ABSTRACT
Objective:To study the clinical characteristics of neonatal leukemoid reaction (NLR).Methods:The newborns with NLR admitted to the neonatal intensive care unit of the Seventh Medical Center of PLA General Hospital from September 2010 to January 2022 were selected as the observation group, and the newborns without NLR, who were admitted to the Hospital at the same time and matched with gestational age and birth weight of the NLR newborns were selected as the control group at a ratio of 1∶2. The gestational age, birth weight, maternal complications, maximum leukocyte count, percentage of neutrophils, C-reactive protein, hemoglobin, platelet count, disease diagnosis and other relevant information of the newborns were recorded, and SPSS 21.0 statistical software was applied to compare the data of the two groups of newborns.Results:A total of 36 cases were in the observation group and 72 cases in the control group. Naive granulocytes were found in the peripheral blood of all patients in the observation group, and leukocyte count was higher than that of the control group [61.7 (54.2, 90.6)×10 9/L vs. 19.6 (14.2,27.3)×10 9/L], the difference was statistically significant ( P<0.001), but there was no statistically significant difference in the percentage of neutrophils, hemoglobin, platelets, and C-reactive protein between the two groups ( P>0.05). The proportion of vaginal delivery, meconium-stained amniotic fluid, and neonatal sepsis in the observation group were higher than that in the control group [69.4% (25/36) vs. 38.9% (28/72), 19.4% (7/36) vs. 5.6% (4/72), 47.2% (17/36) vs. 8.3% (6/72)], and the proportion of gestational diabetes mellitus, gestational hypertension and prenatal use of glucocorticoid was lower than that in the control group, with statistical significance ( P<0.05). There was no significant difference in the incidence of premature rupture of membranes, neonatal asphyxia, intracranial hemorrhage, pulmonary hemorrhage, bacterial meningitis, and bronchopulmonary dysplasia between the two groups ( P>0.05). Conclusions:Newborns with NLR are frequently complicated with sepsis. Early prevention and treatment of maternal comorbidities and active control of infection are important for the prevention and treatment of NLR.
ABSTRACT
As a new group of stem cells found in the human breast in the 21st century, stem cells in human breast milk have the potential to differentiate into ectoderm, mesoderm, and endoderm cells.It is not only rich in sources, but also can be obtained in a non-invasive way.At present, there are relatively few ethical disputes.First, as a potential source of stem cells, it has a great prospect in the field of alternative medicine and regenerative medicine.Second, it can promote newborns early growth and development, repair the damaged tissues, and prevent as well as treat some early diseases.This review summarized stem cells from human breast milk, from aspects of distribution, acquisition, and functional characteristics, and discussed their application in newborns.
ABSTRACT
Objective:To analyze the clinical and gene mutation characteristics of congenital disorder of glycosylation (CDG) caused by compound heterozygous mutation of the COG6 gene ( COG6-CDG). Methods:This study retrospectively analyzed the clinical data and genetic test results of a patient with COG6-CDG in Bayi Children's Hospital, the Seventh Affiliated Medical Center of Chinese PLA General Hospital, in August 2019. Literature was retrieved with keywords including COG6, COG6-CDG, congenital disorders of glycosylation typeⅡL and congenital disorders of glycosylationⅡL in China National Knowledge Infrastructure, Wanfang Database, VIP Database, PubMed, and Web of Science Database from the establishment to July 2020, to summarize the clinical and genetic characteristics of COG6-CDG. Results:(1) Case report: The 59-day-old baby boy, with a gestational age of 27 +5 weeks and birth weight of 1 180 g, presented with multi-system involvement on admission, including unidentified progressive hepatosplenomegaly with jaundice and ascites, persistent thrombocytopenia, microcephaly, hypotonia, hypohidrosis, hyperkeratosis, and recurrent hyperthermia, infection, and hypoglycemia, as well as dysfunctions of the heart, gastrointestinal tract, lungs, kidneys, ocular fundus, and the coagulation system. Despite given ventilator-assisted ventilation, anti-infection therapy, abdominal puncture and drainage, and blood transfusion, the patient still had an aggravated condition and eventually died of multiple organ failures 192 d after birth. Genetic analysis showed that the nuclear family carried compound heterozygous mutations in the COG6 gene (NM_020751.2), including missense mutations of c.662C>T(p.T221M) in exon 7 and c.443T>C(p.I148T) in exon 5, which were both novel mutations and originated from the mother and father, respectively. (2) Literature review: Eight related papers were retrieved, including 20 cases. The main manifestations were various degrees of nervous system abnormalities and growth retardation, complicated by abnormalities of the liver, heart, gastrointestinal tract, blood, immunity, teeth, and bones. All the reported cases suffered from mental and growth retardation, and nine deaths were reported. A total of 11 COG6 gene mutations were identified, and most of them were c.1167-24A>G splicing mutations in a deep intron (seven cases), followed by c.1646G>T (four cases) and c.511C>T (three cases). Conclusions:COG6-CDG commonly manifests as multi-system and multi-organ dysfunctions with poor prognosis. Gene detection is conducive to the accurate diagnosis of COG6-CDG. Our case carries compound heterozygous mutations of c.662C>T(p.T221M) and c.443T>C(p.I148T), which are unreported novel mutations.
ABSTRACT
Objective@#To study the threshold values of lactic acid (Lac)and buffuer excess (BE) when neonatal umbilical arterial blood gas is at pH <7.20.@*Methods@#A total of 2 518 pregnant women admitted in Beijing New Century Women and Children′s Hospital from January 2017 to February 2019 were enrolled.The general conditions in perinatal period and labor methods were counted.Umbilical cord arterial blood was immediately collected before the first cry of newborn and was detected on the Abbott I-STAT automatic blood gas analyzer from the United States, and then the umbilical arterial blood gas was measured.We analyzed the perinatal factors affecting umbilical arterial blood gas.We studied the threshold values of Lac and BE for neonal asphyxia by receiver operating characteristic curve.@*Results@#(1)Maternal anemia, Streptococcus agalactiae infection, precipitate labour, placenta abnormalities had no significant impact on neonatal umbilical artery blood gas.The Lac value in blood gas was higher in the group of premature rupture of fetal membranes and fetal intrauterine distress.The value of BE was lower in the group with premature rupture of fetal membranes and fetal distress (P<0.05). The Lac value in cesarean section group was the lowest[(1.79±1.25) mmol/L], while that in midwifery group was the highest[(4.45±1.58) mmol/L]. pH value was the lowest (7.25±0.07) in the midwifery group and the highest (7.31±0.06) in the cesarean section group.The value of BE was the lowest in the midwifery group[-(5.66±2.52) mmol/L], and the highest in the cesarean section group[-(2.99±2.28) mmol/L], with statistically significant differences among the three groups (P<0.05). (2) Multiple linear regression analysis showed that fetal delivery mode, fetal intrauterine distress, premature rupture of membranes, and gestational diabetes were the factors affecting Lac level in umbilical artery blood gas of newborns.Methods of delivery, intrauterine distress, premature rupture of membranes and placental abnormalities were the factors that affected the BE value of umbilical artery blood gas in newborns.(3) A total of 199 cases with pH value <7.2 were diagnosed as asphyxia, and the receiver operating characteristic curve of Lac and BE values of neonatal umbilical artery blood gas for the diagnosis of asphyxia was drawn.When Lac was >3.97 mmol/L, the sensitivity and specificity of the diagnosis of asphyxia were 0.864 and 0.791, respectively.When BE was ≤-6 mmol/L, the diagnostic sensitivity and specificity of asphyxia were 0.613 and 0.756, respectively.@*Conclusion@#Neonatal umbilical arterial blood gas is affected by many factors.The effect of accouche on umbilical arterial blood gas is large.When there is asphyxia with pH <7.2, the cut points of Lac and BE are >3.97 mmol/L and ≤-6 mmol/L, respectively.
ABSTRACT
Objective To study the threshold values of lactic acid ( Lac) and buffuer excess ( BE) when neonatal umbilical arterial blood gas is at pH <7. 20. Methods A total of 2 518 pregnant women admitted in Beijing New Century Women and Children′s Hospital from January 2017 to February 2019 were enrolled. The general conditions in perinatal period and labor methods were counted. Umbilical cord arterial blood was immediately collected before the first cry of newborn and was detected on the Abbott I-STAT auto-matic blood gas analyzer from the United States,and then the umbilical arterial blood gas was measured. We analyzed the perinatal factors affecting umbilical arterial blood gas. We studied the threshold values of Lac and BE for neonal asphyxia by receiver operating characteristic curve. Results (1)Maternal anemia,Strep-tococcus agalactiae infection,precipitate labour,placenta abnormalities had no significant impact on neonatal umbilical artery blood gas. The Lac value in blood gas was higher in the group of premature rupture of fetal membranes and fetal intrauterine distress. The value of BE was lower in the group with premature rupture of fetal membranes and fetal distress ( P <0. 05 ). The Lac value in cesarean section group was the lowest [(1. 79 ± 1. 25) mmol/L],while that in midwifery group was the highest[(4. 45 ± 1. 58) mmol/L]. pH value was the lowest (7. 25 ± 0. 07) in the midwifery group and the highest (7. 31 ± 0. 06) in the cesarean section group. The value of BE was the lowest in the midwifery group[ －(5. 66 ± 2. 52) mmol/L],and the highest in the cesarean section group[ －(2. 99 ± 2. 28) mmol/L],with statistically significant differences among the three groups (P<0. 05). (2) Multiple linear regression analysis showed that fetal delivery mode, fetal intrauterine distress,premature rupture of membranes,and gestational diabetes were the factors affecting Lac level in umbilical artery blood gas of newborns. Methods of delivery,intrauterine distress,premature rup-ture of membranes and placental abnormalities were the factors that affected the BE value of umbilical artery blood gas in newborns. (3) A total of 199 cases with pH value <7. 2 were diagnosed as asphyxia,and the receiver operating characteristic curve of Lac and BE values of neonatal umbilical artery blood gas for the diagnosis of asphyxia was drawn. When Lac was >3. 97 mmol/L,the sensitivity and specificity of the diag-nosis of asphyxia were 0. 864 and 0. 791,respectively. When BE was≤－6 mmol/L,the diagnostic sensitivi-ty and specificity of asphyxia were 0. 613 and 0. 756,respectively. Conclusion Neonatal umbilical arterial blood gas is affected by many factors. The effect of accouche on umbilical arterial blood gas is large. When there is asphyxia with pH <7. 2,the cut points of Lac and BE are >3. 97 mmol/L and ≤ －6 mmol/L, respectively.
ABSTRACT
Objective To study the role of partial pressure of oxygen in the treatment of pulmonary hypertension induced by meconium aspiration syndrome. Methods Retrospective analysis was performed on 58 patients with meconium aspirate and pulmonary hypertension from January 1,2007 to December 31,2016, 28 patients in the death group,and 30 patients in the survival group. Blood gas analysis about two groups of children with mechanical ventilation were collected at four different time points:before mechanical ventilation ( 0 h) ,12 hours after mechanical ventilation,24 hours after mechanical ventilation and 72 hours after mechan-ical ventilation. The 80 mmHg(1 mmHg=0. 133 kPa) in blood gas analysis of the partial pressure of oxygen was used as the boundary point to study the effects about different blood oxygen partial pressures on the length of mechanical ventilation time in the survival group. Results Blood gas analysis showed that there were no significant differences in pH,partial pressure of oxygen,HCO3-,and lactic acid before mechanical ventilation in the two groups,but the pH values were significantly higher in the survival group after 12 h, 24 h,and 72 h of mechanical ventilation(t values:-2. 07,-3. 48,-7. 11;P <0. 05). Partial pressure of oxygen were higher in the surviving group at 12 h,24 h,and 72 h than those in the death group(t values-2. 87,-4. 88,-11. 29; P<0. 05). The HCO3-values of the survival group at 12 h,24 h and 72 h were higher than the death group, and the differences were statistically significant ( t values: -3. 90, -5. 60,-5. 76,P<0. 001). The lactic acid of survival group was significantly lower than the death group at 72 h after ventilation (t=5. 12,P<0. 001). Compared with the death group,partial pressure of carbon dioxide in 24 h,72 h decreased significantly in the surviving group(t values:5. 67,7. 60;P<0. 05). In the surviving group,the partial pressure of oxygen was maintained above 80 mmHg in 18 patients and the mechanical venti-lation time was (7. 17 ± 1. 95) d. The partial pressure of oxygen was below 80 mmHg in 12 patients of the surviving group and the mechanical ventilation time was (8. 67 ± 2. 50)d. The difference was statistically sig-nificant(t =12. 02,P <0. 001). Conclusion In the treatment of newborn with pulmonary hypertension caused by meconium aspiration,maintaining a higher pH value and a partial pressure of oxygen higher than 80 mmHg may be beneficial to the recovery of children with pulmonary hypertension.
ABSTRACT
Objective To study the changes and significance of inflammatory cytokines and pulmonary surface protein (SP) level in respiratory failure of full-term infants.Method Prospectively selected 30 cases of term baby with respiratory failure requiring mechanical ventilation and pulmonary surfactant (PS) treatment in BaYi Children's Hospital from May 2016 to January 2017 as case group,while 30 cases of term baby with transient tachypnea or hypoglycemia were control group.Blood samples were collected at the first and third day of hospitalization.The interleukin-6 (IL-6),IL-10,and tumor necrosis factor-α (TNF-α) were detected by flow cytometry,serum SPs were detected by enzyme-linked immunosorbent assay method.The statistical analyses were conducted by SPSS 22.0 software.Result The levels of IL-6,IL-10,SP-A,SP-B and SP-C in the case group were significantly higher than those in the control group [IL-6:172.4 (58.4,668.4) ng/L vs.8.3 (5.7,11.2) ng/L,IL-10:10.2 (5.9,31.5) ng/L vs.4.7 (3.6,7.1) ng/L,SP-A:6.94 (2.37,29.64) μg/L vs.0.56 (0.50,0.64) μg/L,SP-B:4.36 (1.99,5.25)μg/L vs.1.44 (1.25,1.79) μg/L,SP-C:0.87 (0.19,2.66) μg/L vs.0.14 (0.10,0.16) μg/L,P ＜0.05].After exogenous PS treatment,serum SP-A,SP-B,SP-C,IL-6 and IL-10 levels in the surviving group were significantly lower comparing with the first day (P ＜ 0.05).The IL-6,SP-A and SP-C levels in the first day death group were significantly higher than those in survival group(P ＜ 0.05).Conclusion Inrespiratory failure of full-term infants,serum IL-6 levels are consistent with the SP-A and SP-C levels,and a sustained increase may serve as a potential early biomarker for disease progression.
ABSTRACT
Objective To investigate the risk factors affecting the prognosis of preterm infants with septic shock. Methods A retrospective study was conducted to analyze the clinical data of 114 preterm children with septic shock admitted to the Neonatal Intensive Care Unit (NICU) of the PLA Army General Hospital from February 2014 to January 2017. According to the outcomes, these cases were divided into two groups, the cured group and the death group (including those died after ineffective treatment and withdrawal of treatment). Clinical data including the general clinical data, perinatal risk factors, clinical features and prognosis of the two groups of children, as well as the occurrence of related complications were statistically analyzed by t-test, Wilcoxon nonparametric test, Chi-square test or Fisher's exact probability method. Logistic regression was used to analyze the factors influencing the prognosis. Predictive values of the indicators were evaluated using receiver operating characteristic (ROC) curve. Results (1) Among the 114 patients, 87(76.3%) were cured and 27(23.7%) were dead. (2) In the death group, there were more infants complicated with amniotic fluid pollution, anemia and thrombocytopenia (platelet count <100×109/L) and the C-reactive protein (CRP) levels were higher than those in the cured group [29.6% (8/27) vs 8.1% (7/87), χ2=6.618; 22.2% (6/27) vs 5.9% (5/87), χ2=4.665; 59.3% (16/27) vs 23.3% (20/87), χ2=12.546; 36.0 (1.0-80.0) mg/L vs 7.5 (1.0-25.0) mg/L, Z=2.400], while the hemoglobin level was lower [(122.2±43.3) g/L vs (140.5±34.4) g/L, t=2.260] (all P<0.05). (3) The percentages of infants with patent ductus arteriosus, pulmonary hemorrhage and coagulopathy in the death group were higher than those in the cured group [81.5% (22/27) vs 60.9% (53/87), χ2=3.871; 37.0% (10/27) vs 12.6% (11/87), χ2=6.616;48.2% (13/27) vs 20.7% (18/87), χ2=7.847; all P<0.05]. (4) Multivariate logistic regression analysis showed that amniotic fluid contamination, coagulopathy, patent ductus arteriosus and CRP level were risk factors for poor prognosis in neonates (all P<0.05). (5) A total of 77 pathogens were isolated from the 114 infants with 66 in the cured group and 11 in the death group. Pathogens of Gram-positive and Gram-negative bacteria and fungi in the cured and death groups accounted for 37.9% (25/66) vs 3/11, 37.9% (25/66) vs 6/11, and 24.2% (16/66) vs 2/11, respectively. No significant difference in pathogen distribution was observed between the two groups. (6) The area under the ROC curve of CRP was 0.649 (P=0.024). When the cut-off value of CRP was set at 31 mg/L, the sensitivity and specificity for predicting adverse outcomes in preterm infants with septic shock were 0.802 and 0.556, respectively, and the Yoden index was 0.358. The area under the ROC curve of thrombocytopenia was 0.708 (P<0.001). When the platelet level was set at 94×109/L, its sensitivity and specificity were 0.767 and 0.593, respectively, and the Yoden index was 0.360. Conclusions Amniotic fluid contamination, patent ductus arteriosus, coagulopathy and elevated CRP are important risk factors for death in preterm infants with septic shock. Thrombocytopenia and persistently elevated CRP has predictive values for the prognosis of preterm infants with sepsis shock.
ABSTRACT
ObjectiveTo analyze the clinical characteristics of inflammatory bowel disease (IBD) in neonates.MethodsFrom July 2010 to July 2015, seven neonates were diagnosed with IBD in Affiliated BaYi Children's Hospital, Clinical Medical College in Chinese People's Liberation Army General Hospital, Southern Medical University. The data regarding these neonatal cases were analyzed and compared with 45 children with IBD from literature. Thet-test andChi-square test were used for statistical analysis of the data.ResultsSix cases had ulcerative colitis, and one case had Crohn's disease, both occurred 2-20 days after birth, and were characterized by diarrhea, no increase in body weight, anemia and intermittent higher hypersensitive C-reactive protein. Compared with IBD in children, abdominal pain and abdominal mass were rarer, while anemia was more common in neonatal IBD. All fecal cultures and blood cultures in the seven cases of neonatal IBD were negative. Abdominal X-ray revealed intestinal wall thickening in four cases. Multiple ulcers were observed from the cecum to the rectum by colonoscopy. Chronic intestinal mucosal inflammation associated with acute inflammation were found on pathological examination. Six infants received treatment with 5-aminosalicylic acid (combined with glucocorticoid in four cases), and one received glucocorticoid treatment only. One infant was started on infliximab treatment from two years old. One of these seven cases died one month after discharge due to refusal to continue treatment, and the disease was controlled in the other six cases. After treatment, one infant was lost to follow-up six months after discharge, two were cured at six and 12 months old without further treatment, and three improved and continued treatment.ConclusionsIn neonates with diarrhea, anemia and no increase in body weight, especially when antibiotic treatment is ineffective, colonoscopy should be performed to facilitate early diagnosis of IBD. Standard treatments result in good outcomes.
ABSTRACT
Fetal inflammatory response syndrome is a sub-clinical state that cause fetal immune sys-tem could be activated and released large amounts of proinflammatory cytokines.Either caused by infection of factors such as chorioamnionitis,fetal sepsis or non-infectious factors such as asphyxia,chronic lack of oxy-gen,which are likely to cause neurological damage in preterm or full-term children .This article reviewed the progress on the mechanism of neonatal encephalopathy caused by fetal inflammatory response syndrome.
ABSTRACT
Procalcitonin (PCT) has been recognized a marker of infectious diseases for the past few years.The value of PCT is specific elevation in infectious diseases or inflammation caused by bacterial and it has an important role in the identification of bloodstream infections,bacterial and non-bacterial,rational usage of antibiotics and prediction disease prognosis.PCT is a high value diagnostic indicators.However,the PCT do not reflect a clear advantage in the diagnosis of neonatal infection.In this paper,the composition of the PCT,the source in the body of PCT,the metabolism of PCT,laboratory testing methods of PCT and its applications in neonatal infection were reviewed in order to gain a deeper understanding of the value of PCT in the neonatal diagnosis of infectious diseases.
ABSTRACT
The fetal inflammatory response syndrome (FIRS) is a state of activation of the innate immune system in the fetus body and is a kind of neonatal inflammation for 72 hours after birth.It is defined as the following items ＞ 2:(1) breathing too fast (＞ 60 times/min),accompanied by breathing difficulties or with oxygen desaturation; (2) temperature instability ＞ 37.9 ℃ or ＜ 36 ℃ ; (3) capillary filling time ＞ 3 s;(4) the white blood cell count ＞34 × 109/L,or ＜4 × 109/L; (5) CRP ＞ 10 mg/L; (6) IL-6 or IL-8 ＞70 g/ml;(7) gene testing of 16S rRNA for PCR is positive.FIRS can be induced by infectious and non-infectious factors.In FIRS,fetal immune system is over-activated to the external violation,which causes uncontrolled release of inflammatory mediators and cytokines.A variety of inflammatory mediators and cytokines directly or indirectly activate the coagulation system and interfere with the body's anticoagulation system,which induces the coagulation disorders.Multiple organ systems involved in the inflammatory response throughout this process.FIRS can lead to premature delivery,perinatal death,cerebral white matter damage,necrotizing enterocolitis,and affect fetal lung maturity and multi-organ damage.In order to reduce fetal injury,it is necessary for appropriate treatment and prediction of the FIRS.
ABSTRACT
Objective To analyze the clinical characteristics of Klebsiella pneumoniae infection in preterm infants. Methods Clinical data of 75 preterm infants infected with Klebsiella pneumoniae treated in BaYi Children's Hospital from February 6,2008 to February 10,2010 were retrospectively analyzed.The difference of auxiliary examination between early-onset and late-onset infection group were compared by two independent samples t test.Spearman correlation analysis and non-conditional Logistic regression analysis were used to analyze the high risk factors and the prognostic factors of Klebsiella pneumoniae infection in preterm infants. Results The incidence of Klebsiella pneumoniae infection was 2.8％ (75/2721) in preterm infants,and the mortality rate was 9.3％ (7/75). There were 71 cases of Klebsiella pneumoniae sepsis and 4 cases of Klebsiella pneumoniae pneumonia.Among 75 cases,63 cases were early-onset infection (onset age≤72 h) and 12 were late-onset infection (onset age＞72 h).All patients presented with poor response,heart rate during quiet sleep ＞ 160/min and low oxygen saturation.The mean corpuscular volume and mean corpuscular hemoglobin concentration in early-onset Klebsiella pneunoniae infection cases were higher than those in late-onset neonates [(128.87±24.60) fl vs (113.72±13.54) fl,t=-2.07,P＜0.05and (38.11±2.15) pg vs (36.98±1.05) pg,t=-2.76,P＜0.05].Low birth weight and caesarean section were associated with early-onset Klebsiella pneumoniae sepsis (r=0.250 and -0.240,P＜0.05). The prognosis of Klebsiella pneumoniae infection was associated with hospital stay and duration of premature rupture of membranes (r=0.368 and 0.318,P＜0.05). Conclusions There were no specific clinical manifestations for Klebsiella pneumoniae infection in preterm infants.Preterm infants with low birth weight,long duration of premature rupture of membranes,delivered by caesarean section and received invasive operation are likely to develop Klebsiella pneumoniae infection.
ABSTRACT
Neonatal jaundice is one of the common diseases in preterm neonates. But there are still some problems to be determined,for example,the clinical diagnosis criteria for neonatal jaundice,the prediction,diagnosis and therapies for hyperbilirubinemia,and diagnosis for bilirubin encephalopathy in early-stage and prevention from bilirubin encephalopathy sequelae.
ABSTRACT
The key mechanism of hypoxic-ischemic encephalopathy(HIE) is two-times energy exhaustion.Recently, electrophysiology, cell physiology and imageology are performed to figure out some new biomarkers for clinical diagnosis and prognosis. And now, there are different therapies for HIE. For Sub-low temperature therapy,selecting appropriate time of therapy window is more important, and the therapeutic effects of other therapies,hyperbaric oxygenation, neuroprotectants, neural stem cell transplantation etc, need to be validated clinically.