Use of antenatal corticosteroids among infants with gestational age at 24 to 31 weeks in 57 neonatal intensive care units of China: a cross-sectional study / 中华医学杂志(英文版)

BACKGROUND@#Antenatal corticosteroids (ACS) can significantly improve the outcomes of preterm infants. This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units (NICU) and to explore perinatal factors associated with ACS use, using the largest contemporary cohort of very preterm infants in China.@*METHODS@#This cross-sectional study enrolled all infants born at 24 +0 to 31 +6 weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st, 2019 to December 30th, 2019. The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery. Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.@*RESULTS@#A total of 7828 infants were enrolled, among which 6103 (78.0%) infants received ACS. ACS use rates increased with increasing gestational age (GA), from 177/259 (68.3%) at 24 to 25 weeks' gestation to 3120/3960 (78.8%) at 30 to 31 weeks' gestation. Among infants exposed to ACS, 2999 of 6103 (49.1%) infants received a single complete course, and 33.4% (2039/6103) infants received a partial course. ACS use rates varied from 30.2% to 100% among different hospitals. Multivariate regression showed that increasing GA, born in hospital (inborn), increasing maternal age, maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.@*CONCLUSIONS@#The use rate of ACS remained low for infants at 24 to 31 weeks' gestation admitted to Chinese NICUs, with fewer infants receiving a complete course. The use rates varied significantly among different hospitals. Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.

The efficacy of caffeine in the prevention of apnea in small gestational age of premature infants / 天津医药

Objective To explore the therapeutic effect and security of caffeine citrate in preventing primary apnea of preterm infants by observing the clinical effect, adverse reaction and prognosis of caffeine citrate preventing the primary apnea. Methods A total of 132 preterm infants admitted to neonatal department of Tianjin Central Hospital of Obstetrics and Gynecology were selected during January 2015 to July 2016. They were randomly divided into two groups, one was the caffeine group, and the other was the control group. The infants of caffenine group were intravenous injected caffeine citrate 24 hours after birth, with the first dose 20 mg/kg, and the maintain dose 5 mg/kg every 24 hours, until the corrected gestational age was 34 weeks. The infants of control group were not given methylxanthine drugs. Data were compared between two groups including the incidence of apena after 48 hours of giving drugs, the period of using nasal continuous positive airway pressure (n-CPAP) or ventilator, the incidence of feeding intolerance, tachycardia, patent ductus arteriosus (PDA), intracranial hemorrhage (HIE), necrotizing enterocolitis (NEC),and bronchopulmonary dysplasia (BPD), weight growth rate and the length of hospitalization. Results There were significantly lower incidence of apnea after 48 hours, the period of using nasal continuous positive airway pressure or ventilator, incidence of patent ductus arteriosus and intracranial hemorrhage and the duration of hospitalization in caffeine group than those in control group (P 0.05). Conclusion The preterm infants given caffeine could reduce the incidence of the primary apnea, improve the prognosis of the preterm infants, and no significant adverse reaction.

Risk factors and prevention strategies of perinatal brain injury in premature infants / 中华实用儿科临床杂志

Life quality of the premature babies after rescuing successfully was gained more attention by perina-tal medical field and society with the more success rate of premature rescue. The brain injury is one of the main factors affecting the long term prognosis of the premature infants. The major risk factors of brain damage include gestational age and birth weight,intrauterine hypoxia and infection,the mode of delivery and whether the resuscitation and later treat-ment skills proper and skilled,and so on. So the key point of preventing the brain injury is avoiding premature delivery and extending the gestational age as much as possible. If the premature delivery could not evitable,the obstetrician should use adrenal cortex hormones before delivery to promote fetal lungs maturition,since the increasing application of cortical hormone prenatally and decreasing using that after birth have been shown good effects on long term prognosis of the nervous system in the preterm infants. It is also confirmed that application of magnesium sulfate prenatally could prevent the premature brain injury. There are still no agreements on the relationship between the delivery modes and the brain injury of extremely low birth weight infants. But prolonging the stage of labor is sure to increase the incidence of intracranial hemorrhage in the premature infants thereby affecting the long term prognosis. After birth,we should imple-ment the correct resuscitation processes by skilled and proper technical methods,in order to decrease the mortality and to improve the long term prognosis.