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Objective To study the clinical characteristics and current treatment options of neonatal congenital portosystemic shunt (CPSS).Method A newborn infant diagnosed with CPSS complicated with iliac artery-umbilical vein fistula was studied.CNKI,VIP,WanFang and Pubmed databases were searched using CPSS and Abernethy malformation as keywords.A total of 8 papers on neonatal CPSS were retrieved from 2006 to 2016.Result The case treated in our hospital was a boy with symptom of dyspnea and cyanosis.His ultrasound cardiograph showed pulmonary hypertension,and the heart and abdominal CT scan showed portosystemic shunt,dilated portal vein and umbilical vein,patent ductus venosus (PDV) and iliac artery-umbilical vein fistula.A total of 25 patients were analyzed including our patient and 24 cases reported in 8 papers.Cases of intrahepatic shunt (n =22) were nore common than extrahepatic shunt (n =3),and most cases could be diagnosed with ultrasound.Congenital heart diseases,intrauterine growth retardation,cutaneous hemangioma were common complications of CPSS.Abnormal liver function (52.0％),hyperammonemia (28.0％),pulmonary arterial hypertension (12.0％),dyspnea (12.0％) were common clinical manifestations of neonatal CPSS.Most CPSS cases were treated non-operatively during neonatal periods,and in 40.0％ of cases the shunts were closed spontaneously,but mortality was 20.0％ among previous cases.Conclusion Abnormal hepatic function is the most common clinical symptom of neonatal CPSS.Cases of extrahepatic shunts and complicated with PDV are dangerous and operation should be done as soon as possible,meanwhile complications should be treated appropriately.
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Objective To explore the optimal storage standard of fresh human milk, and to observe the influence of different cold storage condition (time-temperature) on macronutrients (fat, protein, carbohydrates, TS and energy), immune sub-stances (sIgA, lactoferrin, IL-6, 8, 10 and TNF-α) and bacteria indicators of fresh human milk.Methods Fresh milk samples (n=30) were divided and stored at three temperature and nine time points, which are 4℃ (24 h, 48 h, 72 h), -18℃(72 h, 7 d, 14 d, 4 w, 8 w, 12 w), and -80℃ (12 w, 24 w). At each time point, the macronutrients , immune substance, and bacteria colony counts of each milk sample were measured and compared with fresh milk. Results Compared with fresh milk, all indicators with the exception of lactoferrin in stored human milk showed signiifcant difference (P<0.05). Under 4℃ refrigeration condition, fat, IL-6, and TNF-α decreased, bacteria colony counts and Gram-positive colony counts increased over 72 h storage (P<0.05). Under-18℃ freezing condition, fat, protein, TS, energy and IL-6 decreased from 72 h to 12 w storage (P<0.05); carbohydrates and sIgA also decreased from 4 w and 8 w storage, respectively (P<0.05). Under -80℃ freezing condition, fat, protein, TS, energy and IL-6 decreased over 24 W storage (P<0.05).Conclusions The macronutrients, immune substance, and bacteria indicators of human milk were affected obviously by cold storage. Refrigerated at 4℃ should not be longer than 72 h, -80℃ freezing condition should be chosen for more than two months storage.
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Objective To explore the influence of early rapidly increased amino acid dosaging on the nitrogen balance and growth in preterm infants.Methods A total of 37 prematures admitted to our NICU within 24 hours after birth and with birth weight of 1 000 g to 1 800 g from November 2011 to January 2013 were randomly divided into study group (n =18) and control group (n =19).Parenteral nutrition (PE) was provided in both groups within 24 hours after birth.The starting amino acid dose was 1.5g/kg per day,then rose by 1 g/kg per day in study group and by 0.5 g/kg per day in control group,until to maximum of 3.5 g/kg per day.The dosage of lipids,glucose,and electrolytes in parenteral nutrition was provided routinely.The trial was double-blinded.Results In the first 5 days of PE,the nitrogen balance had no significant difference between these two groups (F =0.025,P =0.652) ; however,the time of regaining birth weight was significantly shorter in study group [(7.23±2.48) d] than in control group [(9.42±2.03) d] (t=-2.090,P=0.044).There were no differences between these two groups in trems of completely feeding time,weight gain rate,head circumference growth rate,length of hospital stay,and hospital costs (all P ＞ 0.05).Meanwhile,the rates of neonatal necrotizing enterocolitis,sepsis,mechanical ventilation administration,and damage of hepatic and renal function were also not significantly different.The administration of different dosages of amino acids did not affect the energy intake in both groups (F =1.893,P =0.218).Conclusions Prematures need early amino acid administration,with a starting dosage of more than 1.5 g/(kg · d).Rapid increase of amino acid dosing will not affect early nitrogen balance in premature infants; meanwhile,it contributes to weight gain without increasing the complications and hospitalization costs.