Clinical study on the changes of plasma melatonin and stress factors in neonatal asphyxia / 临床儿科杂志

Objective To explore the changes in plasma melatonin (MT) and glucocorticoid (GC) and the expressions of melatonin receptor 1 (MR1) and glucocorticoid receptor alpha (GR alpha) after neonatal asphyxia. Methods Full-term asphyxia neonates (22 cases of mild asphyxia, 28 cases of severe asphyxia) hospitalized from May 2014 to December 2015 were selected. Another 50 non-asphyxiated full-term newborns hospitalized with single disease such as infection and jaundice at the same time were selected as the control group. Peripheral blood samples were collected within 24 hours after birth and 7 days after birth, and plasma and mononuclear cells were separated. The plasma MT and GC expression levels were detected by ELISA. Real-time PCR was used to detect MR1 and GRα mRNA expression. Results The plasma GC concentrations in mild and severe asphyxia group increased significantly within 24 hours after birth, higher than that in control group. In addition, the plasma GC concentration in severe asphyxia group was significantly higher than that in mild group (P<0.05). The concentration of plasma GC in mild and severe asphyxia group decreased on the 7th day after birth (P<0.05) and was significantly lower than that at 24 hours after birth, but it was still higher in the severe asphyxia group than that in mild group; both the mild and severe asphyxia group had higher GC level than that in control group; the differences are statistically significant (P<0.05). Within 24 hours after birth, the plasma MT concentration in severe asphyxia group was lower than that in mild asphyxia group and control group, and there were significant differences (P<0.05). Compared with 24 hours after birth, the concentrations of plasma MT in severe and mild asphyxia groups increased significantly, higher than that in control group on the 7th day, and there were significant differences (P<0.05). The level of GR alpha mRNA expression decreased within 24 hours after birth in severe asphyxia group, but was increased in the mild asphyxia group, and there were significant differences among the three groups (P<0.05). The expression levels of GRα in both mild and severe asphyxia groups recovered on the 7th days after birth, and there were no significant differences compared with control group (P>0.05). Compared with 24 hours after birth , the expression level of MR1 mRNA in severe asphyxia group increased on the 7th day after birth, higher than that in control group and in mild asphyxia group, and there were significant differences (P<0.05). Conclusions The stress caused by severe asphyxia exceeds the adaptation range in the newborn, and results in the high expressions of MR1 and endogenous MT.

Changes in expression of autophagy-related proteins, Beclin-1 and LC3, and effects of rapamycin on their expression in hypoxic-ischemic hippocampus / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To observe changes in the expression of autophagy-related proteins, Beclin-1 and LC3, in the hippocampal tissue of neonatal rats with hypoxic-ischemic brain damage (HIBD) at different time points, and to investigate the effect of rapamycin (Ra) on the expression of the above two proteins.</p><p><b>METHODS</b>A total of 108 7-day-old Sprague-Dawley rats were randomly divided into sham, HIBD, and Ra groups (n=36 each). The HIBD model was established using the modified Rice method. For sham rats, only the left common carotid artery was separated without ligation or hypoxic treatment. For Ra-treated rats, 0.5 mg/kg Ra was administered by an intraperitoneal injection 1 hour before model establishment. The rats were anesthetized and sacrificed to collect brain tissues at 0, 6, 12, 24, 48, and 72 hours after model establishment. Changes in the expression of Beclin-1 and LC3 proteins in rat hippocampus were examined by Western blot.</p><p><b>RESULTS</b>The expression level of Beclin-1 in HIBD rats began to increase at 0 hour, peaked at 24 hours, and then declined thereafter, similar as those of Beclin-1 and LC3-II in Ra-treated rats. The expression level of LC3-II in HIBD rats began to increase at 0 hour, peaked at 12 hours, and then declined thereafter. At all time points, both Beclin-1 and LC3-II expression levels were significantly higher in HIBD and Ra-treated rats than in sham rats (P<0.05); except LC3-II at 12 hours, Beclin-1 and LC3-II expression levels were significantly higher in Ra-treated rats than in HIBD rats (P<0.05).</p><p><b>CONCLUSIONS</b>Hypoxia-ischemia activates autophagy in rat hippocampal cells, while Ra enhances the expression process of autophagy.</p>

Risk factors for prognosis of neonatal necrotizing enterocolitis: an analysis of 82 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the risk factors for prognosis of neonatal necrotizing enterocolitis (NEC).</p><p><b>METHODS</b>A retrospective analysis was performed on the clinical data of 82 neonates with NEC confirmed between January 2008 and October 2012. The possible prognostic factors in NEC were investigated by logistic regression analysis.</p><p><b>RESULTS</b>In the 82 cases of NEC, the cure rate decreased with the aggravation of condition (P<0.05). The preterm infants had a significantly higher incidence of NEC than the full-term infants at three or more weeks after birth (P=0.004). The univariate analysis showed that the prognosis of NEC was related to the factors such as sepsis, congenital heart disease, scleredema, peritonitis, metabolic acidosis, hyponatremia, leukocyte disorder, thrombocytopenia, elevated C-reactive protein, and severe abdominal X-ray abnormalities (P<0.05), and the further logistic regression analysis revealed that congenital heart disease, scleredema, and metabolic acidosis were main risk factors for the clinical outcome of NEC (P<0.05).</p><p><b>CONCLUSIONS</b>The onset time of NEC is correlated with gestational age in neonates. There are multiple prognostic factors in NEC; special attention should be paid to the patients with congenital heart disease, scleredema, and metabolic acidosis so that early intervention is performed to reduce mortality.</p>

Correlation between serum vitamin D level and severity of community acquired pneumonia in young children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the correlation between serum vitamin D level and severity of community acquired pneumonia (CAP) in young children, and explore related risk factors for CAP.</p><p><b>METHODS</b>One hundred and three children with CAP between October 2011 and April 2012 were enrolled in the study, including 15 cases of severe CAP and 88 cases of mild CAP. Ninety healthy children were used as the control group. 25-(OH)D(3) concentrations were measured by enzyme linked immunoassay.</p><p><b>RESULTS</b>The mean vitamin D concentration in the severe CAP group was significantly lower than in the mild CAP and control groups (P < 0.01), and there was no significant difference between the mild CAP and control groups (P = 0.674). Premature birth and vitamin D < 50 nmol/L were risk factors for severe CAP in the multivariate analysis.</p><p><b>CONCLUSIONS</b>Vitamin D deficiency might be associated with the severity of CAP in young children.</p>

Treatment of myocardial damage with creatine phosphate following neonatal asphyxia: a meta-analysis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of creatine phosphate (CP) in the treatment of myocardial damage following neonatal asphyxia.</p><p><b>METHODS</b>Medical databases were searched for a systematic literature review and meta-analysis of randomized and quasi-randomized trials on the treatment of myocardial damage with CP following neonatal asphyxia. The data was analyzed using Review Manager 5.1.</p><p><b>RESULTS</b>Six trials involving 400 patients (CP treatment/control: 202/198) were included in the survey. The meta-analysis indicated that CP treatment for 7 days decreased serum myocardial enzyme levels (CK, CK-MB, LDH, HBDH and cTnI levels). Both the total effective rate (RR: 1.29; 95% CI: 1.12, 1.48) and the significantly effective rate (RR: 1.78; 95% CI: 1.32, 2.41) in the CP treatment group were significantly higher than in the control group. CP treatment reduced the hospitalization period by 4.07 days compared with the control group (95% CI: -5.25, -2.89).</p><p><b>CONCLUSIONS</b>CP treatment appears to be more effective than routine treatment alone for myocardial damage following neonatal asphyxia. It appears to be safe and it can both decrease serum myocardial enzyme levels and shorten the period of hospitalization. However, as the evidence obtained in this study is not robust due to the poor quality of current studies, further studies of high-quality, large-scale trails are needed.</p>