目的   探讨口服水合氯醛与鼻内给予右美托咪定中深度镇静下行泪道探通术治疗婴幼儿先天性泪道阻塞的疗效、并发症及安全性。方法   随机选择2021年2月—2023年6月在广州医科大学附属妇女儿童医疗中心就诊的先天性泪道阻塞患儿，将其分为观察组和对照组，观察组行中深度镇静后进行泪道探通术，对照组进行表麻下泪道探通术，对比两组的治愈率及并发症发生率。结果   观察组共76例（97眼），总治愈率98.97%，分为3组，6~12月龄组41例（53眼），12~18月龄组14例（15眼），18~36月龄组21例（29眼），对照组共84例（116眼），总治愈率93.10%，6~12月龄组55例（70眼），12~18月龄组15例（24眼），18~36月龄14例（22眼），观察组泪道探通术治愈率高于对照组，差异有统计学意义（χ ² =4.49，P＜0.05）。观察组一次探通的成功率为92.78%，高于对照组61.21%，差异有统计学意义（χ ² =26.86，P＜0.05）。观察组二次探通的成功率为85.71%，高于对照组44.44%，差异有统计学意义（χ ² =4.13，P＜0.05）。发生的并发症主要是出血、皮下水肿、感染、假道形成，观察组并发症的发生率4.12%，低于对照组15.52%，差异有统计学意义（χ ² =7.40，P＜0.05）。观察组中2例患儿口服水合氯醛出现恶心呕吐，改为右美托咪定滴鼻。3例患儿右美托咪定滴鼻后出现口唇苍白，持续10～15 min即可缓解。其余均未有不良反应。结论   中深度镇静下给予婴幼儿泪道阻塞患儿行泪道探通术相比传统表麻下泪道探通术疗效更好，并发症较少，对孩子的心理创伤小，安全且经济实惠。

       Objective  To explore the efficacy，complications and safety of moderate and deep  sedation  under oral administration of chloral hydrate and intranasal administration of dexmedetomidine for the treatment of congenital nasolacrimal duct obstruction（CNLDO） in infants and young children．Methods  Children with CNLDO who visited our hospital from February 2021 to June 2023 were randomly selected and divided into the observation group and the control group．The observation group was performed with lacrimal duct probing after moderate and deep sedation，while the control group was performed with lacrimal duct probing under surface anesthesia．The cure rate and incidence of complications were compared between the two groups．Adverse reactions after using sedatives were observed．Results  The observation group consisted of 76 cases（97 eyes），with a total cure rate of 98.97%．They were divided into three groups：41 cases（53 eyes）in the aged 6-12 months group，14 cases（15 eyes）in the aged 12-18 months group，and 21 cases（29 eyes）in the aged 18-36 months group．The control group consisted of 84 cases（116 eyes），with a total cure rate of 93.10%．There were 55 cases（70 eyes）in the aged 6-12 months group，15 cases（24 eyes）in the aged 12-18 months group，and 14 cases（22 eyes）in the aged 18-36 months group．The cure rate of lacrimal duct probing in the observation group was significantly higher than that in the control group（χ ² =4.49，P＜0.05）．The success  rate of the first probing in the observation group was 92.78%，significantly higher than that in the control group of 61.21%（χ ² =26.86，P＜0.05）．The success rate of the second probing in the observation group was 85.71%，significantly higher than that in the control group of 44.44%（χ ² =4.13，P＜0.05）．The incidence of complications mainly were bleeding，subcutaneous edema，infection，and false passage formation．The incidence of complications in the observation group was 4.12%，lower than that in the control group 15.52%，and the difference was statistically significant（χ ² =7.40，P＜0.05）．Two cases in the observation group experienced nausea and vomiting after taking chloral hydrate orally，and were replaced with dexmedetomidine nasal drops．Three cases of pediatric patients showed pale lips after nasal administration of dexmedetomidine，which lasted for 10-15 minutes and could be relieved．No other adverse reactions were observed．Conclusions  Under moderate and deep sedation，lacrimal duct probing treatment for infants and young children with CNLDO showed better therapeutic effects，fewer complications，less psychological trauma to these patients，which is safe and cost-effective，and is suitable for promotion compared to under traditional surface anesthesia．

目的 探讨振幅整合脑电图（aEEG）联合头颅磁共振成像（cMRI）对早产儿矫正12月龄时神经发育的预测价值。方法 选取110例早产儿为研究对象,并在矫正12月龄时采用Gesell 发育量表评估发育商（DQ）,依据DQ分为Gesell 正常组（DQ≥85,n=83）、Gesell 异常组（DQ<85,n=27）。采集早产儿及母亲临床资料,对比两组出生后72 h内aEEG、矫正胎龄37周时cMRI检查指标差异。结果 两组早产儿及母亲基线资料比较差异无统计学意义（P>0.05）。相较于Gesell 正常组,Gesell 异常组双顶径（BPW）降低[（70.68±5.32）mm vs（66.54±3.69）mm],睡眠-觉醒周期（SWC）不成熟率（20.48% vs 85.19%）、aEEG异常率（30.12% vs 70.37%）、两半球间距（IHD）增高[（2.95±0.83） mm vs（3.56±0.72）mm]（P<0.05）。Pearson相关分析结果显示,DQ值与IHD呈负相关,DQ值与BPW呈正相关（r=-0.361、0.598,P<0.05）。二元Logistic回归分析结果显示,BPW增高是Gesell 异常的独立保护因素（P<0.05）,IHD增高、SWC不成熟及aEEG异常是Gesell 异常的独立危险因素（P<0.05）。结论 早产儿出生后72 h内aEEG异常、矫正胎龄37周时cMRI异常可能提示矫正12月龄时不良神经发育结局。

Objective To evaluate the predictive value of amplitude-integrated electroencephalogram combined with cranial magnetic resonance on neurodevelopment for preterm infants at corrected age of 12 months．Methods A total of 110 preterm infants were selected as study subjects,and Gesell developmental scale was used to evaluate developmental quotient（DQ）at corrected age of 12 months．According to DQ,they were divided into normal Gesell group（DQ≥85,n=83）and abnormal Gesell group（DQ<85,n=27）．Clinical data of preterm infants and their mothers were collected,and the differences of amplitude-integrated electroencephalogram and cranial MRI（cMRI）were compared between two groups．Results There was no significant difference in baseline data between two groups（P>0.05）．Compared with the normal Gesell group,the biparirtal width（BPW）in the abnormal Gesell group was decreased（70.68±5.32mm vs 66.54±3.69mm）,the immaturity rate of sleep-wake cycle（SWC）（20.48% vs 85.19%）,the abnormal rate of aEEG（30.12% vs 70.37%）,and（IHD）（2.95±0.83mm vs 3.56±0.72mm）were increased（P<0.05）．The results of Pearson correlation analysis showed that DQ was negatively correlated with IHD,and DQ was positively correlated with BPW（r=-0.361、0.598,P<0.05）．Binary Logistic regression analysis showed that increased BPW was an independent protective factor for abnormal Gesell（P<0.05）,and increased IHD,immature SWC and abnormal aEEG were independent risk factors for abnormal Gesell（P<0.05）．Conclusions Abnormal aEEG within 72h after birth and abnormal cMRI at corrected age of 37 weeks may lead to adverse neurodevelopmental outcomes at corrected age of 12 months．

目的 探究经鼻间歇正压通气（NIPPV）和经鼻持续正压通气（NCPAP）作为早产儿呼吸窘迫综合征气管插管机械通气拔管后无创呼吸支持过渡的临床效果的差异。方法 纳入2021年1月—2023年6月在广东省吴川市妇幼保健计划生育服务中心治疗的新生儿呼吸窘迫综合征早产儿66例,用随机数字表法将患儿分为NIPPV组（33例）和NCPAP组（33例）。NIPPV组患儿予经鼻间歇正压通气作为过渡期无创呼吸支持,NCPAP组患儿则予以经鼻持续正压通气作为过渡期无创呼吸支持。对比两组患儿治疗前后血气分析结果、脱机失败率、无创呼吸支持时间、无创后吸氧时间、总给氧时间等指标。结果 接受无创呼吸支持12 h后,NIPPV组患儿的PaO₂升至（76.46±1.10）mmHg,高于NCPAP组患儿的（75.51±2.15）mmHg（t=2.249,P=0.028）。此外,NIPPV组患儿的SaO₂升至（96.36±0.52）%,也高于NCPAP组患儿的（96.07±0.59）%（t=2.138,P=0.034）。而NIPPV组患儿的PaCO₂则降至（41.39±0.74）mmHg,较NCPAP组患儿的（41.87±0.95 ）mmHg低（t=-2.230,P=0.025）。NIPPV组无创呼吸支持时间为（3.09±0.52）d,短于NCPAP组的（3.45±0.62）d,且该差异有统计学意义（t=2.584,P=0.012）。同样的,NIPPV组总给氧时间（9.52±0.76）天较NCPAP组的（10.00±0.79）天短,且该差异有统计学意义（t=-2.548,P=0.013）。而两组在脱机失败率、无创呼吸支持后吸氧时间、不良反应发生率等方面比较差异无统计学意义（均P>0.05）。结论 与NCPAP模式相比,早产儿拔管后应用NIPPV模式进行无创呼吸支持取得的临床效果更优。

Objective To explore the difference of clinical effect of nasal intermittent positive pressure ventilation（NIPPV）and nasal continuous positive pressure ventilation（NCPAP）as non-invasive respiratory support mode after extubation in preterm infants with endotracheal intubation．Methods Sixty-six cases of preterm infants with neonatal respiratory distress syndrome treated in our hospital from January 2021 to June 2023 were included．All the subjects were randomly divided into NIPPV group（n=33）and NCPAP group（n=33）．The blood gas analysis results,weaning failure rate,non-invasive respiratory support time,oxygen inhalation time after noninvasive ventilation,total oxygen administration time．were compared between the two groups．Results After 12 hours of noninvasive respiratory support,PaO₂ in the NIPPV group increased to（76.46±1.10）mmHg,which was significantly higher than that（75.51±2.15）mmHg in the NCPAP group（t=2.249,P=0.028）．In addition,SaO₂ in the NIPPV group increased to （96.36±0.52）%,which was also significantly higher than that（96.07±0.59）% in the NCPAP group（t=2.138,P=0.034）．The PaCO₂ in the NIPPV group decreased to （41.39±0.74）mmHg,which was lower than that（41.87±0.95）mmHg in the NCPAP group（t=-2.230,P=0.025）．The duration of non-invasive respiratory support in the NIPPV group（3.09±0.52） days was shorter than that（3.45±0.62）days in the NCPAP group,and the difference was statistically significant（t=2.584,P=0.012）．Similarly,the total duration of oxygen administration in the NIPPV group（9.52±0.76）days was shorter than that（10.00±0.79）days in the NCPAP group,and the difference was statistically significant（t=-2.548,P=0.013）．There were no significant differences in weaning failure rate,oxygen inhalation time after noninvasive respiratory support,and incidence of adverse reactions between the two groups（P>0.05）．Conclusions Compared with NCPAP mode,NIPPV mode for non-invasive respiratory support in preterm infants after extubating has better clinical effect,and it is worthy of clinical application．

目的 检验婴儿孤独症观察量表中文版（AOSI）临床应用的灵敏度与特异度,评价其临床应用效果。方法 随机抽取1岁时曾在清远市妇幼保健院行AOSI评估,于2~3岁时诊断为孤独症谱系障碍（ASD）的48例患儿为ASD组,诊断为正常发展的46例幼儿作为对照组。比较两组患儿的18个条目得分和总分,采用受试者操作特征（ROC）曲线计算AOSI的特异度、灵敏度、阳性预测值与阴性预测值,并判断AOSI的最佳诊断（阳性）分界值;分析AOSI评估结果与《精神障碍诊断与统计手册（第5版）》（DSM-5）中ASD诊断标准的一致性。结果 两组研究对象性别、年龄比较差异无统计学意义（P>0.05）。ASD组各条目得分和总分均高于对照组,且差异具有统计学意义（P<0.01）。AOSI的曲线下面积（AUC）为1.00（P<0.01）,95%置信区间为（1.00,1.00）。不同阳性分界线的灵敏度、特异度、阳性预测值、阴性预测值及一致性相比较,当约登指数等于1.00时AOSI的最佳诊断（阳性截断值）界线为9分时,其上述值均为1.00。AOSI评估结果与DSM-5中ASD的诊断标准完全相一致（Kappa=1,P<0.01）。结论 AOSI应用于评估1岁的婴儿,当取9分为诊断界值时,具有高度的灵敏度与特异度,能较好地预测该婴儿在2~3岁时是否患ASD;AOSI是婴儿期ASD筛查的重要工具,其评估结果可作为ASD高危儿早期干预的证据和ASD的辅助诊断工具,适合于临床推广应用。

Objective To test the sensitivity and specificity of the Chinese version of the Autism Observation Scale for Infants（AOSI）in clinical application and evaluate its clinical application effect．Methods Forty-eight children with autism spectrum disorder（ASD）diagnosed at the age of 2 to 3 years who had undergone AOSI evaluation in Qingyuan Maternal and Child Health Hospital at the age of 1 year（2021）were randomly selected as the ASD group,and 46 children with normal development were randomly selected as the control group．The scores of 18 items and total scores of the two groups of subjects were compared．The specificity,sensitivity,positive predictive value and negative predictive value of AOSI were calculated using the receiver operating characteristic curve（ROC）,and the best diagnostic（positive）cut-off value of AOSI was confirmed．The consistency of AOSI evaluation results with the ASD diagnostic criteria in DSM-5 were compared．Results There was no statistically significant difference in genders or age between two groups（P>0.05）．The scores of each item and total scores in the ASD group were significantly higher than those in the control group,and the difference was statistically significant（P<0.01）．The area under the curve of AOSI（AUC=1.00,P<0.01）had a 95% confidence interval of（1.00,1.00）．Comparing the sensitivity,specificity,positive predictive value,negative predictive value and consistency of different positive boundary points,when the Youden index was equal to 1.00,the optimal diagnostic（positive cut-off value）boundary for AOSI was 9 points,and all of the above values were 1.00． The AOSI evaluation results were completely consistent with the diagnostic criteria for ASD in DSM-5（Kappa=1,P<0.01）．Conclusions AOSI has high sensitivity and specificity when it is used to evaluate the 1-year-old infant．When “9 points” is taken as the diagnostic threshold,it can better predict whether the infant has ASD at the age of 2~3 years．AOSI is an important tool for screening ASD in infancy．Its evaluation results can be used as evidence for early intervention of high-risk infants with ASD and as a assisting tool to diagnosis ASD,which is suitable for clinical application．

目的 探讨早产儿语言-社会行为情况及其影响因素,研究语言-社会行为发育与智能发育之间的关系,为早产儿保健提供指导。方法 采用自制的一般情况问卷对125例早产儿开展随访、追踪,直至2岁时,采用盖泽尔发展量表（GDS）进行语言-社会行为及智能发育评估。结果 早产儿语言发育正常43例（34.4%）,社会行为发育正常40例（32%）。早产儿语言发育商平均为（67.99±25.75）,社会行为发育商平均为（67.75±23.98）,处于发育低下水平。性别、脑出血病史、定期随访史、康复干预史、家庭干预史在语言、社会行为方面比较差异均无统计学意义（P>0.05）。不同胎儿期安胎史、胎龄、出生体质量在语言、社会行为方面比较差异有统计学意义（P<0.05）;且胎儿期反复安胎,胎龄小,出生体质量低,语言及社会行为发育较差。与出生时无中-重度窒息史的患儿相比,出生时有中-重度窒息的患儿存在更多的语言发育异常,比较差异有统计学意义（P<0.05）;但在社会行为发育方面比较差异无统计学意义（P>0.05）。语言-社交行为发育落后的同时,早产儿的大运动、精细动作、适应性行为也存在落后,五大能区比较差异并均有统计学意义（P<0.05）。结论 多数早产儿存在语言-社会行为发育落后,其同时可能伴有更多的运动和适应行为发育问题;语言-社交行为发育落后的患儿在胎儿期存在反复安胎且胎龄较小、出生体质量更低或有中-重度窒息史。对早产儿的语言-社会行为要及时给予关注,早期发现并早期干预,改善预后。

Objective To explore the language-social behavior of preterm infants and its influencing factors,to study the relationship between language-social behavior development and intellectual development,and to provide guidance for preterm infants' health care．Methods A self-administered general questionnaire was used to follow up 125 preterm infants until the age of 2 years,and Gesell development scale（GDS）was used to assess their language-social behavior and intellectual development．Results Preterm infants had normal language development in 43 cases（34.4%）and normal social behavioral development in 40 cases（32%）．The mean language development quotient of preterm infants was（67.99±25.75）and the mean social behavioral development quotient was（67.75±23.98）,which was at the low developmental level．There were no significant differences in gender,history of cerebral hemorrhage,regular follow-up,rehabilitation intervention,family intervention and language or social behavior（P>0.05）．Infants with different fetal age history,gestational age,and birth weight varied significantly in language and social behavior（P<0.05）;and with repeated miscarriage,small gestational age,low birth weight,showed poor language and social behavior development．Compared the children with and without moderate to severe asphyxia at birth,there was statistically significant differences in language development（P<0.05）,but in social behavior there was no significant difference（P>0.05）．The backward development of language-social behavior was accompanied by backwardness in gross motor,fine motor,and adaptive behavior in preterm infants,and the differences in the five major domains were all present and statistically significant（P<0.05）．Conclusions A major of preterm infants have poor language-social behavior development,which may be accompanied by more motor and adaptive behavior development problems;children with poor language-social behavior development have repeated miscarriage prevention at younger gestational ages,lower birth weights,or a history of moderate-to-severe asphyxia during the fetal period．It is important to give timely attention to language-social behavior in preterm infants for early detection and early intervention to improve prognosis．

目的 评价早产儿经胃管喂养后采用空气冲管的应用效果。方法 选择2021年1月–2021年12月广州市第一人民医院收治的经胃管喂养后采用温水冲管的60例早产儿为对照组,选择2022年1月–2022年12月收治的经胃管喂养后采用空气冲管的57例早产儿为研究组。喂养1周后,比较两组患儿体质量增加量、血清白蛋白浓度增加量、大便量、喂养不耐受发生率、胃管堵塞率等指标的差异。结果 无患儿发生胃管堵塞。研究组的血清白蛋白浓度增加量[（2.86±5.61）g/L]高于对照组[（0.84±5.27）g/L]（P<0.05）,而两组患儿在体质量增加量、大便量、喂养不耐受发生率等方面比较差异无统计学意义（P>0.05）。多元线性回归分析结果显示空气冲管为血清白蛋白浓度增加量的影响因素（P<0.05）。结论 采用空气进行胃管冲管的方法可改善早产儿的营养状态。

Objective To evaluate the effects of flushing gastric tube by air after feeding in premature infants．Methods A total of 60 premature infants admitted to Guangzhou First People's Hospital from January 2021 to December 2021 whose gastric tube were flushed with water after feeding were selected as the control group,while 57 admitted from January 2022 to December 2022 whose gastric tube were flushed with air after feeding were selected as the study group．After 1 week of feeding,the differences of weight increase,serum albumin concentration increase,stool volume,feeding intolerance incidence and gastric tube blockage rate were compared between the 2 groups．Results No gastric tube blockage occurred．The increase of serum albumin concentration in the study group[（2.86±5.61）g/L] was significantly higher than that in the control group[（0.84±5.27）g/L]（P<0.05）,but there were no significant differences in weight increase,stool volume and feeding intolerance incidence between the 2 groups．Multiple linear regression analysis showed that the flushing gastric tube with air was an independent influencing factor for the increase of serum albumin（P<0.05）．Conclusions Flushing gastric tube with air can improve the nutritional status of premature infants,which is worthy of clinical application．

目的 分析早产儿发生新生儿坏死性小肠结肠炎（NEC）的临床特点及危险因素。方法 选取2021年3月—2023年3月在濮阳市人民医院出生的早产儿160例,根据有无NEC分为NEC组（40例）和非NEC组（120例）,总结和比较两组患儿的临床资料,分析早产儿NEC的危险因素。结果 NEC组早产儿的发病时间主要集中在出生后的3~21 d,平均发病时间为（12.84±3.5）d。主要临床症状包括肉眼便血23例（57.5%）、腹胀31例（77.5%）、呕吐18例（45.0%）、呼吸暂停7例（17.5%）、肠穿孔9例（22.5%）。Logistic回归分析发现,败血症、输血、呼吸窘迫综合征及新生儿窒息是早产儿发生NEC的危险因素（P<0.05）,而预防应用益生菌以及母乳喂养是NEC的保护因素（P<0.05）。结论 NEC的主要临床表现包括肉眼便血、腹胀、呕吐、呼吸暂停、肠穿孔等;患儿出现NEC与败血症、输血、呼吸窘迫综合征及新生儿窒息等因素相关;母乳喂养和益生菌的应用是其保护因素。

Objective To analyze the clinical characteristics and risk factors of necrotizing enterocolitis（NEC）in premature infants. Methods A total of 160 premature infants born in Puyang People's Hospital from March 2021 to March 2023 were selected and divided into NEC group（40 cases）and non-NEC group（120 cases）according to the presence or absence of NEC．The clinical data were obtained and compared between the two groups．The clinical data of two groups were compared,and the related risk factors of NEC in premature infants were analyzed and summarized. Results The onset time of NEC premature infants is mainly between 3-21 days after birth,with an average onset time of（12.84±3.5）days．The main clinical symptoms included 23 cases（57.5%）of bloody stool,31 cases（77.5%）of abdominal distension,18 cases（45.0%）of vomiting,7 cases（17.5%）of apnea,and 9 cases（22.5%）of intestinal perforation．Logistic regression analysis found that sepsis,blood transfusion,respiratory distress syndrome,and neonatal asphyxia were risk factors for NEC in premature infants（P<0.05）,while prophylactic use of probiotics and breastfeeding were protective factors for NEC（P<0.05）. Conclusions The main clinical manifestations of NEC include bloody stool,abdominal distension,vomiting,apnea,intestinal perforation,etc．NEC in infants is related to sepsis,blood transfusion,respiratory distress syndrome and neonatal asphyxia．Breastfeeding and the application of probiotics are its protective factors．

目的 比较早产胎膜早破(PPROM)≥34周的肥胖孕妇与非肥胖孕妇的早产儿住院结局。方法 回顾性分析2016年1月—2020年12月在本院出生并入住新生儿科的所有出生胎龄≥34周的PPROM早产儿。根据孕妇分娩时体质量指数(BMI),分为肥胖组(BMI≥30 kg/m²)和非肥胖组(BMI＜30 kg/m²),比较2组间的一般情况、妊娠结局及所生晚期早产儿的住院结局,组间比较采用两独立样本t检验及χ²检验。结果 与非肥胖孕妇相比,肥胖孕妇的晚期早产儿分娩后呼吸道并发症发病率高,主要表现为新生儿呼吸窘迫综合征,辅助通气、吸氧和表面活性物质的使用、败血症、感染性肺炎发病率高,母亲妊娠期糖尿病发病率增高,差异均具有统计学意义(P＜0.05),其余新生儿高胆红素血症、新生儿坏死性小肠结肠炎、脑室内出血、早产儿支气管肺发育不良等并发症比较无统计学意义(P＞0.05)。结论 PPROM≥34周的肥胖孕妇与非肥胖孕妇相比,所生晚期早产儿呼吸道并发症和败血症等不良结局的发生率增加。

Objective To compare the hospitalization outcomes of 34 weeks or over preterm infants with preterm premature rupture of membranes (PPROM) in obese and non-obese pregnant women. Methods A retrospective analysis of PPROM preterm infants born in our hospital and admitted to the neonatology department from January 2016 to December 2020 with a gestational age of 34 weeks or over was carried out. According to the pregnant women's body mass index (BMI) at delivery, they were divided into obese group (BMI≥30 kg/m²) and non-obese group (BMI<30 kg/m²). The general conditions, pregnancy outcomes and late premature infants hospitalization outcomes between the two groups were compared using two independent samples t test and χ² test. Results Compared with non-obese pregnant women, the incidence of respiratory complications after delivery in late preterm infants of obese pregnant women was higher, mainly manifested as high incidence of neonatal respiratory distress syndrome, assisted ventilation, oxygen inhalation and the use of surfactants, sepsis, and pneumonia, also maternal gestational diabetes incidence was increased, and the differences were statistically significant (P<0.05); other complications of neonatal hyperbilirubinemia, necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia were not statistically significant (P>0.05). Conclusions Compared with non-obese pregnant women with 34 weeks or over PPROM, obese pregnant women had an increased incidence of adverse outcomes in late preterm infants such as respiratory complications and sepsis.

目的 探讨在早期早产儿配方奶(PF)喂养失败下,更换母乳(HM)或深度水解奶(eHF)对极低出生体质量儿喂养不耐受(FI)的改善情况。方法 选择2016年1月—2018年1月在广州市妇女儿童医疗中心出生、生后PF喂养失败、出现FI的极低出生体质量儿84例,根据家长HM喂养意愿及条件,分为HM喂养组38例和eHF喂养组46例,比较2组患儿更换喂养配方后FI消失时间、FI改善率、达全肠内喂养时间及体质量增长情况等喂养结局。结果 相对于eHF喂养组,HM喂养组FI消失时间更快,FI改善率更高,达全肠内喂养时间更快,差异有统计学意义。HM喂养组平均每日体质量增长量、出院时体质量均明显大于eHF喂养组,住院时间更短,出院时宫外发育迟缓(EUGR)发生率更低,差异有统计学意义。2组患儿坏死性小肠结肠炎、胆汁淤积症、院内感染发生率比较无统计学差异。结论 当极低出生体质量儿PF喂养失败、出现FI时,选择HM或eHF均可改善FI,但HM效果更好,达全肠内喂养时间更快且体质量增长更理想,出院时EUGR发生率较低。

Objective To investigate the improvement of feeding intolerance (FI) by changing human milk (HM) or extensively hydrolyzed formula(eHF) after failure of preterm formula (PF) feeding in very low birth weight (VLBW) infants. Methods Eighty-four VLBW infants who were born in Guangzhou Women and Children's Medical Center from January 2016 to January 2018 with PF feeding failure and FI were divided into HM feeding group (n=38) and eHF feeding group (n=46) according to their parents' HM feeding willingness and conditions.The time of FI disappearance, FI improvement rate, total enteral feeding time and weight gain were compared between the two groups after changing feeding formula. Results Compared with the eHF feeding group, the disappearance time of FI, the time of getting total intestinal feeding in the HM feeding group were shorter, and the improvement rate of FI was higher,the differences were statistically significant.The average daily weight increase and discharge weight of the HM feeding group were significantly more than those of the eHF feeding group, and the length of hospital stay, the incidence of extrauterine growth retardation(EUGR) at discharge were lower, the differences were statistically significant.There was no significant difference in the incidence of necrotizing enterocolitis, cholestasis and nosocomial infection between the two groups. Conclusions In the case of failure of PF feeding and FI in VLBW infants, both HM and eHF could ameliorate FI, but HM had a better effect, with a shorter time of getting total intestinal feeding, better weight gain and a lower incidence of EUGR at discharge.

目的 观察低出生体重早产儿应用抗生素后肠道菌群的动态变化。方法 选取2018年6月—2019年7月在广州市第一人民医院住院的10名低出生体重早产儿,在出生时、出生后1~2周、出生后2~3周、出生后3~4周、出生后4~5周、出生后5~6周时分别收集粪便样本,通过16s高通量测序检测患儿粪便菌群变化并统计分析。结果 应用抗生素后的低出生体重早产儿肠道菌群α多样性(Shannon指数、Simpson指数、ACE指数和PD_whole_tree指数)下降(P均<0.05),肠道菌群结构在门、科、属水平均发生改变,其中Alistipes、Bacteroides、Lactobacillus、unidentified_Lachnospiraceae、unidentified_Ruminococcaceae、Alloprevotella、unidentified_Cyanobacteria、Bacillus、Stenotrophomonas和Acinetobacter菌属相对丰度减少(P均<0.05)。结论 低出生体重早产儿应用抗生素后肠道菌群多样性下降,肠道菌群结构发生改变,并在抗生素停用后仍持续,针对性补充益生菌或益生元可能有助于肠道菌群恢复稳态。

Objective To observe the dynamic changes of gut microbiota in premature infants with low birth weight after antibiotics therapy. Methods 10 low birth weight premature infants hospitalized in Guangzhou First People's Hospital from June 2018 to July 2019 were included. Fecal samples were collected at birth, 1~2 weeks after birth, 2~3 weeks after birth, 3~4 weeks after birth, 4~5 weeks after birth and 5~6 weeks after birth, respectively. The changes of fecal microbiota were detected and analyzed by 16s high-throughput sequencing. Results The α-diversity of gut microbiota (Shannon index, Simpson index, ACE index and PD_whole_tree index) in low birth weight preterm infants treated with antibiotics decreased (P<0.05). The structure of gut microbiota changed at phylum, family and genus levels, among which Alistipes, Bacteroides, Lactobacillus, unidentified_Lachnospiraceae, unidentified_Ruminococcaceae, Alloprevotella, unidentified_Cyanobacteria, Bacillus, Stenotrophomonas and Acinetobacter decreased (P<0.05). Conclusion The diversity of gut microbiota in low birth weight preterm infants decreased and the structure of gut microbiota changed after antibiotic therapy. Targeted supplementation of probiotics or prebiotics may contribute to the recovery of gut microbial homeostasis.