Advances in resuscitation and intensive care have led to high rates of survival among neonates with life -threatening conditions such as asphyxia,prematurity and congenital malformations.The sequelae of neurologic con-ditions arises in the neonatal period include lifelong disabilities such as cerebral palsy,epilepsy,intellectual and beha-vioral disabilities.There is an increasing demand for resource -intense strategies for acute neurological care within neo-natal intensive care unit.Neonatal neurocritical care is a multidisciplinary subspecialty that combines expertise in neo-natology,pediatric neurology,radiology,rehabilitation,surgery,and has led to improved outcomes in newborn that have critical illnesses.Neonatal neurocritical care focus the needs of the developing newborn brain,including attention to physiology to help prevent secondary brain injury,a protocol -driven approach for common conditions such as hypoxic -ischemic encephalopathy and seizures,education of specialized teams that use brain monitoring and imaging to evaluate the effect of critical illness on brain function.

Brain injury of premature infant is a hot topic in the neonatal clinical study. Early diagnosis and intervention can improve the prognosis of premature infants. Although there are some interventions for brain injury of premature infants, most of them do not have evidence-based study to support the clinical application. Antenatal application of magnesium sulfate for pregnant women and application of erythropoietin for preterm infants may be the most promising interventions. Avoiding prematurity and brain damage is the key interventions for brain damage of premature infants.

Therapeutic hypothermia is believed to improve neurodevelopment outcome of infants with moderate-to-severe hypoxic-ischemic encephalopathy(HIE),however,the severe brain injury and neurologic sequelae still can be observed in some infants received therapeutic hypothermia.Optimal monitor and management of systematic complications presented by infants during cooling treatment are necessary for improvement of overall outcome.Therefore,it is essential to understand the functional change of each system of the whole body,to adapt adequate diagnostic methods and to train multidisciplinary staffs to monitor and manage moderate-to-severe HIE infants during therapeutic cooling.With the development of therapeutic hypothermia,it is currently considered as a standard of care for infants with moderate-to-severe HIE.It is recommended that any neonatal intensive care unit(NICU) using routinely therapeutic hypothermia to reference the national or international benchmarking protocols in order to improve the medical quality and prognosis of infants.

Hypoglycemia is a common metabolic problem in newborn infants,which might lead to brain injury even brain death when it keeps extremely low for a long time.Therefore,it is of great importance to monitor blood glucose in neonates,especially in groups of infants who are at risk of hypoglycemia,in order to identify and treat this condition and prevent adverse neurological outcomes promptly.It is given that infant of a diabetic mother,preterm neonate,low birth weight and asphyxia are its risk factors.Relative to blood glucose monitoring methods in clinical,continuous glucose monitoring system is comprehensive,continuous and with low pain.Continuous glucose monitoring system has been applied in high-risk neonates of hypoglycemia in recent years.It is of great help to understand the complete picture and change trend of blood glucose,optimize blood glucose management,study newborn glucose metabolic characteristics and the relationship between hypoglycemia and brain damage,so as to define and manage neonatal hypoglycemia.

10.3969/j.issn.1000-3606.2013.06.024

The morbidity of transient hypothyroxinemia of prematurity (THOP) was high. There is controversial about thyroid hormone supplementation in THOP. Clinical studies suggest that thyroid hormone supplementation can reduce the incidence of patent ductus arteriosus,but no effect on the mortality and the incidence of respiratory disease.Thyroid hormone supplementation can improve the neurodevelopmental outcomes in infants with gestational age less than 28 weeks with THOP, but no effect on infants with gestational age more than 28 weeks. Future research should focus on the normal range of thyroid hormone according to gestational age in preterm infants,and randomized clinical trial welldesigned stratified according to gestational age to study the long-term neurodevelopmental outcome of thyroid hormone replacement therapy in infants with THOP

Objective To evaluate the correlation of interval from injury to surgery with outcome for central cervical spinal cord injury syndrome.Methods A retrospective analysis was done for 31 patients with central cervical spinal cord injury syndrome treated surgically between March 2007 and March 2011.According to the timing of surgical intervention,the patients were divided into early operative group (＜7 days from injury,n =14) and late operative group (≥7 days from injury,n =17).Japanese Orthopedic Association (JOA) score on admission,at postoperative half-year and at final follow-up were recorded and compared between the two groups.JOA recovery rate was determined and analyzed for correlation with operation time point.Results Mean follow-up was (16.1 ± 4.5) months (range,12-25 months).All patients had different degree of neurological recovery.JOA recovery rate in early operative group was apparently better than that in late operative group at final follow-up (P ＜ 0.01).JOA recovery rate at follow-up was negatively correlated with intervals between injury and surgery (r =-0.763,P ＜ 0.01).Conclusion For patients with central cervical spinal cord injury syndrome,time from injury to surgery is negatively correlated with outcome,indicating that early surgery may be associated with better outcomes.

Objective To evaluate the efficacy and safety of oral ibuprofen for closure of patent ductus arteriosus (PDA) in preterm infants.Methods The related literatures till December 31st,2011 in Cochrane Library,PubMed,EMBASE,Ovid,Springer,China Academic Journal Full-text Database,Wanfang Database,VIP Database and China Biological Medical Literature Database were searched.The inclusion criteria were:(1) the subject of the research was preterm infants with birth weight less than 2500 g and/or gestational age less than 37 weeks; (2) randomized or semirandomized controlled trial; (3) the intervention group received oral ibuprofen,while the control group received oral placebos / intravenous indomethacin or ibuprofen; (4) the main outcome was the failure rate of PDA closure; (5) hemodynamic changes with PDA were detected by ultrasonography.Meta-analysis was performed by Review Manager 4.22 software.Results Eleven randomized controlled trials were included,among which,three were high quality reports.Meta-analysis showed lower failure rate of PDA closure in subjects received oral ibuprofen than in those received placebos orally (RR =0.22,95 ％ CI:0.14-0.35),while the number of infants required operative closure of PDA decreased significantly (RR =0.16,95％ CI:0.03-0.86).Further analysis showed the effect of oral ibuprofen was similar to intravenous indomethacin (RR =0.93,95 ％ CI:0.57-1.53),but better than intravenous ibuprofen (RR=0.42,95％CI:0.26-0.67).However,oral ibuprofen did not reduced the ratio of patients required operation compared with intravenous indomethacin or ibuprofen (RR=0.58,95％CI:0.24-1.41).The incidence of gastrointestinal hemorrhage was higher in oral ibuprofen group than that in placebos(RR=1.99,95％CI:1.13-3.50).The serum level of creatine was lower in oral ibuprofen group than in intravenous indomethacin or ibuprofen group (weighted average=-19.10,95％ CI:-25.12-12.31).Compared with intravenous indomethcin group,less necrotizing enterocolitis cases were identified in oral ibuprofen group,but no statistical significance was found (RR=0.57,95％ CI:0.30-1.09).No long-term outcome was reported in any selected literature.Conclusions Oral ibuprofen for PDA closure in preterm infants appears to be as effective as intravenous or indomethacin,and more effective than intraveous ibuproten.Oral ibuproten represents better safety.

Objective To study the changes of cerebral blood flow and cerebral oxygenation during selective head cooling (SHC) in neonates with hypoxic-ischemic brain damage (HIBD). Methods Thirty-eight neonates with moderate and severe HIBD were enrolled in two groups: SHC group (n=18) and normal temperature group (n=20). The gestational age of all subjects were more than 38 weeks and Apgar score in 5 minutes after birth was less than 5 scores. Also, nerve system symptoms and electroencephalogram abnormal was found in 6 hours after birth. Neonates in SHC group had nasopharyngeal temperature maintained 34℃ and in normal trmerature guoup had rectum temperature maintained about 36℃. Seven healthy neonates were as control group. Three groups were observed 84 h. Cerebral blood flow velocity (CBFV) of middle cerebral artery (MCA) was measured with transcranial Doppler (TCD) at 6, 12, 24, 48, 72 and 84 hours after birth. Cerebral cytochrome aa3 (Cytaa3 ) was monitored continuously throughout the study using near infrared spectroscopy (NIRS). Results At 6th hours after birth, Vs [(25. 05?7. 69)cm/s]、Vd [(7. 22?3. 01) cm/s] and Vm [(15. 61?5. 97) cm/s] of MCA and △Cytaa3 in SHC group were lower, and RI (0. 81?0. 15) was higher than control group (P

Oral-facial body-image disturbance is one of the mental disorders.This disorder can often be found in the clinic of stomatology and aesthetic medicine,and it can cause severe distress and impairment.This article discusses the relevance between body-image disturbance and etiological factor,appearance,diagnosis,treatment,etc.