The encephalopathy of prematurity is a new concept in the recent ten years. It speciifcally focuses on brain damage in premature infants. Neonatal neurology, neuropathology, and magnetic resonance imaging studies found that the gray matter injury is accompanied with diffuse white matter injury in the encephalopathy of prematurity. The brain damage could affect brain development. The neurologic outcome is more severe than tissue loss. Encephalopathy of prematurity involves many problems, and it is dififcult to make an independent early diagnosis. Imaging examination is an important way to diagnose the encephalopathy of prematurity. Long-term follow-up and individualized treatment are important for improving the prognosis.

Objective To evaluate the effect of vasodilators in different therapies on pulmonary hypertension of neonates. Methods Vasodilators were given by i.v infusion in the usual way and the air compressor pump was used as nebulizer to inhale Neb-NTG (20 ?g/kg) 2 times daily for 3 days. The changes of heart rate, breath, blood pressure and pulmonary artery mean pressure (PAMP) were monitored before and after the treatment. Results PAMP of the patients with abnormal heart structure was (31.7?6.4) mm Hg(1 mm Hg=0.133 kPa) while PAMP of the patients with oxygen deficiency was (26.9?4.2) mm Hg. There was a significant difference in PAMP between the two groups ( t=2.14,P 0.05 ). Conclusion Pulmonary artery pressure can be decreased by inhaling Neb-NTG and its therapeutic efficacy maybe equales that of vasodilators IV infusion. The nebulized inhalation of Neb-NTC may be an easy and effective therapy for the treatment of pulmonary hypertension in neonates.

ObjectiveTo recognize risk factors, types and prognosis of cerebral white matter injury i n preterm infants. MethodsThrough image examination, we obse rved the development of periventricular white matter injury in 64 preterm infant s. Follow-up was done to evaluate the mental development of them. We also anal yzed the perinaltal risk factors (maternal complications during pregnancy, and n eonatal diseases at early age) that related to periventricular leukomalacia (PVL ). Results Sixty-four preterm infants showed different d egrees of periventricular white matter injury: (1) Eighteen infants had PVL, of whom 6 had multi-site PVL, and 12 presented local PVL; (2) Eight infants had pe rsistent periventricular hyperecho; (3) Thirty-eight infants had transient abno rmality. Forty-six infants were followed up. The incidence of DQ≤75 was 100% a nd 33 33% in 6 infants with multi-site PVL and in 6 infants with local PVL res pectively. Logistic analysis showed that intraventricular hemorrhage (IVH) combi ned with expanded ventricle coorrelated with cerebral white matter injury. Babie s of mother who had pregnant complications had high incidence of PVL. ConclusionPeriventricular white matter injury, especially PVL is har mful in the prognosis of preterm infant. IVH combined with ventricular expansion is an important high risk factor of periventricular white matter injury.

Objective To study the brain development in infants of diabetic mother. Methods The development of cerebral grey matters and white matters was evaluated in 64 infants of pregnant diabetic mother by echoencephalography and medical image analysis system. The parameters were compared with 101 infants of non-diabetic mother. The early brain response function of newborns was assessed. The neurodevelopment after neonatal period was also evaluated. Results The brain in infants of diabetic mathers was immature.The average values of grey density in thalami (76.92?6.60) were significantly lower in full term infants of diabetic mathers than that of the infants of non-diabetic mathers (84.72?6.35). These were also obvious in white matters of frontal lobe [(62.68?5.21) vs (67.60?4.09)] and occipital lobe [(73.39?5.67) vs (78.61?2.95)] (P

Objective:To compare the newborn piglet models of hypoxic ischemic brain damage in hypoxia and hypoxia combined with occlusion of both carotid arteries. Methods: Twenty four 7-day-old piglets were divided into two groups. Group H: mechanical ventilation with low concentration of oxygen,Group HI; mechanical ventilation with low concentration of oxygen combined with occlusion of both carotid arteries. The piglets were inhaled with 10%, 8%, and 6% low-concentration oxygen for 30 min, and grouped into mild, moderate, and severe hypoxia ones. The changes of physiological parameter, cerebral blood flow and cerebral oxygen perfusion were detected. Results: There were no significant differences in blood gas analysis of oxygen saturation, blood lactic acid and pH between the two groups(P＞0. 05) . The mean arterial pressure of severe hypoxia in HI was significantly lower than in H(P＜0.05). The cerebral blood flow in H and HI was relatively stable after different degrees of hypoxia. As compared with the cerebral blood flow perfusion in group H and HI, there were no significant differences between them ( P>0. 05). The cerebral oxygen perfusion in H and HI was significantly descent after different degrees of hypoxia (P＜ 0.05). As compared with the cerebral oxygen perfusion in groups H and HI, there were no significant differences between them. Conclusion: H and HI have the same effect on physiological parameter, cerebral volume and cerebral oxygen perfusion of newborn piglets. The mechanical ventilation with low concentration of oxygen to newborn piglets can develop the HIBD model, it is not necessary to occlude carotid arteries.

Objective To investigate neonatal cerebral oxygenation after hypoxia.Methods Cerebral oxygenation of 39 babies with perinatal hypoxia and 42 neonates without hypoxia was ob- served under quiet state and stimulation of sound by Near Infrared Spectroscopy(NIRS) and com- paired with the findings of EEG and image studies.Results In normal neonates cerebral oxygena- tion was steady under quiet state,where as it increased after sound stimulation.However,newborns with hypoxia showed inhibited brain activities with little changes in cerebral oxygenation in response to sound stimuli.Episodes of deoxygenation were found in 13 cases during monitoring.Conclusion After perinatal hypoxic brain damage,the function of cerebral oxygenation can be still abnomal for a certain period,which is related to the degree of brain damage.

Objective To study the evaluative values of amplitude integrated electroencephalogram (aEEG) in screening neonatal seizures.Methods The aEEG and video electroencephalogram (VEEG) on 32 patients with seizures hospitalized in Peking University First Hospital was conducted on the same day.The parameters of aEEG including the integrated spectra band,background rhythm and primitive electro signal were analyzed and compared with VEEG.Results Seizures presented clinically by 12 cases were detected by VEEG,and their electric discharges were detected by aEEG.The sensitivity of aEEG was 100%.VEEG showed electric discharges during intermediate stage in twenty cases and thus the seventeen of this group were detected by aEEG with its sensitivity of 87% and 100% in the specificity.The positive and negative predictive values of aEEG were 80% and 100%,respectively.But aEEG could not discriminate the attack stage or intermediate stage electric discharges.The abnormal background activity was detected by VEEG in 13 cases and the sensitivity of aEEG was 100% and the specificity was 83%.The positive and negative predictive value by aEEG were 76% and 100% respectively.The electric discharges of 32 cases were detected by VEEG whenever they were in attack stage or intermediate stage.All electric discharges could be detected through primitive electro signal by aEEG.The electric discharges in 3 cases were not detected by integrated spectra band from aEEG,but were detected by primitive electro signal from aEEG.Conclusions The sensitivity and specificity in the screening of neonatal seizures by aEEG is useful and could be applied clinically as a simple and safe screening method for recognizing neonatal seizures.

Objective To investigate the effect of neonatal hypoxic myocardial injury and bradycardia on cerebral hemodynamics and brain tissue regional oxygen saturation (rSO2),and to provide patho-physiological evidence for treatment of neonatal hypoxic-ischemic encephalopathy (HIE) in acute phase.Methods Ninety nine full-term newborns admitted into Department of Neonatology,Peking University First Hospital from December,2005 to December,2008 were enrolled in this study.There were 18 newborns with both myocardial injury and HIE (group 1),31 newborns with HIE but without myocardial injury (group 2) and 50 cases of neonatal jaundice (control group).From 3 to 7 days after birth,Doppler ultrasound was used to measure systolic velocity (Vs),diastolic velocity (Vd) and resistance index (RI) of the anterior cerebral artery; and brain tissue rSO2 was detected by near infrared spectroscopy.The differences among groups were compared by variance analysis and LSD test.Brain tissue rSO2 before and after treatment of 20 newborns with bradycardia for various causes were detected and the difference was compared by paired t test.Results (1) Vs of group 1,group 2 and the control group was (19.35±5.13),(29.35±4.28) and (32.62±7.47) cm/s respectively; Vd was (6.43±2.98),(11.21±3.16) and (11.50±3.03) cm/s; RI was 0.68±0.10,0.62±0.03 and 0.64±0.06; brain tissue rSO2 was (52.4± 2.8)％,(54.6±3.1)％ and (62.1±1.9)％.There were significant differences among the three group(F=29.999,19.393,5.283 and 137.952,P＜0.01).Vs,Vd and rSO2 of group 1 were lower than that of group 2 and the control group (P＜0.05).RI of group 1 was higher than that of group 2 and the control group (P＜0.05).Vs and rSO2 of group 2 were lower than that of control group,but there were no differences between the two groups in Vd and RI.(2) The brain tissue rSO2 of newborns with bradycardia after treatment was higher than that before treatment [(58.7±4.6)％ vs (50.9±3.2)％,t=6.239,P＜0.01].Conclusions The disturbance of cerebral hemodynamics and cerebral oxygenation in HIE newborns are aggravated by hypoxic myocardial injury.Stable heart rate might be very important to early treatment for HIE.

Objective To determine the prognosis and risk factors of neonatal cerebral infarction.Methods From January 2002 to December 2010,44 newborn infants were diagnosed with cerebral infarction by imaging examinations at Peking University First Hospital.The neurodevelopmental outcomes of these newborn infants were followed up and evaluated by clinical manifestations,Gesell development scale,cranial imaging,electroencephalogram and auditory evoked potential.Factors related to prognosis were analyzed with single and multi-factor Logistic regression analysis.Results Thirty-eight (86％) cases were followed up,and of these cases,five children died and the results of three were inconclusive due to small age (less than 6 months old).Among the remaining 30 children,neurodevelopmental outcome was normal in 15 cases and abnormal in the remaining 15 cases,thus,the incidence of sequelae was 50％ (15/30) and the mortality rate was 13％ (5/38).Of the 15 abnormal cases,all had cerebral palsy and movement retardation,eight cases had cognitive impairment,eight cases had epilepsy and five had visual impairment.The incidence of large cerebral infarction (more than one lobe) was 14/15,worse cranial imaging outcome (one month after treatment,cerebral infarction lesion still present or had expanded)was 13/15,and severe complications was 8/15 in the newborns with sequelae,which were higher than in those without sequelae (4/15,5/15 and 1/15,respectively) (x2=13.889,8.889 and 7.778,all P＜0.05).Logistic regression analysis showed that large cerebral infarction was a risk factor for sequelae (OR=38.500,95％C1:3.749-395.407,P=0.002),however,worse cranial imaging outcome (OR=8.563,95％CI:0.909-80.683,P=0.061) and severe complications (OR=18.024,95％CI:0.516-630.163,P=0.111) were not risk factors for sequelae.Cerebral infarction with middle cerebral artery injury had a high risk of movement retardation (OR=6.000,95％CI:1.172-3.725,P=0.025),and those with a large cerebral infarction were more likely to have epilepsy (x2=7.273,P=0.010).The incidence of large cerebral infarction in the newborn infants with cognitive impairment was 8/8,which was much higher than in those without cognitive impairment (46％,10/22),thus,infarct area may be related to cognitive ability (x2=7.273,P=0.010).Conclusions Neonatal cerebral infarction might result in many types of sequelae,with motor impairment being the most common form.A large cerebral infarction is more likely to result in abnormal neurodevelopmental outcome.

Objective To investigate the correlation between hypoglycemia and brain injury of newborns.Methods Medical records and follow-up data of 110 newborns with hypoglycemia (blood glucose level≤2.2 mmol/L) who admitted into neonatal department of Peking University First Hospital from December 2006 to December 2009 were studied.All patients were divided into 3 groups:no brain injury group,mild and severe brain injury group according to their clinical manifestation,cerebral radiological characteristics and cerebral functional tests.By using receiver operating characteristic (ROC) curve and x2 test,the potential optimal blood glucose level and duration of hypoglycemia for predicting brain injury were confirmed.Multivariate Logistic regression was taken to determine independent predictors for brain injury.The analyzed factors included gender,preterm/small for gestational age,hyperbillirubinemia,fetal distress,asphyxia,infection,seizures and maternal hypertensive disorder complicating pregnancy and hyperglycemia.Results Among the 110 hypoglycemia newborns,33 (30.0％) infants suffered from brain injury,of which 23 were mild and 10 were severe.Blood glucose ≤1.7 mmol/L had high specificity (73％) and sensitivity (60％)for predicting brain injury.When blood glucose≤ 1.7 mmol/L,the incidence of brain injury and severe brain injury was 43.6％ (24/55) and 18.2％ (10/55),which was higher than those [16.4％(9/55) and 0.0％ (0/55)] of patients whose glucose level ＞1.7 mmol/L(x2 =9.74 and 11.00,P＜0.01 respectively).Blood glucose ≤ 1.2 mmol/L had high specificity (100％) and sensitivity (81％) for predicting severe brain injury.When blood glucose ≤1.2 mmol/L,the incidence of severe brain injury was higher than that of the patients whose glucose level was higher than 1.2 mmol/L [34.5％ (10/29) vs 0.0％ (0/81),x2 =30.72,P＜0.01].Duration of hypoglycemia ≥12 h had specificity (100％) and sensitivity (36 ％) for predicting brain injury.When duration of hypoglycemia ＜12 h,the incidence of brain injury was lower than that of the patients whose duration of hypoglycemia≥12 h [21.4％ (21/98) vs 6/6,x2 =27.69,P＜0.01].Multivariate Logistic regression showed that fetal distress (OR=4.69,95％CI:1.47-14.97,P=0.009),glucose level≤1.2 mmol/L (OR =5.16,95％CI:1.56-17.03,P=0.007),duration of hypoglycemia≥12 h (OR=8 885 220 297.12,95％CI:0.00-∞,P =0.000) and maternal hyperglycemia (OR =3.34,95％CI:1.01-11.02,P=0.048) were independent risk factors for neonatal brain injury.Conclusions Low blood glucose level and prolonged hypoglycemia might induce injury of neurol system.Fetal distress and maternal hyperglycemia might increase the incidence of brain injury in newborns with hypoglycemia.