Value of three hemolysis tests and carboxyhemoglobin in the diagnosis of hemolytic disease of the fetus and newborn / 中国输血杂志

【Objective】 To investigate the value of three hemolysis tests and carboxyhemoglobin (COHb) level in the diagnosis of hemolytic disease of the fetus and newborn (HDFN). 【Methods】 From January 1, 2019 to December 31, 2022, the neonates hospitalized in the Department of Neonatology of Hebei Provincial Children's Hospital with suspected hemolytic disease who had serological testing were retrospectively enrolled in the study. They were distributed into HDFN group and non-HDFN group according to the final diagnosis. Their clinical and laboratory data were collected and analyzed, and the COHb level was detected by blood gas analyzer. 【Results】 A total of 378 neonates with HDFN and 217 neonates without HDFN were included in the study. Most of the neonates in HDFN group were full-term infants (348/378, 92.1%), with median gestational age of 39.1 (38.3, 40.0) weeks. Three hundred and fifty-four cases (354/378, 93.7%) were ABO-HDFN and the rest were Rh HDFN. There were significant differences in the level of serum total bilirubin, hemoglobin, COHb and reticulocyte percentage at admission between the two groups(P<0.05). The positive rate of three hemolysis tests in HDFN group decreased with the increase of the days after birth. The highest positive rate (more than 80%) was observed within 2 days after birth. Correlation analysis showed a negative relationship between the COHb level and the age (rs = -0.434, P<0.001) . Among the three hemolysis tests in HDFN group, the positive rate of antibody release test was the highest (69.0%), followed by the free antibody test (55.6%) and the direct antiglobulin test (DAT) (36.0%). Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value of COHb was 1.15%.The sensitivity of COHb ≥ 1.15% was 51.8%, higher than single DAT (36.0%) . The diagnosis effectiveness of three hemolysis tests couldn't be improved when combined with COHb detection(Z = -0.727, P>0.05) . 【Conclusion】 The three hemolysis tests are important in the diagnosis of HDFN, among which the antibody release test has the highest sensitivity. COHb has certain value for the diagnosis of HDFN, but joint testing cannot improve the diagnosis effectiveness of three hemolysis tests. Hemolysis tests and/or COHb detection should be conducted for neonates at risk of hemolysis as early as possible after birth.

Relationship between the level of sialic acid during perinatal period and early intelligence development of full term infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the correlation between the status of sialic acid (SA) during perinatal period and early intelligence development of healthy full term infant, and to explore the effect of SA on the early intelligence development.</p><p><b>METHOD</b>A total of 127 pairs of healthy mothers-neonates in the Affiliated Hospital of Nantong University were recruited randomly in this prospective cohort study. The levels of SA from body fluids of mothers-neonates were measured by enzyme-linked immunosorbent assay, such as the full-term maternal and cord blood and the colostrum. The questionnaire surveys were carried out in mothers and mental development evaluation according to Children's Development Center of China (CDCC) were carried out in infants 3 to 4 months of age to obtain the mental development index (MDI) and psycho-motor development index (PDI).</p><p><b>RESULT</b>A total of 120 pairs of maternal-neonatal subjects with complete data were included into statistical analysis. The levels of SA of maternal and cord blood and colostrum were (2.25 ± 0.02), (1.21 ± 0.01), and (5.01 ± 0.06) mmol/L respectively. MDI and PDI of infants 3 to 4 months of age were (99.40 ± 1.87) and (98.53 ± 1.96). The analysis using multiple linear regression indicated that MDI was associated with SA levels of cord blood and colostrum (β = 0.636, 0.175, P < 0.05), and PDI was also associated with them (β = 0.502, 0.262, P < 0.05). The levels of SA of cord blood and colostrums were individually divided into high-level group and low-level one according to the median level. MDI and PDI in high-level group of cord blood were both significantly higher than that in low-level group (111.85 ± 2.79) vs. (108.88 ± 2.0) , (101.08 ± 4.44) vs. (98.88 ± 2.0) P < 0.01. So were MDI and PDI in high-level group of colostrum compared with those in low-level group (111.71 ± 3.07) vs. (108.81 ± 1.56), P < 0.01; (101.29 ± 4.23) vs.(98.56 ± 1.79), P < 0.05. The analysis on correlation between the levels of maternal-neonatal body fluids showed that the level of SA of colostrum was positively correlated with that of cord blood (r = 0.507, P = 0.004). However, no correlation was found either between the level of SA of maternal and cord blood or between the level of SA of maternal blood and colostrums. Further division into high-level and low-level groups was done according to the median level of maternal blood. The levels of SA of colostrum and cord blood in high-level group were markedly higher than those in low-level one (5.12 ± 0.35) vs. (4.87 ± 0.22) and (1.21 ± 0.02) vs. (1.17 ± 0.01), P < 0.05.</p><p><b>CONCLUSION</b>High levels of SA of cord blood and colostrums might be beneficial to the early intelligence development of full term infant. Abundant intake of SA during perinatal period and good function of placenta may play important role in early intelligence development.</p>

Detection and clinical significances of serum IL-18, Caspase-3 and S-100B protein expression level in neonatal hypoxic-ischemic encephalopathy / 中华检验医学杂志

Objective To analyze the levels and clinical significances of IL-18,Caspase-3 and nerve tissue-specific protein S-100B at different disease extent and different stages of infants with hypoxicischemic encephalopathy (HIE).Methods This study was clinical experimental studies.Sixty-seven infants with HIE (23 cases of mild HIE,23 cases of moderate HIE,21 cases of severe HIE) from February 2008 to June 2009 in Hebei Children's Hospital were enrolled.The levels of IL-18,Caspase-3 and S-100B protein in all samples were measured at acute phase (1 d,3 d) and recovery phase (7 d) by ELISA method.Twenty healthy full-term neonates were selected as the normal control group.Multi-factor analysis of variance and Pearson correlation test was used for statistical analysis.Results The levels of the three indicators in the moderate and severe group were higher than the normal control group.In the moderate group,IL-18 levels were(132.15 ± 9.87),(150.31 ± 15.04) and (87.91 ± 9.93) ng/L,Caspase-3 levels were (5.79 ±0.64),(7.36 ± 1.57)and (3.79 ±0.61) μg/L,S-100B levels were(6.82 ±0.61),(9.62 ± 1.29) and (10.76 ± 1.64) μg/L.In the severe group,IL-18 levels were (160.23 ± 16.03),(189.86 ± 18.32) and (107.35 ± 13.02) ng/L;Caspase-3 levels were (6.86 ± 1.02),(9.54 ± 1.43) and (5.25 ± 0.71) μg/L;S-100B levels were(8.90 ± 0.32),(12.54 ± 0.89)and(13.53 ± 0.75) μg/L.In the normal control group,IL-18 levels were (71.08 ± 11.52),(72.53 ± 11.05) and (71.93 ± 11.30) ng/L; Caspase-3 levels were (2.84 ± 0.52),(2.98 ± 0.53) and (2.87 ± 0.52) μg/L; S-100B levels were (1.50 ± 0.25),(1.62 ±0.30)and(1.53 ±0.29) μg/L IL-18 levels,Caspase-3 levels and S-100B levels in severe group were higher than the moderate group and the mild group were higher than the mild group.IL-18 levels were (73.46 ± 4.77),(77.59 ± 4.02) and (72.87 ± 6.92) ng/L ; Caspase-3 levels were (3.13 ± 0.31),(3.63±0.40) and (3.26 ±0.45) μg/L;S-100B levels were(3.68 ±0.40),(5.851 ±0.63) and(6.95 ± 0.58) μg/L in the mild group.S-100B levels in the mild group were higher than that in the normal control group.The IL-18 and Caspase-3 levels were risen in the third day to the first day in the acute phase of the moderate group and severe group,decreased in the recovery phase.Serum S-100B protein levels in the acute and recovery phase increased gradually,and there was no correlation between the three indicators (r-=0.321,0.14,0.48,P=0.438,0.974,0.911 respectively).Conclusions IL-18,Caspase-3 and S-100Bwere involved in the pathophysiological process of HIE.The levels were closely related to the severity and disease progression of HIE,the severer of the illness,and the higher of the levels.Dynamic monitoring the changes of the three indicators may contribute to an early diagnosis,condition monitoring and prognosis of HIE.