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.

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>

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.

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>

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>

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.

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>

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>

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>