Changes of the peripapillary vascular parameters inpremature infants without retinopathy of prematurityusing U-net segmentation

AIM:To quantitatively assess the changes in mean vascular tortuosity(mVT)and mean vascular width(mVW)around the optic disc and their correlation with gestational age(GA)and birth weight(BW)in premature infants without retinopathy of prematurity(ROP).METHODS:A single-center retrospective study included a total of 133(133 eyes)premature infants[mean corrected gestational age(CGA)43.6wk]without ROP as the premature group and 130(130 eyes)CGA-matched fullterm infants as the control group.The peripapillary mVT and mVW were quantitatively measured using computerassisted techniques.RESULTS:Premature infants had significantly higher mVT(P=0.0032)and lower mVW(P=0.0086)by 2.68(10^(4) cm^(-3))and 1.85μm,respectively.Subgroup analysis with GA showed significant differences(P=0.0244)in mVT between the early preterm and middle to late preterm groups,but the differences between mVW were not significant(P=0.6652).The results of the multiple linear regression model showed a significant negative correlation between GA and BW with mVT after adjusting sex and CGA(P=0.0211 and P=0.0006,respectively).For each day increase in GA at birth,mVT decreased by 0.1281(10^(4) cm^(-3))and for each 1 g increase in BW,mVT decreased by 0.006(10^(4) cm^(-3)).However,GA(P=0.9402)and BW(P=0.7275)were not significantly correlated with mVW.CONCLUSION:Preterm birth significantly affects the peripapillary vascular parameters that indicate higher mVT and narrower mVW in premature infants without ROP.Alterations in these parameters may provide new insights into the pathogenesis of ocular vascular disease.

Acquired methemoglobinemia in a third trimester puerpera and her premature infant with sodium nitrite poisoning:A case report

BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit.The subsequent formation of methemoglobin(MetHb)restricts oxygen transport and utilization in the body,resulting in functional hypoxia at the tissue level.In clinical practice,a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia.Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.CASE SUMMARY A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission.Subsequently,she developed vomiting and cyanotic skin.The woman underwent orotracheal intubation,invasive mechanical ventilation(IMV),and correction of internal environment disturbance in the ICU.Her premature infant was born with a higher-than-normal MetHb level of 3.3%,and received detoxification with methylene blue and vitamin C,supplemental vitamin K1,an infusion of fresh frozen plasma,as well as respiratory support via orotracheal intubation and IMV.On day 3 after admission,the puerpera regained consciousness,evacuated the IMV,and resumed enteral nutrition.She was then transferred to the maternity ward 24 h later.On day 7 after admission,the woman recovered and was discharged without any sequelae.CONCLUSION MetHb can cross through the placental barrier.Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.

Research Progress on the Prevention of Premature Infant Lung Injury and Neonatal Respiratory Support

In the past 40 years,advances in neonatal intensive care unit(NICU)technology have enabled premature infants with lower birth weight and younger gestational age to survive.But with it comes an increase in the incidence of long-term respiratory dysfunction,mainly in the form of bronchopulmonary dysplasia(BPD).Preventing lung injury is crucial for preventing BPD and improving the long-term prognosis of premature infants.Therefore,how to avoid ventilator-associated lung injury has become a focus of clinical and scientific research in premature infants in recent years.This article will elaborate on the susceptibility and pathophysiology of premature infant lung injury,ventilation strategies for preventing lung injury,and new advances in neonatal respiratory support.

Ultrasound measurement of the corpus callosum and neural development of premature infants

Length and thickness of 152 corpus callosa Using ultrasonic diagnostic equipment with a were measured in neonates within 24 hours ot b^rtn. neonatal brain-specific probe, corpus callosum length and thickness of the genu, body, and splenium were measured on the standard mid-sagittal plane, and the anteroposterior diameter of the genu was measured in the coronal plane. Results showed that corpus callosum length as well as thickness of the genu and splenium increased with gesta- tional age and birth weight, while other measures did not. These three factors on the standard mid-sagittal plane are therefore likely to be suitable for real-time evaluation of corpus callosum de- velopment in premature infants using cranial ultrasound. Further analysis revealed that thickness of the body and splenium and the anteroposterior diameter of the genu were greater in male infants than in female infants, suggesting that there are sex differences in corpus callosum size during the neonatal period. A second set of measurements were taken from 40 premature infants whose ges- tational age was 34 weeks or less. Corpus callosum measurements were corrected to a gestational age of 40 weeks, and infants were grouped for analysis depending on the outcome of a neonatal behavioral neurological assessment. Compared with infants with a normal neurological assessment, corpus callosum length and genu and splenium thicknesses were less in those with abnormalities, indicating that corpus callosum growth in premature infants is associated with neurobehavioral development during the early extrauterine stage.

Analysis of the clinical characteristics and refraction state in premature infants: a 10-year retrospective analysis

AIM: To report the visual outcomes and refractive status in premature infants with and without retinopathy of prematurity(ROP) who were or not treated. METHODS: The clinical records of all premature infants with or without ROP and with or without treatment between 2007 and 2017 were retrospectively reviewed. Basic demographic data, serial changes in ROP incidence, treatment and outcomes, and the refractive states were analyzed. Correlations among myopia and astigmatism progression, birth weight, gestational age, and treatment methods were also analyzed.RESULTS: A total of 562 screened premature infants(all Chinese, 1124 eyes), were recruited with a 378:184 maleto-female ratio. Birth weight did not directly influence ROP incidence. The overall ROP incidence was 16.55%(93/562 cases). The incidences in boys and girls were 16.14%(33/378 cases) and 17.39%(32/184 cases), respectively, and this difference was not significant. However, all infants with serious ROP(stage IV and V) were male. Myopia combined with astigmatism was common in premature infants with and without ROP(30.99%, 172/555 cases), and myopic refraction(including myopia and myopia combined with astigmatism) was more common in premature infants with ROP(48.84%, 42/86 cases). In the >8.00 diopter group, there were significantly more ROP infants than without ROP. Myopic refraction(including myopia and myopia combined with astigmatism) was most common in infants with ROP after treatment(63.63%, 7/11 cases). CONCLUSION: The refractive state is different between premature infants and mature infants. Those treated for ROP had a higher chance of developing myopia, astigmatism, and higher diopter.

Preventive Effect of Different Dosage of Recombinant Human Erythropoietin on Anemia of Premature Infants

To assess the efficacy and the optimum dose of recombinant human erythropoietin (rhEpo) on the anemia of premature, 45 preterm infants with a gestational age of less than 35 weeks and birth weight of less 1 800 g were randomly assigned to treatment group 1 (n = 15, receiving subcutaneous rhEpo 150 U/kg·time), treatment group 2 (n = 15, receiving 250 U/kg·time), three times a week for 6 weeks, and control group (n = 15, no treatment was given). All preterm infants received supplements of vitamin E (20 IU) and iron (20 mg) each day. Our results showed that postnatal decline of hemoglobin (Hb) and hematocrit (Hct) were lessened in the treatment groups, particularly in the group 2 and the differences were very significant (P<0. 0001 for all). Treated infants had significantly higher reticulocyte counts (Ret) (P<0. 000] for all), but there was no significant difference between the two treatment groups (P>0. 05). Serum iron dropped significantly in the treatment groups as compared with control group (P<0. 01 for all), but no dose-dependent relationship was observed in treated infants (P>0. 05). After treatment, serum levels of erythropoietin was higher in group 2 than those in group 1 and control group (P<0. 0001, P<0. 01 and P<0. 05, respectively). There was no significant difference between group 1 and control group (P>0. 05). No side effects related to rhEpo therapy were observed. Our study suggested that rhEpo therapy stimulates endogenous erythro-poiesis and enhances Ret, Hct and level of Hb in a dose-dependent manner in premature infants. The therapy is more efficient when given in higher dosages.

Early Intervention in the Neurodevelopment of Premature Infants during the First Six Months of Life

Objective: Measure the effects of Early Intervention ad modum Katona (EI-K) in high-risk premature infants by means of clinical, neurobehavioral, and neurophysiologic tests. Method: We used the Amiel-Tison neurologic examination, the Bayley Scale of Infant Behavior, and electroencephalography (EEG) recordings at 42 weeks of conceptional age, and after 6 months of treatment EI-K (n = 14) and compared these results with those of a group of infants without early intervention (nEI) (n = 11). Results: We found better performance of infants in EI-K than nEI group after 6 months of treatment in neurologic and behavioral examination measurements, but found no differences in EEG comparisons. Conclusion: Our data suggest significant benefit of the use of EI-K program over n-EI in the neurologic and neurobe-havior examinations of premature infants after 6 months of age.

Application of FICare mode in premature infants of NICU:A meta-analysis

infants.Methods:Systematic searches in PubMed,EMBASE,The Cochrane Library,Web of Science,Chinese biomedical literature database,China National Knowledge Infrastructure,Wanfang medical and VIP database were performed for randomized controlled trials(RCTs)or quasi-RCTs which explored the effects of FICare mode on growth and development of premature infants in neonatal intensive care unit.Then,meta-analysis was performed by RevMan 5.3 after two independent investigators screened the literature,extracted the data and evaluated the risk of bias of all included studies.Results:A total of 14 articles were included,including 3120 preterm infants and their families.Meta-analysis showed that compared with the traditional management mode,FICare mode can effectively improve the growth rate of premature infants'weight[Weight mean difference(WMD)=4.02,95%CI(2.47,5.56),P<0.001],increase sleep time[WMD=3.25,95%CI(2.05,4.44),P<0.001],improve breastfeeding rate[RR=1.38,95%CI(1.15,1.64),P<0.001],reduce readmission rate[Relative risk(RR)=0.49,95%CI(0.33,0.71),P<0.001],promote the development of the nervous system[WMD=3.96,95%CI(3.18,4.74),P<0.001],improve nursing skills of Premature infants'parents[WMD=17.40,95%CI(13.64,21.1),P<0.001],reduce the influence of maternal and infant separation on parents'emotions.Conclusion:FICare mode can effectively promote the growth and development of premature infants and alleviate the harm caused by the separation of mother and infants.Limited by the quality and region of the included studies,the appeal conclusion still needs to be tested by more high-quality studies.

Predictors of caring behaviors of mothers of premature infants based on the health belief model

Objective:To investigate predictors of caring behaviors of mothers of premature infants based on the health belief model.Methods:This cross-sectional study was conducted by using the structural equation modeling on 168 mothers of premature infants,who were selected by convenience sampling method from October 2017 to February 2018 in Iran.Data were collected by using a standard scale.Validity and reliability of all data collection tools were approved.Data were analyzed by using SPSS V.16 and Mplus6 software.Results:The structural equation modeling of the initial health belief model did not have a good fit,but the fitness of model 2 obtaining from the modified initial model was confirmed by changes in locations of constructs.None of constructs of model 2 had a significant positive association with the caring behavior of mothers of premature infants and only 2.8%of variance of caring behaviors in mothers could be predicted by the sum of variables of demographic characteristics and the modified health belief model constructs.Conclusions:Given that the findings do not approve the use of the health belief model in predicting determinants of caring behavior of mothers of premature infants,it is suggested to apply this model to investigate the effect of educational intervention based on the health belief model on the caring behavior of mothers.

A delayed diagnosis of unsuspected retinoblastoma in an in vitro fertilisation infant with retinopathy of prematurity

Dear Editor,I am Dr.Tian Tian,from the Department of Ophthalmology,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China.I write to present a rare case report of a delayed diagnosis of unsuspected retinoblastoma（RB）in an in vitro fertilisation（IVF）infant with retinopathy of prematurity.

THE DEVELOPMENT OF A MANIKIN TO SIMULATE THE THERMAL PHYSIOLOGY OF PREMATURE INFANTS

This paper describes a manikin (also known as mannequin) to simulate the thermal physiology of premature infants and experiments performed on it.The performance of the manikin is shown to compare well with that a selection of premature infants in terms of their rate of heat loss.

The Issue of Care Given to Premature Infants in the Provincial Hospital Center of Missour

Background: Preterm birth is common in Morocco and it’s around 8%. Several management rules of taking care of preterm infants have been developed but have not been put into action. The geo-graphical inaccessibility to specialized hospitals and the weakness of the reception capacity of the care centers hinder the management of the complications associated with preterm birth. Purpose: The present study is designed to present some epidemiological data of preterm births within the Provincial Hospital Center of Missour during 2012 and to discuss the various problems emerging in the management of treatment and care. Materials and Methods: Retrospective study of preterm births in the maternity ward in the Hospital of Missour during 2012. Results: 37 preterm births among 1121 (3.3%) have been analyzed (51.3% severe premature infants, 45.9% late preterm infants and 2.7% extremely premature infants). 64.2% are originally from difficult areas to reach during winter. All mothers have received upon arrival at the maternity a corticosteroid and calcium antagonists (Adalate*) and an antibiotic treatment to those with a positive infectious anamnesis found in half of the women. We have recorded 3 twin pregnancies and 2 gravidic toxemias. Only 21 babies have been given back to their mothers (namely 56.7%). 5 premature infants (namely 13%) have been referred to the university hospital center of Fez (2 respiratory distress, a malformation and 2 severe premature births) given that there is an absence of a specialized care unit at the hospital, knowing that no baby has received neither surfactant nor caffeine at birth. 14 premature babies (namely 37.8%) have been transferred to the pediatric unit with a total death rate of 16.2% (6 premature) mainly related to neonatal infection and to suffering of the hyaline membranes disease. Conclusion: We emphasize the interest of prevention programs which demand an early diagnosis of preterm birth threats and monitoring high-risk pregnancies, improving the medical care given to low-weight premature by creating “Kangaroo” units at a regional level and the targeting of measures for rural and under-covered areas.

PHENOBARBITAL FOR THE PREVENTION OF IVH INCHINESE PREMATURE INFANTS

Objectivs To evaluate the effect of phenobarbital in preventing intraventricular hemorrhage inpremature infants. Methods A randomized controlled trial for the prevention of neonatal intraventricularhemorrhage (IVH) was carried out in 57 Chinese premature infants with gestation of 34 weeks. These prematureinfants were randomly assigned to prevented (23 cases) or control (34 cases) groups. Results No statisticallysignificant differences in general data between the two groups were found. It was noticed that the average Apgarscore in prevented group was lower than that in the control group. The average age at the time of the loading dosesof phenobarbital was 8.9± 8.3 (0.5～25)h (outborn babies usually delay to receive phenobarbital), and the averageduration of the maintenance dose was 5d. The mean value of serum phenobarbital level obtained on day 4 was 20.9±5.2mg/L. The results demonstrated that the incidence of IVH and severe IVH decreased significantly inprevented group (74% vs 97%, P<0.05 and 13% vs 62%, P<0.01 respectively). NO severe IVH and hydrocephaluswere develOPed in the infants with IVH grade Ⅱ in the prevented group. While 7 infants with grade Ⅱ developedgrade Ⅲ during very short period, and 2 infants had to shunt for hydrocephalus in the control group. Infants onphenobarbital had not observed any side - effects. The duration of clinical symptoms was markedly shortened in theprevented group. Conclusion The study supports the use of phenobarbital for the prevention of IVH and severeIVH in Chinese premature infants. It is suggested that phenobarbital prophylaxis should be routinely carried outin all preterm infants with gestational age 34 weeks within 6h alter birth.

Toxicity and Viral Load in Urine during Valganciclovir Therapy in Premature Infants

Cytomegalovirus (CMV) infection is the most important cause of mental retardation and sensorineural hearing loss. Antiviral treatment with valganciclovir, a relatively new but potential toxic oral drug, is recommended to prevent further hearing deterioration. In this retrospective cohort study we evaluated the relation between the dose of valganciclovir and the reduction of CMV viral load, as well as the toxicity. All neonates with gestational

The trajectories of physical growth in 4 months postnatal corrected age among preterm infants discharged from neonatal intensive care units and associated factors: A prospective study

Objectives Growth retardation is a risk for premature infants.In addition to demographic and perinatal factors,preterm infants’physical growth may be affected by neonatal intensive care unit(NICU)stress,maternal postpartum depression,and mother-infant interaction.This study aimed to investigate the trajectories of physical growth in 4 months corrected age among preterm infants discharged from the NICU and the impactors on these trajectories.Methods A prospective study was conducted among 318 preterm infants from September 2019 to April 2021 in Shanghai,China.Latent growth modeling was applied to identify the weight,length,and head circumference growth trajectories in 4 months corrected age and explore the effects of demographic and medical characteristics,infant stress during NICU stay,maternal postpartum depression,and mother-infant interaction on each trajectory.Results Unconditional latent growth models showed curve trajectories with increasingly slower growth in weight,length,and head circumference until 4 months of corrected age.Conditional latent growth models showed that a longer length of stay in the NICU and more skin punctures were negatively associated with weight at 40 weeks corrected gestational age(β=−0.43 and−0.19,respectively,P<0.05).The maternal postpartum depression between 40 weeks corrected gestational age and 1 month corrected postnatal age was associated with a lower growth rate of length(β=−0.17,P=0.040),while between 2 and 3 months corrected postnatal age,there were lower growth rates of weight and head circumference(β=−0.15 and−0.19,respectively,P<0.05).The mother-infant interaction scores between 40 weeks corrected gestational age and 1 month corrected postnatal age negatively predicted the growth rate of weight(β=−0.19,P=0.020).Conclusion The physical growth trajectories of preterm infants discharged from the NICU were influenced by infant stress during the NICU stay,maternal postpartum depression and mother-infant interaction.

新生儿科护士早产儿体位支持行为评估量表的编制及信效度检验

目的:编制新生儿科护士早产儿体位支持行为评估量表并验证其信效度。方法:以健康行为改变的多理论模型为指导,通过文献回顾形成新生儿科护士早产儿体位支持行为评估量表初稿,通过专家小组讨论对量表初稿条目进行修订,通过专家函询、预调查形成新生儿科护士早产儿体位支持行为评估量表。采用便利抽样法对203名新生儿重症监护室(NICU)和新生儿科病房临床护士进行测评,检验量表信效度。结果:新生儿科护士早产儿体位支持行为评估量表包括4个维度(体位支持的意义、体位支持的自我努力与社会支持、体位支持的物理环境支持、体位支持的信心),共25个条目。探索性因子分析显示,4个维度的累计方差贡献率为87.143%。量表水平的内容效度指数为0.941。量表总体的Cronbach′s α系数为0.972,折半信度为0.765,重测信度为0.862。结论:新生儿科护士早产儿体位支持行为评估量表具有良好的信效度,可用于护士的早产儿支持行为评估。

NICU早产儿母乳喂养链式管理效果评价

目的观察链式管理对NICU早产儿母乳喂养及喂养并发症的影响。方法将180例NICU早产儿按入院时间分为对照组和试验组各90例。对照组实施常规NICU母乳喂养策略,试验组在对照组基础上进行链式管理,构建并实施产房、产科和NICU间横向管理和各科室内部纵向管理。结果最终对照组82例、试验组81例早产儿完成研究。干预后,试验组纯母乳喂养率显著高于对照组,试验组早产儿喂养不耐受、坏死性小肠结肠炎、宫外发育迟缓和新生儿高胆红素血症发生率显著低于对照组(均P<0.05),试验组恢复至出生体质量日龄显著短于对照组,出院体质量显著大于对照组(均P<0.05)。结论链式管理有利于提高NICU早产儿的纯母乳喂养率,降低喂养并发症发生率,促进新生儿生长发育。

不同重力喂养高度及卧位在预防早产儿胃食管反流中的效果分析

目的探讨不同重力喂养高度及卧位预防早产儿胃食管反流的效果。方法选取中国医科大学附属盛京医院新生儿科2022年6—12月出生的早产儿138例为研究对象,按照随机数字表法分为对照组、观察1组、观察2组,每组46例。对照组采用常规仰卧位重力喂养;观察1组采取右侧卧位,确认无残留奶量后,抬高针筒至距离早产儿嘴唇上方20 cm处;观察2组采取俯卧位,其他步骤同观察1组。比较3组呕吐、溢奶、呼吸暂停、血氧饱和度下降、胃残留、减量喂养次数、停喂次数、体质量增长、排便次数、排便量、胎便排尽用时、潴留量及喂养2周后食管24 h反流监测等指标。结果3组早产儿人均喂养次数均为112次;观察1组和观察2组呕吐、溢奶、呼吸暂停、血氧浓度下降等发生率均低于对照组,差异有统计学意义(P<0.05);观察1组和观察2组胃残留比率低于对照组,体质量增长大于对照组,差异均有统计学意义(P<0.05);观察1组和观察2组减量喂养次数、停喂次数均少于对照组,差异有统计学意义(P<0.05);观察1组和观察2组排便次数、排便量均大于对照组,胎便排尽用时、潴留量均小于对照组,差异有统计学意义(P<0.05);观察1组和观察2组食管pH<4次数、反流超过5 min次数、最长单次反流持续时间及反流指数均小于对照组,差异有统计学意义(P<0.05)。结论重力喂养高度及体位改变可降低呕吐、溢奶、呼吸暂停和血氧浓度下降等发生率,预防胃食管反流,有利于早产儿生长发育。

Evaluation of Parents’ Awareness and Knowledge about Problems and Issues Related to Their Premature Infants in an Iranian Hospital

Premature infant is an infant who was born before the end of 37th weeks of pregnancy. Approximately 9.6% of infants are premature and they can be at risk for hospitalization. This study has done for evaluation of awareness and knowledge of parents about problems of premature infants in Neonatal Intensive Care Unit (NICU). This was a descriptive study with 160 parents whose premature infants were admitted to NICU (Tehran-Iran, 2009-2011). Data were collected by a questionnaire for evaluation of awareness and knowledge of parents about problems of prematurity, and then analyzed by using descriptive analytic statistical methods and SPSS software. Based on the results, there was a significant relation between age and the total score of questionnaire (P = 0.022, R = 0.18). Mothers had higher awareness and knowledge than fathers (P < 0.05). The most awareness in parents was about doing of hygienic principle when they entered to NICU and about the importance of regularly and continuous attendance in ward. Awareness and knowledge of parents about problems of their premature infant were related to their age and being a mother or father. Parents had little knowledge about some NICU principles and premature infant’s needs and care.

基于APP的延续照护模式在24月龄内早产儿生长发育中的应用研究

目的探讨基于APP的延续照护模式对24月龄内早产儿体格、神经心理发育的影响。方法选取199例由新生儿科出院的早产儿作为研究对象,根据住院时间将研究对象分为对照组95例(接受常规出院管理)与观察组104例(实施基于APP的延续照护模式)。比较两组早产儿新生儿科门诊随访依从率和3月龄、6月龄、9月龄、12月龄、18月龄、24月龄的体格发育、神经心理发育情况。结果观察组早产儿3月龄、6月龄、9月龄、12月龄、18月龄、24月龄时新生儿科门诊随访依从率高于对照组(P<0.05)。3月龄时,观察组早产儿的头围、体重大于对照组,大运动行为能区、精细运动能区、语言行为能区、个人-社交行为能区得分高于对照组(P<0.05),而两组的身长差异无统计学意义(P>0.05);6月龄、9月龄、12月龄、18月龄、24月龄时,观察组早产儿的头围、身长、体重大于对照组,适应行为能区、大运动行为能区、精细动作行为能区、语言行为能区、个人-社交行为能区得分高于对照组(P<0.05)。结论基于APP的延续照护模式能有效提升早产儿的生长发育水平及生存质量。