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Objective To determine the incidence and risk factors of retinopathy of prematurity (ROP) in preterm infants.Methods Fundus examinations were performed by RetCam Ⅱ ophthalmoscopy on 2185 premature infants (birth weight ≤ 2000 g or gestational age≤34 weeks)admitted into the neonatal intensive care unit of Beijing Bayi Children's Hospital from January 1st 2009 to December 31st 2010.According to the results,all infants were divided into ROP group and nonRO P group.Two-sample t test and Logistic regression analysis were used to investigate the risk factors of ROP.Results Among 2185 premature infants,287 (13.1 ％) cases were diagnosed with RO P.According to International Classification of RO P,34 cases (11.9 ％) were in zone Ⅰ,147 cases (51.2％) in zone Ⅱ,and 106 cases(36.9％) in zone Ⅲ.And there were 117 cases (40.8％) with stage 1 lesion,142 cases (49.5％) with stage 2 lesion,28 cases (9.7％) with stage 3 lesion,and no stage 4 or 5 lesion was identified.Thirty-six cases (12.5 ％) were accompanied by additional diseases.Logistic analysis showed that small gestational age (OR=0.859,95％CI:0.770-0.958,P=0.006),low birth weight (OR=0.729,95％CI:0.6340.838,P=0.000),long duration of oxygen supplement (OR=2.221,95％CI:1.904-2.592,P=0.000),assistant ventilation (OR=3.104,95％CI:2.0964.956,P=0.000),apnea (OR=1.767,95％CI:1.103 2.831,P=0.018) and=anemia (OR=2.242,95％CI:1.641-3.604,P=0.000) were independent risk factors of ROP.Conclusions The incidence of ROP in premature infants is high.Small gestational age and low birth weight,long duration of oxygen supplement,assistant ventilation,apnea and anemia are risk factors of ROP.Preventive measures should be taken against these factors.
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10.3969/j.issn.1000-3606.2013.06.015
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Objective To investigate the clinical features of sepsis caused by gram negative or positive pathogens and funguses in preterm infants.Methods The clinical data of 140 premature infants with sepsis admitted to preterm neonatal intensive care unit of Bayi Children's Hospital from October 2008 to June 2011 were collected and analyzed retrospectively.The clinical features of sepsis caused by different types of pathogens in preterm infants were compared by SPSS 18.0 software.Comparison of measurement data was conducted by one way ANOVA,and comparison between groups was performed by LSD method.Rates among groups were compared by Chi-square test or Fisher's exact test.Results Of 140 preterm infants with sepsis,70 cases were caused by gramnegative bacteria,36 by gram positive bacteria,and 34 by funguses.The top three gram negative sepsis pathogens were Klebsiella pneumonia (55.7 ％,n =39),Escherichia coli (20.0 ％,n =14) and Acinetobacter baumannii (12.9％,n =9).The top three gram positive sepsis pathogens were Staphylococcus epidermidis (36.1％, n =13), Staphylococcus hominis (22.2％, n =8) and Staphylococcus haemolyticus (19.4％,n=7).The top four fungus sepsis pathogens were Candida parapsilosis (44.1％,n=15),Candida albicans (23.5％,n=8),Candida famata (8.8％,n=3)and Cryptococcus laurentii (8.8％,n=3).There were no significant differences in delivery mode,fetal distress, asphyxia, fetal growth restriction, meconium-stained amniotic fluid, maternal infection,hypertensive disorder complicating pregnancy,gestational diabetes mellitus,peripherally inserted central venous catheter,mechanical ventilation before infection,cortical hormon（e） (e)xposure,intraventricular hemorrhage, periventricular leukomalacia, peripheral blood immature-to-total neutrophil ratio,recovery time of platelet,the time of infection onset,fever and hypothermia among the three groups (P＞0.05).While there were differences in gestational age [(30.4 ± 2.3) weeks,(31.0±2.4) weeks and (29.5±1.8) weeks,F=4.317,P=0.015],birth weight [(1512.5±406.0) g,(1563.8±485.4) g and (1328.8±303.2) g,F=3.190,P=0.044],premature rupture of membranes rate [24.3％ (17/70),16.7％ (6/36) and 44.1％ (15/34),X2 =7.241,P=0.034],rate of surgery during neonatal period [12.9％ (9/70),38.9％ (14/36) and 11.8％ (4/34),X2 =10.430,P=0.005],the incidence of lowperfusion [64.3％ (45/70),30.6％ (11/36) and 50.0％ (17/34),X2 =10.922,P=0.004],rate of frequent apnea [67.1％ (47/70),36.1％ (13/36) and 55.9％ (19/34),X2=9.341,P=0.009],incidence of low white blood cell [21.4％ (15/70),8.3％ (3/36) and 32.4％ (11/34),X2=6.267,P=0.042],thrombocytopenia rate [64.3％ (45/70),16.7％ (6/36)and 67.6％ (23/34),X2 =25.576,P=0.000],white blood cell count [(19.9± 17.8) × 109/L,(19.9±14.3) ×109/L and (12.0±8.1)×109/L,F=3.553,P=0.031],platelet count [(159.1±169.1) ×109/L,(311.8±179.7) ×109/L and (121.4±123.4) ×109/L,F=14.140,P=0.000],C-reactive protein [(76.8±70.1) mg/L,(16.6±27.2) mg/L and (31.8±27.5) mg/L,F=17.248,P=0.000],incidence of central nervous system infections [1.4％ (1/70),2.8％ (1/36) and 11.8％(4/34),X2 =5.066,P=0.043],retinopathy rate of premature infants [38.6％ (27/70),50.0％(18/36) and 67.7％ (23/34),X2 =8.780,P=0.012],bronchopulmonary dysplasia rate [8.6％ (6/70),11.1％ (4/36) and 26.5％ (9/34),X2=5.837,P=0.044] and mortality [11.4％ (8/70),0.0％ (0/36) and 2.9％ (1/34),X2 =5.361,P =0.042] among the three groups.Conclusions There are significant differences among sepsis caused by different types of pathogens in risk factors (gestational age,birth weight,premature rupture of membranes and neonatal surgical procedures),clinical manifestations,infection indexes and prognosis in preterm infants.Sepsis caused by gram negative bacilli liked to present shock with obvious increasing of C-reactive protein; and the prognosis is the worst.Central nervous system infection is more common in fungal infection; and the rates of retinopathy of prematurity and bronchopulmonary dysplasia are higher.Sepsis caused by gram positive cocci have mild clinical manifestations and infection indexes variations and better prognosis.
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ObjectiveTo compare the neonatal outcomes between infants of assisted conception (AC) and natural conception (NC). Methods A prospective case-control study was conducted.Eligible mothers were invited to this study at 28 weeks of gestation and were followed up to delivery.All newborns were examined by pediatricians right after birth.Data including gestational age,birth weight,admission to neonatal intensive care unit (NICU),and presence of any major malformation were collected.Statistical analysis was performed with SPSS 13.0.Difference between two groups was compared by x2 test. ResultsSix hundred and seventy-three newborns were enrolled into this study,including 325 in AC group and 348 in NC group.There were no differences between the demographic characteristics of the two groups,including maternal age,parents' education,family income and proportion of primipara (P＞0.05).The incidences of twins (32.62％ vs 3.45％,x2 =98.88),preterm birth (30.46％ vs 7.76％,x2=56.92),low birth weight infant (32.31％ vs 8.91％,x2 =57.07)and admission to neonatal intensive care unit (27.38％ vs 8.91％,x2 =39.16) and proportion of cesarean birth (62.77％ vs 21.55％,x2=117.64) in AC group were significantly higher than in NC group (all P＜0.01),except for the incidence of birth defect (4.62％ vs 2.59％,x2=2.01,P＞ 0.05).However,no significant differences was found in the above items when only singletons were compared between the two groups (P＞0.05),except for the cesarean section rate (61.18％ vs 22.03％,x2 =100.93,P＜0.01).There were no difference in any of the above neonatal outcomes when different assisted reproductive technologies applied were compared(in vitro fertilization-embryo transfer,intracytoplasmic sperm injection and frozen embryo transfer) (P＞0.05).Conclusions Neonatal outcome after assisted conception is a bit worse than natural conception,which might mainly due to the large proportion of multiple pregnancy after assisted conception.In order to improve neonatal outcome after assisted conception,the number of embryos transferred should be limited.