Objective To evaluate the effect of nasal intermittent mandatory ventilation (NIMV)combined with pulmonary surfactant for the treatment of hyaline membrane disease in premature children and to compare the clinical efficacy with conventional mechanical ventilation and continuous positive airway pressure (CPAP). Methods Seventy-four babies with severe respiratory syndrome were given curosurf[100 mg/(kg·dose)],25 of them were given to NIMV, another 25 were given conventional intermittent mandatory ventilation (IMV), the last 24 patients were given conventional CPAP. Blood gas analysis parameters and incidences of respiratory complications including respiratory tract infection and chronic lung disease,frequent apnea and carbon dioxide retention, were compared among the three groups. Results After treatment of 1 h, symptoms and signs of the patients markedly improved. All the three groups showed an increase in arterial oxygen partial pressure, but arterial pressure of carbon dioxide and oxygen index decreased significantly by the time of 6,12,24 h after treatment and there were not significantly difference among the three groups. The rates of respiratory infection and chronic lung disease in NIMV group were less than that of conventional IMV group[(8% vs 36% ) ,(20% vs 72% )],the rates of frequent apnea and carbon dioxide retention in NIMV group were less than that of CPAP group[(8% vs 36% ), (20% vs 72% )]. Conclusion NIMV combined with pulmonary surfactant is a potentially efficient therapy for hyaline membrane disease in premature infants. NIMV treatment of hyaline membrane disease in premature infants can reduce or avoid ventilation-associated pneumonia,chronic lung disease and other complications,but also efficiently reduce the incidence of frequent apnea and carbon dioxide retention.

Objective To explore the value of procalcitonin (PCT) in diagnosis and treatment of neonatal ventilator associated pneumonia(VAP).Methods Sixty neonates needed invasive mechanical ventilation admitted to our NICU from Jan 2012 to Dec 2013 were divided into VAP group (30 cases) and nonVAP group (30 cases),depending on whether the neonates developed to VAP or not in 7 days.The VAP group then was randomly divided into PCT group (15 cases) and control group(15 cases) according to random number table.The levels of serum PCT,C-reactive protein(CRP) and WBC count were detected when the neonates suspected VAP before and after mechanical ventilation.Besides,the sensitivity,specificity,positive and negative predictive values for PCT,CRP and WBC were calculated in the diagnosis of VAP.Results The serum levels of PCT in VAP group had significant difference before and after mechanical ventilation (t =1.58,P =0.000),the levels of PCT were (0.37 ± 0.25) μg/L and (2.17 ± 1.46) μg/L respectively.The levels of PCT in non-VAP group had no significant difference (t =3.67,P =0.055).The levels of CRP and WBC showed no significant differences between VAP and non-VAP group before mechanical ventilation (P ＞ 0.05).Taking PCT ≥0.40 μg/L,CRP≥ 28 mg/L and WBC ≥ 10 × 109/L as the cut off value,the sensitivity of the three indicators diagnosis of VAP were 93.3％,73.3％ and 66.7％ respectively.PCT had the highest sensitivity 93.3 ％,specificity 73.3％,positive predictive 77.8％ and negative predictive 91.7％.The antibiotic duration of PCT group was (12.6 ± 5.6) d compared with (15.1 ± 9.1) d in control group (P =0.018).Conclusion Serum PCT has high sensitivity and specificity in the diagnosis of VAP,PCT combined with clinical pulmonary infection score can improve the diagnostic accuracy of VAP,early diagnosis and timely monitoring of serum PCT is helpful in VAP.PCT guidance substantially reduces antibiotic use in VAP,so that timely surveillance of PCT is necessary for patients on ventilator.

Brain injury in preterm infants is an important reason for making the newborn disability.Neonatal cerebral injury of imaging examination method has a time lag.Looking for a simple,timely,accurate predictor of biological markers of brain injury in preterm infants is particularly important.In this paper,the role of S100B protein,glial fibrillary acidic protein and neuron-specific enolase of brain injury in preterm infants was reviewed,and the significance of early diagnosis of brain injury in preterm infants was discussed.

Objective To investigate the changes of serum myelin basic protein (MBP) and S100B orotein (S100B) in premature infants with periventricular leukomalacia (PVL) and their outcomes.Methods Seventy-eight premature infants with PVL (PVL group)and 43 normal infants (control group)who were hospitalized in our hospital from Nov 2007 to Jul 2008 were enrolled in the study.The infants were sampled for MBP and S100B levels on 1st,3rd,7th and 14th d after birth.Thirty normal infants and 69 infants with PVL were followed up every three months as they discharged until they were one year corrected age and their development quotients(DQ) were measured using Gesell development schedules.Results ( 1 ) The serum MBP levels increased on day 1 [ (7.61 ± 1.78 ) μg/L ],peak on day 3 [ ( 14.53 ± 3.12 ) μg/L],and then decreased.The serum MBP levels in infants with PVL group were significantly higher than those of control group at 1st,3rd,7th and 14th d after birth ( P ＜ 0.05 ).(2) The serum S100B levels increased on day 1,day 3 and day 7 [ (3.82 ±0.68),(4.41 ±0.91,),(5.78 ± 1.54) μg/L],peaked on day 7,and then decreased.The S100B levels of infants in PVL group were significantly higher than those of control group at 1st,3rd and 7th d after birth (P ＜0.05) ;and decreased on day 14 (P＞0.05).(3) Infants whose MBP and S100B levels increased at 7th day after birth had significantly decreased DQ than those of normal infants ( P ＜0.05 ).Conclusion The serum MBP and S100B levels in infants with PVL are correlated with the severity of central nervous system injury.If the serum S100B and MBP levels of PVL infants continues to rise more than 7 d,the DQ are lower,and the outcomes are poor.

Objective To investigate the pathogen and incidence of ventilator-associated pneumonia (VAP) under different pH value of gastric juice,and to explore the endogenous pathogenesis of VAP.Methods Ninety-eight cases were admitted in our neonatal intensive care unit from Dec 2008 to Dec 2010.According to whether VAP happened,they were divided into VAP group (52 cases) and non-VAP group (46 cases).The relation between pH value of gastric juice and the species of pathogenic bacteria in stomach was analyzed.Results The incidence of VAP was 53.1％ (52/98).The pH value of gastric juice affected the species of pathogenic bacteria in stomach.When pH ≤ 4,the major species of pathogenic bacteria were Candida and Gram-positive bacillus; and pH ＞ 4,the major species were Gram-negative bacillus.The incidence of VAP was 34.5％ (10/29) when pH≤4;on the contrary,the incidence was 60.9％ (42/69) when pH ＞ 4.The incidence of VAP at the time of pH ＞ 4 was significantly higher than that of pH ≤4 ( x2 =5.71,P =0.017).Conclusion The pH value of gastric juice is an important factor of the species of pathogenic bacteria in stomach,especially for Gram-negative bacillus,including multi-drug resistant extended-spectrum β-lactamase-producing bacteria.The higher of pH value,the incidence of VAP is higher.

Objective To explore the method that can block the infection route from stomach to lung so as to reduce the incidence of ventilator-associated pneumonia (VAP) in neonates.Methods Neonates with mechanical ventilation were randomly divided into two groups,the treatment group(40 cases) were given probiotics (Bifidobacteria) by nasogastric feeding,control group(40 cases) were given nothing.Prospective survey was performed on the incidence of VAP,gastric juice pH,gastric bacterial colonization,the homology between gastric bacterial colonization and VAP pathogen.Results The VAP incidence of treatment group and control group was 12.5％ (5/40) and 47.5％ (19/40) respectively,there was significant difference between the two groups ( x2 =10.21,P ＜ 0.01 ).The onset time of VAP in treatment group [ ( 5.4 ±2.1 ) d] was later than that of control group[ (4.3 ± 1.0) d] ( t =3.2,P ＜0.01 ).The ratio of treatment group that gastric juice dropped to pH≤3 (80.0％,32/40) was higher than that of control group(47.5％,19/40) ( x2 =11.5,P ＜ 0.01 ) ; and the ratio of gastric bacterial colonization in treatment group ( 30.0％,12/40) was lower than that in control group(80.0％,32/40) ( x2 =16.9,P ＜0.01 ).The homology ratio between VAP pathogen and colonization bacteria in treatment group (40.0％,2/5 ) was lower than that in control group (78.9 ％,15/19 ) ( x2 =8.7,P ＜ 0.01 ).Conclusion Probiotics can reduce gastric juice pH of neonates and inhibit gastric bacterial colonization.The onset time of VAP can be delayed,the incidence of VAP can be reduced effectively.