Clinical analysis of different types of neonatal sepsis: a multi-center retrospective study / 中国新生儿科杂志

Objective:To study the clinical characteristics of different types of neonatal sepsis.Methods:From January 2012 to December 2019, neonates with confirmed sepsis from 5 neonatal centers of central-south China were reviewed. The neonates were assigned into early-onset sepsis (EOS) and late-onset sepsis (LOS) group, and the latter was further subgrouped into hospital-acquired LOS (hLOS) group and community-acquired LOS (cLOS) group. The etiological and clinical characteristics were analyzed. SPSS 26.0 was used for statistical analysis.Results:A total of 580 neonates were enrolled, including 286 (49.3%) in the EOS group and 294 (50.7%) in the LOS group. In LOS group, 147 were in hLOS group and 147 were in cLOS group. The gestational age and birth weight of hLOS group were significantly lower than the other two groups [(32.7±3.6) weeks vs. (37.1±3.7) weeks and (37.7±3.0) weeks, (1 810±717) g vs. (2 837±865) g and (3 024±710) g] ( P<0.05). The common pathogens in EOS and cLOS groups were coagulase-negative staphylococci and Escherichia coli, while Klebsiella pneumoniae was common in hLOS group. Carbapenems usage in the hLOS group was significantly higher than the other two groups [62.6% vs. 28.7% and 16.2%] ( P<0.05). Antibiotics duration in the hLOS group was longer than the other two groups [19 (14, 27) d vs. 15 (12, 20) d and 14 (12, 19) d] ( P<0.05). Conclusions:The clinical characteristics of neonatal sepsis vary among different types of infections, and it is necessary to establish appropriate prevention, control, diagnosis and treatment protocols.

Effects of human milk on short-term outcomes of very/extremely low birth weight preterm infants / 中华围产医学杂志

Objective To study the effects of human milk on feeding intolerance, infant growth and development, complications during hospitalization and length of hospital stay in very/extremely low birth weight (VLBW/ELBW) preterm infants. Methods VLBW/ELBW preterm infants admitted to the Division of Neonatology, Children's Medical Center of the Second Xiangya Hospital from May 2015 to April 2018 were enrolled in this retrospective study and were assigned into two groups: human milk group (human milk accounted for at least 50% of total enteral feeding during hospitalization) and formula group (exclusive formula feeding due to breastfeeding contraindication or insufficient human milk supply). Feeding intolerance, neonatal growth, complications and length of hospital stay were compared between the two groups using independent sample t-test, Mann-Whitney U test and Chi-square test (or Fisher's exact probability test). Results A total of 113 VLBW/ELBW infants were enrolled consisting of 52 in the human milk group and 61 in the formula group. The starting time of enteral feeding, duration of minimal enteral feeding and incidence of feeding intolerance were similar between the two groups (all P>0.05). The increasing rate of milk volume was (8.4±1.6) ml/(kg·d) in the human milk group and (7.6±1.4) ml/(kg·d) in the formula group (t=2.853, P<0.05). The length of parenteral nutrition of the human milk group was shorter than that of the formula group [(29.3±7.6) vs (33.0±7.9) d, t=－2.570, P<0.05], so was the time to full enteral feeding [(30.0±7.8) vs (34.9±8.8) d, t=－3.076, P<0.05]. No significant difference was found in the average weight gain, increment in head circumference or body length, the length of regaining birth weight, or the incidence of extrauterine growth restriction between the two groups (all P>0.05). The incidence of neonatal necrotizing enterocolitis (NEC) in the human milk group was lower than that of the formula group [1.9% (1/52) vs 11.5% (7/61), χ2=3.894, P<0.05]. No statistical difference in the incidence of sepsis, cholestasis, anemia, bronchopulmonary dysplasia (BPD), retinopathy of prematurity or periventricular leukomalacia was observed between the two groups (all P>0.05). There were 14 cases (26.9%) of BPD in the human milk group, of which eight were mild and six moderate. While in the formula group, 24 cases (39.3%) had BPD and among them, four, 18 and two infants were mild, moderate and severe BPD, respectively. BPD cases in the human milk group were less severe than those in the formula group (U=－2.645, P<0.05). The length of hospital stay of the human milk group was shorter than that of the formula group [(47.5±14.8) vs (53.9±16.3) d, t= － 2.129, P<0.05)]. Conclusions Human milk for VLBW/ELBW infants may shorten the time to full enteral feeding and the length of hospital stay, reduce the incidence of NEC, decrease the severity of BPD. VLBW/ELBW infants fed with fortified human milk have similar growth rate as those fed with formula milk.

Metabolic bone disease in the preterm newborn:an update on prevention and treatment / 国际儿科学杂志

Metabolic bone disease is one of the common complications in preterm neonates,which has important influence on the quality of life,even increases the risk of adulthood osteoporosis. Early diagnosis and therapy are important for the improvement of outcome of preterm neonates. This article reviews the progress of prevention and treatment of metabolic bone disease in preterm neonates.

Effect of intrauterine growth retardation on gluconeogenic enzymes in rat liver / 中南大学学报(医学版)

Objective: To investigate the expression of gluconeogenic enzymes phosphoenolpyruvate carboxykinase (PEPCK) and G-6-Pase mRNA of hepatic tissue in rats with intrauterine growth retardation (IUGR) and to explore the molecular mechanism of insulin resistance in IUGR rats. Methods: Pregnant rats were randomly divided into 2 groups: a normal group and a model group. hTe normal group were fed with 21% protein forage and the model group with 10% low protein forage to obtain IUGR pup rats. hTe pup rats were introduced to the normal group and the IUGR group prospectively. At 1, 3 and 8 weeks, the body weight, blood glucose, insulin concentration andinsulin resistance index of the pup rats were measured. Expression of PEPCK and G-6-Pase mRNA were detected by RT-PCR. Results: The birth weight of the IUGR group was significantly lower than that of the normal group (P0.05). The hepatic expression of PEPCK and G-6-Pase mRNA in the IUGR group was significantly higher than that of the normal group at 1, 3 and 8 weeks (P<0.01). Conclusion: The significantly increased expression of PEPCK and G-6-Pase mRNA of hepatic tissue in IUGR rats may increase gluconeogenesis, which is probably one of the molecular mechanisms of insulin resistance and diabetes in IUGR.

Relationship between serum leptin and bone speed of sound in appropriate-for-gestational-age neonates / 临床儿科杂志

Objective To investigate the changes of serum leptin and bone speed of sound (SOS) with gestational age (GA) and relationship between leptin and bone SOS in appropriate-for-gestational-age (AGA) neonates. Methods A total of 65 AGA neonates were recruited and divided into three groups according to their gestational age:preterm infant (GA 31-34 w, 14 cases), late preterm infant (GA 34-37 w, 13 cases), and full-term infant (GA≥37 w, 38 cases). Anthropometric parameters, including birth weight, length, leg length, skin fold thickness were measured in all the subjects, and the neonatal nutritional status and body fat content were evaluated by Ponderal Index (PI) and Weststrate equation (F%) respectively. Serum leptin concentration and tibial SOS were measured within 7 days after birth. Results There were signiifcant differences in GA (F=140.199, P<0.001), birth weight (F=47.042, P<0.001), birth length (F=46.877, P<0.001), leg length (F=17.543, P<0.001), PI (F=11.898, P<0.001) and F%( F=21.955, P<0.001) among three groups. Serum leptin and tibial SOS were signiifcantly different among these groups ( F=49.724, 20.052 respectively, P<0.001), and both of them were positively correlated with gestational age and birth weight (P<0.01). In addition, leptin was positively correlated with tibial SOS, but the correlation disappeared after adjustment for GA and anthropometry. According to the multivariate forward stepwise regression analysis, tibial SOS was found to be signiifcantly positively associated with gestational age and birth weight in the three groups. Conclusions Both bone SOS and serum leptin are signiifcantly correlated with gestational age and birth weight in AGA neonates, and leptin is related with but not the independent direct predictor of bone SOS.

Progress in mechanism of insulin resistance related to intrauterine growth retardation / 国际儿科学杂志

Fetal origins of adult disease,the thrifty phenotype hypothesis, nutritional programming,metabolic programming indicate that nutrition in early life is important.Epidemiological survey demonstrates that insulin resistance is relataed to intrauterine growth retardation,but the exact mechanism is indefinite.This article is about the influence of intrauterine growth retardation to the structure and function of pancreas,and the genes that related to insulin resistance.

Changes of skeletal muscle structure and insulin resistance in low birth weight rat / 中华内分泌代谢杂志

To study the changes in skeletal muscle structure and insulin resistance of low birth weight rats.The low birth weight filial rat model was established by feeding low protein diet to the pregnant rat during gestation.At 7 d,21 d,and 2 months,blood glucose and serum insulin were measured,and the structure of skeletal muscle was observed.From 7 d to 2 months,the muscle fibers of low birth weight rat were atrophic and arranged in disorder.The ultrastructure of skeletal muscle was also abnormal distinctly at 2 months.No differences of blood glucose and rerum insulin were found between the two groups.

Clinical Investigation on Ganciclovir Applied to Treat Neonatal Congenital CMV Infection / 中国医师杂志

Objective To evaluate therapeutic effects of ganciclovir on neonatal congenital CMV infection.Methods 40 cases of neonatal congenital CMV infection was divided into experimental group with ganciclovir(n=18) and control group with general treatment(n=22).The patients of experimental group were treated with higher dosage of ganciclovir:induced treatment 7 5mg/kg,intravenous drip every 12 hours,continous using for 14 days,then maintenance treatment,10mg/kg intravenous drip every day,for 3-day every week,maintenance treatment 2～3months.The patients of control group was treated with routine mehtod.Later on clinical situation,laboratory examination and virology result were compared in the two groups.Result There were significantly differences of clinical situation,laboratory examination and virology test result between posttreatment and pretreatment in experimental group(P0 05).Conclusions Using higher dosage,full course ganciclovir treating neonatal congenital CMV infection have remarkably efficacy in early the disease at the onset,so can be widespread in clinical practice.

INFLUENCE OF L-ARGININE SUPPLEMENTATION ON RENAL FUNCTION AND MECHANISM IN NEONATAL RATS WITH INTRAUTERINE GROWTH RETARDATION / 营养学报

Objective To observe the influence of L-Arg supplementation during early postnatal life on renal function of rats with intrauterine growth retardation(IUGR).Mehod Afer establishment of IUGR model with 10% protein diet,rats were divided randomly into 2 groups: IUGR group and L-Arg treated group(LT group).Normal control group(NC group) rats were fed with 20% protein diet.The level of NO,Cr in serum were measured from 1 w to 3 months and UCr,24 h-proteinuria were measured from 3 w to 3 months.Results(1)The levels of serum NO reduced significantly in group IUGR at every stage,not significantly different between group LT and NC,but more in group LT than in group IUGR.(2)The levels of 24h-proteinuria had no significant difference among three groups at 3 w and 2 month,but was significantly higher in group IUGR than group LT and group NC.(3)The Cr levels had no significant difference at every stage among three groups.The UCr level was decreased in group IUGR than group NC at 2 month and than group NC and LT at 3 month.(4)The level of CCr in group IUGR was decreased significantly at 3 w,2 month and 3 month than group LT and group NC.Conclusion L-Arg can increase serum NO and CCr levels and decrease the level of 24h-proteinuria in rats with IUGR.It is one of the important reasons to increase 24h-proteinuria and reduce CCr level for low NO value.