Analysis of clinical characteristic and risk factors for necrotizing enterocolitis in one of the premature twins / 中国新生儿科杂志

Objective:To study the clinical characteristics and risk factors of necrotizing enterocolitis (NEC) in one of the premature twins.Methods:A retrospective study was conducted on twin premature infants who were admitted to the Department of Neonatology at the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2022 and only one got NEC. The twins were divided into NEC group and control group, the clinical data were collected and analyzed by SPSS 26.0 statistical software.Results:This study enrolled 109 pairs of premature twins, 109 cases in the NEC group, and 109 cases in the control group. Univariate analysis showed that birth weight, pre NEC white blood cell count were lower in NEC group than those in the control group, while the proportion of smaller than gestational age (SGA), donor of twin-to-twin transfusion syndrome, feeding intolerance, incomplete enteral feeding, start feeding time >48 h, red blood cell transfusion 72 h before NEC onset and the neutrophils ratio were higher in the NEC group than that of the control group, the difference was statistically significant ( P<0.05). Multivariate logistic analysis showed that low birth weight ( OR=1.558, 95% CI1.197-2.142), SGA ( OR=1.721, 95% CI 1.217-2.536), feeding intolerance ( OR=3.798, 95% CI 1.347-10.706), and incomplete enteral feeding ( OR=4.319, 95% CI 1.673-11.149) were independent risk factors for NEC ( P<0.05). Conclusions:Low birth weight, small for gestational age, feeding intolerance, and incomplete enteral feeding are independent risk factors for NEC in one of the premature twins.

Analysis of ARX gene variant in a child with X-linked lissencephaly with abnormal genitalia / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical characteristics and genetic basis for a child with X-linked lissencephaly with abnormal genitalia (XLAG).@*METHODS@#A child with XLAG who had presented at the Third Affiliated Hospital of Zhengzhou University in May 2021 was selected as the study subject. Peripheral blood samples of the child and his parents were collected and subjected to high-throughput sequencing. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the result was analyzed by using bioinformatic software.@*RESULTS@#The child was found to have harbored a hemizygous c.945_948del variant in exon 2 of the ARX gene, which as a frameshifting variant has resulted in a truncated protein. His mother was found to be heterozygous for the variant, whilst his father was of wild type. The variant was unreported previously.@*CONCLUSION@#The hemizygous c.945_948del variant of the ARX gene probably underlay the XLAG in this patient. Above finding has provided a basis for the diagnosis and genetic counseling for this family.

Clinical analysis of risk factors for adverse outcomes of neonatal seizure / 中国新生儿科杂志

Objective:To study the neurodevelopmental prognosis and risk factors for adverse outcomes of neonatal seizure.Methods:From December 2019 to November 2020, infants with neonatal seizure diagnosed in our hospital were enrolled in this retrospective study. Based on survival or not, mental development index (MDI), psychomotor development index (PDI) and seizure episodes at the age of 12 months, the infants were assigned into adverse outcome group and normal outcome group. The risk factors for adverse outcomes were statistically analyzed.Results:A total of 75 infants were enrolled,including 39 cases in adverse outcome group and 36 in normal outcome group. 69 cases showed abnormal amplitude-integrated electroencephalogram(aEEG), including 38 mildly abnormal cases,23 moderately abnormal cases and 8 severely abnormal cases, The incidences of adverse outcomes and mortality rates were significantly different ( P<0.05) among infants with different severity levels of aEEG abnormalities and the severity levels of aEEG abnormalities were positively correlated with adverse outcomes ( r=0.367, 0.471, P<0.05).Univariate analysis showed that adverse outcome group had significantly higher incidences of chorioamnionitis, seizure onset age ≤3 d, 5 min Apgar score ≤3, cranial ultrasound abnormalities, brain MR abnormalities and aEEG abnormalities than normal outcome group ( P<0.05).Logistic regression analysis showed that seizure onset age ≤3 d ( OR=3.988, 95% CI 1.376-11.674), abnormal brain MR ( OR=3.296, 95% CI 2.383-17.377) and bilirubin encephalopathy ( OR=3.792,95% CI 2.110-13.216) were independent risk factors for adverse outcomes of neonatal seizure. Conclusions:For neonatal seizure, the infants with more severe abnormal aEEG will have higher incidences of adverse outcomes and mortality. Seizure onset age ≤3 d, brain MR abnormalities and bilirubin encephalopathy were independent risk factors for adverse outcomes of neonatal seizure.

Clinical features and prognosis of 44 neonates with ovarian cysts / 中国新生儿科杂志

Objective:To study the clinical characteristics and imaging features of neonatal ovarian cysts and to analyze treatment and prognosis of ovarian torsion.Methods:From January 2011 to December 2021,neonates with ovarian cysts admitted to the department of neonatology and pediatric surgery of our hospital were retrospectively studied. They were assigned into ovarian torsion group and non-torsion group. Their clinical manifestations, imaging features, pathological results, treatment and prognosis were reviewed and compared.Results:A total of 44 neonates with ovarian cysts were included, all without specific clinical manifestations. 10 neonates were treated with conservative therapy and 34 received surgery. Ovarian torsion were confirmed during surgery in 23 patients. All 34 patients received abdominal ultrasound preoperatively and 31 (91.2%, 31/34) were diagnosed with ovarian cysts. The accuracy rates of ultrasound for cyst location and ovarian torsion were 85.3% (29/34) and 82.6% (19/23),respectively. 30 patients received abdominal CT scan and 23 (76.7%, 23/30) were diagnosed with ovarian cysts. The accuracy rates of CT scan for cyst location and ovarian torsion were 53.3% (16/30) and 47.8% (11/23), respectively. Among the 34 patients treated with surgery, ovarian cyst dissection was performed in 11 patients and cyst resection in 23 patients with torsion necrosis. 24 patients had simple cysts including 15 torsion necrosis (62.5%, 15/24) and 10 had complicated cysts including 8 torsion necrosis(80.0%, 8/10). The average diameter of ovarian cysts was significantly larger in the torsion group [(8.4±1.6) cm] than the non-torsion group [(4.7±1.2) cm] ( P<0.05). Conclusions:Neonatal ovarian cysts are mostly unilateral without specific clinical manifestations. Large, bilateral and complex cysts are prone to torsion necrosis. Abdomen ultrasound has advantages than CT scan for the localization of the ovarian cyst and diagnosis of ovarian torsion. Surgical treatment is necessary after diagnosis.

Clinical characteristics of ureaplasma urealyticum infection in very low birth weight preterm infants / 中国新生儿科杂志

Objective:To study the clinical characteristics and risk factors of intrauterine Ureaplasma urealyticum (UU) infection in very low birth weight preterm infants.Methods:From March 2019 to February 2022, very low birth weight preterm infants with gestational age 28~32 weeks admitted to our hospital were enrolled in this single-center retrospective study. According to the UU test results of respiratory tract samples obtained within 24 h after admission, the infants were assigned into the UU group (UU-PCR positive) and the non-UU group (UU-PCR negative). SPSS 26.0 statistical software was used to compare the clinical characteristics, laboratory indices, and complications between the two groups. Risk factors of UU infection were calculated.Results:A total of 327 preterm infants were included: 45 in the UU group and 282 in the non-UU group. No significant differences existed in gender, gestational age, birth weight and delivery pattern between the two groups ( P>0.05). Compared with the non-UU group, the UU group had significantly higher incidences of premature rupture of membranes (PROM) and chorioamnionitis, elevated white blood cell and platelet counts, procalcitonin and C-reactive protein levels, total duration of oxygen use and ventilation, bronchopulmonary dysplasia, necrotizing enterocolitis and metabolic osteopathy ( P<0.05). Multivariate logistic regression analysis showed that PROM ( OR=5.444, 95% CI 2.749-10.781, P<0.001) and chorioamnionitis ( OR=2.161, 95% CI 1.048-4.454, P=0.037) were independent risk factors for UU infection. Conclusions:PROM and chorioamnionitis are risk factors for UU infection in very low birth weight preterm infants. For high-risk premature infants, the UU test should be completed as soon as possible after birth.

Effects of recombinant human erythropoietin on cerebral blood flow in preterm infants: arterial spin labeling magnetic resonance imaging evaluation / 中国新生儿科杂志

Objective:To study the effects of recombinant human erythropoietin (rhEPO) on cerebral blood flow (CBF) in preterm infants using arterial spin labeling (ASL) magnetic resonance imaging (MRI).Methods:From September 2021 to June 2022, preterm infants (gestational age ≤32 weeks, birth weight ≤1 500 g) admitted to NICU of our hospital within 24 h after birth were randomly assigned into rhEPO group and control group for this prospective study. The rhEPO group was given rhEPO (500 IU/kg iv, once every other day for 2 weeks) within 72 h after birth plus symptomatic supportive treatment. The control group received same amount of normal saline injection. Both groups received brain MRI, diffusion-weighted imaging and ASL at adjusted gestational age of 35~37 weeks and CBF values of interested areas were measured.Results:A total of 85 infants were enrolled, including 40 in the rhEPO group and 45 in the control group. No significant differences existed in the incidences of periventricular-intraventricular hemorrhage, periventricular leukomalacia, focal white matter injury and extensive white matter injury between the two groups ( P>0.05). The CBF values [ml/(100 g·min)] of frontal cortex [left 15.1±3.9 vs. 17.9±3.1, right 15.9 (12.5, 17.8) vs. 18.1(16.1,20.2)], temporal cortex [left 15.8±4.3 vs. 18.6±3.8, right 16.3(13.2,19.4) vs. 18.1(15.7,19.7)], occipital cortex (left 15.8±6.1 vs. 18.8±3.3, right 16.8±5.5 vs. 19.3±4.8), basal ganglia (left 24.7±7.2 vs. 28.7±6.2, right 26.0±7.9 vs. 29.3±6.4) and thalamus (left 32.7±11.8 vs. 37.9±8.6, right 32.1±11.6 vs. 37.6±10.2) in the rhEPO group were significantly lower than the control group ( P<0.05). No significant differences existed of CBF value at the parietal cortex between the two groups ( P>0.05). Conclusions:Early application of rhEPO can reduce CBF in premature infants, which may be related to the neuro-protective effects of EPO.

The survival, complications and prognosis of the extremely preterm infants / 中国新生儿科杂志

Objective:To study the complications and prognosis of extremely premature infants(EPIs) with gestational age (GA) <28 w.Methods:From January 2016 to December 2020, EPIs with GA <28 w admitted to NICU of our hospital were retrospectively studied. Clinical data of the infants and their mothers during pregnancy were reviewed. According to the prognosis, the infants were assigned into the survival group, the death group and the withdrawal group. According to GA, the infants were assigned into <26 w goup, 26~26 +6 w group, ≥27 w group. According to birth weight (BW), the infants were assigned in to ≤750 g group, 750~999 g group and ≥1 000 g group. SPSS 26.0 was used for data analysis. Results:A total of 265 EPIs were included, 122 (46.0%) in the survival group, 47 (17.7%) in the death group and 96 (36.2%) in the withdrawal group. GA and BW of the survival group were significantly higher than the death group and the withdrawal group ( P<0.05). The incidences of tracheal intubation (92.2%) and pulmonary hemorrhage (42.2%) in the death group were the highest among the three groups. The survival group had the highest application of prenatal glucocorticoids (80.3%) and pulmonary surfactants (99.2%) ( P<0.05). In the survival group, the top 3 common complications were bronchopulmonary dysplasia (BPD) (68.0%), pulmonary infections (65.6%) and neonatal sepsis (34.4%). The survival rate increased with GA and BW. Conclusions:The survival rate of EPIs is closely correlated with GA and BW. EPIs with pulmonary hemorrhage and tracheal intubation have poor prognosis. Prenatal glucocorticoids and pulmonary surfactant may improve clinical outcome. BPD and pulmonary infections are common complications of surviving EPIs.

A multicenter survey of critical neonatal care centers construction and treatment of critically-ill neonates at city- and county-level in Henan Province / 中国新生儿科杂志

Objective:To study the current status of critical neonatal care centers (CNCC) construction and treatment of critically-ill neonates at city- and county-level in Henan Province.Methods:A questionnaire survey was conducted in January 2022 to city- and county-level CNCC in Henan Province. The basic information of CNCC, ward settings, neonatal management in the Department of Obstetrics and the treatment of critically-ill neonates in 2019-2021 were analyzed.Results:A total of 188 questionnaires were sent and 183 (97.3%) eligible questionnaires were analyzed, including 30 from city centers and 153 from county centers. The bed occupancy rate in county centers was significantly lower than city centers (67.3%±24.1% vs. 86.1%±23.2%), and the doctor/bed ratio, doctor/rescue bed ratio and nurse/rescue bed ratio were significantly higher than city centers ( P<0.05). All city centers had set up independent Department of Neonatology and the number is 92.8% (142/153) in county center. For 80.9% (148/183) centers, neonates were managed in the Department of Obstetrics with consultations and referrals to the Department of Pediatrics and 19.1% (35/183) were managed in the Department of Pediatrics/Neonatology. The average number of deliveries and admissions to the Department of Neonatology in both city and county centers decreased year on year during 2019-2021, but the proportion of premature and low/very low birth weight infants treated in these centers increased year on year. During 2019-2021, the top three diseases treated at the city centers were neonatal respiratory distress syndrome, neonatal asphyxia and acute respiratory distress syndrome, while the top three diseases treated at the county centers were neonatal asphyxia, neonatal respiratory distress syndrome and meconium aspiration syndrome. The incidence of sudden infant death syndrome in city and county centers was (10~30)/100,000. Conclusions:The construction of CNCC in Henan Province is facing challenges such as decreased hospital admissions, increased critically-ill neonates, insufficient cooperation between Obstetrics and Pediatrics and waste of resources. Rationally allocated and optimised use of resources to improve the ability to treat critically-ill neonates is warranted.

Clinical features and outcomes at discharge of outborn very preterm infants of different ages after interhospital transfer / 中华围产医学杂志

Objective:To analyze the distribution of ages at the interhospital transfer of outborn very preterm infants in China and to compare their perinatal characteristics and outcomes at discharge and neonatal intensive care unit (NICU) treatment.Methods:A total of 3 405 outborn very premature infants with a gestational age of 24-31 +6 weeks who were transferred to the NICUs of the Chinese Neonatal Network (CHNN) in 2019 were included in this retrospective study. According to the age at transfer, they were divided into three groups: early transfer (≤1 d), delayed transfer (>1-7 d) and late transfer (>7 d) groups. Analysis of variance, t-test, Chi-square test (Bonferroni correction), Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare the general clinical condition, treatment, and outcomes at discharge among the three groups. Results:The median gestational age was 29.7 weeks (28.3-31.0 weeks) and the average birth weight was (1 321.0 ± 316.5) g for these 3 405 infants. There were 2 031 patients (59.6%) in the early transfer group, 406 (11.9%) in the delayed transfer group and 968 (28.4%) in the late transfer group. Infants who received continuous positive airway pressure ventilation and tracheal intubation in the delivery room accounted for 8.4% (237/2 806) and 32.9% (924/2 805), respectively. A total of 62.7% (1 569/2 504) of the mothers received antenatal glucocorticoid therapy and the ratio in the early transfer group was 68.7% (1 121/1 631), which was higher than that in the delayed transfer group [56.1% (152/271), χ2=16.78, P<0.017] and the late transfer group [49.2% (296/602), χ2=72.56, P<0.017]. The total mortality rate of very premature infants was 12.7% (431/3 405), and the mortality rates in the early, delayed and late transfer groups were 12.4% (252/2 031), 16.3% (66/406) and 11.7% (113/968), respectively ( χ2=5.72, P=0.057). The incidences of severe intraventricular hemorrhage, late-onset sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia at the corrected gestational age of 36 weeks or discharge were all higher in the delayed and late transfer groups than in the early transfer group, respectively. The incidences of retinopathy of prematurity, retinopathy of prematurity requiring treatment and bronchopulmonary dysplasia at the corrected gestational age of 36 weeks or discharge in the late transfer group were significantly higher than that in the delayed transfer group (Bonferroni correction, all P<0.017). In the late transfer group, the median age of very premature infants at discharge was 66.0 d (51.0-86.0 d), and the corrected gestational age at discharge was 38.9 weeks (37.1-41.2 weeks), and both were greater than those in the early transfer [48.0 d (37.0-64.0 d), Z=260.83; 36.9 weeks (35.7-38.3 weeks), Z=294.32] and delayed transfer groups [52.0 d (41.0-64.0 d), Z=81.49; 37.4 weeks (36.1-38.7 weeks), Z=75.97] (all P<0.017). Conclusions:Many very premature infants need to be transferred to higher-level hospitals after birth. The later the very premature infants are transferred, the higher the incidence of complications will be. It is suggested that intrauterine or early postnatal transport may improve the prognosis of very premature infants.

Influence of periventricular-intraventricular hemorrhage on cerebral blood flow of preterm infants in the late postnatal period observed by arterial spin labeling: a prospective study / 中华实用儿科临床杂志

Objective:To study the influence of periventricular-intraventricular hemorrhage (PVH-IVH) on cerebral blood flow (CBF) of preterm infants in the late postnatal period using arterial spin labeling (ASL) magnetic resonance imaging (MRI).Methods:From January 2023 to June 2023, 65 preterm infants (gestational age <32 weeks, birth weight <1 500 g) who were born in the Department of Obstetrics, Third Affiliated Hospital of Zhengzhou University and transferred to the Neonatal Intensive Care Unit were included in the prospective study.They were examined by the brain MRI and ASL at the corrected gestational age of 35-40 weeks.According to the results of the brain ultrasound within 1 week after birth, they were divided into the mild IVH group (25 cases) and the non-IVH group (40 cases). The CBF values in regions of interest (frontal lobe, temporal lobe, parietal lobe, occipital lobe, thalamus, and basal ganglia) on ASL images were compared.Multiple linear regression analysis was used to analyze the effect of PVH-IVH on CBF values in different ASL regions of interest, including frontal cortex, temporal cortex, parietal cortex, occipital cortex, thalamus, and basal ganglia.Results:Compared with those of non-IVH group, infants in the mild IVH group presented significantly older gestational age [29.0 (28.5, 30.4) weeks vs.28.2 (27.0, 31.0) weeks, Z=-2.398, P=0.016], higher hematocrit (HCT) in the latest examination prior to the brain MRI [29.6(26.4, 32.3)% vs.27.8 (25.6, 30.5)%, Z=-2.155, P=0.031], and larger body weight at the time of examination [2 015.0 (1 930.0, 2 127.5) g vs.1 950.0 (1 900.0, 1 997.5) g, Z=-3.314, P=0.001]. After adjustment for confounding factors of gestational age at birth, latest HCT and weight at the time of examination, the multivariable linear regression analysis showed that CBF values in the frontal lobe (95% CI: -8.367--4.042; P<0.001), temporal lobe (95% CI: -19.077--2.854; P=0.008), parietal lobe (95% CI: -8.344--3.502; P<0.001), occipital lobe (95% CI: -9.446--3.645; P<0.001), basal ganglia (95% CI: -7.543--1.963; P=0.001) and thalamus (95% CI: -8.051--2.372; P<0.001) were significantly lower in infants of the mild IVH group than those of non-IVH group. Conclusions:At the same corrected gestational age, mild IVH is correlated with low CBF values in local cerebral cortex and subcortical gray matter in premature infants.However, the predictive potential of CBF values in long-term neurological prognosis requires further explorations.

Combined oxidative phosphorylation deficiency type 28: a case report and literature review / 中华实用儿科临床杂志

Objective:To summarize the clinical manifestations of a case of combined oxidative phosphorylation deficiency 28 (COXPD-28) caused by the mutations of the SLC25A26 gene, thus providing references for the diagnosis and genetic counseling of the disease. Methods:Clinical data of a case of COXPD-28 treated in the Third Affiliated Hospital of Zhengzhou University in October 2020 were retrospectively analyzed.In addition, The retrieval words " Combined oxidative phosphorylation deficiency 28, SLC25A26 gene" were used to search domestic and foreign databases.The clinical characteristics of combined phosphorylation deficiency 28 and the variation characteristics of SLC25A26 gene were summarized. Results:(1) A female patient full-term delivered after 30 min presented with groaning breath was admitted.Her main manifestations included pale complexion, groaning breathing, metabolic acidosis, and high lactate and pyruvate levels.Symptomatic support treatment like anti-infection and assisted ventilation were given, but her condition gradually worsened and died of respiratory and circulatory failure on the day of admission.The child was compound heterozygous mutation of SLC25A26 gene, the terminating mutation of exon 5 c. 403G>T caused the protein change to p. E135, and the non-synonymous mutation of exon 4 c. 212A>G caused the protein change to p. Y71C.(2) A total of 3 cases of COXPD-28 were searched in online databases, and no cases were reported in China.Through literature review, clinical features of COXPD-28 mainly included respiratory and circulatory fai-lure, elevations of lactate and pyruvate, and reductions of complexes Ⅰ, Ⅲ and Ⅳ in muscle biopsy.Two types of mutations in the SLC25A26 gene were detected, including 3 cases of missense mutations and 1 case of splicing mutation. Conclusions:COXPD-28 is an autosomal recessive genetic disease involving multiple systems and mitochondrial dysfunction.Mutations in the SLC25A26 gene is the pathological cause of COXPD-28.

The correlation between γδ-T lymphocyte subset in early postnatal peripheral blood and brain injury of preterm infants / 中华实用儿科临床杂志

Objective:To investigate the correlation between preterm infants with brain injury and the proportion of lymphocyte subsets, especially γδ-T cells in the postnatal peripheral blood, and to determine the predictive potential of γδ-T cells in the early peripheral blood in brain injury.Methods:It was a prospective study involving 106 preterm infants with gestational age less than 34 weeks who were delivered in the Department of Neonatology, the Third Affiliated Hospital of Zhengzhou University from January 1, to June 1, 2021.Relative levels of γδ-T , CD4 + T, CD8 + T, CD3 + T and total lymphocyte subsets in peripheral blood collected within the first 24 hours after birth were measured by flow cytometry.Recruited infants were divided into brain injury group (36 cases) and non-brain injury group (70 cases) according to serial cranial ultrasound and magnetic resonance imaging(MRI) at the corrected gestational age of 36-37 weeks.Differences in general conditions and the proportion of lymphocyte subsets between groups were compared by the t-test or Chi- square test.Patients in brain injury group were further divided into intracranial hemorrhage(ICH) group(8 cases), periventricular leukomalacia (PVL) group (6 cases)and diffuse white matter damage (WMD) group(22 cases). The proportion of lymphocyte subsets among the different groups was compared by One- Way ANOVA, followed by the LSD- t test. Results:The proportion of γδ-T cells in postnatal peripheral blood of preterm infants at 24 hours after birth in brain injury group was significantly lower than that of non-brain injury group [(0.09±0.12)% vs.0.15±0.13)%, t=-2.445, P=0.016]. No significant differences in the proportion of the CD4 + and CD8 + T cell subsets were found between them.Both preterm infants in PVL group and WMD group had a significantly lower proportion of γδ-T cells at 24 hours after birth compared to that of the non-brain injury group [(0.03±0.05)%, (0.07±0.09)% and (0.15±0.13)%], respectively, ( t=-2.190, -2.659, all P<0.05). Conclusions:γδ-T cells in early postnatal peripheral blood may be involved in the development of brain injury in preterm infants and they had early predictive value for preterm infants at high risk of brain injury, especially the leukomalacia and diffuse white matter injury.

Clinical analysis of 10 cases of Bacillus cereus sepsis in premature infants / 中国新生儿科杂志

Objective:To study the clinical features, diagnosis and treatment of Bacillus cereus sepsis in premature infants.Methods:From February 2011 to February 2021, 10 cases of Bacillus cereus sepsis in premature infants admitted to the Department of Neonatology of our hospital were retrospectively analyzed.Results:The 10 cases of premature infants with Bacillus cereus sepsis included 5 males and 5 females, with gestational age 27 +2~35 +2 weeks, birth weight 940~2 430 g and the age of onset 7~35 days. At the beginning, all the infants showed lethargy and recurrent apnea as the onset symptoms. 8 cases had gray color skin, 7 cases had fever, 7 cases experienced septic shock, 5 cases had neonatal seizures and 4 cases showed abdominal distension. 7 cases were complicated with purulent meningitis and 3 cases with necrotizing enterocolitis. 9 cases had significantly decreased white blood cells and platelets and significantly increased C-reactive protein and procalcitonin at the onset. Among the 7 cases of purulent meningitis, 5 cases had multiple encephalomalacia. During follow-up of all the infants, 4 cases died, 3 cases cured and 3 cases survived with severe neurological sequelae. Conclusions:Bacillus cereus sepsis is a serious infectious disease for premature infants with acute onset, rapid progress and high mortality. Complication of purulent meningitis and serious neurological sequelae are common.

Risk factors of bronchopulmonary dysplasia in very preterm infants: a national multicenter study / 中国小儿急救医学

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

Clinical analysis of twin-to-twin transfusion syndrome combined with necrotizing enterocolitis / 中国小儿急救医学

Objective:To investigate clinical characteristics and high-risk factors of prognosis of twin-to-twin transfusion syndrome(TTTS) combined with necrotizing enterocolitis(NEC).Methods:The clinical data of 102 children with TTTS admitted to the NICU at the Third Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were collected.Fifty-one pairs(102 cases)of twins without TTTS who were hospitalized at the same time and in the same gestational age were selected as the control group, and the relevant case data were collected and compared.The clinical data of 14 children with NEC in TTTS group were analyzed retrospectively.Results:(1)The average gestational age of TTTS group was(32.24±2.12)weeks, and that was (32.47±1.84) weeks in control group, with no statistical significance( P>0.05). The average birth weight of TTTS group was(1 547.63±523.80)g, which was lower than that of control group(1 658.71±454.13)g( P<0.05). There were 14 children in TTTS group with NEC, with an incidence of 13.7%(14/102), and seven children in the control group with NEC, with an incidence of 6.9%(7/102)( P<0.05). The proportion of very low birth weight infants, NEC occurrence within 2 weeks and mortality in TTTS group were higher than those in control group( P<0.05). (2)Compared with the non-NEC group, the NEC group of TTTS children had lower birth weight, the incidence of intrauterine distress and severe postnatal asphyxia, and the rate of sepsis were significantly higher than those in non-NEC group( P<0.05). (3)Among TTTS children, NEC was diagnosed in ten donors(71.4%) and four recipients(28.6%), with statistically significant difference between two groups( P<0.05). (4)The early clinical symptoms of TTTS complicated with NEC were mainly bloody stools, abdominal distension, poor response, apnea, and vomiting. Conclusion:TTTS is one of the risk factors for NEC, which the occurrence time of TTTS combined with NEC is not completely consistent with the classic NEC, which is more likely to occur within 2 weeks after birth.Children with TTTS complicated with NEC mostly occur in donor infants, and fetal distress in utero, severe asphyxia and sepsis are the high risk factors.The early clinical symptoms of TTTS combined with NEC are not significantly different from those of common NEC, mainly including bloody stools, abdominal diste, poor response, apnea, and vomiting.Vigilance should be raised when similar digestive symptoms appear in children.

Pathogen profile and clinical characteristics of catheter-related bloodstream infectionin very low birth weight infants / 中国新生儿科杂志

Objective:To study the pathogen profile and clinical characteristics of catheter-related bloodstream infection (CRBSI) in very low birth weight infants (VLBWI) receiving peripherally inserted central venous catheter (PICC).Methods:From November 2018 to October 2021, VLBWI with CRBSI after PICC admitted to neonatal intensive care unit (NICU) of our hospital were retrospectively studied. The pathogen profile and drug resistance characteristics were analyze. The infants with bacterial infection were assigned into gram-negative (G -) group and gram-positive (G +) group. Their general status, PICC duration and the site of PICC, body weight at infection, use of lipid emulsion and prophylactic antibiotics, clinical manifestations and laboratory results were compared between the two groups. Results:A total of 70 infants with CRBSI were included and 70 strains of pathogenic bacteria were detected. 50.0% (35/70) were G - bacteria with klebsiella pneumoniae (34.3%, 12/35) and serratia marcescens (34.3%, 12/35) as the most common bacteria. Klebsiella pneumoniae showed more severe drug resistance. 47.1% (33/70) were G + bacteria and the most common strain was staphylococcus epidermidis (45.5%, 15/33) with a majority of methicillin-resistant (86.7%, 13/15). 2 cases (6.1%, 2/33) had bacillus cereus infection and both suffered quick death. 2.9% (2/70) were fungi infection. The main clinical manifestation of CRBSI in VLBWI was apnea and shock was the most common complication. G + group showed significantly higher gestational age and lipid emulsion usage but lower body weight than G - bacteria group. No significant differences existed in clinical manifestations, laboratory results and prognosis between the two groups. Conclusions:Most pathogens causing CRBSI in VLBWI with PICC are opportunistic pathogens. It is difficult to differentiate G + and G - bacterial infection based on clinical manifestations and laboratory results. However, VLBWI with higher gestational age and lipid emulsion usage but lower body weight are more susceptible to G + bacterial infection.

Neonatal invasive fungal infection / 中国小儿急救医学

Invasive fungal infection (IFI) is one of the main causes of death and disability in premature infants.The occurrence of neonatal IFI involves host factors (such as extreme prematurity, very low birth weight, immature immune system, and fungal colonization, etc.) and external factors (such as central venous catheterization, mechanical ventilation, parenteral nutrition, and broad-spectrum antibiotic application, etc.). The clinical manifestations of IFI in neonates are nonspecific, which is easily confused with late-onset bacterial sepsis.Thrombocytopenia and hyperglycemia are important features of IFI.G-test and PCR have certain values in the diagnosis of fungal infection.The neonatal IFI should be mainly focused on its prevention.It is crucial for neonatal IFI to take comprehensive preventive measures such as cutting off transmission routes and strengthening medical management.The incidence of fungal infection and high risk factors in NICU where it is located should be considered when using the fluconazole prophylactically.Empirical antifungal treatment should be commenced promptly when a high degree of suspicion for IFI exists based on the presence of specific clinical features and risk factors.Targeted therapy means administer antifungal drugs on the basis of isolation of fungal.In addition, more attention should be given to the issues regarding central nervous system infection and biofilm in the management of neonatal IFI.

Comparison of the effects of caffeine citrate administering at different time on outcome and neuro-development of premature infants / 中国小儿急救医学

Objective@#To investigate the effect of caffeine citrate administering at different time on outcome and neurodevelopment of premature infants.@*Methods@#A total of 113 preterm infants with gestational age less than 32 weeks and birth weight less than 1 500 g who were hospitalized and treated in the neonatal intensive care unit from January 2018 to June 2018 were enrolled.According to the time when caffeine citrate treatment was started, they were divided into early treatment group(≤1 days) with 53 infants and late treatment group(1 to 10 days) with 60 infants.A retrospective analysis was performed for their clinical data.The perinatal conditions, treatment process and clinical outcomes of the two groups were compared and the neurological development was followed up at 12 months old.@*Results@#Compared with the late treatment group, the early treatment group had a significantly shorter durations of mechanical ventilation time, oxygen therapy time, hospitalization days and a significantly lower incidence of bronchopulmonary dysplasia, patent ductus arteriosusand intraventricular hemorrhage or periventricular leukomalacia, and there were significant differences between two groups(P<0.05, respectively). The neonatal behavioral neurological assessment score in the early treatment group was higher than that in the late treatment group at 40 weeks of gestational age, and there was significant difference between two groups(P<0.05). The mental developmental index at 3 months of corrected age, the mental developmental index and psychomotor developmental index at 12 months were significantly better in the early treatment group than those in the late treatment group, and there were significant differences between two groups(P<0.05, respectively).@*Conclusion@#Early use of caffeine citrate can improve the outcome of premature infants and improve the prognosis of nervous system.

Comparison of the effects of caffeine citrate administering at different time on outcome and neuro-development of premature infants / 中国小儿急救医学

Objective:To investigate the effect of caffeine citrate administering at different time on outcome and neurodevelopment of premature infants.Methods:A total of 113 preterm infants with gestational age less than 32 weeks and birth weight less than 1 500 g who were hospitalized and treated in the neonatal intensive care unit from January 2018 to June 2018 were enrolled.According to the time when caffeine citrate treatment was started, they were divided into early treatment group(≤1 days) with 53 infants and late treatment group(1 to 10 days) with 60 infants.A retrospective analysis was performed for their clinical data.The perinatal conditions, treatment process and clinical outcomes of the two groups were compared and the neurological development was followed up at 12 months old.Results:Compared with the late treatment group, the early treatment group had a significantly shorter durations of mechanical ventilation time, oxygen therapy time, hospitalization days and a significantly lower incidence of bronchopulmonary dysplasia, patent ductus arteriosusand intraventricular hemorrhage or periventricular leukomalacia, and there were significant differences between two groups( P<0.05, respectively). The neonatal behavioral neurological assessment score in the early treatment group was higher than that in the late treatment group at 40 weeks of gestational age, and there was significant difference between two groups( P<0.05). The mental developmental index at 3 months of corrected age, the mental developmental index and psychomotor developmental index at 12 months were significantly better in the early treatment group than those in the late treatment group, and there were significant differences between two groups( P<0.05, respectively). Conclusion:Early use of caffeine citrate can improve the outcome of premature infants and improve the prognosis of nervous system.

Analysis of neonatal deaths in different medical institutions in Henan province / 中国小儿急救医学

Objective:To investigate the mortality and causes of death in neonates from different medical institutions in Henan province.Methods:A retrospective analysis was performed on the death cases of 62 different medical institutions in 18 cities of Henan province in 2018, in order to compare the differences of neonatal mortality, age of death and the causes of death between maternal and child health care hospitals and general hospitals.Results:(1) A total of 80 780 newborns were admitted to 62 hospitals and 311 neonates died with a mortality rate of 3.85‰.A total of 33 339 newborns were admitted to 24 maternal and child health care hospitals, and 102 neonates died with a mortality rate of 3.06‰.Among them, 54 cases(52.9%) were premature infants and 48 cases(47.1%)were full-term infants.A total of 47 441 newborns were admitted to 38 general hospitals, and 209 neonates died with a mortality rate of 4.41‰.Among them, 111 cases(53.1%) were premature infants and 98 cases (46.9%) were full-term infants.Neonatal mortality in general hospitals was higher than that in maternal and child health care hospitals( P<0.05). (2) Neonatal death mainly occurred within one week after birth, especially within the first day.There were 67 cases of death(65.7%) in 24 maternal and child health care hospitals within the first day, including 34 cases (50.7%) of full-term infants and 33 cases (49.3%)of premature infants.And there were 87 cases of death(41.6%) in 38 general hospitals within the first day, including 50 cases (57.5%) of premature infants and 37 cases (42.5%) of full-term infants.Neonatal mortality within the first day after birth in maternal and child health care hospitals was higher than that in general hospitals( P<0.05). (3) The leading causes of neonatal death were non-infectious pulmonary diseases(128 cases, 41.2%), followed by birth asphyxia(73 cases, 23.5%) and infection(51 cases, 16.4%), but the causes of death in sequence varies from maternal and child health care hospitals and general hospitals.(4) For early death (within one week after birth) in both general hospitals and maternal and child health care hospitals, the main causes were birth asphyxia for full-term neonates, and pulmonary diseases(mainly respiratory distress syndrome)and birth asphyxia for premature infants.For late-stage death (2-4 weeks after birth) of neonates, infection was the leading cause in both term and preterm infants in general hospitals.For maternal and child health hospitals, the main causes of death for full-term infants were infection, and pulmonary diseases (mainly pulmonary hemorrhage and respiratory distress syndrome) for premature infants. Conclusion:There are some differences between maternal and child health care hospitals and general hospitals in neonatal mortality, mortality within the first day after birth, and causes of death.Therefore, it is necessary to strengthen the corresponding software and hardware constructions for newborns in different medical institutions to further reduce the neonatal mortality rate.