During the fetal-neonatal transition, the body must undergo many important physiological changes to adapt the extrauterine environment. After birth, the blood and energy supply through placenta is stopped with clamping of the umbilical cord and, meanwhile, the pulmonary ventilation function is established when exposure to the air, which results in a series of changes in the respiratory, circulatory and endocrine systems and energy metabolisms, etc. The physiological transition can be relfected in heart rate, blood pressure, oxygen saturation, temperature, and other physiological indicators. The changes of these indicators can be used as references for prevention, diagnosis and treatment of neonatal diseases. This review provides an overview of physiological changes and implications in the lung function, circulatory and endocrine systems, and energy metabolism during the transition at birth as well as intervention measures for abnormal fetal-neonatal transition.

Objective To investigate the effect of long term intelligence on NGF to the newborn rats with hypoxic ischemic brain damage (HIBD).Methods The model of newborn rat hypoxic ischemic brain damage(HIBD) was set,0.01mg/10g dosage NGF and 0.03mg/10g dosage NGF were administered to the rat abdominal cavity respectively. With maze test, the change of learning memory abilities of long term in the rats were observed, the concentration of monoamine neurotransmitters in the brain tissue were determined by high performance liquid chromatography electrochemical detector.Results The function of learning and memory was better in NGF group(small, large amount group)than in the control group, the frequency was lower remarkably than the control group( P

The most radiation exposure for children arises from the medical process, and due to their characteristics such as relatively immature,organ development,they are more sensitive to the radiation than a-dults,and have higher risk of radiation related diseases,so medical radiation exposure should not be ignored.

Objective To investigate the risks and benefits of interventions promoting placental transfusion (PT) at delivery [delayed cord clamping (DCC) or umbilical cord milking (UCM)] compared with early cord clamping (ECC) on outcomes among very low birth weight infants (VLBWI).Methods A systematic search was conducted of PubMed, EMBASE, ClinicalTrials.gov, China Academic Journal Network Publishing Database and Wanfang Medical Databases (January 1965 to July 2014) for randomized controlled trial (RCT) articles relating to PT strategies (DCC and UCM) in VLBWI.The Cochrane Handbook 5.1.0 was used to evaluate the methodological quality and RevMan 5.3 software from Cochrane Collaboration was used for metaanalysis.The fixed effect or random effect model was adopted according to the result of heterogeneity, Results We identified 14 eligible studies describing a total of 659 neonates with an average birth weight ＜ 1 500 g.There were eight studies for DCC and six studies for UCM.Compared with the control, benefits of greater PT decreased any grade intraventricular hemorrhage (IVH) (nine studies, OR=0.49, 95％CI: 0.32-0.77, P ＜ 0.01), increased the blood pressure at four hours of life (eight studies, MD=4.42, 95％CI: 3.85-4.98, P ＜ 0.01), and also showed higher initial hemoglobin (Hb) level (six studies, MD=3.52, 95％CI: 1.67-5.37, P ＜ 0.01) and lower incidence of sepsis during the hospital stay (five studies, OR=0.46, 95％CI: 0.26-0.83, P=0.01).No differences were observed between the groups about the fllowing indicators (all P ＞ 0.05): 5-minute Apgar scores (MD=0.01,95％CI:-0.21-0.22), admission temperature (MD=0.13, 95％CI:-0.15 to 0.41), peak serum bilirubin levels (MD=0.59, 95％CI:-0.13 to 1.31), initial reported hematocrit (MD=3.48, 95％CI:-0.46 to 7.43), mortality before discharge (OR=0.63, 95％CI:0.31-1.25), Bell's stage 2 or greater necrotizing enterocolitis (OR=0.62 ,95％CI: 0.29-1.33), rates of transfusion due to anemia (OR=0.63, 95％CI: 0.35-1.15) and oxygen therapy at 36 weeks of corrected age (OR=0.79, 95％CI: 0.46-1.34).Conclusions It is suggested that enhanced PT (both DCC and UCM) at birth is safe and provide better neonatal outcomes than ECC for those VLBWI, most notably reduces the overall IVH occurrence and lower the incidence of sepsis.The optimal umbilical cord clamping practice and UCM among VLBWI infants remains uncertain and long-term neurodevelopmental outcomes are warranted.

AIM: To study the effect of moderate hypothermia on immature rats with hypoxic-ischimic brain damage (HIBD). METHODS: The rats with HIBD were divided into normothermic recovered group (IN) and moderate-hypothermic recovered group (IH). Sham-operated rat pups were normothermic control group (NC) and moderate-hypothermic control group (HC). 0, 2, 6, 24, 48, 72 h after the end of hypoxic-ischemic (HI) insult, the brain was homogenized for measuring glucose and ATP, brain mitochondria was extracted for SDH activity, complex II activity and the capacity of ATP synthesization. RESULTS: In IN group, the brain glucose was significantly lower at 0 h, and recovered as normal at 2 h. The brain ATP and brain-mitochondrial SDH activities were firstly decreased at 2 h, 6 h and then recovered gradually, it was at it's peak value at 72 h. Brain-mitochondrial complex II activity and the capacity of ATP synthesis were recovered at 2 h, but they decreased again at 6 h and came to normal level at 72 h. In moderate-hypothermic group, all the indexes were significantly higher at all the time point than that in IN groups. CONCLUSION: Moderate hypothermia inhibits the decrease in the mitochondrial SDH activity, mitochondrial complex II activity and the capacity of ATP synthesis, increases the brain ATP concentration, improves the energy metabolism, and then protects the brain tissue. [

With the advent of neonatal intensive care unit (NICU) and the progress of life support technologies,the survival rate has been significantly improved in the last decade;however,the resulting neurological sequelae have also been increased disproportionally.Given the vulnerability and plasticity features of the developmental brain has,properly identification,evaluation,intervention and predication of the neurologically affected newborn in the NICU is of great importance,so the development of precise and reliable bedside neonatal neurodiagnostic techniques (neural critical care unit) is warranted.Non-invasive cerebral monitoring is comprehensively using current available cerebral functioning and cerebral imaging tools to detect various underlying cerebral injury.This review update the clinical implication of bedside amplitude-integrated EEG,routine video-EEG,magnetic resonance imaging,and near-infrared spectroscopy being used in the NICU.

Objective: To investigate the clinical characteristics of early term and full term neonates, and analyze the risk factors associated with short term outcomes in early term neonates. Method: Neonates with birth weight (BW) ≥2 500 g from year 2013 were analyzed retrospectively based on American Congress of Obstericians & Gynecologists (ACOG) latest definition of term infants. According to inclusion and exclusion criteria, early term (gestational age 37-38 weeks) and full term(gestational age 39-40 weeks) neonates were included, whose morbidity constituent proportion was analyzed by χ² test or Fisher accuracy test or t test or Wilcoxon test. Risk factors associated with short term outcomes in early term population were analyzed by Logistic regression analysis. Result: There were 3 002 discharged term infants being investigated, among whom 1 303 cases were included(768 males and 535 females), and 37, 38, 39 and 40 weeks′ gestational age newborns were 160, 324, 450 and 369 respectively. Compared with full term neonates(n=819), early term neonates (n=484) had longer length of hospital stay (LOS)(6.0(5.0, 9.0) vs. 6.0(4.0, 8.0), Z=2.830, P=0.005), higher usage rate of intravenous antibiotics(86.4%(418/484) vs. 80.1%(656/819), χ²=8.009, P=0.005), higher assisted ventilation rate(9.5%(46/484) vs. 2.9%(24/819), χ²=25.528, P<0.01), higher pulmonary surfactant administration rate(4.3%(21/484) vs. 1.1%(9/819), χ²=14.006, P<0.01), as well as higher hypoglycemia incidence(3.9%(19/484) vs. 1.2%(10/819), χ²=10.226, P=0.001). There were no statistically significant differences in 1 min Apgar score (9(9, 10)vs. 9(9, 10), Z=0.860, P=0.390), 5 min Apgar score (10(9, 10) vs. 10(9, 10), Z=0.810, P=0.418), white blood cell count (15 (11, 21) ×10⁹ /L vs.15 (11, 22) ×10⁹ /L, Z=0.880, P=0.379), hemoglobin count(180 (159, 205) vs. 182 (160, 204) g/L, Z=0.560, P=0.576), or platelet count(303(234, 372) ×10⁹/L vs. 301(237, 391) ×10⁹/L, Z=0.550, P=0.584). BW between 2 500 g and 2 999 g(OR 1.69, 95% CI: 1.10-2.62, χ² =5.614, P=0.018), wet lung(OR=2.61, 95% CI: 1.61-4.24, χ²=15.023, P=0.000)and pneumonia(OR 1.88, 95% CI: 1.14-3.08, χ²=6.192, P=0.013) were risk factors in early term neonates′ short term adverse outcomes. Conclusion Early term newborns are still at their "immature" state, and respiratory disorders are major risk factors associated with short term outcomes. Hence, early delivery during 37-38 weeks should be avoided as possible as we can.

Neonatal hypoxic-ischemic encephalopathy (HIE) can result in serious outcomes including death during the newborn period and later neuropsychological handicaps.So far,there have been no obvious effect on the improvement of prognosis with traditional treatments,and the cryogenic treatment is the most effective treatment for the past decade,while the clinical application is limited by age and disease course.At present,stem cell transplantation in the treatment of HIE is the new direction,of which the mesenchymal stem cells are outstanding by its easy materials,low immunogenicity and potential nerve regeneration properties.This paper reviews and updates the progress of mesenchymal stem cell transplantation for neonatal HIE.

Objective To develop clinical practice guidelines for breastfeeding in neonates in hospital conforming to the situation in China by adaptation of existing guidelines.Methods According to ADAPTE methodology and current status of breastfeeding in neonates in hospital,we searched existing guidelines and systematic reviews of breastfeeding,used AGREE Ⅱ to evaluate the guidelines,content analysis method was used to select and integrate the content of the evidence,and feasibility investigation and expert external review were performed for the established guidelines.Results A total of 10 guidelines,3 evidence summaries and 4 systematic reviews were included,and the "Evidence-Based Guideline:Breastfeeding of Neonates in the Hospital" were established,involving 8 aspects:breastfeeding promotion,screening,expression,storage,transport,reception,procedures and quality management,and a total of 83 evidences were recommended,which were practical and recommended by all experts.Conclusion High quality evidence resources provided by the established clinical practice guideline can provide reliable evidence support for clinical practice.

Objective To study the clinical value of neonatal arterial blood pH,base excess and lactate levels within 72 h after birth in assessing early brain injury in asphyxia neonates.Method From June 2015 to November 2016,a retrospective study was performed on the asphyxia newborn admitted to newborn department of Children's Hospital of Fudan University.The data of brain magnetic resonance imaging (MRI),video electroencephalogram (VEEG),and artery blood gas analysis (within 12 h and 72 h) were all collected.The neonates were assigned into brain injury group (severe or moderate injury) and control group (normal or mild injury) according to MRI and VEEG results.The differences of arterial blood pH,base excess and the level of lactate between the two groups were analyzed and indicators of brain injury were evaluated using ROC curves.Result A total of 63 cases were included in the study.Thirty patients were in the control group and 33 patients the brain injury group.The pH within 12 h was lower [(7.32 ±0.09) vs.(7.38 ±0.08)],and the lactic acid level in 12 h and at 24-72 h were significantly higher in the brain injury group than the control group [(7.9 ±4.2) mmol/L vs.(4.9 ±2.4) mmol/L and (3.7 ±3.2) mmol/L vs.(2.2 ± 1.1) mmol/L].The differences were statistically significant (P ＜0.05).The areas under the ROC curve of pH,lactate within 12 h and at 24-72 h were 0.323,0.715,0.643 (P =0.016,0.003,0.051).The cut-off value of lactic acid within 12 h in assessing of brain injury was 7.5 mmol/L,with the sensitivity of 0.46 and the specificity of 0.97.Conclusion The artery lactate level within 72 h after birth can be used to evaluate the severity of brain injury in neonatal asphyxia infants.