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Objective:To study the clinical value of blood neutrophil gelatinase-associated lipocalin (NGAL) in the early diagnosis and prognostic evaluation of late-onset sepsis in very/extremely low birth weight infants (VLBWI/ELBWI).Method:From January 2017 to December 2019, VLBWI/ELBWI older than 3 days admitted to NICU of our hospital were prospectively enrolled in the study. The infants were assigned into suspected-sepsis group and non-infection (control) group according to their clinical symptoms and laboratory indicators. In the suspected-sepsis group, complete blood count, C-reactive protein (CRP), procalcitonin (PCT) and blood culture were examined on the 1st day of disease onset and blood NGAL was examined on the 1st day of disease onset, 3rd day of treatment and 2nd week of treatment. In the control group, blood NGAL was examined at the time of enrollment. The suspected-sepsis group was later assigned into sepsis group and non-sepsis infection group and the sepsis group was further assigned into mild sepsis group and severe sepsis group according to the severity of the disease. Blood NGAL levels between the sepsis group and the non-sepsis infection group on the 1st day of onset and the control group were compared. The dynamic changes of NGAL in the sepsis group and the non-sepsis infection group at different time points were compared and analyzed. ROC curve of NGAL level on the first day of onset predicting sepsis was drawn.Result:(1) On the 1st day of disease, the sepsis group (n=106) had higher level of NGAL compared with non-sepsis infection group (n=121) and the control group (n=84). Non-sepsis infection group had significantly higher level of NGAL compared with the control group ( P<0.05). (2) A gradual decrease of NGAL was found in both sepsis and non-sepsis infection group. Significantly higher level of NGAL in sepsis group was found comparing with non-sepsis infection group at different time points ( P<0.05). (3) For blood culture positive and negative patients in the sepsis group, no statistically significant differences existed in NGAL,CRP, PCT levels on the 1st day of disease onset ( P>0.05).(4) The NGAL level in the severe sepsis group was significantly higher than the mild sepsis group on the 1st day of disease onset ( P<0.05). However,CRP and PCT showed no differences between the two groups. (5) On the 1st day of disease onset, to establish the diagnosis of sepsis, the area under the ROC curve of NGAL level was 0.852. The sensitivity and specificity of cut-off value 205.25 ng/ml were 84.0% and 66.9%, respectively. Conclusion:The serum NGAL level is elevated in VLBWI/ELBWI with late-onset sepsis. The more severe the sepsis,the more elevated the NGAL level. NGAL has certain predictive value for late onset sepsis in VLBWI/ELBWI.
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Objective To study the clinical significance of globus pallidus signal intensity and the intensity ratio of globus pallidus and putamen (G/P ratio) on magnetic resonance T1WI for the early recognition of neonatal bilirubin encephalopathy.Method From January to December 2017,full-term neonates with hyperbilirubinemia admitted to the neonatology department of our hospital were enrolled in the case group,and full-term neonates without hyperbilirubinemia in the control group.The clinical data,globus pallidus T1WI signal intensity,G/P ratio and the follow-up data were collected.According to the level of hyperbilirubinemia,the neonates in the case group were further assigned into mild hyperbilirubinemia group (serum bilirubin:222 to ＜256 μmol/L),moderate hyperbilirubinemia group (serum bilirubin:256 to ＜342 μmol/L),and severe hyperbilirubinemia group (serum bilirubin:≥ 342 μmol/L).According to the injury score of ABE,the neonates with ABE were assigned into mild ABE group,moderate ABE group and severe ABE group.The correlation of globus pallidus T1WI and T2WI signal values,G/P ratio and the serum bilirubin level and ABE degree were analyzed;receiver operating characteristic (ROC) curve was drawn to explore the predictive value of the T1WI signal value and G/P ratio for the diagnosis of ABE;the changes of globus pallidus T1WI and T2WI signal values during the first 6 months after birth and the results of follow-up to 1 year after discharge were also analyzed.Result A total of 175 neonates were included in the case group (65 in the mild hyperbilirubinemia group,71 in the moderate hyperbilirubinemia group and 39 in the severe hyperbilirubinemia group) and 43 neonates in the control group.39 neonates were diagnosed as ABE (21 mild ABE,12 moderate ABE,and 6 severe ABE).The first T1WI signal value and G/P ratio of neonates in the severe hyperbilirubinemia group was higher than the moderate hyperbilirubinemia group,the mild hyperbilirubinemia group and the control group;the T1WI signal value and G/P ratio in the moderate hyperbilirubinemia group was higher than the mild hyperbilirubinemia group and the control group (P ＜ 0.05).No significant difference existed between the mild group and the control group(P ＞ 0.05).T2WI values showed no differences among neonates with different bilirubin levels (P ＞ 0.05).The first T1WI signal value and G/P ratio in the severe ABE group were significantly higher than the moderate and mild ABE group,and the moderate ABE group higher than the mild ABE group (P ＜ 0.05).The ROC curve indicated the optimal cut-off value of T1WI signal and G/P ratio were 628 and 1.38,respectively.Among all the 175 neonates,9 had a decrease in T1WI signal value and an increase in T2WI signal value at 6 months after birth.After 1 year of follow-up visits,7 children were finally diagnosed as chronic bilirubin encephalopathy.All these children had increased signal intensity on T1WI in the acute phase,plus a decreased T1WI signal and an increased T2WI signal in 1 ～ 6 months after birth.Conclusion The globus pallidus T1WI signal and G/P ratio are closely related to the serum bilirubin level and ABE severity.If T1WI signal value ＞ 628 or G/P value ＞ 1.38,ABE should be considered.The T1WI signal value and G/P ratio play important roles as indicators for the early recognition of neonatal bilirubin encephalopathy.
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Objective To evaluate the level of plasma N－terminal pro－brain natriuretic peptide ( NT－proBNP ) in preterm infants with bronchopulmonary dysplasia ( BPD ) after dexamethasone administration and its correlation with the occurrence and severity of BPD.Method The preterm infants in NICU from December 2014 to October 2016 were enrolled in this prospective study.All of the infants were less than 32 weeks′gestational age (GA) and less than 1 500 g birth weight (BW) and they all underwent mechanical ventilation for severe ( stage Ⅲ－Ⅳ) respiratory distress syndrome ( RDS).The infants were assigned to weaning group and non－weaning group according to whether they underwent mechanical ventilation after 14 days of birth.Then the non－weaning group were assigned into the therapy group and control group according to whether treated by dexamethasone.By 14 and 28 days after birth, immunochromatography assay was used to detect the serum NT－proBNP respectively and the results were compared among the groups.Result A total of 157 preterm infants with severe RDS were included , 108 in the weaning group, the remaining 49 in the non－weaning group.(1)Compared with the non－weaning group, the weaning group had higher birth weight and lower plasma NT－proBNP level on day 14 ( P ＜0.05). (2)On day 28, all of the 30 infants in the dexamethasone treated group showed significantly lower plasma NT－proBNP level than the 19 infants in the control group [(2.42 ±0.47) pg/ml vs.(2.90 ±0.44) pg/ml] (P＜0.05).(3)Both of the occurrence of moderate to severe BPD and the plasma NT－pro BNP level on day 28 in the dexamethasone treated group were lower than that in the non－treated group (3/30 vs.8/19) and [(2.72 ±0.51) pg/ml vs.(3.09 ±0.30) pg/ml](P＜0.05).The plasma NT－proBNP level in the infants with BPD was higher than that in the infants without it and the difference was statistically significant ( P＜0.05).Conclusion Dexamethasone could reduce the incidence of BPD and the level of plasma NT －proBNP in infants with severe RDS.The plasma NT－pro BNP level was associated with the occurrence and severity of BPD, thus dynamic monitoring its change could be beneficial.
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Objective To investigate the dynamic changes of soluble urokinase-type plasminogen activator receptor (suPAR) and its predictive value in late-onset sepsis in the newborn.Method To collect the data of neonates aged 7 days and older,who were diagonsed to have infections.They were admitted to neonatal intensive care unit of our Hospital from January 2014 to January 2015.The group of sepsis and nonseptic group were assigned according to the diagnostic criteria of sepsis,and a control group was selected without infection.Blood cultures were collected in patients on the first day when infection was identified and the serum suPAR and CRP were measured on the first day,fourth day and tenth day respectively.The controls were tested with suPAR and CRP when infection was excluded.The levels of blood suPAR and CRP in the three groups were compared and the receiver-operating characteristic curve was performed according to serum suPAR level of neonates with sepsis on the first day.Result A total of 65 infants with infections (40 were septic and 25 were non-septic) were enrolled in this study and 20 patients were selected as control group.There were significant differences in serum suPAR and CRP levels between the patients with and without infection (P ＜ 0.001).The level of suPAR in the survivors of the sepsis group was significantly decreased as time went by,and the difference was statistically significant on the 10th day compared with the 1 st day [9.3 (8.2,13.1) ng/ml vs.18.9 (14.8,24.7) ng/ml,P ＜ 0.05].The level of CRP increased first initially and then decreased with time,while the highest level was on the 4th day and the difference was statistically significant compared with the 10th day [19.0 （ 6.8,56.4) mg/L vs.6.4 (2.5,12.0) mg/L,P ＜ 0.05].The levels of serum suPAR and CRP in non-sepsis group were not significantly different (P ＞ 0.05).There were no deaths in the sepsis group and the non-septic group,but the levels of suPAR between survivals and deaths in the infection groups were statistically significant [15.4(10.6,21.6) ng/ml vs.22.6 (15.4,31.9) ng/ml,Z =-2.063,P =0.039].The area under the receiver-operating characteristic curve of serum suPAR was 0.955 (95％ CI 0.906 ～ 1.000,P ＜0.001),and the sensitivity was 90％ and the specificity was 100％ when the suPAR level was 10.9 ng/ml.Conclusion Early elevated serum suPAR levels were prominently related to the severity of neonatal late-onset sepsis.The level of first day suPAR has a high sensitivity and specificity in the prognosis of sepsis and can be helpful to predict the prognosis.
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Objective To explore the clinical application value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in diagnosis and treatment of symptomatic patent ductus arteriosus (sPDA) in preterm infants. Methods A total of 107 preterm infants with gestational age of 28-32 weeks and birth weight less than 1500 g who were admitted to the neonatal intensive care unit from October 2013 to September 2014 were recruited. Plasma NT-proBNP were on 4th and 7th day after birth. The echocardiography examination was performed within 30 minutes after the blood was drawn. According to the echocardiography examination on 4th day after birth, the infants were divided into the patent ductus arteriosus (PDA) group (n?=?39) and the control group (n?=?68). According to whether there were signiifcant hemodynamics changes of ultrasonography and clinical symptoms, the PDA group were classiifed into the sPDA group (n?=?20) and the asymptomatic PDA group (asPDA, n?=?19). Then according to whether ibuprofen was taken, the sPDA group was further divided into treatment group (n?=?13) and non-treatment group (n?=?7). Results On the 4th day after birth, the level of plasma NT-proBNP in the sPDA group was signiifcantly higher than that in asPDA group, and the level of plasma NT-proBNP in asPDA group was signiifcantly higher than that in the control group (P??0.05). In the treatment group, the level of plasma NT-proBNP on the 7th day after birth was signiifcantly lower than that on the 4th day after birth (P??0.05). In PDA group, the level of plasma NT-proBNP on the 4th day after birth was positively correlated with ductus arteriosus (DA) diameter, ratio of the left atrium to aortic root diameter (LA/AO ratio) and transductal diameter-to-left pulmonary artery ratio (TDD/LPA) (r?=?0.498-0.670, respectively). The area under receiver operator characteristic (ROC) curve for prediction of sPDA by the plasma NT proBNP on the 4th day after birth was 0.969 (95%CI:0.938-1.000). When the NT-proBNP was 13964 pg/ml on the 4th day after birth, the sensitivity for diagnosis sPDA was 95%, the speciifcity was 95.4%. Conclusions The level of plasma NT-proBNP is signiifcantly higher in preterm infants with sPDA and is decreased after treatment. Plasma NT-proBNP on the 4th day after birth is a sensitive marker for predicting sPDA. Dynamic monitoring of plasma NT-proBNP has important clinical value in selection of the treatment strategy in preterm infants with PDA.
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Objective To study the pathological spectrum of neonatal sepsis and antibiotic resistance of bacteria and fungi isolated from neonatal blood samples. Methods Clinical information of neonates with sepsis admitted to neonatal ward of our Hospital were retrospectively collected from January 2007 to December 2014 and analyzed. Results During the study period, a total of 23 224 infants were admitted to neonatal ward. Among them, 608 were diagnosed with sepsis (2. 62% , 608 / 23 224). Blood culture samples were positive in 412 cases, the rest (196 cases) were diagnosed according to clinical manifestations and laboratory tests. The composition ratio of sepsis during the first 4 years was significantly lower than that of the subsequent 4 years (2. 58% , 225 / 9 805 vs. 2. 85% , 383 / 13 419, P < 0. 05). Of 412 bacterial strains isolated, gram-positive bacteria, gram-negative bacteria and fungi accounted for 62. 38% , 30. 34% and 7. 28% , respectively. For the 155 strains isolated during first 4 years, the number of G + bacteria, G - bacteria and fungi were 106 strains (68. 39% ), 40 strains (25. 81% ), 9 strains ( 5. 81% ), respectively. The coagulase-negative staphylococcus ( CONS ) accounted for 90. 57% of G + strains. Klebsiella pneumoniae and Escherichia coli accounted for 50. 00%and 15. 00% of G - strains respectively. 257 strains were isolated during the subsequent 4 years, of which G + bacteria, G - bacteria and fungi accounted for 151 strains (58. 75% ), 85 strains (33. 07% ), 21 strains (8. 17% ), respectively. CONS accounted for 74. 83% of G + strains, Klebsiella pneumoniae and Escherichia coli accounted for 30. 58% and 35. 29% of G - strains. The composition ratio of CONS and Escherichia coli were significantly different between first and subsequent 4 years (P < 0. 05). G +bacteria were resistant to penicillin, oxacillin and macrolide, sensitive to piperacillin / tazobactam and quinolone. We did not identify any G + strain resistant to vancomycin. In general, G - bacteria were resistant to ampicillin and cephalosporins, sensitive to the beta lactamase inhibitor compound preparation and quinolones, and highly sensitive to carbapenems. Fungi generally were sensitive to conazoles. Conclusions Neonatal sepsis are mainly caused by CONS, Klebsiella pneumoniae and Escherichia coli also play important roles. G + bacteria and G - bacteria in general are resistant to penicillin and cephalosporins. All G + bacterial strains isolated from our cohort are sensitive to vancomycin. G - bacteria are generally sensitive to carbapenems. Fungi generally are sensitive to conazoles.
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Objective To analyze the characteristics of blood loss for laboratory test of critically ill premature infants,and to seek feasible measures to reduce the blood loss.Methods Two hundred and forty-six cases of critically ill premature infants admitted to the neonatal intensive care unit from April 2012 to April 2013 were analyzed the blood loss for test during the hospitalization and the clinical features of blood loss with different gestational age,different weight within the first four weeks after admission.Then the application of blood loss according to test category was described.The blood volume demanded in theory was determined by the formula B =5 (∑ s + 0.1),then calculated the phlebotomy overdraw on the basis of the practical blood loss and analyzed the characteristics of overdraw per patients per day in first two weeks after admission.Results Among 246 patients,The median blood loss figure was 25.57 ml for each infants with the range between 7.10 ml ～ 119.20 ml,and the blood loss concentrated in first four weeks,which showed a decreasing trend with time.There was a statistically significant difference(P ＜0.05)that the smaller gestational age,the lower birth weight,the more daily blood loss per patient per day in first two weeks,but no significant differences(P ＞ 0.05) between the third and fourth week.The largest proportion of the blood samples was used for clinical chemical tests(31.49％),followed by blood gas analysis (19.03％),immunoassays (12.69％),blood cultures (12.63％),hematology (12.28％).The practical blood loss was about twice times of blood volume demanded for tests in theory,which the median was 7.8 times to the latter(25.57 ml vs 3.26 ml).It showed statistically significant difference(P ＜0.05) between blood overdraw per patients per day in the first week and the second week.Compared with different gestational age and birth weight,the difference of overdraw was also statistically significant(P ＜0.05).According to test category,blood culture was the most significant samples of phlebotomy overdraw,followed by biochemical,other,blood gas analysis,the percentage was 76％,64％,45％ and 41％ respectively.Conclusion The blood loss for laboratory test and the phenomenon of blood waste is serious in critically ill preterm infants.The smaller the gestational age is,the lower the weight is,the amount of blood loss and phlebotomy overdraw are more significantly.Biochemical and blood gas analysis are the main items of blood loss.
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Objective To determine the relationship between the viral load of cerebrospinal fluid (CSF) and sensorineural hearing loss (SNHL) in newborns with symptomatic congenital cytomegalovirus (CMV) infection.Methods The study cohort comprised 36 newborns with symptomatic congenital CMV infection.CSF from all of the patients were analyzed for the presence of CMV DNA by PCR.Audiological function were performed on them by brain stem auditory evoked potential at birth,at 6 and 12 months of age.Results (1)Of the 36 newborns,15 cases (41.7％) had positive CSF PCR result,17 cases (47.2％) had SNHL.(2) The prevalence of SNHL in the group of newborns with positive CSF PCR result was 60.0％ (9/15),and it was 38.1％ (8/21) in the group of newborns with negative CSF PCR result,there was no significant difference of the prevalence of SNHL between the two groups (P =0.194).(3) In newborns with positive CSF PCR result,the amounts of CSF CMV DNA was not different between the newborns with SNHL and normal hearing (3.35 ± 0.68 vs.3.17 ± 0.56,P =0.36).Conclusion A positive CSF PCR result and the CMV viral load of CSF did not correlate with SNHL.
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Objective To explore the changes of bone metabolic markers during early stage of preterm infants, as well as the relationship with their nutrition status. Methods Preterm infants with gestational age 30-35 weeks admitted to our Hospital were collected from November 2012 to April 2013. Venous blood samples obtained within 24 hours after birth and between 8:00-9:00 AM two weeks after birth were used to determine the Serum β-CTx, osteocalcin ( OC) and propeptide of type I procollagen (PINP) levels by Electro-Chemiluminescence. Analysis of changes of these bone metabolic markers and their relationship with early stage nutrition related indicators were also performed. Results A total of 60 premature infants were collected. There was no significant correlation among serum β-CTx, OC and PINP within 24 hours after birth ( r=0. 170, P＞0. 05 ) . The Serum β-CTx within 24 hours after birth was negatively correlated with gestational age (r= -0. 603, P＜0. 05), whereas the serum OC within 24 hours after birth was positively correlated with gestational age ( r=0. 581, P＜0. 05 ) . However, PINP wasn′t correlated with gestational age significantly (r=0. 134,P＞0. 05). Serumβ-CTx, OC and PINP at 2 weeks after birth increased significantly from the baseline level detected within 24 hours after birth ( P＜0. 05 ) .Δβ-CTx was positively correlated with ΔOC (r=0. 600,P＜0. 05). There was no significant correlation between ΔPINP and Δβ-CTx (r=0. 045,P＞0. 05), as well as ΔOC and ΔPINP (r=0. 110,P＞0. 05).ΔOC was positively correlated with average daily calorie ( P＜0. 05 ) and average daily P/E ( P＜0. 05 ) , negatively correlated with cumulative loss of caloric ( P＜0. 05 ) . There was no significant correlation between Δβ-CTx or ΔPINP with nutrition related indicators of this study. Conclusions Serum OC within 24 hours after birth of preterm infants and their gestational age are positively correlated, while β-CTx detected at the same time and gestational age are negatively correlated. Vigorous metabolism of premature bone occurs during the first two weeks after birth, as the serum β-CTx, OC and PINP levels increased significantly. We suggest that reasonable calorie intake and appropriate protein calorie ratio at early stage after birth is very important for the development of bone of preterm infants.
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To explore the correlation between nucleated red blood cell (NRBC) count and perinatal asphyxia in neonates.Full-term newborns born from May 2011 to November 2012 were recruited and divided into perinatal asphyxia (n =40) and normal (n =30) groups.Apgar score was recorded immediately at delivery.The umbilical arterial blood was also collected into anticoagulant-treated tube and NRBC was counted by Japan OlympusCX41 biological microscope.NRBC count for perinatal asphyxia group [(10.70 ± 2.61)/100 WBC] was significant higher than that for normal group [(2.67 ± 0.35)/100 WBC].A statistically significant negative correlation existed between NRBC and umbilical arterial blood pH,Apgar score at 1 min,BE value (r =-0.802,P ＜ 0.05 ; r =-0.639,P ＜ 0.05 ; r =-0.566,P ＜ 0.05).Associated with perinatal asphyxia in neonates,NRBC may be used as a simple index for assessing the severity of neonatal perinatal asphyxia.