Objective To determine the effect of the addition of sodium glycerophosphate to intravenous nutrition on bone metabolism in very low birth weight or very preterm infants.Methods The medical records of 116 very preterm infants with a birthweight ＜1 500 g or a gestational age ＜32 weeks were retrospectively reviewed. The cases were divided into observation group（53 cases） and control group（63 cases） according to whether or not Sodium Glycerophosphate Injections was added to the intravenous nutrition. The infants in both groups were given calcium and vitamin D supplementation, and in the observation group, sodium glycerophosphate injection was added to intravenous nutrition at 2nd day after birth. The both groups were treated for 2-3 weeks. The general conditions of mothers, comorbidities during pregnancy, and gestational age, sex, and birth weight of the affected child were recorded. The levels of serum calcium, serum phosphorus and serum alkaline phosphatase（ALP） of premature infants were collected at the 1st, 2nd, 4th and 6th weeks after birth were compared.Results No clinical signs and symptoms such as hyperhidrosis, irritability, easily startled and occipital baldness were found in either group. There was no significant difference in the general data of the children and mothers between the 2 groups（P＞0.05）. At the 1st, 2nd, 4th and 6th weeks after birth, the levels of serum calcium in the 2 groups was higher than that at the 1st day after birth, and at the 1st, 2nd, 4th and 6th weeks after birth, the children in the observation group were higher than those in the control group（P＜0.05）. At the 1st, 2nd, 4th and 6th weeks after birth, the levels of serum phosphorus in the 2 groups was lower than that at the 1st day after birth. At the 1st, 2nd, 4th and 6th weeks after birth, the levels of serum ALP in both groups were higher than those at the 1st day after birth, At the 2nd, 4th and 6th weeks after birth were higher than those at the 1st week after birth. In the control group, the level of ALP at 6 weeks after birth was higher than that at the 2nd and 4th weeks after birth, while in the observation group, the level of ALP at the 6th week after birth was higher than that at the 2nd week after birth, but lower than that at the 4th week after birth; at the 2nd, 4th, 6th weeks after birth, the level of ALP in the observation group was lower than that in the control group（P＜0.05）.Conclusion Phosphorus element supplementation with Sodium Glycerophosphate Injection added early to intravenous nutrition significantly improved the bone metabolic parameters in preterm infants, which was conducive to the stability of serum calcium and phosphorus and bone metabolism.

Objective:To summarize the clinical manifestations, treatment and outcome of neonatal pseudo-Bartter syndrome caused by maternal hyperemesis gravidarum.Methods:This retrospective study collected the clinical data of a set of premature twins with pseudo-Bartter syndrome who were admitted to Hebei Children's Hospital in September 2022. Clinical features of the cases were summarized with descriptive analysis.Results:The twins born with a gestational age of 30 +3 weeks required tracheal intubation and mechanical ventilation due to premature birth and respiratory distress. They were transferred to our hospital 2 h after birth. The mother suffered from hyperemesis gravidarum and even had severe vomiting complicated by hypokalemia 3 d before delivery. The blood gas analysis of the twins at 2 h after birth showed severe metabolic alkalosis, hyponatremia, hypokalemia, hypochloremia and hyperlactatemia. Hyperglycemia appeared at 6 h after birth, and scleredema neonatorum at 24 h after birth. No significant abnormalities were found in the tandem mass spectrometer analysis of blood or urine samples. Whole-exome sequencing showed no abnormalities in the genes related to the phenotype. The twins were diagnosed with neonatal pseudo-Bartter syndrome. After symptomatic and supportive treatment, metabolic alkalosis and electrolyte disorders in the twins were completely resolved 4 d after birth. They were cured and discharged 51 d after birth without recurrence. Follow-up revealed no abnormalities in the physical or neurological development of the twins at 11 months after birth. Conclusions:Maternal hyperemesis gravidarum can lead to neonatal pseudo-Bartter syndrome, characterized by severe metabolic disorders as well as respiratory and circulatory dysfunction at the early stage after birth. Timely diagnosis and treatment are conducive to good prognosis in the affected neonates.

Beckwith-Wiedemann 综合征(BWS)是一种人类基因组印记疾病,它与染色体11p15区域的遗传和表观遗传变化有关,该区域包括调节胎儿和产后生长的印记基因[1].具有多种临床表现,包括新生儿低血糖、巨舌症、腹壁缺陷、过度生长和易发生胚胎性肿瘤等[2].

目的 探讨儿童血流感染的病原菌分布情况及中性粒细胞膜碱性磷酸酶(mNAP)、可溶性白细胞分化抗原14亚型(Presepsin)、髓系细胞触发受体-1(TREM-1)的早期预测价值.方法 收集2018年5月—2019年5月在河北省儿童医院住院的血流感染患儿207例作为血流感染组,分析其血培养阳性率及病原菌分布情况.根据血培养结果分为阳性亚组(107例)和阴性亚组(100例);另纳入健康体检儿童100例作为健康对照组.分析各组患儿血清降钙素原(PCT)、C反应蛋白(CRP)、mNAP、Presepsin、TREM-1水平的差异.采用受试者工作特征曲线(ROC)分析血清mNAP、Presepsin、TREM-1水平对儿童血流感染的预测价值.结果 血流感染组患儿血清PCT、CRP、mNAP、Pre-sepsin、TREM-1水平均显著高于健康对照组(t=300.40,97.29,308.60,78.74,59.84,P均<0.05),且阳性亚组患儿血清PCT、CRP、mNAP、Presepsin、TREM-1水平高于阴性亚组(t=14.89,37.72,8.81,43.05,11.09,P均<0.05);细菌培养阳性亚组中,革兰阴性菌38例(35.51％),革兰阳性菌69例(64.49％),革兰阴性菌感染患儿血清PCT、CRP、mNAP、Presepsin、TREM-1水平高于革兰阳性菌感染患儿(t=4.58,5.21,15.23,7.07,3.86,P均<0.05).ROC曲线显示,血清mNAP、Presepsin、TREM-1水平预测儿童血流感染的AUC分别为0.861(95％CI 0.813～0.909)、0.792(95％CI 0.731～0.853)和0.894(95％CI 0.849～0.940).结论 儿童血流感染以革兰阳性菌占多数,较高的mNAP、Pre-sepsin、TREM-1水平对血流感染的确诊具有早期预警价值.

目的:分析新生儿化脓性脑膜炎合并弥漫性气脑的临床特点及病因。方法:对河北省儿童医院新生儿科2019年1月收治的1例新生儿阴沟肠杆菌性脑膜炎合并弥漫性气脑的病例资料进行回顾性分析，中文以"新生儿、脑膜炎、气脑或颅内积气"为检索词在中国知网、万方数据库，英文以"(neonate OR newborn) AND (meningitis) AND (pneumocephalus)"为检索式在PubMed数据库中检索建库至2020年12月报道的临床资料完整的文献，总结该病的临床特点及病因。结果:患儿，男，6日龄，因"发热伴吃奶差1 d"入院。患儿系足月剖宫产娩出，生后5日龄出现发热伴吃奶差，6日龄入院时哭声尖直，前囟张力高，血C-反应蛋白85.13 mg/L，脑脊液白细胞数77 485×10 6/L，多核为主，给予抗感染、呼吸支持，但患儿病情持续恶化，7日龄出现频繁抽搐，前囟膨隆，双侧瞳孔不等大。头颅CT：双侧大脑半球脑水肿、脑疝、颅内积气。9日龄血和脑脊液培养回报阴沟肠杆菌，13日龄头围增大至37 cm，无自主活动，复查头颅CT示弥漫性颅内积气，家长放弃治疗后患儿死亡。经文献检索发现中文病例报道1篇，英文9篇，加上本例共纳入11例患儿。胎龄范围32~39周，足月儿6例。5例患儿入院时年龄<7 d。最主要的首发症状为吃奶量减少或拒乳、体温异常，均病情迅速恶化，出现头围增大、脑疝或多器官功能衰竭，CT平扫均有弥漫性颅内积气。10例患儿死亡，仅1例存活，随访至9月龄，存在严重神经系统发育障碍。10例患儿血和脑脊液细菌培养阳性，5例为柯氏柠檬酸肠杆菌，4例阴沟肠杆菌，1例奇异变形杆菌。 结论:因细菌感染导致的颅内积气在新生儿期罕见，一旦发生，病死率极高。临床医生需早期识别感染的高危因素，及时给予广谱抗生素治疗，以降低病死率及致残率。

患儿女,生后16d,主因"腹泻12 d,间断发热8d,咳嗽4 d加重伴呼吸发憋1 d"入住河北省儿童医院新生儿科.患儿系第3胎第2产,胎龄40+6周,出生体重3 700 g,否认窒息抢救史,母乳喂养.生后4 d无明显诱因出现腹泻,生后8 d出现间断发热,体温最高38.9℃,当地医院查血常规白细胞计数28.32×109/L、C反应蛋白(C-reactive protein,CRP)53mg/L,予头孢哌酮舒巴坦钠治疗,无好转.生后12 d出现咳嗽,并逐渐加重,生后15 d出现呼吸发憋,复查CRP 150 mg/L,生后16 d转入我院.母亲有过1次不明原因流产史,长兄8岁,体健.否认家族中有反复发热、严重感染、不明原因夭折成员.

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

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

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