Background Extracorporeal membrane oxygenation(ECMO)not only significantly improves survival rates in severely ill neonates but also is associated with long-term neurodevelopmental issues.To systematically review the ...Background Extracorporeal membrane oxygenation(ECMO)not only significantly improves survival rates in severely ill neonates but also is associated with long-term neurodevelopmental issues.To systematically review the available literature on the neurodevelopmental outcomes of neonates and infants who have undergone ECMO treatment,with a focus on motor deficits,cognitive impairments,sensory impairments,and developmental delays.This review aims to understand the incidence,prevalence,and risk factors for these problems and to explore current nursing care and management strategies.Data sources A comprehensive literature search was performed across PubMed,EMBASE,and Web of Science using a wide array of keywords and phrases pertaining to ECMO,neonates,infants,and various facets of neurodevelopment.The initial screening involved reviewing titles and abstracts to exclude irrelevant articles,followed by a full-text assessment of potentially relevant literature.The quality of each study was evaluated based on its research methodology and statistical analysis.Moreover,citation searches were conducted to identify potentially overlooked studies.Although the focus was primarily on neonatal ECMO,studies involving children and adults were also included due to the limited availability of neonate-specific literature.Results About 50%of neonates post-ECMO treatment exhibit varying degrees of brain injury,particularly in the frontal and temporoparietal white matter regions,often accompanied by neurological complications.Seizures occur in 18%–23%of neonates within the first 24 hours,and bleeding events occur in 27%–60%of ECMO procedures,with up to 33%potentially experiencing ischemic strokes.Although some studies suggest that ECMO may negatively impact hearing and visual development,other studies have found no significant differences;hence,the influence of ECMO remains unclear.In terms of cognitive,language,and intellectual development,ECMO treatment may be associated with potential developmental delays,including lower composite scores in cognitive and motor functions,as well as potential language and learning difficulties.These studies emphasize the importance of early detection and intervention of potential developmental issues in ECMO survivors,possibly necessitating the implementation of a multidisciplinary follow-up plan that includes regular neuromotor and psychological evaluations.Overall,further multicenter,large-sample,long-term follow-up studies are needed to determine the impact of ECMO on these developmental aspects.Conclusions The impact of ECMO on an infant’s nervous system still requires further investigation with larger sample sizes for validation.Fine-tuned management,comprehensive nursing care,appropriate patient selection,proactive monitoring,nutritional support,and early rehabilitation may potentially contribute to improving the long-term outcomes for these infants.展开更多
Background Hemodynamically significant patent ductus arteriosus(hsPDA)is associated with increased comorbidities in neonates.Early evaluation of hsPDA risk is critical to implement individualized intervention.The aim ...Background Hemodynamically significant patent ductus arteriosus(hsPDA)is associated with increased comorbidities in neonates.Early evaluation of hsPDA risk is critical to implement individualized intervention.The aim of the study was to provide a powerful reference for the early identification of high-risk hsPDA population and early treatment decisions.Methods We enrolled infants who were diagnosed with PDA and performed exome sequencing.The collapsing analyses were used to find the risk gene set(RGS)of hsPDA for model construction.The credibility of RGS was proven by RNA sequencing.Multivariate logistic regression was performed to establish models combining clinical and genetic features.The models were evaluated by area under the receiver operating curve(AUC)and decision curve analysis(DCA).Results In this retrospective cohort study of 2199 PDA patients,549(25.0%)infants were diagnosed with hsPDA.The model[all clinical characteristics selected by least absolute shrinkage and selection operator regression(all CCs)]based on six clinical variables was acquired within three days of life,including gestational age(GA),respiratory distress syndrome(RDS),the lowest platelet count,invasive mechanical ventilation,and positive inotropic and vasoactive drugs.It has an AUC of 0.790[95%confidence interval(CI)=0.749–0.832],while the simplified model(basic clinical characteristic model)including GA and RDS has an AUC of 0.753(95%CI=0.706–0.799).There was a certain consistency between RGS and differentially expressed genes of the ductus arteriosus in mice.The AUC of the models was improved by RGS,and the improvement was significant(all CCs vs.all CCs+RGS:0.790 vs.0.817,P<0.001).DCA demonstrated that all models were clinically useful.Conclusions Models based on clinical factors were developed to accurately stratify the risk of hsPDA in the first three days of life.Genetic features might further improve the model performance.展开更多
Background We collected neonatal neurological,clinical,and imaging data to study the neurological manifestations and imaging characteristics of neonates with coronavirus disease 2019(COVID-19).Methods This case-contro...Background We collected neonatal neurological,clinical,and imaging data to study the neurological manifestations and imaging characteristics of neonates with coronavirus disease 2019(COVID-19).Methods This case-control study included newborns diagnosed with COVID-19 in Wuhan,China from January 2020 to July 2020.All included newborns had complete neurological evaluations and head magnetic resonance imaging.We normalized the extracted T2-weighted imaging data to a standard neonate template space,and segmented them into gray matter,white matter,and cerebrospinal fluid.The comparison of gray matter volume was conducted between the two groups.Results A total of five neonates with COVID-19 were included in this study.The median reflex scores were 2 points lower in the infected group than in the control group(P=0.0094),and the median orientation and behavior scores were 2.5 points lower in the infected group than in the control group(P=0.0008).There were also significant differences between the two groups in the total scale score(P=0.0426).The caudate nucleus,parahippocampal gyrus,and thalamus had the strongest correlations with the Hammersmith neonatal neurologic examination(HNNE)score,and the absolute correlation coefficients between the gray matter volumes and each part of the HNNE score were all almost greater than 0.5.Conclusions We first compared the neurological performance of neonates with and without COVID-19 by quantitative neuroimaging and neurological examination methods.Considering the limited numbers of patients,more studies focusing on the structural or functional aspects of the virus in the central nervous system in different age groups will be carried out in the future.展开更多
Background After the global elimination of smallpox,monkeypox has become the most threatening orthopoxvirus to human health.Very few studies have been reported on pregnant women and newborns.In the case of monkeypox i...Background After the global elimination of smallpox,monkeypox has become the most threatening orthopoxvirus to human health.Very few studies have been reported on pregnant women and newborns.In the case of monkeypox infection,the virus can cause serious adverse pregnancy events in women,which can lead to fetal or neonatal death.Data sources We made a comprehensive review after an extensive literature search in the PubMed/Medline database and websites concerning smallpox and monkeypox.Results Two case reports reported a total of nine pregnant women,six of whom had fetal deaths.In the autopsy of a stillbirth,researchers found that the placenta was infected with monkeypox virus,but the mechanism of infection remains unclear.Smallpox vaccine should be administered to acutely exposed pregnant women and newborns.Several novel recombinant vac-cinia immunogloblin(rVIG)and human-specific monoclonal antibodies are being developed for the prevention and treatment of monkeypox virus infection.After the fetus was delivered,the newborn should take a bath as soon as possible to remove the amniotic fluid and dirt from the body.The appropriate isolation protocol for the newborn should be selected according to the infection status of the mother.It is not known whether monkeypox virus is present in breast milk,and pasteurized breast milk can be given to newborns when breastfeeding is considered.Conclusion This review presents an overview of monkeypox in the perinatal period and guides the future research direction.展开更多
Background Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is an emerging disease.The consequences of SARS-CoV-2 exposure in infants remain unknown.Therefore,this...Background Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is an emerging disease.The consequences of SARS-CoV-2 exposure in infants remain unknown.Therefore,this study aims to investigate whether neonates born to mothers with COVID-19 have adverse brain development.Methods This multicenter observational study was conducted at two designated maternal and children's hospitals in Hubei Province,China's Mainland from February 1,2020 to May 15,2020.Neonates born to mothers with COVID-19 were enrolled.Brain magnetic resonance imaging(MRI)findings,and volumes of grey and white matters,and physical growth parameters were observed at 44 weeks corrected gestational age.Results Of 72 neonates born to mothers with COVID-19,8(11%)were diagnosed with COVID-19,8(11%)were critically ill,and no deaths were reported.Among the eight neonates that underwent brain MRI at corrected gestational age of 44 weeks,five neonates were diagnosed with COVID-19.Among these five neonates,three presented abnormal MRI findings including abnormal signal in white matter and delayed myelination in newborn 2,delayed myelination and brain dysplasia in newborn 3,and abnormal signal in the bilateral periventricular in newborn 5.The other three neonates without COVID-19 presented no significantly changes of brain MRI findings and the volumes of grey matter and white matter compared to those of healthy newborns at the equivalent age(P>0.05).Physical growth parameters for weight,length,and head circumference at gestational age of 44 weeks were all above the 3rd percentile for all neonates.Conclusions Some of the neonates born to mothers with COVID-19 had abnormal brain MRI findings but these neonates did not appear to have poor physical growth.These findings may provide the information on the follow-up schedule on the neonates exposed to SARS-CoV-2,but further study is required to evaluate the association between the abnormal MRI findings and the exposure to SARS-CoV-2.展开更多
基金funded by the National Natural Science Foundation of China(Grant number:82001599)Medical Innovation Research Program of Shanghai,China(Grant number:21Y11907200)Clinical Research Special Project of Shanghai Municipal Health Commission,China(Grant number:202140443).
文摘Background Extracorporeal membrane oxygenation(ECMO)not only significantly improves survival rates in severely ill neonates but also is associated with long-term neurodevelopmental issues.To systematically review the available literature on the neurodevelopmental outcomes of neonates and infants who have undergone ECMO treatment,with a focus on motor deficits,cognitive impairments,sensory impairments,and developmental delays.This review aims to understand the incidence,prevalence,and risk factors for these problems and to explore current nursing care and management strategies.Data sources A comprehensive literature search was performed across PubMed,EMBASE,and Web of Science using a wide array of keywords and phrases pertaining to ECMO,neonates,infants,and various facets of neurodevelopment.The initial screening involved reviewing titles and abstracts to exclude irrelevant articles,followed by a full-text assessment of potentially relevant literature.The quality of each study was evaluated based on its research methodology and statistical analysis.Moreover,citation searches were conducted to identify potentially overlooked studies.Although the focus was primarily on neonatal ECMO,studies involving children and adults were also included due to the limited availability of neonate-specific literature.Results About 50%of neonates post-ECMO treatment exhibit varying degrees of brain injury,particularly in the frontal and temporoparietal white matter regions,often accompanied by neurological complications.Seizures occur in 18%–23%of neonates within the first 24 hours,and bleeding events occur in 27%–60%of ECMO procedures,with up to 33%potentially experiencing ischemic strokes.Although some studies suggest that ECMO may negatively impact hearing and visual development,other studies have found no significant differences;hence,the influence of ECMO remains unclear.In terms of cognitive,language,and intellectual development,ECMO treatment may be associated with potential developmental delays,including lower composite scores in cognitive and motor functions,as well as potential language and learning difficulties.These studies emphasize the importance of early detection and intervention of potential developmental issues in ECMO survivors,possibly necessitating the implementation of a multidisciplinary follow-up plan that includes regular neuromotor and psychological evaluations.Overall,further multicenter,large-sample,long-term follow-up studies are needed to determine the impact of ECMO on these developmental aspects.Conclusions The impact of ECMO on an infant’s nervous system still requires further investigation with larger sample sizes for validation.Fine-tuned management,comprehensive nursing care,appropriate patient selection,proactive monitoring,nutritional support,and early rehabilitation may potentially contribute to improving the long-term outcomes for these infants.
基金funded by the Cohort Project of Specialized Disease,Clinical Research Center,Children's Hospital of Fudan University(2020ZBDL14)National Key R&D Program of China(2022ZD0116003).
文摘Background Hemodynamically significant patent ductus arteriosus(hsPDA)is associated with increased comorbidities in neonates.Early evaluation of hsPDA risk is critical to implement individualized intervention.The aim of the study was to provide a powerful reference for the early identification of high-risk hsPDA population and early treatment decisions.Methods We enrolled infants who were diagnosed with PDA and performed exome sequencing.The collapsing analyses were used to find the risk gene set(RGS)of hsPDA for model construction.The credibility of RGS was proven by RNA sequencing.Multivariate logistic regression was performed to establish models combining clinical and genetic features.The models were evaluated by area under the receiver operating curve(AUC)and decision curve analysis(DCA).Results In this retrospective cohort study of 2199 PDA patients,549(25.0%)infants were diagnosed with hsPDA.The model[all clinical characteristics selected by least absolute shrinkage and selection operator regression(all CCs)]based on six clinical variables was acquired within three days of life,including gestational age(GA),respiratory distress syndrome(RDS),the lowest platelet count,invasive mechanical ventilation,and positive inotropic and vasoactive drugs.It has an AUC of 0.790[95%confidence interval(CI)=0.749–0.832],while the simplified model(basic clinical characteristic model)including GA and RDS has an AUC of 0.753(95%CI=0.706–0.799).There was a certain consistency between RGS and differentially expressed genes of the ductus arteriosus in mice.The AUC of the models was improved by RGS,and the improvement was significant(all CCs vs.all CCs+RGS:0.790 vs.0.817,P<0.001).DCA demonstrated that all models were clinically useful.Conclusions Models based on clinical factors were developed to accurately stratify the risk of hsPDA in the first three days of life.Genetic features might further improve the model performance.
文摘Background We collected neonatal neurological,clinical,and imaging data to study the neurological manifestations and imaging characteristics of neonates with coronavirus disease 2019(COVID-19).Methods This case-control study included newborns diagnosed with COVID-19 in Wuhan,China from January 2020 to July 2020.All included newborns had complete neurological evaluations and head magnetic resonance imaging.We normalized the extracted T2-weighted imaging data to a standard neonate template space,and segmented them into gray matter,white matter,and cerebrospinal fluid.The comparison of gray matter volume was conducted between the two groups.Results A total of five neonates with COVID-19 were included in this study.The median reflex scores were 2 points lower in the infected group than in the control group(P=0.0094),and the median orientation and behavior scores were 2.5 points lower in the infected group than in the control group(P=0.0008).There were also significant differences between the two groups in the total scale score(P=0.0426).The caudate nucleus,parahippocampal gyrus,and thalamus had the strongest correlations with the Hammersmith neonatal neurologic examination(HNNE)score,and the absolute correlation coefficients between the gray matter volumes and each part of the HNNE score were all almost greater than 0.5.Conclusions We first compared the neurological performance of neonates with and without COVID-19 by quantitative neuroimaging and neurological examination methods.Considering the limited numbers of patients,more studies focusing on the structural or functional aspects of the virus in the central nervous system in different age groups will be carried out in the future.
文摘Background After the global elimination of smallpox,monkeypox has become the most threatening orthopoxvirus to human health.Very few studies have been reported on pregnant women and newborns.In the case of monkeypox infection,the virus can cause serious adverse pregnancy events in women,which can lead to fetal or neonatal death.Data sources We made a comprehensive review after an extensive literature search in the PubMed/Medline database and websites concerning smallpox and monkeypox.Results Two case reports reported a total of nine pregnant women,six of whom had fetal deaths.In the autopsy of a stillbirth,researchers found that the placenta was infected with monkeypox virus,but the mechanism of infection remains unclear.Smallpox vaccine should be administered to acutely exposed pregnant women and newborns.Several novel recombinant vac-cinia immunogloblin(rVIG)and human-specific monoclonal antibodies are being developed for the prevention and treatment of monkeypox virus infection.After the fetus was delivered,the newborn should take a bath as soon as possible to remove the amniotic fluid and dirt from the body.The appropriate isolation protocol for the newborn should be selected according to the infection status of the mother.It is not known whether monkeypox virus is present in breast milk,and pasteurized breast milk can be given to newborns when breastfeeding is considered.Conclusion This review presents an overview of monkeypox in the perinatal period and guides the future research direction.
基金supported by the Fundamental Research Funds for the Central Universities(No.2020kfyXGYJ006)Wuhan Emergency Research Project of COVID-19(No.EX20D24).
文摘Background Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is an emerging disease.The consequences of SARS-CoV-2 exposure in infants remain unknown.Therefore,this study aims to investigate whether neonates born to mothers with COVID-19 have adverse brain development.Methods This multicenter observational study was conducted at two designated maternal and children's hospitals in Hubei Province,China's Mainland from February 1,2020 to May 15,2020.Neonates born to mothers with COVID-19 were enrolled.Brain magnetic resonance imaging(MRI)findings,and volumes of grey and white matters,and physical growth parameters were observed at 44 weeks corrected gestational age.Results Of 72 neonates born to mothers with COVID-19,8(11%)were diagnosed with COVID-19,8(11%)were critically ill,and no deaths were reported.Among the eight neonates that underwent brain MRI at corrected gestational age of 44 weeks,five neonates were diagnosed with COVID-19.Among these five neonates,three presented abnormal MRI findings including abnormal signal in white matter and delayed myelination in newborn 2,delayed myelination and brain dysplasia in newborn 3,and abnormal signal in the bilateral periventricular in newborn 5.The other three neonates without COVID-19 presented no significantly changes of brain MRI findings and the volumes of grey matter and white matter compared to those of healthy newborns at the equivalent age(P>0.05).Physical growth parameters for weight,length,and head circumference at gestational age of 44 weeks were all above the 3rd percentile for all neonates.Conclusions Some of the neonates born to mothers with COVID-19 had abnormal brain MRI findings but these neonates did not appear to have poor physical growth.These findings may provide the information on the follow-up schedule on the neonates exposed to SARS-CoV-2,but further study is required to evaluate the association between the abnormal MRI findings and the exposure to SARS-CoV-2.
