Risk factors for failure of nasal high frequency oscillatory ventilation as initial therapy in very low birth weight infants with respiratory distress syndrome / 中国新生儿科杂志

Objective:To study the risk factors of failure using nasal high frequency oscillatory ventilation (nHFOV) as initial therapy in the treatment of respiratory distress syndrome (RDS) in very low birth weight infants (VLBWIs).Methods:From January 2018 to December 2021, VLBWIs with RDS initially supported by nHFOV in NICU of our hospital were retrospectively analyzed. They were assigned into success and failure groups according to the ventilation efficacy. Demographic data and clinical outcomes of the two groups were compared. Risk factors of initial nHFOV failure were analyzed using binary Logistic regression method.Results:A total of 135 infants were included, including 103 in the success group and 32 in the failure group. The initial nHFOV failure rate was 23.7%. The failure group had lower pH (7.26±0.09 vs. 7.33±0.08) and PaO 2 [61.0 (49.6, 77.2) mmHg vs. 83.6 (64.4, 99.0) mmHg] than the success group ( P<0.05) and higher PaCO 2 than the success group [49.0 (42.3, 58.1) mmHg vs. 43.4 (36.0, 50.0) mmHg] ( P<0.05). Using PaCO 2 as predictor, the area under the curve (AUC) was 0.682 (95% CI 0.575-0.788) and the cut-off value was 44.8 mmHg for nHFOV failure and the AUC was 0.716 (95% CI 0.615-0.817) and the cut-off value was 67.1 mmHg for nHFOV success. The incidences of early onset sepsis (EOS), shock within 3 d and hemodynamically significant patent ductus arteriosus (hsPDA) in the failure group were significantly higher than the success group (40.6% vs. 7.8%, 53.1% vs. 2.9%, 31.3% vs. 13.6%, P<0.05, respectively). Binary logistic regression analysis found that PaO 2<67.1 mmHg ( OR=5.458,95% CI 1.730-17.220) on the first blood gas analysis and shock within 3 d ( OR=26.585,95% CI 3.854-183.396) were independent risk factors for initial nHFOV failure ( P<0.05). Conclusions:The failure of initial nHFOV is correlated with the first blood gas parameters, EOS, hsPDA and shock within 3 d. Shock within 3 d and low PaO 2(<67.1 mmHg) were independent risk factors for initial nHFOV failure.

Changes of peripheral perfusion index in very low birth weight infants with late-onset sepsis / 中国小儿急救医学

Objective:To analyze the changes of peripheral perfusion index (PPI) with late-onset sepsis (LOS) in very low birth weight infants during hospitalization.Methods:Very low birth weight infants admitted to the neonatal intensive care unit of Children′s Hospital of Fudan University from August 1, 2021 to August 31, 2022 were consecutively included.Infants with admission age ≥three days and unstable circulation, or positive blood culture within three days after birth were excluded.From the day of admission, the PPI values of the right hand and either foot of the infants were measured with Masimo SET Radical-7 everyday while whether LOS occurred during hospitalization was observed.The mean PPI curve of very and extremely low birth weight infants without LOS was plotted.For those with LOS confirmed by blood culture, the PPI change trajectory three days before and after the occurrence of LOS was drawn, and the change trend of PPI before the occurrence of LOS was analyzed by trend chi-square test.Non-parametric test was used to analyze the effect of LOS on pre- and post-ductal PPI values.Results:A total of 107 very low birth weight infants were included in the final analysis.Among them, there were 11 infants confirmed as LOS by blood culture, 37 infants diagnosed as clinical LOS, and 59 infants without LOS.Pre-and post-ductal PPI values of very low birth weight infants without LOS were 2.06±1.30 and 1.72±0.92, respectively; those with clinical LOS were 1.90±0.94 and 1.58±0.83, respectively; those with LOS confirmed by blood culture were 1.92±1.11 and 1.62±0.82, respectively.For infants with LOS confirmed by blood culture, the pre-and post-ductal PPI values showed a continuous downward trend during three days before the onset of disease, with the lowest PPI values on the first day before the diagnosis of blood culture.The downtrend of pre-ductal PPI was statistically significant ( χtrend2=5.57, P<0.05). Conclusion:The PPI value of very low birth weight infants show a downward trend when LOS occurs.It should be observed dynamically in clinical practice, which is helpful to suspect or identify LOS as early as possible.

Risk factors for pulmonary hemorrhage in very low and extremely low birth weight infants / 国际儿科学杂志

Objective:To analyze the risk factors of pulmonary hemorrhage in very low and extremely low birth weight, and to provide reference for the treatment of pulmonary hemorrhage.Methods:The clinical data of very low and extremely low birth weight infants hospitalized in Qingdao Women and Children′s Hospital NICU from January 2017 to December 2021 were retrospectively analyzed.Eighty-six infants who were diagnosed with pulmonary hemorrhage were selected as the pulmonary hemorrhage group, and two hundred and two infants without pulmonary hemorrhage were selected as the control group.The differences of the survival rates, complications and parameters of platelet between the two groups were compared, and the risk factors of pulmonary hemorrhage by multivariate Logistic regression were analyzed.Results:The survival rate of pulmonary hemorrhage group and control group were 65.1%(56/86) and 90.1%(182/202), respectively.The survival rate of control group was significantly higher than that in the pulmonary hemorrhage group( χ2=26.241, P<0.01). There was no significant difference in fluid intake between the two groups within three days after birth( t=0.936, 1.811, 1.840, P=0.350, 0.073, 0.069). The multivariate Logistic regression analysis showed hemodynamically significant patent ductus arteriosus( OR=2.304, 95% CI: 0.213~1.564, P=0.010), disseminated intravascular coagulation( OR=3.143, 95% CI: 0.061~2.521, P=0.028), thrombocytopenia( OR=0.991, 95% CI: -0.015~-0.005, P=0.001) and low mean platelet volume( OR=0.337, 95% CI: -1.657~-0.739, P=0.001) were the risk factors of pulmonary hemorrhage. Conclusion:Hemodynamically significant patent ductus arteriosus, disseminated intravascular coagulation, thrombocytopenia and low mean platelet volume were associated with increased risks for pulmonary hemorrhage in very low and extremely low birth weight.These risk factors should be actively monitored and treated, which is helpful to early identify and prevent pulmonary hemorrhage.

Establishment of risk prediction model for nosocomial infection in preterm very low birth weight infants / 中国热带医学

@#Abstract: Objective　To establish a risk prediction model for nosocomial infection in preterm very low birth weight infants, and conduct internal validation. Methods　A total of 206 cases of very low birth weight premature infants hospitalized in the Department of Neonatology of Union Hospital Affiliated to Tongji Medical College from January 2018 to June 2020 were included in this study, factors that may affect the nosocomial infection of children were collected, and the infants were divided into two groups according to whether there is nosocomial infection. The influencing factors were compared between the two groups, and multivariate Logistic regression analysis was performed after screening variables with LASSO regression. According to the results of multi factor analysis, the nomogram model was constructed and verified internally. Results　A total of 29 of 206 children had nosocomial infection (14.08%), and 33 pathogenic bacteria were detected, including 23 Gram-negative bacteria, 9 Gram-positive bacteria and 1 fungus. The results of multivariate logistic regression analysis based on LASSO regression showed that the risk factors for nosocomial infection of VLBW premature infants were 28-31+6 weeks of gestation, amniotic fluid pollution, mechanical ventilation, indwelling gastric tube, unreasonable use of antibiotics, and hospitalization time ≥ 7 days. The protective factors were Apgar score ≥ 7 points at 1 min and breast feeding accounting for 50% or more (P<0.05). The Area Under Curve (AUC) of ROC curve of nomogram model was 0.946 [95%CI(0.923, 1.000)]. The calibration curve showed that the probability of hospital infection predicted by the model was basically consistent with the actual probability. The decision curve showed that when the probability threshold of nomogram model to predict the risk of nosocomial infection of very low birth weight premature infants was 0-0.85, the net rate of return was greater than 0. Conclusion　Preterm infants with extremely low birth weight are at high risk of nosocomial infection, mainly affected by factors such as gestational weeks, hospitalization time, amniotic fluid pollution, etc. The nomogram model constructed by the above factors has high accuracy and discrimination for predicting nosocomial infection in such children.

Mortalidad en recién nacidos de muy bajo peso al nacer en la Red Neonatal NEOCOSUR: causalidad y temporalidad / Mortality in very low birth weight (VLBW) infants in South American NEOCOSUR Neonatal Network: timing and causes

Introducción. La mortalidad de los recién nacidos de muy bajo peso de nacimiento (RNMBPN) se ha mantenido en ~26 % en los últimos 16 años en la Red Neonatal NEOCOSUR. Objetivo. Determinar la causa de muerte de los RNMBPN y su temporalidad en el período 20072016 en la Red Neonatal NEOCOSUR. Población y métodos. Estudio observacional de cohorte multicéntrica; análisis retrospectivo de datos obtenidos prospectivamente. Se incluyeron recién nacidos entre 24 y 31+6 semanas de edad gestacional y peso de nacimiento de 500-1500 g, en 26 centros de la Red Neonatal NEOCOSUR. Las causas de muerte se analizaron según ocurriera en sala de partos (SP) o durante la estadía en la unidad de cuidados intensivos neonatales (UCIN). La edad posnatal de muerte se determinó a través de análisis de Kaplan-Meier. Resultados. Se incluyeron un total de 11.753 RNMBPN con una mortalidad global del 25,6 %. Las causas de muerte predominantes en SP fueron malformaciones congénitas (43,3 %), enfermedades respiratorias (14,3 %) y prematuridad (11,4 %). Las causas de muerte predominantes en UCIN fueron las respiratorias (24,2 %) e infecciosas (24,1 %). La edad promedio de muerte fue de 10,2 días y mediana de 4 días. El 10,2 % de las muertes ocurrieron en SP; el 21,5 %, durante el primer día; el 52 % ocurrió en los primeros 4 días y el 63,8 %, durante la primera semana de vida. Conclusiones. Se encuentran importantes diferencias en las causas de muerte de RNMBPN según ocurra en SP o en UCIN. Las infecciosas y respiratorias son las más relevantes luego del ingreso a la unidad de cuidados intensivos.

Introduction. Mortality in very low birth weight infants (VLBWIs) has remained at ~26% in the past 16 years in the NEOCOSUR Neonatal Network. Objective. To determine the cause of death of VLBWIs and its temporality in the 2007-2016 period in the NEOCOSUR Neonatal Network. Population and methods. Observational, multicenter cohort study; retrospective analysis of data collected prospectively. Newborn infants born between 24 and 31+6 weeks of gestation age with a birth weight between 500 and 1500 g in the 26 sites of the NEOCOSUR Neonatal Network were included. The causes of death were analyzed depending on whether they occurred in the delivery room (DR) or in the neonatal intensive care unit (NICU). The postnatal age at time of death was determined using the KaplanMeier test. Results. A total of 11 753 VLBWIs were included; overall mortality was 25.6%. The prevailing causes of death in the DR were congenital malformations (43.3%), respiratory diseases (14.3%), and prematurity (11.4%). The prevailing causes of death in the NICU were respiratory diseases (24.2%) and infections (24.1%). The average and median age at death were 10.2 and 4 days, respectively. Also, 10.2% of deaths occurred in the DR; 21.5% on day 1, 52% in the first 4 days, and 63.8% in the first week of life. Conclusions. Important differences were observed in the causes of death of VLBWIs depending on their occurrence in the DR or the NICU. Infectious and respiratory conditions were the most relevant factors following admission to the NICU.

Association Between Antibiotic Overexposure and Adverse Outcomes in Very-Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing Enterocolitis: A Multicenter Prospective Study

Objectives To explore the associations between higher antibiotic use rates (AURs) and adverse outcomes in very-low-birthweight (VLBW) infants without culture-proven sepsis or necrotizing enterocolitis (NEC) in a multicenter of China. Methods A prospective cohort study was performed on VLBW infants admitted to 24 neonatal intensive care units from January 1, 2018, to December 31, 2018. AUR was calculated as calendar days of antibiotic therapy divided by total hospital days. The composite primary outcome was defned as mortality or severe morbidity, including any of the following: severe neurologic injury, bronchopulmonary dysplasia (BPD), and stage 3 or higher retinopathy of prematurity. Results A total of 1,034 VLBW infants who received antibiotics without culture-proven sepsis or NEC were included in this study. The overall AUR of eligible VLBW infants was 55%, and the AUR of each eligible VLBW infant ranged from 3 to 100%, with a median of 56% (IQR 33%, 86%). After generalized propensity score and logistic regression analysis of 4 groups of VLBW infants with diferent AUR range, infants in the higher quartile AUR, (Q3, 0.57~0.86) and (Q4, 0.87~1.00), had higher odds of composite primary outcome (adjusted OR: 1.81; 95% CI: 1.23–2.67; adjusted OR 2.37; 95% CI: 1.59–3.54, respectively) and BPD (adjusted OR: 3.09; 95% CI: 1.52–6.57; adjusted OR 3.17; 95% CI: 1.56–6.57, respectively) than those in the lowest AUR (Q1). Conclusions Antibiotic overexposure in VLBW infants without culture-proven sepsis or NEC was associated with increased risk of composite primary outcome and BPD. Rational empirical antibiotic use in VLBW infants is urgently needed in China.

Early application of non-invasive high frequency oscillatory ventilation in very low birth weight infants with respiratory distress syndrome / 中华实用儿科临床杂志

Objective:To observe the clinical efficacy and safety of non-invasive high frequency oscillatory ventilation(NHFOV) on the early respiratory support in very low birth weight infants with respiratory distress syndrome(RDS).Methods:It was a prospective cohort study involving very low birth weight infants with RDS admitted to the Central Hospital of Chongqing Three Gorges from January 2017 to January 2020 with a gestational age of 28-32 weeks.According to the applied non-invasive respiratory support, very low birth weight infants with NRDS were divided into control group[continuous positive airway pressure (CPAP) group]and observation group(NHFOV group). Therapeutic effect, complications and adverse effects between 2 groups were compared.Results:A total of 78 very low birth weight infants with RDS were included, among which 38 cases were supported with NHFOV group and 40 cases were CPAP group.(1) Therapeutic efficacy: there were no significant differences in the use of pulmonary surfactant and death rate between 2 groups (all P>0.05). Compared with the CPAP group, patients in the NHFOV group had significantly lower incidence of non-invasive ventilation failure(4 cases vs.13 cases), duration of non-invasive ventilation [(7.60±1.68) days vs. (10.75±2.38) days], duration of oxygen exposure [(12.34±2.66) days vs.(17.20±4.36) days] and times of apnea [(1.68±1.57) times/day vs.(4.80±2.60) times/day] (all P<0.05). There was no significant difference in the incidence of complications between 2 groups (all P>0.05). (2) Adverse events: compared with CPAP group, patients in the NHFOV group had significantly lower incidence of abdominal distension [13 cases(34.2%) vs. 25 cases (62.5%)], delayed duration of respiratory secretion disappearance [(12.65±2.33) days vs.(7.87±2.70) days], low viscosity of secretions [thin sputum, 31 cases (81.6%) vs.22 cases (55.0%); ropy sputum, 7 cases (18.4%) vs.18 cases(45.0%)], and less airway obstruction [2 cases (5.2%) vs.15 cases (37.5%)] (all P<0.05). No significant difference in the incidence of nasal septum injury was detected between 2 groups (1 case vs.0) ( P>0.05). Conclusions:NHFOV is safe and effective in the early application of NRDS in very low birth weight infants with RDS, which has less adverse events.It is expected to be used in the treatment of children with frequent apnea and a large number of respiratory secretions that is prone to obstruction.

Progress on the correlation between neonatal critical illness score and neurological prognosis of very low birth weight infants / 国际儿科学杂志

Neonatal critical illness score is a scoring system that assesses the severity of neonatal disease and predicts the risk of death.However, it also has an important reference value for the evaluation of neurological prognosis.Since various neonatal critical scores have different assessment contents, the evaluation performance of neurological prognosis is also different.Score for neonatal acute physiology, score for neonatal acute physiology, version-Ⅱ, score for neonatal acute physiology, perinatal extension, version-Ⅱ, nursery neurobiological risk score, et al, have good predictive value for long-term neurological prognosis.The predictive value of clinical risk index for babies, clinical risk index for babies and version-Ⅱ remains unproven.This article reviews the correlation between neonatal critical illness score and the neurological prognosis of very low birth weight infants(VLBWI), in order to provide references for the early identification and prognositic judgement of VLBWI nerve damage.

Cognitive Outcomes of Children with Very Low Birth Weight at 3 to 5 Years of Age

Clinical analysis of retinopathy of prematurity in preterm infants with very low birth weight / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the clinical characteristics of retinopathy of prematurity(ROP)in preterm infants with very low birth weight. <p>METHODS: A retrospective analysis was made of 3 121 premature infants who were admitted to the ophthalmic clinic and neonatal department of our hospital from December 2009 to June 2018 and underwent fundus examination. There were 1 862 males and 1 259 females. Among them, there were 400 premature infants with very low birth mass whose body mass was less than 1 500g. 191 males and 209 females. To compare the detection rate of ROP, gestational age, gender ratio, diagnosis time of ROP, severity of ROP and prevalence of other eye diseases, among different birth quality groups in preterm infants with extremely low birth mass.<p>RESULTS: In this study, 3 121 premature infants were screened, and the ROP detection rate was 8.2%(255/3 121). There were 400 premature infants with very low birth mass with a body mass less than 1 500g, ROP detection rate was 23.8%(95/400), stage 1-2 lesions that do not require treatment were 93.7%(89/95), pre-threshold and threshold lesions were 3.2%(3/95), stage 4-5 lesions were 3.2%(3/95). ROP detection rates of birth weight(g)<1 000, 1 000-1 499, ≥1 500, were: 25.0%, 23.7%, 5.9%, respectively. There were statistically significant differences in gestational age, ROP diagnostic time, between different birth weight groups(<i>P</i><0.001). There were significant differences in the severity of ROP among the groups with birth weight <1 000g, 1 000-1 499g and ≥ 1 500g. But, there was no significant difference in the severity of ROP between the group with birth weight 1 000-1 499g and the group with birth weight ≥1 500g(<i>P</i>>0.05). There was no statistical difference in the incidence of other eye diseases in different birth weight groups(<i>P</i>>0.05).<p>CONCLUSION: The lower of birth weight, with the higher of incidence of ROP. The severity of ROP in preterm infants with birth weight <1 000g was significantly higher than that of preterm infants with birth weight≥1 000g. Ophthalmology should combine obstetrics and neonatology to reduce the incidence of very low birth weight premature infants, and improve the compliance of screening and follow-up of retinopathy of very low birth weight premature infants, which is an important way to reduce the blindness caused by ROP.

Clinical analysis of retinopathy of prematurity in preterm infants with very low birth weight / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the clinical characteristics of retinopathy of prematurity(ROP)in preterm infants with very low birth weight. <p>METHODS: A retrospective analysis was made of 3 121 premature infants who were admitted to the ophthalmic clinic and neonatal department of our hospital from December 2009 to June 2018 and underwent fundus examination. There were 1 862 males and 1 259 females. Among them, there were 400 premature infants with very low birth mass whose body mass was less than 1 500g. 191 males and 209 females. To compare the detection rate of ROP, gestational age, gender ratio, diagnosis time of ROP, severity of ROP and prevalence of other eye diseases, among different birth quality groups in preterm infants with extremely low birth mass.<p>RESULTS: In this study, 3 121 premature infants were screened, and the ROP detection rate was 8.2%(255/3 121). There were 400 premature infants with very low birth mass with a body mass less than 1 500g, ROP detection rate was 23.8%(95/400), stage 1-2 lesions that do not require treatment were 93.7%(89/95), pre-threshold and threshold lesions were 3.2%(3/95), stage 4-5 lesions were 3.2%(3/95). ROP detection rates of birth weight(g)<1 000, 1 000-1 499, ≥1 500, were: 25.0%, 23.7%, 5.9%, respectively. There were statistically significant differences in gestational age, ROP diagnostic time, between different birth weight groups(<i>P</i><0.001). There were significant differences in the severity of ROP among the groups with birth weight <1 000g, 1 000-1 499g and ≥ 1 500g. But, there was no significant difference in the severity of ROP between the group with birth weight 1 000-1 499g and the group with birth weight ≥1 500g(<i>P</i>>0.05). There was no statistical difference in the incidence of other eye diseases in different birth weight groups(<i>P</i>>0.05).<p>CONCLUSION: The lower of birth weight, with the higher of incidence of ROP. The severity of ROP in preterm infants with birth weight <1 000g was significantly higher than that of preterm infants with birth weight≥1 000g. Ophthalmology should combine obstetrics and neonatology to reduce the incidence of very low birth weight premature infants, and improve the compliance of screening and follow-up of retinopathy of very low birth weight premature infants, which is an important way to reduce the blindness caused by ROP.

Cord blood vitamin D levels and its relationship to early-onset sepsis in the very low birth weight infants / 中国小儿急救医学

Objective To investigate the association between serum 25(OH) D levels and the inci-dence of early-onset sepsis(EOS) in the very low birth weight infants(VLBWI) and the gestational age be-low 34 weeks. Methods The cord blood of 159 VLBWI were collected between January and December 2017,including 31 clinically diagnosed EOS and 128 non-EOS patients. Serum 25(OH)D<10 ng/ml was de-fined as severe vitamin D deficiency,25(OH)D 10 to 20 ng/ml as vitamin D deficiency,25(OH)D 20 to 30 ng/ml as vitamin D insufficiency and 25(OH)D >30 ng/ml as vitamin D sufficiency. Results There were no differences in gender,gestational age,birth weight and Apgar score between the EOS group and the non-EOS group(P>0. 05). Serum 25(OH) D was(9. 08 ± 4. 21) ng/ml in the EOS group and(11. 91 ± 5. 37) ng/ml in the non-EOS group(P＝0. 007). The rate of severe vitamin D deficiency was 67. 7%(21/31)in the EOS group and 41. 4%(53/128) in the non-EOS group. The rate of vitamin D deficiency was 32. 3%(10/31)in the EOS group and 52. 3%(67/128)in the non-EOS group. But there was no difference of vitamin D deficiency distribution in the two groups(P＝0. 152). The cut-off value of serum 25(OH)D level in predic-ting EOS was 10. 06 ng/ml. Conclusion The incidence of vitamin D deficiency is as high as 95%,calling for urgent attention on vitamin D supplementation in those VLBWI. Low 25(OH)D level( <10 ng/ml)might be predictive of EOS.

Association between vitamin D level at birth and respiratory morbidities in very-low-birth-weight infants / 소아과

PURPOSE: This study aimed to evaluate vitamin D status at birth in very-low-birth-weight infants (VLBWIs: <1,500 g) and to determine the association between vitamin D level and respiratory morbidity. METHODS: A retrospective study was conducted at Soonchunhyang University Bucheon Hospital between November 2013 and November 2017. We collected blood samples and data on respiratory morbidity from 230 VLBWIs on the first day of life. Patients who were transferred to other hospitals (n=19), died before 36 weeks of gestational age (n=18), or whose blood samples were not collected immediately after birth (n=5) were excluded. Finally, 188 patients were enrolled. VLBWIs with different vitamin D levels were compared with respect to demographic features, maternal diseases, respiratory morbidities, and other neonatal diseases. RESULTS: The mean serum vitamin D level, as measured by 25-hydroxyvitamin D (25(OH)D), was 13.4±9.3 ng/mL. The incidence of vitamin D deficiency (<20 ng/mL) was 79.8%, and 44.1% of preterm infants had severe vitamin D deficiency (<10 ng/mL). Logistic analysis shows that a low serum 25(OH)D level (<20 ng/mL) was a risk factor for respiratory distress syndrome (odds ratio [OR], 4.32; P=0.010) and bronchopulmonary dysplasia (OR, 4.11; P=0.035). CONCLUSION: The results showed that 79.8% of preterm infants in this study had vitamin D deficiency at birth. Low vitamin D status was associated with respiratory morbidity, but the exact mechanism was unknown. Additional studies on the association between vitamin D level and neonatal morbidity are required.

National Registry Data from Korean Neonatal Network: Two-Year Outcomes of Korean Very Low Birth Weight Infants Born in 2013–2014

BACKGROUND: The aim of this study was to observe long-term outcomes of very low birth weight infants (VLBWIs) born between 2013 and 2014 in Korea, especially focusing on neurodevelopmental outcomes. METHODS: The data were collected from Korean Neonatal Network (KNN) registry from 43 and 54 participating units in 2013 and 2014, respectively. A standardized electronic case report form containing 30 items related to long-term follow up was used after data validation. RESULTS: Of 2,660 VLBWI, the mean gestational age and birth weight were 291/7 ± 26/7 weeks and 1,093 ± 268 g in 2013 and 292/7 ± 26/7 weeks and 1,125 ± 261 g in 2014, respectively. The post-discharge mortality rate was 1.2%–1.5%. Weight < 50th percentile was 46.5% in 2013 and 66.1% in 2014. The overall prevalence of cerebral palsy among the follow up infants was 6.2% in 2013 and 6.6% in 2014. The Bayley Scales of Infant Developmental Outcomes version II showed 14%–25% of infants had developmental delay and 3%–8% of infants in Bayley version III. For the Korean developmental screening test for infants and children, the area “Further evaluation needed” was 5%–12%. Blindness in both eyes was reported to be 0.2%–0.3%. For hearing impairment, 0.8%–1.9% showed bilateral hearing loss. Almost 50% were readmitted to hospital with respiratory illness as a leading cause. CONCLUSION: The overall prevalence of long-term outcomes was not largely different among the VLBWI born between 2013 and 2014. This study is the first large national data study of long-term outcomes.

Investigation and analysis of influencing factors of oral feeding progression in very-low-birth-weight infants / 中国实用护理杂志

Objective To investigate oral feeding progression and its influencing factors in very-low-birth-weight infants. Methods Investigation was conducted among 114 infants with the Gestational age≤30 weeks,birth weight≤1 500 g using very low birth weight infants clinical information questionnaire and oral feeding survey. Results The very low birth weight infants started enteral nutrition(20.61±4.67) h after admission, achieved a total enteral nutrition (41.47 ± 15.53) days after birth with the correct gestational age was (34.35 ± 2.76) weeks. The infants started oral feeding (41.47 ± 15.53) days after birth with the correct gestational age(34.58±1.98)weeks.The infants achieved full oral feeding(55.19±16.30) days after birth with the correct gestational age(36.40 ±1.99)weeks.Single factor and multiple regression analysis showed that birth weight,gestational age,BPD were significant factors of oral feeding progression. Conclusions The smaller gestational age, birth weight, the longer duration the infants reach the oral feeding milestones, Infants with BPD have obvious oral feeding progression. The medical staffs should learn that the very low birth weight have oral feeding difficulties and thus take positive and effective measures to promote the advancement of oral feeding.

Analysis of the clinical characteristics of late-onset sepsis in very low birth weight infants / 临床儿科杂志

Objective To explore the clinical characteristics including the morbidity, clinical manifestation, and pathogens of late-onset sepsis (LOS) in very low birth weight (VLBW) infants in neonatal intensive care unit (NICU). Methods Clinical data of all VLBW infants in NICU from January 2011 to December 2013 were collected. According to the results of blood culture, the VLBW infants diagnosed with LOS were divided into confirmed LOS group and clinical LOS group. The morbidity, clinical manifestations, common pathogens, and drug sensitivity of LOS were retrospectively analyzed. Results In 226 VLBW infants, there were 117 cases of LOS with the morbidity at 51.8%. Forty-five infants were confirmed to have LOS by blood culture, accounting for 19.9% (45/226); another 72 infants were diagnosed with clinical LOS, accounting for 31.9% (72/226). The rates of tachycardia and temperature fluctuation in confirmed LOS group were higher than those in clinical LOS group, and there were significant differences (P<0.05). There were 51 strains of pathogenic bacteria, with 32 Gram-negative bacteria (62.7%), 16 Gram-positive bacteria (31.4%), and 3 fungi (5.9%).The common pathogenic bacteria were Klebsiella pneumoniae and coagulase negative Staphylococcus,the most of which were multidrug-resistant bacteria.Conclusions The incidence of LOS in VLBW infants is high. The main clinical manifestations are sudden changes in breathing, heart rate, mental state, and skin color. Although these manifestations are not specific,they could serve as early warning.The common pathogenic bacteria are Klebsiella pneumoniae and coagulase negative Staphylococcus,and both of them are multidrug resistant.

Improved intervention of skin care at PICC site for very low birth weight infants / 中华护理杂志

Objective To discuss the application effect of improved intervention of skin care at PICC site for very low birth weight infants.Methods By convenience sampling method,70 cases admitted from July 2015 to June 2016 were selected as the control group,other 70 cases admitted from July 2016 to June 2017 were selected as the experimental group.The control group was applied with conventional nursing,while the experimental group was applied with improved intervention.Skin damage around PICC insertion site was observed and compared between two groups.Results The incidence rate of PICC site with skin injury in the experimental group was significantly lower than that in the control group(P＜0.05).Conclusion The improved intervention for the very low birth weight infants with PICC can significantly reduce the incidence rate of PICC site with skin injury,and guarantee the safety of infants.

The impact of a quality improvement effort in reducing admission hypothermia in preterm infants following delivery / 소아과

PURPOSE: Hypothermia at admission is associated with increased mortality and morbidity in preterm infants. We performed a quality improvement (QI) effort to determine the impact of a decrease in admission hypothermia in preterm infants. METHODS: The study enrolled very low birth weight (VLBW) infants born at Gangnam Severance Hospital between January 2013 and December 2016. This multidisciplinary QI effort included the use of occlusive wraps, warm blankets, and caps; the delivery room temperature was maintained above 23.0℃, and a check-list was used for feedback. RESULTS: Among 259 preterm infants, the incidence of hypothermia (defined as body temperature <36.0℃) decreased significantly from 68% to 41%, and the mean body temperature on neonatal intensive care unit admission increased significantly from 35.5℃ to 36.0℃. In subgroup analysis of VLBW infants, admission hypothermia and neonatal outcomes were compared between the pre-QI (n=55) and post-QI groups (n=75). Body temperature on admission increased significantly from 35.4℃ to 35.9℃ and the number of infants with hypothermia decreased significantly from 71% to 45%. There were no cases of neonatal hyperthermia. The incidence of pulmonary hemorrhage was significantly decreased (P=0.017). Interaction analysis showed that birth weight and gestational age were not correlated with hypothermia following implementation of the protocol. CONCLUSION: Our study demonstrated a significant reduction in admission hypothermia following the introduction of a standardized protocol in our QI effort. This resulted in an effective reduction in the incidence of massive pulmonary hemorrhage.

Quality improvement of delivery room management for very low birth weight infants / 国际儿科学杂志

Events in the delivery room significantly impact the outcomes of newborns,especially for the very low birth weight infants. Quality improvement of delivery room management for very low birth weight in-fants will reduce the very low birth weight infants′mortality and improve their quality of life. The prenatal ,in-trapartum and postnatal interventions include delayed umbilical cord clamping,thermoregulation,starting resusci-tation with CPAP from the first breath and with low concentration oxygen. In this article,we reviewed researches about the improvements of delivery room management,and summed up the specific measures to reduce the very low birth weight infants′median durations of hospitalization and improve their long-term outcomes.

Quality improvement of delivery room management for very low birth weight infants / 国际儿科学杂志

Events in the delivery room significantly impact the outcomes of newborns,especially for the very low birth weight infants. Quality improvement of delivery room management for very low birth weight in-fants will reduce the very low birth weight infants′mortality and improve their quality of life. The prenatal ,in-trapartum and postnatal interventions include delayed umbilical cord clamping,thermoregulation,starting resusci-tation with CPAP from the first breath and with low concentration oxygen. In this article,we reviewed researches about the improvements of delivery room management,and summed up the specific measures to reduce the very low birth weight infants′median durations of hospitalization and improve their long-term outcomes.