Early-onset neonatal sepsis as a risk factor for peri-intraventricular hemorrhage in premature infants / Sepse precoce como fator de risco para hemorragia peri-intraventricular em prematuros

ABSTRACT Objective: To assess early-onset sepsis as a risk factor of peri-intraventricular hemorrhage in premature infants born at less than or equal to 34 weeks' gestation and admitted to a neonatal intensive care unit (NICU). Methods: This retrospective cohort study included premature patients born at less than or equal to 34 weeks' gestation who were admitted to the NICU of a tertiary hospital in southern Brazil, and born from January 2017 to July 2021. Data were collected from patients' medical records. Early-onset sepsis was measured according to the presence or absence of diagnosis within the first 72 hours of life, whereas the outcome, peri-intraventricular hemorrhage, was described as the presence or absence of hemorrhage, regardless of its grade. Results: Hazard ratios were calculated using Cox regression models. A total of 487 patients were included in the study, of which 169 (34.7%) had some degree of peri-intraventricular hemorrhage. Early-onset sepsis was present in 41.6% of the cases of peri-intraventricular hemorrhage, which revealed a significant association between these variables, with increased risk of the outcome in the presence of sepsis. In the final multivariate model, the hazard ratio for early-onset sepsis was 1.52 (95% confidence interval 1.01-2.27). Conclusion: Early-onset sepsis and the use of surfactants showed to increase the occurrence of the outcome in premature children born at less than or equal to 34 weeks' gestation. Meanwhile, factors such as antenatal corticosteroids and gestational age closer to 34 weeks' gestations were found to reduce the risk of peri-intraventricular hemorrhage.

RESUMO Objetivo: O objetivo do presente trabalho foi avaliar a sepse precoce como fator de risco para hemorragia peri-intraventricular (HPIV) em prematuros com 34 semanas ou menos, admitidos em Unidade de Terapia Intensiva (UTI) Neonatal. Métodos: Este estudo de coorte retrospectivo incluiu pacientes prematuros com 34 semanas ou menos, que receberam alta da UTI Neonatal de hospital terciário, no sul do Brasil, nascidos no período de janeiro de 2017 a julho de 2021. Os dados foram coletados por meio dos prontuários desses pacientes. A sepse precoce foi mensurada conforme a presença ou a ausência do diagnóstico nas primeiras 72 horas de vida. Já o desfecho, hemorragia peri-intraventricular, foi descrito conforme a presença ou ausência da hemorragia, independentemente do grau. Resultados: Hazard ratios (HR) foram calculados por meio de modelos de regressão de Cox. Foram incluídos no estudo 487 pacientes. Destes, 169 (34,7%) apresentaram algum grau de hemorragia peri-intraventricular. A sepse precoce esteve presente em 41,6% dos casos de hemorragia peri-intraventricular e apresentou associação significativa, elevando o risco do desfecho quando presente. No modelo multivariável final, o HR para a sepse precoce foi de 1,52 (intervalo de confiança de 95% — IC95% 1,01-2,27). Conclusão: Sepse precoce e uso de surfactante demonstraram aumentar a ocorrência do desfecho em crianças prematuras até 34 semanas, enquanto fatores como corticoide antenatal e idades gestacionais mais próximas a 34 semanas mostraram reduzir o risco de ocorrência hemorragia peri-intraventricular.

Características clínicas y epidemiológicas de madres con recién nacidos prematuros y de bajo peso / Clinical and epidemiological characteristics of mothers with preterm and low weight infants i: en

Introducción: El parto prematuro y el bajo peso al nacer constituyen un problema de salud a escala mundial, ya que representan un predictor importante del desarrollo y crecimiento posnatal, así como un indicador de morbilidad y mortalidad infantil. Objetivo: Caracterizar a madres con recién nacidos prematuros y de bajo peso según variables clínicas y epidemiológicas. Métodos: Se realizó un estudio descriptivo, de corte transversal, desde enero hasta diciembre de 2022, de 35 madres con recién nacidos prematuros y de bajo peso, pertenecientes al Policlínico Docente Área Este de la ciudad de Camagüey. Entre las variables analizadas figuraron: edad, estado nutricional, clasificación del riesgo, control prenatal, riesgo reproductivo preconcepcional, consulta multidisciplinaria, enfermedades propias del embarazo, estado al nacer, deficiencias detectadas y causas. Resultados: En la serie predominaron el grupo etario de 35 y más años (25,7 %), la obesidad (37,1 %), las madres con elevados riesgos (45,7 %), quienes recibieron entre 8-14 controles prenatales, y malos antecedentes obstétricos (31,4 %). Por otra parte, 22,9 % de las madres tuvieron hijos con bajo peso y 31,4 %, prematuros; en tanto, hubo dificultades en el seguimiento por ausencias (57,1 %). Conclusiones: Las madres presentaron características clínicas y epidemiológicas desfavorables, tales como la edad de 35 y más años, la obesidad, el alto riesgo, los malos antecedentes obstétricos y la infección vaginal como enfermedad propia del embarazo, que influyeron en que los neonatos fueran prematuros o de bajo peso, o ambos.

Introduction: Preterm birth and low birth weight constitute a health problem worldwide, since they represent an important predictor of development and postnatal growth, as well as an indicator of newborn morbidity and mortality. Objective: To characterize mothers with preterm and low weight infants according to clinical and epidemiological variables. Methods: A descriptive, cross-sectional study was carried out from January to December, 2022, of 35 mothers with preterm and low weight infants, belonging to the East Area Teaching Polyclinic in Camagüey city. Age, nutritional state, risk classification, prenatal control, preconcepcional reproductive risk, multidisciplinary visits, diseases characteristic of pregnancy, birth state, detected deficiencies and causes were among the analyzed variables. Results: In the series there was prevalence of the 35 and over age group (25.7%), obesity (37.1%), high risk mothers (45.7%) who received among 8-14 prenatal controls, and bad obstetric history (31.4%). On the other hand, 22.9% of the mothers had low weight children and 31.4% preterm children; as long as there were difficulties in follow up due to absences (57.1%). Conclusions: The mothers presented unfavorable clinical and epidemiological characteristics, such as the 35 and over years, obesity, high risk, bad obstetric history and vaginal infection as a disease characteristic of pregnancy, which influenced the infants to be preterm or low weight, or both.

Óbitos neonatais por enterocolite necrosante: estudo de coorte retrospectiva / Neonatal deaths from necrotizing enterocolitis: a retrospective cohort study / Muertes neonatales por enterocolitis necrozante: estudio de cohorte retrospectivo

Introdução:A enterocolite necrosante é uma doença que pode afetar o trato gastrointestinal de recém-nascidos,cujas manifestações clínicas podem ser caracterizadas por vômitos biliosos, sangue nas fezes, distensão abdominal, além de alterações nos parâmetros hemodinâmicos e instabilidade térmica. As populações mais vulneráveis a essa enfermidade são recém-nascidos de baixo peso,expostos ao ambiente de terapia intensiva neonatal. Objetivos: Identificar o perfil de recém-nascidos e os fatores maternos e neonatais associados à ocorrência de óbitos por enterocolite necrosante, em maternidade de referência do Ceará-Brasil. Metodologia: Trata-se de coorte retrospectiva, estudo que objetiva a descrição da incidência de determinado evento ao longo do tempo, além do estabelecimento de relações causais entre os fatores associados ao acontecimento. Incluíram-serecém-nascidos que tiveram óbitos por enterocolite necrosante entre 2019 e 2021, comficha de investigação de óbitos neonatais preenchida corretamente, não sendo excluído nenhum recém-nascido, totalizando amostra de 29 óbitos.Resultados: Identificou-se que o perfil dos recém-nascidos foi,em maioria, deprematuros e com baixo peso e fatores de risco para outras doenças associadas,como a sepse, o que acarretourealização de procedimentos invasivos e internação em ambiente de terapia intensiva neonatal.Conclusões: A prematuridade e o baixo peso ao nascer foram as variáveis relevantes no estudo e podem estar associadas à piora das condições clínicas do recém-nascido e ao desenvolvimento de enterocolite necrosante (AU).

Introduction: Necrotizing Enterocolitis is a disease that can affect the gastrointestinal tract of newborns, whose clinical manifestations can be characterized by bilious vomiting, blood in stool, abdominal distension, in addition to changes in hemodynamic parameters and thermal instability. The populations most vulnerable to this disease are low birth weight newborns exposed to the neonatal intensive care environment. Objectives: This study aimed to identify the profile of newborns and maternal and neonatal factors associated with the occurrence of deaths from necrotizing enterocolitis in a reference maternity hospital in Ceará, Brazil. Methodology: This is a retrospective cohort study seeking to describe the incidence ofa particular event over time, as well as establish causal relationships between the factors associated with the event. The study population comprised newborns who died from necrotizing enterocolitis between 2019 and 2021, who had neonatal death investigation forms filled out correctly, with no newborns being excluded, totaling a sample of 29 deaths. Results: It was identified that the profile of newborns was mostly premature, of low birth weight and with risk factors for other associated diseases such as sepsis, leading to invasive procedures and hospitalization in a neonatal intensive care environment. Conclusions: Prematurity and low birth weight were relevant variables in the study and may be associated with worsening of the newborn's clinical conditionsand development of necrotizing enterocolitis (AU).

ntroducción:La Enterocolitis Necrotizante es enfermedad que puede afectar el tracto gastrointestinal del recién nacido, cuyas manifestaciones clínicas pueden caracterizarse por vómitos biliosos, sangre en las heces, distensión abdominal, además de cambios en los parámetros hemodinámicos e inestabilidad térmica.Las poblaciones más vulnerables a esta enfermedad son recién nacidos con bajo peso expuestos al entorno de cuidados intensivos neonatales.Objetivos: Identificar el perfil de recién nacidos y los factores maternos y neonatales asociados a la ocurrencia de muertes por enterocolitis necrotizante, en maternidad de referencia en el Ceará-Brasil.Metodología: Estudio de cohorte retrospectivo, para describir la incidencia de determinado evento a lo largo del tiempo, además de establecer relaciones causales entre los factores asociados al evento.Se incluyeron recién nacidos fallecidos por enterocolitis necrotizante entre 2019 y 2021, quienes tuvieron formulario de investigación de muerte neonatal correctamente diligenciado, no excluyéndose ningún recién nacido, totalizando muestra de 29 defunciones.Resultados:El perfil de los recién nacidos fue mayoritariamente prematuro y de bajo peso al nacer y con factores de riesgo para otras enfermedades asociadas, como sepsis, con procedimientos invasivos y hospitalización en ambiente de cuidados intensivosneonatales.Conclusiones:La prematuridad y el bajo peso al nacer fueron variables relevantes en el estudio y pueden estar asociados con empeoramiento de las condiciones clínicas de recién nacidos y desarrollo de enterocolitis necrotizante (AU).

Clinical characteristics of premature infants with respiratory ureaplasma urealyticum infection / 中国新生儿科杂志

Objective:To study the clinical characteristics of ureaplasma urealyticum (UU) infection in preterm infants with gestational age <34 weeks.Methods:From January 2017 to December 2021, premature infants with gestational age <34 weeks admitted to neonatal department of our hospital were enrolled in this prospective cohort study. UU-DNA from respiratory tract samples were examined using quantitative fluorescence polymerase chain reaction method. The infants were assigned into UU (+) group and UU (-) group. Perinatal factors and clinical characteristics were compared between the two groups.Results:A total of 182 preterm infants were enrolled, including 59 cases (32.4%) in UU (+) group and 123 (67.6%) in UU (-) group. UU (+) group had significantly lower gestational age and birth weight and significantly higher incidences of vaginal delivery, premature rupture of membranes (PROM) >18 h and maternal chorioamnionitis than UU (-) group ( P<0.05). Compared with UU (-) group, UU (+) group had significantly higher leucocyte count, neutrophil count and interleukin-6 at 1, 24 and 72 h after birth ( P<0.05). No significant differences existed in C-reactive protein and procalcitonin between the two groups at each time point ( P>0.05). In UU (+) group, the incidences of intrauterine pulmonary infection and bronchopulmonary dysplasia (BPD) were higher and the incidence of respiratory distress syndrome was lower than UU (-) group ( P<0.05). No significant differences existed in the incidences of intraventricular hemorrhage, periventricular leukomalacia, feeding intolerance, necrotizing enterocolitis, retinopathy of prematurity between the two groups ( P>0.0 5). UU (+) group had significantly longer duration of oxygen therapy than UU (-) group ( P<0.05). No significant differences existed in the duration of invasive mechanical ventilation and hospital stay between the two groups ( P>0.05). Conclusions:Preterm infants <34 weeks with positive UU in respiratory tract secretions have higher incidences of vaginal delivery, PROM>18 h and maternal chorioamnionitis. Leukocyte and neutrophil count and interleukin -6 are higher in these infants. They need prolonged oxygen therapy and have increased risks of intrauterine pulmonary infection and BPD.

Development and validation of a risk prediction model for low Apgar scores in extremely premature infants / 中国新生儿科杂志

Objective:To establish a risk prediction model for the occurrence of low 1 min Apgar scores in extremely premature infants (EPIs).Methods:From January 2017 to December 2021, EPIs delivered at our hospital were retrospectively analyzed and randomly assigned into training set group and validation set group in a 7∶3 ratio. 17 clinical indicators were selected as predictive variables and low Apgar scores after birth as outcome variables. Lasso regression and multi-factor logistic regression were used within the training set group to select the final predictors for the final model, and the calibration, distinguishability and clinical decision making curves of the final model were evaluated in the validation set group.Results:A total of 169 EPIs were enrolled, including 117 in the training set group and 52 in the validation set group. 4 indicators including gender, fetal distress, assisted conception and delivery time were selected as the final predictors in the final model. Both the training set group and the validation set group had good calibration curves. The area under the receiver operating characteristic curve (AUC) of the prediction model was 0.731, the sensitivity was 72.2%, the specificity was 60.5% and the AUC of the external validation curve was 0.704. The clinical decision making curve showed that the model had a greater benefit in predicting the occurrence of low Apgar score in EPIs within the threshold of 2% to 75%.Conclusions:The clinical prediction model established in this study has good distinguishability, calibration and clinical accessibility and can be used as a reference tool to predict low Apgar scores in EPIs.

Risk factors of hydrocephalus secondary to severe intraventricular hemorrhage in preterm infants / 中国新生儿科杂志

Objective:To study the risk factors of secondary hydrocephalus after severe intraventricular hemorrhage (IVH) in preterm infants for prevention and early identification of post-hemorrhagic hydrocephalus (PHH).Methods:From June 2013 to June 2021, preterm infants with severe IVH admitted to our hospital were retrospectively analyzed. They were assigned into PHH group and non-PHH group. Rank sum test or chi-square test was used for comparison between the two groups and multivariate logistic regression analysis was used to analyze the risk factors of PHH in preterm infants.Results:A total of 246 preterm infants with severe IVH were enrolled, including 68 cases (27.6%) in the PHH group and 178 cases (72.4%) in the non-PHH group. Multivariate logistic stepwise regression analysis showed that male gender ( OR=2.014, 95% CI 1.063-3.817), gestational age ≤30 week ( OR=2.240, 95% CI 1.210-4.146), 5-min Apgar score ≤5 ( OR=3.980, 95% CI 1.483-10.685), placental abruption ( OR=2.940, 95% CI 1.324-6.531) were independent risk factors for PHH in preterm infants and thrombocytopenia was the protective factor for PHH in preterm infants ( OR=0.305, 95% CI 0.147-0.632). The incidence of moderate thrombocytopenia in non-PHH group was significantly higher than PHH group ( P<0.05). No significant differences existed in the incidences of mild and severe thrombocytopenia between the two groups ( P>0.05). Conclusions:Male gender, gestational age ≤30 week, 5-min Apgar score ≤5, placental abruption are risk factors for PHH in premature infants with severe IVH and moderate thrombocytopenia has protective effects.

Risk factors for retinopathy of prematurity in very low birth weight infants / 中国新生儿科杂志

Objective:To study the risk factors for retinopathy of prematurity (ROP) in very low birth weight infants (VLBWIs).Methods:From October 2020 to December 2021, VLBWIs with gestational age(GA) ≤32 weeks admitted to the neonatal department of our hospital were retrospectively studied. According to the occurrence of ROP, they were assigned into ROP group and non-ROP group. The clinical data of the two groups were compared and the risk factors of ROP in VLBWI were analyzed.Results:A total of 251 VLBWIs were enrolled, including 60 cases (23.9%) in ROP group and 191 (76.1%) in non-ROP group. The GA and birth weight (BW) of ROP group were significantly lower than non-ROP group [28(26,30) w vs. 29(28,31) w, 1 035(840,1 285) g vs. 1 260(1 110,1 380) g, respectively, all P<0.001]. The ROP group had longer duration of oxygen therapy [42.0(26.0, 53.5) d vs. 24.0(18.0, 34.0) d], higher incidences of blood transfusion [2.5(1.0, 3.0) times vs. 2.0 (1.0, 2.0) times] and hyperglycemia (80.0% vs. 16.8%), higher average [(5.6±0.5) mmol/L vs. (5.1±0.5) mmol/L] and peak [10.4(7.8,13.2) mmol/L vs. 6.5(6.1,6.8) mmol/L] blood glucose levels in the first week than the non-ROP group (all P<0.001). Multivariate analysis showed that longer duration of oxygen therapy ( OR=1.047, 95% CI 1.008-1.087, P=0.018) and higher peak blood glucose level in the first week ( OR=1.268, 95% CI 1.092-1.474, P=0.002) were the independent risk factors for ROP. Conclusions:Longer duration of oxygen therapy and higher peak of blood glucose level in the first week are risk factors for ROP in VLBWIs.

Effects of patent ductus arteriosus on bronchopulmonary dysplasia in very low birth weight preterm infants / 中国新生儿科杂志

Objective:To study the effects of patent ductus arteriosus (PDA) on bronchopulmonary dysplasia (BPD) in very low birth weight preterm infants (VLBWIs).Methods:From January 2018 to December 2020,VLBWIs hospitalized in NICU of our hospital were retrospectively analyzed.They were assigned into BPD group and non-BPD group according to whether BPD occurred. Clinical data including the severity of BPD , the diameter and duration of PDA and ibuprofen usage were analyzed. The predictive values of PDA diameter and duration for BPD were calculated using area under curve (AUC) of receiver operating characteristic curve (ROC) analysis.Results:A total of 173 VLBWIs were enrolled, including 42 in the BPD group and 131 in the non-BPD group. The incidence of hemodynamically significant PDA (hsPDA) in the BPD group was significantly higher than the non-BPD group (45.2% vs. 22.1%, P=0.001).hsPDA ( OR=2.806, 95% CI 1.307-5.745, P=0.005), PDA diameter ≥1.5 mm ( OR=7.003, 95% CI 1.323-48.884, P<0.001) and PDA duration >1 w ( OR=7.754, 95% CI 1.203-49.989, P=0.031) were all risk factors for BPD.As for the severity of BPD, hsPDA, PDA diameter ≥1.5 mm, PDA duration >1 w and FiO 2max >30% within 72 h after birth were risk factors for grade Ⅱ~Ⅲ BPD. The incidence of ibuprofen usage was significantly higher in grade Ⅱ~Ⅲ BPD group. If the diameter of PDA was 1.25 mm, the AUC was 0.806 (95% CI 0.706-0.906, P<0.001), sensitivity 82.6% and specificity 68.7% for grade Ⅱ~Ⅲ BPD. If the PDA duration was 10.5 d, the AUC was 0.821 (95% CI 0.718-0.925, P<0.001), sensitivity 65.2% and specificity 91.3%. Conclusions:hsPDA, larger PDA diameter and longer PDA duration are risk factors for the occurrence and severity of BPD in VLBWIs.

Risk factors and clinical outcomes of early-onset pulmonary hypertension in preterm infants with gestational age≤ 32 weeks / 中国新生儿科杂志

Objective:To study the risk factors and clinical outcomes of early pulmonary hypertension in preterm infants with gestational age(GA)≤32 w.Methods:From October 2017 to May 2021,preterm infants with GA≤ 32 w admitted to NICU of our hospital were retrospectively studied. According to their echocardiography 2 w after birth, the infants were assigned into early-onset pulmonary hypertension (ePH) group and non-PH group. SPSS 21.0 statistical software was used to analyze the general status, complications and clinical outcomes of the two groups. Multiple logistic regression was used to analyze the risk factors of early-onset PH.Results:A total of 183 cases were enrolled, including 24 in the ePH group and 159 in the non-PH group. The incidences of birth asphyxia, hemodynamically significant patent ductus arteriosus (hsPDA), FiO 2≥30% within 6 h after birth, late-onset PH, severe bronchopulmonary dysplasia(BPD) and intracranial hemorrhage(ICH) in the ePH group were significantly higher than the non-PH group( P<0.05). hsPDA was the independent risk factor for early-onset PH ( OR=11.781, 95% CI 4.192-33.108). Conclusions:Preterm infants with GA≤32 w and early-onset PH are at increased risks of ICH, late-onset PH and severe BPD, hsPDA is the independent risk factor for early-onset PH.

Effects of recombinant human erythropoietin on cerebral blood flow in preterm infants: arterial spin labeling magnetic resonance imaging evaluation / 中国新生儿科杂志

Objective:To study the effects of recombinant human erythropoietin (rhEPO) on cerebral blood flow (CBF) in preterm infants using arterial spin labeling (ASL) magnetic resonance imaging (MRI).Methods:From September 2021 to June 2022, preterm infants (gestational age ≤32 weeks, birth weight ≤1 500 g) admitted to NICU of our hospital within 24 h after birth were randomly assigned into rhEPO group and control group for this prospective study. The rhEPO group was given rhEPO (500 IU/kg iv, once every other day for 2 weeks) within 72 h after birth plus symptomatic supportive treatment. The control group received same amount of normal saline injection. Both groups received brain MRI, diffusion-weighted imaging and ASL at adjusted gestational age of 35~37 weeks and CBF values of interested areas were measured.Results:A total of 85 infants were enrolled, including 40 in the rhEPO group and 45 in the control group. No significant differences existed in the incidences of periventricular-intraventricular hemorrhage, periventricular leukomalacia, focal white matter injury and extensive white matter injury between the two groups ( P>0.05). The CBF values [ml/(100 g·min)] of frontal cortex [left 15.1±3.9 vs. 17.9±3.1, right 15.9 (12.5, 17.8) vs. 18.1(16.1,20.2)], temporal cortex [left 15.8±4.3 vs. 18.6±3.8, right 16.3(13.2,19.4) vs. 18.1(15.7,19.7)], occipital cortex (left 15.8±6.1 vs. 18.8±3.3, right 16.8±5.5 vs. 19.3±4.8), basal ganglia (left 24.7±7.2 vs. 28.7±6.2, right 26.0±7.9 vs. 29.3±6.4) and thalamus (left 32.7±11.8 vs. 37.9±8.6, right 32.1±11.6 vs. 37.6±10.2) in the rhEPO group were significantly lower than the control group ( P<0.05). No significant differences existed of CBF value at the parietal cortex between the two groups ( P>0.05). Conclusions:Early application of rhEPO can reduce CBF in premature infants, which may be related to the neuro-protective effects of EPO.

Efficacy and safety of noninvasive high-frequency oscillatory ventilation in the treatment of respiratory distress syndrome in premature infants : a Meta-analysis / 中国新生儿科杂志

Objective:To evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (nHFOV) as the initial ventilation mode for respiratory distress syndrome (RDS) in premature infants.Methods:From the establishment of the databases [(PubMed, Embase, Cochrane Library, CNKI, Wanfang database, CQVIP and CBM (SinoMed)] to March 1, 2022, literature on randomized controlled trials (RCTs) using nHFOV and nasal continuous positive airway pressure(NCPAP) as the initial ventilation modes for RDS in premature infants were searched. The qualities of the included literature were evaluated according to Cochrane Evaluation Manual. RevMan 5.4 software was used for Meta-analysis.Results:Seven RCTs involving 786 children were included for the final Meta-analysis, with 395 cases in the nHFOV group and 391 cases in the NCPAP group. The results showed that the nHFOV group had lower intubation rates than the NCPAP group ( OR=0.34, 95% CI 0.22~0.51, P<0.001). No significant differences existed in mortality rates and complication rates between the two groups ( P>0.05). Conclusions:nHFOV as the initial treatment for RDS in premature infants may reduce the incidence of early treatment failure without increasing complications.

Clinical effects of bi-level positive airway pressure and heated humidified high flow nasal cannula ventilation as initial treatment for premature infants with respiratory distress syndrome / 中国新生儿科杂志

Objective:To compare the efficacy and safety of bi-level positive airway pressure (BiPAP) ventilation and heated humidified high flow nasal cannula (HHHFNC) ventilation as initial respiratory support for premature infants with respiratory distress syndrome (RDS).Methods:From January 2019 to June 2021, premature infants [gestational age (GA) 28~35 weeks)] with grade Ⅰ to Ⅲ RDS admitted to Suining County People's Hospital were prospectively enrolled. The infants were randomly assigned into BiPAP group and HHHFNC group. The clinical characteristics, ventilation efficacy and complications were analyzed.Results:A total of 33 infants were in BiPAP group and 32 in HHHFNC group. No significant differences existed between the two groups in the following items: the frequency of apnea within 24 h of ventilation, FiO 2 and PaCO 2 at 24 h, the use of pulmonary surfactant (PS), the incidence of non-invasive ventilation failure within 72 h, non-invasive ventilation duration and the age achieving total enteral nutrition. HHHFNC group had lower score in premature infants pain profile (PIPP) than BiPAP group at 24 h of non-invasive ventilation [4 (3, 6) vs. 8 (6, 11), P<0.001]. No significant differences existed in nasal injury, pneumothorax, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and mortality rate between the two groups ( P>0.05). Conclusions:As the initial treatment for premature infants with grade Ⅰ to Ⅲ RDS, BiPAP and HHHFNC has similar rates of non-invasive ventilation failure within 72 h,non-invasive ventilation duration and adverse events. HHHFNC may ease the pain of the infants.

Congenital hypothyroidism in preterm infants:analysis of factors in the pathogenesis and clinical prognosis / 中国新生儿科杂志

Objective:To investigate the characteristics of congenital hypothyroidism (CH) in premature infants and analyze the predictors of transient congenital hypothyroidism(TCH) and permanent CH (PCH).Methods:A retrospective study was conducted on the preterm infants with CH born in Beijing from January 2008 to June 2018. They were screened, diagnosed and treated by the Beijing Neonatal Disease Screening Center. They were assigned into TCH and PCH groups according to the clinical prognosis. Univariate analysis and Logistic regression analyses were used to determine the predictors of PCH, and the receiver operating characteristic curve (ROC) was drawn to determine the best cut-off point.Results:A total of 2 216 892 newborns were screened, 15 382 were initially screened positive, the median time of screening was 4(4,10) d after birth, and the median time of postnatal reexamination was 30(22,42) d after birth, 14 576 newborns were reexamined, the reexamination rate was 94.8%. A total of 92 preterm infants were diagnosed with CH, of which 60 were TCH, accounting for 65.2%; 28 were PCH, accounting for 30.4%; and 4 were lost to follow-up, accounting for 4.3%. Univariate analysis showed that in the PCH group, the abnormal rate of thyroid B-ultrasound, levothyroxine (LT4) dose at 1-year old, thyrotropin (TSH) level at 2 years old, LT4 dose at 2 years old, LT4 dose and free thyroxine (FT4) level at 3 years old were higher than those in the TCH group. Logistic regression analysis revealed that abnormal B-ultrasound ( OR=12.184,95% CI 2.270~65.403), and elevated TSH level at 2 years old ( OR=2.033,95% CI 1.280~3.228),increased LT4 dose at 3 year old ( OR=21.435,95% CI 3.439~133.584) are the risk factors for PCH. The maximum area under ROC curve was 0.798 at 3 years old (95% CI 0.680~0.916), the best cut-off point was 1.3 μg/(kg·d) for the 3-year-old drug dose; followed by 2-year-old TSH level, which was 0.683 (95% CI 0.548~0.817), the best cut-off point was 4.51 μIU/ml. Conclusions:TCH accounted for a large proportion of preterm infants with CH. During the follow-up, the increased LT4 dose at 3 years old and the elevated TSH level at 2 years old were the early predictors of PCH.

Status and influencing factors of enteral nutrition support for preterm infants / 中国小儿急救医学

Premature infants have immature gastrointestinal function and are prone to various comorbidities after birth, which have a great impact on their near and long-term prognosis.Proper nutritional support is the basis of their survival and treatment plan, of which enteral nutrition is the main tool.However, the management of enteral nutrition varies considerably between neonatal facilities worldwide, and the nutritional management of preterm infants varies between physicians.This review summarized and discussed the existing literature on enteral nutrition in preterm infants, to provide a review of the current status of enteral nutrition support in preterm infants in China and abroad and the factors that currently influence the time to achieve adequate enteral nutrition, aiming to provide a reference for improving clinical practice protocols.

Meta-analysis of efficacy and safety of early intratracheal instillation budesonide combined with pulmonary surfactant in the prevention of bronchopulmonary dysplasia / 中国小儿急救医学

Objective:To evaluate the efficacy and safety of early intratracheal drops of budesonide combined with pulmonary surfactant in the prevention of bronchopulmonary dysplasia(BPD).Methods:Embase, PubMed, Cochrane Library, CNKI and Wanfang database were searched from the establishment of library construction to February 2022.Literature selection, quality assessment and data extraction were conducted according to the inclusion and exclusion criteria, and Meta-analysis was performed on the included literature using Rev Man 5.3 software.Results:Nine randomised controlled studies were included in this study, with a total of 884 children, including 433 in the experimental group and 451 in the control group.The results showed that there was a statistically significant difference in the incidence of BPD between the two groups[ OR=0.40, 95% CI(0.29, 0.53), P<0.001], and there was no statistically significant difference in the morbidity between the two groups[ OR=0.65, 95% CI(0.34, 1.22), P=0.18]. The risks of retinopathy of prematurity[ OR=0.42, 95% CI(0.54, 1.28), P=0.40], patent ductus arteriosus[ OR=0.79, 95% CI(0.57, 1.10), P=0.17], intracranial hemorrhage[ OR=1.09, 95% CI(0.77, 1.53), P=0.63], necrotizing enterocolitis[ OR=0.89, 95% CI(0.55, 1.44), P=0.64], and neonatal septicemia[ OR=0.73, 95% CI(0.49, 1.08), P=0.11] occurred in the experimental group had no statistically significant differences compared to the control group (all P>0.05). Conclusion:Early postnatal intratracheal drops of budesonide combined with pulmonary surfactant can significantly reduce the incidence of BPD, and has no significant effect on mortality or short-term complications.

Progress of mesenchymal stem cells in the treatment of bronchopulmonary dysplasia / 国际儿科学杂志

Bronchopulmonary dysplasia(BPD) is a chronic lung disease in the premature infants, which is an important cause of poor prognosis in the premature infants.The pathogenesis of BPD involves a variety of prenatal and postnatal mechanisms affecting the development of immature lungs.The combined effect of BPD alters lung morphogenesis, disrupts capillary gas exchange in the alveoli, and leads to pathological and clinical features of BPD.The current clinical methods used to treat BPD are still difficult to improve its prognosis.Mesenchymal stem/stromal cell(MSC) is a promising and innovative therapy for the treatment of a wide range of diseases due to the ease of extraction, low immunogenicity, anti-inflammatory properties and regenerative ability.In recent years, many experimental and clinical studies have found and proved that mesenchymal stem cell transplantation has a certain effect on BPD, so MSC may become the promising treatment for BPD in the future.However, the possibility that MSC may promote tumor growth, the presence of heterogeneous cell populations resulting in different efficacy, and ethical issues regarding the use of this treatment in humans make it a number of therapeutic challenges.This article reviews the mechanism of action and treatment of MSC in BPD, as well as the research progress in the treatment of BPD with MSC.

What the skin of 341 premature newborns says - a transversal study

Abstract Objectives: Determine the frequency of dermatological diagnoses in preterm newborns up to 28 days of life and associated perinatal factors. Method: a cross-sectional analytical study with a convenience sample and prospective data collection, was conducted between November 2017 and August 2019. Overall, 341 preterm newborns who had been admitted to a University hospital - including those admitted to the Neonatal Intensive Care Unit - were evaluated. Results: 61 (17.9%) had less than 32 weeks gestational age (GA), with a mean GA and birth weight of 33.9 ± 2.8 weeks and 2107.8 ± 679.8g (465 to 4230g), respectively. The median age at the time of evaluation was 2.9 days (4 h to 27 days). The frequency of dermatological diagnoses was 100% and 98.5% of the sample had two or more, with an average of 4.67 +1.53 dermatoses for each newborn. The 10 most frequent diagnoses were lanugo (85.9%), salmon patch (72.4%), sebaceous hyperplasia (68.6%), physiological desquamation (54.8%), dermal melanocytosis (38.7%), Epstein pearls (37.2%), milia (32.2%), traumatic skin lesions (24%), toxic erythema (16.7%), and contact dermatitis (5%). Those with GA< 28 weeks showed more traumatic injuries and abrasions, whereas those with ≥ 28 weeks had physiological changes more frequently, and those with GA between 34-366/7 weeks, had transient changes. Conclusion: Dermatological diagnoses were frequent in our sample and those with higher GA showed a higher frequency of physiological (lanugo and salmon patch) and transient changes (toxic erythema and miliaria). Traumatic lesions and contact dermatitis were among the 10 most frequent injuries, reinforcing the need to effectively implement neonatal skin care protocols, especially in preterm.

Early death, morbidity and pharmacotherapy in extremely premature and very premature in neonatal intensive care units / Morte precoce, morbidade e farmacoterapia em prematuros extremos e muito prematuros em unidades de terapia intensiva neonatal

Abstract Objectives: to evaluate the evolution of extremely preterm and very preterm infants admitted to neonatal intensive care units, regarding the use of ventilatory support, morbidities, medication use, death, survival and viability. Methods: a non-concurrent cohort study, with 163 very premature and extreme newborns hospitalized in three neonatal intensive care units, during 2016 and 2017. A descriptive analysis of the data obtained from the medical records was performed. The outcomes studied were the use of ventilatory support, morbidities, medication use, death and causes of death. A survival curve was constructed and a viability limit was defined. Results: in the study, 28.2% were extreme and 71.8% were very premature. In this order of subgroups, the need for mechanical ventilation was higher for the extremes (65.2% and 41.0%) and the main diagnosis was early sepsis (78.6% and 82.6). Off-label (60.5% and 47.9%) and off-license (25.3% and 29.0%) medications were used. Most deaths (57.8%) occurred between the extremes, mainly due to septic shock. Survival was lower for the lowest gestational ages and the limit of viability was between 26 and 27 weeks. Conclusions: the main morbidities were from the respiratory system, with high use of off-label and unlicensed medications. Extremes had a greater demand for intensive care in addition to needing more drugs and progressing more to death.

Resumo Objetivos: avaliar a evolução dos prematuros extremos e muito prematuros internados em unidades de terapia intensiva neonatais, quanto ao uso de suporte ventilatório e de medicamentos, óbito, sobrevida e viabilidade. Métodos: estudo de coorte não concorrente, com 163 recém-nascidos muito prematuros e extremos internados em três unidades de terapia intensiva neonatais, durante 2016 e 2017. Realizou-se análise descritiva dos dados obtidos dos prontuários. Os desfechos estudados foram o uso de suporte ventilatório, morbidades, uso de medicamentos, óbito e causas de óbito. Foi construída curva de sobrevivência e delimitado um limite de viabilidade. Resultados: no estudo, 28,2% eram extremos e 71,8% muito prematuros. Nessa ordem de subgrupos, a necessidade de ventilação mecânica foi maior para os extremos (65,2% e 41,0%) e o principal diagnóstico foi sepse precoce (78,6% e 82,6).Medicamentos off-label (60,5% e 47,9%) e sem-licença (25,3% e 29,0%) foramutilizados. A maioria dos óbitos (57,8%) ocorreu entre os extremos, principalmente por choque séptico. A sobrevivência foi menor para as menores idades gestacionais e o limite de viabilidade ficou entre 26 e 27 semanas. Conclusões: as principais morbidades foram do sistema respiratório, com alto uso de medicamentos off-label e sem licença. Extremos tiveram maior demanda de cuidados intensivos além de necessitarem de mais medicamentos e evoluírem mais ao óbito.

Effects of kinesiology taping on swallowing functions in newborns with swallowing difficulties: a randomized controlled pilot study

SUMMARY OBJECTIVE: This study investigated the efficacy of kinesiology taping application in premature infants with dysphagia. METHODS: A total of 60 premature newborns (born ≤37weeks' gestational age who reached the age ≥34 weeks of postmenstrual age) with sucking and swallowing problems were randomly assigned to the kinesiology taping group [n=31; 18 males, 13 females; mean postmenstrual age 35.4 weeks (SD 0.9 weeks, range 34-38 weeks)] or control group without kinesiology taping application [n=29; 16 males, 13 females; mean postmenstrual age age 35.6 weeks (SD 1.4 weeks, range 34-40 weeks)]. RESULTS: Kinesiology taping group yielded significant improvement in the oral reflexes (p<0.001) and in the sucking functions including tongue movement, sucking power, number of sucks and sucking pause, maintenance of alertness, jaw movement, tongue cupping, and maintenance of rhythm (p<0.001, p=0.011, p=0.002, and p=0.001, respectively). There was a significant difference in favor of the taping group with respect to the number of neonates whose feeding improved (26 (84%) vs. 7 (24%), p<0.001). CONCLUSION: The results of this study show that kinesiology taping can be applied as a safe and effective method to improve feeding functions in premature infants with sucking and swallowing difficulties.

Conducto arterioso permeable: mecanismos moleculares del cierre y su relacion con el tratamiento

El conducto arterioso establece una conexión esencial entre la arteria aorta descendente proximal y la arteria pulmonar principal cerca del origen de la rama pulmonar izquierda, siendo vital durante la vida fetal y generalmente cerrándose poco después del nacimiento en la mayoría de los recién nacidos a término; no obstante, en recien nacidos pretermino, es común la persistencia del conducto arterioso debido a estímulos vasodilatadores que mantienen su permeabilidad y flujo sanguíneo constante, requiriendo enfoques de tratamiento que involucran la inhibición de la prostaglandina E2 y antiinflamatorios no esteroides, aunque la comparación de su eficacia con métodos conservadores sigue siendo poco clara, especialmente en recién nacidos prematuros extremos. La presente revisión tiene como objetivo proporcionar una comprensión de los mecanismos moleculares clave detrás de la fisiopatología del conducto arterioso persistente y su abordaje terapéutico.

The ductus arteriosus establishes an essential connection between the proximal descending aorta and the main pulmonary artery near the origin of he left pulmonary branch, being vital during fetal life and generally closing shortly after birth in most term newborns; However, in preterm infants, persistence of the ductus arteriosus is common due to vasodilator stimuli that maintain its patency and constant blood flow, requiring treatment approaches involving prostaglandin E2 inhibition and nonsteroidal anti-inflammatory drugs, although the comparison of their efficacy with conservative methods remains unclear, especially in extremely preterm infants. The present review aims to provide an understanding of the key molecular mechanisms behind the pathophysiology of patent ductus arteriosus and its therapeutic approach.