forty-one strains of bacteria were isolated from 121 specimens, among which gram-negative bacillus accounted for 56.1% and gram-positive cocci for 46.3%. The duration of hospital stay of VLBWIs with nosocomial infection was significantly longer than that without [(43.7±15.5) d vs (26.3±14.4) d] (t = -7.058, P＜0.01). The fatality rate of VLBWIs with and without nosocomial infection was 3.6% (2/56) and 3.9% (4/102), and there was no significant difference (x2 = 0.012,P＞0.05). Logistic regression showed that mechanical ventilation (OR = 3.388, 95% CI: 1.656-6.932, P=0.001) and parenteral nutrition (OR= 7.054, 95%CI: 2.005-24.813, P=0.002) were risk factors of nosocomial infection. Conclusions The incidence of nosocomial infection in VLBWIs in NICU is high. Mechanical ventilation and parenteral nutrition should be avoided and the duration of invasive operation and treatment should be shortened as much as possible to minimize the chances of nosocomial infection in VLBWIs.
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Objective To explore the causes and adverse effects of hypocarbia in newborns during mechanical ventilation. Methods Two hundred and forty-six newborns received assisted ventilation from Jan. 1994 to Dec. 2003 were retrospectively reviewed. Results The morbidity of hypocarbia was 14. 2%. It is common in preterm infants and the onset time of which were (31. 6?26. 9) hours after mechanical ventilation. The common primary disease was respiratory distress syndrome (RDS) (22. 6%). The mortality (32. 9%) and incidence of intracranial hemorrhage (20%) in hypocarbia cases were higher than those of the control group (7. 1 % and 5. 7%) (P
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Objective To evaluate the neonatal outcomes and the prevalence of congenital malformations in children born after in-vitro fertilization(IVF). Methods IVF children (211 cases) born of 156 mothers from July 1994 to October 2003 and 218 controls were studied. Those controls were randomly chosen from the same hospital matched for the time and season of birth and maternal age. Results The incidence of multi-gestation (37.2% vs 2.3%, OR =24.62, 95% CI : 9.1~72), preterm birth (37.2% vs 8.5%, OR =6.41, 95% CI : 3.5~12.0), cesarean section (97.0% vs 71.8%, OR =14.9,95% CI :5.0~49.5), pregnancy-induced hypetension (22.4% vs 10.8%, OR = 2.39, 95% CI :1.3~4.9), threatened abortion (4.5% vs 0%, OR =3.11,95% CI :2.0~4.8) were significantly higher in the IVF group, but the prevalcnce of fetal distress (14.6% vs 4.5%) was lower comparing with control group( P