Table of Content

15 September 2014 Volume 32 Issue 9

  

Interpretation of the guideline for clinical practice of nutrition support in Chinese neonates

ZHUANG Siqi

. 2014, 32(9):  801.  doi:10.3969 j.issn.1000-3606.2014.09.001

Abstract ( 668 )   PDF (1208KB) ( 9130 )  

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This paper explains most important points in the 2013 Guideline, including updated required RDI for total calorie, fluid and macronutrients such as protein, fat and carbohydrate in neonates, especially premature infants. It also covers the ways of delivering the nutrition (enteral vs parenteral), different dairy category and the handling of possible side effect in PN. The unified nutrition management is important.

Proper understanding of the infant formula foods for special medical purposes

CUI Yutao

. 2014, 32(9):  804.  doi:10.3969 j.issn.1000-3606.2014.09.002

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General rules for infant formula for special medical purposes were published by National Health and Family Planning Commission of the People’s Republic of China in 2010. Lactose-free or low lactose formula is suggested to be a part of treatment in bottle-fed infants with acute diarrhea. Lactase is suggested to be taken before each feeding in breastfeeding infants with acute diarrhea. Partial hydrolyzed formula (pHF) can be added when the breast milk is insufficient and it is mainly used during the transition from extensively hydrolyzed formula to standard formula during allergy treatment. Extensively hydrolyzed formula should be suggested as the nutritional support during milk avoidance for most of cow’s milk allergy infants. Amino acid formula is the clinical tool to diagnose the cow’s milk allergy and provides the nutritional support to severe cow’s milk allergy infants. Although preterm/low birth weight formula can decrease the rate of the extrauterine growth retardation and sustain the fast growth of preterm babies with insufficient breast milk, Breast-milk with fortifier is strongly recommended as the main nutritional support to keep preterm and low birth weight infants’ growth. Infants with disorders of amino acid catabolism should choose specific formula.

Treatment and prevention of nosocomial infections in neonatal intensive care units

YANG Jing, HUA Ziyu

. 2014, 32(9):  808.  doi:10.3969 j.issn.1000-3606.2014.09.003

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Nosocomial infection is a serious problem in the diagnosis, treatment and management of neonatal disease. Neonatal intensive care unit (NICU) is high risk place for nosocomial infections whose clinical features vary with age, nation and region. The improvemnts in hand hygiene measures and antibiotic stewardship and control of the risk are recommended to effectively prevent nosocomial infections in NICU and to improve the healthcare service in neonates.

Analysis of factors in outcomes of infants with pulmonary hemorrhage

ZHENG Liling, WU Bin

. 2014, 32(9):  812.  doi:10.3969 j.issn.1000-3606.2014.09.004

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Objective??To investigate the risk factors in the outcome of neonatal pulmonary hemorrhage. Methods A total of 69 cases of neonatal pulmonary hemorrhage from January 2005 to December 2011 were studied. They were divided into 2 groups according to clinical outcome (death or alive). The data of the two groups were compared using single factor analysis. The risk factors were analyzed using multi-factor analysis. Results The death of neonates with pulmonary hemorrhage was correlated with aspiration pneumonia, coagulation abnormalities, DIC, heart failure and MPV. Multi-factor analysis showed that DIC (OR=6.90, 95%CI: 1.514-31.419), heart failure (OR=9.62, 95%CI: 1.710-54.150) and MPV <11 prior to pulmonary hemorrhage (OR=7.01, 95%CI: 1.475-33.312) were the independent risk factors of neonatal pulmonary hemorrhage. Conclusions For the neonatal pulmonary hemorrhage with DIC, heart failure and low MPV, active intervention should be implemented.

Clinical analysis for fungal septicemia in 23 neonates

YU Shijuan, LI Luquan

. 2014, 32(9):  816.  doi:10.3969 j.issn.1000-3606.2014.09.005

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Objective　To investigate the risk factors, pathogens spectrum and antimicrobial susceptibility of neonatal fungal septicemia. Methods Medical records of 23 neonates with fungal septicemia from May 2009 to August 2013 were analyzed retrospectively. Results A total of 36 strains of fungi including 20 strains of Candida parapsilosis (55.6%) and 11 strains of Candida albicans (30.6%) were isolated from 23 patients. Fungal pathogens were susceptible to amphotericin and fluorouracil, with susceptibility being 69.4%-77.8%. Prematurity, low birth weight, application of broad-spectrum antibiotics and invasive operation might be the risk factors of fungal septicemia. Fifteen cases (65.2%) had good outcomes (survival or partial restoration), while 8 cases (34.8%) had poor outcomes (withdrawing therapy or death). The duration of antifungal therapy in good prognosis group was longer than that in poor prognosis group (t=2.982, P<0.05). No significant difference in indicators of liver and kidney function was observed between before antifungal therapy and within 2 weeks after treatment. Meanwhile, no significant difference of WBC was found between before antifungal therapy and within 2 weeks after treatment. The platelet counts were increased within one week after initial antifungal therapy (P <0.05). Conclusions Candida is the main pathogen of neonatal fungal  septicemia and sensitive to amphotericin B. Long enough course of antifungal therapy is necessary to improve the cure rate.

Changes of IL-8 and ICAM-1 in early stage of cerebral white matter damage and their correlations with prognosis in premature infants

DUAN Yang, SUN Fuqiang, LI Yueqin

. 2014, 32(9):  821.  doi:10.3969 j.issn.1000-3606.2014.09.006

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Objective　To explore the IL-8 and ICAM-1 in premature infants with cerebral white matter damage (CWMD) and their correlations with prognosis. Methods One hundred and two cases of CWMD were selected from March 2009 to June 2012 as experimental group and 42 cases of normal preterm children were selected as control group. Serum IL-8 and ICAM-1 levels were measured during 48-72 h after birth. Motor development index (psychomotor developmental index, PDI) and mental development index (mental development index, MDI) were evaluated by Bayley scale. The correlations of IL-8 and ICAM-1 levels with prognosis were analyzed. Results Serum IL-8 and ICAM-1 levels in the experimental group were significantly higher than those in the control group (P<0.05). MDI and PDI scores in the experimental group were significantly lower than those in the control group (P<0.05). There were negative correlations of serum IL-8 and ICAM-1 levels with MDI (r=-0.64, P<0.05; r= -0.66, P<0.05)+ and PDI (r=-0.70, P<0.05; r=-0.71, P<0.05). Conclusions Serum IL-8 and ICAM-1 levels in infants with CWMD are significantly increased, and are negatively correlated with MDI and PDI scores.

T lymphocyte subsets and the cytokines in the newborns with infectious diseases

HAO Li, ZHENG Chengzhong

. 2014, 32(9):  825.  doi:10.3969/ j.issn.1000-3606.2014.09.007

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Objective　To study the T Lymphocyte Subsets and the cytokines in the newborns with infectious diseases. MethodsTwenty cases of neonatal bacterial pneumonia (bacterial group), 15 cases of rotavirus enteritis (virus group) and 20 newborns with jaundice (control group) were recruited in this study. The peripheral CD4+T Cells and lymphocyte subsets were assessed by flow cytometry. ResultsThe IL-4 level was significantly different among different groups (F=3.39, P=0.041).
The levels of IL-17 and IFN-γ did not differ significantly among different groups (F=0.28 and 1.24 respectively, P>0.05). The IL-4 level was higher in bacterial group than that in virus group and control group (P<0.05). The percentages of CD3+, CD4+, CD19+and NK cells and the ratio of CD4+/CD8+had significant difference among different groups (F=3.30-26.69, P<0.05). The percentages of CD3+and CD4+cells and the ratio of CD4+/CD8+were lower in bacterial group and virus group than those in control group (P<0.05). The percentage of CD19+cells was higher in bacterial group and virus group than that in control group (P<0.05). The percentage of NK cells was lower in virus group than that in bacterial group and control group (P<0.05). ConclusionsThe pattern of cytokines level is different in newborns with infection caused by different pathogens. Newborns with infectious diseases have immune dysfunction and Th2-dominated imbalance. The low percentages of T lymphocyte subsets indicate the depressed cellular immunity after infection, which may result in atypical symptom and prolonged disease coue.

Changes of serum adiponectin and insulin like growth factor-1 in neonates with hypoxic-ischemic encephalopathy and their clinical significances

LI Wei, JIN Youpeng, SUN Zhengyun

. 2014, 32(9):  829.  doi:10.3969 j.issn.1000-3606.2014.09.008

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Objective　To explore the changes and clinical value of serum insulin like growth factor-1 (IGF-1) and adiponectin in newborns with hypoxic ischemic encephalopathy (HIE). Methods Fifty-two HIE newborns were recruited in this study, including 15 severe, 20 moderate and 17 mild HIE newborns. Twenty healthy newborns were selected as controls. Serum levels of IGF-1 and adiponectin were detected 3-to-5 days (acute period) and 10-to-14 days (recovery period) after birth. Results Serum levels of IGF-1 and adiponectin in the acute period differed significantly among groups of different severity (P<0.05). Serum levels of IGF-1 and adiponectin were decreased with the increase of HIE severity. The level of adiponectin in moderate and severe HIE was lower than that in mild HIE (P<0.05). In recovery period, the level of IGF-1 in severe HIE was lower than that in control (P<0.05). Serum levels of IGF-1 and adiponectin in the acute period was positivity correlated with those in umbilical cord blood of HIE newborns (r=0.531, r=0.611, P<0.01). Conclusions Decreased levels of IGF-l and adiponectin in HIE newborns are correlated with the pathological process of HIE, and can be regarded as indices for severity of HIE. IGF-l and adiponectin is of significance in the clinical diagnosis and prognosis of HIE.

The relationships of IGF-1 and IGFBP-3 with growth of very low birth weight infants in the early postnatal stage

FAN Xi, CUI Qiliang, ZHANG Hui, WU Fan, LIANG Shaozhen, TAN Daifeng, LIN Yuanqing, TAN Huiyuan, ZHU Lifeng

. 2014, 32(9):  833.  doi:10.3969 j.issn.1000-3606.2014.09.009

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　Objective　To explore the relationships of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) with growth of very low birth weight (VLBW) infants in the early postnatal stage. Methods According to the individual gestational age and birth weight, 32 cases of VLBW infants were divided into small for gestational age (SGA) group and appropriate for gestational age (AGA) group. After birth, all the infants were given the same nutritional intake. The body weight, body length, head circumference and body mass index (BMI) were monitored at different time points (d0, d7, d14 and d28 after birth). Serum IGF-1 and IGFBP-3 levels were measured by radiommunoassay, and IGF-1/IGFBP-3 molar ratio was calculated. Results There was no significant difference of body weight, body length, head circumference and BMI between two groups at d0, d7, d14 after birth. Body weight and BMI in SGA group were less than those in AGA group at
d28 after birth (P< 0.05). The levels of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 in SGA group and IGF-1/IGFBP-3 in AGA group did not change with age after birth. The levels of IGF-1 and IGFBP-3 were increased in AGA group after birth. The level of IGF-1 in AGA group at d14 and d28 after birth was higher than that in AGA group at d0 after birth (P< 0.05). The level of IGFBP-3 in AGA group at d28 after birth was higher than that in AGA group at d0 after birth (P< 0.05). The levels of IGF-1 and IGFBP-3 in SGA group at d28 after birth were lower than those in AGA group at d28 after birth (P< 0.05). Conclusions Serum IGF-1 and IGFBP-3 levels in SGA group are lower than those in AGA group. Low levels of IGF-1 and IGFBP-3 may result in growth retardation.

Follow-up of 103 infants with congenital heart disease in Changzhou

WANG Jinxiu, ZHANG Lin, LI Xiaoying, WANG Ying, CHEN Li

. 2014, 32(9):  839.  doi:10.3969 j.issn.1000-3606.2014.09.010

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Objective　To establish a system of the screening, evaluation and intervention of congenital heart disease (CHD) in China. Methods All infants (16070) born in Changzhou Maternal and Child Health Hospital from May 1st 2011 to April 30th 2013 were screened for CHD. The infants with CHD were followed up till 1 year of age. Results One hundred and three infants were diagnosed with CHD, and the incidence rate was 0.641??. The top three CHD types in incidences were VSD (0.205??), PDA (0.174??) and ASD (0.10??), respectively. In these infants, 94 cases were followed-up and 9 cases were lost. The incidence of small gapped VSD, ASD and premature PDA were high. Some infants with serious CHD were subjected to surgery, and others were still followed up. Conclusions The incidence of CHD in Changzhou is comparable with that in the whole country. The follow-up can improve the life quality of CHD infants.

A correlational analysis of histological chorioamnionitis and brain injury in preterm infants

ZOU Zhihui, YANG Bingyan, WANG Weiqiong, ZHANG Xiaomin, CHEN Shaobo, LAI Chunhua, LU Junfeng, YANG Chunhui, DUAN Lifeng

. 2014, 32(9):  843.  doi:10.3969 j.issn.1000-3606.2014.09.011

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Objective To explore the correlation between histological chorioamnionitis (HC) and brain injury in preterm infants. Methods Three hundred and forty-seven cases of infants at the gestational age of 28-31 weeks who were admitted to the neonatology department of our hospital were analyzed retrospectively. They were divided into the HC group and the control group according to the pathological examination. Moreover, HC group was divided into FV group and non-FV group according to the pathological findings of fetal vasculitis (FV). Based on the findings of periodical ultrasonography, the incidences of periventricular leukomalacia (PVL), periventricular-intraventricular hemorrhage (PVH-IVH), and the PVL+PVH-IVH were compared among groups. Results The incidences of PVL in the HC group and the control group were 17.9% and 10.3% respectively. The incidences of PVL+PVH-IVH in the two groups were 5.5% and 1.48% respectively, and the difference between two groups was significant (P<0.05). The incidences of PVH-IVH in the two groups were 28.9% and 26.2% respectively, and the difference between two groups was not significant (P>0.05). In the HC group, the incidences of PVL in FV group and non-FV group were 28.1% and 9.87% respectively, and the difference between two groups was significant (P<0.05). The incidences of PVH-IVH in FV group and non-FV group were 34.3% and 24.7% respectively, and the difference between two groups was not significant (P>0.05). The incidences of PVL+PVH-IVH in FV group and non-FV group were 7.81% and 3.70% respectively, and the difference between the two groups was not have significant (P>0.05). Conclusions HC may increase the ncidences of PVL and PVL+PVH-IVH in the preterm infants, while its effect is minimal on PVH-IVH. FV could increase the incidence of brain injury in preterm infants.

Relationship between serum leptin and bone speed of sound in appropriate-for-gestational-age neonates

LUO Kaiju, CHEN Pingyang, ZHAO Yafan, HE Mingfeng

. 2014, 32(9):  846.  doi:10.3969 j.issn.1000-3606.2014.09.012

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Objective　To investigate the changes of serum leptin and bone speed of sound (SOS) with gestational age (GA) and relationship between leptin and bone SOS in appropriate-for-gestational-age (AGA) neonates. Methods A total of 65 AGA neonates were recruited and divided into three groups according to their gestational age: preterm infant (GA 31-34 w, 14 cases), late preterm infant (GA 34-37 w, 13 cases), and full-term infant (GA ≥ 37 w, 38 cases). Anthropometric parameters, including birth weight, length, leg length, skin fold thickness were measured in all the subjects, and the neonatal nutritional status and body fat content were evaluated by Ponderal Index (PI) and Weststrate equation (F%) respectively. Serum leptin concentration and tibial SOS were measured within 7 days after birth. Results There were significant differences in GA (F=140.199, P<0.001), birth weight (F=47.042, P<0.001), birth length (F=46.877, P<0.001), leg length (F=17.543, P<0.001), PI (F=11.898, P<0.001) and F% ( F=21.955, P<0.001) among three groups. Serum leptin and tibial SOS were significantly different among these groups ( F=49.724, 20.052 respectively, P<0.001), and both of them were positively correlated with gestational age and birth weight (P<0.01). In addition, leptin was positively correlated with tibial SOS, but the correlation disappeared after adjustment for GA and anthropometry. According to the multivariate forward stepwise regression analysis, tibial SOS was found to be significantly positively associated with gestational age and birth weight in the three groups. Conclusions Both bone SOS and serum leptin are significantly correlated with gestational age and birth weight in AGA neonates, and leptin is related with but not the independent direct predictor of bone SOS.

Clinical analysis of an nosocomial outbreak of Klebsiella pneumoniae in neonatal intensive care unit

WANG Mingjie, YU Xiaohe, LI Wen, CAO Chuanding, WU Anhua, LIAO Zhengchang, ZHOU Meijuan, JIANG Ling, GAO Hongmei, YUE Shaojie

. 2014, 32(9):  850.  doi:10.3969 j.issn.1000-3606.2014.09.013

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Objectives To discuss the clinical characteristic, cause and measures to prevention and control of nosocomial infection in a neonatal intensive care unit (NICU). Methods Retrospectively analyzed an nosocomial infection outbreak of Klebsiella pneumoniae in NICU. Results From Sept. 3, 2010 to Oct. 3, 2010, there were 7 cases of hospital infection in 12 cases of sputum cultured Klebsiella Pneumoniae. The gestational age (GA) of 7 hospital infection cases was 28.5±2.6 week. The irth weight of infection cases was 941.4±309.8 g. The onset of infection was at 31.7±12.8 d of hospitalization. The nosocomial incidence was 2.41% in the hospital, which was 5.79% in preterm infants, 50.00% in GA <28w infants, and 42.86% in extremely low birth weight infant (ELBW). All sputum culture results were displayed as multi-drug resistant of Klebsiella pneumoniae, penicillin and third-generation cephalosporin antibiotic resistance rate of 75% to 100%. The resistance rates to penicillin and cephem antibiotics were 75% -100%, carbapenems was 58.3%, piperacillin/tazobactam was 25.0%. All nosocomial patients were cured. Conclusions GA <28w and ELBW infants are at increased risk of nosocomial infection in NICU. The emergence of carbapenems resistant Klebsiella Pneumoniae has been increasing with the widespread use of carbapenems. Hospital infection can be controlled by standardized medical behavior, which can decline the nosocomial infection incidence and mortality of preterm infants in NICU.

Retrospective analysis of distribution and antibiotic resistance of pathogenic bacteria in neonatal sepsis over 10 years

HUANG Meng, LI Kecheng, XU Xu

. 2014, 32(9):  855.  doi:10.3969 j.issn.1000-3606.2014.09.014

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Objective??To analyze distribution and antibiotic resistance pathogenic bacteria in neonatal sepsis in 10 years. Methods The distribution of pathogens and their antibiotic resistance were retrospectively analyzed in neonatal sepsis from January, 2004 to December, 2013. The results were compared between 2004-2008 and 2009-2013. Results The percentage of Streptococcus agalactiae rose from 1.0% to 4.2% and fungi rose from 1.9% to 7.9% in all pathogens in past 10 years. But the distribution of pathogenic bacteria was not significantly different. The ESBLs of Escherichia coli were increased from 28.6% to 36.0% (P>0.05). The Escherichia coli resistant to imipenem and meropenem had not been found. The Staphylococcus resistance to oxacallin and ampicillin/sulbactam was increased. The Staphylococcus resistant to vancomycin had not been found. Conclusions The main pathogens of neonatal sepsis are coagulase-negative staphylococci and E. coli. The fungi and Streptococcus agalactiae infections are significantly increased.

Expression of STAT3 in children with focal cortical dysplasias type IIIa

WANG Jiangya, LI Wenling, WU JIANG,LOU Yan

. 2014, 32(9):  859.  doi:10.3969 j.issn.1000-3606.2014.09.015

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　Objectives　To detect the expression of STAT3 in children with FCD (focal cortical dysplasias) type IIIa. Methods The expression of STAT3 and P-STAT3 (ser727) were determined in temporal lobe specimens from 26 children with FCD type IIIa and from 5 normal control by immunohistochemistry, immunofluorescence and Western blot. Results The expression of P-STAT3 (ser727) was obviously higher in FCD type IIIa than in control group. P-STAT3 (ser727) was located mainly in the nucleus of astrocytes. Conclusions Activated STAT3 might contribute to the patholgenesis of FCD type IIIa by mediating proliferation of astrocytes.

Cardiac troponin I in children with left-to-right shunt congenital heart disease

ZHANG Zhifang, CHEN Yiwei, LI fen,GAO Wei, YU Zhiqing, ZHOU Aiqing, ZHONG Yumin, ZHANG Yuqi

. 2014, 32(9):  863.  doi:10.3969 j.issn.1000-3606.2014.09.016

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　Objective??To analyze the level of cardiac troponin I (cTnI) in children with left-to-right shunt congenital heart disease (CHD). Methods In this study, 146 children with secundum atrial septal (ASD) defect, 132 children with ventricular septal defect (VSD) and 300 healthy children were recruited. The levels of cTnI and N-terminal pro-brain natriuretic peptide (NTproBNP) were measured and their correlation with clinical data was analyzed. Results The serum cTnI and NT-proBNP levels in both ASD and VSD patients were significantly higher than those in normal children (H=3.89 and 5.27, P<0.01). The serum cTnI and NT-proBNP levels in VSD patients were significantly higher than those in ASD patients (P<0.05). The ratio of pulmonary to systemic arterial pressure (Pp/Ps), pulmonary vascular resistance index (PVRI) and standardized left ventricular end diastolic volume in VSD patients were significantly higher than those in ASD patients (P<0.05). Multiple regression analysis showed that Pp/Ps was significantly correlated with cTnI in VSD patients. (β=0.81, SE=0.03, P=0.000). Conclusions Significant volume and pressure overload due to a left-to-right shunt induce myocardial injury and could lead to irreversible myocardial remodeling in children with CHD. The serum cTnI level is a sensitive biomarker for myocardial damage in VSD patients.

Study on pulmonary function changes in infants with human bocavirus or mycoplasma pneumonia

CHEN Ying,YING Fang, LI Ling, WANG Meijuan, YAN Yongdong, XU Hong, GU Guoying, JI Wei

. 2014, 32(9):  867.  doi:10.3969 j.issn.1000-3606.2014.09.017

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Objective　To discuss the pulmonary function change in infants with human bocavirus (HBoV) pneumonia or mycoplasma pneumonia (MP) and its clinical significance. Methods One hundred and forty infants under 3 years old who were admitted due to pulmonary infection were recruited from January, 2013 to October, 2013. Among them, HBoV-DNA was detected in 64 cases, and MP-DNA was detected in 76 cases. Thirty eight normal age-matched infants were selected as controls. The shape of tidal breathing flow-volume loops (TBFVLs) and change of every index were measured with a Pulmonary Testing System (Jaeger MasterScope). Results The ratio of time to peak tidal expiratory flow (PTEF) to total expiratory time (TPTEF/TE), the ratio of VPTEF to expiratory volume (VPTEF/VE), tidal expiratory flow at 25% of the remaining tidal volume (TEF25%) and the ratio of TEF25% to PTEF (25/PF) were significantly decreased in infants with HBoV and MP infection as compared with healthy infants (P<0.05). However, there was no significant difference of the above indices between infants with HBoV and MP infection (P>0.05). The shape of TBFVLs in infants with HBoV and MP pneumonia was changed and characterized by left-shifted PTEF and trough-like concave in descending limb. The PTEF was decreased in infants with pulmonary infection. Conclusions HBoV or MP infection results in impaired pulmonary function with manifestations of obstruction in small airway. The shape of TBFVLs in infants with HBoV and MP pneumonia is characterized by left-shifted PTEF and trough-like concave in descending limb.

Risk factor for mortality in neonate with congenital esophageal atresia and simple congenital heart disease

CHEN Feng, ZHANG Yu, LI Luquan

. 2014, 32(9):  872.  doi:10.3969 j.issn.1000-3606.2014.09.018

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　Objective:??To investigate the risk factors for mortality in neonates with congenital esophageal atresia (CEA) and simple congenital heart disease (CHD) including atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Methods The medical records of neonates with CEA and simple CHD who had surgery in Children’s Hospital of Chongqing Medical University from 1998 to 2013, were analyzed retrospectively. Factors including neonatal demographics, laboratory results and complications after surgery were compared between survivor and non-survivor groups. Results Seventy five cases were included in this study and the mortality was 10.67% (8/75). There was no significant difference between nonsurvivor group (n=8) and survivor group (n=67) in factors such as gestational age, birth weight, age of admission, age at surgery, duration of surgery, full blood examination, serum electrolytes, blood gases, prevalence of septicemia, pneumothorax, and cold lesion syndrome. However, the prevalence of respiratory failure and heart failure in non-survivor group was higher than that in survivor group (75% vs. 9%, P=0.000; 50% vs. 1.5%, P=0.000, respectively). Conclusions The poor outcome among neonates with CEA plus simple CHD might be associated with respiratory failure and heart failure.

Analysis of screening and therapeutic effect of congenital hypothyroidism in Zhongshan

HUANG Lianhong,SHANGGUAN Yumei, FU Simao, LIU Yuling, OU Junbin, XU Kang, ZHANG Cuimei

. 2014, 32(9):  876.  doi:10.3969 j.issn.1000-3606.2014.09.019

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Objectives??To summarize screening and therapeutic effects of congenital hypothyroidism (CH) in Zhongshan. Methods The thyroid stimulating hormone (TSH) concentration in dried heel blood samples on filter paper was detected using time-resolved fluorescence immunoassay. The cases of positive screening tests were called back for further examination of venous blood TSH concentration using chemiluminescence method. Fifty-four children with permanent CH treated routinely for 2 years (CH group) and 120 age-gender matched health children (control group) were recruited. The physical development (height, body weight) was monitored. The neurodevelopment and temperament type were tested using Pediatric Nneuropsychological Development Assessment and Children's Temperament Scale respectively at 6 and 24 months after birth. Results Two hundred eight-five thousand two hundred forty-two neonates were screened. One hundred and forty cases were confirmed and the incidence rate was 1/2037. There was no statistical difference in length-for-age z score (LAZ) and weight-for-age z score (WAZ) between CH and control group (P>0.05). The neurodevelopment in CH group was normal, but gross motor development was worse than that in control group (P< 0.05). The temperament type and distribution had statistical difference between CH and control group (P< 0.05). The percentage of the difficult type and central difficult type was increased in CH group as compared to control group, especially in the activity, adaptability, reaction intensity and perseverance (P< 0.05). Conclusions The physical and neurodevelopment are nearly normal in patients with CH after early supplementation, but the psychological behavior problems need to be focused on in the process of intervention.

Analysis of drug treatment of the coronary embolism in Kawasaki disease

YU Huijuan, ZHU Weihua

. 2014, 32(9):  881.  doi:10.3969 j.issn.1000-3606.2014.09.020

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Objective　To observe the efficacy of drug treatment of coronary aneurysm complicated with embolism in Kawasaki disease (KD). Methods The clinical data of eight KD children with coronary aneurysm and embolism were retrospectively analyzed. Results Eight KD children (six males and two females) at age of 0.25-5.2 years (mean = 2.89) ,were diagnosed with gigantic coronary artery aneurysms. The diameter of aneurysm was around 8.3-13.8mm. Thrombosis appeared from 19 days to five months after coronary aneurysms formation. The onset manifestations included sudden chest pain and myocardial infarction with symptoms of heart failure in one case, shock in one case and no symptom in six cases. The maximum diameter of the thrombus was 2.8 mm×15.4 mm in the shape of funicular. Four cases had thrombus in the right coronary artery, two cases in the left coronary artery, and two cases in both sides. The patients underwent anticoagulant therapy taking heparin, urokinase, warfarin, aspirin and dipyridamole. Anticoagulant therapy was successful in 7 cases and the thrombus was completely dissolved in 7 days to more than 4 months. One case had recurrent coronary thrombosis after 4 months. One case died in 12 hours after thrombolysis. Conclusions Coronary thrombosis usually appears in the half year after the onset of KD coronary aneurysm. Thrombolysis therapy takes long time in Kawasaki patients. Breaking off of thrombus are rarely seen.

A comparative study of radionuclide imaging technique diagnosis and surgical results for Meckel's diverticulum in children

ZHANG Shuanghong, WAN Shenghua, GUAN Yanxing, DENG Qingqiang, YANG Wenping, CHEN Qingjie

. 2014, 32(9):  885.  doi:10.3969 j.issn.1000-3606.2014.09.021

Abstract ( 381 )   PDF (2152KB) ( 503 )  

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Objective To evaluate the accuracy of ^99mTcO4- gastrointestinal imaging in the diagnosis of Meckel’s diverticulum in children. Methods The clinical data of ^99mTcO4- imaging, surgery and pathological results of 95 children with gastrointestinal bleeding were retrospectively analyzed. Results Forty-four cases of 95 patients had positive finding of ^99mTcO4- ectopic gastric mucous membrane imaging, and positive rate was 46.3%. In the positve cases 52.3% cases (23/44) were diagnosed of intestinal heterotopic gastric mucosa, 47.7% cases (21/44) were suspected of intestinal heterotopic gastric mucosa. The sex ratio (males to females) was 7.8:1. Thirty-seven positive cases underwent operation; among them, 35 cases were found to have Meckel’s diverticulum and 1 case had duplication of the digestive tract; Diverticulum lesion was not found in 1 case. The samples of 35 cases diagnosed surgically of Meckel’s diverticulum were examined by pathologic histology. All 35 cases were confirmed as Meckel’s diverticulum and ectopic gastric mucosa epithelium, including 2 cases with ulcer formation, 1 case with small patches of pancreatic tissue, 1 case with ileocecal junction of suppurative enteritis and 1 case with chronic appendicitis. Conclusions 99mTcO4- radionuclide imaging technique is of high value for the non-invasive diagnosis of children’s Meckel’s diverticulum.

Analysis of inherited metabolic disease in Beijing by gas chromatography-mass spectrometry

PENG Wei, ZHANG Wanqiao, FENG Zhichun

. 2014, 32(9):  888.  doi:10.3969 j.issn.1000-3606.2014.09.022

Abstract ( 352 )   PDF (1288KB) ( 383 )  

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Objective　To learn the incidence of the inherited metabolic diseases in Beijing. Methods Urine samples were analyzed by gas chromatography-mass spectrometry??GC-MS??for inherited metabolic diseases in high risky infants in Beijing . Results Urine samples from 411 high risky infants were analyzed by gas chromatography-mass spectrometry. 269 cases (65.5%) were detected to have metabolic abnormalities, including 19 cases (4.6%) diagnosed of inherited metabolic diseases in which there were 15 cases of methylmalonic academia and 1 case each of propionic academia, hyperphenylalaninemia, urea cycle abnormality and pyroglutamic aciduria. There were 22 suspected cases (5.4%) of inherited metabolic diseases including 13 cases of lactic acidosis, 5 cases of primary glycerol aciduria, 4 cases of fatty acid metabolic disorders including 1 case each of Citrin defects, tyrosinemia, galactosemia 3-methylcrotonoyl coenzyme A carboxylase deficiency and maple syrup urine disease. There were also 228 cases (55.5%) of metabolic abnormalities, such as increasing urine levels of lactic acid, sucrose,lactose, galactose, N-acetyl tyrosine, succinic acid, dicarboxylic acid and abnormal serine/threonine ratio. Conclusions Methylmalonic academia might be the most common inherited metabolic diseases in high risky infants in Beijing. For infants with clinical manifestations but unclear etiology, GC-MS should be performed. MS-MS and gene analysis could be combined if necessary.

Research advances on gene susceptibility of viral myocarditis

LIU Shuang, LIU Tianlong, LIU Xiaolei

. 2014, 32(9):  892.  doi:10.3969 j.issn.1000-3606.2014.09.023

Abstract ( 285 )   PDF (1228KB) ( 447 )  

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Viral myocarditis is an acute or chronic inflammatory disease of the myocardium and may progress to dilated cardiomyopathy (DCM) with life-threatening symptoms including heart failure, arrhythmias and sudden cardiac death. At present, the pathogenesis of viral myocarditis still remains unclear, so it is difficult for clinicians to diagnose, treat and find a specific biomarker. However, the pilot researches showed that pathogenesis of viral myocarditis was associated with genetic susceptibility. This article reviewed the above aspects.

The role of renal tubule remodeling in acute kidney injury

SHEN Yunlin, HUANG Wenyan

. 2014, 32(9):  895.  doi:10.3969 j.issn.1000-3606.2014.09.024

Abstract ( 326 )   PDF (1206KB) ( 344 )  

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　Acute kidney injury (AKI) has emerged as a major public health problem that leads to decreased survival. Renal tubular epithelial cells are mainly damaged cells in AKI. Renal tubular epithelial cell remodeling plays a vital role in AKI. The regulatory mechanism of renal tubule remodeling is not yet clear. This review is written to address the renal tubule remodeling regulation mechanism of AKI.