Clinical treatment outcomes and their changes in extremely preterm twins: a multicenter retrospective study in Guangdong Province, China / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China.@*METHODS@#A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups.@*RESULTS@#Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05).@*CONCLUSIONS@#There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.

Recognition and discussion of several technical details in neonatal resuscitation training / 中国当代儿科杂志

In the current revision of neonatal resuscitation training course material and its in-depth learning, referring to the American original textbook on neonatal resuscitation, the authors have some recognition and discussion about its several technical details or translated words. These include the location and time period of postnatal rapid assessment, the expression of respiratory questions, the pressing position in the tracheal intubation, and the expression of respiratory questions in the flow chart of resuscitation, etc. The accurate understanding and interpretation of the above will help grass-roots training to be carried out more accurately and effectively.

Clinical efficacy of nasal high-frequency ventilation in treatment of neonatal respiratory distress syndrome: a Meta analysis / 中国当代儿科杂志

OBJECTIVE@#To systematically evaluate the clinical efficacy of nasal high-frequency ventilation (nHFV) in the treatment of neonatal respiratory distress syndrome (NRDS).@*METHODS@#A literature search was performed in PubMed, Cochrane Library, EMBase (Ovid), Chinese Biomedical Literature Database, Chinese Journal Full-text Database, Wanfang Data, and Weipu Data to collect the randomized controlled trials (RCTs) that compared the clinical efficacy of nHFV and nasal continuous positive airway pressure (nCPAP) in the treatment of NRDS. A Meta analysis was performed on the included RCTs using Rev Man 5.3 software after data extraction and quality evaluation by Cochrane 5.1.0.@*RESULTS@#A total of 4 RCTs involving 218 patients were included. The Meta analysis showed that compared with the nCPAP group, the nHFV group had a significantly better treatment outcome (RR=1.73, 95%CI: 1.39-2.15, P<0.00001). There were no significant differences in the incidence rates of intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, necrotizing enterocolitis, pneumothorax and retinopathy of prematurity.@*CONCLUSIONS@#Compared with nCPAP, nHFV has better clinical efficacy in the treatment of NRDS, without increasing the risk of related complications.

Progress of intensive care and biomedical engineering related treatment technology in neonates / 国际儿科学杂志

The development of neonatal intensive care unit (NICU) partly depends on modem medical eqnipment and technology.This paper will trace the latest monitor technology and biomedical engineering related treatment technologies in NICU,besides the bedside microbiochemical tests,ultrasound,radiology,brain function monitoring and retinal screening monitoring technology,as well as temperature control,circulation support,renal replacement therapy,provided biomedical related technical guidance for monitoring and treating the critical neonates.

Research advances in circular RNAs / 中国组织工程研究

BACKGROUND:Unlike linear RNAs,circular RNAs (circRNAs) are a novel type of RNA which can form covalently closed circles and are highly expressed in eukaryotic transcriptomes.In the plenitude of naturally occurring RNAs,circRNAs and their biological role are underestimated for years.Recent studies have discovered thousands of endogenous circRNAs in mammalian cells.OBJECTIVE:To review the formation,properties,and functions of circRNAs,and their potential significance in diseases.METHODS:A computer-based search for literature in CNKI and PubMed databases published from January 2000 to December 2016 was performed using the keywords of "circRNA,miRNA,function,mechanism" in English and Chinese,respectively.Finally,62 eligible articles were included for analysis.RESULTS AND CONCLUSION:CircRNAs are largely generated from exonic or intronic sequences,and reverse complementary sequences or RNA-binding proteins are necessary for circRNA biogenesis.A majority of circRNAs that are conserved across specie are stable and resistant to RNaseR,and often exhibit tissue/developmental-stage-specific expression.Recent research has revealed that circRNAs can function as microRNA sponges,regulators of splicing and transcription,and modifiers of parental gene expression.Emerging evidence indicates that circRNAs might play important roles in atherosclerotic vascular diseases,neurological disorders,prion diseases and cancer;exhibit aberrant expression in colorectal cancer;and serve as diagnostic or predictive biomarkers of some diseases.Similar to microRNAs and long noncoding RNAs,circRNAs are arousing general interest in the field of RNA and widely participate in the life process.

Relationship between serum erythropoietin levels and brain injury in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between the levels of erythropoietin (EPO) in serum and brain injury in preterm infants.</p><p><b>METHODS</b>Three hundred and four preterm infants (gestational age: 28-34 weeks) born between October 2014 and September 2015 were enrolled in this study. Brain injury was diagnosed using cerebral ultrasound and MRI. The levels of EPO, S100 protein, neuron-specific enolase (NSE) and myelin basic protein (MBP) in serum were detected using ELISA. To compare the incidence of brain injury in different serum EPO levels in preterm infants, and the relationship between brain injury and serum EPO levels was analyzed.</p><p><b>RESULTS</b>The incidence rate of brain injury in preterm infants was 41.1% (125/304). The incidence rate of brain injury in the low EPO level group was significantly higher than that in the middle-high EPO level groups (P<0.01). The serum levels of S100 protein, NSE, and MBP in the brain injury groups were significantly higher than in the control group (P<0.01). The serum EPO levels were negatively correlated with serum S100 protein concentration and NSE levels (P<0.05). According to the multiple logistic regression analysis, low gestational age, low birth weight, asphyxia, prolonged mechanical ventilation, anemia and low serum EPO levels were the risk factor for brain injury in preterm infants.</p><p><b>CONCLUSIONS</b>There is a higher incidence rate of brain injury in preterm infants with lower serum EPO levels. The serum EPO levels may be correlated with brain injury in preterm infants.</p>

Analysis of CYP21A2 gene mutation in one case of congenital adrenal hyperplasia / 中国当代儿科杂志

CYP21A2 gene mutations in a child with congenital adrenal hyperplasia (CAH), and the child's parents, were detected in the study. The clinical features, treatment monitoring and molecular genetic mechanism of CAH are reviewed. In the study, DNA was extracted from peripheral blood samples using the QIAGEN Blood DNA Mini Kit; a highly specific PCR primer for CYP21A2 gene was designed according to the sequence difference between CYP2lA2 gene and its pseudogene; the whole CYP2lA2 gene was amplified with PrimeSTAR DNA polymerase (Takara), and the amplification product was directly sequenced to detect and analyze CYP2lA2 gene mutation. The child was clinically diagnosed with CAH (21-hydroxylase deficiency, 21-OHD) at the age of 36 days, and the case was confirmed by genetic diagnosis at the age of 1.5 years. The proband had a homozygous mutation at c.293-13C in the second intron of CYP21 gene, while the parents had heterozygous mutations. Early diagnosis and standard treatment of CAH (21-OHD) should be performed to prevent salt-wasting crisis and reduce mortality; bone aging should be avoided to increase final adult height (FAH), and reproductive dysfunction due to oligospermia in adulthood should be avoided. These factors are helpful for improving prognosis and increasing FAH. Investigating the molecular genetic mechanism of CAH can improve recognition and optimize diagnosis of this disease. In addition, carrier diagnosis and genetic counseling for the proband family are of great significance.

Risk factors and pathogen distribution in premature infants with nosocomial sepsis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the main risk factors and pathogen distribution of nosocomial sepsis among premature infants.</p><p><b>METHODS</b>The clinical data of 3418 hospitalized premature infants from January 2003 to December 2010 were retrospectively analyzed for the risk factors and pathogen distribution of nosocomial sepsis.</p><p><b>RESULTS</b>The incidence of neonatal nosocomial sepsis was 3.10% (106/3418), and the median age at diagnosis of neonatal nosocomial sepsis was 19 (4-48) days. The major pathogens of the infections among these premature infants included gram-positive bacteria (45.2%), especially coagulase-negative Staphylococcus (24.3%), and gram-negative bacteria (41.7%), especially Klebsiella pneumoniae (25.2%), as well as fungus (13.0%). Logistic regression analysis showed that the main risk factors included low birth weight, retention of central venous catheters, and long duration of parenteral nutrition (OR: 3.765, 3.051, and 2.998, respectively; P<0.05).</p><p><b>CONCLUSIONS</b>Low birth weight, retention of central venous catheters, and long duration of parenteral nutrition are the main risk factors for neonatal nosocomial sepsis, whereas the leading pathogen is Klebsiella pneumoniae.</p>

Effect of erythropoietin on apoptosis following hyperoxic lung injury in neonatal rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of recombinant human erythropoietin (rhEPO) on apoptosis following hyperoxic lung injury in neonatal rats.</p><p><b>METHODS</b>Ninety-six neonatal Sprague-Dawley rats were randomly divided into four groups: air-exposed control, air-exposed rhEPO-treated, hyperoxia-exposed placebo (95% oxygen), and hyperoxia-exposed rhEPO-treated. rhEPO (800 U/kg) was administered 2, 4, and 6 days after air or hyperoxia exposure. The rats were sacrificed 3, 7 and 14 days after air or hyperoxia exposure for the assessment of lung histological changes by hematoxylin and eosin staining (n=8 each time point). p-JNK levels were measured by Western blot. Lung cell apoptosis was evaluated by TUNEL assay.</p><p><b>RESULTS</b>Compared with the air-exposed control group, inflammatory cell infiltration was found at 3 days and increased obviously at 7 days, and widening of the alveolar septa was observed, the number of alveoli decreased and normal alveolarization disappeared at 14 days after hyperoxia exposure in the hyperoxia-exposed placebo group. rhEPO treatment alleviated significantly the hyeroxia-induced alterations in lung pathology. P-JNK protein levels and the number of apoptosis cells decreased significantly in the hyperoxia-exposed rhEPO-treated compared with those in the hyperoxia-exposed placebo group.</p><p><b>CONCLUSIONS</b>rhEPO may reduce apoptosis and thus provide a protective effect against hyperoxic lung injury in neonatal rats. JNK signal pathway may be involved in the protective mechanism.</p>

Lung fibrosis induced by mechanical ventilation with different tidal volume in neonatal rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the changes of collagen synthesis following mechanical ventilation with different tidal volume and the possible mechanism.</p><p><b>METHODS</b>Twenty-four neonatal Sprague-Dawley rats were randomized to hyperventilation (tidal volume 25 mL/kg), conventional ventilation (tidal volume 10 mL/kg) and no mechanical ventilation (control group) (n=8 each group). They were sacrificed 5 hrs after ventilation. Left lung samples were used for histopathologic examinations and the detection of connective tissue growth factor (CTGF) expression by immunohistochemistry. Right lung samples were used for the detection of expression of procollagenIII mRNA(PcolIII mRNA), cysteinyl leukotriene mRNA(CysLT1 mRNA)and CTGF mRNA by PCR.</p><p><b>RESULTS</b>The severity of lung injury and fibrosis increased significantly with the increasing tidal volume compared with the control group. Lung CTGF mRNA expression in the hyperventilation group was significantly higher than that in the control group (P<0.05). Lung PcolIII mRNA and CysLT1 mRNA levels increased with the increasing tidal volume when compared with the control group. The differences in PcolIII mRNA and CysLT1 mRNA levels between groups were significant (P<0.05). There was a positive correlation between lung PcolIII mRNA expression and the severity of lung injury (r=0.78,P<0.01). CTGF and CysLT levels were positively correlated with PcolIII expression (r = 0.59,0.86,P<0.01).</p><p><b>CONCLUSIONS</b>Mechanical ventilation using different tidal volume leads to different severities of lung injury, followed by the occurrence of lung fibrosis. The degree of lung fibrosis is consistent with the severity of lung injury. CysLT and CTGF may be involved in the development of lung fibrosis.</p>

Multicenter follow-up report of 147 premature infants with brain injuries from 6 hospitals in China / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Sponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association, more than 10 large-scale hospitals participated in the near two-year multicenter investigation for Brain Injuries in Premature Infants in China. The present study presents the follow-up results of 147 premature infants with brain injuries from 6 Third Class A Level hospitals.</p><p><b>METHODS</b>All premature infants with intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) diagnosed in the early neonatal period in the 6 hospitals were followed-up between January 2005 and August 2006. Based on the synthetic results of physical development, examination of nervous system, intelligence tests and cranial ultrasound, the premature infants with brain injuries were classified as normal development, marginal development and retarded development.</p><p><b>RESULTS</b>One hundred and forty-seven premature infants with brain injuries from the 6 hospitals consisted of 141 cases of IVH and 36 cases of PVL (30 cases having IVH and PVL). Based on the synthetic follow-up results, 51.4% of premature infants with brain injuries were generally assessed as normal development, 38.4% as marginal development and 10.7% as retarded development. Among them, delayed growth in head circumference, height and weight was 13.4%; the occurrence frequency of cerebral paralysis (CP) was 7.1% in PVL grade I, 28.6% in PVL grade II and 100% in PVL grade III; 12.7% showed retarded development of intelligence; and 30% presented post-injurious changes on cranial sonography.</p><p><b>CONCLUSIONS</b>The data of the multicenter follow-up can basically reflect the short-term prognosis of premature infants with brain injuries in major big cities of China. About 10% of them have retarded physical, motor-and mental developments. The long-term regular follow-up study is expected for more premature infants with brain injuries, and behavioral sequelae of brain injuries which may occur in peri-school age and adolescence should be paid particularly close attention.</p>

Feature of Ventilation Induced Lung Injury with Different Tidal Volume in Neonatal Rats / 实用儿科临床杂志

Objective To investigate the feature of ventilation induced lung injury(VILI) with different tidal volume in neonatal rats.Methods Thirty-two neonatal rats were assigned to control group(without ventilation),conventional ventilation group(tidal volume 0.010 L?kg-1 for 5 h),hyperventilation 5 h group(tidal volume 0.025 L?kg-1 for 5 h),hyperventilation 3 h group(tidal volume 0.025 L?kg-1 for 3 h) randomly.After ventilation,the lungs were obtained to weigh,score about the degree of lung pathologic injury was count.The levels of IL-6 and IL-10 of lung tissue were detected by enzyme-linked immunosorbent assay.Results The VILI histopathology score in hyperventilation 5 h group,hyperventilation 3 h group,conventional ventilation group and control group were 9.63?1.40,4.40?1.06,6.50?1.85 and 0.00,respectively,the differences were significant among the 4 groups(P=0.000).IL-6 in hyperventilation 5 h group,hyperventilation 3 h group,conventional ventilation group and control group were(785.33?39.06) pg?g-1,(656.78?48.82) pg?g-1,(701.6?33.65) pg?g-1 and(635.02?65.78) pg?g-1,there were significant differences among the 4 groups(P=0.000).The IL-6 level was positively correlated with VILI histopathology score(r=0.78,P

Detective Significance of Cerebral Electrical Admittance Plethysmogram in Newborns with Asphyxia / 实用儿科临床杂志

Objective To study hemodynamics of cerebral blood flow in newborns with asphyxia.Method Bilateral cerebral electrical admittance plethysmogram(BCEAP) was used to explore characteristics of cerebral blood flow in 20 healthy newborns and 20 newborns with asphyxia respectively from first to fourth day after birth.Results Both the ratio of Hs to b-S(Hs/ b-S) and index of admittance differential loop(ADL) Ⅰ+Ⅱ decreased significantly in newborns with asphyxia compared to normal control from first to fourth day after birth(P

Examination of cerebral electrical admittance plethysmogram in healthy newborns / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Cerebral electrical admittance plethysmography is a novel noninvasive technique for evaluating cerebral hemodynamics. This study aimed to measure the reference values of cerebral electrical admittance plethysmogram in healthy newborns.</p><p><b>METHODS</b>Bilateral cerebral electrical admittance plethysmography was performed in 40 healthy newborns.</p><p><b>RESULTS</b>The values of various indexes of cerebral electrical admittance plethysmogram in 40 newborns were obtained by this technique. The index of Admittance Differential Loop (ADL) I+II at the third and fourth days after birth was significantly higher than that at the first day of life (P < 0.05). There were significant differences in the index of ADL I+II and the ratio of Hs to b-S (Hs/ b-S) among different birth weight groups (P < 0.05). No significant differences were found in all the indexes of cerebral electrical admittance plethysmogram between the left and right brain of newborns. Gender and parturition mode had also no effects on these indexes.</p><p><b>CONCLUSIONS</b>The research reported the reference values of cerebral electrical admittance plethysmogram in healthy newborns. The postnatal age and birth weight are influencing factors for the cerebral electrical admittance plethysmogram.</p>

Dynamic Variation of Cardiac Function in Early Term Infants / 实用儿科临床杂志

Objective To investigate the variational regularity of cardiac function in the early term infants.Methods Dynamic change of cardiac function was monitored by color Doppler echocardiography from the 1st day to 7th day after birth in the term infants,the indexes including blood-pumping function and flow rate of all valve orifices.Results Left ventricular ejection fraction appeared to be no difference during the first 3 days after birth.it gradually increased on the 5th and 1st days,while it was obviously higher on the 6th and 7th days than that of the first 3 days(P0.05).Conclusions Blood-pumping function of left ventricle gradually increases with days in the 1st week after birth.it attains to the maximum on the 6th and 7th days.The AV and PV gradually increase in the 1st week,too.Diastolic function of right ventricle is mature step by step.

Prevention and treatment of general complication in extremely low birth weight infants / 实用儿科临床杂志

Objective To analyze the incidence of general complication and methods of prevention and treatment in extremely low birth weight infants (ELBW). Methods The complication of neonatal respiratory distress syndrome(NRDS), bronchopulmonary dys-plysia( BPD), patent ductus arteriosus(PDA),intracranial hemorrhage (IVH), periventricular leukomalacia (PVL) and retinopathy of prematurity (ROP) were analysed in 16 cases of ELBW and 26 cases of very low birth weight(VLBW) infants. Results The incidences of NRDS,BPD,PDA,IVH,PVL,ROP were 81 %,81 %,25 %,50 %,13 %,63 % respectively in ELBW group. The incidences of NRDS, BPD.PDA, IVH.PVL.ROP were 88 % ,42 % ,42 % ,50 % , 12 % ,54 % respectively in VLBW group. The incidence of BPD in ELBW infants was significantly higher than that of VLBW infants (P