Cardiometabolic effects of breastfeeding on infants of diabetic mothers

BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants.It may protect infants against many metabolic diseases,predominantly obesity and type 2 diabetes.Diabetes mellitus(DM)is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood.Breastfeeding protects against infant mortality and diseases,such as necrotizing enterocolitis,diarrhoea,respiratory infections,viral and bacterial infection,eczema,allergic rhinitis,asthma,food allergies,malocclusion,dental caries,Crohn's disease,and ulcerative colitis.It also protects against obesity and insulin resistance and increases intelligence and mental development.Gestational diabetes has short and long-term impacts on infants of diabetic mothers(IDM).Breast milk composition changes in mothers with gestational diabetes.AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15,2022,in this review.RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms.Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM.Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term,the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.CONCLUSION We need more comprehensive research to prove these effects.Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding,every effort should be made to encourage them to breastfeed.

Factor Structure and Measurement Invariance of the Japanese Version of the Mother-to-Infant Bonding Scale

Background: Bonding disorders affect the growth and development of infants. In Japan, the Japanese version of the Mother-to-Infant Bonding Scale (MIBS-J) is widely used for early detection of bonding disorders. Repeated use of a questionnaire has problems of reduced validity. In order to correctly detect bonding disorders at multiple time points, it is necessary to confirm the measurement invariance of the scale. Baba et al. reported that invariance of the MIBS-J factor structure could only be obtained by abridging the scale into three items. Purpose: The aim of this study was to 1) confirm the factor structure and measurement invariance of the MIBS-J between two measurement times and 2) to examine factors that can be used without being affected by measurement time in order to identify item that contribute to measure met invariance. Methods: We analysed the data of 1049 and 878 mothers with a neonate collected in two waves: 5 days (Wave 1) and 1 month postpartum (Wave 2). Exploratory and confirmatory factor analyses were conducted on the data randomly divided into two groups in each wave. Results: The three-item model (MIBS-J items 1, 6, and 8) was most accepted. Measurement invariance and structural invariance were confirmed in the model. This was consistent with Baba et al.’s model. Conclusion: The three MIBS-J items showed measurement invariance and structural invariance in Japanese mothers during 1 month postpartum.

Deoxyribonucleic Acid-Polymerase Chain Reaction Status of HIV Exposed Infants in a Sub Regional Prevention of Mother-to-Child Transmission of HIV Programme during the Period 2009-2020

Introduction: Transitioning to more efficacious Antiretrovirals for HIV infected pregnant women and infant prophylaxis has reduced Mother to child transmission of HIV significantly. This study aimed to determine HIV infection status in HIVexposed infants who had their first DNA polymerase chain reaction test in our molecular Laboratory. Subjects, Materials and Methods: Dried Blood Spots for HIV DNA results from 5 states between 2009 and 2020 were analyzed in the PCR laboratory of the Federal Teaching Hospital, Gombe. Results: Nine thousand eight hundred and twenty-three Human Immunodeficiency Virus Deoxyribonucleic acid polymerase Chain Reaction results were analysed;4937 (50.2%) were males. During the study period, there was an overall declining trend in the mother-to-child transmission rate from 3.8% in 2009 to 1.0% in 2020. 6120 (62.3%) of HIV + mothers received Highly active antiretroviral therapy HAART before pregnancy. 7845 (76.2%) of the infants received Nevirapine prophylaxis. Dried blood spot samples were collected from 4077 (41.5%) at 6 - 8 weeks. 8438 (85.9%) received cotrimoxazole. 9469 (96.4%) were ever breastfed. Of the 9823 HIV DNA PCR results, 255 (2.6%) were positive while 69/4077 (1.7%) and 109/2662 (4.1%) were positive for HIV DNA at 6 - 8 weeks and > 12 weeks respectively. (p = 0.001). 86/747 (11.5%) of infants whose HIV-positive mothers received no ARVS were HIV DNA positive. (p = 0.001). 106/884 (12.0%) of infants who had no Antiretroviral prophylaxis had positive HIV DNA results;7/413 (1.7%) with Zidovudine/Nevirapine prophylaxis had positive results. (p = 0.001). 246/9469 (2.6%) of infants that were ever breastfed were positive for HIV DNA;11/354 (3.0%) that never breastfed had positive HIV DNA. Conclusion: Lack of maternal/infant ARVs and prolonged breastfeeding increased the risk of infant HIV infection.

Relationship between the different replication status of HBV and mutations in the core promoter in mothers and their children infected via mother-to-infant transmission

OBJECTIVE: To study the relationship between the different replication status of hepatitis B virus (HBV) and mutations in the core promoter (CP) in mother and her child infected by mother-to-infant transmission. METHODS: The core promoter was amplified by PCR and cloned into pGEM-T vector with the T-A choning technique. The recombinant plasmid pGEM-CP was confirmed by digestion with restriction enzyme Apa I and Sac I. Two clones were selected to be sequenced in each patient. RESULTS: Every pair of mother and child had same serotype and genotype and the homology of nucleotides encoding 'a' determinant was 98%-100%. The number of mutations in the core promoter of patients with a high replication status was less than that in those with a low replication status. Mutations were mainly distributed in basia core promoter (BCP) and the inbibitor region of Kunitz-type serine protease. This difference was not associated with mother or child. CONCLUSION: The different replication status of HBV is caused by mutations in the core promoter in mother and child infected hy mother-to-infant transmission and appears to be not associated with the status of development of the infection.

Hepatitis B Immunoprophylactic Failure and Characteristics of the Hepatitis B Virus Gene in Mother-Infant Pairs in Parts of China

Objective To determine the hepatitis B immunoprophylactic failure rate in infants born to hepatitis B virus （HBV） infected mothers and to characterize HBV genes. Methods HBV-serological testing was conducted for pregnant women and infants. The complete genomes of 30 HBV isolates were sequenced, and genetic characteristics were analyzed using MEGA 5 software. Results The immunoprophylactic failure rate for infants who had completed the scheduled hepatitis B vaccination program was 5.76% （32/556）. High sequence homology （99.8%-100%） was observed in 8 of the 10 mother-infant pairs. We identified 19 subgenotype C2 strains, 9 subgenotype B2 strains, and 2 subgenotype Cl strains. Three serotypes were detected： adr （19/30）, adw （9/30）, and ayw （2/30）. The frequency of amino acid mutation of the ＇a＇ determinant region was 16.67% （5/30）, including that of Q129H, F134Y,S136Y, and G145E. We detected 67 amino acid mutations in the basal core promoter, precore, and core regions of the genome. Conclusion The immunoprophylactic failure rate in infants born to HBV-infected mothers is low in the regions of China examined during this study. Moreover, HBV mutation in the ＇a＇ determinant region could not account for immunoprophylactic failure for all infants.

Cardiac changes in infants of diabetic mothers

Diabetes mellitus(DM)is a systemic chronic metabolic disorder characterized by increased insulin resistance and/orβ-cell defects.It affects all ages from the foetal life,neonates,childhood to late adulthood.Gestational diabetes is a critical risk factor for congenital heart diseases(CHDs).Moreover,the risk increases with low maternal education,high body mass index at conception,undiagnosed pregestational diabetes,inadequate antenatal care,improper diabetes control,and maternal smoking during pregnancy.Maternal DM significantly affects the foetal heart and foetal-placental circulation in both structure and function.Cardiac defects,myocardial hypertrophy are three times more prevalent in infants of diabetic mothers(IDMs).Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography.Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography,detection of early atherosclerotic changes by measuring aortic intima-media thickness,and retinal vascular changes by retinal photography.Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention.However,other measures to reduce the risk,such as using medications,nutritional supplements,or probiotics,still need more research.This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM,the various cardiac outcomes of gestational DM on the foetus and offspring,cardiac evaluation of foetuses and IDMs,and how to alleviate the consequences of gestational DM on the offspring.

Effect of maternal alcohol consumption on gestational diabetes detection and mother-infant’s outcomes in Kinshasa, DR Congo

Objectives: Since it has been suggested that moderate alcohol drinking would increase insulin sensitivity, which could benefit Gestational Diabetes Mellitus (GDM), the study aimed at evaluating alcohol consumption during pregnancy, and seeing whether this consumption influences GDM detection and maternal/perinatal outcomes. Study design: Women with already known diabetes and those with multiple pregnancy were excluded. All other pregnant women attending antenatal care unit of the university clinics, Kinshasa, DR Congo during the period from 1 March throughout 31 October 2010, were invited at 24-week gestation to enroll in O’Sullivan blood glucose testing and if eligible in 100-gram oral glucose tolerance test. Alcohol consumption, risk factors for GDM, and general characteristics such as age, parity, gestity, BMI, fat mass were registered. Diagnosed GDM was first treated with diet and exercise, thereafter with Metformin, and if necessary with insulin. For other (normal) women data remained blinded until confinement. Maternal and infant’s adverse outcomes such as maternal urinary infection, preeclampsia, cesarean section, intrauterine growth retardation, birth weight percentile 90 in our milieu), Apgar score at the first minute < 7, shoulder dystocia or other birth injury, neonatal hypoglycemia and fetal alcohol syndrome (FAS) were compared and analyzed according to GDM diagnosis as well to alcohol status. Results: Up to 240 pregnant women accepted to enroll into the study. Alcohol consumption concerned 78 (32.5%) of the women, most of them (61 = 25.42%) being heavy consumers. Risk factors for GDM and Physical and blood glucose characteristics were alike (p not significant) in both consumers and non consumers, except for history of HTA in the family that was significantly more frequent (p = 0.02) among drinkers. GDM’s prevalence was 9%. No adverse outcome was more prominent in any subgroup, except Apgar score < 7 at the first minute that was more frequent (p = 0.038) among neonates of GDM mothers. No FAS, neither shoulder dystocia nor neonatal hypoglycemia were diagnosed. When alcohol status was considered, Birthweight ≥ 3800 g was found more frequent (p = 0.0284) in alcohol consumers than in abstainers. Risk of this outcome was three times higher when history of family hypertension was present (odds ratio 2.694;CI: 0.536 - 13.544). Conclusions: The prevalence of alcohol consumption by pregnant women of our series (32.5%) seems not to impact the detection of GDM (9%). FAS was not diagnosed. Lack of significant differences in adverse outcomes between GDM and non GDM could be attributed to huge follow-up of GDM women. Influence of alcohol consumption on birth weight mostly in setting of familial history of hypertension remains to be addressed.

Impact of postnatal maternal depressive symptoms and infant’s sex on mother-infant interaction among Bangladeshi women

Aim: To investigate the impact of postnatal depressive symptoms and infant sex on perceived and observed mother-infant interaction among rural Bangladeshi women. Methods: Fifty women with depressive symptoms and their infants at 2 - 3 months were compared with 50 women without depressed symptoms and their infants, matched on geographic areas, parity and infant sex. The Edinburgh Postnatal Depression Scale assessed depressive symptoms, the Postpartum Bonding Questionnaire assessed the mother’s perception of bonding with the infant and mother-infant interactions were videotaped and analyzed with the Global Rating Scale. Results: Mothers with depressive symptoms were poorer, were less educated and rated lower infant bonding than mothers without depressive symptoms (p = 0.03), yet objective observation revealed no difference between the two groups regarding maternal interactive behavior (p = 0.57). However, infants, particularly boys (p = 0.002), of mothers with depressive symptoms fretted more in mother-infant interaction than infants of mothers without depressive symptoms (p = 0.009). Conclusion: Although mothers with depressive symptoms did not show less sensitivity in interactive behavior at 2 - 3 months than those without depressive symptoms, our results indicate that infants, particularly boys, of mothers with depressive symptoms may be negatively influenced by depressive symptoms.

Assesment of polyunsaturated fatty acids in cord blood of infants of diabetic mothers

Objective:To assess whether infants of diabetic mothers [pre pregnancy diabetics(PPD)and gestational diabetics mellitus(GDM)] have compromised arachidonic and docosahexaenoic acids in their plasma and the relationship with deficiency of the same compounds in their mothers.Methods:This study was conducted on 30 diabetic mothers(both PPD and GDM)and their infants.Twenty healthy infants and their mothers with age and sex matched were included as controls.All infant(of diabetic and non diabetic mothers)were subjected to assessment of APGAR Scoring,thorough history taking and anthropometric measures.Lipid profile components as well as polyunsaturated fatty acids(PUFA)were assessed in diabetic GDM and PPD and non diabetic mothers as well as in their babies.Results:High-density lipoproteir(HDL)level was found to be significantly lower in diabetic mothers(specially those with PPD)compared to non diabetic ones,whereas no significant difference was found between babies of the two groups.Also,the current study revealed that diabetic mothers(GDM and PPD)and their babies had significantly higher levels of PUFA precursors linoleic acids(LA)and alpha linoleic acids(ALA).PUFA arachidonic acid(AA)and docosahexaenoic acids(DHA)were found to be significantly lower in diabetic mothers(GDM and PPD)compared to non diabetic mothers,and same results were found in the babies of the two groups.Conclusion:Neonates with diabetic mothers(both GDM and PPD)have highly compromised plasma levels of AA and DHA PUFA,which affects the child well being by far,and produces hazardous multi-system complications on the long run.

Maternal Depression and Mother-to-Infant Bonding: The Association of Delivery Mode, General Health and Stress Markers

Aim: The aim of the present study was to examine associations among maternal stress level, general health, mother to infant bonding, maternal depression level, and mode of delivery. Methods: Mothers who delivered a single baby at term were recruited with a total 435 mothers participating in the study. Outcome measures: Data were collected 6 months after delivery using General Health Questionnaire (GHQ-28), Mother-to-Infant Bonding Scale (MIBS), Edinburgh Postnatal Depression Scale (EPDS) as well as socio-demographic and medical information at 6 months. Additionally, salivary cortisol and chromogranin levels were determined. Results: The proportion of breast-feeding mothers in the vaginal delivery group (51.4%) was significantly higher than that of the cesarean section group (24%). GHQ-28 scores were significantly related to EPDS scores and MIBS scores (P Conclusion: Maternal general health is associated with maternal psychological health. These results suggest that the support of maternal health is important to maintain maternal psychological status and bonding to infants. Because EPDS scores were significantly worse in the planned cesarean section group (4.2 ± 3.3), careful management is needed of mothers who deliver by planned cesarean section.

A Case Study on the Impact of Mother-to-Mother Support Groups on Maternal, Infant and Young Child Nutrition and Care Practices in Habaswein and Wajir South Districts of North Eastern Kenya

Only about 25% of babies are exclusively breast fed until six months of age in developing countries though they are at a greater risk of infection and infant mortality. The Global Strategy for Maternal, Infant and Young Child Feeding (MI- YCF) Strategy developed by WHO/UNICEF in 2002 was to revitalize world attention to the impact of feeding practices on the nutritional status, growth, development, health and survival of infants and children. The data for this case study was collected through key informant interviews, observations and review of Save the Children nutrition programme reports and surveys. This information was then organized to produce a detailed description of the maternal, infant and young child nutrition programme in Habaswein and Wajir South districts or sub-counties. The maternal and infant young child nutrition (MIYCN) programme was launched in Habaswein and Wajir South districts in January 2012. The MIYCN programme followed recommendations of a Knowledge, Practice and Coverage (KPC) survey report in July 2012. To date, the programme has formed 48 Mother-to-mother Support Groups (MTMSGs), which are actively promoting the uptake of the recommended MIYCN practices in the community. MIYCN indicators have been markedly improved between July 2011 and February 2013 when surveys were conducted. The uptake of kitchen gardening has picked up significantly at Meri site and some mothers now have a changed attitude towards unskilled home deliveries and are conducting referrals for skilled births. The marked improvements in the performance of MIYCN indicators between July 2011 and February 2013 inWajir South and Habaswein districts can be partly attributed to the MIYCN programme established in January 2012. However, a randomized community trial is still required to provide conclusive results on the impact of care support groups on maternal, infant and young child feeding in this region.

基于ERAS理念下产后乳胀护理方案对母婴分离产妇心理及泌乳的影响

目的探究加速康复外科医学(ERAS)理念引导下的产后乳胀护理方案对母婴分离的产妇泌乳及心理的影响。方法选取2022年8月至2023年8月于商丘市第一人民医院分娩且母婴分离的160例产妇作为研究对象,采用随机数表法分为对照组和观察组各80例。对照组产妇实施常规产后乳胀护理方案,观察组产妇采取ERAS理念引导下的产后乳胀护理方案,两组产妇均接受1周的护理干预。比较两组产妇干预1周后的泌乳时间、泌乳量、乳房肿胀程度;采用视觉模拟评分法(VAS评估两组产妇干预前、干预3 d、干预1周后乳房的胀痛严重程度;并比较两组产妇干预前、干预1周后的心理状况评分[状态-特质焦虑量表(STA-I)和爱丁堡产后抑郁量表评分(EPDS)]和健康状况调查问卷(SF-36)评分;采用Spearman相关分析法分析乳房肿胀程度与心理状态的相关性。结果观察组产妇的泌乳时间为(30.22±5.81)h、明显早于对照组的(46.38±7.59)h,泌乳量、Ⅰ级乳房肿胀程度占比分别为(469.51±22.31)mL、50.00%,明显多(高)于对照组的(337.81±33.17)mL、31.25%,差异均有统计学意义(P<0.05);干预3 d和1周后,观察组产妇的VAS评分分别为(3.04±0.99)分、(1.05±0.38)分、明显低于对照组的(4.33±1.02)分、(2.82±0.85)分,差异均有统计学意义(P<0.05);干预1周后,观察组产妇的STA-I、EPDS评分分别为(30.25±3.05)分、(3.76±1.05)分,明显低于对照组的(38.11±3.78)分、(6.89±1.83)分,SF-36评分为(88.51±4.38)分,明显高于对照组的(78.36±4.25)分,差异均有统计学意义(P<0.05);经Spearman相关分析结果显示,产妇乳房肿胀程度与STA-I和EPDS评分均呈正相关(r=0.160、0.234,P<0.05)。结论ERAS理念护理方案可改善母婴分离产妇的泌乳异常、胀痛,减轻焦虑抑郁,提升生活质量。

Mother’s Nutritional Knowledge and Practice towards Children under Two Years of Age and Its Impact on Their Health in Abuzaid Albuluk Pediatric Specialized Hospital in 2023

Background: Nutritional knowledge and practise is an important measure to improve dietary habits and food choices. The daily food should contain balanced nutrition as needed to support optimal growth, avoid deficiency diseases and prevent the diseases which might interfere with the children health. Materials & Methods: A descriptive cross-sectional non-interventional hospital-based study was carried out among 122 mothers and 122 children by using a non-probability convenience sampling technique in the period of 15 March to 15 April 2023, and using interviews with structural questionnaires, the data was analyzed using SPSS version 26. Results: We found that most of the children had moderate health, while most of the mothers had moderate nutritional knowledge and practise towards their children, also we found that the relationship between mothers’ knowledge and practise and child health was significant (P Conclusion: Mothers’ knowledge and practise among children was moderate and children had moderate health. Wrong beliefs and cultural taboos play major roles in decreasing knowledge and practise.

右美托咪定与氢吗啡酮复合滴鼻在腺样体手术患儿术前母婴分离镇静中的应用

目的:探讨右美托咪定与氢吗啡酮复合滴鼻在小儿腺样体手术术前母婴分离过程中的麻醉镇静效果。方法:选取我院2021年1月-2022年8月择期行腺样体手术患儿60例,采用随机数表法分为观察组和对照组各30例,观察组采用1.5μg/kg右美托咪定复合30μg/kg氢吗啡酮滴鼻术前镇静,对照组采用1.5μg/kg右美托咪定滴鼻术前镇静。比较两组患儿滴鼻前(T0)、滴鼻后5 min(T1)、15 min(T2)、25 min(T3)各时间点镇静程度(RASS)评分,母婴分离时(T4)的镇静情绪评分,开放静脉时(T5)的睡眠障碍量表(ESS)评分及各时间点脉搏氧饱和度(SpO_(2))和心率(HR)的变化,全麻诱导期扣面罩接受程度评分,苏醒期躁动评分以及术后不良反应发生情况等。结果:T1~T3时间点RASS评分、T5时间点ESS评分、苏醒期躁动评分,观察组均低于对照组(P<0.05);T4时间点镇静情绪评分、诱导期扣面罩接受程度评分,观察组均高于对照组(P<0.05);惊醒哭闹患儿例数和需辅助麻醉患儿例数,观察组少于对照组(P<0.05);两组患儿T0~T5时间点HR、SpO_(2)水平变化均不显著(P>0.05);两组患儿不良反应发生率比较差异均无统计学意义(P>0.05)。结论:右美托咪定复合氢吗啡酮术前滴鼻,安全有效,利于腺样体手术患儿与父母安静分离,不良反应少,值得进一步推广应用。

Status of New HIV Infections among Infants Born of HIV Positive Mothers on Prevention of Mother to Child Transmission at Kisii Teaching and Referral Hospital, Kenya

Introduction: The goal of Prevention of Mother to child Transmission (PMTCT) is to minimize new HIV infection with PMTCT interventions which can reduce to as low as 2%. Gusii region is number 5 among counties that contribute to 65% of new HIV (Human Immunodeficiency Virus) in infections in Kenya. The study was to determine the prevalence of new HIV infections among infants (3 - 18 months) born of HIV positive mothers on PMTCT follow up at Kisii Teaching and Referral Hospital (KTRH). Method: This was a descriptive cross sectional study involving 96 infants born of HIV positive mothers on PMTCT programme at Kisii Teaching and Referral Hospital (KTRH) was conducted. The infants were between 3 to 18 months of age. The infants were investigated for their HIV status and factors associated with prevalence. The data collection was done during postnatal checkups, antiretroviral treatment follow up and immunization schedule. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: 13.5% (95% C.I = 10.1% to 16.9%) were found to be positive despite their mothers being on PMTCT program. There was no significant difference between gender and status of the infant (χ2 = 0.758, df = 1, p-value = 0.0384). Conclusion: The study confirms that there are still new HIV infections despite being followed up in the PMTCT program. The new HIV infections were associated with mixed feeding. Recommendation: Counseling on Infant feeding, use of ant-retroviral treatment and support from partners should be strengthen in the PMTCT program to ensure reduction of new HIV infections.

母婴床旁及延续护理促进产妇康复效果的实证研究

目的探讨母婴床旁及延续护理对产妇康复的应用效果。方法选取2021年4月1日至5月27日到广西壮族自治区妇幼保健院厢竹院区产科一区收治的280例顺产、单胎的初产妇为研究对象,按照随机数字表法将其分为对照组(n=140)与试验组(n=140),对照组予常规护理+延续护理,试验组予母婴床旁护理+延续护理。对照组与试验组产妇及家属出院后开展电话随访、建立QQ群等延续母婴护理指导。比较两组产妇的母婴护理知识及技能、自我护理能力(ESCA)、中文版育儿胜任感(C-PSOC)、中文版压力知觉(CPSS)的评分。结果干预后,试验组产妇的母婴护理知识及技能掌握程度优于对照组,ESCA、C-PSOC评分均高于对照组,CPSS低于对照组,差异有统计学意义(P<0.05)。结论母婴床旁及延续护理指导,提高产妇母婴护理知识及技能、产妇自我护理能力、育儿胜任感,降低产妇压力感知,促进产妇康复,值得推广应用。

袋鼠式护理临床路径对极低出生体重儿造瘘术后的影响

目的探讨袋鼠式护理临床路径的使用对提高极低出生体重儿造瘘术后奶摄入量、体重增长及提高家长满意度的效果。方法选取2018年11月至2022年12月收治的极低出生体重儿造瘘术后的患儿21例,随机分为观察组10例,对照组11例,观察组采用袋鼠式护理临床路径的要求进行干预,对照组采用常规护理模式进行护理,比较分析2组患儿的生命体征、奶摄入量及体重增长情况,以及家长在住院期间的满意度。结果观察组患儿的生命体征指标与对照组比较无明显变化(P>0.05),奶摄入量及体重增长情况均高于对照组(P<0.05),住院期间家长满意度调查明显高于对照组(P<0.05)。结论袋鼠式护理临床路径的使用可提高极低出生体重儿造瘘术后的奶摄入量,以保证其生长发育需求,增长体重,缩短住院时长,提高家长的满意度。

音乐疗法在无痛分娩中对母婴的影响

目的探索音乐疗法对无痛分娩母婴的影响。方法选择行无痛分娩产妇120例,采用随机数字表法,将所有产妇分成两组,每组60例:非音乐疗法组(对照组)与音乐疗法组(试验组)。记录产妇年龄、体重、身高、孕周及新生儿体重,硬膜外穿刺间隙与麻醉1h后平面;分别于动脉穿刺后(T_(1))、胎儿娩出后(T_(2))和胎儿娩出后2h(T_(3))记录平均动脉压(MAP)、心率(HR)、焦虑自评量表(SAS)评分;于T_(1)、T^(2)、T_(3)时刻分别抽产妇动脉血5mL检测白细胞介素(IL)-1β、IL-6、肿瘤坏死因子-α(TNF-α)、皮质醇、血清强啡肽(DYN)水平;胎儿娩出后抽取脐动脉血行血气分析及阿氏评分(Apgar);记录产后2h子宫出血量、总产程时间;分别观察两组产后12、24、72h的视觉模拟评分法(VAS)评分。结果两组产妇在年龄、体重、身高、孕周及新生儿体重、硬膜外穿刺间隙、麻醉1h后平面、总产程时间、T_(1)时刻(MAP、HR、SAS评分、IL-Iβ、IL-6、TNF-α、皮质醇、血清DYN水平)组间差异无统计学意义(均P>0.05)。试验组T_(2)、T_(3)时刻MAP、HR、SAS评分、IL-1β、IL-6、TNF-α、皮质醇的检测水平均低于对照组,差异均有统计学意义(均P<0.05);试验组血清DYN水平、Apgar评分、pH值、PO_(2),高于对照组,差异均有统计学意义(P<0.05);PCO_(2)值、子宫出血量及产后12、24、72hVAS评分低于对照组,差异均有统计学意义(均P<0.05)。结论音乐疗法应用于无痛分娩,能帮助稳定孕产妇生命体征,缓解焦虑情绪,减轻应激反应的发生;使血清DYN水平增加,相对减少机体的炎性疼痛介质表达,并减轻孕产妇产后的疼痛感。提高新生儿Apgar评分,减少缺氧酸中毒的发生,降低孕产妇产后出血量。

产妇产后创伤后成长的现状及影响因素分析

目的调查产妇产后创伤后成长的现状及其影响因素,为制订提高产妇产后创伤后成长的措施提供参考。方法便利抽样法选取十堰市3所三级医院的201例产妇,使用一般资料调查表、创伤后成长评定量表、事件中心性量表、母婴依恋量表进行调查。结果产妇产后创伤后成长总分为(64.39±13.64)分;母亲身份核心及母婴依恋与产后创伤后成长呈正相关(r=0.357、0.245,均P<0.01);母婴依恋、母亲身份核心、居住地(县城或城镇)、家庭月总收入、分娩后主要长期由谁照顾(父亲或母亲)、对分娩知识的了解程度是产后创伤后成长的影响因素(均P<0.05)。结论产妇产后创伤后成长处于较高水平,母亲身份核心及母婴依恋与产妇产后创伤后成长水平密切相关;管理者可通过对分娩经历的评估促使产妇形成身份核心,采取增强母婴依恋的做法,以提高产妇产后创伤后成长水平。

孕妇肠道、阴道菌群和新生儿胎粪、胎皮脂菌群的相关性研究

目的·分析母亲孕晚期肠道菌群、阴道菌群、新生儿胎粪及胎皮脂菌群的多样性及菌群构成,比较其异同及相关性。方法·前瞻性研究。招募2018年8月—11月于上海交通大学医学院附属新华医院分娩的11对母婴,采集母亲孕晚期粪便样本、阴道拭子及新生儿胎粪;招募2018年12月于上海交通大学医学院附属国际和平妇幼保健院分娩的14名新生儿,采集额部、腋窝、腹股沟部位的胎皮脂及胎粪样本。所有孕妇均为阴道自然分娩。采用16S rRNA基因V3~V4区测序进行微生物检测,分析11对母婴中母亲的肠道菌群、阴道菌群和新生儿的胎粪菌群,以及14名新生儿的胎皮脂菌群和胎粪菌群的多样性、菌群构成,分析异同及相关性。结果·母亲肠道菌群的操作分类单元(operational taxonomic unit,OTU)数、Ace指数、Chao1指数、Shannon指数均高于阴道菌群和新生儿胎粪菌群;新生儿3个部位胎皮脂菌群的Ace指数和Chao1指数均显著高于胎粪菌群(均P<0.01)。母亲肠道菌群、阴道菌群和新生儿胎粪菌群β多样性存在差异(P<0.01);新生儿额部、腋窝和腹股沟3个部位胎皮脂菌群的β多样性相似,但与胎粪菌群存在差异(P<0.01)。在门水平上,母亲肠道菌群优势菌主要为厚壁菌门(Firmicutes,52.76%)和拟杆菌门(Bacteroidetes,41.67%),阴道菌群优势菌为厚壁菌门(74.36%)和放线菌门(Actinobacteria,21.25%),胎皮脂菌群的优势菌为厚壁菌门(84.22%)和变形菌门(Proteobacteria,8.80%),新生儿胎粪菌群在2个批次样本中优势菌均为变形菌门(分别占81.11%和88.72%)。在属水平上,母亲肠道菌群的优势菌为拟杆菌属(Bacteroides,35.42%)和栖粪杆菌属(Faecalibacterium,10.12%),阴道菌群的优势菌为乳杆菌属(Lactobacillus,69.10%)和双歧杆菌属(Bifidobacterium,11.30%),胎皮脂菌群的优势菌为乳杆菌属(79.81%)和假单胞菌属(Pseudomonas,3.23%),胎粪菌群的优势菌在2个批次样本中均为埃希菌属(Escherichia,分别占55.21%和31.18%)。结论·母亲孕晚期肠道菌群的α多样性高于阴道菌群和新生儿胎粪菌群,新生儿胎皮脂菌群α多样性高于胎粪菌群。厚壁菌门在母亲孕晚期肠道菌群、阴道菌群及新生儿胎皮脂菌群中均为优势菌,乳杆菌属在母亲阴道菌群及新生儿胎皮脂菌群中均为优势菌,胎粪菌群以变形菌门和埃希菌属较多。新生儿不同身体部位的胎皮脂菌群结构相似,但与胎粪菌群存在差异。