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 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 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 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.
目的 探讨微量喂养对早产儿早期喂养不耐受喂养结局的影响。方法 选择我院2019年1月—2020年6月胎龄≤34周、出生后1周内反复出现喂养不耐受的早产儿78例,采用随机数字表法分为微量喂养组(38例)和中断喂养组(40例),比较两组患儿喂养不耐受的改善及喂养结局的差异性。结果 相对于直接中断喂养,微量喂养3~5天的患儿喂养不耐受改善率更高、体质量增长速度更快、更早达完全肠内喂养时间、静脉营养时间和住院时间也缩短了。而且胆汁淤积症发生率也低于中断喂养组,差异具有统计学意义,两组坏死性小肠结肠炎发生率比较无差异。结论 对于胎龄≤34周、生后1周内反复出现喂养不耐受的早产儿,在排除了外科或败血症早期表现的情况下,相对于中断喂养,选择微量喂养可改善患儿的喂养结局,而且不会增加坏死性小肠结肠炎的发生。
Objective To investigate the effect of minimal feeding on the outcome of early feeding intolerance in premature infants. Methods Seventy-eight premature infants with gestational age<34 weeks and recurrent feeding intolerance within 1 week after birth in our hospital from January 2019 to June 2020 were selected. They were randomly divided into minimal feeding group (38 cases) and interrupted feeding group (40 cases) to compare the improvement of feeding intolerance and the difference of feeding outcome between the two groups. Results Compared with discontinuation of feeding, the rates of feeding intolerance improvement were higher in children who were given minimal feeding for 3-5 days,and they had faster weight gainand, the time to complete enteral feeding got earlier, intravenous nutrition time and hospitalization time were also shortened. Moreover, the incidence of cholestasis was also lower than that of the interrupted feeding group, and the difference was statistically significant. There was no difference in the incidence of necrotizing enterocolitis between the two groups. Conclusion For premature infants with gestational age<34 weeks and feeding intolerance happened within 1 week after birth, excluding the early manifestation of surgery or sepsis, minimal feeding can improve the feeding outcome of the infants compared with discontinuation of feeding, without increasing the incidence of necrotizing enterocolitis.
目的 评估湿化高流量鼻导管通气治疗早产儿呼吸暂停的效果。方法 选取2014年1月—2016年1月在我院新生儿科住院并诊断为呼吸暂停的早产儿64例,随机分为HHFNC组和NCPAP组各32例,2组在氨茶碱治疗失败后分别采用HHFNC和NCPAP 2种无创辅助呼吸支持。观察2组的治疗效果、无创通气时间、总用氧时间、1周内置管率及不良反应发生率。结果 HHFNC组和NCPAP组治疗早产儿呼吸暂停的有效率分别为90%和86%,差异无统计学意义(P>0.05);2组在无创通气时间、总用氧时间及1周内置管率方面比较无统计学差异(P>0.05);HHFNC组鼻损伤、喂养不耐受发生率低于NCPAP组,差异有统计学意义(P<0.05),NEC和ROP发生率比较无统计学意义(P>0.05)。结论 HHFNC治疗早产儿呼吸暂停的效果与NCPAP相仿,HHFNC可降低早产儿鼻损伤、喂养不耐受发生率,而且并未增加NEC和ROP发生率,临床更适用于早产儿呼吸暂停。
目的 探讨晚期早产儿中小于胎龄儿(SGA)与适于胎龄儿(AGA)出生时的铁代谢状态。方法 选取2020年1—12月合肥市妇幼保健院收治的150例晚期早产儿(胎龄34~36+6周)作为研究对象。按照出生体质量和胎龄将早产儿分为SGA组(36例)和AGA组(114例),分析比较两组早产儿出生时的铁代谢状态,并应用多因素线性回归分析血清铁的影响因素。结果 与AGA组相比,SGA婴儿的更低的血清铁[14.5 μmol /L (11.4,17.1) vs 16.4 μmol /L(14.1,18.4),P=0.004]、更低的血清铁蛋白[135.6 μg/L(101.8,176.2) vs 172.5 μg/L(123.0,218.3),P=0.009]和更低的总铁结合力[30.4 μmol/L(26.8,34.9)vs 35.4 μmol/L(29.5,44.6),P=0.001]。两组早产儿的血红蛋白、平均红细胞体积、平均红细胞血红蛋白含量和平均红细胞血红蛋白浓度比较差异均无统计学意义(P>0.05)。在早产儿围生期特征中,胎盘异常(β= –1.949,P=0.009)和母亲糖尿病的发生(β= –2.324,P=0.001)与血清铁水平呈负相关。结论 与早产AGA相比,早产SGA铁储备水平较低,适量补充铁元素对小于胎龄新生儿身体发育有促进作用。
Objective To explore the iron metabolism status in late preterm infants who are small for gestational age(SGA)compared to those appropriate for gestational age(AGA)at birth.Methods A total of 150 late preterm infants(gestational age 34 to 36+6 weeks)admitted to the Maternal and Child Health Hospital of Hefei from January to December 2020 were selected as the study subjects.The preterm infants were divided into the SGA group(36 cases)and the AGA group(114 cases)according to birth weight and gestational age.The iron metabolism status at birth was analyzed and compared between the two groups of preterm infants,and multiple linear regression analysis was applied to identify the influencing factors of serum iron.Results Compared with the AGA group,SGA infants had lower serum iron(14.5[11.4,17.1] vs 16.4 [14.1,18.4],P=0.004),lower serum iron protein(135.6[101.8,176.2] vs 172.5[123.0,218.3],P=0.009),and lower total iron binding capacity(30.4[26.8,34.9] vs35.4[29.5,44.6]P=0.001).There were no statistically significant differences in hemoglobin,mean corpuscular volume,mean corpuscular hemoglobin,and mean corpuscular hemoglobin concentration between the two groups of preterm infants(P>0.05).Among the perinatal characteristics of preterm infants,placental abnormalities(β= –1.949,P=0.009)and the occurrence of maternal diabetes(β= –2.324,P=0.001)were significantly negatively correlated with serum iron levels.Conclusions Compared with preterm infants appropriate for gestational age,preterm infants who are small for gestational age have lower iron reserves at birth.Adequate supplementation of iron has a promoting effect on the physical development of small for gestational age newborns.
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.