Neonatal acute kidney injury (AKI) is associated with poor clinical outcomes. Consequently, this study was designed to explore the prenatal and postnatal risk factors in Chinese extremely low gestational age neonates (ELGANs). This retrospective study included all ELGANs (born between 23—0/7 and 27—6/7 weeks of gestation) hospitalized from January 2019 to December 2022. These premature babies were divided into the AKI group (n = 39) and the non-AKI group (n = 76) according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. AKI most frequently occurred in the first 10 days of life (median: 8th day, quartile range: 6th – 10th day). Most infants (61.54

Background and aim:Bronchopulmonary dysplasia (BPD) is one of the most important complications of very preterm infants. This study was to investigate changes in the intestinal microbiota of very preterm infants with BPD. Methods:We enrolled 50 very preterm infants at the gestational age of 24+0-31+6 weeks, categorizing them into the BPD group and control group, and fecal samples were collected on days 1, 7, 14, 21, and 28, respectively. Finally, 30 preterm infants were left after excluding 20 preterm infants. We tested and analyzed 16S rDNA of bacteria and short-chain fatty acids (SCFAs) within the feces. Results:The BPD group possessed a higher abundance of Ureaplasma urealyticum (UU) and a lower abundance of Bacteroidota than the control on day 1. The differences in intestinal microbiota were reduced on days 7 and 14, and no difference in SCFAs existed on day 14. New differences emerged over time, with a significant decrease of Veillonella dispar in the BPD group than in the control group on day 28, which showed a continuous decline in the BPD group over time. Conclusion:Intestinal microbiota dysbiosis existed in very preterm infants with BPD. The increased abundance of UU on day 1 and the decrease of Veillonella dispar on day 28 might increase the risk of BPD.

Abstract Background: This retrospective cohort study was conducted to clarify the effect of different onset ages of pulmonary hemorrhage on the survival time in very low birth weight infants (VLBWIs). Methods: The study participants were screened from all VLBWIs admitted to two Chinese neonatal intensive care units from July 31, 2019 to July 31, 2023. The subjects finally included were VLBWIs who survived until the diagnosis of pulmonary hemorrhage was established. This study was retrospectively divided into the death group (n=73) and the survival group (n=54). Results: (1) The death group showed smaller gestational age, lower birth weight, higher proportions of postnatal intubation, grade III-IV respiratory distress syndrome, early onset sepsis, and coagulopathy (p<0.05). (2) The Cox regression analysis showed that the adjusted hazard ratio of onset time is 0.965(95% CI: 0.931-0.998) based on the variables screened by Lasso regression. Restricted cubic spline analysis found the cut-point of onset age is 3 days after birth (P for likelihood ratio test <0.001). (3) The Kaplan-Meier curve showed that infants whose onset age is less than 3 days have a shorter survival time (Log-rank test, p<0.0001). Conclusion: VLBWIs with onset age of pulmonary hemorrhage less than 3 days have a significantly increased risk of death and shorter survival time.

This pilot study aimed to explore the effectiveness and safety of dexibuprofen suppository in the treatment of PDA in preterm infants. Preterm infants with gestational age <34 weeks and color Doppler echocardiographic evidence of hemodynamically significant PDA (hs PDA) with systemic hypoperfusion was intended to be included into this study since January 2020. As of January 1, 2021, this trial had recruited 87 preterm infants who met the inclusion criteria. Neonates were admitted into hospital within 1 hour after birth and were randomly assigned into two groups. Group one included 44 preterm newborns administered with oral ibuprofen. Group two included 43 preterm newborns administered with dexibuprofen suppository. This preliminary study showed that rectal dexibuprofen and oral ibuprofen were both effective for the closure of PDA, and the closure rate of dexibuprofen suppository was comparable to that of oral ibuprofen after the 1st and 2nd courses of treatment. In addition, rectal dexibuprofen did not increase the incidence of adverse outcomes, including bronchopulmonary dysplasia, intraventricular hemorrhage, sepsis, and necrotising enterocolitis. This pilot study showed dexibuprofen suppository is as effective and safe as oral ibuprofen; yet, better designed, muticenter controlled studies are still needed.

Objectives: To explore if there is a positive additive interaction between no folic acid (FA) supplementation in early period of pregnancy and preeclampsia which increases the risk of preterm birth (PTB). Methods: We matched 1471 women who had live-birth singleton preterm infants with 1471 women who had live-birth singleton term infants at 15 Chinese hospitals in 2018. We excluded women who took folic acid less than 0.4 mg/d or less than 12 weeks in early stage, women with gestational hypertension, chronic hypertension, or preeclampsia during previous pregnancy. We calculate odds ratios for PTB by performing conditional logistic regression comparing preterm group with term group. We quantified the interaction between 2 exposures by synergy (S) and relative excess risk due to interaction (RERI). Results: Approximately 40% of preterm cases did not take FA in early pregnancy. After adjusting confounding factors by logistic regression, when the 2 exposures (no early FA supplementation and preeclampsia) co-existed, the risk of all PTB increased significantly (aOR11=12.138; 95% CI 5.726-25.73), the interaction between 2 exposures was positive (S=1.27) and increased 2.385-fold risk of all PTB (RERI=2.385); and there were similar results on iatrogenic PTB (aOR11=23.412; 95% CI 8.882–60.71, S=1.18, RERI=3.347). Conclusion: Our multicenter study showed, for the first time, that there was a positive additive interaction between no FA supplementation in early pregnancy and preeclampsia which increased the risk of all PTB, especially iatrogenic PTB.

Abstract Background Neonatal necrotizing enterocolitis (NEC) is a common critical illness of the gastrointestinal system in neonatal intensive care units with complex causes. We want to explore effects of serum-conjugated bilirubin on the occurrence of NEC in preterm infants. Methods A retrospective study of clinical case data of premature infants from 2017 to 2020 in the Department of pediatrics of the First Affiliated Hospital of Nanjing Medical University was conducted. Among these, 41 were diagnosed with NEC. After screening, 2 cases were excluded because of incomplete data. Propensity-matching score (PSM) was performed according to the ratio of 1:2(2 preterm infants in the NEC group were not matched), and finally, 37 cases were in the NEC group (average time to diagnosis was 18.9 days), and 74 cases in the non-NEC group. We compared the difference between the NEC and non-NEC groups in early serum-conjugated bilirubin and total bilirubin levels (time points: the first day of birth, 1 week after birth, 2 weeks after birth). Results (1) The changing trend of conjugated bilirubin was different between the two groups(F = 4.085, P = 0.019). The NEC group’s serum-conjugated bilirubin levels gradually increased ($$\bar x$$ ± s:12.64±2.68; 17.11±4.48; 19.25±11.63), while the non-NEC group did not show a continuous upward trend ($$\bar x$$ ± s:13.39±2.87; 15.63±3.75; 15.47±4.12). (2) Multiple analyses showed that patent ductus arteriosus(PDA) (odds ratio[OR] = 5.958, 95%confidence interval[CI] = 2.102 ~ 16.882) and increased conjugated bilirubin in the 2nd week (OR = 1.105, 95%CI = 1.013 ~ 1.206) after birth were independent risk factors for NEC. Conclusions The body had already experienced an elevation of conjugated bilirubin before the occurrence of NEC. The change of early conjugated bilirubin may be an important factor in the occurrence of NEC.

OBJECTIVE Bronchopulmonary dysplasia (BPD) is one of the most serious complications affecting extremely preterm infants. We aimed to evaluate temporal trends in BPD and administration of respiratory support among extremely preterm infants in China over a decade. METHODS This was a retrospective study using data from a multicenter database, which included infants born less than 28 weeks' gestation discharged from 68 tertiary neonatal care centers in China between 2010 and 2019. Changes in rates and severity of BPD, as well as modalities and duration of respiratory support, were evaluated. RESULTS Among 4808 eligible infants with gestational age (GA) of 21+6/7  to 27+6/7 weeks and a mean (SD) birth weight of 980 (177) g, no significant change of median GA was found over time. Overall, 780 (16.2%) infants died before 36 weeks' postmenstrual age, 2415 (50.2%) were classified as having no BPD, 917 (19.1%) developed Grade 1 BPD, 578 (12.0%) developed Grade 2 BPD, and 118 (2.5%) developed Grade 3 BPD. The rate of BPD increased from 20.8% in 2010 to 40.7% in 2019 (aRR for trend, 1.081; 95% confidence interval, 1.062-1.099), especially for Grade 1 and Grade 2. Although survival to discharge improved over the decade, the overall survival without BPD did not change during the study period. The use of invasive mechanical ventilation (IMV) remained unchanged. However, the use of noninvasive ventilation (NIV) increased from 71.5% in 2010 to 89.8% in 2019. Moreover, the median duration of NIV increased over time, from 17.0 (4.8, 34.0) days in 2010 to 33.0 (21.0, 44.0) days in 2019, without significant change in the duration of IMV. CONCLUSIONS Although survival increased over the decade and respiratory support practices changed significantly between 2010 and 2019 in China, with increased use and duration of NIV, there was an increased rate of BPD and survival without BPD has not improved.

目的:研究胎龄小于28周的超早产儿发生严重脑室内出血(intraventricular hemorrhage,IVH)的相关危险因素.方法:回顾性收集2016年2月—2021年5月118例超早产儿的临床资料,并通过单因素和多因素Logistic回归模型分析超早产儿发生重度IVH的风险因素.结果:单因素分析显示与超早产儿脑室内出血相关的因素为更小的胎龄、更低的Apgar评分、产前未给予类固醇激素、机械通气、肺出血、高级别的呼吸窘迫综合征(respiratory distress syndrome,RDS)、低血压、高频率的高血糖发作、多次气管插管、较长时间的静脉置管操作(P均<0.05).多因素回归分析显示,低血压(OR=3.508,P=0.021)、较高频率的高血糖发作(OR=5.333,P=0.022)、重度RDS(OR=5.583,P=0.001)、多次气管插管(OR=4.566,P=0.006)和较长的静脉置管操作时间(OR=4.207,P=0.040)等风险因素与重度IVH显著相关.结论:低血压、重度RDS、多次气管插管、较高频率的高血糖发作和静脉置管操作时间较长是超早产儿发生重度IVH的风险因素.

Objective:This study aims to identify the risk factors associated with short stature in children born small for gestational age (SGA) at full-term.Methods:This was a retrospective study. The subjects were full-term SGA infants who were followed up until the age of 2 years. The risk factors for short stature were identified with univariate and multivariate analyses.Results:Of 456 full-term SGA children enrolled in this study, 28 cases had short stature at 2 years of age. A significant decrease in placental perfusion was found in the short children group with intravoxel incoherent motion (IVIM) technology, which was an advanced bi-exponential diffusion-weighted imaging (DWI) model of magnetic resonance imaging (MRI) (p = 0.012). Compared to non-short children born SGA at full-term, the short children group underwent an incomplete catch-up growth. Mothers who suffered from systemic lupus erythematosus were more likely to have a short child born SGA (p = 0.023). The morbidity of giant placental chorioangioma was higher in the short children group. The pulsatility index (PI), resistivity index (RI), and systolic-diastolic (S/D) ratio of umbilical artery were higher in the short children group than in the non-short control group (p = 0.042, 0.041, and 0.043). Multivariate analysis demonstrated that decrease of perfusion fraction (f p) in IVIM of placental MRI, chromosomal abnormalities, short parental height, and absence of catch-up growth were associated with a higher risk of short stature in children born SGA at full-term.Conclusion:Risk factors for short stature in full-term SGA children at 2 years of age included a decrease of perfusion fraction f p in IVIM of placental MRI, chromosomal abnormalities, and short parental height.

目的 调查汉族Rh阴性产妇妊娠期临床特征,为规范其妊娠期管理和减少母儿血型不合所致胎儿及新生儿溶血病(HDFN)提供临床依据.方法 回顾性分析产科住院的271例Rh阴性孕妇及分娩的270例新生儿临床资料.257例(95.2％)新生儿行溶血检查,根据新生儿溶血检查结果进行分组,溶血结果全部为阴性的新生儿纳入A组(n=210),抗体释放实验阳性者纳入B组(n=47).B组中直接抗人球蛋白试验阴性者纳入B1组(n=21),直接抗人球蛋白试验阳性者纳入B2组(n=26).比较B组与A组,B2组与B1组孕妇外院转入率、血清免疫球蛋白G(IgG)抗D效价、分娩方式、新生儿胎龄、出生体质量以及新生儿重症监护病房(NICU)转入率.结果 270例新生儿中,Rh阳性和Rh阴性新生儿占比分别为88.9％和8.1％,A型、B型、O型和AB型血新生儿占比分别为28.5％、25.2％、31.5％和11.8％.271例孕妇IgG抗D效价阴性率和阳性率分别为85.2％和10.4％.A组早产率、剖宫产率、新生儿转入NICU率、孕妇IgG抗D阳性率均低于B组,差异有统计学意义(P＜0.05).A组新生儿合并ABO母儿血型不合的占比低于B组,差异有统计学意义(P＜0.05);B1组早产率、剖宫产率、孕妇IgG抗D阳性率低于B2组,新生儿胎龄及出生体质量高于B2组,差异有统计学意义(P＜0.05);B1组新生儿合并ABO母儿血型不合占比高于B2组,差异有统计学意义(P＜0.05);B1组与B2组新生儿转入NICU率及外院孕妇转入率比较,差异均无统计学意义(P＞0.05).结论 母儿Rh血型不合易致胎儿新生儿溶血病,增加了早产率、剖宫产率、新生儿转入NICU率,严重影响了妊娠结局,需要强化临床规范管理,改善妊娠结局.

目的 探讨胎龄小于32周早产儿中重度支气管肺发育不良(bronchopulmonary dysplasia,BPD)与生后早期动脉血pH值、PaO2及PaCO2的相关性.方法 收集2017年1月至2019年12月南京医科大学第一附属医院新生儿病房胎龄小于32周的236例早产儿的临床资料,其中54例中重度BPD为BPD组,其余为对照组.分析早产儿生后1周内动脉血pH值、PO2及PCO2与中重度BPD的关系.结果 出生后第1天,BPD组pH值显著低于对照组[(7.25±0.12)vs(7.31±0.09),P=0.001];出生后第 7 天,BPD 组 PaO2显著低于对照组[(63.20±23.75)mmHg vs(75.91±20.70)mmHg,1 mmHg=0.133 kPa,P＜0.001],PaCO2 显著高于对照组[(43.59±9.87)mmHg vs(38.26±9.11)mmHg,P＜0.001].除了低胎龄、低出生体质量和机械通气外,出生后第1天的低pH值和第7天的低PaO2是中重度BPD的独立危险因素.结论 早产儿生后早期低pH值和低PaO2可能影响中重度BPD进展.

目的:探讨胎盘绒毛膜血管瘤对胎儿及新生儿的影响.方法:回顾性分析2015-2021年经病理确诊为胎盘绒毛膜血管瘤的25例孕妇及其新生儿的临床资料,总结其临床特征,并根据胎盘绒毛膜血管瘤直径将患儿分为巨大血管瘤组(直径≥5 cm)和普通血管瘤组(直径＜5 cm),比较两组患儿临床特点及结局.结果:19例胎盘绒毛膜血管瘤合并有围产期并发症,胎儿期发生羊水过多7例(28％),胎儿生长受限7例(28％),胎儿宫内窘迫5例(20％),胎儿水肿2例(8％),胎儿贫血3例(12％),胎儿心胸比增大3例(12％),早产9例(36％),新生儿期合并有新生儿贫血6例、凝血功能异常3例、新生儿血小板减少1例、先天性心脏病9例、新生儿心律失常1例、新生儿坏死性小肠结肠炎1例、先天性肺囊腺瘤畸形1例、尿道下裂1例.2例患儿因胎儿期羊水过多、胎儿心胸比增大、重度贫血及生后重度窒息而死亡.其余新生儿目前随访均存活良好,无生长发育迟缓者.巨大血管瘤组羊水增多比例高于普通血管瘤组(P＜0.05).结论:胎盘绒毛膜血管瘤可导致胎儿及新生儿多种并发症,并且肿瘤大小对胎儿及新生儿并发症的发生有一定预测价值,加强围产期监测,及时采取干预措施,可能有助于改善胎儿及新生儿结局.

ObjectivesTo investigate the risk profile of preterm birth (PTB) in 2018 in China.MethodA prospective multicentre case–control study was conducted in 15 hospitals located in seven provinces throughout three geographical areas (the Eastern, South‐Central and North‐Western regions) in China. A total of 3147 preterm (<37+0 weeks) and 3147 term (37+0 to 41+6 weeks) live‐birth mothers were included. Designed questionnaires were used to investigate maternal and fetal information. We calculated multivariable logistic regression and population attributable risk (PAR).ResultsIatrogenic PTB accounted for 48.1% of preterm mothers. Multivariable analysis showed PTB was significantly associated with six categories of maternal and fetal factors, adverse life‐style and psychological conditions (adjusted odds ratio (aOR) 2.063, 95% confidence interval (CI) 1.601–2.657) had the highest PAR% (60.1%). High school and below education level (PAR% = 25.8%), living in town or village (PAR% = 24.4%), low pregnant weight gain (PAR% = 16.8%), hypertensive disorders in pregnancy (aOR: 5.010, 95% CI: 4.039–6.216, PAR% = 15.3%), placental abnormality (aOR: 4.242, 95% CI: 3.454–5.211, PAR% = 14.1%) and multiple pregnancy (aOR: 10.990, 95% CI: 7.743–15.599, PAR% = 11.8%) were significantly associated with PTB with high PAR% value.ConclusionThe main risk factors for PTB in China were placental abnormality, hypertensive disorders in pregnancy and multiple pregnancy. Adverse life‐style and psychological conditions and socio‐economic disadvantage had high public health significance.

ObjectiveIntraventricular hemorrhage (IVH) is a serious neurological complication in premature infants. This study aimed to investigate the white matter impairments and neurodevelopmental outcomes of severe IVH in extremely preterm infants with gestation age less than 28 weeks. MethodsWe retrospectively evaluated the extremely preterm infants between 2017 and 2020. Neurodevelopmental outcomes were evaluated with the Bayley Scales of Infant and Toddler Development-III at 2 years of corrected age. Diffusional kurtosis imaging (DKI) was employed to evaluate the microstructural changes in white matter tracts. Mean kurtosis (MK) and fractional anisotropy (FA) values of DKI were measured in the brain regions including posterior limbs of the internal capsule (PLIC) and the corpus callosum at term equivalent age. ResultsOf 32 extremely preterm infants with severe IVH during the follow-up period, 18 cases were identified as neurodevelopmental impairments. The delay rates of motor and language were 58.4% and 52.7%. The cases with neurodevelopmental impairments had lower MK and FA values in both bilateral PLIC and the corpus callosum. The analysis of multivariable regression models predicting motor and language outcomes at 2 years of corrected age, showed that the decreases of MK values in both PLIC and the corpus callosum at the term equivalent age contributed to a significantly increased risk of neurodevelopmental impairments (all p < 0.05). During follow-up period, obvious loss of nerve fiber bundles was observed with DKI tractography. ConclusionMotor and language abilities at age 2 years were associated with MK values of DKI at the term equivalent age in both PLIC and the corpus callosum of extremely preterm infants with severe IVH. The evaluation of white matter microstructural changes with MK values might provide feasible indicators of neurodevelopmental outcomes of extremely preterm infants with severe intraventricular hemorrhage.

Objective:To study the clinical application of ultrasound-guided puncture and catheter tip positioning in peripherally inserted central catheter (PICC) among very/extremely low birth weight infants (VLBWI/ELBWI).Method:From January 2019 to August 2020, VLBWI/ELBWI admitted to NICU of our hospital and received PICC were prospectively enrolled in the study. Based on the last digit of medical record number was odd or even, the infants were assigned into ultrasound group and X-ray group. In the ultrasound group, puncture and catheter tip positioning were performed at bedside guided by ultrasound, while in the X-ray group, these procedures were performed empirically. The differences of catheterization procedure duration, first-time success rate, the visibility of catheter tip, primary dislocation rate, secondary dislocation rate and complication rate were compared between the two groups using SPSS 25.0.Result:A total of 118 premature infants were enrolled, including 57 cases in ultrasound group (50 cases VLBWI and 7 cases ELBWI) and 61 cases in X-ray group (54 cases VLBWI and 7 cases ELBWI). The catheterization procedure duration [(23.2±7.1) min vs. (34.1±7.5) min], first-time success rate (93.0% vs. 65.6%), the visibility of catheter tip (96.5% vs. 83.6%), primary dislocation rate (7.0% vs. 24.6%) and complication rate (7.0% vs. 21.3%) in ultrasound group were all better than X-ray group ( P<0.05). For ELBWI, the above five indexes in the ultrasound group were better than the X-ray subgroup ( P<0.05). For VLBWI, only the catheterization procedure duration and first-time success rate were better in the ultrasound group than the X-ray group ( P<0.05). Conclusion:Ultrasound-guided PICC catheterization in VLBWI/ELBWI is convenient and accurate, which can improve success rate, reduce radiation exposure and repeated catheterization injury. Timely tracking and adjustment of the catheter under ultrasound can reduce complications after catheterization. This technique is worth popularizing among VLBWI/ELBWI.

目的 探讨极低出生体重儿(VLBW)出生后1周内的液体、热卡及三大营养素(糖类、脂类、蛋白质)摄入量与支气管肺发育不良(BPD)的相关性.方法 回顾性分析2018年1月至2021年5月收治的147例VLBW的临床资料,根据发育情况将其分为BPD组(46例)和非BPD组(101例).比较两组VLBW的临床资料;分析影响VLBW发生BPD的因素.结果 BPD组的出生体重、胎龄小于非BPD组,出生后1、5 min的Apgar评分低于非BPD组,有创通气时间短于非BPD组(P<0.05);BPD组的有创通气率、动脉导管未闭、败血症发生率明显高于非BPD组(P<0.05).出生后1周,BPD组的液体摄入量高于非BPD组,热卡及三大营养素摄入量低于非BPD组(P<0.05).新生儿胎龄、热卡摄入量是BPD发生的保护因素,有创通气、液体摄入量是BPD发生的危险因素(P<0.05).结论 VLWB出生后1周内高液体摄入、低热卡量摄入会增加BPD的发生率.

Objective:To investigate the dynamic changes of thyroid function and risk factors of hypothyroidism and delayed thyroid stimulating hormone (TSH) elevation in late preterm infants.Methods:This study retrospectively recruited 782 late preterm infants admitted to Nanjing Medical University First Affiliated Hospital and performed thyroid function monitoring from January 2017 and December 2019. Thyroid function test was performed in all cases at 4-7 d after birth and repeated at 2-4 weeks of age for those with normal results or two weeks after the first test for those with abnormal. The test would be continued if the second test was abnormal and stopped until the thyroid function became normal or hypothyroidism was diagnosed, based on which, these infants were divided into hypothyroidism ( n=11) and non-hypothyroidism groups ( n=771), or delayed TSH elevation ( n=71) and normal thyroid function groups ( n=450). The characteristics of thyroid hormone changes and perinatal data were compared between different groups using two independent sample t-test and Chi-square test, and risk factors of hypothyroidism and delayed TSH elevation were analyzed using logistic regression tests. Results:(1) Dynamic changes of thyroid function: among these 782 late preterm infants, five infants were found with transient hypothyroxinemia at the first test, and became normal at the second test; 249 (31.8%) exhibited hyperthyrotropinemia, and four of them were diagnosed with hypothyroidism based on the second and the third results; 71(9.1%) with delayed TSH elevation all became normal later; 11(1.4%) were diagnosed with hypothyroidism and treated with thyroxine, among which, seven cases were diagnosed at the first test, three at the second test and one at the third test. (2) Risk factors for hypothyroidism: lower birth weight was noted for infants with hypothyroidism compared with those without [(2 140.9±455.1) vs (2 464.1±474.0) g, t=-2.247, P=0.025]. Multivariate logistic regression analysis found that for every one gram reduction in birth weight, the risk of hypothyroidism elevated by 0.002 times ( OR=1.002, 95% CI: 1.000-1.004, P=0.045). (3) Risk factors for delayed TSH elevation: the birth weight was lower [(2 395.4±420.9) vs (2 523.6±462.3) g, t=-2.200, P=0.028], and the proportion of small for gestational age and twin pregnancy were higher in the delayed TSH elevation group than those in the normal thyroid function group [15.5% (11/71) vs 7.1% (32/450), χ2=5.690, P=0.017; 29.6% (21/71) vs 18.7% (84/450), χ2=4.537, P=0.033]. Multivariate logistic regression analysis found that small for gestational age ( OR=4.366, 95% CI: 1.649-11.564, P=0.003) and twin pregnancy ( OR=1.943, 95% CI: 1.048-3.600, P=0.035) were independent risk factors for delayed TSH elevation. Conclusions:Late preterm infants have a high incidence of different kinds of thyroid dysfunction. Thyroid function monitoring is necessary for late preterm infants because those with lower birth weight are more susceptible to develop hypothyroidism, and those small for gestational age infants and twins are more susceptible to develop delayed TSH elevation.

We report a case of a 2 200 g premature male baby born through cesarean section under maternal endotracheal intubation mechanical ventilation combined with extracorporeal membrane oxygenation at 34 +1 gestational weeks, while his mother was infected with influenza A in late pregnancy. Due to neonatal pneumonia, neonatal respiratory distress syndrome, prematurity, and low birth weight, the neonate was transferred to the neonatal intensive care unit for body temperature maintenance, respiratory support, maintenance of perfusion and internal environment, and nutritional management. The infant was discharged 17 days after birth and was well at six-month-old follow-up. His mother was discharged at 20 days post-delivery.

肺炎克雷伯菌是新生儿院内感染最常见的致病菌之一,常存在于人体上呼吸道和肠道,当机体抵抗力下降时易引起肺部感染、泌尿道感染及血液感染等.随着临床各类广谱抗菌药物的广泛应用,肺炎克雷伯菌耐药性不断增加.近年来,耐碳青霉烯类肺炎克雷伯菌(carbapenem resistant Klebsiella pneumoniae,CRKP)在全球呈广泛传播和流行趋势[1].2017年WHO将耐碳青霉烯的肠杆菌科细菌列为21世纪最重要的耐药病原菌之一.

目的:探讨新生儿肺动脉高压的相关高危因素.方法:收集近3年南京医科大学第一附属医院儿科收治的肺动脉高压新生儿41例,分为足月儿组和早产儿组,回顾性分析了两组的临床资料与新生儿肺动脉高压的关系.结果:早产儿组23例,足月儿组18例.早产儿组胎膜早破、胎盘早剥、绒毛膜羊膜炎、子痫的发生率高于足月儿组,差异有统计学意义(P＜0.05).足月儿组的孕母妊娠期糖尿病5例(占27.8％),早产儿组孕母妊娠期糖尿病共1例(占4.3％),与足月儿组比较,差异有统计学意义(x2=4.437,P=0.035).与足月儿组相比,早产儿组的原发病以呼吸窘迫综合征为主(x2=19.158,P＜0.001),容易合并肺出血(x2=4.433,P=0.035)、颅内出血(x2=8.715,P=0.003).足月儿组原发疾病主要为先天性心脏病(室间隔缺损)(x2=10.786,P=0.001).新生儿肺炎在两组均有较高发生率,但差异无统计学意义(x2=0.327,P＞0.05).两组之间并发代谢性酸中毒、新生儿低血糖、气胸、败血症等统计比较,差异无统计学意义(P＞0.05).早产儿组治愈21例,死亡2例,足月儿组治愈15例,死亡3例,治疗效果两组比较差异无统计学意义(P＞0.05).结论:早产儿肺动脉高压的高危原发疾病是呼吸窘迫综合征、重症肺炎、肺出血以及孕母有胎膜早破、胎盘早剥等并发症;患有先天性心脏病如室间隔缺损的足月儿,要重视可能伴有的肺动脉高压并及时诊治.