Progress in antenatal magnesium sulfate exposure for neuroprotection in preterm infants / 中华围产医学杂志

Magnesium sulfate has been administered to pregnant women at imminent risk of preterm delivery for fetal neuroprotection, but its adverse effects and target population have not been fully studied. This paper summarizes the current protocols according to the existing guidelines and the latest research progress, including the gestational age at intervention, dose, duration of therapy and the need for re-administration, hoping to provide a reference for the clinical use of magnesium sulfate for fetal neuroprotection in China.

Retinopathy of prematurity: risk factors for its development in two neonatal intensive care units in Paraná-Brazil / Retinopatia da prematuridade: fatores de risco para seu desenvolvimento em duas unidades de terapia intensiva neonatais do Paraná-Brasil

ABSTRACT Purpose: Evaluate the patients in two neonatal intensive care units in Paraná/Brazil and identify the risk factors for the development of retinopathy of prematurity. Methods: We performed a prospective cohort study on premature infants with gestational age ≤32 wk and/or with birth weight ≤1500 g who were admitted to the neonatal intensive care unit of Hospital do Trabalhador and Hospital Infantil Waldemar Monastier. These hospitals admit patients referred from other maternity hospitals in the state of Paraná. The study duration was 12 mon. Results: The incidence of retinopathy of prematurity was higher in the Hospital Infantil Waldemar Monastier than in the Hospital do Trabalhador for premature infants who needed to be transported from their birthplace to the intensive care unit (52.2% vs. 29.6%). The following risk factors were associated with the development of the disease: longer hospitalization, low gestational age at birth, longer oxygen use, vasoactive drugs use, no antenatal corticosteroids use, intracranial hemorrhage, and any glycemic disorder. Low birth weight was an independent risk factor for the development of retinopathy of prematurity. Conclusion: Early neonatal care and transportation of premature infants may influence the occurrence and prognosis of retinopathy of prematurity.

RESUMO Objetivos: Avaliar duas unidades de terapia intensiva neonatais do Paraná e identificar os fatores de risco que levam ao desenvolvimento da retinopatia da prematuridade nestas unidades neonatais. Metodos: Foi realizado um estudo de coorte, prospectivo, com avaliação dos bebês prematuros examinados no período de 12 meses com idade gestacional ≤32 semanas e/ou com peso de nascimento ≤1500 gramas, internados na unidade de cuidados intensivos neonatais do Hospital do Trabalhador e do Hospital infantil Waldemar Monastier, que recebe neonatos transportados das maternidades de todo o estado do Paraná. Resultados: A incidência de retinopatia da prematuridade foi maior no Hospital Infantil Waldemar Monastier, entre os prematuros que necessitaram de transporte do local de nascimento para a unidade de cuidados intensivos (52,2% vs 29,6%), Os fatores de risco associados ao desenvolvimento da doença foram; Maior número de dias de internamento, baixa idade gestacional ao nascimento, maior tempo de uso de oxigênio, uso de drogas vasoativas, ausência de uso de corticoide pré-natal, presença de hemorragia intracraniana e qualquer tipo de alteração da glicemia. Conclusão: Os cuidados neonatais precoces e o transporte do recém-nascido pré- termo podem influenciar a ocorrência e o prognostico da retinopatia da prematuridade.

In-hospital outcomes in preterm and small-for-gestational-age newborns: a cohort study

ABSTRACT Objective To compare in-hospital outcomes between small-for-gestational-age and appropriate-for-gestational-age preterm neonates who needed intensive care. Methods A retrospective cohort study with preterm newborns, from January to December 2017. The results are presented as median, frequency, and odds ratio. Numerical variables were compared using the Wilcoxon test. Categorical variables were compared using the χ2 test. We considered p<0.05 as significant. Results Out of 129 preterm newborns included, 20.9% were small-for-gestational-age. Median gestational age was 31 2/7 weeks, birthweight was 1,450g, and length of hospital stay was 39 days. Preterm small-for-gestational-age newborns presented a higher chance of peri-intraventricular hemorrhage (odds ratio of 3.23; p=0.02), retinopathy of prematurity (odds ratio of 2.78 p=0.02), patent ductus arteriosus (odds ratio of 2.50; p=0.04) and a lower chance of presumptive early-onset sepsis (odds ratio of 0.37; p=0.03). Conclusion Preterm small-for-gestational-age neonates were associated with peri-intraventricular hemorrhage, retinopathy of prematurity and patent ductus arteriosus. This emphasizes the need of special care for these neonates.

Fatores associados a agravos gastrointestinais no primeiro ano de prematuros tardios e moderados / Factors associated with gastrointestinal disorders in the first year of late and moderate premature infants

RESUMO Objetivo analisar os fatores associados ao desenvolvimento de agravos gastrointestinais, no primeiro ano de vida de prematuros tardios e moderados. Métodos estudo longitudinal, que acompanhou lactentes nascidos tardios e moderados, durante o primeiro ano de vida, via telefone, para desenvolvimento de agravos gastrointestinais, na percepção materna. Dados coletados por meio de escala likert, na avaliação da condição aguda, e analisados sob comparação de frequência e odds ratio (p<5% e Intervalo de Confiança 95%) entre as variáveis. Resultados os agravos gastrointestinais mais frequentes na avaliação dos primeiros meses de vida foram a cólica e o vômito, que reduziram a intensidade, quanto mais perto do primeiro ano de vida do lactente, seguidos do agravo diarreia que manteve intensidade constante ao longo do primeiro ano. Conclusão o estudo traz implicação para identificação dos fatores de risco, tendo em vista a vulnerabilidade da população de prematuros, ainda pouco descrita na literatura.

ABSTRACT Objective to analyze the factors associated with the development of gastrointestinal disorders in the first year of life of late and moderate premature infants. Methods longitudinal study, which followed infants born late and moderate, during the first year of life, via telephone, to develop gastrointestinal disorders, in the maternal perception. Data collected using the Likert scale, in the assessment of acute condition, and analyzed under comparison of frequency and odds ratios (p<5% and 95% Confidence Interval) between variables. Results the most frequent gastrointestinal injuries in the assessment of the first months of life were colic and vomiting, which reduced the intensity, the closer to the infant's first year of life, followed by the diarrheal condition that maintained constant intensity throughout the first year. Conclusion the study has implications for the identification of risk factors, in view of the vulnerability of the premature population, still little described in the literature.

Advances in correlation between vitamin D nutritional status and diseases in premature infants / 中华围产医学杂志

Premature infants are at high risk of vitamin D deficiency, thereby commonly treated with vitamin D supplementation after birth. However, the nutritional status of vitamin D in premature infants is not optimistic due to the fact of high incidence of vitamin D deficiency. Studies have found that vitamin D is associated with a variety of diseases in premature infants, including metabolic bone disease, respiratory distress syndrome, bronchopulmonary dysplasia, neonatal necrotizing enterocolitis and infection. Clinicians should be aware of the importance of vitamin D for premature infants and prescribe vitamin D supplementation as early as possible with the dose reference of serum 25-hydroxyvitamin D level.

Clinical outcome of late preterm twins and the influence of different ways of conception on their clinical outcomes:a retrospective study / 中国新生儿科杂志

Objective To study the difference of clinical outcome between late preterm twins (LPT) and late preterm singletons (LPS),and the influence of assisted reproduction technology (ART) or natural conception on the clinical outcomes of LPT.Method The data of late preterm infants born in the Beijing Obstetrics and Gynecology Hospital between January 2016 and January 2018 were retrospectively collected.Infants were assigned to LPT group or LPS group according to twins or singleton status.The differences of the demographic data,morbidity,oxygen therapy rate,respiratory support rate,mortality,hospitalization rate and hospitalization time between LPT and LPS were compared.In order to analyze the effects of different ways of conception on LPT,LPT was further divided into assisted reproduction technology (ART) subgroup and natural pregnancy subgroup.Result A total of 1 824 late preterm infants were included in the study,including 582 cases of LPT and 1 242 cases of LPS.The birth weight and body length of LPT were lower than those ofLPS [(2572±395)gvs.(2614±413)g,P＜0.05;(46.5±1.1)cm vs.(47.5 ± 1.0)cm,P ＜0.01],while the cesarean delivery rate of LPT was higher than that of LPS [90.7％ (528/582) vs.39.9％ (496/1 242),P ＜ 0.01].The incidence of respiratory distress syndrome (RDS) in LPT was higher than that of LPS [5.2％ (30/582) vs.3.6％ (45/1 242),P ＜ 0.05],and the length of hospitalization of LPT was also longer than that of LPS[(8.9 ±3.1)d vs.(7.2 ±2.9)d,P ＜0.01],the differences were statistically significant.There were no significant differences between groups in neonatal pneumonia,apnea,hypoglycemia,sepsis,neonatal necrotizing enterocolitis (NEC),grade Ⅲ ～ Ⅳ intracranial hemorrhage,severe asphyxia,bronchopulmonary dysplasia (BPD),oxygen therapy rate,respiratory support rate and mortality rate.There was also no significant difference between ART subgroup and natural pregnancy subgroup in gestational age,gender,cesarean section rate,birth weight,and birth length (P ＞ 0.05).There was no significant difference in RDS,pneumonia,apnea,hypoglycemia,sepsis,NEC,Ⅲ ～ Ⅳ intracranial hemorrhage,severe asphyxia,BPD,oxygen uptake rate,respiratory support rate,mortality rate and hospitalization time between the two subgroups (P ＞ 0.05).Conclusion The birth weight and birth length of LPT are lower than those of LPS,and the incidence of RDS is higher.The hospitalization time of LPT is also longer than that of LPS.It is necessary to strengthen the high-risk management of twin pregnant women and post-natal management of LPT.

Predictive factors of mortality in extremely preterm infants / 中华儿科杂志

Objective@#To investigate the predictive factors of mortality in extremely preterm infants.@*Methods@#The retrospective case-control study was accomplished in the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University. A total of 268 extremely preterm infants seen from January 1, 1999 to December 31, 2015 were divided into survival group (192 cases) and death group (76 cases). The potential predictive factors of mortality were identified by univariate analysis, and then analyzed by multivariate unconditional Logistic regression analysis. The mortality and predictive factors were also compared between two time periods, which were January 1, 1999 to December 31, 2007 (65 cases) and January 1, 2008 to December 31, 2015 (203 cases).@*Results@#The median gestational age (GA) of extremely preterm infants was 27 weeks (23+3-27+6 weeks). The mortality was higher in infants with GA of 25-<26 weeks (OR=2.659, 95% CI: 1.211-5.840) and<25 weeks (OR=10.029, 95% CI: 3.266-30.792) compared to that in infants with GA> 26 weeks. From January 1, 2008 to December 31, 2015, the number of extremely preterm infants was increased significantly compared to the previous 9 years, while the mortality decreased significantly (OR=0.490, 95% CI: 0.272-0.884). Multivariate unconditional Logistic regression analysis showed that GA below 25 weeks (OR=6.033, 95% CI: 1.393-26.133), lower birth weight (OR=0.997, 95% CI: 0.995-1.000), stage Ⅲ necrotizing enterocolitis (NEC) (OR=15.907, 95% CI: 3.613-70.033), grade Ⅰ and Ⅱ intraventricular hemorrhage (IVH) (OR=0.260, 95% CI: 0.117-0.575) and dependence on invasive mechanical ventilation (OR=3.630, 95% CI: 1.111-11.867) were predictive factors of mortality in extremely preterm infants.@*Conclusions@#GA below 25 weeks, lower birth weight, stage Ⅲ NEC and dependence on invasive mechanical ventilation are risk factors of mortality in extremely preterm infants. But grade ⅠandⅡ IVH is protective factor.

Mechanisms of vascular endothelial growth factor receptor 2 expression regulation by erythropoietin in a premature rat model of periventricular white matter damage / 中华围产医学杂志

Objective@#To explore the mechanisms of vascular endothelial growth factor receptor 2 (VEGFR2) expression regulated by recombinant human erythropoietin (rh-EPO) in a premature rat model of periventricular white matter damage. @*Methods@#Sprague-Dawley rats aged three days were randomly divided into five groups: sham group without hypoxia-ischemia (HI), HI group (HI with saline administration), HI+erythropoietin (EPO) group, HI+erythropoietin receptor (EPOR) antagonist group and HI+EPO+EPOR antagonist group. Rat pups were either subjected to permanent ligation of the right common carotid artery and 6% O2+94% N2 for two hours (HI) or sham operated and exposed to normal air (sham). After the operation, rats in the HI+EPOR antagonist and HI+EPO+EPOR antagonist groups received a single intraventricular injection of EPOR antagonist (5 μl). Four hours after the operation, rats in the HI+EPO and HI+EPO+EPOR antagonist groups received a single intraperitoneal injection of rh-EPO (5 U/g). Western-blot was performed to detect EPOR, phosphorylated EPOR (p-EPOR), extracellular regulated protein kinases (ERK) and phosphorylated ERK (p-ERK) at 60 and 90 minutes after the models were established successfully, and also used to analyze the expression of VECFR2 on day 2 and 4. Analysis of variance and SNK test were used as statistical methods. @*Results@#At 60 and 90 minutes after model establishment, the expression of EPOR protein in rat brain tissues was increased in HI (1.717±0.206 and 1.416±0.242), HI+EPO (2.557±0.222 and 2.111±0.159) and HI+EPO+EPOR antagonist (1.547±0.170 and 1.452±0.250) groups as compared with that in sham group (1.095±0.182 and 0.751±0.136), that in HI+EPO group was higher than that in HI and HI+EPO+EPOR antagonist groups, and that in HI+EPOR antagonist group (1.088±0.160 and 1.020±0.174) was lower than that in HI group. All differences were statistically significant (F=30.154 and 20.265, both P<0.05). The expressions of p-EPOR, p-ERK and VEGFR2 in the five groups were consistent with the expression of EPOR, and the differences were also statistically significant (all P<0.05). In addition, the expression of VEGFR2 in HI+EPO+EPOR antagonist group was lower than that in HI group on day 4 (1.053±0.118 vs 1.439±0.074, F=54.248, P<0.05). No statistically significant difference in ERK expression was found among all groups at 60 or 90 minutes after modeling (F=1.117 and 0.734, both P>0.05). @*Conclusions@#ERK signaling pathways will be affected by EPO binding to EPOR. As a result, VEGFR2 expression was increased leading to enhanced angiogenesis in a premature rat model of periventricular white matter damage.

Effect of maternal gestational diabetes mellitus on neonatal respiratory diseases in late-preterm infants / 中国新生儿科杂志

Objective To evaluate the effects of gestational diabetes mellitus (GDM) and its treatment during pregnancy on neonatal respiratory diseases in late-preterm infants.Method From January 2013 to December 2016,respiratory outcome of singleton infants (gestational age:34-36 weeks) of GDM mothers(GDM group) was compared with infants delivered from mothers without GDM(non-GDM group).We also studied the relationship between maternal GDM treatment (insulin-treated GDM and diet-controlled GDM) and neonatal respiratory outcome,including incidences of respiratory diseases,mechical ventilation and oxygen supplementation.Result A total of 2 174 late-preterm infants were enrolled in this study,including 425 in GDM group and 1 749 non-GDM group.The average birth weight was (2 688 ± 423) g,ranging from 1 320 g to 4 275 g,and mean gestational age was (35.5 ± 0.7) weeks.Comparing with nonGDM group,the incidence of cesarean delivery was significantly higher in GDM group (35.5％ vs.30.5％,P ＜0.05),so was the incidence of antenatal corticosteroids (19.1％ vs.13.0％,P ＜0.01).GDM group was more likely to develop wet lung comparing with non-GDM group (8.0％ vs.5.4％,P ＜ 0.05).A similar incidence of neonatal respiratory distress syndrome (RDS),apnea,pneumonia,pneumothorax and pulmonary hypertension were found in the two groups (P ＞0.05).In the GDM group,a total of 91 infants were born to mothers with insulin-treated GDM and 334 diet-controlled GDM.Comparing with the diet controlled group,insulin treatment group was associated with higher risk of neonatal RDS (6.6％ vs.1.8％,P ＜ 0.05) and higher incidence of mechanical ventilation (13.2％ vs.6.0％,P ＜ 0.05).A similar incidences of wet lung,apnea,pneumonia,pneumothorax and pulmonary hypertension were found in the two groups (P ＞ 0.05).Conclusion The late-preterm infants born to GDM mothers with insulin treatment have higher incidences of neonatal RDS and mechanical ventilation,and they need much more care.

Comparison of the effects of caffeine citrate and aminophylline combined with naloxone in the treatment of premature infants with apnea / 中国基层医药

Objective To compare the effects of caffeine citrate and aminophylline combined with naloxone in the treatment of premature infants with apnea.Methods From March 2015 to March 2017,140 premature infants with apnea who were treated in neonatal intensive care unit in Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected in the research.The children were randomly divided into the study group and the control group according to the digital table,with 70 cases in each group.The control group was treated with aminophyl-line combined with naloxone,and the observation group was treated with caffeine citrate.The adverse reaction of children during the treatment was recorded,and the level of apnea was evaluated after treatment.The blood gas index of children before and after 48h treatment was compared,the mortality rate of the children was counted,and the incidence of brain injury during the 1 year follow -up was analyzed.Results After treatment for 48h,the level of PaO2in the two groups was significantly higher [study group: (10.54 ±0.41) kPa,control group: (9.66 ± 0.39) kPa] than those before treatment[study group: (7.18 ±0.26) kPa,control group: (7.21 ±0.24) kPa],and the level of PaCO2[study group: (5.31 ±0.24) kPa,control group: (5.82 ±0.25) kPa]was significantly lower than those before treatment[study group: (6.83 ±0.28) kPa,control group: (6.77 ±0.30) kPa](t＝19.153,13.624,11.271,7.304;P＝0.000,0.000,0.000,0.000),and the level of PaO2in the study group was significantly higher than that in the control group,and the level of PaCO 2in the study group was significantly lower than that in the control group(t＝6.029,4.327;P＝0.000,0.000).The overall effective rate of apnea therapy in the study group (92.86%) was significantly higher than 77.14%in the control group (χ2＝4.509,P＝0.034).The mortality rate(1.43%) and the incidence rate of brain injury (0.00%) of the study group were significantly lower than those of the control group (10.00%and 7.14%)(χ2＝4.773,5.185;P＝0.029,0.023).The incidence rate of adverse reactions (30.00%) of the study group was significantly lower than 50.00%of the control group (χ2＝5.833,P＝0.016).The endometri-al thickness of the study group was significantly lower than that of the control group (P＜0.05).The rate of ovulation success(87.84%) and pregnancy success rate (45.94%) of the study group were significantly higher than those of the control group(72.97%and 28.39%)(χ2＝5.189,4.890;P＝0.023,0.027).The rate of abortion(8.82%) of the study group was significantly lower than 33.33%of the control group (χ2＝5.242,P＝0.022).During the period of treatment,the incidence rate of adverse drug reactions (6.77%) of the study group was not significantly different from 8.11%of the control group (χ2＝0.098,P＝0.754).Conclusion Compared with aminophylline combined with naloxone treatment,caffeine citrate can significantly improve the blood gas status of apnea preterm infants,improve the overall curative effect of apnea,prevent the occurrence of neonatal death and brain injury,and reduce the adverse reactions of the children during the treatment.It is worthy of clinical application.

Short- and long-term respiratory complications in late preterm infants: a review / 中华围产医学杂志

There are more and more late preterm infants in recent years. Due to the immature physiological and metabolic functions, late preterm neonates are more prone to various short- and long-term respiratory complications in their early postnatal period, such as neonatal respiratory distress syndrome, wet lung and apnea in the short term, and asthma and respiratory syncytial virus infection in the long term, which significantly increase the admission and fatality rate of late preterm infants in their infancy and school age compared with the full-term ones. Clinicians should be much aware of the short- and long-term respiratory complications in late preterm infants so as to promote clinical management and improve the long-term quality of lives of these infants.

Mechanisms of vascular endothelial growth factor receptor 2 expression regulation by erythropoietin in a premature rat model of periventricular white matter damage / 中华围产医学杂志

Objective To explore the mechanisms of vascular endothelial growth factor receptor 2 (VEGFR2) expression regulated by recombinant human erythropoietin (rh-EPO) in a premature rat model of periventricular white matter damage.Methods Sprague-Dawley rats aged three days were randomly divided into five groups:sham group without hypoxia-ischemia (HI),HI group (HI with saline administration),HI+erythropoietin (EPO) group,HI+erythropoietin receptor (EPOR) antagonist group and HI+EPO+EPOR antagonist group.Rat pups were either subjected to permanent ligation of the right common carotid artery and 6％ O2+94％ N2 for two hours (HI) or sham operated and exposed to normal air (sham).After the operation,rats in the HI+EPOR antagonist and HI+EPO+EPOR antagonist groups received a single intraventricular injection of EPOR antagonist (5 μ l).Four hours after the operation,rats in the HI+EPO and HI+EPO+EPOR antagonist groups received a single intraperitoneal injection of rh-EPO (5 U/g).Western-blot was performed to detect EPOR,phosphorylated EPOR (p-EPOR),extracellular regulated protein kinases (ERK) and phosphorylated ERK (p-ERK) at 60 and 90 minutes after the models were established successfully,and also used to analyze the expression of VECFR2 on day 2 and 4.Analysis of variance and SNK test were used as statistical methods.Results At 60 and 90 minutes after model establishment,the expression of EPOR protein in rat brain tissues was increased in HI (1.717±0.206 and 1.416±0.242),HI+EPO (2.557±0.222 and 2.111±0.159) and HI+EPO+EPOR antagonist (1.547±0.170 and 1.452±0.250) groups as compared with that in sham group (1.095±0.182 and 0.751 ±0.136),that in HI+EPO group was higher than that in HI and HI+EPO+EPOR antagonist groups,and that in HI+EPOR antagonist group (1.088±0.160 and 1.020±0.174) was lower than that in HI group.All differences were statistically significant (F=30.154 and 20.265,both P＜0.05).The expressions of p-EPOR,p-ERK and VEGFR2 in the five groups were consistent with the expression of EPOR,and the differences were also statistically significant (all P＜0.05).In addition,the expression of VEGFR2 in HI+EPO+EPOR antagonist group was lower than that in HI group on day 4 (1.053 ± 0.118 vs 1.439± 0.074,F=54.248,P＜0.05).No statistically significant difference in ERK expression was found among all groups at 60 or 90 minutes after modeling (F=1.117 and 0.734,both P＞0.05).Conclusions ERK signaling pathways will be affected by EPO binding to EPOR.As a result,VEGFR2 expression was increased leading to enhanced angiogenesis in a premature rat model of periventricular white matter damage.

Impacto da corticoterapia no prognóstico do prematuro tardio / Impact of corticoisteroids on late preterm prognosis: systematic review

Pouco se sabe sobre os efeitos da corticoterapia antenatal (CTA) nos fetos pré-termo tardios (PTT). Esta revisão tem como proposta examinar se há, ou não, benefícios no uso de corticoide para o incremento da maturação pulmonar fetal e melhoria dos resultados perinatais. Vários estudos avaliando as desordens respiratórias no neonato, a redução da morbimortalidade neonatal e duração do tempo de internação deram suporte a esta revisão. Parece não haver melhora da morbidade respiratória e suas complicações com a utilização da corticoterapia nos PTT, concluindo-se pela necessidade de mais estudos, em especial direcionados para casos de gestações que não apresentem maturidade pulmonar após 34 semanas com maior risco de parto prematuro.(AU)

Little is known about the effects of antenatal corticosteroids in late pre-term fetuses. This review clarify whether there is benefits in using steroids in late pre-term fetus to increase fetal lung maturation and improve perinatal outcomes, or not. Several studies in which the primary outcomes were respiratory disorders, neonatal mortality and hospitalization length were examined in this review. It seems that corticosteroids do not improve respiratory morbidity or its complications. It is concluded that more studies, in particular those including pregnancies with fetal lung immaturity after 34 weeks presenting higher risk of premature labor.(AU)

Predictive effect of neonatal morbidities on the poor outcomes at 12 months corrected age in very low birth weight premature infants / 中华儿科杂志

Objective@#To investigate the prognostic effect of neonatal morbidities on poor outcomes at 12 months corrected age in very low birth weight (VLBW) premature infants .@*Method@#From November 2013 to October 2014, a multi-center retrospective study was conducted in 8 tertiary Maternal and Children′s hospitals in Guangdong, Hunan and Fujian. The premature infants survived to a postmenstrual age (PMA) of 36 weeks with birth weight less than 1 500 g and without congenital diseases were included, and divided into two groups according to poor outcomes. The birth weight, gestational age, morbidities and poor outcomes (death, cerebral palsy, cognitive delay, et al) were recorded. Data were analyzed with Chi-square test to investigate the relationship between morbidities and poor outcomes. And the predictive effect of the top three morbidities were analyzed by Logistic regression analysis.@*Result@#Total of 834 VLBW premature infants (473 boys and 361 girls) finished the follow-up, whose average gestational age and birth weight were (30.6±1.8) weeks and (1 189±159)g. The incidences of BPD, severe ROP, NEC, brain injury and sepsis were 207 (24.8%), 119 (14.3%), 58 (7.0%), 281 (33.7%) and 124 (14.9%), respectively. There were significant differences between the two groups in the incidences of BPD, severe ROP, NEC, brain injury and sepsis(χ2=42.10, 47.20, 4.81, 44.28, 18.63, all P<0.01), which had significant correlation with poor outcomes at 12 months corrected age. The three top morbidities were severe ROP, BPD and brain injury(OR=3.82, 2.90, 2.80). Combined morbidities with BPD, severe ROP and brain injury correlated with higher risk of poor outcomes (one morbidity, OR=3.14, β=1.15; two morbidities, OR=7.31, β=1.99; three morbidities, OR=22.41, β=3.11; all P<0.01).@*Conclusion@#BPD, severe ROP, NEC, brain injury and sepsis were the risk factors of poor outcomes at 12 months corrected age in VLBW infants. And the more combined morbidities with severe ROP, BPD and brain injury, the higher risk of poor outcomes in this population. Trial registration Clinical Trails, NCT03104946.

Investigation of the value of stable micro bubble test for early diagnosis of hyaline membrane disease in premature infants / 天津医药

Objective To explore the value of stable micro bubble test (SMT) for early diagnosis of hyaline membrane disease (HMD), and to provide early intervention for clinical diagnosis method of hyaline membrane disease in premature infants. Methods A total of 288 premature infants admitted to neonatal intensive care unit (NICU) of Ankang City Central Hospital from January 1st, 2013 to January 1st, 2016 were involved into the study. The primary gastric juice 1-2 mL was extracted for SMT test within 30 minutes after the birth. The number of the stable micro bubble with diameter<15μm was counted by low magnification. The clinical symptoms and X-ray results within 6 h after the birth were used as the gold standard of diagnosis of HMD. The premature infants were divided into the case group and control group. The general information was compared between two groups. The optimal critical stable micro bubble value was determined by the ROC curve. The number of micro bubbles <5/mm2, <10/mm2, <15/mm2 and <20/mm2 were used as the threshold, and the sensitivity, specificity, positive and negative predictive values were calculated for HMD diagnosis. Results Among the 288 cases of premature infants, 91 cases (31.6%) were diagnosed as HMD, 197 cases (68.4%) were diagnosed as non HMD. There were lower gestational age, lower birth weight and more proportion of male babies in the case group compared with those of control group (P<0.05). There were no significant differences in prenatal usage of hormones, premature rupture of membranes, the proportion of cesarean section and 5-min Apgar scores between two groups. The number of micro bubbles of 15/mm2 was the optimal threshold for diagnosis of HMD, and AUC was 0.80 (0.73-0.84). When the number of micro bubbles of 5/mm2 was used for the diagnosis, 38 cases were in line with the diagnosed as HMD. When the number of micro bubbles of 10-15/mm2 was used for the diagnosis, 16 cases were in line with diagnosed as HMD. The number of micro bubbles of<15/mm2 was used as boundary value of HMD. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index for SMT prediction and early diagnosis of HMD were 89.0%, 91.4%, 82.7%, 94.7%and 80.4%, which can be used as predictive indicators of HMD. Conclusion SMT test is simple, rapid, economic, high sensitivity and good specificity, which can effectively predict and early diagnose HMD, and have high clinical value.

Investigation of the value of stable micro bubble test for early diagnosis of hyaline membrane disease in premature infants / 天津医药

Objective To explore the value of stable micro bubble test (SMT) for early diagnosis of hyaline membrane disease (HMD), and to provide early intervention for clinical diagnosis method of hyaline membrane disease in premature infants. Methods A total of 288 premature infants admitted to neonatal intensive care unit (NICU) of Ankang City Central Hospital from January 1st, 2013 to January 1st, 2016 were involved into the study. The primary gastric juice 1-2 mL was extracted for SMT test within 30 minutes after the birth. The number of the stable micro bubble with diameter<15μm was counted by low magnification. The clinical symptoms and X-ray results within 6 h after the birth were used as the gold standard of diagnosis of HMD. The premature infants were divided into the case group and control group. The general information was compared between two groups. The optimal critical stable micro bubble value was determined by the ROC curve. The number of micro bubbles <5/mm2, <10/mm2, <15/mm2 and <20/mm2 were used as the threshold, and the sensitivity, specificity, positive and negative predictive values were calculated for HMD diagnosis. Results Among the 288 cases of premature infants, 91 cases (31.6%) were diagnosed as HMD, 197 cases (68.4%) were diagnosed as non HMD. There were lower gestational age, lower birth weight and more proportion of male babies in the case group compared with those of control group (P<0.05). There were no significant differences in prenatal usage of hormones, premature rupture of membranes, the proportion of cesarean section and 5-min Apgar scores between two groups. The number of micro bubbles of 15/mm2 was the optimal threshold for diagnosis of HMD, and AUC was 0.80 (0.73-0.84). When the number of micro bubbles of 5/mm2 was used for the diagnosis, 38 cases were in line with the diagnosed as HMD. When the number of micro bubbles of 10-15/mm2 was used for the diagnosis, 16 cases were in line with diagnosed as HMD. The number of micro bubbles of<15/mm2 was used as boundary value of HMD. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index for SMT prediction and early diagnosis of HMD were 89.0%, 91.4%, 82.7%, 94.7%and 80.4%, which can be used as predictive indicators of HMD. Conclusion SMT test is simple, rapid, economic, high sensitivity and good specificity, which can effectively predict and early diagnose HMD, and have high clinical value.

The influence of breast-feeding on common comorbidities of very low birth weight infant / 中国新生儿科杂志

Objective To study the influence of breast-feeding on the common neonatal comorbidities of very low birth weight (ELBW) infants.Method A retrospective study was conducted in our hospital from July 2014 to September 2015.The ELBW infants with birth weight between 1 000 g and 1 500 g were enrolled into the study.The infants were assigned into three groups according to human milk intake during hospitalization:high-volume breast feeding group (the high-volume group) (human milk equal to or greater than 75％),small-volume breast feeding group (the small-volume group) (human milk less than 75％) and premature formula group (the formula group) (exclusive formula fed during hospitalization).The general status,weight gain,the incidences of gastrointestinal dysfunction,neonatal necrotizing enterocolitis (NEC),late onset sepsis,premature retinopathy (ROP),bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) during hospitalization were compared between the three groups.Logistic regression analysis was applied.Result A total of 210 cases were included in the study.32 cases in the high-volume group,73 cases in the small-volume group and 105 in the formula group.The incidence of NEC (Bell's stage Ⅱ and Ⅲ) in the high-volume group was significantly lower than the small-volume group and the formula group (6.3％ vs.24.7％,26.7％) (P ＜ 0.05).No statistical differences existed as for the incidences of gastrointestinal dysfunction,sepsis,ROP,BPD,and PVL (P ＞0.05).Logistic regression analysis showed that the odds ratio (OR) of survival without NEC in the highvolume group were 0.183 compared with the formula group and 0.204 compared with the small-volume group;and the 95％ confidence interval were 0.041 ～0.818,0.044 ～ 0.938 respectively.No statistically significant differences existed among the three groups in the growth rate of body weight,the time needed to regain birth weight,the time needed to reach total enteral nutrition and the length of hospital stay (P ＞0.05).Conclusion High-volume breast milk intake can reduce the incidence of NEC (Bell's stage Ⅱ and Ⅲ).Breast-feeding has little adverse effects on common comorbidities of ELBW infants.Enhanced breastfeeding has similar efficacy comparing with formula feeding in the catch-up growth.

Perfil de recém-nascidos pré-termo internados na unidade de terapia intensiva de hospital de alta complexidade / Profile of preterm newborn hospitalized in intensive care unit of highcomplexity hospital

INTRODUÇÃO: A pesquisa epidemiológica consiste em alicerce para avanços nos cuidados da saúde. Nacionalmente, os estudos sobre caracterização de diferentes populações não são frequentes,principalmente no que concerne aos recém-nascidos pré-termo (RNPT). OBJETIVO: Caracterizar RNPT atendidos na Unidade de Terapia Intensiva (UTI) Neonatal do Hospital Estadual Mário Covas de Santo André (SP) pelo delineamento gestacional, perinatal e período de internação. MÉTODOS: Trata-se de estudo transversal descritivo. Foram analisados 218 prontuários de todos os pacientes atendidos pelo serviço de fisioterapia no período de 2008 a 2011 e, então, delimitada a amostra consecutiva com 81 deles, que seguiram os critérios de inclusão e exclusão. Os dados foram organizados e tabulados pelo programa SPSS v.17.0. O teste do χ2 foi utilizado para comparar as frequências de complicações neonatais. RESULTADOS: As genitoras tinham idade média de 25,7 anos; destas, 68,6% realizaram pré-natal. As intercorrências gestacionais foram observadas em 37,3% (as infecções do trato urinário foram as mais comuns, em 28%). A média do peso ao nascimento foi 1.478,6 g, e a de idade gestacional, de 30,8 semanas. O tempo médio de internação dos RNPT foi de 36 dias.As patologias respiratórias ocorreram em 93,8%, sendo o desconforto respiratório precoce a mais comum (95,2%). RNPT que necessitaram de ventilação mecânica foram 97,6% e as patologias neurológicas foram menos frequentes (9,87%). CONCLUSÃO: As complicações respiratórias foram frequentes nessa população e associadas significantemente com idade gestacional inferior a 32 semanas. Longos períodos de internação após o nascimento estão intimamente relacionados com baixo peso e idade gestacional ao nascimento.

INTRODUCTION: Epidemiological research consists of foundation for advances in health care. Nationally, studies on characterization of different populations are not common, especially in relation to newborn preterm infants (PTI). OBJECTIVE: Characterize the newborn preterm infants attended in the Neonatal Intensive Care Unit of the Hospital Estadual Mário Covas in Santo André the delineation of the breast profile, gestational, perinatal and period of hospitalization. METHODS: This is a descriptive cross-sectional study. We analyzed 218 medical records of all patients seen by the physiotherapy service from 2008 to 2011 and then bounded to the consecutive sample of 81 of them, which followed the inclusion and exclusion criteria. The data were organized and tabulated with SPSS v.17.0 program. The chi-square test was used to compare the frequency of neonatal complications. RESULTS: The mothers had a mean age of 25.7 years, and 68.6% received prenatal care. The pregnancy complications were observed in 37.3%, with the most common urinary tract infections in 28%. The mean birth weight was 1478.6 g and gestational age of 30.8 weeks. The average length of stay of preterm infants was 36 days. Respiratory disorders occurred in 95.2%, with early respiratory distress the most common (95.2%). PN requiring mechanical ventilation were 97.6% and neurological disorders were less frequent (9.87%). CONCLUSION: Respiratory complications were common in this population and significantly associated with gestational age less than 32 weeks. Prolonged hospitalization after birth is closely related to low birth weight and gestational age at birth.

Clinical study of complications and hospitalization in 389 late preterm infants / 重庆医学

Objective To analyze the morbidity,mortality,and hospitalization of complications in late preterm infants.Meth-ods A total of 389 late preterm infants were retrospectively analyzed.The influence of delivery mode on respiratory complications was compared.And the influence of respiratory complications on length of hospital stay,hospital expenses and mortality were ana-lyzed and compared.Results Our data showed that main complications were diagnosed as respiratory complications(23.65%).Oth-er complications were diagnosed as hypoglycemia (20.57%),feeding intolerance (1 7.48%),hyperbilirubinemia (14.91%),and in-tracranial hemorrhage (8.23%).Respiratory morbidity was significantly higher in preterm infants by caesarean section than by va-ginal delivery (32.34% vs .10.39%,P <0.05).The time and cost of hospitalization and the mortality were higher in late preterm infants accompanied by respiratory complications than those in infants without respiratory complications(P <0.05).Conclusion There were very prone to a variety of complications in late preterm infants.In order to reduce the morbidity of respiratory complica-tions in late preterm infant,indications for caesarean section must be strictly mastered.We should pay more attention to respiratory complications,which might be helpful to short the length of hospital stay,save hospitalization expenses and reduce the mortality.

Comparative study of visual functions in premature pre-school children with and without retinopathy of prematurity / Estudo comparativo das funções visuais em pré-escolares nascidos prematuros com e sem retinopatia da prematuridade

Purpose: Observe whether there are differences in visual functions among premature infants with treated retinopathy of prematurity (ROP) in relation to preterm infants with ROP and spontaneous regression; and among these two groups with ROP and the control group without ROP. Methods: Crosssectional observational no blind study. Premature infants were born between 06/199206/2006 and were exam between 06/200912/2010; registered in data of Hospital de Olhos Sandalla Amin Ghanem; with gestational age less than or equal to 32 weeks and 1,599 g born weigh; without ROP and ROP stages II or III, in one of the eyes, with spontaneous regression or with treatment; at least three visits during the selection period at maximum 6 months in the first exam and minimum 4 years of age in reassessment (chronological age) were include. Premature that did not respond or were not located for reassessment and those that did not have conditions to do the exams were exclude. Study's groups: G1 ROP posttreatment; G2ROP postspontaneous regression; G3 without ROP (control). Visual function evaluated with visual acuity (VA), contrast sensitivity test (CST), color test (CT), eye movement, stereopsis. Results: Overall, there were 24 premature infants and 48 eyes. Normal VA: 64.28% (G1), 87.5% (G2) and 100% (G3); Normal CST: 66.67% (G1), 100% (G2) and 55.56% (G3); Normal Ishihara CT: 100% (G1 and G2) and 86% (G3); Normal Farnsworth CT: 20% (G1), 75% (G2) and 50% (G3). Normal stereoacuity: 0.00% (G1); 25% (G2) and 3.5% (G3). Strabismus: 37% (G2), 0.00% (G1 and G3). The prevalent tendency for lower response in CST and CT between the premature children in group G3 and Farnsworth color test in G1 is a curious result of this work and more study is necessary about these visual functions in older premature children. Conclusion: The visual functions showed no statistically significant difference among the groups studied. .

Objetivo: Observar se há diferença nas funções visuais entre os prematuros com retinopatia da prematuridade (ROP) pós-tratamento em relação aos prematuros com retinopatia da prematuridade pós-regressão espontânea. E entre cada um destes grupos com o controle sem ROP. Métodos: Estudo transversal, observacional, não cego. Incluídas crianças prematuras nascidas entre 06/1992-06/2006 e examinadas entre 06/2009 e 12/2010; idade gestacional menor ou igual a 32 semanas e peso ao nascimento menor ou igual a 1.599 g; cadastrados no banco de dados do Hospital de Olhos Sandalla Amin Ghanem; com diagnóstico de retinopatia estágio II ou III em pelo menos um dos olhos com regressão espontânea ou por tratamento da ROP e sem retinopatia da prematuridade; mínimo de três consultas no período de seleção; máximo de seis meses de idade cronológica para o primeiro exame no HOSAG; idade cronológica mínima de quatro anos no período da reavaliação. Foram excluídas crianças prematuras que não responderam ou não foram localizados para os exames de reavaliação; e que não ofereciam condições de realização dos exames, por apresentarem comprometimento severo do sistema nervoso central ou síndromes impeditivas. Os prematuros foram divididos em três grupos: G1- prematuros com ROP pós-tratamento; G2- com ROP pós-regressão espontânea; e G3- sem ROP. Função visual avaliada por meio da acuidade visual (AV), teste de sensibilidade ao contrate (TSC), teste de cores (TC), exame de motricidade ocular e estereopsia. Resultados: Foram examinados 24 prematuros (48 olhos). No grupo G1 formado por 7 prematuros; G2, 8 prematuros e G3, 9 prematuros. AV normal: 64,28% (G1), 87,5% (G2) e 100% (G3); TSC normal: 66,67% (G1), 100% (G2) e 55,56% ...