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Objective:To investigate clinical characteristics and potential risk factors of very preterm/very low birth weight infants with bronchopulmonary dysplasia (BPD).Methods:A retrospective epidemiological study was performed in 341 neonates with birth weights<1 500 g or gestational age between 23 + 0 to 31 + 6 weeks, who were born in Foshan Women and Children Hospital and were admitted to neonatal intensive care units (NICU) within 24 hours of birth. These neonates were divided into non-BPD group and BPD group. Clinical characteristics and potential risk factors were comparatively analyzed between groups. Risk factors for BPD were identified by binary logistic regression analysis. Results:Among the total of 341 enrolled neonates, including 255 neonates without BPD and 86 neonates with BPD, the total incidence of BPD was 25.2%. The incidences of BPD in the infants with gestational age of <30 weeks, 30-32 weeks, and >32 weeks, as well as birth weight <1 000 g, 1 000-1 499 g, and ≥1 500 g were 43.8%(63/144), 15.1%(22/146), 2.0%(1/51), 80.0%(36/45), 20.2%(41/203), 9.7%(9/93), respectively. The gestational age, birth weight, the proportion of cesarean section, and extubation rate within 7 days were lower in BPD group than those in non-BPD group [(28.5±2.4)weeks vs (30.7±1.8)weeks, (1 087.9±312.8)g vs (1 418.4±247.9)g, 54.6%(47/86) vs 75.7%(193/255), 57.1%(44/77) vs 90.0%(108/120), all P<0.05]. Compared to the non-BPD group, the proportion of Apgar score of ≤7 points 5 minutes after birth [16.3%(14/86) vs 2.4%(6/255)], postnatal endotracheal intubation rate [62.8%(54/86) vs 27.4%(70/255)], volume of red blood cell transfusion ≥3 times [31.4%(27/86) vs 6.3%(16/255)], pulmonary surfactant (PS) utilization [82.6%(71/86) vs 44.7%(114/255)], rate of conventional mechanical ventilation [89.5%(77/86) vs 47.0%(120/255)], combined with hemodynamically significant patent ductus arteriosus (HsPDA) [34.9%(30/86) vs 8.2%(21/255)], diagnosed with neonatal respiratory distress syndrome (NRDS) [94.2%(81/86) vs 5.9%(15/255)], combined with clinically diagnosed sepsis [17.4%(15/86) vs 7.0%(18/255)], combined with ≥3 stage retinopathy of prematurity (ROP) [20.9%(18/86) vs 2.7%(7/255)] and mortality [10.5%(9/86) vs 0.8%(2/255)], length of conventional mechanical ventilation, duration of oxygen consumption, and length of hospital stays were higher in the BPD group (all P<0.05). The results of multivariate logistic regression analysis showed that small gestational age ( OR=1.285, 95% CI: 1.010-1.633), Apgar score ≤7 points within 5 min of birth ( OR=5.712, 95% CI: 1.411-23.115), mechanical ventilation duration ( OR=1.113, 95% CI: 1.043-1.188) and oxygen duration ( OR=1.139, 95% CI: 1.092-1.188) were high risk factors for the development of BPD, while heavier birth weight ( OR=0.996, 95% CI: 0.994-0.998) was protective factor for BPD. Conclusions:The smaller the gestational age and the lower the birth weight, the higher the incidence of BPD, Apgar score≤7 points within 5 min of birth, long conventional mechanical ventilation time, and long duration of oxygen consumption are the risk factors for BPD. Prevention of premature delivery, reduction of asphyxia at birth, reduction of endotracheal intubation and invasive ventilation duration, and reduction of oxygen use time are effective measures to reduce the occurrence of BPD.
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Objective:To investigate the pathogenesis, precaution and treatment of neonatal congenital complete heart block (CCHB) in twins.Methods:The clinical data of a case of premature twins with neonatal CCHB from the Department of Neonatology, the First Affiliated Hospital of Xinxiang Medical University were retrospectively analyzed and related literature was reviewed.Results:(1)Case review: the 37-year-old gravida had no symptoms.Fetal ultrasound cardiogram(fUCG)at 23 weeks of gestation indicated bradycardia and CCHB.Then, the mother was diagnosed with undifferentiated connective tissue disease.After treatment with human immunoglobulin, dexamethasone and hydroxychloroquine, fUCG at 31 weeks of gestation still suggested CCHB.An emergency cesarean section was performed on the diagnosis of threatened preterm labor.With weakly positive neonatal antinuclear antibody (ANA), and positive Ro60 and Ro52 autoantibodies, twins were diagnosed with CCHB by 24 hour-Holter monitors.One of the twins was discharged with CCHB (ventricular rate of 80-90 times/min) after systemic therapy, but the weight increased to 2 200 g. The other one of the twins suffered from the sudden decrease of heart rate and blood pressure and finally died of sudden cardiac arrest.(2) Literature search: two cases in Chinese and 9 cases in English were reviewed.Among them, 9 cases were sjogren syndrome type A (SSA)/Ro and sjogren syndrome type B(SSB)/La related CCHB, and 2 cases were idiopathic CCHB.Conclusions:The placental transfer of anti-SSA or anti-SSB is an important mechanism of neonatal CCHB in twins, and other factors may also be involved.Current treatments are unsatisfactory.Most patients need pacemaker implantation.Early diagnosis and prenatal management can improve the prognosis.
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Objective To investigate the effects of ω-3 polyunsaturated fatty acids(ω-3PUFAs)and ω-6 polyunsaturated fatty acids(ω-6PUFAs)on Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway,and the expressions of tumor necrosis factor-α(TNF-α),interleukin(IL)-1β and IL-6 in neonatal rats with brain injury induced by lipopolysaccharide (LPS). Methods Ninety-six neonatal rats were divided into control group,ω-3PUFAs group,ω-6PUFAs group,and LPS group by using random number table method. Intraperitoneal injection of LPS was performed in LPS group,ω-6PUFAs group and ω-3PUFAs group to establish models of rat brain injury. The rats in control group received 9 g/L saline. Twelve newborn rats were killed at 1 d or 5 d after intraperito-neal injection in each group for hippocampus selection. Real -time PCR and Western blot were used to detect the mRNA and protein expression levels of TLR4,NF-κB,TNF-α,IL-1β and IL-6. Results One day after mode-ling,TLR4,NF-κB,TNF-α,IL-1β and IL-6 mRNA expressions in ω-3PUFAs group (10. 63 ± 0. 07,5. 86 ± 1. 05,7. 65 ± 2. 29,5. 23 ± 1. 31,3. 36 ± 0. 72)were lower than those in ω-6PUFAs group (18. 83 ± 2. 10,8. 79 ± 2. 08,11. 95 ± 3. 23,10. 97 ± 2. 24,6. 37 ± 1. 17)and LPS group (15. 76 ± 1. 59,7. 13 ± 1. 10,9. 71 ± 2. 14,7. 83 ± 0. 85,4. 78 ± 0. 51),and the differences were all statistically significant(all P＜0. 05);which in ω-6PUFAs group were higher than those in LPS group,and the differences were all significant (all P＜0. 05). TLR4,NF-κB,TNF-α, IL-1β and IL-6 protein levels in ω-3PUFAs group (1. 57 ± 0. 11,1. 58 ± 0. 09,1. 55 ± 0. 09,1. 63 ± 0. 31,1. 36 ± 0. 12)were lower than those in ω-6PUFAs group (1. 96 ± 0. 17,2. 21 ± 0. 12,1. 95 ± 0. 23,1. 97 ± 0. 24,1. 77 ± 0. 17)and LPS group (1. 73 ± 0. 15,1. 87 ± 0. 10,1. 79 ± 0. 14,1. 83 ± 0. 15,1. 58 ± 0. 11)in 1 d,and the diffe-rences were all significant (all P＜0. 05),and those in ω-6PUFAs group were higher than those in LPS group (all P＜0. 05). Similarly,TLR,NF-κB,TNF-α,IL-1β and IL-6 mRNA and protein expression levels in ω-3PUFAs group (3. 78 ± 0. 88,3. 86 ± 0. 62,6. 26 ± 1. 94,3. 65 ± 1. 44,2. 11 ± 0. 87;1. 15 ± 0. 08,1. 32 ± 0. 10,1. 46 ± 0. 04, 1. 38 ± 0. 14,1. 21 ± 0. 09)were lower than those in ω-6PUFAs group (7. 76 ± 1. 65,5. 51 ± 0. 88,7. 96 ± 2. 13,5. 35 ± 1. 75,4. 88 ± 1. 35;1. 42 ± 0. 15,1. 51 ± 0. 36,1. 65 ± 0. 13,1. 72 ± 0. 23,1. 48 ± 0. 10)and LPS group (6. 21 ± 1. 87, 4. 98 ± 0. 73,7. 11 ± 2. 10,4. 84 ± 1. 75,4. 25 ± 0. 64;1. 35 ± 0. 13,1. 44 ± 0. 22,1. 59 ± 0. 10,1. 61 ± 0. 18,1. 35 ± 0. 07) in 5 d (all P＜0. 05),and which in ω-6PUFAs group were higher than those in LPS group,and the differences were sig-nificant (all P＜0. 05). Conclusion ω-6PUFAs can up-regulate the activity of TLR4,NF-κB,and reduce the re-lease of TNF-α,IL-1β and IL-6;and ω-3PUFAs can down-regulate the activity of TLR4,NF-κB,and reduce the release of TNF-α,IL-1β and IL-6,so it has a neural protective effect in brain injury induced by LPS.
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Objective To compare the effect of three types of lipid emulsions on the IL-1βand IL-6 expressions in acute lung injury induced by lipopolysaccharide (LPS) in rats. Methods One hundred young SD rats were divided into control,LPS,ω-6,ω-9 andω-3 group. Age 29 days, the control group were intravenously injected with saline,ω-6 group injected lipid emu-sion (C14-24),ω-9 group injected long chain fat emusion,ω-3 group injected fish oil fat emusion. Then the control group fol-lowed by intratracheal instillation of saline, and the reamining four groups were sprayed with LPS. Pathologic changes in lung tissue section were observed. The expression levels of IL-1βmRNA and IL-6 mRNA were determined by RT-PCR,and the con-centrations of IL-1βand IL-6 in bronchoalveolar lavage fluid (BALF) were measured by enzyme-linked immune-specific assay. Results Infiltration and bleeding were observed in lung tissue under light microscopy in ALI rats. The lung indexes and patho-logical scores of ALI model groups were significantly higher than those of control group (P0.005) of the expressions of IL-1βand IL-6 mRNA betweenω-9 andω-3 group. Conclusions ω-6 PUFAs can accentuate inflammation by up-regulating the levels of IL-1βand IL-6 whileω-9 PUFAs andω-3 PUFAs can relieve inflammation by down-regulating the levels of IL-1βand IL-6.
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10.3969/j.issn.1000-3606.2013.06.016
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OBJECTIVE To perform a retrospective analysis to determine the prevalence of hospital infection and associated risk factors and offer strategies in our neonatal intensive care unit(NICU).METHODS The study enrolled 1082 neonatal patients hospitalized between Jan 1,2006 to Dec 31,2007.RESULTS There were 58 nosocomial infections(NI) in 1082 neonatal patients,and the infection rate was 5.36%.The most common infection was superficial(62.07%).The mortality of NI was 6.90%.The lower gestational age and birth weight,were risk factors of NI.Logistic regression analysis indicated that mechanical ventilation and birth weight ≤1500g were independent risk ractors for NI(P