Mäki M, Ruuska T, Kuusela A L, Karikoski-Leo R, Ikonen R S
Department of Pediatrics, University Hospital of Tampere, Finland.
Crit Care Med. 1993 Dec;21(12):1863-7. doi: 10.1097/00003246-199312000-00013.
To establish the prevalence of upper gastrointestinal mucosal lesions in full-term and preterm infants under stress.
A prospective, cohort study.
Neonatal intensive care unit at a university teaching hospital.
Seventeen (14 preterm, 3 term; median gestational age 29.7 wks; median birth weight 1230 g) consecutive, unselected infants treated in intensive care.
Gastroscopy, using a prototype fiberoptic gastroscope designed for newborns, was performed for the first time at the age of 3 to 7 days. Biopsy specimens were taken when possible. Ranitidine treatment and follow-up endoscopies were performed in selected patients. Blood pressure, heart rate, oxygen saturation by pulse oximeter, and the general condition of the infants were monitored at 1-min intervals during the endoscopy. Central nervous system ultrasonography examination was repeatedly performed before and after the procedure.
At the time of first endoscopy, 15 of 17 infants were asymptomatic for gastrointestinal tract problems, one had melena, and one hematemesis. Upper gastrointestinal endoscopy revealed pathology in 16 (94%) infants, macroscopic esophagitis in six infants, hemorrhagic gastritis in nine infants, and gastritis with ulcers in six infants. Microscopically, the lesions were also clear. A peculiar finding was acute gastritis with cystic gland deformation ("cystic gastritis") seen in five of the infants under stress; one of these infants also had intestinal metaplasia in the gastric mucosa. Seven infants were treated with ranitidine without side-effects. Follow-up endoscopies demonstrated normalization of the lesions in five of six infants studied. The procedure, including biopsies, seemed to be safe, even for very low-birth weight infants.
Gastric mucosal lesions are highly prevalent in preterm infants in intensive care before any symptoms occur. Further research on preterm infants under stress is needed in order to determine the risk factors and optimal treatment for the esophageal and gastric mucosal lesions described here.
确定处于应激状态的足月儿和早产儿上消化道黏膜病变的患病率。
一项前瞻性队列研究。
一所大学教学医院的新生儿重症监护病房。
17例（14例早产儿，3例足月儿；中位胎龄29.7周；中位出生体重1230克）在重症监护室接受治疗的连续、未经挑选的婴儿。
使用专为新生儿设计的原型纤维胃镜在3至7日龄时首次进行胃镜检查。尽可能采集活检标本。对选定患者进行雷尼替丁治疗和随访内镜检查。在内镜检查期间，每隔1分钟监测婴儿的血压、心率、经脉搏血氧仪测得的血氧饱和度以及一般状况。在检查前后反复进行中枢神经系统超声检查。
首次内镜检查时，17例婴儿中有15例无胃肠道问题症状，1例有黑便，1例有呕血。上消化道内镜检查显示16例（94%）婴儿有病变，6例婴儿有肉眼可见的食管炎，9例婴儿有出血性胃炎，6例婴儿有胃炎伴溃疡。显微镜下，病变也很明显。一个特殊发现是5例处于应激状态的婴儿出现了伴有囊性腺体变形的急性胃炎（“囊性胃炎”）；其中1例婴儿胃黏膜还有肠化生。7例婴儿接受了雷尼替丁治疗，无副作用。对6例接受研究的婴儿中的5例进行的随访内镜检查显示病变恢复正常。该检查，包括活检，即使对极低出生体重儿似乎也是安全的。
在重症监护的早产儿中，在出现任何症状之前，胃黏膜病变非常普遍。需要对处于应激状态的早产儿进行进一步研究，以确定此处所述食管和胃黏膜病变的危险因素及最佳治疗方法。
