In order to understand the status of neonatal transport research at home and abroad,we summarized and analyzed the research progress of neonatal transport through the literature search.Thus we evaluated the current application of a variety of transport critical rating system.Intrauterine transport is considered the safest mode of transport,and promote intrauterine transport of high-risk mothers.It is suggested that the parents participate in the transshipment process and return the stable children to the local hospital for further treatment and promote the family-centered treatment mode.In transit,mobile ECMO,hypothermia and other advanced equipment in foreign countries have been applied.It is recommended to use the respiratory function monitor to monitor the respiration during transit.It can provide the parameters of respiratory wave,identify air leak,accidental release,spontaneous breathing.

Objective To investigate the variation of plasma mitochondrial coupling factor -6 and explore the significance in neonatal sepsis.Methods The study of 88 cases of pediatric inpatients in our hospital were divided into non-sepsis group (46 cases)and sepsis group (42 cases).CF-6 concentration in venous blood of all study subjects was determined by enzyme linked immunosorbent assay (ELISA).Re-sults The plasma CF-6 concentrations in peripheral venous blood of the patients with sepsis were signifi-cantly higher than those in non sepsis group(107.65 ±50.38)pg/ml vs (38.96 ±29.87)pg/ml,The con-centrations of CF-6 in the infected group were higher than those in the normal control group(P <0.05). Conclusions The concentration of mitochondrial coupling factor -6 in neonatal sepsis was significantly higher,and has a certain pathological and physiological significance in the pathogenesis of neonatal sepsis.

Objective To investigate the present incidence and the risk factors of retinopathy of prematurity (ROP).Methods The clinical data of 1 356 premature infants who were born in our hospital from Dec 2008 to Feb 2011 with birth weight of 2 500 g or less and gestational age of 37 weeks or less were analyzed retrospectively,and divided into ROP group(n =208) and without ROP group(n =1 148).They were screened for ROP from 4 ～ 6 weeks of chronological age or 32 weeks of postmenstrual age.Results In 1 356 cases,there were 208 cases with ROP,the incident rate was 15.34％,of which 36 cases were severe diseases (2.65％).Compared with the infants without ROP,the development of ROP was correlated with birth weight [(1 528 ±243) g vs (1 960 ± 187) g],gestational age [(30.92 ±0.72) weeks vs (32.87 ± 1.28) weeks],oxygen uptake time ＞ 8 d (123 cases vs 865 cases),pulmonary surfactants (18 cases vs 216 cases),septicemia (42 cases vs 154 cases),in utero distress (63 cases vs 511 cases) and anemia (64 cases vs 237 cases) (P ＜ 0.05).Logistic regression analysis suggested that birth weight,gestational age,oxygen uptake time ＞8 d,septicemia and pulmonary surfactants were significant risk factors associated with the development of ROP(P ＜ 0.05).Meanwhile,there were significant differences in the incidence of infants with ROP at different birth weight and different gestational age (P ＜ 0.05).Conclusion The birth weight and gestational age are lower,the incidence of ROP is higher and the disease is more serious.The probability of ROP,particularly severe ROP,is highest in the most immature infants while it is lower in the least immature ones.

Objective To evaluate the levels of plasma coupling factor 6(CF6) and cytochrome C(Cyt-c) in neonatal sepsis,and to explore the clinical significance in neonatal sepsis.Methods A total of 88 neonates admitted to Hunan Children's Hospital from January 2015 to April 2015 were collected.Neonates were divided into non-sepsis group(n=42) and sepsis group(n=46).According to the severity of infection,the non-sepsis group was further divided into non-infection group(n=20) and common infection group(n=22);the sepsis group was further divided into general sepsis group (31 cases,no organ failure) and severe sepsis group (15 cases,combined with multiple organ failure).Femoral venous blood was collected in all patients before the use of antibiotics after admission.The levels of Cyt-c and CF6 in plasma were measured by ELISA,and the levels of C-reactive protein(CRP),procalcitonin (PCT) were measured.The changes of CF6 and Cyt-c between these groups were compared,and the sensitivity and specificity with the traditional sepsis index (CRP,PCT) were analyzed.The correlation between the levels of CF6,Cyt-c and neonatal critical illness score was analyzed.Results (1)In sepsis group,the levels of CF6 and Cyt-c[(109.7±8.9)pg/ml and (44.5±4.9)ng/ml] were significantly higher than those in the non-sepsis group[(46.3±6.0)pg/ml,(31.8±6.7)ng/ml,P<0.01,respectively].(2) In the non-infection group,common infection group,general sepsis group and severe sepsis group,the levels of CF6 were (32.1±8.9)pg/ml,(59.3±7.2)pg/ml,(79.3±5.9)pg/ml,and (172.6±6.1)pg/ml,respectively;the levels of Cyt-c were (29.3±8.6)ng/ml,(35.4±4.1) ng/ml,(43.1±5.9) ng/ml,and (44.5±5.9)ng/ml,respectively.The differences between these groups were significant(P<0.01).(3)The receiver operating characteristic curve showed that the sensitivity and specificity of CF6 were 0.761,0.732,and the Cyt-c were 0.739,0.714.(4)Cyt-C and CF6 were negatively correlated with the neonatal critical illness score(r=-0.599,P<0.001;r=-0.337,P<0.01).Conclusion The levels of CF6 and Cyt-c increase in neonatal sepsis.The damage of mitochondria may be one of the pathological mechanisms in neonatal sepsis.The levels of CF6 and Cyt-c were closely related to the severity of neonatal sepsis.

Objective To analysis the clinical outcome at discharge and its risk factors of extremely preterm infants.Method To retrospectively analysis the clinical outcome at discharge and it's risk factors of extremely preterm infants (less than 28 weeks gestation) admitted from September 2008 to August 2014 in our Hospital.Result A total of 179 cases were enrolled.Survival rate was 59.2％ (106/179).Unfavorable outcome rate was 74.3％ (133/179),among them 73 cases died.The top five causes of death were severe bronchopulmonary dysplasia (BPD) (28 cases),Ⅲ ～ Ⅳ o intraventricular hemorrhage (IVH) (19 cases),sepsis (16 cases) and necrotizing enterocolitis (NEC) (6 cases).Among the 60 survivals with unfavorable outcomes,35 cases had either severe neurologic or ophthalmological sequela,and 25 cases had severe pulmonary sequela.Univariate analysis showed that,comparing with improved group,unfavorable outcome group had higher rates of not receiving prenatal steroids,placental abruption,male,small for gestation age,resuscitation with chest compression,admission age older than 72 hour,severe respiratory distress syndrome (RDS),without pulmonary surfactant (PS) usage,mechanical ventilation beyond 2 weeks and sepsis (P ＜ 0.05).Logistic regression analysis showed that those without prenatal steroids (OR =9.402,P =0.002),small for gestational age (OR =8.271,P =0.018),resuscitation with chest compression (OR =6.325,P =0.023),admission age older than 72 hour (OR =4.174,P =0.028) were independent risk factors for unfavorable outcome of extremely premature at discharge.Conclusion Extremely preterm infants have a higher rate of unfavorable outcome at discharge.Avoid small for gestational age,transfer properly and in time both in utero and after birth,and conduct prenatal steroids could improve their clinical outcome at discharge.

High mobility group box 1 protein(HMGB1) is widely present in eukaryotic nuclei and named for its rapid migration during polyacrylamide gel electrophoresis. Studies have shown that HMGB1 playes an important role in the development of gene transcription,inflammation,cancer and other diseases. In this paper, the biological characteristics of HMGB1 and its research progress in pediatric diseases are reviewed.

Objective To realize the clinical characteristics of fungemia in premature infants.Methods Clinical characteristics of fungemia in premature infants in the intensive care unit of a children''s hospital between January 2011 and December 2015 were analyzed retrospectively, general condition of premature infants, laboratory-related indicators, and antimicrobial susceptibility testing results were compared.Results From January 2011 to December 2015, 42 premature infants with confirmed fungemia were treated in this hospital, 22 (52.38％) of whom were with fungemia caused by Candida albicans(C.albicans), 13 (30.95％) by Candida parapsilosis (C.parapsilosis), 3 by Candida krusei (C.krusei), and 4 by other fungi.Patients were grouped according to the main pathogens causing infection: C.parapsilosis group and C.albicans group.Maternal genitourinary tract infection rate and incidence of fungal meningitis in C.albicans group were both higher than C.parapsilosis group(27.27％ vs 7.69％, 27.27％ vs 0.00％ respectively), peripherally inserted central catheter (PICC) rate in C.albicans group was lower than that in C.parapsilosis group(22.73％ vs 69.23％), platelet count in C.parapsilosis group was lower than C.albicans group, differences were all statistically significant (all P<0.05).Conclusion The major fungi causing fungemia in premature infants were C.parapsilosis and C.albicans, maternal reproductive system infection during pregnancy can easily lead to candidemia, premature infants with candidemia are more vulnerable to developing fungal meningitis;PICC is more likely to lead to C.parapsilosis fungemia, and platelet decline is more obvious.

Objective To investigate the effect of illness severity on preterm infant's hypothalamusputituary-adrenal (HPA) axis, we measured the serum concentration of cortisol,aldosterone and adrenocorticotropic hormone (ACTH). Methods Ninety preterm infants who were transferred to our hospital within 72 hours after birth were involved. These preterm infants were divided into two groups:gestational age (GA) ≥34 weeks' preterm infants and GA <34 weeks' preterm infants. We evaluated these preterm infants at the time of admission,day 7 and day 14 after birth with neonatal critical illness score (NCIS). Then they were divided into mild group and severe group by the lowest score. We measured their serum cortisol,aldosterone and ACTH at the time of admission,day 7 and day l4 after birth. Results (1) The serum cortisol concentration of preterm infants with severe illness was higher than that of preterm infants with mild illness. Among the GA ≥34 weeks' preterm infants,the serum cortisol concentration of preterm infants with severe illness was significandy higher than that of preterm infants with mild illness within 72 hours after birth (t = -2.263,P =0. 029). Among the GA <34 weeks' preterm infants,the serum cortisol concentration of preterm infants with severe illness was significantly higher than that of preterm infants with mild illness on day 14 after birth (t =-2. 913 ,P =0. 006). (2) Among the preterm infants with severe illness,the serum cortisol concentration of the GA≥34 weeks' was significantly higher than that of the GA < 34 weeks' within 72 hours after birth (t =-2. 641 ,P =0. 010) ;the serum cortisol concentration of the GA <34 weeks' was significantly higher than that of the GA≥34 weeks' on the day 14 after birth(t = -2. 189,P =0. 036) . (3) The serum cortisol concentration was significantly decreased in the GA≥34 weeks'preterm infants (F = 4. 679, P =0. 012). (4) The serum cortisol concentration of aldosterone and ACTH was not significantly different between preterm infants with severe illness and those with mild illness. Conclusion The preterm infant already has the ability to respond to stimuli by regulating cortisol secretion. The serum cortisol concentration increases as disease severity worsens.Serum aldosterone and ACTH concentration are not correlated with the severity of the disease.

Objective To study the effectiveness of family-integrated-care (FICare) for preterm infants with moderate to severe bronchopuhnonary dysplasia (BPD) in neonatal intensive care unit (NICU).Method Preterm infants with moderate to severe BPD in Hunan Children's Hospital from January 2015 to March 2016 were selected as the objects.These infants were assigned into two groups (FICare group and control group) in the base of whether the parents agreed to implement FICare.If the infant was enrolled into FICare group,the parents need to spend 3 hours in ward every day,and participate in nursing services under the guidance of nurses.The nursing services included bathing,cuddling,skin care,breast-feeding,and so on.If the infant was enrolled into control group,these nursing services were implemented by nurses.Oxygen exposure time,breast-feeding rate,time of begin oral feeding,time of total oral feeding,weight growth rate during hospitalization,weight of discharge,length of stay,readmission rate within 30 days,the rate of parents that mastered basic care knowledge and skills when discharge from hospital,the rate of satisfaction,and the rate of follow-up within 30 days of the two groups were compared.Result There were 106 cases in our study,54 in the FICare group and 52 in the control group.Compare the FICare group and the control group,there were statistical differences between two groups in the follow aspects (all P ＜ 0.05):oxygen exposure time [(57.1 ±20.9) d vs.(71.4 ±32.6) d],breast-feeding rate (77.8％ vs.44.2％),time of total oral feeding [(46.1 4 19.6) d vs.(59.4 ± 30.2) d,length of stay [(65.8 ± 18.4) d vs.(84.3 ±35.0) d],the rate of parents that mastered basic care knowledge and skills when discharge from hospital (96.3％ vs.82.7％),the rate of satisfaction (94.4％ vs.84.6％),the rate of follow-up within 30 days (92.6％ vs.73.1％).Conclusion FICare could significantly reduce oxygen exposure time of preterm infants with moderate to severe BPD,could improve the level of parents mastered basic care knowledge and skills of preterm infants,especially in critically ill preterm children,and could shorten length of stay of them.FICare is beneficial to the healthy growth of premature infants with BPD.

Objective To explore the application of high frequency oscillation in the area of respiratory distress syndrome (RDS) of premature.Methods A total of 101 cases with RDS of premature was collected who needed the machine support in neonatal intensive care unite (NICU) during 2010.11.01-2011.10.30.Forty one cases (high frequency oscillation group) received the high frequency oscillation,while 60 cases received the common ventilation (Control Mechanical Ventilation group;control group).The results of blood gas analysis were recorded before ventilation,after ventilation for 2 hours,after ventilation for 12 hours,and after ventilation for 24 hours.The chest X-Ray and the complication were examined.Results The result of the blood-gas before ventilation,after ventilation for 2 hours,after ventilation for 12 hours,and after ventilation for 24 hours,FIO2,PO2,PCO2,and Pa(A-a) were statistically analyzed,and F-value was 16.202,14.764,16.135,8.434,P ＜ 0.01.For chest X-ray in high frequent oscillation group,there were 36 cases who had improved after ventilation 24 hours and all had improved after ventilation 72 hours;however,in common ventilation group,there were 30 cases who had improved after 24 hours and 50 cases had improved after 72 hours,x2 =15.372 and 7.584,P ＜ 0.01,there was statistical difference for two groups.However,there were not different in cerebral injury/healing damage and retinopathy of prematurity (ROP) for two groups.Conclusions High frequency oscillation is an effective way to treat RDS of premature.