After birth,premature infants have greater nutritional needs,because of decreased intrauterine nutrient deposition,immaturity of the gastrointestinal tract (GI),and medical conditions such as hypoxia,acidosis and surgery.In order to reach the optimal growth rate,continual reassessment and delivery of adequate energy and nutritional support are imperative.We suggest initiating enteral feeding in the first few days after birth to prime the GI in the premature infant,and then gradually achieve full enteral feedings when clinical condition is stable.Many signs may suggest feeding intolerance.Clinicians should composite these factors to determine.The use of drugs such as erythromycin to treat feeding intolerance in premature infants needs to be clarified.

Preterm infants are often significantly growth retarded at the time of hospital discharge.They often in the nutritional crisis after hospital discharge,and should be carefully follow up evaluated.Preterm formula and fortified breast milk may improve the growth of preterm infants and is a reasonable option for preterm infants.Preterm formula and fortified breast milk are recommended for preterm infants with weights below the 10th percentile for age at the time of hospital discharge and those birth weights below 1 500 g.After hospital discharge,exclusively human milk-fed preterm infants are at increased risk for suboptimal growth compared to formula-fed infants.Infants with BPD are at increased risk of growth retardation after hospital discharge.Protein and mineral enriched formula may provide short-term growth catch-up.

Objective To evaluate the predictive value of cord blood bilirubin levels for subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease.Methods A total of 292 term newborns with ABO hemolytic disease admitted from August 1,2011 to July 31,2012 were enrolled.Cord blood bilirubin levels were analyzed and the clinical characteristics of the neonatal hyperbilirubinemia group (n=34) and non-hyperbilirubinemia group (n=258) were compared.A receiver operating characteristic (ROC) curve analysis was performed to identify the predictive value of the occurrence and cut-off point of hyperbilirubinemia in term infants with ABO hemolytic disease.Paired-t-test,Chi-square test and Spearman correlation were used for statistical analysis.Results Of the 292 term infants with ABO hemolytic disease,34 cases had hyperbilirubinemia,with an incidence of 11.6％.Cord blood bilirubin levels were significantly associated with the presence of hyperbilirubinemia.The mean cord blood bilirubin level in infants who developed hyperbilirubinemia was (52.4± 13.2) μ mol/L,and was (35.0±8.0) μ mol/L for those who did not develop hyperbilirubinemia (t=7.540,P=-0.001).When cord blood bilirubin concentration increased,the incidence of hyperbilirubinemia gradually increased (x2=113.715,P＜0.001; rs=7.19,P＜0.001).The ROC area under the curve of 0.882 (standard error 0.005,95％CI:0.873-0.891,P＜0.001) was significant in predicting neonatal hyperbilirubinemia by cord blood bilirubin,and the occurrence of hyperbilirubinemia increased with increasing cord blood bilirubin level.Neonatal cord blood total bilirubin ≥ 50 μ mol/L predicted hyperbilirubinemia,and the positive predictive value was 0.683,negative predictive value was 0.959,sensitivity was 0.690 and specificity was 0.958.Conclusions Cord blood bilirubin level is useful in predicting subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease.

When directly breast feeding for preterm infants is not available,a preferred alternative is expressed maternal milk or donor breast milk.The evidences to date indicated that feeding preterm infants with expressed maternal milk and donor breast milk was associated with a slower growth in the early postnatal period,the effects on long-term growth in preterm infants was still unclear.Feeding with expressed maternal milk and donor breast milk could deliver preterm infants a degree of specific components of human milk.The potential benefits of the specific components for preterm infants were associated with promoting neurodevelopment and decreasing the incidence of feeding complications.Before expressed maternal milk and donor breast milk are widely used in clinical practice,further studies are still needed to explore the long-term effects on growth and development in preterm infants.

After birth,the premature infants usually need a proper way for intestinal nutrition.The composition and configuration of nutrition admixture must meet the special requirements of the premature infants.In the first few days,because of invisible water lose,they should maintain a stable internal environment,and 1 week later,they need to gradually achieve a stable growth rate.Parenteral nutrition may lead to various complications,such as infection,metabolic complications,etc.monitoring the index,then adjusting the dosage,and achieving full enteral nutrition as soon as possible,may be effective prevention measures.

As survival of premature infants has increased,nutritional support has become a more prominent component of patient care.Aggressive nutritional strategies can reduce the incidence of extrauterine growth retardation (EUGR),speed up the physical growth and promote the development of intelligence.But excessive weight gain may also increase the risk of obesity and cardiovascular diseases in the future.This review mainly introduces and interprets the enteral nutrient supply for preterm infants:commentary from the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN),2010,to provide an evidence-based medicine nutritional guideline for preterm infants.

BACKGROUND: Non-adherent mesenchymal stem cells (NA-MSCs) can form colony forming unit of fibroblasts and induce the differentiation into adipocytes, osteoblasts, and chondrocytes. OBJECTIVE: To determine the effect of epithelial growth factor (EGF) on colony formation of fibroblasts and differentiation into neuron-like cells from NA-MSCs.METHODS: Bilateral femur and tibia as well as total MSCs were separated, and repeated-transfer was employed to purify NA-MSCs. The fifth-passage total MSCs and NA-BMCs were induced in a medium containing EGF and basic fibroblast growth factor (b-FGF) for 2 weeks. Colony unit formation of fibroblasts, effect of EGF on colony-forming unit of fibroblasts, and relative protein expression detected by toluidine blue and immunocytochemical staining were observed. RESULTS AND CONCLUSION: Both total MSCs and NA-BMC could generate colony-forming unit of fibroblasts. After treatment of EGF, colony-forming unit of fibroblasts from NA-BMC was increased significantly. Immunocytochemical staining demonstrated that two weeks later both neuro-specific NeuN and NF-200 were observed in total MSCs and NA-BMC; while, toluidine blue staining indicated that neuron-specific Nissl body was observed in some cells. EGF can effectively promote colony-forming unit of fibroblast from NA-BMC, and repeated-transfer NA-BMC can induce differentiation into neuron-like cells.

BACKGROUND: Non-adherent mesenchymal stem cells (NA-MSCs) can form colony forming unit of fibroblasts and induce the differentiation into adipocytes, osteoblasts, and chondrocytes.OBJECTIVE: To determine whether non-adherent mesenchymal stem cells (NA-MSCs) in adult mouse bone marrow could differentiate into neuron-like cells in cerebral ischemic region.METHODS: Bilateral femur and tibia of β-Gal transgenic mice was separated, and repeated-transfer was used to collect the fifth-passage purified NA-MSCs which were adjusted at concentration of 1×10~(12)/L Middle cerebral artery occlusion was established in the two groups. After 7 days, 3 μL fifth-passaged NA-MSCs suspension was injected into cerebral ischemic region in the transplantation group, while an equal amount of saline was injected into model group. Survival, distribution, and differentiation of donor cells in cerebral ischemic region were observed at 8 weeks after transplantation.RESULTS AND CONCLUSION: LacZ staining showed that donor cells could express β-Gal protein after 8 weeks and survived in the ischemic region. Simple and double immunohistochemical staining indicated that β-Gal-positive donor cells were detected in necrotic region and at necrotic edge of ischemic model. Additionally, partial cells could express neuro-specific NeuN protein and glial cell-specific GFAP. NA-MSCs are able to survive and migrate in cerebral ischemic region; moreover, partial NA-MSCs can differentiate into mature neuron-like cells or glial cells which participate in repairing brain injury.

Objective Study the effect of NMDA receptor antagonist GAPA on the [Ca 2+ ]i of the bilirubin precipitated brain tissue. Methods 10 ug/g of GAPA was administrated peritoneally to Gunn rat with bilirubin induced encephalopathy, brain tissue suspensions was prepared, Fura 2/AM was loaded. the neural cytosolic Ca 2+ was measured by flurescence imaging analysis. Results The concentration of neural cytosolic Ca 2+ in bilirubin precipitated brain tissue was significantly more than that in the control group; NMDA receptor antagonist GAPA could significantly decrease the cytosolic Ca 2+ overload. Conclusion Cytosolic Ca 2+ overload was found in the bilirubin precipitated brain tissue. NMDA receptor antagonist GAPA could prevent the cytosolic Ca 2+ overload in bilirubin induced brain tissue.

Objective To study the role of placental leptin in intrauterine cord leptin production and its relationship with neonatal anthropometry. Methods Forty women and their babies were enrolled in this study. Placental tissue was obtained from mothers and assayed for leptin mRNA by reverse transcription/polymerase chain reaction (RT/PCR). Blood was taken from the umbilical cord of the babies at delivery. Serum leptin was measured by radio-immunoassay. Neonatal anthropometric measurements were recorded within 48 hours after delivery. Linear regression analysis was used to explore the relationship between placental leptin mRNA, serum leptin concentrations and anthropometric measures. Results Placental tissue expressed leptin mRNA at comparable or greater levels than adipose tissue. The placenta of the small for gestational age (SGA) neonates expressed leptin mRNA at significantly lower levels than that of the appropriate for gestational age (AGA) neonates (P=0.042), while the placenta of the large for gestational age (LGA) neonates expressed leptin mRNA at significantly higher levels than that of the AGA neonates (P=0.03). Placental leptin mRNA expression levels correlated with leptin concentrations in cord blood (r=0.61), newborn birth weight (r=0.60) and Ponderal Index (r=0.56). Conclusions Placenta provides a source of leptin for the growing fetus, and this placental leptin might be a growth factor in intrauterine fetal development.