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Objective To study the clinical characteristics,diagnosis and clinical outcomes of neonatal purulent meningitis in southwest and northwest regions of China.Method There were 5 tertiary hospitals in southwest and northwest regions of China with well capacity of treating neonatal diseases collaborated as the neonatal meningitis network.From January 2010 to December 2014,clinical symptoms,signs and outcomes of cases with the diagnosis of neonatal meningitis were retrospectively studied.Result During the study period,a total of 63 514 neonates were admitted to 5 neonatal departments in Chongqing and Shanxi Province,China,and 407 cases were diagnosed of bacterial meningitis.255 (62.7％) cases were males.The mean gestational age was (37.1 ±3.2) weeks.125 (30.7％) were preterm infants and69 late-preterm infants.The mean birth weight was (2 859 ± 771) g,90 (22.1％) cases were low birth weight infant.The incidence of neonatal purulent meningitis were 0.64％ (From 2010 to 2014,0.30％,0.72％,0.64％,0.89％ and 1.12％ respectively),and 77.6％ of the cases were the late-onset infection.The mortality rate were 9.1％ (From 2010 to 2014,6.3％,4.0％,9.8％,8.4％ and 8.5％ respectively).The incidence of neurological sequelae was 5.9％ (From 2010 to 2014,12.5％,8.0％,6.1％,6.3％ and 11.6％ respectively).The mean duration of hospital stay was 21 days.Mean duration of antibiotic treatment was 19 days.The remission rate was 85.0％ (346/407).Conclusion From 2010 to 2014,on average,the incidence of neonatal purulent meningitis was 0.64％,mortality rate was 9.1％,neurological sequelae was 5.9％,and remission rate was 85.0％.Among these years the mortality and neurological sequelae of neonatal purulent meningitis were not decreasing.
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Microbiota is closely related to human health and diseases,while it is affected by many factors in neonates.We summarized our primary research on gut microbiota and the associated neonatal diseases.Pathogenic bacteria may cause neonatal ventilator associated pneumonia (VAP) by the form of biofilms.Straptococcus spp.,commonly seen in neonatal oropharynx,facilitate pathogenic process through secretion of autoindueer-2 (AI-2).Significantly increased Proteobacteria and decreased Firmicutes in gut tissues and feaces in neonates with necrotizing enterocolitis (NEC) are associated with deficiency of short chain fatty acids (SCFAs)and impaired differentiation of regulatory T cells (Treg).One-week empirical antibiotic therapy for neonatal early-onset septicemia may remarkably affect the diversity of gut microbiota in early life,which is likely to damage the intestinal mucosal barrier.Obvious deficiency of intestinal Bacteroides in newborns born abdominally will delay the establishment of a healthy and balanced intestinal flora.
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Objective To study the etiologies of long duration fever in neonates and to provide clinical evidence for early diagnosis and intervention. Methods From January 1st, 2004 to December 31st, 2013, data from neonates admitted to the Department of Neonatology, Childrenˊ s Hospital of Chongqing Medical University were retrospectively analyzed. Results Among 238 neonates with long duration fever, 165 cases were male and 73 female. Pneumonia(n = 196), skin / mucosa infection (n =67), sepsis (n = 46), meningitis/ encephalitis (n = 25) and neonatal necrotizing enterocolitis (n = 24) were the most common etiologies. Diabetes insipidus was the only noninfectious cause of fever in this study. The incidence of high fever in cases diagnosed with meningitis/ encephalitis, sepsis, diabetes insipidus, immunodeficiency or urinary tract infection were significantly higher than other causes (P <0. 05) . Continuous fever or other special fever types were more common in cases diagnosed with pneumonia ( χ2 = 4. 581, P = 0. 032 ) . Incidences of sepsis, infectious diarrhea or meningitis/encephalitis in late neonates were significantly higher than early neonates ( P < 0. 05 ) . Conclusions Long duration fever in neonates is most likely caused by infectious diseases and diabetes insipidus is the only noninfectious cause of neonatal fever in our study.
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Neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) is an autosomal recessive disease caused by SLC25A13 gene mutations, and is characterized by delayed jaundice clearance, liver dysfunction, and elevated aminoacidemia. The confirmed diagnosis depends on gene analysis. Citrin deficiency is one of the important causes of neonatal intrahepatic cholestasis in China. Recently more and more researches about NICCD were reported. The paper summarized the epidemiology, pathogenesis, clinical characteristics, and progresses in diagnosis and treatment of NICCD.
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Obgective To analyze the demographic data,non-specific items,pathogens and antibiotic sensitivity between the children with early-onset and late-onset sepsis,in order to guide the diagnosis and treatment of neonatal sepsis.Methods Three hundred and fifty-two cases with positive blood culture were retrospectively recruited and divided into an early-onset group and a late-onset sepsis group according to the onset of sepsis.Results Of 352 cases,144 cases (40.91％) were the early-onset children while 208 cases (59.09％) were the late-onset children,and in the late-onset group,108 cases occurred due to nosocomial infection.Most neonates of the early-onset term were term infants [107/144 cases (74.31％)],while the preterm infants [77/208 cases (37.02％)] and low birth weight infants[70/208 cases(33.65％)] accounted for the majority of the late-onset group.The asphyxia,perinatal intrauterine distress,meconium-staining amniotic fluid and premature rupture of fetal membranes ≥ 18 h occurred more frequently in the early-onset group [21/144 cases (14.58％),14/144 cases (9.72％),26/144 cases (18.06％),31/144 cases (21.53％)],respectively,while those in the late-onset group were [17/208 cases (8.17％),9/208 cases(4.33％),13/208 cases(6.25％),17/208 cases(8.17％)],respectively,there were significant differences (x2 =4.622,3.886,5.950,13.345,all P ＜ 0.05) between 2 groups.In the early-onset group abnormal temperature[72/208 cases(34.62％)vs 30/144 cases(20.83％)],vomiting or abdominal distention[109/208 cases (52.40％) vs 35/144 cases (24.31％)],lethargy [79/208 cases (37.98％) vs 38/144 cases (26.39 ％)] and umbilicalitis or skin pustule [33/208 cases (15.87 ％) vs 11 / 1 44 cases (7.64 ％)] occurred more frequently in late-onset group,and there were significant differences (x2 =7.853,8.763,5.153,5.265,all P ＜ 0.05).Besides,more cases in the late-onset group had elevated immature neutrophil vs total neutrophil count ratio [27/184 cases (14.67％)] and C-reactive protein value [76/206 cases (36.89％)],compared with those in early-onset group [9/133 cases (6.77％),38/143 cases(26.57％)],and there were significant differences (x2 =4.794,4.087,allP ＜ 0.05).Compared with early-onset group,patients in the late-onset group were more likely to suffer from suppurative meningitis [17.79％ (37/208 cases) vs 8.33％ (12/144 cases);x2 =6.348,P ＜ 0.05].In terms of pathogens,the main pathogens in the early-onset group were gram negative bacteria[39.58％ (57/144 cases),including detection of Klebisella pneumoniae in 21 cases and E.coli in 20 cases] and coagulase negative staphylococcus[32.64％ (47/144 cases)].In late-onset group,the main pathogens were gram positive bacteria [58.65％ (122/208 cases)],including detection of coagulase negative staphylococcus in 90 cases(43.27％) and E.coli [17.79％ (37/208 cases)].There was no significant difference in prognosis between 2 groups(x2 =1.187,P =0.552).Conclusions Early-onset sepsis and late onset sepsis differ in the clinical manifestation and laboratory findings.Distinguishing neonatal early-onset and late onset septicemia is of clinical significance in choosing appropriate antibiotics.
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BACKGROUND:It is particularly important to establish an ideal animal model of pulmonary fibrosis to investigate the underlying pathogenesis and screen effective drugs to prevent and control pulmonary fibrosis. OBJECTIVE: To establish a modified scheme of establishing mouse models that can reflect pulmonary fibrosis formation in humans. METHODS: Fifty-six male C57BL/6 mice were randomly divided into two groups: A (a single large-dose injection) and B (multiple smal-dose injections). Mice in group A were subjected to a single intravenous injection of bleomycin 200 mg/kgviathe tail vein; and mice in group B received intravenous injections of bleomycin 50 mg/kg via the tail vein per week, totaly for 6 weeks.
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Objective To evaluate the significance of routine blood test and C‐reaction protein(CRP) ,procalcitonin(PCT ) in early diagnosis of neonatal septicemia .Methods Totally 95 cases of confirmed septicemia ,158 cases of the clinical diagnosis of sep‐ticemia and 160 cases of non‐septicemia who were admitted to Newborn Diagnosis and Treatment Center of Children′s Hospital of Chongqing Medical University from January 2013 to May 2014 were enrolled for this study .The routine blood test ,CRP and PCT concentration of the three groups were analyzed .Taking blood culture as the gold standard ,receiver operating characterristic (ROC) curve was drawn ,sensitivity and specificity of single or combined indicator in early diagnosis of septicemia was analysed .Results There was a significant difference between confirmed septicemia group and non‐septicemia group in PCT ,CRP ,WBC ,I/T ,PLT (P< 0 .05) ;the area under the ROC curve(AUC) was 0 .892 ,0 .847 ,0 .828 ,0 .700 ,0 .681 ,respectively ;the five indicators for con‐firmed the diagnosis positive rate of septicemia group and non‐septicemia group was statistically significant (P < 0 .05) ;the single indicator PCT had better diagnosis value ,its sensitivity and specificity was 84 .2% and 66 .9% .With the application of regression of binary Logistic the AUC of combining PCT ,CRP ,WBC was 0 .974 ,its sensitivity and specificity was 94 .7% and 87 .5% ,which was higher diagnosis value than the only one indicator alone .Conclusion The combination of PCT ,CRP and WBC have contribute to early diagnosis of neonatal septicemia .
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Objective To investigate the effect of EDTA combined with ciprofloxacin on Pseudomonas aeruginose biofilm in vivo.Methods Pseudomonas aeruginosa was inhaled into the lung of guinea pigs and colonized,formed biofilm.After 7 days,the model was treated with ciprofloxacin,EDTA alone,or a combination of both for 7 days.The number of colony in the lungs is measured by agar plate.The pathological change of the lung is observed by hematoxylin and eosin (HE) staining and scanning electron microscope.Results EDTA combined with ciprofloxacin make the number of bacteria in the lungs reduced from l05 CFU/g to 10 CFU/g(t =24.67,P＜0.05),the lung lesion was less-sever histophathologically.Conclusion The combination of EDTA with ciprofloxacin has significant activity to remove mucoid PA biofilm in vivo.
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Self-directed learning(SDL)is an important learning form for the future educational development and the continued medical education.SDL facilitates the learning effects of advanced studying doctors in neonatology.This article investigates the major developments and influencing factors relative to self directed learning,and provides insight into the practice and progress of self directed learning of the advanced studying doctors in neonatology.
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Objective To investigate the clinical value of color Doppler flow imaging(CDFI) in the diagnosis and clinical follow-up of retinopathy of prematurity(ROP).Methods From March 2008 to February 2009,98 eyes of 49 premature infants(gestational age≤37 weeks,or birth weight≤2 000 g) underwent ROP screening by RetCam digital retinal camera and indirect ophthalmoscopy in the fourth to sixth postnatal week.At the same time,they were also examined by 8-14 MHz CDFI.Results Determined by RetCam digital retinal camera and indirect ophthalmoscopy,ROP was found in 41 eyes,including 8 eyes at stage Ⅰ,19 eyes at stage Ⅱ,6 eyes at stage Ⅲ,8 eyes at scarring stage and no eye at stage Ⅳ andⅤ.Compared with ophthalmologic examination,the specificity of CDFI for ROP diagnosis was 85.5%,and the sensitivity was 76.7%.Detected by CDFI,typical changes were not found in the infants with ROP at stage Ⅰ.In the infants with ROP at stage Ⅱ and Ⅲ,abundant blood flow signals were found in the central retinal artery(CRA).Increased amounts of the small vessels and irregular circuitousness were also observed.There was no obvious change in the systolic velocity(VS) of CRA.The diastolic velocity(Vd) was decreased and the resistance index(RI) was increased.A strong zonal echo protruded into the vitreum.Small blood flow signals which came from CRA by tracing toward their distal end were found in the same position using CDFI.Conclusions Detected by CDFI,the sonographic features of infants with ROP at stage Ⅰ are not typical,but those of infants with ROP at stage Ⅱ and Ⅲ are specific.CDFI is valuable in clinical ROP screening of high risk group.
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Objective To study computed tomography (CT) in evaluating prognosis for hypoxic ischemic encephalopathy (HIE) in infants. Methods Eighty-five infants diagnosed as HIE underwent CT one week,two months,three to six months and one to one and a half years after birth,respectively. At the same time,neonatal behavior neurological assessment (NBNA) was made at 12 to 14 days after birth. Development quotient (DQ) was used to evaluate their prognosis at age of 1 to 1.5 years. Results Rate of poor prognosis was 40.9% (9/22) in the infants with severe HIE by CT and 5.7% (3/52) in those with moderate HIE within one week after birth. Rate of poor prognosis was 60.0% in the infants with abnormal CT at age of two months. There was no significant difference in their prognosis for infants of moderate HIE with NBNA scores greater than or equal to 35 and less than 35,12 to 14 days after birth. And,72.7% (8/11) of the infants with severe HIE by CT with NBNA less than 35 showed little recovery at 12th-14th days after birth. Conclusions Combination of CT and clinical follow-up with NBNA score one month after birth could play an important role in the evaluation for therapy regime,length of treatment and prognosis in the infants with HIE.
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Objective:To investigate the epidemiological characteristics of bacteria and their susceptibility to antimicrobials and to establish a basis for empirical treatment of the neonatal infections. Methods:Identification of bacteria were performed according to the National Standard of Clinical Microbiological Test. Disk diffusion were used for antimicrobial susceptibility test. Results: A total of 2,244 strains were isolated from the samples collected in our neonatal ward from Jan. 1987 to Dec. 1998. The predominant species ranked the first three were Staphylococcus epidermidis, Staphylococcus saprophyticus and Escherichia coli in the group I (infections acquired outside of hospital). Escherichia coli, Klebsiella and pseudomonas aeruginosa ranked the first three in the group Ⅱ(nosocomial infections). The resistance rates of bacterial isolates from group Ⅱ to antimicrobial agents including penicillin and ampicillin were significantly higher than that from group I (P＜0.05). The sensitivity rate was 82.2% by using amikacin only, but raised to 89% when combined with penicillin. Conclusion: Gram-negative bacteria were the main pathogens of nosocomial infections of neonates in our hospital but Gram-positive bacteria were the main pathogens of infections acquired outside of hospital. The nosocomial pathogens were more prone to developing drug resistance. It is recommended that the combinative use of amikacin and penicillin be employed as primary antibiotics for treatment of neonatal infections.
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Objective: To improve the traditional preparation procedure of effervescent tablets in order to raise stabilization. Methods: The orthogonal design was used for improvement of process. Results: The optimum procedure condition was A 3B 2C 1. That is adding 7.5% citric acid, 11.25% sodium bicarbonate encapsulated by 5% PEG. Conclusion: The new procedure is superior to the traditional procedure, and it is suitable for the requirement of production on a large scale.
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Objective To explore whether the neurons induced from mesenchymal stem cells(MSCs) have synapse function or not.Methods Passage 4-5 MSCs in good shape was induced by Salvia miltiorrhiza with optimized protocol for several times,and then the observation under inverted phase contrast microscope,immunofluorocytochemistry and the measurement of neurophysiological function were carried out.Ca2+ influx and synapse function were detected with laser-scanning confocal microscopy(LSCM),taking 50 mmol/L KCl as stimuli to evoke action potential.Results The cells that had been induced for 5 h at 4th time from MSCs,looked like neurons and displayed that the processes stretched out to form complex net.Immunofluorocytochemistry presented that the rate of TUJ-1 expression was(96.7?2.8)% and that of synaptophysin was(96.2?2.1)%.When the neuron-like cells were stimulated by high concentration of KCl,intracellular Ca2+ influx enhanced quickly.When the neuron-like cells were stimulated by high KCl solution for the first time,SynaptoRed-C2 anchored onto the membrane,and after the second excitation,the fluorescence intensity decreased quickly.Conclusion The neuron-like cells derived from MSCs that are induced by salvia miltiorrhiza with optimized protocol have synapse function.
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Objective To observe the effect of ambroxol on the structure of Pseudomonas aeruginosa biofilm (BF) in an established biofilm model in vitro. Method Mature BF was formed after 7 days′ culture of Pseudomonas aeruginosa on plate. The BF structure was observed by scanning electron microscope (SEM). The parameters of BF structure were analyzed though pictures from confocal laser scanning microscopy (CLSM) with Image Structure Analyzer (ISA) software. Fluorescence intensity of the viable bacteria in BF treated by ambroxol alone and together with ciprofloxacin were determined with fluorescence microscopy. Results After the treatment of ambroxol, the BF was destroyed and the matrix outsides became thin and abnormal compared with the control by SEM, and small amount of bacteria dispersed. The results of ISA showed that with the treatment of 2 mg/ml ambroxol, BF was decreased in thickness, average diffusion distance (ADD) and textual entropy (TE) were decreased in comparison with the group without ambroxol treatment (P
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Objective To explore the distribution and differentiation of bone mesenchymal stem cells (MSCs) in the brain of neonatal rats with hypoxic ischemic encephalopathy (HIE). Methods MSCs were isolated and purified by adhering to the culture glassware wall and prelabeled with bromodeoxyuridine (BrdU) for 72 h before transplantation. The model of HIE was established. At 24 h after hypoxic ischemia, approximate 4?10 6 cells were injected into the brain of neonatal rats with HIE through the right side bregma. The Nestin, neuron specific enolase (NSE) and glial fibrillary acid protein (GFAP) were detected by immunofluorochemistry at 4 weeks after injection. Results Majority of MSCs were distributed in the cortex, hippocampus of the lesioned hemisphere. The number of MSCs was (2781?254) in the left hemisphere, but (4708?281) in the right hemisphere. There was significant difference (t=18.70, P0.05). The expression ratio of NSE was (3.79?0.95)% in the left hemisphere, but (5.69?1.48)% in the right hemisphere (t=3.404, P0.05). Conclusion MSCs are mainly distributed in the lesioned hemisphere and can differentiate into neuronal-like cells, express the mark of neural stem cells, neurons and neuroglial cells at 28 d after intracortical transplantation.