Objective To studytherolesof hypoxia-inducible factor-lalpha( HIF-1α )and vascular endothelial growth factor ( VEGF) in the pathogenesis of hypoxia-induced pulmonary hypertension ( HPH) in neonatal rats.Methods Wistar neonatal rats were assigned into HPH group and the control group using random number table method. Neonatal rats in HPH group were exposed to hypoxia according to HPH model. On day 3 , 7 ,14 and 210f hypoxia,the mean pulmonary artery pressure ( mPAP) , the level of mRNA and protein expression of HIF-1α and VEGF in lung tissue were examined using RT-PCR and Western blot methods respectively. The correlation of HIF-1,VEGF and mPAP were also analyzed. Results The mPAP ( mmHg)in HPH group on day 3 ,7 ,14 and 210f hypoxia were all higher than the control up[8.5±1.5)vs.5.2±1.0),(12.1±2.1)vs.9.6±0.8),(12.9±2.0)vs.(9.1±0.8),(21.0±2. 3) vs. (11. 2 + 1. 6) ,P < 0. 05]. 0n day 3, 7 and 140f hypoxia,the mRNA of HIF-1α in lung tissue of HPH group were significantly higher than the control group ( P <0. 05 ) . On day 70f hypoxia, the HIF-1αprotein in lung tissue of HPH group was significantly higher than the control group(P <0. 05 ) . On day 7 ,14 and 210f hypoxia,the mRNA and protein of VEGF in lung tissue of HPH group were also significantly higher than the control group( P <0. 05 ). Correlation analysis showed that HIF-1α protein were positively correlated with mPAP on day 3 ,7 . 14 and 210f hypoxia in HPH group ( r = 0. 504 .P = 0. 002) , and VEGF protein were positively correlated with mPAP in HPH group on day 7 , 14 and 210f hypoxia( r = 0. 782, P < 0. 001) .Conclusion Both HIF-1α and VEGF play roles in the occurrence and development of HPH in neonatal rats.

Object To investigate the pathological changes,physiological condition,neurobehavior and motor development of the 3-day-old rats with ischemic brain injury.Methods Ninety six 3-day-old male Sprague-Dawley rats were randomly assigned to experimental and control groups.Occlusion of both carotid arteries was performed in the experimental group,while the rats in the control group only received skin incisions without carotid ligation.Physical examinations and neurobehavioral development of the rats were recorded daily from the first day after operation until 3 weeks after birth,including weight,eye opening, incisor eruption,ear unfolding,righting reflex,negative geotaxis,limb placing and grasping reflex. Specimens of the brain tissue were obtained in 24 hours after operation and 3 weeks after birth for the hematoxylin-eosin staining and immunohistochemistry staining to investigate the pathological changes.All the reaults were compared between the 2 groups.Results Compared with the control group,rats in the experimental group were found growth retardation,suppression of primitive reflexes and impaired motor abilities (P < 0.05 ).The brain tissue obtained from the rats after operation showed white matter rarefaction,liquefaction and microglia hyperplasia with Hematoxylin-eosin staining and myelin formation disorder with immunohistochemistry staining.Conclusions Ischemic brain injury of the 3-day-old rats could result the mental retardation,neurobehavioral and motor development disorder because of the white matter injury.

Objective To evaluate the diagnostic value of ultrasonography in neonatal necrotizing enterocolitis (NEC)by Meta analysis.Methods PubMed,EMbase,CBM,CNKI,VIP and WanFang databases were retrieved to incorporate studies on the diagnostic value of ultrasound in NEC that met the inclusion criteria.The retrieval time limit was from establishment of the databases to July 24th,2015. QUADAS was used to assess the quality of the literatures and Meta -Disc software (Version 1 .4)was used for Meta analysis.The SROC was drawn and the area under curve (AUC)of SROC was calculated.Results A total of 7 studies were included and 485 patients were involved.The sensitivity of the ultrasonography was 0.65 (95%CI 0.58 ~0.71 )and the specificity was 0.61 (95%CI 0.55 ~0.67).The AUC of the SROC was 0.726.Conclusion The ultrasonography showed no clear advantage for diagnosis of NEC.Combining with clinical manifestations would enhance the diagnostic ability of the ultrasound.

Objective To investigate the role and significance of E selectin in the pathogenesis of neonatal acute lung injury (ALI).Method Ninety neonatal Sprague Dawley (SD) rats (6 or 7 days after birth) were randomly assigned to the control group (n =10) and ALI group (n =80).The rats in the ALI group received intraperitoneal injection of lipopolysaccharide (LPS) at dose of 4 mg/kg and they were divided into eight subgroups with 10 rats in each group according to different sacrifice time (0.5 h,1 h,2 h,3 h,4 h,8 h,12 h and 24 h after injection).Rats in the control group were injected intraperitoneally the same volume of normal saline and they were sacrificed at 4 hours after injection.Expression of the E-selectin in lung tissue was detected dynamically by immunohistochemistry and the serum soluble endothelial selectin (sE-selection) was detected by enzyme-linked immunosorbent assay (ELISA).The pathological changes of the lung tissue and the wet/dry lung weight ratio (W/D ratio) were recorded.Result The strong expression of a large number of E-selectin was detected in the vascular endothelial cells of the lung tissue in the ALI group,while only moderate expression of E-selection was observed in the control group.The W/D ratio in the ALI group gradually increased from 0.5 h after intraperitoneal injection of LPS,reached the peak at 8 h,and then began to decline.The ratio was significantly higher in the ALI group than that of the control group from 4 to 12 h after injection (P ＜ 0.05).The mean optical density of E-selectin in lung tissue of ALI group was also higher than that of the control group and the average optical density of ALI group at 2 h,3 h,4 h and 8 h was significantly higher [2 h:(0.36 ±0.09),3 h:(0.38 ±0.01),4 h:(0.44 ± 0.06),8 h:(0.30 ± 0.09),control group:(0.24 ± 0.01),P ＜ 0.05].The level of serum sE-selectin gradually increased after intraperitoneal injection of LPS,reached the peak at 2 h,and then decreased gradually.The level of sE selection was significantly higher than that of the control group at the point of 2 h,3 h,4 h and 8 h (P ＜ 0.05).The level of serum sE-selectin increased along with the expression of E-selectin in lung tissues,and they were positively correlated (r =0.730,P ＜ 0.01).Conclusion The increased expression of E-selectin and the elevation of serum sE-selectin level may reflect the injury of pulmonary vascular endothelial cells induced by systemic inflammatory response.

Objective To study the clinical characteristics and current treatment options of neonatal congenital portosystemic shunt (CPSS).Method A newborn infant diagnosed with CPSS complicated with iliac artery-umbilical vein fistula was studied.CNKI,VIP,WanFang and Pubmed databases were searched using CPSS and Abernethy malformation as keywords.A total of 8 papers on neonatal CPSS were retrieved from 2006 to 2016.Result The case treated in our hospital was a boy with symptom of dyspnea and cyanosis.His ultrasound cardiograph showed pulmonary hypertension,and the heart and abdominal CT scan showed portosystemic shunt,dilated portal vein and umbilical vein,patent ductus venosus (PDV) and iliac artery-umbilical vein fistula.A total of 25 patients were analyzed including our patient and 24 cases reported in 8 papers.Cases of intrahepatic shunt (n =22) were nore common than extrahepatic shunt (n =3),and most cases could be diagnosed with ultrasound.Congenital heart diseases,intrauterine growth retardation,cutaneous hemangioma were common complications of CPSS.Abnormal liver function (52.0％),hyperammonemia (28.0％),pulmonary arterial hypertension (12.0％),dyspnea (12.0％) were common clinical manifestations of neonatal CPSS.Most CPSS cases were treated non-operatively during neonatal periods,and in 40.0％ of cases the shunts were closed spontaneously,but mortality was 20.0％ among previous cases.Conclusion Abnormal hepatic function is the most common clinical symptom of neonatal CPSS.Cases of extrahepatic shunts and complicated with PDV are dangerous and operation should be done as soon as possible,meanwhile complications should be treated appropriately.

Objective To study the neurological prognosis of neonates with ventriculomegaly and its influencing factors.Method A retrospective study was conducted among neonates with ventriculomegaly in Peking University First Hospital from January 2013 to December 2015.A series of cranial ultrasonography were performed after birth and the Gesell development scale was conpleted after six months.x2 test and two-independent-sample t test were used for statistical analysis.Result Among 103 cases of ventriculomegaly,95 cases (92.2％) had mildly enlarged lateral ventricles and 8 cases (7.8％) significantly enlarged.83 cases received serial cranial ultrasound examinations after birth.The lateral ventricles of 9 patients (10.8％) bacame wider and 74 (89.2％) not.The Gesell development scales were completed in 65 cases 6 months after birth.Among them,8 patients with widening lateral ventricles got poor prognosis (100％).Among 57 patients without progressively widening lateral ventricles,6 (10.5％) had poor prognosis.The difference was statistically significant (P ＜ 0.001).No correlation was found between the severity of the lateral ventricle widening and the neurological outcome (P =1.000).There were 2 cases with other abnormalities,and 1 case got poor prognosis on follow-up.Conclusion Most neonatal ventriculomegaly patients have mild and isolated lateral ventricle enlargement.Most of them remain stable or gradually return to normal.The patients with progressively widening lateral ventricles are likely to have adverse neurological prognosis.

Objective To compare the clinical efficacy of nasal intermittent positive pressure ventilation (NIPPV) and heated humidified high flow nasal cannula (HHHFNC) in the treatment of respiratory distress syndrome (RDS) among low-birth-weight premature infants.Method From May to December 2015,low-birth-weight premature infants with RDS who were born and treated in our hospital were randomly assigned into NIPPV group and HHHFNC group according to their initial ventilation mode.The incidence of initial treatment failure,the usage of pulmonary surfactant (PS),the parameters of respiratory support treatment and the incidence of complications were analyzed.Result A total of 70 cases with grade Ⅰ ～ llⅢ of RDS were included,including 33 males and 37 females.The birth weight ranged from 1 020 to 2 450 g,with a average of (1 845 ± 475) g.NIPPV and HHHFNC group each had 35 cases.No significant differences existed between the two group in the following items:the rate of mechanical intubation within 72 h (5.7％ vs.11.4％),use of PS (0％ vs.8.6％),incidence of severe apnea (11.4％ vs.14.3％),pneumonia (11.4％ vs.14.3％),the duration of invasive mechanical ventilation [76.3 (30.8,150.4) h vs.97.6 (56.2,142.6) h],non-invasive ventilation [65.0 (43.0,119.0) h vs.96.0 (65.0,134.0) h] and the duration of oxygen therapy [154.0 (47.0,340.0) h vs.148.0 (72.0,327.0) h,it was no (P ＞ 0.05).Also,no significant differences in the incidence of bronchopulmonary dysplasia,necrotizing enterocolitis,retinopathy of prematurity,patent ductus arteriosus,intra-ventricular hemorrhage,nose injury,pneumothorax between the two groups.Conclusion As an initial respiratory support for the treatment of low-birth-weight RDS preterm infants,HHHFNC has similar efficacy and safety with NIPPV,and further clinical research is needed.

Objective To review the trends of survival rates and complications in extremely low birth weight (ELBW) infants and to improve the prognosis of ELBW infants.Method From January 1999 to December 2015,ELBW infants in our hospital were retrospectively studied.Their survival rates and complications were compared among groups with different birth weight,and the risk factors for survival were identified using multivariate unconditional logistic regression analysis.Result A total of 243 ELBW infant were collected.The median gestational age of ELBW infant was 27.3 weeks (23 ～ 34 weeks),and their median birth weight was 890 g (490 ～ 995 g).Excluding 40 cases refused treatment,the cure and survival rates of the remaining 203 ELBW infants were 43.8％ (89/203) and 65.0％ (132/203),respectively.The survival rate in ELBW infant with birth weight ＜ 600 g was 0/3,increased to 70.8％ (68/96) when birth weight was 900 ～ 999 g,with an ascending trend with increased birth weight (x2 trend =12.673,P ＜0.001).The most common complications of 243 cases were neonatal respiration distress syndrome [87.7％ (213/243)],sepsis [45.3％ (110/243)],intraventricular hemorrhage [37.4％ (91/243)],bronchopulmonary dysplasia [36.6％ (89/243)] and pheumonia [36.6％ (89/243)].The incidence of complications (including intracerebral hemorrhage and hydrocephalus),decreased with increased birth weight.Multivariate unconditional logistic regression analysis found that birth weight below 800 g (＜ 700 g:OR =22.333,95％ CI 1.493 ～ 334.148,P =0.024;700 ～ 799 g:OR =3.573,95％ CI 1.075 ～ 11.874,P =0.038),stage Ⅲ necrotizing enterocolitis (OR =8.803,95％ CI 1.308 ～ 59.244,P =0.025),stage Ⅲ and Ⅳ of intraventricular hemorrhage (OR =8.902,95％ CI 1.127 ～ 70.338,P =0.038) and mechanical ventilation (OR =3.597,95％ CI 1.043 ～ 12.410,P =0.043) were risk factors affecting the ELBW infant's survival.Conclusion As birth weight increases,the survival rate also increases,and the rate of complications decreases.Birth weight,stage Ⅲ necrotizing enterocolitis,stage Ⅲ and Ⅳ intraventricular hemorrhage and mechanical ventilation are risk factors for the ELBW infant's survival.

Objective To study the risk factors and prognosis of very/extremely low birth weight preterm (VLBW/ELBW) infants with bronchopulmonary dysplasia (BPD) during the first three years of life.Method From January 1st to December 31st,2012,a retrospective study was conducted on the VLBW/ELBW preterm infants with ＞ 28 days of hospitalization in the NICU of our hospital.The infants were assigned into BPD group (FiO2 ＞ 21％) and non-BPD group depending on the oxygen requirement on the 28th day after birth.The incidences of bronchitis,pneumonia,wheezing and re-hospitalization during the first three years of life were analyzed.The pulmonary function tests were performed at one-year-age.Independent-sapmles t test,Kruskal-wallis test and x2 test were used to compare the results between the two groups.Result A total of 72 patients were enrolled into this study.34 patients in the BPD group and 38 in the non-BPD group.The gestational age,birth weight and the use of INSURE technique of BPD group were significantly lower than non-BPD group,while the duration of hospital stays were longer than non-BPD group (P ＜0.05).The ratio of male,neonatal respiratory distress syndrome (RDS),patent ductus arteriosus (PDA),intrauterine infection,mechanical ventilation,nosocomial infection and the inhalation of high concentrations of oxygen were significantly higher in BPD group than non-BPD group (P ＜ 0.05).Incidences of bronchitis and wheezing during 0 ～ 1,1 ～ 2 and 2 ～ 3 years of age in the BPD were significantly higher than non-BPD group,separately.No significant differences existed in the incidences of pneumonia and re-hospitalization between the two groups.Pulmonary function test showed that the respiratory rate (RR) and peak tidal expiratory flow in the BPD group were significantly higher than non-BPD group,while the tidal volume,peak expiratory time and peak expiratory volume were significantly lower in BPD group than non-BPD group (P ＜ 0.05).Conclusion BPD often occurs in preterm infants with gestational age less than 32 weeks.It may cause impaired pulmonary function,characterized by obstruction in small airway,and increases the risk of bronchitis and wheezing during the first three year of life.

Objective To study the clinical and imaging features of neonatal acute osteomyelitis.Method From 2011 to 2016,the clinical feature,laboratory results,pathogen,imaging features,treatment and prognosis of neonates who were diagnosed with acute osteomyelitis in NICU of People's Hospital of Xinjiang Uygur Autonomous Region were retrospectively studied.Result A total of 13 cases were enrolled during the study period,5 males and 8 females,with onset age of 7 ～30 d.8 cases had different degrees of fever and 5 of them showed dyspnea;8 cases had elevated skin temperature and swelling at the affected area;7 cases presented with irritability;6 cases had anorexia;all cases had elevated white blood cell count.Blood culture were taken immediately after their admission,and culture from the pus were taken for some patients.5 cases had positive blood culture and Staphylococcus aureus was the main pathogen.6 cases had positive pus culture,and 4 cases showed gram positive (G +) bacteria and 2 cases gram negative (G-) bacteria.Humerus and tibia were the main foci of the infection.4 cases had X-ray examination within 7 days of onset showing soft tissue swelling and no sign of bone destruction.13 cases had X-ray examination at 7 to 14 days of disease.Among them only 1 case showed soft tissue swelling,and the rest 12 cases had different levels of bone destruction and periosteal reaction.2 cases had X-ray examination after 14 days of disease,showing stiffening ring,inflammatory changes and periosteal reaction.All patients were treated with broad-spectrum antibiotics after admission,and the affected limbs were immobilized.3 cases had further surgical treatment.11 patients recovered and were discharged,1 patient was treated at local hospital after diagnosis and 1 patient refused further treatment due to serious complications after 35 d of hospital stay and was lost on follow-up.Conclusion The clinical manifestation of neonatal osteomyelitis is atypical,the radiological and pathogen examination should be carried out once osteomyelitis is suspected.Appropriate antibiotics and timely surgery can prevent further damage and long-term sequela.