Neuropsychological development of large for gestational age infants at the age of 12 months / 中国当代儿科杂志

OBJECTIVES@#To investigate the level of neuropsychological development in large for gestational age (LGA) infants at the age of 12 months.@*METHODS@#The infants, aged 12 to <13 months, who attended the Outpatient Service of Child Care in the First Affiliated Hospital of Shandong First Medical University from December 2021 to June 2023, were enrolled as subjects. According to the gestational age and birth weight, they were divided into preterm appropriate for gestational age (AGA) group, preterm LGA group, early term AGA group, early term LGA group, full-term AGA group, and full-term LGA group. A modified Poisson regression analysis was used to investigate the association between LGA and neuropsychological development outcome at 12 months of age.@*RESULTS@#After adjustment for confounding factors, compared with the full-term AGA group at the age of 12 months, the full-term LGA group had a significant increase in the risk of language deficit (RR=1.364, 95%CI: 1.063-1.750), the early term LGA group had significant increases in the risk of abnormal gross motor, fine motor, language, and the preterm LGA group had significant increases in the risk of abnormal language, social behavior, and total developmental quotient (P<0.05); also, the early term AGA group had higher risks of developmental delay across all five attributes and in total developmental quotient at the age of 12 months (P<0.05); except for the language attribute, the preterm AGA group had higher risks of developmental delay in the other 4 attributes (P<0.05).@*CONCLUSIONS@#The neuropsychological development of LGA infants with different gestational ages lags behind that of full-term AGA infants at 12 months of age, and follow-up and early intervention of such infants should be taken seriously in clinical practice.

Por que devemos nos preocupar com os bebês a termo internados em uma unidade de terapia intensiva neonatal / Por qué deberíamos preocuparnos por los bebés nacidos a término ingresados en una unidad de cuidados intensivos neonatal / Why we should care about full-term infants admitted to a neonatal intensive care unit

RESUMO O objetivo deste estudo foi analisar a razão pela qual devemos nos preocuparmos com os bebês a termo internados em uma unidade de terapia intensiva neonatal. Trata-se de estudo documental, descritivo e retrospectivo de 262 recém-nascidos (RNs) a termo. As variáveis utilizadas foram: características dos RN; diagnóstico principal, tempo de permanência e acompanhamento pela equipe multiprofissional; e encaminhamento pós-alta. Houve prevalência do sexo masculino (52%), de Apgar 9 no 5º minuto e da raça/cor branca do RN e da mãe (61,1% e 48,9%, respectivamente). O diagnóstico principal foi a disfunção respiratória (28,8%), e o tempo de permanência foi de oito dias. Houve diferença significativa entre os tempos de permanência (p=0,013), em que as doenças cardiorrespiratórias e outras doenças levaram a um menor tempo de internação em relação à má formação ou às doenças maternas. O serviço social foi o mais procurado para o acompanhamento (81,2%) e a fisioterapia, o menos buscado (18%). RNs com maior peso ficaram menos tempo internados, e os acompanhados por fisioterapia apresentaram tempo de permanência mais elevados (p<0,001). O principal desfecho foi a alta hospitalar (68,7%) e encaminhamentos para a Unidade Básica de Saúde (57%). Os achados deste estudo apontam a presença de bebês menos graves, baixo número de estudos específicos para a população a termo e outros diagnósticos que nos remetem a cuidados não intensivos.

RESUMEN El objetivo de este estudio fue analizar el motivo de preocupación por los recién nacidos a término ingresados en una unidad de cuidados intensivos neonatal. Se trata de un estudio documental, descriptivo y retrospectivo, realizado con 262 recién nacidos (RN) a término. Las variables utilizadas fueron: características de los RN; diagnóstico principal, tiempo de estancia y seguimiento por el equipo multidisciplinar; y derivación posterior al alta. Hubo predominio del sexo masculino (52%), Apgar 9 al 5º minuto y raza/color blanca del RN y de la madre (61,1% y 48,9%, respectivamente). El principal diagnóstico fue disfunción respiratoria (28,8%), y la estancia hospitalaria fue de ocho días. Hubo una diferencia significativa entre el tiempo de estancia (p=0,013), en que las enfermedades cardiorrespiratorias y otras enfermedades resultaron en una menor estancia hospitalaria con relación a malformaciones o enfermedades maternas. El trabajo social fue el más buscado para el seguimiento (81,2%), y la fisioterapia, el menos buscado (18%). Los RN con mayor peso tuvieron una menor estancia hospitalaria, y aquellos que recibían seguimiento de fisioterapia tuvieron mayor tiempo de estancia (p<0,001). El principal desenlace fue el alta hospitalaria (68,7%) y las derivaciones a la Unidad Básica de Salud (57%). Los hallazgos de este estudio apuntan a la presencia de recién nacidos menos graves, un bajo número de estudios específicos para la población a término y otros diagnósticos que nos remiten a cuidados no intensivos.

ABSTRACT This study aims to analyze why we should care about full-term newborns admitted to a neonatal intensive care unit. This is a documented, descriptive, and retrospective study of 262 full-term newborns. Variables used: newborns' characteristics; main diagnosis, length of stay, follow-up by a multidisciplinary team; post-discharge referral. Most newborns were boys (52%), had a 5-minute Apgar score of nine, and most newborns and their mothers were white (61.1% and 48.9% respectively). Respiratory dysfunction was the main diagnosis (28.8%). Length of stay was eight days. There was a significant difference regarding length of stay (p=0.013), in which those with cardiorespiratory and other diseases stayed less time compared to those with malformation or maternal diseases. The social service was the most sought (81.2%) service, whereas physical therapy the least sought (18%). Newborns with higher weight were hospitalized for less time. Those that underwent physical therapy had longer stay (p<0.001). Main outcome was hospital discharge (68.7%) and referrals to the Basic Health Unit (57%). This study outcomes indicated newborns with less severe conditions, low number of specific studies for the full-term population, other diagnoses that refer to non-intensive care.

Study on colonization of Group B Streptococcus in pregnant women of Mongolian and Han nationality and the status of neonatal early-onset septicemia / 中华急诊医学杂志

Objective:To explore the carrier status of group B streptococci (GBS) in pregnant women of Mongolian and Han nationality and the neonatal GBS infection in order to identify the high risk factors of GBS infection in Mongolian and Han newborns in this area.Methods:Totally 7289 pregnant women and their newborns born alive were tested for GBS in the Affiliated Hospital of Inner Mongolia Medical University from June 2017 to June 2020, and their newborns were cultured for GBS, and the venous blood of newborns delivered by GBS positive women were detected for anti-GBS capsular polysaccharide antibody level, in order to determine the high risk factors of neonatal GBS infection.Results:Among the 7289 pregnant women, 3136 were Mongolian pregnant women (2599 full-term delivery and 537 premature delivery) and 4153 were Han pregnant women (3541 full-term delivery and 612 premature delivery). The results of GBS test showed that the GBS carrier rate was 8.19% in the Mongolian preterm delivery group, 4.35% in the Mongolian term group, 11.93% in the Han preterm group, and 5.76% in the Han term group, indicating that the carrier rate of GBS in the preterm group was significantly higher than that in the term group, regardless of Mongolian and Han nationality ( P < 0.05). Further comparing the GBS carrier rate of Mongolian and Han pregnant women, the GBS carrier rate of Mongolian pregnant women was significantly lower than that of Han pregnant women regardless of the premature delivery group and term group ( P < 0.05). (2) A total of 434 newborns were born by GBS positive parturients. The positive rates of GBS in Mongolian premature infants, Mongolian full-term infants, Han premature infants and Han full-term infants were 29.55%, 14.16%, 31.51% and 17.65%, respectively, suggesting that the positive rate of GBS in premature infants was significantly higher than that in full-term infants, regardless of Mongolian and Han nationality ( P<0.05). Further comparing the positive rate of GBS in Mongolian and Han newborns, there was no significant difference in the positive rate of GBS between Mongolian newborns and Han newborns, no matter the premature delivery group and the full-term group. (3) This study compared the incidence of early-onset GBS septicemia in Mongolian and Han newborns. The results showed that the incidence of early-onset GBS septicemia in Mongolian premature infants was 23.08%, and none in full-term infants. The incidence of early-onset GBS septicemia in Han premature infants was 26.09%. The incidence of early-onset GBS septicemia in term infants was 5.56%. The incidence of neonatal GBS septicemia in the preterm group was significantly higher than that in the term group, regardless of Mongolian and Han nationality. By further comparing the incidence of GBS septicemia in Mongolian and Han newborns, there was no significant difference in the positive rate of GBS between Mongolian newborns and Han newborns regardless of the premature delivery group and the term group. (4) In both Mongolian and Han nationality, the level of anti-GBS capsular polysaccharide antibody in premature infants was significantly lower than that in term infants ( P < 0.05). (5) Regardless of the Mongolian and Han nationality, compared with GBS negative group, GBS positive rate was higher in pregnant women aged≥35 years old, with history of menstruation, miscarriage, vaginitis, floating population, and those who had not undergone pre-pregnancy examination,,which were the high risk factors for GBS-positive pregnant women during pregnancy. (6) In both Mongolian and Han nationality, the incidence of chorioamnionitis, puerperal infection, premature delivery and premature rupture of membranes in the GBS positive group was higher than that in the GBS negative group, and the incidence of fetal distress and neonatal asphyxia in the GBS positive group was also higher than that in the GBS negative group. Conclusions:The carrier rate of GBS in Mongolian pregnant women is lower than that in Han pregnant women, and positive GBS during pregnancy will increase the incidence of adverse maternal and fetal outcomes such as chorioamnionitis, puerperal infection, premature delivery, premature rupture of membranes, fetal distress, neonatal asphyxia and neonatal early-onset GBS septicemia. The high risk factors are maternal age ≥ 35 years old, history of menstruation, abortion, vaginitis, floating population, and infection without pre-pregnancy examination. We should attach great importance to the perinatal high risk factors and formulate corresponding intervention measures accordingly, and make rational use of antibiotics for prenatal prevention, so as to further reduce the incidence of early-onset GBS septicemia in newborns.

Investigation on the IGF-1 and lipid level in term small for gestational age infants within 24 hours postnatally / 中国新生儿科杂志

Objective:To study the insulin-like growth factors-1 (IGF-1) and lipid level of term small for gestational age (SGA) infants within 24 hours postnatally and to explore the correlation between IGF-1 and blood lipids.Methods:A prospective study was conducted on singleton term SGA and appropriate for gestational age infant (AGA) who were delivered and admitted to the neonatal ward of Guangdong Women and Children Hospital within 24 hours after birth from May 2020 to January 2021, and the infants were divided into SGA and AGA groups to compare the differences in IGF-1 and lipid levels within 24 hours after birth and to analyze the correlation between IGF-1 and lipids.Results:A total of 95 cases in the SGA group and 84 cases in the AGA group were included in the study. The proportion of infants with IGF-1 <25 ng/ml was significantly higher in SGA group (87.4%) than in the AGA group (52.4%). It was also found that the proportion of infants with IGF-1 <25 ng/ml in SGA was significantly higher than that in AGA within different gender composition groups, early-term and full-term births groups. The triglyceride (TG) level was higher in the SGA group than that in the AGA group, but the high-density lipoprotein cholesterol (HDL-C) level was lower than that in the AGA group ( P<0.05). IGF-1 level within 24 hours postnatally in SGA and AGA was positively correlated with HDL-C levels ( P<0.01) and negatively correlated with TG ( P<0.01), and HDL-C level was a predictor of IGF-1. Conclusions:Compared with term AGA, SGA term infants showed insufficient IGF-1 and HDL-C secretion and high TG within 24 hours after birth. Nutritional support for SGA should be given promptly after birth to avoid hypoglycemia and to stimulate IGF-1 secretion.

Summary of best evidence for management of labor course induced by oxytocin drip in term pregnancy / 中国实用护理杂志

Objective:To search, evaluate and summarize the best evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy, and to provide reference for clinical practice in order to reduce the complications during labor, such as the proportion of instrument delivery, prolonged labor duration, uterine rupture, postpartum hemorrhage, etc. Standardize the management process of induction of labor with oxytocin, improve the satisfaction of pregnant women to participate in the decision of induction of labor, and improve the outcome of the newborn.Methods:Take the evidence-based nursing method, in view of the full-term pregnancy pregnant women oxytocin drip induced labor evidence-based labor management problems, nearly 10 years related literature retrieval from January 1st 2011 to April 9th, 2021, the Australian JBI evidence-based health care center of literature quality evaluation criteria and evidence classification system, all kinds of research evaluation and classification of retrieval.Results:Early detection to 340 articles, and eventually into 9 articles, including 1 clinical decision, 6 guides, 2 pieces of system evaluation. Totally 45 pieces evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy were sumarized, including induced labor time, oxytocin side effects, induced labor before evaluation, induced labor of guardianship, infusion solution, such as health education, and other seven aspects.Conclusions:The present study summarized 45 pieces of best evidence on the management of labor induced by oxytocin infusion during term pregnancy, which provided some evidence-based basis for midwives, obstetric nurses and managers. Through the application of the best evidence, it is beneficial to improve the outcome of pregnant women in the neonatal perinatal period, standardize the process of inducing labor with oxytocin, and improve the quality of obstetric care.

Fatores materno-infantis associados ao desenvolvimento de bebês prematuros e a termo / Maternal-infant factors associated to the development of preterm and full-term babies / Factores materno-infantiles asociados al desarrollo de bebés prematuros y a término

Conhecer a influência de variáveis materno-infantis e ambientais no processo desenvolvimental torna possível que atrasos sejam minimizados. Pretendeu-se comparar variáveis sociodemográficas e de desenvolvimento de bebês prematuros e a termo aos três meses de idade e identificar as influências de fatores materno-infantis associadas ao desenvolvimento destes bebês. Participaram 275 díades mãe-bebê, sendo 168 prematuros e 107 a termo. Aplicou-se uma entrevista para coleta das variáveis materno-infantis e as Escalas Bayley III para avaliar o desenvolvimento. Os resultados indicaram que há diferenças significativas entre a termo e prematuros em relação à escolaridade materna, presença de irmãos e não planejamento materno da gravidez. Prematuros apresentaram maiores atrasos no desenvolvimento cognitivo, em linguagem expressiva, motor fino e motor amplo. A identificação de atrasos aos três meses apontou para a importância de programas de estimulação precoce como fator de proteção para evitar atrasos no desenvolvimento e como orientação aos cuidadores primários do bebê.

Knowing the influence of maternal-infant and environmental factors in the developmental process makes it possible to minimize delays. We intended to compare socio-demographic and developmental variables of preterm and full-term babies at three months of age, and to identify the influences of maternal-infant factors associated with the development of these babies. Participants were 275 mother-baby dyads, 168 being preterm and 107 full-term babies. We applied an interview to collect maternal-infant variables and we used the Bayley III Scales to evaluate development. The results indicated that there are significant differences between full-term and preterm babies regarding maternal education, the presence of siblings, and lack of maternal pregnancy planning. Preterm babies displayed more delays in cognitive development, expressive language, fine and gross motor development. The identification of delays at three months pointed to the importance of early stimulation programs as a protective factor to avoid developmental delays and as guidance to the primary caregivers of the baby.

Conocer la influencia de variables materno-infantiles y ambientales en el proceso de desarrollo hace posible que atrasos sean minimizados. Se pretendió comparar variables sociodemográficas y de desarrollo de bebés prematuros y a término a los tres meses de edad e identificar la influencia de factores materno-infantiles asociadas al desarrollo de estos bebés. Participaron 275 díadas madre-bebé, siendo 168 prematuros y 107 a término. Se aplicó una entrevista para la colecta de las variables materno-infantiles y las Escalas Bayley III para evaluar el desarrollo. Los resultados indicaron que hay diferencias significativas entre bebés a término y prematuros con respecto a la escolaridad materna, presencia de hermanos y falta de planeamiento materno del embarazo. Los prematuros presentaron mayores atrasos en el desarrollo cognitivo, en lenguaje expresivo, control motor fino y grueso. La identificación de atrasos a los tres meses mostró la importancia de programas de estimulación temprana como factor de protección para evitar atrasos del desarrollo y como orientación a los cuidadores primarios del bebé.

Prognostic effect of intrauterine pregnancy induced by different methods of cervical ripening / 中国基层医药

Objective@#To investigate the effect of different cervical ripening methods on induction of labor in term pregnancy.@*Methods@#160 cases of labor induction of full-term pregnancy primipara were selected as the research subjecs.According to the different methods of cervical ripening, they were divided into two groups.The observation group (n=80) underwent dinoprostone suppositories induced labor, the control group (n=80) received intravenous infusion of small dose of oxytocin.The cervical Bishop score, cervical ripening effect, induction of labor, mode of delivery, neonatal outcome were observed in the two groups.@*Results@#Before treatment, the Bishop scores of the two groups had no statistically significant difference (t=0.436, P>0.05). After treatment for 24h, the Bishop score of the observation group was (8.3±2.6)points, which was higher than (5.9±2.0)points of the control group (t=6.544, P<0.05). In the observation group, the total effective rate of cervical ripening was 95.0%, which was higher than 66.2% of the control group (Z=-5.716, P<0.05). The duration of labor in the observation group was (12.6±4.5)h, which was significantly shorter than (21.7±7.8)h in the control group (t=9.039, P<0.05). The total labor, postpartum hemorrhage volume had no statistically significant differences between the two groups (t=2.298, 1.102, all P>0.05). In the observation group, 66cases (82.5%) were vaginal delivery, 14cases(17.5%) were cesarean section, those were 49cases(61.2%) and 31cases(38.8%) in the control group.The delivery mode of the observation group was significantly better than that of the control group(χ2=8.935, P<0.05). There were no statistically significant difference between the two groups in neonatal birth weight and postnatal 1min and 5min Apgar scores (all P>0.05).@*Conclusion@#Parturient with dinoprostone suppositories full-term pregnancy abortion can improve the cervical Bishop score and cervical ripening effect, improve the quality of delivery, it is better than oxytocin, and worthy of clinical application.

Comparison of two kinds of cervical ripening balloons in promoting full-term pregnancy cervical mature and inducing labor / 实用医学杂志

Objective To explore the clinical effects of single-cavity and COOK cervical ripening balloon in promoting full-term pregnancy cervical mature and inducing labour. Methods 126 puerpera who were expect-ant in the obstetrics department of our hospital were selected from January 2016 to June 2017,and all of the puer-pera were induced labor by cervical ripening balloon.In 61 of them,single-cavity balloon was used,and 65 cases were induced labor by COOK balloon. Determining the cervical ripening situation,the time needed for inducing efficient uterine contraction,the first stage of labor time,the total labor time,vaginal delivery rate,natural labor situation,postpartum hemorrhage,amniotic fluid turbidity,puerperal infection and newborn asphyxia of the two groups.Results the time needed for inducing efficient uterine contraction of the two groups were(16.39±2.68)h, (14.54 ± 3.30)h,and the two groups were statistically different(P<0.05).There were no statistically significant differences in other items of two groups(P>0.05).Conclusion single-cavity balloon and COOK balloon are sim-ilar in promoting full-term pregnancy cervical ripening.The difference is that the time needed for inducing efficient uterine contraction of the single-cavity balloon is longer than COOK balloon,but have no adverse effect to the puer-pera and the newborn.Both types of balloons are recommended to be used in promoting full-term pregnancy cervical ripening and inducing labor.

Risk factors for respiratory distress syndrome in full-term neonates / 영남의대학술지

BACKGROUND: Respiratory distress syndrome (RDS) is a one of the most common cause of respiratory morbidity and mortality in neonates. This study was conducted to investigate the risk factors for RDS in full-term neonates.METHODS: We conducted this retrospective study using medical records. The study group included 80 full-term neonates diagnosed with RDS and hospitalized in the neonatal intensive care unit between January 2012 and December 2016, at Yeungnam University Hospital. We analyzed sex, gestational age, birth weight, delivery method, maternal age, number of pregnancy, history of abortion, and complication of pregnancy. The control group included 116 full-time neonates who were hospitalized with jaundice during the same period.RESULTS: The incidence of full-term RDS was more common in males (odds ratio [OR], 3.288; 95% confidence interval [CI], 1.446–7.479), cesarean section (OR, 15.03; 95% CI, 6.381–35.423), multiparity (OR, 4.216; 95% CI, 1.568–11.335). The other factors rendered no significant results.CONCLUSION: The risk factors for RDS in full-tern neonates were identified as male sex, cesarean section, and multiparity. Further studies involving more institutions are needed to clarify the risk factors for RDS in fullterm infants.

Uso da sacarose para o alívio da dor: repercussão na amamentação materna durante a internação do recém-nascido a termo / Use of sucrose for pain relief: consequences on breastfeeding of fullterm newborns during hospitalization

Durante o período de internação, o recém-nascido (RN) é submetido a uma série de procedimentos dolorosos ou não, que podem incidir sobre o seu comportamento e sobre a confiança da mãe para o cuidado e para a amamentação materna. Temos como questionamento, se sacarose 25% que é oferecida como medida de alivio da dor em RN a termo internado em alojamento conjunto interfere negativamente na amamentação materna exclusiva durante a internação. Objetivo: Verificar a associação entre uso da sacarose 25% que é oferecida como medida de alívio dor aguda em RN a termo, e a amamentação materna durante a internação em alojamento conjunto. Métodos: Trata-se de um estudo observacional, transversal, descritivo e analítico. A amostra foi constituída por 215 binômios cujo nascimento e internação ocorreram entre os meses de Junho a Setembro de 2017 em uma maternidade do interior paulista intitulada "Amiga da Criança". Os binômios foram incluídos no estudo somente após autorização da mãe, com assinatura de um termo de consentimento livre e esclarecido. Os dados foram coletados por meio do prontuário e planilhas especificas. Os RN foram divididos em dois grupos: RN expostos e não expostos ao uso da sacarose durante a internação. Como houve diferença estatística entre os grupos para o tempo de internação, para analisar a influência do uso da sacarose na amamentação durante toda internação, foi feita uma relativização das variáveis de aleitamento materno pelo total de dias de internação do RN. As associações foram verificadas pelo teste "U" de Mann-Whitney, com valor de p significativo para ? <= 0,05. Resultado: Dos 215 RN estudados durante toda internação, 111 (51,6%) RN foram expostos ao uso da sacarose. Foi utilizado sacarose para 188 (60,1%) dos procedimentos dolorosos, sendo que a mesma foi usada associada a outros métodos como o colo em 18 (5,7%) e sucção não nutritiva 64 (20,4%) dos procedimentos. Somando-se o uso isolado ou em associação a outras medidas, a sacarose foi utilizada 270 (86,2%) vezes sendo a medida mais aplicada na prática clínica da maternidade. No grupo que utilizou sacarose as médias de frequência de mamadas, uso de copo, translactação, tempo médio por mamada e amamentação assistida foram respectivamente: 7,9, 0,2, 0,5, 11,4 e 1,0 . No grupo que não utilizou a sacarose, respectivamente, as a médias das mesmas variáveis foram de 8,7, 0,03, 0,06, 18,6 e 0,8. Houve diferença estatisticamente significativa entre os grupos para as variáveis de alimentação: frequência de mamada (p=0,03), utilização de copo (p=0,01), realização de translactação (p=0,00), tempo médio por mamada (p=0,00) e amamentação assistida (p=0,02). Conclusão: As associações dos dados encontrados comprovaram a hipótese do presente estudo, ou seja o uso da sacarose a 25% para alívio da dor aguda influenciou negativamente na amamentação materna do RN durante a internação, pois, o grupo de RN que recebeu esta substância adocicada durante os procedimentos de punção arterial, venosa e capilar, apresentou menor frequência de mamada, menor tempo médio por mamada, maior uso de complemento lácteo, mais necessidade de translactação e necessitou de mais amamentação assistida por um profissional de enfermagem, quando comparado ao grupo de RN não expostos a ela. Faz-se necessária a inclusão de medidas não farmacológicas com a participação da mãe em substituição à sacarose, uma vez que tratou-se de pesquisa em uma Maternidade Amiga da Criança

Introduction: During the period of hospitalization, full-term newborns (NB) undergo a series of painful procedures, which may affect his behavior and the mother's confidence in both taking care of and breastfeeding the baby. We question whether 25% sucrose, which is offered as a measure of pain relief in hospitalized NB infants, negatively interferes with exclusive mother's breastfeeding during hospitalization in rooming-in care. Aim: Verify the association between the use of 25% sucrose offered as pain relief in full-term newborns and exclusive mother's breastfeeding during hospitalization in shared rooms. Methods: This is a study based on observation, and it is transversal, descriptive and analytical study. The sample consisted of 215 binomials whose birth and hospitalization occurred between June and September of 2017 in a maternity hospital in the countryside of São Paulo, in a Child-Friendly Maternity. The binomials were included in the study only after authorization obtained from the mother, with the signing of a free and previously informed consent form. The data were collected through medical records and specific worksheets. The NB were divided into two groups: NB exposed and not exposed to the use of sucrose during hospitalization, respectively. There was a statistical difference between the groups due to the hospitalization period; thus, to analyze the influence of sucrose use on breastfeeding during all hospitalization, a relative analysis of the variables of breastfeeding by the total number of days of hospitalization of the newborn was made. Associations were verified by the Mann-Whitney "U" test, with a significant p value for ? <= 0.05. Results: From 215 NBs studied during all hospitalization, 111 (51.6%) were exposed to the use of sucrose. Sucrose was applied for 188 (60.1%) of the painful procedures, and it was used in association with other methods such as lap in 18 (5.7%) and non-nutritive suction in 64 (20.4%) of the procedures. Added the isolate use or in association with other measures, sucrose was used 270 (86.2%) times, being the most applied measure in clinical practice of maternity. In the sucrose group, the average of frequency of feeding, cupping, translactation, average time per feeding and assisted breastfeeding were respectively: 7.9, 0.2, 0.5, 11.4 and 1.0. In the nonsucrose group, the average of the same variables were 8.7, 0.03, 0.06, 18.6 and 0.8, respectively. There was a statistically significant difference between the groups for feeding variables: feeding frequency (p = 0.03), cup use (p = 0.01), translactation (p = 0.00), average time per feed (p = 0.00) and assisted breastfeeding (p = 0.02). Conclusion: The associations of the data confirmed the hypothesis of the present study, that is, the use of sucrose at 25% for acute pain relief influenced negatively the maternal breastfeeding of newborns during hospitalization, since the group of newborns who received this sugary substance during the venous and capillary puncture procedures, presented lower breastfeeding frequency, lower average time for breastfeeding, greater use of milky complement, higher need for translactation and required more breastfeeding assisted by a nursing professional, when compared to the NB group who was not exposed to it. It is necessary to include non-pharmacological measures with the participation of the mother instead of sucrose, since it was a research in a Child-Friendly Maternity

Uso da sacarose para o alívio da dor: repercussão na amamentação materna durante a internação do recém-nascido a termo / Use of sucrose for pain relief: consequences on breastfeeding of fullterm newborns during hospitalization

Introdução: Durante o período de internação, o recém-nascido (RN) é submetido a uma série de procedimentos dolorosos ou não, que podem incidir sobre o seu comportamento e sobre a confiança da mãe para o cuidado e para a amamentação materna. Temos como questionamento, se sacarose 25% que é oferecida como medida de alivio da dor em RN a termo internado em alojamento conjunto interfere negativamente na amamentação materna exclusiva durante a internação. Objetivo: Verificar a associação entre uso da sacarose 25% que é oferecida como medida de alívio dor aguda em RN a termo, e a amamentação materna durante a internação em alojamento conjunto. Métodos: Trata-se de um estudo observacional, transversal, descritivo e analítico. A amostra foi constituída por 215 binômios cujo nascimento e internação ocorreram entre os meses de Junho a Setembro de 2017 em uma maternidade do interior paulista intitulada "Amiga da Criança". Os binômios foram incluídos no estudo somente após autorização da mãe, com assinatura de um termo de consentimento livre e esclarecido. Os dados foram coletados por meio do prontuário e planilhas especificas. Os RN foram divididos em dois grupos: RN expostos e não expostos ao uso da sacarose durante a internação. Como houve diferença estatística entre os grupos para o tempo de internação, para analisar a influência do uso da sacarose na amamentação durante toda internação, foi feita uma relativização das variáveis de aleitamento materno pelo total de dias de internação do RN. As associações foram verificadas pelo teste "U" de Mann-Whitney, com valor de p significativo para ? <= 0,05. Resultado: Dos 215 RN estudados durante toda internação, 111 (51,6%) RN foram expostos ao uso da sacarose. Foi utilizado sacarose para 188 (60,1%) dos procedimentos dolorosos, sendo que a mesma foi usada associada a outros métodos como o colo em 18 (5,7%) e sucção não nutritiva 64 (20,4%) dos procedimentos. Somando-se o uso isolado ou em associação a outras medidas, a sacarose foi utilizada 270 (86,2%) vezes sendo a medida mais aplicada na prática clínica da maternidade. No grupo que utilizou sacarose as médias de frequência de mamadas, uso de copo, translactação, tempo médio por mamada e amamentação assistida foram respectivamente: 7,9, 0,2, 0,5, 11,4 e 1,0 . No grupo que não utilizou a sacarose, respectivamente, as a médias das mesmas variáveis foram de 8,7, 0,03, 0,06, 18,6 e 0,8. Houve diferença estatisticamente significativa entre os grupos para as variáveis de alimentação: frequência de mamada (p=0,03), utilização de copo (p=0,01), realização de translactação (p=0,00), tempo médio por mamada (p=0,00) e amamentação assistida (p=0,02). Conclusão: As associações dos dados encontrados comprovaram a hipótese do presente estudo, ou seja o uso da sacarose a 25% para alívio da dor aguda influenciou negativamente na amamentação materna do RN durante a internação, pois, o grupo de RN que recebeu esta substância adocicada durante os procedimentos de punção arterial, venosa e capilar, apresentou menor frequência de mamada, menor tempo médio por mamada, maior uso de complemento lácteo, mais necessidade de translactação e necessitou de mais amamentação assistida por um profissional de enfermagem, quando comparado ao grupo de RN não expostos a ela. Faz-se necessária a inclusão de medidas não farmacológicas com a participação da mãe em substituição à sacarose, uma vez que tratou-se de pesquisa em uma Maternidade Amiga da Criança

Introduction: During the period of hospitalization, full-term newborns (NB) undergo a series of painful procedures, which may affect his behavior and the mother's confidence in both taking care of and breastfeeding the baby. We question whether 25% sucrose, which is offered as a measure of pain relief in hospitalized NB infants, negatively interferes with exclusive mother's breastfeeding during hospitalization in rooming-in care. Aim: Verify the association between the use of 25% sucrose offered as pain relief in full-term newborns and exclusive mother's breastfeeding during hospitalization in shared rooms. Methods: This is a study based on observation, and it is transversal, descriptive and analytical study. The sample consisted of 215 binomials whose birth and hospitalization occurred between June and September of 2017 in a maternity hospital in the countryside of São Paulo, in a Child-Friendly Maternity. The binomials were included in the study only after authorization obtained from the mother, with the signing of a free and previously informed consent form. The data were collected through medical records and specific worksheets. The NB were divided into two groups: NB exposed and not exposed to the use of sucrose during hospitalization, respectively. There was a statistical difference between the groups due to the hospitalization period; thus, to analyze the influence of sucrose use on breastfeeding during all hospitalization, a relative analysis of the variables of breastfeeding by the total number of days of hospitalization of the newborn was made. Associations were verified by the Mann-Whitney "U" test, with a significant p value for ? <= 0.05. Results: From 215 NBs studied during all hospitalization, 111 (51.6%) were exposed to the use of sucrose. Sucrose was applied for 188 (60.1%) of the painful procedures, and it was used in association with other methods such as lap in 18 (5.7%) and non-nutritive suction in 64 (20.4%) of the procedures. Added the isolate use or in association with other measures, sucrose was used 270 (86.2%) times, being the most applied measure in clinical practice of maternity. In the sucrose group, the average of frequency of feeding, cupping, translactation, average time per feeding and assisted breastfeeding were respectively: 7.9, 0.2, 0.5, 11.4 and 1.0. In the nonsucrose group, the average of the same variables were 8.7, 0.03, 0.06, 18.6 and 0.8, respectively. There was a statistically significant difference between the groups for feeding variables: feeding frequency (p = 0.03), cup use (p = 0.01), translactation (p = 0.00), average time per feed (p = 0.00) and assisted breastfeeding (p = 0.02). Conclusion: The associations of the data confirmed the hypothesis of the present study, that is, the use of sucrose at 25% for acute pain relief influenced negatively the maternal breastfeeding of newborns during hospitalization, since the group of newborns who received this sugary substance during the venous and capillary puncture procedures, presented lower breastfeeding frequency, lower average time for breastfeeding, greater use of milky complement, higher need for translactation and required more breastfeeding assisted by a nursing professional, when compared to the NB group who was not exposed to it. It is necessary to include non-pharmacological measures with the participation of the mother instead of sucrose, since it was a research in a Child-Friendly Maternity

A comparison between preterm and full-term infants' preference for faces / Uma comparação entre recém-nascidos prematuros e a termo na preferência por faces

Abstract: Objective: Visual preference for faces at birth is the product of a multimodal sensory experience experienced by the fetus even during the gestational period. The ability to recognize faces allows an ecologically advantageous interaction with the social environment. However, perinatal events such as premature birth, may adversely affect the adequate development of this capacity. In this study, we evaluated the preference for facial stimuli in preterm infants within the first few hours after birth. Methods: This is a cross-sectional observational study of 59 newborns, 28 preterm and 31 full-term infants. The babies were assessed in the first hours of life, with two white boards in the shape of a head and neck: one with the drawing of a face similar to the human face (natural face), and one with the drawing of misaligned eyes, mouth and nose (distorted face). After the newborn fixated the eyes on the presented stimulus, it was slowly moved along the visual field. The recognition of the stimulus was considered present when the baby had eye or head movements toward the stimulus. Results: The preterm infants, in addition to showing a lower occurrence of orientation movements for both stimuli, on average (1.8 ± 1.1 to natural faces and 2.0 ± 1.2 for distorted ones) also showed no preference for any of them (p = 0.35). Full-term newborns showed a different behavior, in which they showed a preference for natural faces (p = 0.002) and a higher number of orientations for the stimulus, for both natural (3.2 ± 0.8) and distorted faces (2.5 ± 0.9). Conclusion: Preterm newborns recognize facial stimuli and disclose no preference for natural faces, different from full-term newborns.

Resumo: Objetivo: A preferência visual por faces ao nascimento é produto de uma experiência sensorial multimodal vivenciada pelo feto ainda no período gestacional. A habilidade de reconhecer faces possibilita uma interação ecologicamente vantajosa com o ambiente social. Entretanto, eventos perinatais, como o nascimento prematuro, podem prejudicar o desenvolvimento adequado dessa habilidade. Neste trabalho, avaliamos a preferência por estímulos faciais de recém-nascidos prematuros nas primeiras horas após o nascimento. Métodos: Trata-se de um estudo observacional transversal feito com 59 recém-nascidos, 28 prematuros e 31 nascidos termos. Os bebês foram avaliados, nas primeiras horas de vida, com duas pranchas brancas em formato de cabeça e pescoço: uma com o desenho de uma face similar ao rosto humano (face natural) e outra com o desenho de olhos, boca e nariz desalinhados (face distorcida). Após o recém-nascido fixar o olhar no estímulo apresentado, era lentamente movimentado ao longo do campo visual. O reconhecimento do estímulo foi considerado presente quando o bebê apresentou movimentos dos olhos ou cabeça em direção ao estímulo. Resultados: Os recém-nascidos prematuros, além de apresentar menor ocorrência de movimentos de orientação para ambos os estímulos, em média (1,8 ± 1,1 para faces naturais e 2 ± 1,2 para faces distorcidas), também não apresentaram preferência por qualquer um deles (p = 0,35). Diferente foi o comportamento dos recém-nascidos a termo, que apresentaram preferência por faces naturais (p = 0,002) e um número maior de orientações para o estímulo, tanto para faces naturais (3,2 ± 0,8) quanto para faces distorcidas (2,5 ± 0,9). Conclusão: Recém-nascidos prematuros reconhecem os estímulos faciais e não apresentam preferência por faces naturais, diferentemente de recém-nascidos a termos.

Clinical analysis of the difference between full-term and preterm infants with purulent meningitis / 国际检验医学杂志

Objective To discuss and compare the clinical characteristics and difference of full-term and preterm neonatal purulent meningitis(NPM),for early diagnosis and reasonable treatment.Methods 72 newborns with NPM were collected.According to the gestational age,33 cases were divided into the full-term group(37-42 weeks) and 39 cases were divided into the preterm group (＜37 weeks).The clinical data,symptoms and signs,the related infection,the lab tests of blood and cerebrospinal fluid and pathogenic examination were analyzed and compared.Results The sex,the day age of hospital admission and onset between the two groups were no difference(P＞0.05).The rate of low-birth weight infant was 6.1％,which was significantly lower than preterm neonates(59.0 ％)(P＜0.05).The mainly clinical manifestations of full-term newborns with NPM were fever(75.8 ％),convulsions (45.5％),poor response(78.8％),and poor eating milk(45.5％).But the mainly clinical manifestations of preterm neonates with NPM were jaundice(30.8 ％),apnea(20.5 ％) and lower muscular tension(61.5 ％).There were 17 cases(51.5 ％) with NPM combined with septicemia in the full-term group,which was more than preterm neonates(20.5 ％)(P＜0.05).According to the results of the lab tests,18 full-term neonates (54.5 ％) with NPM with increased CRP levels were more than preterm neonates (28.2 ％) (P＜0.05).Besides,the preterm NPM neonates showed higher protein levels (2.35 ± 0.78) g/L and lower glucose(1.84 ±0.69) mmol/L in cerebrospinal fluid than these in the full-term group(P＜0.05).However,there was only 2 full-term NPM neonate with a positive cerebrospinal fluid culture,and 15 patients with a positive blood culture(8 full-term neonates and 7 preterm neonates).Conclusion Because of the atypical clinical characteristics and difference between the full-term neonates and the preterm neonates,the clinical symptoms and signs of neonates should be closely monitored.Therefore,it's suggested that the early diagnosis and reasonable treatment be a key plan for the low mortality and disability.

Clinical analysis of the difference between full-term and preterm infants with purulent meningitis / 国际检验医学杂志

Objective To discuss and compare the clinical characteristics and difference of full-term and preterm neonatal purulent meningitis(NPM),for early diagnosis and reasonable treatment.Methods 72 newborns with NPM were collected.According to the gestational age,33 cases were divided into the full-term group(37-42 weeks) and 39 cases were divided into the preterm group (＜37 weeks).The clinical data,symptoms and signs,the related infection,the lab tests of blood and cerebrospinal fluid and pathogenic examination were analyzed and compared.Results The sex,the day age of hospital admission and onset between the two groups were no difference(P＞0.05).The rate of low-birth weight infant was 6.1％,which was significantly lower than preterm neonates(59.0 ％)(P＜0.05).The mainly clinical manifestations of full-term newborns with NPM were fever(75.8 ％),convulsions (45.5％),poor response(78.8％),and poor eating milk(45.5％).But the mainly clinical manifestations of preterm neonates with NPM were jaundice(30.8 ％),apnea(20.5 ％) and lower muscular tension(61.5 ％).There were 17 cases(51.5 ％) with NPM combined with septicemia in the full-term group,which was more than preterm neonates(20.5 ％)(P＜0.05).According to the results of the lab tests,18 full-term neonates (54.5 ％) with NPM with increased CRP levels were more than preterm neonates (28.2 ％) (P＜0.05).Besides,the preterm NPM neonates showed higher protein levels (2.35 ± 0.78) g/L and lower glucose(1.84 ±0.69) mmol/L in cerebrospinal fluid than these in the full-term group(P＜0.05).However,there was only 2 full-term NPM neonate with a positive cerebrospinal fluid culture,and 15 patients with a positive blood culture(8 full-term neonates and 7 preterm neonates).Conclusion Because of the atypical clinical characteristics and difference between the full-term neonates and the preterm neonates,the clinical symptoms and signs of neonates should be closely monitored.Therefore,it's suggested that the early diagnosis and reasonable treatment be a key plan for the low mortality and disability.

Risk factors and prevention of neonatal respiratory distress / 中国小儿急救医学

In recent years, with the increase of elective cesarean section rate and other factors,the rate of neonatal respiratory distress in full-term neonates is rising,which has aroused widespread concern.The risk factors and related mechanisms of respiratory distress syndrome in full-term infants were reviewed from two aspects of maternal and infant.Selective cesarean section, gestational age, fetal sex and some pregnancy complications can affect the rate of respiratory distress syndrome in full-term infants.Timely use of respiratory support and early use of pulmonary surfactant, and the combined use of comprehensive measures can reduce the mortality of neonatal respiratory distress syndrome rate.

Human Umbilical Cord Blood CD34-Positive Cells as Predictors of the Incidence and Short-Term Outcome of Neonatal Hypoxic-Ischemic Encephalopathy: A Pilot Study

BACKGROUND AND PURPOSE: Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of neurological handicap in developing countries. Human umbilical cord blood (hUCB) CD34-positive (CD34⁺) stem cells exhibit the potential for neural repair. We tested the hypothesis that hUCB CD34⁺ stem cells and other cell types [leukocytes and nucleated red blood cells (NRBCs)] that are up-regulated during the acute stage of perinatal asphyxia (PA) could play a role in the early prediction of the occurrence, severity, and mortality of HIE. METHODS: This case-control pilot study investigated consecutive neonates exposed to PA. The hUCB CD34⁺ cell count in mononuclear layers was assayed using a flow cytometer. Twenty full-term neonates with PA and 25 healthy neonates were enrolled in the study. RESULTS: The absolute CD34⁺ cell count (p=0.02) and the relative CD34⁺ cell count (CD34+%) (p<0.001) in hUCB were higher in the HIE patients (n=20) than the healthy controls. The hUCB absolute CD34⁺ cell count (p=0.04), CD34⁺% (p<0.01), and Hobel risk scores (p=0.04) were higher in patients with moderate-to-severe HIE (n=9) than in those with mild HIE (n=11). The absolute CD34⁺ cell count was strongly correlated with CD34⁺% (p<0.001), Hobel risk score (p=0.04), total leukocyte count (TLC) (p<0.001), and NRBC count (p=0.01). CD34+% was correlated with TLC (p=0.02). CONCLUSIONS: hUCB CD34⁺ cells can be used to predict the occurrence, severity, and mortality of neonatal HIE after PA.

Establishment of reference range for thromboelastography in pregnancy / 中国输血杂志

Objective To establish a reference range for the normal value of thromboelastography (TEG) in pregnant females.Methods According to the results of pregnancy and physical examination,166 pregnant females and 64 healthy females without pregnancy were selected as the pregnant group and the non-pregnant control group,respectively.The TEG value and the traditional coagulation index were measured.The TEG parameters of the two groups were compared and analyzed,establishing a reference range for the parameters.We further analyzed the effect of full-term pregnancy on TEG results and the correlation between traditional coagulation index and TEG test results.Results The traditional coagulation index and TEG test results of the pregnant females andthe non-pregnant females were significantly different.According to the results,a new TEG reference range was established:R 3.9-7.5 min,K 1.0-2.4 min,α 57.6°-74.9°,MA 55.7-75.7 mm,LY30 0-0.56％,CI(-0.97)-3.6.Full-term pregnancy had no significant effect on TEG results.In addition to LY30,other parameters of TEG had some correlation with the traditional coagulation index.Conclusions The general TEG reference range does not apply to pregnant females and established TEG normal reference range for pregnant females can be applied for clinical use.

Thyroid abnormalities in term infants with fungal sepsis / Alterações tireoidianas no recém-nascido de termo com sepse fúngica

Summary Objective: To describe thyroid alterations in term newborns (TNB) with fungal sepsis during NICU hospitalization. Method: The study included six TNB that during the clinical and laboratory manifestations of sepsis with positive cultures for fungus showed changes in thyroid hormones, called low T3 syndrome and low T3-T4 syndrome. TNB that could present hormonal changes caused by disease as those born to mothers with thyroid disease, or who had perinatal asphyxia and major surgeries were excluded. Results: Of six TNB with fungal sepsis, five had positive culture for Candida albicans and one had positive culture for Candida tropicalis. Low T3 syndrome was observed in two TNB (50%), while T3-T4 syndrome was observed in other two (100%). The four children progressed to septic shock. Conclusion: Fungal sepsis is becoming more common among newborns admitted to NICU. Thyroid insufficiency could be a marker of disease severity with possible need for hormone supplementation.

Resumo Objetivo: descrever as alterações tireoidianas em recém-nascidos de termo (RNT) que apresentaram sepse fúngica durante internação na UTI neonatal. Método: foram incluídos seis RNT que, durante as manifestações clínicas e laboratoriais de sepse, com culturas positivas para fungo, apresentaram alterações dos hormônios tireoidianos, denominadas síndrome do T3 baixo e síndrome do T3 e T4 baixo. Foram excluídos RNT que apresentaram alteração hormonal por doença, como RNT filhos de mães com doença tireoidiana, asfixia perinatal e cirurgias de grande porte. Resultados: dos seis RNT com sepse fúngica, cinco apresentavam cultura positiva para Candida albicans e um para C. tropicalis. A síndrome do T3 baixo foi observada em duas crianças (50%) e a do T3 e T4 baixo em dois RN (100%). As quatro crianças evoluíram com choque séptico. Conclusão: a sepse fúngica é cada vez mais frequente nos recém-nascidos internados em UTI neonatal. A insuficiência tireoidiana pode vir a ser marcadora de gravidade da doença, e a suplementação hormonal pode ser necessária.

Impact of early repetitive painful procedures on pain response in full-term infants / 中华实用儿科临床杂志

Objective To explore the impact of early repetitive painful procedures on subsequent pain behaviors and physiological indicators in full-term infants.Methods Sixty-two full-term neonates were enrolled (male 36 cases,female 26 cases) from the medical center of neonatal care at Nanjing Children's Hospital Affiliated to Nanjing Medical University from March to May in 2009.The data of all painful procedures were performed on those neonates and their responses to them were collected by using digital video recording were collected.The Neonatal Facial Coding System C(NFCS) and Neonatal Infant Pain Scale(NIPS) were used prospectively to evaluate the pain response to painful procedures.Results The average experience of pain caused by operation on newborn at the hospital was 56.5 times (12-249 times),and the daily average was 5.9 times (4-26 times).After they were exposed to more than 10 repetitive pain procedures,the full-term neonates showed the declining pain response assessed by NFCS and NIPS during the subsequent painful procedures (NFCS:P10=0.012,P20=0.015,P30=0.041;NIPS:P10=0.006,P20=0.015,P30=0.049),and the temporarily enhanced pain response was observed in the preparation phase of the subsequent painful procedures (NFCS:P2＜0.001,P3＜0.001,P4=0.004,P5=0.009;NIPS:P2＜0.001,P3＜0.001,P4=0.045,P5 =0.031).Bnt there was no difference in preparation phase.There was no alternation in latency and crying time after repetitiing painful procedures,but the proportion of crying neonates in the preparation phase of the painful procedures was increased(P=0.032).Conclusions After exposed to repetitive pain,full-term neonates expressed hypoalgesia during subsequent painful procedures,but the temporary irritation was enhanced during the following phases exposed to stress.

Meta-analysis on partial risk factors of full-term infants with low birth weight / 中华流行病学杂志

Objective To evaluate the risk factors of fluil-term infants with low birth weight.Methods All related Chinese and English literatures published from 1980 to February 25,2016 were collected from CBM,CNKI,Wang Fang Data,Medline and Embase databases,and screened with inclusion and exclusion criteria and Stata13.0 software was used in this Meta-analysis.Results Twenty three studies were included and there were 278 020 subjects.Female infants (pooled OR=1.60,95％CI:1.49-1.72),less antenatal care visits (pooled OR=1.81,95％CI:1.54-2.11),maternal passive smoking (pooled OR=1.49,95％CI:1.08-2.06),pregnancy-induced hypertension (pooled OR=2.96,95％CI:1.85-4.74) and hypamnion (pooled OR=2.71,95％CI:1.87-3.93) were the risk factors for fluil-term infants with low birth weight.Conclusion Departments of maternal and health care should encourage pregnant women to have antenatal care visits to find and treat their pregnancy complications,and avoid passive smoking actively through health education for the purpose to prompt the birth quality of infants.