Research hotspots in post-discharge follow-up management of preterm infants / 中国当代儿科杂志

Preterm infants, especially those born extremely or very prematurely, are at high risk for growth retardation and neurodevelopmental disorders. Regular follow-up after discharge, early intervention, and timely catch-up growth are important guarantees for improving the quality of life of preterm infants and improving the quality of the population. This article provides an overview of the research hotspots in follow-up management of preterm infants after discharge over the past two years, including follow-up modes, nutritional metabolism and body composition follow-up, growth pattern follow-up, neurodevelopmental follow-up, early intervention, etc., in order to provide clinical guidance and research ideas for domestic peers.

Physical growth and neurodevelopment of preterm infants at the corrected age of 18-24 months / 中国当代儿科杂志

OBJECTIVES@#To investigate the levels of physical growth and neurodevelopment in preterm infants at the corrected age of 18-24 months.@*METHODS@#The physical growth data and neurodevelopment data of 484 preterm infants at corrected age of 18-24 months were prospectively collected by a post-discharge follow-up system for preterm infants. The infants were regularly followed up in Shenzhen Bao'an Maternal and Child Health Hospital Affiliated to Jinan University from April 2018 to December 2021. The neurodevelopment was evaluated by the Children Neuropsychological and Behavioral Scale-Revision 2016. A total of 219 full-term infants served as controls. The infants were divided into groups (extremely preterm, very preterm, moderate late preterm, and full-term) based on gestational age, and the groups were compared in the levels of physical growth and neurodevelopment.@*RESULTS@#Except that the moderate preterm group had a higher length-for-age Z-score than the full-term group (P=0.038), there was no significant difference in physical growth indicators between the preterm groups and the full-term group (P>0.05). Each preterm group had a significantly lower total developmental quotient (DQ) than the full-term group (P<0.05). Except for the social behavior domain, the DQ of other domains in the extremely preterm and very preterm groups was significantly lower than that in the full-term group (P<0.05). The <32 weeks preterm group had a significantly higher incidence rate of global developmental delay than the full-term group (16.7% vs 6.4%, P=0.012), and the incidence rate of global developmental delay tended to increase with the reduction in gestational age (P=0.026).@*CONCLUSIONS@#Preterm infants can catch up with full-term infants in terms of physical growth at the corrected age of 18-24 months, but with a lower neurodevelopmental level than full-term infants. Neurodevelopment monitoring and early intervention should be taken seriously for preterm infants with a gestational age of <32 weeks.

Sleep initiation patterns and their influence on sleep quality in infants and young children / 中国当代儿科杂志

OBJECTIVES@#To investigate the current status of sleep initiation patterns, influencing factors for sleep initiation patterns, and the influence of sleep initiation patterns on sleep quality in infants and young children.@*METHODS@#A total of 521 infants and young children, aged 0-35 months, who underwent physical examination at the outpatient service of the Department of Growth and Development in Shenzhen Bao'an Women's and Children's Hospital Affiliated to Jinan University were enrolled as subjects. A self-designed questionnaire and Brief Infant Sleep Questionnaire were used to collect the information on family background, parenting behaviors, and sleep quality in the past one week. A multivariate logistic regression analysis was used to evaluate the influencing factors for sleep initiation patterns. A multiple linear regression analysis was used to evaluate the influence of sleep initiation patterns on the number of nighttime awakenings.@*RESULTS@#Among the 521 infants and young children, 258 (49.5%) were breastfed/bottle fed to initiate sleep, 62 (11.9%) were rocked/held to initiate sleep, 39 (7.5%) slept independently, and 162 (31.1%) initiated sleep accompanied by parents. The multivariate logistic regression analysis showed that the children with breastfeeding and a younger age were more likely to be breastfed/bottle fed to initiate sleep (P<0.05) and that the children with a younger age were also more likely to be rocked/held to initiate sleep (P<0.05). The multiple linear regression analysis showed that sleep initiation with breastfeeding/bottle feeding significantly increased the number of nighttime awakenings (P<0.05).@*CONCLUSIONS@#Most infants and young children initiate sleep by being breastfed/bottle fed, rocked/held, or accompanied. The sleep initiation pattern is associated with the age of children and whether they are still breastfeeding. Sleep initiation with breastfeeding/bottle feeding can increase the number of nighttime awakenings. io.

Assessment of growth pattern of preterm infants up to a corrected age of 24 months / 中国当代儿科杂志

OBJECTIVES@#To assess the growth of preterm infants up to a corrected age of 24 months, and to understand the growth trend and pattern of preterm infants.@*METHODS@#A preterm infant follow-up database was established based on the Internet Plus follow-up system. A total of 3 188 preterm infants who were born from April 2018 to April 2021 were enrolled. Their length, weight, and head circumference were recorded at birth and at the corrected ages of 1, 3, 6, 12, 18, and 24 months. The preterm infants were grouped by perinatal factors. The growth curves of these infants were plotted and compared with the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standard and World Health Organization (WHO) standard.@*RESULTS@#The weight, length, and head circumference curves of each group of preterm infants grouped by various perinatal factors all rose rapidly within the corrected age of 6 months, but the growth rate slowed down after the corrected age of 6 months. Based on the actual age for the groups of preterm infants with different gestational ages (<28 weeks, 28-31@*CONCLUSIONS@#The physical growth rate of preterm infants is faster within the corrected age of 6 months, and the growth rate slows down after the corrected age of 6 months. Preterm infants with a smaller gestational age need longer time to catch up in weight and head circumference. More attention should be paid to the physical growth of extremely preterm infants, extremely low birth weight infants, and small-for-gestational-age infants.

Application of the Children Neuropsychological and Behavioral Scale-Revision 2016 in young children with autism spectrum disorder / 中国当代儿科杂志

OBJECTIVE@#To compare the assessment results of the Children Neuropsychological and Behavioral Scale-Revision 2016 (CNBS-R2016) between young children with autism spectrum disorder (ASD) and global developmental delay (GDD, without ASD) and to explore whether CNBS-R2016 could be helpful to early identification of ASD.@*METHODS@#A total of 260 ASD and 371 GDD children aged 18-30 months were enrolled to finish the assessment of CNBS-R2016. The development quotients (DQs) of the five domains of CNBS-R2016 including gross motor, fine motor, adaptability, language and social behavior were compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of the autism-predicted domain in identifying ASD and GDD.@*RESULTS@#The DQs of all the five domains in the ASD group were lower than those in the GDD group (P<0.05). The language DQ and total DQ of the ASD group had a negative correlation with the score of the autism-predicted domain (r=-0.566, -0.552 respectively, P<0.01). When the cut-off value of the autism-predicted domain was 10.5, the largest area under the ROC curve was 0.835, and the sensitivity and specificity for the diagnosis of ASD were 0.750 and 0.798 respectively.@*CONCLUSIONS@#The development of ASD children aged 18-30 months is worse than that of GDD children. CNBS-R2016 may be helpful to distinguish ASD from children with developmental delay.

Effect of perinatal factors on postnatal development of lymphocyte subsets in early preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the postnatal changes in lymphocyte subsets in early preterm infants and the effect of perinatal factors on lymphocyte subsets.</p><p><b>METHODS</b>A total of 61 early preterm infants were enrolled. Flow cytometry was used to measure the absolute counts of lymphocytes and lymphocyte subsets at 1, 7, 14, and 28 days after birth, as well as at 6 months after birth for 17 of these early preterm infants. The effects of perinatal factors, such as antepartum use of hormone, intrauterine infection, gestational age at birth, and Ureaplasma urealyticum (UU) colonization, on lymphocyte subsets were analyzed.</p><p><b>RESULTS</b>The absolute counts of lymphocyte subsets except natural killer (NK) cells were lowest at birth, increased rapidly at 1 week after birth, and reached the levels in healthy infants at 6 months; the count of NK cells remained at a low level and increased significantly at 6 months after birth. Compared with those with a gestational age of <28 weeks, the early preterm infants with a gestational age of ≥28 weeks had significantly higher absolute counts of T cells, T helper (Th) cells, and NK cells at 7 days after birth, a significantly higher absolute count of T cells at 14 days after birth, and significantly higher absolute counts of lymphocytes and Th cells at 28 days after birth (P<0.05). Compared with the group not using hormone, the group using hormone showed a significantly higher absolute count of T cells at 7 days after birth and significantly higher absolute counts of lymphocytes and all subsets at 14 days after birth (P<0.05). There was no significant difference in lymphocyte subsets at 1 day after birth between the intrauterine infection and non-infection groups (P>0.05); the intrauterine infection group had significantly higher absolute counts of B cells at 7 and 14 days after birth than the non-infection group. Compared those without UU colonization, the infants with UU colonization had significantly higher absolute counts of lymphocytes, T cells, Th cells, and Ts cells at 1 day after birth and a significantly higher absolute count of B cells at 14 days after birth.</p><p><b>CONCLUSIONS</b>Early preterm infants have deficiencies in innate immune cells at birth and normal levels at about 6 months after birth. Various perinatal factors including antepartum use of hormone, gestational age at birth, intrauterine infection, and UU colonization have long-term effects on lymphocyte subsets in early preterm infants.</p>

Tidal breathing pulmonary function after treatment in neonates with respiratory distress syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the pulmonary function after treatment in neonates with respiratory distress syndrome (RDS) at varying disease severity levels and different gestational ages.</p><p><b>METHODS</b>A total of 107 neonates with RDS were divided into <34 weeks group (65 neonates), late preterm group (21 neonates), full-term group (21 neonates). Another 121 non-RDS children were enrolled as the control group. According to the severity of RDS, the RDS neonates were divided into mild RDS group (grades 1 and 2; 76 neonates), and severe RDS (grades 3 and 4; 21 neonates). The tidal breathing pulmonary function was measured at a corrected gestational age of 44weeks.</p><p><b>RESULTS</b>The pulmonary function parameters showed no significant differences across the groups of RDS neonates of different gestational ages; the tidal volume per kilogram of body weight (VT/kg) showed no significant difference between the RDS and non-RDS groups, while the RDS group had significantly higher ratio of time to peak tidal expiratory flow to total expiratory time (tPTEF/tE) and ratio of volume to peak tidal expiratory flow to total expiratory volume (vPTEF/vE) than the non-RDS group of the same gestational age (P<0.05). At a corrected gestational age of 44 weeks, the two groups of neonates with varying severity levels of RDS had significantly lower tPTEF/tE and vPTEF/vE than the control group (P<0.05), and tPTEF/tE and vPTEF/vE tended to decrease with the increasing severity level of RDS.</p><p><b>CONCLUSIONS</b>Neonates with RDS have significantly decreased pulmonary function than those without RDS. At a corrected gestational age of 44 weeks, the tidal breathing pulmonary function in neonates with RDS is not associated with gestational age, but is associated with the severity of RDS.</p>

Measurement of tidal breathing pulmonary function in premature infants with different gestational ages / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of the tidal breathing pulmonary function in premature infants with different gestational ages.</p><p><b>METHODS</b>A total of 75 premature infants were classified into three groups according to their gestational ages: <32 weeks, 32-33(+6) weeks and 34-36(+6) weeks. Fifty-five full-term infants (39-40 weeks group) were selected as the control group. All infants were given the tidal breathing pulmonary function test at 3-5 days after birth. Moreover, all infants were given the tidal breathing pulmonary function test again at 40 weeks of the corrected gestational age.</p><p><b>RESULTS</b>At 3-5 days after birth, the three groups of premature infants had significantly lower inspiratory time, time to peak tidal expiratory flow (tPTEF), and ratio of tPTEF to total expiratory time (tPTEF/tE) than the control group (P<0.05). The parameter values of the tidal breathing pulmonary function were lower when the gestational age was lower. Even at 40 weeks of the corrected gestational age, the three groups of premature infants still had significantly lower tPTEF and tPTEF/tE than the control group (P<0.05).</p><p><b>CONCLUSIONS</b>The tidal breathing pulmonary function of neonates is influenced by the gestational age. The tidal breathing pulmonary function of premature infants is obviously impaired, and the lower the gestational age, the more obvious the impairment.</p>

Association of Ureaplasma urealyticum infection with bronchopulmonary dysplasia in very low birth weight infants with respiratory distress syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between Ureaplasma urealyticum (UU) infection in the lower respiratory tract and the incidence of bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants with respiratory distress syndrome (RDS).</p><p><b>METHODS</b>Seventy-three VLBW infants diagnosed with neonatal RDS, who had received at least one dose of pulmonary surfactant, as well as mechanical ventilation, and were hospitalized for over 28 days, were recruited. Endotracheal aspirates were obtained from the lower respiratory tract and examined by real-time PCR to detect UU DNA. The infants were divided into UU infection and non-UU infection groups according to examination results. Clinical characteristics and the incidence of BPD were compared between the two groups.</p><p><b>RESULTS</b>Compared with the non-UU infection group, the UU infection group had a higher rate of maternal vaginal delivery, higher incidence of recurrent nosocomial pulmonary infection and premature rupture of membranes (PROM), and longer durations of PROM, oxygen supplementation, and hospital stay; in addition, the UU infection group had higher plasma IgM level, leukocyte count, and neutrophil count within 3 hours after birth. Among 73 VLBW infants, 45 developed BPD; the incidence of BPD in the UU infection group was 90% (19/21), versus 50% (26/52) in the non-UU infection group (P<0.01).</p><p><b>CONCLUSIONS</b>UU infection in the lower respiratory tract increases the incidence of BPD in VLBW infants with RDS.</p>

Influencing factors for lymphocyte subsets in children aged 0-6 years / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the influencing factors for lymphocyte subsets in children 0 to 6 years of age.</p><p><b>METHODS</b>Umbilical artery blood samples from 45 healthy full-term infants and venous blood samples from 79 healthy children between 0 and 6 years were collected. According to the methods of delivery, the full-term infants were divided into vaginal delivery group (n=22) and cesarean section group (n=23). Healthy children were divided into different age groups: 28 days to 12 months (n=25), 1-3 years (n=26), and 3-6 years (n=28). Lymphocyte subsets were examined by flow cytometry. The influencing factors including delivery method, sex, and age, which might have an effect on the lymphocyte subsets, were analyzed.</p><p><b>RESULTS</b>There were significant differences in T and Ts cell counts, percentage of B cells, and percentage and count of natural killer (NK) cells between the full-term infants of vaginal delivery and cesarean section (P<0.05). The absolute counts and percentages of different lymphocyte subsets showed no significant differences between males and females in healthy children (P>0.05). The counts of all lymphocyte subsets except Ts and NK cells varied significantly between different age groups (P<0.05).</p><p><b>CONCLUSIONS</b>Lymphocyte subsets in children under 6 years of age are more profoundly affected by age. Delivery method is also a contributing factor in newborn infants. The reference range of lymphocyte subsets in children should be established for different age groups.</p>

Dynamic changes of intestinal 16S rDNA metagenome in 5 infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the dynamic changes of intestinal 16S rDNA metagenome in healthy infants.</p><p><b>METHODS</b>Seventeen fecal samples were collected at ages of 3 days, 1 month, 6 months and 1 year in 5 infants. Total bacterial DNAs were extracted and submitted high throughout sequencing on the V6 viable region of 16S rDNA. Tags and Operational Taxonomic Units (OTU) were then obtained and analysis of taxonomy, abundance and alpha diversity were performed.</p><p><b>RESULTS</b>In total 2,190.66 Mbp raw data in 17 samples were produced. The OTU numbers ranged from 36 to 308. The dominate phylum included Proteobacteria, Firmicutes and Bacteroidetes and Actinobacteria. The bacterial families>1% increased from only 2-4 per sample on day 3 to 7 at 1 or 6 months, 10 at 12 months. The average npShannon and Simpson index on day 3, at 1 month, 6 months and 1 year were 1.117, 1.460, 2.088, 2.50 and 0.443, 0.408, 0.229, 0.143 respectively.</p><p><b>CONCLUSIONS</b>Infants' intestines harbor abounding bacterial genomes. Distinct individual differences exist in infants in terms of intestinal bacterial abundance and composition. The abundance and diversity of gut bacteria increase over time.</p>

Clinical significance of dynamic pressure-volume curve in neonatal mechanical ventilation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the characteristics and role of dynamic pressure-volume curve (P-V curve) in neonatal mechanical ventilation.</p><p><b>METHODS</b>A dynamic P-V curve was automatically drawn by the Stephanie ventilator. The slope rate of dynamic P-V curve was measured in 25 neonates who received mechanical ventilation 1, 24, 48 and 72 hrs after ventilation and before weaning from ventilation. Minute-ventilation (MV), mean airway pressure (Pmean), and fraction of inspired oxygen (FiO2) were recorded. The patterns of dynamic P-V curve during abnormal ventilation (resistance to ventilator, part or complete airway obstruction, airway leaking and tracheal catheter exodus) were observed.</p><p><b>RESULTS</b>With the improvement of pulmonary disease, the slope rate of P-V curve and MV increased, Pmean and FiO2 decreased, and the P-V curve shifted to the volume axle. The slope rate of curve 48 and 72 hrs after ventilation and before weaning from ventilation (1.05+/-0.48, 1.10+/-0.42 and 1.13+/-0.37 mL/cmH2O respectively) increased significantly compared with that 1 hr after ventilation (0.76+/-0.53 mL/cmH2O) (p<0.05 or 0.01). Abnormal ventilation led to abnormal appearance of dynamic P-V curve.</p><p><b>CONCLUSIONS</b>The increasing slope rate of dynamic P-V curve and the curve shifting to volume axle in neonatal mechanical ventilation may be associated with the improvement of pulmonary disease. The appearance changes of the curve may be of value in the assessment of abnormal ventilation.</p>

The situation and countermeasure of medical measurements / 中国医疗器械杂志

This paper introduces the significance, the present development situation and some suggestions of the medical measurements.