Clinical effect of white noise combined with glucose in reducing the pain of retinopathy screening in preterm infants / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect of white noise combined with glucose in reducing the procedural pain of retinopathy screening in preterm infants.@*METHODS@#A total of 396 preterm infants with a gestational age of 28-34 weeks and a birth weight of ≤2 000 g were randomly divided into 4 groups according to the intervention method for reducing pain in retinopathy screening: control group with 100 infants (no white noise or glucose intervention), white noise group with 96 infants, glucose group with 98 infants and white noise + glucose group with 102 infants. The Premature Infant Pain Profile (PIPP) was used to determine pain score during retinopathy screening, and the four groups were compared in terms of PIPP score before and after retinopathy screening.@*RESULTS@#There were no significant differences in PIPP score, heart rate and blood oxygen saturation between the four groups at 3 minutes before screening (P>0.05). At 1 and 5 minutes after screening, the white noise, glucose and white noise + glucose groups had significantly lower heart rate and PIPP score but significantly higher blood oxygen saturation than the control group (P<0.05).The white noise + glucose group had significantly lower heart rate and PIPP score but significantly higher blood oxygen saturation than the white noise and glucose groups (P<0.05).@*CONCLUSIONS@#White noise combined with glucose can reduce the procedural pain of retionopathy screening and keep vital signs stable in preterm infants.

A review on neonatal acute respiratory distress syndrome / 中国当代儿科杂志

Acute respiratory distress syndrome (ARDS) is a common clinical critical disease and is one of the main causes of death and disability in neonates. The etiology and pathogenesis of neonatal ARDS are complicated. It is an acute pulmonary inflammatory disease caused by the lack of pulmonary surfactant (PS) related to various pathological factors. It is difficult to distinguish neonatal ARDS from other diseases. At present, there is no specific treatment method for this disease. Respiratory support, PS replacement, extracorporeal membrane oxygenation, nutrition support and liquid management are main treatment strategies. This paper reviews the research advance in etiology, clinical characteristics, diagnosis and treatment strategies of neonatal ARDS.

Healthcare-associated infection and drug resistance of Acinetobacter baumannii in neonatal intensive care units / 中国感染控制杂志

Objective To investigate the clinical characteristics and antimicrobial resistance of Acinetobacter baumannii(A.baumannii) in neonatal intensive care units (NICUs).Methods The clinical isolation and antimicrobial resistance of A.baumannii causing healthcare-associated infection(HAD in 4 NICUs of a hospital from October 2012 to October 2014 were analyzed statistically.Results A total of 11 640 neonates were admitted in 4 NICUs,500(4.3 ％) developed HAI,51 (10.2 ％) developed 52 cases of A.baumannii infection.Distribution of A.baumannii infection was as follows:NICU of extremely premature infants,premature infants,full-term infants,and surgical NICU were 42,1,4,and 5 cases respectively.Incidences of A.baumannii HAI in 4 seasons were compared,difference was statistically significant(x2 =16.05,P＜0.05),infection mainly occurred in the spring and summer.A.baumannii had high resistance rates to β-1actam antibiotics (such as piperacillin/sulbactam,cefepime,imipenem)and gentamycin(＞90 ％),resistance rate to amikacin was the lowest (51.9 ％).Among 52 strains of A.baumannii,46 were multidrug-resistant strains,and 3 were extensively drug-resistant strains.Conclusion A.baumannii HAI is most serious in NICU of extremely premature infants,resistance rates to commonly used antimicrobial agents are high.

Mortality rate and cause of death in hospitalized neonates: an analysis of 480 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the mortality rate and the cause of death of hospitalized neonates.</p><p><b>METHODS</b>The clinical data of 480 neonates who died between January 2008 and December 2014 were collected. The mortality rates of neonates with different gestational ages, birth weights, sexes, and ages in days were analyzed. The abnormal perinatal factors, cause of death, and death grade were summarized.</p><p><b>RESULTS</b>Among the 41 910 hospitalized neonates, 480 (1.1%) died, and the mortality rates of preterm infants and full-term infants were 1.7% and 0.7%, respectively. The mortality rate of hospitalized neonates decreased from 1.4% in 2008 to 1.1% in 2014, and the decrease was more apparent in the preterm infants with a gestational age of <32 weeks and the neonates with a birth weight of <1 000 g. Among preterm infants and full-term infants, those with a lower gestational age tended to have a higher mortality rate, but post-term infants had an increased mortality rate. The infants with a lower birth weight tended to have a higher mortality rate. Male neonates had a significantly higher mortality rate than female neonates (1.31% vs 0.92%; P<0.05). Among the neonates who died, 61.3% had definite abnormal perinatal factors, including abnormal amniotic fluid (29.4%), premature rupture of membranes (16.9%), placental abnormality (16.9%), fetal intrauterine distress (14.0%), and abnormal umbilical cord (12.3%). Among the 480 neonates who died, 57 (11.9%) died within 24 hours after birth, 181 (37.7%) died within 2-7 days, and 242 (50.4%) died within 8-28 days. The three most common causes of death were infection, birth defect, and respiratory distress syndrome. The most common cause of death was respiratory distress syndrome in 2008-2011 and infection in 2012-2014. Respiratory distress syndrome was the most common cause of death in preterm infants with a gestational age of <32 weeks, neonates with a birth weight of <1 500 g, and neonates who died with 24 hours; infection was the most common cause of death in neonates with a gestational age of 32-42 weeks, neonates with a birth weight of 1 500-4 000 g, and neonates who died within 8-28 days. Neonatal asphyxia was the major cause of death in post-term infants. Inevitable deaths (grade 1) accounted for 54.4%, deaths that could be avoided under certain conditions (grade 2) accounted for 23.3%, and deaths caused by concerns about prognosis or economic reasons (grade 3) accounted for 22.3%.</p><p><b>CONCLUSIONS</b>In recent years, the treatment of neonates has gradually improved, and the mortality rate of neonates is gradually decreasing, especially in neonates with low gestational age and birth weight. Important measures for reducing the mortality rate in neonates include enhancing perinatal management, reducing abnormal perinatal factors, preventing infection, and increasing parents' confidence in treatment.</p>

Impact of premature rupture of membranes on neonatal complications in preterm infants with gestational age <37 weeks / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of premature rupture of the membrane (PROM) on neonatal complications in premature infants.</p><p><b>METHODS</b>The registration information of 7684 preterm infants with gestational age <37 weeks were collected from the cooperative units in the task group between January 1, 2014 to December 31, 2014. Specially trained personnel from each cooperative units filled in the unified form in a standardized format to record the gender, gestational age, birth weight, PROM, placental abruption, antenatal corticosteroid, Apgar score, amniotic fluid pollution, and complications of the infants. The data were analyzed comparatively between the cases with PROM and those without (control).</p><p><b>RESULTS</b>The preterm mortality rate was significantly lower but the incidences of ICH, NEC, ROP and BPD were significantly higher in PROM group than in the control group (P<0.05). The 95% confidence interval of the OR value was <1 for mortality, and was >1 for ICH, NEC, ROP and BPD. After adjustment for gestational age, birth weight, gender, mode of delivery, placental abruption, placenta previa, prenatal hormones, gestational diabetes mellitus (GDM), gestational period hypertension and 5-min Apgar score <7, the incidences of NEC, ROP and BPD were significantly different between the two groups (P<0.05) with 95% confidence interval of OR value >1, but the mortality rate and incidence of ICH were not significantly different between the two groups (P>0.05).</p><p><b>CONCLUSION</b>PROM is a risk factor for NEC, ROP and BPD in preterm infants, and adequate intervention of PROM can reduce the incidences of such complications as NEC, ROP and BPD in the infants.</p>

Detection of subtelomeric copy number variations in children with intellectual disability / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To detect subtelomeric copy number variations in children with genetic intellectual disability (ID) using multiplex ligation-dependent probe amplification (MLPA), and to investigate the pathogenesis of genetic ID.</p><p><b>METHODS</b>A total of 68 children with ID who had normal results of G-banding karyotype analysis were included in the study. Their subtelomeric copy number variations were detected using MLPA P036.</p><p><b>RESULTS</b>Among the 68 children with ID, 7(10%) showed subtelomeric copy number variations, and all the variations were deletion mutations. Among them, 1 case carried 2 subtelomeric microdeletions, and 1 case carried 4 subtelomeric microdeletions.</p><p><b>CONCLUSIONS</b>Subtelomeric copy number variations are important causes of genetic ID. MLPA can be used as an economic and effective method for investigating the pathogenesis of genetic ID.</p>

Analysis of MLC1 gene mutation in a Chinese family with megalencephalic leukoencephalopathy with subcortical cysts / 中国当代儿科杂志

The clinical data of a patient with megalencephalic leukoencephalopathy (MLC) with subcortical cysts and her parents were collected. MLC1 gene mutation was detected by polymerase chain reaction and direct DNA sequencing. The patient presented with motor developmental delay and giant skull, and brain magnetic resonance imaging showed diffuse white matter swelling accompanied by subcortical cysts in bilateral frontal and parietal lobes. Gene sequencing identified two heterozygous mutations of MLC1, including missense mutation in exon 3 (c.217G>A, p.Gly73Arg) and splice site mutation in intron 9 (c.772-1G>C in IVS9-1). The patient's parents both had heterozygous mutation c.772-1G>C in IVS9-1 with normal phenotype. It can be presumed that c.772-1G>C in IVS9-1 comes from the parents, and c.217G>A (p.Gly73Arg) is a de novo mutation.

Clinical and imaging features of premature infants with different degrees of bronchopulmonary dysplasia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical and imaging features of premature infants with different degrees of bronchopulmonary dysplasia (BPD).</p><p><b>METHODS</b>A prospective study was performed on the clinical data of 59 premature infants (gestational age <32 weeks) with BPD. Among the 59 premature infants, 37 cases had mild BPD and the other 22 cases had moderate to severe BPD. The clinical and imaging data were compared between these premature infants with different degrees of BPD.</p><p><b>RESULTS</b>The durations of mechanical ventilation, oxygen therapy, antibiotic therapy, parenteral nutrition, and hospitalization in the moderate to severe group were significantly longer than those in the mild group (P<0.05). The incidence of nosocomial infection and number of times of red blood cell transfusion in the moderate to severe group were significantly higher than that in the mild group. The rates of X-ray changes, including grade I respiratory distress syndrome (1 day after birth) and hypolucency of lungs (4-10 days and ≥ 28 days after birth) were significantly higher in the mild group than in the moderate to severe group. The rates of X-ray changes in classical BPD stage III (4-10 days after birth) and IV (≥ 28 days after birth) were significantly higher in the moderate to severe group than in the mild group.</p><p><b>CONCLUSIONS</b>The durations of mechanical ventilation, oxygen therapy, and antibiotic therapy and the incidence of nosocomial infection are correlated with the severity of BPD. The premature infants with severer BPD need a longer duration of parenteral nutrition and more times of red blood cell transfusion and have more typical imaging changes of BPD. Imaging examination has a predictive value for the severity of BPD.</p>

Perinatal high-risk factors for necrotizing enterocolitis in preterm infants: a case-control study / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the timing of presentation and perinatal high-risk factors for necrotizing enterocolitis (NEC) in preterm infants with a gestational age of <33 weeks.</p><p><b>METHODS</b>A case-control study was conducted in 49 preterm infants with NEC (gestational age <33 weeks) who were admitted to the Neonatal Intensive Care Unit of Beijing Bayi Children's Hospital between October 1, 2010 and December 30, 2012, as well as preterm infants without NEC during the same period. The timing of presentation of NEC was retrospectively analyzed, and the perinatal high-risk factors for NEC were determined by multivariate logistic regression analysis.</p><p><b>RESULTS</b>The median age of onset was 17.5 days (range: 3-106 d) in preterm infants with NEC. Sex, being small for gestational age, delivery mode and antenatal corticosteroid therapy were not associated with the development of NEC; low gestational age, low birth weight and neonatal asphyxia increased the risk of NEC, and low gestational age was identified as an independent high-risk factor for the development of NEC.</p><p><b>CONCLUSIONS</b>Low gestational age is an important risk factor for the development NEC in preterm infants under 33 weeks' gestation, and the median age of onset is 17.5 days.</p>

Effects of recombinant human interleukin-11 on LPS-induced intestinal epithelial cell injury in rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effects of recombinant human interleukin-11 (rhIL-11) on the proliferation and apoptosis of rat intestinal epithelial cell line (IEC-6).</p><p><b>METHODS</b>IEC-6 cells were treated with LPS to establish necrotizing enterocolitis (NEC) model in vitro. rhIL-11 (100 ng/mL) was administered following LPS treatment and these cells were used as the IL-11 treatment group. The cells treated with normal saline only served as the control group. MTT assay was used to determine an optimal concentration (5-200 μg/mL) and time (1-24 h). MTT assay was used to measure the proliferation of IEC-6 cells at 3, 6, 9 and 12 hours after rhIL-11 treatment. Flow cytometry was used to evaluate the apoptosis of IEC-6 cells.</p><p><b>RESULTS</b>IEC-6 cells treated with various concentrations of LPS at various time points showed a lower proliferation than the control group (P<0.05). After 9 hours of rhIL-11 treatment, the proliferation activity of IEC-6 cells in the IL-11 treatment group significantly increased compared with the NEC model group without rhIL-11 treatment (P<0.05), reaching to the level of the control group. The total apoptotic and necrotic rate of IEC-6 cells in the IL-11 treatment group decreased significantly compared with the NEC model group without rhIL-11 treatment (P<0.01), but were still higher than the control group (P<0.05).</p><p><b>CONCLUSIONS</b>rhIL-11 can promote proliferation and reduce apoptotic and necrotic rates of IEC-6 cells treated with LPS.</p>

Analysis of operation feasibility in ventricular septal defects and congestive heart failure newborns / 中华实用儿科临床杂志

Objective To evaluate the feasibility and safety on closing ventricular septal defects (VSDs) under cardiopulmonary bypass(CPB) in neonatal patients with VSD and congestive heart failure.Methods From Oct.2010 to Sep.2012,16 newborn infants with VSD and congestive heart failure in Neonatal Intensive Care Unit(NICU),the Bayi Children's Hospital Affiliated to Beijing Military General Hospital,were selected as the observed group,VSD repair operation was done under CPB.As the control group,18 patients in Pediatrical Cardiac Surgical Department were randomly selected in the same period in hospital,and selective VSD repair operations were done under CPB.Between the 2 groups,demographics(body weight,gender,VSD diameter),clinical characteristics (CPB time,aortic crossclamp time) and early outcomes were compared.Results For the diameter of VSD and gender,there were no significant difference between the 2 groups (P ＞ 0.05).For the body weight,the patients in control group [(8.27 ± 3.39) kg] were more heavier than those in observed group [(3.69 ± 0.72) kg] (P ＜ 0.01).In the operation period,there were no significant differences in CPB time and aortic crossclamp time between 2 groups(all P ＞ 0.05).The lactate value of the patients in observed group [(2.76 ± 1.12) mmol/L] was significantly higher than that in control group [(1.65 ±0.34) mmol/L] (P ＜ 0.01).At the same time,the ventilation time [(3.69 ± 1.66) days] and PICU stay [(9.75 ± 3.44) days] were significantly longer than those in control group[(2.00 ±0.89) days and (6.17 ± 1.98) days] (all P ＜ 0.01).All the patients in the 2 groups discharge out of the hospital,there was no significant difference in outcome.Conclusions The newborns with VSD and congestive heart failure in NICU,can be not improved after the medical management,then closing the VSD is feasible and safe under CPB.

Gas chromatography-mass spectrometry technology for finding serum markers of neonatal sepsis / 中华实用儿科临床杂志

Objective To find the potential biomarkers of neonatal sepsis through comparing neonates with sepsis and without sepsis in serum metabolin differences.Methods Thirty neonates,who were diagnosed as sepsis from the Neonatal Center of Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital during Aug.2012 to Feb.2013,were enrolled as the experimental group;while another 30 non-sepsis neonates were selected as the control group,the data of them were not significantly different from those of the experimental group.1.5 mL supernatant of radial artery blood was saved in-80 ℃ refrigerator after centrifugation in 4 ℃.Gas chromatography-mass spectrometry (GC-MS) technology was used for data acquisition after the serum sample thawinged at the room temperature and pretreated.The software of the GC-MS instrument was available for denoising,peak detection and peak area integral.Principal components analysis(PCA) model and partial least squares-discriminant analysis(PLS-DA) model were established by Matlab2011 software after the data standardized.The potential biomarkers were screened by t-test.Results The differences of the serum metabolites between sepsis neonates and non-sepsis neonates in PCA and PLS-DA model were visible.Compared with the control group by t-test,the experimental group had increased in the contents of glucose,lactic acid,urea,pyruvic acid,phenylalanine,and decreased in the contents of leucine,isoleucine,alanine,glutamine,palmitic acid,palmitoleic acid,linoleic acid,stearic acid.The sensitivity,specificity,Youden's index,compliance rate of the discriminant composited by the above metabolites were 93.33％,100.00％,0.9333 and 96.66％.Conclusions GC-MS technology can be used to detect the neonatal sepsis.The discriminant formed by the above metabolites can be used for the diagnosis of neonatal sepsis.

Risk factors for hydrocephalus after periventricular-intraventricular hemorrhages in premature infants / 中华实用儿科临床杂志

Objective To study the risk factors for secondary hydrocephalus after periventricular-intraventricular hemorrhage(PVH-IVH) in premature infants.Methods From Jun.2007 to Jun.2012,214 premature infants who were admitted to the Neonatal Intensive Care Unit after birth were enrolled and head ultrasonography showed PVH-IVH from 3 to 7 days after birth.They were classified into PVH-IVH alone group (n =161) and secondary hydrocephalus after PVH-IVH group (n =53) based on the different prognosis.Single factor and multivariate Logistic regression analysis were used to identify risk factors for secondary hydrocephalus after PVH-IVH.Results Single analysis indicated 8 factors associated with hydrocephalus after PVH-IVH,including male,gestational age ＜ 28 weeks,birth weight ＜ 1000 g,severe asphyxia,PVH-IVH Ⅲ or Ⅳ,metabolic acidosis,hyponatremia,and hypoglycemia or hyperglycemia (all P ＜0.05) ;multivariate Logistic regression analysis showed that male (OR =3.317),severe asphyxia (OR =13.838),PVH-IVH Ⅲ or Ⅳ (OR =43.281),and hyponatremia (OR =2.731) were independent risk factors for hydrocephalus after PVH-IVH (all P ＜ 0.05).Conclusions Male,severe asphyxia,PVH-IVH Ⅲ or Ⅳ,and hyponatremia are closely related to hydrocephalus after PVH-IVH in preterm infants.After PVH-IVH,these clinical risk factors should be followed closely in the prevention of hydrocephalus.

Comprehensive management strategy for critical newborns with transposition of great arteries / 中华实用儿科临床杂志

Objective To summarize the clinical experience of comprehensive management of critical newborns with transposition of great arteries (TGA) by neonatologists and cardiac surgeons.Methods Seventeen critical newborns with TGA rescued by combined efforts of neonatologists and pediatric cardiac surgeons from Oct.2010 to Oct.2012were retrospectively analyzed.Results Of the 17 newborns(14 cases were male,3 cases were female),9 cases were TGA with ventricular septal defect(TGA/VSD),8 cases TGA with intact ventricular septal defect (TGA/IVS).The babies aged from 1-45 days,weighed from 2.7-4.6 kg at operation.Of the 9 cases TGA/VSD babies,3 cases were treated with prostaglandins E (PGE) for hypoxemia correction and selective operation opportunity ;2 cases underwent emergency arterial switch operation (ASO) for severe cardiac shock.All of the 8 cases TGA/IVS babies received PGE treatment preoperatively for life threatening hypoxemia,and 4 cases of them underwent emergency ASO.There were 12 cases delayed sternal closure and 5 cases of them were emergency babies.Peritoneal dialysis was employed for 6 cases and extracorporeal membrane oxygenation (ECMO) for l case.There were 6 cases with postoperative incision infection,including 5 emergencies.Thirteen newborns survived and 4 cases died at hospital:one case complicated with postoperative septicemia and severe mediastinitis which leaded to pericardium patch rupture and fatal pulmonary arterial hemorrhage;one case with abnormal inferior vena cava connection and severe low cardiac output syndrome;one case with disseminated intravascular coagulation (DIC) due to septicemia and severe mediastinitis postoperatively,one case with abnormal coronary artery during surgery and difficult coronary artery transplantation and insufficient blood supply after aorta was open.Conclusions Correcting hypoxemia and stabilizing the severe babies are critical in NICU to avoid emergency surgery.Emergent ASO is the optimized medical therapy for those with persistent severe hypoxemia and heart failure.

Bedside diode laser photocoagulation for 103 cases with serious retinopathy of prematurity in NICU / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of the bedside diode laser photocoagulation for severe retinopathy of prematurity in neonatal intensive care unit (NICU).</p><p><b>METHOD</b>Data of 103 patients with prethreshold or threshold retinopathy of prematurity (ROP), treated with diode laser photoablation after vecuronium-induced anesthesia and mechanical ventilation from March 2009 to July 2011 in NICU of Bayi Children's Hospital.</p><p><b>RESULT</b>Totally 199 eyes in 103 patients received laser therapy with at least 5 months follow up. Among these eyes, zone I disease was found in 76 eyes (38.2%) of 39 infants, zone II disease was found in 123 eyes (61.8%)of 64 infants and additional disease was found in 180 eyes of 91 infants. After treatment 191 (96.0%) of 199 eyes had favorable outcomes and 8 developed to partial retinal detachment. The rate of favorable outcomes in zone I diseases and zone 2 diseases were 89.5% and 100% respectively. The laser therapy was undertaken in all patients safely and the use of ventilator was stopped quickly [after a mean of (6.7 ± 1.3) h].</p><p><b>CONCLUSION</b>Bedside laser photocoagulation in NICU is a safe and effective treatment mode for severe ROP and should be used widely.</p>

Lung ultrasound for diagnosis of neonatal atelectasis / 中华儿科杂志

<p><b>OBJECTIVE</b>The diagnosis of neonatal atelectasis (NA) is usually based on clinical manifestations and chest X-rays, lung ultrasounds are not included in the diagnostic work-up of NA.Recently, ultrasounds have been used extensively and successfully in the diagnosis of many kinds of lung diseases, but few studies have addressed NA. The aim of this study was to evaluate the ultrasound imaging features of NA-and to evaluate the value of lung ultrasound in diagnosing NA.</p><p><b>METHOD</b>From May, 2012 to June, 2013, 40 newborn infants with NA and another 40 neonates without lung disease were enrolled into this study.Lung ultrasound was performed at the bedside by a single expert physician.In a quiet state, the infants were positioned in supine, side or prone postures. The lung field was divided into three areas by the anterior auxilary and posterior auxilary line. The regions of the bilateral lungs were scanned by the probe which was vertical or parallel with the ribs, then compared the results with conventional chest X-ray findings.</p><p><b>RESULT</b>(1) The main ultrasound imaging features of neonatal NA include lung consolidation with air bronchograms, pleural line abnormalities and A-line disappearance. Besides, lung pulse and lung sliding disappearance could be seen by real-time ultrasound. (2) The sensitivity of lung ultrasound for diagnosis of NA was 100%, while it was only 70% for conventional chest X-rays.</p><p><b>CONCLUSION</b>Use of ultrasound to diagnose NA is accurate and reliable, the sensitivity was superior to that of conventional chest X-ray examination, which also has many other advantages including easy-operating, non-ionizing, can be performed at the bedside, therefore, ultrasonic can provide important value for clinicians.</p>

Diagnostic and therapeutic methods for perioperative children with congenital heart disease with airway stenosis in pediatric intensive care unit / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the diagnostic and therapeutic methods for perioperative children with congenital heart disease (CHD) with airway stenosis in pediatric intensive care unit (PICU).</p><p><b>METHOD</b>Fiberoptic bronchoscopy was used for the diagnosis of 100 CHD cases in PICU who were clinically considered to have possible airway malformation because of complicated difficult-to-control lung infection, atelectasis and failure with the ventilator after surgery from January 2010 to October 2011. Cases who were confirmed to have severe airway stenosis by bronchoscopy and weaning from the ventilator after surgery were treated with balloon expandable stents into the desired position in the bronchoscopy.</p><p><b>RESULT</b>There were 73 cases (73%) of CHD patients with airway abnormalities, including 31 cases of severe stenosis (31%), moderate stenosis in 29 cases (29%), mild stenosis in 13 cases (13%). Nine of the 10 children in whom the mechanical ventilation was hard to be stopped after surgery because of severe airway stenosis were weaned from mechanical ventilation successfully by fiberoptic bronchoscopy, while one case died from primary disease with severe sepsis after the placement of bronchial stents.</p><p><b>CONCLUSION</b>CHD children with difficult-to-control lung infection, atelectasis and failure with ventilator after surgery are often complicated with airway abnormalities. The therapeutic bronchoscopy with airway stent can be used for cases with weaning from the ventilator because of severe airway stenosis.</p>

Therapeutic effect of Ommaya reservoir implantation on hydrocephalus in premature infants following intraventricular hemorrhage and factors associted with the therapeutic effect / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of Ommaya reservoir implantation on hydrocephalus in premature infants following intraventricular hemorrhage (IVH) and to investigate factors influencing the therapeutic effect.</p><p><b>METHODS</b>An ambispective cohort study was conducted on the clinical and follow-up data of 20 premature infants (gestational age <32 weeks, birth weight <1500 g) who received Ommaya reservoir implantation because of hydrocephalus following IVH. The therapeutic effect of Ommaya reservoir implantation was observed. These patients were divided into cure and treatment failure groups according to their treatment outcomes. The factors influencing therapeutic effects were investigated by univariate analysis.</p><p><b>RESULTS</b>Hydrocephalus was relieved significantly at 30 days after Ommaya reservoir implantation. However, some patients showed significantly decreased therapeutic effects since 3 months after operation: during 3-6 months after operation, 7 cases underwent ventriculoperitoneal shunt, 4 cases discontinued treatment because of economic reasons, and 1 case underwent endoscopic third ventriculostomy due to scalp hematoma with skin necrosis. The ventricles of the remaining 8 cases returned to normal size at 12-18 months after operation. As for postoperative complications, secondary IVH was seen in 8 cases, intracranial infection in 2 cases, and scalp hematoma with skin necrosis in 1 case. The univariate analysis revealed significant differences in gestational age, birth weight and duration of hydrocephalus before Ommaya reservoir implantation between the cure and the treatment failure groups (P<0.05).</p><p><b>CONCLUSIONS</b>Ommaya reservoir implantation has a remarkable short-term therapeutic effect on hydrocephalus in premature infants following IVH, but later the effect decreases in some patients. Low gestational age, low birth weight and long duration of hydrocephalus may be the main factors influencing therapeutic effects of Ommaya reservoir implantation.</p>

Research progress in cytokines and signaling pathways for promoting pulmonary angiogenesis and vascular development / 中国当代儿科杂志

With the advances in pre- and post-natal medical care, the incidence of bronchopulmonary dysplasia (BPD) is on the rise, while its pathogenesis remains not clear. New BPD theory shows that the core pathogenesis of BPD is simple alveolar structure and pulmonary microvascular abnormalities that eventually lead to reduced pulmonary gas exchange, so the research on pulmonary microvascular development was gradually taken seriously. Pulmonary angiogenesis and vascular development require the participation of various cytokines and signaling pathways, the most important of which include VEGF/VEGFR pathway, Ang/Tie pathway, Ephrins/Eph pathway, and Notch/Jagged1 pathway. These cytokines and signaling pathways play important roles in pulmonary vascular development.

Clinical application of proportional assist ventilation in very low birth weight infants with ventilator dependence / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of proportional assist ventilation (PAV) on physiology and respiratory mechanics in very low birth weight (VLBW) infants with ventilator dependence by comparison with conventional assist/control (A/C) ventilation.</p><p><b>METHODS</b>Forty-six infants with ventilator dependence were randomly divided into two groups according to the ventilation model: PAV (n=23) and A/C (n=23). The gain of resistive and elastic unloading was set based on the runway method in the PAV group. Ventilation parameters were set based on the conventional method in the A/C group. Infants were observed for 30 minutes three times per day for three consecutive days. Arterial gas analysis results, transcutaneous saturation of oxygen (SPO2), heart rate, blood pressure (BP), respiratory rate (RR), mean airway pressure (MAP), peak inspiratory pressure (PIP), tide volume (VT), minute volume (MV) and oxygenation index (OI), were compared between the two groups.</p><p><b>RESULTS</b>Compared with the A/C group, PaO2 and OI in the PAV group were significantly higher while PIP and MAP were significantly lower. There were no significant differences in FiO2, SPO2, pH, PaCO2, PEEP, VT, MV and RR between the two groups. Although mean arterial blood pressure and heart rate in the PAV group were not different from the A/C group, beat-to-beat variabilities in systolic and diastolic arterial blood pressure were significantly lower in the PAV group than in the A/C group.</p><p><b>CONCLUSIONS</b>PAV may safely maintain gas exchange at lower airway pressures compared with A/C ventilation in VLBW infants. It can also improve oxygenation and infant-ventilator synchronization.</p>