Effect of red blood cell storage duration on the clinical effect of exchange transfusion and internal environment in neonates with hyperbilirubinemia / 中国当代儿科杂志

OBJECTIVE@#To study the effect of red blood cell (RBC) storage duration on the clinical effect of exchange transfusion (ET) and internal environment in neonates with hyperbilirubinemia.@*METHODS@#A retrospective analysis was performed for the clinical data of 135 neonates with hyperbilirubinemia who received ET between January 2015 and August 2018. According to RBC storage duration, the neonates were divided into short-term storage group (RBCs were stored for ≤7 days) with 56 neonates and long-term storage group (RBCs were stored for >7 days) with 79 neonates. The two groups were compared in terms of serum total bilirubin (TBIL) level and the rate of TBIL reduction at 0 and 12 hours after ET, as well as the duration of continued phototherapy and rate of repeated ET. Routine blood test parameters, electrolytes, blood glucose, and blood gas parameters were measured before ET and at 0 hour after ET.@*RESULTS@#At 0 hour after ET, there were no significant differences in the TBIL level and the rate of TBIL reduction between the two groups (P>0.05). At 12 hours after ET, the long-term storage group had a significantly higher TBIL level and a significantly lower rate of TBIL reduction than the short-term storage group (P7 days in ET for neonates with hyperbilirubinemia does not affect the immediate effect of ET, but these neonates tend to have a poor outcome after continued phototherapy and high risk of hyponatremia, hyperkalemia, and metabolic acidosis.

Pathogen distribution, risk factors, and outcomes of nosocomial infection in very premature infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the pathogen distribution and risk factors of nosocomial infection in very preterm infants, as well as the risk of adverse outcomes.</p><p><b>METHODS</b>A retrospective analysis was performed for the clinical data of 111 very preterm infants who were born between January and December, 2016 and had a gestational age of <32 weeks and a birth weight of <1 500 g. According to the presence or absence of nosocomial infection after 72 hours of hospitalization, the infants were divided into infection group and non-infection group. The infection group was analyzed in terms of pathogenic bacteria which caused infection and their drug sensitivity. A multivariate logistic regression analysis was used to investigate the potential risk factors and risk of adverse outcomes of nosocomial infection in very preterm infants.</p><p><b>RESULTS</b>Gram-negative bacteria were the main pathogens for nosocomial infection in very preterm infants and accounted for 54%, among which Pseudomonas aeruginosa was the most common one; the following pathogens were fungi (41%), among which Candida albicans was the most common one. The drug sensitivity test showed that Gram-negative bacteria were highly resistant to β-lactam and carbapenems and highly sensitive to quinolones, while fungi had low sensitivity to itraconazole and high sensitivity to 5-fluorocytosine and amphotericin B. Early-onset sepsis, duration of peripherally inserted central catheter, steroid exposure, and duration of parenteral nutrition were risk factors for nosocomial infection in very preterm infants (P<0.05). Compared with the non-infection group, the infection group had significantly higher risks of pulmonary complications (P<0.05), as well as a significantly longer length of hospital stay and a significantly higher hospital cost (P<0.001).</p><p><b>CONCLUSIONS</b>Nosocomial infection in very preterm infants is affected by various factors and may increase the risk of adverse outcomes. In clinical practice, reasonable preventive and treatment measures should be taken with reference to drug sensitivity, in order to improve the prognosis of very premature infants.</p>

Intracerebral transplantation of human umbilical cord-derived mesenchymal stem cells in neonatal rat model of hypoxic-ischemic brain damage: protective effect to injured brain / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the brain protection and the possible mechanism of human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) in neonatal rat model of hypoxic-ischemic brain damage (HIBD).</p><p><b>METHODS</b>Successfully establishing a neonatal rat model of HIBD, hUC-MSCs labeled with BrdU were transplanted into the lateral ventricle 24 hours after HIBD. The number of apoptotic cells and the expression of Caspase-3 were detected by TUNEL and Western blot respectively at 24 and 48 hours after transplantation. The neurological functions of HIBD rats were evaluated by Longa score, and the survival, differentiation and pro-differentiation effects of hUC-MSCs were identified by immunofluorescence at 1 to 3 weeks after transplantation.</p><p><b>RESULTS</b>At 24 and 48 hours after transplantation, apoptotic cells and Caspase-3 expression in the MSCs group were less than in the HIBD group (P<0.05). At 2 and 3 weeks after transplantation, the Longa score in the MSCs group was lower than in the HIBD group (P<0.05). After transplantation, positive cells labeled with BrdU were seen in the brain tissue. The expression levels of glial fibrillary acidic protein (GFAP) and neuron specific esterase (NSE) in the MSCs group were higher than in the HIBD and sham-operated control groups (P<0.05), and increased gradually with the transplantation time (P<0.05).</p><p><b>CONCLUSIONS</b>hUC-MSCs transplantation in HIBD rats can inhibit Caspase-3 expression and reduce apoptotic cells in the early stage, and in the later period, the survival hUC-MSCs can differentiate into neural-like cells and promote the differentiation of endogenous neural-like cells, providing protective effects to brain.</p>

Latest study progress of umbilical cord-derived mesenchymal stem cells treating neonatal hypoxic-ischemic brain damage / 中华实用儿科临床杂志

Severe neonatal hypoxic-ischemic encephalopathy (HIE)can result in serious outcomes including death during the newborn period and permanent neuropsychological handicaps in the form of cerebral palsy,learning disability,epilepsy and so on.So far,there have been no effective treatments in clinical practice.Stem cell transplantation therapy brings new hope for HIE treatment.Among them,umbilical cord-derived mesenchymal stem cells have many advantages such as rich source,easy collection,shorter doubling time,lower immunogenicity and long-term survi-val after transplantation,it will have a broad application prospects as a cell source for the treatment of neonatal HIE.

Pathogens and risk factors for ventilator-associated pneumonia in neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the pathogens, drug sensitivity and risk factors for ventilator-associated pneumonia (VAP) in neonates.</p><p><b>METHODS</b>Retrospective analysis was performed on the clinical data of 401 neonates who were admitted to the neonatal intensive care unit and received mechanical ventilation for 48 hours or longer from January 2008 to February 2012. Eighty-five of the 401 neonates suffered VAP.</p><p><b>RESULTS</b>The main pathogens for VAP were Gram-negative bacteria (97%), including Klebsiella pneumoniae (51%), Acinetobacter baumannii (17%) and Escherichia coli (12%) as the three most frequent ones. The drug sensitivity test showed that these pathogens developed resistance to amoxicillin, amoxicillin/clavulanic acid, piperacillin, ceftazidime, cefazolin, and cefotaxime, with a susceptibility rate of below 15%, and demonstrated decreased sensitivity to imipenem and meropenem, with a susceptibility rate of below 75%. The independent risk factors for neonatal VAP included birth weight (OR=1.399, P<0.05), duration of mechanical ventilation (OR=1.966, P<0.01), length of hospital stay (OR=1.812, P<0.01), times of tracheal intubation (OR=2.056, P<0.01), and 1 min Apgar score (OR=2.146, P<0.01).</p><p><b>CONCLUSIONS</b>The incidence of neonatal VAP is influenced by many factors. The main pathogens for neonatal VAP are Gram-negative bacteria and antibacterial agents should be properly used according to drug sensitivity test results. Comprehensive prevention and control measures should be taken to reduce the incidence of VAP.</p>