Impact of introducing a standardized nutrition protocol on very premature infants' growth and morbidity.
- 作者列表："Wittwer A","Hascoët JM
BACKGROUND:Inappropriate nutritional intake in premature infants may be responsible for postnatal growth restriction (PGR) and adverse long-term outcomes. OBJECTIVE:We evaluated the impact of an updated nutrition protocol on very premature infants' longitudinal growth and morbidity, and secondly the compliance to this new protocol. DESIGN:All infants born between 26-32 weeks gestation (GA) were studied retrospectively during two 6-month periods before (group 1) and after (group 2) the introduction of an optimized nutrition protocol, in a longitudinal comparative analysis. RESULTS:158 infants were included; 72 before and 86 after the introduction of the protocol (Group 1: (mean±SD) birthweight (BW) 1154±276 g, GA 29.0±1.4 weeks; Group 2: BW 1215±332 g, GA 28.9±1.7 weeks). We observed growth improvement in Group 2 more pronounced in males (weight z-score) at D42 (-1.688±0.758 vs. -1.370±0.762, p = 0.045), D49 (-1.696±0.776 vs. -1.370±0.718, p = 0.051), D56 (-1.748±0.855 vs. -1.392±0.737, p = 0.072), D63 (-1.885±0.832 vs. -1.336±0.779 p = 0.016), and D70 (-2.001±0.747 vs. -1.228±0.765 p = 0.004). There was no difference in females or in morbidities between the groups. We observed low compliance to the protocol in both groups: similar energy intake but higher lipid intake in Group 1 and higher protein intake in Group 2. CONCLUSION:The quality of nutritional care with a strictly-defined protocol may significantly improve weight gain for very preterm infants. As compliance remained low, an educational reinforcement is needed to prevent PGR. CLINICAL TRIAL REGISTRATION:This retrospective study was registered by ClinicalTrials.gov under number NCT03217045, and by the CNIL (Commission Nationale de l'Informatique et des Libertés) under study number R2015-1 for the Maternity of the CHRU of Nancy.
背景: 早产儿营养摄入不当可能是出生后生长受限 (PGR) 和不良长期结局的原因。 目的: 我们评估了更新的营养方案对极早产儿纵向生长和发病率的影响，其次评估了对这一新方案的依从性。 设计: 在纵向比较分析中，在引入优化营养方案之前 (组1) 和之后 (组2) 的两个6个月期间，对出生在26-32周妊娠 (GA) 之间的所有婴儿进行回顾性研究。 结果: 共纳入158名婴儿; 方案引入前72名，引入后86名 (组1 :( 平均 ± SD) 出生体重 (BW) 1154 ± 276g，GA 29.0 ± 1.4周; 组2: BW 1215 ± 332g，GA 28.9 ± 1.7周)。我们观察到第2组的生长改善在男性中更明显 (体重z评分)，在第42天 (-1.688 ± 0.758 vs. -1.370 ± 0.762，p = 0.045)，D49 (-1.696 ± 0.776 vs. -1.370 ± 0.718，p = 0.051)，D56 (-1.748 ± 0.855 vs. -1.392 ± 0.737，p = 0.072)，D63 (-1.885 ± 0.832 vs. -1.336 ± 0.779 p = 0.016)，而D70(-2.001 ± 0.747对-1.228 ± 0.765 p = 0.004)。两组之间的女性或发病率没有差异。我们观察到两组对方案的依从性低: 第1组能量摄入相似，但脂质摄入较高，第2组蛋白质摄入较高。 结论: 严格定义的营养护理方案的质量可以显著改善极早产儿的体重增加。由于依从性仍然很低，需要加强教育以防止PGR。 临床试验注册: 这项回顾性研究由ClinicalTrials.gov注册，编号为NCT03217045，由CNIL (national ale de l 'informatique et des libert é s委员会) 注册，编号为R2015-1，研究编号为Nancy CHRU的产妇。
METHODS::Background: Early onset sepsis (EOS) is potentially life-threatening problem especially in preterm. EOS diagnosis is challenging due to its non-specific signs and laboratory tests. Mean platelet volume (MPV) has been used as predictor of many inflammatory diseases.Objectives: To assess the correlation between serial MPV measurement and EOS occurrence in preterm infants and to determine MPV effectiveness in combination with C reactive protein (CRP) to diagnose EOS and mortality prediction.Methods: The study was carried out on 95 preterm infants with antenatal risk factor for EOS. Blood samples were taken for complete blood count (CBC) including MPV evaluated at birth (cord blood) and at 72 h of life. CRP analyzed on days 1 and 3, subsequently patients were identified in two groups: sepsis (n = 28) and no-sepsis (n = 67).Results: MPV was significantly higher on both day 1 (10.23 ± 0.92) fl and day 3 (10.77 ± 1.16) fL in the sepsis group compared with no-sepsis (8.11 ± 0.29) fl and (8.53 ± 0.42) fl, respectively. MPV of 8.6 fL was identified as cut off value in patients probably resulting in sepsis with a sensitivity of 97.14% and a specificity of 100%. MPV of 10.4 fl was determined as cut off value in patients possibly resulting in death with a sensitivity of 70% and a specificity of 82.5%. The combination of both MPV and CRP on day 1 resulted in improving performance of MPV with higher negative predictive value (93.1%) and higher sensitivity (80%).Conclusion: High cord blood and day 3 MPV can be used as surrogate marker for prediction of EOS and associated mortality in preterm neonates.
METHODS::Objective: This study used near-infrared spectroscopy (NIRS) to detect the pulmonary regional oxygen saturation (rSO2) of premature infants. The oxygenation state of the lung tissue was also evaluated, which provided preliminary evidence regarding the application of NIRS in oxygen therapy for premature infants.Methods: NIRS was used to measure the pulmonary rSO2 of 26 premature infants (gestational age <32 weeks). The correlations between pulmonary rSO2 and the arterial partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), and pulse oxygen saturation (SpO2) were analyzed. The diagnostic value of NIRS was evaluated via both Pearson's correlation and receiver operating characteristic (ROC) curve analyses.Results: Pulmonary rSO2 was positively correlated with both PO2 and SaO2; the linear correlation coefficients (r) were 0.544 (p = .004) and 0.515 (p = .007), respectively. No significant correlation was found between rSO2 and SpO2 (p = .098). SpO2 was positively correlated with PO2 (r = 0.402, p = .042) and SaO2 (r = 0.625, p = .001). NIRS could be used to predict hypoxemia (area under the curve [AUC] = 0.843; Youden's index =0.654) when the pulmonary rSO2 was 62.39%, the sensitivity was 88.9%, and the specificity was 23.5% (p = .005) as well as predict hyperoxemia (AUC = 0.775; Youden's index = 0.65) when the pulmonary rSO2 was 61.99%, the sensitivity was 100%, and the specificity was 35% (p = .045). SpO2 predicted hypoxemia (AUC = 0.784, p = .019) but not hyperoxemia (AUC = 0.7, p = .144).Conclusion: NIRS objectively reflects the changes in oxygenation in the lung tissue. This study provides evidence for the clinical application of NIRS.
METHODS::The global incidence of diabetes mellitus, including diabetes in pregnant women, is on the rise. Diabetes mellitus in a pregnant woman jeopardizes not only maternal health but can also have significant implications on the child to be born. Therefore, timely diagnosis and strict glycemic control are of utmost importance in achieving a safe outcome for both the mother and fetus. The treating physician should be aware of the complications that can arise due to poor glycemic control during pregnancy. The objective of this article is to discuss the key concerns in a neonate born to diabetic mother, the underlying pathogenesis, and the screening schedule during pregnancy.