Associations between UGT1A1, SLCO1B1, SLCO1B3, BLVRA and HMOX1 polymorphisms and susceptibility to neonatal severe hyperbilirubinemia in Chinese Han population.

BACKGROUND: Severe neonatal hyperbilirubinemia could lead to kernicterus and neonatal death. This study aimed to analyze the association between single nucleotide polymorphisms in genes involved in bilirubin metabolism and the incidence of severe hyperbilirubinemia. METHODS: A total of 144 neonates with severe hyperbilirubinemia and 50 neonates without or mild hyperbilirubinemia were enrolled in 3 institutions between 2019 and 2020. Twelve polymorphisms of 5 genes (UGT1A1, SLCO1B1, SLCO1B3, BLVRA, and HMOX1) were analyzed by PCR amplification of genomic DNA. Genotyping was performed using an improved multiplex ligation detection reaction technique based on ligase detection reaction. RESULTS: The frequencies of the A allele in UGT1A1-rs4148323 and the C allele in SLCO1B3-rs2417940 in the severe hyperbilirubinemia group (30.2% and 90.6%, respectively) were significantly higher than those in the controls (30.2% vs.13.0%, 90.6% vs. 78.0%, respectively, both p < 0.05). Haplotype analysis showed the ACG haplotype of UGT1A1 were associated with an increased hyperbilirubinemia risk (OR 3.122, p = 0.001), whereas the GCG haplotype was related to a reduced risk (OR 0.523, p = 0.018). CONCLUSION: The frequencies of the A allele in rs4148323 and the C allele in rs2417940 are highly associated with the incidence of severe hyperbilirubinemia in Chinese Han neonates. TRIAL REGISTRATION: Trial registration number:ChiCTR1800020424; Date of registration:2018-12-29.

Evaluating Nitrogen Management Practices for Greenhouse Gas Emission Reduction in a Maize Farmland in the North China Plain: Adapting to Climate Change.

Quantification of the trade-offs among greenhouse gas (GHG) emissions, yield, and farmers' incomes is essential for proposing economic and environmental nitrogen (N) management strategies for optimizing agricultural production. A four-year (2017-2020) field experiment (including four treatments: basic N fertilizer treatment (BF), suitable utilization of fertilization (SU), emission reduction treatment (ER), and high fertilization (HF)) was conducted on maize (Zea mays L.) in the North China Plain. The Life Cycle Assessment (LCA) method was used in this study to quantify the GHG emissions and farmers' incomes during the whole maize production process. The total GHG emissions of BF, SU, ER, and HF treatments in the process of maize production are 10,755.2, 12,908.7, 11,950.1, and 14,274.5 kg CO2-eq ha-1, respectively, of which the direct emissions account for 84.8%, 76.8%, 74.9%, and 71.0%, respectively. Adding inhibitors significantly reduced direct GHG emissions, and the N2O and CO2 emissions from the maize fields in the ER treatment decreased by 30.0% and 7.9% compared to those in the SU treatment. Insignificant differences in yield were found between the SU and ER treatments, indicating that adding fertilizer inhibitors did not affect farmers' incomes while reducing GHG emissions. The yield for SU, ER, and HF treatments all significantly increased by 12.9-24.0%, 10.0-20.7%, and 2.1-17.4% compared to BF, respectively. In comparison with BF, both SU and ER significantly promoted agricultural net profit (ANP) by 16.6% and 12.2%, with mean ANP values of 3101.0 USD ha-1 and 2980.0 USD ha-1, respectively. Due to the high agricultural inputs, the ANP values in the HF treatment were 11.2%, 16.6%, and 12.4% lower than those in the SU treatment in 2018-2020. In conclusion, the combination of N fertilizer and inhibitors proved to be an environmentally friendly, high-profit, and low-emissions production technology while sustaining or even increasing maize yields in the North China Plain, which was conducive to achieving agricultural sustainability.

Risk factors for death caused by early onset sepsis in neonates: a retrospective cohort study.

OBJECTIVE: To evaluate the association between traditional laboratory findings and death, and to find risk factors for death in infants with early onset sepsis (EOS). STUDY DESIGN: This was a single-center, case-control, retrospective trial conducted between January 2020 and August 2021. Infants with EOS were enrolled and divided into two groups based on outcome before hospital discharge: non-survivors (Mortality group) and survivors (Survival group). RESULTS: Out of 556 eligible neonates, there were 38 (6.8%) deaths. After univariate analysis and ROC curve analysis, there were a total of 12 values with significant differences (p < 0.05) between two groups, which included birth weight (BW), weight on admission, gestational age, age on admission, mode of delivery, septic shock, heart failure, respiratory failure, pulmonary hypertension, hypothermia, serum lactic acid, and aspartate aminotransferase (AST). Moreover, after multivariate analysis performed for those 12 values, the binary logistic regression analysis showed that taking death as a reference, the BW (OR = 1.00, 95% CI[1.001, 1.002], p < 0.001), PPHN (OR = 2.60, 95% CI[1.04, 6.52], p > 0.001), septic shock (OR = 6.15, 95% CI [2.52, 15.00], p < 0.001), heart failure (OR = 6.22, 95% CI[0.90, 43.05], p > 0.001), serum lactic acid (OR = 0.82, 95%CI[0.75, 0.90], p < 0.001), and AST (OR = 1.00, 95% CI[0.99, 1.00], p > 0.001) could be regarded as risk factors for death with 94.0% correct predictions. CONCLUSIONS: The factors affecting the prognosis of EOS in neonates were BW, PPHN, septic shock, heart failure, serum lactic acid, and AST. Timely correction of these modifiable risk factors for death may decrease the mortality of EOS in neonates.

Neonatal Adverse Events' Trigger Tool Setup With Random Forest.

OBJECTIVE: This study aimed to develop a trigger tool for detection of neonatal adverse events (AEs) and to validate its effectiveness. STUDY DESIGN: Random forest (RF) algorithm was used to build the predictive model by analyzing data from the medical records of 782 neonates in our previous study. Thirteen variables for each patient were used to predict neonatal AEs. Next, the critical variables were selected based on recursive elimination of variables to form the list of triggers. Then, a trigger tool with those triggers was established and tested by reviewing medical records. The positive predictive value of individual triggers and of the entire tool was evaluated. RESULTS: Data from 782 neonates, including 297 patients with and 485 patients without AEs, were collected to build the original RF model. Then, the 6 most important variables, including diarrhea, antibiotic use, fever, death, skin damage, and suspected necrotizing enterocolitis, were selected to establish a neonate-focused trigger tool. The forest with the 6 variables predicted AEs with a sensitivity of 70.7%, a specificity of 92.0%, and an error rate of 16.1%. In a validation study of the trigger tool, 655 neonates with birth weights ≥1500 g were enrolled, and review of their medical records revealed 1709 triggers and 1172 unique AEs. The 3 most common AEs identified were skin damage, iatrogenic diarrhea, and environmental factor-related fever. The total positive predictive value of the trigger tool was 0.686. CONCLUSIONS: The neonate-focused trigger tool developed using the RF algorithm efficiently and reliably identifies AEs among hospitalized neonates with birth weights ≥1500 g.

Report about term infants with severe hyperbilirubinemia undergoing exchange transfusion in Southwestern China during an 11-year period, from 2001 to 2011.

OBJECTIVES: This study was intended to explore the etiology and risk factors of severe neonatal hyperbilirubinemia and to analyze the adverse events associated with ECT (Exchange Transfusion), as well as to identify the factors related to the poor prognosis. METHODS: All of the full-term neonates who had undergone ECT for hyperbilirubinemia at Children's Hospital of Chongqing Medical University from January 2001 to December 2011 were enrolled in this study. General demographic characteristics, comorbidities, pre- and post-exchange TSB(Total Serum Bilirubin) levels, duration and frequency of ECT, and clinical outcomes were recorded and analyzed anonymously. RESULTS: Of 614 total infants, 368 patients (59.9%) with ABO incompatibility were identified, of whom 197 (53.5%) developed acute bilirubin encephalopathy (ABE) and 16 (4.3%) suffered a poor prognosis. The etiology was unidentified in 103 patients (16.8%), of whom 62 (60.1%) developed ABE and 9 (8.7%) had a poor prognosis. Identified adverse events secondary to ECT included thrombocytopenia (54.6%), hyperglycemia (42.8%), apnea (3.3%) and necrotizing enterocolitis (NEC) (1.3%). No ECT-related mortality was documented in this study. CONCLUSIONS: The etiology, peak TSB level before ECT, and time of ECT had a significant impact on the outcome of severe neonatal hyperbilirubinemia. ABO incompatibility was the most common cause of extreme neonatal hyperbilirubinemia. Pathological weight loss could be involved in the development of extreme hyperbilirubinemia with an unidentified cause.

[Effects of different types and concentration of oral sweet solution on reducing neonatal pain during heel lance procedures].

OBJECTIVE: To compare the effect of different types and concentrations of sweet solutions on neonatal pain during heel lance procedure. METHOD: Totally 560 full term neonates (male 295, female 265) were randomized into 7 groups:placebo group (plain water), 10% glucose, 25% glucose, 50% glucose, 12% sucrose, 24% sucrose and 30% sucrose groups.In each group, 2 ml corresponding oral solutions were administered through a syringe by dripping into the neonate's mouth 2 minute before heel lance. The procedure process was recorded by videos, from which to collect heart rate, oxygen saturation and pain score 1 min before puncture, 3, 5 and 10 min after puncture. RESULT: The average heart rate increase 3, 5 and 10 min after procedure in the 25% and 50% glucose groups, 12% and 24% and 30% sucrose groups was significantly lower than those in the placebo group (P < 0.01 or 0.05). The average heart rate increase 3 min after procedure in the sucrose group was lower than that in the glucose group (P < 0.01).Neonates who received 30% sucrose has a significantly lower average heart rate increase than those who received 12% and 24% sucrose 3 min after heel lance (both P < 0.05) . The average oxygen saturation decrease 3, 5, 10 min after procedure was significantly lower than those in the placebo group (P < 0.01). The average oxygen saturation decrease 3 min after procedure in the sucrose groups was significantly lower than that in the glucose groups (P < 0.01). The average pain score 3, 5, 10 min after procedure was significantly lower than those in the placebo group (P < 0.01). The average pain score 3 min after procedure in the sucrose groups was significantly lower than that in the glucose groups (P < 0.01). CONCLUSION: Oral administration of sweet solutions is an effective way to relieve neonatal pain on procedure, and sucrose has a better pain relief action than glucose, moreover, 30% sucrose provides better effect in control of heart rate increase 3 min after heel lance, but the best concentration of sucrose for pain relief needs further study.