OBJECTIVE:To elucidate the characteristics of lymphocyte subsets in bronchopulmonary dysplasia (BPD) diagnosis following Jensen's criterion to understand the spectrum of lymphocytes in different degrees of BPD. STUDY DESIGN:This single-center retrospective cohort study included 120 neonates admitted to the neonatal intensive care unit between 1 July 2014 and 30 June 2021, who had undergone peripheral blood lymphocyte subpopulation detection. RESULTS:Thirty-one neonates were included in the control group, whereas 33 infants with BPD were included in the case group. In addition, we selected 56 infants with a gestational age (GA) <37 weeks without BPD who were receiving oxygen therapy. Among the three groups, the B cell and NK cell frequencies were significantly higher and the frequencies of T cells and CD4+ cells were significantly lower in the BPD group. In newborns without BPD, the distribution of T lymphocyte subsets was similar at different GAs. Comparing different degrees of BPD, the patients in the grades 2-3 BPD group had significantly lower percentages of T lymphocytes and CD4+ T cells than those in the other groups. Remarkably, the frequencies of NK cells were significantly higher in patients with grades 2-3 BPD, and the Treg cells slightly increased with BPD severity, although the differences were not significant. CONCLUSION:Healthy neonates had similar ratios of lymphocyte subsets among different GAs; although as the GAs increased, the percentage of lymphocytes increased slightly. Severe BPD was associated with lower CD4+ T cells and higher NK cells. However, whether such changes were the cause or the consequence of BPD has not been determined.

Parkinson's disease (PD) is a common neurodegenerative disorder caused by genetic, epigenetic, and environmental factors. Recent advance in genomics and epigenetics have revealed epigenetic mechanisms in PD. These epigenetic modifications include DNA methylation, post-translational histone modifications, chromatin remodeling, and RNA-based mechanisms, which regulate cellular functions in almost all cells. Epigenetic alterations are involved in multiple aspects of neuronal development and neurodegeneration in PD. In this review, we discuss current understanding of the epigenetic mechanisms that regulate gene expression and neural degeneration and then highlight emerging epigenetic targets and diagnostic and therapeutic biomarkers for treating or preventing PD.

Apert综合征是新生儿期罕见的遗传性疾病，因FGFR2基因变异导致，发病率1/65 000，其特征为颅缝早闭、尖头畸形、并指（趾）畸形，常合并皮肤、骨骼、大脑和其他器官异常。本文报告1例Apert综合征早产儿，以提高临床医生对此病的认识。

Background: Very premature infants with cerebral hemorrhage often have decreased cerebral oxygenation (CrSO2) monitored by near-infrared spectroscopy (NIRS) in the first few days after birth. This study aimed to analyze the correlation between NIRS data of very premature infants monitored in the first 72 hours of life and clinical data, as well as their impact on cerebral oxygenation and cerebral fractional tissue oxygen extraction ( cFTOE )Methods: From July 2017 to June 2019, neonates of gestation age between 28 to 31 weeks were recruited from the Seventh medical center of Chinese PLA general hospital, Beijing, China. While arterial blood gas(ABG) analysis was monitored from neonates' admission to 72 hours after birth, data such as CrSO2, transcutaneous arterial oxygen saturation (SpO2), oxygen saturation (SaO2), heart rate(HR), and mean arterial blood pressure (MABP) were collected simultaneously. cFTOE was calculated as follows: cFTOE = [(SpO2 - CrSO2)/SpO2]. Head ultrasounds were generally obtained at 6–48 hours, 1week, and 1month of age. The linear mixed model was used to analyze the blood gas value, CrSO2, cFTOE, and other system signals. Findings: 145 newborns were included in this study. CrSO2 was significantly related to partial pressure of oxygen (PaO2), glucose (Glu) within 72 hours after birth (F=6·53 and 5·82, respectively, P<0·05). Compared with intraventricular hemorrhage (IVH) infants, CrSO2 was decreased and cFTOE was increased over time at three days old neonates without IVH. In contrast, infants with IVH had gradually increased CrSO2 and decreased cFTOE within 72 hours after birth, and compared to infants without IVH they had lower mean CrSO2 (P<0·05) and higher mean cFTOE (P<0·05). Interpretation: Newborns with lower CrSO2 and higher cFTOE, who were prone to occur hypoperfusion or hypoglycemia. Neonates with IVH had lower CrSO2 and higher cFTOE within 72 hours after birth, and the change trends of them were opposed to the infants without IVH.Funding: National Natural Science Foundation of China supported this study(81471492).Declaration of Interests: The authors declare no conflicts of interest.Ethics Approval Statement: This study was a prospective cohort study and the protocol was approved by the ethics committee of Seventh medical center of Chinese PLA general hospital.

目的 总结伏立康唑治疗早产儿侵袭性真菌感染的疗效及安全性. 方法 2010年1月至2011年1月,北京军区总医院附属八一儿童医院极早产儿重症监护中心收治侵袭性真菌感染早产儿4例,均使用伏立康唑治疗.总结4例患儿的救治过程及效果,结合文献分析伏立康唑治疗早产儿侵袭性真菌感染的疗效及安全性. 结果 4例患儿胎龄27-3～34周,均为男婴,出生体重1 030～1 940 g.均曾全身性使用广谱抗生素治疗,预防性或治疗性使用氟康唑抗真菌治疗,但依然血培养阳性,近平滑假丝酵母菌2例,白假丝酵母菌和克柔假丝酵母菌各1例.遂给予静脉滴注伏立康唑(4 mg/kg,每12小时1次)治疗14～28 d.治疗后,全部患儿真菌血培养转阴,G试验阴性.2例患儿出现丙氨酸转氨酶升高(分别升高至79和51 U/L),停药后缓解;3例患儿发生早产儿视网膜病.未出现中枢神经系统并发症,无电解质紊乱、肾功能损害等情况发生,未发现较严重的药物不良反应. 结论 伏立康唑治疗早产儿侵袭性真菌感染有效,且短期内相对安全.

Objective To study the clinical features of term infants who have patent ductus arteriosus (PDA) and need for surgical ligation. Method Retrospective analyses were performed before and after surgical bedside ligation treatment about the clinical manifestation, laboratory examinations, environmental indicators, inflammatory markers, and biochemical changes on 16 cases of PDA term newborns who required ventilator support and were ibuprofen medications ineffective in the neonatal intensive care. Result All patients had dyspnea, shortness of breath after activities, cyanoderma, three depressions positive, precordial murmur, and lungs moist rales. Liver increased over the ribs 3cm in seven cases of neonatal. 3 cases had edema of both legs. Preoperative chest X-ray radiograph showed an increase of pulmonary blood and, lung markings, as well as patchy shadow. All patients had metabolic acidosis and hypoproteinemia (total protein, albumin, and prealbumin all decreased). The average inside diameter of PDA was 4.244 ± 1.080 mm (2.5mm to 6.0mm). The time of the PDA ligation was 17.938 ± 8.706 days after birth; the average preoperative intubation and mechanical ventilation time was 10.125 ± 6.087 days. Signs and symptoms in postoperative children improved obviously. Pulmonary blood was significantly reduced in lung at 3 days after operation. The average postoperative ventilation was 3.667 ± 2.743 days. Conclusion Bedside ligation closure of PDA is safe and effective for left to right shunt heavier, drugs ineffective, even combined with other cardiac malformations. Surgical closure patent ductus arteriosus is a good choice for the treatment of congestive heart failure, to prevent the occurrence of pulmonary vascular disease, and to short the duration of mechanical ventilation.

Objective To explore the risk factors related to the prognosis of necrotizing enterocolitis(NEC) among premature infants,so as to provide reference for making clinical decisions.Methods Totally,53 preterm infants(with gestational age≤32w and Bell stage Ⅱor Ⅲ),who were admitted to Bayi Children's Hospital Affiliated to Beijing Military Area Commands General Hospital from January 2008 to October 2012 were enrolled.Based on their prognosis,36 infants were assigned into the recovery group and 17 infants into the poor outcome group.Retrospective analysis was conducted on their clinical data.Results Single factor analysis showed that severe asphyxia,transfusion of red blood cells three days before NEC occurring,patent ductus arterious(PDA),pneumonia,decreased PLT count and prolonged prothrombin time(PT) were significantly correlated with the poor outcome of NEC(P0.05).Further analysis by Logistic regression indicated that severe asphyxia,transfusion of red blood cells three days before NEC occurring and decreased PLT count were independent predictors.Conclusions Severe asphyxia,transfusion of red blood cells three days before NEC occurring and decreased PLT count are high risk factors affecting the prognosis of NEC among premature infants.Great attention should be paid to these factors to improve the outcome of NEC.

目的 研究早产儿近平滑假丝酵母菌败血症临床特点. 方法 对2008年2月至2010年11月北京军区总医院附属八一儿童医院早产儿病房收治的11例近平滑假丝酵母菌败血症患儿的临床表现与入院时、确诊真菌感染时及抗真菌治疗2周时3个时间点的血常规、肝肾功能及血气分析进行对比分析.采用单因素方差分析、LSD法、Tamhane T2法以及非参数多组秩和检验进行比较. 结果 11例患儿发生感染的时间平均为(20.2±12.0)d,并发早产儿视网膜病变8例,气胸3例.临床表现主要包括呼吸暂停(6例)、血小板减少(5例)、反应差(4例)、皮肤灌注差(2例)以及撤机困难、体温升高各1例.11例患儿人院时、确诊真菌感染时及抗真菌治疗2周时的白细胞计数[(7.6±2.7)、(8.6±4.7)和(17.9±8.4)×109/L,F=10.671,P=0.000]、血小板计数[(209.1±77.7)、(73.0±40.9)和(257.4±163.5)×109/L,F=8.758,P=0.001]、平均红细胞体积[(120.9±1.1)、(100.4±13.7)和(91.5±8.3) fl,F=19.618,P=0.000]、平均红细胞血红蛋白含量[(39.4±2.2)、(33.0±3.6)和(30.8±2.2) g/L,F=28.885,P=0.000]、C反应蛋白[2.7(1.0～12.0)、27.0(1.0～96.0)和5.0(1.0～60.0) mg/L,F=10.611,P=0.005]、谷丙转氨酶[6.4(2.0～11.0)、12.0(3.0～81.0)和16.0(6.0～213.0) U/L,F=11.430,P=0.003]、总胆红素[110.1(51.5～324.8)、84.4(16.9～241.9)和56.7 (11.5～254.8) μmol/L,F=6.192,P=0.045]、肌酸激酶[(300.7±279.3)、(819.0±584.2)和(46.4±28.6) nmol/L,F＝12.178,P=0.000]、肌酸激酶同工酶[35.0(23.0～798.0)、107.0(32.0～250.0)和27.0(16.0～51.0) nmol/L,F=12.508,P=0.002]、乳酸脱氢酶[(618.3±248.6)、(815.0±156.0)和(232.8±61.3) μmol/L,F=32.205,P=0.000]、血钙水平[(1.7±0.4)、(2.0±0.3)和(2.0±0.2) mmol/L,F=3.535,P=0.042]差异有统计学意义.11例均使用氟康唑进行治疗,均对该药物敏感. 结论 近平滑假丝酵母菌败血症的临床表现主要为呼吸暂停、反应差、皮肤灌注差、血小板明显下降,体温升高并不常见.在怀疑早产儿患感染性疾病时,应同时考虑真菌感染,尤其是近平滑假丝酵母菌感染的可能.

<正>患儿,男,因胎龄31~(+5)5周,生后呼吸呻吟0.5小时人院。第1胎第1产,顺产出生,出生体重1570g,孕母胎膜早破81小时,胎盘、脐带、羊水无异常。1分钟、5分钟A pgari分为8分、10分,生后逐渐出现呼吸呻吟。人院查体:体温36.290,呼吸45次/分,脉搏144次/分,身长40 cm.头围27.5 cm,体重1545 go自然呼吸下全身皮肤颜色红润,反应可,前囟张力不高,胸廓对称,无畸形,无三凹征。双肺呼吸音弱,可闻及呻吟声,未闻及干湿啰音,心腹查体未见明显异常。诊疗经过:人院后给予CPAP辅助呼吸。1周

Objective To study the risk factors for secondary hydrocephalus after periventricular-intraventricular hemorrhage(PVH-IVH) in premature infants.Methods From Jun.2007 to Jun.2012,214 premature infants who were admitted to the Neonatal Intensive Care Unit after birth were enrolled and head ultrasonography showed PVH-IVH from 3 to 7 days after birth.They were classified into PVH-IVH alone group (n =161) and secondary hydrocephalus after PVH-IVH group (n =53) based on the different prognosis.Single factor and multivariate Logistic regression analysis were used to identify risk factors for secondary hydrocephalus after PVH-IVH.Results Single analysis indicated 8 factors associated with hydrocephalus after PVH-IVH,including male,gestational age ＜ 28 weeks,birth weight ＜ 1000 g,severe asphyxia,PVH-IVH Ⅲ or Ⅳ,metabolic acidosis,hyponatremia,and hypoglycemia or hyperglycemia (all P ＜0.05) ;multivariate Logistic regression analysis showed that male (OR =3.317),severe asphyxia (OR =13.838),PVH-IVH Ⅲ or Ⅳ (OR =43.281),and hyponatremia (OR =2.731) were independent risk factors for hydrocephalus after PVH-IVH (all P ＜ 0.05).Conclusions Male,severe asphyxia,PVH-IVH Ⅲ or Ⅳ,and hyponatremia are closely related to hydrocephalus after PVH-IVH in preterm infants.After PVH-IVH,these clinical risk factors should be followed closely in the prevention of hydrocephalus.

Objective To explore the morbidity and mortality rates for ＜32 weeks gestational age(GA) preterm infants in Bayi Children's Hospital,the Military General Hospital of Beijing,aims to identify clinically applicable strategies for improvement in outcomes of preterm infants.Methods Neonatal data were collected from 1838 infants of very low GA (＜ 32 weeks) who were born at or transferred to Bayi Children's Hospital,the Military General Hospital of Beijing,in 2010-2012.The infants were divided into 7 groups according to GA.The clinical data and complications were analyzed,and the mortality rate during initial hospitalization and major neonatal morbidity such as bronchopulmonary dysplasia (BPD),necrotizing enterocolitis (NEC),severe retinopathy of prematurity (ROP),severe intraventricular hemorrhage(IVH),and sepsis in survivors were assessed.Results From 2010 to 2012,there was a significant decreasing trend in the mortality rate for infants ＜32 weeks GA(6.8％ in 2010,4.0％ in 2011 and 2.7％ in 2012; x2 =12.269,P ＜0.01).The mortality rate were also decreased in each GA group from 2010 to 2012,but there was no significant difference(all P ＞0.05) except 28 week GA infants(P =0.01).The major morbidity rate in survivors of infants ＜ 32 weeks GA was 20.8％ in 2010,18.4％ in 2011 and 15.5 ％ in 2012 (x2 =6.436,P ＜ 0.05).The major morbidity rate in the survivors were also decreased in each GA group from 2010 to 2012,but there was no significant differences(all P ＞ 0.05).Mortality and major morbidity rates in all years were highest in infants at the lowest GAs (GA ＜ 28 weeks) especially in 25 weeks GA infants,and decreased with GA increasing.There was no significant difference in the incidence of moderate and severe BPD,severe NEC,Ⅲ or Ⅳ grade IVH,stage Ⅲ to Ⅴ ROP and sepsis for infants ＜ 32 weeks GA from 2010 to 2012 (all P ＞ 0.05).Conclusions Mortality and major neonatal morbidity in the survivors decreased in infants ＜32 weeks GA between 2010 and 2012.But extremely low GA infants(＜28 week) have high mortality and major morbidity known to be associated with long term adverse consequences.Optimized the management of severe complications can help to improve the outcome of the infants' medicare.

目的 研究早产儿真菌败血症的临床特点.方法 回顾性分析37例早产儿真菌败血症的临床资料.结果 早产儿生后平均17 d易发生真菌感染,前3位检出率是白假丝酵母菌(35.1％),近平滑假丝酵母菌(29.7％)和无名假丝酵母菌(10.8％).临床表现以血小板减低,反应差,灌注差,呼吸节律、心率的改变,低体温常见,其次是体重不增,喂养不耐受,机械通气中痰多,不易撤离呼吸机以及不明原因的病情恶化等.早产儿真菌感染时,血小板下降,血小板分布宽度、血小板平均体积及C反应蛋白(CRP)增高.CRP增高和血小板的降低可作为真菌感染的敏感指标并可辅助评估抗真菌治疗的有效性.真菌感染时对肝脏、心肌有损伤,ALT、TBIL、CK、CK-MB、ALB、LDH升高.药敏结果仅3例对氟康唑耐药.结论 对住院17 d左右的早产儿,血小板减低,反应差,灌注差,呼吸节律、心率的改变,低体温,体重不增,喂养不耐受等表现,结合血小板下降,CRP、血小板分布宽度、血小板平均体积增高,高度怀疑真菌感染.

Objective To analyze the clinical characteristics of Klebsiella pneumoniae infection in preterm infants. Methods Clinical data of 75 preterm infants infected with Klebsiella pneumoniae treated in BaYi Children's Hospital from February 6,2008 to February 10,2010 were retrospectively analyzed.The difference of auxiliary examination between early-onset and late-onset infection group were compared by two independent samples t test.Spearman correlation analysis and non-conditional Logistic regression analysis were used to analyze the high risk factors and the prognostic factors of Klebsiella pneumoniae infection in preterm infants. Results The incidence of Klebsiella pneumoniae infection was 2.8％ (75/2721) in preterm infants,and the mortality rate was 9.3％ (7/75). There were 71 cases of Klebsiella pneumoniae sepsis and 4 cases of Klebsiella pneumoniae pneumonia.Among 75 cases,63 cases were early-onset infection (onset age≤72 h) and 12 were late-onset infection (onset age＞72 h).All patients presented with poor response,heart rate during quiet sleep ＞ 160/min and low oxygen saturation.The mean corpuscular volume and mean corpuscular hemoglobin concentration in early-onset Klebsiella pneunoniae infection cases were higher than those in late-onset neonates [(128.87±24.60) fl vs (113.72±13.54) fl,t=-2.07,P＜0.05and (38.11±2.15) pg vs (36.98±1.05) pg,t=-2.76,P＜0.05].Low birth weight and caesarean section were associated with early-onset Klebsiella pneumoniae sepsis (r=0.250 and -0.240,P＜0.05). The prognosis of Klebsiella pneumoniae infection was associated with hospital stay and duration of premature rupture of membranes (r=0.368 and 0.318,P＜0.05). Conclusions There were no specific clinical manifestations for Klebsiella pneumoniae infection in preterm infants.Preterm infants with low birth weight,long duration of premature rupture of membranes,delivered by caesarean section and received invasive operation are likely to develop Klebsiella pneumoniae infection.

OBJECTIVE:To investigate the clinical features of Candida albicans sepsis in preterm infants.METHODS:Retrospective analysis was performed on the clinical data of 13 preterm infants with Candida albicans sepsis, who were born at 28 to 36 weeks of gestational age and who weighed between 1400 and 2815 g.RESULTS:The infants were infected with Candida albicans at the age of 19±11 d, with the main clinical manifestations being apnea, poor response, poor skin perfusion, blood oxygen concentration decrease, dark skin, yellowish skin, heart rate increase in the rest state, copious phlegm and difficulty in weaning from the ventilator. The infants showed significantly decreased platelet and increased C-reactive protein (CRP), platelet distribution width (PDW), alanine transaminase (ALT), creatine kinase isoenzyme-MB (CK-MB), total bilirubin (TBIL), creatine kinase (CK), and lactate dehydrogenase (LDH). CK and LDH were significantly decreased after 2 weeks of antifungal therapy. Only 3 cases developed drug resistance to fluconazole and these showed response when treated with voriconazole instead. Of the 13 cases, 10 were cured, 2 abandoned therapy and 1 died.CONCLUSIONS:The clinical manifestations of Candida albicans sepsis are nonspecific in preterm infants. Infectious diseases are probably caused by Candida albicans in preterm infants 2-3 weeks after birth. Preterm infants show decreased platelet and increased CRP, PDW, ALT, CK-MB, TBIL, CK, and LDH when infected with Candida albicans.

Objective To study the characteristic changes of platelets during candida sepsis in premature infants.Methods Clinical manifestations of 24 preterm infants who developed candida sepsis during hospitalization were analyzed retrospectively.Complete blood counts(CBC) and CRP were measured at 3 different time-points:at the time of admission,at the occurrence of fungal sepsis and after two weeks of anti-fungal treatment and the results were compared using one way ANOVA analysis.Results In all 24 premature babies who developed candida sepsis,13 patients were diagnosed with candida albicans septicemia,and 11 with candida parapsilosis sepsis.At the time of candida sepsis,the WBC amount was not significantly changed comparing with the level at the time of hospital admission [WBC:(8.5 ±4.3) × 10 9 /L vs.(8.6 ± 2.9) × 10 9 /L,P 0.05].In contrast,several parameters were significantly increased(P 0.05) during fungal sepsis [PLT:(99.8 ± 49.1) × 10 9 /L vs.(197.0 ±62.8) ×10 9 /L],CRP:[(29.3 ± 34.5) mg /L vs.(2.7 ± 3.4) mg /L];MPV:[(12.3 ± 0.9) fl vs.(11.1 ± 1.1) fl],and PDW:[(17.6 ± 3.2) % vs.(13.6 ± 2.7) %] P 0.05].Furthermore,platelet level in the candida parapsilosis sepsis group was lower than the level in the candida albicans group [(73.0 ± 40.9) × 10 9 /L vs.(122.5 ± 44.8) × 10 9 /L,P 0.05].The remaining parameters in CBC analysis at the three different time points among the two groups were not statistically significant(P 0.05).Conclusions The most prominent CBC indicator of fungal septicemia in premature infants is thrombocytopenia.Comparing with the platelet level during candida albicans sepsis,thrombocytopenia is more severe during candida parapsilosis sepsis.Therefore,close monitoring platelet level may help early diagnosis and treatment of candida sepsis.

Objective To study the characteristics of early laboratory tests on neonatal septicemia. Methods This was a prospective observational study with institutional ethics approval and written maternal consent. There were 3111 cases of clinical medical records of neonatal were selected from neonatal intensive care unit (NICU)of BaYi Children's Hospital in the General Military Hospital of Beijing from January 2009 to December 2010. a total of 173 neonates with neonatal septicemia were included in neonatal septicemia group (n=173)and the others included in control group(n=2938). The blood samples were collected from neonates for blood routine test and routine biochemical analysis, There had no significance difference between two groups among gender, birth weight, mode of delivery, gestational age at delivery, etc.(P>0.05). The relationship between neonatal septicemia related risk factors and results of blood routine test and routine biochemical analysis were analyzed by multivariate non-conditional logistic regression. Results Compared with the control group, hemoglobin (Hb), platelet (PLT), mean corpuscular volume (MCV), blood glucose (Glu)in neonatal septicemia group were significantly lower than those in control group (P<0.05), but C-reacting protein (CRP), total bilirubin (TBIL), direct bilirubin (DBIL), lactate (LAC), blood urea nitrogen (BUN) in neonatal septicemia group were significantly higher than those in control group (P<0.05). Multivariate non-conditional logistic regression analysis on risk factors of neonatal septicemia was used further, dependent variable, covariates were PLT, Hb, MCV, CRP, TBIL, DBIL, BUN, Glu, LAC, the results showed those close correlation risk factors of neonatal septicemia including: PLT, MCV, CRP, TBIL, BUN, Glu and LAC (OR=0.744-1.512, 95%CI: 0.631-1.772; P<0.05). Conclusions The higher of CRP, TBIL, LAC, BUN values and the lower of PLT, MCV, Glu vales, the greater of the risk of neonatal septicemia. It is necessary to take effective treatment measures as soon as possible. Key words: neonatal; septicemia; C-reacting protein; platelet; lactate

侵袭性真菌感染(invasion fungal infection,IFI)是指真菌侵入人体,在组织、器官或血液中生长繁殖,导致炎症反应和组织器官损伤的病理生理过程.早产儿因其不成熟的免疫系统及薄弱的生物屏障,且多需要侵入性的操作(包括静脉穿刺、导管置入等),更多的抗生素使用几率,让他们成为真菌感染的高发群体.如何预防其发病,减少IFI对早产儿的损伤,成为新生儿工作者关注热点.国内相关研究较少.现就早产儿侵袭性真菌感染的流行病学、检测手段、预防性治疗等方面现状与进展作综述如下.

1病例摘要患儿胎龄31+5周,因“生后呼吸呻吟0.5h”入院.患儿系第1胎第1产,侧切顺产娩出,出生体质量1 570 g,孕母胎膜早破81 h,胎盘、脐带无异常.新生儿Apgar评分为8～10分,生后逐渐出现呼吸呻吟.入院查体:自然呼吸下,全身皮肤颜色红润,反应可,胸廓对称,无畸形,三凹征阴性,双肺呼吸音弱,可闻及呻吟声,未闻及哕音,心率144次/min,心律齐,各瓣膜听诊区未闻及明显杂音,腹软,肝脾肋下未触及,肠鸣音存在,四肢肌张力低下.血常规提示白细胞总数增高,粒细胞比例高于正常.血气分析:PaCO2 50 mm Hg(1 mm Hg =0.133 kPa),PaO2 64 mm Hg.入院后给予氨溴索促进肺表面活性物质分泌,静脉营养支持.生后1周时患儿出现呼吸暂停数次,肺部听诊可闻及细湿性哕音,血气分析提示持续低氧血症,给予无创呼吸机辅助呼吸、头罩吸氧、抗感染治疗后呼吸困难缓解.但呼吸困难时有反复,生后第36天胸部CT提示双肺多发囊状影,提示先天性肺发育不良.加用利尿剂、小剂量激素雾化吸入治疗后仍反复呼吸困难,常在哭闹后发作,发作时患儿有发绀、抬肩、鼻翼扇动表现,三凹征阳性,双肺可闻及干性啰音.患儿生后第4天开始鼻饲喂养,吞咽功能欠协调,经口腔刺激按摩治疗后于生后第42天可以完全过渡到经口喂养.

OBJECTIVE To study the efficacy of bedside treatment by laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU). METHODS The clinical data of 30 cases of ROP who underwent peripheral laser ablation on bedside in the NICU from March to August 2009 were studied retrospectively. RESULTS A total of 59 eyes from 30 patients received the laser therapy, with a total cure rate of 95%. According to the International Classification of ROP, 26 eyes of 13 infants had zone 1 disease, and 33 eyes of 17 infants had zone 2 disease. The birth gestational age and birth weight as well as corrected gestational age and corrected weight at operation in the zone 1 disease group were significantly lower than those in the zone 2 disease group. The number of laser spots in the zone 1 disease group was significantly higher than that in the zone 2 disease group. The cure rate in the zone 2 disease group (100%) was significantly higher than that in the zone 1 disease group (88%). CONCLUSIONS Laser retinal photocoagulation on bedside in the NICU is effective for both zone 1 and zone 2 ROP. As compared with the infants with zone 2 disease, the infants with zone 1 disease may have a poor outcome.