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Objective:To study the incidence and risk factors of early hyperglycemia in extremely preterm infants (EPIs).Methods:From January 2018 to December 2021, EPIs with gestational age (GA) <28 w born in our hospital and admitted to the neonatal department were retrospectively studied. According to the occurrence of early hyperglycemia (within 1 w after birth), the infants were assigned into hyperglycemia group and non-hyperglycemia group. Univariate and logistic regression were used to analyze the risk factors of early hyperglycemia in EPIs.Results:A total of 218 cases of EPIs were enrolled, including 70 (32.1%) in the hyperglycemia group and 148 (67.9%) in the non-hyperglycemia group. The incidence of early hyperglycemia in EPIs with GA<25 w was 10/20 and 11/16 in EPIs with birth weight (BW) ≤700 g. The GA and BW of the hyperglycemia group were significantly lower than the non-hyperglycemia group ( P<0.05). More infants in the hyperglycemia group had 1-min and 5-min Apgar≤7 than the non-hyperglycemia group ( P<0.05). Logistic regression analysis showed that increased BW ( OR=0.995, 95% CI 0.993~0.997, P<0.05) was a protective factor for early hyperglycemia in EPIs, while male gender ( OR=2.512,95% CI 1.232~5.123, P<0.05), vasoactive drug use during the first week of life ( OR=2.687, 95% CI 1.126~6.414, P<0.05), maternal hypertension during pregnancy ( OR=14.735, 95% CI 1.578~137.585, P<0.05) were risk factors for early hyperglycaemia in EPIs. Conclusions:Early hyperglycemia are common among EPIs. Low BW, male gender, vasoactive drug use during the first week of life and maternal hypertension during pregnancy may increase the risk of early hyperglycemia.
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Objective:To analyze the risk factors of pulmonary hemorrhage in very low and extremely low birth weight, and to provide reference for the treatment of pulmonary hemorrhage.Methods:The clinical data of very low and extremely low birth weight infants hospitalized in Qingdao Women and Children′s Hospital NICU from January 2017 to December 2021 were retrospectively analyzed.Eighty-six infants who were diagnosed with pulmonary hemorrhage were selected as the pulmonary hemorrhage group, and two hundred and two infants without pulmonary hemorrhage were selected as the control group.The differences of the survival rates, complications and parameters of platelet between the two groups were compared, and the risk factors of pulmonary hemorrhage by multivariate Logistic regression were analyzed.Results:The survival rate of pulmonary hemorrhage group and control group were 65.1%(56/86) and 90.1%(182/202), respectively.The survival rate of control group was significantly higher than that in the pulmonary hemorrhage group( χ2=26.241, P<0.01). There was no significant difference in fluid intake between the two groups within three days after birth( t=0.936, 1.811, 1.840, P=0.350, 0.073, 0.069). The multivariate Logistic regression analysis showed hemodynamically significant patent ductus arteriosus( OR=2.304, 95% CI: 0.213~1.564, P=0.010), disseminated intravascular coagulation( OR=3.143, 95% CI: 0.061~2.521, P=0.028), thrombocytopenia( OR=0.991, 95% CI: -0.015~-0.005, P=0.001) and low mean platelet volume( OR=0.337, 95% CI: -1.657~-0.739, P=0.001) were the risk factors of pulmonary hemorrhage. Conclusion:Hemodynamically significant patent ductus arteriosus, disseminated intravascular coagulation, thrombocytopenia and low mean platelet volume were associated with increased risks for pulmonary hemorrhage in very low and extremely low birth weight.These risk factors should be actively monitored and treated, which is helpful to early identify and prevent pulmonary hemorrhage.
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ObjectiveTo explore the influencing factors of different scores on predicting death risk of extremely low birth weight infants （ELBWI）. MethodsA total of 186 cases of ELBWI admitted by the Children's Hospital affiliated to Nanjing Medical University and the Lishui Branch of the Affiliated Zhongda Hospital of Southeast University were admitted from January 1， 2019 to January 1， 2021， and 125 ELBWIs were finally included after screening by inclusion and exclusion criteria. There were 47 cases in the death group and 78 cases in the survival group. General data and the items of 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）， clinical risk index for babies Ⅱ （CRIB-Ⅱ） and the national critical illness score （NCIS） were collected. Univariate and multivariate analysis was performed and nomogram was evaluated using receiver operating characteristic curve （ROC）. ResultsIt was found that systolic blood pressure， maximum inhaled oxygen concentration， BE value and birth weight were important factors in ELBWI mortality risk assessment ［systolic blood pressure OR： 0.968， 95%CI： 0.938-0.999， P=0.043； maximum inhaled oxygen concentration OR： 1.020， 95%CI： 1.006-1.034， P=0.006； BE OR： 0.868， 95%CI： 0.786-0.959， P=0.005； birth weight OR： 0.994， 95%CI： 0.991-0.997， P=0.000］. ROC showed that the area under the curve of the above four variables is 0.71， and the 95% confidence interval is 0.610-0.799， which is better than CRIB score. ConclusionLower systolic blood pressure， higher inhaled oxygen concentration， higher BE and lower birthweight are important influencing factors to predict the death risk of ELBWI. The above four items should be included in the newly developed score assessment to obtain a more effective ELBWI prediction system.
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With the progress of perinatal medicine and the improvement of cure rate in preterm infants, the diagnosis and treatment of patent ductus arteriosus in extremely low birth weight infants is a great challenge for neonatal medicine.Continuous left-to-right shunt through catheters can lead to systemic hypotension, pulmonary perfusion, increased left ventricular volume load, prolonged mechanical ventilation, and increased risk of complications and death such as pulmonary hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage.Conservative treatment is still the first choice and drug treatment is not completely effective, while the long-term impact of both on newborns is still unclear, which need a reasonable assessment of the pros and cons.Surgical ligation can improve cardio-pulmonary function, but the indication and time of the arterial catheter are also controversial for its self-closing, thus more evidence-based studies are needed.We review the current management status and controversy of patent ductus arteriosus in extremely low birth weight infants to explore the scientific and effective clinical measures.
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Objective@#To investigate the correlation of early incubator temperature fluctuation on intraventricular hemorrhage (IVH) in very/extremely-low birth weight infants (E/VLBW).@*Methods@#From July 2015 to September 2016, 270 patients of hospitalized E/VLBW were included in this study. Temperature changes including incubator temperature and abdominal temperature within 72 hours after admission and routine clinical data were collected,the E/VLBW were divided into IVH group and non-IVH group, as well as the occurrence and grading of IVH. Chi-square test, t test and nonparametric test and logistic regression analysis were used to explore the effect of early incubator temperature fluctuations in E/VLBW on IVH.@*Results@#Of the 270 V/ELBW studied, the incidence of IVH was 24.4% (66/270) , severe IVH(grade Ⅲ and Ⅳ) was 5.2% (14/270) . Univariate analysis showed that in addition to common IVH risk factors such as gestational age, body weight, 1/5 min Apgar score, sex, delivery, hyperglycemia, prenatal steroid and mechanical ventilation, fluctuations of body temperature and incubator temperature were relevant for IVH in E/VLBW (P<0.05) . Logistic regression analysis of the above relevant risk factors showed fluctuations of temperature (OR=1.10) was also an independent risk factor for IVH in E/VLBW(P<0.05) , in addition to sex(OR=0.42) , 1 min Apgar score (OR=0.71) , and hyperglycemia (OR=3.67) .@*Conclusion@#Fluctuation of incubator temperature is an independent risk factor for IVH in V/ELBWI. During centralized nursing and nursing operations, the operating time should be shortened as much as possible to reduce the number of fluctuations of incubators and body temperature to reduce the incidence of IVH and improve the quality of life.
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Objective To investigate the correlation of early incubator temperature fluctuation on intraventricular hemorrhage (IVH) in very/ extremely-low birth weight infants (E/VLBW). Methods From July 2015 to September 2016, 270 patients of hospitalized E/VLBW were included in this study. Temperature changes including incubator temperature and abdominal temperature within 72 hours after admission and routine clinical data were collected,the E/VLBW were divided into IVH group and non-IVH group, as well as the occurrence and grading of IVH. Chi-square test, t test and nonparametric test and logistic regression analysis were used to explore the effect of early incubator temperature fluctuations in E/VLBW on IVH. Results Of the 270 V/ELBW studied, the incidence of IVH was 24.4%(66/270), severe IVH(gradeⅢandⅣ) was 5.2%(14/270). Univariate analysis showed that in addition to common IVH risk factors such as gestational age, body weight, 1/5 min Apgar score, sex, delivery, hyperglycemia, prenatal steroid and mechanical ventilation, fluctuations of body temperature and incubator temperature were relevant for IVH in E/VLBW (P＜0.05). Logistic regression analysis of the above relevant risk factors showed fluctuations of temperature ( OR=1.10)was also an independent risk factor for IVH in E/VLBW( P＜0.05), in addition to sex( OR=0.42), 1 min Apgar score ( OR=0.71), and hyperglycemia ( OR= 3.67). Conclusion Fluctuation of incubator temperature is an independent risk factor for IVH in V/ELBWI. During centralized nursing and nursing operations, the operating time should be shortened as much as possible to reduce the number of fluctuations of incubators and body temperature to reduce the incidence of IVH and improve the quality of life.
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Extremely low birth weight infants with nutrition deficiency always suffer complication of extrauterine growth restriction(EUGR).EUGR is a risk factor for growth of the nervous system,cardiovascular system,lung,gastrointestinal tract and other organs.At present,there are still some difficulties in the clinical management,such as how to balance the contradiction between parenteral nutrition and metabolic syndrom,and how to provide the essential nutrients.Great efforts are still needed to establish appropriate nutrition management.
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Objective To explore the risk factors of extremely low birth weight infants(ELBWI) with bronchopulmonary dysplasia(BPD).Methods The clinical data in 151 ELBWI in NICU of the Provincial Hospital Affiliated to Shandong University and Sichuan Provincial People's Hospital from 2010 to 2015,admitted at 24 after birth and survived until to 28 h after birth,were performed the survey analysis.The newborns of oxygen dependency(FiO2 ＞ 21％) more than 28 d were included into the BPD group,on the contrary,the newborns were included into the non-BPD group.The maternal pregnant factors,neonatal factors and disease treatment factors were compared between the two groups.Results (1) Among 151 ELBWI,57 cases developed BPD with incidence rate of 37.7 ％.(2) The univariate analysis results showed that maternal chorioamnionitis,premature rupture of membrane more than 18 h,birth weight,gestational age,sepsis,patent ductus arteriosus (PDA),neonatal respiratory distress syndrome (NRDS),mechanical ventilation(MV),MV time,parenteral nutrition time,frequency of blood transfusion were associated with the BPD occurrence in ELBWI.Caffeine use was a protective factor.(3)The multivariate Logistic regression analysis displayed that MV (OR=6.975,95％CI:1.464-33.219) and maternal chorioamnionitis(OR=3.890,95％CI:1.656-9.140) were the independent factors of BPD occurrence in ELBWI.Conclusion Reducing intrauterine infection and preterm birth as far as possible and reasonable respiratory support after birth can effectively reduce the incidence rate of BPD in ELBWI.
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Objective To explore the risk factors of extremely low birth weight infants(ELBWI) with bronchopulmonary dysplasia(BPD).Methods The clinical data in 151 ELBWI in NICU of the Provincial Hospital Affiliated to Shandong University and Sichuan Provincial People's Hospital from 2010 to 2015,admitted at 24 after birth and survived until to 28 h after birth,were performed the survey analysis.The newborns of oxygen dependency(FiO2 ＞ 21％) more than 28 d were included into the BPD group,on the contrary,the newborns were included into the non-BPD group.The maternal pregnant factors,neonatal factors and disease treatment factors were compared between the two groups.Results (1) Among 151 ELBWI,57 cases developed BPD with incidence rate of 37.7 ％.(2) The univariate analysis results showed that maternal chorioamnionitis,premature rupture of membrane more than 18 h,birth weight,gestational age,sepsis,patent ductus arteriosus (PDA),neonatal respiratory distress syndrome (NRDS),mechanical ventilation(MV),MV time,parenteral nutrition time,frequency of blood transfusion were associated with the BPD occurrence in ELBWI.Caffeine use was a protective factor.(3)The multivariate Logistic regression analysis displayed that MV (OR=6.975,95％CI:1.464-33.219) and maternal chorioamnionitis(OR=3.890,95％CI:1.656-9.140) were the independent factors of BPD occurrence in ELBWI.Conclusion Reducing intrauterine infection and preterm birth as far as possible and reasonable respiratory support after birth can effectively reduce the incidence rate of BPD in ELBWI.
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Objective To explore the risk factors and outcomes associated with pulmonary hemorrhage in very low and extremely low birth weight infants.Methods Retrospective analysis were performed to predict risk factors for pulmonary hemorrhage in very low and extremely low birth weight infants (birth weight less than 1200g) admitted to NICU of Shengjing Hospital from Jan.2010 to Dec.2015.Infants at similar birth weight without pulmonary hemorrhage were as controls.We compared the characteristics of both maternal and infants.Multivariable Logistic regression models were derived to predict pulmonary hemorrhage.Short outcomes of the infants were assessed.Results Of the 435 neonates,71 developed pulmonary hemorrhage (pulmonary hemorrhage group),364 were as controls (control group).Gestational age[(28.2±1.7)week],birth weight[(936±192)g] in pulmonary hemorrhage group were significantly lower than those in control group[(29.5±2.1)week,(1033±134)g,t=4.776,5.145,P<0.01].Neonatal respiratory distress syndrome(RDS)(76.1%),pulmonary surfactant (PS)use(PS use≥2 courses)[76.1%(9.9%)],patent ductus arteriosus (PDA)(66.2%)were significantly higher than those in control group[41.2%,30.8%(4.1%),38.7%;χ2=33.457,28.970(4.074),32.798,P<0.05].Antenatal corticosteroids utility ratio (21.1%)was lower than that in the control group (41.2%;t=10.177,P< 0.001).Multiple factors Logistic stepwise regression analysis showed that RDS (OR=3.739,95%CI 1.383-10.113,P<0.05 ),PDA (OR=2.206,95%CI 1.205-4.093,P<0.05),and 5 minutes Apgar score <7(OR=2.851,95%CI 1.191-6.828) were independent risk factors of pulmonary hemorrhage,and higher birth weight (OR=0.998,95%CI 0.996-1.000,P<0.05) and the use of antenatal corticosteroids (OR=0.432,95%CI 0.224-0.834,P<0.05) were the protection factors in pulmonary hemorrhage.In pulmonary hemorrhage group,the incidence of intracranial hemorrhage,retinopathy of prematurity and severe bronchopulmonary dysplasia(16.9%,12.7% and 18.3%) were significantly higher than those in control group (5.8%,4.4% and 2.2%;χ2=36.824,7.520 and 33.568,P<0.01);Compared to control group,the mortality in pulmonary hemorrhage group was higher (49.3% vs.14.0%;χ2=46.634,P<0.01).Conclusion Pulmonary hemorrhage in very low and extremely low birth weight infants is associated with multiple factors.Prevention of premature birth and prenatal corticosteroids treatment can help prevent the occurrence of pulmonary hemorrhage.The incidences of poor outcomes are higher in newborns with pulmonary hemorrhage.
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Because of immature gastrointestinal tract development and the influence of postnatal disease status,extremely low birth weight infant feeding has become a majoy problem. Early positive parenteral feeding and proper enteral feeding are very helpful to the growth and development of extremely low birth weight infant.
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Objective To evaluate the safety and effects of feeding very low birth weight infants and extremely low birth weight infants with human donors' milk in China.Methods One hundred and ninety-nine very low birth weight infants and extremely low birth weight infants (VLBWI/ELBWI) admitted to NICU in Nanjing Maternity and Child Health Care Hospital were analyzed retrospectively (from August 1,2013 to July 31,2014) one year before and one year after the establishment of human donors' milk bank.Only 1 infant's parents(1/199 cases) refused to use donor milk,and 198 infants were fed with donors' milk since their own mothers' milk was unavailable.One hundred and forty-eight infants admitted to NICU from August 1,2012 to July 31,2013 were chosen as the control group,who were fed with formula milk since their own mothers' milk was unavailable.The mortality,incidence of necrotizing enterocolitis (NEC) and sepsis,time to full enteral feeding and hospital stay between 2 groups were analyzed.Results One year before the establishment of breast milk bank,there were 148 cases of very low or extremely low birth weight infants receiving mixed feeding,and 16 cases of them had neonatal necrotizing enterocolitis,the incidence rate was 10.81％.Since the establishment of human milk bank,187 women donated breast milk in the first year and 260 555 mL of human milk were collected and delivered.Only 1 infant (1/199 cases) refused to use donor milk,and 198 infants were fed with donors' milk since their own mothers' milk was unavailable.Nine babies with VLBWI/ELBWI were diagnosed as NEC in donor milk feeding group,and 16 cases were diagnosed as NEC in formula-feeding group.The incidence rate of NEC was lower in the donor-milk-feeding group (4.52％ vs 10.81％,x2 =5.02,P ＜ 0.05).Donor-milk-feeding group reached full enteral feeding[(16.4 ± 5.3) d vs (18.2 ± 6.2) d,t =2.84,P ＜ 0.05] and had shorter period of hospital stay[(35.1 ± 9.5) d vs (37.3 ± 10.4) d,t =2.05,P ＜ 0.05] compared with formula feeding group.The mortality and incidence of sepsis had no difference between 2 groups (all P ＞ 0.05).Conclusions Donors' breast milk is associated with a lower risk of NEC,sooner full enteral feeding and shorter hospital stay.Further research is needed to confirm these findings and measure the growth and long term neurodevelopment effects of donors' breast milk.
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Objective To summarize the causes,related factors and outcome of extremely premature infants and extremely low birth weight infants.Methods One hundred and three cases of extremely premature infants and extremely low birth weight infants were admired to First Affiliated Hospital of Inner Mongolia Medical University between January 2009 and December 2015.The study was performed to analyze the clinical data of the 103 cases,included history of pregnancy,birth situation,treatment and prognosis.Results In these 103 cases,67 infants survived,36 infants died.The survival rate was 65.0％ (67/103).The extremely premature infants and extremely low birth weight infants were mainly associated with pregnancy-induced hypertension,infection,premature rupture of membranes.Factors that could affect the outcome of these cases included gestational age,sex,birth weight,pulmonary hemorrhage,bronchopulmonary dysplasia and necrotizing enterocolitis(P ＜0.05).The survival infants with long-term hospitalization often complicated with anemia.The top four causes of the death mostly were pulmonary hemorrhage,pneumonia,neonatal respiratory distress syndrome,and necrotizing enterocolitis.Conclusion In order to reduce the incidence of extremely premature infants and extremely low birth weight infants,improve the survival rate and infants quality of life,we should monitor the high-risk pregnant women closely during pregnancy period,prevent and treat all kinds of complications and prevent the occurrence of nosocomial infection.
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Bronchial defects in neonates are known to occur very rarely as a complication of mechanical ventilation or intubation. This causes persistent air leakage that may form massive pneumomediastinum or pneumothorax, leading to cardiac tamponade or cardiorespiratory deterioration. Early diagnosis and treatment of bronchial defects are essential, as they can be accompanied by underlying severe lung parenchymal diseases, especially in preterm infants. We encountered an extremely low birth weight infant with an air cyst cavity in the posterior mediastinum that displaced the heart anteriorly, thereby causing cardiopulmonary deterioration. During exploratory-thoracotomy, after division of the air cyst wall (mediastinal pleura), we found a small bronchial defect in the posterior side of the right main bronchus. The patient had shown respiratory distress syndrome at birth, and she was managed by constant low positive pressure ventilation using a T-piece resuscitator after gentle intubation. As the peak inspiratory pressure was maintained low throughout and because intubation was successful at the first attempt without any difficulty, we think that the cause of the defect was not barotrauma or airway injury during intubation. The fact that the margin of the defect was very clear also suggested a congenital origin. To our knowledge, this is the first case of congenital bronchial defect in English literature.
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Humans , Infant, Newborn , Barotrauma , Bronchi , Cardiac Tamponade , Early Diagnosis , Heart , Infant, Extremely Low Birth Weight , Infant, Premature , Intubation , Lung , Mediastinal Emphysema , Mediastinum , Parturition , Pneumothorax , Positive-Pressure Respiration , Respiration, ArtificialABSTRACT
Extrauterine growth restriction is a major clinical problem for very low and extremely low birth weight infants.They need the rapid accumulation of protein and energy after born;otherwise it will lead to an increase in nutritional deficiencies,malnutrition and neurological problems.The ideal nutritional strategies is to provide parenteral nutrition after birth,amino acids and lipids are initially provided at a minimum of 2.0 g/(kg · d) and 1.0 g/(kg — d),which advance to 3.5-4.0 g/(kg · d) and 3.0 g/(kg · d),keep the appropriate protein/energy ratio.The appropriate vitamin,minerals and elements should be provided.Enteral feeding should be initiated immediately about 24 h after birth,minimal feeding [10-20 mL/(kg · d)] should last 3-5 days.Human milk should gradually increase to 75-120 mL/(kg · d) and add human milk fortifier.Parenteral nutrition is stopped when human milk fed to 120 mL/(kg · d).
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Objective To investigate the usefulness of calcium and phosphorus supplementation in parenteral nutrition for extremely low-birth-weight (ELBW) infants.Methods According to the inclusion criteria,66 ELBW infants hospitalized after birth in neonatal ward of Tongji Hospital from June 2009 to December 2012 were divided into three groups with random number table:28 infants in the first group were treated with parenteral nutrition without calcium and phosphorus supplementation,21 infants in the second group were treated with parenteral nutrition with calcium supplementation only,and 17 infants in the third group was treated with parenteral nutrition with calcium and phosphorus supplementation.The blood levels of ionic calcium,blood phosphorus,and urine calcium and creatinine were determined once a week (total of 4 times).The speed of sound (SOS) was detected for shin bones by quantitative ultrasound at the date of admitting and the end of 4weeks.Results After administrations of supplementation,the blood levels of ionic calcium in the second group were significantly higher than those in the first group [on the 14th day,(1.82 ± 0.35) mmol/L vs.(1.14 ±0.47) mmol/L,t=5.800,P=0.005;onthe21stday,(1.77±0.45) mmol/Lvs.(1.07±0.43) mmol/L,t=5.492,P=0.004; on the 28th day,(1.61±0.58) mmol/Lvs.(0.92±0.44) mmol/L,t=4.556,P=0.025].The blood levels of ionic calcium in the third group were also significantly higher than those in the first group [on the 14th day,(1.55 ± 0.30) mmol/L vs.(1.14 ± 0.47) mmol/L,t =3.570,P =0.001 ; on the 21st day,(1.58 ±0.38) mmol/L vs.(1.07 ±0.43) mmol/L,t =4.151,P=0.000; on the 28th day,(1.55 ±0.35) mmol/L vs.(0.92 ±0.44) mmol/L,t =5.302,P =0.003].The blood levels of phosphorus were significantly elevated in the third group compared with those in the first group [on the 14th day,(1.86 ±0.10) mmol/L vs.(1.65 ±0.17) mmol/L,t=5.217,P=0.012; on the21st day,(1.88 ±0.14) mmol/Lvs.(1.61 ±0.13) mmol/L,t =6.442,P=0.003; on the 28th day,(1.89 ±0.15) mmol/L vs.(1.58 ±0.14) mmol/L,t =6.891,P =0.000] and the second group [on the 14th day,(1.86 ± 0.10) mmol/L vs.(1.53 ±0.15) mmol/L,t =8.100,P=0.000; on 21st day,(1.88 ±0.14) mmo/Lvs.(1.57 ±0.14) mmol/L,t =6.787,P =0.000; on the 28th day,(1.89 ± 0.15) mmol/L vs.(1.62 ± 0.18) mmol/L,t =5.043,P =0.000].The calcium-to-phosphorus ratios markedly increased in the second group compared with those in the first group (on the 14th day,0.69 ±0.18 vs.0.33 ±0.14,t =7.601,P =0.000; on the 21st day,0.66±0.16 vs.0.37 ±0.14,t =6.62,P=0.001 ; on the 28th day,0.62 ±0.15 vs.0.39 ±0.12,t =5.776,P =0.005) while declined in the third group (on the 14th day,0.14 ± 0.10 vs.0.33 ± 0.14,t =5.294,P =0.010; on the 21st day,0.13 ± 0.12 vs.0.37 ± 0.14,t =6.102,P =0.002; on the 28th day,0.12 ± 0.11 vs.0.39 ± 0.12,t =7.711,P =0.000).The third group showed significantly increased SOS values than those in the first and second groups [(381 ± 87) m/s vs.(135 ± 87) m/s,t =9.815,P =0.000;(381 ±87) m/s vs.(146 ±68) m/s,t =9.774,P=0.000].Conclusions Proper supplementation of calcium and phosphorus via parenteral nutrition can achieve increased bone mineral contents and stable blood ionic calcium and phosphorus levels,and avoid hypercalciuria in ELBW infants.PN therapy with calcium and phosphorus supplementation in ELBW infants needs further studies.
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PURPOSE: Early administration of parenteral amino acids has been shown to limit catabolism and improve growth in extremely low birth weight infants (ELBWI). This study aimed to evaluate the relationship between an earlier aggressive administration of amino acids and blood urea nitrogen (BUN). METHODS: We retrospectively analyzed the medical records of all ELBWI who were born and admitted to Hanyang University Hospital from March 2007 to December 2009. The high initial dose group received > or =3.0 g/kg/d amino acids, while the lower initial dose group did not received a minimum of > or =3.0 g/kg/d parenteral AA at < or =3 days of age. RESULTS: There were no differences in gestational age, birth weight and sex between the groups. Mean fluid intake and total calories during the first 48 hours of life were similar between two groups. There is no correlation between amino acid intake and BUN level in ELBWI during study period. However, gestational age showed a significant negative correlation with BUN level in ELBWI on day 3 and 7. CONCLUSION: An earlier, more aggressive administration of amino acids was safe and well-tolerated. There is no correlation between amino acid intake and BUN level in ELBWI infants within 7 days of life.
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Humans , Infant , Infant, Newborn , Amino Acids , Birth Weight , Blood Urea Nitrogen , Gestational Age , Infant, Low Birth Weight , Medical Records , Retrospective StudiesABSTRACT
PURPOSE: We investigated the incidence and clinical course of hypoalbuminemia and identified relevance of prognosis including mortality in extremely low birth weight infants (ELBWIs). Also, we assessed the efficacy of intravenous albumin infusion. METHODS: A retrospective study including 83 preterm infants or =2.5 g/dL serum albumin, n=42) group and the hypoalbuminemia ( or =grade III, 4.9%), necrotizing enterocolitis (NEC, > or =stage IIa, 46.3%), pneumonia (4.9%), sepsis (24.4%). In univariate analysis, there were no statistically significant differences in major morbidities such as PDA, IVH, NEC, bronchopulmonary dysplasia and mortality between the normoalbuminemia and the hypoalbuminemia groups except gestational age (26+6+/-2+1 vs. 26+0+/-1+5, P=0.045) and birth weight (868+/-117 vs. 783+/-121, P=0.002). In multivariate logistic regression, birth weight is the only meaningful factor associated with hypoalbuminemia (OR.995, 95% CI .990-.999, P=0.019). The mortality (47.2% vs. 0%, P=0.065) and morbidities did not differ between the intravenous albumin infusion and the control group. CONCLUSION: In ELBWIs, there were no significant differences in major morbidities and mortality between the hypoalbuminemia and the normoalbuminemia groups. The lower birth weight is the only factor associated with hypoalbuminemia. In addition, major morbidities and mortality rate were not affected by the albumin infusion.
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Humans , Infant , Infant, Newborn , Birth Weight , Bronchopulmonary Dysplasia , Ductus Arteriosus, Patent , Enterocolitis, Necrotizing , Gestational Age , Hemorrhage , Hypoalbuminemia , Incidence , Infant, Low Birth Weight , Infant, Premature , Intensive Care, Neonatal , Logistic Models , Mortality , Pneumonia , Prognosis , Retrospective Studies , Sepsis , Serum AlbuminABSTRACT
PURPOSE: To evaluate the causes of nil per os (NPO) before reaching full enteral feeding and compare the clinical outcomes of extremely low birth weight infant (ELBWI) by NPO duration. METHODS: We retrospectively reviewed the medical records of 92 ELBWI who were born and admitted to Neonatal intensive care unit (NICU) of Seoul National University Children's Hospital from January 2009 to December 2011. We analyzed the perinatal factors and causes of NPO. To compare neurodevelopmental outcomes and growth, we used K-ASQ (Korean ages & stages questionnaires) and growth Z-score. RESULTS: There were total 163 fasting episodes before reaching full enteral feeding. Mean NPO time was 6.7+/-5.6 days and mean frequency of NPO was 1.8 episodes. Most common cause of NPO was the medication for patent ductus arteriosus (PDA) closure (47.5%) and the next was the feeding intolerance (25.3%). Longer NPO group (more than 7 days) showed longer time to full enteral feeding and hospital day. Incidence of necrotizing enterocolitis was significantly higher in the longer NPO group. But there was no difference between two groups in the incidence of sepsis, cholestasis, and osteopenia. Changes in height Z-score from birth to postmenstrual age 35 weeks were significantly higher in the longer NPO group. In longer NPO group, catch-up of weight Z-score at CA 8 months was poor. And number of patients with score under cutoff level in K-ASQ was higher. CONCLUSION: NPO duration seems to be related with long term growth and neurodevelopment. Effort to minimize fasting time is needed by keeping enteral feeding during PDA medication and active management for feeding intolerance.
Subject(s)
Humans , Infant , Infant, Newborn , Bone Diseases, Metabolic , Cholestasis , Ductus Arteriosus, Patent , Enteral Nutrition , Enterocolitis, Necrotizing , Fasting , Incidence , Infant, Extremely Low Birth Weight , Infant, Low Birth Weight , Intensive Care, Neonatal , Medical Records , Parturition , Retrospective Studies , Seoul , SepsisABSTRACT
Introduction: Data on cost, short term complications and outcome of Sri Lankan extremely low birth weight (ELBW) babies is largely unavailable. Objective: To determine the cost, selected short term complications (surfactant treated and untreated) and short term outcome of ELBW infants in a tertiary care unit in Sri Lanka. Design, setting and method: A descriptive longitudinal study was carried out at Castle Street Hospital for Women over a 6 month period on all ELBW infants, excluding babies who were born after less than 23 completed weeks of gestation and babies who were transferred from the unit. Results: During the study period there were 39 ELBW babies. Ranges of birth weights and maturity were from 540g to 980g (mean 853g) and from 25 weeks to 34+3days respectively. Fifty one percent were small for gestational age. Survival rate was 76.9% at discharge. Hospital stay, intensive care unit stay, duration of mechanical ventilation and supplemental oxygen were 60.6, 13, 3.5 and 9.0 days per survivor respectively. Direct cost per survivor was SLR 82,207. Incidences of complications were 19.4% intraventricular haemorrhage, 8.3% necrotising enterocolitis, 22.2% pulmonary air leak, 11.1% pulmonary haemorrhage and 2.7% patent ductus arteriosus. Average weight gain on discharge was 5.2g/kg/day. Conclusions: Overall survival rate was 77%. IVH was significantly less in surfactant treated babies.