Clinical significance of oral immune therapy with colostrum on reducing incidence of nosocomial infection in very low birth weight preterm infants

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doi:10.3877/cma.j.issn.1673-5250.2019.05.009

Objective

To investigate the effect of oral immune therapy with colostrum on reducing incidence of nosocomial infection in very low birth weight (VLBW) preterm infants.

Methods

A total of 198 VLBW preterm infants who were hospitalized in neonatal intensive care unit (NICU) of the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University from May 2016 to April 2018, were enrolled as research subjects. They were divided into observation group (n=108, treated by oral immune therapy with colostrum) and control group (n=98, treated by equal amount of normal saline to replacing colostrum) based on informed consent and offer colostrum or not within the first 72 h after VLBW preterm infants birth. The independent-samples t test and chi-square test were used to compare the clinical data, incidence rate of nosocomial infection and clinical outcomes between two groups of patients. This study was reviewed by the Ethics Committee of the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University (Approval No. 2018-06-0328-02). Informed consents were obtained from the guardians or entrusted agents of all infants.

Results

①There were no significant differences between two groups of VLBW preterm infants in gestational age, birth weight, proportion of small for gestational age, head circumference, constituent ratio of gender and delivery mode, incidence rate of time of premature rupture of membranes >18 h, usage of prenatal antibacterials in mother, incidence rate of asphyxia of infants, time of parenteral nutrition, proportion of twins and incidence rate of patent ductus arteriosus (P>0.05). The rate of central venous catheterization and mechanical ventilation were 38.9% and 32.4% in observation group, which were higher than those of 25.6% and 14.4% in control group, and the differences were statistically significant (χ²=3.958, P=0.047; χ²=8.625, P=0.003). ②The total incidence rate of nosocomial infection and clinical sepsis were 21.3% and 13.0% in observation group, which were lower than those of 34.4% and 25.6% in control group, and the differences were statistically significant (χ²=4.279, P=0.039; χ²=5.123, P=0.024). There were no significant differences between two groups in the incidence rates of proven sepsis, ventilator associated pneumonia (VAP) and urinary tract infection (P>0.05). ③There were no significant differences between two groups in length of hospital stay, head circumference and weight on the day of discharge, and discharge rate of improved disease conditions (P>0.05).

Conclusions

Oral immune therapy with colostrum can reduce the incidence of nosocomial infection in VLBW preterm infants.

Key words: Cross infection, Immunotherapy, Colostrum, Intensive care units, neonatal, Pneumonia, ventilator-associated, Infant, very low birth weight, Infant, premature

表1 2组患儿临床资料比较

组别	例数	胎龄(周，±s)	出生体重(g, ±s)	小于胎龄儿[例数(%)]	头围(cm，±s)	性别[例数(%)]		母亲分娩方式[例数(%)]
组别	例数	胎龄(周，±s)	出生体重(g, ±s)	小于胎龄儿[例数(%)]	头围(cm，±s)	男	女	阴道分娩	剖宫产
观察组	108	30.0±1.8	1 239±189	38(35.2)	27.4±1.8	59(54.6)	49(45.4)	45(41.7)	63(58.3)
对照组	90	29.7±1.7	1 261±188	21(23.3)	27.5±1.8	42(46.7)	48(53.3)	46(51.1)	44(48.9)
检验值	?	t＝－1.380	t＝0.832	χ²＝3.296	t＝0.114	χ²＝1.246		χ²＝1.763
P值	?	0.169	0.407	0.069	0.910	0.264		0.184
组别	例数	母亲胎膜早破>18 h[例数(%)]	母亲产前使用抗菌药物[例数(%)]	窒息[例数(%)]	中心静脉置管[例数(%)]	机械通气治疗[例数(%)]	静脉营养时间[d，M(P₂₅～P₇₅)]	双胎[例数(%)]	动脉导管未闭[例数(%)]
观察组	108	41(38.3)	33(30.6)	64(59.3)	42(38.9)	35(32.4)	14.0(10.0～20.0)	39(36.1)	59(54.6)
对照组	90	43(47.8)	31(34.4)	59(65.6)	23(25.6)	13(14.4)	13.0(9.8～20.0)	38(42.2)	46(51.1)
检验值	?	χ²＝1.789	χ²＝2.739	χ²＝0.827	χ²＝3.958	χ²＝8.625	Z＝－0.730	χ²＝0.771	χ²＝0.244
P值	?	0.181	0.254	0.363	0.047	0.003	0.466	0.380	0.621

表1 2组患儿临床资料比较

组别	例数	胎龄(周，±s)	出生体重(g, ±s)	小于胎龄儿[例数(%)]	头围(cm，±s)	性别[例数(%)]		母亲分娩方式[例数(%)]
组别	例数	胎龄(周，±s)	出生体重(g, ±s)	小于胎龄儿[例数(%)]	头围(cm，±s)	男	女	阴道分娩	剖宫产
观察组	108	30.0±1.8	1 239±189	38(35.2)	27.4±1.8	59(54.6)	49(45.4)	45(41.7)	63(58.3)
对照组	90	29.7±1.7	1 261±188	21(23.3)	27.5±1.8	42(46.7)	48(53.3)	46(51.1)	44(48.9)
检验值	?	t＝－1.380	t＝0.832	χ²＝3.296	t＝0.114	χ²＝1.246		χ²＝1.763
P值	?	0.169	0.407	0.069	0.910	0.264		0.184
组别	例数	母亲胎膜早破>18 h[例数(%)]	母亲产前使用抗菌药物[例数(%)]	窒息[例数(%)]	中心静脉置管[例数(%)]	机械通气治疗[例数(%)]	静脉营养时间[d，M(P₂₅～P₇₅)]	双胎[例数(%)]	动脉导管未闭[例数(%)]
观察组	108	41(38.3)	33(30.6)	64(59.3)	42(38.9)	35(32.4)	14.0(10.0～20.0)	39(36.1)	59(54.6)
对照组	90	43(47.8)	31(34.4)	59(65.6)	23(25.6)	13(14.4)	13.0(9.8～20.0)	38(42.2)	46(51.1)
检验值	?	χ²＝1.789	χ²＝2.739	χ²＝0.827	χ²＝3.958	χ²＝8.625	Z＝－0.730	χ²＝0.771	χ²＝0.244
P值	?	0.181	0.254	0.363	0.047	0.003	0.466	0.380	0.621

表2 2组患儿医院感染发生率比较[例数(%)]

组别	例数	医院感染总发生率	确诊败血症	临床败血症	VAP	尿路感染
观察组	108	23(21.3)	6(5.6)	14(13.0)	0(0)	3(2.8)
对照组	90	31(34.4)	6(6.7)	23(25.6)	2(2.2)	2(2.2)
χ²值	?	4.279	0.106	5.123	—^a	0
P值	?	0.039	0.744	0.024	0.205	1.000^b

表2 2组患儿医院感染发生率比较[例数(%)]

组别	例数	医院感染总发生率	确诊败血症	临床败血症	VAP	尿路感染
观察组	108	23(21.3)	6(5.6)	14(13.0)	0(0)	3(2.8)
对照组	90	31(34.4)	6(6.7)	23(25.6)	2(2.2)	2(2.2)
χ²值	?	4.279	0.106	5.123	—^a	0
P值	?	0.039	0.744	0.024	0.205	1.000^b

表3 2组患儿临床结局比较

组别	例数	住院时间(d, ±s)	出院时头围(cm, ±s)	出院时体重(g, ±s)	好转出院[例数(%)]
观察组	108	47.4±17.0	31.8±1.5	2 084±251	94(87.0)
对照组	90	47.3±16.1	32.0±1.3	2 086±249	85(94.4)
检验值	?	t＝－0.040	t＝0.691	t＝0.051	χ²＝3.105
P值	?	0.968	0.490	0.959	0.078

表3 2组患儿临床结局比较

组别	例数	住院时间(d, ±s)	出院时头围(cm, ±s)	出院时体重(g, ±s)	好转出院[例数(%)]
观察组	108	47.4±17.0	31.8±1.5	2 084±251	94(87.0)
对照组	90	47.3±16.1	32.0±1.3	2 086±249	85(94.4)
检验值	?	t＝－0.040	t＝0.691	t＝0.051	χ²＝3.105
P值	?	0.968	0.490	0.959	0.078

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