Objectives To explore the status of parental nutrition practice of hospitalized late preterm infants and the factors influencing the clinical prescription. Methods A multi-center, prospective cohort study was conducted during October 2015 to October 2017. Infants born after 34 weeks and before 37 weeks were enrolled from twenty-five hospitals in the Beijing area of China. Data of enteral and parenteral nutrition were collected. Results A total of 1,463 late preterm infants were enrolled in this study, 53.9% of infants were supported by parenteral nutrition. Over 60% of 34 weeks’ infants were on parenteral nutrition during the 2nd to the 4th day. Logistic regression analysis showed that gestational age(GA) (OR = 0.69, 95%CI 0.58–0.81), birth weight (OR = 0.41, 95%CI 0.26–0.65), hypoglycemia (OR = 2.77, 95%CI 1.90–4.04), small for gestational age (SGA) (OR = 2.18, 95%CI 1.34–3.55), feeding intolerance (OR = 6.41, 95%CI 1.90–21.59), neonatal respiratory distress syndrome (NRDS) (OR = 2.16, 95%CI 1.12–4.18), neonatal infection(OR = 1.56 95%CI 1.16–2.10), and slow enteral nutrition advancement rate (OR = 0.92, 95%CI 0.90–0.95) were factors influencing the administration of parenteral nutrition. Conclusion Over half of hospitalized late preterm infants were prescribed with parenteral nutrition. Infants with lower GA, lower birth weight, diagnosed with hypoglycemia, SGA, feeding intolerance, NRDS, neonatal infection, or a slower rate of enteral nutrition advancement had a higher likelihood of receiving parenteral nutrition.

This article elaborates the key points of the updated recommendations and the latest evidence of the important steps in China neonatal resuscitation guideline (revised in 2021), aiming to help clinicians better understand the guideline and guide training to achieve a standardized and efficient resuscitation and further to improve neonatal outcomes.

Objective:To study the current status of delivery room/operating room (DR/OR) resuscitation, early respiratory supports and respiratory tract complications in extremely low birth weight (ELBW) infants.Method:Between January 2017 and December 2017, ELBW infants born in sixteen medical institutions in Beijing were retrospectively studied. The infants were assigned into groups according to whether they were discharged following medical advice(follow-advice group and not-follow-advice group) and whether their gestational age (GA) was less than 28 weeks (<28 w group and ≥28 w group). The treatment, respiratory support and respiratory tract complications of ELBW infants were summarized.Result:A total of 137 ELBW infants were admitted to 16 NICUs. Of all ELBW infants, 98 cases (71.5%) were intubated in DR/OR, mothers of 97 infants (70.8%) received antenatal steroid (ANS) therapy. 80.3% of the infants (110/137) were diagnosed with respiratory distress syndrome (RDS) and 107 cases (97.3%, 107/110) received at least one dose of pulmonary surfactant (PS) replacement therapy. 92 cases (67.2%, 92/137) were discharged following doctor's advice. Compared with the follow-advice group, the not-follow-advice group who were hospitalized for less than 14 days had smaller GA and higher proportion of GA<28 w ( P<0.01). The not-follow-advice group who were hospitalized for less than 14 days had higher incidences receiving chest compressions and epinephrine than the follow-advice group ( P<0.05). The incidence of bronchopulmonary dysplasia (BPD) was 54.3% (50/92) in follow-advice group. Compared with ≥28 w group, infants in <28 w group had longer duration of non-invasive ventilation [(37.8±19.6)d vs. (24.2±13.0)d], higher incidence of BPD (75.6% vs. 30.3%), longer hospital stay, [85.0(71.0,102.5) d vs. 64.0(53.0,76.0) d] and more home-based oxygen therapy (22.4% vs. 7.0%)( P<0.05). The duration of mechanical ventilation in <28 w group was 10.0(1.3, 29.0)d and 4.7(2.2,10.3)d in ≥28 w group. Conclusion:Most ELBW infants need tracheal intubation after birth. The infants with smaller GA need longer duration of respiratory support and have higher incidence of long-term complications of respiratory tract.

The Apgar score, as a convenient and practical method for clinical screening in newborns during the first minutes of life, has been widely used for more than six decades. However, with the advent of modern medical technology, the continued use of Apgar score has been a matter of controversy due to its limitations, including that it is prone to be influenced by many factors. We provide a new insight into the Apgar score, based on the updated clinical evidence, its relationship with neonatal resuscitation, and its predictive value in neonatal outcome.

中晚期早产儿(late or moderately preterm，LMPT)占早产儿的绝大多数，但缺乏相关营养支持指南。欧洲儿童胃肠、肝病和营养学会营养委员会通过系统性文献回顾，为提出LMPT喂养建议提供依据。LMPT发育尚不成熟，易被忽视，母乳喂养率和母乳喂养持续时间均低于足月儿，营养相关性并发症如低血糖、喂养困难等发病率均较高，母乳喂养不足还可能对神经系统远期预后产生影响。因此，本文推荐对LMPT进行母乳喂养并给予积极营养支持，强调对LMPT母亲给予专业的、长期的泌乳支持及随访。

Background Postnatal care and growth in extremely low birth weight (ELBW) infants are being increasingly focused on worldwide. However, few data from China have been reported, expecially multicenters. This multicenter study was designed to investigate the problems existing in postnatal care, weight gain and the related risk factors in in-patient ELBW infants. Methods Eligible ELBW infants admitted to involved neonatal intensive care units (NICUs) in 2017 in Beijing were studied retrospectively. Except for general early outcomes, Weight Z score and feeding practice related information was caculated, and collected. Growth retardation (GR) was diagnosed if body weight Z score at discharge dropped more than one standard deviation (SD) compared with birth. Results Of our cohort of 137 ELBW infants, 92 infants discharged with medical advice were analyzed. Full enteral feeding reached at 37.0 (27.0, 51.8)days. Exclusive breast milk feeding rate was 30.4% at discharge. All infants had decreased weight Z score, and its change was similar in different weight subgroups. The incidence of GR was 66.3%. Multiple-factor analysis showed the risk factors for GR were small for gestational age(OR 34.768, 95%CI 1.652-731.728), average weight gain rate < 15 g/(kg.d)(OR 249.062, 95%CI 11.211-5532.889), and non-invasive and/or mechanicl ventilation duration > 28days(OR 6.867, 95%CI 1.211–38.957), P ༜0.05. Keeping ELBW infants staying in hospital longer was beneficial to their weight gain (OR = 0.950, 95% CI 0.909–0.993, P < 0.05). Conclusion Maintaining appropriate weight gain in early age is still a great challenge in ELBW infants. Fetal growth, early nutrition and sickness are critical influencing factors.

Objective:To investigate the status and influencing factors of enteral nutrition support in late preterm infants (34-36 +6 gestational weeks) treated in different grades of hospitals in Beijing. Methods:This was a prospective study involving late preterm infants treated in 25 hospitals in Beijing from October 2015 to October 2017. Data about nutritional management and nutrition-related complications were recorded. Exclusive breastfeeding status of the infants by gestational age(GA) and hospital levels was analyzed. The achievement of full enteral feeding and the potential influencing factors were also analyzed. t-test, Mann-Whitney U test, analysis of variance (ANOVA), Kruskal-Wallis test and Chi-square test were used for statistical analysis. Logistic regression and Cox regression analysis were used in multivariate analysis. Results:(1) A total of 1 463 late preterm infants with GA of 35.6±0.8 (ranging from 34.9 to 36.1) weeks was enrolled in this study. Compared with the infants with GA of 35-35 +6 and 36-36 +6 weeks, those born at 34-34 +6 gestational weeks had longer hospital stay [10 (8-13) vs 8 (7-10) and 7 (6-9) d, both P<0.05], greater loss of minimum weight [4.3% (2.6%-6.3%) vs 3.8% (2.0%-5.6%) and 3.3% (1.9%-5.5%), both P<0.05], higher incidence of apnea [5.3% (20/369) vs 2.1% (12/566) and 1.3% (7/528), both P<0.05] and respiratory distress syndrome (RDS) [7.1% (28/369) vs 3.0% (17/566) and 3.2% (17/528), both P<0.05], and lower percentage of failure to regain birth weight at discharge [32.5% (120/369) vs 38.7% (219/566) and 47.9% (253/528), both P<0.05]. Only the incidence of premature rupture of membranes among all maternal complications during pregnancy had statistical difference between 34-34 +6, 35-35 +6 and 36-36 +6 GA groups [6.2% (23/369) vs 12.7% (72/566) and 11.9% (63/528), χ2=10.244, P=0.007]. (2) The rate of enteral feeding increment in hospital was 13.7 (10.5-17.3) ml/(kg·d) and 46.0% (673/1 463) of the infants were fed formula. The exclusive breastfeeding rate increased from 4.5% (66/1 463) during hospitalization to 14.4% (211/1 463) at discharge. The breastfeeding rate at discharge varied widely among the 25 hospitals ( χ2=327.893, P<0.001) ranging from 32% to 0. (3) Logistic regression analysis demonstrated that gestational diabetes mellitus ( OR=2.426, 95% CI: 1.075-5.437, P=0.033) and premature rupture of membranes ( OR=8.726, 95% CI: 1.193-63.802, P=0.033) were the prenatal risk factors influencing the exclusive breastfeeding in late preterm infants. Enteral nutrition achieving 150 ml/(kg·d) and 120 kcal/(kg·d) (1 kcal=4.184 kJ) were noted for 28.4% (416/1 463) and 19.2% (281/1 463) of the late preterm infants at discharge, respectively. Cox regression analysis showed that hospital grades ( HR=1.470, 95% CI: 1.030-2.098, P=0.034), the length of hospital stay ( HR=1.162, 95% CI: 1.097-1.231, P<0.001), birth weight ( HR=0.946, 95% CI: 0.898-0.995, P=0.003), exclusive breastfeeding ( HR=2.354, 95% CI:1.031-5.374, P=0.042), feeding intolerance ( HR=3.677, 95% CI: 1.201-11.253, P=0.023), parenteral nutrition ( HR=1.900, 95% CI: 1.379-2.616, P<0.001), and the rate of enteral feeding advancement ( HR=1.426, 95% CI: 1.369-1.484, P<0.001) were independent factors associated with full enteral feeding at discharge. Conclusions:Exclusive breastfeeding rate in late preterm infants is low and enteral nutrition support varies greatly in different hospitals. The rate of enteral feeding increment is slow for hospitalized late preterm infants and most fail to achieve full enteral feeding at discharge. Gestational diabetes mellitus and premature rupture of membranes are prenatal risk factors affecting breastfeeding of late preterm infants. Those with low birth weight, exclusive breastfeeding in hospital, feeding intolerance, parenteral nutrition support, longer hospital stay or rapid enteral feeding advancement are more likely to achieve full enteral feeding at discharge.

Breastfeeding has great benefits for public health and social economy, while the exclusive breastfeeding rate within six months after birth and early initiation rate of breastfeeding in China are lower than the average level of the world. "Early skin to skin contact (SSC), early sucking and early initiation of breastfeeding"is an important start to ensure the success of breastfeeding. SSC between mother and baby is the first key step. Continuous SSC can stabilize the vital signs of newborns, provide the infants with healthy flora from mothers to establish a good micro-ecology and stimulate the rooting reflex of the baby to get colostrum as early as possible to protect them from infections and save their lives. Kangaroo mother care(KMC) for preterm/low birth weight infants can promote breastfeeding, and effectively reduce severe infections and mortality. Early SSC and KMC at the beginning of life are crucial to ensure successful breastfeeding.

Background An adequate maternal vitamin D (vitD) intake is rarely achieved in actual practice. The aim of this study was to assess maternal factors associated with neonatal vitD deficiency. Methods This is a single-institution prospective case-control study. Consecutive single-birth neonates admitted between September 2014 and February 2015 were prospectively enrolled. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured by spectrometry. The associations between neonatal vitD deficiency (defined as 25(OH)D <15 ng/mL) and several maternal characteristics, including body mass index (BMI) at delivery, education, health insurance status, birth season, sun exposure time, egg consumption, and vitD supplementation during pregnancy, were examined using multivariable logistic regression and their respective odds ratios (ORs) reported. Results A total of 125 mother-infant dyads were enrolled, with a gestational age of 36.8±2.7 weeks. Fifty-six percent (70/125) of the neonates had vitD deficiency. Maternal factors that were significantly associated with vitD deficiency included winter birth, insufficient sun exposure time, high maternal BMI at delivery, insufficient egg consumption, insufficient vitD supplementation during pregnancy, and disadvantaged health insurance. Disadvantaged insurance status and insufficient vitD supplementation during pregnancy were the two most influential factors of neonatal vitD deficiency, with an OR of 7.5 (95% confidence interval [CI], 2.0-37.6) and 7.0 (95% CI, 2.7-20.7), respectively. Conclusions Neonatal vitD deficiency is very rampant. An individualized vitD supplementation strategy may be developed by taking into consideration pregnant women's socioeconomic status and lifestyles.

综述国内外心力衰竭患者液体限制治疗的研究现状,包括液体作用机制、液体限制疗法现状、国内外最新指南建议及临床研究,以期为医护人员对心力衰竭患者液体摄入的指导提供信息支持,达到使患者在病情改善基础上提高生活质量的目的.

母乳喂养对婴儿近期的生长发育、肠道微生态的改善、免疫机能的调节具有显著的促进作用,同时可以促进婴儿远期神经系统发育、降低代谢综合征的风险.帮助母乳喂养的足月儿度过宫内铁储备耗竭后的阶段、降低铁缺乏风险,从而最大程度地发挥母乳喂养的优势是目前的关注热点.本文从母亲相关因素、脐带结扎时间、性别因素、辅食添加及预防性铁剂补充多个方面回顾了母乳喂养儿铁营养状况影响因素的相关研究,分析显示提高母亲铁营养相关知识水平、注重孕期铁元素的补充和膳食指导、延迟断脐可以增加新生儿出生时的铁储备量;积极提倡纯母乳喂养,对生长需求不同的婴儿进行适时、合理的辅食添加,对铁缺乏高危儿进行预防性铁剂补充均可以在不同程度上预防母乳喂养儿出现铁缺乏.

Objective To evaluate the effects of the second phase of Neonatal Resuscitation Program (NRP) in China. Methods A mail survey and an onsite assessment were conducted to collect data. (1) Mail survey: Different levels of domestic hospitals (except those in Tibet, Hong Kong, Macao and Taiwan) were randomly selected to collect information on in-hospital NRP training, resuscitation equipments, incidence of birth asphyxia and neonatal mortality caused by birth asphyxia from year 2010 to 2014. (2) Onsite assessment: One provincial level, two prefecture level and two county level hospitals or healthcare institutions were randomly selected in four provinces. A questionnaire survey was conducted among randomly selected health workers including midwives, obstetricians and pediatricians. Megacode performance of those health workers was evaluated. Trend Chi-square test was used for statistical analysis. Results (1) Questionnaires were gathered from 347 hospitals via the mail survey with a response rate of 74.6% (347/465). In the 347 hospitals, 97.5% (10410/10674) of the obstetricians, paediatricians, and midwives received in-hospital training, and 72.7% (7765/10674) of them received training from county or above level. (2) In the onsite assessment of the four provinces, 205 health workers were randomly selected and completed the questionnaire survey. Among them, 85.4%(175/205) received training more than three times, 52.7% (108/205) received over two days of training in the previous training workshops, but only 62.0% (127/205) could share one set of training manikin with less than eight trainees in training workshops. Megacode performance of 96 health workers was evaluated. The results showed that all of the health workers were qualified in terms of total score and achieved an average score of over 1.5 in the performance of every primary resuscitation skill. Health workers attained relatively high scores in performing initial steps in resuscitation and tracheal intubation, and in identifying the indication of chest compression and epinephrine administration. However, their average scores in preparation for resuscitation, positive pressure ventilation and teamwork were relatively low. (3) Over 90% of the 347 hospitals had basic resuscitation equipment such as neonatal bag and mask, devices for tracheal intubation and radiation warmer. But fewer were equipped with umbilical venous catheter, T-piece or oxygen-air blender, especially at the county level hospitals. The incidence of neonatal asphyxia decreased from 2.33%(7810/335190) in 2010 to 1.79%(9227/515481) in 2014. The mortality from asphyxia at birth decreased from 2.41 to 1.64 per 10000 live births [(81/335190) and (85/515481)]. Trend analysis revealed that the incidence of neonatal asphyxia (χ2trend=20.56, P<0.01) and the mortality at birth (χ2trend=77.34, P<0.01) declined over time. Conclusions The second phase of NRP has promoted the generalization of the neonatal resuscitation technology and resulted in decreased incidence of asphyxia and asphyxial mortality. Future programs should focus on measures to improve practical skills and teamwork, to increase the allocation of resuscitation equipment and to strengthen trainings among obstetricians and midwives.

Objective To evaluate the nutritional status of extremely low birth weight (ELBW) infants and the effects of nutritional support strategy alterations on their growth during hospitalization.Method From 2005 to 2014,clinical data of ELBW infants admitted to the neonatal intensive care unit (NICU) in our hospital were retrospectively analyzed.The clinical data included their general status,enteral and parental nutritional support strategy and complications during hospitalization The patients were assigned into pre5 group and late5 group.Those who survived and discharged from 2005 to 2009 were the pre5 group,and those who survived and discharged fromn 2010 to 2014 were the late5 group.The independent t test and chi square test were used for statistical analysis.Result A total of 58 ELBW infants were enrolled in the study,including 18 patients in the pre5 group and 40 in the late5 group.No statistically significant differences existed between the two groups on gestational age,birth weight,Z score (weight for length and gender),birth length,head circumference and main complications during hospitalization (P ＞0.05).Pre5 group had higher incidence of small for gestational age (SGA) than late5 group (16/18 vs.25/40,P =0.037),while the EUGR ratio at discharge (14/18 vs.21/40,P =0.061) was similar.When compared with pre5 group,late5 group had larger amount of initial enteral feeding volume [4.4 ml/(kg · d) vs.2.4 ml/(kg · d),P =0.014] and feeding volume at the end of the first week [(19.8 ± 16.0) ml/(kg · d) vs.(12.2 ±9.5) ml/(kg · d),P =0.036].Similarly,the starting dose of amino acids in parenteral nutrition [2.0g/(kg· d) vs.1.0 g/(kg· d),P＜0.001],maximum dose of amino acids [4.0g/(kg.d) vs.3.5 g/(kg · d),P ＜ 0.001],total calories at the end of the first week [(82.6 ± 12.6) kcal/(kg · d) vs.(71.1±15.2) kcal/(kg· d),P=0.004] and the second week [(103.7 ±19.8) kcal/(kg· d) vs.(92.3 ± 17.9) kcal/(kg · d),P =0.041],the weight gain velocity from birth to discharge [(18.7 ± 2.9) g/(kg.d) vs.(16.9±2.8) g/(kg· d),P=0.031] and change of Z scores (AZ) [-0.6 (-1.0,-0.4) vs.-1.2 (-1.6,-0.8),P =0.004] showed significantl differences between the two groups,with better outcomes in late5 group.However,the duration of parenteral nutrition,the total amount of amino acids,the time reaching total enteral feeding,the length of hospital stay were similar between the two groups.Ten cases(61.1％)of infants in pre5 group were breastfed,and four of them used human milk fortifier (HMF) (fortified rate was 22％).32 cases (80％) in late5 group were breastfed and 23 cases used HMF (fortified rate was 57.5％).The time to initiate HMF in the late5 group was at (30.2 ± 13.2) days,and human milk amount was (89.9 ± 34.5) ml/kg,fortified duration was (32.8 ± 15.7) days.Conclusion The enteral feeding strategy were more vigorous in the last 5 years than before,the initial feeding volume,the increasing rate,the initial dosage of amino acid,and maximum dosage of amino acid had been increased.Human milk and HMF of preterm infants were preferred.The vigorous nutritional support strategy were effective for the weight gain of ELBW infants without obvious side effects during hospitalization.

Aim: To compare the details of preterm infants enteral feeding between the two hospitals in China and in the United States, and to analyze the reason of the differences.Methods: A retrospective cohort study was conducted. Infants <32 weeks were enrolled from Cincinnati University Hospital (CUH) during January 2011 to January 2012 and Peking Union Medical College Hospital (PUMCH) during January 2011 to May 2012. Basic data and enteral feeding data of the two groups were compared.Results: Eighty-two infants in CUH group and 74 infants in PUMCH group were enrolled, infants in CUH group were much smaller than PUMCH group (gestational age (29.1 +/- 2.0) versus (30.6 +/- 1.3) weeks, p = 0.000, birth weight (1204 +/- 328) versus (1406 +/- 320) g, p = 0.000). Significantly more infants in CUH group received human milk as the first enteral feeding (78/82 versus 7/74, p = 0.000). Human milk feeding rate in first 28 days in CUH group was much higher (77/82 versus 7/74, p = 0.000). The initial milk volume, and the milk volume on the 7th, 14th, 21st and 27th day of CUH group were significant larger [(15.9 versus 9.3 ml/kg.d, p = 0.000), (79.8 versus 35.2 ml/kg.d, p = 0.000), (133.2 versus 76.4 ml/kg.d, p = 0.000), (140.6 versus 108.6 ml/kg.d, p = 0.000), (142.2 versus 121.5 ml/kg.d, p = 0.002)]. CUH group achieved full enteral feeding sooner (12.0 versus 22.4 d, p = 0.000).Conclusion: Preterm infants achieved full enteral feeding sooner at CUH compared to PUMCH. Human milk feeding may improve enteral feeding tolerance. We need more aggressive enteral feeding proposal in PUMCH.

WRKY proteins comprise one of the largest transcription factor families in plants and form key regulators of many plant processes. This study presents the characterization of 58 WRKY genes from the castor bean (Ricinus communis L., Euphorbiaceae) genome. Compared with the automatic genome annotation, one more WRKY-encoding locus was identified and 20 out of the 57 predicted gene models were manually corrected. All RcWRKY genes were shown to contain at least one intron in their coding sequences. According to the structural features of the present WRKY domains, the identified RcWRKY genes were assigned to three previously defined groups (I-III). Although castor bean underwent no recent whole-genome duplication event like physic nut (Jatropha curcas L., Euphorbiaceae), comparative genomics analysis indicated that one gene loss, one intron loss and one recent proximal duplication occurred in the RcWRKY gene family. The expression of all 58 RcWRKY genes was supported by ESTs and/or RNA sequencing reads derived from roots, leaves, flowers, seeds and endosperms. Further global expression profiles with RNA sequencing data revealed diverse expression patterns among various tissues. Results obtained from this study not only provide valuable information for future functional analysis and utilization of the castor bean WRKY genes, but also provide a useful reference to investigate the gene family expansion and evolution in Euphorbiaceus plants.

目前，国内外尚无新生儿窒息多器官损害的多中心研究，更无公认的诊断标准、常规或指南。在清华大学自主科研基金资助下，全国新生儿窒息多器官损害临床诊断多中心研究协作组成立，制定了本标准。

Objective To evaluate the levels of ghrelin, adiponectin, leptin and true insulin in human milk from mothers with and without gestational diabetes mellitus (GDM), and to assess the effects of these parameters on infant growth. Methods Fifty-two GDM mothers and their healthy infants (GDM group) and 49 non-GDM mothers and their healthy infants (control group) were enrolled from Beijing Obstetrics and Gynecology Hospital and Peking Union Medical College Hospital from January 2010 to August 2010. The levels of ghrelin, adiponectin, leptin and true insulin in colostrum and human milk 90 days postpartum (mature milk) were determined by enzyme-linked immunosorbent assay. Infant weight, length and head circumference at birth and at 90 days old were measured. The two-sample t-test, sum-rank test and Spearman correlation analysis were used for statistical analysis. Results Compared with the control group, ghrelin was significantly lower in human milk from GDM mothers both in colostrum [136.7 (102.7-181.4) vs 175.4 (137.5-235.0) ng/L, t= -2.737] and mature milk [111.8 (77.5-184.2) vs 210.9 (147.3-381.9) ng/L, t= -3.268]. Adiponectin was also significantly lower in human milk from GDM mothers both in colostrum [21.7 (14.6-51.8) vs 57.0 (23.1-113.9)μg/L, t=-2.858] and mature milk [11.7 (8.4-14.4) vs 15.1 (11.9-18.5)μg/L, t=-2.625], however, true insulin level was higher in colostrum [22.8 (13.4-50.2) vs 20.4 (7.8-30.8) mU/L, t=-2.007] and mature milk [33.6 (22.5-54.1) vs 23.5 (13.5-31.6) mU/L, t=-2.009]. The differences were statistically significant (all P < 0.05). (2) In the colostrums of the GDM group, true insulin level was negatively associated with ghrelin (r=-0.342), but positively associated with adiponectin (r=0.305). In the control group, the level of true insulin in mature milk was positive associated with leptin in colostrums( r=0.456)and mature milk(r=0.629). The differences were statistically significant (all P < 0.05). (3) In the GDM group, adiponectin level in colostrum was negatively associated with neonatal birth weight (r= - 0.323, P=0.025); the leptin/adiponectin ratio was negatively associated with neonatal birth weight (r= -0.403, P=0.005) and head circumference (r= -0.327, P=0.039) at birth. Adiponectin level in mature milk was negatively associated with infant length 90 days postpartum (r=-0.406, P=0.040). In the control group, the leptin/adiponectin ratio in colostrum was negatively associated with neonatal head circumference at birth (r= -0.370, P=0.024). Adiponectin level in mature milk was positively associated with infant weight 90 days postpartum (r=0.432, P=0.007). Conclusion Women with GDM have different levels of ghrelin, adiponectin and true insulin in their milk from the normal controls, which may affect infant growth.

目的 探讨极低出生体重儿早发血小板减少症的相关因素.方法 选择2011-2013年我院NICU收治的极低出生体重儿进行回顾性研究.根据生后72 h内有无血小板减少症分为早发血小板减少症组和无早发血小板减少症组,对两组患儿临床情况进行比较.结果 108例研究对象入选,发生早发血小板减少症45例(41.7％),患儿血小板计数在中位数8天恢复正常.男婴(OR=6.036)、早发感染(OR =8.358)及孕母患妊娠期高血压疾病(OR=5.990)与极低出生体重儿早发血小板减少症相关(P＜0.05),胎龄、出生体重、胎膜早破、窒息、产前应用地塞米松、呼吸窘迫综合征等对极低出生体重儿早发血小板减少症无明显影响.结论 早发血小板减少症是极低出生体重儿的常见合并症,男婴、早发感染及孕母患妊娠期高血压疾病是极低出生体重儿早发血小板减少症的危险因素.

Based on the EST sequence,a 2 102 bp cDNA was isolated from the rubber tree (Hevea brasilien-sis)latex (representing the laticicfer cytoplasm)with specific primers via RACE and RT -PCR.The sequence designated as HbPPO1 contains a 1 803 bp long open reading frame (ORF),81 bp 5′UTR and 218 bp 3′UTR. Sequence analysis indicated that HbPPO1 putatively encodes 600 amino acids with a theoretical molecular weight (Mw)of 67.88 kDa and isolectric point (pI)of 8.56,which was predicted to be localized to the plastid.The pro-tein contains the conserved Tyrosinase,PPO1 _DWL and PPO1 _KFDV domains specific to polyphenol oxidases, and shares the similarity of 85.2%,82.0%,79.8% and 78.2% with its homologs in Manihot esculenta,Ricinus communis,Jatropha curcas and Populus euphratica.Expression analysis showed that,among the examined tissues such as laticifer,bark and leaf,HbPPO1 expressed relatively more in the laticifer and the expression level was sig-nificantly inhibited by ethylene.

随着我国医学科学的进步和新生儿重症监护水平的提高,胎龄小于28周的超早产儿(extremely preterm infants)抢救成功率逐年上升,如何保证他们从宫内至宫外的平稳过渡、达到理想的生长状态从而改善远期预后成为我们新生儿科医生面临的挑战,值得我们去探索和实践.