Objective To study the clinical features of hand-foot-mouth disease(HFMD) in neonates.Method From April 2015 to May 2016,the clinical manifestations,laboratory examinations,treatments and prognosis of neonates with HFMD in our hospital were retrospectively analyzed.Result A total of 6 cases of neonatal HFMD were included,with 4 males and 2 females.The ages of 2 patients were ≤7 days and the other 4 patients 8 ～ 28 days.5 patients developed this disease during April to July,while the other one in January.2 cases had a definite contract history of HFMD.4 cases presented with fever and rashes in hand and foot,one case with fever,rash and oral ulcer,and one case with rash in hip and oral ulcer without fever.The nucleic acid test of enterovirus were positive in 4 cases.The symptoms of these neonatal HFMD were mild and recovered after symptom-relieving treatment.Conclusion HFMD in neonates with fever and/or rash should be considered during the HFMD epidemic period.

Objective To study the differences of coagulation indices on the first day of birth in newborns with different gestational ages.Method Premature infants born in our hospital between January 2014 and December 2015 were enrolled in this study as the observational group,and they were divided into early preterm group,moderate preterm group,and late preterm group according to their gestational ages.Healthy full-term infants born during the same period were selected as the control group by 3:1 The clinicaldata and coagulation indices of the infants and their mothers in each group were compared.Result There were 44,50,71,and 52 cases in the early preterm,moderate preterm,late preterm,and control group,respectively.The prothrombin time (PT),activated partial thromboplastin time (APTT),and thrombin time (TT) of the premature infants in the early preterm group,moderate preterm group,and late preterm group were all longer than those of the control group [PT:(16.1 ±4.3) s,(16.8 ±4.9) s,(15.8 ±4.8) s,vs.(13.0±1.3)s;APTT:(88.3±38.1) s,(93.5±37.7) s,(91.0±32.3) s,vs.(66.0±17.8) s;TT:(25.4 ±4.6) s,(25.1 ±5.5) s,(25.0 ±3.3) s,vs.(24.0 ±3.3) s;all P＜0.05].The fibrinogen level of the premature newborns in three groups were all lower than that of the full-term infants in the control group [(1.11 ± 0.46) g/L,(1.12 ± 0.44) g/L,(1.12 ± 0.45) g/L vs.(1.28 ± 0.37) g/L,P ＜ 0.05].The differences of all the indices among the three groups of premature infants were all not statistically significant (P ＞ 0.05).The comparison of the coagulation indices of the mothers of the newborns from all four groups showed no significant differences (P ＞ 0.05).Conclusion Compared with full-term infants,preterm infants showed significantly poorer coagulation function on the first day of birth.However,there were no significant differences in coagulation indices among preterm infants of different gestational ages.

Objective To study the correlation between abdominal near-infrared spectroscopy monitoring and the risk of necrotizing enterocolitis (NEC) in preterm infants.Method From September 2015 to June 2016,preterm infants admitted to the NICU of our hospital were enrolled in this study.Nearinfrared spectroscopy (NIRS) was used to monitor the tissue oxygen saturation (StO2) of lower right abdomen of the patients.These preterm infants were assigned into NEC group and non-NEC group depending on whether NEC was developed during hospitalization.The abdominal StO2 within the first week after birth were compared between the two groups.Result A total of 77 infants were enrolled in this study,18 preterm infants in the NEC group and 59 in the non-NEC group.The gestational age and birth weight of the patients in the NEC group were lower than the non-NEC group.The NEC gioup had significantly higher incidences of mechanical ventilation,vasoactive agent usage and comorbidity of infection than the non-NEC group (P ＜0.05).No significant differences in the proportion of gender,application of umbilical venous catheters and the incidence of patent ductus arteriosus between the two groups (P ＞ 0.05).The abdominal StO2 of the NEC group was significantly lower than the non-NEC group (69.0％ ± 5.8％ vs 82.8％ ± 6.7％,P ＜0.001).Multivariate logistic regression analysis showed that lower abdominal StO2 is an independent risk factor for NEC (OR =0.676,95％ CI 0.548 ～ 0.834,P ＜ 0.001).Conclusion Abdominal NIRS monitoring may be helpful for the early diagnosis of NEC.

Objective To study the clinical characteristics of neonatal pertussis.Method From January 2011 to December 2015,clinical data of newborns with pertussis treated in our hospital were retrospectively analyzed,including the general information,clinical manifestations,laboratory examinations,treatment and prognosis.Result A total of 68 newborns with pertussis were found during the study period,including 1 case in 2011,5 cases in 2012,1 case in 2013,18 cases in 2014 and 43 cases in 2015.The time needed for diagnosis was 7 to 35 days after onset of symptoms,and 80.9％ (55/68) in 14 days.The predominant manifestation was paroxysmal cough (68 cases,100％).Other common symptoms included flushing in 45 cases (66.2％) and cyanosis with coughing in 40 cases (58.8％).The uncommon symptoms included whooping cough (20 cases,29.4％),wheezing (10 cases,14.7％),fever (3 cases,4.4％) and apnea with decreased heart rate during cough (2 cases,2.9％).12 patients (17.6％) had elevated peripheral white blood cells or lymphocytes.The clinical manifestations didn't disappear despite erythromycin therapy,and the whooping cough continued for 12 to 42 days during the course of disease.22 cases (32.4％) had complications,including pneumonia in 12 cases,myocardial damage in 10 cases,heart failure in 2 cases,respiratory failure in 1 case,atrial tachycardia in 1 case and lung consolidation in 1 case.Conclusion Neonatal pertussis is not uncommon and has a tendency to increase year by year,and it's challenging for early diagnosis.The patients who have a whooping cough without fever should be considered of pertussis until otherwise ruled out.Leukocyte and lymphocyte count are of little value in the diagnosis of this disease.

Objective To study the changes of serum interleukin-8 (IL-8) and interleukin-10 (IL-10) in preterm infants delivered from mothers with chorioamnionitis (CA) and the possible effects on bronchopuhmonary dysplasia (BPD) and brain injury of preterm infants.Method From October 2014 to October 2015,clinical data from mothers without clinical manifestations of CA giving birth to a preterm baby (gestational age:26 to 33 weeks) were collected in Changzhou Maternal and Child Health Hospital and Suzhou Municipal Hospital.The infants were assigned to CA group and non-CA group according to their mother's placenta pathology.The levels of serum IL-8 and IL-10 were measured using enzyme-linked immunosorbent assay (ELISA) on day 1 and day 7,while the levels of WBC,CRP and PCT were measured at birth.The incidences of BPD and brain injury were also reviewed.Result A total of 67 preterm infants were included,with 51 in the CA group and 16 non-CA group.The levels of IL-8 were significantly higher in the CA group than the non-CA group on both day 1 and day 7 [(21.6 ±9.7) ng/L vs.(7.3 ±2.3) ng/L,(26.6 ± 12.9) ng/L vs.(7.3 ± 2.1) ng/L].The IL-10 levels were significantly lower on day 1 [(1.92±0.17) ng/Lvs.(2.04±0.18) ng/L] and higher on day 7 [(2.42±0.60) ng/L vs.(2.03 ±0.18) ng/L] in the CA group.Significant differences existed on the incidences of BPD (54.9％ vs.25.0％) and brain injury (74.5％ vs.43.8％) between the two groups (P ＜ 0.05).The levels of CRP and PCT were higher in CA group (P ＜ 0.05) and the WBC was similar between the two groups (P ＞ 0.05).In CA group,on both day 1 and day 7,infants with BPD had similar IL-8 and IL-10 levels comparing with infants without BPD(P ＞ 0.05),also were infants with brain injury comparing with infants without brain injury.Conclusion Chorioamnionitis in pregnant women may affect serum cytokines levels in premature infants and lead to high incidences of BPD and brain injury.

Objective To study the clinical effects of pulmonary recruitment maneuvers combined with pressure regulation volume control (PRVC) in the treatment of severe respiratory distress syndrome (RDS) in premature infants.Method From July 2015 to September 2016,preterm infants of grade Ⅲ-Ⅳ RDS who received PRVC treatment in neonatal department of Huai'an Maternal and Child Health Hospital were assigned into recruitment maneuver group and control group (without recruitment maneuver) using randon number table.The ventilator parameters were observed at 1,2,6,12,18 h and 24 h after ventilation.Recovery rate,duration of oxygen therapy and ventilation,duration of hospital stay,incidence of second dose of pulmonary surfactant and complications were compared between two groups.Result A total of 18 cases were included in recruitment maneuver group and 19 cases in control group.The recovery rate of recruitment maneuver group was higher than control group (16/18 vs.10/19).The duration of oxygen therapy [(6.6 ± 2.3) d vs.(11.8 ± 3.0) d],duration of ventilation [(4.1 ± 2.3) d vs.(6.4 ± 2.8) d],duration of hospital stay [(26.7 ± 7.0) d vs.(33.0 ± 8.4) d] in recruitment maneuver group were significantly shorter than control group (P ＜ 0.05).The proportion of bronchopulmonary dysplasia (1/18 vs.8/19),retinopathy of premature (1/18 vs.7/19),patent ductus arteriosus that require medication closure (1/18 vs.7/19)and incidence of second dose of pulmonary surfactant (2/18 vs.9/19) in recruitment maneuver group were significantly lower than control group (P ＜ 0.05).While the complication of air leak,necrotizing enteritis,Ⅲ-V grade intracranial hemorrhage showed no significant differences between the two groups (P ＞ 0.05).Conclusion Recruitment maneuvers combined with PRVC in treatment of severe RDS premature infants can improve recovery rate and oxygenation.It can also shorten the duration of oxygen therapy,ventilation and hospital stay.It can reduce the incidence of bronchopulmonary dysplasia and retinopathy of premature.It is worth spreading in clinical practice.reduce the incidence of bronchopuhmonary dysplasia and retinopathy.It is worthy of promotion.

Objective To study the influence of breast-feeding on the common neonatal comorbidities of very low birth weight (ELBW) infants.Method A retrospective study was conducted in our hospital from July 2014 to September 2015.The ELBW infants with birth weight between 1 000 g and 1 500 g were enrolled into the study.The infants were assigned into three groups according to human milk intake during hospitalization:high-volume breast feeding group (the high-volume group) (human milk equal to or greater than 75％),small-volume breast feeding group (the small-volume group) (human milk less than 75％) and premature formula group (the formula group) (exclusive formula fed during hospitalization).The general status,weight gain,the incidences of gastrointestinal dysfunction,neonatal necrotizing enterocolitis (NEC),late onset sepsis,premature retinopathy (ROP),bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) during hospitalization were compared between the three groups.Logistic regression analysis was applied.Result A total of 210 cases were included in the study.32 cases in the high-volume group,73 cases in the small-volume group and 105 in the formula group.The incidence of NEC (Bell's stage Ⅱ and Ⅲ) in the high-volume group was significantly lower than the small-volume group and the formula group (6.3％ vs.24.7％,26.7％) (P ＜ 0.05).No statistical differences existed as for the incidences of gastrointestinal dysfunction,sepsis,ROP,BPD,and PVL (P ＞0.05).Logistic regression analysis showed that the odds ratio (OR) of survival without NEC in the highvolume group were 0.183 compared with the formula group and 0.204 compared with the small-volume group;and the 95％ confidence interval were 0.041 ～0.818,0.044 ～ 0.938 respectively.No statistically significant differences existed among the three groups in the growth rate of body weight,the time needed to regain birth weight,the time needed to reach total enteral nutrition and the length of hospital stay (P ＞0.05).Conclusion High-volume breast milk intake can reduce the incidence of NEC (Bell's stage Ⅱ and Ⅲ).Breast-feeding has little adverse effects on common comorbidities of ELBW infants.Enhanced breastfeeding has similar efficacy comparing with formula feeding in the catch-up growth.

Objective To evaluate the nutritional status of extremely low birth weight (ELBW) infants and the effects of nutritional support strategy alterations on their growth during hospitalization.Method From 2005 to 2014,clinical data of ELBW infants admitted to the neonatal intensive care unit (NICU) in our hospital were retrospectively analyzed.The clinical data included their general status,enteral and parental nutritional support strategy and complications during hospitalization The patients were assigned into pre5 group and late5 group.Those who survived and discharged from 2005 to 2009 were the pre5 group,and those who survived and discharged fromn 2010 to 2014 were the late5 group.The independent t test and chi square test were used for statistical analysis.Result A total of 58 ELBW infants were enrolled in the study,including 18 patients in the pre5 group and 40 in the late5 group.No statistically significant differences existed between the two groups on gestational age,birth weight,Z score (weight for length and gender),birth length,head circumference and main complications during hospitalization (P ＞0.05).Pre5 group had higher incidence of small for gestational age (SGA) than late5 group (16/18 vs.25/40,P =0.037),while the EUGR ratio at discharge (14/18 vs.21/40,P =0.061) was similar.When compared with pre5 group,late5 group had larger amount of initial enteral feeding volume [4.4 ml/(kg · d) vs.2.4 ml/(kg · d),P =0.014] and feeding volume at the end of the first week [(19.8 ± 16.0) ml/(kg · d) vs.(12.2 ±9.5) ml/(kg · d),P =0.036].Similarly,the starting dose of amino acids in parenteral nutrition [2.0g/(kg· d) vs.1.0 g/(kg· d),P＜0.001],maximum dose of amino acids [4.0g/(kg.d) vs.3.5 g/(kg · d),P ＜ 0.001],total calories at the end of the first week [(82.6 ± 12.6) kcal/(kg · d) vs.(71.1±15.2) kcal/(kg· d),P=0.004] and the second week [(103.7 ±19.8) kcal/(kg· d) vs.(92.3 ± 17.9) kcal/(kg · d),P =0.041],the weight gain velocity from birth to discharge [(18.7 ± 2.9) g/(kg.d) vs.(16.9±2.8) g/(kg· d),P=0.031] and change of Z scores (AZ) [-0.6 (-1.0,-0.4) vs.-1.2 (-1.6,-0.8),P =0.004] showed significantl differences between the two groups,with better outcomes in late5 group.However,the duration of parenteral nutrition,the total amount of amino acids,the time reaching total enteral feeding,the length of hospital stay were similar between the two groups.Ten cases(61.1％)of infants in pre5 group were breastfed,and four of them used human milk fortifier (HMF) (fortified rate was 22％).32 cases (80％) in late5 group were breastfed and 23 cases used HMF (fortified rate was 57.5％).The time to initiate HMF in the late5 group was at (30.2 ± 13.2) days,and human milk amount was (89.9 ± 34.5) ml/kg,fortified duration was (32.8 ± 15.7) days.Conclusion The enteral feeding strategy were more vigorous in the last 5 years than before,the initial feeding volume,the increasing rate,the initial dosage of amino acid,and maximum dosage of amino acid had been increased.Human milk and HMF of preterm infants were preferred.The vigorous nutritional support strategy were effective for the weight gain of ELBW infants without obvious side effects during hospitalization.

Objective To study the protective effect of cessation of enteral feeding on transfusionrelated necrotizing enterocolitis of newborn (TRNEC).Method Newborns who need blood transfusion in our neonatal intensive care unit (NICU) from January 2015 to February 2016 were randomly assigned to the cessative feeding group (fasting for 6 h when blood transfusion) and the feeding group according to the method of random number table.The abdominal perimeter,the level of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6),and the incidence of NEC within 48 hours after transfusion in these newborns were analyzed and compared.Result A total of 106 newborns with blood transfusion were included in this study,54 in the cessative feeding group and 52 in the feeding group.There were no significant differences between the two groups in gender,gestational age,birth weight,underlying diseases and abdominal perimeter before transfusion (P ＜ 0.05).The incidence of TRNEC in the cessative feeding group was significantly lower (3.7％) than that in the feeding group (17.3％) (P ＜ 0.05).The abdominal perimeters at 6 h and 12 h a fter blood transfusion in the cessative feeding group were both significantly lower than that in the feeding group (P ＜ 0.05).Within 48 h after blood transfusion,the incidence of vomiting,abdominal distention and bloody stools in the cessative feeding group were all significantly lower than that in the feeding group (P ＜0.05).Furthermore,at 6 and 12 h after receiving blood transfusion,the cessative feeding group both showed lower levels of the serum TNF-α and IL-6 than the feeding group (P ＜ 0.05).However,the levels of the serum TNF-α and IL-6 at 6 h after blood transfusion and 12 h after blood transfusion in both groups were all showed no significant differences (P ＞ 0.05).Conclusion Cessation of enteral feeding for 6 h during blood transfusion is a positive protective measure that can reduce the incidence of TRNEC.

Objective To analyze the correlative factors of neonatal deaths in neonatology department to improve the treatment level and reduce the death rate of the hospitalized newborn patients.Method The medical records and death review data of the infants who died in the neonatology department of the Hospital from 2009 to 2015 were retrospectively reviewed.They were assigned to three groups according to the therapeutic measures before their death,including comfort care group,do not resuscitate (DNR) group and active treatment group.Gestational age,birth weight,postnatal age at death and the direct cause of death were compared between groups by x2 test.Result A total of 337 infants were enrolled in this study.There were 112 cases (33.2％) in the comfort care group,73 cases (21.7％) in the DNR group and 152 cases (45.1％) in the active treatment group.Compared to the proportion of the different group during 2009-2012,the proportion of the comfort care group during 2013-2015 significantly increased(38.9％ vs.27.2％,P =0.023),and the proportion of the active treatment group significantly decreased (38.3％ vs.52.5％,P =0.009),while the proportion of the DNR group showed no significant difference (22.9％ vs.20.4％,P =0.580).The proportion of the comfort care group was significantly higher in the group of neonates who died in early neonatal period than that in the late neonatal period and post-neonatal period (42.9％ vs.9.3％,P ＜0.001),while the proportion of the active treatment group and DNR group decreased(17.9％ vs.30.9％,P =0.009;39.2％ vs.59.8％,P =0.001).The proportion the comfort care group increased with the decrcasing gestational age and birth weight (P =0.001 and 0.002).Of the 34 term infants,the top two principle causes of death were severe asphyxia (4.1.1％,14.cases) and congenital defects (32.4％,11 cases).Of the 303 preterm infants,the top three direct causes of death were neonatal respiratory distress syndrome (31.4％,95 cases),neonatal pulmonary hemorrhage (22.4％,68 cases) and congenital defects (6.3％,19 cases).Conclusion The proportion of comfort care and DNR was higher than the proportion of active treatment before the newborns' death and it was relative to gestational age and birth weight.Preterm infants were the predominant population of the infant deaths in the neonatology department.Neonatal respiratory distress syndrome was the principle cause of death in preterm infants,and severe asphyxia was the main cause of death in term infants.