Advances in relationship between the gut-lung axis and bronchopulmonary dysplasia / 国际儿科学杂志

Bronchopulmonary dysplasia(BPD), a common respiratory disease in premature infants, leads to poor long-term prognosis.The crosstalk between the gut and lung which can be mediated by microbiota is known as the gut-lung axis.Recently, an increasing amount of evidence has indicated that the gut microbiota is closely related to the pathogenesis of many respiratory diseases.The gut-lung axis affects the occurrence and development of BPD through microbiota translocation and regulation of immune pathways.At present, the relationship between the gut-lung axis and BPD is still in the research stage and exploring the potential association may help to search early markers and new therapies for BPD.In order to provide insights into preventing and treating BPD, this review describes the relationship between the gut-lung axis and BPD.

Exploration of cut-off values of amino acid levels in premature infants in Sichuan / 中华实用儿科临床杂志

Objective:To detective the cut-off values of amino acid levels in premature infants in Sichuan.Methods:Data of newborns screening for inherited metabolic diseases (IMD) by tandem mass spectrometry in Sichuan Province from January 2018 to December 2019 were retrospectively analyzed.They were divided into premature infant group ( n=2 264, 1 312 males and 952 females) and full-term infant group ( n=53 275, 28 269 males and 25 006 females). The cut-off values of amino acids in dry blood spots were expressed as percentage ( P0.5 - P99.5), and rank sum test was used for comparison between preterm and full-term infants. Results:(1) The distribution of 11 amino acids [alanine (ALA), arginine (ARG), citrulline (CIT), glycine(GLY), leucine (LEU), methionine (MET), ornithine (ORN), phenylalanine (PHE), proline (PRO), tyrosine (TYR) and valine (VAL)] in premature infants were abnormal.(2) The cut-off values of amino acids in premature infants were as follows: ALA: 135.20-552.33 μmol/L, ARG: 1.34-47.04 μmol/L, CIT: 5.66-32.02 μmol/L, GLY: 181.48-909.93 μmol/L, LEU : 71.10-283.29 μmol/L, MET: 4.21-34.51 μmol/L, ORN: 40.58-293.76 μmol/L, PHE: 23.60-106.30 μmol/L, PRO: 77.76-358.24 μmol/L, TYR: 27.52-352.91 μmol/L, VAL: 53.74-228.37 μmol/L.(3) The cut-off values of amino acid in full-term infants were as follows: ALA: 135.20-552.33 μmol/L, ARG: 1.30-42.73 μmol/L, CIT: 5.92-30.35 μmol/L, GLY: 208.17-980.09 μmol/L, LEU: 72.91-287.49 μmol/L, MET: 4.27-33.90 μmol/L, ORN: 48.40-305.59 μmol/L, PHE: 27.63-92.27 μmol/L, PRO: 97.38-372.75 μmol/L, TYR: 40.19-276.54 μmol/L, VAL: 65.75-237.92 μmol/L.(4) Except for PHE ( Z=-0.58, P>0.05), the other indicators were significantly different between 2 groups [ALA ( Z=-15.32, P<0.05), ARG ( Z=-5.62, P<0.05), CIT ( Z=-5.86, P<0.05), GLY ( Z=-14.52, P<0.05), LEU ( Z=-5.62, P<0.05), MET ( Z=-5.22, P<0.05), ORN ( Z=-13.01, P<0.05), PRO ( Z=-22.09, P<0.05), TRY ( Z=-2.09, P<0.05), VAL ( Z=-17.82, P<0.05)]. Conclusions:The establishment of the cut-off values of amino acids in premature infants in Sichuan provides a theoretical basis for laboratory diagnosis of IMD screening, which enhances the accuracy of diagnosis and avoids excessive medical treatment.

Isolated chylous ascites in preterm infants:a case report and literature review / 中华全科医师杂志

The clinical data of 5 cases of chylous ascites in preterm infants admitted in NICU of Peking Union Hospital from 2001 to 2021 were retrospectively analyzed. There were 3 boys and 2 girls with the gestational age of 29 +1 weeks, and birth weight of (1 122±323) g. No peritoneal effusion was found on prenatal ultrasound examination. All the five cases diagnosed with chylous ascites after the initiation of enteral nutrition on d4 to d10. All cases were resolved by conservative treatment, including fasting with total parenteral nutrition for 3 wks. The parenteral nutrition strategy was specified by high protein concentration (4 g·kg -1·d -1) and low lipid emulsion (2.0-2.5 g·kg -1·d -1). Formula containing 50% medium chain triglyceride or human milk was fed sequentially, and no feeding intolerance or abdominal distension were observed. All patients were discharged stable and followed up for 3-5 years,and no recurrence occurred. The PubMed and Wanfang database were searched for cases of chylous ascites in preterm infants, and 7 cases were reported in literature. Six cases were diagnosed by antenatal ultrasound between 21 and 23 weeks of gestational age. Three cases underwent radionuclide lymphoscintigraphy, and 2 of them demonstrated peritoneal lymphatic fistula or lymphatic dilatation. Five cases were treated with fasting plus intravenous infusion of octreotide. Three infants who failed to respond to conservative treatment underwent surgical treatment. Four cases were complicated with sepsis and needed intravenous antibiotic treatment.

Clinical characteristics and pathogenic distribution of late-onset sepsis among premature infants with gestational age less than 34 weeks in Henan Province / 中华临床感染病杂志

Objective:To analyse the pathogenic bacteria distribution and clinical characteristics of late-onset sepsis (LOS) among premature infants with gestational age less than 34 weeks in Henan Province.Methods:The clinical data of 6 590 premature infants admitted to 17 medical institutions in Henan Province from January 2019 to December 2020 were retrospectively analyzed. The gestational age of infants was less than 34 weeks and was admitted to the neonatal ward within 7 days after birth. SPSS 19.0 statistical software was used for data analysis.Results:Among 6 590 premature infants LOS developed in 751 cases (11.40%), of whom the diagnosis was confirmed in 276 cases (36.75%) and 475 cases (63.25%) were diagnosed clinically. The fatality rate related to LOS was 13.58%. There were significant differences in the incidence of LOS and infection-related mortality among infants with different gestational ages and body weights ( χ2=388.894 and 13.572, χ2=472.282 and 9.257, P<0.05 or <0.01). Among 276 children with confirmed LOS, 286 strains of pathogenic bacteria were isolated. Gram-negative bacteria were most prevalent (178 strains), accounting for 62.24% of all infections, followed by fungi (58 strains, 20.28%). Klebsiella pneumoniae was most frequently detected Gram-negative bacteria (117 strains, 40.91%), among which 32.48% (38/117) was carbapenem-resistant Klebsiella pneumoniae. The proportion of diagnosed sepsis, the proportion of catheterization, and the infection-related mortality of infants with LOS in tertiary hospitals were all higher than those in secondary hospitals ( χ2=6.212, 5.313 and 4.435, all P<0.05). The proportion of exclusive breastfeeding in secondary hospitals was lower than that in tertiary hospitals ( χ2=19.216, P<0.05). The time of antibacterial drug use before infection in specialized hospitals was longer than that in general hospitals ( χ2=3.276, P<0.05). Conclusion:The incidence of LOS among preterm infants in Henan Province is high, which was mainly caused by Gram-negative bacteria. The clinical characteristics of LOS caused by different pathogens and in different health institutions are different, the prevention and control strategy should be developed accordingly to reduce the incidence LOS of preterm premature infants.

Research progress of cow′s milk protein allergy and intestinal flora characteristics in premature infants / 中华实用儿科临床杂志

Cow′s milk protein allergy (CMPA) is the most common food allergy in infancy.Since the early symptoms of CMPA in premature infants lack specificity and are prone to misdiagnosis or missed diagnosis, which would induce inappropriate fasting and unreasonable application of antibiotics, more attention should be paid to CMPA in premature infants.It has been proved in accumulating studies that the establishment and improvement of intestinal flora is the basic factor for the maturation of the immune system and the induction of immune response balance after birth.There are differences in the type and amount of intestinal flora between food allergic infants and non-allergic infants.Compared with term infants, preterm infants have significantly lower diversity and abundance of intestinal flora, immature gastrointestinal tract and immune system development, and are at greater risk for allergies.The use of probiotics can enhance intestinal barrier function and improve immune tolerance.The clinical diagnosis and treatment of preterm CMPA, the characteristics of intestinal flora and the use of probiotics in preterm infants would be reviewed in this paper.

Impact of hypertensive disorder complicating pregnancy on neonatal mortality and major complications in preterm infants / 中华实用儿科临床杂志

Objective@#To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants.@*Methods@#The general clinical data of preterm infants with gestational age 24-36+ 6 weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed.@*Results@#The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ2=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ2=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ2=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis.@*Conclusions@#HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.

Analysis of high-risk factors and clinical characteristics of respiratory distress syndrome in late preterm infants / 重庆医学

Objective To compare the characteristics of respiratory distress syndrome(RDS) between early preterm infants and late preterm(LP) infants,and to investigate the high-risk factors and clinical characteristics of RDS in LP infants.Methods A total of 240 premature infants with RDS treated in our hospital from January 2014 to January 2015 were selected and divided into 2 groups according to the gestational age(GA),143 cases in early preterm group (GA <34 weeks) and 97 cases in LP group(GA 34-36 weeks).The basic situation,high risk factors in perinatal period,clinical characteristics,treatment and prognosis in RDS premature infants were retrospectively analyzed.Results The delivery mode in the LP group was mainly dominated by cesarean section,the cesarean section rate reached 83.51%,which was significantly higher than that in the early preterm group (P<0.05).The premature occurrence rate caused by cesarean section because of premonitory uterine rupture was higher (27.84%);the treatment effect of pulmonary surfactant(PS) and noninvasive assisted ventilation therapy in the LP group was inferior to that in the early premature group,moreover the mechanical ventilation rate was higher,the duration of mechanical ventilation was longer;the incidence rates of pulmonary hypertension and intrauterine infection were higher than those in the early preterm group.Conclusion LP infants with RDS are mainly dominated by cesarean section without onset of labor process,intrauterine infection may be its risk factor,PS use is effective,but its effect is more poor than that in the early preterm group,the mechanical ventilation rate in the LP group is higher,but the prognosis is good.

Vaccination strategies of premature infants and low birth weight infants / 中华实用儿科临床杂志

Vaccines are the most effective means of preventing and controlling infectious diseases.Immune system of premature infants and low birth weight infants are weaker and they have a higher risk of complication from vaccine-preventable diseases than full term infants.Vaccination is often delayed in preterm infants and low birth weight infants in China since the healthcare workers and parents worry about safety and effectiveness of vaccines.The delayed vaccination increases the rate of preventable infections.Therefore,timely and reasonable vaccination is very important for preterm infants and low birth weight infants.

The practice of continuing nursing model in life of puerperae with preterm infants / 中华护理杂志

Objective To explore the application of continuing nursing model in life of puerperae with preterm infants and evaluate its effects.Methods Based on continuous nursing model of Ahmadi,puerperae's continuing nursing program was constructed.Randomized controlled trail design was used,and totally 110 puerperae in a hospital in Beijing were recruited from August 2016 to March 2017.The experimental group received continuing nursing intervention model,and the control group received routine nursing care.Parenting knowledge and psychological evaluation of the two groups were collected 3 days before discharge,1 month,3 months and 6 months after discharge.Results Ninety-eight puerperae completed the study.In the experimental group,the score of parenting knowledge was higher than that of the control group(P＜0.01),and the total score of mental health assessment and scores of depression and anxiety were lower than those in the control group (P＜0.05).Conclusion Puerperae's continuing nursing program based on the continuous nursing model of Ahmadi improved maternal ability and positive emotion,and promoted quality of life.

Comparison of Follow-up Courses after Discharge from Neonatal Intensive Care Unit between Very Low Birth Weight Infants with and without Home Oxygen

In order to investigate the clinical impact of home oxygen use for care of premature infants, we compared the follow-up courses after neonatal intensive care unit (NICU) discharge between very low birth weight infants (VLBWIs) with and without home oxygen. We retrospectively identified 1,232 VLBWIs born at 22 to 32 weeks of gestation, discharged from the NICU of 43 hospitals in Korea between April 2009 and March 2010, and followed them up until April 2011. Clinical outcomes, medical service uses, and readmission and death rates during follow-up after the NICU discharge were compared between VLBWIs with (HO, n = 167) and those without (CON, n = 1,056) home oxygen at discharge. The HO infants comprised 13.7% of the total VLBWIs with significant institutional variations and showed a lower gestational age (GA) and birth weight than the CON infants. The HO infants had more frequent regular pediatric outpatient clinic visits (12.7 ± 7.5 vs. 9.5 ± 6.6; P < 0.010) and emergency center visits related to respiratory problems (2.5 ± 2.2 vs. 1.8 ± 1.4; P < 0.010) than the CON infants. The HO infants also had significantly increased readmission (adjusted hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.25–2.04) and death risks (adjusted HR, 7.40; 95% CI, 2.06–26.50) during up to 2 years following the NICU discharge. These increased readmission and death risks in the HO infants were not related to their prematurity degree. In conclusion, home oxygen use after discharge increases the risks for healthcare utilization, readmission, and death after NICU discharge in VLBWIs, regardless of GA, requiring more careful health care monitoring during their follow-up.

Pérdida de peso corporal y velocidad de crecimiento postnatal en recién nacidos menores de 1,500 gramos durante su estancia en un hospital de tercer nivel de atención / Body weight and postnatal growth velocity in premature ≤ 1,500 g during their hospital stay in a teartiary level of care

Introducción: La pérdida de peso en los primeros cinco a siete días de vida y el crecimiento en los prematuros depende de muchos factores. Existe una asociación inversa entre la edad gestacional y la pérdida de peso corporal en la primera semana de vida: a menor edad gestacional y menor peso al nacimiento es más difícil lograr una velocidad de crecimiento adecuada. Los objetivos de este estudio fueron determinar la pérdida de peso corporal en recién nacidos ≤ 1,500 g, calcular la velocidad de crecimiento absoluta (g/día) y relativa (g/kg/día), y correlacionar la pérdida ponderal porcentual con la edad gestacional. Material y métodos: Estudio observacional, longitudinal y retrospectivo de recién nacidos ≤ de 1,500 g. Las variables de estudio fueron edad gestacional, peso, talla y perímetro cefálico al nacer, con seguimiento de peso diario, talla y perímetro cefálico semanal. Se calculó la pérdida ponderal máxima, la velocidad de crecimiento y se correlacionó la pérdida ponderal máxima con la edad gestacional. Resultados: Se analizaron 101 casos, con edad gestacional promedio de 30.2 ± 2.3, peso al nacer de 1,190.7 g ± 204.5, 42 neonatos (41.6%) fueron con peso bajo para la edad gestacional y 59 (58.4%) con peso adecuado para la edad gestacional. El porcentaje máximo de pérdida de peso fue de 8.6 ± 4.5%, la recuperación del peso se presentó en el día 10.9 ± 5.2; la velocidad de crecimiento fue de 19.3 ± 5.4 g/día y 16.9 ± 5.4 g/kg/día; a menor edad gestacional hay mayor pérdida ponderal máxima con una correlación negativa baja y significativa (r = -0.422, p < 0.0001). Conclusiones: La velocidad de crecimiento absoluta (g/d) y relativa (g/kg/d) son útiles en la valoración nutricia diaria de todo recién nacido prematuro, permite detectar patrones de crecimiento subóptimos y realizar de manera oportuna intervenciones nutricionales para mejorar la velocidad de crecimiento. La pérdida ponderal en recién nacidos prematuros tiene una asociación significativa negativa, inversa con la edad gestacional.

Introduction: Weight loss in the first five to seven days of life and growth in preterm infants depends on many factors. In the first week of life, there is an inverse association between gestational age and loss of body weight; with very low birth weight and low gestational age is more difficult to achieve adequate growth velocity. The objectives were to determine the loss of body weight in infants less than 1,500 g calculate, the absolute growth velocity (g/day) and relative (g/kg/day), and correlate the percentage weight loss and gestational age. Methods: Observational, longitudinal and retrospective study of preterm neonates ≤ 1,500 g. The variables analyzed were at birth: weight, gestational age, length, and cephalic circumference, then monitoring the weight per day, and length and cephalic circumference, per week. It was calculated maximum weight loss and growth velocity. For maximum weight loss and gestational age, Pearson correlation was used. Results: Cases of 101 infants, with birth weight 1,190.7 ± 204.5 g and gestational age of 30.2 ± 2.3 were analyzed, 42 neonates (41.6%) had low birth weight for gestational age and 59 (58.4%) adequate weight for gestational age; the maximum average of weight loss was 8.6% ± 4.5; loss was presented in day 4.2 ± 1.7 and weight regain was presented on day 10.9 ± 5.2. Growth velocity was 19.3 ± 5.4 g/day and 16.9 ± 5.4 g/kg/day, an inverse negative correlation was observed between weight loss and gestational age (r = -0.422, p < 0.0001). Conclusions: The absolute growth velocity (g/day) and relative (g/kg/day) are useful in assess the nutritional condition in premature infants, and gives the opportunity to clinicians detect suboptimal growth velocity patterns and make adequate interventions. An inverse negative correlation was observed between weight loss and gestational age.

Significado que le asigna el padre a la hospitalización de su hijo recién nacido pretérmino extremo en la unidad de cuidado intensivo neonatal  / Meaning assigned by the parent to the hospitalization of extreme preterm newborn child in the neonatal intensive care unit

Objetivo: identificar el significado que le asigna el padre a la hospitalización de su hijo recién nacido pretérmino extremo, en la Unidad de Cuidado Intensivo Neonatal. Diseño, muestra y participantes: estudio cualitativo, metodología de etnoenfermería, muestreo por saturación de información, realizadas veintiuna entrevistas, ocho padres que cumplían criterios de inclusión. Resultados: surgen dos temas, "La hospitalización del recién nacido pretérmino extremo: cambios en la estructura social y cultural del padre", con cinco patrones: aferro a las creencias religiosas y cambios en la forma de ver al vida; lazos y relaciones con: el recién nacido, la pareja, familia y amigos; la hospitalización: un aprendizaje y curso intensivo del cuidado del recién nacido pretérmino extremo; organización del padre frente a la responsabilidad laboral y económica; una nueva percepción de la vida, a partir de la hospitalización del Recién Nacido Pretérmino Extremo. El segundo tema: "UCIN: primer hogar para el recién nacido pretérmino extremo", con dos patrones: el equipo de salud: un salvavidas para el neonato y una bendición para los papás; la URN: un camino necesario en la vida del recién nacido pretérmino extremo. Conclusiones: el significado que le da el padre a la hospitalización de su hijo recién nacido pretérmino extremo está enmarcado dentro del Modelo del Sol Naciente y los factores que conforman la dimensión de la estructura social y cultural.

Objective: Identify the meaning assigned by the parent to the hospitalization of preterm newborn child in the Neonatal Intensive Care Unit. Design, sample and participants: Qualitative study, ethno nursing methodology, sampling saturation of the information, twenty one interviews made, eight parents who met inclusion criteria. Results: Raises two issues, first "The hospitalization of very preterm neonate: changes in social and culture structure of the father", with five pattern: cling to religious beliefs and changes in the way of looking at life; ties and relations: the baby, the couple, family and friends; the hospitalization learning and intensive course about the care of very preterm neonate; organization of the parent off the job and financial responsibility; a new perception of the life, from hospitalization Extreme Preterm Newborn. The second issue "Neonatal Intensive Care Unit: the first home of Extreme Preterm Newborn" with two patterns: the health team: a lifesaving for the baby and a blessing for parents; the Neonatal Intensive Care Unit a necessary path in life of Extreme Preterm Newborn. Conclusions: The meaning assigned by the parent to the hospitalization of extreme preterm newborn child is framed within the model of the Rising Sun and the factors that make up the dimension of social and cultural structure.

US and MR Imaging of Candidiasis of the Nervous System in Premature Infants: Two Case Reports

Candidiasis of the central nervous system (CNS) is a rare condition and like other opportunistic fungal infections, most commonly occurs in immune-compromised patients. Because of the increasing use of antibiotics and the improving survival rate of premature infants requiring intensive care, the incidence of fungal infections in the brain has increased. We report the findings of ultrasonography and MR imaging in two cases of candidiasis of the CNS in premature infants.

Clinical Considerations of the Surgical Closure of the PDA in the Premature Infants / 대한흉부외과학회지

BACKGROUND: Surgical closure of the PDA in premature infants with complications or contraindications to indomethacin use, or recurrence of symptomatic PDA is a safe and effective procedure with low operative risk and minimal complications. MATERIAL AND METHOD: From April 1996 to August 1998, 11 premature infants with body weight under 1.5 kg at operation underwent operation for a symptomatic PDA (male:5, female: 6). Associated dise ases were congenital heart disease(7), hyaline membrane disease(6), intraventricular hemor rhage(4), pneumonia(4), pneumothorax(3), hyperbilirubinemia(2), necrotizing enterocolitis(2), renal failure(1), epilepsy(1), and hydrocephalus(1). Surgical techniques are hemoclipping(8) and ligation(3). The size of PDA was 3~6 mm (5.0+/-1.2). RESULT: Systolic and diastolic blood pressure rised and heart rates decreased after PDA closure. ABGA improved postoperatively. There were no surgical complications. Six infants with improved ABGA data were weaned from mechanical ventilatory support. The follow-up durations after discharge were 3 month to 12 month. Five deaths were not related to operation. The causes of death were hyaline membrane disease(2), bronchopulmonary dysplasia with pneumonia(1), sepsis(1), and con gestive heart failure with respiratory distress syndrome(1). CONCLUSION: Early operative closure is the treatment of choice in most premature infants with a hemodynamically significant shunt(PDA), recurrence of symptomatic PDA, complications of Indomethacin, or contraindi cations to Indomethacin.