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.

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.

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.

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.

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.

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.

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.

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.

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。

≤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。

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。

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。

低出生体重早产儿经外周静脉穿刺置入中心静脉导管异位的影响因素分析

目的:探讨低出生体重早产儿(LBW-PI)经外周静脉穿刺置入中心静脉导管(PICC)发生置管异位影响因素.方法:选取2020年1月至2023年7月本院拟行PICC置管的LBW-PI 96例为研究对象.根据是否发生置管异位,将其分别纳入研究组(n=24,PICC发生异位者)和对照组(n=72,PICC无异位者).收集患儿的临床资料,分析LBW-PI PICC异位发生的影响因素.结果:LBW-PI的PICC异位率为25.00%(24/96).多因素非条件Logistic回归分析结果显示,出生胎龄<32周、出生时体重<1500g、置管前机械通气、左上肢置管、置管时日龄1d、置管护士层级、贵要静脉置管、头静脉置管均为导致LBW-PI发生PICC异位的独立影响因素(OR>1,P<0.05).结论:LBW-PI的PICC异位率高,可能与早产儿出生胎龄、出生时体重、置管前机械通气、置管时日龄、左上肢置管、置管护士层级、头静脉和贵要静脉等有关.

1例超低出生体重儿经外周静脉置入中心静脉导管置管后并发心包填塞的护理

本文总结1例经外周静脉置入中心静脉导管(PICC)引起心包填塞的护理,以提高临床对本病的认识及预防。通过观察患儿局部与全身情况,采用胸部X线和心脏彩超进行检查,确诊患儿发生心包填塞及PICC异位,通过紧急行心包穿刺术,缓解心包填塞症状;及时拔除中心静脉置管,给予呼吸、循环、营养、重新置管等方面的支持治疗,并积极做好早产儿术后精细化护理。通过实施上述措施后,该患儿术后第7天心包腔无液性暗区、心影缩小,心率恢复正常,并在治疗68d后康复出院。积极预防深静脉导管并发症,在置管前应充分评估患儿,做好置管前准备。同时,置管及维护人员应具备丰富的临床经验,根据个体选择合适的置管方式、护理方案,才能降低不良事件发生率,保障置管的安全性。

初乳灌肠对极低出生体重儿胎粪排出和免疫反应的影响

目的探讨初乳灌肠对极低出生体重儿胎粪排出和免疫反应的影响。方法将128例极低出生体重儿随机分为干预组和对照组各64例。干预组采用2 mL/kg初乳灌肠;对照组采用1 mL/kg开塞露+1 mL/kg生理盐水1∶1稀释灌肠。灌肠自早产儿出生后24 h开始,至胎粪排尽时停止。结果干预组脱落10例,对照组脱落9例。干预组胎粪排尽时间和达到完全肠内营养时间显著短于对照组,体质量增长速度显著高于对照组(均P<0.05);干预组首次排出与排尽时的胎粪中的分泌型免疫球蛋A浓度、出生后第1次与第6天尿液中的分泌型免疫球蛋A浓度显著高于对照组(均P<0.05);干预组坏死性小肠结肠炎、喂养不耐受发生率显著低于对照组(均P<0.05)。结论初乳灌肠能促进极低出生体重儿胎粪排出,缩短达到完全肠内营养时间,提高体质量增长速度,提高早产儿免疫功能,降低相关并发症发生率。

全身运动质量评估风险分级干预策略对低出生体重儿神经发育的影响

目的 研究全身运动质量评估(GMs)不同风险分级干预对低出生体重儿在纠正6、12个月龄神经发育的影响。方法 选取新生儿科住院接受全身运动质量评估的低出生体重儿150例,出院后在门诊复评GMs。150例早产儿按GMs 2个阶段的评估结果分为高风险Ⅰ级、中风险Ⅱ级、低风险Ⅲ级,制定不同早期干预策略,比较3组患儿纠正6、12个月龄神经发育结果及纠正12个月龄时神经发育结局。结果 纠正6个月龄3组患儿龄精细动作、社会适应、语言、个人社交行为4个领域发育商评分比较,差异均有统计学意义(P<0.05)。纠正12个月龄3组患儿在粗大运动、精细运动、社会适应、语言、个人社交行为5个领域商评分比较,差异有统计学意义(P<0.01)。纠正12个月龄,神经发育结局异常9例,其中脑性瘫痪1例(高风险Ⅰ级),运动发育迟缓8例(高风险Ⅰ级2例、中风险Ⅱ级4例、低风险Ⅲ级2例)。结论 应用GMs评估结果不同风险分级精细化管理指导。能够促进低出生体重儿神经发育,减少神经发育异常,可在临床工作中进一步推广和应用。

两种母乳低温保存方式在低出生体质量早产儿喂养中的应用

目的:比较冷藏的新鲜母乳和冷冻母乳对低出生体质量早产儿(low birth weight infant,LBWI)喂养的影响。方法:以286例LBWI为研究对象,按家属意愿分为观察组142例,予冷藏的新鲜母乳(0~4℃,保存24 h)喂养;对照组144例,予冷冻母乳(-20~-18℃,保存3~6个月)喂养。患儿入院后即开始干预,喂养1周后,比较两组喂养不耐受的发生率、经口喂养率、全经口喂养开始时间、肠道菌群的变化,及新生儿坏死性小肠结肠炎(necrotizing enterocolitis of newborn,NEC)、院内感染等发生率。结果:观察组第8天经口喂养率高于对照组(P=0.002),喂养不耐受的发生率低于对照组(P<0.001),肠道菌群的建立优于对照组(P=0.041);观察组出院前全经口喂养开始时间较对照组提前(P<0.001),喂养不耐受和院内感染的发生率均低于对照组(P=0.041,P=0.046)。而两组新生儿坏死性小肠结肠炎、胆汁淤积症和支气管肺发育不良的发生率差异均无统计学意义(均P>0.05)。结论:与冷冻母乳相比,冷藏的新鲜母乳能提高LBWI经口喂养率,使全经口喂养开始时间提前,降低喂养不耐受和院内感染的发生率,优化肠道菌群的建立。本研究结果在一定程度上验证了新鲜母乳冷藏对LBWI干预的有效性和可行性。

一例超低出生体重儿脐动脉置管后并发肢体缺血性坏死的护理

总结2022年11月我院收治的1例超低出生体重儿(ELBWI)脐动脉置管后并发肢体缺血性坏死的护理经验。护理要点:组建多学科团队,制定精细化护理方案,肢体缺血性坏死的及时识别,予以个体化护理包括做好血管活性药物用药护理,避免药物不良反应,保证湿度与温度,维持有效外环境以及局部氧疗。经过精心的治疗及护理,患儿顺利出院,且未发现肢体生长异常等远期并发症。

极低出生体重儿中心静脉血管通路装置安全管理中国专家共识

为完善我国极低出生体重儿静脉治疗技术体系,为其提供更合理的中心静脉血管通路装置,促进相关领域的发展,相关专家遵循循证学依据,采用最新的高质量证据,根据问题和推荐强度等级分类,国际血管联盟中国分部护理专业委员会在诸多领域的专家、各级医院医生和护士中广泛收集建议,构建了此共识。旨在为新生儿科的医务人员的临床决策提供参考,确保临床相关操作规范,并帮助管理极低出生体重儿的中心静脉血管通路装置。