Objective To investigate the different influences of pre-and/or postnatal hypoxia on the thyroid function of newborns. Methods Newborn infants of fetal hypoxia and/or birth asphyxia diagnosed and treated in pediatric department of Tianjin Medical University Genera] Hospital during last 5 years ,were assigned into intrauterine distress group (group B,n =87) ,birth asphyxia group (group C,n =36) and both of birth asphyxia and intrauterine distress group (group D,n = 75 ). Normal neonates born during the same period served as control group( group A,n =30). Blood concentrations of T3 ,T4 and TSH were detected by radioimmunoassay. Results The serum levels of T3 ,T4 and TSH in A,B,C,and D groups were (0. 86±0. 22) μg/L, (0. 62±0.21)μg/L,(0. 46±0. 19)μg/L,(0. 54±0. 19)μg/L; (125. 13±36.37)μg/L, (107.46±32.21)μg/L,(74.60±26.52)μg/L, (102.23±30.29) μg/L; (6.28±1.96) μg/L, (4.91±1.69) mIU/L, (8.66±2. 00) mIU/L, (5. 64±1.17 mIU/L). There were significant differences among the 4 groups ( P < 0. 01 ). As compared to A group,the serum T3 and T4 concentrations of B ,C and D groups were significantly decreased (P <0. 01 ,P <0. 05 ). No difference of TSH concentrations was found between A and D groups( ( P > 0. 05),but there was significant decrease in B group and significant increase in C group( P <0. 01 ). Conclusion Preand postnatal hypoxia results in decreases of T3 and T4 values,it is likely that newborns of intrauterine distress have decreased TSH, whereas those of birth asphyxia have increased TSH.

Objective To compare the impact of four kinds of interventions (intermittent enteral feeding, continuous enteral feeding, motilium, low-dose erythromycin) on feeding intolerance in preterm infants. Methods 160 cases preterm infants with feeding intolerance (28～32 weeks of gestational age) were divided into 4 groups :intermittent enteral feeding ,continuous enteral feeding,oral motilium and intravenous infusion of low-dose erythromycin treatment group. We recorded the amount of each feeding, the disappearance time of vomiting,abdominal distension,gastric retention,and the time of total enteral nutrition feeding. We observed the characteristics of meconinm excretion. We recorded the daily body weight to calculate the growth rate,and observed the time period of their body weight return to its birth weight. Results Meconium discharge time and total enteral nutrition feeding time of the intermittent feeding group were (3.6±1.6) days and ( 15.8±5.6) days,those of continuous feeding group were (5.2±2. 0) days and( 17. 1±4. 4) days,showing significant difference between these two groups ( P < 0. 05 ). The rate of improving feeding intolerance in the 4 groups were 37. 5% ,32. 5% ,80. 0% and 87.5% ,and there was significant difference between the furst two groups and the after two groups ( P < 0. 05 ). The disappearance time of vomiting in the four groups were(4. 33±2. 49) days, (4. 85±2. 14) days, (2.97±1.27) days and(2. 16±1.65) days,showing significant difference between the first two groups and the following two groups( P <0.05). The disappearance time of abdominal distension in the low-dose erythromycin groups was (2. 47±1.34) days, and that in the motilium group was (3. 59±1.35 ) days, showing significant difference between the two groups ( P <0. 05 ). Conclusion Both motilium and low-dose erythromycin can improve feeding intolerance in premature infants,which is recommendable for clinical application. The low-dose erythromycin is the first choice of the four groups,followed by the motiliumand intermittent enteral feeding, and the last one is continuous enteral feeding.

Objective To explore the relationship between TLR3 mRNA expression on peripheral blood mononuclear cells(PBMCs)and acute rotavirus(RV)diarrhea.Methods Sixty-one children with acute RV diarrhea served as study subject,the expression of TLR3 mRNA on PBMCs was detected by real-time fluorescence quantitative RT-PCR.the concentrations of IFN-γand TNF-α in serum were measured by the method of Enzyrme-linked immunosorbent assay(EUSA).Results The expression of TLR3 on PBMCs and the serum levels of IFN-γ and TNF-α in the serious diarrhea group were 0. 820±0.051,(33.67±12.88)Pg/ml, (62.21±14.65)pg/ml,respectively,while it were 0.717±0.040,(24.01±10.06)pg/ml,(50.99± 12.18)pg/ml in the slight diarrhea group,and 0.525±0.029,(12.52±5.19)pg/ml,(28.65±7.44)pg/ml in the control group.Compared with the control group.the expression of TLR3 on PBMCs and the serum levels of IFN-γ,TNF-α in the serious and slight diarrhea group were significantly higher(P<0.01).There were significant differences between the serious and slight diarrhea group(P<0.01).There were positive relationship between the expression of TLR3 on PBMCs and tHe serum IFN-γ,TNF-α levels(r=0.431,P< 0.05,r=0.372,P<0.05).Conclusion The expression of TLR3 on PBMCs in children with acute rotavirus dialThea iS up-regulated,TLR3 and its mediated immune response are associated with the development of acute rotavirus diarrhea.

Invasive fungal infection(IFI) is becoming increasingly important issue in pediatrics and pediatric intensive care unit. IFI often occurs in newborns and children with immune dysfunction. Candida and Aspergillus spp. are the most commonly isolated organisms. Early diagnosis can improve the prognosis of IFI. The 1,3-β-D-glucan(G)test,galatomannan antigen(GM)test and PCR test can aid earlier dignosis for IFI in high-risk children.

Objective To explore the changes of alveolar morphology and alveolar epithelial cells in rats with hyperoxia-induced chronic lung diseases (CLD). Methods CLD model in neonatal rats was established by inhalation of high concentration oxygen(85%～90% ). Eighty neonatal rats were randomly exposed to hyperoxia (model group) and to room air (control group) (n =40 each). Radical alveolar counts and the alveolar septum thickness were used to evaluate alveolar development. The site and intensity of expression of SPC,AQP5 protein were detected by immunohistochemical staining,the dynamic expression of SPC mRNA,AQP5mRNA was detected by RT-PCR on day 1,3,7,14 and 21 after exposure. Results There were no significant differences about alveolar wall thickness and RAC between experimental groups and control group on day 1～3 ( P > 0. 05 ). But there was significant difference between the model group and the control groups on day 7 and 14 (P <0. 01 ). For model group,alveolar septum thickness peaked on day 21, the difference was significant compared with control group ( 10. 62±5.01 vs 3.62±0. 88, P < 0. 001 ), but RAC decreased to the lowest level, the difference was significant compared with control group ( 3.57±1.24 vs 10. 47±0. 88,P <0. 001 ). The expression of SPC decreased on day 3 manifestedly but increased on day 7 and the levels of SPC were higher than that in the control group. Experimental group showed gradual decrease in AQP5 expression as the lung impairment devastated. Conclusion Alveolar development was delayed and alveolar epithelial cell (AEC) was damaged in the neonatal CLD rats. The changes of SPC,AQP5 expression suggested AECI was severely damaged and failed in full recovery, meanwhile the quantity of AEC Ⅱ was increased but the ability of its differentiation and transformation was decreased.

Objective To evaluate the effects of inhaled nitric oxide (iNO) therapy combined with conventional ventilation in the infants with persistent pulmonary hypertension of the newborn (PPHN).Methods NO inspiration was added for 22 infants with PPI-IN ventilated with FiO2≥0. 9,PIP≥30 cm H2O,PEEP≥3 cm H2O,RR≥50 bpm for 4～6 hours,with SpO2 still < 90% and PaO2 <55 mm Hg. The iNO concentration started at (10～20)×10-6 for 20 infants,and (20～40)×10-6 for 2 infants. The iNO would be stopped when the concentration reached 40×10 -6 without any sign of improvement. The SpO2 ,blood gas analyses,blood pressure, heart rate and NO: concentration were moraitored during therapy and the resulting data compared to readings before administration of int. Results Clinical situation were significantly improved in 20 (91%) of the infants with SpO2 gradually going up after 10 minutes of int. Before iNO,mean Fit2 was 0. 9±0. 1 ,SpO2 was(76. 3±13.3)% ,and Pat2 was (46. 4±10. 1 ) man Hg. From 1 to 6 hours after iNO,SpO2 increased to(95. 1±3.8)% ,Pat2 increased to(92. 8±24.7) mm Hg,FiO2 decreased to 0.6 s0. 1.The differences were significant (P < 0. 01 ). Eighteen of 22 (82%) infants surviving. Conclusion iNO is effective in alleviating PPHN in infants. There are no remarkable side effects. It is more beneficial to start the iNO concentration at (10～20)×10-6 while some infants may need NO concentration at up to (20～40)×10-6.

Objective To evaluated T-wave characteristics in newborn infants with different gestational age. Methods One hundred and forty-two newborn infants were divided into four groups based on the gestation age consisting of the 28～30 weeks group,31～33 weeks group,34～36 weeks group and 37～40weeks group, respectively. The T-wave characteristics of electrocardiogram were compared among the newborn infants of four groups. Results TV1 amplitudes ( mV, median ( interquartile range) ) of 4 groups were -0. 10( -0. 30～0. 10), -0. 10( -0. 30～0. 15), -0. 10( -0. 45～0. 25 ) and 0. 10( -0. 30～0. 70) ,respectively. There was a statistical elevation of TV1 amplitude with the increase of the gestational age. TV5 amplitudes( mV, median ( interquartile range ) ) of 4 groups were 0. 10 ( - 0. 10～0. 30), 0. 10 ( - 0. 20～0. 30) ,0. 15( -0. 05～0. 25) and 0. 10( -0. 10～0. 50) ,respectively. No significant differences of TV5 amplitudes were found among 4 groups. The incidences of low or inverted T-waves in leads I and aVL, or low and flat T-waves in all leads reduced significantly with the increase of the gestational age. Conclusion The TV1 amplitude and the incidence of abnormal T-wave in newborn infants are correlated to the gestational age,and TV5 amplitude is not correlated to the gestational age.

objective To explore the indication of mechanical ventilation and evaluate the effects of mechanical ventilation with the least delay on the Severe cases of hand-foot-mouth disease(HFMD).Methods Retrospective cohort study was conducted among the severe HFMD cases(n=66)admitted to pediatric intensive care unit(PICU)between July 2008 and september 2009.Sixty-six cases were divided into two groups:42 cases(group A,July 5 to October 31,2008)were ventilated with the common mechanical ventilation,24 cases(group B,April 21 to september 30,2009)were ventilated at least delay when the symptoms of neurogenic pulmonary edema appeared.Then the diffcrences on the survival rate and the mortality in the group A and group B were investigated.Results Twenty out of 42 patients died(47.6%),eighteen were cured(42.6%) and four showed improved signs(9.5%)in group A.Twenty-two out of 24 patients were cured(91.7%),two showed improved signs(8.3%)and no death in group B.The clinical effect of group B was much better tllan group A(P<0.001).Conclusion Early mechanical ventilation would improve the survival rate and decrease the mortality of severe hand-foot-mouth disease.

Objective To evaluate the parenteral complications and their risk factors and to study the immune status by detecting immunoglobulin and lymphocyte subsets in children with rotavirus enteritis. Methods Sixty-four children with rotavirus enteritis who were treated in Shengjing Hospital of China Medical University between January 2007 and December 2008(observation group) and 18 healthy chiIdren for health screening at pediatric health care center (normal control group) were reeruimd.Clinical manifestations were collected,stool specimens were detected for rotavirus using ELISA,lymphocyte subsets were detected using flow cytometer,and immunoglobulin.liver enzyme and myocardial enzyme were detected.Results Rotavirus enteritis may be complicated by parenteral complications(liver,myocardium,respiratory and nervous system).The activity of ALT,AST,LDH,CK and CK-mB were higher in observation group than that in normal control group(P<0.05).In observation group,liver injury rate in children younger than 12 months was higher than that in children older than 12 months,and the activity of CK and CK-mB were highcr in severe diarrhea cases[CK(324.5±995.5)U／dl,CK-mB(93.8 4±61.5)U／dl]than that in mild diarrhea cases [CK(252.8±130.4)U／dl,CK.mB(59.6±32.6)U／dl](P<0.05).The level of IgG was lower in observation group[(4.46±1.56)g／L]than that in control group[(5.80±1.67)g／L](P<0.05).Lymphocytes subsets study revealed that the activity of CD4+ in observation group[(29.0±4.18)％]was lower than that in control group[(38.6±3.97)％](P<0.05),the activity of CDl9+ [(38.8±3.94)％]was higher than that in control group[(23.1±7.70)％](P<0.05)and the CD4+／CD8+ ratio was reverse in observafion group.Conclusion Rotavirus enteritis may be complicated by parenteral injuries which get liver,myocardium,respiratory and nervous system involved.Children with rotavirus enteritis Call lead to low immune function.Determination of liver enzyme,myocardial enzyme,immunoglobulin and lymphocyte subsets has important clinical significance to monitoring the change of condition and guiding treatment.

with the development of emergency medicine with respiratory failure in children,imaging has played an important role in critical care of children.Critically ill patients often require ventilator,which need to use imaging methods to monitor the trerapeutic effects and adverse reactions.By imaging tests.it can be helpful in understanding the nature of lung diseases,verifying intubation's location,monitoring ventilatory complications,assessing the comprehensive effect of ventilator,and facilitating ventilator parameter adjustment and mode selection.