Objectives. To investigate the occurrence of and risk factors for late- onset septicemia (LOS) in a national cohort of extremely premature infants who received very early full human milk feeding. Methods. A prospectiv...Objectives. To investigate the occurrence of and risk factors for late- onset septicemia (LOS) in a national cohort of extremely premature infants who received very early full human milk feeding. Methods. A prospective study of all infants born in Norway in 1999 and 2000 with gestational age of < 28 weeks or birth weight of < 1000 g was performed. Extensive clinical information, including data on feeding practices and episodes of septicemia, was collected on predefined forms. LOS was defined as growth of bacteria or fungi in blood cultures in conjunction with clinical symptoms consistent with systemic infection occurring after day 6 of life. Cox regression models, including models allowing for time- dependent covariates, were applied in the analysis of LOS. Results. Of 464 eligible infants, 462 (99.6% ) were enrolled and 405 (87.7% ) survived until day 7. LOS was diagnosed for 80 (19.7% ). The predominant pathogens were coagulase- negative staphylococci, followed by Candida spp. Case fatality rates associated with septicemia were 10% in general and 43% for Candida spp septicemia. Necrotizing enterocolitis or bowel perforation was diagnosed for 19 infants (4% ). Enteral feeding with human milk was initiated within the third day for 98% of patients, and 92% were receiving full enteral feeding (FEF) with human milk within the third week. Both high Clinical Risk Index for Babies scores and an umbilical venous catheter in situ at 7 days of age significantly predicted LOS.However, the overall most influential risk factor for LOS was the number of days without establishment of FEF with human milk, with an adjusted relative risk of 3.7 (2.0- 6.9) for LOS if FEF was not established within the second week of life. Conclusions. The incidence and case fatality rate of septicemia for this cohort of extremely preterm infants were lower than values in comparable studies. The main difference, compared with other studies, was the feeding practice, and the data suggest that very early FEF with human milk significantly reduces the risk of LOS among extremely premature infants.展开更多
The anomalous change of two polar sea ice and tropical ocean SST is a very important index for global climate monitoring and prediction. In this paper, the wave resonance principle is used to calculate month by month ...The anomalous change of two polar sea ice and tropical ocean SST is a very important index for global climate monitoring and prediction. In this paper, the wave resonance principle is used to calculate month by month running cross couple correlation coefficient time series between sea ice in different sea area of two Polars, as well as between them and five elements of E1 Nino events, to analyze their variation features, and to find out their resonance periods. The resonance period of two waves is just the strongest interaction period.Some results are concluded as follows. 1) The Arctic sea ice to the Pacific-side (NPI1) and Atlantic-side (NP12) show a strong positive-negative feedback impact each other to the Antarctic Ross Sea ice (SPI2) with equal intensity. 2) Both NPI1 and NPI2 give a strong positive and negative feedback to the Antarctic Wedded Sea ice (SPI3) while it is rather weak in convercse status. It means that, the Arctic sea ice plays a leading and controlling role on the Wedded Sea ice. 3) SST of Nino 4 area in thecentral equatorial Pacific has a best resonance period with SPI2 with cycle period of 132 months. It closely relates to quasi-11 years oscillation period of both SST of Nino 4 area and SPI2. SST of Nino 4 has also a resonance period to SPI3 with cycle of 61 months. There also exist strong interaction periods between the Antarctic sea ice and other elements of ENSO event but weaker than SST of Nino 4 area.展开更多
Objectives. To investigate the incidence, causes, predictors, and outcomes of septicemia in the first week of life in a national cohort of extremely premature infants. Methods. A prospective study of survival of all i...Objectives. To investigate the incidence, causes, predictors, and outcomes of septicemia in the first week of life in a national cohort of extremely premature infants. Methods. A prospective study of survival of all infants with gestational age of < 28 weeks or birth weight of < 1000 g who were born in Norway in 1999- 2000 was performed. Data on the maternal prenatal history, delivery, and neonatal course, including detailed information on episodes of microbiologically verified septicemia, were collected on predefined forms. Septicemia was reported in 2 groups, ie, episodes diagnosed on the day of delivery (ie, very early- onset septicemia [VEOS]) and episodes diagnosed from day 2 to day 7 of life (ie, early- onset septicemia [EOS]). Logistic regression models were used for the selection of variables for predictor analysis in each group. Results. Of 462 included infants, VEOS occurred for 15 (32.5 per 1000 population) and EOS for 15 (35.5 per 1000 population). The most prevalent bacteria were Escherichia coli in VEOS (n=9) and staphylococci (coagulase- negative staphylococci and Staphylococcus aureus) (n=15) in EOS. Case fatality rates were 40% and 13% , respectively. Independent predictive factors for VEOS were clinical chorioamnionitis (odds ratio [OR]: 10.5; 95% confidence interval [CI]: 3.3- 33.4) and high maternal age (OR: 1.2; 95% CI: 1.0- 1.3), whereas not receiving systemic antibiotic therapy within 2 days of age (OR: 13.6; 95% CI: 3.7- 50.2) and receiving nasal continuous positive airway pressure (n- CPAP) support at 24 hours of age (OR: 9.8; 95% CI: 2.5- 38.4) independently predicted septicemia after the first day of life. Conclusions. Whereas vertically transmitted septicemia was dominated by Gram- negative bacteria, with predictors being exclusively of maternal origin, EOS was dominated by typically nosocomial flora, with n- CPAP treatment at 24 hours of age being a powerful predictor. Early n- CPAP treatment, as opposed to mechanical ventilation, as a powerful predictor of septicemia in the early neonatal period,even with adjustment for early systemic antibiotic treatment, is a new observation among extremely premature infants that warrants additional study.展开更多
文摘Objectives. To investigate the occurrence of and risk factors for late- onset septicemia (LOS) in a national cohort of extremely premature infants who received very early full human milk feeding. Methods. A prospective study of all infants born in Norway in 1999 and 2000 with gestational age of < 28 weeks or birth weight of < 1000 g was performed. Extensive clinical information, including data on feeding practices and episodes of septicemia, was collected on predefined forms. LOS was defined as growth of bacteria or fungi in blood cultures in conjunction with clinical symptoms consistent with systemic infection occurring after day 6 of life. Cox regression models, including models allowing for time- dependent covariates, were applied in the analysis of LOS. Results. Of 464 eligible infants, 462 (99.6% ) were enrolled and 405 (87.7% ) survived until day 7. LOS was diagnosed for 80 (19.7% ). The predominant pathogens were coagulase- negative staphylococci, followed by Candida spp. Case fatality rates associated with septicemia were 10% in general and 43% for Candida spp septicemia. Necrotizing enterocolitis or bowel perforation was diagnosed for 19 infants (4% ). Enteral feeding with human milk was initiated within the third day for 98% of patients, and 92% were receiving full enteral feeding (FEF) with human milk within the third week. Both high Clinical Risk Index for Babies scores and an umbilical venous catheter in situ at 7 days of age significantly predicted LOS.However, the overall most influential risk factor for LOS was the number of days without establishment of FEF with human milk, with an adjusted relative risk of 3.7 (2.0- 6.9) for LOS if FEF was not established within the second week of life. Conclusions. The incidence and case fatality rate of septicemia for this cohort of extremely preterm infants were lower than values in comparable studies. The main difference, compared with other studies, was the feeding practice, and the data suggest that very early FEF with human milk significantly reduces the risk of LOS among extremely premature infants.
文摘The anomalous change of two polar sea ice and tropical ocean SST is a very important index for global climate monitoring and prediction. In this paper, the wave resonance principle is used to calculate month by month running cross couple correlation coefficient time series between sea ice in different sea area of two Polars, as well as between them and five elements of E1 Nino events, to analyze their variation features, and to find out their resonance periods. The resonance period of two waves is just the strongest interaction period.Some results are concluded as follows. 1) The Arctic sea ice to the Pacific-side (NPI1) and Atlantic-side (NP12) show a strong positive-negative feedback impact each other to the Antarctic Ross Sea ice (SPI2) with equal intensity. 2) Both NPI1 and NPI2 give a strong positive and negative feedback to the Antarctic Wedded Sea ice (SPI3) while it is rather weak in convercse status. It means that, the Arctic sea ice plays a leading and controlling role on the Wedded Sea ice. 3) SST of Nino 4 area in thecentral equatorial Pacific has a best resonance period with SPI2 with cycle period of 132 months. It closely relates to quasi-11 years oscillation period of both SST of Nino 4 area and SPI2. SST of Nino 4 has also a resonance period to SPI3 with cycle of 61 months. There also exist strong interaction periods between the Antarctic sea ice and other elements of ENSO event but weaker than SST of Nino 4 area.
文摘Objectives. To investigate the incidence, causes, predictors, and outcomes of septicemia in the first week of life in a national cohort of extremely premature infants. Methods. A prospective study of survival of all infants with gestational age of < 28 weeks or birth weight of < 1000 g who were born in Norway in 1999- 2000 was performed. Data on the maternal prenatal history, delivery, and neonatal course, including detailed information on episodes of microbiologically verified septicemia, were collected on predefined forms. Septicemia was reported in 2 groups, ie, episodes diagnosed on the day of delivery (ie, very early- onset septicemia [VEOS]) and episodes diagnosed from day 2 to day 7 of life (ie, early- onset septicemia [EOS]). Logistic regression models were used for the selection of variables for predictor analysis in each group. Results. Of 462 included infants, VEOS occurred for 15 (32.5 per 1000 population) and EOS for 15 (35.5 per 1000 population). The most prevalent bacteria were Escherichia coli in VEOS (n=9) and staphylococci (coagulase- negative staphylococci and Staphylococcus aureus) (n=15) in EOS. Case fatality rates were 40% and 13% , respectively. Independent predictive factors for VEOS were clinical chorioamnionitis (odds ratio [OR]: 10.5; 95% confidence interval [CI]: 3.3- 33.4) and high maternal age (OR: 1.2; 95% CI: 1.0- 1.3), whereas not receiving systemic antibiotic therapy within 2 days of age (OR: 13.6; 95% CI: 3.7- 50.2) and receiving nasal continuous positive airway pressure (n- CPAP) support at 24 hours of age (OR: 9.8; 95% CI: 2.5- 38.4) independently predicted septicemia after the first day of life. Conclusions. Whereas vertically transmitted septicemia was dominated by Gram- negative bacteria, with predictors being exclusively of maternal origin, EOS was dominated by typically nosocomial flora, with n- CPAP treatment at 24 hours of age being a powerful predictor. Early n- CPAP treatment, as opposed to mechanical ventilation, as a powerful predictor of septicemia in the early neonatal period,even with adjustment for early systemic antibiotic treatment, is a new observation among extremely premature infants that warrants additional study.
