Objective To explore the value of procalcitonin (PCT) in diagnosis and treatment of neonatal ventilator associated pneumonia(VAP).Methods Sixty neonates needed invasive mechanical ventilation admitted to our NICU from Jan 2012 to Dec 2013 were divided into VAP group (30 cases) and nonVAP group (30 cases),depending on whether the neonates developed to VAP or not in 7 days.The VAP group then was randomly divided into PCT group (15 cases) and control group(15 cases) according to random number table.The levels of serum PCT,C-reactive protein(CRP) and WBC count were detected when the neonates suspected VAP before and after mechanical ventilation.Besides,the sensitivity,specificity,positive and negative predictive values for PCT,CRP and WBC were calculated in the diagnosis of VAP.Results The serum levels of PCT in VAP group had significant difference before and after mechanical ventilation (t =1.58,P =0.000),the levels of PCT were (0.37 ± 0.25) μg/L and (2.17 ± 1.46) μg/L respectively.The levels of PCT in non-VAP group had no significant difference (t =3.67,P =0.055).The levels of CRP and WBC showed no significant differences between VAP and non-VAP group before mechanical ventilation (P ＞ 0.05).Taking PCT ≥0.40 μg/L,CRP≥ 28 mg/L and WBC ≥ 10 × 109/L as the cut off value,the sensitivity of the three indicators diagnosis of VAP were 93.3％,73.3％ and 66.7％ respectively.PCT had the highest sensitivity 93.3 ％,specificity 73.3％,positive predictive 77.8％ and negative predictive 91.7％.The antibiotic duration of PCT group was (12.6 ± 5.6) d compared with (15.1 ± 9.1) d in control group (P =0.018).Conclusion Serum PCT has high sensitivity and specificity in the diagnosis of VAP,PCT combined with clinical pulmonary infection score can improve the diagnostic accuracy of VAP,early diagnosis and timely monitoring of serum PCT is helpful in VAP.PCT guidance substantially reduces antibiotic use in VAP,so that timely surveillance of PCT is necessary for patients on ventilator.

Objective To investigate the incidence of retinopathy of prematurity (ROP) in our hospital and to explore the risk factors of ROP.Methods Premature infants hospitalized in our hospital in January 2010 to December 2012 were chosen,and the gestational ages were less than 36 gestational weeks,birth weights were under 2 500 g.All the cases underwent ROP screening at two weeks after birth,and then they received regular follow-up.Children with systemic conditions and oxygen to the mother during pregnancy,oxygen,preeclampsia,placental abruption,and other factors were analyzed.Results Two hundred and fifty-five cases completed the retinal screening,terminated follow-up after the peripheral retinal neovascularization or disease degradation.We found ROP in 16 cases (26 eyes),ROP prevalence rate was 6.3％ (5.1％),including phase Ⅰ 12 cases,phase Ⅱ3 cases,phase Ⅲ 1 case.Gestational age,birth weight,inhale oxygen time,oxygen concentration,mechanical ventilation were associated with ROP (P ＜ 0.05).Mother oxygen during pregnancy,preeclampsia,placental abruption had nothing to do with the incidence of ROP.Conclusion Premature birth,high concentrations of oxygen,mechanical ventilation are major risk factors of ROP.Timely screening of ROP and found early to do the retinal laser photocoagulation in premature,can control the disease,reduce the blindness rate of premature infants.

Brain injury in preterm infants is an important reason for making the newborn disability.Neonatal cerebral injury of imaging examination method has a time lag.Looking for a simple,timely,accurate predictor of biological markers of brain injury in preterm infants is particularly important.In this paper,the role of S100B protein,glial fibrillary acidic protein and neuron-specific enolase of brain injury in preterm infants was reviewed,and the significance of early diagnosis of brain injury in preterm infants was discussed.

Objective To investigate the pathogen and incidence of ventilator-associated pneumonia (VAP) under different pH value of gastric juice,and to explore the endogenous pathogenesis of VAP.Methods Ninety-eight cases were admitted in our neonatal intensive care unit from Dec 2008 to Dec 2010.According to whether VAP happened,they were divided into VAP group (52 cases) and non-VAP group (46 cases).The relation between pH value of gastric juice and the species of pathogenic bacteria in stomach was analyzed.Results The incidence of VAP was 53.1％ (52/98).The pH value of gastric juice affected the species of pathogenic bacteria in stomach.When pH ≤ 4,the major species of pathogenic bacteria were Candida and Gram-positive bacillus; and pH ＞ 4,the major species were Gram-negative bacillus.The incidence of VAP was 34.5％ (10/29) when pH≤4;on the contrary,the incidence was 60.9％ (42/69) when pH ＞ 4.The incidence of VAP at the time of pH ＞ 4 was significantly higher than that of pH ≤4 ( x2 =5.71,P =0.017).Conclusion The pH value of gastric juice is an important factor of the species of pathogenic bacteria in stomach,especially for Gram-negative bacillus,including multi-drug resistant extended-spectrum β-lactamase-producing bacteria.The higher of pH value,the incidence of VAP is higher.

Objective To explore the method that can block the infection route from stomach to lung so as to reduce the incidence of ventilator-associated pneumonia (VAP) in neonates.Methods Neonates with mechanical ventilation were randomly divided into two groups,the treatment group(40 cases) were given probiotics (Bifidobacteria) by nasogastric feeding,control group(40 cases) were given nothing.Prospective survey was performed on the incidence of VAP,gastric juice pH,gastric bacterial colonization,the homology between gastric bacterial colonization and VAP pathogen.Results The VAP incidence of treatment group and control group was 12.5％ (5/40) and 47.5％ (19/40) respectively,there was significant difference between the two groups ( x2 =10.21,P ＜ 0.01 ).The onset time of VAP in treatment group [ ( 5.4 ±2.1 ) d] was later than that of control group[ (4.3 ± 1.0) d] ( t =3.2,P ＜0.01 ).The ratio of treatment group that gastric juice dropped to pH≤3 (80.0％,32/40) was higher than that of control group(47.5％,19/40) ( x2 =11.5,P ＜ 0.01 ) ; and the ratio of gastric bacterial colonization in treatment group ( 30.0％,12/40) was lower than that in control group(80.0％,32/40) ( x2 =16.9,P ＜0.01 ).The homology ratio between VAP pathogen and colonization bacteria in treatment group (40.0％,2/5 ) was lower than that in control group (78.9 ％,15/19 ) ( x2 =8.7,P ＜ 0.01 ).Conclusion Probiotics can reduce gastric juice pH of neonates and inhibit gastric bacterial colonization.The onset time of VAP can be delayed,the incidence of VAP can be reduced effectively.

Objective:To observe the characteristics of early changes in choroidal thickness and choroidal microvascular morphology in the macula of patients with systemic lupus erythematosus (SLE) using swept-source optical coherence tomography angiography (OCTA).Methods:A cross-sectional study was conducted.Thirty-seven patients (37 eyes) who were diagnosed with SLE without obvious ocular symptoms in Hebei General Hospital from January 2022 to July 2022 were enrolled in this study as a SLE group.At the same time, 35 normal adults (35 eyes) matched with age and sex were included as a control group.Swept-source OCT was used to perform a 9 mm×9 mm radial scan of the macular region of subjects to obtain the average choroidal thickness of the macular central concave area, the paracentral concave area (1-3 mm), and the pericentral concave area (3-6 mm). OCTA was used to perform a 3 mm×3 mm scan of the macular region and images of retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) blood flow density, choroidal capillary plexus (CC) blood flow density, and microvascular blood flow in the macular region were obtained and binarized using ImageJ software (Phansalkar method) to calculate the choroidal capillary flow void area (FDa) and percentage of flow deficits (FD%). The study protocol followed the Declaration of Helsinki and was approved by the Ethics Committee of Hebei General Hospital (No.202310). Informed consent was obtained from all subjects.Results:The choroidal thickness of the subfoveal region in SLE group was (268.73±81.67)μm, which was significantly higher than (230.14±68.14) μm of control group ( t=2.170, P=0.033). The blood flow density of SCP, DCP and CC in the macular central zone area of SLE group were (16.58±3.90)%, (14.25±3.15)% and (51.80±4.27)%, respectively, which were significantly lower than (20.55±4.41)%, (16.57±3.74)% and (54.33±3.41)% of control group ( t=-4.043, -2.851, -2.763; all at P<0.05). The FDa and FD% in SLE group were 3.43(3.25, 3.56)mm 2 and 38.11%(36.13%, 39.52%), which were greater than 3.25(3.21, 3.32)mm 2 and 36.11%(35.64%, 36.84%) of control group, and the differences were statistically significant ( Z=-3.470, -3.476; both at P<0.05). Conclusions:OCTA can detect an increase in choroidal thickness and a decrease in blood flow density of CC in eyes with SLE without obvious ocular symptoms.