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In recent years, the use of broad-spectrum antibiotics in clinical practice has led to an increase in the detection of Carbapenem-resistant Klebsiella pneumoniae(CrKP)in neonatal intensive care units.CrKP infection in newborns usually lacks specific clinical manifestations and can lead to bacteremia, meningitis and abdominal infections, which can be life-threatening.Combination of carbapenem antibiotics or newer drugs such as ceftazidime/avibactam, tigecycline and polymyxin are currently effective treatment options for CrKP infection in neonates.In addition to rational drug use, strict antimicrobial stewardship, hospital infection prevention and control measures are needed to reduce the colonisation and spread of CrKP in the neonatal ward.
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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.
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Necrotizing enterocolitis(NEC)is a serious gastrointestinal disease in the neonatal period and one of the main causes of death in premature infants.In recent years, with the advancement of neonatal intensive care, the survival rate of children with NEC has been improved.However, the survivors are often accompanied by poor neurological prognoses, such as periventricular leukomalacia, intraventricular hemorrhage, neurodevelopmental disorders.The pathogenesis of NEC has not been fully elucidated.This review discusses the factors that may influence NEC related brain injury, such as hypoxia and ischemia, inflammatory response, nutrition, and brain-gut axis, in order to provide an overview on the pathogenesis of NEC.
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As a critical bowel disease in neonates and preterm births, neonatal necrotizing enterocolitis(NEC)is hard to diagnose and treat in time, leaving bad outcomes.With the development of perinatal medicine, the survival rate of premature infants has gradually increased.NEC has become a major digestive system disease that seriously affects the morbidity and compromised life quality of premature infants.Abdominal ultrasound examination has been widely used in the early diagnosis, treatment guidance and outcome assessment of NEC.It is non-invasive and in real time, with high sensitivity and specificity.This review summarizes recent progress on the application of abdominal sonography in the prediction, diagnosis, assessment and treatment guidance of NEC.
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Necrotizing enterocolitis(NEC)is an acute inflammatory disease of the intestine which is related to gut dysbiosis.Gut microbiota of NEC patients in meconium or feces are different from those of healthy infants.Although the pathogenic bacteria and metabolites of NEC have not been specified, short-chain fatty acids, lithocholic acid and tryptophan derived metabolites may play protective or aggravating roles in NEC.Probiotics and fecal microbiota transplantation that target on gut microbiota may optimize the composition of gut microbiota and thereby decrease the incidence of NEC.Besides, the early diagnosis of NEC is challenging due to its unspecific presentations.Once diagnosed, it is often severe.More research about disease biomarkers based on gut microbiota is needed.
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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.
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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.
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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.
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Objective To study the clinical value of cord-blood procalcitonin (PCT) for the diagnosis of neonatal intrauterine bacterial infection. Method Embase, Cochrane library, PubMed, Wanfang Database, CNKI Database and Chinese Biomedical Literature Database were searched from the establishment date of the databases to the end of 2018. Articles involving PCT and intrauterine infection were enrolled. The research background, design information and diagnostic parameters were extracted and analysed using Meta-Disc 1.4 software. Heterogeneity of the data were studied and corresponding effect models were selected according to the heterogeneity results. Data from all studies were weighted and quantitatively combined. Summary receiver operating curve (SROC) were drawn and the area under the curve (AUC) were calculated. Finally, sensitivity analysis were carried out. Result A total of 318 articles, including 242 in foreign languages and 66 in Chinese, were retrieved. According to the inclusion criteria, 9 articles were finally obtained. A total of 3571 newborns from five countries (France, Poland, Australia, Czech and China) were included. In the 9 articles, cord-blood PCT was used to diagnose intrauterine infection in six articles. The pooled sensitivity, specificity and SROC AUC were 73.7％, 82.6％ and 0.839. For the rest three articles in which cord-blood PCT was used to diagnose early-onset sepsis, the pooled sensitivity, specificity and SROC AUC were 92.3％, 97.2％and 0.987, respectively. The sensitivity analysis of cord-blood PCT detection showed that disease severities and the differences of PCT detection threshold caused the heterogeneity. Conclusion Cord-blood PCT has diagnostic value for intrauterine infection of neonates and for early-onset sepsis of neonates .
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Objective To study the diagnostic value of abdominal ultrasound for neonatal necrotizing enterocolitis (NEC). Method Neonates diagnosed with NEC admitted to Department of Shengjing Hospital from January 2016 to December 2018 were retrospectively analyzed. They were assigned into NEC stage Ⅱ group and NEC stage Ⅲ group based on the modified Bell-NEC grading criteria. Meanwhile, according to the timing of imaging examination, the patients were assigned into the group within 7 days after the onset of NEC and the group between 8 and 14 days. They were then grouped into conservative treatment group and surgery group. The difference between abdominal X-ray plain film and abdominal ultrasound in the performance of diagnosing NEC within groups were compared. Result A total of 60 patients with NEC were studied, including 38 with NEC stage Ⅱand 22 with NEC stage Ⅲ, among them 14 patients underwent surgery, others had conservative treatment. The average gestational age was (33.3±3.2) weeks and the average birth weight was (2047±831) g. The positive detection rate of pneumatosis intestinalis and hepatic portal venous gas by abdominal ultrasound vs. X-ray plain film in≤7 d group were 38.3％ (23/60) vs. 15.0％ (9/60) (P=0.004) and 15.0％(9/60) vs. 1.7％ (1/60) (P=0.008), respectively, indicating the positive detection rate of abdominal ultrasound was significantly higher than that of X-ray within 7 d after the onset of NEC. However, there was no significant difference in the detection rate between abdominal ultrasound and abdominal X-ray 8～14 d after the onset of NEC (P>0.05). The detection rate of intestinal wall thickening and peritoneal effusion by abdominal ultrasound together with the detection rate of intestinal dilatation and free gas in abdominal cavity by abdominal X-ray plain film in the conservative treatment group were significantly lower than those in the surgery group (P<0.05). Conclusion Abdominal ultrasound can help detecting the characteristic features of NEC (pneumatosis intestinalis and hepatic portal venous gas) in time, which has great value for early diagnosis and assessing severity.
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Objective To investigate the association between serum 25(OH) D levels and the inci-dence of early-onset sepsis(EOS) in the very low birth weight infants(VLBWI) and the gestational age be-low 34 weeks. Methods The cord blood of 159 VLBWI were collected between January and December 2017,including 31 clinically diagnosed EOS and 128 non-EOS patients. Serum 25(OH)D<10 ng/ml was de-fined as severe vitamin D deficiency,25(OH)D 10 to 20 ng/ml as vitamin D deficiency,25(OH)D 20 to 30 ng/ml as vitamin D insufficiency and 25(OH)D >30 ng/ml as vitamin D sufficiency. Results There were no differences in gender,gestational age,birth weight and Apgar score between the EOS group and the non-EOS group(P>0. 05). Serum 25(OH) D was(9. 08 ± 4. 21) ng/ml in the EOS group and(11. 91 ± 5. 37) ng/ml in the non-EOS group(P＝0. 007). The rate of severe vitamin D deficiency was 67. 7%(21/31)in the EOS group and 41. 4%(53/128) in the non-EOS group. The rate of vitamin D deficiency was 32. 3%(10/31)in the EOS group and 52. 3%(67/128)in the non-EOS group. But there was no difference of vitamin D deficiency distribution in the two groups(P＝0. 152). The cut-off value of serum 25(OH)D level in predic-ting EOS was 10. 06 ng/ml. Conclusion The incidence of vitamin D deficiency is as high as 95%,calling for urgent attention on vitamin D supplementation in those VLBWI. Low 25(OH)D level( <10 ng/ml)might be predictive of EOS.
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Objective To investigate the expression of occludin in the intestinal epithelial cells of neonatal rats with necrotizing enterocolitis ( NEC) . The influence of vitamin D on NEC and the expression of occludin was also explored. Methods Sixty neonatal Wistar rats from different litters were divided into four groups 48 hours after birth:10 in the breast-fed+ control group,10 in the breast-fed +vitamin D group,20 in the NEC+ control group and 20 in the NEC+ vitamin D group. In groups with NEC,neonatal rats were sep-arated from their mothers and treated with rat milk substitute+hypoxia+hypothermia. In groups with vitamin D treatment,paricalcitol was given through intraperitoneal injection 30 minutes before,one day and two days after the induction of NEC. The tissue was harvested from the ileum of the rats 72 hours after induction of NEC. Microscopically,the tissue was assessed according to the Nadler scoring system. The expression and location of occludin was observed after immunofluorescence staining. Western blotting was performed and quantified to compare the expression of occludin among groups. Results In NEC rats,the intestinal structure was destructed. Separation of the submucosal or muscular layer,discharge or disappearance of the villa was accompanied by necrosis of the intestinal cells. Vitamin D treatment could significantly alleviate those chan-ges,with the Nadler score 1. 70 ± 0. 21 compared to 2. 90 ± 0. 23 without vitamin D treatment ( P<0. 01 ) . The expression of occludin was decreased in NEC rats and vitamin D could partly rescue this decrease (P<0. 01). The distribution of occludin was sparse and discontinuous in NEC rats while after vitamin D treatment,the distribution was maintained even and continuous. Conclusion The expression of occludin in intestinal epithelial cells is significantly reduced in NEC rat. Vitamin D treatment may inhibit the development of NEC by maintaining the expression of occludin.
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Objective To observe the therapeutical effect of posterior vertebral column resection on chronic thoracolumbar tuberculosis with secondary paraplegia and to provide a safe and effective method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia.MethodsFrom Aug.2007 to Mar.2010,12 cases with chronic thoracolumbar tuberculosis and secondary paraplegia were surgically treated by posterior vertebral column resection and Titanium net support for bone graft and internal fixation operation treatment.Cobb angle was measured,and conditions of internal fixation were observed before and after the operation by X-ray films.Neurological status were evaluated by Frankel grades.ResultsThe follow-up periods was 6- 18 months( on average 11 months).Operations eased all patients' back and chest pain.Frankel grade increased from C preoperatively to grade D or E postoperatively in 6 cases,from grade D to E in 4 cases and from grade B to C in 1 case.No obvious improvement of Frankel grade was observed in the other patient of grade B.The average Cobb angles were(76.0 ± 23.4) ° before surgery,( 15.5 ± 6.3 ) ° at one week after surgery and ( 16.0 ± 8.2) °at the last follow-up.The difference in the Cobb angle before and at one week after treatment was significant( t =3.41,P ＜ 0.01 ).No difference was found in the Cobb angle between at one week after treatment and at the last follow-up (t =1.58,P ＞ 0.05 ).All patients got bony fusion with Titanium net.No complications occurred with internal fixation.Conclusion Posterior vertebral column resection is a feasible method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia.It achieves neurological decompression with high correction rate and minor injury,and no anterior surgery is needed.
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Objective To observe the therapeutical effect by using pedicle screw and interbody fusion cage,and compare with posterior interbody simple autogenous bone graft. Methods From August 2006 to January 2009,46 cases of lumbar spondylolisthesis patients were treated by using pedical screw internal fixation system, including 24 cases of cage-graft (group A), 22 cases of interbody simple autogenous bone graft (group B), efficacy evaluation using JOA evaluation standard, and measured lumbar olisthe reset rate, relative intervertebral space height and lumbosacral angle of recovery and observed fusion rate through the preoperative and postoperative follow-up X-ray films. Results All the patients' waist pain symptoms relieved after operative reduction. At 18 months of follow-up , group A of lumbar olisthe reset rate was 94.7%, relative intervertebral space height was (74.93 ± 7.85)% ,lumhosacral angle was 36.6° ± 3.6° ,meanwhile group B was 89.9%, (68.72 ± 12.40)%,39.3°± 5.6°. There were significant differences between two groups (P<0.05). Bone graft fusion rate in group A was 95.83% (23/24), in group B was 90.91%(20/22), there was significant difference between two groups (P < 0.05). Conclusion Pedicle screw system and interbody cage-graft in treatnent of lumber spondylolisthesis can effectively prevent the loss of reduction,mid and long-term effects are satisfactory,it is a stable and reliable method.
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Objective To evaluate the femoral neck anteversion (FNA) of patients with unilateral developmental dysplasia of the hip (DDH) and reveal the developmental regularity of the proximal femur.Methods 366 three-dimensional CTs of unilateral DDH patients were categorized into three age groups:＜18 months, 18 months-3 years,and＞3 years.The femoral neck anteversion of both sides were measured and a statistical comparison was performed between them.The line chart showing the relationship of femoral neck anteversion and age was drawn to reveal the developmental regularity of the proximal femur.Results In total,the affected side of unilateral DDH had an femoral neck anteversion 1°～5° significantly larger than the unaffected side (P＜0.05).There was no statistical difference between affected and unaffeted sides in age group＜18 months and 18 months-3 years,while it was significant in age group＞3 years.Conclusion Pathological changes of the proximal femur were observed not only the affected side in unilateral DDH but also the unaffected side.The FNA symmetrically developed with age older.
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Objective To define the normal reference values of acetabular index and Sharp angle through 2333 standard anterior-posterior pelvic radiographs. Methods In our study, 2333 normal anteriorposterior pelvic radiograph images with standard exposure were selected. All the images were diagnozed normal by two radiologists and two pediatricians according to the criteria of T(o)nnis. All subjects were without any neuromuscular diseases and congenital defoemity. The acetabular index was measure in the subjects between age 0 to 10 years, and the groups were divided monthly within 1 year and yearly between 1 to 10years. The Sharp angle was measure in the subjects after 10 years, and the groups were divided yearly in adolescence and decadely in adults. Normal values of each age groups and the correlation charts were completed according to statistical analysis. Results The mean acetabular index was 28.39° in neonates followed by a steep decrease in the first three months after born. It decreased to 22.17°in the 1st year, 12.80°in the 10th years and then kept constant. Acetabular index of the female was generally 1°-2°larger than that of the male with statistical significance. The mean Sharp angle was 46.72°in the 10th years, which decreased to 39.10°in the 18th years and 35.69°in elderly people. Another declination was observed after age 40.Generally no gender difference was observed. Conclusion Acetabular index and Sharp angle vary with age.They reflect a dramatic morphological change in the acetabulum before adulthood and stay constant afterwards. Gender difference is obvious in many age groups but not all. Normal reference ranges of both gender at all age groups should be considered in clinical evaluation.
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Objective To investigate mesenchymal stem cells genetically modified by nerve growth factor to repair acute spinal cord injury in rats. Methods Fifty six Wistar rats of inbred strain were randomly divided into sham operation group cell transplantation group and simple injury group. The spinal cord injury model was prepared according to the modified Allen's method. NGFβ (hNGFβ) and GFP genes were transfected into MSCs by replication-deficient recombinant adenovirus vector (Ad-hNGFβ) and replication-deficient recombinant retrovirus vector (Rt-GFP) respectively. GFP positive MSCs were transplanted into intradural space of injured spinal cord at 7 days after spina coral injury. Spinal cord was dissected at 24 h, 1 and 2 weeks after transplantation. To observe the expression of GFAP and nestin and the distribution of MSCs after transplantation following the spina corol injury. Results MSCs migrated to the injured parenchyma In transplantation group, the expression of GFAP and NGF protein was higher than in the control group (P<0.05), the BBB score in transplantation group was higher than that in the control group (P<0.05). Conclusion The MSCs transplantation repaired the injured spinal cord to some extent.