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Objective:To study the application effect of family integrated ward in maintaining the optimal target pulse oxygen saturation (SpO 2) in premature infants with bronchopulmonary dysplasia (BPD). Methods:This was a retrospective cohort study. Premature infants with BPD admitted to the neonatal intensive care unit of Children's Hospital of Nanjing Medical University from June 2019 to January 2022 were enrolled. Based on whether to stay in family integrated ward and implement family integrated care (FICare), these premature infants were divided into the family ward group and the control group. The ratio of optimal target SpO 2 within 24 h before discharge, the duration of home oxygen therapy, and ratio of readmission due to respiratory disease within 6 months after discharge were analyzed between the two groups. Results:During the study period, a total of 167 premature infants with BPD were admitted, including 101 in the family ward group and 66 in the control group. Compared with the control group, the family ward group showed a higher proportion of achieving the optimal target SpO 2 within 24 h before discharge (58.0% vs. 24.0%), shorter duration for home oxygen therapy (7.0 d vs. 12.0 d), and a lower readmission rate within 6 months after discharge (16.5% vs. 30.2%), which had statistically significant difference (all P<0.05). Further regression analysis showed that participating in the family integrated ward significantly reduced the demand for home oxygen therapy and the duration of home oxygen therapy, but had no significant impact on the readmission rate within 6 months after discharge. Conclusions:Family integrated ward can effectively increase the proportion of achieving the optimal target SpO 2 for premature infants with BPD within 24 h before discharge, reduce the demand for home oxygen therapy, and shorten the time of home oxygen therapy after discharge, which is beneficial for improving the living quality of premature infants with BPD.
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Objective:To study the clinical application and complications of umbilical arterial catheterization (UAC) in premature infants.Methods:From January 2021 to December 2022, premature infants with UAC successfully inserted in NICU of our hospital were enrolled. According to birth weight (BW), the infants were assigned into three groups: <1 000 g, 1 000~1 499 g and ≥1 500 g. The perinatal data, UAC usage, UAC-related complications and risk factors of UAC-related complications were retrospectively analyzed.Results:A total of 39 premature infants received UAC, with gestational age 29.3(27.3, 30.4) weeks and BW 1 100 (900, 1 310) g. The insertion length (IL) of UAC was calculated using the average value of two formulas: a, IL (cm) =4×BW (kg) +7; and b, IL(cm) =3×BW (kg)+9. The accuracy of tube end position was determined using chest/abdomen radiography. 30(76.9%) cases had accurate position, 6(15.4%) had higher position and 3(7.7%) had lower position. The proportion of appropriately positioned tube end in <1 000 g, 1 000~1 499 g and ≥1 500 g groups were 80.0%, 76.5% and 71.4%, respectively, without statistically significant differences ( P>0.05) .No significant differences existed among the three groups in UAC duration and UAC routinely removal rate ( P>0.05). 9 cases (23.1%) of UAC were removed for specific reasons, including 4 cases of arterial spasm, 2 cases of withdrawal of treatment, 1 case of tube end displacement, 1 case of abdominal distension and 1 case of death. 21 cases received 1 U/ml heparin (0.9%NaCl solution) 0.5~1 ml/h arterial infusion. 23.8% (5/21) had hypernatremia and the level of sodium became normal after reducing the concentration of NaCl solution. Arterial vasospasm occurred in 4 patients with skin color changes of one side of the lower extremities. After UAC removal, the skin color returned to normal. Conclusions:UAC is helpful and safe for preterm infants, however, its complications should be alerted to.
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Objective:To study the correlation between adverse clinical outcomes and early postnatal weight loss(representing the results of fluid management) during hospitalization in extremely premature infants(EPIs).Methods:From January 2019 to March 2023, EPIs (gestational age (GA)<28 weeks) admitted to neonatal intensive care unit(NICU) of our hospital were retrospectively analyzed. According to weight loss (WL) within the first 3 d after birth, the infants were assigned into no-WL group, WL<6% group, WL 6%-10% group and WL>10% group. The following items were compared among the four groups: fluid intake within the first 7 d after birth, the incidences of hemodynamically significant patent ductus arteriosus (hsPDA), PDA requiring surgical ligation, duration of invasive mechanical ventilation, ≥stage II necrotizing enterocolitis(NEC), grade 3-4 intraventricular hemorrhage(IVH), moderate bronchopulmonary dysplasia (BPD), severe BPD, mortality rates and total length of hospital stay.Results:A total of 119 EPIs were enrolled, including 41 in no-WL group, 22 in WL<6% group, 31 in WL 6%-10% group and 25 in WL>10% group. Among the four groups, no significant differences existed in fluid intake on d1 and d5-d7 after birth ( P>0.05). WL 6%-10% and >10% groups had significantly lower fluid intake during d2-d4 than no-WL group ( P<0.05).On d4, WL 6%-10% and >10% groups had lower fluid intake than WL <6% and no-WL groups( P<0.05).WL 6%-10% and >10% groups showed lower incidences of hsPDA than no-WL group ( P<0.05).WL>10% group had lower incidences of ≥stage II NEC, moderate BPD, shorter duration of invasive mechanical ventilation and total hospital stay than no-WL group( P<0.05). No significant differences existed in the incidences of PDA requiring surgical ligation, grade 3-4 IVH, severe BPD and mortality rates among the four groups ( P>0.05). Conclusions:For EPIs, a certain degree of WL within the first 3 d after birth is beneficial to reduce the incidences of hsPDA, NEC, moderate BPD, duration of invasive mechanical ventilation and total hospital stay. Focusing on body weight is helpful for a more optimal fluid management strategy in the early postnatal period.
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Objective To analyze the factors influencing early-onset sepsis in preterm infants and construct nomogram model.Methods A total of 124 neonates with premature sepsis admitted to Shanxi Children's Hospital(Shanxi Maternal and Child Health Hos-pital)from January 2020 to December 2021 were collected.According to gestational age,the neonates were divided into premature group(n=33)and full-term group(n=91),and the clinical characteristics of the two groups were compared,and nomogram model was es-tablished to internally validate the predictiveness and accuracy of the model.Results Compared with the full-term group,the proportion of females in premature group was higher(x2=7.147,P＜0.05),the 1min Apgarscore in premature group was lower(x2=-3.398,P＜0.05),the proportion of perinatal mothers with pregnancy complications in premature group was higher(x2=7.846,P＜0.05),the incidence of pneumonia and poor response in preterm infants of premature group were higher(x2=18.210,P＜0.05;x2=14.814,P＜0.05),but the incidence of jaundice in premature group was lower(x2=10.400,P＜0.05).Multivariate Logistic regression analysis showed that female and pneumonia were risk factors for early-onset sepsis in preterm infants(P＜0.05).The results of the nomogram model showed that the C-index of the model was 0.886.The predicted incidence was generally consistent with the actual incidence,the area under the receiver operator characteristic curve was 0.886,and the decision curve showed a high net benefit value at threshold proba-bilities of 4％-100％.Conclusion Female,preterm infants with pneumonia have a higher risk of early-onset sepsis.The nomogram model of premature sepsis constructed in this study has high clinical value and can provide a reference basis for clinical prevention of early-onset sepsis in preterm infants.
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Objective To understanding the current situation and influencing factors of healthcare-associated infec-tion(HAI)in premature infants,provide theoretical and practical basis for the prevention and control of HAI in pre-mature infants.Methods Premature infants who were admitted to the neonatal ward of a hospital from January 2016 to December 2021 were investigated and analyzed retrospectively.Medical records of premature infants were consulted to collect basic information as well as diagnosis and treatment information of premature infants during hos-pitalization.Results A total of 3 559 premature infants were included in analysis,including 1 964 males and 1 595 females.The average birth weight was(2 108.66±631.17)g.109(3.06％)infants had HAI infection.The main infection types were lower respiratory tract infection(44.04％),bloodstream infection(28.44％),and gastrointestinal tract infection(14.68％).38 strains of HAI-related pathogens were detected,including 33 strains(86.84％)of Gram-negative bacteria,3 strains of Gram-positive bacteria,and 2 strains of fungi.The main isolated pathogens were Enterobacter aero genes(28.95％)and Klebsiella pneumoniae(28.95％).Univariate and unconditional multivariate logistic regression analysis showed that amniotic fluid contamination,birth weight＜2 500 g,ventilator use,and central venous catheterization were independent risk factors for HAI in premature infants(OR values were 2.424,3.805,3.776,5.412,respectively,all P＜0.05).Cesarean section was a protective factor for HAI in premature in-fants(OR=0.362,P＜0.05).Conclusion Premature infants have a high risk of HAI and multiple influencing fac-tors.Clinical attention should be paid,evidence-based prevention and control measures should be actively adopted to reduce exposure to risk factors and protect the health of premature infants.
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Objective:A warming fixation device for premature infants was made and its clinical application effect was discussed.Methods:The warming fixation device for premature infants was designed and used in clinic. Sixty premature infants admitted to the neonatal ward of Baoding Hospital, Beijing Children's Hospital, Capital Medical University from January to June 2022 were selected as the control group, and 60 premature infants admitted from July to December 2022 were selected as the experimental group. In the control group, umbilical vein catheterization or central vein catheterization were performed using Astro Boy heating box, restraint band or artificial restraint. The preterm infants in the experimental group were radiated into the Astro Boy warm box with self-designed preterm warming fixation device for catheterization. The time of catheterization, the number of limb protrusion, the number of participants in catheterization operation, and the body temperature from 20 minutes of catheterization operation to the end of catheterization operation were recorded in the two groups. The frequency of hypothermia (< 36.5?℃) was calculated, and the differences in various indexes between the two groups were compared.Results:① The warming fixation device for premature babies consists of two parts: warm sleeping bag and soft pad. The warm sleeping bag includes 4 parts: head, arm, chest and abdomen, and lower limbs. The chest and abdomen were designed with rectangular covering cloth, which can be opened to facilitate umbilical vein puncture for premature infants. There were 3 groups of restraint belts on the rectangular soft pad, which can respectively fix the arms, chest and abdomen of the warm sleeping bag and the lower limbs. During the catheterization operation, use Velcro to secure the warm sleeping bag to the cushioned surface, and select the area of exposed skin according to the piercing site. ② There were no significant differences in gender, body weight and gestational age between the experimental group and the control group [male: 48.3% vs. 46.7%, body weight (kg): 1.86±0.06 vs. 1.82±0.06, gestational age (weeks): 31.33±0.31 vs. 32.25±0.34, all P > 0.05]. Compared with the control group, the catheterization time of experimental group was significantly shortened (minutes: 21.30±0.43 vs. 30.02±0.64, P < 0.01), the number of limb protrusion was significantly reduced (0 time: 70.0% vs. 33.3%, 1 time: 26.7% vs. 50.0%, P < 0.01), and the number of participants in catheterization operation was significantly reduced (people: 1.77±0.06 vs. 2.37±0.06, P < 0.01). The frequency of hypothermia in experimental group was significantly lower than that in the control group [6.12% (6/98) vs. 26.50% (31/117), χ2 = 15.536, P < 0.01]. Conclusion:The warming fixation device for premature infants is convenient to use, which can effectively shorten the tube placement time, save human resources, and reduce the incidence of hypothermia in premature infants.
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@#COVID-19 infection in pregnant mothers is associated with higher risk of intrauterine growth retardation and premature births. Very low birth weight infants are more susceptible to neurodevelopmental and chronic respiratory problems. An infant delivered at 33 weeks via caesarean section to a COVID-19 Stage 5A positive mother, weighing 1.43kg at birth. She was kept nil by mouth with parenteral nutrition (PN) support since day five of life until referred to dietitian on day 22 of life for enteral nutrition (EN) establishment. Feeding was administered intermittently via oro-gastric Ryles tube. She was kept under non-invasive ventilation (NIV) mode and had difficulty in weaning from ventilation, leading to slow feeding progress. Initially, enteral trophic feeding was administered using premature infant formula fortified with modular products. In the later stage of feeding, modular products were tapered off and the formula was concentrated. Frequency of bowel output when using fortified formula is lesser compared to when using concentrated and supplemented formula. There is no significant difference in renal profile observed in both stages of feeding. Increasing energy intake using easily digestible sources is preferable as opposed to concentrating feeds even further due to concerns about osmolality and excess administration of other solutes. Intermittent bolus feeding mode may have an effect on dependency on oxygen since intermittent feeds can decrease tidal volume, minute ventilation and dynamic compliance. Additional research is necessary to establish optimal caloric density and nutritional compositions of feedings, feeding mechanisms and its’ effect on feeding tolerance.
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RESUMO Objetivo Revisar a literatura de maneira sistematizada acerca da relação do impacto da prematuridade na transição das consistências alimentares em lactentes no período de introdução da alimentação complementar. Estratégia de pesquisa Foram pesquisados os bancos de dados EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), LIVIVO, PubMed/Medline, Scopus e Web of Science e Google Scholar, Open Grey e ProQuest Dissertations & Theses na literatura cinzenta foram pesquisados desde 10/08/2020. Critérios de seleção "PECOS": População (P): Lactentes, Exposição (E): Prematuridade, Comparação (C): Recém-nascidos a termo, Desfecho (O): Progressão de consistências alimentares em recém-nascidos prematuros com ou sem comparação, Tipos de estudos (S): Estudo de coorte; Caso-controle; Transversal. Análise dos dados A qualidade metodológica dos estudos observacionais selecionados foi avaliada usando a Meta-Analysis of Statistics Assessment and Review Instrument (MASTARI). Resultados Um total de 3.310 artigos foram encontrados, sendo 9 selecionados para a realização da síntese qualitativa. Nos estudos selecionados foi observada a relação entre intervenções orais invasivas e dificuldade alimentar para todas as habilidades avaliadas e quanto menor a idade gestacional, mais frequente são os comportamentos de dificuldades alimentares. Conclusão Não foi observada relação entre a prematuridade e dificuldades na progressão das consistências no período da introdução das consistências alimentares na maioria dos estudos, somente três deles demonstraram tal relação.
ABSTRACT Purpose To systematically review the literature regarding the impact of prematurity on the transition of food consistencies in infants during the introduction of complementary feeding. Research strategies Searches were conducted in the EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, and Web of Science databases, Google Scholar; for gray literature, searches were conducted on Open Gray, and ProQuest Dissertations & Theses databases, from August 10, 2020, onwards. Selection criteria "PECOS" was selected to determine inclusion criteria: Population (P): Infants; Exposure (E): Prematurity; Comparison (C): Full-term newborns; Outcomes (O): Progression of food consistencies in premature newborns with or without comparison; Study design (S): Cohort study, Case-control; Cross-sectional. Data analysis The methodological quality of the selected observational studies was assessed using the Meta-Analysis of Statistics Assessment and Review Instrument (MASTARI). Results A total of 3,310 articles were found, of which nine were selected for qualitative synthesis. Among the selected studies, a relationship between invasive oral interventions and feeding difficulties was observed for all assessed skills, with feeding difficulties being more frequent in infants with lower gestational age. Conclusion Most studies found no significant relationship between prematurity and difficulties in the progression of food consistencies during the introduction of complementary feeding; only three studies demonstrated such a relationship.
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ABSTRACT Objective: To perform a cross-cultural adaptation and assess the content validity of the Neonatal Medical Index (NMI) for the Brazilian context. Methods: The cross-cultural adaptation was completed in six steps, including translation, synthesis of translations, back translation, submission to an expert committee, testing of the prefinal version, and appraisal by the original author. The expert committee assessed the equivalence between versions based on the percentage of agreement, and content validity was evaluated using the content validity index (CVI) for each item of the scale (I-CVI) and for the overall scale (S-CVI) in terms of representativeness and clarity. Participants of the prefinal version also evaluated the CVI for clarity. Results: After two evaluation rounds of the expert committee it was attained 98% agreement, attesting to the equivalence between the instrument versions, maximum values for representativeness I-CVI and S-CVI/Ave (1.00), and high values for clarity I-CVI (all items ≥0.97) and S-CVI/Ave (0.98). The expert committee members defined that the Brazilian version of the instrument would be called Índice Clínico Neonatal (NMI-Br). The NMI-Br reached high values of CVI for clarity (all I-CVI ≥0.86 and S-CVI/Ave=0.99) among the participants of the prefinal version. Conclusions: The NMI-Br is the Brazilian version of the NMI, obtained in a rigorous cross-cultural validation process, counting with adequate values of content validity.
RESUMO Objetivo: Realizar a adaptação transcultural e avaliar a validade de conteúdo do Neonatal Medical Index (NMI) para o contexto brasileiro. Métodos: A adaptação transcultural foi realizada em seis etapas, incluindo tradução, síntese das traduções, retrotradução, submissão a um comitê de especialistas, teste da versão pré-final e avaliação do autor original. O comitê de especialistas avaliou a equivalência entre as versões com base na porcentagem de concordância, e a validade de conteúdo foi avaliada por meio do índice de validade de conteúdo (IVC) para cada item da escala (I-IVC) e para a escala geral (S-IVC) em termos de representatividade e clareza. Os participantes da versão pré-final também avaliaram o IVC quanto à clareza. Resultados: Após duas rodadas de avaliação do comitê de especialistas obteve-se 98% de concordância, atestando a equivalência entre as versões do instrumento, valores máximos para representatividade I-IVC e S-IVC/Ave (1,00) e altos valores para clareza I-IVC (todos os itens ≥0,97) e S-IVC/Ave (0,98). Os membros do comitê de especialistas definiram que a versão brasileira do instrumento se chamaria Índice Clínico Neonatal (NMI-Br). O NMI-Br alcançou altos valores de IVC para clareza (todos I-IVC ≥0,86 e S-IVC/Ave=0,99) entre os participantes da versão pré-final. Conclusões: O NMI-Br é a versão brasileira do NMI, obtido em rigoroso processo de validação transcultural, contando com valores adequados de validade de conteúdo.
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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.
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O objetivo deste artigo foi analisar a associação entre os fatores sociodemográficos, as características maternas e neonatais e o tempo de introdução da alimentação complementar em recém-nascidos pré-termo e com baixo peso. Trata-se de um estudo de coorte prospectivo feito com 79 recém-nascidos pré-termo com peso menor ou igual a 1.800g. Os dados foram coletados no momento da alta hospitalar e ao 6º, 9º e 12º mês de idade gestacional corrigida (IGC), com auxílio de um questionário estruturado para analisar o tempo de introdução da alimentação complementar e texturas dos alimentos introduzidos. Além disso, para avaliar o risco de atraso de desenvolvimento, utilizou-se o Survey of Well-being of Young Children (SWYC-BR). Para análise das variáveis, aplicou-se regressão de riscos proporcionais de Cox. A introdução da alimentação complementar foi observada nos recém-nascidos pré-termo, com a mediana de idade de introdução de alimentos líquidos (3,50; IQ: 2,50-5,00), seguido por sólidos (4,70; IQ: 3,20-5,20) e pastosos (5,00; IQ: 4,50-5.50). Ainda, verificou-se associação da idade gestacional (RR = 1.25; IC95%: 1,02-1,52) em todo o processo da introdução alimentar. Para os alimentos sólidos e pastosos, aqueles com o maior tempo de internação (RR = 1,03; IC95%: 1,10- 1,05) e em amamentação mista (RR = 2,97; IC95%: 1,24-7,09) adiaram mais o tempo para introduzir a alimentação complementar. Para alimentos líquidos, recém-nascidos pré-termo menos graves (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0,96; IC95%: 0,94-0,98]) e mães que estavam amamentando na alta hospitalar (RR = 11,49; IC95%: 1,57-84,10) postergaram a introdução alimentar. Diretrizes para melhor orientação de profissionais e pais e/ou responsáveis sobre o momento ideal de introdução alimentar se faz necessário.
This study aimed to analyze the association between sociodemographic factors, maternal and neonatal characteristics and the time taken to introduce complementary feeding in low birthweight and preterm newborns. This is a prospective cohort study of 79 preterm newborns weighing less than or equal to 1,800g. Data were collected at the time of hospital discharge and at the 6th, 9th ,and 12th months of corrected gestational age (CGA), using a structured questionnaire to analyze the time taken to introduce complementary feeding and the texture of the foods introduced. Furthermore, the Survey of Well-being of Young Children (SWYC-BR) was used to assess the risk of developmental delay. Cox proportional hazards regression was used to analyze the variables. The introduction of complementary feeding was assessed in preterm newborns based on the median age of introduction of liquid foods (3.50; IQR: 2.50-5.00), followed by solid (4.70; IQR: 3.20-5.20) and soft foods (5.00; IQR: 4.50-5.50). There was also an association with gestational age (RR = 1.25; 95%CI: 1.02-1.52) throughout the process of food introduction. For solid and soft foods, those with the longest length of stay (RR = 1.03; 95%CI: 1.10-1.05) and on mixed breastfeeding (RR = 2.97; 95%CI: 1.24-7.09) delayed the introduction of complementary feeding the longest. For liquid foods, less severe preterm newborns (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0.96; 95%CI: 0.94-0.98]) and mothers who were breastfeeding at hospital discharge (RR = 11.49; 95%CI: 1.57-84.10) delayed the introduction of complementary feeding. Guidelines are needed to better advise professionals and parents and/or guardians on the ideal time to introduce feeding.
El objetivo de este estudio fue analizar la asociación entre los factores sociodemográficos, características maternas y neonatales y el momento de introducción de la alimentación complementaria en recién nacidos pretérmino (recém-nascidos pré-termo) y de bajo peso. Se trata de un estudio de cohorte prospectivo realizado con 79 recém-nascidos pré-termo con un peso menor o igual a 1.800g. Los datos se recopilaron en el momento del alta hospitalaria y al 6º, 9º y 12º mes de edad gestacional corregida (EGC), con la ayuda de un cuestionario estructurado para analizar el momento de introducción de la alimentación complementaria y las texturas de los alimentos introducidos. Además, para evaluar el riesgo de retraso en el desarrollo, se utilizó la Survey of Well-being of Young Children (SWYC-BR). Para analizar las variables, se aplicó la regresión de riesgos proporcionales de Cox. La introducción de la alimentación complementaria se observó en los recém-nascidos pré-termo, con la mediana de edad de introducción de alimentos líquidos (3,50; IIC: 2,50-5,00), seguido de los sólidos (4,70; IIC: 3,20-5,20) y pastosos (5,00; IIC: 4,50-5,50). Además, se constató la asociación de la edad gestacional (RR = 1,25; IC95%: 1,02-1,52) durante todo el proceso de introducción alimentaria. En el caso de alimentos sólidos y pastosos, aquellos con mayor tiempo de hospitalización (RR = 1,03; IC95%: 1,10-1,05) y en lactancia mixta (RR = 2,97; IC95%: 1,24-7,09) retrasaron más la introducción de alimentación complementaria. En el caso de alimentos líquidos, los recém-nascidos pré-termo menos graves (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0,96; IC95%: 0,94-0,98]) y las madres que estaban amamantando al alta hospitalaria (RR = 11,49; IC95%: 1,57-84,10) pospusieron la introducción de alimentos. Se hacen necesarias pautas para una mejor orientación a profesionales y padres o tutores sobre el momento ideal para la introducción alimentaria.
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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.
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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).
Sujet(s)
Humains , Mâle , Femelle , Nouveau-né , Prématuré , Unités de soins intensifs néonatals , Mortalité infantile , Entérocolite nécrosante/anatomopathologie , Néonatologie , Nourrisson à faible poids de naissance , Épidémiologie Descriptive , Études de cohortesRÉSUMÉ
Background: Kangaroo mother care (KMC) have positive effects on the preterm infant's health status in the form of stabilization of vital parameters. Therefore, this study was conducted to evaluate the effect of KMC on stabilization of vital signs in low-birth-weight premature babies. Methods: This is a quasi-experimental study. One hundred and seventy newborns who were admitted to in neonatal intensive care unit of Karnataka institute of medical sciences Hubli, India were selected by convenience sampling. They were randomly divided into experimental group, n=85 and control group, n=85. In the experimental group, newborns were taken daily KMC for four hours during 7 days. In the control group, routine care was performed. The data gathering tool was questionnaire of infants and mother characteristics, checklists of vital signs using SPSS 22 version software. Chi-square test was used as test of significance for qualitative data. Continuous data was represented as mean and SD. P<0.05 was considered as statistically significant.Results: Before intervention, there was no significant difference between the vital signs of the infants in experimental and control groups. However, after intervention, there was a significant difference between the two groups in terms of vital parameters (p<0.001).Conclusions: The findings of this study indicate the effect of KMC on stabilization of vital signs, it is recommended that KMC is taken as one of the routine cares of premature low birth weight babies.
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Objective@#To systematically evaluate the effect of colostrum on immunoglobulin A (IgA) levels among premature infants, so as to provide the evidence for improving premature infants' health with colostrum feeding.@*Methods@#Randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs) pertaining to the effect of colostrum and IgA levels among premature infants were retrieved in national and international databases from inception to September 30, 2022, including CNKI, Wanfang Data, PubMed and Web of Science. Standardized mean difference (SMD) was used as an effect index for meta-analysis. The robustness of the results was evaluated using sensitivity analysis, and the publication bias was evaluated using Begg's test, Egger's test and funnel plot.@*Results @#A total of 650 publications were retrieved initially, and 10 studies were finally included, including 9 RCTs and one1 CCT, with 677 participants. Meta-analysis showed higher secretory salivary secretory IgA levels among premature infants with colostrum feeding than among controls (SMD=0.49, 95%CI: 0.08-0.89), and there were no significant differences between groups in terms of urinary secretory IgA levels (SMD=0.19, 95%CI: -0.39-0.77) or blood IgA levels (SMD=0.29, 95%CI: -0.01-0.59). Sensitivity analysis showed robustness of meta-analysis results, and no publication bias was examined.@*Conclusion@#Colostrum feeding may increase salivary secretory IgA levels among premature infants; however, it has no effect on urine salivary secretory IgA levels or blood IgA levels.
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With the rapid development of perinatal medical technology, the survival rate of preterm infants has increased significantly, but the incidence of bronchopulmonary dysplasia(BPD)is still at a high level.BPD is a common chronic respiratory disease in preterm infants, and the incidence of other complications and death rates of preterm infants with BPD are significantly higher.Currently, the "classic BPD" characterized by lung injury has been converted to "new BPD, " but the pathophysiological mechanism of BPD has not yet been elucidated.In recent years, some experimental studies in vitro and in vivo have demonstrated that alveolar type II epithelial cells can induce epithelial mesenchymal transition(EMT)through multiple signaling pathways, including TGF-β as a hub and Wnt, SPHK1/S1P, etc., which can promote the development of pulmonary fibrosis, and thus provide a new idea for the prevention and treatment of BPD.This article reviews the mechanisms of multiple signaling pathways in EMT in BPD, in order to give a reference for the clinical treatment of BPD.
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Objective To gain an in-depth understanding of the real experiences,feelings and needs of fathers of premature infants in NICU regarding hospital discharge preparation,and to provide a basis for medical institutions on the development of personalized health education plans and continuous nursing care plans for discharged premature infants.Methods By the purposive sampling method,15 fathers of premature infants in NICU of a tertiary obstetrics and gynecology hospital in Zhejiang Province from April 2022 to July 2022 on the day of discharge and 6 weeks after discharge were selected for semi-structured interviews,and the interview data were analyzed using the Colazzi's phenomenological 7-step analysis.Results The experiences and needs of NICU premature fathers in discharge preparation are divided into 4 themes.1.The father's problems coexist with the growth of premature infants,such as expecting to see premature infants on the day of discharge and having confidence in discharge care,experiencing various negative emotions after discharge,and increasing empathy and sense of responsibility after discharge.2.Inadequate ability to care for oneself,including a lack of access to professional care knowledge,a need to improve nursing skills,and an overreliance on premature mothers.3.Social role conflict in the family.4.Longing for assistance,including professional medical advice and more family support.Conclusion Fathers of premature infants in the NICU coexist with negative emotions and growth experiences as they prepare for discharge,with various needs such as reducing role conflict,enhancing independent care ability,and obtaining psychological and multi-party support.To improve their discharge preparation level,nursing staff should develop a personalized health education plan as well as a continuous nursing plan.
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Objective:To investigate the value of the ultrasonography in the diagnosis of the white matter injury of premature infants based on gray-scale ultrasonography radiomics.Methods:A total of 256 premature infants in Huazhong University of Science and Technology Union Shenzhen Hospital and Shenzhen Hospital of Southern Medical University from August 2018 to April 2022 were analyzed retrospectively. The computer-generated random numbers were assigned to the training set and the verification set according to 6∶4 ratio. On the basis of standardized collection of craniocerebral ultrasound images, the radiomics features were extracted from imaging by Pyradiomics 3.0.1 software package, the Mann-Whitney U test and the least absolute shrinkage and selection operator (LASSO) and stepwise regression were used to select the optimal features. Then the Logistic regression was used to build radiomics model. According to MRI, ROC curve was utilized to evaluate the performance of the model. The craniocerebral ultrasound images in the validation set were independently diagnosed by a senior physician and a junior physician, and then the above two physicians diagnosed again with the help of the radiomics, and the diagnostic abilities of this model were compared with those of the junior and senior physicians with and without radiomics assist. Results:A total of 5 optimal features were selected to develop radiomics model. The sensitivity, specificity, accuracy and the area under the ROC curve (AUC) in the training and validation sets were 0.861, 0.775, 0.799, 0.818; 0.929, 0.824, 0.853, 0.876, respectively. The sensitivity, specificity, accuracy and AUC in the senior sonographer, the junior sonographer, and both of them with radiomics assist for the dagnosis in the validation set were 0.929, 0.892, 0.902, 0.910; 0.714, 0.743, 0.735, 0.729; 0.929, 0.919, 0.922, 0.924; 0.857, 0.824, 0.833, 0.841, respectively. Performance of radiomics model reached the level of the senior sonographer (AUC: 0.876 vs 0.910, P=0.284), which was significantly better than the performance of the junior sonographer(AUC: 0.876 vs 0.729, P=0.001). Performance of the junior sonographer with radiomics assist was significantly better than the performance of the junior sonographer(AUC: 0.841 vs 0.729, P=0.003). Performance of the senior sonographer with radiomics assist was comparable to that of the senior sonographer(AUC: 0.924 vs 0.910, P=0.156). Conclusions:The ultrasound diagnosis method based on radiomics technology shows good diagnostic performance for the white matter injury of premature infants. It is helpful to improve the diagnostic ability of junior sonographer. It is expected to assist the sonographers in diagnosis and provide objective, consistent and accurate results for clinical practice.
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Objective:To investigate the risk factors of respiratory distress syndrome (RDS) complicated by pulmonary hemorrhage (PH) in premature infants.Methods:A total of 102 infant patients with RDS whose gestational age was < 37 weeks received treatment in the Department of Neonatology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University) from January 2015 to July 2021 and were included in this study. According to the diagnostic criteria of PH, these infant patients were divided into a PH group and a non-PH group. The clinical data of the two groups were compared using a t-test, non-parametric test, or χ2 test. The risk factors of PH were analyzed. The independent risk factors of RDS complicated by PH in premature infants were determined using multivariate logistic regression analysis. Results:A total of 102 premature infants with RDS were collected, including 51 in the PH group and 51 in the non-PH group. The gestational ages at birth were (32.3 ± 3.0) weeks and (31.6 ± 3.0) weeks in the PH and non-PH groups, respectively. There were 36 males (70.6%) and 33 males (64.7%) in the PH and non-PH groups, respectively. There were no significant differences in proportion of males and gestational ages at birth between the two groups (both P > 0.05). The incidence of gestational age < 32 weeks [52.9% (27/51) vs. 31.3% (16/51)], PH and RDS complicated by patent ductus arteriosus [90.5% (38/42) vs. 70.0% (35/50)], and RDS grade 3-4 [80.4% (41/51) vs. 23.5% (12/51)] in the PH group were significantly higher than those in the non-PH group ( χ2 = 5.29, 4.66, 33.03, all P < 0.05). Multivariate logistic regression analysis showed that RDS grade 3-4 was an independent risk factor of RDS complicated by PH ( OR = 9.83, 95% CI: 3.545-27.265, P < 0.05). The proportion of infants with mechanical ventilation time ≥ 7 days in the PH group was significantly higher than that in the non-PH group [56.9% (29/51) vs. 31.4% (16/51), χ2 = 6.72, P < 0.05]. Conclusion:Gestational age < 32 weeks, PH and RDS complicated by patent ductus arteriosus, and RDS grade 3-4 are the risk factors of PH in premature infants with RDS. RDS grade 3-4 is an independent risk factor.
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Objective@#To compare the effectiveness of less invasive surfactant administration (LISA) and intubate surfactant extubation (INSURE) on respiratory distress syndrome (RDS) among premature infant, so as to provide insights into improving treatment effects and reducing complications of RDS among premature infants.@*Methods@#A total of 71 premature infants with RDS in Anhui Provincial Maternity and Child Health Hospital were randomly assigned into the LISA and INSURE group, and pulmonary surfactant (PS) administration was carried out by LISA and INSURE with basic support therapy and respiratory support therapy. The general information, arterial blood gas analysis before and after treatment, respiratory support time and incidence of complications were collected and compared between the two groups.@*Results@#There were 31 cases in the LISA group, with a gestational age of (29.81±0.99) weeks and 22 male cases, and 40 cases in the INSURE group, with a gestational age of (30.02±1.13) weeks and 26 male cases. There were no significant differences in basic characteristics (including gestational age, birth weight, gender, etc.) between the two groups (all P>0.05). After administration, the level of PaO2 was lower in the LISA group than in the INSURE group [(78.35±6.55) mmHg vs. (87.68±8.21) mmHg, P<0.05], the level of PaCO2 was higher in the LISA group than in the INSURE group [(43.03±6.34) mmHg vs. (38.68±9.69) mmHg, P<0.05], and the incidence of bronchopulmonary dysplasia was lower in the LISA group than in the INSURE group (48.39% vs. 72.50%, P<0.05). Linear regression analysis showed that with the duration of LISA administration increase (2-7 min), the minimum heart rate of premature infants increased linearly (β=13, P<0.05). @*Conclusions@#Compared with INSURE, LISA administration could slowly improve ventilation oxygenation, reduce hyperventilation and incidence of bronchopulmonary dysplasia among premature infants with RDS. The incidence of slow heart rate may be reduced by appropriately prolonging the administration duration.