Clinical features and risk factors of pulmonary hemorrhage in extremely preterm infants / 中国新生儿科杂志

Objective:To study the clinical features and risk factors of pulmonary hemorrhage in extremely preterm (EPT) infants.Methods:From February 2018 to January 2022, EPT infants admitted to NICU of our hospital and diagnosed with pulmonary hemorrhage were retrospectively assigned into the observation group and those without pulmonary hemorrhage were assigned into the control group. Univariate analysis and multivariate logistic regression analysis were used to compare the clinical features and determine risk factors of pulmonary hemorrhage in EPT infants.Results:A total of 114 EPT infants were included, including 28 cases (24.6%) in the observation group with pulmonary hemorrhage and 86 cases in the control group. Pulmonary hemorrhage mainly occurred within the first week after birth. Univariate analysis showed that the observation group had higher incidences of following events than the control group: birth asphyxia, delivery room intubation, severe respiratory distress syndrome, hyperglycemia, thrombocytopenia, severe acidosis, shock, score for neonatal acute physiology with perinatal extension-Ⅱ (SNAPPE-Ⅱ) ≥37 and the highest lactate level. Birth weight was lower in the observation group than the control group ( P<0.05). Logistic regression analysis showed that SNAPPE-Ⅱ≥37, shock and hyperglycemia were risk factors of pulmonary hemorrhage ( OR=4.081, 4.610 and 3.355, respectively, all P<0.05). The incidences of mortality and intracranial hemorrhage in the observation group were higher than the control group. The duration of mechanical ventilation in the observation group was longer than the control group ( P<0.05). No significant differences existed in the duration of nasal continuous positive airway pressure, assist mechanical ventilation and total oxygen use, the incidences of grade Ⅱ-Ⅲ bronchopulmonary dysplasia, retinopathy of prematurity and the length of hospital stay ( P>0.05). Conclusions:SNAPPE-Ⅱ≥37, shock and hyperglycemia are early risk factors for pulmonary hemorrhage in EPT infants. EPT infants with pulmonary hemorrhage have higher incidences of mortality and intracranial hemorrhage, requiring longer periods of mechanical ventilation.

Outcome of Early Versus Late Surfactant Therapy in Preterm Neonates with Respiratory Distress Syndrome at a Tertiary Care Centre

Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD), has been recognized as the most common co-morbidity of prematurity. Prematurity and RDS largely contribute to early neonatal morbidity and mortality. With adequate antenatal steroid and early continuous positive airway pressure, early surfactant therapy improve survival outcome.Material & Methods:Prospective interventional study included newborns with prematurity 28-36 weeks(GA) with clinical Respiratory distress syndrome and birth weight(BW)>650 gm. All subjects were preferably provided early surfactant therapy (within 2hours after birth). Surfactant (survanta) was delivered by INSURE technique (Intubate- Surfactant administration- Extubate) and only those who required further respiratory support were ventilated. Records on birth weight, gestational age, timing of therapy (early/late), sepsis, complications, and survival/death outcome were collected and data was analyzed using SSPS version 20 software.Results:Out of 76 neonates (42 male, 34 female), 46 received early surfactant therapy and 30 obtained it late; Although mortality was observed with both early(36.66%) and late therapy(63.33%), there was significantly higher survival with early therapy. higher mortality occurred in lower Birth weight(LBW) /Gestational age (GA) subgroups. Culture positive sepsis was found in 52.6% with higher association with late therapy . Hypotension was most common complication with late intervention , whereas there was no difference for pulmonary haemorrhage or apnea.Conclusion:Early surfactant administration improved survival with minimal complications in RDS except for extremely premature/LBW babies.

Average treatment effects of a single-dose antenatal corticosteroid on the respiratory morbidity of Filipino preterm neonates

Introduction@#Prematurity-related respiratory disorders are an important public health concern that should be treated efficiently and effectively. Antenatal corticosteroid (ACS) therapy has been recommended to hasten fetal lung maturation in pregnancies at risk but has not been delivered adequately in low to middle-income countries. This study aimed to estimate the treatment effects associated with the use of a single-dose antenatal corticosteroid on the incidence of respiratory-associated morbidity among prematurely delivered neonates. @*Methods@#This was a retrospective cohort study of neonates delivered at 24 to 33 weeks gestation at a tertiary hospital comparing outcomes in those given single-dose ACS with those given no ACS. Association was estimated using logistic and propensity score (PS) analyses, as well as average treatment effect (ATE) and among those treated (ATET). @*Results@#Most neonates (78.11%) received a single dose before delivery (single-dose ACS group) and only a few (21.89%) did not receive any dose (no ACS dose group). The odds ratio of respiratory morbidity in the single-dose ACS group was 0.44 (0.23-0.84) from an adjusted logistic regression model and 0.33 (0.17-0.80) from the PS matching model. The latter model was used to estimate that the average treatment effect from a single-ACS dose on the entire sample was -0.09 (-0.03 to -0.15), while its effect among the actual recipients was -0.08 (-0.02 to -0.15). @*Conclusion@#There is a small benefit attributed to the single-dose ACS, reinforcing the need for dose administration and completion. Future studies are recommended to clarify the estimated association and improve on the methodological constraints encountered.

Effectiveness of kangaroo mother care in intubated preterm neonates 28 to 36 weeks gestational age, weighing 600 to 2000 grams at birth: A randomized controlled trial

Background@#Kangaroo Mother Care (KMC) is the standard of care for stable low birth weight infants. Provision of KMC to intubated preterm infants may also be beneficial, but strong evidence is still lacking. @*Objective@#To determine the effectiveness of KMC in decreasing mortality among intubated preterm neonates. @*Study Design@#This is a non-blinded, parallel, non-inferiority randomized controlled trial. @*Methodology@#All intubated, preterm admissions, 28-36 weeks gestation, weighing 600-2000 grams, with respiratory distress were included. They were randomized to the intervention group who received KMC for 2-4 hours daily while intubated and the control group who received care inside an incubator. Participants’ physiologic status – before, during, and after the intervention – was recorded. The primary outcome was mortality. Secondary outcomes included comorbidities, days intubated, and hospital stay. @*Results@#There was a total of 32 patients. The risk of dying in the KMC group (n=16) was significantly reduced by 78% (RR 0.22; 95% CI 0.06 - 0.87 p=0.009). The KMC patients were also less likely to have hypothermia, nosocomial pneumonia, NEC, and late-onset neonatal sepsis (p<0.05). The KMC group had higher blood sugar levels (110 vs. 58, p=0.001) and required fewer days of intubation (3.5 vs.1.5 days, p<0.000) compared to the control group. There was no difference in the duration of the hospital stay. @*Conclusion@#KMC is effective in decreasing mortality among intubated preterm neonates. Other comorbidities and days of intubation were also reduced.

Effectiveness of kangaroo mother care in reducing morbidity and mortality among preterm neonates on nasal continuous positive airway pressure: A randomized controlled trial

Background@#Prematurity is a major cause of neonatal death. Continuous positive airway pressure (CPAP) is the recognized initial intervention among preterm neonates in respiratory distress. Kangaroo mother care (KMC) may help improve neonatal outcomes. @*Objective@#To determine the effectiveness of KMC in reducing morbidity and mortality among preterm neonates on CPAP via RAM nasal cannula (nCPAP). @*Methods@#A prospective, non-blinded, randomized controlled trial was conducted on eligible preterm neonates requiring nCPAP due to respiratory distress. They were randomly allocated to either KMC (n=35) or conventional care groups (n=35). Outcome measures included duration of nCPAP and oxygen support, physiologic parameters, morbidity, mortality, and length of hospital stay. @*Results@#The durations of nCPAP and oxygen support were both significantly shorter in the KMC group. Morbidities (air leak syndrome, necrotizing enterocolitis, and late-onset sepsis) were also significantly lower in the KMC group. Although the mortality rate and the hospital stay were lower in the KMC group, these were not statistically significant. @*Conclusion@#KMC effectively decreased the duration of nCPAP and oxygen support, as well as the incidence of neonatal morbidities. There were trends towards reduced mortality and length of hospital stay in the neonates who received KMC.

A neonatal morbidities and outcomes among late preterm infants

Background: Late preterm birth (34-36 weeks) infants are at greater risk of (2-3 fold) compared to near term or term babies. The present study was done with the purpose to examine related morbidities and outcomes among late preterm infants.Methods: The study included all late preterm babies (34 0/7 weeks-36 6/7 weeks) admitted to the Basaveshwar Teaching and General Hospital and Sangameshwar Hospital for a period of one and half year (December 2013-May 2015). Short term outcome was assessed in the form of neonatal morbidities and mortality during the study period.Results: A total of 203 late Preterm neonates comprised the study group. Male preponderance was noticed with a ratio of 1.5:1. This study confirmed that late-preterm infants are a population at risk of increased neonatal morbidity. Neonatal hyperbilirubinemia requiring phototherapy forms the major one followed by sepsis, respiratory distress, and feed intolerance. Majority of late preterm neonates required more than 7 days hospital duration.Conclusions: Late preterm infants suffer a large number of intercurrent medical problems during the neonatal period, especially increased likelihood of resuscitation in the delivery room, hypothermia, hypoglycemia, jaundice requiring phototherapy, respiratory pathologies, sepsis and feeding intolerance. Prolonging pregnancy to the maximum safest gestation will result in decrease in such morbidities.

The Effect of Developmental Supportive Positioning on Pain from Venipuncture in Preterm Neonates Admitted to Neonatal Intensive Care Unit

@#Introduction: One non-pharmacological method of pain relief is the application of developmental supportive positioning which is a useful method for achieving this goal. The aim of this study was to investigate the effects of developmental supportive positioning on the pain from venipuncture in preterm neonates admitted to the NICU. Methods: In this clinical trial, 54 preterm neonates admitted to the NICU were divided into control and intervention groups using the randomized block method. The neonates in the intervention group were put into developmental supportive positioning for 20 minutes, and then venipuncture was performed in both groups. Changes in the neonates’ facial expressions as well as neonatal physiological parameters including heart rate, respiratory rate, and blood oxygen saturation were collected at three time points: immediately after needle insertion, two minutes and five minutes after needle removal. The collected data were analyzed using the SPSS 21 software. Results: The results showed a statistically significant difference between the mean scores of facial expression changes, heart rate and neonatal blood oxygen saturation at two and five minutes after needle removal in the intervention and control groups (P <0.05). The comparison of the mean respiratory rate of the neonates at two and five minutes after needle removal showed no significant difference between the intervention and control groups (P >0.05). Conclusion: It seems that developmental supportive positioning of preterm neonates has a positive effect on the relief of the pain caused by venipuncture. Considering the importance of pain control in preterm neonates, it is recommended to use this method when doing venipuncture.

Mortality and Morbidity of Extreme Preterm Neonates

Extremely preterm babies (22–27+6 weeks gestation) are at increased risk of death and morbidity. In recent years, more babies born between 22 and 25 weeks gestation are being resuscitated and requiring prolonged treatment instead of receiving comfort care only. Therefore, the present study was designed to evaluate the morbidity and mortality of extremely premature babies born between 22 weeks and 27weeks+6 days gestation during their hospital stay. Methods: The study was conducted at Rajagiri Hospital in Aluva, a tertiary care hospital in Kerala. This was a retrospective study that included all extremely preterm births between 22 weeks and 27weeks+6 days gestation over a period of 3 years. Results: Forty five extreme preterm neonates were born during the study period out of 2598 NICU admissions (1.7 %). Thirty of those forty five neonates (67 %) survived. The rate of survival of extreme preterms increases with gestational age. Moderate and severe bronchopulmonary dysplasia (BPD) were seen in 7 cases (16 %), grade 3 and 4 intraventricular hemorrhage (IVH) were seen in 6 cases (13 %), necrotizing enterocolitis (NEC) were seen in 8 cases (18%) and retinopathy of prematurity (ROP) requiring treatment were seen in 9 cases (20%). Higher incidence of mortality was seen in neonates who were small for gestational age (SGA) and whose mothers had chorioamnionitis. The average length of hospital stay was 76 days. The mean average duration of mechanical ventilation and non invasive ventilation were 19 days and 32 days respectively. Conclusion: Extremely preterm neonates remain at risk for mortality and major morbidity, with those between 22 to 25 weeks gestation having the highest risk. Survival is feasible in a tertiary care centre where adequate facilities are available. This data can be useful for patient counseling regarding preterm outcomes and NICU stay.

Association of patent ductus arteriosus (PDA) with prematurity and low birth weight neonates

Background: Patent ductus arteriosus (PDA) is a major morbidity encountered in preterm neonates, especially in babies less than 28 weeks gestation or 1000g. It may close spontaneously in preterm neonates; however, failure to close spontaneously in preterm neonates results in significant mortality and morbidity in them.Methods: This prospective study was conducted in a tertiary care hospital in north India over a period of one year. The study cohort consisted of preterm, newborn babies admitted in the hospital with gestational age less than 37weeks and birth weight <2500g.Results: In this study total number of patients admitted during the study were 2930. Out of these preterm low birth weight neonates were 432. Among preterm low birth weight neonates admitted, 132 neonates were excluded as per exclusion criteria. Patent ductus arteriosus was detected in 56 among the 300 neonates giving an overall incidence of patent ductus arteriosus 18.6%, the incidence of patent ductus arteriosus was 56.2% for neonates weighing less than 1000gm, 24.7% for neonates weighing between 1000-1499g, 11.6% for neonates weighing between 1500-1999g and 5.6% for the neonates weighing between 2000-2499g.Conclusions: Thus, incidence of patent ductus arteriosus was inversely proportional to gestational age and birth. Data also suggest that immaturity is the major determinant of the persistent patency of ductus arteriosus.

Use Of Early Labour Room Bubble Cpap In Preterms Born At 28-32 Weeks Of Gestation

Objective: To study the use of early labour room Bubble CPAP in preterm neonates born at 28–32 weeks of gestation and to analyse the outcome in relation to need for mechanical ventilation, duration of hospital stay and mortality at the Neonatal Intensive Care Unit (NICU), Tertiary Care Teaching Government Hospital Kurnool, Andhra Pradesh for a period of 1 Year. Methods : Facility Based Interventional Studied (Randomised Control Study) Participants : Study sample of 109 preterm babies of age 28–32 weeks of gestation Cases : 54 cases, neonates with respiratory distress who were started on CPAP in the labour room within 15 minutes of life. Controls : 55 babies, neonates with respiratory distress who were started on CPAP after 15 minutes to 6 hours of life. In the present study, both the groups(cases and controls) were monitored till they were discharged and the need for mechanical ventilation was noted. Clinical diagnosis of RDS was made based on the time of onset of respiratory distress and clinical examination and respiratory scoring(Silverman Anderson Score) . Chest X–ray and routine investigations were done in all neonates. Duration of CPAP and difference in mortality between the two groups was analysed. Outcome : In the present study, preterm neonates born at 28–32 weeks of gestation who were started on early labour room CPAP vs control group outcome is assessed in relation to need for mechanical ventilation and duration of hospital stay and mortality. Results: It is observed that 16 (29.63%) cases required mechanical ventilation whereas 28 (50.91%) preterm neonatesin the control group needed mechanical ventilation. There was a statistically significant difference between the two groups (p < 0.05). The duration of stay in NICU in neonates with early CPAP was significantly less when compared to the controlled group. 30(76.9%) neonates were discharged within 14 days among cases and 16 (48.48%) neonates among control group. There is no difference in mortality between the 2 groups. Conclusions : The following conclusions could be drawn out of the present study on preterm neonates. 1. The early administration of CPAP in the delivery room in preterm neonates developing respiratory distress decreases the need for mechanical ventilation. 2. The duration of stay in NICU in neonates with early CPAP was significantly less. 3. There is no difference in mortality between the two groups.

Descending Aorta Blood Flow Characteristics before the Development of Necrotizing Enterocolitis in Preterm Neonates

PURPOSE: To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC. METHODS: This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3–9) days after birth and 2 (1–2.5) days before the diagnosis of NEC. RESULTS: Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008). CONCLUSION: Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.

Appropriate indicated use for IVIG in neonatal infections / Uso indicado y apropiado de la inmunoglobulina G intravenosa para el tratamiento de infecciones neonatales

Infection is a leading cause of mortality and morbidity in the newborn and preterm neonates due to immuno-incompetence in these patients. Administration of intravenous immunoglobulin (IVIG) provides immunoglobulin G (IgG) that can protect the body from infection. In theory, morbidity and mortality due to infections in newborns and preterm infants could be reduced by the administration of IVIG. Two meta-analyses were evaluated comparing IVIG to treat various infection versus conventional treatments. The results showed that IVIG is not effective as an adjunctive treatment for suspected or proven infections in neonates.

La infección es la causa principal de la mortalidad y de la morbilidad entre los recién nacidos y los neonatos prematuros debido a la incompetencia inmunológica de estos pacientes. El suministro de inmunoglobulina por vía intravenosa brinda la inmunoglobulina G que protege al cuerpo humano de las infecciones. En términos teóricos, la morbilidad y la mortalidad por infecciones en recién nacidos y en bebés prematuros, podrían reducirse si se administra inmunoglobulina G intravenosa. Se evaluaron dos meta-análisis que comparaban el uso de la inmunoglobulina G intravenosa para tratar diversas infecciones con los tratamientos convencionales. Los resultados demostraron que dicha inmunoglobulina no es eficaz como tratamiento adyuvante para combatir sospechas de infección o infecciones comprobadas en los recién nacidos.

Efficacy of Indomethacin in Pharmacological Closure of PDA in Preterm Neonates: A Prospective Study from Tertiary Care Centre in Rural India

Background Patent ductusarteriosus (PDA) is a fetal shunt necessary for intrauterine survival of the baby, however its closure at birth occurs as pulmonary vascular resistance drops and lungs get expanded for participating in ventilation. However, PDA remains patent in a large proportion of preterm babies and by day -7, 87% of babies <24 wk gestation have a PDA which hinders in ventilation and causes ductal steal to vital organs. Hence, we aimed to study pharmacological closure of ductus in preterm babies. Aims and Objectives 1) To study the efficacy of COX inhibitor, Indomethacin in ductal closure in preterm babies <34 wk gestation. 2) To compare the symptomatology of PDA in different groups of preterm babies <34 wk GA. Methods A Hospital-based prospective study was conducted in tertiary care NICU.A total of 104 consecutive, eligible preterm babies <34 wk with echocardiographically documented PDA. Indomethacin (COX inhibitor) was administered orally in a dose of 0.2 mg/kg 12 h for 3 doses and the babies underwent Echo study in first 48 h, after2 days, 7days, and weekly thereafter till PDA closure. A second cycle of indomethacin was repeated if PDA did not respond to the initial treatment. Results 75/104 (72%) PDAs closed with indomethacin while 13(12.5%) did not respond, and 16(15.38%) showed a reduction in the calibre of PDA. 26–30 wk group showed a brisk response to ductal closure with indomethacin within 108.1±12.44 h, and a mean no. of cycles of indomethacin of 0.98±5.75. Conclusion With indomethacin we achieved 72% (75/104) closure rates. The best response to indomethacin was noted in 30–32 wk GA group, while maximum nonresponders were in 32–34 wk; suggesting as gestation increases, response to PG inhibitors decreases.

Lactoferrin and necrotizing enterocolitis in preterm infants / 国际儿科学杂志

Necrotizing enterocolitis(NEC)in neonates is the most important neonatal problems in nursery and is associated with high neonatal mortality and morbidity.NEC also leads to various long term complications,including short bowel syndrome,systemic infection,eye problems,nutritional deficiency and neurodevelopmental impairments.Lactoferrin(LF) is a component of breast milk and has multiple actions include antimicrobial,antiviral,anti-fungal and enhance immunity and so on.Studies have been completed and a number of trails are going on for evaluation of efficacy and safety of LF in the prevention of NEC.LF prophylaxis and therapy may have a significant impact on improving clinical outcomes of vulnerable premature infants.

Evaluation of TSH Levels in the Program of Congenital Hypothyroidism Newborn Screening in a Pilot Study of Preterm Newborns in Bogotá, Colombia

Abstract Introduction: Preterm infants (<37 weeks of gestation) have low levels of thyroid hormones due to multiple factors. Objective: To evaluate levels of thyroid-stimulation hormone (TSH) in the program congenital hypothyroidism (CH) newborn screening in a sample of preterm infants in the city of Bogotá, Colombia. Methods: The Secretaría de Salud Distrital screening protocol for CH (blood sample is collected from the umbilical cord in all the newborns) remeasured the serum TSH and heel TSH when preterm infants completed 37 weeks of gestation. Results: A total of 59 preterm neonates were rescreened, of which 2 neonates had elevated levels of TSH and 1 neonate had transient hypothyroxinemia. The Kolmogorov-Smirnov 2-sample/bilateral statistical test was used to compare the neonatal TSH levels of preterm and full-term newborns, which do not follow the same distribution. Conclusion: In our pilot study, 2 of the rescreened infants presented high levels of TSH and 1 had transient hyperthyrotropinemia, suggesting the need for rescreening of preterm infants. Additionally, a larger study should be performed to determine the screening cutoff values for preterm newborns.

The hemodynamic response to acoustically modified syllables in premature and full term newborn infants acquired by near infrared spectroscopy / Respuesta hemodinámica a sílabas modificadas acústicamente en recién nacidos prematuros y a término adquirida por espectroscopía del infrarrojo cercano / Resposta hemodinâmica a sílabas modificadas acusticamente em recém-nascidos prematuros e a termo adquirida por espectroscopia do infravermelho próximo

This research assesses, in newborns, the hemodynamic response to acoustically modified syllables (pronounced in a prolonged manner), versus the response to unmodified syllables (pronounced at a normal rate). The aim was to assess which of these stimulation conditions produced better syllable discrimination in two groups of neonates: 13 preterm (mean gestational age 30 weeks, SD 3 weeks), and 13 full term newborns (mean age 38 weeks, SD 1 week). Syllable discrimination, in each condition, was assessed by using an oddball paradigm (equal syllable trials vs. different syllable trials). The statistical analysis was based on the comparison between the hemodynamic response [oxyHbO] obtained by Near Infrared Spectroscopy (NIRS) to different syllable trials vs. equal syllable trials, in each condition. The modified syllable condition was better in producing trial discrimination in both groups. The amplitude of the hemodynamic response to the different syllable trials was greater than the one to the equal syllable trials: for term infants, t = 2.59, p = 0.024, and for preterm t = 2.38, p = 0.035. This finding occurred in the left temporal lobe. These data suggest that the modified syllables facilitate processing of phonemes from birth.

Esta investigación evalúa, en neonatos, la respuesta hemodinámica ante sílabas modificadas acústicamente (pronunciadas de manera prolongada) en comparación con la respuesta a sílabas no modificadas (pronunciadas a una velocidad normal). El objetivo fue evaluar cuál de estas condiciones de estimulación producía una mejor discriminación silábica en dos grupos de neonatos: 13 prematuros (edad gestacional promedio de 30 semanas, DE 3 semanas) y 13 nacidos a término (edad gestacional promedio de 38 semanas, DE 1 semana). La discriminación de sílabas, en cada condición, se evaluó mediante un paradigma oddball (ensayos con sílabas iguales vs. ensayos con sílaba diferente). El análisis estadístico se basó en la comparación de la respuesta hemodinámica [oxyHb] obtenida por espectroscopia de infrarrojo cercano (NIRS) ante ensayos con sílabas iguales Vs. ensayos con una sílaba diferente en cada condición. Se encontró que la condición de sílabas modificadas obtuvo mejores resultados para la discriminación entre ensayos en ambos grupos. La amplitud de la respuesta hemodinámica ante el ensayo con una sílaba diferente fue significativamente mayor que ante el ensayo con sílabas iguales: en recién nacidos a término, t = 2,59, p = 0,024 y en los prematuros, t = 2,38, p = 0,035. Este hallazgo ocurrió en el lóbulo temporal izquierdo. Estos datos sugieren que las sílabas modificadas facilitan el procesamiento de fonemas desde el nacimiento.

Esta pesquisa avalia, em neonatos, a resposta hemodinâmica diante sílabas modificadas acusticamente (pronunciadas de maneira prolongada) em comparação com a resposta a sílabas não modificadas (pronunciadas a uma velocidade normal). O objetivo foi avaliar qual destas condições de estimulação produzia uma melhor discriminação silábica em dois grupos de neonatos: 13 prematuros (idade gestacional média de 30 semanas, DE 3 semanas) e 13 nascidos a termo (idade gestacional média de 38 semanas, DE 1 semana). A discriminação de sílabas, em cada condição, foi avaliada mediante um paradigma oddball (ensaios com sílabas iguais vs. ensaios com sílaba diferente). A análise estadística se baseou na comparação da resposta hemodinâmica [oxyHb] obtida por espectroscopia de infravermelho próximo (NIRS) ante ensaios com sílabas iguais Vs. ensaios com uma sílaba diferente em cada condição. Encontrou-se que a condição de sílabas modificadas obteve melhores resultados para a discriminação entre ensaios em ambos os grupos. A amplitude da resposta hemodinâmica ante o ensaio com uma sílaba diferente foi significativamente maior que perante o ensaio com sílabas iguais: em recém-nascidos a termo, t = 2,59, p = 0,024 e nos prematuros, t = 2,38, p = 0,035. Este descobrimento ocorreu no lóbulo temporal esquerdo. Estes dados sugerem que as sílabas modificadas facilitam o processamento de fonemas desde o nascimento.

Impact of physiotherapy on neuromotor development of premature newborns / Impacto da fisioterapia no desenvolvimento neuromotor de recém-nascidos prematuros

Introduction The population of children born prematurely has increased in line with improving the quality of perinatal care. It is essential to ensure to these children a healthy development. Objective We evaluate the neuromotor development of a group of preterm infants regularly assisted by a physiotherapy service in comparison to full-term newborns, checking, so the impact of the service. Materials and methods We randomly assigned preterm and full-term infants that formed two distinct groups. The group of preterm infants was inserted into a monitoring program of physiotherapy while the other infants were taken as a control group not receiving any assistance in physiotherapy. The groups were compared using the Alberta Infant Motor Scale (AIMS) at forty-week, four and six months of corrected gestational age and the scores were compared using Student's t-test, assuming a significance level of 5% (p < 0.05). Results The preterm group had significantly lower scores at 40th week compared to the control group, but subsequent scores showed no significant differences between the two groups. Conclusion The timely and adequate stimulation was efficient to promote the motor development of premature infants included in a follow up clinic. .

Introdução A população de crianças nascidas prematuramente tem aumentado em função da melhoria da qualidade da assistência perinatal. É fundamental assegurar a essas crianças um desenvolvimento saudável. Objetivo Avaliou-se o desenvolvimento neuromotor de um grupo de recém-nascidos prematuros regularmente assistidos pelo serviço de fisioterapia em comparação aos recém-nascidos a termo, aferindo, assim o impacto do serviço. Materias e métodos Foram alocadas aleatoriamente crianças prematuras e a termo que constituíram dois grupos distintos. O grupo de crianças prematuras foi inserido em um programa de acompanhamento de fisioterapia infantil enquanto o outro grupo foi tomado como controle, não recebendo qualquer assistência fisioterápica. Os grupos foram comparados por meio da Alberta Infant Motor Scale (AIMS), na quadragésima semana, aos quatro e seis meses de idade gestacional corrigida e os escores foram comparados através do test T de Student, assumindo-se um nível de significância de 5% (p < 0,05). Resultados O grupo de prematuros apresentou escores significativamente mais baixos na 40ª semana em relação ao grupo controle, mas os escores subseqüentes não mostraram diferenças significativas entre os dois grupos. Conclusão A estimulação oportuna e adequada mostrou-se eficiente para promover o desenvolvimento motor de crianças prematuras inseridas em um ambulatório de seguimento. .

Metabolic bone disease in the preterm newborn:an update on prevention and treatment / 国际儿科学杂志

Metabolic bone disease is one of the common complications in preterm neonates,which has important influence on the quality of life,even increases the risk of adulthood osteoporosis. Early diagnosis and therapy are important for the improvement of outcome of preterm neonates. This article reviews the progress of prevention and treatment of metabolic bone disease in preterm neonates.

Respiratory distress syndrome in late preterm neonates delivered by elective cesarean section / 中国小儿急救医学

Late preterm neonates have immature respiratory systems and higher incidence of respiratory distress syndrome compared with term neonates.With the increase rate of elective cesarean section world-wild,the association between elective cesarean section and late preterm neonates respiratory distress syndrome has attracted a huge attention.Clinical data have showed that the incidence of respiratory distress syndrome was significantly increased in late preterm neonates delivered by elective cesarean section.The delay of lung fluid movement dilutes the concentration of pulmonary surfactant and causes the alveolar collapse.Compared with early preterm neonates,the respiratory distress syndrome of late preterm neonates appears later with a worse reaction of pulmonary surfactant and higher incidence of complications.Thus,vaginal delivery of late preterm neonates is the optimal choice and early diagnosis and therapy of respiratory distress syndrome is very important.

Cord Blood Soluble fms-Like Tyrosine Kinase 1 and Placental Growth Factor in Preterm Infants with Maternal Preeclampsia / 이화의대지

OBJECTIVES: The purpose of this study was to investigate the relationship of cord blood levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), and vascular endothelial growth factor (VEGF) in preterm infants with maternal preeclampsia. METHODS: Thirty six preterm infants born at Ewha Womans University Mokdong Hospital from January 2006 to August 2006 were studied after prior parental consent at mid-pregnancy. sFlt-1, PlGF, and VEGF levels in the cord blood of preterm neonate, with or without maternal preeclampsia, were measured using enzyme-linked immunosorbent assay. RESULTS: There was no difference in sFlt-1 between infants with and without maternal preeclampsia. Infants with maternal preeclampsia had significantly lower PlGF levels (P=0.035) and higher sFlt-1/PlGF ratio (P=0.080) with borderline significance. Cord blood VEGF levels were not related to maternal preeclampsia. Infants with maternal preeclampsia had lower birth weight (P=0.030), lower neonatal platelet count without statistical significance (P=0.064) and more likely to be small for gestational age (P=0.057). Neonatal platelet count was significantly correlated with cord blood PlGF levels (r=0.674, P=0.032). CONCLUSION: Increased sFlt-1/PlGF ratio and decreased PlGF may not only be related to the pathophysiology of maternal preeclampsia but also affect the neonatal platelet count and birth weight.