Clinical characteristics, pathogen distributions and outcomes of bacterial meningitis in preterm and term infants / 中国小儿急救医学

Objective:To investigate and compare the clinical characteristics, pathogen distributions and outcomes of bacterial meningitis in preterm and term infants.Methods:The data of 252 cases of neonatal bacterial meningitis hospitalized in Guangzhou Women and Children′s Medical Center from January 2013 to December 2018 were retrospectively analyzed and divided into two groups according to gestational age: preterm group( n=64)and term group( n=188). The clinical manifestations, laboratory examinations, pathogen distributions and clinical outcomes of the children in two groups were compared. Results:Fever was the most common clinical manifestation in both groups, but the incidences of lethargy, apnea and feeding intolerance in preterm group were significantly higher than those in term group( P<0.05). There was no significant difference in the rate of the first hemogram/cerebrospinal fluid abnormality between two groups( P>0.05). Sepsis, subdural effusion and hydrocephalus were the main complications in both groups.The incidence of complications in premature infants was 60.9%(39/64), which was significantly higher than that in full-term infants(44.7%, 84 /188) , with a statistically significant difference ( P<0.05). Escherichia coli and Streptococcus agalactiae were the most common pathogens in the preterm infants, whereas Klebsiella pneumoniae and Streptococcus agalactiae were the most common pathogens in the term infants.There was no statistical difference in the time of positive bacteria turning negative between two groups, but the course of antibiotics in preterm group was significantly longer than that in term group( P<0.05). The clinical cure/improvement rates in the two groups was about 95%, and the difference between two groups was not statistically significant( P>0.05). Conclusion:Early clinical manifestations of bacterial meningitis in preterm infants are atypical and relatively easy to be missed.The incidence of complications is significantly higher than that of full-term infants, and the duration of antibiotic use is longer.However, the clinical cure/improvement rate of premature infants is not worse than that of full-term infants after reasonable and standardized early treatment.

A multicenter study on the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis / 中华实用儿科临床杂志

Objective To explore the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis(NEC).Methods A retrospective study was carried out in the infants with NEC admitted to 6 cooperative hospitals in Guangdong Province between January 2005 and December 2014.The clinical features and risk factors of poor prognosis in preterm and full-term infants diagnosed NEC,early onset and late onset NEC were analyzed.Results A total of 449 cases who met the criteria were admitted during the study time.The mortality was 23.6％ (106/449 cases),of which the preterm group was 24.6％ (58/238 cases) while the full-term group was 22.7％ (48/211 cases),the early onset group was 22.1％ (45/204 cases) while the late onset group was 24.3％ (57/235 cases).The median number of NEC onset in preterm group was 11 d after birth while the number of the full-term group was 6 d.Full-term infants who diagnosed NEC were more likely to manifest themselves as abdominal distension (52.1％ vs.42.0％,x2 =4.597,P =0.032),vomiting(36.5％ vs.17.2％,x2 =21.428,P =0.000) and bloody stool(30.3％ vs.21.4％,x2 =4.653,P =0.031);but in the onset of NEC,preterm infants more likely to have feeding intolerance (21.0％ vs.12.8％,x2=5.309,P =0.021).The early onset group of full-term NEC was much common in twins or multiplets(9.4％ vs.1.1％,x2 =6.226,P =0.013),which rate of surgical therapy was much higher (41.0％ vs.27.0％,P =0.036) and the breast-feeding rate before NEC was lower than the late onset group(14.5％ vs.32.6％,x2 =9.500,P =0.002),the differences were statistically significant.The gestational age and birth weight were bigger in the early onset group of preterm NEC[(33.8 ±2.5) weeks vs.(32.2 ±2.8) weeks,t =4.261,P =0.000;(2.1 ±0.5) kg vs.(1.7 ± 0.5) kg,t =4.735,P =0.000)],but length of stay was shorter than the late onset group (18.0 d vs.26.5 d,P =0.000).Logistic regression analysis showed that the risk factors of poor prognosis of full-term NEC were shock,peritonitis and sepsis;while risk factors of poor prognosis of preterm NEC were small for gestational age infant,pulmonary hemorrhage,shock,intestinal perforation and sepsis;the risk factors of poor prognosis of the early onset group of full-term NEC was shock;while those of the late onset group were shock and peritonitis;the risk factors of poor prognosis in the early onset group of preterm NEC were shock and sepsis,while those in the late onset group were pulmonary hemorrhage,shock,intestinal perforation and sepsis.Conclusions Compared to the preterm NEC,the onset time of full-term NEC was earlier and the clinical manifestations were more typical.Early identification and management of shock,peritonitis,intestinal perforation,sepsis and pulmonary hemorrhage can reduce the risk of poor prognosis of neonate NEC.

Clinical analysis of 2 siblings with late-onset meningitis caused by group B streptococcus which were homogenous to the colonization bacteria of their mother / 中华实用儿科临床杂志

Objective To raise awareness of the late-onset meningitis caused by group B streptococcus (GBS) which was homogenous to the maternal colonization.Methods The clinical data of late-onset GBS meningitis in neonates twins whose pathogens were homogenous to their maternal colonization were collected from Department of Neonatology,Guangzhou Women and Children's Medical Center.The general conditions,clinical symptoms,laboratory tests and drug treatment of the twins and their mother were retrospectively analyzed,and the GBS homology during inpatient care was tested.And the progress of the twins' condition was investigated by telephone follow-up.Results The mother had two pregnancies without prenatal GBS screening or intrapartum antimicrobial intervention for GBS,everything was normal during pregnancy and delivery.Twins were born through cesarean section.The elder sister was discharged with Linezolid taken orally after 167 days in hospital without convulsions,shaking or other discomfort.The elder sister was followed up for every 2 weeks,and in the last time of follow-up,cerebrospinal fluid white blood cell counts were 45 × 106/L,protein level was 1.52 g/L and Linezolid was withdrawn.The younger brother was discharged after 58 days in hospital with follow-up for every 2 weeks,and in the last time of follow-up,cerebrospinal fluid white blood cell counts were 30 × 106/L,protein level was 0.66 g/L.During the hospitalization and follow-up without convulsions and irritation,and the cranial magnetic resonance imaging of the twin brother was normal.Test results showed that the GBS bacteria strain for twins and their mother were all serotype Ⅲ.The possibility of the GBS homology was more than 90％.Conclusions The toxicity of serotype Ⅲ GBS strain was strong.More proactive precautions should be considered to apply for the mother whose first birth already had GBS infection.Early identification and intervention of infection risk factors would help optimize the anti-infection treatment program and reduce nerve system damage and other adverse outcomes caused by invasive GBS infection.

Progress on advantages and disadvantages of enteral feeding patterns in the very preterm infants / 国际儿科学杂志

Enteral feeding is very important to the gastrointestinal tract maturity,growth and the development of the nervous system.However,on account of the physiological distinctiveness of the very preterm infants,it may be difficult to give oral feeding directly at an early stage.Therefore,nasogastric and duodenal tubes are always needed to proceed continuous or intermittent enteral feeding,while different ways have different feature.At the present,there is no definite conclusion about which way is the best one for this kind of infants.Larger sample and uniform multi-center study will be necessary.

Efficacy and mental development comparison of caffeine citrate and aminophylline for treating primary apnea in premature infants / 中国新生儿科杂志

Objective To study the mental development and efficacy of caffeine citrate and aminophylline in treating primary apnea in premature infants. Methods Preterm infants who were diagnosed as primary apnea, received caffeine citrate therapy and recovered in the neonatal ward of our Hospital from December 2013 to December 2014, and followed-up in the high-risk infants outpatient clinic of our Hospital after discharge were recruited in the caffeine group. Preterm infants of aminophylline group were recruited randomly by number method. They were diagnosed as primary apnea, received aminophylline therapy and recovered in our neonatal ward from December 2011 to December 2013, and followed-up regularly in the high-risk infants outpatient clinic of our Hospital after discharge. The treatment effect and mental development at 6 and 12 months of corrected age between the two groups were compared. Results Each group included 150 cases of premature infants. The time (h) of oxygen therapy, noninvasive mechanical ventilation, and invasive mechanical ventilation in the caffeine group were all significantly shorter than that in the aminophylline group [(119. 1 ± 100. 2) vs. (156. 5 ± 134. 1), (107. 4 ± 100. 2) vs. (156. 7 ± 139. 8), (146. 4 ± 122. 6) vs. (270. 9 ± 257. 2), P < 0. 05]. The incidence of patent ductus arteriosus and bronchopulmonary dysplasia in the caffeine group were significantly lower than that in the aminophylline group (24. 0% vs. 45. 3% , 9. 3% vs. 21. 3% , P <0. 05). The scores of gross motor, fine motor and social intercourse in caffeine group were significantly higher than aminophylline group at 6 months of corrected age ( P < 0. 05). The scores of gross motor, fine motor, language and adaptability of infants at 12 months of corrected age from caffeine group were significantly higher than that of infants from aminophylline group ( P < 0. 05). Conclusions Caffeine citrate treatment of primary apnea in preterm infants is more effective than aminophylline. Caffeine citrate treatment can improve mental development of premature infants.

Focus on bioethics problems of the premature treaments / 国际儿科学杂志

With the development of the prenatal medicine, the survival rate of the premature has im-proved obviously. However,doctors should focus on the ethics problem whether treat the extreme survival and critical diseased premature is necessary. During the process,the attitude of parents and the medical care personnel impact the premature survival rate. Therefore, the role excellent communication skills and the hospital ethics committee to improve the premature rate and avoid the medical conflict should not be ignored.