Clinicians should be now able to customize ventilatory strategies to the specific pathophysioiogy of the newborn with respiratory disorders.This paper focused on the various strategies that may be employed to manage the wide range of respiratory disorders encountered by preterm and term newborn infants,including respiratory distress syndrome of the very(extremely) low birth weight infants,meconium aspiration syndrome,persistent pulmonary hypertension of the newborn,bronchopulmonary dysplasia,pneumothorax and pulmonary hemorrhage.

Invasive fungal infection is an important cause of mortality and morbidity in preterm infants.Extremely preterm and extremely low birth weight infants are at highest risk because of the intensive and invasive nature of the care that these infants receive.How to prevent and treat the invasive fungal infection in preterm infants has become a new hot spot in the neonatologists.This review focused the progress on treatment and prevention of invasive fungal infections in preterm infants.

The development of cardiovascular system in very premature infants is immature.Hypotension and patent ductus arteriosus are common problems in the few days of life.The enormous difference that these infants receive cardiovascular support may affect the morbidity and mortality.Volume expansion,inotropes,cyclooxygenase inhibitor and glucocorticoid is commonly used drugs,but when and how to treat for these extremely low birth weight infants with cardiovascular problems has been plagued by clinical doctors.

Objective To investigate the cause and clinical characteristics of neonatal thrombocytopenia (NT).Methods A retrospective analysis was performed.71 cases with NT were selected as our subjects.The morbidity of NT was calculated.Results Among the 71 cases with NT,34 were term infants and 37 were preterm infants.The morbidity of NT in preterm infants was significantly higher than that in term infants (x2 =24.56,P ＜0.01).Common causes for NT included intrauterine growth restriction(IUGR),severe asphyxia,severe sepsis or necrotizing enterocolitis (NEC).IUGR was the more frequent cause for early-onset thrombocytopenia than for late-onset thrombocytopenia (x2 =9.20,P =0.002).Severe sepsis or NEC was the more frequent cause for late-onset thrombocytopenia than for early-onset thrombocytopenia (x2 =13.58,P ＜ 0.01).The cases of bleeding in mild thrombocytopenia group was less than that in severe thrombocytopenia group(x2 =5.85,P =0.016).Conclusion IUGR which is the common cause for NT frequently induces earlyonset thrombocytopenia.Severe sepsis or NEC frequently induces late-onset thrombocytopenia accompanied with high bleeding risk.Earlier diagnosis of the cause for NT and tailed treatments can achieve better efficacy.

There is a great controversy over the application of corticosteroids in preventing and treating bronchopulmonary dysplasia(BPD).Prenatal use of corticosteroids may reduce the occurrence of BPD.Intravenous corticosteroids within 1 week after birth can reduce the incidence of BPD.However,in light of the short and long-term adverse reactions,it is not recommended.For premature infants with BPD in high risk,clinicians should weigh the pros and cons and may apply a small dose,short course of corticosteroids for intervention in 1 week after birth.Early inhalation or instilling of corticosteroids may be an effective and safe way to reduce the occurrence of BPD.

Application of sustained lung inflation (SLI)during neonatal resuscitation can increase alveolar opening,promote lung fluid absorption and maintain the appropriate functional residual capacity (FRC) which can complete the transition from fetal phase of respiratory system to neonatal period.In recent years,SLI has also been confirmed by a large number of animal experiments and clinical studies,and it is expected to be practically applied in the resuscitation of newborns.However,more randomized controlled trials with a large number of samples is required for exploring suitable populations,methods of operation,and recent or long-term effects on newborns.Now,the application and research of SLI in neonatal resuscitation are described.

Objective To evaluate the effect of postural drainage assisting trachea suction on meconium aspiration syndrome. Methods Total 61 cases of asphyxia neonates with MAS who were born in our hospital from Jan,2007 to Dec,2008, were divided into control group (24 cases) and observing group( 37 cases). The neonates in control group had endotracheal suction directly after intubation. But the infant in observing group was treated with endotracheal suction after postural drainage. The amount of suction from endotracheal tube,the complication of MAS and the outcome of these newborns were evaluated. Results The total amount of meconium drainage from endotrachea in observing group was statistics significantly more than that in control group [( 2. 16 ± 1.82) ml vs ( 1.23 ± 0. 97 ) ml, P ＜ 0. 05 )]; The intubating times in observing group were statistical significantly less than that in control group[( 1.19 ± 0. 46) vs ( 1.79 ± 0. 83 ) times, P ＜0. 01 ). The incidence of complication in observing group was 8. 11% ,which was significantly lower than that in control group(29. 17% ,P ＜0. 05). There were shorter needing oxygen time [(21.30 ± 22. 38) h vs (52. 91 ±39. 20) h,P ＜0. 01]and shorter hospitalization days [(9. 24 ±3.94) d vs ( 14. 39 ±6. 49) d,P ＜0.01 )]in observing group than those in control group respectively. The mortality in control group was 4. 17%, and no death occurred in observing group. Apgar scores of the first minute was similar in both groups ( P ＞ 0. 05 ). But there was significant difference(70. 16% vs 58. 34% ,respectively;P ＜0. 05) in the fifth minute Apgar scoring of 8 ～ 10 scores between the observing group and the control group. Conclusion Postural drainage assisting endotracheal suction may remove meconium in trachea effectively, decrease the complications of MAS and shorten the oxygen days and hospitalization time.

Objective To investigate the clinical effect and safety of paracetamol in premature infants with patent ductus arteriosus(PDA). Method A protrospective comparsion study was performed onthe data of premature infants with PDA. Seventy-two premature infants with echocardiographically comfirmed PDA were randomized into the oral paracetamol group(n1=18) and the ibuprofen group(n2=54), and the rate of ductal closure, side effects and complications were compared between the two groups. Results The ductus was 66.7% (12 infants) in the paracetamol group, which was similar to 70.4% (38 cases) in the ibuprofen group, with no significant difference(χ2=0.087,P=0.768).Except for the incidence of hyperbilirubinemia in the paracetamol group was higher than that in the ibuprofen group (P<0.05), no statistical differences were found in the other index (P>0.05), including oliguria,NEC,renal impairment,the incidence of IVH3-4 and gastrointestinal bleeding. Conclusions The clinical effect of paracetamol in premature infants with PDA is similar to that of ibuprofen , withlower incidence of hyperbilirubinemia, and paracetamol is worthy of amplication in clinical practice.

Objective To investigate the prenatal or intrapartum risk factors,resuscitation and its outcomes among full term but dying newborns after severe asphyxia (Apgar score was 0～1 at 1 min after birth).Methods Totally,39 dying full-term newborns,who were admitted to the neonatal intensive care unit of Shenzhen Maternity&Child Healthcare Hospital,Southern Medical University from January,2003 to June,2014 were analyzed retrospectively.Information on perinatal influencing factors and outcomes of resuscitation were collected and analyzed with Chi-square test.Results All of the babies were divided into died (n=7,18％,one refused to further treatment) and survived group [n=32,among which 15 suffered from hypoxic-ischemic encephalopathy(HIE) (seven mild,seven moderate and one severe case)].Fetal heart beat was undetectable in more babies in the died group than in the survived group [2/7 vs 0％(0/32),x2=4.695,P=0.028].There were 19 infants with Apgar score ≤ 5 at 5 min,and seven of them died (7/19).The other 12 survived with HIE occurred in eight cases (four mild,three moderate and one severe case) and the rest four babies did not report any neurological complications.Among the ten infants with Apgar score ≤ 5 at 10 min,seven died or refused to treatment and the other three survived with moderate HIE.Conclusions Most of the dying term babies may have promising outcomes after effective resuscitation,especially for those with Apgar score over 5 at 5 min.However,for those dying term babies with Apgar score remains ≤ 5 at 5 min,management after resuscitation should be strengthened to reduce the occurrence of any sequelae or complications.

Objective To assess the safety, efficacy, temporary side effects and feasibility of oral ibuprofen suspension in the treatment of patent ductus arteriosus (PDA) with hemodynamic significance in premature infants. Method A randomized controlled trial including seventy-four premature infants with PDA was performed from February 2007 to May 2008. Infants were randomly assigned to two groups: testing group (36 patients) received three doses of oral ibuprofen suspension (10 mg/kg at 24-hour intervals) and control group (38 patients) did not receive such treatment. The cure rate of PDA, relative side effects of ibuprofen and complications during treatment were recorded.Results The closure rate of ductus arteriosus in the testing group was 52.8% (19/36), which was higher than that of control group (18.4%, 7/38) (χ2=9.575, P=0.002). The severe side effects did not occur in testing group, such as oliguria, renal impairment, prone of bleeding, gastrointestinal perforation and novel appearing or deteriorative of intraventricular hemorrhage (IVH). Compared with the infants in control group (26.3%, 10/38), the morbidity of abdominal distension or gastric retention in testing group (33.3%, 12/36) was higher, while there was no statistically significant difference (χ2=0.436, P=0.509). The hospital stay [(22.8±14.8) d vs (24.1±17.1) d], mechanical ventilation rate [5.6% (2/36) vs 2.6% (1/38)] and oxygen supplement time [(8.3±9.3) d vs (8.8±8.3) d] between the testing and control groups remained no significant difference (P>0.05). Conclusions Oral ibuprofen suspension could be effective in closing PDA of preterm infants; no significant complications and side-effects occurred during oral ibuprofen treatment. It is suggested that oral ibuprofen suspension treatment was safe, effective and well tolerated for preterm infants with PDA.