Incidence and risk factors of acute kidney injury in preterm infants: a multicenter retrospective study / 中国小儿急救医学

Objective:To estimate the incidence and risk factors of acute kidney injury (AKI) in preterm infants, and provide basis for better evaluation and treatment of renal function in preterm infants.Methods:All the hospitalized premature infants who were admitted to three research centers (Department of Neonatology at Beijing Children′s Hospital; Department of Neonatology at Beijing Obstetrics and Gynecology Hospital; Department of Neonatology at Shunyi Maternal and Children′s Hospital of Beijing Children′s Hospital)from January 1, 2017 to June 30, 2019 and had more than two serum creatinine values or urine output were included.The incidence of AKI in preterm infants was calculated and the difference among different gestational weeks was compared.Preterm infants were divided into AKI and non-AKI groups according to AKI diagnostic criteria, and the clinical characteristics between two groups were compared, and the risk factors of AKI in preterm infants were analyzed.Results:A total of 763 premature infants were included in the analysis.Twenty two cases were diagnosed with AKI.The incidence of AKI in premature infants was 2.9%.The incidence of AKI was 33.3% (3/9), 3.7% (5/134), and 2.3% (14/620) in the 24-27 + 6 weeks, 28-31 + 6 weeks, and 32-36 + 6 weeks gestational age, respectively, and the difference was statistically significant ( χ2=31.010, P<0.001). Preterm infants in AKI group had a higher proportion of males(77.3% vs. 53.3%), lower gestational weeks[29(27, 33) weeks vs.31(29, 33)weeks], higher proportions of infants with diabetic mothers(40.9% vs.19.4%), lower Apgar scores at 1 and 5 minutes[8(7, 10) vs.9(8, 10), 9(9, 10) vs.10(9, 10), respectively], higher proportions of invasive and noninvasive respiratory support(45.5% vs.11.3%, 63.6% vs.19.2%, respectively), longer duration of invasive respiratory support[260(136, 742)h vs.72(18, 160)h], longer hospital stays[66(19, 88)d vs.42(26, 58)d], and higher rates of sepsis (27.3% vs. 6.5%), respiratory distress syndrome(40.9% vs. 11.6%), and patent ductus arteriosus that requiring ibuprofen or surgical closure(13.6% vs. 3.0%), diuretic(27.3% vs. 3.9%), and vasoactive drug use (22.7% vs. 3.6%) than those in non-AKI group, and the differences were statistically significant(all P<0.05). Multivariate regression analysis showed that sepsis was an independent risk factor for AKI in preterm infants ( P=0.039, OR=3.498, 95% CI 1.065-11.490) after adjustment of gestational age and birth weight. Conclusion:The incidence of AKI is relatively high in preterm infants with gestational age<28 weeks.Compared with preterm infants without AKI, preterm infants with AKI have smaller gestational weeks and longer hospital stay.Sepsis is an independent risk factor for AKI in preterm infants.

Exploration and reflection on diagnostics online teaching / 中华医学教育探索杂志

In order to ensure the normal teaching order during the prevention and control of the COVID-19 epidemic, the second semester of the 2019-2020 academic year in Central South University was devoted to the online teaching. In response to the school's call, the diagnostics teaching team has applied the Tencent classroom software, WeChat mini programs, analog teaching software and digital curriculum platform to carry out online teaching activities. On the basis of summarizing the previous online teaching experience, we have made a preliminary discussion and reflection on the online teaching, which will provide ideas and directions for the reform of medical education.

Epidemic features of coronavirus disease 2019 in Hunan Province / 中南大学学报(医学版)

OBJECTIVES@#To explore and analyze the epidemic features of coronavirus disease 2019 (COVID-19) in Hunan Province from January 21, 2020 to March 14, 2020, as well as to investigate the COVID-19 epidemics in each city of Hunan Province.@*METHODS@#The epidemic data was obtained from the official website of Hunan Province's Health Commission. The data of each city of Hunan Province was analyzed separately. Spatial distribution of cumulative confirmed COVID-19 patients and the cumulative occurrence rate was drawn by ArcGIS software for each city in Hunan Province. Some regional indexes were also compared with that in the whole country.@*RESULTS@#The first patient was diagnosed in January 21, sustained patient growth reached its plateau in around February 17. Up to March 14, the cumulative confirmed COVID-19 patients stopped at 1 018. The cumulative occurrence rate of COVID-19 patients was 0.48 per 0.1 million person. The number of cumulative severe patients was 150 and the number of cumulative dead patients was 4. The mortality rate (0.39%) and the cure rate (99.6%) in Hunan Province was significantly lower and higher respectively than the corresponding average rate in the whole country (0.90% and 96.2%, Hubei excluded). The first 3 cities in numbers of the confirmed patients were Changsha, Yueyang, and Shaoyang. While sorted by the cumulative occurrence rate, the first 3 cities in incidence were Changsha, Yueyang, and Zhuzhou.@*CONCLUSIONS@#The epidemic of COVID-19 spread out smoothly in Hunan Province. The cities in Hunan Province implement anti-disease strategies based on specific situations on their own and keep the epidemic in the range of controllable.

A multicenter survey of short-term respiratory morbidity in late-preterm infants in Beijing / 中华实用儿科临床杂志

Objective:To study the respiratory morbidity and the risk factors of respiratory complications in late-preterm infants.Methods:The data of 959 late-preterm infants in 21 hospitals in Beijing from October 2015 to April 2016 were collected.These infants were divided into the respiratory morbidity group (237 cases) and the control group (722 cases) according to whether they had short-term respiratory morbidity after birth.Clinical data of the two groups were compared.Results:Among the 959 late-preterm babies, 530 were male and 429 were female.Two hundred and thirty-seven cases (24.7%) developed short-term respiratory morbidity after birth.Infectious pneumonia developed in the most cases (81 cases, 8.4%), followed by transient tachypnea (65 cases, 6.8%), amniotic fluid aspiration (51 cases, 5.3%), and respiratory distress syndrome (24 cases, 2.5%) successively.All the infants recovered and discharged.There were no differences between gender and maternal age between 2 groups (all P>0.05). Compared with the control group, more late-preterm infants were delivered by cesarean section (73.4% vs.59.7%, χ2=14.43, P<0.001) and the 1-minute Apgar score was lower [(9.41±1.66) scores vs.(9.83±0.53) scores, t=5.40, P<0.001] in the respiratory morbidity group.The differences were statistically significant.There were more cases with maternal complications in the respiratory morbidity group that in the control group (66.7% vs.58.6%, χ2=4.877, P=0.027), but no difference in various complications between 2 groups was observed ( P>0.05). In the respiratory morbidity group, the most frequent complications were maternal hypertension and preeclampsia (27.8% vs.22.6%, χ2=2.728, P=0.099). There were no differences between 2 groups in gestational age, birth weight and birth length (all P>0.05). There were more infants small for gestational age and large for gestational age in the respiratory morbidity group than in the control group (18.8% vs.14.1%, 6.3% vs.2.4%, χ2=8.960, P=0.011). The duration of hospitalization of the respiratory morbidity group was significantly longer than that of the control group [(9.00±4.42) d vs.(6.82±4.19) d, t=6.676, P<0.001] since the infants with respiratory morbidity needed to be hospita-lized. Conclusions:Respiratory diseases occur in about 1/4 of late-preterm infants.Infants who are delivered by cesarean section and whose mothers are complicated with the maternal hypertension and preeclampsia should be monitored closely.Respiratory support should be provided for infants not appropriate for gestational age who are more likely to suffer from respiratory diseases, so that they can successfully pass through the transition period.

A multi-center research on risk factors of hyperbilirubinemia in late preterm infants / 中华全科医师杂志

Objective To investigate the risk factors of hyperbilirubinemia in late preterm infants. Methods The clinical data of 815 late preterm infants (449 males and 366 females) from 25 hospitals in Beijing were collected from October 2015 to April 2016, including 340 cases(41.7％) with hyperbilirubinemia (hyperbilirubinemia group), and 475 cases without hyperbilirubinemia (control group). The clinical data of two groups were compared, and the maternal factors influencing hyperbilirubinemia in late preterm infants were analyzed with logistic regression. Results There were no significant differences in gender ratio (M:F 1.39 vs. 1.12, t=1.811,P=0.172)and birth weight[(2502.6±439.6)g vs. (2470.2±402.9)g,χ2=2.330,P=0.127)]between two groups. The incidence rates of hyperbilirubinemia in infants of 34 wks, 35 wks and 36 wks of gestational age were 22.9％(87/174), 35％(119/300) and 42.1％(143/341) respectively (χ2=1.218,P=0.544). The multivariate logistic regression analysis indicated that the maternal age(OR=1.044,95％ CI:1.010-1.080,P=0.011)was independent risk factor and multiple births(OR=1.365,95％CI:0.989-1.883,P=0.048), premature rupture of membranes(OR=2.350,95％ CI:1.440-3.833,P=0.001), cesarean section(OR=1.540,95％CI:0.588-4.031,P=0.014)were risk factors for hyperbilirubinemia in late preterm infants. Conclusions The incidence of hyperbilirubinemia in late preterm infants is relatively high. Maternal age, multiple births, premature rupture of membranes and cesarean section are risk maternal factors related to hyperbilirubinemia in late preterm infants.

Comparison analysis of clinical features of varicella in pregnant women and outcomes of mothers and their newborns / 中华传染病杂志

Objective To investigate the clinical features of varicella and the prognosis in pregnant women and their newborns .Methods Clinical data of pregnant women with varicella zoster virus (VZV) infection (n= 25) and their newborns hospitalized in Beijing Ditan Hospital from 1st Jan .2008 to 31st Dec .2014 were retrospectively analyzed and randomly compared to non‐pregnant women with VZV infection (n=50) .Clinical features and prognosis of varicella in pregnant women and their infants were analyzed .Chi‐square test was used for categorical data and t test was used for quantitative data .Results Time to rash scab of varicella in pregnant women was longer than non‐pregnant women ([10 .1 ± 2 .1] d vs [5 .6 ± 1 .4] d ,t=10 .941 ,P<0 .05) .The rate of bacterial infection in pregnant women was higher than non‐pregnant varicella women (72 .0% [18/25] vs 32 .0% [16/50] ,χ2 = 10 .761 , P < 0 .05) , with statistical significance .Among 25 cases of varicella pregnant women ,the pregnancy complications were observed in 3 cases of diabetes ,2 cases of premature rupture of membranes ,5 cases of anemia and 1 case of oligoamnios .Seven cases out of 25 pregnant women underwent parturition during fever and varicella period ,and 3 cases (12 .0% ) were complicated with intrapartum hemorrhage . Twenty five varicella pregnant women were all cured after antiviral and supportive treatment and gave birth to their babies ,with no abortion ,stillbirth or birth defects .No congenital varicella was observed in newborns .Of the 25 infants ,4 developed (16 .0% ) varicella within 2 weeks after birth and they were all born from mothers who developed varicella around delivery time .The clinical features of neonatal varicella presented with classic rash with no fever .The time to rash scab was longer (11 .0 ± 2 .1) d and antibody test for VZV was negative .All neonates were cured after antiviral and immunoglobulin treatment .Conclusions Longer duration of skin rash scab and higher rate of bacterial infections are the features of varicella in pregnant women .Intrapartum hemorrhage occurrs more commonly in pregnant women with varicella onset around delivery time .Varicella occurring during mid‐pregnancy may not increase the risk of neonatal birth defects after treatment .The newborns whose mothers with varicella onset during perinatal time especially around delivery time may suffer from varicella .The prognosis of neonatal period varicella is good after treatment .

Dynamic changes and the significance of T-cell subsets and serum soluble interleukin-2 receptor in neonates with hyperbilirubinemia / 中华围产医学杂志

Objective To investigate the dynamic changes and the clinical significance of T-cell subsets and serum soluble interleukin-2 receptor (sIL-2R)in neonates with hyperbilirubinemia.Methods Thirty-one neonates with hyperbilirubinemia, admitted to the hospital from Decembr 1,2006 to January 31, 2007, were enrolled and divided into two subgroups: severe jaundice group and mild jaundice group according to the bilirubin level. Thirty-two age-mached healty newborns were as controls(control group Ⅰ). The T-cell subsets and sIL-2R of peripheral venous blood samples from these neonates were measured and compared. Sixteen of these 31 neonates with hyperbilirubinemiawere followed up and another twenty-six age-mached healty newborns were as controls(control group Ⅱ ). The level of serum bilirubin in convalescence of sixteen hyperbilirubinemia neonates and control group Ⅱ were tested and analyzed also. Results The levels of CD3, CD4, CD4/CD8 in the neonates with hyperbilirubinemia were lower compared with those of control group Ⅰ [(54.0±5.1)% vs (62.0±4.7)%, (26.8±5.0)% vs (43.0±4.7)%, 0.8±0.1 vs 1.4±0.2] (P＜0.01), but was higher in convalescence than in peak phase[ (62.4±3.3)% vs (55.1±4.2)%, (43.6±2.5)% vs (26.1±4.4)%, 1.4 ± 0.1 vs 0.8±0.1] (P＜0.01). The peak level of sIL-2R in the hyperbilirubinemia group was (319.4± 185.2) kU/L, higher than that in the convalescence [(129.7±99.3) kU/L] and in the control group Ⅱ [(171.9±102.2) kU/L] (P＜0.01). The serum bilirubin level showed negative correlation with CD4/CD8 ( r = -0.99, P ＜ 0.01 ) and positive correlation with sIL-2R (r=0.95, P＜0.05). The sIL-2R level was negatively correlated with CD4/CD8 (r=-0.92, P＜0.05). Conclusions Neonates, when suffering from hyperbilirubinemia, are immunosuppressed which may recover with the alleviation of jaundice.

Clinical study on peripheral T lymphocyte subsets in children with hand-foot-and-mouth disease / 中华传染病杂志

Objective To evaluate the dynamic changes of T lymphocyte subsets in children with hand-foot-and-mouth disease(HFMD)and to provide new evidence for the therapy and prognosis.Methods Peripheral venous blood samples of 346 HFMD cases in acute stage who were hospitalized in Beijing Ditan Hospital from May 1,2008 to August 31,2008 were collected and T lymphocyte subsets were assayed by flow cytometer.Meanwhile,T lymphocyte subsets of 67 HFMD cases in recovery phase were also detected.The pathogens were determined by reverse transcriptionpolymerase chain reaction(RT-PCR)using pharynx swab samples from 99 cases.Different samples were compared by independent-sample t test,paired t test or variance analysis.Results The average levels of T lymphocyte subsets of HFMD children in different agc groups were all lower than reference levels of healthy children in according age groups.In severe cases.T lymphocyte(TL)/lymphocyte (L)ratio in all age groups,helper T cell(Th)/L ratio in children older than 1 year,TL,Th and Th/suppressor T cell(Ts)ratio in children of 1-2 years old were all lower than those in common eases (P＜0.05).The Th/L ratio tended to increase with the disease progression.Ratios of TL/L and Th/L in common cases were increased in recovery phase(TL/L:56.3±8.6 vs 61.1±9.1,t=2.56,P＜0.05;Th/L:30.2±7.2 vs 34.9±7.9,t=2.90,P＜0.05)and all indices of severe cases except Ts/Lratio and Th/Ts ratio increased apparently in recovery phase(P＜0.01).TL[(1.738±0.976)×10~6/Lvs(2.696±1.946)×10~6/L,t=2.17,P＜0.05],Th/L ratio(25.9±7.0 vs 30.2±7.2,t=2.34,P＜0.05),Th[(0.864±0.550)×10~6/L vs(1.459±0.879)×10~6/L,t=2.90,P＜0.01]and L[(3.352±1.458)×10~6/L vs(4.664±2.435)×10~6/L,t=2.32,P＜0.05]of severe cases in acute phase were all lower than those of common cases(P＜0.05),while those were not significantly different in recovery phase between two groups(P＞0.05).The T lymphocyte subsets of enterovirus(EV)71 positive cases were lower than EVT1 negative cases,but there was no significant difference between these two groups(P＞0.05).Conclusion T lymphocyte immune responses may be correlated with HFMD onset and progression.

Immune responses of infants born to HBsAg positive mothers after combined passive immunoprophylaxis and active immunoprophylaxis / 中华传染病杂志

Objective To evaluate the immune responses and its dynamic changes of the babies born to hepatitis B surface antigen (HBsAg) positive mothers after combined passive immunoprophylaxis and active immunoprophylaxis. Methods Two hundred and forty-nine infants born to HBsAg positive mothers were enrolled. All of these infants have received both passive immunoprophylaxis by injecting hepatitis B immunoglobuin (HBIG) and active immunoprophylaxis by vaccinated with hepatitis B vaccine simultaneously 12 hours after birth. After that, all infantscompleted the whole vaccination program. The titers of serum HBsAg and hepatitis B surface antibody (HBsAb) of the infants were checked at 7, 12, 24 and 36 months after birth. The data was analyzed by chi square test. Results Infants born to HBsAg positive mothers showed various immune response modes. The no response rate, low response rate and strong response rate were 8.0% (20/249),11.7% (29/249) and 80.3% (200/249) respectively in the 7-month infants, which were 10.8% (12/120), 26.7% (32/120) and 62.5% (75/120) respectively in 12-month infants. The results from further follow-up showed that no response rate, low response rate and strong response rate were 14.8% (4/27), 33.3% (9/27) and 51.9% (14/27) respectively in the 24-month babies and were 14.3 (1/7), 28. 6% (2/7) and 57.1% (4/7) respectively in the 36-month babies. There were statistically significant difference between the 7-month infants group and other groups (x2= 21.98,P＜0.01). The HBsAb titers of high-response infants group declined over time. The infants with higher antibody titers tended to not decline or decline more slowly. In infants who have even achieved HBsAb titers higher than 1000 mIU/mL, 57.6% (19/33) of them showed decreased titers in 36 months. The titer decrease peaked at 24 month after birth (57.9%, 11/19). In infants who have achieved HBsAb titers of 100 to 1000 mIU/mL, 73.8% (31/42) of them showed decreased titers in 36 months. The titer decrease peaked at 12 month after birth (54.8%, 17/31). HBsAg positive infants usually showed no response at 7 month, who accounted for 70% (14/20,x2 = 128.61, P＜0.01) of all no response infants. Ninety-nine percent (189/191) of HBsAg negative infants showed strong responses. The infants born to both HBsAg positive and hepatitis B e antigen (HBeAg)positive mothers tended to show no response. However, the difference between these infants and others was not statistically significant (9.1% vs 5.5%,x2 =0.24,P＞0.05). Conclusions The immune responses of infants born to HBsAg positive mothers after combined passive and active immunoprophylaxis change over time. The non-response status is usually found in HBsAg positive infants. HBsAg negative infants usually show strong response. Infants born to both HBsAg positive and HBeAg positive mothers tend to show low response. It is recommended to follow standard immunoprophylaxis procedure. The follow-up and active monitor are very important during 7 months to 2 years after birth.

Serological changes for syphilis in infants born to treated syphilitic mothers / 中华围产医学杂志

Objective To explore the serological variations for syphilis in infants delivered by treated syphilitic mothers and its influencing factors. Methods Totally, 146 singleton gravidas, who had been treated for syphilis during pregrancy from January 2006 to January 2008 in our hospital, were chosen. Rapid plasma reagin(RPR) and treponema pallidum particle agglutination assay (TPPA) of these mothers before delivery and of the newborns within 3 d after delivery were tested and 92 of the 146 babies were followed up until the age of 24 months. Results (1) Among the 146 neonates, 104 (71.2%) were positive for both RPR and TPPA and 140 (95.9%) TPPA positive only. The RPR positive rate in neonates born to RPR+ + TPPA+ mothers were higher than those born to TPPA+ (only) mothers (81.4% vs 36.4%,χ2 = 25. 3, P<0. 01). 90.4% of the RPR+ neonates (94/104) showed lower or equivalent RPR titers compared to their mothers. (2) Among the 92 babies bein g followed up, the seroreversion of RPR were found in 98. 2%(n = 56) of the 57 babies, who were RPR+ +TPPA+ at delivery, at the 6 months and 100% (n=57) within 8 months, with the peak time within 2 months after birth (78. 9%, n = 45). While, 100% of the babies were found to be TPPA-within 24 mo with the peak time at 10～18 mo (64. 9%, n = 37). For those babies with TPPA+ at delivery, all turned to be TPPA- at 18 mo, with the peak time at 6 ～ 12 mo (57. 1%, n = 20). (3) The seroreversion time of babies with maternal RPR between 1:1～1:4 was later than those with maternal RPR (P<0.05). The seroreversion time of babies with maternal RPR titer of 1:4 was longer than those with maternal RPR titer of 1 > 1 [(2.5±0.8) mo vs (1. 2±0. 4) mo,P<0. 01]. However, the maternal RPR titer did not affect the TPPA reversion time (P > 0.05). The seroreversion time of RPR in infants with neonatal RPR titer of 1 : 4 was later than those with neonatal RPR titer of 1:1 [(3.7±0. 9) mo vs (2. 3±0. 6) mo,P<0. 01], and babies with RPR titer at 1 : 1 - 1 :4 showed longer duration than those with neonatal RPR- in TPPA seroreversion [(11. 2±2. 8) mo, (12.2±2.9) mo, and (11.0±2.2) mo vs ( 6. 9±2. 1) mo, P< 0.01, respectively]. Conclusions Most infants born to syphilitic mothers are serological positive for syphilis despite of standard maternal treatment during pregnancy. Infants, with higher maternal RPR titer during the pregnancy or at delivery, may persist to be serological positive for syphilis for a longer perieod, but all will turn to negative finally. Long term follow up is recommended for serological positive infants, and the diagnosis of congenital syphilis should be cautious.

Study on in vivo antioxidant effect of TPD in Rosmarinus officinalis / 中草药

Object To investigate the in vivo antioxidant effect of the extract from Rosmarinus officinalis L. and its active substances. Methods The contents of MDA, the activites of SOD and GSH Px in serum, heart, liver, brain and skeleton muscle were determined in oxidative stress mouse model caused by exercise. Results It was found that in serum, liver, heart and skeleton muscle except the brain, the contents of MDA were decreased and the activities of SOD and GSH Px were increased by 250 mg/kg and 500 mg/kg of total phenolic diterpenes (TPD) extract taken. Conclusion The results showed that R. officinalis has prominent antioxidant effect in exercise mice and the active constituents may be phenolic diterpenes.