Diagnosis and therapeutic strategies of parenteral nutrition-associated liver disease in premature infants / 中华实用儿科临床杂志

Parenteral nutrition - associated liver disease (PNALD)or cholestasis (PNAC)is the main compli-cation of prolonged parenteral nutrition in premature infants. It is characterized by cholestatic jaundice,which is defined as direct serum bilirubin of ≥34. 2 μmol/ L with or without liver enzymes abnormalities,rule out other causes. The risk factors contributing to the incidence of PNALD are premature,low birth weight,the duration of parenteral nutrition (PN),components of PN,sepsis,intestinal disease,genetic susceptibility. Although the damage is frequently mild,and resolves after discontinuation of parenteral nutrition,in some cases it progresses into cirrhotic changes. Ursodeoxycholic acid and lipid emulsions based on fish oil with a high content of long - chain polyunsaturated fatty acids ω - 3 has been proposed to be efficacy. But effective preventive and therapeutic strategies for PNALD have not been established yet. In-novative therapeutic strategies needs to be investigated.

Diagnosis and treatment of five neonatal cerebral venous sinus thrombosis / 中华儿科杂志

Objective@#To summarize the clinical presentations and imaging features of cerebral venous sinus thrombosis (CVST) in 5 newborns.@*Methods@#The clinical data of 5 newborns with CVST admitted to Department of Neonatology of Maternal and Children Hospital of Hubei Province from February 2017 to April 2018 were analyzed retrospectively. The risk factors, clinical presentations, imaging manifestations and treatment of CVST were investigated.@*Results@#Of the 5 full term neonates, 4 were males and 1 female, with 4 aged less than 7 days and 1 more than 7 days; one with the history of maternal gestational diabetes mellitus, one with maternal gestational hypertension. The clinical presentations included seizures (3 cases), fever (3 cases), dehydration (1 cases), lethargy (2 cases), hypoglycemia (2 cases), thrombocytopenia (2 cases). Electroencephalogram (EEG) showed electrical seizures in 3 cases. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) showed 4 cases of intracranial hemorrhage, 3 cases of cerebral parenchymal infarction. For the sites of the thrombi, 4 were in the superior sagittal sinus, 3 in straight sinus, 2 in transverse sinus and 1 in sinus confluence. CT showed intracranial hemorrhage in 2 cases and venous sinus dilatation in 2 cases. Doppler ultrasound showed 2 cases of intraventricular hemorrhage and 2 cases of changes of venous sinus blood flow. Three neonates were treated with anticoagulant and thrombolytic therapy, followed by recanalization of the veins and discontinuing of seizures.@*Conclusions@#Seizure is the main clinical presentation of CVST. The main radiologic manifestations are cerebral infarction and hemorrhage. Timely brain MRI and MRV are helpful in the early diagnosis and treatment of CVST.

Clinical practice of procalcitonin and hypersensitive c-reactive protein test in neonatal infection

To study the clinical practice of procalcitonin and hypersensitive c-reactive protein test in neonatal infection. Two hundred cases of our hospital treatment confirmed infection early newborn children were selected from February 2014 to March 2015. According to the condition, the children were divided into four groups as follows: severe infection group, local infection group, non-infection group and healthy newborns group. At the same time, the new healthy newborns were chosen as control group. The levels of serum procalcitonin and high-sensitivity C-reactive protein were detected in all children and the levels in severe infection group children before and after treatment were also quantitatively detected and the test results were analyzed. There was significant difference in procalcitonin among the four groups [pS<0.05]. The positive rate of the high-sensitivity C-reactive protein in local infection group has no significant difference compared with the non-infection group [p>0.05]. But there was significant difference between the local infection group and healthy newborn group. As for the severe infection group, both the levels of procalcitonin and positive rate of high-sensitivity C-reactive protein had significant difference compared with the other groups. The detection of procalcitonin and high-sensitivity C-reactive protein could contribute to the diagnose of the early infection neonatal children and has important values in diagnosis and treatment of infectious diseases in the newborns

Diagnosis and clinical observation of lactose-free milk powder on treatment of neonatal diarrhea

Neonatal lactose intolerance syndrome is a series of digestive system symptoms caused by the lack of lactase, and could not fully digest the lactose in breast milk or cow milk. Lactose is one of the disaccharides mainly existed in mammalian milk. Lactose content in breast milk is 7.2g/100ml, cow milk is 4.7g/100ml. Dairy products are the main energy sources for the newborn, and lactose provides 20% energy for infants. During the growth of the newborn, lactose not only play an significant role in energy supply, but also involve in the development of the brain growing. This study mainly studied the lactose development features, the reasons for lactose intolerance, and the measures to treat lactose deficiency

incidence of infants with rotavirus enteritis combined with lactose intolerance

This study was to research the incidence of infants with rotavirus enteritis combined with lactose intolerance and the clinical effect of low lactose milk powder for infantile rotavirus enteritis with lactose intolerance. The control group were 126 cases of infants with diarrhea randomly collected from our hospital at the same period, which their rotavirus detection was negative. The observation group was 185 cases of infants with rotavirus, which was tested to be positive. Through the urine galactose determination, 62 cases of the control group were positive and 124 cases of the observation group were positive. Then 124 cases of infants with rotavirus combined with lactose intolerance were randomly divided into two groups. 60 cases in the control group were given rehydration, correction of acidosis, oral smecta, Intestinal probiotics and other conventional treatment, then continued to the original feeding method. While, 64 cases in the treatment group, on the basis of routine treatment, applied the low lactose milk feeding. To observe the total effective rate for the two groups. The incidence of lactose intolerance in children with rotavirus enteritis [67.03%] was significantly higher than that of children with diarrhea [49.2%], which was tested to be negative. And the difference was statistically significant [p<0.5]. In the aspect of reducing the frequency of diarrhea, and diarrhea stool forming time, the treatment group has the obvious superiority. The total effective rate was 95.4% for treatment group, which was higher than that in the control group [76.7%], the difference was statistically significant [P<0.05]

Conclusion: Infants with rotavirus enteritis was easier to merge with lactose intolerance. The low lactose milk powder could improve the therapeutic effectively and could reduce the duration of disease, and restored to normal diet for 2 weeks feeding time

Prevention infection of newborn nosocomial and distribution of multiple drug resistant organism of the medicinal

2124 neonates were monitored from February 2013 to August 2014, among which 1119 were admitted from outpatient department [outpatient group], 782 were transferred from other departments [other department group], and 223 were from other hospitals [other hospital group]. Through it we explore the distribution of multidrug resistant organism in neonates, which were admitted to the hospital through various ways, and therefore analyze the risk factors of nosocomial infection to avoid cross infection of multi drug resistant organism in neonatology department. The results showed that 105 strains of multi drug resistant bacteria were detected in the neonatal department. Among them, there were 57 strains from the outpatient group, 27 from the other department group, and 21 from the other hospital group. Neonates with the hospitalization time of more than 14 days and low birth weight infants [1500 g] were the high-risk groups of drug-resistant strains in nosocomial infection. So the infection in neonates from other departments or hospitals should be strengthen, especially the prevention and control in neonates with the hospitalization time than 14 days and low birth weight infants [1500 g] in order to reduce the occurrence of multiple drug-resistant strains cross infection

Relationship between cytokine levels in serum and cerebrospinal fluid and brain injury in preterm infant with ;intrauterine infection / 中华实用儿科临床杂志

Objective To evaluate the relationship between the cytokine levels in the serum and cerebrospinal fluid and the brain injury in preterm infants. Methods From August of 2012 to August of 2013,51 preterm infants were included and 46 infants were survived. All of them were born at the Maternal and Child Hospital of Hubei Pro-vince,with GA≤32 weeks and high risk factors of intrauterine infection and suffering from early onset sepsis. Ac-cording to the screening findings of cerebral ultrasound and/or MRI,the infants were divided into normal group(n=28) and abnormal groups(n=18) with intracranial hemorrhage or white matter damage. The levels of interleukin(IL)-6,IL-1β and tumor necrosis factor-α( TNF-α) in the serum within 12 hours after birth and in cerebrospinal fluid within 72 hours after birth were investigated. The differences in cytokines between two groups were compared with t-test and Chi-square test,and high risk factors of brain injury were analyzed by Logistic regression models. Results The ab-normal group had higher incidence of clinical maternal chorioamnionitis[44. 44%(8/18 cases) vs 14. 29%(4/28 ca-ses),χ2=5.168,P=0.038] and higher white blood cell count[(11.51±9.03)×109/L vs(6.95±5.64)×109/L,t=-2. 107,P=0. 041]. In the abnormal group,the levels of serum IL-6 [(44. 83±16. 31) ng/L],and IL-6,IL-1βand TNF-αin cerebrospinal fluid [(51. 85±15. 65) ng/L,(11. 95±2. 58) ng/L and(193. 11±67. 25) ng/L] were higher than those in the normal group[(36.83±8.76) ng/L,(42.56±12.89) ng/L,(10.26±2.91) ng/L and(160.56± 29. 02) ng/L,respectively] with the statistical difference(t=-2. 687,-2. 250,0. 269,-2. 243,P=0. 010,0. 029,0. 044, 0. 030). Maternal chorioamnionitis,higher serum TNF-αand cerebrospinal fluid IL-6 were high risk factors for brain in-jury(P=0. 014,0. 031,0. 047). Conclusion Increased systemic and cerebrospinal fluid cytokine levels are possibly re-lated to the preterm brain injury when intrauterine infection occurred.

MR cholangiography and dynamic examination of duodenal fluid in the differential diagnosis between extrahepatic biliary atresia and infantile hepatitis syndrome / 华中科技大学学报（医学）（英德文版）

In order to evaluate the value of magnetic resonance cholangiography (MRC) and dynamic examination of duodenal fluid in the differential diagnosis between extrahepatic biliary atresia (EHBA) and infantile hepatitis syndrome (IHS), 52 patients with infantile cholestatic jaundice were examined by MRC and duodenal fluid examination. Original interpretations were compared with clinical outcome. Calculated sensitivity of duodenal fluid examination in diagnosis of EHBA was 100%, and specificity was 91.1%. Sensitivity of MRC in the diagnosis of EHBA was 94.4% and specificity 88.24%. The sensitivity of MRC and examination of duodenal fluid combined in diagnosis of EHBA was 94.4% and specificity 97.06%. We are led to conclude that MRC and dynamic examination of duodenal fluid are useful in the differential diagnosis between IHS and EHBA and the combined use of the two techniques yield better results.

MR Cholangiography and Dynamic Examination of Duodenal Fluid in the Differential Diagnosis between Extrahepatic Biliary Atresia and Infantile Hepatitis Syndrome / 华中科技大学学报（医学）（英德文版）

In order to evaluate the value of magnetic resonance cholangiography (MRC) and dynamic examination of duodenal fluid in the differential diagnosis between extrahepatic biliary atresia (EHBA) and infantile hepatitis syndrome (IHS), 52 pa tients with infantile cholestatic jaundice were examined by MRC and duodenal fluid examination. Original interpretations were compared with clinical outcome. Calculated sensitivity of duodenal fluid examination in diagnosis of EHBA was 100%, and specificity was 91.1%. Sensitivity of MRC in the diagnosis of EHBA was 94.4 % and specificity 88.24 %. The sensitivity of MRC and examination of duodenal fluid combined in diagnosis of EHBA was 94.4 % and specificity 97.06 %. We are led to conclude that MRC and dynamic examination of duodenal fluid are useful in the differential diagnosis between IHS and EHBA and the combined use of the two techniques yield better resutls.