Persistent pulmonary hypertension of the newborn is a critical illness in neonatal period.Rational treatments are based on the correct diagnosis and differential diagnosis. In this paper, the clinical manifestations and diagnosis of persistent pulmonary hypertension of the newborn, the relationship between the relevant clinical diagnostic procedures, auxiliary examination method and the common need to identify the disease are described, with emphasis on Echocardiographic diagnosis of pulmonary hypertension.

Brain Injuries ; etiology ; prevention & control ; Humans ; Hyperbilirubinemia ; complications ; prevention & control

Persistent pulmonary hypertension of newborn (PPHN) is a clinical syndrome,characterized by pulmonary arterial pressure elevated relative to systemic blood pressure,leading to extrapulmonary right-to-left shunting of blood across the ductus arteriosus and foramen ovale,causing severe hypoxemia.Pulmonary vascular remodeling is pathognomonic of hypoxia-induced PPHN.The regulatory mechanism and cell composition of vascular wall were dysfunction,which led to vascular wall thickened.The review focus on three aspects,such as endothelial cells,smooth muscle cells,and adventitial cells,described the relation and the possible mechanisms between hypoxia-induced PPHN and pulmonary vascular remodeling.

Obgective To analyze the demographic data,non-specific items,pathogens and antibiotic sensitivity between the children with early-onset and late-onset sepsis,in order to guide the diagnosis and treatment of neonatal sepsis.Methods Three hundred and fifty-two cases with positive blood culture were retrospectively recruited and divided into an early-onset group and a late-onset sepsis group according to the onset of sepsis.Results Of 352 cases,144 cases (40.91％) were the early-onset children while 208 cases (59.09％) were the late-onset children,and in the late-onset group,108 cases occurred due to nosocomial infection.Most neonates of the early-onset term were term infants [107/144 cases (74.31％)],while the preterm infants [77/208 cases (37.02％)] and low birth weight infants[70/208 cases(33.65％)] accounted for the majority of the late-onset group.The asphyxia,perinatal intrauterine distress,meconium-staining amniotic fluid and premature rupture of fetal membranes ≥ 18 h occurred more frequently in the early-onset group [21/144 cases (14.58％),14/144 cases (9.72％),26/144 cases (18.06％),31/144 cases (21.53％)],respectively,while those in the late-onset group were [17/208 cases (8.17％),9/208 cases(4.33％),13/208 cases(6.25％),17/208 cases(8.17％)],respectively,there were significant differences (x2 =4.622,3.886,5.950,13.345,all P ＜ 0.05) between 2 groups.In the early-onset group abnormal temperature[72/208 cases(34.62％)vs 30/144 cases(20.83％)],vomiting or abdominal distention[109/208 cases (52.40％) vs 35/144 cases (24.31％)],lethargy [79/208 cases (37.98％) vs 38/144 cases (26.39 ％)] and umbilicalitis or skin pustule [33/208 cases (15.87 ％) vs 11 / 1 44 cases (7.64 ％)] occurred more frequently in late-onset group,and there were significant differences (x2 =7.853,8.763,5.153,5.265,all P ＜ 0.05).Besides,more cases in the late-onset group had elevated immature neutrophil vs total neutrophil count ratio [27/184 cases (14.67％)] and C-reactive protein value [76/206 cases (36.89％)],compared with those in early-onset group [9/133 cases (6.77％),38/143 cases(26.57％)],and there were significant differences (x2 =4.794,4.087,allP ＜ 0.05).Compared with early-onset group,patients in the late-onset group were more likely to suffer from suppurative meningitis [17.79％ (37/208 cases) vs 8.33％ (12/144 cases);x2 =6.348,P ＜ 0.05].In terms of pathogens,the main pathogens in the early-onset group were gram negative bacteria[39.58％ (57/144 cases),including detection of Klebisella pneumoniae in 21 cases and E.coli in 20 cases] and coagulase negative staphylococcus[32.64％ (47/144 cases)].In late-onset group,the main pathogens were gram positive bacteria [58.65％ (122/208 cases)],including detection of coagulase negative staphylococcus in 90 cases(43.27％) and E.coli [17.79％ (37/208 cases)].There was no significant difference in prognosis between 2 groups(x2 =1.187,P =0.552).Conclusions Early-onset sepsis and late onset sepsis differ in the clinical manifestation and laboratory findings.Distinguishing neonatal early-onset and late onset septicemia is of clinical significance in choosing appropriate antibiotics.

Objective: To investigate the changes of haemodynamics, pulmonary mechanics and blood gas in volume controlled and pressure controlled ventilatory patterns during one-lung ventilation (OLV). Methods: 20 patients with patent ductus arteriosus (PDA) underwent left thoracotomy PDA ligation with right OLV. The patients were divided into three groups: two-lung ventilation with volume controlled (TLV-VCV), one-lung ventilation with volume controlled (OLV-VCV), and one-lung ventilation with pressure controlled (OLV-PCV). After two-lung ventilation with VCV, one-lung ventilation was started by VCV and the ventilation mode was then switched to PCV. All measurements were made 25 min after initiation of the ventilation mode. The respiratory mechanics index was measured by side stream spirometry (SSS), including peak airway pressure (Ppeak), plateau pressure (Pplat), airway resistance (Raw), lung compliance (Cdyn) and inspiratory and expiratory minute ventilation (Mvi, Mve). Cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), left ventricular ejectiontime (LVETi), and aortic blood flow acceleration (ACC) were also measured, by using the transesophageal Doppler (TED) monitor. Arterial blood gases was determined in every ventilation mode. Results: Ppeak、Pplat and Raw were significantly higher during OLV-VCV than that during TLV-VCV (P

Objective To compare the effects of oral Sildenafil(SIL)and intravenous prostaglandin E_1(Alprostadil,PGE_1)in treatment of postoperative pulmonary hypertension(PH)associated with congenital heart defects(CHD).Methods Data were collected from 24 children with postoperative mPAP≥35 mmHg in our hospital between August 2004 and March 2005.These children were randomly divided into three groups:8 children(group A)initially received SIL(0.35 mg/kg,orally by nasal gastric tube),followed by the addition of intravenous PGE_1(20 ng/kg per min)at 40 min.The second group of 8 children(group C)initially received intravenous PGE_1 followed by the addition of SIL at 20 min(dose as above).And remains(group B)were placebo-controlled.The changes of hemodynamic variables,arterial blood gas,lung static compliance(C)and work of breathing(W)were measured after drugs were given.Results Compared with group B,the mPAP and mPAP/mSAP was significantly reduced(P

Objective To investigate the functional status of adrenal cortex status in newborn with septic shock, and explore the diagnostic criteria of relative adrenal insufficiency (RAI) and catecholamine resistance in shock. Methods Fifty newborns with septic shock, 28 males and 22 females, admitted into neonatal intensive care unit (NICU) of Hangzhou Second People's Hospital from Jan. 2005 to Jun. 2009, were involved in the present study. Serum cortisol levels of the newborn patients were measured with radio immunoassay at baseline and 30 and 60 minutes after-administration of a low-dose (1?g) of adrenocorticotrophic hormone (ACTH). The patients were divided into two groups by maximal cortisol increment levels: normal adrenal function (NAF) group and RAI group. Some clinical factors, for example, the fluid demands on 1st day, shock duration, mortality, neonatal critical illness score (NCIS) and the incidence of catecholamine resistance shock, were observed. According to prognosis these newborn patients were then divided into two groups: nonsurvivors and survivors. The serum cortisol levels were compared after ACTH test between the two groups. Results Nineteen RAI and 31 NAF were observed in the 50 cases. The fluid demands on 1st day, shock duration and mortality were higher, while NCIS was lower in RAI group than in NAF group (P

Objective To evaluate the role of using non-invasive ventilation with bi-level positive airway pressure (BiPAP) in order to reduce the need of re-intubation in pediatric patients with respiratory failure after cardiac surgery. Method From January 2007 to December 2007, 25 patients aged from three months to 11 years with median 2.3 years operated on for cardiac surgery with respiratory insufficiency after extubation and re-intubation indicated were enrolled in this study. They were put on non-invasive nasal (mask) BiPAP ventilation before re-intubation. The arterial blood gas, A-aDO2 and PaO2/FiO2 were measured. In addition, clinical data including heart rate, respiratory rate, and the product of heart rate and systolic pressure were recorded before and after BiPAP. The software SPSSD 13.0 was used to process by ANOVA test for statistical analysis. Meanwhile, the outcome of these patients was analyzed. Results Twenty-five patients with 30 episodes of respiratory insufficiency were treated with BiPAP ventilation with median duration of 1.96 days ranged from 0.03 to 12 days. Of these respiratory failure episodes, 25 ones (83.3%) could be controlled by BiPAP and the needs of re-intubation were avoided. Five episodes of respiratory failure in 4 patients could not be quelled and the endo-tracheal tubes were inserted in these patients. All patients were saved with a median of mechanical ventilation duration of 3.4 days and ICU stay of 10.6 days. No major complications were observed. The heart rate, respiratory rate and the rate-pressure product were decreased significantly one hour after BiPAP (P < 0.05 all). Meanwhile, patients showed rapid improvement of oxygenation. The pH, SpO>2 and PaO2/FiO2 were increased significantly and A-aDO2 was decreased significantly (P < 0.05 all). The PaCO2, was decreased significantly four hours after BiPAP (P < 0.05). Conclusions Non-invasive nasal mask BiPAP can be used safely and effectively in children after cardiac surgery to improve oxygenation/ventilation, decreasing the work of breathing. It may be particularly useful in patients with high risk of re-intubation.