Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China / 中华儿科杂志

Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34+0 weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.

Effect of L-arginine on Pax2 expression in the kidneys of pup rats with intrauterine growth retardation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of L-arginine (L-Arg) on Pax2 expression in the kidneys of pup rats with intrauterine growth retardation (IUGR).</p><p><b>METHODS</b>Pregnant rats were randomly assigned into three groups：normal, IUGR and L-Arg treated IUGR. The rats in the normal group were fed with ordinary forage (21% protein) during pregnancy. Those in the other two groups were fed with low diet forage (10% protein) during pregnancy. The L-Arg treated group was given drinking water containing L-Arg (200 mg/kg) daily during 21 days of lactation. Pax2 expression in renal tissues was measured with immunohistochemical staining and Western blot in pup rats of 7 days, 21 days, 2 months and 3 months old.</p><p><b>RESULTS</b>The immunohistochemical staining showed that Pax2 was not expressed in the pup rats from the normal group at any time point. Pax2 positive cells were found in renal glomerulus and kidney tubules of 2-months- and 3-months-old rats from the IUGR and L-Arg treated groups. And Pax2 expression in 3-months-old rats was significantly higher than that in 2-months-old rats (P<0.05). L-Arg treatment decreased significantly the Pax2 expression in 2-months- and 3-months-old rats when compared with the untreated IUGR group (P<0.05). Western blot showed that Pax2 protein was not expressed in 7-days- and 21-days-old pup rats from three groups. Pax2 protein expression in 2-months- and 3-months-old pup rats from the IUGR and L-Arg treated groups increased significantly compared with normal controls. Pax2 protein expression in the pup rats from the L-Arg treated group was significantly lower than that in the untreated IUGR pup rats (P<0.01).</p><p><b>CONCLUSIONS</b>Pax2 is expressed in the kidneys of IUGR rats during adulthood. L-Arg treatment can decrease the expression of Pax2.</p>

Comparison of therapeutic effect of different doses of ganciclovir for neonatal congenital cytomegalovirus infection / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Ganciclovir is a first-line drug for treatment of cytomegalovirus (CMV) infection. However, some ganciclovir treatment-related side-effects can be found. This study aimed to compare the efficacy and side effects of relatively low and high doses of ganciclovir in the treatment of neonatal congenital CMV infection.</p><p><b>METHODS</b>One hundred and sixty-seven neonates with congenital CMV infection were randomly assigned to high-dose (n=79) and low-dose ganciclovir groups (n=88). The high-dose ganciclovir group was injected with ganciclovir of 7.5 mg/kg in the inducement phase and of 10 mg/kg in the maintaining phase. The low-dose ganciclovir group was injected with ganciclovir of 5 mg/kg in the inducement and the maintaining phases. The efficacy and side effects were observed in the two groups.</p><p><b>RESULTS</b>After treatment the clinical symptoms and signs were obviously improved in both groups. CMV-IgM became negative in 93.8% of neonates in the high-dose ganciclovir group and 93.1% of neonates in the low-dose ganciclovir group (P>0.05). CMV-DNA became negative in 80.8% of neonates in the high-dose ganciclovir group and in 86.7% in the low-dose ganciclovir group (P>0.05). The low-dose ganciclovir group had lower incidence of side effects than the high-dose ganciclovir group: vomiting 2.3% vs 11.4%; anemia 8.0% vs 20.3%; reduction of neutrophilic granulocytes 5.7% vs 16.5%; increase in platelet count 8.0% vs 18.9% (P<0.05).</p><p><b>CONCLUSIONS</b>Low-dose ganciclovir has the same clinical efficacy to high-dose ganciclovir for treatment of neonatal congenital CMV infection, but fewer side effects occur in the low-dose group.</p>