Clinical features and short-term outcomes of 14 cases of neonatal limb thrombosis / 中国小儿急救医学

Objective:To summarize the risk factors, clinical manifestations, diagnosis and treatment of limb thrombosis in neonates.Methods:The clinical data of 14 neonates with limb thrombosis were hospitalized in neonatology department at Shengjing Hospital of China Medical University from February 2012 to February 2022 were retrospectively analyzed.Results:All the 14 cases of limb thrombosis were premature infants, with an average gestational age of 29 weeks and 5 days(27 weeks and 3 days to 33 weeks and 1 day), including eight cases of arterial embolism and six cases of venous embolism.Among them, 13(92.9%) cases were diagnosed with infectious diseases such as septicemia or neonatal necrotizing enterocolitis within 48 hours before embolization, and all had a history of peripheral arterial and venous catheterization.During the early stage of embolization, limb artery embolism was characterized by weakened distal artery pulsation, pale skin, gradual cyanosis and even gangrene.Limb venous embolism was manifested as limb swelling, skin congestion and cyanosis, but the arterial pulsation was normal.Fourteen cases were confirmed by vascular ultrasound.All the eight cases with arterial embolization were treated with heparin anticoagulation, five of which were cured, with an effective rate of 62.5%.The average time of heparin use in five cases was 2.5 days(2-3 days). One patient was not effective after 2 days of heparin treatment, and recovered after thrombectomy.Another two cases had distal limb gangrene, and them were treated with heparin for 5 days and 7 days.All of the six cases with venous embolism were cured, of which four cases were treated with heparin for an average of 8.5 days(4-15 days), and the other two cases were cured after general treatment.There were no bleeding events in the 12 infants treated with heparin.Conclusion:Peripheral arterial and venous catheterization during infection of preterm infants is the most common cause of limb thrombosis.The smaller body weight and gestational age, the thinner blood vessels, the higher risk of occurrence.Vascular ultrasound is the most commonly used examination method for neonatal thrombosis, and heparin anticoagulant therapy is the most commonly used treatment measure.When the treatment effect of heparin is not good, other treatment methods should be sought.

Integration of traditional tests and biomarkers for the early diagnosis of neonatal necrotizing enterocolitis / 中华实用儿科临床杂志

Necrotizing enterocolitis (NEC) is the most common and serious acute intestinal necrotizing disease in newborns, especially in preterm infants.Infants with smaller gestational age are more prone to NEC.NEC-related mortality reaches up to 20%-30%, and 25% of the survivors suffer from serious sequelae such as the short bowel syndrome, growth restriction and long-lasting neurological dysplasia.Due to the atypical symptoms, early diagnosis of NEC is difficult, and the patient′s condition has already been serious at the time of diagnosis in general.Ultrasound and abdominal X-ray are traditional tools for the diagnosis of NEC.Serum, urine and fecal biomarkers have been gradually applied to clinical practice in recent years.Through integrating traditional tests with biological markers and optimizing the clinical decision-making system for NEC, precise clinical diagnosis and individualized treatment can be achieved.

Study on the anti-inflammatory and analgesic pharmacodynamics of Zhonghua Dida Pill and its effect on inflammation in arthritis model rats / 国际中医中药杂志

Objective:To investigate the anti-inflammatory and analgesic effects of Zhonghua Dieda Pills; To preliminarily explore its mechanism on adjuvant arthritis model rats.Methods:Three inflammatory models and two pain models were used to investigate the anti-inflammatory and analgesic effects of Zhonghua Dieda Pills. After establishing the adjuvant arthritis rat model, the rats were divided into normal group, model group, dexamethasone group (0.8 mg/kg), and Zhonghua Dieda Pills (2.0, 1.0, 0.5 g/kg) groups according to random number table method. Each group was given corresponding drugs once a day for 5 weeks. The toe volume was measured at 1, 3 and 5 weeks after administration, and the swelling degree was calculated; the organ indices of rats were calculated and the histopathological changes of articular cartilage were observed by HE staining; the expressions of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β) in joint tissues were detected by immunohistochemistry.Results:Zhonghua Dieda Pills (2.0 g/kg) group significantly reduced the swelling of foot and plantar of rats, reduced the swelling of ear of mice, and reduced the dry weight of granuloma of rats ( P<0.05); Zhonghua Dieda Pills (1.4 g/kg) group significantly reduced the number of twisting of rats, and the pain threshold after 3 h of administration was significantly higher than that of the control group ( P<0.05); Zhonghua Dieda Pills (2.0 g/kg) group significantly reduced the swelling of the foot and metatarsal of arthritic rats after 3-5 weeks of administration ( P<0.05), decreased the thymus index ( P<0.05), and reduced the expression levels of IL-1β, TNF-α and TGF-β in joint tissues ( P<0.05). Conclusion:Zhonghua Dieda Pills have confirmed anti-inflammatory and analgesic effects, which may play a therapeutic role in adjuvant arthritis model rats by reducing the levels of inflammatory factors such as IL-1β, TNF-α and TGF-β.

Progress of blood biomarkers in early prediction of bronchopulmonary dysplasia / 国际儿科学杂志

Bronchopulmonary dysplasia(BPD)is one of the most serious lung disease in the small gestational preterm infants, which may affect their development in infancy and adult quality of life.Blood samples of premature infants are easy to be collected and detected, and their biological markers are helpful for early prediction of BPD, which is of great significance for reducing the incidence of severe BPD and improving the poor prognosis of infants.In recent years, a variety of biological markers have been found in cord blood and serum of premature infants, including matrix metalloproteinase 9, tissue inhibitor of metalloproteinases 1, soluble Klotho protein, vascular endothelial growth factor, interleukin and N-terminal pro-brain natriuretic peptides, etc., some of which have been applied in clinic.It has broad application prospect for screening high-risk premature infants with BPD and effectively predicting the occurrence and severity of early BPD.

Fetal inflammatory response syndrome and neonatal clinical outcomes / 中国小儿急救医学

Fetal inflammatory response syndrome(FIRS) is a state of systemic inflammatory response in the fetus, induced by infectious and non-infectious pathways, with increased levels of cytokines represented by interleukin-6.Chorioamnionitis and funisitis are common placental pathological changes of FIRS.FIRS can not only lead to premature birth, but also is closely related to multiple organ damage such as brain injury, lung injury, early-onset sepsis, necrotizing enterocolitis, and cardiovascular system diseases during the neonatal period.Therefore, reducing the damage caused by FIRS to neonates is a common clinical problem that obstetricians and pediatricians will face together.

Progress on the relationship between vitamin D and neonatal bronchopulmonary dysplasia / 国际儿科学杂志

Bronchopulmonary dysplasia is one of the most common complications of preterm infants.The main pathological feature is dysplasia of the alveoli and pulmonary microvessels.Vitamin D is a steroid hormone.By binding to vitamin D receptors, it can protect the barrier function of alveolar epithelium, promote pulmonary vascularization, inhibit pulmonary fibrosis, regulate immune function, and repair damaged lung epithelial cells.It is beneficial to lung development and the improvement of lung function in preterm infants.Therefore, monitoring the level of vitamin D in the perinatal period and supplementing with appropriate doses is expected to be one of the ways to reduce the occurrence of moderate and severe bronchopulmonary dysplasia and improve the lung development of preterm infants.

Selection Principles and Analysis of Common Prescriptions in Clinical Practice Guidelines of Traditional Chinese and Western Medicine Based on Cough in Children / 中国实验方剂学杂志

ObjectiveTo collect common prescriptions from multiple channels based on the mainstream guidance materials combined with ancient books to provide references for the selection principles of common prescriptions in clinical practice guidelines of traditional Chinese medicine （TCM） and western medicine. MethodWith the research on the selection of commonly used prescriptions in Clinical Practice Guidelines of Chinese and Western Medicine for Cough in Children as an example，the nation-recommended Schedule Ⅲ drugs and prescriptions for cough in children in the clinical diagnosis and treatment guidelines of TCM （TCM and western medicine）/expert consensus/clinical pathway/diagnosis and treatment protocols，three TCM pediatric textbooks， the experience of famous experts， and ancient books were searched for the establishment of a prescription database and analysis of medication regularity. ResultThe results showed that there were 71 commonly used prescriptions for the treatment of cough in children. The top 3 clinically indicated syndromes were the syndrome of phlegm-heat blocking the lung，the syndrome of wind-heat invading the lung，and the syndrome of wind-cold attacking the lung，and the top 5 efficacies corresponding to high-frequency drugs were reliving cough and dyspnea， clearing heat/resolving phlegm， dispersing wind/dissipating cold， clearing heat/purging fire， and dispersing wind/dissipating heat. The most commonly used Chinese medicines included Armeniacae Semen Amarum， Platycodonis Radix， Bolbostemmatis Rhizoma， Ephedrae Herba， Scutellariae Radix， Pinelliae Rhizoma， and Citri Reticulatae Pericarpium. Some drugs showed high internal correlations with Armeniacae Semen Amarum and Platycodonis Radix. There were 228 prescriptions for the treatment of cough in children based on the ancient books in the Chinese Medical Code. The most commonly used Chinese medicines were Pinelliae Rhizoma， Armeniacae Semen Amarum， Ginseng Radix et Rhizoma， Poria， Citri Reticulatae Pericarpium， Platycodonis Radix， Zingiberis Rhizoma Recens， and Bolbostemmatis Rhizoma. The top 5 efficacies corresponding to high-frequency drugs were dispersing wind/dissipating cold， relieving cough and dyspnea， clearing heat/resolving phlegm， warming cold/resolving phlegm， and tonifying Qi. Some drugs showed high internal correlations with Pinelliae Rhizoma and Platycodonis Radix. As revealed by the comparison of ancient and modern medication， the medication principles could be roughly classified into two categories： ventilating the lung/descending Qi and resolving phlegm. In ancient medication， the drugs for cough in children were mainly used for warming， tonifying， dissipating cold， excreting water， alleviating edema， and astringing lung and intestines， while in modern medication， the prescriptions were mainly for dispersing wind， clearing heat， tonifying yin， and moistening dampness. ConclusionThis study systematically analyzed the commonly used prescriptions for the treatment of cough in children and provided references for the selection of TCM in clinical practice guidelines.

Establishment and Evaluation of Rat Model of Acute Coronary Syndrome with Combined Blood Stasis and Poison / 中国实验方剂学杂志

ObjectiveTo compare the feasibility of establishing the rat model of acute coronary syndrome with combined blood stasis and poison by lipopolysacharide （LPS） injection， ligation of coronary artery and different combinations of the two methods. MethodA total of 225 male SD rats were randomly divided into sham operation group， simple coronary artery ligation group， first injected LPS group ［LPS（5 mg·kg）injection 24 h before coronary artery ligation］ and follow injected LPS group ［LPS（5 mg·kg）injection 10 min after coronary artery ligation］. The indexes of each group were detected at 3， 24， 72 h after modeling， and the model was comprehensively evaluated. The general state and macroscopic evaluation indexes of traditional Chinese medicine （TCM） syndrome （tongue and pulse） of rats in each group were observed. ECG and echocardiography were used to evaluate cardiac function， and the myocardial ischemia and infarction areas were measured by Evans blue/2，3，5-triphenyltetrazolium chloride （TTC） staining. The content of creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， creatine kinase （CK）， and troponin T （cTnT） in serum as well as interleukin-1 β （IL-1β） and IL-6 changes were determined by biochemical method or enzyme-linked immunosorbent assay （ELISA）. Hematology analyzer was adopted to determine the white blood cell （WBC） count， and the four coagulation indexes， platelet aggregation rate， hemorheology and other coagulation evaluation indexes were also detected. The myocardial tissue was observed by hematoxylin-eosin（HE）staining. ResultAfter 3 h of modeling， compared with the conditions in sham operation group， the R， G and B values of tongue of rats （P<0.01）， pulse amplitude （P<0.01）， and cardiac function in simple coronary artery ligation group were decreased， and the color of hypoglossal veins became purple（P<0.01）. The content of CK， LDH， cTnT， IL-1β and IL-6 in serum（P<0.05）， myocardial infarction area（P<0.01）， and total number of WBCs （P<0.05）were increased. Compared with simple coronary artery ligation group， first injected LPS group and follow injected LPS group had increased hypoglossal veins， decreased R value of tongue and elevated cTnT content （P<0.01）， while follow injected LPS group had reduced B value of tongue， decreased cardiac output （CO）（P<0.05）， increased IL-1β content， and thinned left ventricular anterior walls at end-systole （LVAWs）（P<0.01）. After 24 h of modeling， compared with sham operation group， simple coronary artery ligation group presented significantly decreased R， G and B values of tongue， lengthened purplish dark hypoglossal veins （P<0.01）， reduced pulse amplitude（P<0.01） and cardiac function， enlarged myocardial infarction area（P<0.01）， increased whole blood viscosity， platelet aggregation rate， fibrinogen （FIB）， shortened prothrombin time （PT） and thrombin time （TT）（P<0.01）， and elevated total number of WBCs （P<0.01）and content of CK， LDH， cTnT and IL-6 in serum（P<0.05）. Compared with the conditions in simple coronary artery ligation group， the pulse amplitude， R， G and B values of tongue （P<0.01）， and ejection fraction （EF） and fractional shortening （FS） scores （P<0.05）dropped， and hypoglossal veins were deepened and lengthened（P<0.05）， and cTnT content was increased（P<0.01）in first injected LPS group and follow injected LPS group. However， follow injected LPS group had thinned LVPWs， increased LDH content， platelet aggregation rate（P<0.05）， myocardial infarction area， and total number of WBC， level of IL-1β（P<0.05）， and shortened TT（P<0.01）. Additionally， 72 h after modeling， compared with sham operation group， simple coronary artery ligation group showed significantly reduced pulse amplitude， lowered R， G and B values of tongue， thickened and lengthened hypoglossal veins（P<0.01）， decreased cardiac function， and increased content of cTnT， FIB， whole blood viscosity（P<0.01），platelet aggregation rate， level of IL-6 and IL-1β（P<0.05）. Compared with the conditions in simple coronary artery ligation group， the hypoglossal veins of the first injected LPS group and the follow injected LPS group were more purple， and the content of cTnT was boosted（P<0.01）， whereas follow injected LPS group had decreased pulse amplitude， R， G and B values of tongue， EF and FS scores （P<0.05）， and enlarged myocardial infarction area（P<0.01）. ConclusionCompared with the other modeling methods and models at different modeling time， the established model by LPS injection 10 min after coronary artery ligation for 24 h was more consistent with the clinical characteristics of acute coronary syndrome with combined blood stasis and poison.

Establishment and Evaluation of Rat Model of Acute Coronary Syndrome with Combined Blood Stasis and Poison / 中国实验方剂学杂志

ObjectiveTo compare the feasibility of establishing the rat model of acute coronary syndrome with combined blood stasis and poison by lipopolysacharide （LPS） injection， ligation of coronary artery and different combinations of the two methods. MethodA total of 225 male SD rats were randomly divided into sham operation group， simple coronary artery ligation group， first injected LPS group ［LPS（5 mg·kg）injection 24 h before coronary artery ligation］ and follow injected LPS group ［LPS（5 mg·kg）injection 10 min after coronary artery ligation］. The indexes of each group were detected at 3， 24， 72 h after modeling， and the model was comprehensively evaluated. The general state and macroscopic evaluation indexes of traditional Chinese medicine （TCM） syndrome （tongue and pulse） of rats in each group were observed. ECG and echocardiography were used to evaluate cardiac function， and the myocardial ischemia and infarction areas were measured by Evans blue/2，3，5-triphenyltetrazolium chloride （TTC） staining. The content of creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， creatine kinase （CK）， and troponin T （cTnT） in serum as well as interleukin-1 β （IL-1β） and IL-6 changes were determined by biochemical method or enzyme-linked immunosorbent assay （ELISA）. Hematology analyzer was adopted to determine the white blood cell （WBC） count， and the four coagulation indexes， platelet aggregation rate， hemorheology and other coagulation evaluation indexes were also detected. The myocardial tissue was observed by hematoxylin-eosin（HE）staining. ResultAfter 3 h of modeling， compared with the conditions in sham operation group， the R， G and B values of tongue of rats （P<0.01）， pulse amplitude （P<0.01）， and cardiac function in simple coronary artery ligation group were decreased， and the color of hypoglossal veins became purple（P<0.01）. The content of CK， LDH， cTnT， IL-1β and IL-6 in serum（P<0.05）， myocardial infarction area（P<0.01）， and total number of WBCs （P<0.05）were increased. Compared with simple coronary artery ligation group， first injected LPS group and follow injected LPS group had increased hypoglossal veins， decreased R value of tongue and elevated cTnT content （P<0.01）， while follow injected LPS group had reduced B value of tongue， decreased cardiac output （CO）（P<0.05）， increased IL-1β content， and thinned left ventricular anterior walls at end-systole （LVAWs）（P<0.01）. After 24 h of modeling， compared with sham operation group， simple coronary artery ligation group presented significantly decreased R， G and B values of tongue， lengthened purplish dark hypoglossal veins （P<0.01）， reduced pulse amplitude（P<0.01） and cardiac function， enlarged myocardial infarction area（P<0.01）， increased whole blood viscosity， platelet aggregation rate， fibrinogen （FIB）， shortened prothrombin time （PT） and thrombin time （TT）（P<0.01）， and elevated total number of WBCs （P<0.01）and content of CK， LDH， cTnT and IL-6 in serum（P<0.05）. Compared with the conditions in simple coronary artery ligation group， the pulse amplitude， R， G and B values of tongue （P<0.01）， and ejection fraction （EF） and fractional shortening （FS） scores （P<0.05）dropped， and hypoglossal veins were deepened and lengthened（P<0.05）， and cTnT content was increased（P<0.01）in first injected LPS group and follow injected LPS group. However， follow injected LPS group had thinned LVPWs， increased LDH content， platelet aggregation rate（P<0.05）， myocardial infarction area， and total number of WBC， level of IL-1β（P<0.05）， and shortened TT（P<0.01）. Additionally， 72 h after modeling， compared with sham operation group， simple coronary artery ligation group showed significantly reduced pulse amplitude， lowered R， G and B values of tongue， thickened and lengthened hypoglossal veins（P<0.01）， decreased cardiac function， and increased content of cTnT， FIB， whole blood viscosity（P<0.01），platelet aggregation rate， level of IL-6 and IL-1β（P<0.05）. Compared with the conditions in simple coronary artery ligation group， the hypoglossal veins of the first injected LPS group and the follow injected LPS group were more purple， and the content of cTnT was boosted（P<0.01）， whereas follow injected LPS group had decreased pulse amplitude， R， G and B values of tongue， EF and FS scores （P<0.05）， and enlarged myocardial infarction area（P<0.01）. ConclusionCompared with the other modeling methods and models at different modeling time， the established model by LPS injection 10 min after coronary artery ligation for 24 h was more consistent with the clinical characteristics of acute coronary syndrome with combined blood stasis and poison.

Selection Principles and Analysis of Common Prescriptions in Clinical Practice Guidelines of Traditional Chinese and Western Medicine Based on Cough in Children / 中国实验方剂学杂志

ObjectiveTo collect common prescriptions from multiple channels based on the mainstream guidance materials combined with ancient books to provide references for the selection principles of common prescriptions in clinical practice guidelines of traditional Chinese medicine （TCM） and western medicine. MethodWith the research on the selection of commonly used prescriptions in Clinical Practice Guidelines of Chinese and Western Medicine for Cough in Children as an example，the nation-recommended Schedule Ⅲ drugs and prescriptions for cough in children in the clinical diagnosis and treatment guidelines of TCM （TCM and western medicine）/expert consensus/clinical pathway/diagnosis and treatment protocols，three TCM pediatric textbooks， the experience of famous experts， and ancient books were searched for the establishment of a prescription database and analysis of medication regularity. ResultThe results showed that there were 71 commonly used prescriptions for the treatment of cough in children. The top 3 clinically indicated syndromes were the syndrome of phlegm-heat blocking the lung，the syndrome of wind-heat invading the lung，and the syndrome of wind-cold attacking the lung，and the top 5 efficacies corresponding to high-frequency drugs were reliving cough and dyspnea， clearing heat/resolving phlegm， dispersing wind/dissipating cold， clearing heat/purging fire， and dispersing wind/dissipating heat. The most commonly used Chinese medicines included Armeniacae Semen Amarum， Platycodonis Radix， Bolbostemmatis Rhizoma， Ephedrae Herba， Scutellariae Radix， Pinelliae Rhizoma， and Citri Reticulatae Pericarpium. Some drugs showed high internal correlations with Armeniacae Semen Amarum and Platycodonis Radix. There were 228 prescriptions for the treatment of cough in children based on the ancient books in the Chinese Medical Code. The most commonly used Chinese medicines were Pinelliae Rhizoma， Armeniacae Semen Amarum， Ginseng Radix et Rhizoma， Poria， Citri Reticulatae Pericarpium， Platycodonis Radix， Zingiberis Rhizoma Recens， and Bolbostemmatis Rhizoma. The top 5 efficacies corresponding to high-frequency drugs were dispersing wind/dissipating cold， relieving cough and dyspnea， clearing heat/resolving phlegm， warming cold/resolving phlegm， and tonifying Qi. Some drugs showed high internal correlations with Pinelliae Rhizoma and Platycodonis Radix. As revealed by the comparison of ancient and modern medication， the medication principles could be roughly classified into two categories： ventilating the lung/descending Qi and resolving phlegm. In ancient medication， the drugs for cough in children were mainly used for warming， tonifying， dissipating cold， excreting water， alleviating edema， and astringing lung and intestines， while in modern medication， the prescriptions were mainly for dispersing wind， clearing heat， tonifying yin， and moistening dampness. ConclusionThis study systematically analyzed the commonly used prescriptions for the treatment of cough in children and provided references for the selection of TCM in clinical practice guidelines.

Chinese thoracic surgery experts consensus on postoperative follow-up plans for esophageal squamous cell carcinoma / 中国胸心血管外科临床杂志

@#Resection is one of the most important treatments for esophageal squamous cell carcinoma, and routine postoperative follow-up is an effective method for early detection and treatment of recurrent metastases, which can improve patients' quality of life and prognosis. This consensus aims to provide a reference for colleagues responsible for postoperative follow-up of esophageal squamous cell carcinoma patients in China, and further improve the standardization of the diagnosis and treatment of esophageal squamous cell carcinoma.

Progress of neonatal respiratory viral infection / 国际儿科学杂志

The common pathogens of neonatal respiratory viruses include respiratory syncytial virus, influenza virus, parainfluenza virus, adenovirus and rhinovirus, among which respiratory syncytial virus is the most common.Neonates infected with respiratory viruses can not only show respiratory symptoms such as cough, nasal obstruction and rhinorrhea, but also lead to multiple organ injury in severe cases.It is one of the causes of neonatal death.In the past, more attention has been paid to the harm caused by bacterial infection in the neonatal period.However, with the constant mutation of previous virus and the emergence of new virus, there are also some reports about the outbreaks of respiratory tract virus infection in neonatal wards.Neonatal immune system is immature.Newborns are susceptible to respiratory virus infection.Therefore, clinicians should pay more attention to the harm caused by respiratory infection in neonatal period.

Clinical characteristics and risk factors of neonatal adrenal hemorrhage / 国际儿科学杂志

Objective:To explore the clinical characteristics and risk factors of neonatal adrenal hemorrhage(NAH), and to improve the understanding, diagnosis and treatment of this disease.Methods:In this study, a retrospective nested case-control study was used to collect clinical data of neonates diagnosed with NAH from January 2011 to December 2021 in the Department of Neonatology, Shengjing Hospital of China Medical University, and telephone follow-up were conducted for them.NAH infants with manifestations of neonatal hyperbilirubinemia were selected as the case group, and the random number table method was used to select the neonatal hyperbilirubinemia infants with NAH excluded by imaging in the same period at a ratio of 1: 2 as the control group.Characteristics of the clinical data of the two groups were compared and analyzed by Logistic regression to explore the risk factors of NAH.Results:During the study period, a total of 31 cases of NAH were diagnosed, with an average gestational age of(37.6±2.2) weeks, including 19 males, 25 full-term infants, 6 cases with macrosomia, 30 cases with natural labor, 29 cases with hyperbilirubinemia, 8 cases with birth injury, 7 cases with asphyxia, 9 cases with bilirubin encephalopathy, 12 cases with sepsis, 13 cases with intracranial hemorrhage, 17 cases with anemia, 9 cases with respiratory disease, 5 cases with hyperkalemia, 6 cases with hyponatremia.The results of NAH ultrasonography showed that 8 cases of hematoma had medium and low echoes, 6 cases of mixed echoes, and 17 cases of liquid flocculent echoes with or without punctate echoes.Color Doppler flow imaging results showed no blood flow signal.There were 26 cases on the right side, 4 cases on the left side, and 1 case on both sides.A total of 26 cases were followed up.Ultrasonography showed that most haematomas were absorbed within 1 to 3 months and disappeared within 6 months.Twenty-nine cases were included in the case group and 58 cases in the control group.Univariate analysis showed that age, birth weight, macrosomia, mode of delivery, bilirubin encephalopathy, neonatal sepsis, abdominal distension, anemia, asphyxia, total bilirubin, indirect bilirubin, Hb and CRP were significantly higher than those in the control group( P<0.05). Multivariate logistic regression analysis showed that macrosomia( OR=7.415, 95% CI=1.342~40.956, P=0.022) and asphyxia( OR=12.075, 95% CI=1.293~112.736, P=0.029) were independent risk factors of NAH. Conclusion:NAH is common in naturally born full-term infants, with a lack of specific clinical manifestations.Unexplained persistent hyperbilirubinemia may be its first symptom, often accompanied by anemia and ion disturbance.A few infants may have adrenal insufficiency.Macrosomia and asphyxia may be the risk factors for the occurrence of NAH.

The expression and effect of nuclear transporter KPNA2 in bronchopulmonary dysplasia neonatal rats / 中国小儿急救医学

Objective:To study the dynamic changes of the localization and expression of nuclear transporter KPNA2 in the occurrence and development of bronchopulmonary dysplasia(BPD) in neonatal rats, and explore its role in the pathogenesis of BPD in premature infants.Methods:The BPD model of newborn SD rats was induced with 85% oxygen concentration( n=50), and the control group was inhaled with air( n=50). The lung tissue samples were collected on 1 d, 3 d, 7 d, 10 d, and 14 d, respectively, in the two groups and separated.Purification and culture of alveolar type Ⅱ epithelial cells.The distribution and expression of KPNA2 were detected by immunohistochemistry, immunofluorescence, western blot and RT-PCR. Results:Immunohistochemistry showed that KPNA2 mainly located in alveolar epithelial cells′ cytoplasm and nucleus, and BPD group was more expressive than control group.Cell immunofluorescence showed that KPNA2 in control group was mainly localized in the nucleus, and in BPD group, KPNA2 was mainly localized in the cytoplasm from 3 d to 14 d. The nuclear expression of KPNA2 was weaker than that in the control group, and the cytoplasmic expression was stronger than that in the control group.The expression trends of KPNA2 total protein, plasma protein and mRNA were basically the same.The BPD group began to increase on the 1st day ( P<0.05), and was still higher than the control group on the 14th day( P<0.05); in BPD group, KPNA2 nucleoprotein expression began to decrease on the 3rd day( P<0.01), continued to decrease to 14 days( P<0.05). Conclusion:The dysfunction of KPNA2 nuclear transport in neonatal rats exposed to hyperoxia may be an important mechanism that affects the early initiation of the DNA damage response of BPD alveolar epithelial cells.

Comparative analysis of magnetic resonance imaging for purulent meningitis in premature and full term infants / 中华实用儿科临床杂志

Objective:To compare the head magnetic resonance imaging (MRI) changes and the distribution of pathogens of purulent meningitis in premature and full term infants.Methods:This retrospective study assessed clinical data in 43 cases of neonatal purulent meningitis with positive blood or cerebrospinal fluid bacterial culture admitted to the Neonatal Ward of Shengjing Hospital of China Medical University from January 2012 to November 2019.According to the gestational age, those patients were divided into the premature infant group and the full term infant group.The general situation, head MRI and pathogen characteristics of both groups were compared.Results:The incidence of premature rupture of fetal membranes in the premature infant group was higher than that in the full term infant group [50.00%(13/26 cases) vs.5.88%(1/17 cases)], the rate of cesarean section in the premature infant group was higher than that in the term infant group [61.54%(16/26 cases) vs.23.53%(4/17 cases)], and there were significant difference between the 2 groups ( χ2=9.011 and 5.969, respectively, all P<0.05). There was no significant difference between 2 groups in age of onset [(9.8±7.0) d vs.(8.9±5.5) d], diagnosis[(13.0±7.1) d vs.(10.2±6.1) d] and examination [(16.1±7.9) d vs.(13.1±6.5) d] (all P>0.05). The top 3 pathogens were Klebsiella pneumonia ( K. pneumoniae) in 14 cases, Escherichia coli ( E. coli) in 11 cases and Streptococcus agalactiae (GBS) in 7 cases. K. pneumoniae was the most common pathogen in premature infants, and GBS was the most common pathogen in term infants.In the first MRI, white matter injury (WMI) was the most common disease (19 cases), the abnormal rate of MRI in the premature infant group was 65.38% (17/26 cases), the incidence of intracranial hemorrhage in the premature infant group was higher than that in the term infant group, the abnormal rate of MRI in the term infant group was 52.94% (9/17 cases), and the incidence of cerebral infarction in the term infant group was higher than that in the premature infant group.The MRI positive rates of meningitis caused by K. pneumoniae, E. coli and GBS were 57.14% (8/14 cases), 72.73% (8/11 cases) and 71.43% (5/7 cases), respectively.Infants with K. pneumoniae infections suffered from the main complications of WMI and intracranial hemorrhage.Infants infected with E. coli were prone to WMI in the early stage and hydrocephalus in the late stage.Infants with GBS were prone to WMI and cerebral infarction in the early stage and cerebromalacia in the late stage. Conclusions:There were some differences in the distribution of pathogenic bacteria and head MRI changes between premature infants and term infants, and head MRI of purulent meningitis caused by different pathogenic bacteria.A thorough understanding of the distribution of pathogens and the characteristics of head MRI in premature and full term infants contributed to the early diagnosis, treatment and prognosis of this disease.

Ureaplasma urealyticum infection and neonatal diseases / 中华实用儿科临床杂志

Ureaplasma urealyticum (UU) is an opportunistic pathogenic microorganism, widely colonized in the reproductive tract of women in childbearing age, and can cause fetal infection through vertical transmission.UU infections in neonates can cause damages to multiple systems, such as pneumonia, bronchopulmonary dysplasia, necroti-zing enterocolitis, intracranial hemorrhage, meningitis, and retinopathy of prematurity.Therefore, it is of important signi-ficance to avoid serious consequences in the neonatal period and improve long-term adverse outcomes by understan-ding the biological characteristics and epidemiological characteristics of UU and the neonatal diseases associated with UU infections, attaching great importance to the early screening and early intervention of UU infections and grasping the optimal treatment opportunity.

Advances in clinical application of glucocorticoid in prevention and treatment of BPD of preterm infants / 国际儿科学杂志

Bronchopulmonary dysplasia is a chronic lung disease unique to premature infants, which has a great impact on the survival and long-term quality of life of preterm infants.At present, there are no specific prevention and treatment methods for BPD.The clinical treatment is mainly comprehensive.Glucocorticoids are the most widely used in clinical practice.The drugs mainly include dexamethasone, hydrocortisone and budenonide.The route of administration includes intravenous administration, aerosol inhalation, intratracheal infusion combined with pulmonary surfactants, but its efficacy and possible adverse reactions need to be weighed.This article reviews the different results by different administration routes and dose of glucocorticoids.

The usage of intravenous immunoglobulin in neonatal infection / 中国小儿急救医学

Intravenous immunoglobulin(IVIG) contains multiple-antigen-specific IgGs and may protect the host from a wide spectrum of pathogens including but not limited to virus and bacteria.With a low IgG level, neonates, especially preterm infants are prone to infection.IVIG can rapidly increase the concentration of serum IgG level, and enhance the anti-infectious and immune-regulatory functions.It has been widely used as a common treatment against neonatal infections.However, there has been inadequate evidence to support the routine usage of IVIG.While prolonged IVIG usage may be beneficial to the extremely or very low birth weight with sepsis, the prophylactic usage of IVIG to decrease the risk of late-onset sepsis in preterm infants depends on the situation of nosocomial infections in different NICUs and the cost-effect efficiency.

Metabolic bone disease of prematurity: diagnosis and management / 中国小儿急救医学

Metabolic bone disease(MBD) in preterm infant is a disorder of calcium and phosphorus metabolism that leads to a decrease in bone mineral content, resulting in clinical, biochemical, and imaging changes.It occurs mostly in very low birth weight and extremely low birth weight newborns.The clinical symptoms usually occur from 6 to 12 weeks after birth, mainly manifested as dyspnea accompanied by mechanical ventilation for a long time, rickety-like changes, and even fracture in severe cases.At present, diagnosis of MBD is characterized by biochemical markers, radiology and ultrasound.As the clinical manifestations of MBD in prematurity occur late, early screening and prevention for high-risk groups play an important role to reduce the risk of MBD.

Respiratory tract microecology and bronchopulmonary dysplasia of preterm infants / 国际儿科学杂志

Bronchopulmonary dysplasia(BPD)is a serious complication of respiratory system in preterm infants.The etiology and pathogenesis are complex and have not been clarified yet.In recent years, studies have shown that there is a certain relationship between respiratory microecology and BPD.Before premature infants develop BPD, their respiratory tract microecology has changed, including abnormal microbial diversity and evolution pattern.Therefore, research on the colonization and evolution of neonatal respiratory tract microecology and its relationship with BPD is expected to provide new ideas for its prevention and treatment.