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Objective:To construct a Chinese neonatal model of early-onset sepsis (EOS) using the Kaiser Permanente sepsis risk calculator and laboratory indicators and validate its clinical prediction potential.Methods:Newborns with a gestational age of ≥34 weeks, who were hospitalized in the Department of Neonatology, the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2022 were retrospectively recruited.Their clinical data were collected.Predictors were screened via the multivariate regression analysis, and the Nomogram model was constructed using R software and RStudio software.Hosmer-Lemeshow test, receiver operating characteristic curve, the decision curve analysis (DCA) were used to evaluate the prediction potential of the Nomogram.Results:A total of 769 patients were enrolled, including 107 patients in the EOS group (5 culture-confirmed cases and 102 clinically diagnosed cases), and 662 cases in the non-EOS group.Ten variables were screened and introduced into the Nomogram, including the gestational age, birth weight, body temperature, white blood cell count, C-reactive protein, procalcitonin, premature rupture of membranes≥18 h, infection of Group B Streptococcus, ventilator application, and prenatal antibiotics.The predictive model showed good discrimination and consistency, with the area under the curve of 0.834 (95% CI: 0.771-0.896). The DCA of the prediction model showed that it was effective in clinical application within the effective threshold of 6%-95%, with a net benefit following the application of corresponding treatment measures. Conclusions:A Chinese neonatal model of EOS was created by using the Kaiser Permanente sepsis risk calculator and laboratory indicators, which has been validated effective.It provides references for clinical management and the guidance for the use of antibiotics.
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A 10-day-old male infant presented with skin erythema and blisters for 6 days. Skin examination showed scattered or confluent erythema all over the body, tense blisters of varying sizes on the normal skin or an erythematous base, and some blisters were ulcerated and erosive; bloody bullae and erythematous erosive patches could be seen on the oral mucosa. Histopathological examination revealed subepidermal blisters, and there were some neutrophils and a few eosinophils in the blisters. Direct immunofluorescence assay showed homogeneous linear IgA and granular C3 deposits along the basement membrane zone, without IgG deposits. The diagnosis of neonatal linear IgA bullous dermatosis was confirmed. After comprehensive treatments including nutritional support and anti-infection treatment, skin erythema and blisters subsided, and the mucosal damage was attenuated. The telephone follow-up 16 months after discharge showed that the infant was in good general condition with normal growth and development, and the oral mucosal lesions had subsided and healed, without new skin lesions.
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Objective:To summarize the clinical characteristics of neonatal brain abscess and improve the understanding of diagnosis and treatment of this disease.Methods:Clinical data of five cases of neonatal brain abscess admitted to the First Affiliated Hospital of Zhengzhou University from December 2018 to March 2021 were retrospectively analyzed and followed-up.Results:Among five cases, four cases were premature and one was term infant, three were girls and two were boys. The age of onset was 10, 5, 2, 28 and 11 days after birth, and all had fever as the first manifestation. Three cases had positive blood or cerebrospinal fluid cultures, and the diagnosis of brain abscess was confirmed by head imaging, with the most common lesion being in the frontal lobe. One case was treated conservatively, and four cases underwent abscess aspiration and drainage. After treatment, the range of lesions in five cases was reduced and the clinical symptoms were improved. The neurodevelopmental assessment after discharge did not reveal any intelligence or motor retardation in three cases, and were developing as the same age, while the other two cases had various degrees of neurological sequelae.Conclusion:The clinical characteristics of neonatal brain abscess are not specific, so it is necessary to conduct head imaging examination as early as possible for neonates with septicemia and meningitis with poor therapeutic effect or recurrent disease, so as to improve the early diagnosis rate and long-term prognosis.
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Objective:To summarize the clinical features of neonatal lupus erythematosus(NLE) and improve the understanding of the disease.Methods:The clinical data of 17 NLE neonates admitted to the First Affiliated Hospital of Zhengzhou University from February 2015 to September 2021 were retrospectively analyzed, and relevant literatures were reviewed.Results:Of the 17 patients, nine were boys and eight were girls.There were 13 cases of skin damage and eight cases of heart damage, including four cases of atrioventricular block, one case of QT interval prolongation complicated with atrial premature beat, three cases of atrial septal defect, one case of ventricular septal defect, two cases of patent ductus arteriosus, one case of pericardial effusion, one case of pulmonary hypertension, and two cases of cardiac insufficiency.One case developed skin damage and heart block at the same time.There were 15 patients with blood system damage and 11 patients with hepatobiliary system damage.Among the serological indicators, 17 cases were positive for anti-ANA antibody, 12 cases were positive for anti-SSA-60, 13 cases were positive for anti-SSA-52, seven cases were positive for SSB, one case was positive for Sm, and three cases were positive for RNP.Among them, four neonates with atrioventricular block were positive for anti-SSA-60 and anti-SSA-52.Most of the patients with skin lesions had good prognosis, and only one patient had brown scars, one neonate with second-degree type Ⅱ atrioventricular block and one neonate with QT interval prolongation combined with premature atrial contractions had normal electrocardiograms.Additionally, two patients still had third-degree atrioventricular block, and the other one patient was installed with a pacemaker at one year and two months, and left spastic cerebral palsy.A total of 16 mothers had serological tests, among which ten cases had abnormal connective tissue antibodies before delivery and six cases had abnormal connective tissue antibodies after delivery.Conclusion:There is no significant gender difference in NLE, third-degree atrioventricular block is difficult to reverse, and most patients with extracardiac damage have a good prognosis.
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In recent years, with the improvement of medical level, central catheter placement is widely used in newborns, especially in infants of very low birth weight and other critical newborns.It effectively reduces the damage of frequent venipuncture and stimulant drugs on blood vessels of children.However, the establishment of neonatal catheter access is closely related to mechanical injury, infection and thrombosis.The use of central catheters is the most common cause of thrombosis in newborns and infants.At present, there are few related reports, and there is no management standard for catheter-related thrombosis in China.This review analyzed the risk factors, diagnosis, prevention and treatment of neonatal catheter-related thrombosis.
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Antenatal corticosteroid administration to women at risk of preterm delivery within 34 gestational weeks can effectively reduce the incidence of respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis in preterm infants. Due to concerns that antenatal corticosteroids may impair the development of the newborn's nervous system, there is a controversy regarding the use of antenatal corticosteroids in pregnant women ≥34 gestational weeks and those with complications. This article reviews the short- and long-term effects of antenatal corticosteroid administration on the nervous system of neonates born to women at different gestational ages and with comorbidities. More and higher-quality evidence is required for routine application of antenatal corticosteroids in pregnant women ≥34 gestational weeks.
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Although great progress has been made in perinatal and neonatal medicine, the morbidity and mortality of premature complications remain high.At present, the prevention and treatment of preterm infants with broncho-pulmonary dysplasia, brain injury, necrotizing enterocolitis, retinopathy of prematurity and other complications are cha-llenging.Experimental evidences have shown that regenerative medicine based on mesenchymal stem cells is a promising therapeutic strategy for premature complications, although it has potential risks like tumorigenicity and immune rejection.Exosomes are the key mediators of mesenchymal stem cells, which have been a promising method for the treatment of premature complications.This study aims to review the research progress of exosomes derived from mesenchymal stem cells in the treatment of premature complications.
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OBJECTIVE@#To explore the genetic basis for an infant with neonatal diabetes (NDM) and multiple malformations.@*METHODS@#Genetic variants were detected by next generation sequencing (NGS). Suspected variant was verified by Sanger sequencing.@*RESULTS@#A de novo heterozygous variant, c.1454_1455del(p.K485Rfs), was detected in exon 5 of the GATA6 gene. The variant was undetected in his parents and unreported previously. Bioinformatic analysis predicted the variant to be pathogenic.@*CONCLUSION@#The heterozygous variant of c.1454_1455del(p.K485Rfs) of the GATA6 gene probably underlies the disease in this child. Genetic testing can facilitate diagnosis and genetic counseling for NDM.
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Adulto , Femenino , Humanos , Recién Nacido , Masculino , Anomalías Múltiples , Diabetes Mellitus/genética , Pruebas Genéticas , Heterocigoto , Secuenciación de Nucleótidos de Alto Rendimiento , Eliminación de Secuencia/genéticaRESUMEN
Nasal continuous positive airway pressure (nCPAP) has been widely used in neonatal respiratory support, but how to successfully withdraw nCPAP has not been further studied, and there is no unified standard of timing and mode of nCPAP weaning.This paper reviews the research progress of nCPAP weaning in premature infants.
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Nasal continuous positive airway pressure (nCPAP) has been widely used in neonatal respiratory support,but how to successfully withdraw nCPAP has not been further studied,and there is no unified standard of timing and mode of nCPAP weaning.This paper reviews the research progress of nCPAP weaning in premature infants.
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Objective To observe ultrasonographic features and significance of scoring of the lung in preterm infants.Methods Totally 37 preterm infants (preterm group) and 33 term infants (term group) without cardiopulmonary disease nor hypoproteinemia were enrolled,and infants in each group were divided into<1 week,1-4 weeks and >4 weeks subgroup,respectively.All the infants underwent lung ultrasonography and scoring.The ultrasonography scores were compared between preterm infants and term infants among different ages.Results The main ultrasonic manifestations of the lung in preterm infants were diffuse distribution of dense B-lines,with or without " falls sign" suggesting alveolar effusion.The ultrasonographic score of the lung in preterm infants and term infants was (15.24± 2.76) and (12.21 ±3.62),respectively (t=3.962,P<0.001).There was no statistical difference of ultrasonographyic scores in <1 week subgroups between preterm infants and term infants (t =-0.669,P =0.513).There were statistical differences of ultrasonographic scores in 1-4 weeks subgroups and >4 weeks subgroups between preterm group and term group (both P<0.05).In preterm group,the ultrasonographic scores demonstrated no statistical difference among 3 subgroups (F=0.960,P=0.393),whereas statistical difference was found among 3 subgroups in term group (F =4.277,P =0.023).The ultrasonographic score of preterm infants showed negative correlation with gestational age (r=-0.352,P=0.033),and the linear regressive equation was Y=33.805-0.548X.Conclusion The main ultrasonic manifestations of the lung in preterm infants were diffuse distribution of dense B-lines,some with "falls sign" suggesting alveolar effusion,which are more significant in smaller gestational age infants.
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Cytomegalovirus infection is one of the most common diseases of newborn viral infection,can cause neurological,digestive,respiratory and blood system damage.In addition to the diagnosis of jaundice,impairment and other clinical manifestations,this disease's diagnosis mainly depend on laboratory examination.Therefore,the application of a sensitive and specific method for early diagnosis of congenital cytomegalovirus(CCMV) infection is particularly important advances in clinical detection method and the research of CCMV infection is reviewed.
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Fetal intrauterine growth restriction is one of the common diseases in the perinatal period,which not only increases the child morbidity and mortality in the perinatal period,affecting the long-term development of the nervous system,and can make the risk of adult obesity,hypertension,type Ⅱ diabetes increased significantly.A number of studies suggest that the down-regulation of A amino acid transporter expression is closely associated with intrauterine growth restriction.The down-regulation of A amino acid transporter expression may be an important cause of intrauterine growth restriction.
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Gastroesophageal reflux (GER) was very common among preterm infants, which could cause several complications and severely affects the prognosis. The standardization of diagnosis and treatment of gastroesophageal reflux was very important for preterm infants. Due to less adverse reactions, nonpharmacological therapy was the most advisable choice in preterm infants with GER. In this paper, nonpharmacological therapies including body positioning, feeding frequency and modality, changing food patterns, gastric tube, and nonnutritive sucking were reviewed. Body positioning was the safest and most effective nonpharmacological therapy. Other nonpharmacological strategies such as changes of feeding frequency and modality might also be useful. The role of some strategies was still controversial, thereby needing to be further investigated. Selection of what kind of specific nonpharmacological therapy should be based on the specific conditions.
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With the rapid development of assisted reproductive technique (ART),children conceived through ART represent a substantial proportion of the population.Although most researchesonthe safety of A RT offspring are optimistically,it is still worrisome that there are some inconsistent even controversial results.The risk of ARToffspringin perinatal outcomes,birth defects,growth and development,neurological prognosis and imprinting disorders still exist.Therefore,the persistent long-term follow-up of ART children to assess its impact on the long-term prognosis of offspring is particularly important.
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Objective To investigate the effect of long term intelligence on NGF to the newborn rats with hypoxic ischemic brain damage (HIBD).Methods The model of newborn rat hypoxic ischemic brain damage(HIBD) was set,0.01mg/10g dosage NGF and 0.03mg/10g dosage NGF were administered to the rat abdominal cavity respectively. With maze test, the change of learning memory abilities of long term in the rats were observed, the concentration of monoamine neurotransmitters in the brain tissue were determined by high performance liquid chromatography electrochemical detector.Results The function of learning and memory was better in NGF group(small, large amount group)than in the control group, the frequency was lower remarkably than the control group( P