[Risk factors for bronchopulmonary dysplasia in twin preterm infants: a multicenter study]. / åŒèƒŽæ—©äº§å„¿æ”¯æ°”ç®¡è‚ºå‘è‚²ä¸è‰¯å±é™©å› ç´ åˆ†æžï¼šä¸€é¡¹å¤šä¸­å¿ƒç ”ç©¶.

OBJECTIVES: To investigate the risk factors for bronchopulmonary dysplasia (BPD) in twin preterm infants with a gestational age of <34 weeks, and to provide a basis for early identification of BPD in twin preterm infants in clinical practice. METHODS: A retrospective analysis was performed for the twin preterm infants with a gestational age of <34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020. According to their conditions, they were divided into group A (both twins had BPD), group B (only one twin had BPD), and group C (neither twin had BPD). The risk factors for BPD in twin preterm infants were analyzed. Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins. RESULTS: A total of 904 pairs of twins with a gestational age of <34 weeks were included in this study. The multivariate logistic regression analysis showed that compared with group C, birth weight discordance of >25% between the twins was an independent risk factor for BPD in one of the twins (OR=3.370, 95%CI: 1.500-7.568, P<0.05), and high gestational age at birth was a protective factor against BPD (P<0.05). The conditional logistic regression analysis of group B showed that small-for-gestational-age (SGA) birth was an independent risk factor for BPD in individual twins (OR=5.017, 95%CI: 1.040-24.190, P<0.05). CONCLUSIONS: The development of BPD in twin preterm infants is associated with gestational age, birth weight discordance between the twins, and SGA birth.

Type VII Aplasia Cutis Congenita in Neonates Related to Maternal HBV Infection? Case Report and Literature Review.

Aplasia cutis congenita (ACC) is a rare disease with an unclear pathogenic mechanism. ACC has been suggested to result from the disrupted development or degeneration of skin in the uterus. This study describes two cases that may have underlying pathogenic cause that have not been previously reported. Two neonates who were admitted to the neonatal intensive care unit due to "skin lesions on the limbs" without other deformities or complications were diagnosed with type VII ACC by dermatologist. The mothers showed positivity for hepatitis B virus (HBV) surface antigen and elevated level of HBV DNA copies, which may be related to ACC. But this association could be a coincidence. Both neonates were treated with antibacterial dressings and achieved satisfactory healing.

Short term outcomes of extremely low birth weight infants from a multicenter cohort study in Guangdong of China.

With the increase in extremely low birth weight (ELBW) infants, their outcome attracted worldwide attention. However, in China, the related studies are rare. The hospitalized records of ELBW infants discharged from twenty-six neonatal intensive care units in Guangdong Province of China during 2008-2017 were analyzed. A total of 2575 ELBW infants were enrolled and the overall survival rate was 55.11%. From 2008 to 2017, the number of ELBW infants increased rapidly from 91 to 466, and the survival rate improved steadily from 41.76% to 62.02%. Increased survival is closely related to birth weight (BW), regional economic development, and specialized hospital. The incidence of complications was neonatal respiratory distress syndrome (85.2%), oxygen dependency at 28 days (63.7%), retinopathy of prematurity (39.3%), intraventricular hemorrhage (29.4%), necrotizing enterocolitis (12.0%), and periventricular leukomalacia (8.0%). Among the 1156 nonsurvivors, 90.0% of infants died during the neonatal period (≤ 28 days). A total of 768 ELBW infants died after treatment withdrawal, for reasons of economic and/or poor outcome. The number of ELBW infants is increasing in Guangdong Province of China, and the overall survival rate is improving steadily.

Clinical treatment outcomes and their changes in extremely preterm twins: a multicenter retrospective study in Guangdong Province, China. / è¶ æœªæˆç†ŸåŒèƒŽå„¿ä¸´åºŠæ•‘æ²»ç»“å±€åŠå˜åŒ–åˆ†æžï¼šä¸€é¡¹å¹¿ä¸œçœå¤šä¸­å¿ƒå›žé¡¾æ€§ç ”ç©¶.

OBJECTIVES: To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China. METHODS: A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups. RESULTS: Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05). CONCLUSIONS: There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.

Small for gestational age is a risk factor for thyroid dysfunction in preterm newborns.

BACKGROUND: Thyroid hormones play an important role in the normal growth and maturation of the central nervous system. However, few publications addressed the altered thyroid hormone levels in preterm small for gestational age (SGA) newborns. We hypothesized preterm SGA infants have higher thyroid-stimulating hormone (TSH) concentrations than appropriate for gestational age (AGA) ones within the normal range and an increased incidence of thyroid dysfunction. METHODS: The study was designed to compare thyroid hormone levels within the normal range and the incidence of thyroid dysfunction in the SGA and AGA groups to test the hypothesis. The medical records of all preterm infants admitted to the neonatal intensive care unit (NICU) at the First Affiliated Hospital of Shantou University Medical College, Shantou, China, between January 1, 2015 and December 31, 2018, were reviewed. Blood samples were collected between 72 and 96 h of life and analyzed with TSH, free thyroxine (FT4) and free triiodothyronine (FT3) assays. Thyroid function test (TFT) results, and neonatal demographic and clinical factors were analyzed to identify the associations between SGA birth and altered thyroid concentrations and thyroid dysfunction. RESULTS: TSH and FT4 concentrations were significantly higher in the SGA group than the AGA group ((3.74(interquartile range (IQR):2.28 ~ 6.18) vs. 3.01(IQR: 1.81 ~ 5.41) mU/L, p = 0.018), and (17.76 ± 3.94 vs. 17.42 ± 3.71 pmol/L, p = 0.371), respectively). The higher TSH levels were associated with being SGA or Z-score of birth weight (BW) for GA after adjusting for potential confounders ((ßSGA = 0.68 (95% confidence interval (CI) 0.15 ~ 1.21), p = 0.013) or (ßZ-score = - 0.25 (95%CI -0.48 ~ - 0.03), p = 0.028), respectively). However, we did not find a significant association between SGA birth and altered FT4 concentrations. Furthermore, compared with the AGA group, the SGA group presented an increased incidence of transient hypothyroxinemia with delayed TSH elevation (dTSHe), a higher percentage receiving levothyroxine (L-T4) therapy, and a higher rate of follow-up within the first 6 months of life. CONCLUSIONS: Preterm SGA newborns had significantly higher TSH concentrations within the normal range and an increased incidence of thyroid dysfunction. The SGA newborns with these features should be closely followed up with periodical TFTs and endocrinologic evaluation.

Short-term outcomes of extremely preterm infants at discharge: a multicenter study from Guangdong province during 2008-2017.

BACKGROUND: An increasing number of extremely preterm (EP) infants have survived worldwide. However, few data have been reported from China. This study was designed to investigate the short-term outcomes of EP infants at discharge in Guangdong province. METHODS: A total of 2051 EP infants discharged from 26 neonatal intensive care units during 2008-2017 were enrolled. The data from 2008 to 2012 were collected retrospectively, and from 2013 to 2017 were collected prospectively. Their hospitalization records were reviewed. RESULTS: During 2008-2017, the mean gestational age (GA) was 26.68 ± 1.00 weeks and the mean birth weight (BW) was 935 ± 179 g. The overall survival rate at discharge was 52.5%. There were 321 infants (15.7%) died despite active treatment, and 654 infants (31.9%) died after medical care withdrawal. The survival rates increased with advancing GA and BW (p < 0.001). The annual survival rate improved from 36.2% in 2008 to 59.3% in 2017 (p < 0.001). EP infants discharged from hospitals in Guangzhou and Shenzhen cities had a higher survival rate than in others (p < 0.001). The survival rate of EP infants discharged from general hospitals was lower than in specialist hospitals (p < 0.001). The major complications were neonatal respiratory distress syndrome, 88.0% (1804 of 2051), bronchopulmonary dysplasia, 32.3% (374 of 1158), retinopathy of prematurity (any grade), 45.1% (504 of 1117), necrotizing enterocolitis (any stage), 10.1% (160 of 1588), intraventricular hemorrhages (any grade), 37.4% (535 of 1431), and blood culture-positive nosocomial sepsis, 15.7% (250 of 1588). The multivariate logistic regression analysis indicated that improved survival of EP infants was associated with discharged from specialist hospitals, hospitals located in high-level economic development region, increasing gestational age, increasing birth weight, antenatal steroids use and a history of premature rupture of membranes. However, twins or multiple births, Apgar ≤7 at 5 min, cervical incompetence, and decision to withdraw care were associated with decreased survival. CONCLUSIONS: Our study revealed the short-term outcomes of EP infants at discharge in China. The overall survival rate was lower than the developed countries, and medical care withdrawal was a serious problem. Nonetheless, improvements in care and outcomes have been made annually.

Risk factors of severe hand, foot and mouth disease in Shantou, China: a case-control study.

INTRODUCTION: In clinical perspectives, how to distinguish a small proportion of children at risk of developing neurological complications from a large number of children with mild symptoms still remains a challenge for primary care doctors. METHODOLOGY: From January 2012 to December 2015, 225 cases with severe hand, foot and mouth disease (HFMD) matched with 492 controls were enrolled in the age-matched, case-control study. Continuous variables were examined by univariate analysis using a chi-squared or Fisher's exact test, and categorical variables were reported by relative risks (odd's ratio). Multivariate logistic regression was used to analyze the independent risk factors for severe HFMD. RESULTS: Peak body temperature over 37.5℃，total duration of fever over 3 days, lethargy, enterovirus 71 (EV71) infection were independent risk factors for severe HFMD. CONCLUSIONS: Peak body temperature over 37.5℃，total duration of fever over 3 days, lethargy, EV71 infection were independent risk factors for severe HFMD.

A pre-term infant of 32 weeks gestation with congenital tuberculosis treated successfully with antituberculosis chemotherapy.

An infant of 32 weeks gestation was separated from her mother at birth for treatment of hyaline membrane disease and, on recovery, was cared for by adoptive parents. At 25 days, she was treated for pneumonia with immunoglobulins and multiple antibiotics and appeared to respond. Her symptoms recurred at 8 weeks and tuberculosis was confirmed by detection in an acid-fast bacilli smear of gastric aspirate. Her mother presented with disseminated tuberculosis with meningitis 1 month after delivery. Criteria for the diagnosis of congenital tuberculosis in the infant were confirmed.

Insulin resistance and its association with catch-up growth in Chinese children born small for gestational age.

OBJECTIVE: To assess insulin resistance and ß-cell function from birth to age 4 years and to examine their associations with catch-up growth (CUG) in Chinese small-for-gestational-age (SGA) children. METHODS: Weight and height were measured yearly from birth to age 4 years, and transformed into age- and gender-adjusted SD scores. Fasting serum insulin and glucose were measured, and fasting insulin resistance and ß-cell function were estimated using the homeostasis model assessment (HOMA). RESULTS: The mean HOMA-IR of the SGA group was significantly lower than that of the appropriate-for-gestational-age (AGA) group at ages 2 and 3 years old, and the mean HOMA% of the SGA group was significantly lower than that of the AGA group at age 4 years old. At 4 years of age, HOMA for insulin resistance was positively correlated with the height gain and SD of height gain between 0 and 5 months, and HOMA% was positively correlated with the weight gain and SD of weight gain between 6 and 12 months in SGA children. CONCLUSIONS: SGA children with CUG show a greater propensity to develop insulin resistance than AGA children between ages 2 and 4 years old. HOMA parameters are related to CUG in the first year of life.

[Serum levels of leptin and several growth-related hormones in premature infants].

OBJECTIVE: Leptin (LEP) is mainly produced by white adipose tissue and participates in the energy metabolism and regulation of growth. Cooperating with the other metabolic hormones, it plays an important role in the developments of fetus and neonates. This study was designed to test the serum levels of LEP, neuropeptide Y (NPY), insulin (INS) and insulin-like growth factor-1 (IGF-1) and measure the body mass index (BMI) and head circumference (HC) at different days of life of premature infants with or without serious diseases and to find the changes of serum levels of LEP as well as NPY, INS and IGF-1, the relationship between those hormones and the changes of body weight and the influences of diseases on the levels of those hormones in premature infants. METHOD: The clinical data as well as weights, lengths, HC of 40 sick premature infants (sick group) and 30 premature infants without any diseases (control group) were collected and the serum levels of LEP, NPY, INS and IGF-1 were determined by using radioimmunoassay (RIA) at d 1, d 7 and d 12 of life. BMI was calculated by weight (kg)/length (m)(2). SPSS13.0 was used to analyze the data RESULT: (1) In sick group the serum LEP levels were 0.74 +/- 0.21, 0.60 +/- 0.18, 0.82 +/- 0.12 (mg/L) (P < 0.01), the BMI were 9.81 +/- 1.24, 8.36 +/- 0.87, 9.08 +/- 1.12 (kg/m(2)) (P < 0.01) on d 1, d 7 and d 12, respectively. In control group serum LEP levels were 0.78 +/- 0.17, 0.71 +/- 0.17, 0.88 +/- 0.58 (mg/L) (P < 0.01), the BMI were 10.03 +/- 1.04, 9.35 +/- 0.80, 11.06 +/- 0.82 (kg/m(2)), on d 1, d 7 and d 12, respectively (P < 0.01). In both groups, serum LEP levels as well as the BMI decreased on d 7 and reincreased on d 12. The differences of serum LEP levels and BMI between sick group and control group at d1 were not significant (P > 0.05); compared with control group, the serum LEP levels and BMI on d 7 and d 12 in sick group were lower and the differences were significant. (2) There were positive correlations between serum LEP levels and BMI in sick group as well as in control group. (3) In sick group, the serum NPY levels at d 1, d 7, d 12 were 55.33 +/- 9.38, 46.64 +/- 6.17, 75.13 +/- 9.12 (ng/L) (P < 0.01), INS were 10.07 +/- 2.63, 7.71 +/- 2.77, 10.37 +/- 2.29 (mU/L) (P < 0.01), IGF-1 were 38.66 +/- 11.42, 31.98 +/- 7.34, 41.84 +/- 8.05 (mg/L) (P < 0.01), respectively. In control group, the serum NPY levels at d1, d 7 and d 12 were 57.77 +/- 7.15, 48.49 +/- 8.81, 81.36 +/- 8.51 (ng/L) (P < 0.01), INS were 11.55 +/- 1.99, 8.28 +/- 2.87, 15.42 +/- 3.80 (mU/L) (P < 0.01), IGF-1 were 37.76 +/- 7.07, 34.33 +/- 8.97, 50.19 +/- 8.38 (mg/L) (P < 0.01), respectively. In both groups, serum levels of NPY, INS and IGF-1 had positive correlations with serum LEP levels as well as BMI on the corresponding days and decreased on d 7 and reincreased on d 12. CONCLUSION: (1) The serum LEP levels decreased on 7 d of life and reincreased on 12 d of life, which corresponded to the changes of the physical development of premature infants. (2) The serum LEP levels in sick premature infants decreased definitely as compared with control group, which suggested that diseases had negative influences on the LEP levels and the physical developments were slowed down in sick premature infants. (3) The serum levels of NPY, INS and IGF-1 had positive correlations with LEP levels as well as BMI at the early period of life, which suggested that NPY, INS and IGF-1, cooperating with LEP, might take part in the regulation of development of premature infants.

Neuroprotective effect of memantine combined with topiramate in hypoxic-ischemic brain injury.

Glutamate receptor-mediated neurotoxicity is a major mechanism contributing to hypoxic-ischemic brain injury (HIBI). Memantine is a safe non-competitive NMDA receptor blocker characterized by its low affinity and fast unblocking kinetics. Topiramate is an AMPA/KA receptor blocker and use-dependent sodium channel blocker with several other neuroprotective actions and little neurotoxicity. We hypothesized that the coadministration of memantine and topiramate would be highly effective to attenuate HIBI in neonatal rats. Seven-day-old Sprague-Dawley rat pups were subjected to right common carotid artery ligation and hypoxia for 2 h, and then were randomly and blindly assigned to one of four groups: vehicle, memantine, topiramate and combination group. Brain injury was evaluated by gross damage and weight deficit of the right hemisphere at 22d after hypoxic-ischemia (HI) and by neurofunctional assessment (foot-fault test) at 21d post-HI. Acute neuronal injury was also evaluated by microscopic damage grading at 72 h post-HI. Results showed the combination of memantine and topiramate improved both pathological outcome and performance significantly. The drug-induced apoptotic neurodegeneration was assessed by TUNEL staining at 48 h post-HI and the result showed no elevated apoptosis in all observed areas. The result of the experiment indicates the combination therapy is safe and highly effective to reduce brain damage after HIBI.