Objective:To study the risk factors and clinical outcomes of early pulmonary hypertension in preterm infants with gestational age(GA)≤32 w.Methods:From October 2017 to May 2021,preterm infants with GA≤ 32 w admitted to NICU of our hospital were retrospectively studied. According to their echocardiography 2 w after birth, the infants were assigned into early-onset pulmonary hypertension (ePH) group and non-PH group. SPSS 21.0 statistical software was used to analyze the general status, complications and clinical outcomes of the two groups. Multiple logistic regression was used to analyze the risk factors of early-onset PH.Results:A total of 183 cases were enrolled, including 24 in the ePH group and 159 in the non-PH group. The incidences of birth asphyxia, hemodynamically significant patent ductus arteriosus (hsPDA), FiO 2≥30% within 6 h after birth, late-onset PH, severe bronchopulmonary dysplasia(BPD) and intracranial hemorrhage(ICH) in the ePH group were significantly higher than the non-PH group( P<0.05). hsPDA was the independent risk factor for early-onset PH ( OR=11.781, 95% CI 4.192-33.108). Conclusions:Preterm infants with GA≤32 w and early-onset PH are at increased risks of ICH, late-onset PH and severe BPD, hsPDA is the independent risk factor for early-onset PH.

目的 回顾性分析胎龄小于32周早产儿的临床资料,探讨优化抗生素管理对早产儿近期临床结局的影响.方法 收集2017年1月1日至2018年6月30日、2019年1月1日至2020年12月31日于青岛大学附属医院新生儿监护室住院治疗的胎龄小于32周早产儿的临床资料.优化抗生素管理于2019年1月开始实施,将上述临床资料分为两组:优化前组158例(2017年1月1日至2018年6月30日);优化组156例(2019年1月1日至2020年12月31日),回顾性分析两组患儿的临床资料.结果 与优化前组相比,优化组在早期抗生素使用时间(6 d比10 d)、抗生素使用总时间(11 d比16 d)、肠外营养时间(18 d比29.5 d)方面均明显缩短(P＜0.01),早产儿视网膜病变(retinopathy of prematurity,ROP)的发生率明显降低(7.69％vs 15.82％,P＜0.05);Logistic 回归分析显示优化抗生素管理与近期不良结局无明显关联(P＞0.05),抗生素使用时间延长、血培养阳性及机械通气是近期不良结局的危险因素.结论 优化抗生素管理,缩短早产儿不必要的抗生素暴露,可减少肠外营养时间,降低ROP发生率,且不增加近期临床不良结局.延长抗生素使用时间增加近期临床不良结局.

目的 动态监测极早产儿维生素D水平并探讨其对极早产儿肺部疾病的影响.方法 选取2019年6月-2020年12月期间于青岛大学附属医院新生儿重症监护室(neonatal intensive care unite,NICU)住院、并经得家长知情同意的胎龄＜32周的极早产儿共126例,于生后24 h、1月、2月(或出院时)检测血清25-(OH)D水平.根据生后血清25-(OH)D水平,将极早产儿分为3组,维生素D缺乏组(n=71),25(OH)D＜12 ng/ml;维生素D不足组(n=46),25(OH)D 12～＜20 ng/ml;维生素D充足组(n=9),25(OH)D＞20～≤100 ng/ml.所有早产儿在喂养耐受后给予维生素AD(其中维生素D 500 IU,维生素A 1500 IU)每日1粒,及维生素D3 400 IU;收集早产儿一般临床资料,比较各组间呼吸窘迫综合征(respiratory distress syndrome,RDS)、呼吸机使用时间、住院时间、早期肺高压、动脉导管未闭(patent ductus arteriosus,PDA)、支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生情况.结果 (1)共纳入极早产儿126例,胎龄为26～31+6周,平均胎龄(29.75±1.52)周,其中男65例(51.59％),女61例(48.41％).出生时维生素D缺乏组、不足组、充足组3组间的胎龄、出生体重、头围、身长等一般资料比较,差异均无统计学意义(P＞0.05).(2)出生时维生素D平均水平为(10.57±4.79)ng/ml,维生素D缺乏率达92.86％.每日口服维生素D900 IU,1月龄时(18.14±2.88)ng/ml,维生素缺乏率为72.3％,2月龄时(21.13±7.48)ng/ml,维生素D缺乏率为53.17％,无维生素D过量.(3)出生时维生素D缺乏组的RDS、BPD发生率明显升高,差异有统计学意义(P＜0.05).但出生时维生素D水平与BPD的严重程度无明显相关性(P=0.984).不同维生素D水平组间Apgar评分、咖啡因使用时间、机械通气比率、无创通气时间、总用氧时间、PDA、住院时间及早期肺高压差异无统计学意义(P＞0.05).结论 (1)极早产儿普遍存在维生素D缺乏,补充维生素D 900 IU后,2月龄维生素D缺乏率仍然占53.17％,建议对早产儿进行个体化补充维生素D.(2)极早产儿出生时维生素D缺乏增加RDS、BPD的风险.

Objective:To study the effects of different sizes of maternal placental chorionic hemangioma (PCH) on neonatal clinical outcome.Methods:February 2013 to December 2020, neonates whose mothers with PCH delivered in our hospital were retrospectively analyzed. According to the diameter of PCH, the neonates were assigned into giant PCH group (diameter≥4 cm) and ordinary PCH group (diameter<4 cm). Clinical characteristics and outcomes were compared between the two groups.Results:A total of 35 cases were enrolled in the study. 13 cases (37.1%) were male, 12 cases (34.3%) were Cesarean section delivered, 11 cases (31.4%) were premature infants, 12 cases (34.3%) had low birth weight and 12 cases (34.3%) were admitted to NICU, 7 cases (20.0%) had intrauterine distress, cardiac enlargement and abnormal hematological indexes, respectively, 6 cases (17.1%) needed respiratory support; 5 cases (14.2%) had increased amniotic fluid and fetal edema, respectively, 4 cases (11.4%) received blood transfusion, 3 cases (8.5%) had postnatal asphyxia, 2 cases (5.7%) had brain injury and 2 cases (5.7%) had congenital malformation. 15 cases were in the giant PCH group and 20 cases in the ordinary PCH group. Compared with the ordinary PCH group, the giant PCH group had significantly higher incidences of prematurity, low birth weight, increased amniotic fluid, intrauterine distress, NICU hospitalization, fetal edema, cardiac enlargement, respiratory support, abnormal hematological indexes, blood transfusion and mortality ( P<0.05). Conclusions:Maternal complications with giant PCH may significantly increase the risk of neonatal complications, thus perinatal monitoring should be strengthened.【 Key words】Placental chorionic hemangioma; Infant, newborn; Clinical outcome

Objective:To investigate clinical characteristics of neonatal necrotizing enterocolitis (NEC) in preterm infants with monochorionic twins (MCT).Methods:Two cases of MCT preterm baby girl with NEC who were delivered by cesarean section in the Affiliated Hospital of Qingdao University on February 11 and January 18, 2021 (case 1 and case 2, both of them were the second of MCT) were selected into this study. Clinical data of case 1 and 2 were collected by retrospective study method, and their clinical manifestations, diagnosis and treatment were analyzed. Literature about NEC in MCT was retrieved with key words of " twins" " twins pregnancy" " multiple pregnancy" " monochorionic twins" " neonatal necrotizing enterocolitis" both in Chinese and English, based on PubMed, China National Knowledge Infrastructure, and Wanfang Data Service Platform. Literature retrieval time was set from the establishment of above databases to August 2021. This study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (Approval No. QYFY WZLL 26856).Results:①Clinical data analysis: case 1 and 2 had no complications of twin-twin transfusion syndrome (TTTS) and twins reversed arterial perfusion sequence (TRAPS). Case 1 was born at 34+ 5 gestational weeks with birth weight of 1 790 g. She was hospitalized in department of neonatology 10 min after birth due to " premature birth, groaning and spit" . She was diagnosed as NEC because of hematochezia on the 9th day after birth, and had abdominal distension on the 11th day after birth, intestinal wall gas observed by abdominal X-ray examination, and portal vein gas observed by abdominal ultrasound. On the 11th day after birth, by exploratory laparotomy showed part of intestinal necrosis, necrotic bowel resection and enterostomy were performed. Case 1 had poor tolerance of breast-fed on day 10 postoperatively, and without weight gain. On day 48 postoperatively, she was fed with deeply hydrolyzed formula milk, but still feeding intolerance. Loop stoma reversal and intestinal anastomosis were performed on day 60 after previous operation. Her postoperative pathological biopsy of ileum showed that the intestinal mucosa was chronically inflamed. Case 1 received breastfeeding after the second operation, and the milk was added smoothly. Case 1 was discharged after 86 days of hospitalization. Follow-up to December 2021, her corrected age was 9-month, and her physical, language, and motor development were normal. Case 2 was born at 35+ 6 gestational weeks with birth weight of 2 390 g. Case 2 was hospitalized in department of neonatology due to " premature birth and low viability" 14 minutes after birth. She had hematochezia on day 4 after birth. She was diagnosed as NEC because of abdominal intestinal dilatation and gas accumulation were observed by abdominal X-ray examination. After treatment with gastrointestinal decompression, fasting and antibacterial drugs, her symptoms gradually improved, but abdominal distension occurred on day 26 after birth, and by abdominal angiography showed intestinal stenosis. Colectomy and anastomosis were performed on day 33 after birth. Her postoperative pathological biopsy of colon tissue showed chronic inflammation of intestinal mucosa, and she was discharged on day 49 of hospitalization. Follow-up to December 2021, her corrected age was 10-month, and her physical, language, and motor development were normal. ②Literature review results: according to retrieval strategis formulated in this study, 3 pieces of abroad literature related to NEC in MCT were retrieved, among which 6 cases of NEC in MCT were included. These 6 cases of NEC in MCT all were complicated with TTTS before birth, and 3 cases were treated with fetoscopic laser photocoagulation of communicating vessels for TTTS, while the other 3 cases did not receive any prenatal interventions for TTTS. Analysis results of the total of 8 cases of MCT preterm infants with NEC included 2 cases in this study were as follows. The average gestational age of them was 28 weeks, average birth weight was 1 176 g, 4 case were newborn baby boys and 4 cases were nweborn baby girls, and average onset time of NEC was 9 days after birth. All 8 cases of preterm infants were treated by surgery for NEC, and 5 cases survived, 3 cases died.Conclusions:Even for MCT preterm infants without complications related to twins such as TTTS and TRAPS, the risk of NEC in MCT preterm infants might be increased due to placental hemodynamics instability and intestinal ischemia and hypoxia. Careful assessment of the intestinal function of MCT preterm infants can enable early diagnosis and early treatment of NEC, thereby improving its prognosis and reducing neonatal mortality.

Objective:To investigate the effects of nutritional intake in the first two weeks of life on bronchopulmonary dysplasia (BPD) in preterm infants with gestational age (GA) ≤ 32 weeks.Methods:A retrospective case-control study was conducted 154 preterm infants with birth weight ≤ 1500 g and GA ≤ 32 weeks were enrolled from neonatal intensive care unit (NICU) of Affiliated Hospital of Qingdao University between January 1, 2016 and December 31, 2017. These infants were divided into BPD group or non-BPD group. All clinical and nutritional data were collected and analyzed to investigate the effects of early-life (within 2 weeks after birth) nutritional intake on BPD.Results:Among a total of 154 eligible neonates, 68 were without BPD and 86 with BPD (55.8%). Mild, moderate and severe BPD accounted for 39.5% (34/86), 58.1%(50/86)and 2.4%(2/86)of all BPD cases respectively. GA and birth-weight of BPD group were significantly lower than that of non-BPD group [(28.35 ± 1.55)weeks vs. (30.12 ± 1.23)weeks; (1050.91 ± 190.6)g vs. (1205.88 ± 195.83)g, both P = 0.000]. The duration of mechanical ventilation in BPD group was longer than that in non-BPD group [(2.65 ± 1.08)days vs. (0.47 ± 0.12)days, P < 0.05]. The incidences of complications in BPD group, including neonatal asphyxia, sepsis and patent ductus arteriosus, were all higher than those in non-BPD group( P < 0.05). The fluids and caloric intake, enteral fluids and caloric intake were significantly lower in BPD group on Day 7 and 14 of life ( P < 0.05). The macronutrient intake in BPD group was also consistently lower, reaching statistical significance for carbohydrate intake on Day 7 and 14 of life, and for protein and lipid intake on Day 14 of life ( P < 0.05). Multivariate logistic regression analysis showed that mechanical ventilation ( OR = 2.257, 95% CI: 1.143~4.456, P = 0.019) and GA ( OR = 0.325, 95% CI: 0.215~0.49, P = 0.000) were high-risk factors for BPD. The decreased odds of developing BPD were associated with higher levels of enteral calories on Day 14 of life ( OR = 0.96, 95% CI: 0.94~0.98, P = 0.000), fluids on Day 7 of life ( OR = 0.927, 95% CI: 0.876~0.981, P = 0.009) and protein intake on Day 14 of life ( OR = 0.044, 95% CI: 0.011~0.177, P = 0.000). Conclusions:GA and mechanical ventilation were independent high-risk factors for BPD. Higher intake of protein and enteral calories were protective factors. Proactive early enteral nutrition support, adequate protein intake and decreasing the duration of mechanical ventilation may reduce the risk of BPD.

目的 探讨妊娠期急性脂肪肝(AFLP)产妇及其新生儿临床特征与不良结局的关系.方法 回顾性分析2013年1月-2016年12月就诊于本院的15例AFLP产妇及其分娩新生儿的临床资料.结果 15例产妇孕周为33～39+6周,绝大多数为初产妇(11例,占73.3％),常见首发症状为消化道症状(12例,占80.0％);实验室检查显示多数产妇存在肝肾功能异常、低蛋白血症、低糖血症、凝血功能异常等,待胎儿娩出后逐渐恢复正常.15例产妇共娩出新生儿19例,其中足月儿10例,早产儿9例;男性新生儿13例,女性新生儿6例.19例新生儿中死亡2例,17例存活儿中发生宫内窘迫5例、新生儿窒息8例.13例转入新生儿重症监护室,均存在不同程度代谢性酸中毒,发生新生儿低糖血症7例,合并多脏器损伤8例,其中脑损伤7例.结论 AFLP是妊娠中晚期少见的致命性并发症,新生儿不良预后受产妇临床表现影响并加重产妇并发症.

目的 研究分析氧气雾化与超生雾化吸入对婴幼儿支气管肺炎治疗的临床效果.方法 选取我院2015年2月—2017年3月接收的支气管肺炎婴幼儿62例,分为两组,对照组使用超声雾化吸入治疗,研究组则为氧气雾化吸入治疗,对患儿的治疗效果予以观察.结果 研究组患儿的声音嘶哑、咳嗽及肺部鸣音等临床症状改善时间均短于对照组,统计学上的差异性明显(P<0.05).结论 临床上使用氧气雾化吸入对患支气管肺炎患儿进行治疗的效果更明显,值得予以推广使用.

血清25-(OH)D水平可以作为维生素D营养状况的客观指标,一般认为血清25-(OH)D≥75 nmol/L是维生素D较为理想的水平.儿童是维生素D缺乏的潜在高危人群,维生素D缺乏不仅可使儿童患佝偻病,而且还与心脑血管疾病、呼吸系统疾病、自身免疫性疾病、肾脏疾病、神经精神疾病、肿瘤、糖尿病等密切相关.本文就此方面的研究进展进行系统综述.