BACKGROUND:Moderate-to-severe preterm brain injury (PBI), including intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), remains an important cause of adverse neurodevelopmental outcomes in preterm infants. Early risk stratification using routinely collected clinical data may help prioritize surveillance in vulnerable infants. METHODS:We retrospectively included 318 preterm infants admitted between 2015 and 2024 as the development cohort. Thirty-three candidate predictors derived from perinatal factors, first laboratory tests within 24 h of admission, and selected early hospitalization variables were evaluated. Seven machine-learning algorithms were developed using stratified 10 × 5 nested cross-validation with prespecified preprocessing, class-balancing, and feature-selection procedures. Candidate models were compared primarily using the mean fold-level area under the receiver operating characteristic curve (AUROC). After model selection, the finalized LightGBM model was calibrated using Platt scaling, and its pooled out-of-fold (OOF) performance was summarized. Two prespecified thresholds (Youden and high-sensitivity) were used for risk stratification. A small independent temporal cohort of 35 infants was used for preliminary external validation. RESULTS:PBI occurred in 62/318 infants (19.5%) in the development cohort and 6/35 infants (17.1%) in the temporal external cohort. During candidate-model comparison, LightGBM achieved the highest mean fold-level AUROC (0.768, 95% CI 0.708-0.825). The finalized 14-feature LightGBM model, evaluated using pooled OOF predictions after Platt calibration, yielded an AUROC of 0.747 (95% CI 0.679-0.811), a PR-AUC of 0.392, and a Brier score of 0.136. At the Youden threshold (0.18), sensitivity was approximately 0.70 and specificity approximately 0.85; at the high-sensitivity threshold (0.10), sensitivity was approximately 0.95 and specificity approximately 0.50. Key predictors included ventilation status and early physiologic and laboratory indicators. In the small temporal external cohort (n = 35), the AUROC was 0.897 (95% CI 0.672-1.000); however, this high point estimate should not be overinterpreted because of the limited sample size, wide confidence interval, and suboptimal calibration, and should therefore be considered preliminary. CONCLUSIONS:We developed an interpretable LightGBM model using routinely available early postnatal and early hospitalization data to support risk stratification for PBI in preterm infants. The model showed moderate internal discrimination and a positive net benefit across clinically relevant thresholds. Preliminary temporal external validation in a small cohort yielded highly uncertain estimates; larger multicenter studies are needed to confirm generalizability, refine calibration, and determine the most appropriate implementation strategy before routine clinical use.

Abstract Background To explore the effect of non-pharmacological interventions (NPIs) on respiratory pathogen profiles among hospitalized infants aged 0–3 months in Beijing during the coronavirus disease 2019 (COVID-19) pandemic. Methods Respiratory specimens were collected from 1,184 infants aged 0–3 months who were hospitalized for acute respiratory infection at the Children’s Hospital affiliated with the Capital Institute of Pediatrics from January 2018 to December 2023. The data were divided into three groups—the pre-epidemic (January 2018 to December 2019), epidemic prevention and control (January 2020 to December 2022), and post-epidemic (January 2023 to December 2023) groups—based on the outbreak of COVID-19 and the implementation and termination of NPIs. The specimens were tested for 14 respiratory pathogens, including influenza virus A (Flu A), influenza virus B, respiratory syncytial virus, parainfluenza virus (PIV), adenovirus (ADV), human metapneumovirus (HMPV), human bocavirus, human rhinovirus (HRV), coronavirus, Chlamydia trachomatis, Chlamydia pneumoniae (C.pn), Mycoplasma pneumoniae, Bordetella pertussis, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results A total of 1,184 infants, including 649 males and 535 females, with acute respiratory infections were admitted. The positive detection rate for respiratory pathogens was 51.77% (n = 613). In 2023, the proportion of infants with respiratory infections after the epidemic was 19.4% (319/1646), the positive detection rate of respiratory pathogens was 68.3% (218/319), and the mixed infection detection rate of respiratory pathogens was 16.1% (35/218). Prior to the epidemic, these rates were 11.9% (431/3611), 37.1% (160/431), and 5.0% (8/160), respectively. During the epidemic prevention and control period, these rates significantly increased to 12.4% (434/3486), 54.1% (235/434), and 11.1% (26/235) (P < 0.05), respectively. Post-epidemic, the proportion of newborns testing positive for respiratory pathogens decreased, while the number of infants aged 29–90 days significantly increased. The proportion of admission weight and contact history with respiratory patients increased significantly compared to before and during the epidemic, with statistical significance (P < 0.05). After the epidemic, a total of 13 respiratory pathogens were detected throughout the year. There were statistically significant differences in the detection rates of Flu A, PIV, SARS-CoV-2, HRV, HMPV, ADV, and C.pn before, during, and after implementation of the NPIs during the COVID-19 epidemic (P < 0.05). Post-epidemic, the detection rates of Flu A, PIV, and SARS-CoV-2 were significantly higher than those before and during the epidemic (P < 0.017). The detection rates of HRV, HMPV, and ADV significantly increased after the epidemic compared to those before the epidemic (P < 0.017). Before the epidemic, the positivity rate of respiratory pathogens was high in the first and fourth quarters. After the termination of NPIs, the positive detection rate decreased in the first quarter but increased in the second, third, and fourth quarters, with a statistically significant difference (P < 0.05). Conclusion The implementation and lifting of COVID-19 NPIs have caused significant changes in the detection and seasonal distribution of respiratory pathogens in infants aged 0–3 months in Beijing. NPIs temporarily reduced the detection rate of respiratory pathogens in infants during the prevalence of COVID-19. Understanding the prevalence of respiratory pathogens before and after the epidemic is particularly important for the prevention and control of respiratory diseases in infants.

Objective:To investigate the incidence and risk factors of hypertensive disorders in pregnancy (HDP) in high altitude areas and their influence on maternal and infant outcomes.Methods:This was a retrospective case-control study. A total of 220 newborns were selected as the high altitude group, who were born to 216 mothers with HDP and admitted to the Neonatal Intensive Care Unit of the Lhasa People's Hospital from June 1, 2018, to June 1, 2020. The low altitude group consisted of 235 newborns born to 231 mothers with HDP and admitted to the Department of Neonatology of the Children's Hospital Affiliated to Beijing Capital Institute of Pediatrics from January 1, 2018, to December 31, 2021. Differences in the types of HDP between the two groups and the risk factors for the high incidence of preeclampsia-eclampsia and early-onset preeclampsia in high altitude area were analyzed. The influences of HDP in high and low altitude areas on maternal and infant outcomes were compared. Statistical analysis was performed using t-test, Mann-Whitney U test, Pearson Chi-square test, or continuous correction Chi-square test, and univariate and multivariate logistic regression analysis. Results:Maternal age and the proportions of primiparae and women of advanced age or having irregular prenatal examination were greater in the high altitude group than those in the low altitude group (all P<0.05). Besides, the incidence of early-onset preeclampsia, eclampsia, preeclampsia-eclampsia, and chronic hypertension complicated by preeclampsia were also higher in the high altitude group (all P<0.05). Multivariate logistic regression analysis showed that high altitude was a risk factor for the development of preeclampsia-eclampsia ( OR=4.437, 95% CI:2.582-7.626). Adverse pregnancy history ( OR=2.576, 95% CI:1.217-5.452) and irregular prenatal examination ( OR=2.862, 95% CI:1.412-5.800) were independent risk factors for early-onset preeclampsia in pregnant women in high altitude areas. Twin-pregnancy was a protective factor for early-onset preeclampsia in pregnant women in high altitude areas ( OR=0.183, 95% CI: 0.054-0.623). The incidence of maternal heart failure [7.9% (17/216) vs 0.4% (1/231), χ2=15.98], placental abruption [7.9% (17/216) vs 3.5% (8/231), χ2=4.11], hemolysis, elevated liver function and low platelet count syndrome [14.4% (31/216) vs 1.7% (4/231), χ2=24.64], premature delivery [86.1% (118/216) vs 73.6% (170/231), χ2=10.79], fetal growth restriction [52.3% (115/220) vs 18.7% (44/235), χ2=56.26], fetal distress [18.2% (40/220) vs 8.1% (19/235), χ2=10.26], neonatal asphyxia [29.5% (65/220) vs 11.1% (26/235), χ2=24.26], severe asphyxia [8.6% (19/220) vs 2.6% (6/235), χ2=8.10] and the proportion of neonates requiring mechanical ventilation within 24 h after birth [69.5% (153/220) vs 42.6% (100/235), χ2=33.54] as well as neonatal death within 7 d after birth [5.5% (12/220) vs 1.3% (3/235), χ2=6.22] in the high altitude group were significantly higher than those in the low altitude group (all P<0.05). Conclusion:High altitude is a risk factor for preeclampsia-eclampsia, and the adverse effects of HDP on mothers and infants are more severe in high altitude areas.

Objective:To analyze the risk factors and clinical features of premature infants with bronchopulmonary dysplasia(BPD)at high altitude in Tibet and low altitude in Beijing.Methods:A retrospective case-control study was conducted.The clinical data of children with gestational age ≤32 weeks admitted to the Department of Neonatology of Lhasa People′s Hospital(altitude of 3 600 m)and the Department of Neonatology of Children′s Hospital Affiliated to Capital Institute of Pediatrics(altitude of 50 m)from January 1, 2018 to December 31, 2021 were collected.Cases were divided into BPD group and non-BPD group.Premature infants with BPD were divided into high altitude group and low altitude group according to different altitudes.The clinical characteristics and high risk factors of BPD were analyzed.Results:There were 379 premature infants with gestational age ≤32 weeks, 351 were included in the study, including 110 cases in group and 241 cases in non-BPD group.There were 48 cases in high altitude group and 62 cases in low altitude group.The incidence of BPD in high altitude areas(Lhasa)was 38.7%(48/124), among which mild, moderate and severe BPD accounted for 75.0%(36 cases), 18.8%(9 cases)and 6.3%(3 cases), respectively.The incidence rates of BPD were 100%(2/2), 86.7%(13/15)and 38.7%(33/107) in gestational age <28 weeks, 28 to 29 + 6 weeks and 30 to 32 weeks, respectively.There was a statistically significant difference among different gestational age groups( χ2=19.696, P<0.001). The incidence of BPD in low altitude areas(Beijing)was 27.3%(62/227), among which mild, moderate and severe BPD accounted for 74.2%(46 cases), 4.8%(3 cases)and 21.0%(13 cases), respectively.The incidence rates of BPD in gestational age<28 weeks, 28 to 29 + 6 weeks and 30 to 32 weeks were 100%(15/15), 45.6%(36/79)and 8.3%(11/133), respectively.There was a statistically significant difference among different gestational age groups( χ2=77.474, P<0.001). The incidence of BPD in high altitude areas was significantly higher than that in low altitude areas( χ2=4.841, P=0.028). Multivariate regression analysis showed that high altitude( OR 146.893, 95% CI 19.044-1 133.064), birth weight( OR 0.996, 95% CI 0.993-0.999), asphyxia( OR 4.187, 95% CI 3.020-21.670), non-invasive mechanical ventilation( OR 1.171, 95% CI 1.106-1.240)and invasive mechanical ventilation( OR 1.198, 95% CI 1.065-1.347)were significantly correlated with the occurrence of BPD.The gestational age at birth, small for gestational age infant, the fraction of inspired oxygen and the incidence of pregnancy induced hypertension in pregnant women in high altitude group were higher than those in low altitude group( P<0.05). The incidence of patent ductus arteriosus, the use time of noninvasive and invasive mechanical ventilation, the length of hospital stay, the age of mother, the application of prenatal hormone and the twin ratio in high altitude group were significantly lower than those in low altitude group( P<0.05). Conclusion:High altitude in Tibet is a high-risk factor for the occurrence of BPD in preterm infants.Strengthening maternal health care in high altitude areas of Tibet and doing a good job in asphyxia resuscitation in delivery room may be important measures to reduce BPD in preterm infants.

Background At present, there are a variety of mechanical ventilation mode of breathing for premature infants with respiratory distress syndrome (NRDS) , but the application of these techniques in Tibetan Plateau are limited because of the low air pressure and oxygen content and etc. The NRDS initial breathing support measures can only be performed with INSURE technique (tracheal intubation—injection of pulmonary surfactant—nasal continuous positive airway pressure ventilation after extubation) and invasive mechanical ventilation (MV) . It is currently unclear what factors influence the selection of the NRDS initial breathing support therapy in premature infants in Tibetan Plateau. Objective To explore the factors in selection of supporting NRDS initial breathing strategies in high altitude area and evaluate the early clinical outcomes of different supporting strategies. Methods The clinical data of 183 premature infants diagnosed with NRDS and their mother's general data in Paediatri neonatal ward of Lhasa People's Hospital from June 2018 to June 2020 were analyzed retrospectively. According to the accepted initial respiratory support mode, they were divided into INSURE group (n=122) and MV group (n=61) . Multifactorial Logistic regression analysis was used to explore influencing factors in selection of NRDS initial breathing support treatment. Results The gestational age, birth weight, 1 min, 5 min and 10 min Apgar scores in MV group were lower than those in INSURE group and the proportion of prenatal application of glucocorticoids was higher than that in INSURE group (P<0.05) . The difference was statistically significant after comparing the composition of premature infants of different gestational ages between INSURE group and MV group (P<0.05) . The difference was statistically significant as well after comparing the composition of NRDS 5 min Apgar score between INSURE group and MV group (P<0.05) . The mortality and incidence of pulmonary hemorrhage in MV group were higher than those in INSURE group (P<0.05) . Among the surviving infants, the incidence of bronchopulmonary dysplasia (BPD) in MV group was higher than that in INSURE group〔43.2% (16/37) vs 16.1% (18/112) 〕 (P<0.05) . Multifactoral Logistic regression analysis showed that gestational age, Apgar score at 5 minutes after birth and whether to use prenatal glucocorticoid were influencing factors in selecting MV for premature infants with NRDS (P<0.05) . Conclusion In Tibet Plateau, the gestational age at birth, Apgar at 5 minutes after birth and whether to use glucocorticoids before delivery are closely related in the selection of the NRDS initial breathing support strategy.

Objective:To explore the prognostic indicators and influencing factors of neonatal asphyxia in Tibet.Methods:From March 2019 to March 2020, the clinical data of 126 asphyxiated newborns admitted to the neonatology department of Lhasa People's Hospital were retrospectively studied. According to the prognosis, they were divided into good prognosis group and poor prognosis group, and the clinical characteristics of the two groups were compared. The predictive value of Apgar score after birth, arterial blood gas analysis within 6 hours [pH, alkali residue (BE)] and their combined detection on the prognosis of asphyxiated newborns was analyzed. Logistic regression analysis was used to analyze the related factors affecting the prognosis of asphyxiated newborns.Results:31 cases (24.6%) in the poor prognosis group and 95 cases (75.4%) in the good prognosis group. The Apgar score at 1, 5 and 10 minutes after birth and pH and BE within 6 hours in the poor prognosis group were significantly lower than those in the good prognosis group (all P<0.05). The incidence of meconium stained amniotic fluid, fetal intrauterine distress, brain damage, lung damage, myocardial damage, kidney damage, abnormal coagulation function and multiple organ damage after asphyxia in the good prognosis group were significantly higher than those in the good prognosis group (all P<0.05). The Apgar score at the 1, 5 and 10 minutes after birth combined with arterial blood gas analysis (pH and BE) within 6 hours after birth had high predictive value for the prognosis of asphyxiated newborns, with the area under receiver operating characteristic (ROC) curve of 0.79, sensitivity of 68.4% and specificity of 90.3%. Multivariate regression analysis showed that meconium stained amniotic fluid ( OR=4.501, 95% CI: 1.262-16.056), lung damage ( OR=5.004, 95% CI: 1.007-24.866) and brain damage ( OR=10.786, 95% CI: 2.726-42.673) were independent risk factors affecting the prognosis of neonatal asphyxia ( P<0.05). Conclusions:In Tibet, there are many factors affecting the poor prognosis of neonatal asphyxia. High attention and intervention should be given to mothers in perinatal period and asphyxiated newborns in order to reduce the incidence of poor prognosis of neonatal asphyxia.

目的 探讨新生儿重症监护病房(neonatal intensive care unit,NICU)中不同胎龄危重新生儿甲状腺功能异常的发病情况及临床转归,为NICU中新生儿甲状腺功能异常的诊断提供帮助.方法 选取2019年10月至2020年10月拉萨市人民医院NICU收治住院的未行新生儿筛查的危重新生儿.根据出生胎龄分为胎龄≥37周组、胎龄32～36+6周组、胎龄<32周组,比较不同胎龄组新生儿甲状腺功能异常发生情况和临床转归.结果 共纳入271例危重新生儿,≥37周组154例,32～36+6周组80例,<32周组37例.胎龄<32周组和胎龄32～36+6周组甲状腺素(thyroxine,T4)、游离三碘甲腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、三碘甲腺原氨酸(triiodothyronine,T3)水平均低于胎龄≥37周组,胎龄<32周组促甲状腺素(thyroid stimulating hormone,TSH)水平高于胎龄≥37周组和胎龄32～36+6周组,差异有显著性(P<0.05);胎龄<32周组F4、FT3、FT4、T3水平与胎龄32～36+6周组比较差异无显著性(P>0.05);胎龄32～36+6周组TSH水平与胎龄≥37周组比较差异无显著性(P>0.05).胎龄与FT4、T4、FT3、T3呈正相关,相关系数r分别为0.254、0.364、0.405、0.297(P均为0.000);与TSH呈弱负相关,相关性系数r为-0.116(P=0.006).甲状腺功能异常的总发生率为34.3％,胎龄<32周组甲状腺功能异常发生率高于胎龄≥37周组和胎龄32～36+6周组(P<0.05).三组先天性甲状腺功能减退症、高TSH血症发生率差异无显著性(P>0.05).胎龄<32周组暂时性低甲状腺素血症、低T3综合征发生率明显高于其他两组(P<0.05).3例先天性甲状腺功能减退症患儿干预治疗4周后TSH、FT4恢复至正常水平.对于暂时性甲状腺功能异常的患儿未给予药物干预,在出生后4～6周的随访中,85.1％的高TSH血症、100％的暂时性低甲状腺素血症、95.2％的低T3综合征患儿恢复正常.结论 NICU中危重新生儿甲状腺功能异常发生率高.暂时甲状腺功能异常、无甲状腺功能减退临床表现的危重患儿不建议积极药物干预,但需定期监测甲状腺功能.

Objective:To study the characteristics of eosinophilia in preterm infants with gestational age (GA)<34 weeks and its correlation with bronchopulmonary dysplasia (BPD).Method:From January 2018 to March 2020, preterm infants with GA less than 34 weeks were admitted to our hospital and their clinical data within 8 weeks after birth were reviewed retrospectively. The infants were assigned into different groups according to the degree of eosinophilia. Logistic regression was used to analyze the relationship between eosinophilia and BPD.Eosinophilia in children with and without BPD at different GA were compared. The eosinophil counts (EC) in children with different degrees of BPD within 8 weeks after birth were studied. The predictive value of EC at different time points within 4 weeks after birth for BPD was analyzed using receiver operating characteristic (ROC) curve.Result:A total of 234 cases of premature infants were included and 152 cases were diagnosed as eosinophilia, with an incidence of 65.0%. The mild, moderate and severe eosinophilia accounted for 23.7%(36/152), 50.7%(77/152) and 25.7%(39/152), respectively and EC peaked (1.47×10 9/L) at the 4th week after birth. EC levels are related to clinical features including GA, premature rupture of membranes, sepsis, BPD, red blood cell infusion, tracheal intubation, and postnatal steroid use. Statistically significant differences existed in the incidence and severity of BPD among children with different degrees of eosinophilia ( P<0.001). After adjusting for multiple factors such as GA, birth weight, RDS, sepsis, invasive ventilator duration and other factors, eosinophilia was an independent risk factor for BPD ( OR=11.424, 95% CI2.474~52.742, P=0.002). The EC at the 3rd week after birth had the highest sensitivity to predict the occurrence of BPD (78.1%) and the area under the ROC curve was the largest (95% CI 0.663~0.799, P<0.001). Conclusion:The incidence of eosinophilia in premature infants is high, reaching peak at the 4th week after birth. Eosinophilia may be associated with BPD and EC at the 3rd week after birth has clinical value in predicting the occurrence of BPD.

Objective:To investigate the correlation between platelet parameters of very low birth weight infants and severe complications and length of hospital stay in premature infants, and to explore whether platelet parameters are helpful to reflect the occurrence of severe complications in premature infants and predict the length of hospital stay.Methods:General conditions, clinical characteristics, and platelet parameters [platelet (PLT), platelet mean volume (MPV), platelet distribution width (PDW), and platelet quality index (PMI)] on the first day of after birth of very low birth weight infants admitted to the Neonatal Department of Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2016 to June 2020 were retrospectively analyzed. Children with intracerebral hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) were grouped by different degree of disease and correct gestational age at discharge grouping, the clinical features and platelet parameters were compared. Multivariate Logistic regression was used to analyze the correlation between platelet parameters and these 3 diseases, and the ROC curve was used to study its predictive value for moderate to severe complications and length of hospital stay in premature infants.Results:A total of 177 children with very low birth weight were included, the incidence of moderate to severe IVH, moderate to severe BPD and moderate to severe NEC respectively were 8.5%, 22.0%, 5.1%. (1) PMI of the moderate and severe IVH group was significantly lower than that of the non-moderate and severe IVH group, and PMI was an independent risk factor for developing moderate to severe IVH in children with very low birth weight (OR=0.008, 95%CI: 0.000-0.255, P=0.021). The AUC predicted by PMI was 0.825 (95%CI: 0.744-0.905, P＜0.001), and the optimal cut-off point was 1.77 fl/nl. (2) MPV of moderate and severe BPD group was significantly higher than that of non-moderate and severe BPD group, which was an independent risk factor for the occurrence of moderate and severe BPD (OR=3.613, 95%CI: 1.840-7.095, P＜0.001). The AUC predicted by MPV was 0.784 (95%CI: 0.704-0.865, P＜0.001), and the optimal cut-off point was 11.05 fl. (3) MPV of group with long hospital stay was higher than group with short hospital stay, after adjusting for multiple factors, such as gestational age, mother gestational hypertension, gestational HELLP syndrome, premature rupture of membranes, moderate and severe BPD, moderate and severe NEC, higher MPV was an independent risk factor for long hospital stay (OR=2.052, 95%CI: 1.307-3.221, P=0.002). The AUC of long hospital stay predicted by MPV was 0.656 (95%CI: 0.548-0.763, P=0.002). The sensitivity was 54% and specificity was 82%, when the cut-off point was 11.35 fl.Conclusion:Platelet parameters on the first day after birth are associated with severe complications and length of hospital stay in premature infants. PMI was associated with moderate to severe IVH, MPV was associated with moderate to severe BPD and length of hospital stay. Monitoring platelet parameters on the first day after birth may be of certain value for prognosis assessment.

目的 探讨血清氨基末端脑钠肽前体(amino-terminal pro-brain natriuretic peptide,NTproBNP)对新生儿常见疾病的血流动力学评估价值.方法 选择2017年10月至2018年3月收治于首都儿科研究所附属儿童医院的新生儿368例.采用电化学发光免疫分析方法检测血清NTproBNP,采用Spearman相关性检验和秩和检验回顾性分析影响NTproB-NP水平的因素,采用ROC曲线下面积分析NTproBNP对于伴血流动力学异常的动脉导管未闭(hemodynamic significantpatent ductus arteriosus,hsPDA)的诊断价值.结果 NTproBNP水平在足月与早产、不同性别之间差异无统计学意义(P=0.413,P=0.887),且与日龄呈负相关(r=-0.238,P＜ 0.000).在新生儿日龄＜7d组,NTproBNP与CRP、肌酸激酶同工酶(creatine kinase isoenzyme-MB,CK-MB)、肌红蛋白(myoglobin,MYO)相关(r=0.192,P=0.003;r=0.293,P＜0.000;r=0.432,P＜0.000);感染、先天性心脏病者NTproBNP显著升高(P=0.007,P＜0.000);对于hsPDA的诊断,NT-proBNP(AUC=0.756 7)优于hsTnT (AUC=0.640 7,P=0.047),NTproBNP+hsTnT模型并不优于NTproBNP模型(P=0.110).在新生儿日龄≥7d组,NTproBNP与降钙素原(PCT)、高敏肌钙蛋白(hsTnT)、CK-MB、MYO相关(r=0.297,P=0.011;r=0.436,P＜0.000;r=0.242,P=0.005;r=0.257,P=0.004);贫血、先天性心脏病者NTproBNP显著升高(P=0.009,P＜ 0.000).结论 血清NTproBNP能够较准确预测新生儿hsPDA,在新生儿伴血流动力学异常性疾病的临床诊断中具有较大应用价值.

OBJECTIVE:To observe the therapeutic effect of Ommaya reservoir implantation on hydrocephalus in premature infants following intraventricular hemorrhage (IVH) and to investigate factors influencing the therapeutic effect.METHODS:An ambispective cohort study was conducted on the clinical and follow-up data of 20 premature infants (gestational age <32 weeks, birth weight <1500 g) who received Ommaya reservoir implantation because of hydrocephalus following IVH. The therapeutic effect of Ommaya reservoir implantation was observed. These patients were divided into cure and treatment failure groups according to their treatment outcomes. The factors influencing therapeutic effects were investigated by univariate analysis.RESULTS:Hydrocephalus was relieved significantly at 30 days after Ommaya reservoir implantation. However, some patients showed significantly decreased therapeutic effects since 3 months after operation: during 3-6 months after operation, 7 cases underwent ventriculoperitoneal shunt, 4 cases discontinued treatment because of economic reasons, and 1 case underwent endoscopic third ventriculostomy due to scalp hematoma with skin necrosis. The ventricles of the remaining 8 cases returned to normal size at 12-18 months after operation. As for postoperative complications, secondary IVH was seen in 8 cases, intracranial infection in 2 cases, and scalp hematoma with skin necrosis in 1 case. The univariate analysis revealed significant differences in gestational age, birth weight and duration of hydrocephalus before Ommaya reservoir implantation between the cure and the treatment failure groups (P<0.05).CONCLUSIONS:Ommaya reservoir implantation has a remarkable short-term therapeutic effect on hydrocephalus in premature infants following IVH, but later the effect decreases in some patients. Low gestational age, low birth weight and long duration of hydrocephalus may be the main factors influencing therapeutic effects of Ommaya reservoir implantation.

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.

Objective To establish an obese rat model,to observe the level of serum adiponectin and the expression of NF-κB,VCAM-1,ICAM-1,to explore the mechanism of angiopathy.Methods Forty-eight four-week-old healthy male SD rats were randomly divided into control group(n = 18)and high-fat group(n = 30).The high-fat group was fed the high-fat diet to establish the obese rat model.After 8 weeks,the rats in high-fat group with body weight more than 20% of average body weight of control group were selected as the obese rats.The level of serum adiponectin was measured by Enzyme-Linked Immuno Sorbent Assay.The expression of NF-κB,VCAM-1 and ICAM-1 in vascular endothelium was detected by immunohistochemistry.Results The average body weight was significantly heavier in high-fat group than in control group(446.82 ± 10.05 g vs.365.21 ± 13.20 g,P 0.01).Twenty-two rats were selected as obese rats in high-fat group(obese group),whose body weight was 20% more than the average weight of control group.The level of serum adiponectin were significantly lower in obese rats than in control group(0.61 ± 0.13 ng/ml vs.1.00 ± 0.17 ng/ml,P 0.01).The expression of NF-κB,VCAM-1,ICAM-1 in vascular endothelial was significantly higher in obese group than in control group.Meanwhile,the adiponectin levels were negatively correlated with NF-κB,VCAM-1,ICAM-1 in obese rats(r =-0.938 to-0.891,P 0.001).Conclusion In obesity due to high-fat diet the level of serum adiponectin may be reduced and the inhibition of the serum adiponectin on NF-κB may be decreased,and thus the expression of VCAM-1 and ICAM-1may be increased.It causes the accumulation of artery vessel thickening and change,and causes the vascular disease.