OBJECTIVES:To evaluate the effect of colostrum oral immune therapy (COIT) on clinical outcomes in very low birth weight (VLBW) infants. METHODS:A computer-based search was conducted in databases including China National Knowledge Infrastructure, Wanfang Data, Weipu Database, Chinese Biomedical Literature Service System, PubMed, Embase, Web of Science, the Cochrane Library, and CINAHL for randomized controlled trials regarding the application of COIT in VLBW infants published from the establishment of the database to February 2024. Meta analysis was performed using RevMan 5.3 software. RESULTS:A total of 14 randomized controlled trials were included, involving 1 386 VLBW infants, with 690 in the COIT group and 696 in the control group. The results showed that COIT significantly reduced the incidence of clinical late-onset sepsis (LOS) (RR=0.75, 95%CI: 0.64-0.88, P<0.001), the incidence of blood culture-proven LOS (RR=0.72, 95%CI: 0.57-0.92, P=0.008), mortality rate (RR=0.70, 95%CI: 0.52-0.95, P=0.020), the incidence of necrotizing enterocolitis (RR=0.65, 95%CI: 0.46-0.92, P=0.020), and the incidence of feeding intolerance (RR=0.49, 95%CI: 0.29-0.80, P=0.004). It also shortened the time to achieve full enteral nutrition (MD=-2.13, 95%CI: -4.03 to -0.23, P=0.030). CONCLUSIONS:COIT can reduce the incidence rates of LOS, necrotizing enterocolitis, and feeding intolerance, as well as the mortality rate, while also shortening the time to achieve full enteral nutrition in VLBW infants.

Objectives We aimed to identify the factors associated with necrotizing enterocolitis (NEC) and to assess the associations of the initial empirical antibiotic therapy (IEAT) duration and antibiotic therapy duration/hospital stay ratio (A/H ratio) before NEC with subsequent NEC in very low birth weight (VLBW) infants with gestational age less than 32 weeks without proven sepsis. Methods A retrospective study was conducted at the NICU of the First Affiliated Hospital of Medical University of Anhui province from June 2015 to May 2022, and 567 VLBW infants with gestational age less than 32 weeks were included in the study. We divided the VLBW infants into those with and without NEC according to modified Bell’s criteria. We then used descriptive statistics to identify the factors associated with NEC and multivariate analyses to evaluate the associations of IEAT duration and A/H ratio with the occurrence of NEC. Results Of the 567 VLBW neonates admitted to our center, 547 survived and reached the normal discharge criteria. Fifty-one infants (8.99%) were diagnosed as showing NEC. Infants with NEC had a longer total parenteral nutrition time, total enteral nutrition time, and IEAT duration, as well as a higher A/H ratio than those without NEC. In multivariate analyses adjusted for the other factors, IEAT duration was associated with an increased odds of NEC [odds ratio (OR) = 1.267; 95% confidence interval (CI), 1.128–1.423], and the A/H ratio was also associated with increased odds of NEC (OR = 8.718; 95% CI, 2.450–31.030). For the A/H ratio, the area under the curve (AUC) was 0.767 and the ideal cutoff was 0.357, and the sensitivity and specificity were 0.843 and 0.645, respectively. Conclusion Prolonged antibiotic therapy may increase the risk of NEC in VLBW infants with a gestational age of fewer than 32 weeks and should be used with caution.

目的 研究影响胎龄小于32周的极/超低出生体质量儿支气管肺发育不良及其严重程度的危险因素,为新生儿临床工作提供帮助.方法 选取2019年1月至2021年1月于安徽医科大学第一附属医院新生儿科住院超过28天的130例胎龄小于32周的极/超低出生体质量儿,根据支气管肺发育不良诊断标准分为支气管肺发育不良(BPD)组54例和非支气管肺发育不良(nB-PD)组76例;其中54例BPD早产儿,根据BPD诊断标准分为轻度BPD组43例、中重度BPD组11例.分析该130例患儿的围产期因素,其中孕母因素包括是否使用产前激素、生产方式、是否多胎、是否为初产妇、产妇年龄、是否合并相关疾病如重度子痫前期、绒毛膜羊膜炎、阴道流液、产前发热、胎膜早破;新生儿因素包括胎龄、出生体质量、Apgar评分、性别、首选通气方式、机械通气时间及是否使用INSURE技术.对各组间有统计学差异的因素,采用logistic回归分析探究影响患儿BPD及其严重程度的危险因素.结果 logistic分析提示,胎龄越小(OR=0.110,95％CI:0.007～0.638)、机械通气时间越长(OR=2.178,95％CI:1.046～4.534)、用氧时间越长(OR=1.635,95％CI:1.148～2.327)和未采用INSURE技术(OR=0.006,95％CI:0.000～0.972)是患儿发生BPD的危险因素.机械通气时间越长(OR=1.567,95％CI:1.228～1.720)、用氧时间越长(OR=1.358,95％CI:1.009～1.828)是患儿BPD严重程度的危险因素.结论 胎龄小、未采用INSURE技术、机械通气时间及用氧时间长是患儿发生BPD的危险因素;机械通气时间和用氧时间越长是患儿BPD严重程度的危险因素.因此,对于胎龄小于32周的极/超低出生体质量儿,应首选INSURE技术及无创通气,减少机械通气及用氧时间.

Background: Necrotizing enterocolitis (NEC) is a common life-threatening disease in very low birth-weight (VLBW) infants. Probiotic prophylaxis is often used in the VLBW infants as a protective factor. Objectives: This retrospective study assessed risk factors of NEC and observed the effect of probiotic prophylaxis duration on NEC. Methods: The study encompassed 237 VLBW neonates admitted to the NICU of the First Affiliated Hospital of the Anhui Medical University, Anhui Province, who received probiotic prophylaxis. In this study, the participants’ clinical characteristics, treatments, and outcomes were compared between the NEC (n = 19) and non-NEC (n = 218) groups. Moreover, factors associated with NEC were analyzed by logistic regression, and the probiotic prophylaxis duration was analyzed by receiver operating characteristic (ROC) curves. Results: As the analysis revealed, 19 (8.02%) neonates were suffering from NEC. The probiotic prophylaxis duration (OR = 0.693, 95% CI = 0.574 - 0.836) was associated with the risk of NEC after adjusting for gestational age, duration of empirical antibiotic use, RBC transfusion, and late-onset sepsis. For the probiotic prophylaxis duration, the areas under curve was 0.870, the ideal cutoff was 10.5 days, and the sensitivity and specificity were 0.844 and 0.895, respectively. Conclusions: Probiotic prophylaxis was associated with the decreased risk of NEC. The findings revealed that an effective duration of use might be more than 10.5 days of probiotic prophylaxis application.

Objective To investigate the effect of intestinal flora from children with Irritable Bowel Syndrome (IBS) on intestinal motility and acid-sensitive ion channel expression in mice. Methods Fecal samples of children with IBS identified according to Rome Ⅳcriteria and healthy children were collected and made into fecal microbiota solution. A pseudo-aseptic mouse model was established, mice were randomly divided into two groups:the control group was given fecal microbiota solution of healthy children,and the experimental group was given fecal microbiota solution of IBS children. The intestinal propulsion rate was measured, Serum Motilin (MOT) and Gastrin (Gas) were determined by ELISA, the expression and distribution of ASICs in intestinal tissues of mice were determined by immunohistochemistry. Results Compared with the control group, intestinal propulsion rate, serum MOT and Gas level were significantly reduced in the experimental group (P＜0.05), the expression of ASIC3 in the small intestine and colon of mice from experimental group was significantly increased (P＜0.05);the expression of ASIC3 in small intestine and colon was negatively correlated with the intestinal propulsion rate (P＜0.05). Conclusions Intestinal flora of children with IBS can promote the expression of ASIC3 in intestinal tissue of mice, and the effect of intestinal microorganism on intestinal motility may be related to the activation of ASICs.

目的 探讨极低出生体重儿肺出血死亡的原因,对影响肺出血预后的危险因素进行分析.方法 选取2015年8月至2019年12月发生肺出血的极低出生体重儿41例,按照预后分为存活组(25例)和死亡组(16例);并按照胎龄分层,超早产儿12例(胎龄≤28周),早产儿29例(28周<胎龄<37周).分析各组的一般临床情况、止凝血功能及肺出血发生后的通气模式及参数选择情况.结果 早产儿组存活组出生体重大于死亡组,两组有统计学差异(P<0.05);早产儿组存活组活化部分凝血酶原活动度(APTT)低于死亡组,两组有统计学差异(P<0.05);存活组的高频振荡通气使用率高于死亡组(P<0.05);存活组呼气末正压PEEP显著高于死亡组,两组有统计学差异(P<0.01).结论 出生体重和活化部分凝血酶原活动度是影响早产儿肺出血预后的危险因素;肺出血发生后,高频振荡通气优于同步间歇指令通气;呼气末正压是影响极低出生体重儿肺出血预后的危险因素.

Objective To investigate the effect of intestinal flora in children with functional constipation (FC) on expression of acid-sensitive Ion channel 3(ASIC3) in rats and their regulation in intestinal motility. Methods Faeces of FC children identified according to RomeⅣ criteria and healthy children from the First Affiliated Hospital of Anhui Medical University from December 2017 to June 2018 were collected, and then made into fecal microbiota solution.A pseudo - sterile rat model was established, according to the random number table method, and the rats were randomly divided into the treatment group and the control group, with 12 rats in each group, then the treatment group was given fecal microbiota solution of the children with FC and the control group was given fecal microbiota solution of the healthy children.The visceral sensitivity and intestinal propulsion rate of rats were determined by means of abdominal withdrawal reflex (AWR), while the intestinal microorganism of rats and children with FC were determined by 16SrDNA high-throughput sequencing, and the expressions of ASIC3 of intestinal in mRNA and protein were determined by adopting fluorescence quantitative PCR and Western blot. Results The species and quantity of intestinal flora of the children with FC and rats implanted with FC faecal bacteria were reduced(all P<0.05), and firmicutes and bacteroidetes were the main bacteria; compared to the control group, the small intestine propulsion rate(52% vs.74%) and visceral sensitivity(78 mmHg vs.63 mmHg) of the treated group were significantly decreased compared with those in the control group (all P<0.05); the mRNA (0.003 1±0.000 8 vs.0.012 4±0.002 5) and protein levels of ASIC3 (0.013 2±0.001 9 vs.0.072 1±0.008 7) in the small intestine were down-regulated significantly(all P<0.05); and the mRNA (0.002 8±0.000 7 vs.0.009 4±0.001 1) and protein levels of ASIC3(0.038 2±0.004 5 vs.0.089 7±0.009 4) in the colon were down-regulated significantly(all P<0.05). Conclusions Children with FC have intestinal flora disorder, and intestinal flora of FC children may affect intestinal motility by down-regulating the expression of intestinal ASIC3 in rats. Key words: Acid-sensitive ion channels; Intestinal flora; Visceral sensitivity; Intestinal motility; High throughput sequencing

Objective To explore the efficacy and safety of prolonged intravenous infusion duration of meropenem for neonatal late-onset sepsis.Methods One hundred and twenty neonates with late-onset sepsis were randomly divided into 3-hour group and 30-minute group,with 60 cases in each group.The two groups were administered meropenem(20 mg/kg per time,every 8 hours) for intravenous infusion durations of 3 hours and 30 minutes respectively. The duration for clinical symptoms remission was recorded. The levels of complete blood cell count,C-reactive protein(CRP) and procalcitonin(PCT) before treatment and after one week of treatment,death and application of assisted ventilation therapy were compared between the two groups.The incidence of adverse effects was observed in both groups.Results After treatment,the WBC count,proportion of neutrophil granulocyte,levels of CRP and PCT in both groups decreased compared to the levels before treatment (all P<0.05),and the levels in the 3-hour group were lower than those in the 30-minute group (all P<0.05).In the 3-hour group,the duration for clinical symptoms remission was shorter,the proportions of death and cases using assisted ventilation therapy were lower compared to the 30-minute group(all P<0.05).The levels of ALT,AST,urea nitrogen and creatinine in both groups were within normal limits,and no significant differences in those indices between the two groups(all P>0.05).Conclusion For neonatal late-onset sepsis,the intravenous administration of meropenem for 3 hours can achieve better efficacy compared to the intravenous administration for 30 minutes,and does not increase the incidence of adverse effects.

Objective To observe the effects of budesonide for preventing bronchopulmonary dysplasia .Methods 56 patients with ex-tremely low birth weight born from the neonatal department of the First Affiliated Hospital of Anhui Medical University ,with gestational age of ＜32 weeks and the weight of birth ＜1 500 g,who need ventilation and PS replacement therapy ,were randomly divided into 2 groups,with 28 cases in each group,group A:control group,mechanical ventilation +PS therapy.Group B:mechanical ventilation +PS +budesonide van trachea.Observe the time of tube extraction ,high flow oxygen inhalation time ,oxygen stopping time,and hospital stays.Observe the untoward effect of the groups :ichoremia,necrotizing enterocolitis ,neonatal leukodystrophy ,and bronchopulmonary dysplasia.Two groups of patients were followed up for six months ,followed by long-term follow-up:pulmonary hypertension ,arterial ducts,respiratory tract infections ,and backward growth.Results Compare group B with group A ,the time of tube extraction ,high flow oxygen inhalation time,oxygen stopping time were statistically significant (P＜0.01).There was no statistically significant difference in hospital stays (P＞0.05);In adverse reactions,the incidence of bronchopulmonary dysplasia was statistically significant (0 vs.5,P＜0.05).There was no statistically significant difference in the incidence of other adverse reactions (P＞0.05)and the others were no statistical difference(P＞0.05).Conclusion Using budesonide can reduce the time of oxygen using and mechanical ventilation ,and reduce the incidence of BPD of vary low birth weight premature.

OBJECTIVE:To study the changes in C-reactive protein (CRP) and procalcitonin (PCT) levels in neonates with necrotizing enterocolitis (NEC) and their clinical significance. METHODS:According to the modified Bell's staging criteria, 142 neonates with NEC were divided into stage I group (n=40), stage II group (n=72), and stage III group (n=30). All the 18 neonates who underwent surgical treatment had stage III NEC, and among the 124 neonates who underwent conservative treatment, 12 had stage III NEC and the others had stage I or II NEC. CRP and PCT were measured before treatment, on the next day after treatment, and during the recovery stage. RESULTS:Before treatment, on the next day after treatment, and during the recovery stage, the stage III group had a higher level of CRP than the stage I and stage II groups (P<0.05). On the next day after treatment, the stage II and stage III groups had an increase in CRP (P<0.05), and the stage III group had an increase in PCT (P<0.05). The stage II and stage III groups had lower CRP and PCT in the recovery stage than before treatment and on the next day after treatment (P<0.05). The stage III group had higher incidence rate of respiratory failure and rate of mechanical ventilation than the stage I and stage II groups (P<0.05), and the stage III group had a higher incidence rate of sepsis than the stage II group (P=0.010). Gastrointestinal perforation and intestinal stenosis were observed in 10 and 8 neonates respectively in the stage III group. CRP on the next day after treatment had a value in predicting stage III NEC (P<0.05), and CRP before treatment and on the next day after treatment had a value in predicting the need for surgery (P<0.05). CONCLUSIONS:Levels of CRP and PCT and their changes can help with the early diagnosis of Bell stage II/III NEC, and CRP can be used to predict the development of stage III NEC and the need for surgery.

Objective To explore the value of detection of cerebellar cistem width with MRI in evaluating fetal posterior fossa abnormality.Methods A total of 189 pregnant women (24-36 gestational weeks) suspected with abnormal development of fetal posterior fossa in our hospital were selected and received MRI examination to analyze the impact of cerebellar cistem width on the developmental malformation of posterior fossa and the prognosis.Results Among the 189 fetus,there were 69,88 and 32 fetus with a cerebellar cistern width ＜8.0,8-10 and ＞10 mm respectively.There were 27 cases of pure cerebellar cistern expansion and five cases of non-pure cerebellar cistern expansion (one case of cistema magna arachnoid cyst and four cases of Danva's malformation) among those ＞ 10mm.According to postpartum ultrasound or MRI follow-up visit,in the groups ＜8.0,8-10 and ＞ 10 mm,there were two cases (2.9％),five cases (5.7％) and 10 cases (31.3％) of posterior fossa malformation respectively.The proportion of posterior fossa malformation in ＞10 mm group was significantly higher than that in the groups ＜8.0 and 8-10 (P ＜ 0.05).The postpartum gross motor,fine activity,cognitive function,language function and social function scores in fetus in the groups ＜8.0,8-10 and ＞ 10 mm were from high to low,showing statistical difference (P ＜ 0.05).Conclusion MRI can clearly show the structure of cerebellar cistern and carry out accurate radial line measurement.When the cerebellar cistern width is increased to ＞10 mm,the probability of malformation and poor postpartum development is markedly increased.

目的：评价酚妥拉明在毛细支气管炎合并心衰早期治疗中的应价值。方法：2013年1月～2014年12月，安医附院儿科2病区住院收治毛细支气管炎合并心衰120例，其中未给予酚妥拉明纳入对照组60例，给予酚妥拉明治疗60例纳入治疗组，对比相关指标。结果：治疗组症状缓解时间、湿罗音消失时间、住院天数低于对照组，差异具有统计学意义（ P＜0．05）；治疗组治愈率86．67％、好转率11．67％、无效率1．67％，对照组则为78．33％、30．00％、8．33％，两组临床疗效差异无统计学意义（P＞0．05）。结论：酚妥拉明用于毛细支气管炎合并心衰的早期治疗可加速患儿康复。

Objective:To evaluate the phentolamine in the early treatment of bronchiolitis complicated with heart failure should be value.Methods:December January 2013 to 2014,the Affiliated Hospital of Anhui Medical University Department of pediatrics ward 2 hospital treated bronchiolitis complicated with heart failure in 120 cases,which did not give phentolamine were included in the control group (60 cases),treated with phentolamine in treating 60 cases into treatment group and comparison of relevant indicators.Results:in the treatment group,the symptoms remission time,wet rales disappearance time,length of hospital stay was lower than that of the control group,the difference has statistical significance (P<0.05);treat-ment group,the cure rate was 86.67%,improvement rate 11.67%,effective rate of 1.67%and control group was 78.33%and 30.00%and 8.33%, two groups of clinical curative effect difference no statistical significance (P>0.05).Conclusion:phentolamine for early treatment of bronchiolitis can accelerate the rehabilitation of children with heart failure.