Clinical features and short-term outcomes of 14 cases of neonatal limb thrombosis / 中国小儿急救医学

Objective:To summarize the risk factors, clinical manifestations, diagnosis and treatment of limb thrombosis in neonates.Methods:The clinical data of 14 neonates with limb thrombosis were hospitalized in neonatology department at Shengjing Hospital of China Medical University from February 2012 to February 2022 were retrospectively analyzed.Results:All the 14 cases of limb thrombosis were premature infants, with an average gestational age of 29 weeks and 5 days(27 weeks and 3 days to 33 weeks and 1 day), including eight cases of arterial embolism and six cases of venous embolism.Among them, 13(92.9%) cases were diagnosed with infectious diseases such as septicemia or neonatal necrotizing enterocolitis within 48 hours before embolization, and all had a history of peripheral arterial and venous catheterization.During the early stage of embolization, limb artery embolism was characterized by weakened distal artery pulsation, pale skin, gradual cyanosis and even gangrene.Limb venous embolism was manifested as limb swelling, skin congestion and cyanosis, but the arterial pulsation was normal.Fourteen cases were confirmed by vascular ultrasound.All the eight cases with arterial embolization were treated with heparin anticoagulation, five of which were cured, with an effective rate of 62.5%.The average time of heparin use in five cases was 2.5 days(2-3 days). One patient was not effective after 2 days of heparin treatment, and recovered after thrombectomy.Another two cases had distal limb gangrene, and them were treated with heparin for 5 days and 7 days.All of the six cases with venous embolism were cured, of which four cases were treated with heparin for an average of 8.5 days(4-15 days), and the other two cases were cured after general treatment.There were no bleeding events in the 12 infants treated with heparin.Conclusion:Peripheral arterial and venous catheterization during infection of preterm infants is the most common cause of limb thrombosis.The smaller body weight and gestational age, the thinner blood vessels, the higher risk of occurrence.Vascular ultrasound is the most commonly used examination method for neonatal thrombosis, and heparin anticoagulant therapy is the most commonly used treatment measure.When the treatment effect of heparin is not good, other treatment methods should be sought.

Clinical characteristics and risk factors of neonatal adrenal hemorrhage / 国际儿科学杂志

Objective:To explore the clinical characteristics and risk factors of neonatal adrenal hemorrhage(NAH), and to improve the understanding, diagnosis and treatment of this disease.Methods:In this study, a retrospective nested case-control study was used to collect clinical data of neonates diagnosed with NAH from January 2011 to December 2021 in the Department of Neonatology, Shengjing Hospital of China Medical University, and telephone follow-up were conducted for them.NAH infants with manifestations of neonatal hyperbilirubinemia were selected as the case group, and the random number table method was used to select the neonatal hyperbilirubinemia infants with NAH excluded by imaging in the same period at a ratio of 1: 2 as the control group.Characteristics of the clinical data of the two groups were compared and analyzed by Logistic regression to explore the risk factors of NAH.Results:During the study period, a total of 31 cases of NAH were diagnosed, with an average gestational age of(37.6±2.2) weeks, including 19 males, 25 full-term infants, 6 cases with macrosomia, 30 cases with natural labor, 29 cases with hyperbilirubinemia, 8 cases with birth injury, 7 cases with asphyxia, 9 cases with bilirubin encephalopathy, 12 cases with sepsis, 13 cases with intracranial hemorrhage, 17 cases with anemia, 9 cases with respiratory disease, 5 cases with hyperkalemia, 6 cases with hyponatremia.The results of NAH ultrasonography showed that 8 cases of hematoma had medium and low echoes, 6 cases of mixed echoes, and 17 cases of liquid flocculent echoes with or without punctate echoes.Color Doppler flow imaging results showed no blood flow signal.There were 26 cases on the right side, 4 cases on the left side, and 1 case on both sides.A total of 26 cases were followed up.Ultrasonography showed that most haematomas were absorbed within 1 to 3 months and disappeared within 6 months.Twenty-nine cases were included in the case group and 58 cases in the control group.Univariate analysis showed that age, birth weight, macrosomia, mode of delivery, bilirubin encephalopathy, neonatal sepsis, abdominal distension, anemia, asphyxia, total bilirubin, indirect bilirubin, Hb and CRP were significantly higher than those in the control group( P<0.05). Multivariate logistic regression analysis showed that macrosomia( OR=7.415, 95% CI=1.342~40.956, P=0.022) and asphyxia( OR=12.075, 95% CI=1.293~112.736, P=0.029) were independent risk factors of NAH. Conclusion:NAH is common in naturally born full-term infants, with a lack of specific clinical manifestations.Unexplained persistent hyperbilirubinemia may be its first symptom, often accompanied by anemia and ion disturbance.A few infants may have adrenal insufficiency.Macrosomia and asphyxia may be the risk factors for the occurrence of NAH.

Comparative analysis of magnetic resonance imaging for purulent meningitis in premature and full term infants / 中华实用儿科临床杂志

Objective:To compare the head magnetic resonance imaging (MRI) changes and the distribution of pathogens of purulent meningitis in premature and full term infants.Methods:This retrospective study assessed clinical data in 43 cases of neonatal purulent meningitis with positive blood or cerebrospinal fluid bacterial culture admitted to the Neonatal Ward of Shengjing Hospital of China Medical University from January 2012 to November 2019.According to the gestational age, those patients were divided into the premature infant group and the full term infant group.The general situation, head MRI and pathogen characteristics of both groups were compared.Results:The incidence of premature rupture of fetal membranes in the premature infant group was higher than that in the full term infant group [50.00%(13/26 cases) vs.5.88%(1/17 cases)], the rate of cesarean section in the premature infant group was higher than that in the term infant group [61.54%(16/26 cases) vs.23.53%(4/17 cases)], and there were significant difference between the 2 groups ( χ2=9.011 and 5.969, respectively, all P<0.05). There was no significant difference between 2 groups in age of onset [(9.8±7.0) d vs.(8.9±5.5) d], diagnosis[(13.0±7.1) d vs.(10.2±6.1) d] and examination [(16.1±7.9) d vs.(13.1±6.5) d] (all P>0.05). The top 3 pathogens were Klebsiella pneumonia ( K. pneumoniae) in 14 cases, Escherichia coli ( E. coli) in 11 cases and Streptococcus agalactiae (GBS) in 7 cases. K. pneumoniae was the most common pathogen in premature infants, and GBS was the most common pathogen in term infants.In the first MRI, white matter injury (WMI) was the most common disease (19 cases), the abnormal rate of MRI in the premature infant group was 65.38% (17/26 cases), the incidence of intracranial hemorrhage in the premature infant group was higher than that in the term infant group, the abnormal rate of MRI in the term infant group was 52.94% (9/17 cases), and the incidence of cerebral infarction in the term infant group was higher than that in the premature infant group.The MRI positive rates of meningitis caused by K. pneumoniae, E. coli and GBS were 57.14% (8/14 cases), 72.73% (8/11 cases) and 71.43% (5/7 cases), respectively.Infants with K. pneumoniae infections suffered from the main complications of WMI and intracranial hemorrhage.Infants infected with E. coli were prone to WMI in the early stage and hydrocephalus in the late stage.Infants with GBS were prone to WMI and cerebral infarction in the early stage and cerebromalacia in the late stage. Conclusions:There were some differences in the distribution of pathogenic bacteria and head MRI changes between premature infants and term infants, and head MRI of purulent meningitis caused by different pathogenic bacteria.A thorough understanding of the distribution of pathogens and the characteristics of head MRI in premature and full term infants contributed to the early diagnosis, treatment and prognosis of this disease.

The expression and effect of DNA damage repair protein NBS1 in neonatal rats with bronchopulmonary dysplasia / 国际儿科学杂志

Objective:To investigate the dynamic expression of DNA damage repair protein Nijmegen breakage syndrome protein 1(NBS1) in the neonatal rats with bronchopulmonary dysplasia(BPD), and its influence on the development and progression of BPD.Methods:Newborn rats were randomly divided into the BPD model group( n=50) and the control group( n=50) within 12 h after birth.The inhaled oxygen concentration was 80%-85% in the model group, and the control group inhaled air.In the two groups, lung tissue samples were collected on days 1, 3, 7, 10 and 14, and isolated, purified and cultured alveolar epithelial type Ⅱ cells(AEC Ⅱ). We observed pulmonary morphological changes under light microscope and evaluated alveolar development degree by radiate alveolar counts(RAC). Immunohistochemistry and cell immunofluorescence were used to observe the localization and expression of NBS1.Western blot and real-time quantitative PCR were used to detect the expression level of NBS1. Results:Compared with the control group, the RAC value in the model group was decreased significantly from 7 d after birth(control group 7.58±1.24, model group 5.42±1.24, P<0.01). Immunohistochemistry showed that NBS1 protein was mainly located in the nucleus of alveolar epithelial cells.In the model group, NBS1 was mainly expressed in the nucleus on the 1st day.With the prolonged exposure time, the number of cytoplasmic staining cells increased and the expression in the nucleus decreased.Cell immunofluorescence farther showed that NBS1 protein was mainly located in the nucleus in AEC Ⅱ.Compared with the control group, cytoplasmic staining in model group was enhanced from 3 d, while nuclear staining was gradually weakened, and was mainly located in the cytoplasm at 14 d. Western blot results showed that the expression of NBS1 protein in the model group peaked at 1 d compared to the control group(control group 0.72±0.29, model group 1.28±0.22, P<0.01), and then gradually decreased, with lower expression at 14 d compared to the control group(control group 0.73±0.19, model group 0.49±0.11, P<0.05). Similarly, the mRNA expression level of NBS1 in the model group peaked at 1 d compared to the control group(control group 1.00±0.00, model group 1.18±0.06, P<0.01), and then gradually decreased, with lower expression at 14 d than that in the control group(control group 1.07±0.13, model group 0.76±0.11, P<0.05). Conclusion:In the neonatal rats with BPD, the down-regulation expression and nuclear enrichment disorder of NBS1 may affect the DNA damage response and be one of the mechanisms mediating the onset of oxidative stress damage in BPD.

Update on the lung function of preterm infants with bronchopulmonary dysplasia / 国际儿科学杂志

Bronchopulmonary dysplasia (BPD) is one of the most common complications of the respiratory system in preterm infants, particularly in infants with the gestational age<32 weeks or the birth weight<1 500 g. The incidence of BPD did not decrease during the last twenty years.It is characterized by alveolar and microvascular dysplasia, presenting with less alveolar counts, enlarged and simplistic structure and slight airway damage.BPD patients may be oxygen-dependent and need repeated mechanical ventilation for a long time after birth.The lung function of BPD patients included normal large airway function, small airway dysfunction and decreased compliance that may last well till adulthood.The incidence of respiratory symptoms like cough and wheeze, as well as respiratory diseases like inflammation and asthma significantly increased, and may even impair growth and the development of the neurological system.In some patients it may develop into the chronic lung disease in adulthood.

Progress in prognostic factors of neonatal seizures / 国际儿科学杂志

Neonatal seizure is one of the most common manifestations of newborns, which could lead to severe neurological sequelae, such as epilepsy, cerebral palsy, developmental delay, mental retardation and even death.The causes of neonatal seizures are the key factors contributing to prognosis.In addition, individual factors, types of seizure and EEG could affect the prognosis in varying degrees.Therefore, for patients with poor prognosis, early diagnosis and treatment could effectively improve the prognosis and reduce the mortality.

The expression and effect of long non-coding RNA H19 in BPD neonatal rats / 国际儿科学杂志

Objective To investigate the expression of long non-coding RNA H19 (LncRNA H19)and its regulation of histone methyltransferase 2 (enhancer of zeste homolog 2,EZH2) in the lung tissue of neonatal rats with bronchopulmonary dysplasia (BPD),and to lay a foundation for elucidating the pathogenesis of BPD lung epithelium-interstitial transformation (EMT).Methods The BPD model of SD neonatal rats was induced by hyperoxia (inhalation oxygen concentration was 85％) (n =50),and oxygen inhalation concentration of the control group was 21％ (n =50).The two groups were collected at ld,3d,7d,14d and 21d after birth in lung tissue.Immunohistochemistry,Western blot,real-time quantitative PCR and other techniques were used to detect the intracellular localization,and the expression level of EZH2 protein and the mRNA expression level of H19 and EZH2.Results Immunohistochemistry showed that EZH2 protein was located in the nucleus and cytoplasm of alveolar epithelial cells,and the expression of EZH2 protein in the model group was significantly enhanced compared with the control group.Similarly,the results of Western blot demonstrated that the expression of EZH2 protein in the model group increased from ld (control group:0.196 ± 0.030,model group 0.650 ±0.149) to 21d (control group 0.934 ± 0.215,model group 1.785 ± 0.298) rather than the control group (P ＜ 0.05).Compared with the control group,the mRNA expression level of H19 in the model group increased from 7d (control group 2.591 ± 0.211,model group 3.558 ± 0.093,P ＜ 0.05) and the expression level of EZH2 mRNA started to increase from 3d (control group 1.246 ±0.015,model group 2.148 ± 0.215,P ＜0.05).Moreover,the differences between the two groups were obvious with the time of hyperoxia exposure.Conclusion In the development of BPD,the expression levels of H19 and EZH2 protein in lung tissue is up-regulated,and the peak of H19 expression precedes EZH2,which suggest that H19 might be involved in the pathogenesis of pulmonary dysplasia induced by EZH2-mediated EMT.

Diagnostic value of abdominal ultrasound for neonatal necrotizing enterocolitis / 中国新生儿科杂志

Objective To study the diagnostic value of abdominal ultrasound for neonatal necrotizing enterocolitis (NEC). Method Neonates diagnosed with NEC admitted to Department of Shengjing Hospital from January 2016 to December 2018 were retrospectively analyzed. They were assigned into NEC stage Ⅱ group and NEC stage Ⅲ group based on the modified Bell-NEC grading criteria. Meanwhile, according to the timing of imaging examination, the patients were assigned into the group within 7 days after the onset of NEC and the group between 8 and 14 days. They were then grouped into conservative treatment group and surgery group. The difference between abdominal X-ray plain film and abdominal ultrasound in the performance of diagnosing NEC within groups were compared. Result A total of 60 patients with NEC were studied, including 38 with NEC stage Ⅱand 22 with NEC stage Ⅲ, among them 14 patients underwent surgery, others had conservative treatment. The average gestational age was (33.3±3.2) weeks and the average birth weight was (2047±831) g. The positive detection rate of pneumatosis intestinalis and hepatic portal venous gas by abdominal ultrasound vs. X-ray plain film in≤7 d group were 38.3％ (23/60) vs. 15.0％ (9/60) (P=0.004) and 15.0％(9/60) vs. 1.7％ (1/60) (P=0.008), respectively, indicating the positive detection rate of abdominal ultrasound was significantly higher than that of X-ray within 7 d after the onset of NEC. However, there was no significant difference in the detection rate between abdominal ultrasound and abdominal X-ray 8～14 d after the onset of NEC (P>0.05). The detection rate of intestinal wall thickening and peritoneal effusion by abdominal ultrasound together with the detection rate of intestinal dilatation and free gas in abdominal cavity by abdominal X-ray plain film in the conservative treatment group were significantly lower than those in the surgery group (P<0.05). Conclusion Abdominal ultrasound can help detecting the characteristic features of NEC (pneumatosis intestinalis and hepatic portal venous gas) in time, which has great value for early diagnosis and assessing severity.

Cord blood vitamin D levels and its relationship to early-onset sepsis in the very low birth weight infants / 中国小儿急救医学

Objective To investigate the association between serum 25(OH) D levels and the inci-dence of early-onset sepsis(EOS) in the very low birth weight infants(VLBWI) and the gestational age be-low 34 weeks. Methods The cord blood of 159 VLBWI were collected between January and December 2017,including 31 clinically diagnosed EOS and 128 non-EOS patients. Serum 25(OH)D<10 ng/ml was de-fined as severe vitamin D deficiency,25(OH)D 10 to 20 ng/ml as vitamin D deficiency,25(OH)D 20 to 30 ng/ml as vitamin D insufficiency and 25(OH)D >30 ng/ml as vitamin D sufficiency. Results There were no differences in gender,gestational age,birth weight and Apgar score between the EOS group and the non-EOS group(P>0. 05). Serum 25(OH) D was(9. 08 ± 4. 21) ng/ml in the EOS group and(11. 91 ± 5. 37) ng/ml in the non-EOS group(P＝0. 007). The rate of severe vitamin D deficiency was 67. 7%(21/31)in the EOS group and 41. 4%(53/128) in the non-EOS group. The rate of vitamin D deficiency was 32. 3%(10/31)in the EOS group and 52. 3%(67/128)in the non-EOS group. But there was no difference of vitamin D deficiency distribution in the two groups(P＝0. 152). The cut-off value of serum 25(OH)D level in predic-ting EOS was 10. 06 ng/ml. Conclusion The incidence of vitamin D deficiency is as high as 95%,calling for urgent attention on vitamin D supplementation in those VLBWI. Low 25(OH)D level( <10 ng/ml)might be predictive of EOS.

Expression of cyclin A2 and its inhibitory factor in BPD neonatal rats and its effect on alveolar development / 国际儿科学杂志

Objective To investigate the effects of cyclinA2 and its inhibitor p21 on alveolar development in bronchopulmonary dysplasia (BPD) neonatal rats.Methods Eighty newborn rats were randomly divided into a model group (FiO2 =80％-85％) and a control group (FiO2 =21％).The degree of alveolar development was evaluated by radial alveolar count (RAC) and alveolar septal thickness.The distribution and expression of cyclinA2 and p21 were detected by immunohistochemistry and Western blot.Results The RAC value of the model group was lower than that of the control group from 3 days.The thickness of the alveolar seprum was higher than that of the control group from 7 days (P ＜0.05).The expression of p21 protein in the model group began to increase from 3d,peaked on 14d,and lasted for 21d.The expression of cyclinA2 protein in model group was higher than that in control group at 14d and 21d (P ＜0.05).There was a negative correlation between RAC and p21 protein expression in model group (r =-0.5966,P ＜0.01),and no correlation with cyclinA2 (r=0.7276,P＞0.05);there was no correlation between RAC and p21 in the control group (r =-0.2929,P ＞ 0.05),and positively correlated with cyclinA2 (r =0.8476,P ＜ 0.01).The alveolar septal thickness of the model group and the control group were both positively correlated with p 21 (r =0.4291,P＜0.05;r=0.4447,P ＜0.05),and negatively correlated with cyclinA2 (r=-0.6814,P ＜0.01;r=-0.7636,P ＜0.01).Conclusion The imbalance of cell cycle regulatory protein cyclinA2 and its inhibitor p21 expression in neonatal rats exposed to hyperoxia may be one of the related factors that interfere with the development of BPD alveoli.

The expression and effect of TRF1 and TRF2 in neonatal rats with bronchopulmonary dysplasia / 国际儿科学杂志

Objective To investigate the dynamic expression of telomere repeat binding factor 1 (TRF1) and telomeric repeat binding factor 2 (TRF2) in the development and progression of bronchopulmonary dysplasia (BPD) in neonatal rats and to clarify its role in BPD alveolar dysplasia.Methods The neonatal rat BPD model (n =40) was induced by using neonatal SD rats with inhaled oxygen concentration of 85％.The control group was prepared by inhaled air (n =40).In the two groups,10 rats were randomly selected from 1 day,3 days,7 days,and 14 days after the experiment.The lung tissue samples were collected,HE staining was performed to observe the pathological changes,and the alveolar development degree was evaluated by radial alveolar counting (RAC).Immunohistochemistry was used to observe the localization and expression of TRF1 and TRF2.Western Blot and real-time quantitative PCR (RT-PCR) were used to detect the expression levels of TRF1 and TRF2 proteins and genes in lung tissue.Results Immunohistochemical staining showed that TRF1 was mainly localized in the nucleus of alveolar epithelial cells and bronchial epithelial cells.TRF2 protein was found in the nucleus and cytoplasm of alveolar epithelial cells and bronchial epithelial cells.The expression was significantly higher than that of the control group.Compared with the control group,the TRF1 and TRF2 proteins increased significantly from 1d (TRF1 in control group:0.163 ±0.022,in model group:0.251 ±0.022;TRF2 in control group:0.156 ±0.012,in model group:0.240 ±0.018) to 14d (TRF1 in control group:0.193 ± 0.024,in model group:0.230 ± 0.025;TRF2 in control group:0.225 ± 0.017,in model group:0.350 ±0.012) rather than the control group (P ＜ 0.05).The mRNA expression levels of TRF1 and TRF2 increased continuously from 1d to 7d of hyperoxia exposure (TRF1 in control group:0.946 ± 0.028,in model group:1.590 ± 0.228;TRF2 in control group:0.834 ± 0.083,in model group:1.783 ±0.262) and decreased at 14d (TRF1 in control group:2.217 ± 0.225,in model group:1.259 ± 0.217,P＜0.05;TRF2 in control group:2.143 ±0.250,in model group:0.997 ±0.199,P ＜0.05).Conclusion In the developmental stage of BPD,TRF1 and TRF2 act as negative regulators of telomere length,and protein levels are up-regulated,which suggest that they be involved in the pathological process of BPD alveolar dysplasia.

Recent outcomes of unexplained neonatal seizure: a retrospective study of clinical features in 47 cases / 国际儿科学杂志

Objective To explore the relationship between features of neonatal seizure and recent outcomes of patients with unexplained neonatal seizure,which may provide evidence for early assessment of prognosis.Methods Forty-seven cases of unexplained neonatal seizure admitted to the Department of Neonatology in Shengjing Hospital of China Medical University from January 2014 to June 2018,were followed-up at the age of more than 6 months.According to the recent outcomes (recurrent seizures during non-neonatal period and levels of development when they were followed-up),the patients were divided into good recent outcomes group (34 cases) and poor recent outcomes group (13 cases).The general information,characteristics of seizure and EEG changes during neonatal period were analyzed retrospectively.Results There was no significant difference in gender,gestational age,birth weight,onset of first seizure,type of seizure,duration of seizure,and interval of seizures between two groups (P ＞ 0.05).There were 11 cases in poor recent outcomes group and 30 cases in good recent outcomes group that finished EEG.Compared with patients with good recent outcomes,patients with poor recent outcomes had significantly more abnormal EEG,paroxysmal abnormal changes and paroxysmal abnormal changes with abnormal background activity (90.9％ vs.43.3％,63.6％ vs.10.0％,36.4％ vs.6.7％),with statistically significant difference (P ＜ 0.05).Thirty-nine cases with recurrent seizures during non-neonatal period had significantly higher rate of dysplasia than the 34 cases that without recurrent seizures (50.0％ vs.12.8％),with statistically significant difference (P ＜0.05).Conclusion The recent outcomes of unexplained neonatal seizure may be related the EEG changes,but not gender,gestational age,birth weight,features of seizure.The neonates with unexplained neonatal seizure whose EEG manifest as paroxysmal abnormalities,were more likely to get poor recent outcomes,such as recurrent seizures and (or) dysplasia during non-neonatal period.

Recent outcomes of unexplained neonatal seizure: a retrospective study of clinical features in 47 cases / 国际儿科学杂志

Objective@#To explore the relationship between features of neonatal seizure and recent outcomes of patients with unexplained neonatal seizure, which may provide evidence for early assessment of prognosis.@*Methods@#Forty-seven cases of unexplained neonatal seizure admitted to the Department of Neonatology in Shengjing Hospital of China Medical University from January 2014 to June 2018, were followed-up at the age of more than 6 months.According to the recent outcomes(recurrent seizures during non-neonatal period and levels of development when they were followed-up), the patients were divided into good recent outcomes group(34 cases)and poor recent outcomes group(13 cases). The general information, characteristics of seizure and EEG changes during neonatal period were analyzed retrospectively.@*Results@#There was no significant difference in gender, gestational age, birth weight, onset of first seizure, type of seizure, duration of seizure, and interval of seizures between two groups(P>0.05). There were 11 cases in poor recent outcomes group and 30 cases in good recent outcomes group that finished EEG.Compared with patients with good recent outcomes, patients with poor recent outcomes had significantly more abnormal EEG, paroxysmal abnormal changes and paroxysmal abnormal changes with abnormal background activity(90.9% vs.43.3%, 63.6% vs.10.0%, 36.4% vs.6.7%), with statistically significant difference(P<0.05). Thirty-nine cases with recurrent seizures during non-neonatal period had significantly higher rate of dysplasia than the 34 cases that without recurrent seizures(50.0% vs.12.8%), with statistically significant difference(P<0.05).@*Conclusion@#The recent outcomes of unexplained neonatal seizure may be related the EEG changes, but not gender, gestational age, birth weight, features of seizure.The neonates with unexplained neonatal seizure whose EEG manifest as paroxysmal abnormalities, were more likely to get poor recent outcomes, such as recurrent seizures and(or)dysplasia during non-neonatal period.

Advances in clinical applications of amplitude-integrated electroencephalogram in premature infants / 中华实用儿科临床杂志

Amplitude-integrated electroencephalogram(aEEG)is a new method for bedside monitoring of cerebral function which is gradually used in clinical routine.Although the grading criteria has not been unified, some studies suggest that aEEG recorded during the very early period after birth can not only indicate the maturation of brain development, but also provide values of clinical application on the early identification, determination of the severity and long-term prognosis assessment of brain injury(e.g.white matter injury, intracranial hemorrhage, etc.)in premature infants.

Cystic periventricular leukomalacia: magnetic resonance imaging changes and motor development outcomes in neonates at different stages after birth / 中国新生儿科杂志

Objective To compare the magnetic resonance imagings (MRI) of neonates diagnosed with cystic periventricular leukomalacia (cPVL) at different stages after birth , and to clarify the relationship of MRI and motor development outcomes.Method Data of neonates admitted to the Shengjing Hospital of China Medical Univerisity from January 2010 to May 2015 diagnosed with cPVL by MRI were studied retrospectively.Subjects were assigned into two groups according to time of diagnosis : early－diagnosed group (≤7 d) and late－diagnosed group (＞7 d).The MRI and subsequent motor development outcome were compared between two groups.Result There were 35 neonates in early－diagnosed group.The cysts were mainly located in the anterior horn of the lateral ventricle (35 infants), the body of the lateral ventricle (2 infants) and the centrum semiovale (1 infants).Only one cyst were found in 17 infants, two cysts in 14 infants, three or more cysts in 4 infants.There were 45 cases in the late－diagnosed group, the cysts were mainly located in the centrum semiovale ( 35 infants ) and the posterior horn of the lateral ventricle (34 infants), the body (20 infants) and the anterior horn (10 infants) of lateral ventricle.Only one cyst were found in 3 infants, two cysts in 5 infants, three or more cysts in 37 infants.Among the 23 infants in the early－diagnosed group with follow－up, 22 infants are clinically normal , one infant with spastic diplegia (4.3%).Among the 24 infants in the late－diagnosed group with followe－up, 4 infants are clinically normal , 20 infants with spastic hemiplegia , diplegia or quadriplegia (83.3%).There are significant differences of incidence of cerebral palsy between the two group (P＜0.05).Conclusion MRI imaging showed that the location, number of cysts are different between the early－diagnosed and late－diagnosed group, and the motor development outcome of the early－diagnosed group are better , which indicates the prognosis of cPVL that occurred in utero are better than acquired cPVL after birth.

Clinical effects of caffeine during weaning of mechanical ventilation in very/extreme low birth weight premature infants / 中国新生儿科杂志

Objective To study the clinical effects of caffeine during weaning of mechanical ventilation in very/extreme low birth weight ( VLBW/ELBW) premature infants.Method From January 2013 to December 2014, VLBW/ELBW premature infants with early mechanical ventilation in the neonatal department of our hospital were enrolled in the retrospective study.The infants were assigned into control group (admitted in 2013 ) and observation group ( admitted in 2014).Infants in the observation group received caffeine citrate 24 hours before extubation, and the control group didn′t.Both groups were treated with nasal continuous positive airway pressure ( NCPAP) after extubation.The success rate of weaning , duration of hospital stay, duration of non－invasive assisted ventilation,duration of oxygen application and the incidences of related complications were compared between the two groups .Result A total of 100 cases were studied, including 50 cases in the control group and 50 in the observation group, respectively.No significant differences were found between the two groups in gender , gestational age, birth weight, neonatal respiratory distress syndrome severity , mechanical ventilation duration , prenatal glucocorticoid use and the proportion of high risk factors of intrauterine infection ( P ＞0.05 ).The success rate of weaning in the observation group was higher than the control group ( 96.0% vs.82.0%).Duration of hospital stay (49.7 ±2.3 days), non－invasive ventilation duration ( 9.1 ±0.9 days ), and oxygen use ( 23.1 ± 1.9 days) in the observation group were all shorter than the control group ( 56.4 ±2.1 days, 12.2 ± 1.2 days, 32.8 ±2.5 days, respectively).The incidence of bronchopulmonary dysplasia (BPD) was significantly lower than the control group (40.0% vs.62.0%, P＜0.05).No significant differences were found in the incidences of feeding intolerance and necrotizing enterocolitis (NEC) between the two groups (P＞0.05).Conclusion The use of caffeine 24 hours before weaning in combination with NCPAP can improve the success rate of weaning , reduce the incidence of BPD without increasing the incidence of feeding intolerance and NEC in VLBW/ELBW infants with mechanical ventilation.

The regulatory effect of hyperoxia exposure on the transdifferentiation level of type Ⅱ alveolar epithelial cells in newborn rats / 国际儿科学杂志

Objective To investigate the effect of hyperoxia on the transdifferentiation level of type Ⅱ alveolar epithelial cells (AEC Ⅱ) in vivo and in vitro,in order to illuminate the mechanism of epithelial injury in bronchopulmonary dysplasia (BPD).Methods Newborn Wistar rats were randomly devided into control group (room air inhalation) or model group (85％ oxygen inhalation) after birth.Lung tissue sampling and AEC Ⅱ isolation was conducted on 7 d,14 d,21 d.Type Ⅰ alveolar epithelial cells (AEC Ⅰ) marker aquaporin 5 (AQP5) and AEC Ⅱ marker surfactant protein C (SP-C) were examined by Western blot and florescent real-time PCR.AEC Ⅱ isolated from normal newborn rats was randomly devided into normoxia group (21％ oxygen) or hyperoxia group (85％ oxygen) after 24 h culture,and continued culturing for another 48 h in vitro.Then the morphological changes of cells were observed under inverted phase contrast microscope.The expression and location of markers for AEC Ⅰ and AEC Ⅱ was examined by immunofluorescence double staining.The protein expression of AQP5 and SP-C was evaluated by Western blot,and the mRNA expression of these markers was examined by florescent real-time PCR.Results In AEC Ⅱ isolated from the animal models,the AQP5 protein expression increased from 7 d while the SP-C expression decreased from 14 d in the model group comparing with the control group.In the model group,AQP5 mRNA expression increased and SP-C mRNA expression decreased since 7 d after hyperoxia exposure (P ＜ 0.05),with the difference between groups more obvious as exposure time extending.After culturing in vitro,AEC Ⅱ isolated from normal newborn rats expressed more AQP5 and less SP-C,with more cells double stained in the hyperoxia group compared with the normoxia group,examined by immunofluorescence double staining.The protein and mRNA examination results both showed that AQP5 expression increased and SP-C expression decreased in the hyperoxia group compared with the normoxia group (P ＜0.01).Conclusion After hyperoxia exposure,no matter in vivo or in vitro,the expression of AEC Ⅱ marker SP-C decreases while the expression of AEC Ⅰ marker AQP5 increases.These results indicate that the excessive transdifferentiation of AEC Ⅱ takes part in the recovery process after hyperoxia induced lung injury.

Clinical analysis of the early extrapulmonary complications in preterm infants with bronchopulmonary dysplasia / 中国小儿急救医学

Objective To clinically analyze the incidence of early extrapulmonary complications in premature infants with bronchopulmonary dysplasia(BPD),including periventricular intraventricular hemorrhage(PVH-IVH),white matter injury(WMI),parenteral nutrition associated cholestasis(PNAC) and metabolic bone disease(MBD),in order to direct the prevention and monitoring of these complications in BPD patients.Methods The clinical data of premature infants who were admitted to the neonatal department between September 2014 and December 2015 was retrospectively analyzed.A total of 87 premature infants diagnosed with BPD were studied as BPD group,while other 90 premature infants without BPD who were hospitalized at the same time were randomly selected as non BPD group.The occurrence of several common extrapulmonary complications was compared between two groups,including PVH-IVH,WMI,PNAC and MBD.Results The incidence of PVH-IVH in BPD group increased compared with non BPD group[(26.4%(23/87) vs 11.1%(10/90)] (P＜0.01),grade Ⅰ-Ⅱ PVH-IVH was more often seen in the BPD group too[24.1%(21/87) vs.11.1%(10/90)](P＜0.05),although the difference between two groups regarding the incidence of grade Ⅲ-Ⅳ PVH-IVH was not significant (P＞0.05).The incidence of WMI in BPD group was much higher than that in non BPD group[33.3%(29/87) vs 16.7%(15/90)] (P＜0.05),especially periventricular leukomalacia,the severe type of WMI,was more often found in BPD group than that in non BPD group[13.7%(12/87) vs 2.2%(2/90)](P＜0.05).The incidences of PNAC[22.9%(20/87) vs 5.5%(5/90)],MBD[17.2%(15/87) vs 3.3%(3/90)] and MBD with imaging changes[6.9%(6/87) vs 0] were all higher in BPD group compared with non BPD group,with significant differences between the two groups (P＜0.05).Conclusion BPD patients are more likely to have early extrapulmonary complications like PVH-IVH,WMI,PNAC and MBD than other preterm infants.It is crucial to prevent these complications reasonably and monitor them regularly for the BPD patients in order to improve the quality of life.

Study of the variation in expression and the significance of markers for alveolar epithelial cells in bron-chopulmonary dysplasia newborn rats / 中国小儿急救医学

Objective To investigate the variation in expression and the significance of markers indi-cating typeⅠalveolar epithelial cells ( AECⅠ) and type Ⅱ alveolar epithelial cells ( AECⅡ) in hyperoxia induced bronchopulmonary dysplasia( BPD) model. Methods A total of 80 term normal Wistar rats were randomly devided into model group (85% oxygen) or control group (room air) within 12 h after birth,with 40 rats in each group. On day 7,day 14,day 21 after exposure,the pathological characteristics of lung tissues were observed using HE staining, the expression and location of AECⅠ marker aquaporin 5 ( AQP5 ) and AECⅡmarker surfactant protein-C ( SP-C) were examined using immunofluorescence double staining. West-ern blot analysis was employed to examine the expressions levels of AQP5 and SP-C proteins,while real-time PCR was used to evaluate the mRNA expression of AQP5 and SP-C. Results Alveolar developmental disor-der was observed in lung tissues of the model group,including fewer,larger,simplified alveoli,thicker alveo-lar walls,and fewer alveolar secondary septa. Immunofluorescence double staining showed increased and dis-organized AQP5 and SP-C expression, with significantly higher ratio of double-stained cells/SP-C positive cells in the model group ( P<0. 001 ) . Comparing to the control group, the expression of AQP5 and SP-C protein increased from 7 d after hyperoxia exposure,which continued to 21 d. The mRNA expression levels of these two markers both significantly increased in the model group compared with the control group, with AQP5 starting from 7 d while SP-C starting from 14 d after hyperoxia exposure (P<0. 05),and the differ-ence between two groups became more significant with the exposure time extending. Conclusion The expression of AECⅠ marker AQP5 and AECⅡ marker SP-C both increase in the lung tissues of hyperoxia induced BPD newborn rats,with more AECⅡ transdifferentiated into AECⅠ. These changes of the markers indicate that there is excessive transdifferentiation of AECⅡ in the recovery process after BPD lung injury.

The effects of hyperoxia on alveolar epithelial cells of neonatal rats with bronchopulmonary dysplasia / 国际儿科学杂志

Objective To investigate the effects of alveolar epithelial cells (AEC) on bronchopulmonary dysplasis(BPD) induced by hyperoxia in newborn rats.Methods The model of BPD induced by hyperoxia in neonatal rats was established.HE staining was used to observe the alveolar septum and alveoli development.The expression of the specific surfactant protein C (SPC) on type Ⅱ alveolar epithelial cells (AEC Ⅱ) and the expression of specific aquaporin 5 (aquaporin5 AQP5) on type Ⅰ alveolar epithelial cells (type Ⅰ alveolar epithelialcells,AECⅠ) were measured by immunohistochemistry.Results There was no significant difference of AQP5 between experimental groups and control group at 1 d,but significantly lower expression of AQP5 could be seen in experimental group1 on day3 (P ＜ 0.05).And then,the AQP5 level of lung tissue of newborn rats at 5,7,14d after experiment in groupl was significantly lower than that of in air control group (P ＜ 0.05).The expression of SPC protein had no significant difference between experimental groups and control group at 1 d,but the SPC level of lung tissue of newborn rats at 3,7,14d after experiment in group1 was significant lower than that of in air control group (P ＜ 0.05).Conclusion Hyperoxia exposure leads to the expression of SP-C and AQP5 decreased,which may be key points for the development of BPD.AECⅡ may play an important role in the repairation of alveolar epithelial cells in neonatal rats with BPD induced by hyperoxia.