OBJECTIVE:To examine the associations between neonatal-maternal characteristics and mechanical ventilation duration in critically ill neonates, and to explore differences between respiratory distress syndrome (RDS) and non-RDS subgroups. METHODS:This retrospective study included 319 neonates who required mechanical ventilation in the neonatal intensive care unit of our hospital between 1 January 2022 and 31 December 2024. Data on neonatal demographics, Apgar scores, initial arterial blood gas parameters and maternal characteristics, including age, delivery mode and comorbidities, were collected. The primary outcome was total ventilation duration. Correlation and subgroup analyses were performed. RESULTS:The median duration of total mechanical ventilation (invasive + non-invasive) was 133.0 (interquartile range (IQR): 146.0) h. All neonates received invasive mechanical ventilation with a median duration of 48.0 (IQR: 58.0) h, and 83.7% subsequently required non-invasive ventilation support. Ventilation duration was negatively correlated with gestational age (r = -0.503, p < 0.001) and birth weight (r = -0.473, p < 0.001) and positively correlated with blood pH (r = 0.142, p = 0.011), using PS (r = 0.439, p < 0.001) and bicarbonate (r = 0.141, p = 0.012). No significant associations were found with Apgar scores, lactate or maternal age. Compared with non-RDS neonates, those with RDS had significantly longer ventilation durations (135.0 (IQR: 147.0) vs 73.5 (IQR: 100.8) h, p < 0.001), as well as lower gestational age and birth weight, altered blood gas parameters and a higher rate of caesarean deliveries (all p < 0.05). Maternal comorbidity rates did not differ significantly between the groups (p > 0.05). The results of multivariate regression analysis showed that the independent factors affecting mechanical ventilation time were gestational age, pulmonary surfactant, birth weight, blood pH, HCO3- and mode of delivery. CONCLUSIONS:Neonatal factors, especially gestational age and birth weight, critically impact ventilation duration in critically ill neonates. Tailored respiratory management addressing diagnosis and key perinatal factors (gestational age, birth weight) may improve outcomes.

Background Existing research on neonatal mortality risk factors mainly emphasizes maternal preconception risks and severe antenatal comorbidities, leaving a significant gap in understanding the risk factors among uncomplicated pregnancies.This cohort study aims to identify the key risk factors for neonatal mortality within the first two weeks of birth among healthy mothers.​ Methods A cohort study was conducted, collecting data on delivery, labor complications, neonatal variables, and transfers. Multivariate logistic regression, weighted restricted cubic spline (RCS) curves, threshold effect, and interaction analyses were employed to explore the associations between these factors and neonatal mortality risk.​ Results Multivariate logistic regression analysis revealed that higher gestational age (P < 0.001) and birth weight (P < 0.001) were protective factors against neonatal mortality. Conversely, threatened abortion (P = 0.006), history of perinatal asphyxia (P = 0.014), intraventricular hemorrhage (P = 0.016), neonatal shock (P = 0.014), teratogenesis (P < 0.001), and seizures (P = 0.010) significantly increased the risk of neonatal mortality. RCS modeling demonstrated a non-linear inverted J-shaped relationship between gestational age, birth weight, and mortality, with elevated risk observed when gestational age was < 33 weeks and birth weight was < 1,530 g. No significant interaction was detected between gestational age and birth weight (P > 0.05).​ Conclusion Neonates with a gestational age < 33 weeks, birth weight < 1,530 g, and co-existing conditions face a substantially higher mortality risk. Clinicians should exercise enhanced vigilance and prioritize targeted interventions for these high-risk neonates in clinical practice. Trial registration This cohort study have been registered in the Chinese Clinical Trial Registry (Registration No. ChiCTR2500096024,Registration Date 2025-01-16).

目的 探讨早产儿发生脑室周围-脑室内出血(PIVH)的影响因素.方法 选取2017年3月至2021年12月北京市朝阳区妇幼保健院新生儿科收治的509例早产儿为研究对象,根据颅脑超声检查结果将发生PIVH的早产儿作为出血组,未发生PIVH的早产儿作为未出血组.采用单因素分析及多因素Logistic回归分析探讨早产儿发生PIVH的影响因素.结果 509例早产儿中共180例(35.4％)发生PIVH,其中Ⅰ级30例、Ⅱ级123例、Ⅲ级25例、Ⅳ级2例.出血组母亲高龄者占比及患儿胎龄≤32周、出生体质量≤1500 g、出生后窒息、呼吸困难、使用有创呼吸机、使用肺表面活性物质、首次感染指标异常者占比高于未出血组(P<0.05).多因素Logistic回归分析结果显示,患儿胎龄≤32周〔OR=2.831,95％CI(1.314,6.102)〕、出生体质量≤1500 g〔OR=6.210,95％CI(2.439,15.807)〕、首次感染指标异常〔OR=9.532,95％CI(5.710,15.910)〕是早产儿发生PIVH的危险因素,使用表面活性物质〔OR=0.311,95％CI(0.141,0.685)〕是早产儿发生PIVH的保护因素(P<0.05).结论 患儿胎龄≤32周、出生体质量≤1500 g、首次感染指标异常是早产儿发生PIVH的危险因素,使用肺表面活性物质是早产儿发生PIVH的保护因素.

Objective To investigate the epigenetic regulation mechanism of folic acid deficiency in inhibition of the expression of Brachyury, a key developmental gene, and its effect on the differentiation of embryoid bodies (EBs). Methods Firstly, the cell model of folic acid-deficient embryonic stem cells (ESCs) differentiated into EBs was established. According to the folate level, they were divided into normal group, folate deficiency group and folate supplement group. MassARRAY system and RT-PCR were used to detect the methylation and expression level of Brachyury gene in EBs to clarify the effect of the deficiency on the expression. RT-PCR and chromatin immunoprecipitation (ChIP)-qPCR were used to detect the expression of DNA methylase and histone methylation modification, respectively to explore the epigenetic regulation mechanism of folic acid deficiency on Brachyury expression. At the same time, the expression levels of pluripotent markers and triploblastic markers were detected to explore the effect of abnormal expression of Brachyury on EBs differentiation. Results ① In the differentiation of ESCs into EBs under folic acid deficiency, the expression level of Brachyury was decreased significantly, only 0.19±0.08 times of that in the normal group, and folate supplementation increased the level to 0.62±0.14 times of that of the normal group. The methylation level of promoter region of Brachyury in EBs was increased from (30.75±0.5)% in the normal group to (37.93±1.24)% in the folic acid-deficient group, and decreased to (31.88±2.67)% after folic acid supplementation. ② The expression level of DNMT3b, DNA de novo methylase, in folic acid-deficiency group was increased by 1.59±0.31 times higher than that of normal group. H3K27me3 modification was enhanced in the EBs with folate deficiency, and the relative enrichment level was 0.22±0.03 in the normal group, 0.32±0.02 in the folate deficiency group, and 0.24±0.01 in the folate supplement group. ③After the differentiation of folic acid-deficient ESCs into EBs, the cell morphology was significantly changed with the smaller EBs spheres and irregular shape. Folic acid supplementation resulted in normal volume and regular shape of EBs spheres. ④ ESCs pluripotent markers, Nanog and Sox2, were significantly up-regulated, and their relative levels in EBs of folate deficiency group was 3.18±0.95 and 4.23±1.59 times higher than those of normal group. The expression of ectodermal marker Fgf5 and mesodermal marker Gsc in folic acid-deficient EBs were significantly down-regulated, which was 0.42±0.04 times and 0.61±0.20 times in folic acid-deficient EBs when compared with those in normal EBs, respectively. Conclusion Through the dual epigenetic regulation of DNA methylation and histone H3K27 methylation, folic acid deficiency causes significant down-regulation of Brachyury and ultimately leads to the blocked differentiation of EBs.

Objective:To analized brain function monitoring results with amplitude- integrated electroencephalogram (aEEG) in neonatal ward.Methods:The clinical data of 1 370 newborns received aEEG monitoring in Neonatal Department of our hospital from September 2017 to August 2019 were retrospectively analyzed.Results:Among 1 370 neonates undergoing aEEG examination,abnormalities were demonstrated in 308 cases with an overall abnormal rate of 22.5%. The abnormal rate in critical neonates was 27.7% (240/868),while that in non-critical neonates was 13.6% (68/502) (χ2=36.304, P<0.01). Neonates with convulsion had the highest aEEG abnormal rate (57.1%, 16/28), followed by small for gestational age (SGA) (48.8%, 20/41), asphyxia (41.5%, 49/118), premature (31.1%, 92/296)and erythrocytosis (29.7%, 11/37). Among 308 cases of abnormal aEEG, the main types of abnormalities were abnormal background activity in 229 cases (74.4%),insignificant sleep-wake cycles in 139 cases (45.1%) and abnormal original EEG in 117 cases (40.0%). Among 308 cases of abnormal aEEG, 38.0%(117 cases) had corresponding clinical manifestations and 62.0%(191 cases) had no clinical manifestations. The sensitivity of aEEG monitoring is 73.6%(117/159), and the specificity is 84.2%(1 020/1 211). Conclusions:The abnormal rate of aEEG is high in hospitalized neonates,especially in critically ill neonates. It is necessary to carry out routine aEEG examination for hospitalized neonates in order to early detect brain function damage.

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.

Abstract. Background:. Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China. Methods:. The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD. Results:. A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082–4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606–3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044–1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061–2.424), DRI (OR, 2.094; 95% CI, 1.328–3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679–4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777–6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996–0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379–0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160–0.467) were preventive factors for BPD (all P < 0.05). Conclusion:. Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.

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.

B族链球菌(group B streptococcus，GBS)是新生儿感染的主要病原之一。母亲存在泌尿生殖道、胃肠道GBS定植是引起新生儿早发型GBS疾病的主要危险因素。约50%存在GBS定植的产妇在胎膜破裂后或分娩过程中将GBS垂直传播给新生儿。如产时未预防性应用抗生素，GBS阳性母亲所生新生儿早发型GBS疾病发生率可达1%～2%。美国妇产科学会建议孕妇在妊娠36～37周进行GBS筛查，筛查阳性者应在分娩前≥4 h接受抗生素预防治疗(胎膜完整且产程没有发动的剖宫产分娩者无需预防)。如有必要终止妊娠，不能单纯为在分娩前用满4 h抗生素而延迟分娩。

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound has received increasing attention from neonatal physicians. Nevertheless, clear reference standards and guideline limits are needed for accurate application of this diagnostic modality. This document aims to summarize expert opinions and to provide precise guidance to help facilitate the use of the lung ultrasound in the diagnosis of neonatal lung diseases.

报道1例出生时极重度贫血并发多脏器功能损伤新生儿患者的临床资料,介绍新生儿危重症救治经验.

Objective To study the levels of antibodies against bordetella pertussis among pregnant women and neonates in Beijing. Method From December 2016 to March 2017, pregnant women and their newborns from three women and children′s hospitals in Beijing were enrolled in this study. 3 ml of venous blood from the mothers and 3 ml of umbilical cord blood from neonates were drawn.Pertussis bacillus IgG antibody (PER-IgG) and pertussis toxin IgG antibody (PT-IgG) were tested using enzyme-linked immunosorbent assay. χ2 test was used to compare the positive rate of pertussis IgG antibodies in maternal and cord blood in the three hospitals. Correlational analyses of the antibodies levels in each hospital were conducted. The demographic characteristics, history of cough during pregnancy and history of DTaP vaccination of the mothers were collected via questionnaires. Result A total of 612 pairs of venous blood and cord blood samples were collected, including 4 mothers delivered twins and 616 cases of cord blood sample were collected. No history of pertussis were found in the 612 mothers. Among the 616 cases of umbilical cord blood, positive rate of PER-IgG was 13.3％ (82/616), positive rate of PT-IgG was 0.5％ (3/616). Among 612 cases of venous blood from the mothers, positive rate of PER-IgG was 7.7％ (47/612), positive rate of PT-IgG was 0.3％ (2/612). Positive rates of PER-IgG and PT-IgG in the mothers′ venous blood were not correlated with their residences (P=0.676 and 0.544). Positive rates of PER-IgG (r=0.842, P<0.001) and PT-IgG (r=0.619, P<0.001) in the mothers′ blood were positively correlated with the positive rate in umbilical cord blood. Conclusion This study shows that the positive rate of PER-IgG is very low in the maternal and umbilical cord blood in Beijing. Positive correlations of PER-IgG and PT-IgG between mother and umbilical cord blood were existed. Most mothers and their newborns do not have enough protection against pertussis.

目的 了解北京地区新生儿细胞色素P450(cytochrome P450,CYP450)重要单核苷酸多态性(single nucleotide polymorphisms,SNPs)位点及其代谢表型的分布情况,为儿童的精准用药提供支持.方法 利用Taqman-PCR方法检测1000例新生儿的CYP2D6(100C>T),CYP2C9(1075A>C),CYP2C19(681G>A),CYP2C19(636G>A),CYP3A4(878T>C)和CYP3A5(6986A>G)位点基因型及等位基因频率,并计算其代谢表型分布.结果 ①CYP2D6(100C>T)和CYP3A5(6986A>G)位点的杂合型基因型频率较高,分别为51.7％和44.9％.CYP3A5(6986A>G)位点的突变型等位基因频率较高,为61.8％.②CYP2D6,CYP2C9和CYP3A4均以快代谢型为主,检出率分别为79.0％,99.8％和100％.慢代谢型主要是CYP2C19和CYP3A5基因,检出率分别为12.5％和39.4％.③CYP450各亚型基因型分布在不同性别间比较差异均无统计学意义(χ2=0.113～3.316,均P>0.05).结论 CYP3A5(6986A>G)和 CYP2D6(100C>T)在新生儿人群中的突变频率较高,CYP3A5 和 CYP2C19 的慢代谢型人群分布较高,在临床用药中要注意结合基因检测结果来确定用药剂量.

Background: Neonatal stroke (NS) is a common, severe central nervous system disease that is the main cause of death and disability in neonates. Therefore, great attention has already been paid to it by clinicians. However, much knowledge remains yet to be discovered about this disease. Objectives: To understand the clinical features, increase awareness, reduce missed diagnoses or misdiagnoses, and improve the prognosis of NS. Methods: A retrospective analysis was conducted on clinical data from 51 patients with NS recording perinatal factors, clinical manifestations, imaging findings, and treatment outcomes. Results: 1) Logistic multi-factor regression analysis showed that cesarean section, perinatal hypoxia, small for gestational age and maternal-fetal infection were the main risk factors of NS, 2) A total of 84.3% of the patients presented neurological symptoms or signs, of which 78.4% had convulsions as the primary symptom or major manifestation, and 67.5% had positioning significance, while 15.7% of the patients had no clinical manifestations, 3) Onset of symptoms: 76.7% within 24 hours after birth, 86.0% within 48 hours, 90.7% within 72 hours, and 7.0% after 3 days, with only 2.0% after 7 days, 4) Bilateral hemisphere involvement was present in 49.1% of cases, left hemisphere involvement in 31.4%, right hemisphere and basal ganglia involvement in 19.6% each, 5) The incidence of sequelae in living babies was 45.8%, and the overall rate of a poor prognosis was 49.1%. Conclusions: 1) Convulsion was the most common primary symptom of NS,15.7% of the patients had no clinical manifestations. 2) The patients had an NS onset within several minutes to hours after birth, with > 75% having an onset within 24 hours, 85% within 48 hours, and > 90% within 72 hours after birth, 3) Caesarean section, perinatal hypoxia and small for gestational age were closely associated with NS, 4) Patients often exhibited bilateral hemisphere injury.

目的 探讨小儿细菌性痢疾的临床诊断方法,比较磷霉素钙与利福昔明对小儿细菌性痢疾的疗效.方法 选择2009年6月至2009年9月诊治的28例儿童细菌性痢疾患儿,采集一般资料并行实验室检查后,随机分为对照组12例和治疗组16例,对照组采用磷霉素钙治疗,治疗组采用利福昔明治疗,疗程5～7天.比较两组患儿的退热时间、腹痛缓解时间和腹泻缓解时间.结果 临床诊断细菌性痢疾的患儿其志贺菌阳性率为25％,与阴性患儿的临床症状比较差异无显著性.利福昔明治疗组与磷霉素钙治疗组,二者在退热时间、腹痛缓解时间及腹泻缓解时间方面无明显差异.结论 小儿细菌性痢疾的诊断需结合临床表现和流行病学特点.在细菌性痢疾的治疗方面,磷霉素钙与利福昔明是等效的.