[A multicenter study of neonatal stroke in Shenzhen, China]. / 深圳市新生儿脑卒中多中心现况调查.

OBJECTIVES: To investigate the incidence rate, clinical characteristics, and prognosis of neonatal stroke in Shenzhen, China. METHODS: Led by Shenzhen Children's Hospital, the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022. The incidence, clinical characteristics, treatment, and prognosis of neonatal stroke in Shenzhen were analyzed. RESULTS: The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137, 1/6 060, and 1/7 704, respectively. Ischemic stroke accounted for 75% (27/36); boys accounted for 64% (23/36). Among the 36 neonates, 31 (86%) had disease onset within 3 days after birth, and 19 (53%) had convulsion as the initial presentation. Cerebral MRI showed that 22 neonates (61%) had left cerebral infarction and 13 (36%) had basal ganglia infarction. Magnetic resonance angiography was performed for 12 neonates, among whom 9 (75%) had involvement of the middle cerebral artery. Electroencephalography was performed for 29 neonates, with sharp waves in 21 neonates (72%) and seizures in 10 neonates (34%). Symptomatic/supportive treatment varied across different hospitals. Neonatal Behavioral Neurological Assessment was performed for 12 neonates (33%, 12/36), with a mean score of (32±4) points. The prognosis of 27 neonates was followed up to around 12 months of age, with 44% (12/27) of the neonates having a good prognosis. CONCLUSIONS: Ischemic stroke is the main type of neonatal stroke, often with convulsions as the initial presentation, involvement of the middle cerebral artery, sharp waves on electroencephalography, and a relatively low neurodevelopment score. Symptomatic/supportive treatment is the main treatment method, and some neonates tend to have a poor prognosis.

Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units.

BACKGROUND: This study aimed to describe length of stay (LOS) to discharge and site variations among very preterm infants (VPIs) admitted to 57 Chinese neonatal intensive care units (NICUs) and to investigate factors associated with LOS for VPIs. METHODS: This retrospective multicenter cohort study enrolled all infants < 32 weeks' gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network, within 7 days after birth in 2019. Exclusion criteria included major congenital anomalies, NICU deaths, discharge against medical advice, transfer to non-participating hospitals, and missing discharge date. Two multivariable linear models were used to estimate the association of infant characteristics and LOS. RESULTS: A total of 6580 infants were included in our study. The overall median LOS was 46 days [interquartile range (IQR): 35-60], and the median corrected gestational age at discharge was 36 weeks (IQR: 35-38). LOS and corrected gestational age at discharge increased with decreasing gestational age. The median corrected gestational age at discharge for infants at 24 weeks, 25 weeks, 26 weeks, 27-28 weeks, and 29-31 weeks were 41 weeks, 39 weeks, 38 weeks, 37 weeks and 36 weeks, respectively. Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals. CONCLUSIONS: The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents. Large variation of LOS independent of infant characteristics existed, indicating variation of care practices requiring further investigation and quality improvement.

[Correlation between end-tidal carbon dioxide and partial pressure of arterial carbon dioxide in ventilated newborns].

OBJECTIVE: To study the correlation between end-tidal carbon dioxide (PetCO2) and partial pressure of arterial carbon dioxide (PaCO2) in ventilated newborns. METHODS: Thirty-one ventilated newborn underwent mainstream PetCO2 monitoring; meanwhile, arterial blood gas analysis was performed. The correlation and consistency between PetCO2 and PaCO2 were assessed. RESULTS: A total of 85 end-tidal and arterial CO2 pairs were obtained from 31 ventilated newborns. The mean PetCO2 (41±10 mm Hg) was significantly lower than the corresponding mean PaCO2 (46±11 mm Hg) (P<0.01). There was a significant positive correlation between PetCO2 and PaCO2 (r=0.92, P<0.01). The overall PetCO2 bias was 5.1±4.3 mm Hg (95% limits of consistency, -3.3 to 13.6 mmHg), and 5% (4/85) of the points were beyond the 95%CI. When the oxygenation index (OI) was less than 300 mm Hg (n=48), there was a significant positive correlation between PetCO2 and PaCO2 (r=0.85, P<0.01); the PetCO2 bias was 5.9±4.3 mm Hg (95% limits of consistency, -2.6 to 14.5 mm Hg), and 4.2% (2/48) of the points were beyond the 95%CI. When the OI was more than 300 mm Hg (n=37), there was also a significant positive correlation between PetCO2 and PaCO2 (r=0.91, P<0.01); the PetCO2 bias was 4.1±4.1 mm Hg (95% limits of consistency, -3.9 to 12.1 mm Hg), and 5% (2/37) of the points were beyond the 95%CI. CONCLUSIONS: There is a good correlation and consistency between PetCO2 and PaCO2 in ventilated newborns.

Protection of androgen against hypoxic-ischemic brain damage in neonatal rats and possible mechanisms.

OBJECTIVE: Some research has shown that androgen has a neuroprotection against hypoxia-ischemia brain damage (HIBD). However, the relevant mechanism has not been fully elucidated. This study aimed to explore the neuroprotection of androgen against HIBD in neonatal rats and the possible mechanism. METHODS: Sixty-four seven-day-old Sprague-Dawley (SD) rats were randomly assigned into three groups: Sham-operation, HIBD and Androgen. The HIBD model was induced by ligation of the left carotid common artery along with hypoxia exposure in neonatal rats from the latter two groups. The Sham-operation group was not subjected to hypoxia-ischemia (HI). The Androgen intervention group received an injection of testosterone propionate (25 mg/kg) immediately after HIBD. Bcl-2 and Bax protein expressions in the cortex and hippocampal CA region were detected by immunohistochemical method at 6, 24 and 72 hrs and at 7 days after HI. The contents of SOD and MDA in the brain tissue homogenate were measured by the thiobarbituric acid (TBA) method and the xanthine oxidase luminescence method respectively at 6, 24 and 48 hrs after HI. RESULTS: There were few Bcl-2 and Bax immune positive cells in the cortex or hippocampus in the left hemisphere in the Sham-operation group at 6 hrs after operation. This was significantly different from the HIBD control and Androgen intervention groups (P < 0.01). The expression of Bcl-2 protein in the cortex and hippocampus of the Androgen intervention group was significantly higher than that of the HIBD control group at 6, 24 and 72 hrs after HI (P < 0.05 or 0.01). The expression of Bax protein in the cortex and hippocampus of the Androgen intervention group was significantly lower than that of the HIBD control group at 24 hrs after HI (P < 0.05). The SOD content in the brain tissue homogenate of the HIBD control group was significantly reduced, in contrast, the MDA content in the brain tissue homogenate of the HIBD control group increased significantly at 6 hrs after HI compared with the Sham-operation group (P < 0.05). The SOD content was reduced to a nadir and the MDA content increased to a peak at 24 hrs after HI in the HIBD control group. Androgen intervention increased significantly the SOD activity at 6,24 and 48 hrs after HI and decreased significantly the MDA content at 6 and 24 hrs after HI as compared with the HIBD control group (P < 0.05 or 0.01). CONCLUSIONS: The neuroprotection of androgen against neonatal HIBD is produced possibly through an increase of Bcl-2 protein expression and a reduction in Bax protein expression, thus decreasing neuronal apoptosis after HI. There may also be a reduction in the consumption of antioxidant and an inhibition of the formation of oxidant free radicals to alleviate neuronal damage following HI.