Objective To study the expressions of cysteinyl aspartate specific proteinase 3 ( Caspase 3 ) and proliferating cell nuclear antigen ( PCNA ) in intestinal tissue of neonatal rats with necrotizing enterocolitis ( NEC ) , and the protective effect of glutamine ( Gln ) on NEC. MethodsThirty-six neonatal Sprague-Dawley ( SD) rats were randomly assigned into 3 groups at 48 h after birth (12 in each group). The control group were fed with milk replacer. The NEC group were fed with milk replacer and experiencing cold exposure after hypoxic-reoxygenation twice a day for 3 days, The Gln+NEC group were fed with milk replacer plus Gln and experiencing cold exposure after hypoxic-reoxygenation twice a day for 3 days. All the rats were sacrificed and intestinal tissues obtained at day 3 of the establishment of model. The histological changes of ileal tissues were studied using hematoxy lin-eosin ( HE ) staining. The expressions of Caspase 3 and PCNA were detected using immunohistochemical(IHC)method.Results Caspase3expressioninNECgroup(77.3±8.6)℅was significantly higher than the control group (18. 9 ± 3. 4)℅ and Gln+NEC group (50. 3 ± 6. 2)℅ ( P<0. 05). Also, Caspase 3 in Gln+NEC group was significantly higher than the control group (P<0. 05). PCNA expression in the NEC group ( 15. 0 ± 1. 9 )℅ was significantly lower than the control group (34. 2 ± 5. 8)℅ and the Gln +NEC group ( 24. 0 ± 3. 9 )℅ ( P <0. 05 ) . PCNA expression in the Gln+NEC group was significantly lower than the control group ( P<0. 05). The pathological score of the intestinal tissues was significantly correlated with Caspase 3 expression ( r = 0. 769, P = 0. 005 ), Caspase3/PCNA ratio (r=0. 835,P=0. 002) and PCNA expression (r= -0. 698, P=0. 014) in the NECgroup.Conclusions Up regulation of Cas pase3 and down regulation of PCNA might be correlated with the process of NEC. Gln might be effective in prevention and healing of NEC by inhibiting apoptosis and promoting cell proliferation.

Objective To study the closure time of neonatal ductus venosus and the Z score regression equation, and to explore the variation of closure time of neonatal ductus venosus with gestationalage.Methods Color doppler ultrasound was applied to detect the closure time of neonatal ductus venosus in normal newborns, Z score regression equation ( lnY =a +bX +cX2 ) for the closure time of neonatal ductus venosus ( Y ) was developed by regression analysis which used gestational age ( X) as an independent variable. The Z scores of the closure time of neonatal ductus venosus in different gestational age were calculated by the formula [ Z = ( M - Y )/S x , M for observation value, Y for predictivevalue].Results There were 432 cases in our study.The closure time of neonatal ductus venosus was negatively related to gestational age ( r = -0. 938 , P <0. 001 ) . The nonlinear regression equation was lnY= -5. 228+0. 089X-0. 000228X2, R2 =0. 854, Sx =0. 214(P<0. 001). Based on the predicted mean of the closure time and Sx related to different gestational age, Z scores for specific closure time of neonatal ductus venosus could be calculated by the formula [ Z =( M -Y)/Sx ] . The Z scores were normally distributed,and did not change with gestational age.Conclusions Theclosure & nbsp;time of neonatal ductus venosus is negatively related to gestational age. The Z scores obtained by the predicted nonlinear regression equation are normally distributed.

Objective To study the clinical features and follow-up of newborns with severe hypoxic-ischemic encephalopathy ( HIE) , and to provide the basis for rational diagnosis, treatment and follow-up.Methods Clinical data of cases of HIE from the Neonatal Department of our Hospital from January 2011 to October 2014 were studied retrospectively. The data of general information, laboratory examination, treatment, outcome, follow-up and prognosis of the patients were collected. Multivariate logistic regression analysis was used to study the influential factors of the prognosis of HIE.Results A total of 123 infants with sever HIE were enrolled in our study. In addition to general therapy, 6 cases were treated with mild hypothermia, and 21 cases were treated with high pressure oxygen. 60 cases improved our treatment, 55 cases had withdrawal treatment with parental consent, and 8 cases died. Single factor analysis showed that 5 minutes Apgar score, convulsions, coma, pH, BE, organ injury, and mild hypothermia treatment were the risk factors that affect the prognosis of severe HIE. Multiple factors analysis showed that 5 min Apgar score <3 points ( OR=4. 071 ,95℅CI 1. 309-15. 613 ) and BE≤-10 mmol/L ( OR=36. 810, 95℅CI 5. 913-41. 119) were independent risk factors of prognosis of severe HIE ( P<0. 05). Hospitalization within the first 72 hours of life ( OR=0. 096, 95℅CI 0. 096-0. 353) was a protective factor of severe HIE. Multiorgan injury ( mainly the injury of brain, lung and heart) and electrolyte imbalance ( mainly hypocalcemia and hyponatremia ) were common complications of serve HIE. In the follow-up of these patients, 33 cases were loss in follow up, and 49 cases died (8 cases died during hospitalization, 41 cases died after withdrawal of treatment). The top five causes of death were abandonment of treatment due to financial reasons and the fear of adverse outcome (n=20), multiple organ dysfunction ( n =16 ) , and pneumothorax ( n =4 ) , diffuse intravascular coagulation (n=6), and shock (n=3). 41 cases survived were followed up for 9~54 months. The critical clinical conditions observed among these infants included cerebral palsy ( n = 5 ) , epilepsy ( n = 3 ) and developmental retardation(n=26).Conclusions There are many complications of severe HIE.The mortality of severe HIE is high, and the incidence of poor outcome of survivors is also high. Timely detection of risk factors is the key to the prevention of severe HIE. Long-term prognosis of severe HIE requires proper organization of neonatal follow up.

Objective To identify risk factors associated with repeat use of pulmonary surfactant ( PS) in the treatment of respiratory distress syndrome ( RDS ) in the term and near-term neonate. Methods There were 130term and near-term new borns with RDS who were treated with pulmonary surfactant were enrolled. These infants were categorized into two groups: single-dose group (85 cases) and repeat-dose group (45 cases). The differences in basic information were compared between the two groups, and logistic regression analysis was used to identify the risk factors for repeat use of pulmonary surfactant.Results TherepeatutilizationrateofPSwas34.6℅.The incidence of asphyxia,maternal gestational hypertension, X-ray RDS grade 3-4, the age of first dose PS,respiratory support time in the repeat-dose group was significantly higher than in the single-dose group (P<0. 05). PaO2/FiO2 and the cure rate in the repeat-dose group were significantly lower than in single-dose group ( P<0. 05 ) . The incidence of sepsis, pulmonary hemorrhage, shock and patent ductus arteriosus ( PDA) in the repeat-dose group was significantly higher than in the single-dose group ( P<0. 05). Further logistic regression analysis showed that birth asphyxia ( OR=5. 674 , 95℅CI 1. 378 -23. 354 , the age of first dose of PS (OR=1.092, 95℅CI 1.002 -1.191)and PDA(OR =23.499, 95℅CI 2.348 -235.152)were the independent risk factors for repeat use of pulmonary surfactant.Conclusions Birth asphyxia,the age of first dose PS and PDA are the risk factors for repeat use of pulmonary surfactant in the treatment of RDS in the term and near -term neonate.

Objective To study the effects of extensively hydrolyzed formula forvery/extremely low birth weight(VLBW/ELBW)infants.Methods From Jun.2013 to Oct.2015,78VLBW/ELBW infants admitted to our hospital within 12 hours of birth were randomly assigned into two groups:hydrolyzed protein formula feeding group ( hydrolyzed formula group) and preterm formula feeding group (control group). Infants with hospital stay <28 days were excluded. Prospective study was conducted between two groups comparing the duration of meconium discharge, the time required for total enteral feeding average hospital stay, feeding intolerance and physical growth and blood biochemical indices on the28thday.Results A total of 78 infants were enrolled,35 in hydrolyzed formula group and 43 in control group. Comparing with control group, feeding intolerance in hydrolyzed formula group was significantly lower ( 25. 7℅ vs. 72. 0℅) . The duration of meconium discharge [ ( 4. 9 ± 0. 8 ) d vs. (8. 8 ± 1. 6)d], the time required for total enteral feeding[(13. 4 ± 2. 0) d vs. (18. 9 ± 2. 6) d] and average hospital stay duration [ ( 33. 7 ± 5. 1 ) d vs. ( 41. 8 ± 6. 8 ) d ] was shorter in hydrolyzed formula group ( P<0. 05). The body length on the 28th day in hydrolyzed formula group was longer than control group[ (43. 8 ± 1. 2 ) cm vs. ( 42. 6 ± 2. 0 ) cm, P < 0. 05 ] . The concentration of serum albumin [ (32. 5 ± 3. 0 ) g/L vs. ( 30. 0 ± 4. 5 ) g/L ] and hemoglobin [ ( 112. 4 ± 11. 4 ) g/L vs. ( 106. 3 ± 13. 0) g/L] in hydrolyzed formula group were significantly higher than the control group( P<0. 05). No significant difference was found between the two groups regarding the time required returning to birth weight [(10. 9 ±2. 2)d vs. (10. 1 ±1. 7)d],body weight [(1759 ±107)g vs. (1627 ±435)g], head circumference[(30. 3 ± 1. 0)cm vs. (29. 7 ± 1. 6)cm] on the 28th day and the incidence of extrauterine growthretardation(EUGR)(40.0℅vs.44.1℅)atdischarge.Conclusions Comparing with preterm formula feeding, early feeding with extensively hydrolyzed formula can reduce the incidence of feeding intolerance on VLBW/ELBW infants. Extensively hydrolyzed formula also can accelerate meconium discharge, reduce hospital stay duration and the time required for total enteral feeding. But the growth of weight and head circumference on the 28th day and the incidence of EUGR at discharge were not altered by extensively hydrolyzed formula.

Objective To study whether a lactose-free,hydrolyzed protein formula would ameliorate feeding intolerance and weight gain in very low birth weight infants.Methods The study was conducted on very low birth weight infants ( gestational age ≤34 weeks, birth weight ≤1500 g) in our NICU from August 2010 to August 2013. According to the number of admission, the cases were assigned into lactose-free hydrolyzed protein formula group ( hydrolyzed protein group) and preterm formula group. The data of basic information ( gestational age, birth weight, way of labor, sex, asphyxia ), commencement of feeding time ( days) , enteral caloric intake, parenteral nutrition caloric intake, The time ( days) required to regain birth weight, weight gain index, days of parenteral nutrition, prealbumin level, feeding intolerance, the incidence of necrotizing enterocolitis ( NEC ) and extrauterine growth retardation(EUGR)werecollected.Results A total of 83 infants were recruited in the study. 40 infants were in hydrolyzed protein group and 43 infants were in preterm formula group. There were no differences between groups for basic information ( P>0. 05). The weight gain index of hydrolyzed protein group was higher than that of preterm formula group (13. 5 ± 2. 4 g/d vs. 11. 9 ± 3. 7 g/d, P=0. 036). There were less cases of feeding intolerance in hydrolyzed protein group than in preterm formula group & nbsp;(28/40 vs. 38/43, P=0. 038). The differences of the incidence of NEC (1/40 vs. 2/43) and EUGR (21/40vs.25/43)showed no significance statistically.Conclusions Lactose-free hydrolyzed protein formula can obviously improve feeding intolerance and early weight gain of premature infants.

Objective To study the relationship between neurodevelopment and early nutritional status of very low birth weight(VLBW)infants in NICU.Methods VLBW infants admitted to NICU of our hospital from January 2013 to December 2014 and received regular follow-up management at our high-risk infant outpatient clinic were retrospectively studied. All infantsˊdevelopmental quotient ( DQ) were evaluated at 3 months of corrected gestational age ( cGA) . DQ ≥130 was defined as excellent, 115-129 above medium, 85-114 medium, 70 -84 below medium and ≤69 abnormal. According to their DQ scores, infants were assigned into two groups, normal neurodevelopment group ( DQ≥85 ) and abnormal neurodevelopment group ( DQ<85 ) . Nutritional status during hospitalization between the two groups were compared.Results A total of 125 VLBW infants were recruited.At three months of cGA, 2 cases ( 1. 6℅) had excellent DQ score; 3 ( 2. 4℅) above medium; 63 ( 50. 4℅) medium;57 (45. 6℅) below medium. 68 cases (54. 4℅) in the normal development group and 57 (45. 6℅) in the abnormal group. The total energy intake, the proportion of enteral energy supply on 4 d, 7 d, 14 d after birth and amino acid supply on 4 d, 7 d were significantly higher in the normal neurodevelopment group than the abnormal group (P<0. 05). Comparing with the abnormal group, weight loss of VLBW infants in the normal neurodevelopment group was less; the time needed to reach birth weight and exclusive enteral nutrition in the normal neurodevelopment group was shorter. The differences were statistically significant between the two groups(P<0.05).Conclusions VLBW infantsˊearly nutritional status may influence their neurodevelopmental outcome.

Objective To measure vitamin D levels in newborn cord blood inorder to ascertain appropriate supplementation regimes.Methods A total of 6420 newborn umbilical cordblood 25-hydroxyvitamin D [ 25-( OH ) D ] concentrations were measured by enzyme linked immunosorbent assay, and the correlation between 25-( OH ) D and gestational or birth weight or season was retrospectively analyzed.Results There were 5358(83.5℅)of the 6420,had umbilical cord blood concentrations of 25-(OH)D <50. 0 nmol/L. The 25-(OH)D levels M(Q1,Q3)increased from very preterm births, moderately preterm, later preterm, full-term infants to post-term infants [ 29. 0 ( 22. 5, 38.9),33.4(26.3,41.6),35.1(26.9,43.3),35.7(28.1,45.0),43.3(33.5,52.8)nmol/L, P <0. 001]. The 25-(OH) D levels M(Q1,Q3) increased from very low birth weight infants, low birth weight, normal birth weight infants to macrosomia [29. 0(22. 4,38. 8),34. 6(27. 5,44. 2),35. 1(28. 1, 44. 7),35. 7(28. 0,47. 5), P<0. 001]. The 25- (OH)D levels were positively correlated respectively in gestational ages and body weights ( r =0. 619 , 0. 180 , P <0. 05 ) . Newborn umbilical cord blood concentration of 25- ( OH ) D levels varied with season ( P all <0. 001 ) , the lowest in spring [ 30. 4 (24.1,38.3)]and highest in autumn[39.3(31.6,50.9)].Conclusions Premature and low birth weight infants are especially at high risk of vitamin D deficiency and should receive appropriate vitamin D supplementation. In addition, there should be an ongoing promotion of vitamin D supplements to pregnant women and the awareness of sun exposure to achieve vitamin D sufficiency.

ObjectiveTo study the efficacy and safety of heated humidified high flow nasal cannula ( HHHFNC) and nasal continuous positive airway pressure( NCPAP) ventilation for prevention of extubation failure in extremely low birth weight(ELBW)infants in our NICU.MethodsFrom Jan.2011 to Dec. 2014, 129 ELBW infants admitted to our hospital were randomly assigned into HHHFNC group and NCPAP group. The inclusion criteria were gestational age ( GA ) <34 w, birth weight ( BW )<1000 g, admission within 7 d after birth and transition to noninvasive respiratory support after a period of mechanical ventilation with an endotracheal tube. The primary outcome included:the incidence of extubation failure, nasal injury, air leak, abdominal distention and bronchopulmonary dysplasia ( BPD). Results Statistically significant difference sexisted between the two groups on oxygen the rapyduration, the time required reaching total enteral feedings and the incidences of nasal injury, air leak, abdominal & nbsp;distention and necrotizing enterocolitis ( P<0. 05). The incidence of extubation failure within 7 days was 25. 8℅ in HHHFNC group and 47. 6℅ in NCPAP group ( P <0. 05 ) . No differences between the 2 groups on total ventilation duration, non-invasive ventilation duration, re-intubation rate at 3d after extubation, BPD, retinopathy of prematurity ( ROP ) , intracerebral hemorrhage ( ICH ) , periventricular leukomalacia(PVL)and patent ductus arteriosus(PDA).Conclusions HHHFNC is an effective and safe method for prevention of extubation failure in ELBW infants.

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.