接近足月新生儿的研究进展

接近足月新生儿或称晚期早产儿(near-term infant or late preterm infant)是指胎龄在35～37周,更接近成熟足月的新生儿.在产科和儿科的临床工作中,接近足月新生儿往往被认为和足月新生儿无差异而被送回到母亲身边.但大量国外数据显示,接近足月新生儿和足月新生儿相比更容易出现一些临床问题.

393例晚期早产儿早产危险因素及并发症分析

晚期早产儿(Late preterm infant,LPI)是指胎龄满34周而未满37周的早产儿[1].晚期早产儿曾被称为近足月儿(Near-term infant),与足月新生儿相比,易发生多种围产期并发症,直接影响其存活率及生存质量.本文就2011年湖州市妇幼保健院出生的393例晚期早产儿早产危险因素及并发症进行回顾性分析,报告如下.

ObjectiveTo characterize recent trends of nosocomial infection (NI) among preterm infants admitted to Canadian Level 3 NICUs during 2008-2012, and its association with neonatal outcomes.MethodsA retrospective observational cohort study was performed including infants born <33 weeks gestational age and admitted to 24 NICU sites participating in the Canadian Neonatal NetworkTM during 2008-2012. NICU sites were classiifed into three groups according to their baseline NI rates in 2008 [Low NI group (≤14%), Medium NI group (14.1%-19%) and High NI group (>19% )], and NICU sites were also classiifed according to their NI trend during 2008-2012 (decreased, null and increased). Trends in NI were further examined for each baseline-NI group. Trends for a composite outcome indicating mortality or severe morbidities (intraventricular hemorrhage grades ≥3 or periventricular leukomalacia, retinopathy of prematurity stages ≥3, bronchopulmonary dysplasia or necrotizing enterocolitis stages ≥2) were examined for each baseline-NI and trend-NI NICU site groups using multivariable logistic regression analyses adjusted for potential confounders.ResultsBaseline high NI group showed signiifcantly decreased trends in NI rates, while for with medium or low baseline NI groups showed no signiifcant trends in NI rates. The composite outcome (mortality during NICU stay or any severe neonatal morbidity such as intraventricular hemorrhage grades 3-4, periventricular leukomalacia, retinopathy of prematurity stages 3-5, bronchopulmonary dysplasia and necrotizing enterocolitis stages 2-3) decreased signiifcantly for sites with decreased (OR=0.89, 95%CI=0.85-0.93) or null (OR=0.94, 95%CI=0.90-0.98) NI trends, but no significant trends in the composite outcome were detected for sites with increased NI rates.Conclusions The neonatal outcome is possibly influenced by NI rates and trend. The trend in the mortality and the risk of bronchopulmonary dysplasia, retinopathy of prematurity stage ≥3 and intraventricular hemorrhage >2 were signiifcantly decreased for sites with decreased NI trend, suggesting that these improved outcomes may be associated with effort to decrease NI rate.

早产儿生后两周内营养供应对青春期身体组成及血压的影响

目的 充足的营养对早产儿至关重要.关于早期营养及其对后期生长影响的纵向信息十分有限.本研究的目的是确定早产儿的早期能量和蛋白质供应对青春期身体组成和血压的影响.方法 本研究于2007～2008年对36例男性青少年(12.3±1.7岁)和25例女性青少年(11.5±1.8岁)进行了调查,他们系出生于1989年10月1日至1995年12月31日之间胎龄23～34周、出生体重＜1850 g的早产儿.根据其出生后两周内的营养模式(肠内与肠外)、能量供应(每日＜70千卡/kg与每日≥70千卡/kg)及蛋白质供应情况(每日超过2.5 g/kg ≥5 d与每日超过2.5 g/kg＜5 d),将调查对象分组,比较各组青春期身高、体重、血脂、血压等的差异.结果 在控制出生体重和生理成熟度的基础上,婴儿期能量摄入每天≥70千卡/kg的青少年身高(163 ±11 cm)和体重(58±16 kg)大于能量摄入每天＜70千卡/kg的青少年(身高156±11 cm,体重49± 16 kg),差异有统计学意义(P＜0.05)；两组间血压与体脂百分含量未见明显差异.结论 婴儿期较高的能量摄入与青春期的体格大小相关,但并不会构成不利的风险因素,如血压升高或体脂增加.

促进住院早产儿母乳喂养

围产医学不断发展的今天,无论发达国家的新生儿重症监护病房(NICU)还是发展中国家的NICU,工作重点已转移到对早产儿、先天复杂畸形儿的救治.除各种新的治疗方法、手段的探索和应用外,营养支持是早产儿治疗中的重要组成部分.