Value of bedside echocardiography in predicting persistent patency of the ductus arteriosus during the early postnatal period in very low birth weight infants / 中国当代儿科杂志

OBJECTIVES@#To study the value of bedside echocardiography in predicting persistent patency of the ductus arteriosus during the early postnatal period in very low birth weight (VLBW) infants.@*METHODS@#A retrospective analysis was performed for 51 VLBW infants who were admitted from March 2020 to June 2021, with an age of ≤3 days and a length of hospital stay of ≥14 days. According to the diameter of patent ductus arteriosus (PDA) on days 14 and 28 after birth, the infants were divided into three groups: large PDA group (PDA diameter ≥2 mm), small PDA group (PDA diameter <2 mm), and PDA closure group (PDA diameter =0 mm). The echocardiographic parameters measured at 72 hours after birth were compared among the three groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of the echocardiographic parameters in predicting persistent patency of the ductus arteriosus (PDA≥2 mm) at the ages of 14 and 28 days.@*RESULTS@#On day 14 after birth, there were 17 infants in the large PDA group, 11 in the small PDA group, and 23 in the PDA closure group. On day 28 after birth, there were 14 infants in the large PDA group, 9 in the small PDA group, and 26 in the PDA closure group. There were significant differences in gestational age, birth weight, rate of pulmonary surfactant use, and incidence rate of hypotension among the three groups (P<0.05). PDA diameter, end-diastolic velocity of the left pulmonary artery, left ventricular output, and left ventricular output/superior vena cava flow ratio measured at 72 hours after birth were associated with persistent patency of the ductus arteriosus at the ages of 14 and 28 days (P<0.05), and the ratio of the left atrium to aorta diameter was associated with persistent patency of the ductus arteriosus at the age of 28 days (P<0.05). The ROC curve analysis showed that the area under the curve that the PDA diameter measured at 72 hours after birth predicting the persistent patency of the ductus arteriosus at the ages of 14 and 28 days was the largest (0.841 and 0.927 respectively), followed by end-diastolic velocity of the left pulmonary artery, with the area under the curve of 0.793 and 0.833 respectively.@*CONCLUSIONS@#The indicators obtained by beside echocardiography at 72 hours after birth, especially PDA diameter and end-diastolic velocity of the left pulmonary artery, can predict persistent patency of the ductus arteriosus at the ages of 14 and 28 days in VLBW infants, which provides a basis for the implementation of early targeted treatment strategy for PDA.

Dyspnea and situs inversus in a boy aged 3 days / 中国当代儿科杂志

A boy was admitted on day 3 after birth due to shortness of breath for 2 days and cyanosis for 1 day. He had clinical manifestations of dyspnea in the early postnatal period and situs inversus, and was finally diagnosed with Kartagener syndrome. His condition was improved after oxygen therapy, anti-infective therapy, and aerosol therapy. The genetic testing showed that there was a large-fragment loss of heterozygosity, exon 48_50, and a hemizygous mutation, c.7915C > T(p.R2639X), in the

Clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight infants / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight (ELBW) infants.@*METHODS@#A retrospective analysis was performed for 49 ELBW infants who were admitted from January 1, 2018 to July 30, 2020, with an age of ≤14 days on admission and a duration of parenteral nutrition of > 14 days. According to the type of lipid emulsion received, the ELBW infants were divided into two groups: soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) (@*RESULTS@#The 49 ELBW infants had a mean birth weight of (892±83) g and a mean gestational age of (28.2±2.3) weeks. There was no significant difference between the two groups in the incidence rates of hemodynamically significant patent ductus arteriosus, intraventricular hemorrhage, neonatal necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia (BPD), grade Ⅲ BPD, sepsis, and pneumonia (@*CONCLUSIONS@#The application of multi-oil fat emulsion in ELBW infants does not reduce the incidence rate of complications, but compared with MCT/LCT emulsion, SMOF can reduce the severity of PNAC in ELBW infants.

Long-term prognosis of neonates with necrotizing enterocolitis / 中国当代儿科杂志

OBJECTIVE@#To investigate the long-term prognosis of neonates with necrotizing enterocolitis (NEC).@*METHODS@#A total of 83 preterm infants with NEC who survived and were discharged between December 2014 and September 2016 were enrolled and divided into surgery group (n=57) and non-surgery group (n=26). There were 0, 33 and 24 cases of stage I, II and III NEC respectively in the surgery group and 7, 19 and 0 cases respectively in the non-surgery group. The physical development and neurodevelopmental outcomes of the infants were followed up after discharge.@*RESULTS@#Of the 83 infants, the mean corrected age at the end of follow-up was 21±6 months. Of the 83 infants, 31 (37%) had subnormal body weight, and the surgery group had a higher rate of subnormal body weight than the non-surgery group (P<0.05). Twenty-two infants (27%) had subnormal body length and 14 children (17%) had subnormal head circumference among the 83 infants. Eighteen infants (22%) had motor developmental delay/developmental disorders, and the surgery group had a higher incidence rate of the disorders than the non-surgery group (28% vs 8%; P<0.05). Five infants (6%) were diagnosed with cerebral palsy, among whom 4 were in the surgery group and 1 was in the non-surgery group.@*CONCLUSIONS@#Long-term physical development and neurodevelopmental outcomes may be adversely affected in neonates with NEC, in particular in those with severe conditions who need surgical treatment, suggesting that long-term follow-up should be performed for neonates with NEC.

Factors influencing the prognosis of patent ductus arteriosus in very low birth weight infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the factors influencing the prognosis of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants.</p><p><b>METHODS</b>A total of 194 VLBW infants who were admitted from January 2012 to December 2014 were enrolled as study subjects. According to cardiac ultrasound findings and treatment outcome, these infants were divided into non-PDA group, spontaneous closure group, pharmaceutical closure group, and surgical closure group. Their clinical and echocardiographic characteristics were analyzed.</p><p><b>RESULTS</b>The spontaneous closure rate of PDA was 58.7%. The spontaneous closure group showed significantly higher gestational age, birth weight, and proportion of small-for-gestational-age infants than the pharmaceutical and surgical closure groups (P<0.05). The pharmaceutical and surgical closure groups had a significantly higher incidence rate of neonatal respiratory distress syndrome and a significantly higher proportion of infants who were given pulmonary surfactant (PS) than the spontaneous closure group (P<0.05). During different periods of time, the spontaneous closure group had a significantly smaller ductus arteriosus diameter than the pharmaceutical and surgical closure groups (P<0.05). The multivariate logistic regression analysis showed that gestational age, application of PS, and ductus arteriosus diameter at 48 hours were significantly associated with the prognosis of PDA. The major transductal flow pattern in the spontaneous closure group was closing pattern, while in the pharmaceutical and surgical closure groups, the main flow patterns were pulmonary hypertension and growing patterns within 48 hours and growing pattern on days 4 and 7.</p><p><b>CONCLUSIONS</b>The VLBW infants have a high spontaneous closure rate of PDA. A decreased closure rate of PDA is associated with the lower gestational age and the application of PS. PDA with a large ductus arteriosus diameter and a growing or pulsatile flow pattern cannot easily achieve spontaneous closure.</p>

Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China: A Multi-center Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>With the progress of perinatal medicine and neonatal technology, more and more extremely low birth weight (ELBW) survived all over the world. This study was designed to investigate the short-term outcomes of ELBW infants during their Neonatal Intensive Care Unit (NICU) stay in the mainland of China.</p><p><b>METHODS</b>All infants admitted to 26 NICUs with a birth weight (BW) < l000 g were included between January l, 2011 and December 31, 2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors.</p><p><b>RESULTS</b>A total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age (GA) was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants (23.3%) died and another 69 infants (26.7%) died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas (53.6% vs. 35.3%, P = 0.019). BW < 750 g and GA < 28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization.</p><p><b>CONCLUSIONS</b>Our study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries.</p>

Infant Neurological International Battery predicts neurological outcomes of preterm infants discharged from the neonatal intensive care unit / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To explore the Infant Neurological International Battery (Infanib) as a screening tool for early detection of gross motor developmental delay in preterm infants discharged from NICU, and to predict their later neuromotor dysfunction (cerebral palsy or motor retardation).</p><p><b>METHODS</b>A cohort of preterm infants who were admitted to the neonatal intensive care unit between June 2008 and March 2010 were enrolled in the study. Infanib assessment was performed at corrected age 3-4 months and 6-7 months. Peabody Developmental Motor scale-2 (PDMS-2) and neuro-examinations were used to confirm the last motor retardation. The sensitivity, specificity, positive predictive value and negative predictive value of the Infanib were calculated.</p><p><b>RESULTS</b>A total of 147 preterm infants were participated in this study, and 129 infants were followed up at correct age 12 months or more than 12 months. Eleven (8.5%) had celebral palsy, 28 (21.7%) had motor retardation, and 90 (69.8%) normal mortor development. The predictive validity of the Infanib at correct age 3-4 months (n=14) was: sensitivity 84.6%, specificity 75.6%, positive predictive value 60.0% and negative predictive value 91.9%. The predictive validity of the Infanib at correct age 6-7 months (n=117) was: sensitivity 100%, specificity 91.7%, positive predictive value 82.5% and negative predictive value 100%.</p><p><b>CONCLUSIONS</b>The Infanib can be used as an appropriate screening tool and validity measurement for early detection of gross motor developmental delay in preterm infants.</p>

Application of neurally adjusted ventilatory assist in preterm infants with respiratory distress syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To observe the effects of neurally adjusted ventilatory assist (NAVA) on the patient-ventilator synchrony, gas exchange, and ventilatory parameters in preterm infants with respiratory distress syndrome (RDS) during mechanical ventilation.</p><p><b>METHODS</b>Ten preterm infants with RDS received mechanical ventilation in NAVA mode for 60 minutes and in synchronized intermittent mandatory ventilation (SIMV) mode for 60 minutes, and the two modes were given in a random order. The vital signs, patient-ventilator synchrony, blood gas values, and ventilatory parameters were compared between the two ventilation modes.</p><p><b>RESULTS</b>Inspiratory trigger delay was significantly shorter with NAVA than with SIMV (P<0.05). There were no significant differences in arterial pH, PaCO2, PaO2 and PaO2/FiO2 between the two modes. The spontaneous respiratory rate, peak inspiratory pressure (PIP), electrical activity of the diaphragm and work of breathing were significantly lower in NAVA than in SIMV (P<0.05).</p><p><b>CONCLUSIONS</b>Compared with SIMV, NAVA appears to improve patient-ventilator synchrony, decrease PIP, and reduce diaphragmatic muscle load and work of breathing in preterm infants with RDS during mechanical ventilation.</p>

Amplitude-integrated electroencephalographic changes in neonates with acute bilirubin encephalopathy / 中华儿科杂志

<p><b>OBJECTIVE</b>To characterize amplitude-integrated electroencephalo graphic (aEEG) traces in neonates with acute bilirubin encephalopathy (ABE), explore the value of aEEG in early diagnosis and prediction of neurological outcome of ABE.</p><p><b>METHOD</b>aEEG records of 10 cases with ABE (Oct 2009-Nov 2011) were reviewed to identify neonates with a diagnosis of ABE. Clinical data were collected. The aEEG traces were classified according to background activity (normal, moderate, or severely abnormal), presence of seizures and sleep-wake cycling (SWC). Brainstem auditory evoked potential (BAEP) and magnetic resonance imaging (MRI) were studied. The neuromotor development of survivors with ABE was assessed by using the Infant Neurological International Battery (INFANIB).</p><p><b>RESULT</b>The characteristics of aEEG tracings in these infants with ABE were shown continuous normal voltage (CNV, n = 5), discontinuous voltage (DNV, n = 4), discontinuous voltage with burst-suppression (BS)BS+ (n = 1); mature SWC (n = 2), immature SWC (n = 5), no SWC (n = 3); 8 infants (80%) had electrical seizures: single seizure (n = 2); repetitive seizures (n = 2), and status epilepticus (SE) (n = 4). Among the 10 infants with ABE, no infants had normal aEEG, 3 had mildly abnormal aEEG, and 7 had severely abnormal aEEG. Eight infants accepted BAEP test, 2 were mildly abnormal and 6 were severely abnormal. Six infants accepted MRI, 1 was normal and 5 were abnormal. By chi-square analysis and Spearman rank correlation analysis, the results of aEEG classification were correlated with the phase of ABE and the severity of BAEP. These infants were followed up for more than 6 months (range 6 months to 1 year). In 3 infants with mildly abnormal aEEG, 2 were normal and 1 was transit in infanib score at 6 months of age. Of 7 infants with severely abnormal aEEG, 1 died, 3 were abnormal (2 Spastic dyskinesia and 1 hypotonia), 2 were transit in infanib score at 6 months old. 1 lost to follow-up.</p><p><b>CONCLUSION</b>Amplitude-integrated electroencephalography can provide important information of the status of cerebral function in neonates with ABE and help to predict its neurological outcome.</p>

Predicting outcome in necrotizing enterocolitis with the score for neonatal acute physiology: a retrospective study of 62 cases / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the value of the score for neonatal acute physiology (score for neonatal acute physiology, SNAP) in predicting outcome and risk of surgery of necrotizing enterocolitis (NEC).</p><p><b>METHOD</b>A total of 62 NEC patients in neonatal intensive care unit (NICU) of Zhejiang University Children's Hospital were reviewed from October 2001 to October 2011. All the patients were classified into surgery group and non-surgery group according to whether the patient had the surgical intervention. Also the patients were divided into death group and alive group according to the outcome. Data on gestational age at birth, gender, birth weight, early clinical manifestations, treatment and prognosis of all patients were collected. SNAP-II and score for neonatal acute physiology and perinatal extension II (SNAPPE-II) were calculated on the day of diagnosis.</p><p><b>RESULT</b>Abdominal distension, which was seen in 91.9% of the cases, was the commonest early clinical manifestation. The next was residual and bloody stool. SNAP-II and SNAPPE-II score in surgery group (26.5,26.5) were higher than that of the non-surgery group (13.0, 13.0,P = 0.002, 0.006). And the same scores in death group (29.0,32.0) were higher than those in the alive group (8.0, 8.0) (P = 0.000, 0.000). Measuring the scores as a predictor of surgery, the area under ROC curve for SNAP-II was 0.745, and was 0.714 for SNAPPE-II. The area under ROC curve for SNAP-II was 0.916, and was 0.929 for SNAPPE-II.The best positive point of SNAP-II and SNAPPE-II for predicting surgery was 22 and 28. The best positive point of SNAP-II and SNAPPE-II for predicting death was 18.5 and 22.</p><p><b>CONCLUSION</b>The SNAP-II and SNAPPE-II score may be used to predict the prognosis and the risk of surgery in the NEC patients. The scores are also good predictors of mortality in the early period when NEC occurs.</p>

Infantile polycystic kidney disease: a case report and literature review / 中华儿科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics, diagnosis, treatments and outcomes of perinatal autosomal recessive polycystic kidney disease.</p><p><b>METHODS</b>The clinical data of one case with infantile polycystic kidney disease diagnosed in perinatal stage and the reports of 11 cases seen in the past 15 years searched in Pubmed, OVID and Elsevier and CNKI, Wanfang database by using the polycystic kidney disease, infant, perinatal, autosomal recessive and case report as keyword were reviewed and analyzed.</p><p><b>RESULTS</b>The infant was characterized by huge kidneys, severe respiratory and renal compromise. The kidneys were symmetrically enlarged and highly echogenic by ultrasonographic examination and showed high-signal intensity on T2-weighted images by MRI. Histologic analysis showed pulmonary hypoplasia, numerous dilated and elongated tubular structures in the kidney and dilated intrahepatic biliary ducts. Among the 12 cases, 8 cases' presumptive diagnosis was made by prenatal ultrasound revealed enlarged kidneys and oligohydramnios. All cases suffered respiratory distress after birth, and 5 cases complicated pneumothorax. 6 cases died in neonatal stage because of respiratory failure.1 case died 2 m after birth because of renal failure. Five cases are alive and underwent dialysis, nephrectomy or renal transplant.</p><p><b>CONCLUSION</b>Newborn infants with perinatal autosomal recessive polycystic kidney disease often have poor outcome and died from respiratory and renal failure. Aggressive respiratory support and renal replacement therapy (including nephrectomy, dialysis and transplantation) may give these infants a favorable outcome.</p>

Diagnostic value of amplitude-integrated electroencephalography in predicting outcome of newborn patients in neonatal intensive care unit / 中华儿科杂志

<p><b>OBJECTIVE</b>To assess the diagnostic value of amplitude-integrated electroencephalography (aEEG) in predicting outcome of newborns who were at high risk for central nervous system without severe hypoxic-ischemic encephalopathy.</p><p><b>METHODS</b>Forty-two consecutive patients at risks for neurological disorders referred to our level-III NICU were prospectively enrolled in the study over a period of 3 years. They were classified on the basis of their primary diagnoses including hypoglycemic brain damage, meningoencephalitis, bilirubin encephalopathy, and metabolic disease. Clinical data were collected. Amplitude-integrated and raw EEG tracings were assessed for background pattern, sleep-wake cycling, and epileptiform activity. The neuromotor development of survivors was assessed by using the Infant Neurological International Battery (INFANIB).</p><p><b>RESULT</b>The characteristic of aEEG tracings in 42 infants showed continuous normal voltage (CNV)(n = 15), discontinuous voltage (DC)(n = 9), burst-suppression (BS) BS(+) (n = 6), BS(-)(n = 7), flat (FT, n = 5); mature sleep-wake cycling (SWC, n = 4), immature SWC (n = 14), no SWC (n = 24); 30 infants (71.4%) had electrical seizures: single seizure (n = 6); repetitive seizures (n = 7), and status epilepticus (SE) (n = 17).aEEG of 20 infants who had poor outcome showed FT (n = 5), BS(-)/SE (n = 6), BS(-)/ repetitive seizures (n = 1) , BS(+)/SE (n = 1), BS(+)/repetitive seizures (n = 1), DC/SE(n = 6). Chi-square analysis and Spearman rank correlation analysis showed the classification of aEEG background pattern, SWC and comprehensive score (score system was developed by evaluation of the above 3 variables) were correlated with the outcome of these infants at high neurological risks.</p><p><b>CONCLUSION</b>Amplitude-integrated electroencephalography can provide important information of the status of cerebral function in neonates at high neurological risk and help to predict their outcome.</p>

Clinical analysis of surgical intervention in the treatment of necrotizing enterocolitis in neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the high-risk factors, prognostic factors, and operation time for surgical intervention in the treatment of necrotizing enterocolitis (NEC) in neonates.</p><p><b>METHODS</b>Sixty-two NEC neonates who received treatment in the neonatal intensive care unit from October 2001 to October 2011 were enrolled. Patients were assigned to surgery (n=20) and non-surgery groups (n=42). The two groups were compared with respect to general data, complications, clinical symptoms, laboratory examination results, treatment and prognosis.</p><p><b>RESULTS</b>Compared with non-surgery group, the surgery group had significantly higher rates of respiratory distress syndrome, gurgling sound disappearance, C-reactive protein increase, platelet count decrease, positive blood culture, pneumoperitoneum and fixed intestinal loop on X-ray, and mechanical ventilation (P<0.05). Cured patients in the surgery group had significantly lower rates of circulation failure and multiple bowel perforations than patients who died (P<0.05), as shown by the prognostic factor analysis. Of the 20 patients in the surgery group, 19 (95%) underwent operation within one week after diagnosis of NEC and 15 survived the operation.</p><p><b>CONCLUSIONS</b>There are multiple risk factors in surgical intervention for NEC. Bowel lesions and circulation failure are associated with postoperative prognosis. The operation is usually performed within one week after diagnosis of NEC.</p>

Value of radiographic assessment scale in necrotizing enterocolitis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>This study was conducted to determine the value of the radiographic assessment scale in the diagnosis of neonatal necrotizing enterocolitis, and as measured by need for surgery.</p><p><b>METHODS</b>A total of 61 neonates were classified into three groups according to the Bell's Staging Criteria: NECⅠ(n=25), NECⅡ(n=11) and NEC Ⅲ(n=25). Data on gestational age at birth, gender, birth weight, clinical manifestations, treatment and prognosis of the patients were collected. Radiographic assessment scale scores were evaluated by a pediatric radiologist.</p><p><b>RESULTS</b>Radiographic assessment scale scores in the NECⅠ, NECⅡand NEC Ⅲ groups were 3.2±1.4, 5.3±1.7 and 8.9±1.7, respectively (P<0.05). The score was highest in the NEC Ⅲ group and lowest in the NECⅠgroup. Based on the different therapies, the NEC Ⅲ group was subdivided into operative and non-operative groups. Radiographic assessment scale scores in the two subgroups were 8.71±1.86 and 9.36±1.21 respectively (P>0.05). Radiographic assessment scale scores in neonates with intestinal perforation (9.6±1.1) were higher than in those with intestinal necrosis (6.8±1.8) (P<0.05). The majority of patients (80%) who underwent operation had radiographic assessment scale scores above 7. The effective rate was 96% and 64% respectively in the NECⅠand the NECⅡ groups. Of the children in the NECⅢ group, the cure rate was 71% in the operative group, and the effective rate was 9% in the non-operative group.</p><p><b>CONCLUSIONS</b>The radiographic assessment scale may be used to evaluate the severity of disease in neonates with NEC. Patients with a score on the radiographic assessment scale above 7 have indications for surgical intervention and have better short-term treatment response rates.</p>