RESUMEN
Objective:To investigate and compare the clinical characteristics, pathogen distributions and outcomes of bacterial meningitis in preterm and term infants.Methods:The data of 252 cases of neonatal bacterial meningitis hospitalized in Guangzhou Women and Children′s Medical Center from January 2013 to December 2018 were retrospectively analyzed and divided into two groups according to gestational age: preterm group( n=64)and term group( n=188). The clinical manifestations, laboratory examinations, pathogen distributions and clinical outcomes of the children in two groups were compared. Results:Fever was the most common clinical manifestation in both groups, but the incidences of lethargy, apnea and feeding intolerance in preterm group were significantly higher than those in term group( P<0.05). There was no significant difference in the rate of the first hemogram/cerebrospinal fluid abnormality between two groups( P>0.05). Sepsis, subdural effusion and hydrocephalus were the main complications in both groups.The incidence of complications in premature infants was 60.9%(39/64), which was significantly higher than that in full-term infants(44.7%, 84 /188) , with a statistically significant difference ( P<0.05). Escherichia coli and Streptococcus agalactiae were the most common pathogens in the preterm infants, whereas Klebsiella pneumoniae and Streptococcus agalactiae were the most common pathogens in the term infants.There was no statistical difference in the time of positive bacteria turning negative between two groups, but the course of antibiotics in preterm group was significantly longer than that in term group( P<0.05). The clinical cure/improvement rates in the two groups was about 95%, and the difference between two groups was not statistically significant( P>0.05). Conclusion:Early clinical manifestations of bacterial meningitis in preterm infants are atypical and relatively easy to be missed.The incidence of complications is significantly higher than that of full-term infants, and the duration of antibiotic use is longer.However, the clinical cure/improvement rate of premature infants is not worse than that of full-term infants after reasonable and standardized early treatment.
RESUMEN
Objective:To investigate the effect of a breathing pattern intervention (RPI) on the oral feeding of pre-term infants with suck-swallow-breath (SSwB) coordination disorder.Methods:Sixty pre-term infants with SSwB coordination disorder were divided into an observation group ( n=30) and a control group ( n=30) using a random number table. Both groups were given routine feeding training, including oral exercise intervention, non-nutritive sucking training, and swallowing induction training during nursing, while the observation group was additionally provided with 15 minutes of breathing pattern training once a day, including breathing pattern observation, resistive breathing training prior to eating and passive breathing pattern intervention during eating. Before and after the 7-day intervention, the Pre-term Infant Oral Feeding Readiness Assessment (PIOFRA) was used to evaluate each subject′s oral feeding ability. Rate of transfer (RT), proficiency (PRO), minimum oxygen partial pressure (SaO 2) and SaO 2 fluctuations were also recorded during the feeding process. Results:After 1 week of the intervention, significant improvement was observed in both groups. In the observation group the average RT (2.76±0.36ml/min), PRO, minimum SaO 2, the number of SaO 2 fluctuations, and PIOFRA score (33.28±0.58) were all significantly better than the control group′s averages. Conclusion:Breathing pattern intervention based on routine feeding training can enhance breathing coordination during swallowing and ultimately improve the oral feeding of pre-term infants with SSwB coordination disorders in a relatively short period of time.
RESUMEN
Objective To explore the impact of family single room practices in NICU on maternal anxiety and breastfeeding status and neuropsychological development in preterm infants. Methods One-hundred NICU-born preterm infants were divided into the experimental group (n= 48) and the control group (n=52) according to random number table. Neonates in the experimental group were guaranteed parental care in the family ward for at least 4 hours a day during hospitalization in NICU, while the control group used a traditional video-based approach for daily scheduled visits. Finally, the results of exclusive breastfeeding, nosocomial infection, maternal anxiety, parental satisfaction, and full-term NBNA score after correction of gestational age were collected and recorded. Results The rates of exclusive breastfeeding were 82.50%(33/40),42.50%(17/40)during hospitalization and six months old in the experimental group, and 17.07%(7/41),12.20%(5/41)in the control group. The difference between the two groups was statistically significant during hospitalization and at 6 months of age (χ2=32.25, 9.40,P <0.01). The score of maternal anxiety was 33.00(31.00, 41.75)in the experimental group, and 43.00(34.50, 46.00)in the control group. The difference between the two groups was statistically significant (Z=-2.97, P =0.003).The NBNA score in the experimental group was 38.50(38.00, 40.00), and 37.00(36.00, 39.00)in the control group. The difference between the two groups was statistically significant(Z=-2.86, P<0.01). Conclusions The development of family ward is conducive to raising the rate of exclusive breastfeeding, reducing the incidence of nosocomial infection, relieving the anxiety of mother-infant separation and enhancing the satisfaction of parents, which can promote the behavioral and neuropsychological development of preterm infants.
RESUMEN
Objective To study the clinical efficacy and safety of Simo Decoction for the treatment of feeding intolerance of near term infants; To explore the value of increase of time averaged mean velocity (TAMV) in the superior mesenteric artery. Methods Totally 85 patients were randomly divided into control group (41 cases) and observation group (44 cases). Both two group were given comprehensive treatment and feeding regulation, lasted for 7 d. The observation group was given Simo Decoction on the basis of the control group, 1 mL/kg each time, 3 times a day, orally or nasal feeding, lasted for 2 days. After the treatment, no gastric retention time, vomiting ceased time, total enteral nutrition time, and hospitalization time were compared, and the total TCM syndrome scores and TAMV increase were observed. Clinical efficacy was evaluated and safety indexes were monitored. Results No gastric retention time, vomiting ceased time, total enteral nutrition time and hospitalization time in the observation group were shorter than the control group (P<0.05). Compared with before treatment, the total TCM syndrome scores in the two groups decreased after treatment (P<0.05); After treatment, the total TCM syndrome scores in the observation group were lower than those in the control group (P<0.05). The total effective rate was 86.36% (38/44) in the observation group and 68.29% (28/41) in the control group. The observation group was significantly better than the control group (P<0.05); After treatment, the TAMV increase in the observation group was higher than that in the control group (P<0.05). No adverse reactions occurred in both groups. Conclusion Simo Decoction can improve the symptoms and shorten the time of hospitalization in the treatment of feeding intolerance of near term infants, with confirmed efficacy and no obvious adverse reactions, which can be prejudged and monitored by monitoring TAMV increase.
RESUMEN
Objective To study the predictive validity of fidgety general movement assessment in pre-term twins and multiplets for motor development outcomes.Methods A total of 53 pre-term twins or multiplets delivered between July 2011 and February 2016 participated in this study.They were assessed using a general movements (GM) assessment and participated in the follow-up program until one year old.The motor development outcomes of the infants at one year old were determined according to clinical diagnoses and the Peabody developmental motor scale number two (PDMS-2) evaluation.The predictive validity of fidgety general movement assessment for motor development outcomes was calculated against the standard motor development of infants at one year old.Results There were 53 twins or multiplets who accepted the GM assessment of fidgety movement period.Of these,43 were assessed as normal (NF) and ten (19％) as lacking a normal level of fidgety movement (F-).All 53 cases were followed-up for the motor development outcome.Forty-three cases (81.1％) were assessed as normal at one year old,while ten (18.9％) were assessed as abnormal.All ten had cerebral palsy,and no motor development retardation was found.The predictive value of F-for cerebral palsy was 90.0％ in terms of sensitivity,97.7％ in terms of specificity,90.0％ in positive predictive value,and 97.7％ in terms of negative predictive value.Conclusions Among pre-term twins or multiplets,the fidgety general movement assessment can be a useful early indicator of motor development difficulties.
RESUMEN
Clinical risk index for babies( CRIB) is applied in low birth weight preterm neonates to assess the initial severity of illness,predict mortality risk rates,evaluate their own performance,and audit the performance between different medical institutions.CRIB plays an important role in the progressive develop-ment of neonatology.The scoring rules and advantagse of CRIB scorni g system were introud ced in this arti-cle.Teh scoring system is able to correctly predict mortaliyt probabilities and long-term neurodevelopmental outcomes for low birth weight preterm infants.
RESUMEN
Background and Aim: Central corneal thickness (CCT) of term and preterm infants in Indian population is not known. We did a prospective noninterventional study to measure the CCT in term and preterm infants. Materials and Methods: An ultrasonic pachymeter was used. The data regarding the date of birth, expected date of delivery, birth weight were recorded. The preterm and the term infants were followed up at 8 weeks, 20 weeks and at 1‑year. Results: A total of 85 (170 eyes) children were included in the study. The mean age was 264.6 ± 21.8 days postconception. The mean birth weight and CCT were 1834.4 ± 512.1 g and 595.8 ± 72.4 μ respectively. A comparison of CCT on the basis postgestational age showed a mean thickness of 620.7 ± 88.8 and 574.4 ± 78.3 μ in the <260 days and >260 days age groups respectively. The difference was statistically significant (Student’s test, P = 0.002). The CCT of preterm infants (<260 days) decreased from a mean value of 620.7 ± 88.8 μ to 534.1 ± 57.6 μ at the end of 1‑year. Conclusion: We present the data of CCT in term and preterm infants in Indian population. We believe that the premature babies have slightly thicker corneas than mature term babies.
RESUMEN
PURPOSE: Indomethacin has been reported as the prophylaxis and initial treatment of preterm infants with patent ductus arteriosus (PDA). However, there was controversy over indomethacin treatment in full-term infants with symptomatic PDA. Therefore, we evaluate the effect of indomethacin as a treatment of full-term infants with symptomatic PDA. METHODS: A retrospective study was performed to evaluate the effectiveness of indomethacin in full-term infants who had birth weight > or =2,500 g and a gestational age > or =37 weeks with symptomatic PDA at Chonnam National University Hospital between January 2007 and December 2009. According to responsiveness of indomethacin, we classified them into three groups: 1) complete responder which were completely closed after indomethacin treatment, 2) partial responder which were incompletely closed but symptoms were improved, 3) non responder which were conducted surgical ligation because did not respond. RESULTS: Among the total 29 full-term infants treated with indomethacin, 13 (44.8%) were complete responder, 8 (27.6%) were partial responder, and 8 (27.6%) were non responder. There were no significant differences in birth weight, narrow diameter of PDA, and dose of indomethacin between three groups. However, the age at initiation of treatment using indomethacin of complete (4.8+/-4.5 days, P=0.03) and partial responder (6.3+/-2.0 days, P=0.04) were earlier than those of non responder (13.8+/-8.1 days). CONCLUSION: Indomethacin can expect an effective treatment of PDA in full-term infants prior to surgical ligation.
Asunto(s)
Humanos , Lactante , Recién Nacido , Peso al Nacer , Conducto Arterioso Permeable , Edad Gestacional , Indometacina , Recien Nacido Prematuro , Ligadura , Estudios RetrospectivosRESUMEN
Objective To study the clinic value of brain edema detected by ultrasound examination in high risk term infants. Meth-ods The study group included 140 term infants who were found having brain edema in cranial ultrasound examinations. 152 term infants with normal ultrasound scan were selected as a control group. The risk factors of brain edema were collected, and univariate analysis and multivariate logistic regression analysis were performed. Results (1) There was no difference of incidence of brain edema between the infants with or without maternal ill historys, fetal distress or hypoalbuminemia, with P > 0.05. (2) In the univariate regression model, as-phyxia,hypoxic -ischemic encephalopathy (HIE) ,ventilation and metabolic acidosis were associated with an increased risk of brain ede-ma. In the multivariate logistic regression model, HIE was associated with a greater risk of brain edema and ventilation was possibly asso-ciated with brain edema. Conclusion Brain edema detected by ultrasound examination in high risk term infants has close relationship with HIE. It suggest that there is a consistency between ultrasound results and clinic situation. The detection of brain edema by ultrasound can assist doctor in clinic practice.
RESUMEN
PURPOSE: Vasodilator therapy in infants with persistent pulmonary hypertension of the newborn(PPHN) frequently causes systemic hypotension due to non-selectivity for pulmonary vessels. Blood pressure(BP) cuffs can increase systemic vascular resistance around which they are applied without affecting pulmonary vessels. We studied the effects of BP cuffs on the circulatory and respiratory status of infants with PPHN receiving vasodilator therapy. METHODS: Mechanically ventilated 16 term infants(gestational age of 39.9+ 1.3 weeks and birth weight of 3,533+/-318 gm with PPHN who had right to left shunt on echocardiogram and survived over 5 days were included for the study. All infants received vasodilator(tolazoline)therapy. We applied BP cuffs for neonatal use to four extremities of study infants(n=8) and inflated them to systolic pressure. Those who received vasodilator therapy alone served as control(n=8). We analyzed systolic and mean BP, respiratory parameters, presence of right to left shunt an clinical outcome at 1, 2, 6, 12, 24, 48, 72hr after initiation of vasodilator therapy. RESULTS: Systolic BP increased significantly in study group(from 37+/-11 to 46+/-13 mmHg) from 6 hours after BP cuff application compared to control group(from 39+/-8 to 40+/-13 mmHg), and this effect persisted up to 72 hour(52+/-18 vs. 46+/-16 mmHg)(P<0.05). Mean BP also increased significantly in study group(30 +/-10 to 38+/-12 mmHg) from 6 hours compared to control group(32+/-11 to 33 15 mmHg) and maintained up to 72 hour occurred(43+17 vs. 3715 mmHg)(P<0.05). Reversal of right to left shunt occurred significantly earlier in study group than control group(30+/-10 vs. 52+/-18 hr)(P<0.01). Respiratory parameters such as mean airway pressure, oxygenation index and duration of ventilator care and hospitalization were not different. Four of five infants in the study group and five of eight in control group survived. CONCLUSION: Application of BP cuffs to the infants with PPHN treated with vasodilator resulted in increase innd mean BP and early reversal of right to left shunt. We suggest that application of BP cuffs can play a useful role in the management of infants with PPHN.
Asunto(s)
Humanos , Lactante , Recién Nacido , Peso al Nacer , Presión Sanguínea , Extremidades , Hospitalización , Hipertensión , Hipertensión Pulmonar , Hipotensión , Oxígeno , Resistencia Vascular , Ventiladores MecánicosRESUMEN
We retrospectively evaluated datas on 61 cases of neonatal sepsis confirmed by clinical symptoms and blood cultures at the NICU of Gil general hospital From Mar. 1989, to Fed. 1992. The results obtained were as follows: 1) The mean gestational age was 32.7+/-2.6 Weeks in preterm infants, and 39+/-1.5 weels on term infants. The mean birth weight was 1,701.4+/-422.4 g in preterm infants, and 3,232+/-581.7 g in term infants. 2) There were 61 infants with neonatal sepsis identified among 13, 486 live births, resulting in an incidence of 0.45%. The sex ratio of male to female was 1.2:1. The incidencdence was higher in preterm infants (2.21%) than in term infants (0.27%). 3) The most commom presenting symptoms of neonatal sepsis were apnea and bradycardia (53.6%) in preterm infants, jaundice (33.3%) in term infants 4) The concurrent diseases in neonatal sepsis were urinary tract infection (UT)(25%), pneumonia (21%), hyaline membrane disease (21%) in the order of frequency. Hyaline membrane disease (33.3%) was the most frequently associated disease in preterm infants, UTI (41.4%) in term infants 5) Gram positive organisms were isolated in 33 casess (52%), gram negative organisms in 30 cases (48%). The most common ortanism isolated from blood cultures was CONS (28.6%). The more common organisms in preterm infants were CONS (26.7%), Enterococcus (23.3%) and Klebsiella (10%). CONS (30.3%), E. Coli (27.3%) and Staphylococcus aureus (12%) were more frequent in term infants. 6) The significant diagnostic laboratory findings for neonatal sepsis were leukopenia ( or =1+.2 or more of abnormal hematologic values were significantly more frequent in preterm infants (P or =24hrs)(9.0%) in term infants. 8) Early onset neonatal sepsis (72< or =hr of age) was found in 40 cases (65.6%). 9) The overall mortality rate of neonatal sepsis was 26.0%(39,3% in preterm infants, 15.2% in term infants). The mortality rate was significantly high in pseudomonas infection. 10) In low birth weight infants, the susceptibility to neonatal sepsis was greatest in the infants of lowest birth weight (1,00-1,500 gm) and the mortality rate was inversely proportional to birth weight. 11) Sensitivity to antibiotics in gram postitive organisms were chlorampjenicol (37%), Erythromycin (29%), ampicillin (26%) and cephalothin (26%). It clearly showed that newer antibiotics such as vancomycin is neccessary. In cases of gram negative organisms, sensitivity to antibiotics were amikacin (85%), gentamicin (65%), tobramycin (58%) and cephalothin (54%).
Asunto(s)
Femenino , Humanos , Lactante , Recién Nacido , Masculino , Amicacina , Ampicilina , Antibacterianos , Apnea , Peso al Nacer , Bradicardia , Cateterismo , Catéteres , Cefalotina , Enterococcus , Eritromicina , Gentamicinas , Edad Gestacional , Hospitales Generales , Enfermedad de la Membrana Hialina , Incidencia , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Intubación , Intubación Intratraqueal , Ictericia , Klebsiella , Leucopenia , Nacimiento Vivo , Membranas , Mortalidad , Parto , Neumonía , Infecciones por Pseudomonas , Estudios Retrospectivos , Factores de Riesgo , Rotura , Sepsis , Razón de Masculinidad , Staphylococcus aureus , Trombocitopenia , Tobramicina , Infecciones Urinarias , VancomicinaRESUMEN
Intracranial hemorrhage is the most common neuropathologic finding in premature infants. But in full-term infants, it is less common and rarely causes death. We found out intracranial hemorrhages in 21 full-term neonates by real-time neurosonography and concluded as followings. 1) Among 21 neonates, 17 infants were male and 4 infants were female. 2) In 11 (52.3%) infants the hemorrhage was detected within 7 days after birth. 3) The intracranial hemorrhage was not related with delivery type nor Apgar score. 4) In 13 cases (61.9%) the hemorrhage was in the subependymal germinal matrix and the degree was Grade I. 5) Precipitating or associated factors were asphyxia, pneumonia, ventilator care, RDS and congenital heart disease. 6) Symptoms and signs were seizure, apnea, lethargy, cyanosis, jaundice, anemia or bulging fontanel.