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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.
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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.
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Objective:To study the predictive value of the amplitude-integrated electroencephalography (aEEG) within 6 hours and 3 days after birth and magnetic resonance imaging(MRI) on the adverse neurobehavioral development of asphyxiated preterm infants at the correction age of 6 months.Methods:From December 2017 to June 2019, 50 asphyxiated preterm infants who were delivered at the obstetrical department transferred to the division of neonatology in the Third Affiliated Hospital of Anhui Medical University were monitored by aEEG within 6 hours after birth, then once a day for at least 4 h. MRI was administered at 40 weeks of corrected age, neuromotor developmental function of the infants was assessed by the Geisel developmental diagnostic scale at 6 months of corrected age, then the infants were divided into good prognosis group and poor prognosis group according to the assessment results. SPSS 19.0 software was used for statistical analysis.The software of SPSS 19.0 was used to analyze the data.Independent sample t-test and χ 2 test were used to analyze the difference between the two groups.The relationship between aEEG grading and MRI, and their predictive value for adverse neurobehavioral development were analyzed at 6 months of corrected age. Results:The degree of white matter damage( H=24.896) and intracranical hemorrhage( H=29.245) of premature infants with different aEEG clinical grades were different (both P<0.01) on MRI. The sensitivity of aEEG within 6 hours and 3 days after birth on predicting poor prognosis was 96.2% and 97.8%, the specificity was 56.2% and 62.5%, the negative predictive value was 98.2% and 99.0%, the positive predictive value was 37.8% and 52.3%, the correct index was 52.4% and 60.3%, respectively. The aEEG was combined with MRI, the sensitivity (90.0%, 97.0%), specificity (89.0%, 99.0%), negative predictive value (99.2%, 99.5%), positive predictive value (80.6%, 88.5%), and correct index (79%, 96%) were all improved. Conclusion:The combination of aEEG grading and MRI can improve the prognostic value on neurodevelopmental prognosis, and provide a better evaluation basis for clinical follow-up and intervention of asphyxiated premature infants with brain injury.
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Objective:To study the effect of breast feeding on tissue oxygen saturation of newborns, and to explore the mechanism.Methods:A total of 60 full-term newborns in the Third Affiliated Hospital of Anhui Medical University from December 2018 to April 2019 were enrolled in this study.There were 30 infants were fed by breast milk (BM group) and 30 infants were fed by formula milk (FM group). Cerebral tissue oxygen saturation index(cTOI), splanchnic tissue oxygen saturation index (sTOI), cerebral tissue hemoglobin index(cTHI) and splanchnic tissue hemoglobin index(sTHI) of infants before, during and after feeding were measured by near infrared reflectance(NIRS).Results:In the BM group, cTOI during feeding [(63.42±2.55)%] was significantly higher than that before feeding [(61.13±2.80)%]( P<0.05), and cTOI after feeding [(62.19±2.44)%] was not significantly different from that before feeding ( P>0.05). In the FM group, no significant difference in cTOI was observed before feeding [(61.70±2.25)%], during feeding [(61.74±2.25)%], and after feeding [(61.12±2.05)%]. In the BM group, cTHI du-ring feeding [(1.31±0.37) mmol/(L·min)] was significantly higher than that before feeding[(1.04±0.35) mmol/(L·min)] ( t=-2.52, P<0.05), and cTHI after feeding [(1.36±0.39) mmol/(L·min)] was not signi-ficantly different from that during feeding ( P>0.05). In the FM group, there was no significant change of cTHI before feeding [(1.28 ±0.33)mmol/(L·min)], during feeding [(1.29±0.39)mmol/(L·min)] and after feeding [(1.33±0.42) mmol/(L·min)] ( P>0.05). In the BM group, sTOI and sTHI showed a downward trend, but there was no statistical difference ( P>0.05), respectively.In the FM group, there was no significant change of sTOI and sTHI , respectively( P>0.05). Conclusions:Breast feeding can increase the level of cTOI.The reason is breast milk can well activate brain automatic regulation mechanism, and increase cerebral blood perfusion and oxygen supply, exerting a positive impact on the changes of cerebral hemodynamics in newborns.
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Objective@#To investigate the influence of different delayed cord clamping(DCC) time on cerebral tissue oxygen saturation in normal newborns after birth and to explore the causes.@*Methods@#From November 2018 to February 2019, 164 healthy full term newborns were delivered in the Department of Obstetrics, Binhu Hospital, the Southern District of the Third Affiliated Hospital of Anhui Medical University.The newborns were divided into early cord clamping (ECC) group, DCC groups for 1 minute, 2 minutes and 3 minutes according to the different cord clamping time, and the changes of cerebral tissue oxygen saturation index (cTOI) and cerebral tissue hemoglobin index(cTHI) were monitored by near infrared spectroscopy (NIRS) for 15 minutes after birth.@*Results@#After birth, cTOI increased gradually but cTHI was basically stable.The cTOI in DCC group was higher than ECC group, but there was no difference between group 3 and group 4.In ECC group, the cTOI tended to be stable about 6 minutes after birth, and the stable range was 55%-59%.In DCC group, group 2 tended to be stable about 8 minutes after birth, and the stable range was 59%-64%.Group 3 and group 4 tended to be stable about 10 minutes after birth, the stable range was 64%-69%.There was no difference in cTHI among the groups.@*Conclusions@#Delayed cord clamping can increase cerebral oxygenation in newborns.The cause may not be due to the direct increase in cerebral blood flow, but the increase in brain oxygen content, and the optimal duration of DCC is 2 minutes.
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Objective To investigate the influence of different delayed cord clamping(DCC) time on cerebral tissue oxygen saturation in normal newborns after birth and to explore the causes.Methods From November 2018 to February 2019,164 healthy full term newborns were delivered in the Department of Obstetrics,Binhu Hospital,the Southern District of the Third Affiliated Hospital of Anhui Medical University.The newborns were divided into early cord clamping (ECC) group,DCC groups for 1 minute,2 minutes and 3 minutes according to the different cord clamping time,and the changes of cerebral tissue oxygen saturation index (cTOI) and cerebral tissue hemoglobin index (cTHI) were monitored by near infrared spectroscopy (NIRS) for 15 minutes after birth.Results After birth,cTOI increased gradually but cTHI was basically stable.The cTOI in DCC group was higher than ECC group,but there was no difference between group 3 and group 4.In ECC group,the cTOI tended to be stable about 6 minutes after birth,and the stable range was 55％-59％.In DCC group,group 2 tended to be stable about 8 minutes after birth,and the stable range was 59％-64％.Group 3 and group 4 tended to be stable about 10 minutes after birth,the stable range was 64％-69％.There was no difference in cTHI among the groups.Conclusions Delayed cord clamping can increase cerebral oxygenation in newborns.The cause may not be due to the direct increase in cerebral blood flow,but the increase in brain oxygen content,and the optimal duration of DCC is 2 minutes.
