Monkeypox(Mpox),a zoonotic infection caused by the Mpox virus,has reemerged as a global public health concern,with unique implications for neonatal health.Although rare in newborns,cases of neonatal Mpox pose signific...Monkeypox(Mpox),a zoonotic infection caused by the Mpox virus,has reemerged as a global public health concern,with unique implications for neonatal health.Although rare in newborns,cases of neonatal Mpox pose significant diagnostic and therapeutic challenges due to limited clinical data and the vulnerability of this population.This narrative review explores the pathophysiology,clinical presentation,diagnostic barriers,and therapeutic strategies associated with Mpox in neonates.Vertical and perinatal transmission have been identified,with some cases presenting with vesicular rashes,fever,lymphadenopathy,and systemic involvement such as respiratory or neurological complications.Diagnosis often relies on polymerase chain reaction testing,yet resource limitations and symptom overlap with other neonatal infections can hinder accurate identification.Antiviral treatments like tecovirimat and cidofovir are considered in severe cases,but dosing in neonates remains uncertain due to a lack of robust safety data.Supportive care,including hydration,fever management,and prevention of secondary infections,is critical.Breastfeeding decisions require individualized assessment due to the unknown risk of viral transmission through breast milk.Preventive strategies emphasize early isolation,surveillance,and infection control measures in neonatal care settings.The review highlights significant research gaps in understanding neonatal Mpox,especially concerning long-term outcomes and optimal treatment protocols.A coordinated global effort is essential to improve diagnostics,develop safe therapeutic options,and establish evidence-based guidelines tailored to neonates.展开更多
BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital...BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system.Truncus arteriosus(TA)is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation,leading to complications such as pulmonary hypertension,heart failure,and severe hypoxia.Although rare individually,the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges,with limited documentation in medical literature.CASE SUMMARY We present a 36-week preterm neonate with CS associated with TA type 1,pre-senting with respiratory distress,cyanosis,and altered spinal curvature.This case demonstrates the complexity of managing neonates with multiple congenital de-fects.Here,the patient was managed with oxygen supplementation,heart failure medication,nasogastric feeding,and multidisciplinary care to optimize her for surgical corrections.A coordinated,interdisciplinary approach was employed to optimize outcomes,particularly in a resource-limited setting.Immediate re-spiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient’s quality of life and survival.CONCLUSION Recognizing co-existing congenital anomalies and their embryological interre-lation is critical in holistic patient care,particularly during neonatal and infancy.展开更多
Objective:To analyze the value of bedside cranial ultrasonography in the early diagnosis of neonatal brain tissue injury in intrauterine distress.Methods:128 neonates with suspected intrauterine distress admitted to t...Objective:To analyze the value of bedside cranial ultrasonography in the early diagnosis of neonatal brain tissue injury in intrauterine distress.Methods:128 neonates with suspected intrauterine distress admitted to the Yichang Central People’s Hospital from January 2023 to December 2024 were selected as study subjects based on the inclusion and exclusion criteria,and all subjects underwent bedside craniocerebral ultrasonography and MRI,and the results of MRI were used as the gold standard to divide the infants into the brain-injury group(n=31)and the no-brain-injury The children were divided into brain injury group(n=31)and no brain injury group(n=97),and the value of bedside cranial ultrasonography for early diagnosis of brain tissue injury in neonates with intrauterine distress was analyzed.Results:(1)Among the 128 cases of intrauterine distress neonates,31 cases were examined for abnormal signs,including 22 cases(70.97%)examined by bedside craniocerebral ultrasonography and 28 cases(90.32%)examined by MRI.(2)Bedside cranial ultrasound detected hypoxic-ischemic encephalopathy in 6 cases,accounting for 4.69%,ventricular widening in 2 cases,accounting for 1.56%,intracranial hemorrhage in 8 cases,accounting for 6.25%,periventricular softening of white matter in 5 cases,accounting for 3.91%,and cerebral edema in 1 case,accounting for 0.78%,while MRI detected hypoxic-ischemic encephalopathy in 9 cases,accounting for 7.03%.3 cases of ventricular widening,accounting for 2.34%,4 cases of intracranial hemorrhage,accounting for 3.13%,9 cases of periventricular-intraventricular white matter softening,accounting for 7.03%,and 3 cases of cerebral edema,accounting for 2.34%were examined.Among them,the detection rate of periventricular-intraventricular hemorrhage by bedside cranial ultrasound was significantly higher than that of MRI(P<0.05).Conclusion:The diagnostic value of bedside cranial ultrasound in periventricular-intraventricular hemorrhage is high,but the diagnostic value is not as good as that of MRI in other brain tissue injuries,and clinically appropriate examination protocols can be selected according to the specific types of craniocerebral injuries.展开更多
BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated n...BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.展开更多
BACKGROUND Phocomelia is a rare congenital disorder characterized by the absence or under-development of the proximal limbs.Phocomelia can occur as a syndrome or a limb-specific deformity.While historically linked to ...BACKGROUND Phocomelia is a rare congenital disorder characterized by the absence or under-development of the proximal limbs.Phocomelia can occur as a syndrome or a limb-specific deformity.While historically linked to thalidomide,non-thalido-mide causes include genetic mutations,vascular disruptions,and teratogenic exposures.This case highlights the diagnostic and therapeutic challenges in a neonate with bilateral phocomelia,low birth weight,asphyxia and jaundice.CASE SUMMARY We report a 2-week-old term neonate with bilateral phocomelia,micrognathia,jaundice,and low birth weight.The pregnancy was unremarkable,with no tha-lidomide exposure.The mother had a history of early pregnancy losses.Clinical evaluation revealed absent humeri and radii bilaterally,with hands attached proximally to the trunk.Genetic testing was not performed,limiting the identi-fication of underlying etiology.The patient was managed with supportive care,parental counseling,and planning for long-term rehabilitation.This case un-derscores the importance of multidisciplinary care in managing congenital ano-malies.Genetic evaluation is crucial in unexplained congenital anomalies.Routine detailed ultrasounds in high-risk pregnancies aid in early diagnosis and parental preparedness.CONCLUSION Bilateral phocomelia presents significant functional challenges.Comprehensive diagnostic workups and early rehabilitation strategies are essential for optimizing patient outcomes.展开更多
BACKGROUND Congenital intestinal atresia(CIA)is a common intestinal malformation in the neonatal period,and surgery is currently the main treatment method.The choice of postoperative feeding is crucial for the recover...BACKGROUND Congenital intestinal atresia(CIA)is a common intestinal malformation in the neonatal period,and surgery is currently the main treatment method.The choice of postoperative feeding is crucial for the recovery of gastrointestinal function in children.AIM To compare and analyze the effects of different postoperative feeding methods on gastrointestinal function reconstruction in newborns with CIA.METHODS Twenty-six children diagnosed with neonatal CIA,treated with minimally invasive surgery at Shijiazhuang Maternal and Child Health Hospital between January 2021 and May 2024,were selected for this single-center prospective randomized controlled study.They were divided into two groups using envelope randomization:Enteral nutrition(EN)group(n=13)and parenteral nutrition(PN)group(n=13).Baseline and clinical characteristics were collected,and recovery time of bowel sounds and time to first defecation were used as evaluation indices for gastrointestinal functional reconstruction.Differences between the groups were analyzed using t-test,χ2 test,and Fisher’s exact test.Spearman’s correlation tests and linear regression models were employed to analyze factors influencing time to first defecation.RESULTS The time to bowel sound recovery(51.54 vs 65.85,P=0.013)and first defecation(58.15 vs 76.62,P<0.001)was shorter in the EN group compared to the PN group.Clinical improvements in the EN group,including discharge weight(P=0.044),hospital stay(P=0.027),white blood cell count(P=0.023),albumin content(P=0.013),and direct bilirubin content(P=0.018),were also better than those in the PN group.No substantial differences in postoperative complications were found between the groups.Correlation analysis indicated that abdominal infection and operation time may relate to time to first defecation.Linear regression analysis demonstrated a considerable association between EN feeding and shorter time to first defecation.Abdominal infection and an operation time>2 hours may be risk factors for prolonged time to first defecation.CONCLUSION EN substantially promotes the recovery of gastrointestinal function after CIA in neonates and can improve clinical outcomes in children.Future research should explore optimal EN practices to enhance clinical application and child health.展开更多
BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complicat...BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complications such as myocarditis,which may present with life-threatening symptoms if not promptly recognized.CASE SUMMARY We describe the case of a 26-day-old male neonate who presented with respiratory distress,poor feeding,and irritability.Initial evaluation revealed an RSV infection confirmed via nasopharyngeal swab.As the clinical course progressed,the infant developed cardiac arrhythmias,elevated cardiac enzymes,and echocardiographic findings consistent with myocarditis.Management included mechanical ventilation,corticosteroid therapy,L-carnitine,and vitamin D supplementation.The patient responded well to treatment and was successfully extubated and discharged in stable condition after nine days of hospitalization.CONCLUSION This case highlights the importance of early recognition and multidisciplinary management of RSV-associated myocarditis in neonates.展开更多
Objective:To explore the construction and application value of a home skin care guidance program for neonates.Methods:From February 2024 to February 2025,60 neonates were selected as samples and randomly grouped by dr...Objective:To explore the construction and application value of a home skin care guidance program for neonates.Methods:From February 2024 to February 2025,60 neonates were selected as samples and randomly grouped by drawing.Group A received the constructed home skin care program for neonates,while Group B received routine care.The mastery of skin care knowledge by parents,emotional scores of mothers,and adverse reaction rates of neonates were compared.Results:The mastery of skin care knowledge by parents in Group A was higher than that in Group B,P<0.05.The anxiety(SAS)and depression(SDS)scores of mothers in Group A were lower than those in Group B,P<0.05.The adverse reaction rate of neonates in Group A was lower than that in Group B,P<0.05.Conclusion:The construction of a home skin care program for neonates can reduce adverse reactions of mothers,improve parents’mastery of neonatal skin care knowledge,and is beneficial for reducing adverse events such as neonatal eczema,diaper dermatitis,and infection.展开更多
BACKGROUND： Spontaneous otoacoustic emissions （SOAEs） are regarded as a valuable audio- metric parameter that objectively reflects the function of outer hair cells （OHCs）. Many studies have reported that the inci...BACKGROUND： Spontaneous otoacoustic emissions （SOAEs） are regarded as a valuable audio- metric parameter that objectively reflects the function of outer hair cells （OHCs）. Many studies have reported that the incidence of SOAEs in adults is less than 50%. Therefore, measurement of SOAEs may be of little value to clinical examinations. However, the incidence of SOAEs in infants and neonates is higher than in adults. OBJECTIVE： To analyze the basic characteristics of SOAEs in 2–4 day old neonates, and to demonstrate the difference in OHC function between sexes and ears. DESIGN, TIME AND SETTING： Neurophysiological contrast study, performed in the Department of Neonates, Beijing Chaoyang Hospital, Capital Medical University, between December 2007 and August 2008. PARTICIPANTS： A total of 112 newborns （224 ears） consisting of 59 females and 53 males were included in this study. METHODS： The probe was adapted and embedded in the neonate external auditory canal with a foam rubber earplug after checking and clearing up the outer ear canal. The presence of SOAEs was determined when the signal amplitude had a clear peak exceeding –30 dB, or was 3 dB above the noise floor. MAIN OUTCOME MEASURES： The incidence of SOAEs, the number of SOAE signal peaks, and the maximal tension of SOAEs. RESULTS： The incidence in females （79.7%） was higher than males （76.4%） （P 〉 0.05）, and the incidence in right ears （86.6%） was higher than in left ears （69.6%） （P 〈 0.05）. There were no significant difference in the number of SOAE peaks between females and males （4.49 vs. 4.28）, or between right ears and left ears （4.62 vs. 4.12） （P 〉 0.05）. The mean maximum SOAE level per ear in females （–3.29 ± 9.28） dB sound pressure level （SPL） was slightly higher than that in males （–3.91 ± 9.14） dB SPL （P 〉 0.05）. Also, the mean maximum SOAE level in right ears （–2.03 ± 9.11） dB SPL was higher than in left ears （–5.50 ± 9.65） dB SPL （P 〈 0.05）. The maximum SOAE level showed a positive correlation with maximum SOAE number in emitting ears （r = 0.55, P 〈 0.01）. CONCLUSION： The incidence of SOAEs in neonates is high （78.1%） within 4 days of birth. The in-cidence of SOAEs and the maximum SOAE level exhibited a significant difference between right and left ears, but the difference between sexes was insignificant. Both the strongest SOAE signal peak and number of SOAEs per ear are representative of the function OHCs.展开更多
This study attempts to discuss the correlation between UGT1A1＊28 as uridine diphosphate glucuronosyltransferase gene promoter and coding region Gly71 Arg gene polymorphism with neonatal hyperbilirubinemia of neonates...This study attempts to discuss the correlation between UGT1A1＊28 as uridine diphosphate glucuronosyltransferase gene promoter and coding region Gly71 Arg gene polymorphism with neonatal hyperbilirubinemia of neonates in Wuhan. A total of 168 neonates were divided into the hyperbilirubinemia group（case group, n=108） and healthy neonates group（control group, n=60）. Their DNA was obtained through blood extraction. The gene exon mutation of UGT1A1 was detected by Sanger sequencing, which revealed the relationship between UGT1A1＊28 and Gly71 Arg polymorphism with neonatal hyperbilirubinemia of neonates. The results showed that：（1） The frequency of UGT1A1＊28 allele mutation in the case group and the control group was 9.3% and 10% respectively, with the difference being not significant between the two groups（P〉0.05）.（2） The frequency of Gly71 Arg allele mutation in the case group and the control group was 35.1% and 21.7% respectively, with the difference being significant between the two groups（P〈0.01）.（3） The serum bilirubin level of Gly71 Arg mutant homozygous and heterozygous subgroups（n=66） in the case group was 302.7±31.4 μmol/L, which was significantly higher than 267.3±28.5 μmol/L of the wild subgroup（n=42）（P〈0.01）. It was suggested that the occurrence of neonatal hyperbilirubinemia of neonates in Wuhan was not associated with UGT1A1＊28 gene polymorphism, but closely with the Gly71 Arg gene polymorphism. Meanwhile, the Arg allele mutation was related to the degree of jaundice.展开更多
Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled ...Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled trial was conducted.Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB(experimental group)or 0 dB(control group)2 min before radial artery blood sampling and continued until 5 min after needle withdrawal.Pain-related cortical response was measured by regional cerebral oxygen saturation(rScO_(2))monitored with near-infrared spectroscopy,and facial expressions and physiological parameters were recorded by two video cameras.Two assessors scored the Premature Infant Pain Profile-Revised(PIPP-R)independently when viewing the videos.Primary outcomes were pain score and rScO_(2)during arterial puncture and 5 min after needle withdrawal.Secondary outcomes were pulse oximetric oxygen saturation(SpO_(2))and heart rate(HR)during arterial puncture,and duration of painful expressions.The study was registered at the Chinese Clinical Trial Registry(ChiCTR2200055571).Results Sixty neonates(experimental group,n=29;control group,n=31)were included in the final analysis.The maximum PIPP-R score in the experimental and control groups was 12.00(9.50,13.00),12.50(10.50,13.75),respectively(median difference−0.5,95%CI−2.0 to 0.5),and minimum rScO_(2)was(61.22±3.07)%,(61.32±2.79)%,respectively(mean difference−0.325,95%CI−1.382 to 0.732),without significant differences.During arterial puncture,the mean rScO_(2),HR,and SpO_(2)did not differ between groups.After needle withdrawal,the trends for rScO_(2),PIPP-R score,and facial expression returning to baseline were different between the two groups without statistical significance.Conclusion The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score,behavioral and physiological parameters in neonates with procedural pain.展开更多
Although hypothermia therapy is effective to treat neonatal hypoxic-ischemic encephalopathy,many neonatal patients die or suffer from severe neurological dysfunction.Erythropoietin is considered one of the most promis...Although hypothermia therapy is effective to treat neonatal hypoxic-ischemic encephalopathy,many neonatal patients die or suffer from severe neurological dysfunction.Erythropoietin is considered one of the most promising neuroprotective agents.We hypothesized that erythropoietin combined with hypothermia will improve efficacy of neonatal hypoxic-ischemic encephalopathy treatment.In this study,41 neonates with moderate/severe hypoxic-ischemic encephalopathy were randomly divided into a control group（hypothermia alone for 72 hours,n = 20） and erythropoietin group（hypothermia ＋ erythropoietin 200 IU/kg for 10 days,n = 21）.Our results show that compared with the control group,serum tau protein levels were lower and neonatal behavioral neurological assessment scores higher in the erythropoietin group at 8 and 12 days.However,neurodevelopmental outcome was similar between the two groups at 9 months of age.These findings suggest that erythropoietin combined with hypothermia reduces serum tau protein levels and improves neonatal behavioral neurology outcome but does not affect long-term neurodevelopmental outcome.展开更多
Resting-state functional magnetic resonance imaging has revealed disrupted brain network connectivity in adults and teenagers with cerebral palsy. However, the specific brain networks implicated in neonatal cases rema...Resting-state functional magnetic resonance imaging has revealed disrupted brain network connectivity in adults and teenagers with cerebral palsy. However, the specific brain networks implicated in neonatal cases remain poorly understood. In this study, we recruited 14 termborn infants with mild hypoxic ischemic encephalopathy and 14 term-born infants with severe hypoxic ischemic encephalopathy from Changzhou Children's Hospital, China. Resting-state functional magnetic resonance imaging data showed efficient small-world organization in whole-brain networks in both the mild and severe hypoxic ischemic encephalopathy groups. However, compared with the mild hypoxic ischemic encephalopathy group, the severe hypoxic ischemic encephalopathy group exhibited decreased local efficiency and a low clustering coefficient. The distribution of hub regions in the functional networks had fewer nodes in the severe hypoxic ischemic encephalopathy group compared with the mild hypoxic ischemic encephalopathy group. Moreover, nodal efficiency was reduced in the left rolandic operculum, left supramarginal gyrus, bilateral superior temporal gyrus, and right middle temporal gyrus. These results suggest that the topological structure of the resting state functional network in children with severe hypoxic ischemic encephalopathy is clearly distinct from that in children with mild hypoxic ischemic encephalopathy, and may be associated with impaired language, motion, and cognition. These data indicate that it may be possible to make early predictions regarding brain development in children with severe hypoxic ischemic encephalopathy, enabling early interventions targeting brain function. This study was approved by the Regional Ethics Review Boards of the Changzhou Children's Hospital(approval No. 2013-001) on January 31, 2013. Informed consent was obtained from the family members of the children. The trial was registered with the Chinese Clinical Trial Registry(registration number: ChiCTR1800016409) and the protocol version is 1.0.展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)have been increasingly applied worldwide owing to many advantages.Even with these advantages,the related complications should not be ignored,especially in neona...BACKGROUND Peripherally inserted central catheters(PICCs)have been increasingly applied worldwide owing to many advantages.Even with these advantages,the related complications should not be ignored,especially in neonates.The available evidence about PICC-related thrombosis was manifold,but the cardiac tamponade,an emergency and life-threatening complication,has been rarely reported.Early recognized cardiac tamponade by ultrasound may reduce mortality.CASE SUMMARY A neonate weighting 2.8 kg was born at 40 wk of gestation.He was admitted to the Surgery Intensive Care Unit due to suspected congenital megacolon.A PICC line was inserted via the left antecubital fossa for the administration of total parenteral nutrition.Three days later,the patient was still on total parenteral nutrition.Cardiac tamponade caused by PICC was found on ultrasound.The patient recovered spontaneously after an emergency pericardiocentesis.CONCLUSION Proficiency in the use of point-of-care ultrasound may save the life of patients,since it enables clinicians to treat patients faster,more accurately,and in a noninvasive way at the point of care.展开更多
Enzyme-linked colorimetric analysis and adioimmunoassay were employed to detect serum fasting total bile acids(FBA) and choloyglycin (CG) respectively in cases of 32 neonatal hepatitis , 33 cases of neonatal unconjuga...Enzyme-linked colorimetric analysis and adioimmunoassay were employed to detect serum fasting total bile acids(FBA) and choloyglycin (CG) respectively in cases of 32 neonatal hepatitis , 33 cases of neonatal unconjugated hyperbilirubinemia and 34 cases of breast milk jaundice(BMJ). FBA and CG in acute period of neonatal hepatitis were obviously elevated and decreased gradually in convalescent and recovered period. The difference was significant for each stage as compared with controls. Acute FBA correlated strongly with the course. Both neonatal unconjugated hyperbilirubinemia and BMJ differed significantly from controls in FBA and CG. The results suggested that serum FBA and CG were helpful in Judging the course and state of neonatal hepatitis, and cholestasis might existed in neonatal unconjugated hyperbilirubinemia.展开更多
Lesions of the brainstem have been reported in the clinical scenarios of hypoxic-ischemic encephalopathy(HIE), although the prevalence of these lesions is probably underestimated. Neuropathologic studies have demonstr...Lesions of the brainstem have been reported in the clinical scenarios of hypoxic-ischemic encephalopathy(HIE), although the prevalence of these lesions is probably underestimated. Neuropathologic studies have demonstrated brainstem involvement in severely asphyxiated infants as an indicator of poor outcome. Among survivors to HIE, the most frequent clinical complaints that may be predicted by brainstem lesions include feeding problems, speech, language and communication problems and visual impairments. Clinical series, including vascular and metabolic etiologies, have found selective involvement of the brainstem with the demonstration of symmetric bilateral columnar lesions of the tegmentum. The role of brainstem lesions in HIE is currently a matter of debate, especially when tegmental lesions are present in the absence of supratentorial lesions. Differential diagnosis of tegmental lesions in neonates and infants include congenital metabolic syndromes and drug-related processes. Brainstem injury with the presence of supratentorial lesions is a predictor of poor outcome and high rates of mortality and morbidity. Further investigation will be conducted to identify specific sites of the brainstem that are vulnerable to hypoxic-ischemic and toxic-metabolic insults.展开更多
BACKGROUND:Exhaled nitric oxide(eNO)is one of the airway condensate derived markers,reflecting mainly airway inflammation in asthma and other lung diseases.The changes of eNO levels as pathophysiology of neonatal hypo...BACKGROUND:Exhaled nitric oxide(eNO)is one of the airway condensate derived markers,reflecting mainly airway inflammation in asthma and other lung diseases.The changes of eNO levels as pathophysiology of neonatal hypoxemic respiratory failure(HRF)in early postnatal life have not been thoroughly studied.The present study was to establish a method for measuring eNO concentrations in neonates with or without HRF.METHODS:Twenty-two newborn infants with HRF and 26 non-NRF controls were included within the first 24 hours of postnatal life.Their eNO levels were detected with a rapid-response chemiluminescence analyzer daily during the first week of their postnatal life,and lung mechanics and gas exchange efficiency were monitored at the same time,such as pulse oxygen saturation(SpO2),inspired fraction of oxygen(FiO2)and other parameters.RESULTS:During the first two days of postnatal life,eNO values of HRF neonates were significantly higher than those of the control neonates(day 1,7.9±3.2 vs.5.8±1.8 parts per billion[ppb],P〈0.05;day 2,8.8±3.2 vs.6.0±2.4 ppb,P〈0.05),but there were no significant differences in the following days.With SpOJFiO2 increasing,difference of eNO values between the HRF and non-HRF neonates became narrowed,but there was still a two-fold difference of eNO/[SpO2/(FiO2×100)]on days 5-7.CONCLUSION:We established a method for measuring eNO and found difference in neonates with or without HRF,which diminished with prolonged postnatal days,reflecting pathophysiological characteristics of HRF.展开更多
BACKGROUND Patent ductus arteriosus(PDA)is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights.When PDA persists,interstitial lung water content incr...BACKGROUND Patent ductus arteriosus(PDA)is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights.When PDA persists,interstitial lung water content increases,which could lead to abnormal circulation hemodynamics and pulmonary edema.It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA.AIM To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA.METHODS From January 2018 to March 2020,69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group.At the same time,89 very low-weight preterm neonates without PDA were randomly selected as the control group.All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth.The clinical characteristics and main ultrasonography results were compared between the two groups.Pearson’s analysis was used to analyze the correlation between lung ultrasonography score(LUS)and other related clinical and ultrasonography results in all neonates.In the PDA group,PDA diameters were recorded,and the correlation with LUS and left atrium to aortic(LA/AO)dimension ratio were also analyzed.LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA.When the ratio is≥1.5,it suggests the possibility of hemodynamic changes in persistent PDA.A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa.RESULTS A total of 158 neonates were enrolled in this study,including 69 in the PDA group and 89 in the control group.There were no statistical differences in sex,gestational age,birth weight,ventilator dependence,hospitalization length and left ventricular ejection fraction between the two groups(P>0.05).The LUS and LA/AO ratio in the PDA group were higher than those in the control group(P<0.05),but there was no difference of LUS in neonates with or without use of the ventilator(t=0.58,P=0.16).In all cases,LUS was negatively correlated with gestational age(r=-0.28,P<0.01)and birth weight(r=-0.36,P<0.01),while positively correlated with the LA/AO ratio(r=0.27,P<0.01).In the PDA group,PDA diameter was positively correlated with the LA/AO ratio(r=0.39,P<0.01)and LUS(r=0.31,P<0.01).Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA(area under the curve=0.741;sensitivity=93.75%;specificity=50.94%).CONCLUSION Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.展开更多
The use of caspofungin in neonates is beyond the instructions. Therefore, a retrospective analysis was performed to investigate the hepatic safety of caspofungin during the treatment of fungal diseases in neonates. A ...The use of caspofungin in neonates is beyond the instructions. Therefore, a retrospective analysis was performed to investigate the hepatic safety of caspofungin during the treatment of fungal diseases in neonates. A retrospective analysis was conducted on 23 neonates with Candida infection who were treated or prevented with caspofungin. Among the 23 neonates treated with caspofungin, 13 cases were cured(57%), and 10 cases showed improvements(43%). In addition, there were no adverse reactions associated with drug use, such as gastrointestinal tract, thrombocytopenia, and liver function damage. In summary, caspofungin achieved good results in the treatment or prevention of Candida infection in neonates, and no severe adverse reactions closely related to its use were found. However, the economy and safety of antifungal drugs should be considered in clinical practice for reasonable use.展开更多
BACKGROUND Familial hemophagocytic lymphohistiocytosis type 2(FHL2)is a rare genetic disorder presenting with fever,hepatosplenomegaly,and pancytopenia secondary to perforin-1(PRF1)mutation.FLH2 has been described in ...BACKGROUND Familial hemophagocytic lymphohistiocytosis type 2(FHL2)is a rare genetic disorder presenting with fever,hepatosplenomegaly,and pancytopenia secondary to perforin-1(PRF1)mutation.FLH2 has been described in Chinese but usually presents after 1 year old.We describe a female Chinese neonate with FHL2 secondary to compound heterozygous PRF1 mutation with symptom onset before 1 mo old.We review Chinese FHL2 patients in the literature for comparison.CASE SUMMARY A 15-d-old female neonate was referred to our hospital for persistent fever and thrombocytopenia with diffuse petechiae.She was born to a G5P3 mother at 39 wk and 4 d via cesarean section secondary to breech presentation.No resuscitation was required at birth.She was described to be very sleepy with poor appetite since birth.She developed a fever up to 39.5°C at 7 d of life.Leukocytosis,anemia,and thrombocytopenia were detected at a local medical facility CONCLUSION A literature review identified 75 Chinese FHL2 patients,with only five presenting in the first year of life.Missense and frameshift mutations are the most common PRF1 mutations in Chinese,with 24.8%having c.1349C>T followed by 11.6%having c.65delC.The c.658G>C mutation has only been reported once in the literature and our case suggests it can be pathogenic,at least in the presence of another pathogenic mutation such as c.1066C>T.展开更多
文摘Monkeypox(Mpox),a zoonotic infection caused by the Mpox virus,has reemerged as a global public health concern,with unique implications for neonatal health.Although rare in newborns,cases of neonatal Mpox pose significant diagnostic and therapeutic challenges due to limited clinical data and the vulnerability of this population.This narrative review explores the pathophysiology,clinical presentation,diagnostic barriers,and therapeutic strategies associated with Mpox in neonates.Vertical and perinatal transmission have been identified,with some cases presenting with vesicular rashes,fever,lymphadenopathy,and systemic involvement such as respiratory or neurological complications.Diagnosis often relies on polymerase chain reaction testing,yet resource limitations and symptom overlap with other neonatal infections can hinder accurate identification.Antiviral treatments like tecovirimat and cidofovir are considered in severe cases,but dosing in neonates remains uncertain due to a lack of robust safety data.Supportive care,including hydration,fever management,and prevention of secondary infections,is critical.Breastfeeding decisions require individualized assessment due to the unknown risk of viral transmission through breast milk.Preventive strategies emphasize early isolation,surveillance,and infection control measures in neonatal care settings.The review highlights significant research gaps in understanding neonatal Mpox,especially concerning long-term outcomes and optimal treatment protocols.A coordinated global effort is essential to improve diagnostics,develop safe therapeutic options,and establish evidence-based guidelines tailored to neonates.
文摘BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system.Truncus arteriosus(TA)is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation,leading to complications such as pulmonary hypertension,heart failure,and severe hypoxia.Although rare individually,the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges,with limited documentation in medical literature.CASE SUMMARY We present a 36-week preterm neonate with CS associated with TA type 1,pre-senting with respiratory distress,cyanosis,and altered spinal curvature.This case demonstrates the complexity of managing neonates with multiple congenital de-fects.Here,the patient was managed with oxygen supplementation,heart failure medication,nasogastric feeding,and multidisciplinary care to optimize her for surgical corrections.A coordinated,interdisciplinary approach was employed to optimize outcomes,particularly in a resource-limited setting.Immediate re-spiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient’s quality of life and survival.CONCLUSION Recognizing co-existing congenital anomalies and their embryological interre-lation is critical in holistic patient care,particularly during neonatal and infancy.
文摘Objective:To analyze the value of bedside cranial ultrasonography in the early diagnosis of neonatal brain tissue injury in intrauterine distress.Methods:128 neonates with suspected intrauterine distress admitted to the Yichang Central People’s Hospital from January 2023 to December 2024 were selected as study subjects based on the inclusion and exclusion criteria,and all subjects underwent bedside craniocerebral ultrasonography and MRI,and the results of MRI were used as the gold standard to divide the infants into the brain-injury group(n=31)and the no-brain-injury The children were divided into brain injury group(n=31)and no brain injury group(n=97),and the value of bedside cranial ultrasonography for early diagnosis of brain tissue injury in neonates with intrauterine distress was analyzed.Results:(1)Among the 128 cases of intrauterine distress neonates,31 cases were examined for abnormal signs,including 22 cases(70.97%)examined by bedside craniocerebral ultrasonography and 28 cases(90.32%)examined by MRI.(2)Bedside cranial ultrasound detected hypoxic-ischemic encephalopathy in 6 cases,accounting for 4.69%,ventricular widening in 2 cases,accounting for 1.56%,intracranial hemorrhage in 8 cases,accounting for 6.25%,periventricular softening of white matter in 5 cases,accounting for 3.91%,and cerebral edema in 1 case,accounting for 0.78%,while MRI detected hypoxic-ischemic encephalopathy in 9 cases,accounting for 7.03%.3 cases of ventricular widening,accounting for 2.34%,4 cases of intracranial hemorrhage,accounting for 3.13%,9 cases of periventricular-intraventricular white matter softening,accounting for 7.03%,and 3 cases of cerebral edema,accounting for 2.34%were examined.Among them,the detection rate of periventricular-intraventricular hemorrhage by bedside cranial ultrasound was significantly higher than that of MRI(P<0.05).Conclusion:The diagnostic value of bedside cranial ultrasound in periventricular-intraventricular hemorrhage is high,but the diagnostic value is not as good as that of MRI in other brain tissue injuries,and clinically appropriate examination protocols can be selected according to the specific types of craniocerebral injuries.
文摘BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.
文摘BACKGROUND Phocomelia is a rare congenital disorder characterized by the absence or under-development of the proximal limbs.Phocomelia can occur as a syndrome or a limb-specific deformity.While historically linked to thalidomide,non-thalido-mide causes include genetic mutations,vascular disruptions,and teratogenic exposures.This case highlights the diagnostic and therapeutic challenges in a neonate with bilateral phocomelia,low birth weight,asphyxia and jaundice.CASE SUMMARY We report a 2-week-old term neonate with bilateral phocomelia,micrognathia,jaundice,and low birth weight.The pregnancy was unremarkable,with no tha-lidomide exposure.The mother had a history of early pregnancy losses.Clinical evaluation revealed absent humeri and radii bilaterally,with hands attached proximally to the trunk.Genetic testing was not performed,limiting the identi-fication of underlying etiology.The patient was managed with supportive care,parental counseling,and planning for long-term rehabilitation.This case un-derscores the importance of multidisciplinary care in managing congenital ano-malies.Genetic evaluation is crucial in unexplained congenital anomalies.Routine detailed ultrasounds in high-risk pregnancies aid in early diagnosis and parental preparedness.CONCLUSION Bilateral phocomelia presents significant functional challenges.Comprehensive diagnostic workups and early rehabilitation strategies are essential for optimizing patient outcomes.
文摘BACKGROUND Congenital intestinal atresia(CIA)is a common intestinal malformation in the neonatal period,and surgery is currently the main treatment method.The choice of postoperative feeding is crucial for the recovery of gastrointestinal function in children.AIM To compare and analyze the effects of different postoperative feeding methods on gastrointestinal function reconstruction in newborns with CIA.METHODS Twenty-six children diagnosed with neonatal CIA,treated with minimally invasive surgery at Shijiazhuang Maternal and Child Health Hospital between January 2021 and May 2024,were selected for this single-center prospective randomized controlled study.They were divided into two groups using envelope randomization:Enteral nutrition(EN)group(n=13)and parenteral nutrition(PN)group(n=13).Baseline and clinical characteristics were collected,and recovery time of bowel sounds and time to first defecation were used as evaluation indices for gastrointestinal functional reconstruction.Differences between the groups were analyzed using t-test,χ2 test,and Fisher’s exact test.Spearman’s correlation tests and linear regression models were employed to analyze factors influencing time to first defecation.RESULTS The time to bowel sound recovery(51.54 vs 65.85,P=0.013)and first defecation(58.15 vs 76.62,P<0.001)was shorter in the EN group compared to the PN group.Clinical improvements in the EN group,including discharge weight(P=0.044),hospital stay(P=0.027),white blood cell count(P=0.023),albumin content(P=0.013),and direct bilirubin content(P=0.018),were also better than those in the PN group.No substantial differences in postoperative complications were found between the groups.Correlation analysis indicated that abdominal infection and operation time may relate to time to first defecation.Linear regression analysis demonstrated a considerable association between EN feeding and shorter time to first defecation.Abdominal infection and an operation time>2 hours may be risk factors for prolonged time to first defecation.CONCLUSION EN substantially promotes the recovery of gastrointestinal function after CIA in neonates and can improve clinical outcomes in children.Future research should explore optimal EN practices to enhance clinical application and child health.
文摘BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complications such as myocarditis,which may present with life-threatening symptoms if not promptly recognized.CASE SUMMARY We describe the case of a 26-day-old male neonate who presented with respiratory distress,poor feeding,and irritability.Initial evaluation revealed an RSV infection confirmed via nasopharyngeal swab.As the clinical course progressed,the infant developed cardiac arrhythmias,elevated cardiac enzymes,and echocardiographic findings consistent with myocarditis.Management included mechanical ventilation,corticosteroid therapy,L-carnitine,and vitamin D supplementation.The patient responded well to treatment and was successfully extubated and discharged in stable condition after nine days of hospitalization.CONCLUSION This case highlights the importance of early recognition and multidisciplinary management of RSV-associated myocarditis in neonates.
文摘Objective:To explore the construction and application value of a home skin care guidance program for neonates.Methods:From February 2024 to February 2025,60 neonates were selected as samples and randomly grouped by drawing.Group A received the constructed home skin care program for neonates,while Group B received routine care.The mastery of skin care knowledge by parents,emotional scores of mothers,and adverse reaction rates of neonates were compared.Results:The mastery of skin care knowledge by parents in Group A was higher than that in Group B,P<0.05.The anxiety(SAS)and depression(SDS)scores of mothers in Group A were lower than those in Group B,P<0.05.The adverse reaction rate of neonates in Group A was lower than that in Group B,P<0.05.Conclusion:The construction of a home skin care program for neonates can reduce adverse reactions of mothers,improve parents’mastery of neonatal skin care knowledge,and is beneficial for reducing adverse events such as neonatal eczema,diaper dermatitis,and infection.
基金the Science and Technology Planning Project of Beijing, China, No. Z080507030808018
文摘BACKGROUND： Spontaneous otoacoustic emissions （SOAEs） are regarded as a valuable audio- metric parameter that objectively reflects the function of outer hair cells （OHCs）. Many studies have reported that the incidence of SOAEs in adults is less than 50%. Therefore, measurement of SOAEs may be of little value to clinical examinations. However, the incidence of SOAEs in infants and neonates is higher than in adults. OBJECTIVE： To analyze the basic characteristics of SOAEs in 2–4 day old neonates, and to demonstrate the difference in OHC function between sexes and ears. DESIGN, TIME AND SETTING： Neurophysiological contrast study, performed in the Department of Neonates, Beijing Chaoyang Hospital, Capital Medical University, between December 2007 and August 2008. PARTICIPANTS： A total of 112 newborns （224 ears） consisting of 59 females and 53 males were included in this study. METHODS： The probe was adapted and embedded in the neonate external auditory canal with a foam rubber earplug after checking and clearing up the outer ear canal. The presence of SOAEs was determined when the signal amplitude had a clear peak exceeding –30 dB, or was 3 dB above the noise floor. MAIN OUTCOME MEASURES： The incidence of SOAEs, the number of SOAE signal peaks, and the maximal tension of SOAEs. RESULTS： The incidence in females （79.7%） was higher than males （76.4%） （P 〉 0.05）, and the incidence in right ears （86.6%） was higher than in left ears （69.6%） （P 〈 0.05）. There were no significant difference in the number of SOAE peaks between females and males （4.49 vs. 4.28）, or between right ears and left ears （4.62 vs. 4.12） （P 〉 0.05）. The mean maximum SOAE level per ear in females （–3.29 ± 9.28） dB sound pressure level （SPL） was slightly higher than that in males （–3.91 ± 9.14） dB SPL （P 〉 0.05）. Also, the mean maximum SOAE level in right ears （–2.03 ± 9.11） dB SPL was higher than in left ears （–5.50 ± 9.65） dB SPL （P 〈 0.05）. The maximum SOAE level showed a positive correlation with maximum SOAE number in emitting ears （r = 0.55, P 〈 0.01）. CONCLUSION： The incidence of SOAEs in neonates is high （78.1%） within 4 days of birth. The in-cidence of SOAEs and the maximum SOAE level exhibited a significant difference between right and left ears, but the difference between sexes was insignificant. Both the strongest SOAE signal peak and number of SOAEs per ear are representative of the function OHCs.
基金supported by the National Natural Science Foundation of China(No.81370099)
文摘This study attempts to discuss the correlation between UGT1A1＊28 as uridine diphosphate glucuronosyltransferase gene promoter and coding region Gly71 Arg gene polymorphism with neonatal hyperbilirubinemia of neonates in Wuhan. A total of 168 neonates were divided into the hyperbilirubinemia group（case group, n=108） and healthy neonates group（control group, n=60）. Their DNA was obtained through blood extraction. The gene exon mutation of UGT1A1 was detected by Sanger sequencing, which revealed the relationship between UGT1A1＊28 and Gly71 Arg polymorphism with neonatal hyperbilirubinemia of neonates. The results showed that：（1） The frequency of UGT1A1＊28 allele mutation in the case group and the control group was 9.3% and 10% respectively, with the difference being not significant between the two groups（P〉0.05）.（2） The frequency of Gly71 Arg allele mutation in the case group and the control group was 35.1% and 21.7% respectively, with the difference being significant between the two groups（P〈0.01）.（3） The serum bilirubin level of Gly71 Arg mutant homozygous and heterozygous subgroups（n=66） in the case group was 302.7±31.4 μmol/L, which was significantly higher than 267.3±28.5 μmol/L of the wild subgroup（n=42）（P〈0.01）. It was suggested that the occurrence of neonatal hyperbilirubinemia of neonates in Wuhan was not associated with UGT1A1＊28 gene polymorphism, but closely with the Gly71 Arg gene polymorphism. Meanwhile, the Arg allele mutation was related to the degree of jaundice.
基金This work was supported by grants from Guangdong Nurse Association[gdshsxh2021a058]Department of Science and Technology of Guangdong Province[2014A020212396].
文摘Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled trial was conducted.Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB(experimental group)or 0 dB(control group)2 min before radial artery blood sampling and continued until 5 min after needle withdrawal.Pain-related cortical response was measured by regional cerebral oxygen saturation(rScO_(2))monitored with near-infrared spectroscopy,and facial expressions and physiological parameters were recorded by two video cameras.Two assessors scored the Premature Infant Pain Profile-Revised(PIPP-R)independently when viewing the videos.Primary outcomes were pain score and rScO_(2)during arterial puncture and 5 min after needle withdrawal.Secondary outcomes were pulse oximetric oxygen saturation(SpO_(2))and heart rate(HR)during arterial puncture,and duration of painful expressions.The study was registered at the Chinese Clinical Trial Registry(ChiCTR2200055571).Results Sixty neonates(experimental group,n=29;control group,n=31)were included in the final analysis.The maximum PIPP-R score in the experimental and control groups was 12.00(9.50,13.00),12.50(10.50,13.75),respectively(median difference−0.5,95%CI−2.0 to 0.5),and minimum rScO_(2)was(61.22±3.07)%,(61.32±2.79)%,respectively(mean difference−0.325,95%CI−1.382 to 0.732),without significant differences.During arterial puncture,the mean rScO_(2),HR,and SpO_(2)did not differ between groups.After needle withdrawal,the trends for rScO_(2),PIPP-R score,and facial expression returning to baseline were different between the two groups without statistical significance.Conclusion The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score,behavioral and physiological parameters in neonates with procedural pain.
基金supported by a grant from the Health and Family Planning Commission of Hebei Province of China,No.20150033a grant from the Science and Technology Research and Development Project of Handan City of Hebei Province of China,No.152810879-6
文摘Although hypothermia therapy is effective to treat neonatal hypoxic-ischemic encephalopathy,many neonatal patients die or suffer from severe neurological dysfunction.Erythropoietin is considered one of the most promising neuroprotective agents.We hypothesized that erythropoietin combined with hypothermia will improve efficacy of neonatal hypoxic-ischemic encephalopathy treatment.In this study,41 neonates with moderate/severe hypoxic-ischemic encephalopathy were randomly divided into a control group（hypothermia alone for 72 hours,n = 20） and erythropoietin group（hypothermia ＋ erythropoietin 200 IU/kg for 10 days,n = 21）.Our results show that compared with the control group,serum tau protein levels were lower and neonatal behavioral neurological assessment scores higher in the erythropoietin group at 8 and 12 days.However,neurodevelopmental outcome was similar between the two groups at 9 months of age.These findings suggest that erythropoietin combined with hypothermia reduces serum tau protein levels and improves neonatal behavioral neurology outcome but does not affect long-term neurodevelopmental outcome.
基金supported by the Jiangsu Maternal and Child Health Research Project of China,No.F201612(to HXL)Changzhou Science and Technology Support Plan of China,No.CE20165027(to HXL)+1 种基金Changzhou City Planning Commission Major Science and Technology Projects of China,No.ZD201515(to HXL)Changzhou High Level Training Fund for Health Professionals of China,No.2016CZBJ028(to HXL)
文摘Resting-state functional magnetic resonance imaging has revealed disrupted brain network connectivity in adults and teenagers with cerebral palsy. However, the specific brain networks implicated in neonatal cases remain poorly understood. In this study, we recruited 14 termborn infants with mild hypoxic ischemic encephalopathy and 14 term-born infants with severe hypoxic ischemic encephalopathy from Changzhou Children's Hospital, China. Resting-state functional magnetic resonance imaging data showed efficient small-world organization in whole-brain networks in both the mild and severe hypoxic ischemic encephalopathy groups. However, compared with the mild hypoxic ischemic encephalopathy group, the severe hypoxic ischemic encephalopathy group exhibited decreased local efficiency and a low clustering coefficient. The distribution of hub regions in the functional networks had fewer nodes in the severe hypoxic ischemic encephalopathy group compared with the mild hypoxic ischemic encephalopathy group. Moreover, nodal efficiency was reduced in the left rolandic operculum, left supramarginal gyrus, bilateral superior temporal gyrus, and right middle temporal gyrus. These results suggest that the topological structure of the resting state functional network in children with severe hypoxic ischemic encephalopathy is clearly distinct from that in children with mild hypoxic ischemic encephalopathy, and may be associated with impaired language, motion, and cognition. These data indicate that it may be possible to make early predictions regarding brain development in children with severe hypoxic ischemic encephalopathy, enabling early interventions targeting brain function. This study was approved by the Regional Ethics Review Boards of the Changzhou Children's Hospital(approval No. 2013-001) on January 31, 2013. Informed consent was obtained from the family members of the children. The trial was registered with the Chinese Clinical Trial Registry(registration number: ChiCTR1800016409) and the protocol version is 1.0.
文摘BACKGROUND Peripherally inserted central catheters(PICCs)have been increasingly applied worldwide owing to many advantages.Even with these advantages,the related complications should not be ignored,especially in neonates.The available evidence about PICC-related thrombosis was manifold,but the cardiac tamponade,an emergency and life-threatening complication,has been rarely reported.Early recognized cardiac tamponade by ultrasound may reduce mortality.CASE SUMMARY A neonate weighting 2.8 kg was born at 40 wk of gestation.He was admitted to the Surgery Intensive Care Unit due to suspected congenital megacolon.A PICC line was inserted via the left antecubital fossa for the administration of total parenteral nutrition.Three days later,the patient was still on total parenteral nutrition.Cardiac tamponade caused by PICC was found on ultrasound.The patient recovered spontaneously after an emergency pericardiocentesis.CONCLUSION Proficiency in the use of point-of-care ultrasound may save the life of patients,since it enables clinicians to treat patients faster,more accurately,and in a noninvasive way at the point of care.
文摘Enzyme-linked colorimetric analysis and adioimmunoassay were employed to detect serum fasting total bile acids(FBA) and choloyglycin (CG) respectively in cases of 32 neonatal hepatitis , 33 cases of neonatal unconjugated hyperbilirubinemia and 34 cases of breast milk jaundice(BMJ). FBA and CG in acute period of neonatal hepatitis were obviously elevated and decreased gradually in convalescent and recovered period. The difference was significant for each stage as compared with controls. Acute FBA correlated strongly with the course. Both neonatal unconjugated hyperbilirubinemia and BMJ differed significantly from controls in FBA and CG. The results suggested that serum FBA and CG were helpful in Judging the course and state of neonatal hepatitis, and cholestasis might existed in neonatal unconjugated hyperbilirubinemia.
文摘Lesions of the brainstem have been reported in the clinical scenarios of hypoxic-ischemic encephalopathy(HIE), although the prevalence of these lesions is probably underestimated. Neuropathologic studies have demonstrated brainstem involvement in severely asphyxiated infants as an indicator of poor outcome. Among survivors to HIE, the most frequent clinical complaints that may be predicted by brainstem lesions include feeding problems, speech, language and communication problems and visual impairments. Clinical series, including vascular and metabolic etiologies, have found selective involvement of the brainstem with the demonstration of symmetric bilateral columnar lesions of the tegmentum. The role of brainstem lesions in HIE is currently a matter of debate, especially when tegmental lesions are present in the absence of supratentorial lesions. Differential diagnosis of tegmental lesions in neonates and infants include congenital metabolic syndromes and drug-related processes. Brainstem injury with the presence of supratentorial lesions is a predictor of poor outcome and high rates of mortality and morbidity. Further investigation will be conducted to identify specific sites of the brainstem that are vulnerable to hypoxic-ischemic and toxic-metabolic insults.
基金This work was supported by grants from the National Natural Science Foundation of China(30872801)the Excellence in Doctorate Research Program by Ministry of Education(20090071110061)Shanghai Rising-Star Program(09QA1400700).
文摘BACKGROUND:Exhaled nitric oxide(eNO)is one of the airway condensate derived markers,reflecting mainly airway inflammation in asthma and other lung diseases.The changes of eNO levels as pathophysiology of neonatal hypoxemic respiratory failure(HRF)in early postnatal life have not been thoroughly studied.The present study was to establish a method for measuring eNO concentrations in neonates with or without HRF.METHODS:Twenty-two newborn infants with HRF and 26 non-NRF controls were included within the first 24 hours of postnatal life.Their eNO levels were detected with a rapid-response chemiluminescence analyzer daily during the first week of their postnatal life,and lung mechanics and gas exchange efficiency were monitored at the same time,such as pulse oxygen saturation(SpO2),inspired fraction of oxygen(FiO2)and other parameters.RESULTS:During the first two days of postnatal life,eNO values of HRF neonates were significantly higher than those of the control neonates(day 1,7.9±3.2 vs.5.8±1.8 parts per billion[ppb],P〈0.05;day 2,8.8±3.2 vs.6.0±2.4 ppb,P〈0.05),but there were no significant differences in the following days.With SpOJFiO2 increasing,difference of eNO values between the HRF and non-HRF neonates became narrowed,but there was still a two-fold difference of eNO/[SpO2/(FiO2×100)]on days 5-7.CONCLUSION:We established a method for measuring eNO and found difference in neonates with or without HRF,which diminished with prolonged postnatal days,reflecting pathophysiological characteristics of HRF.
基金Zhejiang Medical and Health Science and Technology Project,No.2020ky690Zhejiang Natural Science Public Welfare Fund,No.LGF20H020004.
文摘BACKGROUND Patent ductus arteriosus(PDA)is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights.When PDA persists,interstitial lung water content increases,which could lead to abnormal circulation hemodynamics and pulmonary edema.It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA.AIM To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA.METHODS From January 2018 to March 2020,69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group.At the same time,89 very low-weight preterm neonates without PDA were randomly selected as the control group.All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth.The clinical characteristics and main ultrasonography results were compared between the two groups.Pearson’s analysis was used to analyze the correlation between lung ultrasonography score(LUS)and other related clinical and ultrasonography results in all neonates.In the PDA group,PDA diameters were recorded,and the correlation with LUS and left atrium to aortic(LA/AO)dimension ratio were also analyzed.LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA.When the ratio is≥1.5,it suggests the possibility of hemodynamic changes in persistent PDA.A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa.RESULTS A total of 158 neonates were enrolled in this study,including 69 in the PDA group and 89 in the control group.There were no statistical differences in sex,gestational age,birth weight,ventilator dependence,hospitalization length and left ventricular ejection fraction between the two groups(P>0.05).The LUS and LA/AO ratio in the PDA group were higher than those in the control group(P<0.05),but there was no difference of LUS in neonates with or without use of the ventilator(t=0.58,P=0.16).In all cases,LUS was negatively correlated with gestational age(r=-0.28,P<0.01)and birth weight(r=-0.36,P<0.01),while positively correlated with the LA/AO ratio(r=0.27,P<0.01).In the PDA group,PDA diameter was positively correlated with the LA/AO ratio(r=0.39,P<0.01)and LUS(r=0.31,P<0.01).Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA(area under the curve=0.741;sensitivity=93.75%;specificity=50.94%).CONCLUSION Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.
文摘The use of caspofungin in neonates is beyond the instructions. Therefore, a retrospective analysis was performed to investigate the hepatic safety of caspofungin during the treatment of fungal diseases in neonates. A retrospective analysis was conducted on 23 neonates with Candida infection who were treated or prevented with caspofungin. Among the 23 neonates treated with caspofungin, 13 cases were cured(57%), and 10 cases showed improvements(43%). In addition, there were no adverse reactions associated with drug use, such as gastrointestinal tract, thrombocytopenia, and liver function damage. In summary, caspofungin achieved good results in the treatment or prevention of Candida infection in neonates, and no severe adverse reactions closely related to its use were found. However, the economy and safety of antifungal drugs should be considered in clinical practice for reasonable use.
文摘BACKGROUND Familial hemophagocytic lymphohistiocytosis type 2(FHL2)is a rare genetic disorder presenting with fever,hepatosplenomegaly,and pancytopenia secondary to perforin-1(PRF1)mutation.FLH2 has been described in Chinese but usually presents after 1 year old.We describe a female Chinese neonate with FHL2 secondary to compound heterozygous PRF1 mutation with symptom onset before 1 mo old.We review Chinese FHL2 patients in the literature for comparison.CASE SUMMARY A 15-d-old female neonate was referred to our hospital for persistent fever and thrombocytopenia with diffuse petechiae.She was born to a G5P3 mother at 39 wk and 4 d via cesarean section secondary to breech presentation.No resuscitation was required at birth.She was described to be very sleepy with poor appetite since birth.She developed a fever up to 39.5°C at 7 d of life.Leukocytosis,anemia,and thrombocytopenia were detected at a local medical facility CONCLUSION A literature review identified 75 Chinese FHL2 patients,with only five presenting in the first year of life.Missense and frameshift mutations are the most common PRF1 mutations in Chinese,with 24.8%having c.1349C>T followed by 11.6%having c.65delC.The c.658G>C mutation has only been reported once in the literature and our case suggests it can be pathogenic,at least in the presence of another pathogenic mutation such as c.1066C>T.
