Seminars in Fetal & Neonatal Medicine最新文献

英文中文

Short- and longer-term growth and development of fat mass in preterm infants 早产儿脂肪量的短期和长期生长和发展。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-04-09 DOI: 10.1016/j.siny.2025.101636

Shipra Jain , Belal N. Alshaikh , Seham Elmrayed , Tanis R. Fenton

Preterm infants typically experience faster growth rates than term-born infants, often doubling their weight in six to eight weeks. However, many face challenges leading to growth faltering and suboptimal neurodevelopment. To achieve optimal growth, these infants often require fortified breastmilk or high-nutrient formula. While meeting nutrition and growth targets are essential, concerns arise about rapid postnatal growth during their catch-up phase, particularly regarding increased body fat at term-corrected age, possibly increasing their risk for obesity and chronic health conditions later. However, evidence suggests that although preterm infants may have higher body fat at term-corrected age, this difference diminishes by three months corrected age, aligning more closely with term-born infants. Systematic reviews of more than 20,000 individuals observed that small for gestational age preterm infants do not have higher adiposity in childhood and adulthood; rather, they exhibit lower body mass indexes, waist circumferences, similar body and visceral fat and blood pressure compared to their appropriate for gestational age preterm-born peers. Therefore, it is reassuring that promoting early growth in preterm infants does not necessitate a trade-off when it comes to supporting long-term metabolic outcomes versus neurodevelopment. Healthcare providers should encourage a responsive feeding approach, even in preterm infants, guided by infants' physiological needs, hunger and satiety once they exhibit feeding cues. This approach respects the child's developmental needs and encourages healthy eating habits, fostering positive parent-child feeding relationships, and ultimately allowing the child to grow and develop to their full potential without compromising their long-term health outcomes.

早产儿的生长速度通常比足月出生的婴儿快，通常在六到八周内体重会增加一倍。然而，许多人面临着导致生长迟缓和神经发育不佳的挑战。为了达到最佳生长，这些婴儿通常需要强化母乳或高营养配方奶粉。虽然达到营养和生长目标至关重要，但人们对婴儿在追赶阶段的产后快速生长感到担忧，特别是在足月矫正年龄时体脂增加，这可能增加他们以后患肥胖症和慢性疾病的风险。然而，有证据表明，尽管早产儿在足月矫正年龄时可能有较高的体脂，但这种差异在3个月矫正年龄时就会减弱，与足月婴儿更接近。对2万多人的系统回顾发现，小于胎龄的早产儿在儿童期和成年期没有更高的肥胖；相反，他们表现出较低的身体质量指数、腰围、相似的身体和内脏脂肪和血压，与同龄的胎龄早产儿相比。因此，当涉及到支持长期代谢结果和神经发育时，促进早产儿的早期生长并不一定需要权衡，这是令人放心的。医疗保健提供者应鼓励反应性喂养方法，即使是早产儿，根据婴儿的生理需求，饥饿和饱腹感，一旦他们表现出喂养线索的指导。这种方法尊重儿童的发展需要，鼓励健康的饮食习惯，培养积极的亲子喂养关系，最终使儿童在不损害其长期健康结果的情况下成长和发展，充分发挥其潜力。

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引用次数: 0

Amino acids and protein for preterm infants: How much and for what? 早产儿需要多少氨基酸和蛋白质？

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-04-09 DOI: 10.1016/j.siny.2025.101633

William W. Hay

Protein and amino acids derived from protein digestion in the gastrointestinal tract or from intravenous infusions are fundamental for normal metabolism, growth, and neurodevelopmental outcomes in the fetus and the preterm infant of the same gestational age. Many studies support that at least 3.0–3.5 g/kg/day of protein or amino acids are needed to achieve normal nitrogen/protein balance and growth rates and the large fractional increase of lean mass in later gestation, either in the fetus or the preterm infant; this relationship is direct and linear. Faster growth rates in earlier gestation require more amino acids and protein than the late preterm or term infant. Protein synthesis and accretion also require sufficient energy, but above ∼120 kcal/kg/day, energy is largely diverted to fat production but not lean mass growth. Optimal IV amino acid solutions remain to be developed, and mature maternal milk and donor human milk require protein supplements to achieve appropriate protein balance and growth. Additional supplements of growth factors might augment increased protein intakes and fortifiers. While excess amino acid and/or protein intakes do not promote growth or development and might even be harmful, providing less than the amounts required guarantees poorer outcomes and should be avoided.

通过胃肠道消化或静脉输注获得的蛋白质和氨基酸是相同胎龄的胎儿和早产儿正常代谢、生长和神经发育结果的基础。许多研究支持至少3.0-3.5 g/kg/天的蛋白质或氨基酸，以达到正常的氮/蛋白质平衡和生长速度，并在妊娠后期，无论是胎儿还是早产儿瘦体重的大幅度增加；这种关系是直接和线性的。妊娠早期的快速生长比晚期早产儿或足月婴儿需要更多的氨基酸和蛋白质。蛋白质的合成和增加也需要足够的能量，但超过120千卡/公斤/天，能量大部分被转移到脂肪生产，而不是瘦体重的增长。最佳的静脉注射氨基酸解决方案仍有待开发，成熟的母乳和供体母乳需要补充蛋白质以达到适当的蛋白质平衡和生长。额外补充生长因子可能会增加增加的蛋白质摄入量和强化剂。虽然过量摄入氨基酸和/或蛋白质不会促进生长发育，甚至可能有害，但低于所需量的氨基酸和/或蛋白质摄入会导致较差的结果，应该避免。

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引用次数: 0

Exclusive enteral nutrition in preterm infants: How early is too early? 早产儿独家肠内营养：多早算太早？

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-04-09 DOI: 10.1016/j.siny.2025.101631

Ariel A. Salas , Shalini Ojha

With the growing availability of maternal and donor milk, neonatal feeding practices are undergoing significant transformation. Increasingly, neonatal units are prioritizing exclusive enteral nutrition soon after birth, a shift that represents a substantial advance in neonatal care. However, critical questions remain regarding the implementation, safety, and long-term outcomes of this approach. This review consolidates the evidence supporting early and exclusive enteral nutrition, exploring its potential to redefine neonatal care practices, particularly in high-resource settings. By examining challenges such as variability in practices, resource constraints, and clinical decision-making during acute illness, this discussion aims to provide a roadmap for integrating these practices into routine care and advancing outcomes for preterm and vulnerable infants.

随着母体和供体乳汁供应的增加，新生儿喂养方式正在发生重大转变。越来越多的新生儿单位在出生后不久就优先考虑独家肠内营养，这一转变代表了新生儿护理的重大进步。然而，关于该方法的实施、安全性和长期结果，仍存在一些关键问题。本综述整合了支持早期和独家肠内营养的证据，探讨了其重新定义新生儿护理实践的潜力，特别是在高资源环境中。通过研究实践中的变异性、资源限制和急性疾病期间的临床决策等挑战，本讨论旨在为将这些实践纳入常规护理和提高早产儿和弱势婴儿的预后提供路线图。

引用次数: 0

Parenteral nutrition for preterm infants: benefits and risks in 2025 早产儿肠外营养：2025年的益处和风险

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-04-09 DOI: 10.1016/j.siny.2025.101635

Nicholas D. Embleton , Chris H.P. van den Akker , Mark Johnson

Parenteral nutrition (PN) has been a key component of neonatal care for preterm infants since the 1980's and provides macronutrients for growth, along with electrolytes, minerals, vitamins and trace elements. In this article we consider common issues with routine provision to very preterm infants including estimation of nutrient requirements, optimal starting doses of PN, rates of increase and maximum intakes. We consider monitoring strategies and outline common complications which may be serious and fatal. Finally, we consider risk-benefit ratios in different populations of preterm infants, and outline some of the major uncertainties in current practice.

自20世纪80年代以来，肠外营养（PN）一直是早产儿新生儿护理的关键组成部分，它提供了促进生长的大量营养素，以及电解质、矿物质、维生素和微量元素。在这篇文章中，我们考虑了常规提供给非常早产儿的常见问题，包括营养需求的估计，PN的最佳起始剂量，增加率和最大摄入量。我们考虑监测策略并概述可能严重和致命的常见并发症。最后，我们考虑了不同早产儿人群的风险收益比，并概述了当前实践中的一些主要不确定性。

引用次数: 0

The value of thromboelastography to neonatology 血栓弹性成像对新生儿科的价值。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101610

Francesca Manzoni , Ludovica Raymo , Vittoria Carolina Bronzoni , Andrea Tomaselli , Stefano Ghirardello , Monica Fumagalli , Giacomo Cavallaro , Genny Raffaeli

Hemostatic derangements are common in critically ill and premature neonates. Nevertheless, hemostasis assessment in neonates is still challenging. The hemostatic system undergoes age-related physiological changes during its maturation and exhibits quantitative and qualitative differences between infants and adults. Conventional coagulation tests are mainly responsive to procoagulant factors, regardless of the contribution of cellular elements, anticoagulants and fibrinolytic contributors and, therefore, their role in predicting bleeding in neonatal acquired coagulopathy is somewhat limited. Viscoelastic coagulation tests offer a promising alternative, enabling a bedside and real-time assessment of the entire hemostatic process in short turn-around times with a limited amount of blood. These tests allow a targeted hemostatic monitoring and a tailored management of blood products and anticoagulation. The routine use of VCTs in the NICU remains limited, especially for premature infants, due to the lack of established normative ranges. In this review we will provide an overview of the main evidence related to the clinical application of viscoelastic monitoring in the neonatal setting.

止血失常在重症和早产新生儿中很常见。然而，新生儿的止血评估仍具有挑战性。止血系统在成熟过程中会发生与年龄相关的生理变化，婴儿与成人在数量和质量上都存在差异。传统的凝血试验主要对促凝血因子做出反应，而不考虑细胞元素、抗凝剂和纤维蛋白溶解剂的作用，因此在预测新生儿获得性凝血病的出血方面作用有限。粘弹性凝血试验提供了一种很有前景的替代方法，只需少量血液就能在短时间内对整个止血过程进行床旁实时评估。通过这些检测，可对止血过程进行有针对性的监测，并对血液制品和抗凝剂进行有针对性的管理。由于缺乏既定的标准范围，VCT 在新生儿重症监护室中的常规使用仍然有限，尤其是在早产儿中。在本综述中，我们将概述与新生儿粘弹性监测临床应用相关的主要证据。

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引用次数: 0

Health and societal infant mortality burden of neonatal hemolytic disorders 新生儿溶血性疾病的健康和社会婴儿死亡率负担。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101620

Ramesh Vidavalur , Vinod K. Bhutani

Hemolytic disorders in neonates, once exceedingly common causes of infant mortality, have become increasingly rare and now largely non-fatal. Global advancements in neonatal care and deeper understanding of the mechanisms of neonatal hemolysis have significantly improved survival outcomes, particularly among those in high-income countries. However, regional disparities persist due to non-equitable healthcare access. Their long-lasting health consequences have been attributed to social, demographic factors that are most likely amenable to healthcare governance. In this review, we focus our attention to neonatal hemolytic disorders to i) analyze data resourced from the Global Burden of Disease (GBD) 2021 report; ii) study the trends in infant mortality rates (IMR) as related to hemolytic disorders including its severe complication, extreme hyperbilirubinemia (EHB-IMR); iii) evaluate geospatial disparities among GBD super regions; and iv) examine these trends in relation to the socio-demographic index (SDI) of the countries that comprise the “super-regions”. From 1991 to 2021, global EHB-related IMR has declined significantly, from 73 to 25 per 100,000 live births. By 2021, EHB and kernicterus accounted for only 0.7 % of all under-five deaths. High-income countries have dramatically minimized hemolytic disease fatalities, but matched progress eludes regions like South Asia and sub-Saharan Africa. The inverse relationship between SDI and EHB-IMR highlight these national disparities to manifest as slower decline in IMR. In order to achieve equitable healthcare access for all regions, an improved understanding of the societal risk factors would guide re-engineering solutions that are also empowered by audited resource utilization to evaluate remedial governance policies.

新生儿溶血性疾病曾经是婴儿死亡的常见原因，但现在已经越来越罕见，而且基本上不致命。全球新生儿护理的进步和对新生儿溶血机制的深入了解显著改善了生存结果，特别是在高收入国家。然而，由于不公平的医疗保健机会，区域差距仍然存在。它们对健康造成的长期影响归因于社会和人口因素，这些因素最有可能适用于医疗保健治理。在本综述中，我们将重点关注新生儿溶血性疾病，以i)分析来自全球疾病负担（GBD） 2021报告的数据；ii)研究与溶血性疾病相关的婴儿死亡率（IMR）趋势，包括溶血性疾病的严重并发症——极端高胆红素血症（EHB-IMR）；iii)评估GBD超级区域之间的地理空间差异；第四，研究这些趋势与构成“超级区域”的国家的社会人口指数（SDI）的关系。从1991年到2021年，全球ehb相关的死亡率显著下降，从每10万活产73例降至25例。到2021年，EHB和核黄疸仅占所有5岁以下儿童死亡的0.7%。高收入国家大幅减少了溶血性疾病死亡人数，但南亚和撒哈拉以南非洲等地区却没有取得相应的进展。SDI和EHB-IMR之间的负相关关系突出了这些国家差异表现为IMR下降较慢。为了在所有地区实现公平的医疗保健机会，更好地了解社会风险因素将指导重新设计解决方案，这些解决方案还可以通过审计资源利用情况来评估补救性治理政策。

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引用次数: 0

A practical review of iron deficiency in pregnancy 妊娠期缺铁的实际回顾。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101611

Kimberly A. Moyle

Iron deficiency is a highly prevalent nutritional deficiency and the most common cause of anemia worldwide. Pregnant individuals are particularly susceptible due to increased demands to support expanding maternal blood volume and fetal growth. Iron deficiency and iron deficiency anemia are associated with maternal and neonatal morbidity, including preterm birth, preeclampsia, postpartum hemorrhage, and low birth weight. Iron is essential to support the rapidly growing fetal brain. Maternal iron deficiency is linked to cognitive delays, motor impairment, and neuropsychiatric disease in the offspring with effects lasting beyond childhood. Despite its high prevalence and profound clinical implications, it remains underdiagnosed and undertreated in pregnancy. This is potentiated by a lack of consensus regarding laboratory diagnosis and recommendations for screening and treatment. Here, we review the physiology, clinical implications, diagnosis, and treatment of iron deficiency in pregnancy.

缺铁是一种非常普遍的营养缺乏症，也是全世界最常见的贫血原因。孕妇尤其容易受到影响，因为需要增加对母体血容量和胎儿生长的支持。缺铁和缺铁性贫血与孕产妇和新生儿发病率有关，包括早产、先兆子痫、产后出血和低出生体重。铁元素对于支持胎儿快速发育的大脑至关重要。母亲缺铁与后代的认知迟缓、运动障碍和神经精神疾病有关，其影响持续到儿童期以后。尽管它的高患病率和深远的临床影响，它仍然未被诊断和治疗不足的妊娠。由于缺乏对实验室诊断和筛查和治疗建议的共识，这种情况更加严重。在这里，我们回顾生理，临床意义，诊断和治疗缺铁妊娠。

引用次数: 0

Should granulocyte transfusion therapy for septic neutropenic neonates be resurrected? 粒细胞输注治疗感染性中性粒细胞减少新生儿是否应该恢复？

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101616

Shelley M. Lawrence

Nearly half a century ago, granulocyte transfusions were trialed in critically ill, septic, neutropenic neonates and showed improved survival when used concurrently with antimicrobials. Benefits were particularly noteworthy for Gram-negative and fungal infections. The introduction of granulocyte colony-stimulating factor into clinical medicine in 1991 and inherent problems associated with granulocyte procurement for transfusion caused granulocyte transfusions to become nearly extinct for this patient population. Simultaneous technological and clinical management advancements have enabled the survival of younger neonates, who are at the highest risk for neutropenia and neonatal sepsis. These infants have well-documented developmental deficiencies in the number and functional capabilities of their neutrophils compared to older patients. A continued surge in antimicrobial resistance and an increasing number of Gram-negative infections have created an urgent need for clinicians to rethink old therapies and consider new ones. This review details the evolution of granulocyte transfusions and whether they should be resurrected in neonatal patients.

近半个世纪以前，粒细胞输注在危重症、脓毒症、中性粒细胞减少的新生儿中进行了试验，并在与抗菌素同时使用时显示出生存率的提高。对革兰氏阴性和真菌感染的益处尤其显著。粒细胞集落刺激因子于1991年引入临床医学，以及与输血粒细胞获取相关的固有问题导致粒细胞输注在这一患者群体中几乎绝迹。同时，技术和临床管理的进步使年轻新生儿的生存成为可能，他们是中性粒细胞减少症和新生儿败血症的最高风险。与老年患者相比，这些婴儿在中性粒细胞的数量和功能能力方面有充分的发育缺陷。抗菌素耐药性的持续激增和革兰氏阴性感染的数量不断增加，迫切需要临床医生重新考虑旧的治疗方法并考虑新的治疗方法。这篇综述详细介绍了粒细胞输注的演变，以及它们是否应该在新生儿患者中复活。

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引用次数: 0

Prenatal diagnosis and treatment of congenital anemias 先天性贫血的产前诊断与治疗。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101613

Yair J. Blumenfeld

引用次数: 0

A practical guide to reducing/eliminating red blood cell transfusions in the neonatal intensive care unit 新生儿重症监护室减少/消除输注红细胞的实用指南。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2024.101545

Robin K. Ohls , Timothy M. Bahr , Thomas G. Peterson , Robert D. Christensen

Red blood cell transfusions can be lifesaving for neonates with severe anemia or acute massive hemorrhage. However, it is imperative to understand that red cell transfusions convey unique and significant risks for neonates. The extremely rare risks of transmitting a viral, bacterial, or other microbial infection, or causing circulatory overload are well known and are part of blood transfusion informed consent. Less well known, and not always part of the consent process, are more common risks of transfusing the smallest and most immature NICU patients; specifically, multiple transfusions may worsen inflammatory conditions (particularly pulmonary inflammation), and in certain subsets are associated with retinopathy of prematurity and neurodevelopmental delay. Instituting non-pharmacological transfusion-avoidance techniques reduces transfusion rates. Pharmacological transfusion-avoidance, specifically erythropoietic stimulating agents, further reduces the risk of needing a transfusion. The protocols described herein constitute an efficient and cost-effective transfusion-avoidance program. Using these protocols, many NICU patients can remain transfusion-free.

对于患有严重贫血或急性大出血的新生儿来说，输注红细胞可以挽救他们的生命。然而，我们必须明白，输注红细胞对新生儿具有独特而重大的风险。传播病毒、细菌或其他微生物感染或导致循环负荷过重的风险极为罕见，这是众所周知的，也是输血知情同意书的一部分。给最小和最不成熟的新生儿重症监护病房患者输血的风险则不那么为人所知，也不总是同意程序的一部分；具体来说，多次输血可能会加重炎症（尤其是肺部炎症），在某些亚群中还与早产儿视网膜病变和神经发育迟缓有关。采用非药物避免输血技术可降低输血率。药物避免输血，特别是促红细胞生成剂，可进一步降低需要输血的风险。本文介绍的规程是一项高效且经济的避免输血计划。使用这些方案，许多新生儿重症监护病房的患者都可以避免输血。

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