Background Chromosome 17q23.1-q23.2 deletion syndrome is a rare genetic disorder characterized by various congenital defects, including microcephaly, heart and lung defects, limb abnormalities, and mild-to-severe developmental delay. Respiratory distress and severe pulmonary hypertension (PH) are possible initial symptoms. Case presentation We report two cases of full-term neonates with respiratory distress presenting shortly after birth. They both presented with severe PH in the early postnatal period, with oxygenation indices exceeding 70. Their symptoms were temporarily relieved with comprehensive treatment but PH either persisted into, or reappeared in infancy. Case 1 had an anomalous origin of the right upper lobe bronchus on chest computed tomography (CT) imaging, while Case 2 had an atrial septal defect and cor triatriatum sinister on echocardiography. Case 2 also exhibited bilateral inner ear malformations and bilateral irregularities in the morphology of the auditory ossicles on temporal bone CT imaging. Whole-exome sequencing revealed a 2.0-2.3 Mb de novo heterozygous deletion at 17q23.1-q23.2 encompassing T-box transcription factor 2 and 4 genes in both infants, which were confirmed by quantitative real-time PCR. Despite receiving intensive care, they succumbed to irreversible PH and respiratory and heart failure, with one passing away at 3 months and the other at 20 months of age. Conclusions This is the first report of two cases of chromosome 17q23.1-q23.2 deletion syndrome diagnosed after birth in China, both associated with intractable PH, expanding the current clinical phenotype spectrum of this disorder.

Aim:To analyze the clinical characteristics, antimicrobial therapies, and outcomes of neonates with carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infections. Methods:This single-center retrospective study included 22 neonates with CRE bloodstream infections at a tertiary children's hospital in China (September 1, 2019-August 31, 2024). Data of clinical characteristics, risk factors, pathogens, carbapenemase testing, antimicrobial therapy, and outcomes were analyzed. Results:All 22 neonates had hospital-acquired late-onset infections (males, 77.3%; preterm infants, 81.8%). Prior to onset, 72.7% of the neonates had a history of broad-spectrum antibiotic exposure. Klebsiella pneumoniae was the predominant pathogen (91.9%). Eighteen isolates underwent carbapenemase testing, with KPC being the most prevalent carbapenemase (66.7%). The antimicrobial agents were changed for 8 infants based on the carbapenemase testing results. Six neonates with KPC-producing CRE infections received ceftazidime-avibactam (CAZ-AVI), and two neonates with NDM-producing CRE infections were treated with CAZ-AVI plus aztreonam. All 20 neonates who completed full treatment achieved clinical cure, while two neonates succumbed to infection before effective therapy initiation. The all-cause mortality rate was 13.6%. Conclusion:Neonates with immature immunity are more susceptible to CRE bloodstream infections, but clinical cure could be achieved after effective antimicrobial therapy. Carbapenemase testing plays a crucial role in the decision making on treatment of neonatal CRE infections.

Although whole-exome sequencing (WES) is now widely used to diagnose neonatal genetic diseases, the genetic causes in over half of the cases remain unresolved, primarily due to variants of uncertain significance (VUS). Therefore, reclassifying VUS may be an effective strategy to improve WES’s diagnostic yield. However, not all reclassification approaches are suitable for clinicians. Patients in the neonatal unit of Hebei Provincial Children’s Hospital who underwent WES for suspected genetic diseases and demonstrated VUS were re-evaluated from January 2019 to December 2023 using user-friendly methods. A total of 676 individuals were tested, with 101 phenotype-associated VUS identified in 82 patients. Thirty (29.7%) VUS classifications were changed: 24 were upgraded to likely pathogenic or pathogenic, and 6 were downgraded to likely benign. VUS reclassification clarified the molecular diagnosis in 19 cases, increasing the WES diagnostic rate from 30.2% to 33.0%. Computational prediction contributed the most to reclassification, whereas clinical phenotype-related evidence was also particularly significant in upgrading variants. Moreover, phenotype-associated VUS with a score of ≥3 points are more likely to be classified as likely pathogenic or pathogenic, thus requiring more attention. This study provides a practical reference for clinicians in managing VUS reclassification.

Objective To investigate the value of three hemolysis tests and carboxyhemoglobin (COHb) level in the diagnosis of hemolytic disease of the fetus and newborn (HDFN). Methods From January 1, 2019 to December 31, 2022, the neonates hospitalized in the Department of Neonatology of Hebei Provincial Children's Hospital with suspected hemolytic disease who had serological testing were retrospectively enrolled in the study. They were distributed into HDFN group and non-HDFN group according to the final diagnosis. Their clinical and laboratory data were collected and analyzed, and the COHb level was detected by blood gas analyzer. Results A total of 378 neonates with HDFN and 217 neonates without HDFN were included in the study. Most of the neonates in HDFN group were full-term infants (348/378, 92.1%), with median gestational age of 39.1 (38.3, 40.0) weeks. Three hundred and fifty-four cases (354/378, 93.7%) were ABO-HDFN and the rest were Rh HDFN. There were significant differences in the level of serum total bilirubin, hemoglobin, COHb and reticulocyte percentage at admission between the two groups(P<0.05). The positive rate of three hemolysis tests in HDFN group decreased with the increase of the days after birth. The highest positive rate (more than 80%) was observed within 2 days after birth. Correlation analysis showed a negative relationship between the COHb level and the age (rs = -0.434, P<0.001) . Among the three hemolysis tests in HDFN group, the positive rate of antibody release test was the highest (69.0%), followed by the free antibody test (55.6%) and the direct antiglobulin test (DAT) (36.0%). Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value of COHb was 1.15%.The sensitivity of COHb ≥ 1.15% was 51.8%, higher than single DAT (36.0%) . The diagnosis effectiveness of three hemolysis tests couldn't be improved when combined with COHb detection(Z = -0.727, P>0.05) . Conclusion The three hemolysis tests are important in the diagnosis of HDFN, among which the antibody release test has the highest sensitivity. COHb has certain value for the diagnosis of HDFN, but joint testing cannot improve the diagnosis effectiveness of three hemolysis tests. Hemolysis tests and/or COHb detection should be conducted for neonates at risk of hemolysis as early as possible after birth.

Glutathione synthetase deficiency (GSSD) is an autosomal-recessive metabolic disorder caused by glutathione synthetase (GSS) gene mutations. No more than 90 cases of GSSD have been reported worldwide; thus, the spectrum of GSS mutations and the genotype-phenotype association remain unclear. Here, we present a severely affected infant carrying a compound heterozygous GSS variation, c.491G > A, and a novel variant of c.1343_1348delTACTTC. We also summarize the clinical manifestations, treatment protocol, prognosis, and genetic characteristics of previously reported GSSD cases in China. In this case study, our patient presented with tachypnea, jaundice, intractable metabolic acidosis, and hemolytic anemia. Urinary-organic acid analysis revealed elevated 5-oxoproline levels. Further, this patient showed improved outcomes owing to early diagnosis and the timely administration of vitamins C and E. Therefore, our study indicates that in clinical cases of unexplained hemolytic anemia and metabolic acidosis, GSSD should be considered. Additionally, genetic testing and antioxidant application might help identify GSSD and improve the prognosis.

目的:探讨新生儿期起病的经典型半乳糖血症的病例特点，提高临床医生对该病的认识。方法:回顾性分析1例临床及基因诊断的经典型半乳糖血症患儿的临床特征及诊治经过。结果:患儿，女，生后12 d，因发热半天入院。入院查体及实验室检查显示患儿意识反应差、皮肤黄染、末梢循环差、肝脾异常肿大、肝功能障碍、凝血功能障碍、C-反应蛋白显著升高，血培养大肠埃希菌阳性，给予抗感染及对症治疗后病情一度好转出院。出院7 d因体重下降、肝功能异常再次入院，经基因检测，最终确诊为经典型半乳糖血症，经饮食干预及对症治疗，再次好转出院。目前已随访至24月龄，肝功能正常，无白内障、神经系统发育异常等并发症。结论:经典型半乳糖血症患儿的临床表现无显著特异性，早期可以败血症表现为首发症状，对于生后早期出现不明原因的多器官功能障碍(尤其是肝功能障碍)或反复感染(尤其是革兰阴性菌感染)的病例，需考虑该病可能，血尿代谢病筛查及基因检测可协助明确诊断。

Objective:To study the clinical features of neonatal hyperthyroidism.Methods:From September 2013 to September 2020, clinical data of neonates with hyperthyroidism admitted to the neonatal intense care unit of our hospital were retrospectively collected and analyzed.Results:A total of 7 neonates were included. The average gestation age was (35.8±2.3) weeks with 5 cases had GA<37 weeks. The median age of diagnostic was 16 d (7~18 d). The common clinical manifestations included tachycardia, irritability, low-grade fever, hyperhidrosis, bulimia, poor weight gain, diarrhea and jaundice. The levels of serum free triiodothyronine (FT 3) and thyroxine (FT 4) were elevated in all 7 cases and thyroid stimulating hormone (TSH) were decreased. The Doppler ultrasound of thyroid gland in two neonates revealed enlarged thyroid gland with abundant blood flow. All 7 mothers had hyperthyroidism with 4 mothers provided the history of hyperthyroidism and the other 3 were also confirmed after their infants were diagnosed. All 7 infants were treated with anti-thyroid drugs (ATD) and 2 were additionally given β-blockers to control heart rate. The median ATD duration was 40 d (7~58 d). 2 cases (both preterm infants) had slight decrease in FT 4 during medication. FT 4 of all 7 cases returned to normal before TSH. Conclusions:Neonatal hyperthyroidism has various and nonspecific clinical manifestations. Early diagnosis and timely treatment are important to prevent short-term and long-term adverse outcomes. Whether their mothers provide definite history of thyroid disorder or not, the thyroid function of the suspected neonates should be carefully monitored.

Background N-methyl-D-aspartate (NMDA) receptors are ligand-gated ion channels that mediate excitatory synaptic transmission in the central nervous system. The functional NMDA receptors are heterotetramers consisting mainly of two GluN1 and two GluN2 subunits. GluN2 is encoded by the GRIN2D gene. A few case series have shown that GRIN2D variants are linked to developmental and epileptic encephalopathy. In this article, we report a novel GRIN2D variant, namely c.2021C > A (p.T674K) in a neonate with intractable epileptic encephalopathy. Case presentation A 12-day-old boy who had stiffness of the lower and upper extremities since birth was transferred from a local hospital to our department. On admission, the patient presented with head tilting backwards, staring, apnea and hypertonia of limbs. Video electroencephalogram showed continuous, generalized or multi-focal spike-wave and spike-and-slow wave discharges and hypsarrhythmia. A treatment regimen composed of phenobarbital, midazolam, levetiracetam and clonazepam was administered, which however led to only partial control of the seizure. Whole-exome sequencing identified c.2021C > A (p.T674K) in GRIN2D in the patient while such a mutation was not detected in the parents. The patient was hospitalized for 1 month and died of sudden cardio-respiratory arrest 2 weeks after discharge. Conclusions A novel variant of GRIN2D was identified in a neonate with epileptic encephalopathy. Epilepsy associated with this GRIN2D mutation is refractory to conventional anti-epileptic medications.

Nonketotic hyperglycinemia (NKH) is a lethal autosomal recessive disease resulting from alterations in glycine metabolism, commonly caused by mutations in glycine decarboxylase (GLDC). The symptoms of NKH usually manifest in the neonatal period, and can be categorized into severe NKH and attenuated NKH based on the clinical outcome. To date, only a few NKH cases have been reported in China. We here report a case of a neonate with severe NKH carrying a novel compound heterozygous variant in GLDC. The patient was a 68-h-old girl who had progressive lethargy, no crying, and poor sucking ability from birth, and was therefore transferred to our department. On admission, the patient was supported by intubation and ventilation and presented with profound coma. Metabolic investigation indicated a markedly increased glycine concentration both in the plasma and cerebrospinal fluid (CSF). Symptomatic treatments were administered, but the patient's condition did not improve substantially. Whole-exome sequencing identified compound heterozygous mutations (c.1261G>C, p.G421R and c.450 C>G, p.N150K) in GLDC, which were inherited from the mother and the father, respectively. The patient was hospitalized for 8 days in our department and died 2 days after discharge. We further summarize the clinical features, genetic characteristics, administered treatment, and prognosis of previously reported Chinese NKH patients for context. Our results highlight that due to the non-specific clinical phenotypes of NKH and difficulty in obtaining CSF samples, genetic testing is a crucial tool, not only for a diagnosis but also for predicting the clinical outcome and can potentially help to determine the optimal therapeutic strategy.

Objective: To analyze the clinical characteristics and treatment of tricuspid valve prolapse caused by chordal rupture complicated with persistent pulmonary hypertension in neonates. Methods: The clinical data of a male neonate with tricuspid valve prolapse complicated with persistent pulmonary hypertension admitted to the Neonatal Intensive Care Unit of Children's Hospital of Hebei Province in November 2018 was analyzed retrospectively. Related literature up to September 2020 was searched with the strategy of "(neonate OR newborn) AND (tricuspid valve prolapse) AND (rupture OR necrosis) AND (papillary muscle OR chordae tendineae) AND (pulmonary hypertension)" in Wanfang, CNKI and PubMed database in Chinese and English. The characteristics of the disease were summarized. Results: A male full-term neonate was admitted due to presenting severe cyanosis for 9 hours. He was born by caesarean section and presented severe cyanosis and dyspnea at 10 min of ages, unresponsive to the positive airway pressure resuscitation. After 9 hours of mechanical ventilation, there was no improvement. Thus he was transferred to Children's Hospital of Hebei Province. On admission, the initial blood gas analysis showed an arterial partial pressure of oxygen of 22.5 mmHg (1 mmHg=0.133 kPa). The echocardiography revealed prolapsed anterior leaflet of tricuspid valve, severe tricuspid regurgitation (TR) and pulmonary artery hypertension, and right to left shunt via a patent foramen ovale. The arterial duct was closed. The chest X-ray was normal. The boy was treated with nitric oxide, milrinone, and continued mechanical ventilation initially. Addition of prostacyclin analog (treprostinil) on day 3 led to significant improvement of pulmonary blood flow, oxygenation, and stabilization, so that the extracorporeal membrane oxygenation therapy was avoided. At 11 months after birth, the boy underwent cardiac surgery. At surgery, the rupture of chordal tendineae in anterior leaflet of tricuspid valve was found. Tricuspid annuloplasty, valvuloplasty and repair of patent foramen ovale were successfully performed. The follow-up echocardiogram at postoperative 3 months showed only mild tricuspid insufficiency. The boy was well at last follow-up at 22 months of age with normal cognitive skill development. According to literature, 20 cases of papillary muscle or chordae tendineae rupture in neonates had been reported in 12 English papers. Among the total 21 neonates, there were 12 male infants and only one premature infant with gestational age of 33 weeks. They presented with profound cyanosis soon after birth. All of them received endotracheal intubation and mechanical ventilation. Other treatments included inhalation of nitric oxide, intravenous milrinone, vasoactive drugs, diuretics and prostacyclin, etc. Extracorporeal membrane oxygenation (ECMO) was used in 6 infants as a bridge to surgical treatment. Two cases reported earlier death of cardiopulmonary failure without operation and the rest 19 survived after surgery. The followed surgery or autopsy revealed that all of them had tricuspid valve prolapse, rupture of papillary muscle or chordae tendineae. Conclusions: The severe TR resulting from rupture of papillary muscle or chordate tendineae in neonates is rare and could cause severe hypoxemia. Early recognition, adequate cardiopulmonary support to stabilize the hemodynamic status and timely surgery can significantly reduce the mortality.

目的 探讨基于信息共享系统优化的院前转运模式在危重新生儿中的应用效果.方法 回顾性分析2019年2月—2020年2月河北省儿童医院收治的94例实施基于信息共享系统优化的院前转运的危重新生儿的资料,记为A组,另回顾性分析同期88例实施常规转运的危重新生儿的资料,记为B组.比较两组新生儿转运过程花费时间和转院后住院时间,转运前、转运中和转运后疾病危重程度评分,转归情况以及不良事件发生情况.结果 A组转运过程花费时间和转院后住院时间均短于B组(均P<0.05);两组新生儿疾病危重程度评分组间、时间、交互作用比较,差异均有统计学意义(均P<0.05).A组转运前、转运中和转运后疾病危重程度评分差异无统计学意义(P>0.05),B组转运中疾病危重程度评分低于转运前(P<0.05),转运后低于转运中、转运前(P<0.05),且A组转运中、转运后疾病危重程度评分均高于B组(P<0.05);A组转归情况优于B组(P<0.05).A组不良事件发生率低于B组(P<0.05).结论 基于信息共享系统优化危重新生儿院前转运模式能够缩短转运过程花费时间和转院后住院时间,降低新生儿疾病危重程度,有助于病情转归,降低不良事件发生率.

Objective:To study the etiologies and clinical features of neonatal shock and evaluate the risk factors of mortality.Method:From January 2018 to September 2020, the clinical data of neonatal shock patients admitted to neonatal intensive care unit of our hospital were retrospectively collected. Their etiologies and clinical features were analyzed. The infants were assigned into the cured group and the death group. The risk factors for death were analyzed using univariate and multivariate Logistic regression methods.Result:A total of 99 neonatal shock cases were collected. The neonates had a gestational age (GA) of (37.7±2.9) weeks, a birth weight (BW) of (2 969±756) g, and male 55, female 44. The median age on admission was 12 days. 26 cases were premature infants. The most common type of shock was septic shock (78/99, 78.8%). The other causes included cardiogenic (6/99, 6.1%), hypovolemic (6/99, 6.1%), asphyxial (5/99, 5.1%) and congenital genetic metabolic diseases (4/99, 4.0%). The mortality rate was 21.2% (21/99). Escherichia coli and Group B streptococcus were the most common pathogenic bacteria. The mortality was significantly higher in premature infants than the full-term infants (42.3% vs. 13.7%, P<0.05). The death group had significantly higher incidences of infants with BW<2 500 g, GA<37 weeks, admission age < 3 d, pH<7.15 on admission, blood lactic acid (>4 mmol/L) on admission, hypotension, coagulation dysfunction, multiple organ dysfunction syndrome than the cured group. Logistic regression analysis indicated that pH<7.15 on admission and hypotension were the independent risk factors of death. Conclusion:Septic shock is the leading cause of neonatal shock in our patients. pH<7.15 on admission and hypotension are the independent risk factors of death from neonatal shock.

Background: Classical Galactosemia (CG) is a rare autosomal recessive metabolic disease caused by mutations in the galactose-1-phosphate uridyl transferase (GALT) gene. This study aim to identify pathogenic mutations underlying classic galactosemia in two Chinese families. Methods: We collected blood samples from two Chinese families and extracted genomic DNA. High-throughput sequencing, sanger sequencing, and bioinformatics analysis were used to investigate the molecular cause of manifestations in the two Chinese families. Results: We found compound heterozygous mutations (c.396C>G; p.His132Gln and c.974C>T; p.Pro325Leu) in family 1 and a homozygous missense variant (c.974C>T; p.Pro325Leu) in family 2. Bioinformatics and Sanger sequencing were performed to verify the identified variants. Conclusion: The present study identified the GALT mutations as a genetic etiology in the two Chinese families with classic galactosemia and expanded the phenotypic and mutational spectrum of GALT. Our findings could be useful in providing evidence for prenatal interventions and more precise pharmacological treatments to patients. High-throughput sequencing conducted in our study is a convenient and useful tool for clinical diagnosis of galactosemia and other associated genetic disorders.

Objective:To evaluate the effect of continuous quality improvement (QI) in reducing the incidence of nosocomial infection (NI) and complications of premature infants in the neonatal intensive care unit (NICU).Method:This was a prospective, observational study of preterm neonates before and after QI efforts to reduce NI and complications. Premature infants with gestational age less than 34 weeks and age less than 7 days admitted to NICU in Hebei Children's Hospital from May 2015 to April 2018 were enrolled in the study. The premature infants admitted without continuous QI from May 2015 to April 2016 were taken as the control group, and those admitted from May 2016 to April 2017 after the implementation of QI measures related to NI were included in intervention group 1, and those admitted from May 2017 to April 2018 were included in intervention group 2. The SPSS 23.0 software was used to analyze the incidence of NI and the severe complications, such as bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), periventricular leukomalacia (PVL) and severe intraventricular hemorrhage (IVH) in the three groups.Result:A total of 738 premature infants were included in this study, including control group ( n=216), intervention group 1 ( n=295) and intervention group 2 ( n=227). No significant differences were found in the gestional age, birth weight and other clinical characteristics among the three groups ( P>0.05). After QI, the incidence of NI decreased significantly, with 15.3%, 10.2% and 7.5% in the three groups respectively. There was significant difference between the intervention group 2 and the control group ( P < 0.05). A total of 80 premature infants in the three groups developed NI, of which sepsis, ventilator-associated pneumonia and urinary tract infection accounted for 85.0%, 13.8% and 1.2%, respectively. Compared with the control group, the compliance rate of hand washing after intervention was significantly improved, the days of peripheral central venous catheterization and the days of antibiotics therapy were significantly shortened, and the difference was statistically significant ( P<0.05). There was no significant difference in the incidence of BPD, ROP, severe IVH or PVL among the three groups ( P>0.05). The hospital stay of intervention group 2 was shorter than that of control group and intervention group 1, and the difference was statistically significant ( P<0.05). Conclusion:Through the implementation of continuous QI measures, the incidence of nosocomial infection in premature infants of NICU can be declined, and the related complications of premature infants can also be reduced.

OBJECTIVE:To describe the clinical features, treatments and prognosis of very low birth weight infants (VLBWIs) requring mechanical ventilation, to assess the risk factors associated with the mortality of VLBWIs, and to evaluate the significance of the scoring system based on clinical risk index for babies (CRIB) and the score for neonatal acute physiology-perinatal extension II (SNAPPE-II) for predicting mortality risk for premature infants in China.METHODS:Perinatal data were collected from 127 VLBWIs requring mechanical ventilation who were admitted to the neonatal intensive care unit (NICU) from January 2010 to October 2011.RESULTS:The enrolled infants had a mean gestational age of 31±2 weeks, a mean birth weight of 1290±170 g, a male/female ratio of 1.23∶1, and extremely low birth weight infant accounting for 6.3%. Of the 127 cases, 48.0% were administered with pulmonary surfactant (PS), and 49.6% received endotracheal intubation ventilation. The overall in-hospital mortality was 41.7%. Multivariate logistic regression revealed the following independent risk factors for mortality: low birth weight, multiple birth, cesarean section, and low PaO2/FiO2 ratio (OR = 1.611, 7.572, 4.062, and 0.133 respectively; P<0.05). SNAPPE-II and CRIB showed good performance in predicting prognosis, with areas under the ROC curve of 0.806 and 0.777 respectively.CONCLUSIONS:The overall mortality rate of VLBWIs is still relatively high. The high-risk factors for VLBWI mortality include low birth weight, multiple birth, cesarean section, and low PaO2/FiO2 ratio. The neonatal illness severity scoring system (using SNAPPE-II and CRIB) can be used to quantify illness severity in premature infants.

Objective To study the changes of the erythrocyte innate immune function in the patients with neonatal respiratory distress syndrome(RDS).Methods The expression and activity of CR1 on erythrocytes were measured quantitatively in 24 patients diagnosed with RDS and 20 premature controls without respiratory diseases when they are 24 hours and 7 days old.The innate immune activity of erythrocyte was measured according to erythrocyte quick innate immune adherence reaction on cancer cells.Quantitative expression of CR1 on erythrocytes was measured by one-step enzymelinked immunosorbent assay.The repeated measurement design analysis of variance was used to compare the data between the two groups.Results The quantity and activity of ECR1 of case group in 7 d were significantly higher than that in 24 h(P0.05) The quantity and activity of ECR1 were significantly lower in case group in 24 h than in control group.[ECR1 quantity expression(2.11±0.16) vs.(3.02±0.13),ECR1 activity(9.67±1.06)% vs.(14.70±1.17)%,P0.05],There was no statistical significance between the two groups in 7 d [ECR1 quantity expression(2.83±0.12) vs.(3.13±0.17),ECR1 activity(13.46±0.89)% vs.(14.50±0.98) %,P0.05].There is a significant positive correlation between the quantity and activity of ECR1 at any time in both groups(0r1,P0.05).Conclusion In patients with RDS,erythrocyte innate immune function was found to be low.

Objective To investigate the relationship between platelet counts and prognosis in newborns with septicemia.Methods Parameters in 243 newborns with septicemia were analyzed retrospectively,to show the bacterial kinds.The difference between Gram-positive cocci and Gram -negative bacillus in neonatal septicemia were observed in terms of platelet counts and prognosis.platelet counts,the degree of critical illness(neonatal critical illness scoring,NCIS),and the incidence rate of NEC were also observed the relationship with prognosis.The relationship between different stage of NEC with platelet counts,the effects of plate-reduction level to prognosis.Results The mortality was 11.52%(28/243),the incidence rate of thrombocytopenia was 36.63%(89/243),the mortality of thrombocytopenia was 22.47%(20/89),the incidence rate of NEC was 5.35%(13/243),Gram-positive cocci and Gram-negative bacillus [74.64%(103/138) vs 25.36%(35/138) respectively].There had no difference in sex,gestation age(weeks)(36.15±3.48 vs 37.36±3.94),birth weight(g)(2603.75±882.66 vs 2833.24±941.22),and invasion age(days)(7.72±4.92 vs 9.06±5.45) between the death group and survival group,also including pneumonia and jaundice(P0.05).However,comparing the death group and survival group,platelet counts(×109/L)(80.36±34.48 vs 184.73±62.70),NCIS(84.27±23.37 vs 93.45±15.63)and the incidence rate of NEC[28.57%(8/28) vs 2.73%(5/153)]were closely correlated with prognosis(P0.05).There was no difference in platelet counts(t=0.85,P0.05) and the mortality of septicemia(χ2=0.037,P0.05) between Gram-positive cocci and Gram-negative bacillus in newborns with septicemia.Plate-reduction were correlated with NCIS(t=4.84,P0.05),NEC(χ2=6.29,P0.05)and the mortality of neonatal septicemia(χ2=16.51,P0.05).NEC stage Ⅱ or higher had more level plate count than NEC stage Ⅰ(t=5.60,P0.05).There was an inverse association between the mortality of neonatal septicemia and platelet count(r=-0.535;P0.05).Conclusion There is association between the prognosis of neonatal septicemia and the level of platelet count.Platelet counts are good indicators of prognosis and severity in neonatal septicemia.

Objective:To find out the nosocomial infection feature through analysing the situation of nosocomial infection of the children in the ICU and supply theoretic basis for prevention and control of nosocomial infection. Method:A descriptive study was conducted,take 101 patients of nosocomial infection cases in the ICU from september,2009 to June,2010 as subject,set up the case control group. Analysed the influence factors of nosoeomial infection. Results:The results included duration in the ICU,antibiotics categories,the duration of antibiotics application,machinery ventilation,the use of Hormone,the quantities of foundation disease,the pneumonia of newborn,the NRDS of newborn,the sex distribution in new babys,premature birth and the birth weight. Conclusion:Using the antibiotics reasonably,reducing attack operation,shorting duration in the ICU are advantageous in prevention and control of nosocomial infection.

目的 通过对重症监护病房住院患儿医院感染发生情况进行研究,探讨其发病特征,为预防和控制医院感染提供依据. 方法 以2009年6至11月我院重症监护病房872例患儿为研究对象,确定医院感染病例;采用描述性研究方法对ICU发生医院感染患儿进行研究. 结果 ICU医院感染率为11.58%,感染部位以呼吸道为主,病原体致病菌以G-菌为主,其次是G+菌,病毒和真菌也有检出. 结论 合理使用抗菌药将有利于预防和控制儿科医院感染.充分了解医院感染的特征,对易感者实施重点保护,有助于减少医院感染的发生.

Objective:To investigate pathogens characteristics isolated from neonates with septicemia and analyze their drug resistance so as to provide evidence for early and clear diagnosis of clinical pathogens and rational use of antibiotics. Methods:The results of blood culture and drug susceptibility test for neonatal patients with septicemia treated in our hospital from January 2007 to December 2009 were retrospectively analyzed. Results:Out of the blood samples,243 stains were detected,with a result of Gram-negative (60 strains) accounting for 24.70% (60/243) and Gram-positive (183 strains) accounting for 75.30%(183/243). Staphylococcus epidermidis 24.69% (60/243),staphylococcus haemolyticus 20.16% (49/243),escherichia coli 8.64% (21/243),staphylococcus aureus 7.41% (18/243) and Klebsiella pneumoniae 6.58% (16/243) were the five most common pathogens. Gram-positive cocci demonstrated a strong resistance to penicillin (95.3%) and erythromycin (90.5%) and was 100% sensitive to vancomycin. The resistance of Gram-negative bacilli to ampicillin (90.0%) and gentamycin (50.0%) was high,and their susceptibility to imipenem and ceftazidime was evident. Conclusions:Much more attention should be paid to drug resistance detection in the treatment of neonatal septicemia. Choosing sensitive antibiotics based on the drug sensitivity tests may decrease the occurrence of drug-resistant bacteria and increase the clinical curative effects.