Clinical characteristics and risk factors for early-onset necrotizing enterocolitis in preterm infants with very/extremely low birth weight / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical characteristics and risk factors for early-onset necrotizing enterocolitis (NEC) in preterm infants with very/extremely low birth weight (VLBW/ELBW).@*METHODS@#A retrospective analysis was performed on the medical data of 194 VLBW/ELBW preterm infants with NEC who were admitted to Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. These infants were divided into early-onset group (onset in the first two weeks of life; n=62) and late-onset group (onset two weeks after birth; n=132) based on their onset time. The two groups were compared in terms of perinatal conditions, clinical characteristics, laboratory examination results, and clinical outcomes. Sixty-two non-NEC infants with similar gestational age and birth weight who were hospitalized at the same period as these NEC preterm infants were selected as the control group. The risk factors for the development of early-onset NEC were identified using multivariate logistic regression analysis.@*RESULTS@#Compared with the late-onset group, the early-onset group had significantly higher proportions of infants with 1-minute Apgar score ≤3, stage III NEC, surgical intervention, grade ≥3 intraventricular hemorrhage, apnea, and fever or hypothermia (P<0.05). The multivariate logistic regression analysis showed that feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, and hemodynamically significant patent ductus arteriosus were independent risk factors for the development of early-onset NEC in VLBW/ELBW preterm infants (P<0.05).@*CONCLUSIONS@#VLBW/ELBW preterm infants with early-onset NEC have more severe conditions compared with those with late-onset NEC. Neonates with feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, or hemodynamically significant patent ductus arteriosus have a higher risk of early-onset NEC.

Investigation on the application of venous access in very low birth weight infants / 中国实用护理杂志

Objective:To explore the types of venous access, indwelling time and the correlation with catheter-related bloodstream infection (CRBSI) of very and extremely low birth weight infants (VLBW & ELBW) in NICU.Methods:The self-designed venous access data collection form was used to collect the venous access data of VLBW & ELBW infants who were admitted to NICU of Children′s Hospital of Fudan University from January to December 2019. SPSS 22.0 software was used for data analysis, description and binary Logistic regression analysis.Results:A total of 218 cases were collected, including 9 cases of peripheral intravenous (PIV), 30 cases of PIV+ umbilical vein catheter (UVC), 43 cases of PIV+PICC, 136 cases of PIV+UVC+PICC. The average indwelling time of UVC was 6 days, the average indwelling time of PICC was 22 days. There were 23 cases (10.55%) got CRBSI and 195 cases (89.45%) without CRBSI. Binary Logistic regression analysis showed that birth weight ( OR=1.003, 95% CI 1.000-1.006, P<0.05) and combination form of venous access ( OR=0.139, 95% CI 0.023-0.834, P<0.05) of VLBW & ELBW infants were associated with CRBSI. Conclusions:In NICU, PIV, UVC and PICC are the three main ways to indwell venous access for VLBW & ELBW infants. The occurrence of CRBSI is closely related to the type and combination of indwelling venous access.

Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants / 浙江大学学报·医学版

To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1 h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all <0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (all <0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (all <0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively). Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

Sex differences in clinical outcomes of extremely preterm infants/extremely low birth weight infants: a propensity score matching study / 中国当代儿科杂志

OBJECTIVES@#To study the effect of sex on the clinical outcome of extremely preterm infants (EPIs)/extremely low birth weight infants (ELBWIs) by propensity score matching.@*METHODS@#A retrospective analysis was performed for the medical data of 731 EPIs or ELBWIs who were admitted from January 1, 2011 to December 31, 2020. These infants were divided into two groups: male and female. A propensity score matching analysis was performed at a ratio of 1:1. The matching variables included gestational age, birth weight, percentage of withdrawal from active treatment, percentage of small-for-gestational-age infant, percentage of use of pulmonary surfactant, percentage of 1-minute Apgar score ≤3, percentage of mechanical ventilation, duration of mechanical ventilation, percentage of antenatal use of inadequate glucocorticoids, and percentage of hypertensive disorders in pregnancy. The two groups were compared in the incidence rate of main complications during hospitalization and the rate of survival at discharge.@*RESULTS@#Before matching, compared with the female group, the male group had significantly higher incidence rates of neonatal respiratory distress syndrome, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and patent ductus arteriosus (P<0.05), while after matching, the male group only had a significantly higher incidence rate of BPD than the female group (P<0.05). There was no significant difference in the rate of survival at discharge between the two groups before and after matching (P>0.05).@*CONCLUSIONS@#Male EPIs/ELBWIs have a higher risk of BPD than female EPIs/ELBWIs, but male and female EPIs/ELBWIs tend to have similar outcomes.

Changing trend of abdominal regional oxygen saturation in very/extremely low birth weight infants in the early postnatal stage: a prospective study / 中国当代儿科杂志

OBJECTIVES@#To study the changing trend of abdominal regional oxygen saturation (A-rSO@*METHODS@#The VLBW/ELBW infants who were admitted to the neonatal intensive care unit from September 2019 to May 2021 were enrolled as subjects. Near-infrared spectroscopy was used to monitor A-rSO@*RESULTS@#A total of 63 VLBW/ELBW infants were enrolled, with 30 infants in the <29 weeks group and 33 in the ≥29 weeks group. A-rSO@*CONCLUSIONS@#In infants with VLBW/ELBW, A-rSO

Usefulness of peritoneal drainage in extremely low birth weight infants with intestinal perforation: a single-center experience

PURPOSE: Necrotizing enterocolitis and intestinal perforation are the most common surgical emergency in the neonatal intensive care unit. The purpose of this study is to evaluate if peritoneal drainage (PD) is beneficial in extremely low birth weight infants with intestinal perforation.METHODS: Retrospective cohort study of extremely low birth weight infants with a diagnosis of intestinal perforation. They were received primary PD (n = 23, PD group) or laparotomy (n = 13, LAP group). Laboratory and physiologic data were collected and organ failure scores calculated and compared between preprocedure and postprocedures. Data were analyzed using appropriated statistical tests.RESULTS: Between January 2005 and December 2015, 13 infants (male:female = 9:4) received laparotomy. Of 23 infants (male:female = 16:7) received PD, 20 infants received subsequent laparotomy. There were no demographic differences between PD and LAP groups. And there were no differences in total organ score in either group (PD, P = 0.486; LAP, P = 0.115). However, in LAP group, respiratory score was statistically improved between pre- and postprocedure organ failure score (P = 0.02). In physiologic parameter, PD group had a statistically worsening inotropics requirement (P = 0.025). On the other hand, LAP group had a improvement of PaO₂/FiO₂ ratio (P = 0.01).CONCLUSION: PD does not improve clinical status in extremely low birth weight infants with intestinal perforation.

Observation on the efficacy and complications of intravenous nutrition strategy in premature infants with birth weight < 1 500 g / 中华危重病急救医学

Objective@#To explore the safety and efficacy of intravenous nutrition strategy for preterm infants with birth weight < 1 500 g combined with literatures.@*Methods@#The clinical data of 93 preterm infants with very low or extremely low birth weight (< 1 500 g) who were admitted to the neonatal intensive care unit (NICU) of Liaocheng People's Hospital of Shandong Province from October 2012 to December 2018 were retrospectively analyzed. On the basis of active treatment of primary disease and early enteral nutrition, all preterm infants received "all-in-one" intravenous nutrition strategy. The intravenous nutrient solution containing 6% pediatric compound amino acids, 20% fat emulsion, glucose, vitamins, NaCl, KCl, microelements and minerals was transfused uniformly in 20-24 hours. The changes in growth and biochemical indexes of preterm infants before and after intravenous nutrition intervention were observed. The occurrence of intravenous nutritional complications such as parenteral nutrition associated cholestasis (PNAC) and prognosis were recorded. The receiver operating characteristic (ROC) curve was plotted to assess the predictive power of each indicator for extra uterine growth retardation (EUGR).@*Results@#Ninety-three preterm infants were enrolled in the final analysis. The gestational age was (28.75±1.93) weeks and the birth weight was (1 113.28±190.48) g. All the children except 4 non-surviving preterm infants were discharged from hospital. The average hospitalization time was (51.64±15.98) days. In 89 surviving preterm infants, the maximum weight loss percentage was (4.42±3.12)%, and the time to regain birth weight was (6.36±2.60) days. In these surviving preterm infants, the daily average growth rate of weight gain was (19.53±4.64) g/kg, and the weekly average growth of body length and head circumference gain was (1.06±0.34) cm and (0.69±0.22) cm, respectively. The mean duration of intravenous nutrition was (21.56±8.54) days in 89 surviving preterm infants. The body weight, body length and head circumference of these surviving preterm infants were increased significantly at discharge compared with their admission to NICU [body weight (g): 2 191.63±186.00 vs. 1 118.71±188.78, body length (cm): 45.21±1.50 vs. 37.34±2.56, head circumference (cm): 31.04±1.27 vs. 25.96±1.80]. The level of albumin (Alb) was significantly increased (g/L: 27.52±3.77 vs. 25.70±3.88), however the blood urea nitrogen (BUN) level was significantly reduced (mmol/L: 1.65±1.39 vs. 5.11±3.20) with statistical differences (all P < 0.05). In the 89 surviving preterm infants, 79 preterm infants (88.8%) suffered from premature anemia and 48 (53.9%) achieved transfusion criteria. Forty-two preterm infants (47.2%) had glucose metabolism disorder and 38 (42.7%) had electrolyte disturbances. PNAC occurred in 9 preterm infants (10.1%). Thirty-eight preterm infants (42.7%) had EUGR in weight. ROC curve analysis showed that the combination of gestational age, birth weight and time to restore birth weight had a good predictive value for EUGR in very low or extremely low birth weight preterm infants, and the area under the ROC curve (AUC) was 0.902, the sensitivity was 86.4%, and the specificity was 86.8%.@*Conclusions@#The intravenous nutrition strategy for preterm infants with birth weight < 1 500 g is effective and safe. However, intravenous nutrition can cause some complications, such as glucose metabolism disorder, electrolyte disturbances and PNAC, etc. So the process of intravenous nutrition should be closely monitored. To start EN as early as possible and shorten the duration of intravenous nutrition is an important measure for the prevention of PNAC. The combination of gestational age, birth weight and the time to regain birth weight has a good predictive value for EUGR, and intervention can be strengthened early in hospital to avoid EUGR.

The clinical application and significance of TcpCO2 after weaning of machanical ventilation in very or extreme low birth weight infants / 中国小儿急救医学

Objective@#To analysis the transcutaneous carbon dioxide pressure(TcpCO2)in very low birth weight infant (VLBW) and extremely low birth weight infant (ELBW) after the time of tube drawing, and further guidance the management of premature ventilator breathing.@*Methods@#Premature infants with gestational age less than 32 weeks, birth weight below 1 500 g, hospitalized from March 2016 to December 2018 in our hospital, who needed early mechanical ventilation due to respiratory distress within 24 hours after birth and intended to be withdrawn were enrolled.Fifty-five infants in the observation group were monitored by TcpCO2 and blood gas was collected at 1 h, 6 h, 12 h, 24 h, 48 h, and 72 h after weaning; 55 infants in the control group were collected arterial blood gas only.When TcpCO2 monitoring and PaCO2 indicated hypercapnia, clinical intervention was actively given.The value of blood gas PaCO2 in the two groups and the TcpCO2 value of the observation group were recorded at different time points (1 h, 6 h, 12 h, 24 h, 48 h, 72 h) after weaning, and the failure of weaning was recorded in both group.@*Results@#There was no significant difference in the general information (gender, gestational age, birth weight, and whether prenatal maternal glucocorticoids) between the two groups (P>0.05). There were no significant differences in mechanical ventilation time, noninvasive ventilation mode and time between the two groups(P>0.05). The failure rate of withdrawal within 24 h and 72 h was lower in the observation group than the control group[3.6% (2/55) vs.14.0% (8/55), 7.3% (4/55) vs. 21.0% (12/55)], the difference was statistically significant (P<0.05). There was a significant difference in blood gas PaCO2 between the two groups at 6 h, 12 h, and 24 h after weaning (P<0.05), but had no significant difference between the two groups at 1 h, 48 h, and 72 h (P>0.05). The values of TcpCO2 and PaCO2 had no significant difference in the observation group at the same time point (P>0.05), and there was a correlation between them(r=0.761, P<0.05).@*Conclusion@#VLBW and ELBW undergoing mechanical ventilation are given continuous TcpCO2 monitorings after weaning, which not only has the characteristics of continuous and non-invasive monitoring, but also help to identify hypercapnia early and give symptomatic treatment, and reduce the incidence of weaning failure.And it proves a good correlation between TcpCO2 and PaCO2.

Risk factors of neurodevelopmental outcomes in very/extremely low birth weight infants / 中华实用儿科临床杂志

Objective@#To analyze the risk factors of adverse neurodevelopmental prognostic in very /extremely low birth weight infants (VLBWI/ELBWI).@*Methods@#The 24 hours VLBWI/ELBWI admitted to the neonatal intensive care unit between January 2016 and October 2016 were enrolled.These infants were followed up and neurodevelopmental evaluation was performed at a corrected age of 12 months by using the Bayley Scales of Infant Development Ⅱ (BSID-Ⅱ). According to the neurodevelopmental outcomes, they were divided into normal and abnormal neurodeve-lopment groups.The data of prenatal, intrapartum and postpartum periods in the two groups were compared.Potential risk factors of neurodevelopmental impairment were analyzed with Logistic stepwise regression.@*Results@#A total of 167 VLBWI/ELBWI were enrolled, among which 14 cases died during hospitalization or after giving up treatment.At the corrected age of 12 months, 140(91.5%) infants completed follow-up and 13(8.5%) were lost to follow-up.Among 140 infants who completed neurodevelopmental evaluation at the corrected age of 12 months, there were 86 males, 54 females, and in which 28 cases had extremely low birth weight, 112 cases with very low birth weight, with gestational age of (30.4±2.2) weeks (25.3-36.0 weeks). There were one hundred and twenty-five cases with normal neurodevelopmental outcomes and 15 cases with abnormal neurodevelopmental outcomes.The results of univariate analysis showed that birth weight<1 000 g, exposure to antenatal steroids, N -terminal brain natriuretic peptide (NT-proBNP) ≥35 000 ng/L and bronchopulmonary dysplasia (BPD) in the two groups were statistically significant(P<0.05). Logistic stepwise regression showed that NT-proBNP level≥35 000 ng/L may independently predict neurodevelopmental impairment among VLBWI/ELBWI (OR=22.774, 95%CI: 3.079-168.425, P=0.002). Exposure to antenatal steroids may be a protective factor for neurodevelopmental impairment (OR=0.125, 95%CI: 0.020-0.782, P=0.026).@*Conclusions@#Plasma NT-proBNP level ≥35 000 ng/L may independently predict neurodevelopmental impairment among VLBWI/ELBWI.Antenatal corticosteroids may be the protective factor of poor neurodevelopmental outcomes.

Observation on the efficacy and complications of intravenous nutrition strategy in premature infants with birth weight < 1 500 g / 中华危重病急救医学

To explore the safety and efficacy of intravenous nutrition strategy for preterm infants with birth weight < 1 500 g combined with literatures. Methods The clinical data of 93 preterm infants with very low or extremely low birth weight (< 1 500 g) who were admitted to the neonatal intensive care unit (NICU) of Liaocheng People's Hospital of Shandong Province from October 2012 to December 2018 were retrospectively analyzed. On the basis of active treatment of primary disease and early enteral nutrition, all preterm infants received "all-in-one" intravenous nutrition strategy. The intravenous nutrient solution containing 6% pediatric compound amino acids, 20% fat emulsion, glucose, vitamins, NaCl, KCl, microelements and minerals was transfused uniformly in 20-24 hours. The changes in growth and biochemical indexes of preterm infants before and after intravenous nutrition intervention were observed. The occurrence of intravenous nutritional complications such as parenteral nutrition associated cholestasis (PNAC) and prognosis were recorded. The receiver operating characteristic (ROC) curve was plotted to assess the predictive power of each indicator for extra uterine growth retardation (EUGR). Results Ninety-three preterm infants were enrolled in the final analysis. The gestational age was (28.75±1.93) weeks and the birth weight was (1 113.28±190.48) g. All the children except 4 non-surviving preterm infants were discharged from hospital. The average hospitalization time was (51.64±15.98) days. In 89 surviving preterm infants, the maximum weight loss percentage was (4.42±3.12)%, and the time to regain birth weight was (6.36±2.60) days. In these surviving preterm infants, the daily average growth rate of weight gain was (19.53±4.64) g/kg, and the weekly average growth of body length and head circumference gain was (1.06±0.34) cm and (0.69±0.22) cm, respectively. The mean duration of intravenous nutrition was (21.56±8.54) days in 89 surviving preterm infants. The body weight, body length and head circumference of these surviving preterm infants were increased significantly at discharge compared with their admission to NICU [body weight (g): 2 191.63±186.00 vs. 1 118.71±188.78, body length (cm): 45.21±1.50 vs. 37.34±2.56, head circumference (cm): 31.04±1.27 vs. 25.96±1.80]. The level of albumin (Alb) was significantly increased (g/L: 27.52±3.77 vs. 25.70±3.88), however the blood urea nitrogen (BUN) level was significantly reduced (mmol/L: 1.65±1.39 vs. 5.11±3.20) with statistical differences (all P < 0.05). In the 89 surviving preterm infants, 79 preterm infants (88.8%) suffered from premature anemia and 48 (53.9%) achieved transfusion criteria. Forty-two preterm infants (47.2%) had glucose metabolism disorder and 38 (42.7%) had electrolyte disturbances. PNAC occurred in 9 preterm infants (10.1%). Thirty-eight preterm infants (42.7%) had EUGR in weight. ROC curve analysis showed that the combination of gestational age, birth weight and time to restore birth weight had a good predictive value for EUGR in very low or extremely low birth weight preterm infants, and the area under the ROC curve (AUC) was 0.902, the sensitivity was 86.4%, and the specificity was 86.8%. Conclusions The intravenous nutrition strategy for preterm infants with birth weight < 1 500 g is effective and safe. However, intravenous nutrition can cause some complications, such as glucose metabolism disorder, electrolyte disturbances and PNAC, etc. So the process of intravenous nutrition should be closely monitored. To start EN as early as possible and shorten the duration of intravenous nutrition is an important measure for the prevention of PNAC. The combination of gestational age, birth weight and the time to regain birth weight has a good predictive value for EUGR, and intervention can be strengthened early in hospital to avoid EUGR.

Risk factors of neurodevelopmental outcomes in very/extremely low birth weight infants / 中华实用儿科临床杂志

Objective To analyze the risk factors of adverse neurodevelopmental prognostic in very/extremely low birth weight infants (VLBWI/ELBWI).Methods The 24 hours VLBWI/ELBWI admitted to the neonatal intensive care unit between January 2016 and October 2016 were enrolled.These infants were followed up and neurodevelopmental evaluation was performed at a corrected age of 12 months by using the Bayley Scales of Infant Development Ⅱ (BSID-Ⅱ).According to the neurodevelopmental outcomes,they were divided into normal and abnormal neurodevelopment groups.The data of prenatal,intrapartum and postpartum periods in the two groups were compared.Potential risk factors of neurodevelopmental impairment were analyzed with Logistic stepwise regression.Results A total of 167 VLBWI/ELBWI were enrolled,among which 14 cases died during hospitalization or after giving up treatment.At the corrected age of 12 months,140(91.5％) infants completed follow-up and 13(8.5％) were lost to follow-up.Among 140 infants who completed neurodevelopmental evaluation at the corrected age of 12 months,there were 86 males,54 females,and in which 28 cases had extremely low birth weight,112 cases with very low birth weight,with gestational age of (30.4 ± 2.2) weeks (25.3-36.0 weeks).There were one hundred and twenty-five cases with normal neurodevelopmental outcomes and 15 cases with abnormal neurodevelopmental outcomes.The results of univariate analysis showed that birth weight ＜ 1 000 g,exposure to antenatal steroids,N-terminal brain natriuretic peptide (NT-proBNP) ≥35 000 ng/L and bronchopulmonary dysplasia (BPD) in the two groups were statistically significant (P ＜ 0.05).Logistic stepwise regression showed that NT-proBNP level ≥ 35 000 ng/L may independently predict neurodevelopmental impairment among VLBWI/ELBWI (OR =22.774,95％ CI:3.079-168.425,P =0.002).Exposure to antenatal steroids may be a protective factor for neurodevelopmental impairment (OR =0.125,95％ CI:0.020-0.782,P =0.026).Conclusions Plasma NT-proBNP level ≥ 35 000 ng/L may independently predict neurodevelopmental impairment among VLBWI/ELBWI.Antenatal corticosteroids may be the protective factor of poor neurodevelopmental outcomes.

Effect of low dose heparin on coagulation index and therapeutic outcomes in premature infants with sepsis / 中华全科医师杂志

Objective To investigate the effect of low dose heparin on blood coagulation and therapeutic outcomes in premature infants with sepsis.Methods Clinical data of 69 septic preterm newborns weighting less than 1 500 g treated in Beijing Obstetrics and Gynecology Hospital were retrospectively analyzed.Among them,29 infants received heparin therapy (6 U/kg,q 8 h,for 3 d,then q12 h,heparin group)and 40 infants did not receive heparin therapy (control group),the coagulation index and therapeutic outcomes were compared between two groups.Results The coagulation indexes PT,TT,APTT and D dimer in heparin group were all significantly lower than those in control group [(15.5±3.5) s vs.(19.0±3.9) s,(15.4±3.5) s vs.(18.8±3.5) s,(47.5±8.6) s vs.(58.4±18.1) s,(1.7±0.8) mg/L vs.(2.6±1.9) mg/L;t=-3.815,4.275,-3.004,-2.459,P＜0.05].The overall clinical effective rate in heparin group was significantly higher than that in control group (86.2％ vs.60.0％,x2 =4.408,P＜0.05).Conclusion Low dose heparin can significantly improve the blood coagulation function and improve the therapeutic effect of premature infants with sepsis.

The clinical application and significance of TcpCO2 after weaning of machanical ventilation in very or extreme low birth weight infants / 中国小儿急救医学

Objective To analysis the transcutaneous carbon dioxide pressure(TcpCO2 )in very low birth weight infant (VLBW) and extremely low birth weight infant (ELBW) after the time of tube drawing, and further guidance the management of premature ventilator breathing. Methods Premature infants with gestational age less than 32 weeks, birth weight below 1 500 g, hospitalized from March 2016 to December 2018 in our hospital,who needed early mechanical ventilation due to respiratory distress within 24 hours after birth and intended to be withdrawn were enrolled. Fifty-five infants in the observation group were monitored by TcpCO2 and blood gas was collected at 1 h, 6 h, 12 h, 24 h, 48 h, and 72 h after weaning;55 infants in the control group were collected arterial blood gas only. When TcpCO2 monitoring and PaCO2 indicated hy-percapnia, clinical intervention was actively given. The value of blood gas PaCO2 in the two groups and the TcpCO2 value of the observation group were recorded at different time points (1 h, 6 h, 12 h, 24 h, 48 h, 72 h) after weaning,and the failure of weaning was recorded in both group. Results There was no significant difference in the general information ( gender, gestational age, birth weight, and whether prenatal maternal glucocorticoids) between the two groups ( P>0. 05). There were no significant differences in mechanical ventilation time, noninvasive ventilation mode and time between the two groups(P>0. 05). The failure rate of withdrawal within 24 h and 72 h was lower in the observation group than the control group[3. 6% (2/55) vs. 14. 0% (8/55), 7. 3% (4/55) vs. 21. 0% (12/55)], the difference was statistically significant ( P< 0. 05). There was a significant difference in blood gas PaCO2 between the two groups at 6 h, 12 h, and 24 h after weaning (P<0. 05), but had no significant difference between the two groups at 1 h, 48 h, and 72 h (P>0. 05). The values of TcpCO2 and PaCO2 had no significant difference in the observation group at the same time point (P>0. 05),and there was a correlation between them(r＝0. 761, P<0. 05). Conclusion VLBW and ELBW undergoing mechanical ventilation are given continuous TcpCO2 monitorings after wea-ning, which not only has the characteristics of continuous and non-invasive monitoring, but also help to iden-tify hypercapnia early and give symptomatic treatment,and reduce the incidence of weaning failure. And it proves a good correlation between TcpCO2 and PaCO2 .

Tolerability and Effect of Early High-Dose Amino Acid Administration in Extremely Low Birth Weight Infants

PURPOSE: The aim of this study is to examine the tolerability and effect of early highdose amino acid administration in extremely low birth weight infants (ELBWIs). METHODS: This retrospective cohort study included ELBWI (birth weight < 1,000 g, n=142). Biochemical, nutritional, and neurodevelopmental data were compared between infants who received conventional low amino acid (LAA; 1.5 g/kg/day) and those who received high amino acid (HAA; 3 g/kg/day) within the first 48 hours after birth. Neurodevelopmental data included weight, height, and head circumference at discharge, 12 to 14 and 18 to 24 months of corrected age and the Korean Bayley Scale of Infant Development II (K-BSID-II) score at 18 to 24 months of corrected age. RESULTS: The HAA group demonstrated higher peak plasma albumin (3.0±0.4 vs. 3.2±0.5, P < 0.05) and lower serum creatinine (1.7±0.9 vs. 1.4±0.8, P < 0.05) during the first 14 days than the LAA group. Full enteral feeding was achieved significantly earlier in infants in the HAA group than in infants in the LAA group (46.2±23.0 days vs. 34.3±21 days, P < 0.01). There was no difference between the two groups in the z score changes in all growth indicators from birth to discharge and at 12 to 14 and 18 to 24 months of corrected age, as well as in the K-BSID-II score at 18 to 24 months of corrected age. CONCLUSION: Aggressive administration of amino acids during the first 2 days of life in ELBWI was well tolerated and correlated with earlier full enteral feeding, but did not improve growth and neurodevelopment.

The factors affecting the late-onset sepsis in very low and extremely low birth weight infants / 中国小儿急救医学

Objective To explore the risk factors and short outcomes associated with late-onset sep-sis (LOS) in very low and extremely low birth weight infants.Methods Retrospective analysis were per-formed to predict risk factors for LOS in very low and extremely low birth weight infants (birth weight less than 1 200 g) admitted to NICU of Shengjing Hospital from Jan 2010 to Dec 2015.Infants with similar birth weight without LOS were as controls.We compared the characteristics of maternal and neonatal periods in both groups.Multivariable Logistic regression models were derived to predict LOS sepsis.Short outcomes of the infants were assessed.Results Total of 381 very low birth weight infants were admitted during the study period.LOS occurred in 138 infants(36.2%,138/381),who developed sepsis at a mean age of (19.8 ± 11.0)days;the mean gestational age,birth weight and hospitalization time were(29.4 ± 2.1)week,1 064 (953,1 126)g and 55(43,72)d.Other 243 cases were control,mean gestational age,brith weight and hospi-talization time were(29.3 ± 2.0)week,1 060(955,1 144)g and 49(37,63)d.Ninety-seven cases had posi-tive blood culture(70.3%,97/138) in LOS group.Out of the 138 cases of LOS,8 cases(5.8%,8/138) died from their sepsis with a positive blood culture.Infants with LOS were more likely to have a long-term use of ventilation and peripherally inserted central catheteh(PICC),the failure of early enteral feeding,delayed com-plete enteral feeding time and the longer hospital stays compared to uninfected infants.Multivariate Logistic regression analysis showed that long-term use of PICC(OR 1.039,95%CI 1.012-1.067,P=0.004)was an independent risk factor for LOS in very low birth weitht infants. Septic infants,compared with nonseptic infants,had significantly more serious morbidity,including white matter damage(20.3% vs.10.3%),necro-tizing enterocolitis(9.4% vs.2.9%),retinopathy of prematurity(10.9% vs.3.7%),and cholestatic jaun-dice(19.6% vs.11.9%)(P<0.05).Conclusion A number of factors are related to LOS.LOS is associated with poor prognosis of preterm infants.Long-time PICC is a risk factor for LOS.

Influencing factors for bronchopulmonary dysplasia in VLBWI and ELBWI / 国际儿科学杂志

Objective To explore causes and clinical factors associated with bronchopulmonary dyspla-sia( BPD) in very low birth weight infant ( VLBWI) and extremely low birth weight infant( ELBWI) . Methods A retrospective analysis was performed on the clinical data of VLBWI and ELBWI,whose birth weight less than1200g and diagnosed BPD in NICU of Shengjing Hospital between Jan. 1st 2010 and Dec. 31st 2014. No-BPD infants with the same birth weight and during the same period were selected as the control group. Results One handred and twenty-eight cases met the criteria of BPD,whose mean gestational age(GA) was (28. 6 ± 1. 8)weeks. Other 121cases were no-BPD,and mean GA was (30. 8 ± 1. 8)weeks. Maternal hypertension during pregnancy,gestational age,birth weight,small for age infant were lower in BPD group than those in no-BPD group. Prenatal infection,premature rupture of membrances≥18h,cesarean delivery,male,Apgar 1min≤3,intra-partum recovery,alveolar surface active substances,mechanical ventilation and the time,oxygen time were higher in BPD group than those in no-BPD group. Logistic regression analysis indicated that low gestational age( OR=1. 014,P<0. 05),male(OR=2. 771,P<0. 05),duration of invasive mechanical ventilation(OR=1. 014,P<0. 05),duration of CPAP(OR=1. 008,P<0. 05)lead to BPD. Multiple logistic regression model showed that Apgar 1min≤3(95％CI:1. 274～14. 017,χ2 = 5. 550,P=0. 018,OR=4. 226),duration of invasive mechanical ventilation(95％CI:1. 001 ～1. 004,χ2 =10. 410,P =0. 001,OR =1. 003),PDA surgery(95％CI:1. 345 ～129. 693,χ2 =4. 904,P=0. 027,OR=13. 210) were the independent risk factors for the moderate-severe BPD. Conclusion Our study showed that low GA,male,long duration of mechanical ventilation were risk factors of the development of BPD. Apgar 1min≤3,duration of mechanical ventilation,PDA surgery were related with moderate-severe BPD.

Effect of gently caring on clinical outcomes of extremely low birth weight infants / 中国实用护理杂志

Objective To evaluate whether changes in neonatal intensive care have improved outcomes for extremely low birth weight (ELBW) infants in neonatal intensive care unit (NICU). Methods A prospective phase-lag cohort study was performed in a tertiary level NICU. A meticulous nursing strategy based on neonatal individual developmental care assessment program theory and feasible ELBW minimization stimulus was developed. Conventional care was applied in 2013 (period Ⅰ) and gently caring was applied in 2014 (period Ⅱ). The outcomes of ELBW between these 2 periods were compared. Results During these two periods, thirty-seven infants were included in period Ⅰ and 41 infants in period Ⅱ. In periodⅠ46.0%(17/37) of the infants needed oxygen for at least 28 days, but in period Ⅱ it decreased to 24.4%(10/41), there was significant difference (χ2=3.990, P=0.046). The rate of breastfeeding increased from 27.0%(10/37) in periodⅠto 61.0%(25/41) in period Ⅱ, there was significant difference (χ2=9.061, P=0.003). There was no significant difference in the mortality rate and chronic lung disease (P>0.05). The incidence of intracranial hemorrhage decreased from 21.6%(8/37) to 4.9%(2/41), there was significant difference(P=0.041). Conclusions Gently caring may have resulted in less intracranial hemorrhage and improve breastfeeding rate. Parents are satisfied with gentle care and in light of these findings, gentle care deserves further exploration.

Early predictive value of platelet related indicators in patent ductus arteriosus in extremely low birth weight infants / 临床儿科杂志

Objective To analyze the predictive value of platelet related indicators for patent ductus arteriosus (PDA) in extremely low birth weight infants (ELBW). Methods The data of 79 ELBW infants born from June 2013 to June 2016 were retrospective analyzed. There were 48 cases without PDA (nPDA group) and 31 cases with PDA (PDA group). Among 31 cases with PDA, there were 17 cases of non-haemodynamically significant PDA (nhsPDA group) and 14 cases of haemodynamically significant PDA (hsPDA group). The clinical feature and platelet related indicators among nPDA group, PDA group, nhsPDA group and hsPDA group were compared. Multivariate logistic regression was used to analyze the effects of various factors on the occurrence of PDA. ROC curve analysis was performed to evaluate the early predictive value of platelet related indicators for PDA. Results Compared with the nPDA group, the PDA group had a smaller gestational age, a higher proportion of male infants, and a smaller platelet distribution width (PDW), and there were statistically significant differences in all of those (P all0.05). Conclusion PDW has certain early predictive value for PDA in ELBW. ELBW infants with PDW<13.4 GSD need to be watched closely for the occurrence of PDA.

Postdischarge growth assessment in very low birth weight infants / 소아과

PURPOSE: The goal of nutritional support for very-low-birth-weight (VLBW) infants from birth to term is to match the in utero growth rates; however, this is rarely achieved. METHODS: We evaluated postdischarge growth patterns and growth failure in 81 Korean VLBW infants through a retrospective study. Weight and height were measured and calculated based on age percentile distribution every 3 months until age 24 months. Growth failure was defined as weight and height below the 10th percentile at 24 months. For the subgroup analysis, small-for-gestational age (SGA) and extremely low birth weight (ELBW) infants were evaluated. The growth patterns based on the Korean, World Health Organization (WHO), or Centers for Disease Control and Prevention (CDC) standard were serially compared over time. RESULTS: At postconception age (PCA) 40 weeks, 47 (58%) and 45 infants (55%) showed growth failure in terms of weight and height, respectively. At PCA 24 months, 20 infants (24%) showed growth failure for weight and 14 (18%) for height. Growth failure rates were higher for the SGA infants than for the appropriate-weight-for-gestational age infants at PCA 24 months (P=0.045 for weight and P=0.038 for height). Growth failure rates were higher for the ELBW infants than for the non-ELBW infants at PCA 24 months (P<0.001 for weight and P=0.003 for height). Significant differences were found among the WHO, CDC, and Korean standards (P<0.001). CONCLUSION: Advancements in neonatal care have improved the catch-up growth of VLBW infants, but this is insufficient. Careful observation and aggressive interventions, especially in SGA and ELBW infants, are needed.

A single center retrospective study on hospitalization information for 812 cases of very low birth weight and ex-tremely low birth weight infants / 中华实用儿科临床杂志

Objective To analyze the survival rate and hospitalization information for 81 2 cases of very low birth weight (VLBW)and extremely low birth weight (ELBW)infants.Methods The retrospective study was con-ducted in a single center,Department of Neonatology,Hubei Women and Children Hospital,from January 2009 to De-cember 201 4,where the data of 81 2 infants with birth weight(BW)less than 1 500 g was analyzed in regard to perinatal condition,treatment and complications of these in relation to prognosis.Results (1 )A total of 621 cases(76.5%) had favorable prognosis.(2)There was a significant difference in the favorable prognosis rate between different BW groups (χ2 =28.87,P <0.05)and different gestational age(GA)groups (χ2 =1 4.77,P <0.05).The favorable prog-nosis rate for the male infants(χ2 =4.69,P <0.05),puerpera age between 1 7 -25 and 36 -46 years old (χ2 =1 1 .1 9, P <0.05),usage of prenatal hormones(χ2 =8.02,P <0.05),the infants without intrauterine infection (χ2 =8.61 ,P <0.05),the mother without gestational hypertension (χ2 =7.20,P <0.05)and gestational diabetes mellitus(χ2 =1 9.2, P <0.05)were different compared to the control groups.(3)Infants with peripherally inserted central catheter (PICC) (χ2 =33.31 ,P <0.05)and recovery birth weight within 1 0 days(χ2 =29.65,P <0.05)had higher favorable prognosis rate compared to the control groups,which had significant differences.(4)Infants with intraventricular haemorrhage (IVH)(χ2 =1 3.1 6,P <0.05),respiratory distress syndrome (RDS)(χ2 =7.59,P <0.05),necrotizing enterocolitis (NEC)(χ2 =1 3.02,P <0.05)and serious asphyxia (χ2 =6.05,P <0.05)had lower favorable prognosis rates than those did not,with significant differences.(5)Logistic analysis:the lower BW,smaller GA,earlier birth,unused PICC, serious asphyxia,IVH,RDS were risk factors for poor prognosis(all P <0.05).Conclusions The favorable prognosis rate of VLBW and ELBW infants has improved gradually,and is closely related to GA,BW,maternal age,perinatal care,prevention complication,treatment of disease and social factors etc.