Clinical significance of alveolar-arterial oxygen gradients for late preterm and full-term infants with acute respiratory distress syndrome / 中国新生儿科杂志

Objective:To study the clinical significance of alveolar-arterial oxygen gradients (P A-aO 2) for late preterm and full-term infants with acute respiratory distress syndrome (ARDS). Methods:From January 2020 to June 2022, infants (gestational age ≥34 weeks) diagnosed with ARDS were admitted to the Neonatology Department of our hospital. The infants were assigned into the invasive group and the non-invasive group according to the ventilation mode. The infants with the same gestational age and diagnosed with neonatal wet lung were assigned into the control group. P A-aO 2 levels within 1 h after birth were compared among the three groups. The correlation of P A-aO 2 with ARDS, ventilation mode and duration were studied. Receiver operating characteristic (ROC) curve was used to determine the predictive value of P A-aO 2 within 1 h after birth for ARDS and the need of invasive ventilation. Results:A total of 36 cases were enrolled in the invasive group, 19 cases in the non-invasive group and 50 cases in the control group. Within 1 h after birth, P A-aO 2 in the invasive group was significantly higher than the non-invasive group and the control group ( P<0.05), and the non-invasive group higher than the control group ( P<0.05). Correlation analysis showed that P A-aO 2 within 1 h after birth in the invasive group was positively correlated with the duration of invasive ventilation and total mechanical ventilation ( r=0.601, P<0.001; r=0.504, P=0.002); P A-aO 2 before successful withdrawal of invasive ventilation was not correlated with subsequent non-invasive ventilation duration; and no correlation existed between P A-aO 2 within 1 h after birth and the duration of non-invasive ventilation in the non-invasive group. The area under the ROC curve for P A-aO 2 within 1 h after birth to predict ARDS was 0.875, with a sensitivity of 87.3% and a specificity of 72.0% at a cutoff value of 50.0 mmHg. The area under the ROC curve for predicting the need for invasive ventilation in infants with ARDS was 0.851, with a sensitivity of 80.0% at a cutoff value of 73.3 mmHg and a specificity of 75.0%. Conclusions:Late preterm and full-term infants have a higher risk of ARDS at P A-aO 2>50.0 mmHg within 1 h after birth. Infants with ARDS are more likely to require invasive ventilation if P A-aO 2>73.3 mmHg. The higher the level of P A-aO 2, the longer the duration of invasive ventilation and total duration of mechanical ventilation.

Risk factors of hypoglycemia in late preterm infants / 中国新生儿科杂志

Objective:To study the risk factors of hypoglycemia in late preterm infants.Methods:From January 2019 to December 2021, late premature infants admitted to NICU of our hospital were retrospectively studied. The infants with hypoglycemia were assigned into the hypoglycemia group and infants with same gestational age and normoglycemia were assigned into the control group in a 1∶1 ratio. The perinatal and maternal data of the two groups were compared. Multivariate logistic regression analysis was used to determine the risk factors of hypoglycemia in late premature infants.Results:A total of 366 cases each were included in the hypoglycemia group and the control group. No significant difference existed in birth weight between the two groups ( P>0.05). Multivariate logistic regression analysis showed that antenatal corticosteroid ( OR=1.567, 95% CI 1.127-2.180), cesarean section ( OR=2.013, 95% CI 1.376-2.944), twin birth ( OR=2.241, 95% CI 1.479-3.396) and infant of a diabetic mother ( OR=1.635, 95% CI 1.131-2.365) were the risk factors of hypoglycemia in late preterm infants ( P<0.05). Conclusions:Antenatal corticosteroid, cesarean section, twin birth and infant of a diabetic mother are independent risk factors for hypoglycemia in late preterm infants.

Test of Infant Motor Performance in the developmental assessment of preterm infants / 中华实用儿科临床杂志

Objective:To assess the characteristics and correlation of motor development in preterm infants of different gestational weeks by using the Test of Infant Motor Performance (TIMP) method, and to develop better individualized early interventions based on TIMP test results.Methods:A prospective study involving 43 full-term healthy infants and 77 preterm followed up in 3201 Hospital from June 2019 to July 2021 was conducted.Preterm infants were divided into the early preterm group (39 cases) and late preterm group (38 cases) according to their gestational age at birth.TIMP assessment was performed at the gestational age of 40 weeks and the corrected age of 16 weeks after birth.Similarly, the full-term healthy infants were assessed by TIMP at the postnatal age of 16 weeks.The differences between groups were investigated using ANOVA or Mann- Whitney rank sum test.Correlations were analyzed by the Pearson correlation method. Results:There were no significant difference in TIMP scores between early and late preterm infants at the gestational age of 40 weeks [(65.74±6.52) scores vs.(66.96±8.51) scores] and the corrected age of 16 weeks [(101±10) scores vs.(104±8) scores] (all P>0.05). TIMP scores in the full-term healthy group at the corrected age of 16 weeks [(108±10) scores] differed significantly from those of early and late preterm infants ( P<0.05). Compared with full-term infants, early and late preterm infants had lower TIMP scores in observation, supine position, and supine turning (all P<0.05), but a higher TIMP score in standing position ( P<0.05). For both early and late preterm infants, TIMP scores at the gestational age of 40 weeks were significantly positively correlated with those at the corrected age of 16 weeks ( r=0.565, 0.302, all P<0.01). Conclusions:There were significant differences in motor development between preterm infants of different gestational ages and term infants, which had guiding significance for early intervention.English version TIMP could play a positive role in promoting individualized follow-up and early intervention of preterm infants in China.

Late Preterm Infants' Outcome Born from Mothers with Positive Screening but Negative Diagnostic Test for Gestational Diabetes / 대한주산의학회잡지

PURPOSE: The aim of the study is to determine whether late preterm infants from normal oral GTT (glucose tolerance test) but positive GCT (glucose challenge test) mothers are associated with adverse postnatal outcome. METHODS: A retrospective study was performed from singleton infants who were born at 34(+0)-36(+6) weeks between January 2008 and December 2012 and prenatally checked at CHA Gangnam Medical Center. Infants were categorized into three groups according to the results of 50 g oral GCT and 100 g oral GTT; NG group (normal glucose tolerance group, n=603) vs. GIG group (gestational impaired glucose tolerance group; infants of normal oral GTT but positive GCT mothers, n=77) vs. GDM group (gestational diabetes group, n=52). Neonatal outcomes were compared among the three groups. RESULTS: GIG group showed significantly increased incidence of jaundice compared to NG group (9.6% vs. 19.5%, P=0.031). The number of old mothers (> or =35 years at delivery) was significantly higher in GIG group compared to NG group (27.5% vs. 33.8%, P=0.006). After stratification by maternal age, GIG group showed significantly increased respiratory diseases compared to NG group (44% vs. 65.4%, P=0.04). Hypocalcemia and feeding problem increased across the groups (NG vs. GIG vs. GDM; 13.3% vs. 26.9% vs. 32.0%, P= 0.024; 6.0% vs. 11.5% vs. 20.0%, P=0.05, respectively). CONCLUSION: Late preterm infants of normal oral GTT but positive GCT mothers, especially in older mother, have increased risk of postnatal morbidities such as respiratory distress, jaundice, hypocalcemia or feeding intolerance. Thus, careful follow up may be needed in this group since antepartum period.

Neurodevelopmental outcome at 18 months of late preterm infants / 中华实用儿科临床杂志

Objective To study the neurodevelopmental outcome prospectively at 18 months of the late preterm infants.Methods Data from 7 584 live born neonates were collected between January and December.2009 in 3 hospitals located in the north of Chengdu City,Sichuan Province were collected,89 late preterm infants were brought into study ; 170 healthy full-term infants were chosen as the controls randomly.Neurodevelopment outcome was assessed by using neonatal behavioral neurological assessment(NBNA) at 40 weeks corrected gestational age,and Bayley scales of infant development was performed to obtain the physical development index (PDI) and mental development index (MDI) at 3,6,9,12 and 18 months corrected age.Neurodevelopmental outcome of late preterm infants was studied compared with that of the term infants.Results Sixty-three neonates born at the late preterm phase and 115 neonates born at the term phase were successfully followed up.The NBNA scores of the late preterm infants at 40 weeks corrected gestationa] age were significantly lower than those of the term infants.The proportion of the late preterm infants whose scores ≥37 was significantly lower than that of the term infants(82.5％ vs 94.8％),the proportion of late preterm infants whose scores ＜35 was significantly higher than that of the term infants(4.8％ vs 0),the proportion of the late preterm infants whose scores in 35-36 was significantly higher than that of the term infants (12.7％ vs 5.2％,Z =-2.707,P ＜ 0.05) ;At 3,6,9 and 12 months corrected age,the late preterm infants showed a significant lower PDI scores(t =-4.266,-4.594,-5.663,-2.584) and MDI scores (t =-7.121,-7.829,-7.038,-6.002) than those of the term infants(all P ＜0.05).Compared with the term infants,the late preterm infants still had lower MDI scores than the term infants at 18 months corrected age(t =-4.115,P ＜0.05),but no difference was observed in PDI scores between late preterm and the term infants (t =-0.957,P ＞ 0.05).Conclusions Neurodevelopment outcome of the late preterm infants is delayed in the first year compared with term infants.At 18 months corrected age the mental development is still delayed compared with the term infants.Measures should be taken properly to improve the neurodevelopment of the late preterm infants in the early childhood.

The value of serum albumin level for the prognosis of late-preterm infants infection / 中国新生儿科杂志

Objective To study the value of serum albumin ( ALB ) level for the prognosis of late-preterm infants infection. Methods Late-preterm infants admitted to the neonatal intensive care unit ( NICU) from July 2012 to July 2013 were recruited and their clinical data retrospectively reviewed, including the laboratory examination results, neonatal critical illness scores ( NCIS ) , perinatal complications and prognosis. The infants were assigned into three groups based on ALB levels (＞30 g/L, 25-30 g/L, ＜25 g/L). Results A total of 257 cases were recruited and 122 cases (47. 4％) had ALB levels ＜25 g/L. 32 had neonatal sepsis ( sepsis group) , 190 neonatal infection ( infection group) and 35 without infection ( no-infection group ) . The incidences of hypoalbuminemia among these groups were 84. 4％, 50. 0％ and 28. 6％, with the mortality rate 15. 6％, 0. 5％ and 0％. The incidence of hypoalbuminemia and mortality rate in sepsis group were significantly higher than the other groups ( P＜0. 05 ) , and no statistically significant differences between infection group and no-infection group ( P＜0. 05). The ALB level in survived infants [(29. 6±7. 5)g/L] was statistically higher than the deceased ones [(20. 4±6. 9)g/L](P＜0. 05). The incidence of critically ill newborns was 65. 5％ in ALB ＜25 g/L group, significantly higher than the other groups (P＜0. 05). 26. 2％ in ALB ＜25 g/L group had more than 4 organs injuries, significantly higher than ALB ＞30 g/L group ( P＜0. 05 ) . Conclusions Hypoalbuminemia is common among neonates with sepsis. The ALB level had predictive value for the prognosis of neonatal infection.

Morbilidad asociada a la edad gestacional en neonatos prematuros tardíos / Gestational age-associated morbidity in late preterm neonates

Objetivo: comparar la morbilidad a corto plazo, intervenciones, estancia hospitalaria y los costos de prematuros de 34 semanas, con prematuros mayores a 34 semanas (35-36 semanas), hospitalizados en la Unidad de Cuidados Intensivos Neonatales de la Fundación Hospital San José de Buga, Colombia, entre el 19 de septiembre de 2005 y el 18 de septiembre de 2011. Métodos: estudio de cohorte retrospectivo, con 40 recién nacidos de 34 semanas de gestación y 129 de 35-36. Se evaluaron factores materno-neonatales y terapias aplicadas. El análisis incluyó estadísticas descriptivas y análisis bivariado. Para las asociaciones se empleó el riesgo relativo con su intervalo de confianza de 95 %, así como la prueba de chi² de Pearson de independencia. Resultados: se hallaron morbilidades respiratorias en el 32,5 %, ictericia en el 29 %, morbilidades gastrointestinales en el 13,6 %, metabólicas en el 13,6 %, cardiacas en el 1,8 %, hematológicas en el 1,2 %, e hipotermia y sepsis también en el 1,2 %. La falla renal se produjo en el 0,6 %, sin diferencias estadísticas entre los 2 grupos. Se halló diferencia estadísticamente significativa (p< 0,05) para tiempo de ayuno (> 2 días), administración de nutrición parenteral, horas de oxigenoterapia (> 2 y 5 días), horas de ventilación mecánica y estancia prolongada (> 7 días), y fueron los neonatos de 34 semanas los más afectados. El peso, talla y perímetro cefálico al nacer y egreso, fueron menores en aquellos de 34 semanas, mientras el retardo del crecimiento intrauterino fue superior en los de 35 y 36 semanas (26,4 vs. 7,5 %; RR: 1,3; IC 95 %: 1,1-1,5; p< 0,05). La atención hospitalaria de los neonatos de 34 semanas, resulta, por tanto, ser 1,6 y 0,6 veces más costosa en dinero, que la de los de 35 y 36 semanas. Conclusiones: el prematuro tardío debe considerarse inmaduro y con riesgo de morbilidad y mortalidad. Estos tienen gran incidencia de ictericia, morbilidad respiratoria, gastrointestinal y metabólica. Pero, los de 34 semanas, comparados con los de 35 y 36 semanas, requieren más intervenciones.

Objective: to compare the short-term morbidity, the number of interventions, the length of stay at hospital and the incurred costs between 34-weeks neonates and over-34 weeks newborns, who had been admitted to the neonatal intensive care units of Fundacion Hospital San Jose de Buga in Colombia from September 19th 2005 to September 18th 2011. Methods: retrospective cohort study in forty 34-weeks newborns and one hundred twenty nine 35-36 weeks neonates. Maternal and neonatal factors as well as applied therapies were evaluated. The analysis covered summary statistics and bivariate analysis. For finding association, the relative risk with 95 % confidence interval, and the Pearson's chi square test of independence were used. Results: respiratory morbidity was found in 32.5 % of patients, jaundice in 29 %, gastrointestinal morbidity in 13.6 %, metabolic morbidity in 13.6 %, cardiac morbidity in 1.8 %, hematological morbidity in 1.2 % and hypothermia and sepsis were seen in 1.2 % of patients. Renal failure affected 0.6 % of neonates, without statistical difference between the groups. There was statistically significant difference (p< 0,05) for fasting time (over 2 days), parenteral nutrition and time of oxygen therapy (more than 2 and 5 days, respectively), time of mechanical ventilation and long stays at hospital (over 7 days); the 34-weeks neonates were the most affected in terms of morbidity. Weight, size and head perimeter figures at birth and at discharge from the hospital were lower in the 34 weeks group, whereas the delayed intrauterine growth was greater in the 35 and 36 weeks neonates (26,4 vs. 7,5 %; RR: 1,3; IC 95 %: 1,1-1,5; p< 0,05). The care of 34 week neonates at hospital is, therefore, 1.6 and 0.6 times more expensive than that of 35 and 36-weeks newborns. Conclusions: the late preterm infant should be considered as immature with morbidity and mortality risks. The incidence of jaundice, respiratory, gastrointestinal and metabolic morbidities is high; however, the 34-week newborns require more interventions than the 35 and 36 weeks neonates.

Recién nacido prematuro tardío: incidencia y morbilidad neonatal precoz / Late preterm infant: incidence and early neonatal morbidity

La incidencia de prematuridad ha aumentado por el auge en el nacimiento de prematuros tardíos. La prematuridad tardía está asociada a un aumento de la morbilidad y mortalidad neonatal. Determinar la incidencia de nacimientos prematuros tardíos y su relación con complicaciones en el período neonatal. En un estudio cohorte prospectivo se analizó la población global de neonatos en un lapso de 9 meses. Se midieron la frecuencia de prematuridad tardía y los riesgos relativos de complicaciones, admisión a cuidados intensivos, enfermedad respiratoria, soporte ventilatorio y muerte, asociados a la prematuridad tardía. La frecuencia general de prematuridad fue 19 por ciento. Los prematuros tardíos conformaron 12 por ciento del total de nacidos y 66 por ciento de todos los prematuros. El 62,5 por ciento de los prematuros tardíos presentó alguna complicación aguda, mientras que esto ocurrió en 17,7 por ciento de los neonatos a término. Las causas primarias de admisión fueron las enfermedades respiratorias y la ictericia. La mortalidad en el grupo de prematuros tardíos fue 4,7 por ciento, mientras que en los niños a término fue 0,3 por ciento. Los prematuros tardíos manifestaron riesgos relativos aumentados en cuanto a complicaciones agudas, admisión a cuidados intensivos, dificultad respiratoria,  necesidad de ventilación  y muerte. Conclusiones: La frecuencia de prematuridad tardía es alta en nuestra población. Los prematuros tardíos representan dos tercios de todos los niños prematuros. Hay un riesgo aumentado de  hospitalización, dificultad respiratoria y muerte en el prematuro tardío, en comparación al niño a término. Los prematuros tardíos precisan una atención más cuidadosa por parte de los profesionales de salud.

The global incidence of prematurity has increased worldwide within the last twenty years, primarily because of a continuous increment in the birth of late preterm (LPT) infants. LPT infants entail a higher risk of morbidity and mortality than their term peers. To know the frequency of LPT births and their association with the risk of acute neonatal complications, as compared with term newborns. A prospective cohort study was undertaken during a nine-month period. Global incidence of LPT infants was estimated, and relative risks of complications, admission to intensive care, respiratory distress, need of ventilatory support and death in LPT infants were measured in comparison to their contemporaneous term neonates. Total frequency of prematurity was 19 percent. LPT infants represented 12 percent of total births and 66 percent of all preterm infants. 62.5 percent of all LPT infants had to be admitted because of complications, in contrast to 17.7 percent of all term infants. The main causes of admission were respiratory distress and jaundice. Overall mortality in LPT newborns was 4.7 percent, whereas in term infants it was 0.3 percent. LPT infants showed higher relative risks than term infants as regard to acute complications, hospitalizations, respiratory distress, need of ventilatory support and death. Conclusions: The frequency of LPT births in our institution is high. Two thirds of all preterm infants are LPT newborns. Late prematurity is associated with a high risk of hospitalizations, respiratory distress and death, as compared to term birth.  Greater attention needs to be paid to the management of LPT infants.