The early use of iNO in extremely premature neonates with refractory hypoxic respiratory failure / 中国新生儿科杂志

Objective:To study the early use of inhaled nitric oxide (iNO) as a rescue therapy in extremely premature infants (EPIs) with refractory hypoxic respiratory failure (HRF).Methods:Between January 2021 and December 2021, EPIs with refractory HRF receiving iNO within the first week of life in our NICU were enrolled. Their clinical characteristics and outcomes were retrospectively analyzed.Results:A total of 11 EPIs were included with 5 males and 6 females. The median gestational age (GA) was 24(22.6, 25.2) weeks. The median birth weight (BW) was 580(490, 770) g. The most common primary diagnoses were moderate/severe respiratory distress syndrome (RDS) (5/11) and early-onset sepsis (3/11). The median age starting iNO therapy was 6.5(4.5, 34.0)h and the median duration of iNO was 24(12, 36)h. The median iNO starting dose was 5(5, 8) ppm and the therapeutic range was 5-20 ppm. Therapeutic efficacy was defined as ≥30% FiO 2 reduction after 6 h of iNO treatment. The treatment was effective in 8 cases. The oxygenation index (OI) decreased more than 10% from baseline 1 h after initiation in 9 patients and in all 11 patients after 12 h of iNO. The reduction of OI was more prominent in EPIs with a higher OI at baseline. Of the 11 patients, 8 survived, 1 died and 2 abandoned further treatments. Conclusions:As an early rescue therapy for EPIs with refractory HRF, iNO can improve oxygenation without obvious short-term adverse effects.

The efficacy of individualized swallowing training for premature infants with feeding disorders: A randomized controlled trial / 中华物理医学与康复杂志

Objective To observe the effect of individualized swallowing training in the neonatal intensive care unit on the swallowing function of premature infants with feeding disorders.Methods Sixty-two preterm (28 to 32 weeks) infants with feeding disorders were randomly divided into a treatment group (n=34) and a control group (n =28).Both groups were given routine gastric tube feeding,but the treatment group was additionally provided with individualized swallowing training twice a day for 2 weeks,including oral sensory and motor stimulation,milking,family participation,a better environment and a selection of feeding tools.The subjects' daily milk consumption and weight were recorded,along with the age when the gastric tube was removed and the total length of the hospital stay.Results The treatment group showed significantly greater improvement than the control group in their daily milk consumption and weight gain,though both groups showed significant improvements.The average time to removing the gastric tube and the average hospital stay were both significantly shorter for the treatment group than for the control group.Conclusion Individualized swallowing training can effectively improve sucking and swallowing skills and shorten the period of using a gastric tube and the total hospital stay for premature infants.

Clinical analysis of the difference between full-term and preterm infants with purulent meningitis / 国际检验医学杂志

Objective To discuss and compare the clinical characteristics and difference of full-term and preterm neonatal purulent meningitis(NPM),for early diagnosis and reasonable treatment.Methods 72 newborns with NPM were collected.According to the gestational age,33 cases were divided into the full-term group(37-42 weeks) and 39 cases were divided into the preterm group (＜37 weeks).The clinical data,symptoms and signs,the related infection,the lab tests of blood and cerebrospinal fluid and pathogenic examination were analyzed and compared.Results The sex,the day age of hospital admission and onset between the two groups were no difference(P＞0.05).The rate of low-birth weight infant was 6.1％,which was significantly lower than preterm neonates(59.0 ％)(P＜0.05).The mainly clinical manifestations of full-term newborns with NPM were fever(75.8 ％),convulsions (45.5％),poor response(78.8％),and poor eating milk(45.5％).But the mainly clinical manifestations of preterm neonates with NPM were jaundice(30.8 ％),apnea(20.5 ％) and lower muscular tension(61.5 ％).There were 17 cases(51.5 ％) with NPM combined with septicemia in the full-term group,which was more than preterm neonates(20.5 ％)(P＜0.05).According to the results of the lab tests,18 full-term neonates (54.5 ％) with NPM with increased CRP levels were more than preterm neonates (28.2 ％) (P＜0.05).Besides,the preterm NPM neonates showed higher protein levels (2.35 ± 0.78) g/L and lower glucose(1.84 ±0.69) mmol/L in cerebrospinal fluid than these in the full-term group(P＜0.05).However,there was only 2 full-term NPM neonate with a positive cerebrospinal fluid culture,and 15 patients with a positive blood culture(8 full-term neonates and 7 preterm neonates).Conclusion Because of the atypical clinical characteristics and difference between the full-term neonates and the preterm neonates,the clinical symptoms and signs of neonates should be closely monitored.Therefore,it's suggested that the early diagnosis and reasonable treatment be a key plan for the low mortality and disability.

Clinical analysis of the difference between full-term and preterm infants with purulent meningitis / 国际检验医学杂志

Objective To discuss and compare the clinical characteristics and difference of full-term and preterm neonatal purulent meningitis(NPM),for early diagnosis and reasonable treatment.Methods 72 newborns with NPM were collected.According to the gestational age,33 cases were divided into the full-term group(37-42 weeks) and 39 cases were divided into the preterm group (＜37 weeks).The clinical data,symptoms and signs,the related infection,the lab tests of blood and cerebrospinal fluid and pathogenic examination were analyzed and compared.Results The sex,the day age of hospital admission and onset between the two groups were no difference(P＞0.05).The rate of low-birth weight infant was 6.1％,which was significantly lower than preterm neonates(59.0 ％)(P＜0.05).The mainly clinical manifestations of full-term newborns with NPM were fever(75.8 ％),convulsions (45.5％),poor response(78.8％),and poor eating milk(45.5％).But the mainly clinical manifestations of preterm neonates with NPM were jaundice(30.8 ％),apnea(20.5 ％) and lower muscular tension(61.5 ％).There were 17 cases(51.5 ％) with NPM combined with septicemia in the full-term group,which was more than preterm neonates(20.5 ％)(P＜0.05).According to the results of the lab tests,18 full-term neonates (54.5 ％) with NPM with increased CRP levels were more than preterm neonates (28.2 ％) (P＜0.05).Besides,the preterm NPM neonates showed higher protein levels (2.35 ± 0.78) g/L and lower glucose(1.84 ±0.69) mmol/L in cerebrospinal fluid than these in the full-term group(P＜0.05).However,there was only 2 full-term NPM neonate with a positive cerebrospinal fluid culture,and 15 patients with a positive blood culture(8 full-term neonates and 7 preterm neonates).Conclusion Because of the atypical clinical characteristics and difference between the full-term neonates and the preterm neonates,the clinical symptoms and signs of neonates should be closely monitored.Therefore,it's suggested that the early diagnosis and reasonable treatment be a key plan for the low mortality and disability.

Capacidade de mentalização materna e prematuridade: repercussões de uma intervenção em UTIN / Maternal mentalizing capacity and prematurity: effects of na intervention in NICU / Capacidad de mentalización materna y prematuridad: efectos de una intervención en UCIN

As interações mãe-bebê e suas repercussões na construção do psiquismo são abordadas pela Teoria do Apego, destacando-se a capacidade de mentalização materna como determinante na formação de um apego seguro. Este estudo objetivou compreender como uma intervenção psicoterápica, realizada com duplas mãe-bebê prematuro, durante a internação em UTIN, repercute na capacidade de mentalização materna, mediante pesquisa qualitativa de intervenção, exploratória e descritiva, de estudo de casos múltiplos, com avaliações antes e após a intervenção. Participaram duas díades mãe-bebê prematuro, internado em UTIN. Utilizaram-se como instrumentos antes da intervenção ficha de dados sociodemográficos e clínicos, entrevista de história de vida da mãe; e, após, entrevista de história da internação. Analisaram-se os dados por meio de dois eixos temáticos: a) Representações maternas sobre si mesma; b) Representações maternas sobre o bebê. Verificaram-se mudanças na capacidade de mentalização materna, o que favoreceu o vínculo mãe-bebê e a possível aplicação de intervenções voltadas às relações iniciais mãe-bebê prematuro em UTIN.

Mother-infant interactions and their impact on the formation of the psyche are studied by the Attachment Theory, highlighting the maternal mentalizing capacity as a determinant in the formation of a secure attachment. This study aimed to understand how a psychotherapeutic intervention performed with mother-premature baby pairs during hospitalization in NICU affects the maternal mentalizing capacity through a qualitative intervention research, with exploratory and descriptive character, which surveyed multiple cases and assessments before and after the intervention. The research included two mother-premature neonate dyads hospitalized in NICU. Before the intervention, the instruments used were: Socio-Demographic and Clinical Data Sheets and Live History Interview with the mother; after, the instrument used was the Hospitalization History Interview. Data were analyzed according to two themes: a) maternal representations of herself; b) maternal representations of the baby. There were changes in maternal mentalizing capacity, favoring the mother-baby bond and a possible implementation of interventions aimed at the early relationship mother-premature baby in NICU.

Las interacciones madre-hijo y su impacto en la formación de la psique son estudiados por la teoría del apego, destacando la capacidad de mentalización materna como factor determinante en la formación de una unión segura. Este estudio tuvo como objetivo comprender cómo una intervención psicoterapéutica realizada con doble materno-infantil temprana durante el ingreso en la UCIN, afecta la capacidad de mentalización materna por la intervención investigación cualitativa, estudio exploratorio y descriptivo de casos múltiples, con las evaluaciones antes y después de la intervención. Se incluyeron dos díadas madre-hijo temprana ingresados en UCIN. Se utiliza como instrumentos antes de la intervención: Hoja socio-demográficas y clínicas de datos, Entrevista Historia de la Madre de la Vida; y después de: Entrevista Historia de internamiento. los datos se analizaron a través de dos temas: a) las representaciones maternas de la misma; b) las representaciones maternas del bebé. No hubo cambio en la capacidad de mentalización materna, lo que favorece el vínculo madre-bebé y la posible implementación de las intervenciones dirigidas a las primeras relaciones temprana madre-bebé en la UCIN.

Spinal Anaesthesia or General Anaesthesia: Which is better in Premature Neonates: A Case Report.

General anaesthesia in premature neonates is associated with various complications. Spinal anaesthesia can be better choice in premature babies in surgeries below umbilicus. Spinal anaesthesia provides all components of balance anaesthesia with minimum cardiorespiratory disturbance and post-operative nausea vomiting, early ambulation and rapid return of appetite. We report a case of one day old premature new-born who was given successful spinal anaesthesia and was operated with good outcome.

Expansibilidade torácica na avaliação do volume corrente em recém-nascidos prematuros ventilados / Chest expansion for assessing tidal volume in premature newborn infants on ventilators

OBJETIVOS: Avaliar se a observação clínica da expansibilidade torácica prediz o volume corrente em neonatos sob ventilação mecânica e se a experiência do examinador interfere no resultado. MÉTODOS: Estudo observacional que incluiu médicos de baixa experiência (1° ano de residência em pediatria), moderada experiência (2° ano de residência em pediatria, 1° ano de especialização em neonatologia ou em terapia intensiva pediátrica) e experientes (2° ano de especialização em neonatologia, pós-graduandos ou assistentes com experiência mínima de 4 anos em neonatologia). Estes observaram a expansibilidade torácica de recém-nascidos em ventilação mecânica e responderam qual o volume corrente fornecido aos bebês. O volume corrente ofertado foi calculado, indexado ao peso atual do paciente e considerado adequado se entre 4-6 mL/kg, insuficiente se abaixo de 4 mL/kg e excessivo se acima de 6 mL/kg. Para análise dos resultados, foi utilizado o qui-quadrado. RESULTADOS: Foram realizadas 111 avaliações em 21 recém-nascidos, e as respostas fornecidas concordaram com o volume mensurado em 23,1, 41,3 e 65,7 por cento para os médicos de baixa, moderada experiência e experientes, respectivamente. Esses resultados evidenciam que os três grupos não são estatisticamente iguais (p = 0,013) e que o grupo de médicos experientes apresenta maior concordância que os de baixa e moderada experiência (p = 0,007). CONCLUSÃO: A análise clínica da expansibilidade torácica realizada por médicos de baixa e moderada experiência apresenta pouca concordância com o volume corrente ofertado aos recém-nascidos em ventilação mecânica. Embora a experiência dos médicos tenha resultado em maior concordância, a expansibilidade torácica deve ser interpretada com cautela.

OBJECTIVES: To investigate whether clinical observation of chest expansion predicts tidal volume in neonates on mechanical ventilation and whether observer experience interferes with results. METHODS: An observational study that enrolled less experienced physicians in the first year of pediatric residency, moderately experienced (second year pediatric residency, first year of neonatology or pediatric intensive care specialization) or who were already experienced (second year neonatology specialization, graduate students or primary physician supervisors with minimum experience of 4 years in neonatology). These professionals observed the chest expansion of newborn infants on mechanical ventilation and estimated the tidal volume being supplied to the babies. True tidal volume given was calculated, indexed by the patient's current weight, and considered adequate between 4 and 6 mL/kg, insufficient below 4 mL/kg and excessive over 6 mL/kg. Results were analyzed using chi-square test. RESULTS: One hundred and eleven assessments were carried out with 21 newborn infants and the estimates given were in agreement with measured volume in 23.1, 41.3 and 65.7 percent for less, moderately and experienced physicians, respectively. These results are evidence that the three groups are not statistically equal (p = 0.013) and that the group of fully-experienced physicians have a better level of agreement than those with little or moderate experience (p = 0.007). CONCLUSIONS: Clinical analysis of chest expansion by physicians with less or moderate experience exhibit a low level of agreement with the tidal volume given to newborn infants on mechanical ventilation. Although increased experience did result in higher levels of agreement, chest expansion must still be interpreted with caution.