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Objective:To explore the early predictive value of umbilical cord blood S100β protein and lactate combined with amplitude integrated electroencephalogram（aEEG）in small for gestational age（SGA）preterm infants with brain injury.Methods:One hundred and six cases of SGA preterm infants were enrolled in this study in Neonatology Department of Inner Mongolia People's Hospital from January 2019 to December 2021. Umbilical cord blood serum S100β protein and lactate at birth of All SGA preterm infants were tested，and aEEG was monitored at 6h and 72 h after birth，corrected gestational age of 32 weeks and 37 weeks. According to the diagnostic criteria of brain injury in preterm infants，SGA preterm infants were divided into brain injury group（45 cases）and non-brain injury group（61 cases），and compared the differences of S100β protein，lactate and the designated time aEEG between the two groups.SGA preterm infants with brain injury were further divided into symmetrical group（28 cases）and non-symmetrical group（15 cases）. The differences of umbilical cord blood S100β protein and lactate level between the two groups were compared，and the diagnostic value in different types of SGA preterm infants with brain injury was also compared.Results:SGA preterm infants in the brain injury group had significantly higher levels of umbilical cord blood S100β protein［（0.826±0.218）μg/L vs（0.397±0.196）μg/L， t=8.316， P<0.05］and lactate［（8.5±1.3）mmol/L vs（3.8±0.9）mmol/L， t=3.281， P<0.05］than those in non-brain injury group.Symmetric SGA group had higher level of S100β protein than the asymmetric SGA group［（0.924±0.205）μg/L vs（0.438±0.196）μg/L， t=5.734， P<0.05］.But there was no statistically significant difference in lactate levels［（5.6±1.4）mmol/L vs（3.9±1.2）mmol/L， t=0.932， P>0.05］between symmetric SGA group and asymmetric SGA group. The abnormal rates of aEEG in brain injury group and non-brain injury group were respectively 100%（45/45）vs 22.95%（14/61）at 6 h after birth，95.56%（43/45）vs 16.39%（10/61）at 72 h after birth，62.22%（28/45）vs 6.56%（4/61）at 32 weeks of corrected gestational age，22.22%（10/45）vs 3.28%（2/61）at 37 weeks of corrected gestational age. The abnormal rate of brain injury group was higher than the non-brain injury group in the same nodal time，and the differences were statistically significant（ χ 2 value respectively 62.292，64.913，38.074，9.257，all P<0.05）. Conclusion:There were significant value in umbilical cord blood S100β protein，lactate level and aEEG monitoring in the early diagnosis in preterm infants SGA with brain injury. The combination of the three might be more helpful for the early diagnosis and timely treatment of brain injury in SGA preterm infants.
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Objective:To explore the high-risk factors for parenteral nutrition associated cholestasis（PNAC）in extremely/ultra-low birth weight infants，and establish a risk Alignment Diagram prediction model.Methods:We retrospectivly analyzed the clinical data of hospitalized extremely/ultra-low birth weight infants admitted to Neonatology Department at Quanzhou Children's Hospital from January 2019 to December 2020，using multivariate Logistic regression analysis to screen for independent risk factors for the occurrence of PNAC.An Alignment Diagram model prediction model for PNAC was constructed by using R software，and the performance of the model was evaluated through receiver operating characteristic curves.Results:A total of 203 extremely/ultra-low birth weight infants were included，with a median gestational age of 29.14（28.00，30.86）weeks and a median birth weight of 1 170（1 000,1 300）g.Among them，26（12.81%）cases developed PNAC.Multivariate Logistic regression analysis showed that the duration of parenteral nutrition（ OR=1.015 ，95% CI 1.003-1.034），the cumulative amount of glucose（ OR=1.014 ，95% CI 1.001-1.028），small for gestational age（ OR=3.455 ，95% CI 1.127-10.589），and neonatal sepsis（ OR=3.142 ，95% CI 1.039-9.503）were independent risk factors for PNAC（ P＜0.05）；The four independent risk factors mentioned above were introduced into R software to construct an Alignment Diagram model，the area under the receiver operating characteristic curve was 0.835（95% CI 0.842-0.731），and the results of the Hosmer Limeshow goodness of fit test show that：χ 2=5.34，degree of freedom=8， P=0.72.A calibration curve indicated good consistency between the predicted probability of the model and the actual occurrence rate，with good accuracy. Conclusion:The Alignment Diagram model constructed based on four independent risk factors of the duration of parenteral nutrition，glucose accumulation，small for gestational age infants，and neonatal sepsis exhibits high predictive ability，and is expected to provide an intuitive and convenient visualization tool for preventing or reducing the occurrence of PNAC in extremely/ultra-low birth weight infants
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Objective:To study the clinical characteristics and risk factors of necrotizing enterocolitis (NEC) in one of the premature twins.Methods:A retrospective study was conducted on twin premature infants who were admitted to the Department of Neonatology at the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2022 and only one got NEC. The twins were divided into NEC group and control group, the clinical data were collected and analyzed by SPSS 26.0 statistical software.Results:This study enrolled 109 pairs of premature twins, 109 cases in the NEC group, and 109 cases in the control group. Univariate analysis showed that birth weight, pre NEC white blood cell count were lower in NEC group than those in the control group, while the proportion of smaller than gestational age (SGA), donor of twin-to-twin transfusion syndrome, feeding intolerance, incomplete enteral feeding, start feeding time >48 h, red blood cell transfusion 72 h before NEC onset and the neutrophils ratio were higher in the NEC group than that of the control group, the difference was statistically significant ( P<0.05). Multivariate logistic analysis showed that low birth weight ( OR=1.558, 95% CI1.197-2.142), SGA ( OR=1.721, 95% CI 1.217-2.536), feeding intolerance ( OR=3.798, 95% CI 1.347-10.706), and incomplete enteral feeding ( OR=4.319, 95% CI 1.673-11.149) were independent risk factors for NEC ( P<0.05). Conclusions:Low birth weight, small for gestational age, feeding intolerance, and incomplete enteral feeding are independent risk factors for NEC in one of the premature twins.
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Objective To explore the optimal protocol for treating apnea of prematurity by analyzing the effectiveness of different noninvasive assisted ventilation modes combined with caffeine citrate in preterm infants.Methods From October 2019 to August 2022,a total of 90 infants with apnea of prematurity(gestational age≤34 weeks)were chosen as research objects in the Neonatal Intensive Care Unit of the Second Affiliated Hospital of Bengbu Medical College,and the relevant data were retrospectively analyzed.The children were divided into nasal continuous positive airway pressure(NCPAP)combined with caffeine citrate group(44 cases),and noninvasive inter-mittent positive pressure ventilation(NIPPV)sequential NCPAP combined with caffeine citrate group(46 cases)according to the differ-ent treatment protocols adopted in the clinical treatment process.The general clinical data,apnea efficacy,treatment time,and occur-rence of adverse effects between the two groups of prematurity were compared statistically by t-test,x2test,and Mann-Whitney rank sum test.Results The total efficiency of the NIPPV sequential NCPAP combined with caffeine citrate group in treating apnea of prematu-rity was 91.30％,higher than 86.36％in NCPAP combined with caffeine citrate group,and the difference was statistically significant(P＜0.05).Statistically significant differences in failure of non-invasive ventilation and associated treatment time between the two groups(P＜0.05)were observed.The difference between the two groups in the incidence of feeding intolerance and nasal injury was sta-tistically significant(all P＜0.05).Conclusion Early adoption of NIPPV sequential NCPAP ventilation mode can achieve better clinical results,shorten treatment and hospitalization time,and have relatively fewer adverse effects than traditional NCPAP alone in treating apnea of prematurity,which is worthy of clinical promotion.
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【Objective】 To analyze the effect of extensively hydrolyzed formula(eHF) in the treatment of feeding intolerance in preterm infants and the effect on hospital infection, in order to provide reference for the clinical treatment of feeding intolerance in preterm infants. 【Methods】 A total of 208 cases of preterm infants with feeding intolerance diagnosed and treated in Shandong Heze Municipal Hospital from April 2017 to February 2020 were selected into the clinical trial for eligibility assessment, then were randomly assigned into study group(n=100) and control group(n=100) after screening and exclusion. Children in the control group were fed with standard preterm formula, while children in the study group were fed with eHF. Feeding tolerance indicators, including daily milk intake, time to meconium evacuation, time to full gastrointestinal nutrition, total gastric residual counts(GRV1) in the 7-d period after resumption of breastfeeding, ratio of all-day gastric residual counts/all-day estimated milk intake after resumption of breastfeeding(GRV2) were compared between the two groups, and growth indicators(body weight growth rate, head dimension growth rate), complication incidence [necrotizing enterocolitis(NEC), pathological jaundice, positive fecal occult blood or blood in stool] and incidence of hospital-acquired infections. 【Results】 The daily milk intake(t=5.037) of the study group was higher than that of the control group, and the time of foetal excretion(t=9.217), the time to reach full gastrointestinal nutrition(t=15.833), GRV1(t=6.737), GRV2(t=9.956) were lower than those of the control group, and the differences were all statistically significant(P<0.05). The rate of weight gain(t=2.454) and head dimension growth(t=5.469) in the study group was significantly higher than those of the control group(P<0.05). The incidence of the three complications of NEC, pathological jaundice and positive fecal occult blood or blood in stool(χ2=4.310) and the incidence of hospital infections(χ2=4.688) were significantly lower in the study group than in the control group(P<0.05). 【Conclusions】 Compared with the standard formula milk for preterm infants, eHF can significantly improve the feeding intolerance of preterm infants, promote growth and development, and reduce the occurrence of hospital-acquired infections. Therefore, eHF can be widely used in clinic for preterm infants with feeding intolerance.
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【Objective】 To understand the prevalence of retinopathy (ROP) in preterm infants with gestational age ≤34 weeks in the First Affiliated Hospital of Xinjiang Medical University, and to analyze the associated risk factors, so as to provide a basis for early screening of high-risk premature infants. 【Methods】 A retrospective analysis was conducted on the relevant case data of hospitalized premature infants with gestational age ≤34 weeks in neonatal intensive care unit (NICU) of the First Affiliated Hospital of Xinjiang Medical University from June 2015 to June 2020. Infants were divided into ROP group and non-ROP group based on the results of fundus screening. Relevant data were collected to analyze the relevant risk factors for ROP in premature infants. 【Result】 A total of 1 738 premature infants with gestational age ≤34 weeks were included, with 292 cases (16.8%) in ROP group and 1 446 cases in non-ROP group. Logistic regression analysis revealed that bronchopulmonary dysplasia(BPD) (OR=3.379, 95%CI:1.835 - 6.221), anemia (OR=7.388, 95%CI: 4.262 - 12.806), receiving blood transfusion treatment (OR=2.129, 95%CI: 1.278 - 3.547), oxygen requirement time >7 days (OR=3.429, 95%CI: 2.309 - 5.094), and the fraction of inspired oxygen greater than 40% (OR=2.541, 95%CI: 1.540 - 4.193) were independent risk factors for the occurrence of ROP. Among these patients, 167 eyes (103 patients) received treatment of ROP, including 108 eyes treated with intraocular injection of Rizumab, 35 eyes treated with fundus laser, and 24 eyes treated with combination of both. All patients had acceptable outcomes during the follow-up. 【Conclusions】 Premature infants with anemia, BPD, receiving blood transfusion treatment, oxygen requirement time >7 days, and the fraction of inspired oxygen >40% are at high risk of developing ROP. Standardized fundus screening and timely treatment measures are essential to reduce the risk of visual impairment in premature infants.
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Abstract Objectives To evaluate the therapeutic effect of Saccharomyces boulardii supplementation on jaundice in premature infants undergoing phototherapy. Methods In this article, the authors reviewed 100 hospitalized jaundiced premature infants under 35 weeks of gestational age. All infants were assigned to a control group (n= 45) and a treatment group (n= 55) randomly. The infants in the treatment group received S. boulardii supplementation by undergoing phototherapy and the infants in the control group were only treated by phototherapy. The total serum bilirubin levels were detected before and at the end of phototherapy, and transcutaneous bilirubin levels were measured on the 1st, 4th, 8th and 15th day of treatment. The duration of jaundice resolution and phototherapy, stool frequency, and characteristics were compared after phototherapy. Results The duration of jaundice resolution and phototherapy were shortened. Total serum bilirubin level was lower than the control group at the end of phototherapy (p < 0.05). Transcutaneous bilirubin levels decreased more significantly on the 8th and 15th day of treatment (p < 0.05), while there were no significant differences on the post-treatment 1st and 4th day (p > 0.05). In addition, bowel movements including stool frequency and Bristol Stool Form Scale ratings of stools also improved after treatment. Conclusions S. boulardii in combination with phototherapy is effective and safe in reducing bilirubin levels and duration of phototherapy, accelerating jaundice resolution in premature infants with jaundice. The procedure also provided an ideal therapeutic effect of diarrhea induced by phototherapy to promote compliance and maternal-infant bonding.
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Due to the development of neonatal intensive care, the survival rate of very preterm infants and very low birth weight infants has been significantly improved, and the incidence of bronchopulmonary dysplasia (BPD) has been obviously increasing year by year.The pathogenesis of BPD has not been clear, it is considered that inflammation is an important link in the occurrence and development of BPD at present.Neutrophils can use their neutrophil extracellular traps (NETs) to capture and kill pathogens and reduce inflammation, but excessive formation of NETs is easy to induce inflammatory imbalance, so as to damage normal cells or tissues and participate in the pathophysiological process of BPD.This paper reviews the structure, formation, function and regulatory role of NETs in BPD, and the targeted treatment strategies and potential research directions of NETs in BPD.
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Objective:To establish a prompt based feeding process for premature infants and explore its application effects.Methods:This study was a quasi-experimental research method. Firstly, the best evidence of prompt feeding for premature infants was systematically searched and summarized, and the expert consultation method and clinical practice were used to finally formulate a prompt feeding process for premature infants. The process was applied to clinical practice. A total of 82 hospitalized premature infants in the neonatal intensive care unit of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2021 to March 2022 were selected as the control group, and routine feeding management was implemented. A total of 86 hospitalized premature infants from April to September 2022 were selected as the observation group. Feeding management for premature infants based on the prompt feeding process was followed, and the feeding efficiency, transition time of full oral feeding, and days of gastric tube retention, hospital stay and the incidence of feeding related complications in the two groups were compared.Results:The effective recovery rates of the two rounds of expert correspondence questionnaires were 100%, and the authoritative coefficients of expert opinions were 0.863 and 0.875, respectively. The Kendall harmony coefficients of expert opinions were 0.156 and 0.202, respectively, and the significance tests were all P<0.05. The total oral feeding rate of the observation group was 59.84%(5 256/8 784), the mixed feeding rate was 12.26%(1 077/8 784), and the tube feeding rate was 27.90%(2 451/8 784). Compared with the control group′s 52.20%(4 698/9 000), 14.68%(1 321/9 000), and 33.12%(2 981/9 000), the difference was statistically significant ( χ2 = 105.21, P<0.05). The transition time of full oral feeding, number of days of gastric tube retention, and hospitalization time in the observation group were (5.14 ± 1.67), (6.13 ± 1.62), and (12.77 ± 1.37) days, respectively. Compared with the control group′s (6.22 ± 1.59), (7.17 ± 1.55), and (13.72 ± 1.72) days, the differences were statistically significant ( t = 4.206, 4.26, 3.97, all P<0.05). The incidence of milk choking, hypoxia, and vomiting in the observation group were 9.30%(8/86), 6.98%(6/86), and 11.63%(10/86), respectively, which were lower than the 23.17%(19/82), 19.51%(16/82), and 34.15%(28/82) of the control group. The difference between the two groups was statistically significant ( χ2 = 5.99, 5.80, 12.16, all P<0.05). Conclusion:The application of prompt feeding process in premature infants can shorten the transition time of full oral feeding, promote the feeding process, reduce the complications caused by poor feeding, and ensure the feeding safety of premature infants.
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The pathophysiology of neonatal necrotizing enterocolitis (NEC) is not clear, but is considered to be multifactorial.Immaturity of the gut, hypoxia-ischemia, formula feeding and microbial dysbiosis play roles in inducing intestinal inflammatory response.This review discussed the development process of infant gut microbiota, the factors affecting neonatal intestinal colonization, the roles of gut microbiome in the pathogenesis of NEC, and the manifestations of early microecology disorder in NEC.In addition, studies on the use of probiotics to prevent NEC and the risks of using probiotics in preterm infants were also summarized.
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Bronchopulmonary dysplasia (BPD) in premature infants is a chronic lung disease caused by multiple factors that work together to cause alveolarization disorders on the basis of immature lung development.It often requires long-term oxygen therapy or repeated mechanical ventilation treatment.In addition to pulmonary lesions, children with BPD are prone to extrapulmonary complications due to various factors, such as white matter damage, cholestasis, and metabolic bone disease.Therefore, clarifying the relationship between premature BPD and its related complications, understanding the high-risk factors leading to extrapulmonary complications, may be of great significance for improving the long-term prognosis of BPD patients.
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Objective:To investigate the clinical utility of intracavitary electrocardiogram (IC-ECG) localization technique in locating the tip of umbilical venous catheterization (UVC).Methods:From April 2020 to March 2021, premature infants admitted to the Department of Neonatology of the Third Affiliated Hospital of Guangzhou Medical University and received UVC were collected for a prospective study. According to whether IC-ECG was used to determine the position of umbilical vein catheter tip during catheterization, they were divided into IC-ECG group and control group. The differences of catheterization success rate, total incidence of catheter-related complications were compared between the two groups. The relationship between characteristic P waves and the position of the catheter tip in the IC-ECG group was also analyzed.Results:A total of 104 premature infants were enrolled, including 52 cases in IC-ECG group and 52 cases in control group. The catheter placement accuracy rate of the IC-ECG group was higher than that of the control group (53.8% vs. 28.8%, P<0.05). There was no statistically significant difference of the total incidence of catheter-related complications between the two groups ( P>0.05). Among the 40 cases with characteristic P wave changes in the IC-ECG group, 21 cases had normal P wave, of which 13 cases (61.9%) were with the correct position. And 19 cases had low-amplitude bimodal P waves, of which 15 cases (78.9%) were with the correct position. There was no statistically significant difference of the exact position rate of the catheter tips between the two types of P waves ( P>0.05). Conclusions:The use of IC-ECG localization technique in the process of catheterization of umbilical vein can increase the exact position rate of catheterization. Furthermore, when IC-ECG monitoring shows characteristic P wave changes to normal P wave or low-amplitude bimodal P wave, the tip of the UVC catheter may be located accurately.
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OBJECTIVE To systematically evaluate the efficacy and safety of prophylactic use of low-dose hydrocortisone （HC） for the prevention and treatment of bronchopulmonary dysplasia （BPD）， and to provide evidence-based reference for clinical treatment. METHODS PubMed， Embase， Web of Science， Cochrane Library， CJFD， VIP and Wanfang databases were searched by computer； randomized controlled trials （RCT） about prophylactic use of low-dose HC （trial group） versus placebo or dopamine （control group） in very premature infants were collected from the establishment of the database to Jun. 2022. The quality of the included literature was evaluated by using bias risk assessment tool recommended by Cochrane system evaluator’s manual （version 6.2） after screening the literature and extracting the data. Meta-analysis， sensitivity analysis and publication bias analysis were carried out with RevMan 5.3 statistical software. RESULTS A total of 1 437 very premature infants were included in 9 RCTs. Meta- analysis showed that the incidence of BPD [OR＝0.75， 95%CI（0.58，0.95）， P＝0.02] and fatality [OR＝0.72， 95%CI （0.54， 0.97）， P＝0.03] in trial group were significantly lower than control group； the survival rate without BPD [OR＝1.36， 95%CI （1.06，1.74）， P＝0.02]， the incidences of gastrointestinal perforation [OR＝2.23， 95%CI （1.31，3.78）， P＝0.003] and sepsis [OR＝ 1.27， 95%CI （1.01，1.60）， P＝0.04] in trial group were all significantly higher than control group. There was no significant difference in the incidence of necrotizing enterocolitis， paraventricular leukomalacia， intraventricular hemorrhage， patent ductus arteriosus， hyperglycemia， pneumothorax， retinopathy of premature infants between the two groups （P＞0.05）. Results of sensitivity analysis showed that study results were robust. Results of publication bias analysis showed that there was little possibility of publication bias in this study. CONCLUSIONS The early prophylactic use of low-dose HC can reduce BPD in very premature infants， reduce fatality， and improve the survival rate without BPD， but we should pay attention to gastrointestinal perforation and sepsis.
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The hypothalamic-pituitary-thyroid axis gradually becomes mature at gestational age of 30~35 weeks.With the improvement of the treatment level of premature infants, the gestational age of surviving premature infants gradually decreases, and the thyroid axis of young premature infants is immature.Meanwhile, premature infants are more prone to systemic complications, such as ischemia and hypoxia, severe infection, etc., which aggravate the influence on thyroid.Clinically, more and more premature infants are found to be complicated with congenital hypothyroidism, temporary hypothyroxemia, hyperthyrotropin, delayed thyrotropin elevation, low T 3 syndrome and other problems.Abnormal thyroid function affects the outcome of the treatment of premature infant diseases.Early detection and early treatment is the key to improve the treatment, metabolism and the development of premature infant.At present, the timing of screening and treatment of premature thyroid disease is still controversial.In this review, the thyroid function and outcome of premature infants under different pathological conditions are summarized and analyzed to provide a reliable basis for rational selection of screening opportunities and treatment strategies for thyroid diseases in clinical practice.
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Spontaneous intestinal perforation(SIP) is one of the causes of digestive tract perforation in premature infants and requires surgical intervention.Except for preterm delivery, the etiology and pathogenesis of SIP remain unclear.The studies have shown that it may be related to the application of magnesium sulfate, nonsteroidal anti-inflammatory drugs, hormones, vasoactive drugs and low perfusion status, infection, congenital intestinal dysplasia, non-invasive respiratory support, delayed nutrition initiation and other factors.In the management of premature infants, it is particularly important to improve the understanding of SIP, early diagnosis and treatment.
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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.
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Objective:To investigate the trend of posttraumatic stress disorder (PTSD) in the mothers of preterm infants within 6 months and analyze the related factors.Methods:There were 171 mothers of premature infants selected by convenience sampling method who received outpatient follow-up from Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University from July 2018 to November 2019. The mothers were evaluated by post-traumatic stress disorder questionnaire from corrected age 1 month to 6 months of preterm infants, and the general data, maternal anxiety and family management were investigated as well. Linear regression analysis was used to determine the influencing factors of post-traumatic stress disorder for preterm infants within corrected 6 months.Results:The incidence of posttraumatic stress disorder in mothers of premature infants was significantly higher than the domestic norm. The incidence was 35.09%(60/171) in 1 month and the highest score was 4.80 ± 2.09, and then gradually decreased to 12.06%(17/141) in 6 months, with an average score of 3.41 ± 1.82. The results of linear regression analysis showed that the birth weight of preterm infants, hospital stay and the age of the mother, the maternal anxiety score, the Family Management Measure score, re-hospitalization after discharge were the influencing factors of the maternal PTSD score ( t values were -247 - 3.08, all P<0.05). Conclusions:The incidence of post-traumatic stress disorder in mothers of preterm infants within 6 months is higher. Although the incidence gradually decreases over time, it is still significantly higher than the average level, which deserves clinical attention. The mothers of premature infants with low birth weight, long hospital stay and young mothers should be alert to the occurrence of PTSD. During the hospitalization of premature infants, family participatory nursing should be provided as much as possible to improve mothers′ confidence in caring. Alleviating mother′s anxiety, maintaining good family relationship, improving family management ability and providing continuous nursing service after discharge are beneficial to prevent mother from having post-traumatic stress disorder.
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Bronchopulmonary dysplasia(BPD)is a chronic respiratory disease characterized by alveolar and pulmonary microvascular dysplasia.It happens in premature infants, which is a major cause of death and long-term complications in premature infants.Chest radiology examination is essential for BPD, which not only reveals main radiological features such as pulmonary hyperinflation, pulmonary fibrosis and atelectasis, but also evaluates the severity and progression.These provide significant information for clinical treatment and follow-up study of children with BPD.
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Bronchopulmonary dysplasia(BPD) is an important cause of premature infant mortality and long-term organ dysfunction in survivors.There is currently no fundamental treatment for BPD, and glucocorticoids are often used clinically to reduce the risk and severity of BPD.There are systemic administration, inhalation administration and transtracheal administration of glucocorticoids for the prevention and treatment of BPD.Glucocorticoids provide benefits such as anti-inflammatory, but may also cause side effects such as neurodevelopmental impairment.There are various schemes for the dosage form, timing of administration, and cumulative dose of glucocorticoids administration.The clinical advantages and disadvantages of different schemes are inconsistent and controversial.Higher quality clinical trials are needed to provide evidence to support the use of glucocorticoids for the prevention and treatment of BPD.
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Objective:To analyze the potential risk factors of periventricular-intraventricular hemorrhage(PIVH)in premature infants.Methods:A retrospective study was conducted on clinical data of 279 premature infants admitted to the Affiliated Hospital of Guizhou Medical University From January 1, 2019 to December 31, 2019, who completed cranial ultrasound during hospitalization.According to the cranial ultrasound with or without PIVH, the cases were divided into PIVH group and non-PIVH group.The premature infants with PIVH were divided into severe PIVH(grade Ⅲ and Ⅳ)group and mild PIVH(grade Ⅰand Ⅱ)group according to the PIVH grades.A total of 25 factors, which may influnce PIVH, were analyzed by univariate analysis, and then multivariate Logistic stepwise regression analysis(stepwise backwards method)was performed to determine the major risk factors.Results:(1)A total of 279 premature infants were included in the study, 133 of them in PIVH group, and 146 of them in non-PIVH group.Univariate analysis showed that there were statistically significant differences in 14 factors between two groups, including full treatment of antenatal steroid, gestation age, birth weight, neonatal asphyxia, hypothermia, early onset sepsis, metabolic acidosis, hypernatremia, anemia, respiratory distress syndrome, noninvasive ventilation, invasive ventilation, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth( P<0.05). Multivariate analysis showed that gestational age( OR=0.709, 95% CI 0.602-0.835), and full treatment of antenatal steroid( OR=0.354, 95% CI 0.189-0.664) were protective factors for PIVH in premature infants, while neonatal asphyxia( OR=2.425, 95% CI 1.171-5.023), hypothermia( OR=2.097, 95% CI 1.088~4.041), early onset sepsis( OR=12.898, 95% CI 1.433-115.264), metabolic acidosis( OR=2.493, 95% CI 1.398-4.442), invasive ventilation within 72 hours after birth( OR=5.408, 95% CI 1.156-25.297), lumbar puncture within 72 hours after birth ( OR=5.035, 95% CI 1.269-19.993) were independent risk factors for PIVH in premature infants( P<0.05). (2) Among 133 cases of premature PIVH, 20 cases were severe PIVH and 13 cases were mild PIVH.Univariate analysis showed that there were statistically significant differences in 5 factors between two groups, including antenatal magnesium sulfate, gestation age, early onset sepsis, abnormal coagulation, and lumbar puncture within 72 hours after birth.Multivariate analysis showed that early onset sepsis( OR=4.392, 95% CI 1.343-14.367) and abnormal coagulation( OR=3.502, 95% CI 1.234-9.867) were independent risk factors for severe PIVH in premature infants( P<0.05). Conclusion:Gestational age is negatively correlated with the occurrence of PIVH in premature infants, and completion of more than a course of treatment for antenatal dexamethasone is an independent protective factor of PIVH in premature infants.Neonatal asphyxia, metabolic acidosis, hypothermia(<35 ℃), early onset sepsis, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth are independent risk factors for PIVH in premature infants.Abnormal coagulation and early onset sepsis are independent risk factors for severe PIVH in premature infants.