Objective To investigate the cause and clinical characteristics of neonatal thrombocytopenia (NT).Methods A retrospective analysis was performed.71 cases with NT were selected as our subjects.The morbidity of NT was calculated.Results Among the 71 cases with NT,34 were term infants and 37 were preterm infants.The morbidity of NT in preterm infants was significantly higher than that in term infants (x2 =24.56,P ＜0.01).Common causes for NT included intrauterine growth restriction(IUGR),severe asphyxia,severe sepsis or necrotizing enterocolitis (NEC).IUGR was the more frequent cause for early-onset thrombocytopenia than for late-onset thrombocytopenia (x2 =9.20,P =0.002).Severe sepsis or NEC was the more frequent cause for late-onset thrombocytopenia than for early-onset thrombocytopenia (x2 =13.58,P ＜ 0.01).The cases of bleeding in mild thrombocytopenia group was less than that in severe thrombocytopenia group(x2 =5.85,P =0.016).Conclusion IUGR which is the common cause for NT frequently induces earlyonset thrombocytopenia.Severe sepsis or NEC frequently induces late-onset thrombocytopenia accompanied with high bleeding risk.Earlier diagnosis of the cause for NT and tailed treatments can achieve better efficacy.

Objective To study the feasibility, efficacy and safety of laryngeal mask airway (LMA) in neonatal resuscitation. Methods Totally, 369 neonates requiring positive pressure ventilation at birth were randomized into two groups by offering either LMA resuscitation (205 cases) or bag-mask ventilation (BMV) resuscitation (164 cases). The effect in the two groups were observed. Results (1) No significant difference was observed in Apgar scores at 1 min between LMA group and BMV group, but the neonates having higher Apgar scores at 5 min in LMA group were more than in BMV group (x2 =-3. 39,P=0. 001). The successful resuscitation rate of LMA group was higher than that of BMV group (99.02%vs 84. 15% ,x2 =28. 76, P＜0. 01), the total ventilation time of LMA group was shorter than that of BMV group [(36.4±23.7) s vs (66.2±35.4) s] (t=-8.66, P＜0. 01). Among severe asphyxia neonates,seven of nine were successfully resuscitated by LMA, while in BMV group six neonates with severe asphyxia were all switched to endotracheal intubation ventilation. In neonates with Apgar score of 4 to 5 at 1 min after birth, the successful resuscitation rate of LMA group was higher than that of BMV group (100% vs 42. 86%, x2 =23.04, P＜0.01), the ventilation time of LMA group was shorter than that of BMV group [(54.6±33.6) s vs (136.4±42.0) s] (t= -4. 45, P＜0.01). In neonates with Apgar score of 6 to 7 at 1 min after birth, there was no significant difference in the successful resuscitation rate between LMA and BMV group. (2) The successful rate of LMA insertion at first attempt was 98.54% (202/205) and the average insertion time was (7.8 ± 2. 2) s. The adverse effects included vomiting(4 cases)and regurgitation (3 cases). Conclusions In neonatal resuscitation, LMA can be easily inserted. Compared to BMV, LMA is a better choice in resuscitation for neonates with moderate or severe asphyxia and preferable for those medical staffs who are unfamiliar with endotracheal intubation, or even as a substitute of endotracheal intubation ventilation.

ObjectiveTo study the feasibility,efficacy and safety of u tilizing the laryngeal mask airway (LMA) ventilation compared with the endotracheal intubation ( ET ) in neonatal resuscitation for moderate and severe asphyxiated neonates.MethodsNeonates requiring positive pressure ventilation with heartrate ＜60 beats/min were collected and grouped quasi-randomizedly into LMA(36 cases) or ET(32 cases)ventilation.Differences of resuscitation effect,inserting time,successful once insertion rate and adverse reactions between the two groups were observed and compared.Results( 1 ) No significant difference was observed in Apgar scores at 1 min and 5 min between the two groups ( P＞0.05 ).(2) Success rate of once insertion was 94.4％ with average inserting time ( 7.58±1.16 ) s for LMP group,while it was 90.6％ and ( 7.89 ± 1.52) s for ET group.( 3 ) Successful resuscitation rate of LMA group ( 86.11％ ) was slightly lower than ET group (96.88％ ),but there was no statistical difference (P＞0.05).(4) Mean response time of LMA group [ (34.06 ± 10.56) s] was slightly lower than that of ET group [ (41.38 ±27.19) s],also ventilation time of LMA group [( 137.19 ±80.14) s] was slightly lower than that of ET group [ ( 171.09±84.28 ) s ],but neither showed statistical difference ( P＞0.05 ).(5) Adverse reactions were found in LMA group including nausea( 2 cases )and abdominal distention (1 cases),while there were laryngeal edema( 1 cases),pneumothorax(2 cases),respiratory tract bleeding( 1 cases) in ET group.ConclusionThe LMA ventilation is much easier to operate,with its effect no less than that of ET ventilation on resuscitation for moderate and severe asphyxiated cases,even it seems more safe.LMA ventilation can be a good substitute for ET ventilation,especially for those medical staffs who are unfamiliar with ET operation and primary hospital doctors in case of emergency.

Objective To analyze the incidence of retinopathy of prematurity(ROP)among extreme-ly preterm infants,and to evaluate the treatment methods and effects among those with severe ROP.Methods A retrospective analysis was performed to analyze incidence of ROP in 96 cases of extremely preterm infants who were born at a gestational age of 〈28 weeks and survived beyond a postmenstrual age of at least 1 year from Apr 2006 to Oct 2013,and to analyze the treatment outcomes of photocoagulation and ranibizum-ab intravitreal injection among the infants with severe ROP.Results Fifty-six of 96 cases(58.33%)grew into ROP finally and 21 cases(21.88%)grew into severe ROP,2 cases(2.08%)grew into aggressive poste-rior ROP.Fifteen cases with severe ROP were treated with laser photocoagulation.Four cases with severe ROP were received ranibizumab intravitreal injection prior to photocoagulation.Two cases with severe ROP were only treated with ranibizumab intravitreal injection.The eyesight of 96 patients (100%)in this study were all preserved.Conclusion ROP screening should focus on extremely preterm infants because of higher incidence of ROP and severe ROP among them.The infants with severe ROP should be treated with laser photocoagulation in time.The infants in critical condition or with aggressive posterior ROP can be treated with ranibizumab injection.

BACKGROUND: Magnalium which is potential to be the medical biodegraded metal implant is more and more interesting,but it must be well biocompatibility to human body.OBJECTIVE: To evaluate the sensitization of magnalium (AZ31B).METHODS: A total of 35 guinea pigs were randomly divided into saline group (negative control group,n=10),5% volume of formaldehyde (positive control group,n=10),and AZ31B group (n=15).Sensitization test at the maximal dosage was performed according to "Biological evaluation of medical devices-Part 10: Tests for irritation and delayed-type hypersensitivity",including intracutaneous induction,local induction,and provocation.Patch was removed after 6,24,48,and 72 hours,and the skin response was classified accordingto Magnusson and Kligman criteria.Patch was removed after 72 hours,and skin was performed with biopsy,stained with FIE staining,and observed under optic microscope.RESULTS AND CONCLUSION: Sensitization response was not tested in both negative control group and AZ31B group at 24,48,and 72 hours after patch removal; however,moderate erythema was observed in the positive control group.Optic microscope demonstrated that criteria of allergy such as spongiosis,edema,and diffuse as well as perivascular mononuclear infiltration was not observed in the AZ31B group,but a few basophilic calls ware observed.This suggested that AZ31B was biologically safe for sensitization.

Objective:To study the incidence and risk factors of periventricular- intraventricular hemorrhage (PIVH) in extremely preterm infants (EPI) with gestational age (GA)<28 weeks.Methods:A retrospective study was performed in 304 cases of EPI hospitalized between January 2016 and December 2018. The infants were assigned into two groups according to whether PIVH occurred. Univariate analysis and Logistic regression analysis were used to determine the risk factors of PIVH.Results:Among the 304 cases,101 (33.2%) developed PIVH and 44 (14.5%) developed severe PIVH.The incidences of PIVH and severe PIVH in EPI with birth weight (BW) <750 g were 50.6% and 31.0%. The incidences of PIVH and severe PIVH in EPI with GA<26 weeks were 51.4% and 27.5%. Logistic regression analysis revealed that advanced GA ( OR=0.697, 95% CI 0.543~0.895, P=0.005) decreased the risk of PIVH. Prolonged invasive mechanical ventilation ( OR=1.121, 95% CI 1.007~1.249, P=0.037) and use of vasoactive drugs ( OR=1.373, 95% CI 1.040~1.812, P=0.025) within the first week of life increased the risk of PIVH. Conclusions:The incidences of PIVH and severe PIVH in EPI are quite high. Smaller GA, longer use of invasive mechanical ventilation and vasoactive drugs within the first week will increase the risk of PIVH in EPI.

Objective:To study the effects of breastfeeding within 2 weeks after birth on late-onset sepsis in very low birth weight infants (VLBWI).Methods:From July 2018 to June 2019, clinical data of VLBWI (birth weight <1 500 g) born in our hospital were retrospectively reviewed. According to the proportion of breastfeeding volume in total feeding volume within 2 weeks after birth, the infants were assigned into high-proportion breastfeeding group (breastfeeding >50%), low-proportion breastfeeding group (breastfeeding ≤50%) and formula group. The incidences of late-onset sepsis among the three groups were compared using the chi-square test or Fisher's exact probability method. Logistic regression was used to analyze the effects of breastfeeding within 2 weeks after birth on late-onset sepsis.Results:The incidences of late sepsis in high-proportion breastfeeding group, low-proportion breastfeeding group and formula group were 0.4% (1/216), 8.1% (5/62) and 8.0% (2/25), respectively ( P<0.001). Logistic regression analysis showed that compared with the high-proportion breastfeeding group, the low-proportion breastfeeding group ( OR=17.844, 95% CI 2.005~158.775) and the formula group ( OR=23.261, 95% CI 1.916~282.350) had increased risks of late-onset sepsis. Conclusions:For VLBWI, high proportion breastfeeding (breastfeeding >50%) within 2 weeks after birth may reduce the risk of late-onset sepsis.

Objective:To study the effects of early breastfeeding volume on neonatal necrotizing enterocolitis (NEC) and feeding intolerance in very low birth weight infants.Methods:This study retrospectively analyzed the clinical data of 275 cases of very low birth weight infants (birth weight<1 500 g) born in Shenzhen Maternity & Child Healthcare Hospital from June 2017 to May 2018. Based on whether breastfeeding or not and the ratio of breast milk intake over the total volume of intake within two weeks after birth, they were divided into three groups: breast milk intake>50% group (>50% group, n=199), breast milk intake≤50% group (≤50% group, n=55) and formula group ( n=21). Differences in the incidence of NEC and feeding intolerance among the three groups were analyzed using Chi-square test (or Fisher's exact test). Effects of breast milk intake on the incidence of NEC and feeding intolerance were evaluated using univariate and multivariate logistic regression analysis. Results:The incidence of NEC in the >50% group, ≤50% group and formula group was 1.5% (3/199), 27.3% (15/55) and 9.5% (2/21), respectively ( P<0.01), and the incidence of feeding intolerance was 17.6% (35/199), 56.4% (31/55) and 28.6% (6/21), respectively ( χ2=34.826, P<0.01). Univariate logistic regression analysis showed that compared with the >50% group, the risk of NEC in the≤50% and formula group increased ( OR=24.500, 95% CI: 6.755-85.594; OR=6.877, 95% CI: 1.081-43.744); that of feeding intolerance increased in the≤50% group ( OR=6.316, 95% CI: 3.293-12.113). Multivariate logistic regression analysis showed that compared with the >50% group, the risk of NEC in the≤50% and formula groups increased ( OR=28.452, 95% CI: 7.280-111.195; OR=8.610, 95% CI: 1.262-58.766); that of feeding intolerance increased in the≤50% group ( OR=7.207, 95% CI: 3.601-14.425). Conclusions:Breastfeeding accounting for more than half of the total volume of intake within two weeks after birth may reduce the incidence of feeding intolerance and NEC in very low birth weight infants.

Objective To analyse the risk factors associated with spontaneous intestinal perforation (SIP) in extremely premature infants/extremely low birth weight infants. Method From January 2015 to December 2018, infants with gestational age (GA)<28 weeks or birth weight (BW)<1000 g admitted to our neonatal intensive care unit were enrolled to the retrospective nested case-control study.The clinical data of SIP infants (SIP group) and infants with the same GA but without SIP (control group) were randomly selected and compared. Multivariable Logistic regression was used to analyse the risk factors of SIP. Result A total of 409 extremely premature infants/extremely low birth weight infants were born during the study period. Among them, 25 SIP infants and 55 controls were enrolled. The incidence of SIP in infants with GA 22～25 weeks was 11.8％(16/136), which is higher than infants with GA 26～27 weeks (2.0％, 5/247) (χ2=16.057, P<0.001). The incidence of SIP in infants with BW 400～749 g was 13.0％(14/108), which is higher than infants with BW 750～999 g (3.4％, 8/236) (χ2=11.343, P=0.001). Multivariate Logistic regression analysis showed that twins (OR=4.153, 95％CI 1.392～12.384, P=0.011), umbilical veins catheterization (OR=15.942, 95％CI 1.026～247.789, P=0.048) and ibuprofen use within 3 days after birth (OR=15.387, 95％CI 1.519～155.883, P=0.021) were independent risk factors of SIP. Conclusion The smaller the GA and BW, the higher the incidence of SIP. Twins,umbilical veins catheterization and ibuprofen use early after birth may be independent risk factors of SIP.

Objective:To review the treatment experience of extremely premature infants (EPIs) with gestational age (GA) <23 weeks.Methods:From January to November 2021, EPIs with GA<23 weeks treated in our hospital was retrospectively analyzed.Results:A total of 3 patients with GA of 22 weeks were reviewed, including 2 boys and 1 girl. Their birth weight (BW) was 450~498 g. The duration of hospitalization was 112~126 d. The treatment included early "gentle" management strategies, respiratory management, anti-infection, patent ductus arteriosus treatment and parenteral + enteral nutrition. All 3 infants were discharged from the hospital without further oxygen therapy. All had satisfying oral feeding with no neurological sequelae on follow-up.Conclusions:Early "gentle" management is the key to successful treatment and good prognosis for EPIs with GA<23w