The clinical manifestations of neonatal shock are atypical so that the early identification was important.Heart rate variability analysis and pulse oximetry for perfusion index monitoring are great help for early identification of neonatal shock.Much attention should be given to the treatment of neonatal special type of shock in addition to follow the general principles of shock treatment.

Objective To study the heart function,risk factors and associated complications caused by patent ductus arteriosus( PDA)in preterm infants. Methods A retrospective analysis Was conducted at Neonatal Intensive Care Unit of Shenzhen People＇s Hospital from October 2016 to August 2017 to study the cardiac functions of infants less than 3 days after birth betWeen PDA group and non－PDA group(1: 1 paired study according to gestational age and Weight). MeanWhile their clinical data Were collected by case－control analysis method,to explore the risk factors and complications caused by PDA in preterm infants. Results There Were 50 cases in PDA group,and 50 cases in non－PDA group. The physical data betWeen 2 groups had no statistically significant difference(all P＞0. 05). The heart rate (HR),cardiac output(CO)and cardiac output index(CI)in 2 groups Were(148. 36 ± 12. 98)times／min,(0. 52 ± 0. 21)L／min,(0. 44 ± 0. 19)L／( min·m2 )and(142. 52 ± 18. 07)times／min,(3. 48 ± 0. 92)L／min,(2. 99 ± 0. 80)L／(min·m2 ),respectively;the levels of PDA group Were higher than those of the non－PDA group,and the differences Were significant(P﹦0. 021,0. 020,0. 027). Single factor analysis shoWed that PDA in the preterm infants Was significantly associated With asphyxia,premature rupture of membranes and the use of prenatal hormone( P﹦0. 001,0. 009,0. 004). Ventilation time,pneumonia,feeding intolerance,and bronchial pulmonary dysplasia Were asso﹣ciated With PDA in preterm infants(P﹦0. 010,0. 010,0. 000,0. 026). The Logistic regression analysis shoWed that asphyxia Was independent risk factor for PDA in preterm infants(OR﹦7. 280),and prenatal antenatal corticosteroids Was independent protective factor( OR ﹦0. 008). Conclusions In preterm infants With PDA,the HR,CO and CI increase and electronic heart monitoring could identify the hemodynamic changes in preterm infants With PDA. Asphyxia is major high risk factor in PDA in preterm infants,While the use of prenatal antenatal corticosteroids is seen as the pro﹣tective factor. PDA in preterm infants can prolong the ventilation times and increase the pneumonia,feeding intolerance and BPD.

Objective To investigate whether the therapy of combining budesonide with pulmonary surfactant,compared with only surfactant,has an effect on the incidence of bronchopulmonary dysplasia,mortality and other complications in preterm infants.Methods The preterm infants in accordance with the inclusion criteria,who were born during from 12/2016 and 2/2018,were randomly divided into the combination treatment group (treated with the combination of budesonide and pulmonary surfactant) and control group (treated with only surfactant).Ninety eight preterm infants were enrolled this trial,48 of whom are in budesonide group and 50 are in control group.The basic data were not have statistic significant between two groups except for birth weight (P ＞ 0.05).The incidence of bronchopulmonary dysplasia,the mortality and other complication of premature were compared.Results There was a statistic significance in the incidence of bronchopulmonary dysplasia between the budesonide group and control group (42％ vs 66％,P＜0.05);The severity of bronchopulmonary dysplasia and case fatality rate between two groups have no satistical difference.The complications of preterm infants in two groups also have no statistical difference apart from the incidence of PDA (15％ vs 38％,P ＜ 0.05).Conclusion Budesonide combined with pulmonary surfactant can reduce the incidence of bronchopulmonary dysplasia and does not increase mortality and the rate of other complications in preterm infants.