Objective:To investigate predictors of caring behaviors of mothers of premature infants based on the health belief model.Methods:This cross-sectional study was conducted by using the structural equation modeling on 16...Objective:To investigate predictors of caring behaviors of mothers of premature infants based on the health belief model.Methods:This cross-sectional study was conducted by using the structural equation modeling on 168 mothers of premature infants,who were selected by convenience sampling method from October 2017 to February 2018 in Iran.Data were collected by using a standard scale.Validity and reliability of all data collection tools were approved.Data were analyzed by using SPSS V.16 and Mplus6 software.Results:The structural equation modeling of the initial health belief model did not have a good fit,but the fitness of model 2 obtaining from the modified initial model was confirmed by changes in locations of constructs.None of constructs of model 2 had a significant positive association with the caring behavior of mothers of premature infants and only 2.8%of variance of caring behaviors in mothers could be predicted by the sum of variables of demographic characteristics and the modified health belief model constructs.Conclusions:Given that the findings do not approve the use of the health belief model in predicting determinants of caring behavior of mothers of premature infants,it is suggested to apply this model to investigate the effect of educational intervention based on the health belief model on the caring behavior of mothers.展开更多
Background: Preterm birth is common in Morocco and it’s around 8%. Several management rules of taking care of preterm infants have been developed but have not been put into action. The geo-graphical inaccessibility t...Background: Preterm birth is common in Morocco and it’s around 8%. Several management rules of taking care of preterm infants have been developed but have not been put into action. The geo-graphical inaccessibility to specialized hospitals and the weakness of the reception capacity of the care centers hinder the management of the complications associated with preterm birth. Purpose: The present study is designed to present some epidemiological data of preterm births within the Provincial Hospital Center of Missour during 2012 and to discuss the various problems emerging in the management of treatment and care. Materials and Methods: Retrospective study of preterm births in the maternity ward in the Hospital of Missour during 2012. Results: 37 preterm births among 1121 (3.3%) have been analyzed (51.3% severe premature infants, 45.9% late preterm infants and 2.7% extremely premature infants). 64.2% are originally from difficult areas to reach during winter. All mothers have received upon arrival at the maternity a corticosteroid and calcium antagonists (Adalate*) and an antibiotic treatment to those with a positive infectious anamnesis found in half of the women. We have recorded 3 twin pregnancies and 2 gravidic toxemias. Only 21 babies have been given back to their mothers (namely 56.7%). 5 premature infants (namely 13%) have been referred to the university hospital center of Fez (2 respiratory distress, a malformation and 2 severe premature births) given that there is an absence of a specialized care unit at the hospital, knowing that no baby has received neither surfactant nor caffeine at birth. 14 premature babies (namely 37.8%) have been transferred to the pediatric unit with a total death rate of 16.2% (6 premature) mainly related to neonatal infection and to suffering of the hyaline membranes disease. Conclusion: We emphasize the interest of prevention programs which demand an early diagnosis of preterm birth threats and monitoring high-risk pregnancies, improving the medical care given to low-weight premature by creating “Kangaroo” units at a regional level and the targeting of measures for rural and under-covered areas.展开更多
Background The cardiovascular characteristics during septic shock in premature neonates are characterized by elevated ventricular output and normal ejection fraction.However,there is little knowledge about other varia...Background The cardiovascular characteristics during septic shock in premature neonates are characterized by elevated ventricular output and normal ejection fraction.However,there is little knowledge about other variables in premature infants with Klebsiella Pneumoniae(KPN)septicemia and shock.This study aimed to investigate the characteristics of cardiovascular changes in premature infants diagnosed with Klebsiella pneumonia(KPN)septicemia and shock.Methods Our study included premature infants(gestational age≤34 weeks)in the neonatal intensive care unit(NICU)of Guangdong Provincial People.s Hospital from November 1 st,2013 to November 31 st,2016.17 participants diagnosed with KPN septicemia complicated with shock and 17 healthy premature infants were respectively enrolled in study group and control group for analysis.All the infants underwent non-invasive ultrasound cardiac output monitor examinations in normal time,early stage of shock and cured time.Results Compared with the control group,higher values of heart rate(HR)(P<0.001),cardiac output index(CI)(P<0.001),Smith-Madigan inotropy index(SMII)(P<0.001)and oxygen delivery(DO2)(P<0.001),and lower levels of systemic vascular resistance index(SVRI)(P<0.001)were observed in the study group.The difference of mean blood pressure(MBP)was not statistically significant(P=0.943).In the study group,the values of HR(P=0.004),CI(P=0.004),SMII(P=0.004)and DO2(P=0.004)in the early stage of septic shock were significantly higher when compared with the values in the normal time,while the value of SVRI(P<0.001)was significantly lower.HR(P<0.001)and DO2(P=0.009)decreased from the early stage of septic shock to the cured time,while SVRI(P<0.001)increased.There were no significant changes in CI(P>0.999)and SMII(P=0.646)from early stage of septic shock to improvement in the study group.Conclusions Systemic vascular resistance index decreased and oxygen deliver elevated in preterm infants with gestational age less than 34 weeks with Klebsiella Pneumoniae septicemia and shock.Vasoregulatory failure may be the main cause of Klebsiella Pneumoniae septicemia and shock.Vasoactive drugs may be needed during shock.The increase of oxygen deliver level in the early stage of shock indicates that timely and effective vasoactive infusion can prevent the deterioration of the disease.展开更多
Objectives Growth retardation is a risk for premature infants.In addition to demographic and perinatal factors,preterm infants’physical growth may be affected by neonatal intensive care unit(NICU)stress,maternal post...Objectives Growth retardation is a risk for premature infants.In addition to demographic and perinatal factors,preterm infants’physical growth may be affected by neonatal intensive care unit(NICU)stress,maternal postpartum depression,and mother-infant interaction.This study aimed to investigate the trajectories of physical growth in 4 months corrected age among preterm infants discharged from the NICU and the impactors on these trajectories.Methods A prospective study was conducted among 318 preterm infants from September 2019 to April 2021 in Shanghai,China.Latent growth modeling was applied to identify the weight,length,and head circumference growth trajectories in 4 months corrected age and explore the effects of demographic and medical characteristics,infant stress during NICU stay,maternal postpartum depression,and mother-infant interaction on each trajectory.Results Unconditional latent growth models showed curve trajectories with increasingly slower growth in weight,length,and head circumference until 4 months of corrected age.Conditional latent growth models showed that a longer length of stay in the NICU and more skin punctures were negatively associated with weight at 40 weeks corrected gestational age(β=−0.43 and−0.19,respectively,P<0.05).The maternal postpartum depression between 40 weeks corrected gestational age and 1 month corrected postnatal age was associated with a lower growth rate of length(β=−0.17,P=0.040),while between 2 and 3 months corrected postnatal age,there were lower growth rates of weight and head circumference(β=−0.15 and−0.19,respectively,P<0.05).The mother-infant interaction scores between 40 weeks corrected gestational age and 1 month corrected postnatal age negatively predicted the growth rate of weight(β=−0.19,P=0.020).Conclusion The physical growth trajectories of preterm infants discharged from the NICU were influenced by infant stress during the NICU stay,maternal postpartum depression and mother-infant interaction.展开更多
To investigate the role of nitric oxide (NO) in hyperoxic lung injury, the 3 day old preterm rats were randomly assigned to four groups: group I (hyperoxia group), group Ⅱ (hyperoxia+N w nitro L arginine methyl ester...To investigate the role of nitric oxide (NO) in hyperoxic lung injury, the 3 day old preterm rats were randomly assigned to four groups: group I (hyperoxia group), group Ⅱ (hyperoxia+N w nitro L arginine methyl ester (L NAME) group), group Ⅲ (air group), and group Ⅳ (air+L NAME) group. Group Ⅰ and Ⅱ were exposed to ≥90 % O 2 for 3 or 7 days. Group Ⅱ and Ⅳ received subcutaneous L NAMEy on daily basis (20 mg/kg). After 3 day or 7 day exposure, the lung wet weight/dry weight ratio (W/D), total protein and malondialdehyde (MDA) in bronchoalveolar lavage fluid (BALF) and lung pathology were examined in all groups. NO content, expression of endothelial NOS (eNOS) and inducible NOS (iNOS) in lungs were measured in group Ⅰ and Ⅲ. Our results showed that after 3 day exposure, group Ⅰ appeared acute lung injury characterized by the increase of MDA content ( P <0.01) and the presence of hyperaemia, red cell extravasation and inflammatory infiltration; after 7 day exposure, except MDA, total protein and W/D were also increased in comparison with group Ⅲ ( P <0.01, 0.05), pathological changes were more severe than those after 3 day exposure. After 3 and 7 day exposure, total protein in group Ⅱ was significantly increased as compared with group Ⅰ ( P <0.01 for both). The pulmonary acute inflammatory changes were more obvious in group Ⅱ than in group Ⅰ. Occasionally, mild hemorrhage was detected in the lungs of group Ⅳ. BALF protein content in group IV was higher than that in group Ⅲ after 7 day exposure ( P <0.01). After 3 and 7 day exposure, NO content in BALF were all significantly elevated in group Ⅰ as compared with group Ⅲ ( P <0.01 for all). In the lungs of group Ⅰ, strong immunostaining for iNOS was observed in airway and alveolar epithelia, inflammatory cells, which were stronger than those in group Ⅲ. Expression of iNOS in rats after 7 day hyperoxic exposure was stronger than that after 3 day exposure. Shortly after 7 day exposure, stronger immunostaining for eNOS in airway epithelia in group Ⅰ than that in group Ⅲ was seen. Our study suggested that treatment with L NAME worsened acute hyperoxic lung injury in preterm rats and also had a deleterious effect on the rats exposed to air, indicating that endogenous nitric oxide may play a protective role in rats under both physiological and hyperoxic status. Hyperoxia can significantly upregulate the expression of iNOS and eNOS in inflammatory cells, epithelia in the lungs of preterm rats, promote NO generation, which suggests that endogenous NO may mediate the hyperoxic pulmonary damage. Over stimulation of iNOS may contribute to the pathogenesis of hyperoxic lung injury. NO may have dual roles in pulmonary oxygen toxicity.展开更多
<strong>Background:</strong> Breast milk is the best source of nutrition for premature infants and a “good medicine” for disease treatment. However, the rate of exclusive breastfeeding of premature infan...<strong>Background:</strong> Breast milk is the best source of nutrition for premature infants and a “good medicine” for disease treatment. However, the rate of exclusive breastfeeding of premature infants in China still needs to be improved at present, and the factors affecting breastfeeding are different in different places. <strong>Objective:</strong> To investigate the current status and influencing factors of preterm infants breastfeeding in Jingzhou 3A hospitals. <strong>Methods:</strong> A cross-sectional study was conducted to collect breastfeeding information of premature infants in neonatal intensive care unit (NICU) from May to August in 2019 in Jingzhou 3A Hospital, and 152 premature infants’ related information were collected. A questionnaire survey was conducted among the mothers who failed to breastfeed. <strong>Results: </strong>The rate of exclusive breastfeeding among premature infants in NICU was 9.87%. The rates of first breastfeeding and exclusive breastfeeding at discharge were 13.16% and 32.89% respectively. Not producing enough milk and knowing the right way to pump breast milk contributed a lot to the failure of exclusive breastfeeding. <strong>Conclusion: </strong>More attention should be paid to the health education and management to improve the rate of breastfeeding in NICU.展开更多
Background Globally,are skincare practices and skin injuries in extremely preterm infants comparable?This study describes skin injuries,variation in skincare practices and investigates any association between them.Met...Background Globally,are skincare practices and skin injuries in extremely preterm infants comparable?This study describes skin injuries,variation in skincare practices and investigates any association between them.Methods A web-based survey was conducted between February 2019 and August 2021.Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes.The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions.Results Responses from 848 neonatal intensive care units,representing all geographic regions and income status groups were received.Diaper dermatitis(331/840,39%)and medical adhesive-related skin injuries(319/838,38%)were the most common injuries.Following a local skincare guideline reduced skin injuries[medical adhesive-related injuries:adjusted odds ratios(aOR)=0.63,95%confidence interval(CI)=0.45–0.88;perineal injuries:aOR=0.66,95%CI=0.45–0.96;local skin infections:OR=0.41,95%CI=0.26–0.65;chemical burns:OR=0.46,95%CI=0.26–0.83;thermal burns:OR=0.51,95%CI=0.27–0.96].Performing skin assessments at least every four hours reduced skin injuries(abrasion:aOR=0.48,95%CI=0.33–0.67;pressure:aOR=0.51,95%CI=0.34–0.78;diaper dermatitis:aOR=0.71,95%CI=0.51–0.99;perineal:aOR=0.52,95%CI=0.36–0.75).Regional and resource settings-based variations in skin injuries and skincare practices were observed.Conclusions Skin injuries were common in extremely preterm infants.Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries.Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations.展开更多
Dear Editor,Iam Dr.Tian Tian,from the Department of Ophthalmology,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China.I write to present a rare case report of a delayed diagn...Dear Editor,Iam Dr.Tian Tian,from the Department of Ophthalmology,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China.I write to present a rare case report of a delayed diagnosis of unsuspected retinoblastoma(RB)in an in vitro fertilisation(IVF)infant with retinopathy of prematurity.The simultaneous presentation of RB and prematurity of retinopathy(ROP)in an IVF infant is very rare.The relationship between RB and IVF is still indeterminate and mechanisms that lead to ocular or systemic展开更多
BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopt...BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.展开更多
Background Late preterm and early term infants are at increased risk of poor growth,behavioral problems,and developmental delays.This study aimed to investigate the impact of maternal and infant characteristics,feedin...Background Late preterm and early term infants are at increased risk of poor growth,behavioral problems,and developmental delays.This study aimed to investigate the impact of maternal and infant characteristics,feeding practices,and breastmilk composition on infant behavior following late preterm and early term delivery,and to evaluate the association between infant behavior and growth.Methods Data from 52 Chinese mothers and their late preterm/early term infants participating in the Breastfeed a Better Youngster study were used.Maternal and infant characteristics were collected using questionnaires at 1 week postpartum.Breastmilk macronutrient content was measured using a human milk analyzer,and infant behavior was assessed using a 3-day infant behavior diary at 8 weeks postpartum.Feeding practices were collected at both time points using questionnaires.Multivariate models were used to assess associations between potential predictors and infant behavior and between infant behavior and growth.Results Exclusive breastfeeding was associated with greater sleep duration(P=0.02)and shorter crying duration(P=0.01).Mothers with a vocational education reported greater distress duration(P=0.006).Greater colic duration was associated with higher maternal annual income(P=0.004).There was no significant association between infant behavior and growth(all P>0.05).Conclusions Exclusive breastfeeding might promote more favorable infant behaviors in late preterm/early term infants,while the development of infant distress behaviors was associated with some maternal characteristics(maternal education and annual income).However,due to the limitations of diary methods,determinants of infant behavior should ideally be assessed using more objective measures in larger samples.展开更多
Objective:To observe the clinical efficacy of Yinzhihuang Oral Liquid(YOL,茵栀黄口服液)to prevent the premature infantile jaundice.Methods:After excluded hemolytic,suffocation,infection,and the very low birth weight,2...Objective:To observe the clinical efficacy of Yinzhihuang Oral Liquid(YOL,茵栀黄口服液)to prevent the premature infantile jaundice.Methods:After excluded hemolytic,suffocation,infection,and the very low birth weight,242 cases of premature infants were randomly assigned to two groups,the treatment group and the control group.Both groups were taken conventional procedures,such as warmth,feeding,and blood glucose monitoring,and the treated group was administered YOL 5 mL each time,twice daily additionally,and the...展开更多
Cardiovascular variables,including stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index,are common indexes to monitor critical patients in intensive care unit(IC...Cardiovascular variables,including stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index,are common indexes to monitor critical patients in intensive care unit(ICU).A decrease in CO>50%compared with the initial measurement is associated with mortality in preterm neonates with sepsis.But the diagnostic value of these indexes on infected premature infants were less understood before.This study was aimed to evaluate the diagnostic values on infection of premature infants.Methods This was a prospective observational study that included 22 early preterm neonates with proven infection and 16 controls with possible infection.These preterm infants were admitted to neonatal intensive care unit(NICU)from November 2015 to December 2016.Stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index were measured both in healthy time and early stage of proven or possible infection.Clinical characteristics and laboratory data were collected.Results Compared with controls,the change of stroke volume index(△SVI)(P=0.001,95%CI:-2.506 to-0.691),the change of cardiac output index(△CI)(P<0.001,95%CI:-0.537 to-0.202),the change of Smith-Madigan inotropy index(△SMII)(P=0.002,95%CI:-0.113 to-0.027)and the change of systemic vascular resistance index(△SVRI)(P=0.002,95%CI:61.186 to 264.756)were more obvious among preterm infants with infection.△CI had an area under the receiver operating characteristic(ROC)curve of 0.722(P<0.001,95%CI:0.628 to 0.816)for differentiating infected infants from controls.Above a cutoff level of 0.313 L/(min·m^(-2)),△CI had a sensitivity of 66.7%and a specificity of 77.1%.The participants were divided into high△CI group[>0.313 L/(min·m^(-2))]and normal△CI group[≤0.313 L/(min·m^(-2))]according to the cut-off value.Compared with the normal△CI level group,higher stroke volume index(P<0.001,95%CI:1.647 to 3.294),Smith-Madigan inotropy index(P<0.001,95%CI:0.025 to0.110)as well as lower levels of systemic vascular resistance index(P=0.002,95%CI:-396.834 to-221.444)were observed in the high△CI group.Binary logistic regression demonstrated that premature patients with higher increase of CI were associated with the infection(OR:3.080,P=0.026).Conclusions CI,SVI,SVRI and SMII changed obviously in the preterm infants of less than 34 weeks gestation with infection.The increased CI was associated with the infection of preterm patients.CI was expected to be an independent prognostic predictor of infection for preterm infants.展开更多
文摘Objective:To investigate predictors of caring behaviors of mothers of premature infants based on the health belief model.Methods:This cross-sectional study was conducted by using the structural equation modeling on 168 mothers of premature infants,who were selected by convenience sampling method from October 2017 to February 2018 in Iran.Data were collected by using a standard scale.Validity and reliability of all data collection tools were approved.Data were analyzed by using SPSS V.16 and Mplus6 software.Results:The structural equation modeling of the initial health belief model did not have a good fit,but the fitness of model 2 obtaining from the modified initial model was confirmed by changes in locations of constructs.None of constructs of model 2 had a significant positive association with the caring behavior of mothers of premature infants and only 2.8%of variance of caring behaviors in mothers could be predicted by the sum of variables of demographic characteristics and the modified health belief model constructs.Conclusions:Given that the findings do not approve the use of the health belief model in predicting determinants of caring behavior of mothers of premature infants,it is suggested to apply this model to investigate the effect of educational intervention based on the health belief model on the caring behavior of mothers.
文摘Background: Preterm birth is common in Morocco and it’s around 8%. Several management rules of taking care of preterm infants have been developed but have not been put into action. The geo-graphical inaccessibility to specialized hospitals and the weakness of the reception capacity of the care centers hinder the management of the complications associated with preterm birth. Purpose: The present study is designed to present some epidemiological data of preterm births within the Provincial Hospital Center of Missour during 2012 and to discuss the various problems emerging in the management of treatment and care. Materials and Methods: Retrospective study of preterm births in the maternity ward in the Hospital of Missour during 2012. Results: 37 preterm births among 1121 (3.3%) have been analyzed (51.3% severe premature infants, 45.9% late preterm infants and 2.7% extremely premature infants). 64.2% are originally from difficult areas to reach during winter. All mothers have received upon arrival at the maternity a corticosteroid and calcium antagonists (Adalate*) and an antibiotic treatment to those with a positive infectious anamnesis found in half of the women. We have recorded 3 twin pregnancies and 2 gravidic toxemias. Only 21 babies have been given back to their mothers (namely 56.7%). 5 premature infants (namely 13%) have been referred to the university hospital center of Fez (2 respiratory distress, a malformation and 2 severe premature births) given that there is an absence of a specialized care unit at the hospital, knowing that no baby has received neither surfactant nor caffeine at birth. 14 premature babies (namely 37.8%) have been transferred to the pediatric unit with a total death rate of 16.2% (6 premature) mainly related to neonatal infection and to suffering of the hyaline membranes disease. Conclusion: We emphasize the interest of prevention programs which demand an early diagnosis of preterm birth threats and monitoring high-risk pregnancies, improving the medical care given to low-weight premature by creating “Kangaroo” units at a regional level and the targeting of measures for rural and under-covered areas.
基金supported by National key Program(No.2018 YFC1002600)Guangdong Medical Research Foundation(No.A2016177)。
文摘Background The cardiovascular characteristics during septic shock in premature neonates are characterized by elevated ventricular output and normal ejection fraction.However,there is little knowledge about other variables in premature infants with Klebsiella Pneumoniae(KPN)septicemia and shock.This study aimed to investigate the characteristics of cardiovascular changes in premature infants diagnosed with Klebsiella pneumonia(KPN)septicemia and shock.Methods Our study included premature infants(gestational age≤34 weeks)in the neonatal intensive care unit(NICU)of Guangdong Provincial People.s Hospital from November 1 st,2013 to November 31 st,2016.17 participants diagnosed with KPN septicemia complicated with shock and 17 healthy premature infants were respectively enrolled in study group and control group for analysis.All the infants underwent non-invasive ultrasound cardiac output monitor examinations in normal time,early stage of shock and cured time.Results Compared with the control group,higher values of heart rate(HR)(P<0.001),cardiac output index(CI)(P<0.001),Smith-Madigan inotropy index(SMII)(P<0.001)and oxygen delivery(DO2)(P<0.001),and lower levels of systemic vascular resistance index(SVRI)(P<0.001)were observed in the study group.The difference of mean blood pressure(MBP)was not statistically significant(P=0.943).In the study group,the values of HR(P=0.004),CI(P=0.004),SMII(P=0.004)and DO2(P=0.004)in the early stage of septic shock were significantly higher when compared with the values in the normal time,while the value of SVRI(P<0.001)was significantly lower.HR(P<0.001)and DO2(P=0.009)decreased from the early stage of septic shock to the cured time,while SVRI(P<0.001)increased.There were no significant changes in CI(P>0.999)and SMII(P=0.646)from early stage of septic shock to improvement in the study group.Conclusions Systemic vascular resistance index decreased and oxygen deliver elevated in preterm infants with gestational age less than 34 weeks with Klebsiella Pneumoniae septicemia and shock.Vasoregulatory failure may be the main cause of Klebsiella Pneumoniae septicemia and shock.Vasoactive drugs may be needed during shock.The increase of oxygen deliver level in the early stage of shock indicates that timely and effective vasoactive infusion can prevent the deterioration of the disease.
文摘Objectives Growth retardation is a risk for premature infants.In addition to demographic and perinatal factors,preterm infants’physical growth may be affected by neonatal intensive care unit(NICU)stress,maternal postpartum depression,and mother-infant interaction.This study aimed to investigate the trajectories of physical growth in 4 months corrected age among preterm infants discharged from the NICU and the impactors on these trajectories.Methods A prospective study was conducted among 318 preterm infants from September 2019 to April 2021 in Shanghai,China.Latent growth modeling was applied to identify the weight,length,and head circumference growth trajectories in 4 months corrected age and explore the effects of demographic and medical characteristics,infant stress during NICU stay,maternal postpartum depression,and mother-infant interaction on each trajectory.Results Unconditional latent growth models showed curve trajectories with increasingly slower growth in weight,length,and head circumference until 4 months of corrected age.Conditional latent growth models showed that a longer length of stay in the NICU and more skin punctures were negatively associated with weight at 40 weeks corrected gestational age(β=−0.43 and−0.19,respectively,P<0.05).The maternal postpartum depression between 40 weeks corrected gestational age and 1 month corrected postnatal age was associated with a lower growth rate of length(β=−0.17,P=0.040),while between 2 and 3 months corrected postnatal age,there were lower growth rates of weight and head circumference(β=−0.15 and−0.19,respectively,P<0.05).The mother-infant interaction scores between 40 weeks corrected gestational age and 1 month corrected postnatal age negatively predicted the growth rate of weight(β=−0.19,P=0.020).Conclusion The physical growth trajectories of preterm infants discharged from the NICU were influenced by infant stress during the NICU stay,maternal postpartum depression and mother-infant interaction.
基金Hubei Science and Technology Department Foundation (No:2 0 0 0 2 P16 )
文摘To investigate the role of nitric oxide (NO) in hyperoxic lung injury, the 3 day old preterm rats were randomly assigned to four groups: group I (hyperoxia group), group Ⅱ (hyperoxia+N w nitro L arginine methyl ester (L NAME) group), group Ⅲ (air group), and group Ⅳ (air+L NAME) group. Group Ⅰ and Ⅱ were exposed to ≥90 % O 2 for 3 or 7 days. Group Ⅱ and Ⅳ received subcutaneous L NAMEy on daily basis (20 mg/kg). After 3 day or 7 day exposure, the lung wet weight/dry weight ratio (W/D), total protein and malondialdehyde (MDA) in bronchoalveolar lavage fluid (BALF) and lung pathology were examined in all groups. NO content, expression of endothelial NOS (eNOS) and inducible NOS (iNOS) in lungs were measured in group Ⅰ and Ⅲ. Our results showed that after 3 day exposure, group Ⅰ appeared acute lung injury characterized by the increase of MDA content ( P <0.01) and the presence of hyperaemia, red cell extravasation and inflammatory infiltration; after 7 day exposure, except MDA, total protein and W/D were also increased in comparison with group Ⅲ ( P <0.01, 0.05), pathological changes were more severe than those after 3 day exposure. After 3 and 7 day exposure, total protein in group Ⅱ was significantly increased as compared with group Ⅰ ( P <0.01 for both). The pulmonary acute inflammatory changes were more obvious in group Ⅱ than in group Ⅰ. Occasionally, mild hemorrhage was detected in the lungs of group Ⅳ. BALF protein content in group IV was higher than that in group Ⅲ after 7 day exposure ( P <0.01). After 3 and 7 day exposure, NO content in BALF were all significantly elevated in group Ⅰ as compared with group Ⅲ ( P <0.01 for all). In the lungs of group Ⅰ, strong immunostaining for iNOS was observed in airway and alveolar epithelia, inflammatory cells, which were stronger than those in group Ⅲ. Expression of iNOS in rats after 7 day hyperoxic exposure was stronger than that after 3 day exposure. Shortly after 7 day exposure, stronger immunostaining for eNOS in airway epithelia in group Ⅰ than that in group Ⅲ was seen. Our study suggested that treatment with L NAME worsened acute hyperoxic lung injury in preterm rats and also had a deleterious effect on the rats exposed to air, indicating that endogenous nitric oxide may play a protective role in rats under both physiological and hyperoxic status. Hyperoxia can significantly upregulate the expression of iNOS and eNOS in inflammatory cells, epithelia in the lungs of preterm rats, promote NO generation, which suggests that endogenous NO may mediate the hyperoxic pulmonary damage. Over stimulation of iNOS may contribute to the pathogenesis of hyperoxic lung injury. NO may have dual roles in pulmonary oxygen toxicity.
文摘<strong>Background:</strong> Breast milk is the best source of nutrition for premature infants and a “good medicine” for disease treatment. However, the rate of exclusive breastfeeding of premature infants in China still needs to be improved at present, and the factors affecting breastfeeding are different in different places. <strong>Objective:</strong> To investigate the current status and influencing factors of preterm infants breastfeeding in Jingzhou 3A hospitals. <strong>Methods:</strong> A cross-sectional study was conducted to collect breastfeeding information of premature infants in neonatal intensive care unit (NICU) from May to August in 2019 in Jingzhou 3A Hospital, and 152 premature infants’ related information were collected. A questionnaire survey was conducted among the mothers who failed to breastfeed. <strong>Results: </strong>The rate of exclusive breastfeeding among premature infants in NICU was 9.87%. The rates of first breastfeeding and exclusive breastfeeding at discharge were 13.16% and 32.89% respectively. Not producing enough milk and knowing the right way to pump breast milk contributed a lot to the failure of exclusive breastfeeding. <strong>Conclusion: </strong>More attention should be paid to the health education and management to improve the rate of breastfeeding in NICU.
文摘Background Globally,are skincare practices and skin injuries in extremely preterm infants comparable?This study describes skin injuries,variation in skincare practices and investigates any association between them.Methods A web-based survey was conducted between February 2019 and August 2021.Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes.The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions.Results Responses from 848 neonatal intensive care units,representing all geographic regions and income status groups were received.Diaper dermatitis(331/840,39%)and medical adhesive-related skin injuries(319/838,38%)were the most common injuries.Following a local skincare guideline reduced skin injuries[medical adhesive-related injuries:adjusted odds ratios(aOR)=0.63,95%confidence interval(CI)=0.45–0.88;perineal injuries:aOR=0.66,95%CI=0.45–0.96;local skin infections:OR=0.41,95%CI=0.26–0.65;chemical burns:OR=0.46,95%CI=0.26–0.83;thermal burns:OR=0.51,95%CI=0.27–0.96].Performing skin assessments at least every four hours reduced skin injuries(abrasion:aOR=0.48,95%CI=0.33–0.67;pressure:aOR=0.51,95%CI=0.34–0.78;diaper dermatitis:aOR=0.71,95%CI=0.51–0.99;perineal:aOR=0.52,95%CI=0.36–0.75).Regional and resource settings-based variations in skin injuries and skincare practices were observed.Conclusions Skin injuries were common in extremely preterm infants.Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries.Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations.
文摘Dear Editor,Iam Dr.Tian Tian,from the Department of Ophthalmology,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China.I write to present a rare case report of a delayed diagnosis of unsuspected retinoblastoma(RB)in an in vitro fertilisation(IVF)infant with retinopathy of prematurity.The simultaneous presentation of RB and prematurity of retinopathy(ROP)in an IVF infant is very rare.The relationship between RB and IVF is still indeterminate and mechanisms that lead to ocular or systemic
基金Supported by Zhejiang Province Medical Science and Technology Foundation of China,No.2021PY057.
文摘BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.
基金The research was conducted as part of a PhD and expenses were covered from the research group’s funds.
文摘Background Late preterm and early term infants are at increased risk of poor growth,behavioral problems,and developmental delays.This study aimed to investigate the impact of maternal and infant characteristics,feeding practices,and breastmilk composition on infant behavior following late preterm and early term delivery,and to evaluate the association between infant behavior and growth.Methods Data from 52 Chinese mothers and their late preterm/early term infants participating in the Breastfeed a Better Youngster study were used.Maternal and infant characteristics were collected using questionnaires at 1 week postpartum.Breastmilk macronutrient content was measured using a human milk analyzer,and infant behavior was assessed using a 3-day infant behavior diary at 8 weeks postpartum.Feeding practices were collected at both time points using questionnaires.Multivariate models were used to assess associations between potential predictors and infant behavior and between infant behavior and growth.Results Exclusive breastfeeding was associated with greater sleep duration(P=0.02)and shorter crying duration(P=0.01).Mothers with a vocational education reported greater distress duration(P=0.006).Greater colic duration was associated with higher maternal annual income(P=0.004).There was no significant association between infant behavior and growth(all P>0.05).Conclusions Exclusive breastfeeding might promote more favorable infant behaviors in late preterm/early term infants,while the development of infant distress behaviors was associated with some maternal characteristics(maternal education and annual income).However,due to the limitations of diary methods,determinants of infant behavior should ideally be assessed using more objective measures in larger samples.
文摘Objective:To observe the clinical efficacy of Yinzhihuang Oral Liquid(YOL,茵栀黄口服液)to prevent the premature infantile jaundice.Methods:After excluded hemolytic,suffocation,infection,and the very low birth weight,242 cases of premature infants were randomly assigned to two groups,the treatment group and the control group.Both groups were taken conventional procedures,such as warmth,feeding,and blood glucose monitoring,and the treated group was administered YOL 5 mL each time,twice daily additionally,and the...
基金supported by National key Program(No.2018YFC1002600)Guangdong Medical Research Foundation(No.A2016177)Guangdong Natural Science Foundation(No.2016A030313793)。
文摘Cardiovascular variables,including stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index,are common indexes to monitor critical patients in intensive care unit(ICU).A decrease in CO>50%compared with the initial measurement is associated with mortality in preterm neonates with sepsis.But the diagnostic value of these indexes on infected premature infants were less understood before.This study was aimed to evaluate the diagnostic values on infection of premature infants.Methods This was a prospective observational study that included 22 early preterm neonates with proven infection and 16 controls with possible infection.These preterm infants were admitted to neonatal intensive care unit(NICU)from November 2015 to December 2016.Stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index were measured both in healthy time and early stage of proven or possible infection.Clinical characteristics and laboratory data were collected.Results Compared with controls,the change of stroke volume index(△SVI)(P=0.001,95%CI:-2.506 to-0.691),the change of cardiac output index(△CI)(P<0.001,95%CI:-0.537 to-0.202),the change of Smith-Madigan inotropy index(△SMII)(P=0.002,95%CI:-0.113 to-0.027)and the change of systemic vascular resistance index(△SVRI)(P=0.002,95%CI:61.186 to 264.756)were more obvious among preterm infants with infection.△CI had an area under the receiver operating characteristic(ROC)curve of 0.722(P<0.001,95%CI:0.628 to 0.816)for differentiating infected infants from controls.Above a cutoff level of 0.313 L/(min·m^(-2)),△CI had a sensitivity of 66.7%and a specificity of 77.1%.The participants were divided into high△CI group[>0.313 L/(min·m^(-2))]and normal△CI group[≤0.313 L/(min·m^(-2))]according to the cut-off value.Compared with the normal△CI level group,higher stroke volume index(P<0.001,95%CI:1.647 to 3.294),Smith-Madigan inotropy index(P<0.001,95%CI:0.025 to0.110)as well as lower levels of systemic vascular resistance index(P=0.002,95%CI:-396.834 to-221.444)were observed in the high△CI group.Binary logistic regression demonstrated that premature patients with higher increase of CI were associated with the infection(OR:3.080,P=0.026).Conclusions CI,SVI,SVRI and SMII changed obviously in the preterm infants of less than 34 weeks gestation with infection.The increased CI was associated with the infection of preterm patients.CI was expected to be an independent prognostic predictor of infection for preterm infants.
