Efficacy of comprehensive warming intervention strategy on gestational age <32 weeks preterm infants' body temperature during inter-hospital transportation / 中国新生儿科杂志

Objective:To study the effects of comprehensive warming intervention strategy on the body temperature of preterm infants (gestational age <32 weeks and birth weight <1 500 g) during inter-hospital transportation.Method:From October 2016 to July 2019, eligible preterm infants transported to our hospital were retrospectively analyzed. From October 2016 to March 2018, preterm infants transported with routine transportation strategy were assigned into the control group. From April 2018 to July 2019, preterm infants transported with the comprehensive warming intervention strategy were assigned into the experiment group. The body temperature, complications and prognosis before and after the transportation to our NICU were compared.Result:A total of 1 194 premature infants with gestational age <32 weeks were included with 630 cases in the control group and 564 cases in the experiment group. No significant differences existed in demographic data of the mothers, infants and the transportation time between the two groups ( P>0.05). The body temperatures before and after transportation in the experimental group were (36.8±0.5)℃ and (36.7±0.5)℃, significantly higher than the control group [(36.0±0.4)℃ and (36.3±0.6)℃] ( P<0.01). The incidences of hypoglycemia and mortality in the experimental group were 3.7% (21/564) and 4.8% (27/564), significantly lower than the control group [8.4% (53/630) and 7.9% (50/630)] ( P<0.05). Conclusion:Comprehensive warming intervention strategy in inter-hospital transport can effectively improve the body temperature of preterm infants before and after transportation, reducing the incidences of hypoglycemia and mortality.

Comparison of the clinical characteristics of congenital chylothorax in preterm and term infants / 中国新生儿科杂志

Objective:To compare the clinical characteristics of congenital chylothorax in preterm and term infants.Method:From January 2011 to December 2019, the clinical data of infants with congenital chylothorax admitted to our hospital were retrospectively analyzed. The infants were assigned into preterm group (<37 weeks) and term group (≥37 weeks) according to their gestational age. The general information, clinical manifestations, laboratory results, treatment and prognosis of the two groups were compared.Result:A total of 34 infants with congenital chylothorax were included, including 11 premature infants and 23 term infants. No significant differences existed in gender, delivery mode, prenatal diagnosis of pleural effusion, congenital heart disease/chromosome abnormality, birth asphyxia, dyspnea, fetal edema, and location of effusion between the two groups ( P>0.05). Compared with term group, preterm group had significantly fewer leukocytes [3 245(1 007, 7 403)×10 6/L vs. 10 214(6 233,16 458)×10 6/L] and lower protein level [(28.1±7.6) g/L vs. (33.3±6.3) g/L] in the pleural fluid ( P<0.05). No significant differences existed in the proportion of pleural lymphocytes between the two groups ( P>0.05). The proportion of mechanical ventilation (MV) in the preterm group was statistically higher than that the term group [100%(11/11) vs. 65.2%(15/23)], and the duration of MV was statistically longer than the term group [(16(10,25) d) vs. (1(0,11) d)] ( P<0.05). No significant differences existed between the two groups in the application of other treatment options (thoracentesis/drainage, fasting, octreotide and erythromycin pleural injection), time needed for the disappearance of effusion, duration of hospital stay and cure/improvement rate ( P>0.05). Conclusion:Preterm infants may have lower leukocyte count and protein level in the pleural effusion than the term infants. Both preterm and term infants have higher proportion of lymphocytes in the pleural effusion fluid. Although most preterm infants need ventilator support after delivery, most of them achieve complete remission after conservative treatment and the overall prognosis is as good as term infants.

A High-definition Recording Method of Electrocardiogram / 中国医疗器械杂志

In order to improve the clarity of ECG waveforms and the anti-interference ability of ECG acquisition under abnormal conditions, this study proposes a high-definition ECG recording method based on superimposed averaging algorithm. The results show that the proposed method can more clearly reflect the details of the ECG. Meanwhile, it has a significant inhibitory effect on EMG interference. As a result, the proposed method has a positive significance for improving the anti-interference ability of ECG equipment.

Advances in clinical application of near-infrared spectroscopy in monitoring oxygen saturation in brain tissue of premature infants / 国际儿科学杂志

Compared with percutaneous oxygen saturation(SpO 2), cerebral regional tissue oxygen saturation(CrSO 2)reflects the mixed oxygen saturation of brain tissue, and its change is closely correlated with the metabolism of brain tissue after birth.Near-infrared spectroscopy(NIRS)is a non-invasive continuous monitoring technology, which can provide information about changes in blood flow and damage of brain tissue.For now, NIRS has been used as a routine monitoring method in some neonatal intensive care units.Although the current research has not clearly proposed the diagnostic significance of NIRS in neonatal brain injury, current studies have found that detecting changes in CrSO 2 and corresponding interventions in abnormal values can reduce the incidence of brain injury in premature infants.The relationship between CrSO 2 and brain injury and the factors affecting CrSO 2 are still the current research hotspots.This article reviews the factors affecting the changes of CrSO 2 and clinical interventions to maintain its stability.

Effect of bovine lactoferrin supplementation on intestinal inflammatory factor expression in premature rats model of necrotizing enterocolitis / 中华实用儿科临床杂志

Objective:To investigate the protective effects of bovine lactoferrin (bLF) supplementation on intestinal mucosal tissue and its influence on of inflammatory factors in the premature rats model of necrotizing enterocolitis(NEC), and to provide the theoretical basis for prevention of NEC by bLF supplementation.Methods:Premature SD rats were randomly divided into 4 groups, 25 cases in each group.Control group: oral feeding; model group : oral feeding with lipopolysaccharides(LPS) gavage + hypoxic stimulation; high dose bLF intervention group: daily bLF (7 g/L) + oral feeding with LPS gavage + hypoxic stimulation; low dose bLF intervention group: daily bLF (2 g/L) + oral feeding with LPS gavage + hypoxic stimulation.Histopathological analysis was performed by HE staining.The expression levels of interleukin-1β(IL-1β)and interleukin-6(IL-6)in intestinal mucosa were detected by enzyme linked immunosorbent assay (ELISA).Results:(1) Morphological observation: the intestinal wall of model group was thin, and there were different degrees of pneumoconiosis and effusion in intestinal cavity.Under the microscopy, it could be observed that the intestinal tissue necrosis was serious, the intestinal villi fell off, glands arranged disorderly, epithelial edema was significant, the lamina propria and submucosa had severely edema and were separated, and there were a large number of inflammatory cells infiltrated.The above-mentioned manifestations were alleviated in the high-dose and low-dose bLF intervention groups, and no significant abnormalities were found in the control group.(2) The expression of IL-1β and IL-6 in intestinal tissue: the tissue concentration of IL-1β and IL-6 in the model group rats [(380.89±20.25) ng/L, (485.12±31.44) ng/L]were significantly higher than those in the control group[(270.69±45.58) ng/L, (212.62±89.46) ng/L]( q =9.785, 14.030, all P<0.01). The expression of IL-1β and IL-6 in mucosal tissue of ileum was significantly inhibited in hypoxic and LPS-stimulated rats fed with bLF(IL-1β: q=9.105, 8.761, all P<0.01; IL-6: q=8.175, 8.996, all P<0.01). There was no significant difference in the expression of IL-1β and IL-6 between high dose bLF(7 g/L) and low dose bLF (2 g/L) inter vention groups (IL-1β: q=-0.084, P>0.05; IL-6: q=-1.140, P>0.05). Conclusion:Enteral bLF supplementation can alleviate the damage of intestinal tissue in NEC model of premature SD rats, inhibit the expression of IL-1β and IL-6 inflammatory factors in intestinal tissue, and have a protective effect on intestinal tissue.

Application of artificial intelligence in the field of diabetes diet management / 中华内分泌代谢杂志

Diabetes diet management plays an important role in the treatment of diabetes. "Controlling diet" is the most basic and important part of diabetes treatment. Patients with mild diabetes can control blood glucose through diet therapy. Effective diet management assessment can quickly discover the deficiencies of diet self-management in diabetic patients. Artificial intelligence is widely used in the medical field. This article will briefly introduce the role and application progress of artificial intelligence technology in diabetes diet management, including diet recommendation and automatic monitoring.

Early onset of group B streptococcal sepsis in newborn: clinical analysis of 27 cases / 中国新生儿科杂志

Objective To study the clinical features of early-onset Group B streptococcal(GBS) sepsis to improve the management of early-onset GBS sepsis.Method To review the clinical data of 27 cases of early-onset GBS sepsis in the Hospital over the past 5 years (January 2013 to November 2017),and analyze its clinical features,laboratory results,complications,prognosis and perinatal characteristics.Result A total of 27 cases of early-onset GBS sepsis were enrolled within 5 years,accounting for 0.85‰ (27/31 936) of total hospitalized patients over the same period.Among them,6 were premature infants and 21 full-term infants.The time of onset was within 24 hours.In all the cases,except for one full-term infant with fever as the initial symptom,the remainder had dyspnea as the initial symptom,accompanied by poor response and low poor muscle tone.Among them,17 patients required assisted ventilation.One of the full-term infant treated with ECMO within 48 hours after birth because of dyspnea,pulmonary hypertension and persistent hypoxemia,etc.,and improved and discharged;another 10 patients needed hood oxygen supply.5 cases (18.5％,5/27) diagnosed with purulent meningitis.In complete blood count,white blood cells ranged from (0.8～34.2)× 109/L,the minimum platelets counts was 16× 109/L,the maximum CRP was 249 mg/L,and maximum procalcitonin was＞ 100 ng/ml.All blood cultures were sensitive to penicillin.of the 27 patients,2 died despite of medical treatment,and 5 patients died as their parents worried about possible sequelae and discharged against medical advice.Therefore,tlhe total mortality rate was 25.9％ (7/27).All children were administered penicillin after the blood culture results were known,meropenem was subsequently added or replaced with vancomycin according to the clinical progress of the child.The remaining 20 patients recovered and discharged.Conclusion The clinical manifestation of early onset GBS septicemia is critically ill,with early onset,rapid progress,and high mortality.Special attention should be paid to high-risk cases during perinatal period,and early recognition with effective treatment would reduce morbidity and mortality.

A Digital Filtering Method for Eliminating DC Offset in Ambulatory ECG Signals / 中国医疗器械杂志

The amplifier is easy to saturation because of polarization voltage in ambulatory ECG acquisition. The traditional way is using analog high-pass filter to eliminate, but the output tends to have a residue. If upgrading high-pass filter cutoff frequency, it will lead to low frequency distortion of ECG signals. In this paper, a Savitzky-Golay (SG) smoothing filter has been designed by combining the single edge point and the polynomial order , which can fit the polarization voltage components of ECG signals, filter useful components and get drift-free ECG signals by using the subtraction algorithm. The results of ECG filtering experiment verify the feasibility of the SG smoothing filter, and show the filtered ECG signal without any losses of useful components.

Impact of hypertensive disorder complicating pregnancy on neonatal mortality and major complications in preterm infants / 中华实用儿科临床杂志

Objective@#To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants.@*Methods@#The general clinical data of preterm infants with gestational age 24-36+ 6 weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed.@*Results@#The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ2=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ2=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ2=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis.@*Conclusions@#HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.

Effects of bovine lactoferrin on cell viability,proliferation and inflammation in intestinal epithelial cells treated by lipopolysaccharide / 中华实用儿科临床杂志

Objective To evaluate the effects and mechanisms of bovine lactoferrin(bLF)on cell viability,proliferation,and the protective roles in intestinal epithelial cell-6(IEC-6)treated by lipopolysaccharide(LPS).Methods The rat jejunum epithelial cell lines IEC-6 were cultured in vitro.The effects of bLF on cell viability and proliferation in IEC-6 cells were detected by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide(MTT)assay and 5-Bromo-deoxyuridine(Brdu)assay,respectively.Inflammatory cytokines and their mRNA of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and interleukin-8(IL-8)were analyzed by real-time PCR and enzyme-linked immunosorbent assay(ELISA).Western blot was used to measure the levels of mitogen-activated protein kinase(MAPK)activation and nuclear factor kappa β(NF-κB)nuclear translocation.Results Dose dependent effects of bLF on cell viability and proliferation were observed in IEC-6 cells in vitro(F=3.825,5.861,all P<0.05),especially in a dose of 100 mg/L,and bLF significantly stimulated cell viability and proliferation compared with non-treatment group(q=5.240,3.765,all P<0.05).The mRNA levels of IL-1β,IL-6 and TNF-α were decreased by co-stimulation of bLF and LPS compared with the LPS treatments alone in IEC-6 cells in vitro(q=14.28,10.12,16.45,all P<0.001).The secretion of IL-6 and TNF-α was also decreased by co-stimulation of bLF and LPS(q=15.06,6.74,all P<0.01).In vitro,bLF treatment at dose of 100 mg/L could inhibit the activation of MAPK/NF-κB signal pathway induced by LPS(q=12.96,18.54,all P<0.001).Conclusion In vitro,bLF can promote IEC-6 viability and proliferation,and have anti-inflammatory effects via inhibited activation of MAPK/NF-κB nuclear translocation.

A USB-Based Digital ECG Sensor / 中国医疗器械杂志

Based on the ECG-specific BMD 101 integrated circun chip, this study designed a digital ECG sensor. In practical application, users just need to connect the ECG sensor 'o upper computer (such as PC or mobile phone) through USB interface, to realize the functions including display, alarm, saving, transfer etc. After tests, They demonstrate that the sensor can be applied to the detection of arrhythmia, such as bigeminy coupled rhythm, proiosystole etc. Besides, the sensor has various advantages in monitoring an managing the heart health of people out of hospital, including low cost, small volume, usableness, simplicity of operation etc.

The survival of extremely and very preterm infants and advance in respiratory support / 国际儿科学杂志

Extremely and very preterm infants(EPI and VPI) have high mortality and morbidity mainly caused by their lung immaturity and easy to develop bronchopulmonary dysplasia.Antenatal and postnatal respiratory management strategies are associated with their survival and long term outcomes.Antenatal steroids,surfactant therapy and ventilation strategies have shown the potential to improving the outcomes of EPI and VPI.Noninvasive ventilation especially continuous positive airway pressure started at or soon after birth with subsequent selective surfactant administration may be considered as an alternative to routine intuhation with prophylactic or early surfactant administration in such preterm infants.New strategies of ventilation such as high frequency oscillatory ventilation,neutrally adjusted ventilator assist and volume targeted ventilation will be explored.

Value of lung ultrasound on diagnosing transient tachypnea of newborn / 中华实用儿科临床杂志

Objective To evaluate the diagnostic value of lung ultrasonography for transient tachypnea of new-born (TTN).Methods From January to December 201 4,a total of 1 358 children were hospitalized in the Neonatal Intensive Care Center and underwent lung ultrasonography at the Bayi Children′s Hospital,Beijing Military General Hospital.According to the patients′medical histories,clinical presentations,arterial blood gas analysis,chest X -ray examinations,and lung ultrasound examinations,there were 41 2 cases of patients without pulmonary lesions,228 cases of TTN,358 cases of respiratory distress syndrome (RDS),85 cases of meconium aspiration syndrome (MAS),21 5 ca-ses of infectious pneumonia,and 60 other cases at the time of hospital admission.In a resting state,the patients were placed in a supine,lateral recumbent or prone position.By using the anterior and posterior axillary lines as boundaries, the lung was divided into 3 regions:anterior,lateral,and posterior.The probe was perpendicular or parallel to the ribs, and each region of both sides of the lung was scanned.The scan results were compared to the conventional chest X -ray results.Results The main ultrasonic characteristics of TTN was pulmonary edema.In severe cases,the ultrasound showed a white lung or compact B -line.Compact B -line had 1 00.0% sensitivity and 95.3% specificity for diagno-sing severe TTN.Mild TTN presented as pulmonary interstitial syndrome or double lung point.Double lung point might appear during the recovery period of mild TTN or other diseases,such as RDS,MAS,and pneumonia,among others. Lung consolidation and air bronchogram were not observed in patients with TTN.Pleural effusion might occur in a varie-ty of lung diseases,and pleural line abnormality,A -line disappearance,and B -line or pulmonary interstitial syndrome were common ultrasonic manifestations of a variety of lung diseases.Conclusions Ultrasonic diagnosis of TTN,mainly based on pulmonary edema without lung consolidation and air bronchogram,is accuracy and reliable;however,double lung point is not a specific sign of TTN,whereas the identification of a white lung and compact B -line is a sensitive and specific sign of severe TTN.

Analysis of related factors of extremely preterm infants'abnormal neurological findings / 中华儿科杂志

<p><b>OBJECTIVE</b>To observe the effect of intrapartum and postpartum factors on abnormal neurological findings in the extremely preterm infants.</p><p><b>METHOD</b>Clinical data of 62 premature infants (33 of male, 29 of female) were retrospectively analyzed. None of the premature infants had birth defect; their gestational ages were all less than 28 weeks (23(+ 6)-27(+ 6) weeks). They were hospitalized within 12 hours after birth in the neonatal intensive care unit (NICU) of BAYI Children's Hospital from November 2010 to June 2013. The blood gas, birth condition, complications, the mechanical ventilation and the ultrasonic encephalography were recorded. The 62 cases were divided into 2 groups, alive group and died group. Meanwhile, all cases of survial were divided into brain injuries group and normal brain group. Data were analyzed with t-test, Chi square test and Spearman correlation analysis.</p><p><b>RESULT</b>Fifty-six cases were alive, and 6 cases died (3 were during the treatment and 3 were after parents gave up). The average birth weight of brain injuries group was (954 ± 182) g; and that of the normal brain group was (1 071 ± 136) g. There were significant differences between the two groups in gender (χ(2) = 4.314, P = 0.038), gestational age (χ(2) = 11.622, P = 0.001), birth weight (t = 2.728, P = 0.009), which had significant correlation with neurological outcomes. The Spearman correlative coefficients were -0.278, 0.456 and 0.364 respectively. And P values were 0.038, 0.000 and 0.006. The rates of multiple pregnancy, lung hemorrhage and surgical operation in brain injuries group were 45%(9/20), 55%(11/20), 40%(8/20), which were significantly higher than those in normal brain group, 3%(1/36), 17%(6/36), 11%(4/36)(χ(2) = 12.800, 8.936, 4.773, P all < 0.05). These three factors were the high risk factors for adverse neurological outcomes, the odds ratios were 28.64, 6.11 and 5.33 respectively. There was no significant difference in delivery mode, amniotic fluid, maternal infection, asphyxia, necrotizing enterocolitis, patent ductus arteriosus, sepsis, mechanical ventilation, inhaled nitric oxide therapy, blood glucose, blood gas analysis, doses of dopamine between brain injuries group and normal brain group. The birth weight in alive group was (1 029 ± 163) g, which was significantly higher than those in died group (870 ± 144)g (r=0.29, P=0.022). There was no significant difference in other factors between alive group and died group(P all>0.05).</p><p><b>CONCLUSION</b>Gender, gestational age and birth weight may have relation with the neurological outcomes of extremely preterm infants. Multiple pregnancy, pulmonary hemorrhage and surgical operation are the risk factors of brain injuries. Birth weight is related to the survival of extremely preterm infants.</p>

Effect of all-trans retinoic acid on proliferation of fetal alveolar epithelial type Ⅱ cells and expression of pulmonary surfactant C and aquaporin 5 / 中华实用儿科临床杂志

Objective To investigate the effect of all-trans retinoic acid (at-RA) on fetal alveolar epithelial type Ⅱ cells (fAEC Ⅱ s) proliferation and the expression of pulmonary surfactant C (SPC) as well as aquaporin 5 (AQP5).Methods fAEC Ⅱ s were isolated and purified from fetal lung of pregnant SD rats (19 days).After being cultured for 1 day,and the fAEC Ⅱ s were interfered by at-RA for 1,2 and 3 days.Cell proliferation,viability as well as growth state,expressions of SPC mRNA as well as AQP5 mRNA and expressions of protein SPC as well as AQP5 were respectively detected by using 4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide (MTT),inverted microscope,real-time fluorescence quantitative PCR (RT-PCR) and Western blot.Results (1) When fAEC Ⅱ s were treated with at-RA for 1 day,and the cell proliferation and viability did not change (P ＞ 0.05),while the proliferation and viability were significantly improved in 2 days (P ＜ 0.05),and the difference was the most obvious (P ＜ 0.05) at 3 days.(2)Compared with the control group,the cell growth state was better,and the cell adherence was tighter and the refraction was higher in at-RA group.(3) Compared with the control group,at-RA up-regulated the expressions of AQP5 mRNA and AQP5 protein(t =-19.58,-10.44,-16.01,-46.25,-12.79,-27.96,all P ＜ 0.05),and the percentages of control group were 281.07％,766.67％,1 163.33％ and 792.65％,1 310.52％,1 561.56％ in 1,2 and 3 days respectively.(4) Compared with control group,the expressions of SP-C mRNA and SPC protein were up regulated when cells were exposed to at-RA for 1 and 3 d,but while they were down-regulated at 2 days(protein:the percentages of control group were 615.480％,369.450％ and 11.269％,respectively ; mRNA:728.33 ％,400.83 ％,66.57％,respectively)(t=-26.34,-25.26,13.80,-25.25,-31.71,9.12,all P＜0.05).Conclusions at-RA can promote the proliferation and differentiation of fAEC Ⅱs,enhance the fAEC Ⅱ s viability,and improve the expression of SPC and AQP5.

Prospective study of risk factors for preterm infants with bronchopulmonary dysplasia / 中华实用儿科临床杂志

Obgective To explore the risk factors of preterm infants with bronchopulmonary dysplasia(BPD).Methods A prospective cohort study was conducted to analyze the risk factors of preterm infants with BPD.Preterm infants (gestational age ＜ 32 weeks,and admission within 24 h since birth,and survival time more than 28 d since birth) who were sent to the Ward of Extremely Preterm Infants in Bayi Children's Hospital Affiliated to Clinical Medical College in Beijing Military General Hospital of Southern Medical University were enrolled from November 2013 to May 2014.According to the diagnostic criteria of BPD,the subjects were divided into 2 groups(BPD group and non-BPD group).Factors such as maternal information,neonatal basic information,neonatal diseases and treatments were compared between the 2 groups.Risk factors of preterm infants with BPD were analyzed by using t test,Chi-square test,Fisher's exact probability method and Logistic regression analysis.Results (1) A total of 298 cases were enrolled in this study.Among these infants,180 cases were male and 118 cases were female.The gestational age ranged from 25.6 to 31.9 weeks with the average age of (29.9 ± 1.4) weeks and the birth weights ranged from 740 to 2 300 g with the average weight of (1 428.3 ± 289.0) g.There were 19 cases of extremely low birth weight and 175 cases of very low birth weight.Sixty-nine cases of these infants were diagnosed as BPD (43 cases were mild,10 cases were moderate,16 cases were severe) with incidence of 23.2％.(2)The incidence of BPD was negatively related to gestational age and birth weight:the incidence of BPD in preterm infants with gestational age ＜ 28 weeks,28-30 weeks and ≥ 30-32 weeks were 70.4％,41.9％ and 6.2％;the incidence of BPD in preterm infants with birth weight ＜ 1 000 g,1 000-1 500 g and ≥ 1 500-1 800 g were 78.9％,29.5％ and 8.8％.(3) Multivariate Logistic regression found gestational age (OR =4.52),birth weight (OR =3.38),gender (OR =3.04),cytomegalovirus infection (OR =55.27),duration of invasive ventilation ≥ 7 d (OR =3.22),the highest concentration of inspired oxygen ≥400 mL/L (OR =4.14),patent ductus arteriosus(PDA) in need of surgical ligation (OR =7.30),and transfusion of packed red blood cells within 14 d since birth (OR =3.51) were the independent risk factors of BPD (all P ＜ 0.05).(4) Factors such as birth weight (P =0.015),duration of invasive ventilation (P =0.003),duration of inspired oxygen (P =0.000),and PDA in need of surgical ligation or not(P =0.017) were related to the severity of BPD.Conclusions BPD is a multifactorial disease.Taking effective measures to control risk factors is the key for preventing BPD.

Application of extracorporeal membrane oxygenation in neonatal respiratory failure / 中国小儿急救医学

Extracorporeal membrane oxygenation(ECMO) is a kind of extra life support technique that can support cardiac and pulmonary function in a relatively long time.With the application of nitric oxide,pulmonary surfactant and high frequency ventilation,the use of ECMO in neonatal respiratory failure decreased.Although received these treatment,there are some newborn with respiratory failure still required ECMO at last.On this paper,the application of ECMO in neonatal respiratory failure from foreign medical institute was introduced,and compared with the domestic situation,in order to improve the application of ECMO in neonatal respiratory failure.

Value of lung ultrasound in diagnosing infectious pneumonia of newborns / 中华围产医学杂志

Objective To evaluate the value of lung ultrasound in diagnosing infectious pneumonia (IPN) of newborns. Methods Seventy-two infants hospitalized from September 1, 2012 to May 30, 2013, in Bayi Children's Hospital, General Hospital of Beijing Military Command were divided into two groups. The study group consisted of 32 newborn infants diagnosed as IPN by medical history, clinical manifestations and chest X-ray, while the control group consisted of 40 neonates without any lung diseases. In a quiet state, the infants were placed in supine, side or prone position for lung ultrasound examination. The lung field was divided into three areas by the anterior and posterior axillary line. The regions of the bilateral lung were scanned by the probe which was vertical with the ribs. Fisher's exact was performed for stastical analysis. Results The most important ultrasound imaging findings of IPN included lung consolidation of varying size and shape with irregular and serrated margins (100%, 32/32), dynamic air bronchograms (100%, 32/32), A-line disappearance (100%, 32/32) and interstitial syndrome (100%, 32/32). Other common ultrasound signs included pleural line abnormalities (91%, 29/32), lung pulse (38%, 12/32) and dynamic air bronchograms (66%, 21/32) under real-time ultrasound. Pleural effusion was an infrequent sign that existed in 9%(3/32)of IPN patients. None of these abnormalities was observed in the control group. Conclusion Lung ultrasound is reliable for the diagnosis of IPN and can be routinely performed in neonatal intensive care units, and a large area of lung consolidation with irregular margins A-line disappearance, interstitial syndrome and pleural line abnormalities are the main image findings.

Using lung ultrasound to difference the pulmonary reasons of long-term oxygen dependence in premature infants / 中国小儿急救医学

Objective Lung ultrasound has been used extensively to diagnose many types of lung disease.This study aimed to evaluate the pulmonary reasons for long-term oxygen dependence (LTOD) in premature infants using lung ultrasound.Methods Lung ultrasound was routinely performed in 50 premature infants clinically diagnosed with bronchopulmonary dysplasia(BPD).Results Among the 50 patients studied,there were 9 cases of atelectasis,4 cases of pneumonia,2 cases of severe pulmonary edema,and 3 cases of pulmonary edema and consolidation that coexisted with BPD.The babies' oxygen dependence either resolved completely or significantly decreased following appropriate treatments.Conclusion More than onethird of the cases of LTOD in premature babies were caused by either BPD alone or diseases other than BPD.Lung ultrasound plays an important role in differentiating pulmonary causes of LTOD in BPD patients,and the results of our study suggest that modifying the diagnostic criteria for BPD may be necessary.

Clinical characteristics of long-term oxygen dependent neonates / 中国小儿急救医学

Objective To investigate the situation of oxygen supplement and the incidence and clinical characteristics of long-term oxygen inhalation newborns in neonatal intensive care unit(NICU).Methods The records of oxygen supplement and the related clinical data of 12 155 neonates admitted in our NICU from Oct 2009 to May 2011 were collected and retrospectively analyzed.The results were compared with the data from a survey on 19 hospitals in China which reported by other authors.Results In 12 155 newborns,4 951 were full term,7 204 were preterm.One hundred and two patients (0.84％,102/12 155 ) accepted oxygen for more than 28 days.Among them,88 were preterm,14 were full term,with the average gestational age (31.16 ±3.70) weeks,the average birth weight (1.60 ±0.68) kg and the mean oxygen supplement period (40.60 ± 12.25) d.Finally,98 were cured or improved,4 died.The incidence of bronchopulmonary dysplasia (BPD) in 7 204 preterm infants was 1.22％ ( 88/7 204) according to the standard of continuous oxygen supply more than 28 days after birth.The incidence of BPD in preterm infants less than 32 weeks was 4.92％ (68/1 381 ) according to the standard of continuous oxygen supply more than 28 days after birth,while the rate was only 2.10％ (29/1 381 ) according to the standard of continuous oxygen supply more than 36 weeks postmenstrual age.The rates of BPD according to the two different standards were significantly different ( x2 =16.251,P ＜0.001 ).There were significant differences in the rate of supply oxygen( x2 =119.99) and supply oxygen time( F =109.27 ) among different gestational age groups in overall the 5 499 neonates ( P ＜0.001 ),but no significant differences in the average time of oxygen supply and mechanical ventilation among different gestational age groups in infants with long-term oxygen dependence ( P ＞ 0.05 ).There were significant differences in rates of pulmonary surfactant therapy,heart failure,retinopathy of prematurity,congenital heart disease,other congenital malformation and mortality among different gestational age groups in long-term oxygen dependence infants (x2 =8.789,13.538,23.176,7.778,8.842,8.246,P ＜ 0.05 ).As compared with the data from 19 hospitals,the corrected rate of long-term oxygen supplement in preterm infants in our hospital was obviously lower[0.99％ (71/7204) vsl.54％ (190/12 351),P ＜0.001].Conclusion Theincidence of BPD in our NICU is low.Lower gestational age,immature lung and secondary lung injury may be the mainly cause of neonatal long-term oxygen dependence,but some factors such as congenital heart disease,congenital malformations should be considered in more mature infants.The most appropriate standard for BPD still remains to be discussed.