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Anemia is frequent in preterm infants. Red blood cell transfusion practices vary between different centers. The objective of this study was to review red blood cell transfusion practices in preterm infants between 2020 and 2021. This was a narrative review that included studies published on PubMed (Medline) and Web of Science between October 2020 and October 2021. Ten studies were included finally. Red blood cell transfusion frequency was variable. Some neonatal units did not report transfusion protocols. Most studies reported volumes of 10-15 ml/kg per transfusion. The implementation of an anemia care bundle and adoption of restrictive transfusion resulted in a reduction in the number of transfusions, the volume transfused, and a reduction in the rate of multiple transfusions. We suggest that neonatal units that care for preterm infants should have a transfusion protocol based on the best evidence available and this issue may improve.
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RESUMEN La acondroplasia severa con retraso del desarrollo y acantosis nigricans (SADDAN) es una rara y letal displasia esquelética. Presentamos el primer caso detectado en Perú, en un infante de 13 meses con características fenotípicas de macrocefalia relativa, tórax estrecho, extremidades micromélicas y piel en acordeón; asimismo, un marcado retraso del desarrollo psicomotor en todos los hitos (prueba peruana) y acantosis nigricans. El paciente tuvo mala evolución clínica caracterizada por crisis convulsivas recurrentes, dificultad respiratoria progresiva, y falleció por insuficiencia respiratoria concomitante a neumonía. Esta entidad requiere del acceso a exámenes específicos como el panel de displasias esqueléticas, la cual no es parte de la oferta en la mayoría de los hospitales del Perú. Se requiere una mayor atención las enfermedades raras, a fin de proveer diagnósticos e información oportuna a los involucrados.
ABSTRACT Severe achondroplasia with developmental delay and acanthosis nigricans (SADDAN) is a rare and lethal skeletal dysplasia. We present the first case detected in Peru, in a 13-month-old infant with phenotypic characteristics of relative macrocephaly, narrow thorax, micromelic extremities and accordion skin; likewise, a marked delay in psychomotor development in all milestones (Peruvian test), and acanthosis nigricans. The patient had a poor clinical evolution characterized by recurrent seizures, progressive respiratory difficulty, dying from respiratory failure concomitant to pneumonia. This entity requires access to specific exams such as the skeletal dysplasia panel, which is not part of the offering in most hospitals in Peru. Greater attention is required for rare diseases, to provide timely diagnoses and information to those involved.
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Objective:To analyze the difference and reliability of blood 17-hydroxyprogesterone (17-OHP), an indirect screening index for congenital adrenal hyperplasia (CAH), between preterm and full-term infants.Methods:In this retrospective cross-sectional study, a total of 210 285 newborns who underwent CAH screening at the Neonatal Screening Center of Shanghai Children′s Hospital from January 2019 to December 2022 were collected, including 14 312 premature infants and 195 973 full-term infants.The concentration of 17-OHP in dried blood spots on filter paper was determined by an automatic fluorescence analyzer.The distribution of 17-OHP levels in preterm and full-term infants and its statistical index were analyzed.The Kolmogorov-Smirnov test was used for normal distribution.The skewed distribution data was converted into approximately normal distribution using Box-Cox.Outliers were eliminated by the interquartile range method.The cumulative frequency distribution map was drawn by R language programming.The 99.5 th percentile value was used as the screening threshold and compared with the reference value given by the manufacturer or laboratory and with the reference change value (RCV). Results:According to the threshold provided by the laboratory, 26.76‰ of premature infants were tested positive in preliminary screening, and 4 were confirmed with an incidence of 1∶3 578, while 0.79‰ of full-term infants were tested positive in preliminary screening, and 11 were confirmed with an incidence of 1∶17 816.The thresholds for CAH screening established indirectly were 20.35 nmol/L in preterm infants and 10.78 nmol/L in full-term infants.The relative deviations between the indirect CAH screening thresholds and the manufacturer′s or laboratory′s CAH screening thresholds were higher than the RCV, respectively.According to the indirect CAH screening thresholds, the negative and positive coincidence rates of 65 samples in 13 batches from the Centers for Disease Control and Prevention interlaboratory quality assessment program in the United States reached 100%.A retrospective analysis of 210 285 neonates showed that 17-OHP concentration was higher than the screening threshold in all CAH-positive neonates.The application of this screening threshold reduced the false positive rate of preterm infants by 59.79%.Conclusions:It is feasible to establish the CAH screening thresholds for premature and full-term infants by an indirect method, which can improve the efficiency of screening and provide better diagnostic basis for clinical practice.
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Objective:The prediction model of feeding intolerance in preterm infants was established and validated to provide guidance for clinical practice.Methods:This was a case-control study. A retrospective analysis was conducted on 210 premature infants with gestational age less than 34 weeks from September 2022 to May 2023. They were divided into training and validation sets in a 1∶1 ratio. The univariate and multivariate binary Logistic regression analysis were performed on training set samples, first identified the risk factors for feeding intolerance occurrence, and established a premature feeding intolerance risk prediction model based on these risk factors. Visualized the model using a column chart. The performance of the model was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and clinical decision curves in the training and validation sets, respectively. The ROC curve was used to evaluate the differentiation ability of the model, the calibration curve was used to evaluate the consistency of the model, and clinical decision-making was used to evaluate the net benefit status of patients when the model guides clinical interventions.Results:Among them, there were 84 cases in the feeding tolerance and 126 cases in the feeding intolerance. There were 53 males and 31 females with feeding tolerance aged (32.38 ± 1.37) weeks and 73 males and 53 females with feeding intolerance aged (30.01 ± 2.14) weeks. Through univariate Logistic regression analysis of 12 related variables, there were significant differences between the feeding tolerance premature infants and the feeding intolerance premature infants in 8 variables of premature birth weight, birth asphyxia, caffeine use, delayed defecation, gestational age, lactation time, non-invasive ventilation time, and invasive ventilation time ( OR values were 0.032-18.706, all P<0.05). Multiple Logistic regression ultimately screened out three variables, namely premature infant body mass, delayed defecation, and non-invasive ventilation time ( OR = 0.073, 4.926, 1.244, all P<0.05). The area under the ROC curve of the training and validation sets were 0.906 and 0.876, respectively. The calibration curves of the training and validation sets indicated that the model had high consistency. The Hosmer-Lemeshow goodness of fit test showed that χ2 = 7.92, P = 0.442. Conclusions:The prediction model established in this study has high discrimination, calibration, and clinical practical value, and can accurately predict the risk of feeding intolerance in premature infants, providing reference basis for timely nursing and clinical intervention.
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Objective:To select and obtain relevant evidence on the prevention and management of gastric retention in premature infants, so as to form the best summary of evidence.Methods:According to the "6S" evidence model system, we searched the domestic and foreign evidence-based databases, relevant guide websites, and association websites for all literature on the prevention and management of gastric retention in premature infants, including clinical decisions, guidelines, best practice information books, evidence summaries, systematic evaluations, and expert consensus. The search period was from January 1, 2013 to June 8, 2023.Results:A total of 12 articles were included, including 5 guidelines, 1 recommended practice, 5 systematic reviews, 1 expert consensuses. A total of 20 pieces of best evidence were collected, mainly involving 6 aspects of feeding management, placement of gastric tube, position management, gastric residue monitoring, gastric residue treatment, intervening measure.Conclusions:This study summarized the best evidence for the prevention and management of gastric retention in premature infants, so as to provide theoretical basis for clinical management of gastric retention and promote the establishment of enteral nutrition in premature infants.
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Objective To explore the effect of histologic chorioamnionitis(HCA)on clinical outcomes of preterm infants with a gestational age<34 weeks.Methods This retrospective study enrolled 497 cases of premature infants with a gestational age<34 weeks and their mothers who were hospitalized in the Qingdao Women and Children's Hospital from January 2019 to December 2022.According to whether the pathology of placenta was diagnosed as HCA or not,patients were divided into the HCA group(257 cases)and the control group(240 cases).The propensity score matching analysis was performed at a ratio of 1︰1.Ten items were matched,including gestational age,birth weight,gender,cesarean section,gestational diabetes mellitus,gestational hypertension,placental abruption,premature rupture of membranes,use of antenatal glucocorticoids and assisted reproductive technology.The differences of major complications and survival rate were compared between the two groups.Results A total of 156 pairs premature infants were successfully matched.Before matching,the incidences of early-onset sepsis(EOS)and bronchopulmonary dysplasia(BPD)were higher in the HCA group than those of the control group(26.1%vs.7.5%,45.1%vs.25.8%,P＜0.01).The incidence of EOS was higher in the HCA group than that of the control group after matching(24.4%vs.7.7%,P＜0.01),and the incidence of neonatal respiratory distress syndrome(NRDS)was significantly lower in the HCA group than that in the control group after matching(34.0%vs.46.8%,P＜0.05).There were no significant differences in survival rate and the incidences of other complications between the two groups before and after matching(P>0.05).Conclusion Preterm infants exposed to HCA have a higher risk of EOS and a lower risk of NRDS after propensity score matching.HCA has no significant effect on survival rate and other complications of premature infants.
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Abstract Objective To evaluate the effect of oropharyngeal colostrum immunotherapy (OCI) on the mortality of preterm newborns (PTNB) with very low birth weight (VLBW). Method Non-randomized clinical trial, carried out with 138 mother-child pairs attended at a public maternity hospital. The treatment group used raw colostrum, dripping 4 drops (0.2 ml) into the oropharyngeal mucosa, totaling 8 administrations in 24 h, up to the 7th complete day of life (OCI). The control group was composed of newborns admitted to the same maternity hospital before the implementation of the OCI. Analyzes were performed: descriptive, bivariate, multiple logistic regression, and survival analysis, with a significance level of 5% and 95% CI. Results The treatment group had an RR of death of 0.26 (95% CI = 0.07-0.67; p= 0.00), adjusted for maternal age, marital status, gestational hypertension, type of delivery, number of prenatal visits, and birth weight. Number Needed to Treat (NNT) demonstrated that for every 5 individuals treated with OCI, one death was prevented NNT = 4.9 (95% CI = 1.84-5.20); however, for PTNB with VLBW who remained hospitalized for 50, 100 and 150 days, the NNT reduces to 4, 4 and 3, respectively. Conclusion The OCI proved to be a beneficial intervention, since it reduced the risk of mortality in PTNB with VLBW when compared to the control group.
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Resumo Objetivo Analisar as evidências disponíveis sobre a transição alimentar de sonda orogástrica para aleitamento materno diretamente na mama com prematuros internados em unidades hospitalares. Métodos Revisão sistemática da literatura com busca nas bases de dados PubMed/MEDLINE, Web of Science, EMBASE, Scopus, Cochrane CENTRAL, CINAHL, com os critérios de inclusão: estudos experimentais, sem restrição temporal e nos idiomas português, espanhol e inglês. A avaliação metodológica foi realizada por meio das ferramentas Grading of Recommendations Assessment, Development and Evaluation (GRADE) e Revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0) e consistiu em duas etapas: qualidade metodológica e o risco de viés dos estudos. Resultados Foram identificados 10 artigos, todos ensaios clínicos randomizados. As técnicas utilizadas na transição da dieta dos prematuros encontradas foram: sonda-dedo e seringa, copo e sonda-dedo, copo e mamadeira, colher e sucção não-nutritiva, sucção não-nutritiva, sucção não-nutritiva e estimulação oral, comportamento dos prematuros, cheiro do leite materno. Conclusão As técnicas evidenciadas permitiram a transição da dieta, em um período mais curto, reduzindo o tempo de internação, aumentando o ganho de peso e se mostraram seguras, desde que o prematuro tenha maturidade para ser realizada. Contudo, a mamadeira foi desaconselhada, pela ocorrência de episódios de dessaturação, aumento da frequência cardíaca e confusão de bico.
Resumen Objetivo Analizar las evidencias disponibles sobre la transición alimentaria de sonda orogástrica a lactancia materna directamente de la mama con prematuros internados en unidades hospitalarias. Métodos Revisión sistemática de la literatura con búsqueda en las bases de datos PubMed/MEDLINE, Web of Science, EMBASE, Scopus, Cochrane CENTRAL, CINAHL, con los siguientes criterios de inclusión: estudios experimentales, sin restricción temporal y en idioma portugués, español e inglés. La evaluación metodológica se realizó por medio de las herramientas Grading of Recommendations Assessment, Development and Evaluation (GRADE) y Revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0) y consistió en dos etapas: calidad metodológica y riesgo de sesgo de los estudios. Resultados Se identificaron 10 artículos, todos ensayos clínicos aleatorizados. Las técnicas utilizadas para la transición de la dieta de prematuros fueron: dedo-jeringa y jeringa, vaso y dedo-jeringa, vaso y mamadera, cuchara y succión no nutritiva, succión no nutritiva, succión no nutritiva y estimulación oral, comportamiento de los prematuros, olor de la leche materna. Conclusión Las técnicas observadas permitieron realizar la transición de la dieta en un período más corto, con reducción del tiempo de internación y mejor aumento de peso y demostraron ser seguras, siempre que el prematuro tenga madurez para realizarlas. No obstante, se desaconseja la mamadera por la presencia de episodios de desaturación, aumento de la frecuencia cardíaca y confusión tetina-pezón. Número de registro da revisão sistemática: CRD42021240725 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=240725)
Abstract Objective To analyze the available evidence on the transition from orogastric tube feeding to breastfeeding directly from the breast with premature infants admitted to hospital units. Methods Systematic literature review with search in the following databases: PubMed/MEDLINE, Web of Science, EMBASE, Scopus, Cochrane CENTRAL, CINAHL, with the inclusion criteria: experimental studies, without temporal restrictions and in Portuguese, Spanish and English. The methodological assessment was carried out using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0) tools and consisted of two stages: methodological quality and the risk of bias of the studies. Results 10 papers were identified, all randomized clinical trials. The techniques used in transitioning the premature babies' diet were: finger tube and syringe, cup and finger tube, cup and bottle, spoon and non-nutritive sucking, non-nutritive sucking, non-nutritive sucking and oral stimulation, behavior of premature babies, and smell of breast milk. Conclusion The demonstrated techniques allowed the transition of the diet in a shorter period, reducing the length of hospital stay, increasing weight gain 1and proved to be safe, as long as the premature baby is mature enough to undergo the procedure. However, bottle feeding was not recommended due to the occurrence of episodes of desaturation, increased heart rate and nipple confusion. Systematic review registration number: CRD42021240725 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=240725)
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ABSTRACT Objective This study aimed to evaluate the prevalence of hypertensive disorders during pregnancy among Brazilian women with preterm births and to compare the epidemiological characteristics and perinatal outcomes among preterm births of women with and without hypertension. Methods This was a secondary cross-sectional analysis of the Brazilian Multicenter Study on Preterm Birth. During the study period, all women with preterm births were included and further split into two groups according to the occurrence of any hypertensive disorder during pregnancy. Prevalence ratios were calculated for each variable. Maternal characteristics, prenatal care, and gestational and perinatal outcomes were compared between the two groups using χ2 and t-tests. Results A total of 4,150 women with preterm births were included, and 1,169 (28.2%) were identified as having hypertensive disorders. Advanced maternal age (prevalence ratio (PR) 2.49) and obesity (PR= 2.64) were more common in the hypertensive group. The gestational outcomes were worse in women with hypertension. Early preterm births were also more frequent in women with hypertension. Conclusion Hypertensive disorders of pregnancy were frequent among women with preterm births, and provider-initiated preterm births were the leading causes of premature births in this group. The factors significantly associated with hypertensive disorders among women with preterm births were obesity, excessive weight gain, and higher maternal age.
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ABSTRACT Objective: To identify the type of feeding and analyze the sociodemographic and clinical factors associated with exclusive breastfeeding at hospital discharge, in the first and in the last follow-up visit of the third stage of the Kangaroo Mother Care among infants admitted to the kangaroo unit. Method: Longitudinal and retrospective study. A total of 186 infants of gestational age <37 weeks admitted to the kangaroo unit in 2018 and 2019 was included. Data collected from medical records and subjected to inferential analysis and the Poisson regression model (P < 0.05). Results: Exclusive breastfeeding rate was 73.1% at discharge, with a drop at the last follow-up visit (68.1%). At discharge, there was a greater probability of exclusive breastfeeding in younger mothers, with higher education, infants born with higher birth weight and who received exclusive human milk during hospitalization; in the first follow-up visit, in a younger mother and infant who received only human milk during hospitalization; and in the last follow-up visit, a young mother, infant who received only human milk and suckled at the breast for the first time in the kangaroo unit. Conclusion: Most infants hospitalized in the second stage of the Kangaroo Mother Care were exclusively breastfed and presented maternal and clinical factors related to breastfeeding. This fact can help manage the challenges of the method and promote breastfeeding.
RESUMEN Objetivo: Identificar el tipo de alimentación y analizar los factores sociodemográficos y clínicos asociados a la lactancia materna exclusiva al alta hospitalaria, en el primero y en la última visita de seguimiento de la tercera etapa del Método Madre Canguro entre los recién nacidos ingresados en la unidad canguro. Método: Estudio longitudinal y retrospectivo. Se incluyeron 186 neonatos en edad gestacional <37 semanas ingresados en la unidad canguro en 2018 y 2019. Datos recopilados de historias clínicas sometidas a análisis inferencial y modelo de regresión de Poisson (p < 0,05). Resultados: La tasa de lactancia materna exclusiva fue del 73,1% al alta, con descenso en la última visita de seguimiento (68,1%). Al alta hubo mayor probabilidad de lactancia materna exclusiva en madres más jóvenes, con mayor escolaridad, recién nacidos con mayor peso al nacer y que recibieron leche materna exclusiva durante la internación; en la primera visita de seguimiento, en una madre más joven y un recién nacido que recibió únicamente leche materna durante la hospitalización; y en la última visita de seguimiento, una madre joven, recién nacido que recibió sólo leche humana y con la primera succión del pecho en la unidad canguro. Conclusión: La mayoría de los recién nacidos hospitalizados en la segunda etapa del Método Madre Canguro fueron amamantados exclusivamente y presentaron factores maternos y médicos relacionados con la lactancia materna, que pueden ayudar a gestionar los desafíos del método y promover la lactancia materna.
RESUMO Objetivo: Identificar o tipo de alimentação e analisar os fatores sociodemográficos e clínicos associados ao aleitamento exclusivo na alta hospitalar, no primeiro e no último retorno da terceira etapa do Método Canguru entre neonatos internados na unidade canguru. Método: Estudo longitudinal e retrospectivo. Incluídos 186 neonatos com idade gestacional <37 semanas admitidos na unidade canguru em 2018 e 2019. Dados coletados do prontuário submetidos à análise inferencial e ao modelo de regressão Poisson (p < 0,05). Resultados: Taxa de aleitamento exclusivo foi de 73,1% na alta, com queda no último retorno (68,1%). Na alta, houve maior probabilidade de aleitamento exclusivo em mãe mais jovem, com escolaridade superior, neonato nascido com maior peso e que recebeu leite humano exclusivo durante internação; no primeiro retorno, em mãe mais jovem e neonato que recebeu apenas leite humano na internação; e no último retorno, mãe jovem, neonato que recebeu apenas leite humano e com primeira sucção na mama na unidade canguru. Conclusão: A maioria dos neonatos internados na segunda etapa do Método Canguru estava em aleitamento exclusivo e apresentou fatores maternos e clínicos relacionados ao aleitamento, podendo auxiliar no manejo dos desafios do método e na promoção da amamentação.
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ABSTRACT Objective: To evaluate the pattern of eye-gaze of preterm (PT), autism spectrum disorder (ASD) and neurotypical (Ty) children. Methods: A cross-sectional study with eight preterm (born with ≤2000 g weight), nine ASD and five Ty male children, between six and nine years old, was performed. The eye gaze was evaluated presenting a board with a couple in social interaction, and a video with four children playing with blocks, projected in a screen computer, successively, evaluating the time that the children looked at each stimulus. Results: Although all the groups focus on the central social figure with no significant differences, ASD presented significant differences in time fixation of the objects (p=0.021), while premature children fixated more time in the central social interaction than in the whole scene than typical children. Conclusions: Although this study found noteworthy differences in the eye-gaze patterns among the three groups, additional research with a more extensive participant pool is necessary to validate these preliminary results.
RESUMO Objetivo: Avaliar o padrão de fixação visual de crianças nascidas prematuras (PT), com transtorno do espectro do autismo (TEA/ASD) e neurotípicas (Ty). Métodos: Estudo transversal incluindo oito meninos prematuros (nascidos com peso ≤2000 g), nove TEA e cinco Ty, com idade entre 6 e 9 anos. A varredura visual foi avaliada apresentando-se imagem de casal em interação social e vídeo com crianças brincando. A figura e o vídeo foram projetados em tela de computador, sucessivamente, sendo avaliado o tempo de fixação para cada estímulo. Resultados: Apesar de os três grupos de crianças focarem o olhar na figura social central sem diferenças significativas, crianças com TEA apresentaram diferenças significativas no tempo de fixação em objetos (p=0,021), enquanto prematuros fixaram o olhar mais tempo na interação social central do que na cena como um todo. Conclusões: Embora tenham sido notadas algumas diferenças significativas nos padrões de olhar para os três grupos, é necessário realizar mais pesquisas com uma amostra maior para confirmar esses resultados iniciais.
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Objective: To evaluate the rates of exclusive breastfeeding (EBF) and growth of preterm and/or low birth weight newborns during the third stage of the Kangaroo Method (TSKM), at discharge. Methods: Retrospective study in a reference public maternity hospital between Jan/2014 and Dec/2017, including the preterm (less than 37 weeks) and/or low birth weight (less than 2500 g) newborn infants. Information was collected from medical records. Statistics analysis was done in SPSS software. Results: 482 infants were included and followed up at the TSKM ambulatory. The average gestational age was 33 weeks (variation: 24-39 weeks) and birth weight, 1715g (variation: 455-2830 g). EBF occurred in 336 (70.1%) infants at hospital discharge, and in 291 (60.4%) at TSKM discharge. Each additional day of hospital stay increased the chance of infant formula (IF) use by 9.3% at hospital discharge and by 10.3% at TSKM discharge. Staying in the Kangaroo Neonatal Intermediate Care Unit (KNICU) favored EBF at hospital discharge and TSKM discharge (p<0.001). Not performing the kangaroo position increased the chance formula administration to the newborn infant at hospital discharge by 11%. Weight gain and head circumference growth were higher in infants using formula (p<0.001). Conclusions: The length of hospital stay and not performing the kangaroo position favored the use of infant formula at hospital and TSKM discharge. Staying in the KNICU favored exclusive breastfeeding at hospital and TSKM discharge. Weight gain and HC growth were higher in newborns receiving infant formula.
RESUMO Objetivo: Avaliar as taxas de aleitamento materno exclusivo e o crescimento dos recém-nascidos (RN) pré-termo e/ou de baixo peso ao nascer à alta da terceira etapa do Método Canguru (TEMC). Métodos: Estudo retrospectivo realizado em maternidade pública de referência entre janeiro/2014 e dezembro/2017, que incluiu os RN pré-termo (<37 semanas) e/ou de baixo peso (<2.500 g). As informações foram coletadas de prontuários médicos e analisadas pelo programa Statistical Package for the Social Sciences (SPSS). Resultados: Foram seguidos 482 RN, com mediana da idade gestacional de 33 semanas (variação: 24-39 sem) e peso ao nascer 1.715 g (variação: 455-2.830 g). O aleitamento materno exclusivo (AME) ocorreu em 336 (70,1%) RN à alta hospitalar e em 291 (60,4%) à alta da TEMC. Cada dia a mais de permanência hospitalar aumentou a chance do uso de fórmula infantil em 9,3% à alta hospitalar e em 10,3% à alta da TEMC. Permanecer na Unidade de Cuidados Intermediários Canguru (UCINCA) favoreceu o AME à alta hospitalar e da TEMC (p<0,001). Não realizar a Posição Canguru aumentou em 11% a chance de o RN utilizar fórmula infantil à alta hospitalar. O ganho de peso e crescimento do perímetro cefálico foram maiores nos RN em uso de fórmula infantil (p<0,001). Conclusões: O tempo de permanência hospitalar e a não realização da Posição Canguru favoreceram o uso de fórmula infantil à alta hospitalar e da TEMC. Permanecer na UCINCA favoreceu o AME à alta hospitalar e da TEMC. O ganho de peso e crescimento do PC foram maiores nos RN em uso de fórmula infantil.
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ABSTRACT Objective: to construct and validate the content of a bundle for nutrition transition for premature newborns admitted to a Kangaroo Intermediate Care Unit based on Interactive Theory of Breastfeeding. Method: this is a multiple method research, carried out in five steps: systematic review; situational diagnosis; interview with Kangaroo Unit nurses; methodological step - (bundle construction with Interactive Theory of Breastfeeding application, pre-test); and content validity with expert judges and clinical nurses. The methodological step was carried out from January to July 2022 with Kangaroo Unit nurses of a public maternity hospital in Fortaleza-CE. Experts were invited by email using the snowball method. Validity occurred using a Content Validity Index >0.80. Results: the bundle was constructed using 13 items, distributed and organized into corrected age groups: corrected age of ≤32 weeks; from 32 to 34 weeks; and ≥ 34 weeks. In the validity step, the judges, three experts and seven clinical nurses, judged the bundle to be adequate, presenting a Content Validity Index of 1.0. Conclusion: given the lack of standardization for feeding transition in clinical practice, there is difficulty in recognizing the ideal moment to transition from orogastric tube feeding to mothers' breast. The food transition bundle, anchored by the Interactive Theory of Breastfeeding, allows nurses to assess the mother-child dyad, their particularities, time for both, maternal role, involving organizational systems to protect, promote and support breastfeeding. Brazilian Clinical Trials Registry (REBEC) under UTN number: U1111-1285-3181.
RESUMEN Objetivo: construir y validar el contenido de un bundle de transición dietética para bebés prematuros admitidos en la Unidad de Cuidados Intermedios Canguro basado en la Teoría de la Lactancia Materna Interactiva. Métodos: se trata de una investigación de métodos múltiples realizada en cinco steps: revisión sistemática; diagnóstico situacional; entrevista con enfermeras de la Unidad Canguro; etapa metodológica - (construcción de bundle con aplicación de la Teoría de Lactancia Interactiva, pretest); y validez de contenido con jueces expertos y enfermeras clínicas. La etapa metodológica se realizó de enero a julio de 2022 con enfermeras de la Unidad Canguro de una maternidad pública de Fortaleza-CE. Se invitó a los expertos por correo electrónico utilizando el método de bola de nieve. La validación se produjo mediante el índice de validez de contenido >0,80. Resultados: el bundle se construyó utilizando 13 ítems, distribuidos y organizados en grupos de edad corregidos: edad corregida de ≤32 weeks; entre 32 a 34 semanas y ≥ 34 semanas. En la etapa de validez, los jueces, tres expertos y siete enfermeras clínicas, juzgaron adecuado el bundle, presentando un Índice de Validez de Contenido de 1,0. Conclusión: dada la falta de estandarización para la transición alimentaria en la práctica clínica, existe dificultad en reconocer el momento ideal para la transición de la alimentación por sonda orogástrica al pecho materno. El bundle de transición alimentaria, anclado en la Teoría Interactiva de la Lactancia Materna, permite a las enfermeras evaluar el binomio madre-hijo, sus particularidades, el tiempo de ambos, el rol materno, involucrando los sistemas organizacionales de protección, promoción y apoyo a la lactancia materna. Registro Brasileño de Ensayos Clínicos (REBEC) con el número UTN: U1111-1285-3181.
RESUMO Objetivo: construir e validar o conteúdo de um Bundle para transição alimentar para prematuros internados na Unidade de Cuidados Intermediários Canguru baseada na Teoria Interativa de Amamentação. Método: Pesquisa do tipo método múltiplos realizada em cinco etapas: Revisão Sistemática; Diagnóstico Situacional; Entrevista com Enfermeiras da Unidade Canguru; Etapa Metodológica - (Construção do Bundle com aplicação da Teoria Interativa de Amamentação, Pré-teste) e por última, a validação de conteúdo com juízes expertises e enfermeiras assistenciais. A etapa metodológica, foi realizada de janeiro a julho de 2022, com enfermeiras da Unidade Canguru, de uma Maternidade pública de Fortaleza-CE, já os expertises foram convidados por e-mail, pelo método de bola de neve. A validação ocorreu mediante Índice de Validade de Conteúdo >0,80. Resultados: A construção do Bundle ocorreu partindo de 13 itens, distribuídos e organizados em grupos de idade corrigida: idade corrigida de ≤32 semanas; entre 32 a 34 semanas e ≥ 34 semanas. Na etapa de validação, os juízes, três expertises e sete enfermeiras assistenciais, julgaram adequado o Bundle, apresentando Índice de Validade de Conteúdo de 1,0. Conclusão: diante da inexistência de padronização para transição alimentar na prática clínica, existe uma dificuldade para o reconhecimento do momento ideal em realizar a transição da alimentação da sonda orogástrica para o peito materno. O Bundle de Transição Alimentar, ancorado pela Teoria Interativa de Amamentação, possibilita que o enfermeiro avalie o binômio mãe-filho, suas particularidades, tempo de ambos, protagonismo materno, envolvendo os sistemas organizacionais de proteção, promoção e apoio a amamentação. Registro Brasileiro de Ensaios Clínicos (REBEC) sob número UTN: U1111-1285-3181.
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Resumo Objetivo Analisar a suficiência de leite humano nas Unidades de Terapia Intensiva Neonatais da Região Metropolitana de São Paulo, segundo o quantitativo de prematuros, demanda estimada de leite humano e consumo efetivo. Métodos Estudo transversal em Postos de Coleta e Bancos de Leite Humano cadastrados na Rede Paulista de Bancos de Leite Humano em 2017. Utilizou-se dados de estatísticas vitais censitárias de 2017 para identificar a distribuição dos prematuros nas Redes Regionais de Atenção à Saúde. Resultados Participaram do estudo 100% dos Postos de Coleta e 84,6% dos Bancos de Leite Humano de São Paulo. Identificou-se uma insuficiência na distribuição do leite humano pasteurizado, entre a demanda estimada e o consumo efetivo dos prematuros. No período do estudo, apenas as regiões Centro e Sudeste atendiam 100% da cobertura de leite humano, seguidas da região do grande ABC com 44,62%. Conclusão A maioria dos Postos de coleta e Bancos de Leite humano da região metropolitana de São Paulo, não atendem todas as crianças prematuras. O gerenciamento destas unidades pode contribuir para estimular a captação de doadoras e a otimização do leite humano coletado.
Resumen Objetivo Analizar la suficiencia de leche humana en las Unidades de Cuidados Intensivos Neonatales de la Región Metropolitana de São Paulo, de acuerdo con la cantidad de prematuros, la demanda estimada de leche humana y el consumo efectivo. Métodos Estudio transversal en Puntos de Recolección y Bancos de Leche Humana registrados en la Red Paulista de Bancos de Leche Humana en 2017. Se utilizaron datos de estadísticas vitales censitarias de 2017 para identificar la distribución de los prematuros en las Redes Regionales de Atención en Salud. Resultados Participaron en el estudio el 100 % de los Puntos de Recolección y el 84,6 % de los Bancos de Leche Humana de São Paulo. Se identificó una insuficiencia en la distribución de leche humana pasteurizada entre la demanda estimada y el consumo efectivo de los prematuros. En el período del estudio, solo las regiones Centro y Sudeste atendían el 100 % de la cobertura de leche humana, seguidas por la región del Gran ABC con el 44,62 %. Conclusión La mayoría de los Puntos de Recolección y Bancos de Leche Humana de la región metropolitana de São Paulo no atiende a todos los bebés prematuros. La administración de estas unidades puede contribuir para estimular la captación de donantes y la optimización de la leche recolectada.
Abstract Objective To analyze human milk sufficiency in Neonatal Intensive Care Units in the Metropolitan Region of São Paulo according to the number of premature babies, estimated demand for human milk and actual consumption. Methods This is a cross-sectional study, carried out at Human Milk Collection Stations and Human Milk Banks registered with the São Paulo Network of Human Milk Banks in 2017. Data from 2017 census vital statistics were used to identify premature baby distribution in Regional Health Care Networks. Results 100% of Human Milk Collection Stations and 84.6% of Human Milk Banks in São Paulo participated in the study. Pasteurized human milk distribution insufficiency was identified between estimated demand and actual consumption by premature babies. During the study period, only the Center and Southeast regions met 100% of human milk coverage, followed by the Greater ABC region, with 44.62%. Conclusion Most Human Milk Collection Stations and Human Milk Banks in the metropolitan region of São Paulo do not assist all premature children. The management of these units can contribute to encouraging donor recruitment and collected human milk optimization.
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ABSTRACT Objective: To describe the process of best practices implementation for breastfeeding assistance for preterm and low birth weight infants. Method: Participatory research that used the evidence implementation methodology of the JBI, held at a university hospital in southeastern Brazil, with the participation of a multidisciplinary team and managers. Stages: Situational diagnosis, baseline audit and feedback, protocol development, training, implementation, and monitoring. Results: Seven audit criteria were defined. In the baseline audit, three criteria were met, with eleven barriers to be resolved being listed. The strategies carried out were protocol development and multidisciplinary and intersectoral training. After the training, compliance was achieved with the seven criteria audited in the first follow-up audit and five in the second, emphasizing the increase in compliance after the implementation of the outlined strategies. Conclusion: The project achieved the objective of improving evidence-based practice, and allowed the implementation of the institution's first breastfeeding protocol. However, it shows the need to maintain training for adherence and enculturation of new practices.
RESUMEN Objetivo: Describir el proceso de implantación de las mejores prácticas para la asistencia a la lactancia materna en recién nacidos prematuros y de bajo peso al nacer. Método: Investigación participativa que utilizó la metodología de implementación de evidencia del JBI, realizado en un hospital universitario del sudeste de Brasil, con la participación de un equipo multidisciplinario y gestores. Etapas: Diagnóstico situacional, auditoría de base y retroalimentación, desarrollo de protocolo, capacitación, implementación y seguimiento. Resultados: Se definieron siete criterios de auditoría. En la auditoría de base se cumplieron tres criterios y se enumeraron once barreras por resolver. Las estrategias implementadas fueron el desarrollo de protocolo y la capacitación multidisciplinaria e intersectorial. Luego de la capacitación se logró el cumplimiento de los siete criterios auditados en la primera auditoría de seguimiento y de cinco en la segunda, destacando el incremento en el cumplimiento luego de implementar las estrategias trazadas. Conclusión: El proyecto logró el objetivo de mejorar la práctica basada en evidencia y permitió la implementación del primer protocolo de lactancia materna de la institución, pero destaca la necesidad de mantener la capacitación para la adherencia y la inculturación de nuevas prácticas.
RESUMO Objetivo: Descrever o processo de implantação das melhores práticas para assistência à amamentação de recém-nascido prematuro e de baixo peso. Método: Pesquisa participativa que utilizou a metodologia de implementação de evidências do JBI, realizada em hospital universitário no sudeste do Brasil, com participação de equipe multiprofissional e gestores. Etapas: diagnóstico situacional, auditoria de base e feedback, elaboração de protocolo, treinamentos, implementação e monitoramento. Resultados: Foram definidos sete critérios de auditoria. Na auditoria de base, três critérios se mostraram conformes, sendo elencadas onze barreiras para serem solucionadas. As estratégias realizadas foram elaboração de protocolo e treinamentos multidisciplinares e intersetoriais. Após as capacitações obteve-se conformidade dos sete critérios auditados na primeira auditoria de seguimento e de cinco na segunda, enfatizando o aumento da conformidade após concretização das estratégias traçadas. Conclusão: O projeto alcançou o objetivo de melhorar a prática baseada em evidências, e possibilitou a implementação do primeiro protocolo de amamentação da instituição, porém evidencia a necessidade de manutenção dos treinamentos para adesão e enculturação das novas práticas.
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ABSTRACT OBJECTIVE To evaluate the association between gestational age and green areas, urban built areas, and the concentration of particulate matter 2.5 (PM2.5) in the city of São Paulo, analyzing the irregular distribution of these areas and pollution levels above the recommended level. METHODS The study population consisted of a cohort of live births from 2012, and data from the Live Birth Information System (Sinasc) of the city of São Paulo were used. Using satellite images and supervised classification, the distribution and quantity of green areas and built areas in the city of São Paulo was obtained, as well as the concentrations of PM2.5. Logistic regressions were used to obtain possible associations. RESULTS The results of the study show that a lower percentage of green areas is significantly associated with a higher chance of preterm births. A higher building density was positively associated with the odds ratio for preterm birth. We did not find any significant associations between air pollution (PM2.5) and preterm births. CONCLUSIONS The results of this study show that greener areas are less associated with preterm births when compared with less green areas.
RESUMO OBJETIVO Avaliar a associação entre a idade gestacional e as áreas verdes, áreas construídas urbanas e a concentração de material particulado 2,5 (MP2,5) em São Paulo, analisando a distribuição irregular dessas áreas e os níveis de poluição acima do recomendado. MÉTODOS A população utilizada no estudo foi a dos nascidos vivos no ano de 2012, com os dados do Sistema de Informações sobre Nascidos Vivo (Sinasc) na cidade de São Paulo. Por meio de imagens de satélites e realizando a classificação supervisionada, obtivemos a distribuição e quantidade de áreas verdes e de áreas construídas, na cidade de São Paulo, assim como as concentrações de MP2,5. Regressões logísticas foram utilizadas para obter possíveis associações. RESULTADOS Os resultados do estudo mostram que menor percentual de áreas verdes está associado significativamente com maior chance de prematuridade. Maior densidade de construção foi associada positivamente com a razão de chance de nascimento prematuro. Não encontramos resultados significativos entre a poluição do ar (MP2,5) e prematuridade. CONCLUSÕES Os resultados deste estudo demostraram que áreas mais verdes em relação às áreas menos verdes são menos associadas a nascimentos prematuros.
الموضوعات
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant, Premature , Air Pollution , Green Areas , Parks, Recreational , Built Environmentالملخص
Abstract Objectives: to evaluate the effect of oropharyngeal colostrum immunotherapy on the length of hospital stay in preterm newborns with very low birth weight. Methods: interventional ambispective study, which consisted of eight daily administrations of 0.2 ml (four drops) of colostrum, totaling up to 56 syringes (for up to seven days). The control was historic. The main independent variable: length of hospital stay (days). Survival analysis was performed using the Kaplan-Meier Method and the survival effect was estimated - Log Rank Test (Mantel-Cox) and Breslow Test (Generalized Wilcoxon). A significance level of 5% was adopted. Results: of the 109 mother/child pairs, 56 were part of the treatment and 53 were part of the control group. There was no association between oropharyngeal colostrum immunotherapy and length of stay for preterm newborns with very low birth weight in the general sample. However, after stratification, a shorter hospital stay (42 versus 51 days, HR= 1.78, CI95%=1.02-3.09, p=0.04) was demonstrated among premature infants with ≥28 gestational weeks undergoing oropharyngeal colostrum immunotherapy. Conclusions: we found an association between oropharyngeal colostrum immunotherapy and shorter median length of hospital stay in the subgroup of premature infants ≥ 28 weeks of gestational age, but we did not find significant differences in those <28 weeks.
Resumo Objetivos: avaliar o efeito da imunoterapia orofaríngea de colostro no tempo de internamento hospitalar de recém-nascidos pré-termos de muito baixo peso. Métodos: estudo de intervenção, ambispectivo, que consistiu em oito administrações diárias de 0,2 ml (quatro gotas) de colostro, totalizando até 56 seringas (por até sete dias). O controle foi histórico. A variável independente principal: tempo de permanência hospitalar (dias). Realizada análise de sobrevivência pelo Método de Kaplan-Meier e estimado o efeito da sobrevida - Teste de Log Rank (Mantel-Cox) e Teste de Breslow (Wilcoxon Generalizado). Adotou-se o nível de significância de 5%. Resultados: das 109 duplas mães/filho, 56 fizeram parte da análise do grupo tratamento e 53 do controle. Não houve associação entre imunoterapia orofaríngea de colostro e tempo de internamento de recém-nascidos pré-termos de muito baixo peso na amostra geral. Após estratificação demonstrou-se menor tempo de permanência hospitalar (43 versus 51 dias, HR=1,78, IC95%= 1,02-3,09, p=0,04) entre os prematuros com ≥28 semanas gestacionais submetidos a imunoterapia orofaríngea de colostro. Conclusões: encontrou-se associação entre imunoterapia orofaríngea de colostro e menor mediana de tempo de internamento hospitalar no subgrupo de prematuros ≥ 28 semanas de idade gestacional, porém não foram encontradas diferenças significativas naqueles < 28 semanas.
الموضوعات
Humans , Infant, Newborn , Oropharynx , Infant, Premature , Colostrum , Infant, Very Low Birth Weight , Immunotherapy , Length of Stayالملخص
Abstract Objectives: to evaluate the association between the time to initiate the first skin-to-skin contact (SSC) and the daily practice time with the rates of late-onset sepsis in newborns ≤1,800g. Methods: a multicentric cohort study was carried out at the neonatal units located in three Brazilian geographic regions. The SSC time was recorded in individual files by the hospital staff and the newborn's parents. Maternal and neonatal data were obtained from medical records and through questionnaires applied to the mothers. Data analysis was carried out using a tree algorithm classification, which divided the data set into mutually exclusive subsets that best described the variable response. Results: 405 newborns participated in the study, with an average of 31.3 ± 2.7 weeks and 1,412g (QR=1,164-1,605g) as a median birth weight. The first SSC was carried out within 137 hours of life (≤5.7 days) was associated with a lower rate of late sepsis (p=0.02) for newborns who underwent daily SSC of 112.5 to 174.7 min/day (1.9 to 2.9h/day), with a reduction in the sepsis rate from 39.3% to 27.5%. Furthermore, the duration of SSC >174.7min/day (>2.9h/day) was relevant (p<0.001) for newborns who weighed >1,344g, with a reduction in this rate from 24.1% to 6%. Conclusions: SSP has been proven to be significant in reducing late-onset sepsis rates in preterm newborns, especially when carried out in a timely manner (≤5.7 days) and prolonged (>2.9h/day).
Resumo Objetivos: avaliar a associação entre o tempo para iniciar o primeiro contato pele a pele (CPP) e o tempo diário praticado com a taxa de sepse tardia em recém-nascidos ≤1.800g. Métodos: coorte multicêntrica realizada em unidades neonatais de três regiões geográficas brasileiras. O CPP foi registrado em ficha individual pela equipe e pais do recém-nascido. Dados maternos e neonatais foram obtidos por questionários aplicados às mães e em prontuários médicos. A análise dos dados foi realizada por algoritmo da árvore de classificação, que dividiu o conjunto de dados em subconjuntos mutuamente exclusivos que melhor descreveram a variável resposta. Resultados: 405 recém-nascidos participaram do estudo, com média de 31,3±2,7 semanas de idade gestacional e mediana de peso ao nascer 1.412g (IQ=1.164-1.605g). Realizar o primeiro CPP com até 137h de vida (≤5,7 dias) foi associado a menor taxa de sepse tardia (p=0,02) para recém-nascidos que fizeram CPP diário de 112,5 a 174,7 min/dia (1,9 a 2,9h/dia), com redução na taxa de sepse (39,3% para 27,5%). Além disso, a duração do CPP>174,7min/dia (>2,9h/dia) foi relevante (p<0,001) para os recém-nascidos >1.344g, com redução nesse desfecho (21,1% para 6%). Conclusões: o CPP mostrou-se importante para redução das taxas de sepse tardia em recém-nascidos pré-termo, especialmente quando realizado de forma oportuna (≤5,7 dias) e prolongada (>2,9h/dia).
الموضوعات
Humans , Infant, Newborn , Infant, Low Birth Weight , Infant, Premature , Intensive Care Units, Neonatal , Kangaroo-Mother Care Method , Neonatal Sepsis/diagnosis , Brazil , Risk Factors , Cohort Studiesالملخص
Objective:To investigate the clinical characteristics and prognosis of bloodstream infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in preterm infants, and to provide basis for early clinical diagnosis and infection control. Methods:The clinical data of infants with CRKP bloodstream infection admitted to the Preterm Infants Ward of Children′s Hospital Affiliated to Zhengzhou University from January 2015 to December 2022 were retrospectively analyzed. The risk factors for death in preterm infants caused by CRKP bloodstream infection were explored through multivariate logistic regression analysis, and the receiver operating characteristic (ROC) curve was used to analyze the clinical value of each factor on evaluating prognosis. The area under curves (AUC) of each factor in different ROC curve were compared by Delong′s test.Results:A total of 96 preterm infants with CRKP bloodstream infection were included, including 70 in the survival group and 26 in the death group. The first onset symptoms of CRKP bloodstream infection in preterm infants were persistent tachycardia (heart rate>180 per minute) (69 cases, 71.9%), fever (61 cases, 63.5%), and apnea (59 cases, 61.5%). There were 88(91.7%) cases of infection combined with septic shock, and 91(94.8%) cases required vasoactive drug support. Multivariate logistic regression analysis showed that the maximum vasoactive-inotropic score (VIS) within 48 hours of onset (odds ratio ( OR)=1.058, 95% confidence interval (95% CI) 1.022 to 1.095, P=0.001), concurrent purulent meningitis ( OR=8.029, 95% CI 1.344 to 47.972, P=0.022), and concurrent necrotizing enterocolitis (NEC) ( OR=10.881, 95% CI 1.566 to 75.580, P=0.016) were independent risk factors for death in preterm infants with CRKP bloodstream infection. The ROC curve showed that the AUCs for evaluating the prognosis of preterm infants with NEC and purulent meningitis were 0.784 and 0.711, respectively. The AUC for evaluating the prognosis of preterm infants with a maximum VIS ≥52.5 points within 48 hours of onset was 0.840, and the AUC for combining the three factors was 0.931. Compared with NEC and purulent meningitis, the AUC for combining factors was higher, the differences were statistically significant ( P=0.002, P<0.001). Conclusions:Preterm infants with CRKP bloodstream infection who have a maximum VIS ≥52.5 points within 48 hours of onset, with NEC and purulent meningitis have a higher risk of death.
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Objective:To investigate the perinatal prognosis and its impact factors for premature infants with twin-twin transfusion syndrome (TTTS) who were born at ≤34 weeks of gestation.Methods:A retrospective study was conducted on 68 pregnancies of TTTS with gestational age ≤34 weeks at delivery, among them 106 preterm infants (TTTS group) were admitted to the neonatal intensive care unit of the First Affiliated Hospital, Sun Yat-sen University from January 2003 to February 2019. During the same period, another 178 twins without TTTS, congenital malformation, and intrauterine intervention who matched the TTTS group in maternal age (differences within two years) and gestational age (differences within one week) were assigned as non-TTTS group. Perinatal prognosis of TTTS infants born at ≤34 weeks was analyzed by comparing the differences in postnatal early complications and perinatal outcomes (survival time morn than 28 days or not) between the TTTS and non-TTTS groups, recipient and donor twins, mild and severe TTTS infants, and among TTTS infants with different intrauterine interventions. The risk factors for perinatal survival in TTTS infants with gestational age ≤34 weeks were analyzed. Two independent samples t-test, one-way analysis of variance, rank-sum test, Chi-square test, and ordered logistic regression were used for statistical analysis. Results:(1) Among the 68 pregnancies, the overall perinatal survival rate of the neonates was 72.1% (98/136), the double-twin survival rate was 48.5% (33/68), and the rate of at least one survivor was 95.6% (65/68). (2) In the TTTS group, 62 were recipients and 44 were donors. Stage Ⅰ-Ⅱ TTTS was found in 41 cases (mild TTTS group) and stage Ⅲ-Ⅴ in 65 cases (severe TTTS group). (3) The rate of severe brain injury was higher in the severe-TTTS group than those in the mild-TTTS group [9.2% (6/65) vs. 0.0% (0/41), χ 2=4.01, P=0.045]. (4) Gestational age ≤28 weeks ( OR=101.90, 95% CI: 5.07-2 048.37), stage Ⅳ ( OR=14.04, 95% CI: 1.56-126.32) and stage Ⅴ TTTS ( OR=51.09, 95% CI: 3.58-728.81) were independent risk factors for death within 28 days (all P<0.05). (5) Compared with the non-TTTS group, the TTTS group had higher rates of neonatal anemia [51.9% (55/106) vs. 33.1% (59/178), χ 2=9.71], polycythemia [5.7% (6/106) vs. 0.6% (1/178), χ 2=7.18], neonatal persistent pulmonary hypertension [3.8% (4/106) vs. 0.0% (0/178), χ 2=6.81], sepsis [15.1% (16/106) vs. 7.3% (13/178), χ 2=4.40], state Ⅲ or higher retinopathy of prematurity [3.8% (4/106) vs. 0.0% (0/178), χ 2=6.81], congenital cardiac structural abnormality [19.8% (21/106) vs. 0.6% (1/178), χ 2=33.45], heart failure [8.5% (9/106) vs. 0.6% (1/178), χ 2=12.29], and renal insufficiency [14.2% (15/106) vs. 1.1% (2/178), χ 2=20.04] (all P<0.05). Conclusions:Compared with the twin premature infants without TTTS, those with TTTS and ≤34 gestational age were more likely to have cardiac, cerebral, and renal complications. The more severe the TTTS, the higher the incidence of severe brain injury. TTTS preterm infants with gestational age ≤28 weeks and stage Ⅳ or above have high risk of death.