新生儿低血糖症的高危因素及临床防治探讨

目的：探讨新生儿低血糖症的高危因素及临床防治。方法：对2010年1月．2012年8月我院收治的有低血糖高危因素的267例新生儿的临床资料进行回顾性分析。结果：检出低血糖83例,无特异性临床症状;惠有新生儿窒息、新生儿缺氧缺血性脑病、早产儿及小于胎龄儿及糖尿病母亲娩出的新生儿发生低血糖症的发生率较高。早产儿、低出生体重儿、巨大儿低血糖症的发生率显著高于正常胎儿,P〈0．05。结论：对于有低血糖症的高危因素的患儿应严密监测血糖情况,尽早进行防治,避免因低血糖造成脑损伤。     

高龄孕妇分娩新生儿出生体重及出院转归的影响因素分析

摘要 目的：探讨高龄孕妇分娩新生儿出生体重及出院转归的影响因素。方法：选择2021年01月到2022年01月与我院就诊的198例产妇作为研究对象,根据孕妇分娩时的年龄分为观察组和对照组,分娩时年龄满35周岁为高龄产妇组（98例）,分娩时年龄为20~34周岁为适龄组（100例）。比较适龄孕妇和高龄孕妇新生儿出生体重情况和新生儿住院时间,对高龄孕妇新生儿体重和新生儿出院转归影响因素进行Logistic单因素分析和多因素分析。结果：与适龄孕妇相比,高龄孕妇新生儿低出生体重儿、巨大儿发生率更高（P<0.05）,新生儿住院时间明显更长（P<0.05）。对高龄孕妇新生儿体重进行单因素分析结果显示,妊娠糖尿病、产检检查、分娩方式、是否使用催产素、分娩时麻醉方式和脐带情况与高龄孕妇新生儿体重无关（P>0.05）,孕妇年龄、孕前BMI、孕期体重增加情况、妊娠高血压、合并其他疾病状况、孕次、产次、羊水情况与高龄孕妇新生儿体重相关（P<0.05）。进行Logistic多因素回归分析结果显示,孕妇年龄、孕前BMI、孕期体重增加情况、孕次、产次、羊水情况是影响高龄孕妇新生儿出生体重的独立危险因素（P<0.05）。对新生儿出院转归情况进行单因素分析结果显示,胎次、开奶时间、喂养方式和有无接受治疗与新生儿出院转归无相关性（P>0.05）,胎龄、出生体重、Apgar评分、出生窒息史、有无伴发疾病与新生儿转归相关（P<0.05）。进行Logistic多因素分析结果显示,胎龄、出生体重、Apgar评分、出生窒息史、有无伴发病是影响新生儿出院转归的独立危险因素（P<0.05）。结论：孕妇年龄、孕前BMI、孕期体重增加情况、孕次、产次、羊水情况是影响高龄孕妇新生儿出生体重的独立危险因素。新生儿出院转归受到胎龄、出生体重、Apgar评分、出生窒息史、有无伴发病影响。     

雷珠单抗玻璃体内注射对早产儿视网膜病变患儿临床疗效及视网膜功能发育的影响

目的:探讨雷珠单抗玻璃体内注射对早产儿视网膜病变(ROP)患儿临床疗效及视网膜功能发育的影响。方法:收集2014年6月～2018年6月我院收治的80例ROP患儿,随机分为对照组和观察组各40例,对照组患儿采用激光治疗方案,观察组患儿采用雷珠单抗玻璃体内注射治疗方案。比较治疗后两组疗效和复发情况;随访6个月,采用闪光视网膜电图(F-ERG)检查治疗后视网膜功能的发育状况。结果:治疗后,观察组病变控制率明显高于对照组,病变进展率和复发率明显低于对照组(P0.05);F-ERG检查结果显示,对照组视杆细胞系统反应振幅较观察组明显降低,潜伏期较观察组明显延长,最大混合反应a、b波振幅明显低于观察组(P0.05);两组间最大混合反应波振幅比值b/a、潜伏期比较差异无统计学意义(P0.05)。两组间视锥细胞反应a波潜伏期及a、b波振幅比较差异无统计学意义(P0.05);对照组视锥细胞反应b波潜伏期明显比观察组延长,震荡电位(Ops)比观察组明显降低(P0.05)。结论:雷珠单抗玻璃体内注射治疗ROP患儿,疗效确切,操作简单且快速,视网膜功能的发育比激光治疗更趋向正常,适用于ROP患儿。     

不同胎龄早产儿早期凝血指标的变化及其临床意义

目的:研究不同胎龄早产儿早期凝血指标的变化及其临床意义。方法:选取2012年1月至2017年7月期间我院出生的新生儿392例为研究对象。根据新生儿胎龄的不同分为早期早产儿组(胎龄27~31周)78例、中期早产儿组(胎龄32~33周)102例、晚期早产儿组(胎龄34~36周)116例以及足月新生儿组(胎龄37~42周)96例。四组新生儿出生后2h内抽取静脉血检测凝血指标,包括凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB),并应用Pearson相关性分析分析新生儿胎龄与上述各项凝血指标水平的相关性。结果:早期早产儿组、中期早产儿组、晚期早产儿组、足月新生儿组的出生体重以及胎龄呈逐渐上升趋势,不同组别新生儿的出生体重以及胎龄差异均有统计学意义(P0.05)。早期早产儿组、中期早产儿组、晚期早产儿组、足月新生儿组PT、APTT均呈逐渐下降趋势,FIB呈逐渐上升趋势,不同组别新生儿PT、APTT、FIB差异均有统计学意义(P0.05)。Pearson相关性分析显示,新生儿胎龄与PT、APTT呈负相关(r=-0.567、-0.691,P=0.000、0.000),而新生儿胎龄与FIB水平呈正相关(r=0.623,P=0.000)。结论:不同胎龄早产儿早期凝血功能存在异常变化,新生儿胎龄与PT、APTT均呈负相关关系,与FIB呈正相关关系,临床应予以重视,及时检测其凝血指标,必要时应予以干预治疗。     

孕晚期膳食摄入量对新生儿出生体重及胎盘系数影响的研究

目的：探讨孕妇孕晚期膳食摄入量对新生儿出生体重及胎盘系数的影响。方法：纳入241例在2017年10月—2018年1月于上海市新华医院产科分娩的健康产妇,在分娩后72小时内进行回顾性孕晚期食物频率问卷调查,并收集孕妇身高、孕前体重、年龄、分娩方式,和新生儿性别、出生体重、胎龄、胎盘重量,计算胎盘系数（胎盘系数=胎盘重量/出生体重）。根据2013Fenton生长曲线新生儿胎龄别体重将新生儿分为小于胎龄儿组、适于胎龄儿组和大于胎龄儿组。结果：经多因素Logistic回归分析显示,对于体重大于胎龄儿,增加孕晚期能量（OR=0.998, 95%CI: 0.996～1.000）和碳水化合物（OR=0.027, 95%CI: 0.975～0.998）摄入量能够降低其发生率;对于新生儿体重小于胎龄,增加蛋白质摄入（OR=0.977, 95%CI: 0.956～1.000）能够降低其发生率,而碳水化合物供能比增加（OR=1.074, 95%CI: 1.010～1.142）则会增加其发生率。线性回归分析显示,增加孕晚期脂肪摄入量（β=0.020, 95%CI: 0.001～0.039）会增大胎盘系数。结论：孕晚期膳食摄入量影响新生儿出生体重及胎盘系数。     

低出生体重儿肠道微生态研究与展望

低出生体重儿是新生儿中的特殊群体,由于各器官等方面发育相对不成熟,胎龄小,体重轻,患病机率大,早期死亡率高,需要临床更多的干预,这些干预易影响到肠道菌群的正常构建及平衡、影响疾病的治疗及患儿的正常发育,因此探索低出生体重儿肠道微生态的构建规律及影响因素,对指导临床合理喂养及规范治疗具有十分重要的意义。     

重症医学病房中早产儿死亡危险因素的单变量logistic 回归 分析研究

目的:探讨重症医学病房内早产儿的相关性危险因素对其死亡的影响.方法:回顾性收集我重症医学病房从2008年6月1日至2011年8月31日收治的早产患儿共45例,分组后,对相关死亡危险因素进行logistics回归分析研究.结果:45例早产儿死亡的相关危险因素为出生体重(OR=4.157),体重越低,死亡率越高.结论:加强孕期保健,优化围产期管理,促进胎儿成熟,加强对低出生体重儿的管理,可提高早产儿的存活率和存活质量.     

布拉酵母菌散联合非营养性吸吮治疗早产儿喂养不耐受的疗效观察

目的探讨布拉酵母菌散联合非营养性吸吮治疗早产儿喂养不耐受的疗效观察。方法选取早产儿喂养不耐受患者70例,随机分为观察组(n=35例)和对照组(n=35例)。两组患儿喂养方案参照中国新生儿营养支持临床应用指南进行。观察组患儿在此基础上加用布拉酵母菌散0.125 g/次,1次/d,鼻饲或奶瓶给药;并在喂奶前后予以早产儿型硅胶安抚奶嘴吸吮10~15 min。观察两组患儿症状消失时间、达全胃肠喂养时间及恢复出生体重时间,并比较其治疗后的临床效果及并发症发生率。结果观察组患儿呕吐、腹胀消失时间、达全胃肠喂养时间及恢复出生体重时间均明显短于对照组(P0.05);治疗7 d后,观察组患儿临床总有效率(94.29%)明显高于对照组(77.14%)(χ2=4.20,P0.05),观察组患儿总并发症的发生率(40.0%)明显低于对照组(65.7%)(χ2=4.20,P0.05)。结论布拉酵母菌散联合非营养性吸吮治疗早产儿喂养不耐受的疗效较显著,能缩短患儿呕吐、腹胀消失时间,促进患儿体重增长,缩短恢复出生体重时间及达全胃肠喂养时间,减少并发症发生。     

血清STAT3、HIF-3α的表达对早产儿视网膜病变病情严重程度的预测价值

摘要 目的：分析血清信号转导和转录激活因子3（STAT3）、低氧诱导因子3α（HIF-3α）的表达对早产儿视网膜病变（ROP）病情严重程度的预测价值。方法：回顾性分析2021年4月-2022年4月在我院进行诊治的ROP早产儿80例,根据病情严重程度分为ROP轻度组（n=40）和ROP重度组（n=40）,并选取同期健康早产儿为对照组（n=40）。比较不同组别之间的血清STAT3、HIF-3α水平差异,采用Pearson检验分析血清STAT3、HIF-3α水平与ROP病情严重程度之间的相关性,采用多因素Logistic回归分析筛选出预测ROP的危险因素,采用受试者工作特征曲线（ROC）分析各项危险因素预测ROP病情严重程度的价值。结果：ROP轻度组、ROP重度组血清STAT3、HIF-3α水平均高于对照组,且ROP重度组高于ROP轻度组（P<0.05）。Pearson相关性检验显示,血清STAT3、HIF-3α水平与ROP病情严重程度均呈正相关（r=0.812、0.796,P<0.05）。多因素Logistic回归分析结果显示,血清STAT3、HIF-3α水平是ROP病情严重程度的独立危险因素（OR=3.706、3.219,P<0.05）。ROC曲线分析结果显示,血清STAT3、HIF-3α水平变化在预测ROP病情严重程度中具有极高的价值。结论：随着病情加重,ROP患儿血清STAT3、HIF-3α水平升高,该两项指标在预测ROP患者病情中具有极高的价值,可用于评估病情严重程度。     

湖南省9所医院早产儿卡介苗及乙肝疫苗接种情况及未接种原因分析

目的:了解湖南省9所医院早产儿卡介苗及乙肝疫苗接种现状,并分析未接种的原因。方法:收集2014年11月至2015年10月期间参与研究的湖南省9所医院产科分娩的早产儿相关临床资料及卡介苗和第一剂乙肝疫苗的接种资料,分析各医院的接种原则以及未接种的原因。结果:各医院间早产儿的出生体重及出生胎龄比较差异均有统计学意义(P0.05);9所医院遵循的卡介苗和第一次乙肝疫苗接种原则不尽相同;出院时卡介苗未接种率为45.0%,明显高于第一剂乙肝疫苗未接种率的16.7%(P0.05);卡介苗因低体重、疾病、IVIG、家长拒绝而未接种的比例分别为82.5%、12.9%、4.3%、0.3%,第一剂乙肝疫苗因疾病、低体重、IVIG、家长拒绝而未接种的比例分别为53.1%、41.6%、4.0%、1.3%。结论:湖南省9所医院早产儿卡介苗及乙肝疫苗接种率较低,疾病和低体重位居出院时未接种原因的前两位,应规范早产儿疫苗接种,避免遗漏或不恰当推迟疫苗接种。     

Thresholds of glycemia,insulin therapy,and risk for severe retinopathy in premature infants: A cohort study

BackgroundHyperglycemia in preterm infants may be associated with severe retinopathy of prematurity (ROP) and other morbidities. However, it is uncertain which concentration of blood glucose is associated with increased risk of tissue damage, with little consensus on the cutoff level to treat hyperglycemia. The objective of our study was to examine the association between hyperglycemia and severe ROP in premature infants.Methods and findingsIn 2 independent, monocentric cohorts of preterm infants born at <30 weeks’ gestation (Nantes University Hospital, 2006–2016, primary, and Lyon-HFME University Hospital, 2009–2017, validation), we first analyzed the association between severe (stage 3 or higher) ROP and 2 markers of glucose exposure between birth and day 21—maximum value of glycemia (MaxGly_1–21) and mean of daily maximum values of glycemia (MeanMaxGly_1–21)—using logistic regression models. In both the primary (n = 863 infants, mean gestational age 27.5 ± 1.4 weeks, boys 52.5%; 38 with severe ROP; 54,083 glucose measurements) and the validation cohort (n = 316 infants, mean gestational age 27.4 ± 1.4 weeks, boys 51.3%), MaxGly_1–21 and MeanMaxGly_1–21 were significantly associated with an increased risk of severe ROP: odds ratio (OR) 1.21 (95% CI 1.14–1.27, p < 0.001) and OR 1.70 (95% CI 1.48–1.94, p < 0.001), respectively, in the primary cohort and OR 1.17 (95% CI 1.05–1.32, p = 0.008) and OR 1.53 (95% CI 1.20–1.95, p < 0.001), respectively, in the validation cohort. These associations remained significant after adjustment for confounders in both cohorts. Second, we identified optimal cutoff values of duration of exposure above each concentration of glycemia between 7 and 13 mmol/l using receiver operating characteristic curve analyses in the primary cohort. Optimal cutoff values for predicting stage 3 or higher ROP were 9, 6, 5, 3, 2, 2, and 1 days above a glycemic threshold of 7, 8, 9, 10, 11, 12, and 13 mmol/l, respectively. Severe exposure was defined as at least 1 exposure above 1 of the optimal cutoffs. Severe ROP was significantly more common in infants with severe exposure in both the primary (10.9% versus 0.6%, p < 0.001) and validation (5.2% versus 0.9%, p = 0.030) cohorts. Finally, we analyzed the association between insulin therapy and severe ROP in a national population-based prospectively recruited cohort (EPIPAGE-2, 2011, n = 1,441, mean gestational age 27.3 ± 1.4, boys 52.5%) using propensity score weighting. Insulin use was significantly associated with severe ROP in overall cohort crude analyses (OR 2.51 [95% CI 1.13–5.58], p = 0.024). Adjustment for inverse propensity score (gestational age, sex, birth weight percentile, multiple birth, spontaneous preterm birth, main pregnancy complications, surfactant therapy, duration of oxygen exposure between birth and day 28, digestive state at day 7, caloric intake at day 7, and highest glycemia during the first week) and duration of oxygen therapy had a large but not significant effect on the association between insulin treatment and severe ROP (OR 0.40 [95% CI 0.13–1.24], p = 0.106). Limitations of this study include its observational nature and, despite the large number of patients included compared to earlier similar studies, the lack of power to analyze the association between insulin use and retinopathy.ConclusionsIn this study, we observed that exposure to high glucose concentration is an independent risk factor for severe ROP, and we identified cutoff levels that are significantly associated with increased risk. The clinical impact of avoiding exceeding these thresholds to prevent ROP deserves further evaluation.

In this cohort study, Elsa Kermorvant-Duchemin and colleagues examine the association between hyperglycemia and severe retinopathy of prematurity in infants.     

Type 1 Retinopathy of Prematurity and Its Laser Treatment of Large Preterm Infants in East China

Purpose

To describe Type 1 retinopathy of prematurity (ROP) and its laser treatment outcomes in premature infants with birth weight > 1250 g in Eastern China.

Methods

A retrospective review of 3175 ROP records was conducted at Shanghai Eye & ENT Hospital of Fudan University. The records were collected at the ROP clinic from 2006 to 2014, including their demographic and medical information such as gestational age, birth weight, supplemental oxygen therapy, systemic complications, ROP stage, location, presence of plus disease. All infants were examined by RetCam fundus camera. Those with Type 1 ROP were also examined by indirect ophthalmoscope before undergoing transpupillary laser treatment.

Results

A total of 12 infants (24 eyes) with Type 1 ROP and birth weight > 1250 g were enrolled. All infants enrolled had plus disease and ROP in zone II retina. Specifically, 16 eyes (67%) had stage 2 ROP. 8 eyes (33%) had stage 3 ROP. ROP regressed in 23 eyes (96%) following laser treatment. Partial retinal detachment developed in one eye (4%). No severe involution sequelaes or laser-related complications were recorded. Mean follow-up was 30±6 weeks.

Conclusion

Type 1 ROP may occur in large premature infants who have undergone supplemental oxygen therapy. This Type 1 ROP is mainly located in zone II retina. Laser treatment is a safe and effective intervention for these infants.     

Genetic polymorphisms of antioxidant enzymes as risk factors for oxidative stress-associated complications in preterm infants

Abstract

We aimed to identify specific polymorphisms of genes encoding for superoxide dismutase (SOD) 1 (cytoplasmic Cu/ZnSOD), SOD2 (mitochondrial MnSOD), SOD3 (extracellular Cu/ZnSOD) and CAT in a cohort of preterm infants and correlate their presence to the development of respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH) and retinopathy of prematurity (ROP). We carried out a retrospective study to evaluate the allele frequency and the genotype distribution of polymorphisms of SODs and CAT in a population of preterm neonates (n =?152) with a gestational age ≤?28 weeks according to the presence or absence of RDS, BPD, IVH and ROP. Moreover, we evaluated through the haplotype reconstruction analysis whether combinations of the selected polymorphisms are related to the occurrence of RDS, BPD, IVH and ROP. We found that rs8192287 SOD3 polymorphism is an independent protective factor for all grade IVH, while rs4880 and rs5746136 SOD2 polymorphisms are associated with a lower gestational age (rs4880, rs5746136) and birth weight (rs4880). Haplotypes reconstruction showed that SOD1 (GG) decreased the risk of RDS, IVH and ROP; SOD2 (GT) increased the risk of BPD and decreased the risk of RDS, IVH and ROP; SOD3 (TGC) decreased the risk of BPD and IVH; and 4) CAT (CTC) decreased the risk of RDS. The rs8192287 SOD3 polymorphism is per se an independent predictor of a decreased risk of developing IVH. Different SOD2 polymorphisms are associated per se with a lower gestational age and/or birth weight, and haplotypes of SOD1, SOD3 and CAT genes may be independent protecting or risk markers for prematurity complications.     

Genetic polymorphisms of antioxidant enzymes as risk factors for oxidative stress-associated complications in preterm infants

We aimed to identify specific polymorphisms of genes encoding for superoxide dismutase (SOD) 1 (cytoplasmic Cu/ZnSOD), SOD2 (mitochondrial MnSOD), SOD3 (extracellular Cu/ZnSOD) and CAT in a cohort of preterm infants and correlate their presence to the development of respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH) and retinopathy of prematurity (ROP). We carried out a retrospective study to evaluate the allele frequency and the genotype distribution of polymorphisms of SODs and CAT in a population of preterm neonates (n = 152) with a gestational age ≤ 28 weeks according to the presence or absence of RDS, BPD, IVH and ROP. Moreover, we evaluated through the haplotype reconstruction analysis whether combinations of the selected polymorphisms are related to the occurrence of RDS, BPD, IVH and ROP. We found that rs8192287 SOD3 polymorphism is an independent protective factor for all grade IVH, while rs4880 and rs5746136 SOD2 polymorphisms are associated with a lower gestational age (rs4880, rs5746136) and birth weight (rs4880). Haplotypes reconstruction showed that SOD1 (GG) decreased the risk of RDS, IVH and ROP; SOD2 (GT) increased the risk of BPD and decreased the risk of RDS, IVH and ROP; SOD3 (TGC) decreased the risk of BPD and IVH; and 4) CAT (CTC) decreased the risk of RDS. The rs8192287 SOD3 polymorphism is per se an independent predictor of a decreased risk of developing IVH. Different SOD2 polymorphisms are associated per se with a lower gestational age and/or birth weight, and haplotypes of SOD1, SOD3 and CAT genes may be independent protecting or risk markers for prematurity complications.     

Hypothermia in Preterm Infants in the First Hours after Birth: Occurrence,Course and Risk Factors

BackgroundHypothermia is associated with increased morbidity and mortality rates. Preterm infants frequently have hypothermia when they are admitted to the NICU, but there is no data on the occurrence of hypothermia during the first hours after admission.ObjectiveTo investigate the occurrence of hypothermia in preterm infants in the first three hours of admission and to identify risk factors.MethodsInfants < 32 weeks of gestation included in a randomized trial with admission temperature as primary outcome were retrospectively analyzed for the occurrence of hypothermia (< 36.5°C) in the first three hours after admission. Risk factors were identified using linear regression analysis and logistic regression.ResultsIn total 80 infants were included with a median (IQR) gestational age at birth of 29 (27–30) weeks. In 93% of the infants hypothermia occurred in the first three hours after admission. The median (IQR) duration of hypothermia was 101 (34–162) minutes, of which 24 (7–52) minutes the hypothermia was mild, 45 (4–111) minutes moderate, severe hypothermia hardly occurred. Gestational age and the occurrence of hypothermia at birth were independent risk factors for the occurrence of moderate and severe hypothermia and significantly correlated with duration of hypothermia.ConclusionsHypothermia occurred often and for a long period in preterm infants in the first three hours of life, low gestational age and admission temperature were independent risk factors     

深度水解蛋白配方奶在不同体重早产儿喂养中的临床效果观察

目的:评估深度水解配方奶(eHPF)在不同体重早产儿早期喂养中临床应用效果。方法:选取2017年9月至2018年12月出生的早产儿,分为极低出生体重儿组(体重1000-1500g之间)62例和低出生体重儿(体重1500-2000g之间)100例,每组再随机分为两组,分别予以深度水解蛋白奶(eHPF)和早产儿配方奶(SPF)喂养。极低出生体重儿组于12小时后开始微量喂养,低出生体重儿12小时内适量喂养;极低出生体重儿组深度水解蛋白奶喂养2周后改早产儿奶喂养,低出生体重儿组深度水解蛋白奶1周后改早产儿奶喂养。比较深度水解蛋白奶在不同体重早产儿早期喂养中的临床应用效果,不同体重早产儿恢复出生体重时间、每日体重增长速度、胃管留置时间、完全肠内喂养天数、住院天数、喂养不耐受发生率、宫外发育迟缓发生率及尿素氮、碱性磷酸酶指标。结果:深度水解蛋白喂养组极低出生体重儿/低出生体重儿恢复出生体重天数、完全肠道喂养天数、胃管留置时间、住院天数较早产儿奶喂养组明显缩短(P0.05),每天体重增长优于早产儿组,喂养不耐受、宫外发育迟缓发生率明显低于早产儿组(P0.05),尿素氮、碱性磷酸酶无统计学差异(P0.05)。结论:深度水解蛋白奶用于不同体重早产儿早期喂养效果明显优于早产儿配方奶,其更有助于早产儿的生长发育。     

Glutathione status in retinopathy of prematurity.

This study examines the glutathione status of red blood cells in patients with retinopathy of prematurity (ROP) both in vivo and after an in vitro oxidative challenge. Fifty ROP patients of different ages (between 6 weeks and 6 years), born prematurely (gestational age: 28.7 +/- 1.3 weeks; birth weight: 1210 +/- 313 g; mean +/- SD) suffering either from active ROP (<3 months old; n = 12) or from a visual handicap due to preceding ROP (3 months-6 years; n = 38) as well as control patients of similar age and maturity (n = 56) were included. Infants with active disease have the lowest levels of reduced glutathione (GSH), the highest levels of oxidized form (GSSG), the highest GSSG/GSH ratios and the greatest fall in GSH after an in vitro oxidative challenge. After an in vitro oxidative stress, defective glutathione recycling was found in patients with preceding ROP and was suggested as a factor predisposing to oxidative hemolysis. The glutathione redox ratio was warranted as a biochemical screen for active ROP in premature infants.     

脂联素在早产儿血清中的表达及其与体格指标、载脂蛋白和骨密度的关系

目的:探讨脂联素在早产儿血清中的表达水平及其与体格指标、载脂蛋白和骨密度的相关性。方法:选择2017年1月至2018年5月期间我院新生儿科住院的早产儿72例作为研究组,另外选择同期我院出生的足月新生儿58例作为对照组。对比两组新生儿的一般资料、脂联素、载脂蛋白和骨密度水平,分析早产儿血清脂联素水平与体格指标、载脂蛋白和骨密度的相关性,同时分析影响血清脂联素水平的危险因素。结果:两组受试新生儿的性别、胸围、低密度脂蛋白(LDL-C)及高密度脂蛋白(HDL-C)之间的差异无统计学意义(P0.05);研究组新生儿的胎龄、体质量指数(BMⅠ)、身长、头围、总胆固醇(TC)及三酰甘油(TG)明显低于对照组(P0.05);与对照组相比,研究组新生儿血清脂联素、载脂蛋白A-Ⅰ(Apo A-Ⅰ)及左胫骨中段超声波在骨骼中的传播速度(SOS)水平明显下降,而载脂蛋白B(Apo B)和Apo B/Apo A-Ⅰ水平均显著升高,且差异均具有统计学意义(P0.05);早产儿血清脂联素水平与胎龄、BMⅠ、头围、TC、TG、Apo A-Ⅰ及SOS呈正相关(P0.05),与Apo B和Apo B/Apo A-Ⅰ水平呈负相关(P0.05);Logistic回归结果显示,胎龄、BMⅠ、Apo B/Apo A-Ⅰ及SOS是早产儿血清脂联素水平的影响因素(P0.05)。结论:早产儿血清脂联素水平低于足月儿,血清脂联素水平与体格指标、载脂蛋白及骨密度密切相关,可能对新生儿的生长发育具有重要的调节作用。     

Low Birth Weight Is a Risk Factor for Severe Retinopathy of Prematurity Depending on Gestational Age

Objective

To evaluate the impact of low birth weight as a risk factor for retinopathy of prematurity (ROP) that will require treatment in correlation with gestational age at birth (GA).

Study design

In total, 2941 infants born <32 weeks GA were eligible from five cohorts of preterm infants previously collected for analysis in WINROP (Weight IGF-I Neonatal ROP) from the following locations: Sweden (EXPRESS) (n = 426), North America (n = 1772), Boston (n = 338), Lund (n = 52), and Gothenburg (n = 353). Data regarding GA at birth, birth weight (BW), gender, and need for ROP treatment were retrieved. Birth weight standard deviation scores (BWSDS) were calculated with Swedish as well as Canadian reference models. Small for gestational age (SGA) was defined as BWSDS less than −2.0 SDS using the Swedish reference and as BW below the 10^th percentile using the Canadian reference charts.

Results

Univariate analysis showed that low GA (p<0.001), low BW (p<0.001), male gender (p<0.05), low BWSDS_Canada (p<0.001), and SGA_Canada (p<0.01) were risk factors for ROP that will require treatment. In multivariable logistic regression analysis, low GA (p<0.0001), male gender (p<0.01 and p<0.05), and an interaction term of BWSDS*GA group (p<0.001), regardless of reference chart, were risk factors. Low BWSDS was less important as a risk factor in infants born at GA <26 weeks compared with infants born at GA ≥26 weeks calculated with both reference charts (BWSDS_Sweden, OR = 0.80 vs 0.56; and BWSDS_Canada, OR = 0.72 vs 0.41).

Conclusions

Low BWSDS as a risk factor for vision-threatening ROP is dependent on the infant''s degree of immaturity. In more mature infants (GA ≥26 weeks), low BWSDS becomes a major risk factor for developing ROP that will require treatment. These results persist even when calculating BW deficit with different well-established approaches.