Establishment and validation of a nomograph model for prediction of bronchopulmonary dysplasia in very low birth weight infants born earlier than 32 weeks / 中华围产医学杂志

Objective:To investigate the risk factors of bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants with gestational age ≤32 weeks within 28 days after birth and to establish and validate the nomogram model for BPD prediction.Methods:We retrospectively chose VLBW infants with gestational age ≤32 weeks who survived to postmenstrual age (PMA) 36 weeks and were admitted to the neonatal intensive care unit of Peking University Third Hospital from January 2016 to April 2020 as the training cohort. BPD was diagnosed in accordance with the 2018 criteria. The clinical data of these infants were collected, and the risk factors of BPD were analyzed by Chi-square test, Mann-Whitney U test, and multivariate logistic regression, and a nomogram model was established. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to assess the predictive performance. Decision curve analysis (DCA) was constructed for differentiation evaluation, and the calibration chart and Hosmer-Lemeshow goodness of fit test were used for the calibration evaluation. Bootstrap was used for internal validation. VLBW infants with gestational age ≤32 weeks survived to PMA 36 weeks and admitted to Hebei Chengde Maternal and Child Health Hospital from October 2017 to February 2022 were included as the validation cohort. ROC curve and calibration plot were conducted in the validation cohort for external validation. Results:Of the 467 premature infants included in the training cohort, 104 were in the BPD group; of the 101 patients in the external validation cohort, 16 were in the BPD group. Multivariate logistic regression analysis showed that low birth weight ( OR=0.03, 95% CI: 0.01-0.13), nosocomial pneumonia ( OR=2.40, 95% CI: 1.41-4.09), late-onset sepsis ( OR=2.18, 95% CI: 1.18-4.02), and prolonged duration of endotracheal intubation ( OR=1.61, 95% CI: 1.26-2.04) were risk factors for BPD in these groups of infants (all P<0.05). According to the multivariate logistic regression analysis results, a nomogram model for predicting BPD risk was established. The AUC of the training cohort was 0.827 (95% CI: 0.783-0.872), and the ideal cut-off value for predicted probability was 0.206, with a sensitivity of 0.788 (95% CI: 0.697-0.862) and specificity of 0.744 (95% CI: 0.696-0.788). The AUC of the validation cohort was 0.951 (95% CI:0.904-0.999). Taking the prediction probability of 0.206 as the high-risk threshold, the sensitivity and specificity corresponding to this value were 0.812 (95% CI: 0.537-0.950) and 0.882 (95% CI: 0.790-0.939). The Hosmer-Lemeshow goodness-of-fit test in the training and validation cohort showed a good fit ( P>0.05). DCA results showed a high net benefit of clinical intervention in very preterm infants when the threshold probability was 5%~80% for the training cohort. Conclusion:Low birth weight, nosocomial pneumonia, late-onset sepsis, and prolonged tracheal intubation duration are risk factors for BPD. The established nomogram model has a certain value in predicting the risk of BPD in VLBW less than 32 weeks.

Risk factors of bronchopulmonary dysplasia in very preterm infants: a national multicenter study / 中国小儿急救医学

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

Advances in point-of-care ultrasound in neonatal intensive care unit / 中华围产医学杂志

Consensus and guidelines regarding point-of-care ultrasound (POCUS) carried out by neonatologists in neonatal intensive care unit (NICU) have been published in many countries. This review summarizes the development, advantages, limitations, and current issues of POCUS in NICU, aiming to promote the establishment of systematic training courses, accelerate the development of POCUS in NICU in China, and ensure the effectiveness and safety of POCUS implementation.

Analysis of the influencing factors and the adverse effect of gestational weight gain maternal and infant health in Beijing / 中华健康管理学杂志

Objective:To determine the gestational weight gain and its risk factors and adverse effects among pregnant women in Beijing.Methods:Between June 2018 and June 2019, all registered infants and their mothers in a child care center of a third-tier-class hospital in Beijing were selected. A self-made questionnaire was used to collect the basic information of the maternal mothers. Chi-square test and analysis of variance were used to describe the basic characteristics of the study subjects and clarify the harmful effect of gestational weight gain for maternal and infant health. Multiple logistic regression analysis was used to analyze the risk factors of both insufficient and excessive weight gain during pregnancy.Results:A total of 3732 maternal mothers and their babies were included. The average weight gain of maternal mothers during pregnancy was 13.0 kg. The results of this study showed that the proportion of insufficient weight gain during pregnancy was 31.8% and the proportion of excessive weight gain was 24.1%. It was further found that young age, pre-pregnancy body mass index indicating overweight and obesity, primipara, and low education were independent risk factors for excessive weight gain during pregnancy. The risk of excessive weight gain of pre-pregnancy overweight and obesity was 2.40 times ( OR=2.40, 95% CI=1.91-3.03, P<0.001) and 2.90 times higher, respectively, ( OR=2.90, 95% CI=1.59-5.27, P<0.001) when compared with that of pre-pregnancy normal weight. In addition, our results suggested that excessive weight gain significantly increased the risk of macrosomia for the infant and the risk of cesarean section, gestational hypertension, and postpartum weight retention for maternal mothers. Conclusions:Age, pre-pregnancy BMI, primipara, and education level were the influencing factors for gestational weight gain. Considering the serious harmful effects of both insufficient and excessive weight gain for maternal and infant health, weight management during pregnancy should be strengthened for these high-risk populations in the future.

Breast milk acquired cytomegalovirus infections in premature infants: doubts and challenges / 中国小儿急救医学

Breast feeding is the optimal food for all babies. Human milk can promote the immune system and other immature organs of premature infants, and improve the development and long term outcomes. However, breast milk may carry pathogenic microorganisms especially cytomegalovirus, which can be infected through breast feeding. Infected preterm infants could appear a series of clinical symptoms and may developed a series of adversely long-term prognosis. This paper discussed the research progress about preterm infants acquired the cytomegalovirus by breast feeding after birth and focused on the existing clinical prevention treatment strategies.

Discussion on the 2019 Novel Coronavirus susceptible mechanism in children / 国际儿科学杂志

Although children are susceptible to infectious diseases, the cases of children infected with 2019 Novel Coronavirus(2019-nCoV)is relatively low, and the proportion of severe illnesses is even lower.The reason is that the 2019-nCoV cell receptor has low binding capacity in children or the induced intracellular response is low, children’s immune system is immature, lymphocyte depletion and inflammatory factor storms are rare in children, and China′s strict prevention and control measures have kept children away from 2019-nCoV.

Analysis of the understanding and application of the knowledge of premature infants in pediatricians participating in the Second Chinese Preterm Infant Academic Conference / 中国基层医药

Objective:To investigate the understanding and application of the knowledge of premature infants in pediatricians participating in the Second Chinese Preterm Infant Academic Conference through questionnaires, and to carry out targeted continuing education for pediatricians in order to better guide the clinical diagnosis and treatment of grassroots pediatricians.Methods:The research was conducted in the form of a questionnaire survey.The survey objects were pediatricians participating in the " Second Chinese Preterm Infant Academic Conference" , and the results of the questionnaire were summarized and analyzed.The questionnaires were designed based on personal education background, employment time, current status of neonatal specialty in the hospital where they were, and knowledge of premature infant nutrition.Results:A total of 554 valid questionnaires were received.Among the pediatricians surveyed, 37.2% had a master's degree or higher; 344(62.1%) pediatricians came from Grade Ⅲ class A hospitals.According to the geographical distribution, age, education, working years, hospital level, hospital nature, annual delivery of obstetrics in hospitals, the number of beds in neonatal specialty wards, and the number of beds in NICU, the respondents were grouped, and the current status of premature births in China and the situation of using the growth curve(Fenton2013) of premature infants in work were compared.It was found that the proportion of those who used the Fenton curve of the 2013 version in Grade Ⅲ class A hospitals was higher than that in Grade Ⅲ class B hospitals and Grade Ⅱ hospitals(χ 2=47.663, P<0.05). The ratio was higher among women and children's health centers and general hospitals(χ 2=8.072, P<0.05). Conclusion:The academic annual conference for the purpose of continuing education, set up a pre-conference questionnaire for the participants during the preparation period, and set the content of the annual conference according to the needs of the target population, which can better solve the clinical problems of primary doctors and promote the improvement of primary doctors' diagnosis and treatment.

A multicenter survey of short-term respiratory morbidity in late-preterm infants in Beijing / 中华实用儿科临床杂志

Objective:To study the respiratory morbidity and the risk factors of respiratory complications in late-preterm infants.Methods:The data of 959 late-preterm infants in 21 hospitals in Beijing from October 2015 to April 2016 were collected.These infants were divided into the respiratory morbidity group (237 cases) and the control group (722 cases) according to whether they had short-term respiratory morbidity after birth.Clinical data of the two groups were compared.Results:Among the 959 late-preterm babies, 530 were male and 429 were female.Two hundred and thirty-seven cases (24.7%) developed short-term respiratory morbidity after birth.Infectious pneumonia developed in the most cases (81 cases, 8.4%), followed by transient tachypnea (65 cases, 6.8%), amniotic fluid aspiration (51 cases, 5.3%), and respiratory distress syndrome (24 cases, 2.5%) successively.All the infants recovered and discharged.There were no differences between gender and maternal age between 2 groups (all P>0.05). Compared with the control group, more late-preterm infants were delivered by cesarean section (73.4% vs.59.7%, χ2=14.43, P<0.001) and the 1-minute Apgar score was lower [(9.41±1.66) scores vs.(9.83±0.53) scores, t=5.40, P<0.001] in the respiratory morbidity group.The differences were statistically significant.There were more cases with maternal complications in the respiratory morbidity group that in the control group (66.7% vs.58.6%, χ2=4.877, P=0.027), but no difference in various complications between 2 groups was observed ( P>0.05). In the respiratory morbidity group, the most frequent complications were maternal hypertension and preeclampsia (27.8% vs.22.6%, χ2=2.728, P=0.099). There were no differences between 2 groups in gestational age, birth weight and birth length (all P>0.05). There were more infants small for gestational age and large for gestational age in the respiratory morbidity group than in the control group (18.8% vs.14.1%, 6.3% vs.2.4%, χ2=8.960, P=0.011). The duration of hospitalization of the respiratory morbidity group was significantly longer than that of the control group [(9.00±4.42) d vs.(6.82±4.19) d, t=6.676, P<0.001] since the infants with respiratory morbidity needed to be hospita-lized. Conclusions:Respiratory diseases occur in about 1/4 of late-preterm infants.Infants who are delivered by cesarean section and whose mothers are complicated with the maternal hypertension and preeclampsia should be monitored closely.Respiratory support should be provided for infants not appropriate for gestational age who are more likely to suffer from respiratory diseases, so that they can successfully pass through the transition period.

Clinical analysis of periventricular venous cerebral infarction in 16 premature infants / 中华围产医学杂志

Objective:To summarize the clinical features and risk factors of periventricular venous cerebral infarction (PVI) in premature infants to prompt an early diagnosis.Methods:Clinical data of 16 premature newborns diagnosed with PVI by ultrasound in the Department of Pediatrics of Peking University Third Hospital from January 1, 2013, to December 31, 2018, were retrospectively collected. The clinical manifestations, ultrasound findings, risk factors and outcomes were analyzed. Two allocations were performed to the patients: mild PVI group ( n=5) or severe PVI group ( n=11) according to the degree of brain injury suggested by ultrasound findings; and typical PVI group (onset time was 6-96 h after birth; n=14) or atypical PVI group (onset time was less than 6 h or more than 96 h after birth; n=2) according to the onset time. Chi-square or Fisher's exact test was used to analyze the differences in high risk factors and prognosis between the groups. Univariate and multivariate logistic regression analysis were used to analyze the high risk factors related to different groups. Correlations of the severity of brain injury and the onset time with PVI prognosis were analyzed using univariate analysis. Results:(1) The gestational age of the 16 infants with PVI was 25 +2-33 +1 weeks (median 27 weeks). The birth weight ranged from 660 g to 1 760 g (median 1 065 g). All cases showed PVI under ultrasongraphy one week after birth, among which 11 was diagnosed and the other five were misdiagnosed as periventricular intraventricular hemorrhage Grade Ⅲ. Five cases presented with convulsion, while the others did not show any specific symptoms. All cases were shown periventricular intraventricular hemorrhage GradeⅢ or above. Bilateral hemispheres were involved in seven cases, left hemisphere in five and right in four. There were 15 cases with massive infarction and six with midline displacement. Obstructive hydrocephalus occurred in six cases 4-25 d after birth, and eight patients had brain parenchyma softening 5-25 d after birth. (2) The incidence of asphyxia in the mild PVI group was lower than that in the severe PVI group (1/5 vs 10/11, P=0.013) and asphyxia was a high risk factor of severe PVI ( OR=40.000, 95% CI: 1.982-807.100). (3) There was no significant difference in the clinical risk factors between the typical and atypical PVI groups (all P>0.05). (4) Among the 16 cases, nine died, one was lost to follow-up, five had delayed intelligence and motor development and one had normal growth and development. No significant difference in the prognosis (died or discharged after improvement) was found between the mild and severe PVI groups, or between the typical and atypical PVI groups ( P=0.365 or 0.700). Conclusions:PVI usually occurs in very or extremely low birth weight premature infants within one week after birth. Clinical manifestations of PVI include convulsions, but most are non-specific. Asphyxia may lead to severe PVI. PVI has a higher short-term mortality as well as a higher incidence of long-term neurological sequelae.

Impact of hypertensive disorder complicating pregnancy on neonatal mortality and major complications in preterm infants / 中华实用儿科临床杂志

Objective@#To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants.@*Methods@#The general clinical data of preterm infants with gestational age 24-36+ 6 weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed.@*Results@#The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ2=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ2=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ2=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis.@*Conclusions@#HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.

Clinical features and trend analysis of Kawasaki disease from 2007 to 2016: a single-center study / 中华实用儿科临床杂志

Objective To analyze the clinical features of children with Kawasaki disease(KD) in order to find out the trend of its clinical features and to provide guidance for clinical diagnosis and treatment.Methods Children with KD hospitalized in the Pediatric Ward of Peking University Third Hospital from January 2007 to December 2016 were collected and analyzed for their characteristics of onset,clinical features and treatment.The children were divided into 2 groups according to the time:2007 to 2011 group,2012 to 2016 group.The changes in clinical characteristics between the 2 stages were analyzed.Results A total of 337 children with KD were enrolled in this study,including 212 males and 125 females,with a ratio of 1.69 ∶ 1.00.The age of onset was from 2 months to 12 years old.The median age was 24 months.A total of 325(96.4％) children were under 6 years of age.There were 114(33.8％) cases of KD children from 2007 to 2011,among whom incomplete KD (IKD),intravenous gamma globulin non-response and coronary artery injury cases accounted for 23.7％ (27 cases),4.5％ (5 cases),38.6％ (44 cases),respectively;there were 223 (66.2％) cases of KD children from 2012 to 2016,among whom IKD,intravenous gamma globulin non-response and coronary artery injury cases accounted for 38.6％ (86 cases),11.9％ (26 cases),31.4％ (70 cases),respectively.The group of 2012 to 2016 was compared with the the group of 2007 to 2011 and it was found that the proportion of IKD and intravenous gamma globulin non-response cases increased,and the differences were significant (x2 =7.495,4.654,P =0.006,0.031),but the proportion of coronary artery injury cases decreased with no statistical difference (x2 =1.750,P =0.186).Conclusion With the incidence of KD increasing,the proportion of incomplete KD and intravenous gamma globulin non-response KD also showed an upward trend,which should be paid more attention to by clinicians in order to promptly diagnose and implement more targeted treatment.

The aerogenes infection in NICU and sensitivity analysis / 中国新生儿科杂志

Objective To study the risk factors,clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection in NICU.Method Preterm infants diagnosed to have infection of aerogenes in our NICU during July 2014 to October 2014 were selected as the infection group in our study.Uninfected preterm infants whose gestational age and birth weight were similar to the infants in infection group were selected as the control group.The ratio of number of infants in infection group and control group was 1 ∶ 2.The basic situation,clinical application of antibiotics before infection,defecation times,invasive manipulations,and parenteral nutrition time of the two groups were retrospectively collected.The clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection were analyzed.Result There were 8 infants in infection group (male:female =3∶5).The birth weight ranged from 780 to 2 760 g;and gestational age from 28 to 33 w.There were 16 infants in the control group (male:female =1 ∶ 1).The birth weight ranged from 1 070 to 1 780 g,and gestational age,from 29 to 33 w.The incidence of prenatal infection in infection group was higher than that in the control group (3/8 vs.4/16,P ＜ 0.05).Comparing the two study groups,there were statistical differences between them in the following aspects (all P ＜ 0.05):non-invasive respiratory support time [11 (6,36) d vs.4 (0,6) d] and invasive mechanical ventilation time [(1 (0,6) d vs.0 (0,0) d].All the 8 infants in infection group had pneumonia,3 of them with sepsis (1 case was extremely low birth weight infant,and 2 cases were very low birth weight infants),and one of them died from septic shock.Drug sensitivity analysis showed that aerogenes were resistant to all the third generation cephalosporins,and were sensitive to Meropenem and Piperacillin/Tazobactam.The resistance rates of Imipenem were 1/6 in the first month,2/6 in the second month,9/11 in the third month,and 2/4 in the fourth month,respectively.Conclusion Avoidance of prenatal infection and shortening of the application of ventilator may reduce the incidence of aerogenes infection.Most of infants with aerogenes infection have favourable prognosis.The resistance rate of third generation cephalosporins is very high.Aerogenes could develop resistance quickly to the antibiotics which is sensitive initially.

Blepharophimosis-ptosis-intellectual-disability syndrome:a case report and literature review / 临床儿科杂志

Objective To explore the clinical features and gene mutations of blepharophimosis-ptosis-intellectual-disability syndrome (BPID). Methods The clinical data, diagnosis and treatment of a child with BPID in neonatal intensive care unit (NICU) were reviewed. Based on the literature retrieved from PubMed database, the common classification, clinical features, diagnosis and genetic counseling of BPID and its affiliated blepharophimosis-mental retardation syndromes (BMR) were reviewed. Results This male infant was 39 weeks of gestational age with birth weight of 1920 g, and was admitted to NICU 15 min after birth due to dyspnea. The main clinical manifestations were facial deformity such as biepharophimosis, ptosis and micromandible, inspiratory dyspnea with laryngeal cartilage softening, malformations of the thorax and feeding difficulties. A heterozygous mutation in UBE3B gene was identified by complete exon sequencing and he was diagnosed of BPID, a rare genetic disorder. Reviewing the literature, there was no relevant report in domestic. While one foreign literature was found to report 5 patients from 4 families having a subtype of BMR, a kind of autosomal recessive diseases caused by mutations in the UBE3B gene. Conclusion BPID is a rare clinical entity of BMR. Complete exon sequencing can be used to diagnose the disease.

Algorithms for managing common gastrointestinal symptoms in infants / 中华实用儿科临床杂志

Gastrointestinal symptoms such as regurgitation,infantile colic,constipation,dyschezia,and diarrhoea are frequent in infants.These symptoms always were functional gastrointestinal symptoms.It is easily confused with other diseases.The knowledge and management of these symptoms are no uniform or clear.Since double-blind placebo controlled prospective intervention trials are very limited,the algorithms are still based on consensus using the evidence.This article respectively introduces each gastrointestinal symptoms,include clinical manifestations,diagnosis and management referring to Rome Ⅳ and domestic and overseas paediatricians consensus,to improve clinical pediatricians the knowledge of gastrointestinal symptoms and specify the management.

Long-term outcomes of extremely preterm infants and extremely low birth weight infants with low one-minute Apgar score / 中华围产医学杂志

Objective To investigate the relationships between low one-minute Apgar score and the prognosis of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI). Methods Altogether 50 EPI and ELBWI who had a low one-minute Apgar score ( ≤ 7) and were admitted to the Neonatal Intensive Care Unit (NICU) of Peking University Third Hospital from January 1,2010 to December 31, 2015 were enrolled in this study. All of them were divided into two groups according to their Apgar score: mild group (4-7) and severe group (0-3). Medical records of the subjects were reviewed and an at least 18 months follow up study was conducted. Conditions of all subjects during perinatal period and hospitalization were summarized. Outcomes and follow-up results were compared between the two groups by using Fisher exact test. Results (1) General information: Fifty infants were involved, among which 37 had a mild low Apgar score and 13 had a severe low Apgar score. The mean gestational age was (27.7±2.1) weeks and the mean birth weight was (884.4±174.3) grams. (2) Main complications (some infants with more than one complication): There were 42 cases of neonatal respiratory distress syndrome, 12 cases of pulmonary hemorrhage, 21 cases of bronchopulmonary dysplasia, 31 cases of patent ductus arteriosus, 36 cases of intraventricular hemorrhage, 22 cases of white matter damage and six cases of retinopathy of prematurity. (3) Outcomes: The survival rate was 48% (24/50) and the mortality rate was 52% (26/50). Among the 26 infants, five died despite treatment and 21 died within 72 hours after their parents giving up treatment. There were no significant differences in the survival rates, mortality rates and rates of abandon treatment between the two groups [43% (16/37) vs 8/13; 11%(4/37) vs 1/13; 46% (17/37) vs 4/13; Fisher exact test, all P>0.05]. (4) Follow-up results: Twenty-one infants were followed-up to at least 18 months of age, among which four were normal, 10 had growth retardation and recurrent respiratory tract infection and seven had motor development retardation. The incidence of motor development retardation in severe group was higher than that in mild group, and the difference between them was statistically significant (5/8 vs 2/13, Fisher exact test, P=0.046). Conclusions EPI or ELBWI with a low one-minute Apgar score have many nosocomial complications, resulting in high mortality and high incidence of motor development retardation.

Study progress of breast milk stem cells / 中华实用儿科临床杂志

The immense potency of bioactive molecules of human breast milk and importance of breastfeeding is known worldwide.Less attention has been paid on the cellular constituents and properties of breast milk.In the past decade,a research has been done by multidimensional approach to investigat the cells human milk.Technological advances have played an important role in this work,which has resulted in the breakthrough discovery of breast milk stem cells with self renewal and multilineage potentials.Regenerative medicine may benefit from utilizing these cells.Breast milk stem cells are transferred to the offspring during breastfeeding.This contributes substantially to infant health.This review summarizes the current knowledge on the potential of breast milk stem cells,with emphasis on their origin,properties and future applications.

Relationship between fractional exhaled nitric oxide and bronchopulmonary dysplasia in extremely/very low birth weight infants / 中华围产医学杂志

ObjectiveTo investigate the relationship between fractional exhaled nitric oxide (FeNO) and bronchopulmonary dysplasia (BPD) in extremely/very low birth weight infant (ELBWI/VLBWI). MethodsThirty-five ELBWI/VLBWI (gestational age <34 weeks at birth and birth weight <1 500 g), who were admitted to neonatal intensive care unit of Peking University Third Hospital from October 2014 to March 2015 with respiratory distress soon after birth, were enrolled into the study, and divided into BPD group (n=11) and non-BPD group 1 (n=24) according to the diagnosis at discharge. One day before they left the hospital, FeNO level was determined with Exhalyzer D, an equipment for pulmonary function test. Difference of FeNO and nitric oxide (NO) production between the two groups was compared witht-test or Fisher exact test, and the value of FeNO in predicting BPD was tested by receiver-operating characteristic (ROC) curve.ResultsThe mean gestational age at birth in BPD group was significantly less than that in non-BPD group [(29.7±1.9) vs (32.0±1.5) weeks,t=4.005,P=0.000], and the duration of invasive ventilation [(53.0±91.3) vs (15.0±30.2) h, t=1.598,P=0.002] and oxygenation was longer [(42.1±7.8) vs (8.2±6.4) d,t=13.567,P=0.000]. There were more babies required surfactant treatment, prenatal cortisone administration, and inhalation of cortisone and bronchodilator during hospital stay in BPD group than in non-BPD group[10/11 vs 38%(9/24), 11/11 vs 58%(14/24) and 11/11 vs 21%(5/24), Fisher exact test, allP<0.05]. The age and body weight of the babies at the time of FeNO determination in BPD group were older or higher than those in non-BPD group [(46.4±16.3) vs (20.9±11.7) d,t=5.278,P=0.000; (2 090±164) vs (1 892±153) g,t=3.498,P=0.001], but the corrected gestational age was similar [(36.3±3.1) vs (35.0±2.3) weeks,t=1.407,P=0.169]. Both the mean FeNO level and NO production in BPD group were significantly higher than those in non-BPD group [(13.6±6.9) vs (8.0±3.6) ppb (1 ppb=1×10-9 mol/L), (25.6±10.1) vs (18.1±9.0) nl/min,t=2.967 and 2.478,P=0.006 and 0.018]. The area under the ROC curve was 0.749 (P=0.021, 95%CI: 0.539-0.953) which implied that FeNO provided medium power for discrimination of ELBWI/VLBWI with BPD from those without, with a sensitivity of 72.7% and specificity of 75.0% at the cut-off value of 11.55 ppb.ConclusionsFeNO and NO production in BPD infants are significantly higher than non-BPD infants. Measurement of FeNO for ELBWI/VLBWI through mask before discharge is a simple, safe and invasive procedure to objectively evaluate pulmonary function early after birth.

Severe viral infection in neonatal intensive care unit / 中国小儿急救医学

There is a lack of knowledge concerning the frequency and significance in patients treated in the NICU because of the confused and difficult techniques in viral testing. Some researches revealed that the incidence of viral infection in the NICU was 5%. We discussed the common viral infections including re-spiratory syncytial virus,enterovirus,rotavirus,cytomegalovirus,herpes simplex virus,rubella virus,parvovir-us and human immunodeficiency virus. Based on the database of the outbreak of viral infections in NICU,we need for more effective outbreak prevention strategies.

The clinical comparative study of preterm respiratory distress syndrome and transient tachypnea of newborn / 中华儿科杂志

<p><b>OBJECTIVE</b>To completely compare the risk factors, respiratory therapies and complications between respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) in preterm infants.</p><p><b>METHOD</b>Data were collected from preterm infants in Department of NICU, Peking University Third Hospital from January, 2013 to December, 2013. Components of clinical variables, including perinatal risk factors, ventilation therapies, pulmonary surfactant (PS) therapy, blood gas analysis and complications, were retrospectively analyzed. χ² test or Fisher's test or t test were used.</p><p><b>RESULT</b>Ninety-nine preterm infants mean gestational age was (31.9 ± 2.2) weeks and birth weight was (1 661 ± 501) g . Sixty-nine infants were diagnosed with TTN and 30 were diagnosed with RDS. There were significant differences in gestational age ((29.5 ± 2.5) vs. (32.0 ± 3.2) weeks, t = 6.046, P = 0.002), birth weight ((1 115 ± 415) vs. (1 660 ± 531) g, t = 5.916, P = 0.001). Nine cases in the RDS group had Apgar score ≤ 7 while four cases in the TTN group had Apgar score ≤ 7 (P = 0.001). Fourteen cases in RDS group were born through C-section while 55 cases of TTN group were born through C-section (P = 0.025). During 0-2 hours after birth, pH (7.25 ± 0.09 vs. 7.30 ± 0.01, t = -2.144, P = 0.046) was significantly lower in the RDS group. PaO₂((55 ± 20) vs. (41 ± 2) mmHg, 1 mmHg = 0.133 kPa, t = 2.963, P = 0.001) and oxigination index (OI) ((149 ± 58) vs.(100 ± 9) mmHg, t = 3.379, P = 0.003) were significantly lower in the TTN group. In the RDS group, all cases received PS therapy. Twenty-five cases received mechanical ventilation and five cases received noninvasive ventilation. In the TTN group, 12 cases received PS therapy. Forty-four cases received noninvasive ventilation and 25 cases received oxygen inhalation. The cases developing complications, including ventilator associated pneumonia (14(46.7%) vs.4(5.8%), P = 0.038), patent ductus arteriosus (19(63.3%) vs. 9(13.0%), P = 0.025), intraventricular hemorrhage (9(30.0%) vs. 2(2.9%), P = 0.041), bronchopulmonary dysplasia (12(40.0%) vs. 5(7.2%), P = 0.019), were significantly more in the RDS group.</p><p><b>CONCLUSION</b>RDS and TTN are common causes leading to early dyspnea in preterm infants. Preterm infants with RDS are characterized by younger gestational age, lower birth weight, severer acidosis and more complications. Preterm infants with TTN show lower hypoxemia and OI.</p>

Clinical characteristics and cardiac hemodynamic changes of patent ductus ateriosus in preterm infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To study clinical characteristics and evaluate cardiac hemodynamic changes in premature infants with patent ductus ateriosus (PDA).</p><p><b>METHOD</b>One hundred and five infants born at ≤ 34 weeks' gestational age (GA) and ≤2 000 g birth weight (BW) were prospectively enrolled, including 63 males and 42 females, and the mean GA was (31. 1 ± 1.9) weeks and BW (1 401 ± 314) g. Echocardiography was done to detect hemodynamically significant PDA (hsPDA) and to evaluate left ventricular function at 2, 3, 5 and 7 d respectively after birth. On the basis of clinical symptoms and echocardiographic outcome, all the cases were divided into 3 groups: hsPDA group (n = 34), non-hsPDA (nhsPDA) group (n = 44) and non-PDA (nPDA) group (n = 27) to survey and compare general conditions, DA diameter, shunt direction, left ventricular function and complications.</p><p><b>RESULT</b>The hsPDA group had smaller GA ((30. 5 ± 2. 1) vs. (31. 6 ± 1. 6) weeks, P = 0. 01) and greater proportion of pulmonary surfactant use and mechanical ventilation (2, 3, 5 d of birth) than the nhsPDA and the nPDA group (χ2 = 11. 62, 14. 95, 12. 73, 1:1. 59, P = 0. 00; 0. 00, 0. 01, 0. 01). Univariate and multivariate Logistic regression analysis indicated that the average length of stay (ALOS) was correlated with hsPDA (F =3. 52 and P =0. 03, OR 1. 03 and P =0. 02). The ALOS was longer in the hsPDA group than in the nhsPDA and the nPDA group ((39 ±23)vs. (30 ± 16)and(29 ±13) d, P =0.02, 0.03). There was no significant.difference in rates of mortality/giving-up of treatment among the three groups (5. 9% (2/34)vs. 0 (0/44) and 3. 7% (1/27), χ2 = 5. 26, P = 0. 06). Diastolic blood pressure and mean blood pressure were significantly lower in the hsPDA group than in the other two groups (P all <0. 05) at 2, 3 and 5 days after birth and the pulse pressure was found significantly higher in the hsPDA group than in the nPDA group at 2 d after birth. Univariate and multivariate Logistic regression analysis demonstrated that hsPDA was correlated significantly with neonatal respiratory distress syndrome (NRDS) and bronchopulmonary dysplasia (BPD) (χ2 =7. 34 and 7. 39, P = 0. 02 and 0. 02; OR = 3. 46 and 4. 01, P = 0. 04 and 0. 02). Premature infants with hsPDA had normal left ventricular fractional shortening (FS) and left ventricular ejection fraction (LVEF), although the cardiac output (CO) of left ventricle increased significantly(F = 6. 93, P <0. 01) within seven days of birth. There was no significant difference in cardiac hemodynamic parameters among closed group of hsPDA group, nhsPDA group and nPDA group simutaneously reexamined at 7th day after birth. The CO was extremely significantly different among premature infants who had different GAs and BWs. The lower the GAs and the BWs, the lower the value of CO(F =5. 16 and 14. 87, P all <0. 01). The DA diameter was reduced much more dramatically after ibuprofen treatment than before in hsPDA group(t = 5. 58, P <0. 01).</p><p><b>CONCLUSION</b>The GA, PS use and mechanical ventilation were probably associated with hsPDA. The mean blood pressure and diastolic blood pressure were decreased and pulse pressure was increased in preterm infants with hsPDA that correlated significantly with ALOS, NRDS and BPD. In addition, increased CO values were found in hsPDA group. Oral ibuprofen administered to preterm infants for hsPDA at > 24 h of life promoted ductal closure.</p>