微量喂养联合非营养性吸吮对窒息后喂养不耐受新生儿的影响

目的探讨早期微量喂养与非营养性吸吮对窒息后新生儿喂养不耐受的治疗效果及作用机制。方法将67例喂养不耐受的窒息新生儿随机分为治疗组32例,给予早期微量喂养与非营养性吸吮;对照组35例,给予常规喂养。结果两组患儿均未发生坏死性小肠结肠炎、吸入性肺炎等严重的并发症。治疗组在达全量肠内营养时间、恢复至出生体质量时间较对照组明显提前,血清总胆红素水平较对照组明显降低,前白蛋白水平较对照组明显增高。结论微量喂养与非营养性吸吮可促进窒息新生儿胃肠道发育成熟,减少可能发生的喂养问题,并且可降低胆红素水平,改善营养状况。     

新生儿抚触联合非营养性吸吮治疗早产儿喂养不耐受39例分析

目的观察新生儿抚触联合非营养性吸吮、口服红霉素或口服西沙必利3种方法治疗早产儿喂养不耐受的疗效比较。方法将2006年5月至2010年5月河南省安阳市人民医院120例喂养不耐受早产儿随机分为红霉素组43例,西沙必利组38例和新生儿抚触联合非营养性吸吮组(简称抚触联合吸吮组)39例。3组均给予保温、体位疗法、部分静脉营养及改善喂养策略等常规治疗。红霉素组在常规治疗基础上加用红霉素每次2.5mg/kg每6h1次口服;西沙必利组在常规治疗基础上加用西沙必利每次0.1mg/kg,每6h1次进食前30min口服;新生儿抚触联合非营养性吸吮组在常规治疗基础上给予新生儿抚触和非营养性吸吮,疗程均为3～5d。结果 3组患儿在病程和呕吐时间、胃残余、平均增加体重、日增加奶量比较,差异无统计学意义(P>0.05)。结论新生儿抚触联合非营养性吸吮组与红霉素组,西沙必利组治疗早产儿喂养不耐受疗效相当,临床可适当减少对早产儿喂养不耐受的药物治疗,为早产儿喂养不耐受的适度医疗提供临床依据。     

非药物治疗缓解新生儿疼痛效果比较

目的 探讨不同干预方法缓解新生儿疼痛的效果.方法 将160例住院新生儿随机分为对照组(未干预组)、拥抱抚触(TTS)组、吸吮8％葡萄糖水(GS)组和非营养性吸吮(NNS)组各40例,在采足跟血疼痛刺激前、刺激后20 s、1min、2 min、3 min分别记录心率、呼吸频率、经皮氧饱和度和哭声持续时间.结果 穿刺后20 s各组心率、穿刺后1 min各组呼吸均较穿刺前增快,差异有统计学意义(P＜0.01);1 min时TTS组心率恢复至穿刺前水平;2 min时TTS组呼吸频率,GS组和NNS组心率和呼吸频率恢复至穿刺前水平;3 min时对照组恢复至穿刺前水平.各组经皮血氧饱和度穿刺前后差异无统计学意义(P＞0.05).穿刺后哭声持续时间TTS组、GS组和NNS组均短于对照组,差异有统计学意义(P＜0.01),且TTS组哭声持续时间短于GS组和NNS组(P＜0.05).结论 新生儿对急性疼痛很敏感,TTS、吸吮GS和NNS对新生儿均有明显止痛作用,可在临床治疗护理中应用,以减轻新生儿操作性疼痛.     

非营养性吸吮对早产儿血胃泌素、胃动素水平的影响

目的 探讨非营养性吸吮（NNS）对早产儿血胃泌素（GAS）、胃动素（MOT）水平的影响。方法 测定87例早产儿d1（喂养前）、d3及d7空腹血GAS、MOT水平，根据对胃肠道喂养的耐受情况分为禁食组、NNS组（禁食的早产儿予以NNS）和正常畏组。结果 早产儿血GAS、MOT水平出生后7d内随日龄而逐渐升高，其中正常喂养组高于禁食组和NNS组，差异有显著意义（P＜0．05）。生后d7内随日内逐渐升高，其中正常喂养组高于禁食组和NNS组，差异有显著意义（P＜0．05）。生后d7NNS组也显著高于禁食组（P＜0．05）。结论 禁食抑制了早产儿血GAS和MOT的分泌，NNS有促进胃肠道发育和成熟的作用。     

非营养性吸吮对早产儿生长发育的影响

目的探讨非营养性吸吮(NNS)对早产儿生长发育的影响。方法2004-11—2005-09对贵阳医学院附院新生儿室收治的需经间断鼻胃管喂养(INGF)早产适于胎龄儿60例,根据是否辅以非营养性吸吮随机分成无非营养性吸吮(N-NNS)组及NNS组;并以同期出生无窒息、无消化系统解剖及功能异常足月新生儿25例为对照。放射免疫法(RIA)动态监测早产儿生后第1、3、7天血、胃液中胃泌素(GAS)、胃动素(MOT)水平,同时记录胃肠道功能紊乱发生的情况(呕吐、腹胀、胃潴留、消化道出血、坏死性小肠结肠炎)、生长发育指标(体重、头围)及其它临床指标。结果①随日龄增加,各组GAS、MOT有增高趋势,NNS组增高幅度较大。第1天N-NNS组、NNS组血GAS低于对照组(P<0.01),血及胃液MOT低于对照组(P<0.05);第3天N-NNS组及NNS组血GAS、MOT低于对照组(P<0.05),N-NNS组血GAS低于NNS组(P<0.05);第7天N-NNS组血GAS、MOT均低于NNS组及对照组(P<0.05)。②N-NNS组腹胀、胃潴留发生率均高于NNS组(P<0.05);N-NNS组胃肠功能紊乱发生率为60.0%(18/30),NNS组胃肠功能紊乱发生率为26.7%(8/30),两组差异有统计学意义(χ2=6.787,P=0.018)。③NNS组睡眠时间较N-NNS组长,烦躁时间较N-NNS组短,第14天体重及头围增长幅度较N-NNS组大,差异均有统计学意义(P<0.05);N-NNS组呼吸暂停发生率为43.3%(13/30),NNS组呼吸暂停发生率为16.7%(5/30),两组差异有统计学意义(χ2=5.080,P=0.047)。结论NNS能促进GAS、MOT分泌,改善胃肠转运功能,减少胃肠功能紊乱的发生,促进胃肠功能成熟,加快早产儿体格生长。     

非营养性吸吮在机械通气治疗早产儿中的应用

目的：探讨非营养性吸吮在需要机械通气辅助治疗的早产儿中的作用。方法：将68例需要机械通气辅助治疗的早产儿随机分为观察组（n=35）和对照组（n=33）。观察组进行非营养性吸吮,对照组不进行非营养性吸吮。比较两组患儿达全胃肠道喂养时间、恢复至出生体重时间、体重增长速度、住院时间、喂养耐受性、机械通气并发症等。结果：与对照组比较,观察组达全胃肠道营养时间及住院时间缩短（P0.05）。结论：在需要机械通气治疗的早产儿中采用非营养性吸吮可加快其生长发育速度、缩短住院时间,并能提高喂养耐受性,而机械通气并发症发生率没有上升。     

非营养性吸吮在促进危重早产新生儿生长发育中的作用

随着医学技术的发展、早产儿救治率的提高,早产儿喂养已成为重要课题之一。由于胎龄较小的早产儿出生时呼吸功能发育不健全,常需呼吸机辅助呼吸。选择经口气管插管,可能延迟经口喂养的时间,不利于早产儿胃肠道功能发育;而采用经鼻气管插管,便可以配合非营养性吸吮。现就非营养性吸吮在危重早产儿喂养中的应用价值作一探讨。     

抚触疗法及非营养性吸吮治疗早产儿喂养不耐受

早产儿由于胃肠功能未成熟予出现喂养不耐受，限制其成活率的提高。肠外营养只是暂时应急措施，长时间肠外营养可造成肠黏膜萎缩，乳糖酶缺乏，代谢紊乱等一系列不良情况。因此早产儿胃肠功能建立及诱导成熟是其生存的基础。对我院喂养不耐受早产儿在常规治疗基础上，施加抚触疗法及非营养性吸吮干预，取得明显效果。报道如下。     

非营养性吸吮对早产儿呼吸、心率和血氧饱和度的影响

早产儿由于胃肠功能发育不成熟，尤其是胎龄小于34周者胃肠激素水平低下，往往不能耐受经口喂养而需要接受鼻胃管等非生理性的喂养途径。如何使这些早产儿尽快康复是近年来围产医学的研究热点。国内已有运用非营养性吸吮(non-nutritive sucking，NNS)方法对早产儿进行辅助喂养的报道，那么NNS对早产儿的呼吸、心率和血氧饱和度变化的有何影响?我们现将进行的一些探讨总结如下。     

刺激排便及非营养性吸吮治疗早产儿喂养不耐受

目的评估刺激排便联合非营养性吸吮干预早产儿喂养不耐受的治疗效果。方法选择早产儿51例,分为干预组26例,在常规治疗同时施加刺激排便及非营养性吸吮干预措施;对照组25例,用小剂量红霉素治疗。比较两组治疗后胃残留量、腹胀消失、恢复至出生体质量、喂养耐受、肠道营养达418.4 KJ/(kg.d)时间。结果干预组在胃残留量、腹胀消失时间明显优于对照组(P均<0.01);在恢复出生体质量、喂养耐受、肠道营养达418.4 KJ/(kg.d)时间优于对照组(P均<0.05)。结论刺激排便及非营养性吸吮干预早产儿喂养不耐受效果显著,是治疗早产儿喂养不耐受的有效措施之一。     

Pain reduction of heel stick in neonates: Yakson compared to non-nutritive sucking

The purpose of this study was to test the effect of Yakson (i.e. a traditional Korean touching method) and non-nutritive sucking (NNS) on reducing the pain that neonates experience when undergoing the heel stick procedure for blood testing. Ninety-nine healthy neonates were recruited and assigned into three groups: Yakson (n = 33), NNS (n = 33), and control group (n = 33). Each intervention was provided to the Yakson and NNS groups from 1 min before heel stick until the completion of the heel stick. For the Yakson group, a researcher caressed the belly of a neonate with one hand while supporting the back with the other hand. For the NNS group, a pacifier packed with sterile gauze was put in the neonate's mouth. The oxygen saturation levels in the Yakson and NNS group neonates were maintained significantly better than in the control group neonates. There was no significant difference between the groups with regard to heart rate and neonatal infant pain, measured using the Neonatal Infant Pain Scale. Findings indicate that Yakson can be used during heel stick to help neonates maintain their oxygen saturation level following the procedure.     

Cardiac troponin T in neonates with respiratory distress

Objective

The purpose of this study is to assess cardiac troponin T(cTnT) in neonates with respiratory distress as a marker of myocardial dysfunction.

Use of combination therapy with acetaminophen and ibuprofen for closure of the patent ductus arteriosus in preterm neonates

ObjectiveTo compare effectiveness and safety of combination therapy (acetaminophen and ibuprofen) to monotherapy (ibuprofen, indomethacin, or acetaminophen alone) in treatment of the patent ductus arteriosus (PDA) in premature neonates.MethodsThis was a retrospective cohort study of neonates admitted to a tertiary-level neonatal intensive care unit. Included neonates were born at <32 weeks gestation and received pharmacotherapy for PDA closure. Based on the primary therapy received, our cohort was divided into the following four groups: indomethacin alone, ibuprofen alone, acetaminophen alone, and ibuprofen and acetaminophen (in combination). Baseline characteristics, effectiveness, safety, neonatal mortality, and morbidities rates between these groups were compared.ResultsOne hundred and forty neonates were analyzed; 17 received combination therapy, and 123 neonates received monotherapy: 22 (17.9%) ibuprofen, 29 (23.6%) acetaminophen, and 72 (58.5%) indomethacin. The PDA closure rates were 41.7% for indomethacin, 41.2% for combination therapy, 37.9% for acetaminophen, and 31.8% for ibuprofen (P=0.100). Rates of adverse effects were comparable between the groups.ConclusionThe rate of ductal closure was not different between combination therapy and monotherapy. The study did not demonstrate any increased adverse effects in the combination group. Future well-designed prospective clinical trials are needed to guide clinical practice.     

Effect of gender and hand laterality on pain processing in human neonates

Background

Previous studies in adults have reported that handedness and gender can affect pain perception. However, it is currently unclear when these differences emerge in human development. Therefore, we examined prefrontal responses to pain stimulation among newborns during their first acute pain experience after birth.

Methods

Forty newborns at 4-6 days postnatal age were observed during clinically required blood sampling while prefrontal activation was measured with near infrared spectroscopy. Blood sampling in this study was the first experience of a procedure involving skin breaking for these infants. We divided subjects into a right-hand stimulation group (n = 21) and a left-hand stimulation group (n = 19), depending on whether blood was sampled from the right or the left hand. A three-way analysis of variance (ANOVA) was conducted to examine the effects of several variables on the magnitude of the oxy-Hb value in response to pain stimulus, including stimulus side (right hand or left hand), gender (male or female), recording side (right prefrontal area or left prefrontal area) and interactions between these variables.

Results

The data revealed a significant effect of stimulus side (F (1, 72) = 9.892, P = 0.002), showing that the right-hand stimulation induced a greater prefrontal activation than the left-hand stimulation. No significant gender difference or interactions were found.

Conclusion

Our findings suggest that hand laterality affects pain perception even in neonates. However, gender differences in pain perception did not appear to occur during the neonatal period. Further investigations using brain-imaging techniques are required to identify laterality- or gender-related differences in pain processing in humans.     

Risk factors for early sepsis in very low birth weight neonates with respiratory distress syndrome

AIM: To identify maternal and neonatal factors that increase suspicion of early sepsis in Very Low Birth Weight neonates with respiratory distress syndrome. METHODS: The cohort included 282 neonates born at Soroka Medical Centre 1996-2000. Definitions of 'high' and 'low'-suspicion groups for early sepsis were based on comparison between neonates with early sepsis and the remaining cohort. Univariate analysis and logistic regression were used to compare between groups. RESULTS: The incidence of early sepsis in the cohort was 1.8%, and 94% received antibiotics following delivery. Comparing with the remaining cohort, the five neonates with early sepsis had increased incidence of positive maternal cultures, use of antenatal antibiotics, lower 1 min Apgar scores and tendency to leucopenia. A 'low-suspicion' group comprised 38% of the cohort and did not include any neonates with early sepsis. This group were more frequently treated with antenatal steroids and delivered by Caesarean section compared to the 'high-suspicion' group, but otherwise there were no clinical and laboratory differences. CONCLUSION: Although the incidence of early sepsis is low almost all neonates received antibiotics. A 'low-suspicion' group was defined and the role of antibiotic treatment in this group needs to be determined.     

肺表面活性物质治疗新生儿呼吸窘迫综合征的临床对照研究

目的　探讨肺表面活性物质 (PS)治疗新生儿呼吸窘迫综合征 (NRDS)的有效性及临床价值。方法　采用气管内滴注单剂PS治疗NRDS患儿 2 5例 ,并与同期未用PS治疗的 2 5例NRDS患儿进行前瞻性临床对照研究。结果　治疗组在应用PS后 2～ 3h皮肤颜色转红 ,经皮血氧饱和度逐渐升高。 6h后动脉血氧分压 (PaO2 )、动脉 /肺泡血氧分压比值 (a/APO2 )及呼吸机有效指数 (VEI)分别由 ( 48± 14)mmHg( 1mmHg =0 .133kPa)、0 .14± 0 .0 6及 ( 0 .16± 0 .0 9)ml/ (mmHg·kg)上升到 ( 6 5±2 9)mmHg、0 .2 4± 0 .15及 ( 0 .2 9± 0 .16 )ml/ (mmHg·kg) ;而氧合指数 (OI)、吸入氧浓度 (FiO2 )及平均气道压 (MAP)由 11.6± 5 .7、0 .5 9± 0 .13及 ( 15 .6± 3.1)cmH2 O( 1cmH2 O =0 .0 98kPa)逐渐降低至 6 .3±3 .4、0 .47± 0 .10及 ( 13 .5± 2 .4)cmH2 O。经广义线性模型方差分析 ,主效应、分组因素及时间因素对两组PaO2 、a/APO2 、OI、FiO2 、MAP及VEI的值具有明显影响。而分组与时间因素的交互作用无显著影响。治疗组机械通气及氧疗时间较对照组明显缩短 ,二者差异有显著性。结论　PS能有效地改善NRDS患儿肺顺应性及氧合功能 ,缩短需要机械通气及氧疗时间。