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Objective:To explore the needs of parents of hospitalized neonates with the challenges of implementing family-centered care during the Covid-19 pandemic.Methods:Using a method of phenomenological interviewing and Colaizzi′s method of data analysis, the information of 18 parents of admitted infants of Children′s Hospital of Fudan University from January 1 to 20, 2022 were collected and analyzed.Results:In the post-epidemic era, 5 themes of needs for parents of hospitalized neonates during family-centered care were identified: closeness to babies; emotional support; training about feeding; accommodation services; financial support.Conclusions:In the post-epidemic era, experiencing worry, anxiety, uncertainty, helplessness, loss and other negative psychological experience, the parents of hospitalized neonates have many unsatisfied needs. Hospital administrators need to focus on the needs of parents for family-centered nursing care, and actively explore effective coping strategies.
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Objective:To study the clinical features and molecular diagnosis of neonates with Beckwith-Wiedemann syndrome (BWS).Methods:From January 2016 to December 2020, infants admitted to the Department of Neonatology of Children's Hospital of Fudan University with BWS diagnosed during the neonatal period were reviewed. Their clinical data including clinical features, molecular testing results and comorbidities of other congenital diseases were analyzed.Results:A total of 16 BWS neonates (9 males and 7 females) were included, with average gestational age of 34~39 weeks and average birth weight of 2 412~4 275 g. Macroglossia (9/16) and omphalocele (8/16) were the main clinical features. Birth weight >2 SD of the mean (12/16) was the common secondary feature. According to the European BWS diagnostic scoring criteria, 10 infants with a ≥4 score were clinically diagnosed with BWS. 5 infants with a 2~4 score and 1 infant with a 1 score (whose twin brother had a 4 score) were clinically suspected BWS.13 infants received molecular testing. 6 infants with clinical diagnosis and 5 infants with suspected diagnosis were confirmed to have reduced methylation signal in imprint control region 2 and 2 of the clinically diagnosed infants had increased methylation signal in imprint control region 1. 5 infants had atrial septal defect and brain injury were also seen in 5 infants. Abnormal thyroid function, abnormal umbilical cord morphology and abnormal umbilical blood vessels were seen in 4 infants, respectively.Conclusions:The combination of the clinical features and molecular testing can establish the diagnosis of BWS as early as during the neonatal period. Due to the high risk of comorbidities, abdominal ultrasonography, cardiac ultrasonography, cranial MRI and thyroid function tests are necessary after the diagnosis of BWS.
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Management of the neonatal hypoxic-ischemic encephalopathy (HIE) has been evolving from a pre-cooling era with supportive therapy to standardized cooling era and currently to a post-cooling era over the last two decades. To further decrease the mortality and morbidity of HIE in post-cooling era, we need to focus on the selection of HIE patients who may benefit from cooling and optimization of the available cooling approaches, and to identify research gaps with regard to therapeutic strategies such as combining cooling with promising neuroprotective agents.
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The clinical manifestations of neonatal infectious diseases are diverse, lacking specificity, and it may involve multiple organs or systems.At present, there are many clinical indicators of neonatal infectious diseases, each of which has its advantages and disadvantages, and it is difficult to meet the requirements of current diagnosis and treatment.Clinical metagenomic next-generation sequencing (mNGS) can accurately and efficiently analyze the genetic material information of all pathogenic microorganisms, so as to directly detect pathogenic microorganisms for diagnosis and treatment, which has important reference value for the diagnosis of neonatal infectious diseases.Now, the recent advances in metagenomics detection of pathogenic microorganisms and its application in neonatal infectious diseases were reviewed.
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Objective@#To assess the performance of extracorporeal membrane oxygenation (ECMO) in the treatment of neonates with critical diseases.@*Methods@#This study retrospectively analyzed the clinical data of nine critically ill neonates treated with ECMO because of cardiopulmonary failure due to respiratory disorders in Children's Hospital of Fudan University from August 2015 to April 2018. General information, diagnosis, indications and approaches of ECMO, clinical procedure of ECMO, laboratory results, weaning time, survival rate before discharge, length of stay, and mechanical and neurological complications were collected and described.@*Results@#(1) There were six male and three female patients with an average gestational age and body weight of 39.6 weeks (35-41 weeks) and 3 600 g (2 580-4 650 g), respectively. Out of them, six cases survived after successfully weaning from ECMO. (2) Sepsis (two cases), meconium aspiration (two cases), pulmonary hypertension (three cases), diaphragmatic hernia (one case) and pulmonary dysplasia (one case) were diagnosed in the patients. All underwent veno-arterial (VA) ECMO using centrifugal pump. The median age to initiate ECMO was 40 h (23-100 h) after birth, and the median duration of ECMO support was 240 h (70-370 h). During the treatment with ECMO, cholestasis, intracranial hemorrhage and vocal cord paralysis occurred in three cases, and mechanical complications (mainly were bleeding, hemolysis, oxygenated membrane leakage and embolization) occurred in five cases. The mean length of hospital stay for the six survivors was 24 d (20-49 d), and two of them developed neurological complications mainly manifested as cerebral infarction. There were three died cases. One was a baby with diaphragmatic hernia who received hernia repair during ECMO after which celiac space syndrome and necrotizing enterocolitis were developed and his parents refused further treatment. In the second case, the parents gave up treatment when no improvement was achieved after two weeks of ECMO support. While the last case was complicated by severe cerebral hemorrhage during ECMO and died after receiving no further treatment.@*Conclusions@#ECMO is newly applied in the treatment of neonates in China and of great significance for critically ill neonates. However, much need to be learned about its utilization in this population considering the mortality and disability rate are still high.
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Objective@#To observe the changes in cerebral regional oxygen saturation (CrSO2) during neonatal blood exchange transfusion(BET) and its effect on the level of bilirubin in neonates with severe hyperbilirubinemia.@*Methods@#From January 2017 to March 2018, 52 newborns with severe hyperbilirubinemia were hospitalized in the Department of Neonatology, Children′s Hospital of Fudan University.Every newborn was treated with BET.Near infrared spectroscopy was used to monitor CrSO2 in the process of BET.The monitoring lasted from 2 hours before the beginning of BET to 2 hours after the completion of BET.The CrSO2 were recorded every 2 minutes and total surem bilirubin (TSB) and transcutaneous bilirubin(TCB) was measured.During this period, it is accompanied by the monitoring of neonatal body temperature, heart rate, respiration and bolld oxygen saturation(SpO2). The differences in CrSO2 changes at different time points during BET were compared.At the same time, the correlations between CrSO2 and blood oxygen saturation, TSB and TCB levels were analyzed.The results of repeated measurement analysis of variance compared between the two groups were corrected by Bonfferoni.@*Results@#Among the 52 children, there were 33 males (63.46%) and 19 females (36.54%). The gestational age, average birth weight and average head circumference of newborns were (38.6±2.1) weeks, (3 338±444) g and (33.6±3.2) cm, respectively.The Apgar score of newborn was (8.1±1.6) scores at 1 minute after birth.The level of TSB detected for the first time after admission was (457.9±97.8) μmol/L.The CrSO2 after BET (74.6%-76.0%) was significantly higher than that before BET (69.4%-69.0%), and the difference was statistically significant (P<0.05). Correlation analysis showed that during BET, CrSO2 showed a gradual upward trend, SpO2 also showed a synchronous increase, while the level of bilirubin showed a downward trend, and the downward trend of TSB level was more obvious than that of TCB.@*Conclusions@#CrSO2 can reflect the improvement of cerebral oxygenation during neonatal blood exchange transfusion and avoid cerebral hypoxia in the course of treatment.
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Objective To study the phenotypic and genotypic characteristics of Zellweger syndrome caused by PEX1 gene mutation.Method The clinical data of 2 neonates with Zellweger syndrome admitted to the Hospital were retrospectively analyzed.The databases of CNKI,Wipp and Wanfang were retrieved with “peroxisomal disease”,“Zellweger syndrome”,“Zellweger pedigree disorder”,and “PEX1 gene” as key words and the human gene mutation database (HGMD) was retrieved with “PEX1” as the gene name.The biomedical literature database (PubMed),Web of Science database and Embase database were retrieved with “Zellweger syndrome”,“Zellweger spectrum disorder PEX1 gene” as key words.All the databases were retrieved up to Nov 8,2018 to summarize the clinical phenotype and genotype characteristics of children with Zellweger syndrome.Result A total of 2 neonates with Zellweger syndrome were admitted to our Hospital,including 1 male and 1 female.Both the newborns presented with hypotonia,feeding difficulties clinically and showed dilated cerebral ventricles in neuroimaging.They were detected compound heterozygous for PEX1 mutations.Case 1 with the variants [NM_000466:exon 12:c.2050C＞T (p.Q684X);NM_000466:exon20:c.3043G＞T(p.E1015X)] have suffered from seizure at 2 months old.Case 2 with the variants [NM_000466.2:exon5:c.892_895dupTATA (p.Asn299IlefsTer2);NM_000466:exon19:c.2927-2delA] died in the neonatal period.No cases of newborn Zellweger syndrome caused by PEX1 gene mutation have been reported in China.There was a total of 6 articles and 13 cases were reported from foreign literature databases.All the cases presented as hypotonia,abnormal liver function,wide sutures (large fontanelle),hypertelorism and broad nasal bridge clinically.2 newborns carrying 2 missense variants were diagnosed as mild Zellweger spectrum disorder and atypical Zellweger syndrome the 10 newborns with 2 variants typed frameshift,nonsense or splice site were diagnosed as Zellweger syndrome.Conclusion Zellweger syndrome caused by defective gene PEX1 manifested as hypotonia,abnormal liver function,wide sutures (large fontanelle),hypertelorism and broad nasal bridge in neonatal period.Newborns with frameshift,nonsense or splice site variants in PEX1 have more severe clinical phenotypical features.
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Objective To assess the performance of extracorporeal membrane oxygenation (ECMO) in the treatment of neonates with critical diseases.Methods This study retrospectively analyzed the clinical data of nine critically ill neonates treated with ECMO because of cardiopulmonary failure due to respiratory disorders in Children's Hospital of Fudan University from August 2015 to April 2018.General information,diagnosis,indications and approaches of ECMO,clinical procedure of ECMO,laboratory results,weaning time,survival rate before discharge,length of stay,and mechanical and neurological complications were collected and described.Results (1) There were six male and three female patients with an average gestational age and body weight of 39.6 weeks (35-41 weeks) and 3 600 g (2 580-4 650 g),respectively.Out of them,six cases survived after successfully weaning from ECMO.(2) Sepsis (two cases),meconium aspiration (two cases),pulmonary hypertension (three cases),diaphragmatic hernia (one case) and pulmonary dysplasia (one case) were diagnosed in the patients.All underwent veno-arterial (VA) ECMO using centrifugal pump.The median age to initiate ECMO was 40 h (23-100 h) after birth,and the median duration of ECMO support was 240 h (70-370 h).During the treatment with ECMO,cholestasis,intracranial hemorrhage and vocal cord paralysis occurred in three cases,and mechanical complications (mainly were bleeding,hemolysis,oxygenated membrane leakage and embolization) occurred in five cases.The mean length of hospital stay for the six survivors was 24 d (20-49 d),and two of them developed neurological complications mainly manifested as cerebral infarction.There were three died cases.One was a baby with diaphragmatic hernia who received hernia repair during ECMO after which celiac space syndrome and necrotizing enterocolitis were developed and his parents refused further treatment.In the second case,the parents gave up treatment when no improvement was achieved after two weeks of ECMO support.While the last case was complicated by severe cerebral hemorrhage during ECMO and died after receiving no further treatment.Conclusions ECMO is newly applied in the treatment of neonates in China and of great significance for critically ill neonates.However,much need to be learned about its utilization in this population considering the mortality and disability rate are still high.
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Growing evidence from animal experiments and human epidemiological studies has revealed the intriguing communications between the gut,microbiota and brain,i.e.,the gut-microbiota-brain axis.The microbiota establishes its symbiotic rapport with the host early in life and participates in multiple developmental and physiological processes,including regulating brain development and influencing behavior and neurological function.Multiple perinatal factors influence neonatal colonization,and gut dysbiosis is a common finding in preterm infants.Perturbations in the delicate synergetic gut-microbiota-brain communication may have serious consequences,leading to abnormal brain development and long-term neurodevelopment disorders.
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Objective To develop clinical practice guidelines for breastfeeding in neonates in hospital conforming to the situation in China by adaptation of existing guidelines.Methods According to ADAPTE methodology and current status of breastfeeding in neonates in hospital,we searched existing guidelines and systematic reviews of breastfeeding,used AGREE Ⅱ to evaluate the guidelines,content analysis method was used to select and integrate the content of the evidence,and feasibility investigation and expert external review were performed for the established guidelines.Results A total of 10 guidelines,3 evidence summaries and 4 systematic reviews were included,and the "Evidence-Based Guideline:Breastfeeding of Neonates in the Hospital" were established,involving 8 aspects:breastfeeding promotion,screening,expression,storage,transport,reception,procedures and quality management,and a total of 83 evidences were recommended,which were practical and recommended by all experts.Conclusion High quality evidence resources provided by the established clinical practice guideline can provide reliable evidence support for clinical practice.
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Objective To study the clinical value of neonatal arterial blood pH,base excess and lactate levels within 72 h after birth in assessing early brain injury in asphyxia neonates.Method From June 2015 to November 2016,a retrospective study was performed on the asphyxia newborn admitted to newborn department of Children's Hospital of Fudan University.The data of brain magnetic resonance imaging (MRI),video electroencephalogram (VEEG),and artery blood gas analysis (within 12 h and 72 h) were all collected.The neonates were assigned into brain injury group (severe or moderate injury) and control group (normal or mild injury) according to MRI and VEEG results.The differences of arterial blood pH,base excess and the level of lactate between the two groups were analyzed and indicators of brain injury were evaluated using ROC curves.Result A total of 63 cases were included in the study.Thirty patients were in the control group and 33 patients the brain injury group.The pH within 12 h was lower [(7.32 ±0.09) vs.(7.38 ±0.08)],and the lactic acid level in 12 h and at 24-72 h were significantly higher in the brain injury group than the control group [(7.9 ±4.2) mmol/L vs.(4.9 ±2.4) mmol/L and (3.7 ±3.2) mmol/L vs.(2.2 ± 1.1) mmol/L].The differences were statistically significant (P ＜0.05).The areas under the ROC curve of pH,lactate within 12 h and at 24-72 h were 0.323,0.715,0.643 (P =0.016,0.003,0.051).The cut-off value of lactic acid within 12 h in assessing of brain injury was 7.5 mmol/L,with the sensitivity of 0.46 and the specificity of 0.97.Conclusion The artery lactate level within 72 h after birth can be used to evaluate the severity of brain injury in neonatal asphyxia infants.
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Neonatal hypoxic-ischemic encephalopathy (HIE) can result in serious outcomes including death during the newborn period and later neuropsychological handicaps.So far,there have been no obvious effect on the improvement of prognosis with traditional treatments,and the cryogenic treatment is the most effective treatment for the past decade,while the clinical application is limited by age and disease course.At present,stem cell transplantation in the treatment of HIE is the new direction,of which the mesenchymal stem cells are outstanding by its easy materials,low immunogenicity and potential nerve regeneration properties.This paper reviews and updates the progress of mesenchymal stem cell transplantation for neonatal HIE.
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Objective@#To investigate the clinical characteristics of early term and full term neonates, and analyze the risk factors associated with short term outcomes in early term neonates.@*Method@#Neonates with birth weight (BW) ≥2 500 g from year 2013 were analyzed retrospectively based on American Congress of Obstericians & Gynecologists (ACOG) latest definition of term infants. According to inclusion and exclusion criteria, early term (gestational age 37-38 weeks) and full term(gestational age 39-40 weeks) neonates were included, whose morbidity constituent proportion was analyzed by χ2 test or Fisher accuracy test or t test or Wilcoxon test. Risk factors associated with short term outcomes in early term population were analyzed by Logistic regression analysis.@*Result@#There were 3 002 discharged term infants being investigated, among whom 1 303 cases were included(768 males and 535 females), and 37, 38, 39 and 40 weeks′ gestational age newborns were 160, 324, 450 and 369 respectively. Compared with full term neonates(n=819), early term neonates (n=484) had longer length of hospital stay (LOS)(6.0(5.0, 9.0) vs. 6.0(4.0, 8.0), Z=2.830, P=0.005), higher usage rate of intravenous antibiotics(86.4%(418/484) vs. 80.1%(656/819), χ2=8.009, P=0.005), higher assisted ventilation rate(9.5%(46/484) vs. 2.9%(24/819), χ2=25.528, P<0.01), higher pulmonary surfactant administration rate(4.3%(21/484) vs. 1.1%(9/819), χ2=14.006, P<0.01), as well as higher hypoglycemia incidence(3.9%(19/484) vs. 1.2%(10/819), χ2=10.226, P=0.001). There were no statistically significant differences in 1 min Apgar score (9(9, 10)vs. 9(9, 10), Z=0.860, P=0.390), 5 min Apgar score (10(9, 10) vs. 10(9, 10), Z=0.810, P=0.418), white blood cell count (15 (11, 21) ×109 /L vs.15 (11, 22) ×109 /L, Z=0.880, P=0.379), hemoglobin count(180 (159, 205) vs. 182 (160, 204) g/L, Z=0.560, P=0.576), or platelet count(303(234, 372) ×109/L vs. 301(237, 391) ×109/L, Z=0.550, P=0.584). BW between 2 500 g and 2 999 g(OR 1.69, 95% CI: 1.10-2.62, χ2 =5.614, P=0.018), wet lung(OR=2.61, 95% CI: 1.61-4.24, χ2=15.023, P=0.000)and pneumonia(OR 1.88, 95% CI: 1.14-3.08, χ2=6.192, P=0.013) were risk factors in early term neonates′ short term adverse outcomes.@*Conclusion@#Early term newborns are still at their "immature" state, and respiratory disorders are major risk factors associated with short term outcomes. Hence, early delivery during 37-38 weeks should be avoided as possible as we can.
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The most radiation exposure for children arises from the medical process, and due to their characteristics such as relatively immature,organ development,they are more sensitive to the radiation than a-dults,and have higher risk of radiation related diseases,so medical radiation exposure should not be ignored.
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During the fetal-neonatal transition, the body must undergo many important physiological changes to adapt the extrauterine environment. After birth, the blood and energy supply through placenta is stopped with clamping of the umbilical cord and, meanwhile, the pulmonary ventilation function is established when exposure to the air, which results in a series of changes in the respiratory, circulatory and endocrine systems and energy metabolisms, etc. The physiological transition can be relfected in heart rate, blood pressure, oxygen saturation, temperature, and other physiological indicators. The changes of these indicators can be used as references for prevention, diagnosis and treatment of neonatal diseases. This review provides an overview of physiological changes and implications in the lung function, circulatory and endocrine systems, and energy metabolism during the transition at birth as well as intervention measures for abnormal fetal-neonatal transition.
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Objective To investigate the risks and benefits of interventions promoting placental transfusion (PT) at delivery [delayed cord clamping (DCC) or umbilical cord milking (UCM)] compared with early cord clamping (ECC) on outcomes among very low birth weight infants (VLBWI).Methods A systematic search was conducted of PubMed, EMBASE, ClinicalTrials.gov, China Academic Journal Network Publishing Database and Wanfang Medical Databases (January 1965 to July 2014) for randomized controlled trial (RCT) articles relating to PT strategies (DCC and UCM) in VLBWI.The Cochrane Handbook 5.1.0 was used to evaluate the methodological quality and RevMan 5.3 software from Cochrane Collaboration was used for metaanalysis.The fixed effect or random effect model was adopted according to the result of heterogeneity, Results We identified 14 eligible studies describing a total of 659 neonates with an average birth weight ＜ 1 500 g.There were eight studies for DCC and six studies for UCM.Compared with the control, benefits of greater PT decreased any grade intraventricular hemorrhage (IVH) (nine studies, OR=0.49, 95％CI: 0.32-0.77, P ＜ 0.01), increased the blood pressure at four hours of life (eight studies, MD=4.42, 95％CI: 3.85-4.98, P ＜ 0.01), and also showed higher initial hemoglobin (Hb) level (six studies, MD=3.52, 95％CI: 1.67-5.37, P ＜ 0.01) and lower incidence of sepsis during the hospital stay (five studies, OR=0.46, 95％CI: 0.26-0.83, P=0.01).No differences were observed between the groups about the fllowing indicators (all P ＞ 0.05): 5-minute Apgar scores (MD=0.01,95％CI:-0.21-0.22), admission temperature (MD=0.13, 95％CI:-0.15 to 0.41), peak serum bilirubin levels (MD=0.59, 95％CI:-0.13 to 1.31), initial reported hematocrit (MD=3.48, 95％CI:-0.46 to 7.43), mortality before discharge (OR=0.63, 95％CI:0.31-1.25), Bell's stage 2 or greater necrotizing enterocolitis (OR=0.62 ,95％CI: 0.29-1.33), rates of transfusion due to anemia (OR=0.63, 95％CI: 0.35-1.15) and oxygen therapy at 36 weeks of corrected age (OR=0.79, 95％CI: 0.46-1.34).Conclusions It is suggested that enhanced PT (both DCC and UCM) at birth is safe and provide better neonatal outcomes than ECC for those VLBWI, most notably reduces the overall IVH occurrence and lower the incidence of sepsis.The optimal umbilical cord clamping practice and UCM among VLBWI infants remains uncertain and long-term neurodevelopmental outcomes are warranted.
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With the advent of neonatal intensive care unit (NICU) and the progress of life support technologies,the survival rate has been significantly improved in the last decade;however,the resulting neurological sequelae have also been increased disproportionally.Given the vulnerability and plasticity features of the developmental brain has,properly identification,evaluation,intervention and predication of the neurologically affected newborn in the NICU is of great importance,so the development of precise and reliable bedside neonatal neurodiagnostic techniques (neural critical care unit) is warranted.Non-invasive cerebral monitoring is comprehensively using current available cerebral functioning and cerebral imaging tools to detect various underlying cerebral injury.This review update the clinical implication of bedside amplitude-integrated EEG,routine video-EEG,magnetic resonance imaging,and near-infrared spectroscopy being used in the NICU.
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AIM: To study the effect of moderate hypothermia on immature rats with hypoxic-ischimic brain damage (HIBD). METHODS: The rats with HIBD were divided into normothermic recovered group (IN) and moderate-hypothermic recovered group (IH). Sham-operated rat pups were normothermic control group (NC) and moderate-hypothermic control group (HC). 0, 2, 6, 24, 48, 72 h after the end of hypoxic-ischemic (HI) insult, the brain was homogenized for measuring glucose and ATP, brain mitochondria was extracted for SDH activity, complex II activity and the capacity of ATP synthesization. RESULTS: In IN group, the brain glucose was significantly lower at 0 h, and recovered as normal at 2 h. The brain ATP and brain-mitochondrial SDH activities were firstly decreased at 2 h, 6 h and then recovered gradually, it was at it's peak value at 72 h. Brain-mitochondrial complex II activity and the capacity of ATP synthesis were recovered at 2 h, but they decreased again at 6 h and came to normal level at 72 h. In moderate-hypothermic group, all the indexes were significantly higher at all the time point than that in IN groups. CONCLUSION: Moderate hypothermia inhibits the decrease in the mitochondrial SDH activity, mitochondrial complex II activity and the capacity of ATP synthesis, increases the brain ATP concentration, improves the energy metabolism, and then protects the brain tissue. [
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Objective To investigate the effect of long term intelligence on NGF to the newborn rats with hypoxic ischemic brain damage (HIBD).Methods The model of newborn rat hypoxic ischemic brain damage(HIBD) was set,0.01mg/10g dosage NGF and 0.03mg/10g dosage NGF were administered to the rat abdominal cavity respectively. With maze test, the change of learning memory abilities of long term in the rats were observed, the concentration of monoamine neurotransmitters in the brain tissue were determined by high performance liquid chromatography electrochemical detector.Results The function of learning and memory was better in NGF group(small, large amount group)than in the control group, the frequency was lower remarkably than the control group( P