Purpose:The incidence of preterm birth is reported as more than 10% in 2020 all over the world, and the disability and mortality rate are high due to incomplete development. The microvascular developments of neonates with different gestational ages (GAs) are unknown, which are related to cerebral development. This study assessed the cerebral microvascular development of preterm neonates with different GAs using the ultrafast power Doppler imaging technique. Methods:Seventy neonates were enrolled, including 7 full-term (GA = 37 weeks) and 63 preterm neonates (ranging from extremely preterm [GA ≤ 28 weeks] to late preterm [GA = 36 weeks]). Quantitative metrics including microvascular area (MArea) and microvascular diameter (MDiam) were evaluated in three regions of interest (ROIs): the cingulate gyrus (ROI 1), the frontal and parietal junction (ROI 2), and a branch of the anterior cerebral artery near the central sulci (ROI 3). Electroencephalogram signals were recorded and amplitude-integrated electroencephalography (aEEG) was used to measure the brain activity. Statistical correlations were assessed among microvascular quantitative metrics, GA, and aEEG. Results:All the microvascular quantitative metrics have a statistically significant (p < 0.05) positive correlation with GA and aEEG. MArea in ROI 1 has the highest correlation coefficient of 0.67 (p < 0.0001) with GA. Similarly, MArea in ROI 1 has the highest correlation coefficient of 0.53 (p < 0.0001) with aEEG. Conclusion:This study showed that MArea- and MDiam-related parameters were associated with increasing GA in preterm neonates, suggesting a trend toward cerebral microvascular maturation.

BACKGROUND/OBJECTIVE:Preterm birth poses notable neurodevelopmental risks, with cerebral microcirculatory disturbances potentially contributing to long-term impairment. Existing monitoring modalities lack bedside capacity to evaluate these microvascular changes during critical brain development. We characterized cerebral microperfusion and functional maturation patterns in preterm versus full-term neonates using combined ultra-micro angiography (UMA) and an amplitude-integrated electroencephalogram (aEEG). METHODS:In this prospective study, 76 neonates (23 extremely/very preterm [EP/VPT], 27 moderate-late preterm, and 26 term controls) were assessed at term-equivalent age. UMA helped quantify regional microperfusion (color pixel percentage, abbreviated as CPP in this context to differentiate from cerebral perfusion pressure), whereas aEEG (Burdjalov scores) helped evaluate functional maturation at 37-38 and 40 weeks' postmenstrual age. RESULTS:EP/VPT infants demonstrated significant cerebral hyperperfusion with distinct cortex-white matter perfusion gradients. Although preterm infants showed advanced aEEG maturation at 37-38 weeks, this difference normalized by 40 weeks. CONCLUSION:Gestation-dependent cerebral hyperperfusion and transient EEG maturation differences in EP/VPT infants at term-equivalent age support the value of UMA-aEEG integration for neurovascular assessment. The observed perfusion-EEG patterns suggest prematurity-specific neuroadaptation, warranting further investigation of long-term functional correlates.

Objective:Neonates have the highest incidence of thrombosis among pediatric populations, and preterm infants are at a high risk of venous thrombosis, with its risk factors remaining inconclusive and treatment criteria remaining ununified. This study aimed to explore the high-risk factors for venous thrombosis in preterm infants with varying gestational ages and catheterisation types, and to clarify the clinical characteristics, treatment strategies, and short-term prognosis of neonatal venous thrombosis, to provide evidence for clinical decision-making. Methods:A retrospective cohort study was conducted on 282 preterm infants admitted to the Neonatal Intensive Care Unit of Peking University Third Hospital from January 2014 to December 2025, including 94 cases in the thrombosis group and 188 cases in the control group. Clinical data, including maternal prenatal information, infant basic information, diagnosis and treatment course, catheter-related information, and thrombosis-related details, were collected from the electronic medical record system. SPSS 27.0 software was used for statistical analysis using the Kruskal-Wallis test, Student's t-test and Mann-Whitney U test for continuous variables; chi-square test or Fisher's exact test for categorical variables; and univariate and multivariate logistic regression models and Firth's penalised likelihood logistic regression analyses were applied to identify independent risk factors for venous thrombosis in preterm infants. Results:The incidence of venous thrombosis was 0.45% in all hospitalised neonates and 1.0% in hospitalised preterm infants, with no significant differences in baseline data such as gestational age and birth weight between the two groups (P > 0.05). Multivariate logistic regression analysis showed that right- and left-sided lower extremity PICC placement were independent risk factors for venous thrombosis in all preterm infants (P = 0.000 and 0.007, respectively). Maternal anticoagulant or antiplatelet agents use during pregnancy was a clinical predictor(P = 0.046). Stratified analysis by gestational age revealed that right lower extremity PICC placement(P = 0.000) was an independent risk factor for very preterm infants (gestational age <32 0/7 weeks), and PICC placement (P < 0.001) was also an independent risk factor for moderate-to-late preterm infants (32 0/7 weeks ≤ gestational age <37 0/7 weeks). Among all thrombotic groups, 96%(90/94) were associated with central venous catheterisation, including 22 cases of portal vein thrombosis (related to umbilical venous catheterisation) and 68 cases of extremity venous thrombosis (related to PICC placement). The median time from catheterisation to thrombosis was 5 (3.8, 8.0) days, with 59% were deep vein thrombosis and 59% were occlusive thrombosis. Only 34% of infants had clinical manifestations, and the detection rate of asymptomatic thrombosis increased with routine vascular ultrasound application. A total of 40% of patients received pharmacotherapy (mainly nadroparin calcium, supplemented with rt-PA), with 5% discontinuing medication due to active bleeding. For central venous catheters that were no longer in use, superficial vein thrombosis was managed by immediate catheter removal without anticoagulation. For deep vein thrombosis, anticoagulation was administered for at least 3 days, followed by catheter removal after follow-up imaging confirmed thrombus resolution or stabilisation. No thromboembolic events occurred during this process. After treatment, 98% of infants improved and were discharged; 65% of thrombi completely resolved, and 21% reduced in size before discharge, with a median resolution/reduction time of 17 (7, 31) days, and no extremity functional impairment was observed in any case. Compared with the PICC-related thrombosis group, the UVC-related thrombosis group was characterised by significantly higher birth weight (P = 0.010), a shorter interval between catheter placement and thrombosis (4.0 vs. 6.0, P = 0.019), and a shorter duration of hospitalisation (32.5 vs. 53.9, P = 0.003). Conclusion:Lower extremity PICC placement is a core independent risk factor for venous thrombosis in preterm infants, with maternal anticoagulant use during pregnancy perhaps being a clinical predictor for all preterm infants. Neonatal venous thrombosis is mostly catheter-related, with a high proportion of asymptomatic cases, and routine vascular ultrasound can improve its detection rate. Individualised pharmacotherapy based on clinical manifestations and thrombus characteristics is associated with a favourable short-term prognosis, and timely adjustment of an abnormal catheter position is crucial for reducing thrombosis risk. Long-term follow-up is still needed for preterm infants with venous thrombosis to monitor for late adverse outcomes.

IntroductionWe aimed to establish normative developmental patterns of cerebral microperfusion using ultra-micro angiography and evaluate regional microvascular differences in neonates across gestational ages.MethodsThis prospective observational cohort study enrolled 115 neonates from a single-center neonatal intensive care unit or neonatal ward at Peking University Third Hospital (2023–2024). The patients were stratified by postmenstrual age into extremely/very preterm (n = 30), moderate/late preterm (n = 23), and term (n = 62) groups, excluding those with major anomalies/hemodynamic instability. Ultra-micro angiography was performed via the anterior/sphenoid fontanelles during quiet sleep (3–14 days postnatal). Regional color pixel percentage (CPP) and large-vessel hemodynamics [peak systolic velocity [PSV]/end-diastolic velocity [EDV]/ resistance index [RI]] were measured.ResultsUltra-micro angiography revealed distinct postmenstrual age-dependent microvascular perfusion patterns, with cortical and white matter CPP demonstrating progressive increase across postmenstrual age groups (extremely preterm vs. term infants: frontal lobe CPP 22.97 [IQR 20.12–28.92] vs. 47.57 [40.07–55.93]; parietal lobe CPP 25.09 [20.96–29.94] vs. 47.69 [38.93–55.97]), while basal ganglia CPP remained stable [32.96 [30.64–35.02] vs. 33.77 [31.52–37.46]]. Midline regions consistently exhibited the highest perfusion across all ages [term infants: 66.26 (61.33–70.62)]. Concurrent macrovascular assessment showed that anterior/middle cerebral artery peak systolic and end-diastolic velocities increased with maturation, although resistance indices maintained stability.ConclusionUltra-micro angiography-derived CPP quantifies gestational age-dependent microvascular maturation, revealing distinct regional perfusion patterns. Differences in the progression of CPP in various brain regions may serve as a biomarker for risk stratification of neurodevelopment in premature infants.

Objectives: Current guidelines for pulmonary surfactant (PS) administration in preterm infants with respiratory distress rely on clinical signs and FiO2 thresholds. Lung ultrasound offers a promising alternative for accurately diagnosing neonatal respiratory distress syndrome (NRDS) and assessing its severity. This randomized controlled trial aimed to evaluate whether a lung ultrasound-guided strategy for NRDS diagnosis and lung ultrasound scores (LUS)-guided PS administration could improve respiratory outcomes in preterm infants (<32 weeks' gestation), compared to conventional methods. Methods: In this non-blinded randomized controlled trial, 89 preterm infants (≤32 weeks' gestation) with respiratory distress after birth were enrolled. Participants were randomly assigned to either the ultrasound group (PS administration based on ultrasound-confirmed NRDS and LUS criteria) or the control group (PS administration according to standard clinical signs and FiO2 requirements). Results: The ultrasound group demonstrated a significantly lower rate of invasive mechanical ventilation (p = 0.007) and a shorter duration of ventilation (p = 0.005) compared to the control group. Furthermore, the ultrasound group required less PS (p = 0.03), received their first dose at an earlier time (p = 0.017), and experienced fewer radiation exposures both before surfactant treatment and within the first week after birth (p = 0.023 and p = 0.019, respectively). Conclusions: The integration of lung ultrasound for NRDS diagnosis and LUS-guided surfactant therapy facilitates more precise and timely PS use. This strategy reduces the need for and duration of invasive mechanical ventilation and limits early radiation exposure in very preterm infants.

Neonatal hydrocephalus is a serious neurological disease; however, advancements in neonatal care and the increasing survival rate of extremely preterm infants and its incidence, etiology, diagnosis and management have also undergone significant changes. In this study, we aimed to summarize the above clinical changes in neonatal hydrocephalus at our hospital over the past 12 years to provide a reference for clinical practice. This was a single-center retrospective study. To comprehensively collect data on neonatal hydrocephalus, we conducted a case search among hospitalized patients in both the obstetrics and pediatrics departments from January 1, 2010, to December 31, 2021. In the comparative analysis, the infants were divided according to the time of admission into a group for the first 6 years and one for the second 6 years. Between-group comparisons of gestational age, birth weight, etiology, treatment, and prognosis were performed. Sixty-two patients (28 in the first 6 years; 34 in the latter 6 years) were diagnosed with neonatal hydrocephalus. Their gestational ages ranged from 25 to 39+6 weeks (median, 30 weeks), and their birth weights ranged from 600 to 4046 g (median, 1255 g). The gestational age and birth weight were significantly lower in the second 6-year group than in the first 6-year group. Furthermore, there was a significant increase in severe germinal matrix-intraventricular hemorrhage (GMH-IVH) in infants and cerebral parenchymal hemorrhage in the latter 6-year group. In terms of surgical treatment, there are more applications of ventricular access devices (VADs) in the latter 6-year group. Among the 62 infants, 21 (33.9

Most preterm infants with a gestational age < 32 weeks in the neonatal intensive care unit (NICU) undergo blood transfusion therapy during their hospital stay to enhance their oxygen-carrying capacity and improve the oxygenation of vital organs. However, anemia and blood transfusions can lead to intestinal damage. Bedside abdominal ultrasonography and near-infrared spectroscopy (NIRS) are widely applied to monitor intestinal injury and oxygen perfusion. We hypothesized that in preterm infants (gestational age < 32 weeks) with anemia and indications for transfusion, signs of intestinal injury detected by abdominal ultrasound and NIRS may appear earlier than clinical symptoms, signs, and other auxiliary examinations. Herein, we present the protocol of a study designed to assess whether abdominal ultrasonography and NIRS could therefore improve the timeliness, sensitivity, and accuracy of intestinal injury diagnosis, thereby improving prognosis. This prospective observational study will enroll infants with a gestational age between 23 + 0 and 31 + 6 weeks with neonatal anemia, who meet the criteria for blood transfusion, and scheduled to receive transfusion therapy. In addition to routine clinical symptoms, signs, and other auxiliary examination monitoring during the transfusion process, abdominal ultrasound and NIRS findings will be analyzed. The primary outcome is the prediction intestinal injury related to anemia/transfusion using ultrasound and NIRS. A sample size of 100 cases has been set. The etiology of transfusion-associated neonatal enterocolitis (TANEC) remains unclear and may result from multiple factors. Several prospective studies have assessed the significance and advantages of abdominal ultrasound combined with NIRS for monitoring intestinal injury in anemic states and transfusion therapy. Therefore, this trial aims to test the following hypothesis: monitoring intestinal injury in preterm infants (gestational age < 32 weeks) with anemia receiving red blood cell transfusions using abdominal ultrasound and NIRS can provide real-time information on changes in intestinal oxygenation during transfusion, to identify specific signs and trends in the digestive system prior to clinical symptoms and other auxiliary examination methods, thereby guiding and adjusting clinical decisions more accurately, sensitively, and rapidly. If the hypothesis is confirmed, this monitoring approach might provide a basis for early interventions to mitigate intestinal injury risks. ClinicalTrials.gov ID: NCT06857812

BackgroundBedside lung ultrasonography has been widely used in neonatal intensive care units (NICUs). Lung ultrasound scores (LUS) may predict the need for pulmonary surfactant (PS) application. PS replacement therapy is the key intervention for managing moderate to severe neonatal respiratory distress syndrome (NRDS), with early PS administration playing a positive role in improving patient outcomes. Lung ultrasonography aids in the prompt diagnosis of NRDS, while LUS offers a semi-quantitative assessment of lung health. However, the specific methodologies for utilizing LUS in clinical practice remain controversial. This study hypothesizes that, in very preterm infants [<32 weeks gestational age (GA)] exhibiting respiratory distress symptoms, determining PS application through early postnatal LUS combined with clinical indicators, as opposed to relying solely on clinical signs and chest x-rays, can lead to more timely PS administration, reduce mechanical ventilation duration, improve patient outcomes, and lower the occurrence of bronchopulmonary dysplasia (BPD).Methods and designThis is a protocol for a prospective, non-blinded, randomized controlled trial that will be conducted in the NICU of a hospital in China. Eligible participants will include very preterm infants (< 32 weeks GA) exhibiting signs of respiratory distress. Infants will be randomly assigned in a 1:1 ratio to either the ultrasound or control group. In the ultrasonography group, the decision regarding PS administration will be based on a combination of lung ultrasonography and clinical manifestations, whereas in the control group, it will be determined solely by clinical signs and chest x-rays. The primary outcome measure will be the mechanical ventilation duration. Statistical analysis will employ independent sample t-tests with a significance level set at α = 0.05 and a power of 80%. The study requires 30 infants per group (in total 60 infants).ResultsThis study aims to demonstrate that determining PS application based on a combination of LUS and clinical indicators is superior to traditional approaches.ConclusionsThis approach may enhance the accuracy of NRDS diagnosis and facilitate early prediction of PS requirements, thereby reducing the duration of mechanical ventilation. The findings of this research may contribute valuable insights into the use of LUS to guide PS administration.

Functional near infrared spectroscopy(fNIRS)is an emerging neuroimaging tool that reflects the activity and function of brain neurons by monitoring changes in brain oxygen metabolism based on the neurovascular coupling mechanism.It is non-invasive and convenient,especially suitable for monitoring neonatal brain function.This article provides a comprehensive review of research related to the developmental patterns of brain networks concerning language,music,and emotions in neonates using fNIRS.It also covers brain network imaging in neonatal care,resting-state brain network connectivity patterns,and characteristics of brain functional imaging in disease states of neonates using fNIRS.

Introduction Preterm (PT) infants are at high likelihood for poor neurodevelopmental outcomes, including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and other neurodevelopmental disorders (NDDs), which could considerably impair the individuals’ functions throughout their whole life. The current cohort study aims to investigate adverse outcomes, especially NDDs, in PT children, and the related early aberrant brain developmental biomarkers.Methods and analysis This is a prospective cohort study in Beijing, China. We plan to recruit 400 PT infants born at <37 weeks of gestational age (GA), and 200 full-term (FT) controls during the neonatal period (40 weeks corrected GA), then follow them up until they reach 6 years of age. This cohort is designed to assess neuropsychological functions, brain development, related environmental risk factors and the incidence of NDDs by using the following measures: (1) social, emotional, cognitive and sensorimotor functions; (2) MRI, electroencephalogram and functional near-infrared spectroscopy; (3) social economic status, maternal mental health and DNA methylation; and (4) symptoms and diagnosis of NDDs. Main data analyses will include comparing the neurodevelopment outcomes and brain developmental trajectories between PT and FT children using linear or logistic regressions and mixed-effects models. Regression analyses and machine learning will be used to identify early biological predictors and environmental risk or protective factors for later NDDs outcomes.Ethics and dissemination Ethical approval has been obtained from the research ethics committee of Peking University Third Hospital (M2021087). This study is under review in the Chinese Clinical Trial Register. The study results from the current cohort will be disseminated and popularised through social media to participating parents, as well as parents who are giving care to PT children.

Sotos syndrome is an autosomal dominant genetic disorder caused by mutations in the NSD1 gene. In this study, we report a case of Sotos syndrome in a preterm infant. The main clinical manifestations were severe bronchopulmonary dysplasia, congenital heart disease, difficulty feeding, and characteristic facial appearance. The gene mutation was located at 177251854 on chromosome 5, and identified as a shear mutation, c.4765+1 G > A, which is a new mutation. The patient recovered well after symptomatic treatment. To the best of our knowledge, this is the first case of a preterm infant in whom a novel c.4765+1 G > A mutation in the NSD1 gene was identified. When premature infants present with abnormally severe bronchopulmonary dysplasia, feeding difficulties, and other congenital anomalies, Sotos syndrome should be considered.

Preterm birth causes over 50% of neonatal deaths with high incidences ranging from 4% to 16% across countries. The short-term and long-term complications, especially the nervous system sequela, of preterm neonates brought a heavy burden to families and society. Timely clinical intervention is important to reduce poor outcome and prognoses. Cerebral microvascular development is associated with functional development. In this study, we explore the cerebral microvascular development by visualizing the cerebral microvessels of preterm and full-term neonates with different gestational ages (GAs) using ultrafast power Doppler imaging (uPDI) technique. Microvascular density is used as the evaluation index to quantitatively assess the cerebral microvessels. Statistical results on 83 preterm neonates and 13 full-term neonates suggest that the cerebral microvessels develop better with GA increases.

本文报道1例胎粪吸入综合征导致心肺功能衰竭的足月儿病例，应用床旁超声动态监测肺部病变、持续肺动脉高压及各脏器功能，指导体外膜肺氧合治疗，顺利出院。

Background:Central venous catheterization (CVC) is broadly used in neonatal intensive care units (NICUs) for efficient vascular access; however, its establishment and maintenance are associated with numerous risks and complications. Here, we focus on investigating the value of point-of-care ultrasound (POCUS) in the early diagnosis and treatment of pericardial effusion associated with CVC and compare the differences in ultrasound and radiography in CVC localization and monitoring in the NICU. Methods:Twenty-five infants with CVC-associated pericardial effusion (PCE) who were hospitalized in the NICU of Peking University Third Hospital between January 2013 and March 2023 were retrospectively selected for the study. Data concerning their catheterization characteristics, CVC tip position, clinical and imaging manifestations of PCE, treatments, and prognoses were analyzed. Results:The mean gestational age of our cohort was 29.3 ± 3.1 weeks, and the mean birth weight was 1,211 ± 237 g. The incidence of CVC-associated PCE was 0.65%, and 80% of PCE cases occurred within 4 days of CVC. After PCE, the most common symptoms were tachypnea (44%) and tachycardia (64%). Chest radiographs revealed cardiothoracic enlargement, and only 2 cases (9.10%) showed a "flask heart". Cardiac ultrasound showed that the catheter tip extended deep into the heart in 72% of infants with PCE. Cardiac insufficiency was observed in 12 cases (48%). Overall, 8 infants (32%) had pericardial tamponade, 7 (87.5%) of whom underwent pericardiocentesis. Overall, 2 (8%) infants died, and the remaining 23 (92%) were cured. Conclusion:CVC-associated PCE mostly occurs in the early post-catheterization stages (within 4 days) in infants. Some cases may have critical clinical manifestations and progress rapidly, with some even developing pericardial tamponade. A CVC tip being deep into the heart cavity is an important cause of PCE. Compared with chest radiography, point-of-care ultrasound is more accurate for CVC tip positioning and can detect PCE more quickly. Furthermore, it is more advantageous for locating and monitoring CVC-associated PCE. Early identification and diagnosis can effectively reduce fatality rates and improve the prognosis of infants with CVC-associated PCE.

男性新生儿,产后半小时,持续呼吸困难9 min;为辅助生育双胎之一,因脐带绕颈2周,于胎龄34周经剖宫产取出,出生体质量1780 g ,Apgar评分8分;其母孕期存在子痫前期表现,产前接受3次地塞米松促胎肺成熟.

目的 比较3.0 T儿科专用磁共振和3.0 T全身磁共振评估早产儿脑部图像质量,以评估3.0 T儿科专用磁共振在早产儿脑部成像的应用价值.材料与方法 本研究分别在3.0 T儿科专用磁共振和3.0 T全身磁共振进行颅脑成像扫描,采集序列包括常规序列和扩散加权成像(diffusion weighted imaging,DWI)序列,并对两组T2加权成像序列进行主观评分,对3D T1加权成像序列信噪比(signal-to-noise ratio,SNR)、对比噪声比(contrast-to-noise ratio,CNR)和DWI的表观扩散系数(apparent diffusion coefficient,ADC)值进行测量.结果 主观评分显示,3.0 T儿科专用磁共振图像质量与3.0 T全身磁共振评分相当,达到临床诊断需求.儿科专用磁共振图像的双侧额叶、顶叶、颞叶、枕叶灰质和白质,中脑,小脑SNR与全身磁共振图像差异无统计学意义(P>0.05),CNR相当或优于全身磁共振;双侧额叶、顶叶、颞叶、枕叶ADC值与全身磁共振图像差异无统计学意义(P>0.05).结论 3.0 T儿科专用磁共振早产儿颅脑图像的主观评分、SNR与3.0 T全身磁共振无差异,CNR相当或优于3.0 T全身磁共振,表明该新设备具有广阔的临床应用前景.

BackgroundFew studies have examined the reference value of the left ventricular structure and function in preterm infants. This study was designed to establish a point-of-care echocardiographic reference range of left ventricular structure and function based on different gestational age, weight, and body surface area (BSA) for preterm infants within 7 days after birth.MethodsWe retrospectively studied 489 patients with traditional echocardiographic data of left ventricular (LV) M-mode: LV end diastolic dimensions (LVED), LV end systolic dimension (LVES), end-diastolic interventricular septal thickness (IVSd), end diastolic LV posterior wall thickness (LVPWd), left atrial (LA) and aortic root (AO) diameters, and index of LA/AO, LV ejection fraction (LVEF), LV fractional shortening (LVFS), and pulsed wave Doppler: aortic valve flow rate (AV), peak mitral valve flow rate E(MV-E), peak mitral valve flow rate A(MV-A), and MV-E/A. The LV dimensions and the maximum blood flow velocities of the aortic valves and mitral valves according to gestational age, birth weight, and body surface area (BSA) are presented in percentiles tables. Percentile curves of aforesaid four cardiac measurements (LVED, LA diameter (LAD), MV-E, MV-E/A) using the R language Generalized Additive Models for Location, Scale and Shape (GAMLSS) method were developed according to different gestational ages and weights.ResultsMeasurements of all cardiac dimensions and Doppler maximum velocities of AV, MV-E, and MV-E/A showed a correlation with gestational age, weight, and BSA. LVED, LAD, MV-E, and MV-E/A showed a trend of increasing values with gestational age and weight on the percentile curves.ConclusionThe percentile tables and graphs of these point-of-care echocardiographic data can provide reliable reference data for Chinese neonates. Normative values are recommended as a source of reference data for the identification of potentially abnormal echocardiography.

Intraventricular hemorrhage (IVH) is a common disease in preterm neonates. Severe IVH may result in periventricular venous infarction (PVI) which often coexists with periventricular leukomalacia (PVL). PVI accompanied by PVL often leads to severe neurological sequelae. Current inspection methods for PVI and PVL include cranial ultrasound (cUS) imaging and magnetic resonance imaging (MRI). However, only anatomical information can be obtained from these two imaging modalities. Studies demonstrate that the morphology and hemodynamics of microvessels are related to pathological changes in some diseases, which cannot be detected using conventional ultrasound Doppler imaging. Recently, ultrafast power Doppler imaging (uPDI) has been developed to visualize the microvasculature. In this study, the feasibility of uPDI in a human neonate with PVI accompanied by PVL is validated. The microvascular supply of one normal section and two diseased sections with PVL were evaluated by calculating the microvascular density (MD) and power Doppler density (PDD) indexes. Results show that the microvascular supply of brain parenchyma in the diseased sections is higher than that in the normal section, which can be explained as compensatory responses. In conclusion, uPDI has the potential to assess the microvascular supply and predict the prognosis of neonates with PVI or PVL.

OBJECTIVE:To study the clinical features of pericardial effusion caused by central venous catheterization in preterm infants. METHODS:A retrospective analysis was performed on 11 preterm infants with pericardial effusion caused by central venous catheterization. Their catheterization features, manifestations, treatment, and prognosis were analyzed. RESULTS:A total of 11 preterm infants (11/2 599, 0.42%) developed pericardial effusion, with a mean gestational age of (30.1±2.6) weeks and a mean birth weight of (1 240±234) g. Pericardial effusion mostly occurred within 4 days after central venous catheterization (10 cases, 91%). The main manifestations included poor response (6/11, 55%), cyanosis (5/11, 45%), increased respiratory rate (6/11, 55%), increased heart rate (6/11, 55%), aggravated dyspnea (5/11, 45%), and muffled heart sound (5/11, 45%). At the time of disease progression, 7 preterm infants (64%) had a deep position of the end of the catheter, 3 preterm infants (27%) had a correct position, and 1 preterm infant (9%) had a shallow position. Five preterm infants (45%) experienced cardiac tamponade, among whom 4 underwent pericardiocentesis. Seven preterm infants were given conservative medical treatment. Among the 11 children, 2 (18%) died and 9 (82%) improved. CONCLUSIONS:Pericardial effusion caused by central venous catheterization mostly occurs in the early stage of catheterization and has critical clinical manifestations. Pericardiocentesis is required for cardiac tamponade, and early diagnosis and intervention can effectively improve prognosis.

OBJECTIVES:To study the effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus.METHODS:A retrospective analysis was performed on the medical data of 49 preterm infants with obstructive hydrocephalus. According to the treatment regimen, they were divided into two groups: surgical treatment (n=12) and conservative treatment (n=37). The drainage methods, drainage complications, and eventual shunt outcome were analyzed in the surgical treatment group. The two groups were compared in terms of the etiology of hydrocephalus and prognosis.RESULTS:Among the 49 preterm infants with obstructive hydrocephalus, severe intracranial hemorrhage (37 cases; 76%) and central nervous system infection (10 cases, 20%) were the main causes of hydrocephalus. There was no significant difference in the composition of etiology between the two groups (P>0.05). In the surgical treatment group, 4 infants were treated with ventriculosubgaleal shunt and 8 were treated with Ommaya reservoir. One infant had secondary infection and 8 infants eventually underwent ventriculoperitoneal shunt. The surgical treatment group had a significantly higher survival rate than the conservative treatment group (P<0.05). As for the 37 preterm infants with severe intracranial hemorrhage, the surgical treatment group had a significantly higher proportion of infants with normal neurodevelopment than the conservative treatment group (P<0.05). As for the 10 preterm infants with central nervous system infection, neurodevelopmental abnormalities were observed in each of the two groups.CONCLUSIONS:Surgical treatment can improve the survival rate of preterm infants with obstructive hydrocephalus and the prognosis of preterm infants with severe intracranial hemorrhage.