Progress of insulin-like growth factor-1 in preterm related complications / 国际儿科学杂志

With the progress of perinatal medicine, the survival rate of premature infants has been greatly improved, but the incidence of preterm related complications has also increased, including growth retardation, premature brain injury, retinopathy of prematurity, bronchopulmonary dysplasia and necrotizing enterocolitis.Insulin-like growth factor-1(IGF-1)specifically binds to IGF-1 receptor to activate intracellular signaling pathways, so that can promote cell growth, proliferation and differentiation, and inhibit apoptosis.IGF-1 is involved in the development of the heart, brain, lung, and other important organs and promotes tissue growth, so it plays an important role in fetal intrauterine development and neonatal extrauterine growth.At present, some clinical trials have found that recombinant IGF-1 and its binding protein-3 can play a role in the prevention and treatment of retinopathy of prematurity and bronchopulmonary dysplasia, bringing hope for the prevention and treatment of these refractory complications of prematurity.In this review, the function of IGF-1 and its role in preterm related complications are reviewed.

Progress on abdominal sonography in neonatal necrotizing enterocolitis / 国际儿科学杂志

As a critical bowel disease in neonates and preterm births, neonatal necrotizing enterocolitis(NEC)is hard to diagnose and treat in time, leaving bad outcomes.With the development of perinatal medicine, the survival rate of premature infants has gradually increased.NEC has become a major digestive system disease that seriously affects the morbidity and compromised life quality of premature infants.Abdominal ultrasound examination has been widely used in the early diagnosis, treatment guidance and outcome assessment of NEC.It is non-invasive and in real time, with high sensitivity and specificity.This review summarizes recent progress on the application of abdominal sonography in the prediction, diagnosis, assessment and treatment guidance of NEC.

Evolución del síndrome de distrés respiratorio agudo en los neonatos del área de cuidados intensivos del hospital "Delfina Torres de Concha" / Evolution of the acute respiratory distress syndrome in neonates in the intensive care area of ​​the "Delfina Torres de Concha" hospital

Analizar la evolución del síndrome de distrés respiratorio agudo (SDRA) en neonatos pretérminos del área de cuidados intensivos del Hospital General Delfina Torres de Concha. Materiales y Métodos: La investigación es un estudio cuantitativo, de corte transversal y alcance descriptivo. La muestra probabilística quedó conformada por 49 madres de neonatos prematuros. Las técnicas utilizadas son el estudio documental y la encuesta. Los criterios de inclusión incluyeron ambos sexos, que nacieron entre las 26 y las 35 semanas de gestación, durante los meses de julio, agosto y septiembre de 2020. Las variables fueron los factores sociodemográficos de las madres, los factores de riesgo maternos, el género, vía del parto, peso al nacer, complicaciones de los neonatos y la mortalidad infantil. Resultados: Los resultados muestran que la etnia prevalente fue la mestiza (65,3%), el estado civil más representado fue el de unión libre (51,0%) y el nivel de escolaridad es muy bajo, así como el per cápita económico familiar. Los factores de riesgo maternos fueron la hipertensión (21,5%), la edad y la preeclamsia (18,5%, respectivamente). En los recién nacidos prevaleció el sexo masculino (46,9%) sobre el femenino (53.06%), al igual que las cesáreas (55,1%). Las complicaciones más importantes fueron la hemorragia intraventricular (23,8%), la hipertensión pulmonar persistente (20,6%) y la displasia broncopulmonar (15,9%). La tasa de mortalidad infantil se situó en el 32,7%. Conclusiones: Existe una correlación entre las complicaciones severas de los recién nacidos y la mortalidad neonatal. Por la trascendencia familiar y social del fallecimiento de neonatos y la frecuencia de trastornos respiratorios en la morbimortalidad de los recién nacidos en dicho Hospital, se hace necesario realizar estudios que estimulen la prevención y diagnóstico oportuno, especialmente en contextos como el nuestro

To analyze the evolution of acute respiratory distress syndrome (ARDS) in preterm neonates in the intensive care area of the Hospital General Delfina Torres de Concha. Materials and Methods: The research is a quantitative, cross-sectional, descriptive study. The probabilistic sample consisted of 49 mothers of preterm infants. The techniques used were documentary study and survey. The inclusion criteria included both sexes, born between 26 and 35 weeks of gestation, during the months of July, August and September 2020. The variables were sociodemographic factors of the mothers, maternal risk factors, gender, and route of delivery, birth weight, neonatal complications and infant mortality. The results: The results show that the most prevalent ethnic group was mestizo (65.3%), the most represented marital status was a union (51.0%) and the level of schooling was very low, as well as the family economic per capita. Maternal risk factors were hypertension (21.5%), age and preeclamsia (18.5%, respectively). Among the newborns, the male sex (46.9%) prevailed over the female (53.06%), as did cesarean sections (55.1%). The most important complications were intraventricular hemorrhage (23.8%), persistent pulmonary hypertension (20.6%) and bronchopulmonary dysplasia (15.9%). The infant mortality rate was 32.7%. Conclusions: There is a correlation between severe newborn complications and neonatal mortality. Due to the family and social importance of neonatal deaths and the frequency of respiratory disorders in the morbidity and mortality of newborns in this Hospital, it is necessary to carry out studies to stimulate prevention and timely diagnosis, especially in contexts such as ours

Fatores relacionados à prematuridade em uma maternidade pública de Teresina ­ PI: estudo retrospectivo / Factors related to prematurity in a public maternity hospital of Teresina - Piauí: retrospective study

A prematuridade é caracterizada pela idade gestacional inferior a 37 semanas e, devido a esse fator, o neonato nasce exposto a consequências na vida extrauterina, com possibilidade de atraso motor e outras condições adversas. OBJETIVO: Investigar as causas da prematuridade em uma maternidade pública de Teresina-PI. MÉTODOS: Trata-se de um estudo descritivo retrospectivo que avaliou o tempo de bolsa rota, uso de medicações, tipo de parto, idade da parturiente, número de gestações, de partos, de abortos, de consultas no pré-natal, idade gestacional (IG), sorologias para infecções e intercorrências. Foi realizado o teste Quiquadrado para verificar associação do número de consultas com a idade da parturiente (alfa de 5%). RESULTADOS: Dos 4.379 prontuários do primeiro trimestre do ano de 2017 foram analisados e incluídos 310 casos de prematuros. A maior parte das parturientes era primípara e com idade entre 18 e 44 anos. Quase metade da amostra fez menos de seis consultas no acompanhamento pré-natal e o principal tipo de parto foi o cesáreo. As principais intercorrências associadas à prematuridade foram pré-eclâmpsia e ruptura precoce de membranas gestacionais. As mulheres com idade mais avançada apresentam maior associação com a prematuridade (p<0,05). CONCLUSÃO: Os principais fatores observados na amostra de casos de prematuridade foram pré-eclâmpsia, ruptura precoce de membranas gestacionais, parto cesáreo e acompanhamento pré-natal insuficiente.

Xrematurity is characterized by gestational age less than 37 weeks and, due to this fator, the newborn is born exposed to consequences in extrauterine life, with the possibility of motor delay and other adverse conditions. OBJECTIVE: To investigate the causes of prematurity in a public maternity hospital in Teresina ­ PI. METHODS: This is a retrospective descriptive study that evaluated use, type of delivery, parturient's age, number of pregnancies, deliveries, abortions, prenatal consultations, gestational age (IG), serology test was performed complications. The chi-square teste was performed to verify the association between the number of consultations and the parturient's age (5% alpha). RESULTS: Of the 4,379 medical records of the first quarter of 2017, 310 premature cases were analyzed and included. Most of the parturients were primiparous and aged between 18 and 44 years. Almost half of the sample had less than six prenatal visits and the main type of delivery was cesarean. The main complications associated with prematurity were preeclampsia and early rupture of gestational membranes. Older women have a higher association with prematurity (p <0.05). CONCLUSION: The main factors observed in the sample of prematurity were preeclampsia, early rupture of gestational membranes, cesarean section and insufficient prenatal care.

Evaluation of the development on the preterm and term neonatal brain white matter based on metrics derived from diffusion tensor imaging / 西安交通大学学报(医学版)

Objective To explore developmental states on the preterm and term neonatal brain white matter based on the co-variation of metrics derived from diffusion tensor imaging(DTI).Methods This work enrolled 66 neonates,consisting of 33 preterm(21 males and 12 females;gestational age:30.143-36.286 weeks)and 33 full-term neonates(22 males and 11 females;gestational age:37.000 -41.429 weeks).DTI derived metrics included axial diffusivity(AD),radial diffusivity(RD),and fractional anisotropy(FA).Spearman's rank correlation between metrics and postmenstrual age was analyzed in the preterm and term neonates.Developmental states were evaluated according to the method proposed by Dubois:fiber organization was associated with increased AD, decreased RD and increased FA;pre-myelination was related to decreased AD,decreased RD and unchanged/increased FA;myelination was revealed by unchanged AD,decreased RD and increased FA.Mann-Whitney U test was used to compare DTI metrics between the preterm and term neonates.Results According to the method proposed by Dubois,posterior limb of internal capsule and corpus callosum underwent myelination in the preterm-neonate period.Cerebral peduncle started myelination in the term-neonate period.Superior corona radiate,inferior fronto-occipital fasciculus and external capsule underwent pre-myelination on preterm and term neonates.FA values were higher in term neonates than those in preterm neonates in all the selected regions(P＜0.05).AD and RD values were lower in term neonates than those in preterm neonates in the selected regions except for cerebral peduncle(P＜0.05).Conclusion Changes in DTI metrics and the method of Dubois can be used to quantitatively evaluate developmental states of the neonatal brain white matter.The changes coincided with DTI variations associated with pre-myelination and myelination.White matter development is delayed in preterm neonates compared with term neonates.

Meta-analysis of the efficacy and safety of inhaled corticosteroids for preventing chronic lung disease in preterm infants / 临床儿科杂志

Objective To evaluate the efficacy and safety of inhaled corticosteroids for preventing chronic lung disease (CLD) in preterm infants. Methods PubMed, EMBASE, CENTRAL, the ISI Web of Knowledge databases, CBM, CNKI, VIP and Wanfang Data were searched for the period up to Oct. 2016. All randomized controlled trials (RCTs) about inhaled corticosteroids for preventing CLD in preterm infants were collected. The RCTs had been screened, data were extracted and assessed. The mata-analysis was performed by RevMan 5.3 software. Result A total of 12 RCTs were included (a total of 2051 preterm neonates). Compared with control group, in 28 day old group, the incidence of CLD was not significantly different between experimental and control groups (RR=0.87, 95%CI:0.74-1.03, P=0.11) and (RR=1.19, 95%CI:0.59-2.43, P=0.63) and no significant difference among subgroups budesonide (α), beclomethasone (β), fluticasone (γ) (RR=0.89, 95%CI:0.69-1.14, P=0.35), (RR=0.86, 95%CI:0.69-1.08, P=0.19) and (RR=0.91, 95%CI:0.60-1.38, P=0.19). In 36 wk postmenstrual age group,the incidence of CLD was decreased in experimental group and in subgroups inhalation (A), Intratracheal administration (B), α, γ (RR=0.70, 95%CI: 0.61-0.80, P<0.00001), (RR=0.74, 95%CI: 0.63-0.87, P=0.0003), (RR=0.57, 95%CI: 0.43-0.76, P=0.0002), (RR=0.67, 95%CI: 0.57-0.78, P<0.00001) and (RR=0.58, 95%CI: 0.36-0.94, P=0.03); but it is not significantly different in subgroup β(RR=0.98, 95%CI: 0.69-1.39, P=0.90); There was no difference in the motality in experimental and subgroups A ,B, α, β , γ (RR=1.07, 95%CI:0.86-1.33, P=0.55), (RR=1.24, 95%CI: 0.97-1.59, P=0.09), (RR=0.67, 95%CI: 0.43-1.03, P=0.07), (RR=1.04, 95%CI: 0.81-1.33, P=0.78), (RR=1.47, 95%CI: 0.79-2.74, P=0.22) and (RR=0.91, 95%CI: 0.47-1.74, P=0.77). No clinically significant adverse effects were observed during the study. Conclusions This updated review indicated that early administration of inhaled steroids to very low birth weight preterm neonates was effective in reducing the incidence of CLD. There was no statistically significant effect of inhaled steroids on motality, and there was no significant correlation between the mode of administration and the type of drug delivery, It is recommended to observe the 36 week gestational age as the outcome index. More and larger randomised placebo-controlled trials including long-term follow up are needed to establish the efficacy and safety of inhalation corticosteroids.

A Prospective Study to Assess the Neonatal Mortality and Morbidity Associated with Preterm labor and Delivery in a Tertiary Care Hospital.

Background: Preterm labor and delivery are one of the challenging obstetric complications encountered by obstetricians, as are preterm neonates for the pediatricians. Therefore, this study was planned to identify etiological factors and to assess the neonatal mortality and morbidity associated with preterm labor and delivery. Methods: This prospective study was conducted over a 6 months period (September 2014 to February 2015) in the department of Obstetrics/Gynaecology and Paediatrics at Patliputra Medical College, Dhanbad, Jharkhand. 325 antenatal women admitted with threatened preterm labor, with or without rupture of membranes, were recruited. They were followed up from admission till delivery and discharge. Gestational age at onset of preterm labor, associated risk factors, response to tocolytics if given, gestational age at delivery, and neonatal outcome were recorded and analyzed.Results: Incidence of preterm labor was found to be 28.26% and that of preterm deliveries 25.9%. Preterm rupture of membranes and infection were the commonest causes of preterm labor. Irrespective of the use of a course of betamethasone, neonatal mortality was significantly higher (P<0.0001) in babies delivering before 34 weeks (30.4%) as compared to that in babies delivering after 34 weeks (3.4%). Septicemia, respiratory distress syndrome (RDS) and birth asphyxia were the important causes of neonatal morbidity.Conclusion: Our results revealed a high incidence of preterm labor and preterm births in comparison to developed countries. Infection is one important modifiable risk factor which can be reduced. Prolongation of delivery for 48 hours by giving tocolytics for getting the benefit of betamethasone coverage reduces morbidity due to RDS but does not reduce overall neonatal mortality below 34 weeks.

Estatura final de una población de prematuros con muy bajo peso al nacer / Final height in a population of preterm infants with very low birth weight

Los niños nacidos prematuros de muy bajo peso, tienen una mayor frecuencia de baja talla a la edad adulta. En la Argentina no contamos con reportes de estatura final de estos niños. Se evaluaron el peso y estatura de 46 jóvenes de la ciudad de Buenos Aires con antecedentes de prematurez y muy bajo peso al nacer egresados de 7 unidades neonatales de la ciudad de Buenos Aires y conurbano bonaerense, entre los años 1990 y 1995. Los 46 jóvenes (27 mujeres) tenían una edad promedio de 18.97 años (16.04 - 22.93). La estatura media de las mujeres fue de -0,71 sDS (0.20) y -0.75 sDS (0.22) en varones. Se detectó baja estatura en 2 mujeres (7.4%) y 1 varón (5.3%). La incidencia global de baja estatura es de 6.5% (AU)

Infants born prematurely with a very low birth weight more often have short stature in adulthood. In Argentina there are no reports on final height in these children. We evaluated weight and height of 46 adolescents and young adults from the city of Buenos Aires with a history of prematurity and very low birth weight who were discharged from seven Departments of Neonatology in the city of Buenos Aires and Greater Buenos Aires between 1990 y 1995. The 46 youth (27 females) had a mean age of 18.97 years (16.04 ­ 22.93). Mean height of the women was -0.71 SDS (0.20) and mean height of the men was -0.75 SDS (0.22). Low stature was observed in two women (7.4%) and one man (5.3%). Overall incidence of short stature was 6.5%. (AU)

Does Oral Lansoprazole Really Reduce Gastric Acidity in VLBW Premature Neonates?

Premature neonates of very low birth weight (VLBW) whose treatment required the use of naso-gastric tube feeding were investigated. 10 infants suspected of having GERD (gastroesophageal reflux) received oral lansoprazole therapy by tube administration. 9 other infants formed a control group. In the treated group a fasting pH was determined before treatment and again after 7 days treatment. The control group was similarly assessed at an interval of 7 days. Despite acid reduction, the post-treatment pH mean of 1.31 would continue to pose a threat to the esophageal mucosa. The physiology of neonatal acid secretion is discussed to explain these findings.

Fluid and electrolyte balance during the first week of life and risk of bronchopulmonary dysplasia in the preterm neonate

BACKGROUND: Early fluid and electrolyte imbalances may be associated with an increased risk of bronchopulmonary dysplasia. OBJECTIVE: We sought to establish an association between fluid and electrolyte balance in the first week of life and the risk of bronchopulmonary dysplasia. METHODS: Clinical charts of 205 neonates <32 weeks gestational age and/or <1,250 g birth weight (admitted to our NICU between 1997 and 2008) were analyzed. Clinical features, fluid and electrolyte balance were analyzed for the first 7 days of life using multivariate models of generalized estimation equations. A p value <0.05 was considered significant in all of the hypothesis tests. RESULTS: The prevalence of bronchopulmonary dysplasia was 22 percent. Lower gestational age and birth weight, male gender, less frequent use of antenatal steroids, respiratory distress syndrome, use of surfactant, patent ductus arteriosus, duration of invasive ventilation and NICU stay were significantly associated with bronchopulmonary dysplasia. The variation in serum values of potassium, phosphorus and creatinine during the first week of life also revealed an association with bronchopulmonary dysplasia. Higher mean plasma calcium values were associated with spontaneous closure of the patent ductus arteriosus. The use of indomethacin to induce patent ductus arteriosus closure was significantly higher in bronchopulmonary dysplasia patients. CONCLUSIONS: Differences in renal function and tubular handling of potassium and phosphorus are present during the first week of life among preterm neonates who will develop bronchopulmonary dysplasia. The higher rate of patent ductus arteriosus and indomethacin use may influence these differences. Serum levels of calcium also appear to play a role in spontaneous ductus arteriosus closure.

A Case of Ileao-ileal Intrauterine Intussusception in a Preterm Neonate / 대한소아소화기영양학회지

Intussusception in a preterm neonate is a very rare disorder. We experienced a case of intrauterine intussusception presented with symptoms of the small bowel obstruction in a preterm infant whose gestational age was 28(+2) weeks. Urgent ultrasonography of abdomen revealed no definite intussuscepted segment. At emergent surgery performed on the 11th days of life under the diagnosis of distal small bowel obstruction, an ileo-ileal intussusception with distal ileal atresia without perforation was found.