Maternal high-fat diet (HFD) increases the risk of metabolic disorders in offspring. Placental inflammation acts as a critical mediator with poorly addressed etiology. Recently HFD-induced gut dysbiosis is demonstrated to be a key driver of systemic inflammation. Whether inflammatory signals triggered by HFD-induced gut dysbiosis are transmitted to the placenta via the maternal-fetal axis warrant further investigation. This study aims to elucidate the mechanistic connection between maternal gut dysbiosis and placental inflammation, thereby offering insights into microbiota-mediated developmental origins of metabolic diseases in offspring. Female C57BL/6 mice were exposed to high fat diet (HFD) for 5 weeks prior to mating with male mice. Gut microbiota was profiled by using 16 S rRNA sequencing and fecal short-chain fatty acids (SCFAs) were quantified by GC-MS from HFD pregnant mice at gestational day 18.5 (G18.5). Mice were sacrificed at G18.5, and placenta histopathological analysis as well as inflammatory markers and lipopolysaccharide (LPS) level were analyzed. Anti-inflammatory effects of butyrate were evaluated in vitro by using HTR-8/Svneo cells and in vivo through gestational supplementation (0.3 mg/g body weight) in HFD-fed dams. Maternal HFD exposure induced significant placental inflammation as well as hepatic steatosis in the offspring. HFD-fed dams exhibited distinct gut dysbiosis with reduced fecal and serum SCFAs, which was accompanied by elevated placental LPS levels and exacerbated inflammatory responses. Butyrate treatment suppressed the expression of inflammatory cytokines in vitro through down-regulating the phosphorylation of NF-κB, ERK1/2 signaling pathways via G-protein-coupled receptor 41 (GPR41). Furthermore, gestational butyrate intervention effectively alleviated placental inflammation and mitigated fetal hepatic lipid deposition in HFD-exposed offspring. Placental inflammation caused by maternal HFD is closely associated with gut microbiota dysbiosis. Butyrate supplementation during gestation reduces placental inflammation and ameliorated offspring hepatic steatosis, highlighting the therapeutic potential of butyrate for mitigating the adverse metabolic programming effects upon maternal HFD exposure.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by flora disequilibrium and mucosal immunity disorder. Here, we report that salidroside effectively restricts experimental colitis from two aspects of intestinal macrophage pyroptosis and dysbacteriosis-derived colonic Th17/Treg imbalance. In innate immunity, the upregulated TREM1 and pyroptosis-related proteins in inflamed colons were inhibited by salidroside administration and further experiments in vitro showed that salidroside suppressed LPS/ATP-induced bone marrow-derived macrophages (BMDMs) pyroptosis evident by the decline of LDH and IL-1β release as well as the protein level of NLRP3, caspase-1, and GSDMD p30. Moreover, the TREM1 inhibitor weakened the effect of salidroside on BMDMs pyroptosis, whereas salidroside still could downregulate TREM1 when NLRP3 was inhibited. In adaptive immunity, salidroside improved the gut microflora diversity and Th17/Treg ratio in DSS-induced mice, especially promoting the abundance of Firmicutes. Clearance of the gut flora blocked the benefit of salidroside on colonic inflammation and Th17/Treg adaptive immunity, but transplanting salidroside-treated foecal bacterium into flora-depleted wild mice reproduced the resistance of salidroside to gut inflammation. Taken together, our data demonstrated that salidroside protected experimental colitis via skewing macrophage pyroptosis and Th17/Treg balance, indicating its potential effect on UC and other immune disorders.

To assess the amino acid and fatty acid metabolite patterns between infants with and without bronchopulmonary dysplasia in different nutritional stages after birth and identify metabolic indicators of bronchopulmonary dysplasia. This was an observational cohort of preterm infants born at a gestational age ≤32 + 6 weeks and with a body weight ≤2000 g. Amino acid and carnitine profiles were measured in dried blood spots (DBSs) during the early nutrition transitional phase using tandem mass spectrometry. Bronchopulmonary dysplasia was defined as oxygen dependence at 36 weeks of postmenstrual age or 28 days after birth. Metabolomic analysis was employed to define metabolites with significant differences, map significant metabolites into pathways, and identify metabolic indicators of bronchopulmonary dysplasia. We evaluated 45 neonates with and 40 without bronchopulmonary dysplasia. Four amino acids and three carnitines showed differences between the groups. Three carnitines (C0, C2, and C6:1) were high in the bronchopulmonary dysplasia group mostly; conversely, all four amino acids (threonine, arginine, methionine, and glutamine (Gln)) were low in the bronchopulmonary dysplasia group. Pathway analysis of these metabolites revealed two pathways with significant changes (p < 0.05). ROC analysis showed Gln/C6:1 at total parenteral nutrition phase had both 80% sensitivity and specificity for predicting the development of bronchopulmonary dysplasia, with an area under the curve of 0.81 (95% confidence interval 0.71–0.89). Amino acid and fatty acid metabolite profiles changed in infants with bronchopulmonary dysplasia after birth during the nutrition transitional period, suggesting that metabolic dysregulation may participate in the development of bronchopulmonary dysplasia. Our findings demonstrate that metabolic indicators are promising for forecasting the occurrence of bronchopulmonary dysplasia among preterm neonates.

BACKGROUND AND OBJECTIVES:Neonatal nutrition is critical for the growth and development of preterm infants. Dynamic changes in the amino acid profiles in preterm infants of different gestational ages and in different nutritional periods were investigated.METHODS AND STUDY DESIGN:Premature infants who received parenteral nutrition support after birth were enrolled and divided into four groups based on their gestational ages. Blood samples were collected as a dried blood spot before nutritional support, and in the total parenteral nutrition, partial parenteral nutrition, and total enteral nutrition periods. Amino acid concentrations were detected in the samples by liquid chromatography tandem mass spectrometry and compared between the different nutritional periods and gestational ages.RESULTS:Samples from 124 premature infants were statistically analyzed. Concentrations of all amino acids, except glutamine, were statistically different at distinct nutritional periods. Threonine and aspartic acid concentrations gradually increased, while valine, methionine, phenylalanine, and glycine concentrations gradually decreased with the transition from TPN to TEN. At different gestational ages, significant differences were observed in the concentrations of seven amino acids only in the PPN period but not in the others.CONCLUSIONS:The concentrations of amino acids in preterm infants vary with nutritional period.

Objective To study the dynamic changes of blood carnitine and acylcarnitine levels in preterm infants during parenteral and enteral nutritional support,and the relationship between carnitine status and nutritional patterns,gestational age (GA) and weight gain.Method From January 2017 to December 2017,preterm infants admitted to the neonatal intensive care unit (NICU) within 24 hours after birth and received parenteral nutrition support were enrolled.They were assigned into 4 groups according to their GA:ultra-premature infants (＜ 28 weeks),very premature infants (28 ～ 31 weeks),mid premature infants (32 ～ 33 weeks) and late premature infants (34 ～ 36 weeks).They were assigned into 2 groups according to their average daily weight gain:＜ 15 g/(kg · d) group and ≥15 g/(kg · d) group.Blood samples were collected and examined as dried-blood spot specimens on filter paper for four times:after born,given total parenteral nutrition,given enteral combined parenteral nutrition,and given total parenteral nutrition.The concentrations of free carnitine and acylcarnitine were detected using liquid chromatographytandem mass spectrometry (LC-MS/MS).SPSS 21.0 statistical software was used for statistical analysis.Result A total of 124 preterm infants and 410 samples were collected.As the infants experienced gradual transition from parenteral nutrition to enteral nutrition,the free carnitine and most acylcarnitines levels were decreasing (C3,C4,C10DC,C12,C12∶1,C12DC,C14,C16,C16∶ 1,C16-OH and C18,P＜0.05).Preterm infants with small GA showed higher levels of C4-OH (P =0.001) and C5 (P =0.001).Preterm infants with lower velocity of weight gain showed lower concentration of C5-OH (P =0.006) in the early postnatal period.Conclusion Free carnitine and acylcarnitine in preterm infants during the early postnatal period are decreasing with the transition from parenteral nutrition to enteral nutrition,indicating that the exogenous nutrition is relatively insufficient.C4-OH and C5 levels are negatively correlated with GA.In addition,lower level of C5-OH may indicate slow weight gain during the early postnatal period.

Background: Amino acid (AA) metabolic patterns have emerged as an analytical technique to characterize biomarkers compromising normal growth and elucidate underlying nutritional exposure. This study aimed to identify AA metabolites most likely associated with poor growth and examine the association between AA metabolites and nutrition regimens in preterm infants during transition from parenteral nutrition (PN) to enteral nutrition (EN), using gas chromatography-mass spectrometry (GC-MS). Methods: This observational cohort study was conducted in infants born at <32 weeks' gestation with birth weight of <1,500 g. The outcome of extrauterine growth retardation (EUGR) based on whether the weight was <10th percentile for post-menstrual age, was evaluated when full EN reached. Samples were collected at four sampling points according to nutritional status. AA profiles in dried sampling point spots (DBS) were quantified using GC-MS; and were compared simultaneously. The correlation of AA concentration with growth and nutritional parameters was examined using multivariate analysis. Results: We identified 40 eligible infants: 20 in the EUGR group and 20 in the non-EUGR group. AA deficiency progressively emerged during the transition. Lower concentrations of four AAs, including citrulline (Cit), were associated with increased risk of EUGR when adjusted for gestational age, birth weight z-score, age when trophic EN was started, as well as average energy and protein intakes in synchronous nutritional period. Moreover, a lower Cit concentration was positively correlated with the compromised protein and energy deficits in EN during early transition. Conclusion: A low Cit concentration during transition from PN to full EN should be noticed by the clinician to more closely examine nutrition practices to prevent EUGR.

Objective:To assess the value of acoustic radiation force impulse (ARFI) elastography in the diagnosis of children with biliary atresia.Methods:A prospective survey of infants with hepatitis syndrome and hyperbi-lirubinemia in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to December 2018 was performed.The children with hepatitis syndrome were divided into the biliary atresia group( n=45) and non- biliary atresia group( n=30). Thirty children with hyperbilirubinemia were selected as the control group.Shear wave speed (SWS) of all infants was collected by ARFI ultrasound and compared among 3 groups.Receiver ope-rating characteristic curve(ROC curve) was used to analyze the optimal threshold value for SWS in the diagnosis of biliary atresia. Results:The mean SWS values in the biliary atresia group, non-biliary atresia group and the control group were (1.79±0.29) m/s, (1.26±0.12) m/s and (1.08±0.06) m/s, respectively.Compared with the control group, the mean SWS values in the biliary atresia group and non-biliary atresia group were significantly higher ( t=165.43, 15.75, all P<0.05). The mean SWS value in the non-biliary atresia group was significantly lower than that in the biliary atresia group ( t=90.27, P<0.05). With the non-biliary atresia group as reference, the area under the ROC curve of SWS for diagnosis of biliary atresia was 0.98(95% CI: 0.95-1.00), the optimal threshold was 1.45 m/s, and the sensitivity and specificity were 88.9% and 96.7%, respectively. Conclusions:Rapid non-invasive ARFI elastography is effective in the diagnosis of biliary atresia, and thus has important value for early diagnosis and treatment in clinical practice.

Objective:To study the clinical features and molecular diagnosis of neonatal seizures of unknown causes.Method:Clinical data and test results of newborns who were admitted to the Neonatal Department of Xinhua Hospital from January 2016 to December 2018 and diagnosed with neonatal seizures of unknown causes and received next-generation sequencing were retrospectively collected. The clinical outcomes of these infants were also followed up.Result:A total of 33 Chinese neonatal patients who met the criteria were included in the study, including 18 males and 15 females. Seizures were the onset symptoms of all neonatal patients, of which 6 cases (18.2%) without with no other neurological abnormalities or accompanied symptoms. Among the rest of 27 cases (81.8%), 18 infants (54.5%) had other neurological manifestations, 13 cases (39.4%) had abnormal respiratory system manifestations, 12 cases (36.4%) had metabolic and internal environment disturbance, 6 case (18.2%) had feeding difficulties, 6 cases (18.2%) had multiple malformations, 2 cases (6.1%) had abnormal cardiovascular system manifestations, and 2 cases (6.1%) had abnormal hematological system manifestations. According to the clinical characteristics of the infants, 26 patients underwent clinical exome sequencing (CES) and the other 7 underwent whole exome sequencing (WES). The results of 13 infants (13/33, 39.4%) turned out to be positive. Among the patients with positive results, CES provided higher molecular yields for 12 of 26 patients (46.2%) while WES did those for 1 of 7 (14.3%). The diagnoses of patients with positive results included inborn error of metabolism in 5 cases and primary epilepsy in 4 cases. A total of 11 pathogenic genes and a large fragment deletion at the chromosome level were detected, 9 of which were previously unreported.Conclusion:Neonatal seizures of unknown causes has no specific clinical manifestation, majority of the patients are accompanied with other abnormalities, and 39.4% of the patients are diagnosed as genetic diseases by next-generation sequencing. The results suggest that next-generation sequencing is of great value to children with unexplained convulsions, so as to assist in early diagnosis.

目的 比较早产儿与足月儿、小于胎龄儿与适于胎龄儿的血氨基酸谱差异,了解营养阶段和氨基酸或蛋白质摄入量与血氨基酸水平的联系,从代谢的角度为新生儿营养管理提供依据.方法 回顾性调查2012年1月-2016年12月在该院住院的新生儿350例.①根据胎龄分为早产儿组和足月儿组,采用独立样本t检验比较组间血氨基酸谱的差异;②根据出生体质量与胎龄的关系分为小于胎龄儿组和适于胎龄儿组,采用独立样本t检验比较组间血氨基酸水平的差异;③根据采样前营养支持情况分为营养支持前、完全肠外营养(TPN)、部分肠外营养(PPN)和完全肠内营养(TEN)组,通过单因素方差分析和协方差分析比较组间血氨基酸水平的差异;④采用偏相关分析探究氨基酸或蛋白质摄入量与血氨基酸水平的联系.结果 ①早产儿组的血甲硫氨酸、苯丙氨酸、酪氨酸、亮氨酸、精氨酸、甘氨酸和苏氨酸水平均显著高于足月儿,但相同营养阶段的早产儿与足月儿仅个别氨基酸水平在特定的营养阶段差异显著;②小于胎龄儿组的血丙氨酸和酪氨酸水平显著低于适于胎龄儿;③不同营养阶段组间多数血氨基酸水平具有显著差异;④新生儿血天冬氨酸等与肠内蛋白摄入量呈正相关,亮氨酸等与肠外氨基酸摄入量呈正相关.结论 ①早产儿与足月儿的氨基酸代谢特点有所不同,但两者在相同营养阶段的氨基酸代谢状态较为相似;②小于胎龄儿与适于胎龄儿的血丙氨酸和酪氨酸水平差异显著,为寻找生命早期代谢改变的生化标志物提供线索;③营养阶段是新生儿血氨基酸水平的重要影响因素;④新生儿血中部分氨基酸水平的改变与肠内蛋白摄入量或肠外氨基酸摄人量有关.

目的 探讨新生儿心律失常合并先天性心脏病患儿的临床特点及治疗转归.方法 选取2000年1月至2018年2月上海交通大学医学院附属新华医院新生儿科收治诊断的新生儿心律失常合并先天性心脏病患儿临床资料,对其临床特点、治疗及转归情况进行回顾性分析.结果 共纳入患儿95例,其中男54例,女41例,胎龄(38.4±1.8)周,出生体重(3283±497)g.95例患儿心律失常类型为窦性心动过速14例(14.7％),房性期前收缩、房性心动过速49例(51.6％),室性期前收缩11例(11.6％),阵发性室上性心动过速8例(8.4％),心房扑动6例(6.3％),心房颤动1例(1.0％),窦性心动过缓4例(4.2％),Ⅱ度房室传导阻滞1例(1.0％),Ⅲ度房室传导阻滞1例(1.0％).主要合并先天性心脏病类型为房间隔缺损、动脉导管未闭、室间隔缺损.95例患儿中60例(63.2％)给予改善血流动力学药物治疗后临床症状好转,心律失常消失;35例(36.8％)给予抗心律失常药物治疗.出院后随访62例,复发4例(房性期前收缩1例、阵发性室上性心动过速2例、心房扑动1例).结论 新生儿心律失常合并先天性心脏病的病理分型和心律失常类型无相关性,多数经对症处理后缓解.

Necrotizing enterocolitis (NEC) is one of the most widespread and devastating gastrointestinal diseases in neonates. Destruction of the intestinal barrier is the main underlying cause of NEC. The aim of this study was to determine the role of lactadherin in preventing NEC in a neonatal rat model and investigate the molecular mechanism of lactadherin-mediated protection of the intestinal barrier. Neonatal rats were divided into three groups: dam feeding (DF), NEC (NEC), and NEC supplemented with 10 μg/(g·day) recombinant human lactadherin (NEC+L). Intestinal permeability, tissue damage, and cell junction protein expression and localization were evaluated. We found that lactadherin reduced weight loss caused by NEC, reduced the incidence of NEC from 100% to 46.7%, and reduced the mean histological score for tissue damage to 1.40 compared with 2.53 in the NEC group. Intestinal permeability of lactadherin-treated rats was significantly reduced when compared with that of the NEC group. In addition, the expression levels of JAM-A, claudin 3, and E-calcium in the ileum of NEC group animals increased compared with those in the ileum of DF group animals, and these levels decreased in the NEC+L group. Lactadherin changed the localization of claudin 3, occludin, and E-cadherin in epithelial cells. The mechanism underlying lactadherin-mediated protection of the intestinal barrier might be restoring the correct expression levels and localization of tight junction and adherent junction proteins. These findings suggest a new candidate agent for the prevention of NEC in newborns.

Objective To study the clinical features and risk factors of acute pulmonary reperfusion injury after operation in neonates with severe pulmonary stenosis or pulmonary atresia.Method From February 2014 to February 2018,a retrospective analysis was performed in patients with critical pulmonary stenosis or pulmonary atresia who received percutaneous balloon pulmonary valvuloplasty (PBPV) in the neonatal intensive care unit of our hospital.Clinical characteristics,perioperative cardiac structure,hemodynamic data and biochemical results were collected.The neonates were assigned into injury group if they had acute lung reperfusion injury,and non-injury group if not.The risk factors of acute lung reperfusion injury were analyzed using multi-variate Logistic regression model.Result A total of 32 patients (24 prenatal diagnosis and 8 postnatal diagnosis) with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum were enrolled.The main manifestations were dyspnea and cyanosis.Intravenous prostaglandin E was administered to keep the ductus arteriosus open.The age of operation ranged from 1 to 52 days and the median age was 7.5 days.Postoperative acute lung reperfusion injury occurred in 7 cases (21.9％).Preoperative and intraoperative pulmonary valve annulus diameter,balloon diameter,preoperative hemoglobin,hematocrit and blood albumin were significantly lower in the injury group.The operation duration,total length of hospital stay and postoperative duration were longer than in the non-injury group,the differences were statistically significant (P ＜ 0.05).Multi-variate Logistic regression analysis showed that the diameter of pulmonary valve annulus (OR =5.814,95％CI 1.106 ～30.568),preoperative blood albumin (OR =1.361,95％ CI 1.063 ～ 1.742),and hematocrit (OR =1.173,95％ CI 1.010 ～ 1.363) were risk factors of acute lung reperfusion injury,with statistically significant differences (P ＜ 0.05).Conclusion Acute lung reperfusion injury is one of the common complications after the operation of severe pulmonary stenosis or pulmonary atresia.The severity of pulmonary valve annulus stenosis,preoperative hematocrit and blood albumin level may be the risk factors of postoperative acute lung reperfusion injury.

Glutathione synthetase deficiency (GSSD) is a rare inborn error of glutathione metabolism with autosomal recessive inheritance. The severe form of the disease is characterized by acute metabolic acidosis, usually present in the neonatal period with hemolytic anemia and progressive encephalopathy. A case of a male newborn infant who had severe metabolic acidosis with high anion gap, hemolytic anemia, and hyperbilirubinemia is reported. A high level of 5-oxoproline was detected in his urine and a diagnosis of generalized GSSD was made. DNA sequence analysis revealed the infant to be compound heterozygous with two mutations, c.738dupG in exon 8 of GSS gene resulting in p.S247fs and a repetitive sequence in exon 3 of GSS gene. Treatment after diagnosis of GSSD included supplementation with antioxidants and oral sodium hydrogen bicarbonate. However, he maintained a variable degree of metabolic acidosis and succumbed shortly after his parents requested discontinuation of therapy because of dismal prognosis and medical futility when he was 18 days old.

Carbamoyl phosphate synthetase 1 deficiency (CPS1D) is a rare autosomal recessive hereditary disease which usually presents as lethal hyperammonemia. Here we report the case of a newborn infant with lethal hyperammonemia. Blood liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis showed increased concentrations of alanine, glutamine and histidine. Urine gas chromatography-mass spectrometry (GC/MS) showed increased levels of organic acids, while uracil and whey acid were not detected. Subsequent new generation sequencing (NGS) identified two heterozygous mutations in CPS1 gene. Both of them were identified in his parents. One was c.446T>C; p.Leu149Ser, in the 4 exon of CPS1. The other was C.2023delT; p.Cys675fs, in the 17 exon of CPS1. These two novel heterozygous mutations had not been reported previously. Early diagnosis and timely intervention are very important to improve clinical outcome. The new CPS1 gene mutation broadens the spectrum of CPS1 phenotypes. NGS is a credible way in complex diseases without a specific phenotype.

<正>为进一步指导和规范早产儿呼吸窘迫综合征（respiratory distress syndrome,RDS）的早期防治工作,在对我国不同胎龄早产儿RDS发生率及高危因素进行大样本流行病学调查;的基础上,中国医师协会新生儿科医师分会和《中华围产医学杂志》编辑委员会组织有关专家,经过充分讨论达成本共识,以供临床参考。随着证据及经验的不断增加,此共识将适时予以更新修订。1产前糖皮质激素促胎肺成熟

Objective To investigate the mechanism of the weakened immune system in newborns via observing the effect of TLR9 on newborns at different gestational age. Methods We collected umbilical cord blood from 229 neonates at different gestational age from July 2010 to June 2014. According to the gestational age, the samples were divided into 4 groups, which were 28-31 weeks group, 31-34 weeks group, 34-37 weeks group and≥37 weeks group. Flow cytometry was used to detect TLR9 positive cells of cord blood mononuclear( CBMC) and real-time quantitative PCR was applied to determine mRNA expression of TLR9 in order to analyze the relationship between those with gestational age. In the mean time, the correlation between mRNA and protein expressions of TLR9 was analysed. Results The rate of TLR9 positive cell was 15. 93 ± 6. 23%(28-31 weeks), 11. 63 ± 6. 70%(31-34 weeks), 13. 66 ± 6. 88%(34-37 weeks), 20. 51 ± 12. 06%(≥37 weeks), respectively. The rate of TLR9 positive cells was significantly higher in 28-31W group than in 31-34W group(P< 0. 05). TLR9 positive cell rate increased gradually and reached the highest in 37W group with significantly statistical difference(P < 0. 05). There was a positive correlation between the rate of TLR9 positive cell and gestational age from 31 weeks to 37 weeks, (r=0. 273, P=0. 006). The mR-NA expression of TLR9 was 4. 95 ± 3. 44%(28-31 weeks), 8. 89 ± 8. 49 %(31-34 weeks), 13. 91 ± 10. 92%(34-37 weeks), 7. 19 ± 7. 11%(≥37 weeks) , respectively. The mRNA expression increased with gestational age from 28 weeks to 36 weeks,and it had positive correla-tion with gestational age(r=0. 355, P<0. 001). The mRNA expression of TLR9 decreased in≥37 weeks group, and there was no signifi-cant difference compared with 28-31 weeks group(P>0. 05). There was a negative correlation between the mRNA expression of TLR9 and the rate of TLR9 positive cell at the same gestational age in preterm infants(r= -0. 227, P=0. 011). Conclusion The rate of TLR9 posi-tive cell and the mRNA expression of TLR9 are significantly different in newborns at different gestational age. With gestational age increasing, the rate of TLR9 positive cell rises from 31weeks to 37weeks, while the mRNA expression TLR9 is augmented from 28 weeks to 36 weeks.

The aim of the present study was to investigate the effects of lactadherin on plasma D-lactic acid and small intestinal mucin (MUC) 2 and claudin-1 expression levels in rats with diarrhea induced by rotavirus (RV) infection. A total of 75 seven-day-old healthy Sprague-Dawley rats were randomly divided into the following five groups: Control (C), RV infection (RVI), lactadherin before rotavirus infection (LBRI), lactadherin after rotavirus infection (LARI), and blank (B). On day 4 of artificial feeding, the rats in groups RVI, LBRI and LARI were intragastric administered 1×106 PFU RV; whereas the rats in groups C and B were intragastrically administered an equal volume of maintenance solution from the RV supernatant and normal saline, respectively. In the LBRI and LARI groups, rats received daily intragastric administration of 0.25 mg lactadherin for three days prior to and following infection with RV, respectively. The course of diarrheal symptoms was observed in each group and samples were collected on days 1, 4, and 7 post-infection in order to determine the mucosal morphology, plasma D-lactic acid levels and the expression levels of MUC2 and the intracellular junction protein, claudin-1, in the small intestine. On day 4 post-infection, the rats in group RVI demonstrated severely damaged small intestines and typical diarrheal characteristics, as detected by light microscopy; whereas rats in groups LBRI and LARI demonstrated intact small intestinal villi with partial vacuolation of epithelial cells and changes in the position of their nuclei. Electron microscopy demonstrated that the rats in the RVI group had sparse, shortened, disordered intestinal microvilli and widened intercellular junctions; whereas those in groups LBRI and LARI had long intestinal microvilli sparser compared with groups B and C and slightly widened intercellular junctions. Plasma D-lactic acid levels were increased in groups RVI, LBRI and LARI, as compared with groups B and C, and the greatest levels were detected in the RVI group on days 1, 4 and 7 post-infection. In addition to maintaining intestinal permeability, lactadherin enhanced the expression levels of MUC2 and reduced the expression of claudin-1; therefore, further protecting the intestinal epithelial barrier, which may contribute to the prevention and treatment of diarrhea induced by infection with RV.

Objective To investigate the changes of protein and energy intakes and the z-score of weight for age in appropriate for gestational age (AGA) and small for gestational age (SGA) preterm infants with gestational age less than 34 weeks. Methods The data from 314 hospitalized premature infants ( 268 cases of AGA and 46 cases of SGA) during January 2012 to December 2014 were retrospectively collected. The intakes of protein and energy and the changes of weight within 2 weeks after birth were compared. Results Compared with AGA group, the hospital stays, durations of parenteral and enteral nutrition and total enteral nutrition, and time to achieve full dose feeding were signiifcantly longer in SGA group (P?<?0 . 05 ). The energy intakes on day 4 , 8 , and 12 after birth in SGA group was obviously lower than in AGA group;the protein intakes on day 6 and 8 in SGA group was also obviously lower than in AGA group (P?<?0 . 05 ). The daily average weight gain was signiifcantly higher in SGA group than that in AGA group (P?<?0 . 05 ). The z-score of weight for age was gradually away from the median level in both AGA group and SGA group within 2 weeks after birth. Moreover, the z-score of weight for age at 2 weeks was lower in SGA group than that in AGA group (P?<?0 . 05 ). Conclusions The growth velocity in SGA premature infants was faster than that in AGA premature infants with gestation age lower than 34 weeks after recovery of birth weight. There was catch-up growth to some extent. However, the growth of SGA and AGA premature infants need to be improved.

Background: The increasing incidence of invasive Candida infections (ICIs) in preterm infants in the neonatal intensive care unit (NICU) of Xinhua Hospital aroused our concern. We undertook a retrospective study to evaluate the efficacy of different preventive measures for ICI in preterm infants.Methods: Preterm infants with gestational age (GA) <33 weeks admitted between 2010 and 2013 were divided into 3 groups according to the preventive measures applied in different periods: the control group (CG), fluconazole group (FG), and integrated measures group (IMG). We analyzed the incidence of ICI and distribution of fungal pathogens in these 3 groups, and also evaluated the efficiency of various measures in preventing ICIs in preterm infants.Results: The study sample comprised 261 preterm infants born at <33 weeks GA, including 94 in the CG, 99 in the FG, and 68 in the IMG. The differences among the groups were not significant at baseline. ICI developed in 41 of the 261 infants (15.7%). The incidence of ICI varied significantly among the groups: 22.3% in the CG (21/94), 18.2% in the FG (18/99), and only 2.9% in the IMG (2/68) (P = .003). ICI was less frequent in the IMG compared with the CG (P <. 001) and the FG (P = .003).Conclusions: The integrated measures approach is meaningful for the prevention of ICIs in preterm infants in NICUs with many patients but inadequate medical resources in some developing countries. Copyright (C) 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.