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Intrauterine infections is one of the causes of adverse outcomes and high long-term disability rate in perinatal infants.About one million neonatal deaths per year are closely related to prenatal or perinatal infections.Therefore, reducing intrauterine infections during perinatal period is essential to promote the physical and mental health of mothers and children.Now, the types of pathogens in intrauterine infections, their effects on the fetus, the routes of infection, and their control measures were described.
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Objective:To summarize the clinical characteristics and experiences in the diagnosis and treatment of congenital tuberculosis.Methods:This study involved four infants with congenital tuberculosis diagnosed in Guangdong Women and Children Hospital from January 2010 to January 2020. Moreover, publications of 52 congenital tuberculosis cases from Chinese hospitals between January 1994 and January 2019 were retrieved from Wanfang Database, China National Knowledge Infrastructure and PubMed. Clinical data of all patients were retrospectively analyzed.Results:All four cases we reported here were preterm infants with the onset of the disease at 14-30 d after birth and received anti-tuberculosis treatment. The interval between disease onset and diagnosis was 1-34 d. One baby was cured, one was improved, while the other two died. The median age at the onset of the disease in these 56 cases (including the four we reported and 52 from literature) was 14.5 d (7.0-20.7 d) and the median interval between the onset and diagnosis was 10.5 d (7.5~22.0 d). Forty-eight (88.9%) out of the 54 mothers were suffered from active tuberculosis during the perinatal period, including 16 diagnosed before delivery. The main clinical symptoms in these neonates were fever (82.1%, 46/56), respiratory distress (69.6%, 39/56), drowsiness and/or irritation (57.1%, 32/56), cyanosis (53.6%, 30/56), feeding difficulties (53.6%, 30/56), hepatomegaly (48.2%, 27/56) and splenomegaly (41.1%, 23/56). The positive rates of acid-fast staining, culture and polymerase chain reaction detection of Mycobacterium tuberculosis in sputum smears or gastric juice were all less than 33.3%, and the positive rate of spot test for Mycobacterium tuberculosis infection was 7/12. Chest X-ray showed miliary nodules and diffused nodules-patchy in 37.0% (20/54) and 25.9% (14/54) of the patients, respectively. Abdominal ultrasonography found 52.4% (11/21) with hepatomegaly and/or splenomegaly and 47.6% (10/21) with multiple low-density nodules in liver and spleen. The misdiagnosis rate was 28.6% (16/56). The overall mortality rate was 51.8% (29/56). However, the figure was 28.9% (11/38) in infants with anti-tuberculosis treatment and 18/18 in those without. Conclusions:Nonspecific clinical manifestations of congenital tuberculosis, together with low detection rate through laboratory tests, may lead to a higher rate of misdiagnosis and mortality. Therefore, a comprehensive assessment of the mothers of infants with suspected congenital tuberculosis is necessitated. Diagnosis and effective anti-tuberculosis treatment as early as possible are essential to improve the prognosis.
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Objective@#To analyze the predictive value of lactate/albumin(L/A) ratio in neonatal infants with septic shock.@*Methods@#The data of 185 neonatal infants with sepsis from January to December 2017 were retrospective analyzed in Guangdong Women and Children Hospital.The data were divided into low level of L/A group(L/A<0.1), medium level of L/A group(0.1≤L/A<0.2) and high level of L/A group(L/A≥0.2)according to L/A ratio level within 24 hours of sepsis.The clinical features, related laboratory indications and prognosis among the 3 groups were compared.Multivariate Logistic regression was used to analyze the effects of various factors on the occurrence of neonatal septic shock.Receiver operating characteristic (ROC) curve analysis was performed to evaluate the early predictive va-lue of related indicators for neonatal septic shock.@*Results@#A total of 185 neonatal infants with sepsis were collected.There were 88 cases in low level of L/A group, 64 cases in medium level of L/A group and 33 cases in high level of L/A group.There were no significant difference in gender, gestational age, birth weight, 1 and 5-minute Apgar scores, small for gestational age, use of pulmonary surfactant, maternal preeclampsia, gestational diabetes mellitus, maternal fever and severe meconium stained (all P>0.05). There were no statistical differences among three groups in C-reactive protein, white blood cell count, neutrophil count and proportion, leucine count and proportion and platelet count(all P>0.05). Compared with low and medium level of L/A groups, the high level of L/A group had higher proportion of cesarean section, higher procalcitonin and lactate, severe intracranial hemorrhage, periventricular leucomalacia, multiple organ dysfunction syndrome, disseminated intravascular coagulation, septic shock and the dead; low level of L/A group had higher proportion of maternal premature rupture of membranes>24 hours, albumin, pH or base excess(BE), and there were statistically significant differences in all of those(all P<0.05). Multivariate Logistic regression analysis showed that hypoalbuminemia, hyperlacticemia, decreased pH and L/A≥0.1 were independent predictors for neonatal septic shock.L/A more than 0.114 within 24 hours was associated with neonatal septic shock, with a sensitivity of 76.90% and specificity of 81.30%.@*Conclusions@#The increased of L/A within 24 hours of sepsis can be used as an independent risk factor for predicting septic shock in neonatal infants.
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Objective To explore the effect and its possible mechanism of human umbilical cord mesenchymal stem cells (hUCMSCs) on bacterial growth in bronchoalveolar lavage fluid (BALF) of newborns with ventilator associated pneumonia (VAP).Methods Newborns admitted to neonatal intensive care unit (NICU) in Guangdong Women and Children Hospital Affiliated to Guangzhou Medical University from June 1,2012 to December 31,2012 were reviewed.The inclusion criteria were:(1)Positive BALF culture results.(2) Requirement of mechanical ventilation with tracheal intubation.(3) Diagnosed as ventilator-associated pneumonia.Two pieces of BALF samples of newborn were collected and randornaly divided into experimental and control group.hUCMSCs were added into the experimental group,while the same volume of conditioned medium was added into the control group.Both groups were incubated for six hours in humidified CO2 incubator at 37 ℃,then,bacterial growth was assessed by colony forming unit (CFU) counts.Levels of the antimicrobial peptides (Cathelicidin/LL-37 and human HBD-2) were determined by enzyme-linked immunosorbent assay and Western blot.Paired t-test was used for statistical analysis.Results Among the culture results of 31 newborns,there were Klebsiella pneumoniae (6 cases,19.3％),Stenotrophomonas narrow food aeromonas (6 cases,19.3％),Hemolytic staphylococci (5 cases,16.1％),Escherichia coli (3 cases,9.7％),Bacterial meningitis septicemia Elizabeth Platinum (3 cases,9.7％),Acinetobacter baumannii (3 cases,9.7％),Pseudomonas putida (2 cases,6.4％),Pseudomonas aeruginosa (1 case,3.2％),Staphylococcus aureus (1 case,3.2％) and Enterobacter cloacae (1 ease,3.2％).The CFU counts in experimental group were much less than those in control group [(2.60±0.67) ×104] CFU/ml vs [(1.18±0.32) ×105] CFU/ml,(t=-20.19,P＜0.01).Levels of Cathelicidin/LL-37 and HBD-2 in experimental group were higher than those in control group [Cathelicidin/LL-37:(8.98 ± 3.22) ng/ml vs (3.18 ± 1.57) ng/ml,t =17.79,P ＜ 0.01 ;HBD-2:(379.87±11.74) pg/ml vs (39.89±2.86) pg/ml,t=37.62,P＜0.01].Conclusions hUCMSCs had antimicrobial effect on bacterial growth in BALFs from ventilator associated pneumonia possibly by the secretion of antimicrobial peptides (Cathelicidin/LL-37 and HBD-2).