Exclusive breastfeeding and length of hospital stay in premature infants at a Brazilian reference center for kangaroo mother care

Abstract Objective: To evaluate exclusive breastfeeding at discharge and hospital length-of-stay in pre-term infants undergoing or not the Kangaroo-Mother Care Method (KMC). Methods: A retrospective cohort study was conducted including preterm infants < 1800 g admitted to the neonatal unit of a KMC reference center. The infants were grouped into the KMC group and the non-KMC group. Multiple logistic and Poisson regressions were performed to evaluate the association between the KMC and two outcomes, exclusive breastfeeding at discharge, and hospital length-of-stay, adjusted for potential confounders. Results: 115 mother-infant dyads were included, 78 in the KMC group and 37 in the non-KMC group. In the bivariate analysis, the KMC group had a lower prevalence of maternal adverse conditions (6% vs. 32%, p < 0.001), a higher number of prenatal visits (median 6 vs. 3.5, p < 0.001), higher gestational ages (median 32 vs. 31 weeks, p < 0.05), higher birth weights (median 1530 vs. 1365 g, p < 0.01), a lower prevalence of necrotizing enterocolitis (3.8% vs. 16.2%, p < 0.05), parenteral nutrition (50% vs. 73%, p < 0.05), and deep vascular access (49.7% vs. 78.4%, p < 0.01), a higher prevalence of exclusive breastfeeding (65% vs. 8%, p < 0.001) and a shorter length of hospital stay (median 28 vs. 42 days, p < 0.001). In the multiple regression analysis, the KMC group was 23 times more likely to be exclusively breastfed at discharge (OR = 23.1; 95% CI = 4,85-109,93) and had a 19% reduction in the hospital length-of-stay (IDR = 0.81; 95% CI = 0.76-0.86) compared to the non-KMC group. Conclusions: The KMC is associated with better short-term neonatal outcomes and should be encouraged in all Brazilian maternity hospitals.

Risk of dysphagia in a population of infants born preterm: characteristic risk factors in a tertiary NICU

Abstract Objective: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. Method: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. Results: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). Conclusion: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.

Management of lung diseases under ultrasound monitoring: potential to make bronchopulmonary dysplasia in preterm infants as an avoidable disease / 中国当代儿科杂志

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in preterm infants. Despite significant progress in the understanding of its etiology, mechanisms, prevention, and treatment, the prognosis remains poor. BPD not only has a high mortality rate but also causes persistent respiratory, neurological, and cardiovascular impairments in survivors. The author's team has successfully prevented the occurrence of BPD by managing neonatal lung diseases under lung ultrasound monitoring for nearly 7 years, opening up a new approach in BPD prevention. This article provides a brief overview of the approach, aiming to facilitate further research and provide more scientifically sound management strategies to prevent or minimize the occurrence of BPD.

Longitudinal study on catch-up growth in preterm infants with small for gestational age at corrected ages 0-24 months / 中国当代儿科杂志

OBJECTIVES@#To understand the growth and development status and differences between small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants during corrected ages 0-24 months, and to provide a basis for early health interventions for preterm infants.@*METHODS@#A retrospective study was conducted, selecting 824 preterm infants who received regular health care at the Guangzhou Women and Children's Medical Center from July 2019 to July 2022, including 144 SGA and 680 AGA infants. The growth data of SGA and AGA groups at birth and corrected ages 0-24 months were analyzed and compared.@*RESULTS@#The SGA group had significantly lower weight and length than the AGA group at corrected ages 0-18 months (P<0.05), while there were no significant differences between the two groups at corrected age 24 months (P>0.05). At corrected age 24 months, 85% (34/40) of SGA and 79% (74/94) of AGA preterm infants achieved catch-up growth. Stratified analysis by gestational age showed that there were significant differences in weight and length at corrected ages 0-9 months between the SGA subgroup with gestational age <34 weeks and the AGA subgroups with gestational age <34 weeks and 34 weeks (P<0.05). In addition, the weight and length of the SGA subgroup with gestational age 34 weeks showed significant differences compared to the AGA subgroups with gestational age <34 weeks and 34 weeks at corrected ages 0-18 months and corrected ages 0-12 months, respectively (P<0.05). Catch-up growth for SGA infants with gestational age <34 weeks and 34 weeks mainly occurred at corrected ages 0-12 months and corrected ages 0-18 months, respectively.@*CONCLUSIONS@#SGA infants exhibit delayed early-life physical growth compared to AGA infants, but can achieve a higher proportion of catch-up growth by corrected age 24 months than AGA infants. Catch-up growth can be achieved earlier in SGA infants with a gestational age of <34 weeks compared to those with 34 weeks.

Evaluation of diagnostic efficacy and severity of necrotizing enterocolitis in premature infants by intestinal regional oxygen saturation and fecal calprotectin / 中国小儿急救医学

Objective:To evaluate the diagnostic value of intestinal regional oxygen saturation（rSO 2）and fecal calprotectin in the occurrence and severity of necrotizing enterocolitis（NEC）in premature infants. Methods:A prospective observational study was conducted among premature infants admitted to Quanzhou Children's Hospital from October 2019 to December 2022. Intestinal rSO 2 was monitored within two hours of diagnosis of NEC，and fecal calprotectin was measured. Results:A total of 60 patients were included, including 30 cases with NEC and 30 cases without NEC, 14 cases of medical NEC, 16 cases of surgical NEC, and eight infants died due to NEC. Infants with NEC had lower intestinal rSO 2 [49（30，60）% vs. 66（60，69）%] and higher calprotectin levels [479（297，886）μg/g vs. 203（113，275）μg/g] than those in infants without NEC ( P<0.01). The levels of intestinal rSO 2 were lower in surgical NEC than those in medical NEC，and were lower in the death group than that in the survival group ( P<0.01)，but no similar difference was found in the levels of calprotectin. ROC curve analysis showed that intestinal rSO 2 combined with calprotectin had a sensitivity of 73%，a specificity of 100%，and the largest area under curve of 0.91 in the diagnosis of NEC. Intestinal rSO 2 had an optimal cut-off value of 31% in predicting death in infants with NEC，with a sensitivity of 100%，a specificity of 95%，and an area under curve of 0.99. Conclusion:Intestinal rSO 2 and fecal calprotectin can effectively identify the presence of NEC，and their combined detection can improve the diagnostic efficiency. Intestinal rSO 2 is a good predictor of the severity of NEC，but not fecal calprotectin.

Progress of N-terminal pro-brain natriuretic peptide in early diagnosis of bronchopulmonary dysplasia and pulmonary hypertension in premature infants / 中国小儿急救医学

Bronchopulmonary dysplasia（BPD）is a significant complication that greatly impacts the prognosis of preterm infants.The incidence of pulmonary hypertension（PH）in preterms with moderate to severe BPD is relatively high，which further increases the mortality among infants with BPD.Diagnosis of BPD could be made until 36 weeks corrected gestational age，and the clinical manifestations of BPD-PH are also not specific enough for accurate identification.Cardiac catheterization is considered the gold standard for diagnosis，which is an invasive procedure，while echocardiography heavily relies on the experience of operator，limiting early detection of both BPD and BPD-PH.N-terminal pro-brain natriuretic peptide（NT-proBNP），secreted by ventricular myocytes in response to volume or pressure overload，has been widely utilized in assessing cardiac load in cases of congenital heart disease.Recent studies have shown that the blood NT-proBNP levels significantly elevate in infants with BPD within one week after birth and during the development stage of BPD.Additionally，there is a substantial increase in NT-proBNP levels from 28 to 36 weeks corrected gestational age，which has both high sensitivity and high specificity in predicting the occurrence of BPD-PH.Therefore，NT-proBNP is expected to serve as a biomarker for the early prediction of BPD and BPD-PH.This review summarized the biological function，metabolic characteristics，and current research advancements regarding NT-proBNP in BPD and BPD-PH.The aim is to utilize NT-proBNP as an early predictor for BPD and BPD-PH，enabling timely identification of premature infants with high risk factors of these diseases，and facilitating prompt intervention to ultimately enhance prognosis.

Advances in the role of prostaglandins in patent ductus arteriosus / 国际儿科学杂志

The ductus arteriosus is an important lifeline for fetal circulation.Prostaglandins（PG）are involved in the dilatation of the ductus arteriosus during fetal life as well as the anatomical remodeling of the ductus arteriosus after birth. Patent ductus arteriosus（PDA）is a common congenital heart disease in preterm infants.The treatment by inhibiting local PG synthesis is currently the principal means of clinical practice，with indomethacin and ibuprofen being the most commonly applied drugs，but the prevalence of adverse effects has led scholars to focus on other targets of the PG synthesis pathway. This paper reviews relevant medications and combines the physiological effects of PG on ductus arteriosus in different stages to summarize the current drugs of treating PDA and their related research advances，with the aim to provide new strategies for the treatment and future research of this condition.

Salvia miltiorrhiza attenuates white matter injury induced by hypoperfusion in neonatal rats / 中国组织工程研究

BACKGROUND:Premature birth is a major global health problem associated with high mortality and morbidity.White matter injury is the most common brain injury in preterm infants.Salvia miltiorrhiza is a traditional herbal plant that is commonly used to treat cardiovascular and cerebrovascular diseases in Asian countries. OBJECTIVE:To investigate the therapeutic effect of Salvia miltiorrhiza on white matter injury in preterm infants. METHODS:Eighteen neonatal male Sprague-Dawley rats at 3-day gestational age were selected and randomized into normal group,white matter injury group,and Salvia miltiorrhiza group.Animal models of preterm white matter injury were established by permanent ligation of the right common carotid artery in the latter two groups.Rats in the Salvia miltiorrhiza group were given intraperitoneal injection of Salvia miltiorrhiza(5 mg/kg·d)for 7 consecutive days.Normal group and white matter injury group were given the same volume of PBS for intervention.On the 14th day after modeling,the rats were sacrificed.Brains were pathologically observed by hematoxylin-eosin staining under microscope,and the expression levels of myelin basic protein and CC1 in brain tissue were visualized using immunofluorescence.Furthermore,liquid chromatography-tandem mass spectrometry was used to analyze possible pathways for the action of Salvia miltiorrhiza. RESULTS AND CONCLUSION:In the white matter injury group,the structure of the corpus callosum was irregular and the cells appeared swollen and necrotic.In addition,induction of white matter injury resulted in significantly reduced myelin formation,with irregular and loosely arranged nerve fibers and significantly decreased myelin sheaths.Interestingly,white matter injury rats treated with Salvia miltiorrhiza had reduced cellular swelling,reduced lesions,and increased myelin sheaths.The expression of myelin basic protein was closely related to myelin formation,and CC1 was a marker of myelin oligodendrocytes.Salvia miltiorrhiza significantly up-regulated the expressions of myelin basic protein and CC1 in white matter injury rats(P＜0.000 1),indicating that Salvia miltiorrhiza alleviated white matter injury.Liquid chromatography-tandem mass spectrometry analysis showed that the therapeutic effect of Salvia miltiorrhiza in the rat model of white matter injury was closely related to the regulation of complement and coagulation cascades.To conclude,Salvia miltiorrhiza may be a potential therapeutic agent for treating preterm white matter injury.

Status and influencing factors of the discharge readiness of fathers of preterm infants in NICU / 中华护理杂志

Objective To understand the discharge readiness of fathers of preterm infants in the Neonatal Intensive Care Unit(NICU),analyze its influencing factors,and provide a basis for formulating individualized discharge health education plans and continuous care plans.Methods A convenience sampling method was employed to select fathers of preterm infants admitted to the NICU in a tertiary A hospital in Zhejiang Province from March 2022 to June 2022 as the subjects of the study.A general information questionnaire and the Discharge Readiness-Parent Version scale were used for the survey.Multiple linear regression analysis was applied to analyze the factors influencing the discharge readiness of fathers of NICU preterm infants.Results A total of 186 fathers of NICU preterm infants were included in the study.The total score of the Discharge Readiness-Parent Version scale was(179.97±28.20)points;the standardized score was(7.82±1.16)points;33.3％of the fathers of preterm infants had a standardized score of＜7 points.Multiple linear regression analysis results showed that the factors influencing the discharge readiness of fathers of NICU preterm infants included the gestational age at birth,birth weight,length of hospital stay,distance to access healthcare service,as well as the fathers'age,annual family income,and number of children in the family.Conclusion The discharge readiness of fathers of NICU preterm infants is at a moderate level.Nursing staff need to pay attention to the discharge readiness of fathers of preterm infants who have lower gestational age at birth,lower birth weight,longer hospital stays,longer distance to healthcare service,and who are younger,have lower annual family income,and are having their first child.Individualized discharge health education plans and continuous care plans should be formulated for them to improve their caregiving knowledge and skills.

Elaboración e implementación de un protocolo para la Hora Dorada de recién nacidos prematuros utilizando ciencia de la implementación / Elaboration and implementation of a protocol for the Golden Hour of premature newborns using an Implementation Science lens / Elaboração e implementação de protocolo para Hora Ouro do recém-nascido prematuro utilizando ciência da implementação

Objetivo: describir el proceso de diseño e implementación de un protocolo de atención para la primera hora de vida del recién nacido prematuro. Método: investigación participativa, que utilizó el marco de la ciencia de la implementación y los dominios del Consolidated Framework for Implementation Research. Estudio realizado en un hospital escuela del sureste de Brasil, con la participación del equipo multidisciplinario y de los gestores. El estudio se organizó en seis etapas, mediante del ciclo de mejora continua (Plan, Do, Check, Act): diagnóstico situacional; elaboración del protocolo; capacitaciones; implementación del protocolo; relevamiento de barreras y facilitadores; seguimiento y revisión del protocolo. Los datos fueron analizados mediante estadística descriptiva y análisis de contenido. Resultados: el primer protocolo de la Hora Dorada de la institución fue organizado por el equipo multidisciplinario a partir de un enfoque colectivo y dialógico. El protocolo priorizó la estabilidad cardiorrespiratoria, la prevención de hipotermia, hipoglucemia e infección. Después de cuatro meses de capacitación e implementación, el protocolo fue evaluado como una intervención de calidad, necesaria para el servicio, de bajo costo y de poca complejidad. La principal sugerencia de mejora fue realizar actividades educativas frecuentes. Conclusión: la implementación generó cambios e inició un proceso de mejora de la calidad de la atención neonatal, es necesario que la capacitación sea continua para lograr mayor adherencia y mejores resultados.

Objective: describe the process of designing and implementing a care protocol for the first hour of life of premature newborns. Method: a participatory research study using an implementation science framework, the Consolidated Framework for Implementation Research (CFIR) was employed to determine drivers and facilitators of implementation success of the Golden Hour protocol for newborns at a large university hospital in southeastern Brazil. A multi-professional team, including first line providers and managers participated in six stages of quality improvement: situational diagnosis; protocol elaboration; training protocol implementation; barrier and facilitator assessment; and protocol monitoring and review. Qualitative and monitoring data collected across these six stages were analyzed using descriptive statistics and content analysis. Results: the institution's Golden Hour protocol was organized by the multi-professional team based on a collective and dialogical approach. The protocol prioritized the infant's cardiopulmonary stability, as well as prevention of hypothermia, hypoglycemia and infection. After four months of implementation, the care team was evaluated the protocol as a good quality intervention, necessary for the service, low-cost and not very complex. One suggested improvement recommended was to carry out refresher training to address staff turnover. Conclusion: implementation of the Golden Hour protocol introduced an appropriate and feasible neonatal care quality improvement process, which requires periodic refresher training to ensure greater adherence and better neonatal results.

Objetivo: descrever o processo de elaboração e implementação de protocolo assistencial para a primeira hora de vida do recém-nascido prematuro. Método: pesquisa participativa, que utilizou referencial da ciência da implementação e os domínios do Consolidated Framework for Implementation Research. Estudo realizado em hospital universitário no sudeste do Brasil, com participação da equipe multiprofissional e gestores. O estudo foi organizado em seis etapas, por meio do ciclo de melhoria contínua (Plan, Do, Check, Act): diagnóstico situacional; elaboração do protocolo; treinamentos; implementação do protocolo; levantamento de barreiras e facilitadores; monitoramento e revisão do protocolo. Os dados foram analisados por estatística descritiva e análise de conteúdo. Resultados: o primeiro protocolo Hora Ouro da instituição foi organizado pela equipe multiprofissional a partir de uma abordagem coletiva e dialógica. O protocolo priorizou a estabilidade cardiorrespiratória, prevenção de hipotermia, de hipoglicemia e de infecção. Após treinamento e implementação por quatro meses, o protocolo foi avaliado como uma intervenção de qualidade, necessária ao serviço, de baixo custo e pouco complexa. A principal sugestão de melhoria foi realizar ações educativas frequentes. Conclusão: a implementação provocou mudanças e iniciou um processo de melhoria da qualidade da assistência neonatal, sendo necessária a manutenção dos treinamentos para maior adesão e melhores resultados.

Demographics and Clinical Patterns of Retinopathy of Prematurity at the University of Teaching Hospitals, Women and Newborn Hospital

Background: Retinopathy of prematurity (ROP) is a disorder of the developing retina of very low birth weight (VLBW) preterm infants. It is an important cause of childhood blindness and is listed as one of the causes of avoidable blindness in the vision 2020 - “The Right to Sight” Programme.ROP is more prevalent in highly developed countries where neonatal services’ availability, access and outcomes are good. The survival rates of Very low Birth Weight (VLBW) infant and low gestational age (GA) at the University Teaching Hospital (UTH), Women and Newborn Hospital (WNH) Neonatal Intensive Care Unit has improved.Aims: To estimate the prevalence of ROP at UTH, WNH, NICU.Study Design: Hospital-based cross-sectional study.Place and Duration: Neonatal Intensive Care Unit, Women and Newborn hospital at the University Teaching Hospital, in Lusaka, Zambia between November 2021 to April 2022.Methodology: We included 110 (54.5% males and 45.5% females) infants either born at <32 weeks GA or weighed <1500g. Dilated fundus examinations were done at 4 to 6 weeks chronological age or 31 to 33 weeks GA. Medical records were reviewed to identify associated factors.Results: Mean gestational age at birth was 30.6±2 weeks ranging from 27 to 34 weeks, mean birth weight was 1422.7±334.3 g ranging from 900g to 2200 g, mean Apgar score at 1 minute was 7±1.3, at 5 minutes the mean was 7.8±0.9, and at 10 minutes the mean was 8.4±0.7. Twenty-six (23.6%) were products of multiple gestations. Hyaline membrane disease was observed in 14 (12.7%), neonatal sepsis in 48 (43.6%), necrotising enterocolitis in 6 (5.5%), patent ductus arteriosus in one (0.9%), and hyperglycaemia in 56 (50.9%) cases.Conclusion: Our study found no participant with retinopathy of prematurity at UTH NICU. Further, the study could not make associations between suggested risk factors to the development of ROP. However, being a novel study on this topic in the country, it highlights the importance of setting up screening protocols and their attendant equipment in Special Care Baby Units at UTH and improving neonatal care services.

Test of Infant Motor Performance in the developmental assessment of preterm infants / 中华实用儿科临床杂志

Objective:To assess the characteristics and correlation of motor development in preterm infants of different gestational weeks by using the Test of Infant Motor Performance (TIMP) method, and to develop better individualized early interventions based on TIMP test results.Methods:A prospective study involving 43 full-term healthy infants and 77 preterm followed up in 3201 Hospital from June 2019 to July 2021 was conducted.Preterm infants were divided into the early preterm group (39 cases) and late preterm group (38 cases) according to their gestational age at birth.TIMP assessment was performed at the gestational age of 40 weeks and the corrected age of 16 weeks after birth.Similarly, the full-term healthy infants were assessed by TIMP at the postnatal age of 16 weeks.The differences between groups were investigated using ANOVA or Mann- Whitney rank sum test.Correlations were analyzed by the Pearson correlation method. Results:There were no significant difference in TIMP scores between early and late preterm infants at the gestational age of 40 weeks [(65.74±6.52) scores vs.(66.96±8.51) scores] and the corrected age of 16 weeks [(101±10) scores vs.(104±8) scores] (all P>0.05). TIMP scores in the full-term healthy group at the corrected age of 16 weeks [(108±10) scores] differed significantly from those of early and late preterm infants ( P<0.05). Compared with full-term infants, early and late preterm infants had lower TIMP scores in observation, supine position, and supine turning (all P<0.05), but a higher TIMP score in standing position ( P<0.05). For both early and late preterm infants, TIMP scores at the gestational age of 40 weeks were significantly positively correlated with those at the corrected age of 16 weeks ( r=0.565, 0.302, all P<0.01). Conclusions:There were significant differences in motor development between preterm infants of different gestational ages and term infants, which had guiding significance for early intervention.English version TIMP could play a positive role in promoting individualized follow-up and early intervention of preterm infants in China.

Research progress on probiotics and short-term clinical outcomes in extremely premature infants / 中国小儿急救医学

The extremely premature infants have different degrees of immature organ development, abnormal intestinal flora establishment and low immune function, and are prone to necrotizing enterocolitis, late-onset sepsis and other complications.Probiotics can improve intestinal flora, and regulate cell metabolic activity and immune function.Probiotics can be used to prevent necrotizing enterocolitis, and late-onset sepsis and so on.However, the possible harm of probiotics to extremely premature infants should not be ignored.This review summarized the effects of probiotics on extremely premature infants.

Predictive value of serum thrombospondin-1 and transforming growth factor-β1 levels in preterm infants with bronchopulmonary dysplasia / 中国小儿急救医学

Objective:To study the early predictive values of serum thrombospondin-1(TSP-1)and transforming growth factor-β1(TGF-β1) for bronchopulmonary dysplasia(BPD)in preterm infants.Methods:From September 2020 to April 2022, preterm infants with gestational age<32 weeks and ≥28 weeks as well as birth weight<1 500 g admitted to neonatal intensive care unit within 2 hours after birth were enrolled in the study.The dynamic changes of serum TSP-1 and TGF-β1 levels in preterm infants were observed on 1st, 7th, 14th, and 28th day after birth.Preterm infants were divided into BPD group and non-BPD group according to the diagnostic criteria of BPD.Receiver operating characteristic(ROC) curve and area under curve(AUC)was used to analyze the predictive value of serum TSP-1 and TGF-β1 for preterm infants with BPD.Results:According to the diagnostic criteria of BPD, 38 cases were in the BPD group and 52 cases in the non-BPD group.There was no significant difference in gestational age, birth weight and gender between the two groups( P>0.05). The levels of TSP-1 and TGF-β1 in the serum of BPD group were gradually increased, which were significantly higher than those of non-BPD group on the 1st, 7th, 14th, and 28th day( P<0.001). ROC results showed that AUC of TSP-1, TGF-β1 and their combination for predicting BPD were 0.889(95% CI 0.819~0.959), 0.826(95% CI 0.743~0.910), and 0.923(95% CI 0.870~0.976), respectively.The sensitivity were 86.80%, 86.70%, 89.50%, and the specificity were 86.50%, 73.10%, 80.80%, respectively.Cutoff values of TSP-1 and TGF-β1 for predicting BPD were 44.50 μg/L and 6.13 μg/L, respectively. Conclusion:Combined detection of serum TSP-1 and TGF-β1 on the first day after birth has an early predictive value for BPD in preterm infants.

The effects of quality improvement program on the incidence of bronchopulmonary dysplasia in very preterm infants / 中国新生儿科杂志

Objective:To evaluate the effects of quality improvement (QI) program on the incidence of bronchopulmonary dysplasia (BPD) in very preterm infants (VPIs) [gestational age (GA)<32 weeks].Methods:From July to December 2017,VPIs admitted to the Department of Neonatology of Yancheng Maternity and Child Health Care Hospital were retrospectively enrolled and were assigned into pre-quality improvement program group (Pre-QI group).From July to December 2018, VPIs were assigned into post-quality improvement program group (Post-QI group). QI program included delayed umbilical cord clamping (DCC), early postnatal nasal continuous positive airway pressure ventilation (nCPAP) and minimally invasive pulmonary surfactant therapy (MIST). The clinical data and prognostic indicators of the two groups of VPIs and their mothers were compared. Independent sample t-test or continuity-adjusted Chi-square test (or Fisher's exact test) and Logistic regression were used for statistical analysis. Results:A total of 204 VPIs were enrolled, including 96 cases in Pre-QI group and 108 cases in Post-QI group. 1 min Apgar score and hematocrit on admission to the neonatal intensive care unit (NICU) in the Post-QI group were significantly higher than the Pre-QI group( P<0.05). The incidence of delivery room resuscitation, endotracheal intubation at birth and endotracheal intubation in NICU in the Post-QI group were significantly lower than the Pre-QI group( P<0.05). The application of pulmonary surfactant and mechanical ventilation, the incidence of neonatal respiratory distress syndrome and BPD in the Post-QI group were lower than the Pre-QI group ( P<0.05). After adjusting for confounding factors, Logistic regression analysis showed that DCC ( aOR=0.261,95% CI 0.091~0.718, P=0.023), nCPAP ( aOR=0.284,95% CI 0.123~0.667, P=0.015), MIST ( aOR=0.276,95% CI 0.114~0.627, P=0.011) were protective factors of BPD, and MV ( aOR=2.023,95% CI 1.048~3.918, P=0.036) was risk factor of BPD. Conclusions:The QI program consisting of DCC, early nCPAP and MIST for VPIs can reduce the incidence of BPD.

The survival, complications and prognosis of the extremely preterm infants / 中国新生儿科杂志

Objective:To study the complications and prognosis of extremely premature infants(EPIs) with gestational age (GA) <28 w.Methods:From January 2016 to December 2020, EPIs with GA <28 w admitted to NICU of our hospital were retrospectively studied. Clinical data of the infants and their mothers during pregnancy were reviewed. According to the prognosis, the infants were assigned into the survival group, the death group and the withdrawal group. According to GA, the infants were assigned into <26 w goup, 26~26 +6 w group, ≥27 w group. According to birth weight (BW), the infants were assigned in to ≤750 g group, 750~999 g group and ≥1 000 g group. SPSS 26.0 was used for data analysis. Results:A total of 265 EPIs were included, 122 (46.0%) in the survival group, 47 (17.7%) in the death group and 96 (36.2%) in the withdrawal group. GA and BW of the survival group were significantly higher than the death group and the withdrawal group ( P<0.05). The incidences of tracheal intubation (92.2%) and pulmonary hemorrhage (42.2%) in the death group were the highest among the three groups. The survival group had the highest application of prenatal glucocorticoids (80.3%) and pulmonary surfactants (99.2%) ( P<0.05). In the survival group, the top 3 common complications were bronchopulmonary dysplasia (BPD) (68.0%), pulmonary infections (65.6%) and neonatal sepsis (34.4%). The survival rate increased with GA and BW. Conclusions:The survival rate of EPIs is closely correlated with GA and BW. EPIs with pulmonary hemorrhage and tracheal intubation have poor prognosis. Prenatal glucocorticoids and pulmonary surfactant may improve clinical outcome. BPD and pulmonary infections are common complications of surviving EPIs.

Risk factors of hypoglycemia in late preterm infants / 中国新生儿科杂志

Objective:To study the risk factors of hypoglycemia in late preterm infants.Methods:From January 2019 to December 2021, late premature infants admitted to NICU of our hospital were retrospectively studied. The infants with hypoglycemia were assigned into the hypoglycemia group and infants with same gestational age and normoglycemia were assigned into the control group in a 1∶1 ratio. The perinatal and maternal data of the two groups were compared. Multivariate logistic regression analysis was used to determine the risk factors of hypoglycemia in late premature infants.Results:A total of 366 cases each were included in the hypoglycemia group and the control group. No significant difference existed in birth weight between the two groups ( P>0.05). Multivariate logistic regression analysis showed that antenatal corticosteroid ( OR=1.567, 95% CI 1.127-2.180), cesarean section ( OR=2.013, 95% CI 1.376-2.944), twin birth ( OR=2.241, 95% CI 1.479-3.396) and infant of a diabetic mother ( OR=1.635, 95% CI 1.131-2.365) were the risk factors of hypoglycemia in late preterm infants ( P<0.05). Conclusions:Antenatal corticosteroid, cesarean section, twin birth and infant of a diabetic mother are independent risk factors for hypoglycemia in late preterm infants.

Clinical significance of alveolar-arterial oxygen gradients for late preterm and full-term infants with acute respiratory distress syndrome / 中国新生儿科杂志

Objective:To study the clinical significance of alveolar-arterial oxygen gradients (P A-aO 2) for late preterm and full-term infants with acute respiratory distress syndrome (ARDS). Methods:From January 2020 to June 2022, infants (gestational age ≥34 weeks) diagnosed with ARDS were admitted to the Neonatology Department of our hospital. The infants were assigned into the invasive group and the non-invasive group according to the ventilation mode. The infants with the same gestational age and diagnosed with neonatal wet lung were assigned into the control group. P A-aO 2 levels within 1 h after birth were compared among the three groups. The correlation of P A-aO 2 with ARDS, ventilation mode and duration were studied. Receiver operating characteristic (ROC) curve was used to determine the predictive value of P A-aO 2 within 1 h after birth for ARDS and the need of invasive ventilation. Results:A total of 36 cases were enrolled in the invasive group, 19 cases in the non-invasive group and 50 cases in the control group. Within 1 h after birth, P A-aO 2 in the invasive group was significantly higher than the non-invasive group and the control group ( P<0.05), and the non-invasive group higher than the control group ( P<0.05). Correlation analysis showed that P A-aO 2 within 1 h after birth in the invasive group was positively correlated with the duration of invasive ventilation and total mechanical ventilation ( r=0.601, P<0.001; r=0.504, P=0.002); P A-aO 2 before successful withdrawal of invasive ventilation was not correlated with subsequent non-invasive ventilation duration; and no correlation existed between P A-aO 2 within 1 h after birth and the duration of non-invasive ventilation in the non-invasive group. The area under the ROC curve for P A-aO 2 within 1 h after birth to predict ARDS was 0.875, with a sensitivity of 87.3% and a specificity of 72.0% at a cutoff value of 50.0 mmHg. The area under the ROC curve for predicting the need for invasive ventilation in infants with ARDS was 0.851, with a sensitivity of 80.0% at a cutoff value of 73.3 mmHg and a specificity of 75.0%. Conclusions:Late preterm and full-term infants have a higher risk of ARDS at P A-aO 2>50.0 mmHg within 1 h after birth. Infants with ARDS are more likely to require invasive ventilation if P A-aO 2>73.3 mmHg. The higher the level of P A-aO 2, the longer the duration of invasive ventilation and total duration of mechanical ventilation.

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

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

Influence of bronchopulmonary dysplasia on cerebral blood flow in preterm infants: a prospective study based on arterial spin labeling / 中国当代儿科杂志

OBJECTIVES@#To investigate local cerebral blood perfusion in preterm infants with bronchopulmonary dysplasia (BPD) based on cerebral blood flow (CBF) values of arterial spin labeling (ASL).@*METHODS@#A prospective study was conducted on 90 preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g who were born in the Department of Obstetrics and admitted to the Department of Neonatology in the Third Affiliated Hospital of Zhengzhou University from August 2021 to June 2022. All of the infants underwent cranial MRI and ASL at the corrected gestational age of 35-40 weeks. According to the presence or absence of BPD, they were divided into a BPD group with 45 infants and a non-BPD group with 45 infants. The two groups were compared in terms of the CBF values of the same regions of interest (frontal lobe, temporal lobe, parietal lobe, occipital lobe, thalamus, and basal ganglia) on ASL image.@*RESULTS@#Compared with the non-BPD group, the BPD group had a significantly lower 1-minute Apgar score, a significantly longer duration of assisted ventilation, and a significantly higher incidence rate of fetal distress (P<0.05). After control for the confounding factors such as corrected age and age at the time of cranial MRI by multiple linear regression analysis, compared with the non-BPD group, the BPD group still had higher CBF values of the frontal lobe, temporal lobe, parietal lobe, occipital lobe, basal ganglia, and thalamus at both sides (P<0.05).@*CONCLUSIONS@#BPD can increase cerebral blood perfusion in preterm infants, which might be associated with hypoxia and a long duration of assisted ventilation in the early stage.