Extremely low birth weight infants(ELBWI)are the greatest risk infants in NICU.Nutrition management influence directly surviving and prognosis of these infants in addition to the essential life support technology.Nutrition requirement,enteral and parenteral nutrition,feeding after discharge for ELBWI is introduced in this article.The ideal goals of nutrition support for ELBWI is to achieve growth similar to foetal growth coupled with satisfactory functional development and composition of weight gain for a normal fetus.

Humans ; Infant, Newborn ; Infant, Premature ; Nutrition Therapy ; standards

The Apgar score, as a convenient and practical method for clinical screening in newborns during the first minutes of life, has been widely used for more than six decades. However, with the advent of modern medical technology, the continued use of Apgar score has been a matter of controversy due to its limitations, including that it is prone to be influenced by many factors. We provide a new insight into the Apgar score, based on the updated clinical evidence, its relationship with neonatal resuscitation, and its predictive value in neonatal outcome.

Objective To compare the diagnostic values of different parameters for neonatal sepsis by observing clinical presentations and laboratory tests of hospitalized newborn infants and to find out the the early and fast way in neonatal sepsis diagnosis. Methods Newborn infants admitted to NICU from Sept.2007 to Feb.2008,who met all inclusion and exclusion criteria,were enrolled.The situations in perinatal period,exact time of the onset of infection,clinical manifestations and laboratory indexes were recorded.Infants were classified into 3 groups:septic group(n=13),nonseptic group(n=12) and noninfectious group(n=12).Sensitivity,specificity,false positive rate,false negative rate,Youden's index and positive and negative predictive values(PPV and NPV) were calculated for each test. Receiver-operating characteristic curves were analyzed to determine the optimal thresholds. Results Among all the clinical manifestations,abnormal reaction had the hightest specificity(84.6%) and accuracy(67.9%) in diagnosing neonatal sepsis.SIRS criteria,with the specificity of 95.8%,was helpful in clinical suspected eases.However,routine laboratory tests,such as WBC,PLT and GLU,had poor sensitivity or specificity;I/T had better specificity(100%),but was subject to discrepancy among different observers.The area under the ROC for CRP and PCT were 0.734 and 0.878,with the optimal threshold of 15 mg/L(P=0.020,Youden's index=45.5%) and 0.81 ng/ml(P-0.000,specificity=100%,Youden's index=75.0%),respectively.Conclusions Careful clinical inspection warrants early detection of sick infants.Evaluation of SIRS criteria in clinical suspected septic infants may help in early diagnosis.WBC,I/T,PLT can be used as routinely monitoring indexes for high risk neonates.CRP and PCT concentrations also have significant diagnostic values.

Objective To summarise the clinical data of neonatal early onset sepsis (EOS) and investigate the correlation factors, clinical manifestation, diagnosis, therapy and prognosis of EOS. Methods Data of 32 neonatal EOS patients admitted into the neonatal intensive care unit, Peking Union Medical College Hospital from January 2000 to June 2009 were collected and retrospectively analyzed. Results Among 32 EOS infants, there were 23 preterm infants (71.9%), nine term infants (28.1%); 21 low birth weight infants (65.6%), six very low birth weight infants (18.8%) and one macrosomia (3.1%). Among 32 mothers, 27 (84.4%) were accompanied with various kinds of complications during perinatal period, such as 15 perinatal infection (46.9%), six preeclampsia (18.8%), five gestational diabetes mellitus (15.6%) and one hypothyroidism (3.1%). EOS infants had various clinical manifestations, including 25 low response (78.1%), 20 respiration or temperature abnormity (62.5%), 18 pallor and clammy skin (56.3%), 18 feeding intolerance (56.3%), 18 fever (56.3%), 15 metabolic acidosis (46.9%), 8 infectious shock (25.0%), 20(62.5%) high white blood cell count (>25×109/L), 22 (68.8%) low blood platelets (<100×109/L) and 28 (87.5%) high C-reaction protein (>8 mg/L). Blood culture of 24 infants were positive (75.0%), among which nine infections were caused by gram-positive bacteria (9/24, 37.5%), including Listeria monocytogenes, group B Streptococcus, Staphylococcus, et al; 15 infections were caused by gram-negative bacteria (15/24, 62.5%), including Klebsiella Pneumoniae, Enterobacteria, Bacillus Smaragdinus, et al. Antibiotics were used in all infants when EOS was supposed to be or infectious symptoms were presented, and were adjusted under the results of culture. Twenty-two infants (68.8%) were cured, eight(25.0%) were given up from the therapy, two(6.3%) died. Conclusions The neonatal EOS correlates to various kinds of perinatal factors, its clinical manifestations are complicated and usually involves many systems. Multiple factors in perinatal period, clinical manifestation and laboratory examinations should be considered to make early diagnosis, assist management to improve the prognosis.

The article introduces the current situation of higher medical education of Taiwan Province and makes some brief comments and analyses by analyzing its advantages and disadvantages as well as the effectuation condition of higher education reforming measures.

Objective To study the clinical evaluation of gas exchange impairment in neonatal respiratory failure.Methods Blood gas, PaO2/PAO2, Qs/QT, PaO2/FiO2, A-aDO2 and RI of 53 newborn infants with respiratory failure in NICU of PUMCH from Jan. 1993 to Dec. 1997 were measured. Results These infants were divided into two groups according to PaO2/PAO2: moderate and severe respiratory failure. Qs/QT(11±3)%, PaO2/FiO2(183±113), A-aDO2(22.9±6.8)kPa, RI(2.5 ±0.8) in 21 neonates with moderate respiratory failure; Qs/QT(24±6)%, PaO2/FiO2 (82±30), A-aDO2 (49.3 ± 17.8)kPa,RI(7.6 ±3.4) in 32 neonates with severe respiratory failure(P＜0.001). These results in respiratory failure caused by different pathogenesis were different. In meconium aspiration and pneumothorax group there were the highestQs/QT(32±3)% ,A-aDO2 (69.8 ± 12.2)kPa,RI(9.2 ±2.9)and the lowest PaO2/FiO2 (77±39). Mortality of infants with high pulmonary shunt was high. Qs/QT(17±8)% in 38 survives and (24±6)% in 10 died neonates( P＜0.05). Conclusion The clinical evaluation using these indexes for newborn infants with respiratory failure is beneficial in recognizing pathogenesis,guiding therapy and evaluating prognosis.

OBJECTIVE To investigate the incidence and trends of nosocomial infections of preterm infants in NICU and to explore their risk factors and strategies of infection control.METHODS A study was made among 1 026 hospitalized preterm infants from Jan 1992 to Dec 2004.RESULTS There were 316 times nosocomial infections in 266 preterm infants.Cumulative incidence rate for nosocomial infection was 25.9 neonates out of 100 admissions.The incidence density was 18.6 infections per 1000 patient days.The high risk factors for nosocomial infections included the parenteral nutrition,birth weight ≤1 500 g and mechanical ventilation(P

Objective To determine the human milk insulin(HMI) concentrations of healthy,gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) lactating mothers and their correlative factors and to explore the effect of HMI on growth and development of neonates. Methods HMI of colostrum and mature milk collected from 148 healthy lactating mothers and 46 GDM/GIGT mothers were determined by radioimmnuoassay. The intergroup HMI levels were compared by Wilcoxon test. Results (1) In the GDM/GIGT group, colostrum HMI was 28.81 μU/ml(13. 84-43.14 μU/ml), significantly lower than that of mature milk which was 57.50 μU/ml(36. 70-82. 73 μU/ml) (Z=-4. 828,P=0. 000). HMI of mature milk in the healthy group was 35.88 μU/ml(25.91-46.85 μU/ml), lower than in the GDM/GIGT group (Z=-2.874,P=0.004). ( 2 ) The colostrum HMI of the mothers underwent cesarean section was 23.64 μU/ml (14.90-38.51 μU/ml) lower than in the vaginal delivery ones which was 38.89 μU/ml(23.14-65.54 μU/ml)(Z= -4. 510, P= 0. 000). (3) HMI of mature milk in mixed feeding cases was 42.58 μU/ml (26.60-73.06 μU/ml),significantly higher than that of breast feeding ones which was 36.32 μU/ml(26.00-46.16 μU/ml)(Z=-2. 377,P=0.019). (4) Both HMI in colostrum and mature milk were positively correlated with maternal BMI (P＜0.05). Conclusions The mode of delivery significantly affects the HMI in colostrum. GDM/GIGT and the feeding patterns have some effects on HMI levels in mature breast milk. The HMI level is positively correlated with maternal BMI.

Objective To observe the effect of inhaled nitric oxide(INO) on the nitric oxide synthase (NOS) in piglet suffered from severe meconium aspiration syndrome(MAS). Methods Severe MAS model of piglet was reproduced, the oxygenation effect and the activity of pulmonary NOS were measured, hybridization in situ of pulmonary slices was used to show the gene expression of inducible NOS(iNOS). Results INO therapy attenuated respiratory dysfunction in MAS, while discontinuation of INO induced “rebound pulmonary hypertension”. The activity of iNOS in MAS group is higher than that in control group (16.9?3.1) fmol/(mg Pro?min)vs (11.6?2.7) fmol/(mg Pro?min),( P