Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China.

BACKGROUND: Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China. METHODS: The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD. RESULTS: A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082-4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606-3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044-1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061-2.424), DRI (OR, 2.094; 95% CI, 1.328-3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679-4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777-6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996-0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379-0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160-0.467) were preventive factors for BPD (all P < 0.05). CONCLUSION: Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.

[Perinatal conditions of late preterm twins versus early term twins].

OBJECTIVE: To study the perinatal complications of late preterm twins (LPTs) versus early term twins (ETTs). METHODS: A retrospective analysis was performed for the complications of 246 LPTs, 496 ETTs, and their mothers. The risk factors for late preterm birth were analyzed. According to gestational age, the twins were divided into five groups: 34-34+6 weeks (n=44), 35-35+6 weeks (n=70), 36-36+6 weeks (n=132), 37-37+6 weeks (n=390), and 38-38+6 weeks (n=106). The perinatal complications were compared between groups. RESULTS: Maternal hypertension, maternal thrombocytopenia, placenta previa, and premature rupture of membranes were independent risk factors for late preterm birth in twins (P < 0.05). The LPT group had higher incidence rates of respiratory diseases, feeding intolerance, and hypoglycemia than the ETT group (P < 0.05). The 34-34+6 weeks group had a higher incidence rate of neonatal asphyxia than the 37-37+6 weeks and 38-38+6 weeks groups; and had a higher incidence rate of septicemia than 36-36+6 weeks group (P < 0.0045). The 34-34+6 weeks and 35-35+6 weeks groups had higher incidence rates of neonatal respiratory distress syndrome, neonatal apnea, and anemia than the other three groups; and had higher incidence rates of neonatal pneumonia, hypoglycemia and septicemia than the 37-37+6 weeks and 38-38+6 weeks groups (P < 0.0045). The 35-35+6 weeks group had a higher incidence rate of feeding intolerance than the 36-36+6 weeks, 37-37+6 weeks, and 38-38+6 weeks groups (P < 0.0045). The 36-36+6 weeks group had a lower incidence rate of hypoglycemia than the 34-34+6 weeks group and a higher incidence rate of hypoglycemia than the 37-37+6 weeks group (P < 0.0045). CONCLUSIONS: Compared with ETTs, LPTs have an increased incidence of perinatal complications. The incidence of perinatal complications is associated with gestational ages in the LPTs and ETTs.

[Effect and safety of intensive phototherapy in treatment of neonatal hyperbilirubinemia].

OBJECTIVE: To study the effect and safety of intensive phototherapy in the treatment of neonatal hyperbilirubinemia. METHODS: A total of 144 neonates with neonatal hyperbilirubinemia were randomly and prospectively divided into intensive phototherapy group and conventional phototherapy group, with 72 neonates in each group. The therapeutic effect and incidence of complications were compared between the two groups. RESULTS: Within 12 hours after phototherapy, the total serum bilirubin level in the intensive phototherapy group was significantly lower than in the conventional phototherapy group (P<0.05), and the intensive phototherapy group had a significantly greater reduction in serum bilirubin level than the conventional phototherapy group (P<0.05). The intensives phototherapy group had a significantly shorter time of phototherapy than the conventional phototherapy group (P<0.05). The incidence rates of fever, diarrhea, rash, and hypocalcemia and reductions in blood calcium and hemoglobin levels after phototherapy showed no significant differences between the two groups. CONCLUSIONS: During the initial stage of phototherapy, intensive phototherapy can quickly and effectively reduce the serum level of bilirubin in neonates with neonatal hyperbilirubinemia. It can also shorten the total phototherapy time, and does not increase the incidence of adverse events. Therefore, it is superior to conventional phototherapy.

Perinatal risk factors and neonatal complications in discordant twins admitted to the neonatal intensive care unit.

BACKGROUND: Many studies have shown a relationship between birth weight discordance and adverse perinatal outcomes. This study aimed to investigate the perinatal risk factors and neonatal complications of discordant twins who are admitted to the neonatal intensive care unit. METHODS: A total of 87 sets of twins were enrolled in this retrospective study, of which 22 sets were discordant twins and 65 sets were concordant twins. Binary Logistic regression analysis was used to identify the risk factors associated with the occurrence of discordant twins. The common neonatal complications of discordant twins were also investigated. RESULTS: Multivariate analysis showed that the use of assisted reproductive techniques, pregnancy-induced hypertension, and unequal placental sharing were risk factors for the occurrence of discordant twins. The incidence of small for gestational age infants and very low birth weight infants of discordant twins was significantly higher, while the birth weight of discordant twins was significantly lower than those of concordant twins. The duration of hospitalization of discordant twins was longer than that of concordant twins. The incidence of several neonatal complications, such as neonatal respiratory distress syndrome and intracranial hemorrhage, was higher in discordant twins than that in concordant twins. The percentage of those requiring pulmonary surfactant and mechanical ventilation was significantly higher in discordant twins than that in concordant twins. CONCLUSIONS: Use of assisted reproductive techniques, pregnancy-induced hypertension, and unequal placental sharing are perinatal risk factors of discordant twins who are admitted to the neonatal intensive care unit. These infants are also much more likely to suffer from various neonatal complications, especially respiratory and central nervous system diseases. It is important to prevent the occurrence of discordant twins by decreasing these risk factors and timely treatment should be given to discordant twins.

[The influence of preventive iron supplementation to iron nutritional status in breastfed infants].

OBJECTIVE: To analyze the effects to iron status who were given preventive iron supplements for two months from when they were breast-fed to four-month-old. METHODS: A total of 123 infants in four-month-old age who were breast-fed were randomly divided into iron supplementation group (63 cases) and control group (60 cases), iron supplementation group was supplied with low-dose iron (1 mg×kg⁻¹×d⁻¹) for two months with no intervention for control group. Blood samples were collected to test C reactive protein and iron status indicators in six-month-old age group infants, and the growth indices were measured and compared on the gender difference of iron status at and 6 months. RESULTS: After 2 months of low-dose iron supplementation, the hemoglobin of iron supplementation group (26 cases) increased about 5.5 g/L while the control group (34 cases) increases about 0.0 g/L (median), 95% confidence intervals were -7.0 - 13.0 g/L and -9.0 - 15.0 g/L, respectively. The hemoglobin increase of iron supplementation group was higher than the control group, the difference was statistically significant (u = -2.326, P < 0.05). The other iron nutritional status and the growth did not show any significant difference between iron supplementation group and control group (P > 0.05). At age 6 month, the MCV of the boys were (75.89 ± 3.34) fl, while the girls were (77.20 ± 3.17) fl. The boys had lower values of MCV than the girls, and the gender difference was statistically significant (t = 4.73, P < 0.05). The other iron nutritional status did not show any significant gender difference (P > 0.05). CONCLUSION: Low-dose iron supplementation of breast-fed infants at 4-month-old can increase the hemoglobin level when they were 6-month-old, and had no measurable side effect on growth.

[Thrombocytopenia in pregnancy and neonatal outcomes].

OBJECTIVE: To study the relationship between thrombocytopenia in pregnancy associated with various causes and neonatal outcomes. METHODS: Medical records of 140 pregnant women with thrombocytopenia in pregnancy and the neonatal outcomes from January 2009 to December 2010 were reviewed retrospectively. The pregnant women were classified into four groups according to the causes of thrombocytopenia: gestational thrombocytopenia (GT; n=94), pregnancy with immune thrombocytopenic purpura (ITP; n=30), pregnancy with other hematological disease (aplastic anemia or myelodysplastic syndrome; n=12), and other causes (n=4): pregnancy induced hypertension syndrome, pregnancy with systemic lupus erythematosus, and pregnancy with alcoholic cirrhosis. The neonatal outcomes in the four groups were compared. RESULTS: The premature birth rates in the GT and the ITP groups were 11.3% and 16.7%, respectively. There was no significant difference between the two groups. The premature birth rate in the other hematological disease group was 53.8%, which was significantly higher than that in the GT (P<0.01) and the ITP groups (P<0.05). Congenital passive immune thrombocytopenia was found in 2 neonates (2%) in the GT group and in 4 neonates (13%) in the ITP group (P<0.05). In addition, other diseases were also observed in neonates in the ITP group, including 1 case (3%) of ITP and 1 case (3%) of Evans syndrome. Intracranial hemorrhage occurred in one neonate (8%) in the other hematological disease group. Neonatal lupus syndrome was found in 1 case (25%) in the other causes group. CONCLUSIONS: Thrombocytopenia in pregnancy associated with different causes may result in different neonatal outcomes.

[Risk factors for preterm birth and complications in 287 late preterm infants].

OBJECTIVE: To investigate the risk factors for preterm birth and complications in late preterm infants. METHODS: The clinical data of 287 late preterm infants were retrospectively studied. Two hundred and eighty-eight term infants served as the control group. Logistic regression analysis was used to identify risk factors associated with late preterm birth. The common complications in late preterm infants were investigated. RESULTS: Several significant risk factors for late preterm birth were identified by logistic regression analysis: twin pregnancy, gestational diabetes mellitus, eclampsia or preeclampsia, placenta previa, placental abruption and premature rupture of membranes. The duration of hospitalization in late preterm infants was longer than that in term infants. The complications were common in late preterm infants, with a high prevalence of anemia, aspiration pneumonia, hypoglycemia and intracranial hemorrhage. CONCLUSIONS: The late preterm infants are much more likely to suffer various complications. It is important to reduce the incidence of late preterm births by decreasing perinatal risk factors above mentioned.

[Effects of receptor-interacting protein 140 gene knockdown on the proliferation of microglioma cells: experiment with rat microglioma cells].

OBJECTIVE: To investigate the effects of receptor-interacting protein (RIP)140 gene knockdown on the proliferation of microglioma cells. METHODS: Mouse microglioma cells of the line BV-2 were cultured and transfected with 2 kinds of recombinant RIP140-shRNA plasmids (V2MM-71674 and V2MM-71080) or blank plasmid MSCV-EGFP. Real-time PCR and Western blotting were used to detect the mRNA and protein expression of RIP140; and the cell proliferation was detected by MTT assay. RESULTS: There were not significant differences in the RIP140 mRNA and protein expression between the BV-2 and BV-2-MGCV-EGFP groups. Compared to those of the BV-2 group, the RIP140 mRNA expression levels of the BV-2-71674 and BV-2-71080 groups were lower by 73% and 75% respectively. The protein expression levels of the BV-2-71674 and BV-2-71080 groups were remarkably lower than those of the BV-2 and BV-MSGV-EGFP groups. MTT assay showed that there were not significant differences in the proliferation rates at different time points between the BV-2 and BV-2-MSCV-EGFP groups, however, the proliferation rates at the time points of 24, 48, 72, and 96 h of the BV-2-71674 and BV-2-71080 groups were significantly lower than those of the BV-2 group (all P<0.01). CONCLUSION: RIP140 gene knockdown effectively inhibits the proliferation of microglioma cells.

[Expression profile of receptor-interacting protein 140 in the brain: experiment with prenatal and postnatal mice].

OBJECTIVE: To investigate the expression of receptor-interacting protein of 140,000 (RIP140) in the developmental brain. METHODS: The brain tissues of 15-day-old and 20-day-old fetal Balb/c mice and 1, 7, 14, 28, 42, and 56-day-old postnatal mice were collected. The expression of RIP140 was examined by immunohistochemistry. Real-time PCR and Western blotting were used to quantify the expression of the mRNA and protein levels of RIP140. RESULTS: (1) Immunochemistry showed that RIP140 was expressed extensively in the brain of embryonic and newborn mice, mainly present in the neurons in many different brain regions, such as the cerebral cortex, hippocampus and pituitary gland. The cellular location of RIP140 was confined to the nucleus. (2) Real-time PCR revealed that the RIP140 mRNA expression in brain was in an increment as the time went by, peaked on the 7th day after birth, then was in a instable level after that until the adulthood. (3) Western blotting indicated that the protein level of RIP140 was coincident with the mRNA level [r(s) = 0.767, P = 0.016 (bilateral)]. CONCLUSION: The expression and role of RIP140 may be involved in the whole neurodevelopment stages of brain, and may take part in the development and the function of the brain.