Bronchopulmonary Dysplasia in Premature Infants with Very Low Birth Weight: A Single Centre Retrospective Study in China

To investigate bronchopulmonary dysplasia (BPD) and its treatment with dexamethasone (DEX) in premature infants with birth weight (BW) < 1500 g. We retrospectively reviewed the records of preterm infants admitted to the Division of Neonatology, the Second Xiangya Hospital, Central South University between September 2011 and December 2014. Patients were excluded if they needed oxygen therapy but were lost to follow-up at ≤36 weeks post-menstrual age (PMA) or <56 days after birth, or they had severe congenital anomalies. The incidence of BPD was 18% (37/212). Gestational age (GA) was <32 weeks in all BPD patients. GA, BW, and Apgar scores were lower and hospitalization duration and pulmonary surfactant (PS) use were higher in the BPD group than in the non-BPD group (P < 0.05). Risk factors for BPD included neonatal respiratory distress syndrome, neonatal pneumonia, positive sputum culture, pulmonary hemorrhage, respiratory failure. Multivariate logistic regression revealed that GA (odds ratio [OR]: 0.479, P = 0.004) and neonatal respiratory distress syndrome (OR: 6.146, P = 0.043) were independent risk factors for BPD. DEX was administered to 26 patients after the diagnosis of BPD. After one and two weeks of DEX treatment, the oxygen requirement had significantly reduced compared to the week prior to treatment (P < 0.05), while during treatment, the weight gain rate and weight gain efficiency slower significantly than that during either of the two preceding weeks (P < 0.001). These results suggest that low GA was the most important risk factor for BPD, DEX reduced oxygen dependency but decreased weight gain.

Prevention of peripherally inserted central catheter-related infections in very low-birthweight infants by using a central line bundle guideline with a standard checklist

Objective:To investigate the effectiveness and feasibility of using a central line bundle(CLB)guideline with a standard checklist in the prevention of peripherally inserted central catheter(PICC)-related infections(CRIs)in very low-birth-weight infants(VLBWIs).Methods:Fifty-seven VLBWIs who underwent PICC insertion at a hospital in Qingdao,China,between November 2012 and June 2013,were monitored with the CLB guideline and a standard checklist.Fifty-three VLBWIs who underwent PICC insertion were monitored by standard hospital procedures.The incidence of CRIs was compared between the two groups.Results:The incidence of infection significantly decreased from 10.0%catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The indwelling catheter time significantly increased in the study group compared to the control group(31.9±15.0days vs.24.8±7.4 days,respectively,p<0.05).Colonization infections also decreased from 6.9% catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The incidence of catheter-related bloodstream infections decreased from 3.1%catheter days in the control group to 0%catheter days in the study group.Conclusion:The use of a CLB guideline with a standard checklist could be an effective and feasible protocol for preventing CRIs and prolonging indwelling catheter timein VLBWIs.

A Clinical Analysis of Physical and Neurological Development in very Low Birth Weight Infants with MEIR(Massage,Exercises,Intelligence training,and Rehabilitation training)

Objective:This study aimed to investigate the application of MEIR(Massage,Exercises,Intelligence training,and Rehabilitation training)in Chinese VLBW infants and to observe its effects on infants’growth and deve1opment.Methods:Clinical data of 92 VLBW infants who were treated at the neonatal intensive care unit(NICU)of Loudi Centra1 Hospital were retrospectively analyzed.The patients were grouped as the MEIRgroup(n=47)and controls(n=45).Physical and neurodevelopment deve1opment were compared between the two groups.Results:There were differences in height and weight and head circumference between the two groups at all corrected ages(all P<0.05).Abnormal motions,reflexes,muscular tension,audio-visual reactions,and posture,and the total numbers of abnormalities of 3-,6-,9-and 12-corrected month-old infants in the MElRgroup were 1ower than in the control group(all P<0.05).The mental development index and psychomotor development index of 6-and 12-corrected month infants in the MEIR group were higher than in the control group(all P<0.05).Conclusion:MEIR could improve the physical and neurological developments of VLBW infants,reduce the incidence of adverse events,and improve their growth and development.

Application of prolonging small feeding volumes early in life to prevent of necrotizing enterocolitis in very low birth weight preterm infants

Objective:To study the effects of prolonging small feeding volumes early in life on the incidence of necrotizing enterocolitis(NEC)in very low birth weight(VLBW)preterm infants.Methods:A total of 128 VLBW infants who could not be breastfed were assigned into the experimental group(63 cases)and the control group(65 cases)using a random number table.The experiment group was fed 12 mL/(kg·d)on day 1 which was increased to 24 mL/(kg·d)for the first 10 study days.The control group was fed 12 mL/(kg·d)for the first 14e48 hours.Then,the feeding volume increased by 24-36 mL/(kg·d)up to 140e160 mL/(kg·d)and maintained until the 10th day after birth.The incidence of feeding intolerance and NEC,duration of hospitalization,time to full enteral feedings,incidence of intrahepatic cholestasis,and the levels of gastrin and motilin in serum were assessed.Results:The incidence of feeding intolerance was significantly lower in the experimental group compared with the control group(15.87% vs.33.84%).There was a significant reduction in the incidence of NEC between the experimental and control groups(7.9% vs.16% in the control group).Conclusion:A protocol that prolongs small feeding volumes early in life can reduce the incidence and severity of NEC,but still warrants further study.

Neurally adjusted ventilator assist in very low birth weight infants:Current status

Continuous improvements in perinatal care have resultedin increased survival of premature infants.Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease(CLD) or bronchopulmonary dysplasia.Strategies to minimize the risk of lung injury have been developed and include improved antenatal management(education,regionalization,steroids,and antibiotics),exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support.The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patientventilator asynchrony that is associated with poor outcome.Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur.This has led to the development of new ventilation modes including neurally adjusted ventilatory assist(NAVA).This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity(Edi) and transmit it to trigger the ventilator in synchrony with the patient's own respiratory efforts.This permits the patient to control peak inspiratory pressure,mean airway pressure and tidal volume.Back up pressure control(PC) is provided when there is no Edi signal and no pneumatic trigger.Compared with standard conventional ventilation,NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants.NAVA is safe mode of ventilation.The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage,pneumothorax,or necrotizing enterocolitis when compared to conventional ventilation.Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive.Most previous studies and trials were not sufficiently large and did not include longterm patient oriented outcomes.Multicenter,randomized,outcome trials are needed to determine whether NAVA is effective in avoiding intubation,facilitating extubation,decreasing time of ventilation,reducing the incidence ofCLD,decreasing length of stay,and improving long-term outcomes such as the duration of ventilation,length of hospital stay,rate of pneumothorax,CLD and other major complications of prematurity.In order to prevent barotrauma,next generations of NAVA equipment for neonatal use should enable automatic setting of ventilator parameters in the backup PC mode based on the values generated by NAVA.They should also include an upper limit to the inspiratory time as in conventional ventilation.The manufacturers of Edi catheters should produce smaller sizes available for extreme low birth weight infants.Newly developed ventilators should also include leak compensation and high frequency ventilation.A peripheral flow sensor is also essential to the proper delivery of all modes of conventional ventilation as well as NAVA.

Study on the Relationship between Nursing Staffing and Nosocomial Infection in Very Low Birth Weight Infants

Background: At present, there is no domestic research on the relationship between nurse staffing and hospital infection in very low birth weight infants. In this paper, we will explore the relationship between nurses of very low birth weight (VLBW) infants in neonatal intensive care unit (NICU) and nosocomial infections. Methods: The clinical data of 280 very low birth weight infants born in our hospital from January 2010 to January 2020 were collected, and the chi-square test and multiple logistic regression analysis were used to study the nursing staff of each very low birth weight infant who was admitted to the NICU The relationship between the number of infections and hospital infections. Results: On average, each nurse needs to care for 4.3 very low birth weight infants (lowest to highest: 2.50 - 8.42). In the univariate analysis, the higher the incidence of urinary tract infection (P < 0.05), the multivariate logistic regression analysis of neonatal nosocomial infection showed that nurse staffing was significantly related to the incidence of urinary tract infection (OR = 1.78;95% confidence interval, 1.17 - 2.35, P < 0.05). However, there was no significant correlation between nurse staffing and bloodstream infection (OR = 0.91;95% confidence interval, 0.74 - 1.06, P > 0.05) or Ventilator associated pneumonia (VAP) infection (OR = 1.17;95% confidence interval, 0.94 - 1.47, P > 0.05). Conclusion: Our research shows that in the neonatal intensive care unit, the reasonable deployment of nursing staff is an important factor in preventing urinary tract infections in very low birth weight infants. It is important for improving the survival rate of very low birth weight infants and reducing the occurrence of sequelae.

Effect of Aggressive Early High-Dose Intravenous Amino Acid Infusion and Early Trophic Enteral Nutrition on Very Low Birth Weight Infants

Objective: Very-low-birth-weight (VLBW) preterm infants are at risk of growth delay if they do not receive adequate nutritional support. This study evaluated the effect of aggressive early high-dose amino acid infusion plus early enteral trophic feeding on growth in VLBW infants within the first day of life. Study Design: The effect of a high-dose 3 g amino acid (HAA)/kg/d regimen beginning on the first day of life was compared with that of low-dose amino acid (LAA) supplementation at a dose of 0.5 or 1.0 g/kg/d. The primary outcome measures were the days of regained birth weight and achieved full enteral feeding. Result: Compared with the 19 infants in the LAA group, the 17 infants in the HAA group achieved significantly earlier full enteral feeding (7.8 ± 3.6 vs. 15.2 ± 8.9, p = 0.003) and regained birth weight (13.3 ± 3.8 vs. 17.5 ± 7.9, p = 0.047). In addition, shorter parenteral nutrition time was achieved by HAA administration (p Conclusion: Aggressive early simultaneous amino acid administration plus enteral feeding during the first few days of life for preterm infants was associated with improved weight gain and earlier full enteral feeding.

Neonatal Nutrition and Later Outcomes of Very Low Birth Weight and Preterm Infants <32 Gestational Age at a Tertiary Care Hospital of Portugal

Premature infants, especially those born with less than 1500 g, often exhibit slow overall growth. Lack of early nutritional support is an important element. The present authors describe parenteral nutritional practices in a tertiary hospital and evaluate postnatal growth of preterm infants under 32 weeks of gestational age or with a birth weight < 1500 g. For population study, we examined 431 newborn files. Their median gestational age was 29.7 weeks. Of them, 25.4% were small for gestational age (SGA). 77.5% received parenteral nutrition (PN), 54.5% of which was provided on the first day. The average time was 14.7 days. The average weight gain by the 30th day was 425 g. At discharge, 37% were rd month 20% had their weight under P3, decreasing to 10% by the 12th month. Children who initiated PN in the first 24 hours of life had significantly better weight on the 30th day of their life (p th month of corrected age (p = 0.038). And they had better Body Mass Index (BMI) in the 3rd (p = 0.012) and 12th (p = 0.023) months. Despite better feeding practices, there is still significant failure in post natal growth. Early introduction of PN was associated with an improved weight gain, which suggests that nutrition that included amino acids may be critical during the first 24 hours of life.

Rescue case of low birth weight infant with acute hepatic failure

We report a case involving a rescued low birth weight infant(LBWI) with acute liver failure. Case: The patient was 1594 g and 32^(3/7) gestational wk at birth. At the age of 11 d, she developed acute liver failure due to gestational alloimmune liver disease. Exchange transfusion and high-dose gamma globulin therapy were initiated, and body weight increased with enteral nutrition. Exchange transfusion was performed a total of 33 times prior to living donor liver transplantation(LDLT). Her liver dysfunction could not be treated by medications alone. At 55 d old and a body weight of 2946 g, she underwent LDLT using an S2 monosegment graft from her mother. Three years have passed with no reports of intellectual disability or liver dysfunction. LBWIs with acute liver failure may be rescued by LDLT after body weight has increased to over 2500 g.

Associated Factors to Immunization Timeliness and Completion in Preterm and Low Birth Weight Infants at Essos Hospital Center Yaounde

Introduction: Vaccination is very often delayed in premature and low birth weight infants. However, timely vaccination is even more important in this population because of their increased susceptibility to infection. Objective: To assess immunization practice and factors associated with vaccine promptness and completeness in former preterm and low-birth-weight infants. Methods: We conducted a retrospective analytical cross-sectional study (January 2017 to February 2019). Main Measurement: Promptness and completeness at each contact, Statistical analysis was performed using R software version 3.6.2, logistic regression was used to estimate the Odds Ratio (OR) and their 95% Confidence Interval (CI). Results: We recruited 310 children aged 12 to 36 months born before 37 weeks with low birth weight, 163 (52.6%) of whom were female. Two hundred and fifty-three had received the vaccines at the indicated age, with promptness rate of 81.6%, and 97.7% had completed routine immunization at 9 months. The mean age at vaccination initiation was 6 days ± 11 and the mean weight at vaccination initiation was 2233 g ± 494. High prematurity and very low birth weight were associated with a high rate of vaccine delay: 61.5% [OR: 15.56;(CI: 3.22 - 118.52;p = 0.002)] and 66.7% [OR: 19.19;(CI: 4.67 - 92.52;p < 0.001)] respectively. Distance > 5 km with EHC [OR: 3.48;(CI: 1.68 - 7.47;p = 0.001)] was associated with poor vaccination. Women in common-law unions had the lowest vaccine readiness rate (60.6%), (OR: 3.36;CI: 1.006 - 10.70;p = 0.038). The frequency of occurrence of post immunization adverse events was 24.5%, with fever type in 94.7%. Conclusion: Almost all premature and/or low-birth-weight children hospitalized at Essos Hospital Center had completed routine immunization at 9 months, and the majority had received the vaccines in a timely manner. Similar study is needed in rural area.

Gut microbiota in preterm infants receiving breast milk or mixed feeding

BACKGROUND Preterm birth is the leading cause of mortality in newborns,with very-low-birthweight infants usually experiencing several complications.Breast milk is considered the gold standard of nutrition,especially for preterm infants with delayed gut colonization,because it contains beneficial microorganisms,such as Lactobacilli and Bifidobacteria.AIM To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less.METHODS An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less,born at the University Hospital Dr.JoséEleuterio González at Monterrey,Mexico.A total of 40 preterm neonates were classified into breast milk feeding(BM)and mixed feeding(MF)groups(21 in the BM group and 19 in the MF group),from October 2017 to June 2019.Fecal samples were collected before they were introduced to any feeding type.After full enteral feeding was achieved,the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing.Numerical variables were compared using Student’s t-test or using the Mann–Whitney U test for nonparametric variables.Dominance,evenness,equitability,Margalef’s index,Fisher’s alpha,Chao-1 index,and Shannon’s diversity index were also calculated.RESULTS No significant differences were observed at the genus level between the groups.Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group(P<0.011).In addition,higher counts of Gammaproteobacteria were detected in the final than in the initial sample(P=0.040).According to the Margalef index,Fisher’s alpha,and Chao-1 index,a decrease in species richness from the initial to the final sample,regardless of the feeding type,was observed(P<0.050).The four predominant phyla were Bacteroidetes,Actinobacteria,Firmicutes,and Proteobacteria,with Proteobacteria being the most abundant.However,no significant differences were observed between the initial and final samples at the phylum level.CONCLUSION Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria,contributing to the literature of the gut microbiota structure of very low-birth-weight,preterm.

Cut-Off Points of Head, Chest, and Arm Circumferences to Identify Low Birthweight: Meta-Analysis

Background: The cut-off points of newborn anthropometric variables to identify low birthweight (i.e., birthweight Methods: Meta-analysis was performed to summarize cut-off points in studies judged as good quality based on the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS). PubMed (MEDLINE) and nine other databases were searched (January, 2015). PubMed related-citations and references of potentially eligible articles and related reviews were also investigated. The Egger test was used to assess publication bias. Results: With respect to head, chest, and arm circumferences, the cut-off points that involved no publication bias could be summarized based on the data from large numbers of newborns (=21,793, 8917, and 12,912, respectively) in relatively sufficient numbers of studies (=17, 15, and 19, respectively). The optimal cut-off points to identify low birthweight were 33.0 cm (95% confidence interval [CI], 32.8 - 33.2), 30.4 cm (95% CI, 30.3 - 30.6), and 9.3 cm (95% CI, 9.1 - 9.4) for head circumference, chest circumference, and arm circumference, respectively. The summarized cut-off point of birth height, i.e., 47.2 cm (95% CI, 46.7 - 47.7), used to identify low birthweight involved publication bias (n = 13). Conclusion: The cut-off points were determined to identify low birthweight using head, chest, and arm circumferences.

出生缺陷与出生体重、胎龄的相关性

目的分析不同出生体重及胎龄围产儿的出生缺陷发生率,为进一步完善出生缺陷监测系统和降低出生缺陷发生率提供新的科学依据。方法对2003年10月1日至2015年9月30日西安市各级开设产科的医疗保健机构出生的孕28周~生后7 d所有围产儿进行出生缺陷监测并收集相关资料。结果2003至2015年共监测围产儿1236937例,其中出生缺陷儿10619例,出生缺陷发生率为8.59‰。2003至2015年西安市出生缺陷医院监测系统共收集出生体重<2500 g出生缺陷患儿3306例,出生孕周≥28周且<37周的出生缺陷患儿3473例,出生孕周≥42周的出生缺陷患儿共224例。2003至2015年低出生体重儿出生缺陷率显著高于正常体重儿(χ^(2)=37097.79,P<0.001)。2003至2015年早产儿(<37周)出生缺陷率显著高于正常产期儿(χ^(2)=24998.24,P<0.001),过期产儿出生缺陷率(≥42周)显著高于正常产期儿(χ^(2)=196.40,P<0.001)。低体重儿出生缺陷常见缺陷类型前5位依次是先天性脑积水、脊柱裂、先天性心脏病、无脑畸形、唇裂合并腭裂。正常体重儿出生缺陷出生结局以活产为主(占68.60%),而低体重儿出生缺陷出生结局以死胎为主(占54.72%),低体重儿出生缺陷与正常体重儿出生缺陷出生结局比较,差异有统计学意义(χ^(2)=647.59,P<0.001)。正常产期儿出生缺陷出生结局以活产为主(占77.38%),过期产儿出生缺陷出生结局以活产为主(占83.93%),而早产儿出生缺陷出生结局以死胎为主(占57.79%)。早产儿与正常产期儿出生缺陷出生结局比较,差异有统计学意义(χ^(2)=2025.08,P<0.001),早产儿与过期产儿出生缺陷出生结局比较,差异有统计学意义(χ^(2)=245.39,P<0.001),正常产期儿与过期产儿出生缺陷出生结局比较差异有统计学意义(χ^(2)=16.28,P=0.001)。结论早产儿、低出生体重儿及过期产儿出生缺陷发生率显著高于正常产期儿,低体重儿与正常体重儿、早产儿与正常产期儿、早产儿与过期产儿、正常产期儿与过期产儿出生缺陷出生结局比较,差异均有统计学意义。

≤10 kg婴幼儿先天性心脏病的围手术期治疗

目的评估低体重(≤10 kg)婴幼儿先心病的外科手术效果,总结临床经验。方法回顾性分析心外科低体重(≤10 kg)婴幼儿先心病1382例的临床资料。男性665例,女性717例;年龄6 d~3岁,平均(9.58±1.84)个月;体重1.6~10.0 kg,平均(8.82±1.13)kg。其中1305例在全身麻醉下行心脏畸形根治术,77例行姑息手术。结果全组手术顺利,术后死亡13例,占0.94%。死亡原因:低心排综合征7例,恶性心律失常1例,低氧血症5例(其中严重肺部感染2例)。结论低体重婴幼儿先心病的外科手术治疗是安全可行且有价值的,临床效果肯定,但必须正确掌握手术时机,缩短手术时间,严格进行围手术期管理,提高手术疗效。

母乳喂养质量改进在NICU极低出生体重儿中的应用

目的 探讨母乳喂养质量改进对新生儿重症监护室(NICU)极低出生体重儿的影响。方法 选取2021年1月1日—2021年12月31日南京市妇幼保健院NICU收治的70例极低出生体重儿(VLBWI)作为研究对象,按组间基线资料均衡可比的原则分为观察组和对照组,每组35例。对照组采取常规母乳喂养管理和宣教方式,观察组在常规母乳喂养管理的基础上通过增设人力资源、完善管理制度、加强医务人员培训、加大产妇及家属的宣教力度及加强院感监测共五个方面进行母乳喂养质量改进,比较两组VLBWI住院期间母乳喂养情况、生长发育情况、静脉营养时长、住院时长及并发症发生情况。结果 两组一般资料比较差异无统计学意义(P>0.05),观察组首次亲母母乳喂养时间、恢复出生体质量时间较对照组提前,住院期间纯母乳喂养率、体质量增长速率较对照组有所提升,静脉营养持续时间及总住院时长较对照组有所缩短,喂养不耐受、坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)及视网膜病变(ROP)并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论 母乳喂养质量改进措施可提升NICU住院VLBWI纯母乳喂养率,促进其体质量的增长,缩短静脉营养持续时间及总住院时长,减少相关并发症的发生率。

超早产儿获得性巨细胞病毒感染的临床检测及分析

目的探讨获得性巨细胞病毒感染在超早产儿中的临床应用价值。方法回顾性分析本院新生儿科2023年7月1日至9月15日送检的1072例新生儿血清样本的巨细胞病毒相关抗体检测结果。结果1072例样本中有2例患儿确诊获得性巨细胞病毒感染。该2例患儿均为超早产儿(胎龄24~27+6周)、超低出生体重儿(750~999 g),均以血小板降低为首发表现,1例为输血获得性巨细胞病毒感染,另1例为母乳获得性巨细胞病毒感染。结论在超早产儿这类特殊人群中,输血治疗时需警惕输血获得性巨细胞病毒感染,同时也要谨防母乳获得性巨细胞病毒感染,必要时经巴氏消毒后再喂养。

适于胎龄与小于胎龄的极低出生体重儿身长增长对PICC尖端移位的影响及比较

目的探讨极低出生体重儿(very low birth weight,VLBW)中适于胎龄儿(appropriate for gestational age,AGA)和小于胎龄儿(small for gestational age,SGA)身长增长对经外周中心静脉置管(peripherally inserted central catheter,PICC)尖端移位的影响,并横向比较影响程度,帮助医护人员更好地把握导管尖端位置监测的时机。方法回顾性分析2021年1月—2022年6月在医院NICU住院并使用PICC的VLBW,按出生体质量和胎龄关系分为AGA组45例和SGA组19例,记录首次置管当日身长(Ht_(1))以及PICC尖端位置、置管期间胸片检查当日身长(Ht_(n))以及PICC尖端位置,并计算相应的身长增长率。身长增长率与PICC尖端移位的相关性用Spearman秩相关分析。将AGA和SGA的身长增长率分别与PICC尖端移位进行简单线性回归分析,构建回归模型,用协方差分析比较两组回归直线。结果VLBW中AGA组97.8%患儿出现移位,SGA组所有的患儿都出现移位,占比最多的均为移位3个椎体。Spearman秩相关分析结果显示,两组患儿身长增长率与PICC尖端移位均具有相关性(AGA组rs=-0.719,P<0.001;SGA组rs=-0.769,P<0.001),随着VLBW身长增长,PICC尖端逐渐移位远离心脏。简单线性回归分析结果显示,AGA组回归模型(R^(2)=0.517,调整后R^(2)=0.513,F=129.487,P<0.001),SGA组回归模型(R^(2)=0.591,调整后R^(2)=0.585,F=95.385,P<0.001)。协方差分析结果显示,由于回归系数检验没有统计学意义,两条直线平行,说明身长增长率对两组患儿位移的影响一致。截距比较有统计学意义(F=9.265,P=0.003),说明两组患儿位移的起点不同(即增长率为零时的位移位置),说明位移与是否为AGA、SGA有关。结论随着VLBW中AGA和SGA身长增长,PICC尖端逐渐移位远离心脏,但相同的身长增长率,SGA引起的导管尖端移位幅度更大。建议AGA身长增长率12.4%、SGA身长增长率9.5%可作为监测导管尖端位置的重要时机,以免导管尖端进一步移位至非中心静脉,导致相关并发症发生。

新生儿败血症的临床特征及其相关因素研究

目的分析新生儿败血症(NS)的临床特征,并探讨其影响因素。方法回顾性分析2018年6月至2022年6月商丘市第一人民医院5420例新生儿临床资料,将其中发生NS的52例患儿的临床资料纳入发生组,将未发生NS的5368例新生儿临床资料纳入未发生组。查阅资料记录新生儿围产期情况及实验室相关指标情况;收集并记录52例NS患儿的临床表现及病原菌分离鉴定结果。分析NS的临床特征及其相关因素。结果52例NS患儿临床表现主要以体温改变、反应差、黄疸等症状为主;NS患儿的致病菌以表皮葡萄球菌、肺炎克雷伯菌为主;两组新生儿胎龄、出生体重比较,差异有统计学意义(P<0.05);Logistic多因素分析发现,极早产儿(OR=3.594,95%CI:1.997-6.468)、极低出生体重儿(OR=3.724,95%CI:2.071-6.698)、超早产儿(OR=2.244,95%CI:1.158-4.346)、超低出生体重儿(OR=15.111,95%CI:8.286-27.557)是发生NS的影响因素(P<0.05)。结论NS患儿临床表现主要以体温改变、反应差、黄疸等症状为主,致病菌以表皮葡萄球菌、肺炎克雷伯菌为主;极早产儿、超早产儿、极低体重儿、超低出生体重儿是NS发生的影响因素。

Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China

Background:Delivery room resuscitation assists preterm infants,especially extremely preterm infants(EPI)and extremely low birth weight infants(ELBWI),in breathing support,while it potentially exerts a negative impact on the lungs and outcomes of preterm infants.This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.Methods:The clinical data of EPI(gestational age[GA]<28 weeks)and ELBWI(birth weight[BW]<1000 g),admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018,were analyzed.The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation(DRI).The secondary outcomes were survival rates,incidence of bronchopulmonary dysplasia(BPD),and risk factors for BPD.Results:A cohort of 952 preterm infants were enrolled.The incidence of DRI,chest compressions,and administration of epinephrine was 55.9%(532/952),12.5%(119/952),and 7.0%(67/952),respectively.Multivariate analysis revealed that the risk factors for DRI were GA<28 weeks(odds ratio[OR],3.147;95%confidence interval[CI],2.082–4.755),BW<1000 g(OR,2.240;95%CI,1.606–3.125),and antepartum infection(OR,1.429;95%CI,1.044–1.956).The survival rate was 65.9%(627/952)and was dependent on GA.The rate of BPD was 29.3%(181/627).Multivariate analysis showed that the risk factors for BPD were male(OR,1.603;95% CI,1.061–2.424),DRI(OR,2.094;95% CI,1.328–3.303),respiratory distress syndrome exposed to≥2 doses of pulmonary surfactants(PS;OR,2.700;95%CI,1.679–4.343),and mechanical ventilation≥7 days(OR,4.358;95% CI,2.777–6.837).However,a larger BW(OR,0.998;95% CI,0.996–0.999),antenatal steroid(OR,0.577;95%CI,0.379–0.880),and PS use in the delivery room(OR,0.273;95%CI,0.160–0.467)were preventive factors for BPD(all P<0.05).Conclusion:Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants:a meta-analysis

Background The effect of fish oil-containing lipid emulsions on preventing parenteral nutrition-associated cholestasis(PNAC)in very low birth weight(VLBW)infants is not known.Thus,we conducted a meta-analysis to identify any preven-tion effect.Methods PubMed,EMBASE,and CENTRAL were searched up to 26 January 2021 for studies related to the preventive effect of fish oil-containing lipid emulsions and fish oil-free lipid emulsions on cholestasis in VLBW infants.Revman 5.3 was used to synthesize the results.A fixed-effect model was used to summarize the data when the heterogeneity was non-significant(I2<50%),and a random-effects model was used when the heterogeneity was significant(I2>50%).Results Of 728 articles,11 randomized controlled trials met the inclusion criteria.The meta-analysis indicated that fish oil-containing lipid emulsion reduced the occurrence of PNAC significantly with risk ratio(RR)=0.53,95%confidence interval(CI)0.36-0.80,P=0.002.The heterogeneity was non-significant with I2=23%.Subgroup analysis based on par-enteral nutrition duration and median birth weight was performed.The synthesis results for patients with parenteral nutri-tion duration exceeding 14 days revealed I2=35%(P=0.15)and pooled RR=0.47,95%CI 0.30-0.73,P=0.0008;and for patients with duration less than 14 days revealed I2=0%(P=0.72)and pooled RR=1.14,95%CI 0.39-3.35,P=0.81.The synthesis for patients with birth weight more than 1000 g revealed I2=0%(P=0.41)and pooled RR=0.55,95%CI 0.26-1.18,P=0.12;and for patients with birth weight below 1000 g revealed I2=44%(P=0.11)and pooled RR=0.53,95%CI 0.33-0.85,P=0.009.Conclusions The fish oil-containing lipid emulsion can reduce the occurrence of PNAC in VLBW infants based on the avail-able original randomized controlled trial studies,especially for patients with parenteral nutrition duration exceeding 14 days and extremely low birth weight infants.Future studies should be performed before a definitive conclusion can be established.