Clinical treatment outcomes and their changes in extremely preterm twins: a multicenter retrospective study in Guangdong Province, China / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China.@*METHODS@#A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups.@*RESULTS@#Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05).@*CONCLUSIONS@#There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.

Relationship between serum levels of insulin-like growth factor I and growth hormone and neonatal hypoxic-ischemic encephalopathy / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the serum levels of insulin-like growth factor I(IGF-I)and growth hormone (GH) in neonates with hypoxic-ischemic encephalopathy (HIE) and to investigate the relationship of serum levels of IGF-I and GH with the severity of HIE.</p><p><b>METHODS</b>Serum levels of IGF-I and GH were measured within 72 hrs (acute stage) and on the 26-28th days (convalescence stage) of life in 53 HIE neonates. There were 30 babies in the mild HIE group, 15 babies in the moderate HIE group, and 9 babies in the severe HIE group. Thirty normal newborns were used as the control group. Neonatal behavioral neurological assessment (NBNA) was performed on HIE neonates at the acute and convalescence stages.</p><p><b>RESULTS</b>The IGF-I levels of the mild, moderate and severe HIE groups measured within 72 hrs of life were 59.65 +/- 29.61, 33.56 +/- 17.32, and 23.58 +/- 13.57 ng/mL respectively and those of the three HIE subgroups on the 26-28th days after birth were 89.26 +/- 48.65, 71.46 +/- 38.35, and 54.39 +/- 26.39 ng/mL respectively. The serum IGF-I levels of HIE neonates at both acute and convalescence stages were significantly lower than those of the control group (71.23 +/- 35.42 and 96.54 +/- 52.38 ng/mL respectively; both P < 0.01), and associated with the severity of HIE as well as NBNA scores. GH levels were not significantly correlated to the severity of HIE and NBNA scores.</p><p><b>CONCLUSIONS</b>Serum IGF-I levels can be used as a marker for estimating the severity and the outcome of neonatal HIE.</p>