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.

ObjectivesPulmonary hemorrhage (PH) is one kind of critical lung diseases in newborn infants, which is the most difficult one to be diagnosed by ultrasound. This study was to investigate the specific ultrasonic signs of PH in order to better diagnose neonatal PH by using lung ultrasound (LUS). MethodsA total 168 newborn infants were enrolled in this study, which included PH, pneumonia, meconium aspiration syndrome, and newborns without lung diseases, there were 42 cases in each group. In a quiet state, infants were placed in the supine, lateral or prone position for the examination. Each lung was divided into the anterior, lateral and posterior regions, then each region of both lungs was scanned with the probe perpendicular to the ribs or parallel to the Intercostal spaces. ResultsThe major results showed that: (1) the common LUS manifestation of PH includes lung consolidation, air bronchograms, fluid bronchograms, pleural effusion, shred signs, pleural line abnormality and B-lines, while fibrin deposition sign is a rare sign of PH. (2) Co-existing of lung consolidation with fluid bronchograms and pleural effusion is the specific sign of PH with a sensitivity of 81.0%, specificity of 98.4% and the positive predictive value (PPV) was 94.4%. (3) Fibrin deposition sign is an uncommon specific LUS sign of PH with a sensitivity 28.6%, specificity of 100% and the PPV was 100%. (4) Nine patients (21.4%) were diagnosed with PH based on ultrasound findings before oronasal bleeding. (5) The survival rate of infants with PH was 100% in this study. ConclusionLUS is helpful for the early diagnosis of neonatal PH and may therefore improve the prognosis. The lung consolidation with fluid bronchograms and pleural effusion as well as fibrin deposition sign are specific to diagnose PH by using LUS.

Background and Objectives: Lung ultrasound (LUS) has been successfully used in the diagnosis of neonatal lung diseases, but among various lung diseases of the newborn, pulmonary hemorrhage (PH) is the most difficult one to be diagnosed by ultrasound. This study was to investigate the specific ultrasonic signs of PH in order to better diagnose neonatal PH by using ultrasound.Methods: A total 168 newborn infants were enrolled in this study, which included PH, pneumonia, meconium aspiration syndrome (MAS), and newborns without lung diseases, that is 42 cases in each group. In a quiet state, infants were placed in the supine, lateral or prone position for the examination. Each lung was divided into the anterior, lateral and posterior regions, then each region of both lungs was scanned carefully with the probe perpendicular or parallel to the ribs.Results: The results showed that: (1) the common LUS manifestation of PH includes lung consolidation, fluid bronchograms, pleural effusion, shred signs, pleural line abnormality and B-lines. (2) Fibrin deposition sign is an uncommon specific LUS sign of PH with a sensitivity 28.6% and specificity of 100%. (3) Co-existing of lung consolidation with fluid bronchograms and pleural effusion is the most common specific sign of PH with a sensitivity of 81.0% and specificity of 98.4%. (4) Nine patients (21.4%) were diagnosed with PH based on ultrasound findings before blood outflow from their oral, nasal, or tracheal intubation.Conclusions: LUS is of great value in the diagnosis of neonatal PH. LUS can be made diagnosis of PH before blood exits from their oral, nasal, or tracheal intubation. Mastering these specific ultrasonic signs of PH can help us improve the accuracy of using ultrasound to diagnose neonatal PH.Funding Information: This work was supported by a grant from the Social Development Projects, Beijing Chaoyang District Bureau of Science, Technology and Information (SYSF1820, CYSF1922).Declaration of Interests: The other authors have no example conflicts of interest to disclose.Ethics Approval Statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the ethics committee of Beijing Chaoyang District Maternal and Child Healthcare Hospital (No. 2011-LC-Ped-01).Written informed consent was obtained from the participants’ parents.

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.

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

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.

ObjectiveTo investigate the effects of prenatal taurine supplementation on the Rho-ROCK signaling pathway activity and synaptophysin (Syp) expression in brain tissues of rats with intrauterine growth restriction.MethodsEighteen pregnant Sprague-Dawley rats were randomly divided into control group, fetal growth restriction (FGR) group and taurine group, with six rats in each group. Low-protein diet was given in FGR and taurine groups to establish an FGR model. Taurine 300 mg/(kg·d) was supplemented from gestational day 12 until delivery in taurine group. The mRNA expression levels of neurite growth inhibitor-A(Nogo-A), neurite growth inhibitor receptor (NgR), Rho-A and ROCKⅡin fetal rat brain were detected using reverse transcriptase polymerase chain reaction (n=24), which are the key signaling molecules of the Rho-ROCK signal pathway. The protein expression levels of Nogo-A and NgR were detected by Western blot (n=12). The mean optical density in Nogo-A, NgR and Syp was determined by immunohistochemistry (n=18). One-way analysis of variance and LSD-t test were used for statistical analysis.Results(1) Expression of mRNA: the expression levels of Nogo-A, NgR, Rho-A and ROCKⅡ mRNA in fetal rat brain were 4.09±1.34, 3.01±0.77, 39.89±7.71 and 7.82±1.83, respectively in FGR group, and were significantly higher than in control group (1.00±0.13, 1.00±0.10, 1.02±0.30 and 1.00±0.10) (t=4.735, 5.204, 7.682 and 10.675, allP<0.05). The expressions in taurine group (1.07±0.30, 1.20±0.27, 5.36±0.41 and 1.89±0.43) were significantly lower than in FGR group (t=4.645, 4.690, 6.687 and 9.485, allP<0.05), and there was no statistical difference between taurine group and control group (allP>0.05). (2) Expression of protein by Western blot: the expressions of Nogo-A and NgR protein in fetal rat brain were 1.51±0.09 and 0.31±0.05 in FGR group, 0.82±0.06 and 0.06±0.01 in taurine group, and 1.04±0.10 and 0.09±0.12 in control group. The expression was significantly higher in FGR group than in control group (t=9.644 and 5.285, bothP<0.05). The expression was significantly lower in taurine group than in FGR group (t=14.163 and 5.825, bothP<0.05), and there was no statistical difference between taurine group and control group (allP>0.05). (3) Positive expression of protein: the positive expressions of Nogo-A and NgR protein in fetal rat brain were 0.28±0.06 and 0.11±0.02 in FGR group, 0.10±0.02 and 0.04±0.01 in taurine group, and 0.07±0.01 and 0.04±0.01 in control group. The expression was significantly higher in FGR group than in control group (t=9.778 and 7.645, bothP<0.05). The expression in taurine group was significantly lower than in FGR group (t=8.679 and 7.413, bothP<0.05), and there was no statistical difference between taurine group and control group (bothP>0.05). The positive expression of Syp protein in fetal rat brain was 0.08±0.01 in FGR group, and was significantly lower than in control group (0.16±0.04,t=4.600,P<0.05). The expression in taurine group (0.14±0.36) was significantly higher than in FGR group (t=3.181,P<0.05), and there was no statistical difference between taurine group and control group (P>0.05).ConclusionsPrenatal taurine supplementation can improve neural axon development via down-regulating the expressions of the key molecules of Rho-ROCK signal pathway in fetal rat brain tissue.

OBJECTIVE:To explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax. METHODS:This study was divided into two phases. (1) In the first phase, from January 2013 to June 2015, 40 patients with confirmed pneumothorax had lung ultrasound examinations performed to identify the sonographic characteristics of neonatal pneumothorax. (2) In the second phase, from July 2015 to August 2016, lung ultrasound was undertaken on 50 newborn infants with severe lung disease who were suspected of having pneumothorax, to evaluate the sonographic accuracy and reliability to diagnose pneumothorax. RESULTS:(1) The main ultrasonic manifestations of pneumothorax are as follows: ① lung sliding disappearance, which was observed in all patients (100%); ② the existence of the pleural line and the A-line, which was also observed in all patients (100%); ③ the lung point, which was found in 75% of the infants with mild-moderate pneumothorax but not found to exist in 25% of the severe pneumothorax patients; ④ the absence of B-lines in the area of the pneumothorax (100% of the pneumothorax patients); and ⑤ no lung consolidation existed in the area of the pneumothorax (100% of the pneumothorax patients). (2) The accuracy and reliability of the lung sonographic signs of lung sliding disappearance as well as the existence of the pleural line and the A-line in diagnosing pneumothorax were as follows: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. When the lung point exists, the diagnosis is mild-moderate pneumothorax, whereas if no lung point exists, the diagnosis is severe pneumothorax. CONCLUSION:Lung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray.

Taurine is one of the extremely important amino acids in the body,and is also the most abundant free amino acids in the central nervous system(CNS).Taurine as a conditional essential amino acids exerts a wide range of physiological and pharmacological effects.Taurine,especially as a neurotransmitter in the developing CNS,can maintain the structural integrity of the membrane,regulate calcium transport and calcium homeostasis,also as nutritional factors,osmolyte,neuromodulator,neuroprotective agents,plays an important role.In this paper,physiological and biochemical properties of taurine,source and distribution in vivo,synthesis and metabolism,absorption and transport,and its protective effect on the CNS are reviewed.

Objective To explore the expression of paired immuonglobin-like receptor B(PirB)in fetal rat brain tissue with intrauterine growth restriction(IUGR)and the influence of antenatal taurine on its expression. Methods Eighteen pregnant rats were randomly divided into 3groups:normal control group,IUGR models group(IUGR group)and the IUGR+antenatal taurine supplement group(taurine group)(n=6.IUGR models were induced by low protein diet throughout gestation period.Three fetal rats were randomly selected from each nest and were sacrificed to obtain the brains.The PirB positive cell counts were detected by immunohistochemistry,the PirB protein contents were deteceted by Western Blot and the level of mRNA expressions of PirB gene were detected by Real time-PCR. Results Control group,IUGR group,taurine group:1)The PirB positive cell counts in the three groups were respectively 18.40±1.52,66.17±3.66,21.17±2.71;2)The PirB protein semi-quantitative analysis results respectively 0.05,0.31,0.09;3)The level of PirB mRNA 2-ΔΔCT numerical respectively 1(0.87,1.15),0.08(0.06,0.11),1.22(0.97,1.55).Compared control group and taurine group with IUGR group,PirB positive cell counts were lower than that of IUGR group,PirB mRNA and protein expression were lower than that of IUGR group.The differences of comparing IUGR group with taurine group were statistically significant(P0.05). Conclusion The results of this study show that the expression of PirB in fetal rat brain tissues is higher in IUGR groups than that in controls while antenatal taurine can significantly decrease its expression,which suggests that antenatal taurine may play aprotecting role by inhibiting the expression of PirB in fetal brain tissues.

与周围神经系统相比,中枢神经系统损伤后的再生能力很弱,其主要原因是神经元与轴突在修复过程中促进性环境的缺如和抑制性环境的存在.配对免疫球蛋白样受体B(paired immuonglobin-like receptor B,Pir-B)是近年来新发现的继神经生长抑制因子的受体NgR之后三种髓鞘抑制分子Nogo、OMpg、MAG的另一种共同受体,且众多体外研究和动物实验研究发现,同时封闭NgR和Pir-B,几乎可以完全消除髓鞘相关抑制分子对轴突再生的阻碍作用.本文就Pir-B抑制受损神经再生的作用机制及所致相关神经系统疾病展开相关综述.