With the improvement of the treatment of neonatal respiratory distress syndrome,minimal-ly invasive pulmonary surfactant(PS)therapy is gradually considered to be a more ideal drug delivery method for PS because of its simpler operation and less airway damage,and it is a part of the lung protective strategy for premature infants. Therefore,this article reviewed the administration methods,advantages,research status and future problems of minimally invasive PS treatment technology.

Objective To explore the effective measures to reduce the incidence of nosocomial infection through the implementation of continuous quality improvement measures in the neonatal intensive care unit (NICU). Methods One hundred and twenty-two premature infants hospitalized in NICU of the Affiliated Hospital of Inner Mongolia Medical University after continuous quality improvement from January 2018 to November 2018 were selected prospectively as the experimental group, and 125 premature infants using routine nursing management mode from March 2017 to December 2017 were selected as the control group. The occurrence of bloodstream infection in two groups was observed. Results The incidence of bloodstream infection in the experimental group [7.4%(9/122)] was significantly lower than that in the control group [17.6%(22/125)], and the difference was statistically significant (P＝0.015). Compared with the control group, the experimental group had statistically significant differences in implementation rate of hand hygiene, average days of peripherally insterted central catheter indwelling, and antibiotic use rate and average days (P < 0.01). Conclusions The incidence of bloodstream infections in NICU can be effectively controlled through strict continuous quality improvement measures.

Objective To study the relationship between exon10 region mutation of adenosine triphosphate-binding cassette transporters A3 (ABCA3) gene and neonatal respiratory distress syndrome (RDS).Method From September 2014 to January 2018,neonates admitted to the neonatal intensive care unit of our hospital were studied.Mongolian and Han Chinese newborns with RDS were assigned into Mongolian RDS group and Han RDS group.Mongolian and Han Chinese newborns without RDS were assigned into Mongolian control group and Han control group.The genotype frequencies and allele frequencies of ABCA3 exon10 in each group were compared.Result A total of 320 cases were studied,including 60 cases in Mongolian RDS group,100 cases in Han RDS group,60 cases in Mongolian control group,and 100 cases in Han control group.A single-base point mutation C ＞ T in the ABCA3 rs13332514 (F353F) locus was founded in both Mongolian and Han Chinese newborns.The mutation rates in Mongolian RDS group and Mongolian control group were 26.7％ and 18.3％,and the difference was statistically significant (x2 =6.316,P =0.043);the mutation rates in Han RDS group and Han control group were 21.0％ and 13.0％,the difference was also statistically significant (x2 =7.426,P =0.009).No significant differences existed between Mongolian RDS group and Han RDS group,and between Mongolian control group and Han control group (P ＞ 0.05).The genotypes of CC,CT and TT were detected in both Mongolian and Han RDS groups,and the CC and CT genotypes were also detected in the control group.The T allele frequency was 18.3％ in Mongolian RDS group,and 9.2％ in Mongolian control group.The difference was statistically significant (x2 =4.251,P =0.039).The T allele frequency in Han RDS group was 15.0％,and 6.5％ in Han control group.The difference was also statistically significant (x2 =7.530,P =0.006).Conclusion A single-base point mutation C ＞T in the rs13332514 (F353F) locus of ABCA3 exonl0 may be related to the occurrence of RDS in Mongolian and Han newborns in Inner Mongolia.Allele T may be one of the susceptibility genes of RDS.

Objective:To explore the relationship between rs2010963, rs3025039 and rs699947 gene polymorphism of vascular endothelial growth factor(VEGF) gene and bronchopulmonary dysplasia(BPD) in Mongolian premature infants.Methods:A case-control design was used to collect 50 cases of Mongolian premature infants who were hospitalized at the Affiliated Hospital of Inner Mongolia Medical University and diagnosed with BPD from January 2016 to December 2020 as the observation group, while 56 cases of non-BPD premature infants of the same nationality and time period were selected as the control group.Using PCR method to detect the genotype and allele distribution of the VEGF gene rs2010963, rs3025039 and rs699947 locus.Combining clinical data to analyze whether the above gene loci were related to the onset of premature infants with Mongolian BPD in our area.Results:Through genetic testing, it was found that CC, CA and AA genotypes can be detected at the rs699947 site of VEGF gene in premature infants in both the observation group and the control group.The frequencies of the three genotypes in the observation group were 16.0%, 24.0%, and 60.0%, respectively; the frequency of the C allele was 28.0%, the frequency of the A allele was 72.0%, and the frequency of the three genotypes in the control group was 32.1.%, 32.1% and 35.7%, respectively.The frequency of C allele was 48.2%, the frequency of G allele was 51.8%, and the allele and genotype frequencies of this locus between the observation group and the control group were significant differences from those of the control group( P<0.05). Conclusion:The polymorphism of VEGF gene rs699947 locus is associated with the occurrence and development of BPD in Mongolian premature infants, and allele A may be a susceptible factor.

Objective To study the relationship between pulmonary surfactant protein B (SP-B) intron 4 gene polymorphism and bronchopulmonary dysplasia (BPD) in premature infants.Method From January 2016 to January 2019,premature infants diagnosed with BPD in our hospital were selected as the BPD group,and non-BPD premature infants of the same ethnic group were selected as the control group.The genotype and allele distribution of SP-B intron 4 were analyzed using polymerase chain reaction (PCR)method.Result A total of 74 infants with BPD were included,including 30 Mongolian infants and 44 Han infants.A total of 134 cases were in the control group,including 56 Mongolian infants and 78 Han infants.Wild type and variant type (including insertion and deletion) could be detected in SP-B intron 4 gene in both Mongolian and Han infants.The frequencies of wild and variant genotypes and alleles in Mongolian BPD infants were similar with the control group [36.7％ (11/30) vs.19.6％ (11/56),21.7％ (13/60) vs.12.5％ (14/112)] (P ＞ 0.05).The frequencies of wild and variant genotypes and alleles in Han infants with BPD were significantly different from the control group [31.8 ％ (14/44) vs.12.8 ％ (10/78),20.5 ％(18/88)vs.7.1％(11/156)] (P＜0.05).Conclusion The variation of intron 4 gene in SP-B may be related with the genetic susceptibility of Han infants with BPD in Inner Mongolia.

Objective:To evaluate the efficacy and safety of early intratracheal drops of budesonide combined with pulmonary surfactant in the prevention of bronchopulmonary dysplasia(BPD).Methods:Embase, PubMed, Cochrane Library, CNKI and Wanfang database were searched from the establishment of library construction to February 2022.Literature selection, quality assessment and data extraction were conducted according to the inclusion and exclusion criteria, and Meta-analysis was performed on the included literature using Rev Man 5.3 software.Results:Nine randomised controlled studies were included in this study, with a total of 884 children, including 433 in the experimental group and 451 in the control group.The results showed that there was a statistically significant difference in the incidence of BPD between the two groups[ OR=0.40, 95% CI(0.29, 0.53), P<0.001], and there was no statistically significant difference in the morbidity between the two groups[ OR=0.65, 95% CI(0.34, 1.22), P=0.18]. The risks of retinopathy of prematurity[ OR=0.42, 95% CI(0.54, 1.28), P=0.40], patent ductus arteriosus[ OR=0.79, 95% CI(0.57, 1.10), P=0.17], intracranial hemorrhage[ OR=1.09, 95% CI(0.77, 1.53), P=0.63], necrotizing enterocolitis[ OR=0.89, 95% CI(0.55, 1.44), P=0.64], and neonatal septicemia[ OR=0.73, 95% CI(0.49, 1.08), P=0.11] occurred in the experimental group had no statistically significant differences compared to the control group (all P>0.05). Conclusion:Early postnatal intratracheal drops of budesonide combined with pulmonary surfactant can significantly reduce the incidence of BPD, and has no significant effect on mortality or short-term complications.

Objective:To evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (nHFOV) as the initial ventilation mode for respiratory distress syndrome (RDS) in premature infants.Methods:From the establishment of the databases [(PubMed, Embase, Cochrane Library, CNKI, Wanfang database, CQVIP and CBM (SinoMed)] to March 1, 2022, literature on randomized controlled trials (RCTs) using nHFOV and nasal continuous positive airway pressure(NCPAP) as the initial ventilation modes for RDS in premature infants were searched. The qualities of the included literature were evaluated according to Cochrane Evaluation Manual. RevMan 5.4 software was used for Meta-analysis.Results:Seven RCTs involving 786 children were included for the final Meta-analysis, with 395 cases in the nHFOV group and 391 cases in the NCPAP group. The results showed that the nHFOV group had lower intubation rates than the NCPAP group ( OR=0.34, 95% CI 0.22~0.51, P<0.001). No significant differences existed in mortality rates and complication rates between the two groups ( P>0.05). Conclusions:nHFOV as the initial treatment for RDS in premature infants may reduce the incidence of early treatment failure without increasing complications.

Objective:To explore the carrier status of group B streptococci (GBS) in pregnant women of Mongolian and Han nationality and the neonatal GBS infection in order to identify the high risk factors of GBS infection in Mongolian and Han newborns in this area.Methods:Totally 7289 pregnant women and their newborns born alive were tested for GBS in the Affiliated Hospital of Inner Mongolia Medical University from June 2017 to June 2020, and their newborns were cultured for GBS, and the venous blood of newborns delivered by GBS positive women were detected for anti-GBS capsular polysaccharide antibody level, in order to determine the high risk factors of neonatal GBS infection.Results:Among the 7289 pregnant women, 3136 were Mongolian pregnant women (2599 full-term delivery and 537 premature delivery) and 4153 were Han pregnant women (3541 full-term delivery and 612 premature delivery). The results of GBS test showed that the GBS carrier rate was 8.19% in the Mongolian preterm delivery group, 4.35% in the Mongolian term group, 11.93% in the Han preterm group, and 5.76% in the Han term group, indicating that the carrier rate of GBS in the preterm group was significantly higher than that in the term group, regardless of Mongolian and Han nationality ( P < 0.05). Further comparing the GBS carrier rate of Mongolian and Han pregnant women, the GBS carrier rate of Mongolian pregnant women was significantly lower than that of Han pregnant women regardless of the premature delivery group and term group ( P < 0.05). (2) A total of 434 newborns were born by GBS positive parturients. The positive rates of GBS in Mongolian premature infants, Mongolian full-term infants, Han premature infants and Han full-term infants were 29.55%, 14.16%, 31.51% and 17.65%, respectively, suggesting that the positive rate of GBS in premature infants was significantly higher than that in full-term infants, regardless of Mongolian and Han nationality ( P<0.05). Further comparing the positive rate of GBS in Mongolian and Han newborns, there was no significant difference in the positive rate of GBS between Mongolian newborns and Han newborns, no matter the premature delivery group and the full-term group. (3) This study compared the incidence of early-onset GBS septicemia in Mongolian and Han newborns. The results showed that the incidence of early-onset GBS septicemia in Mongolian premature infants was 23.08%, and none in full-term infants. The incidence of early-onset GBS septicemia in Han premature infants was 26.09%. The incidence of early-onset GBS septicemia in term infants was 5.56%. The incidence of neonatal GBS septicemia in the preterm group was significantly higher than that in the term group, regardless of Mongolian and Han nationality. By further comparing the incidence of GBS septicemia in Mongolian and Han newborns, there was no significant difference in the positive rate of GBS between Mongolian newborns and Han newborns regardless of the premature delivery group and the term group. (4) In both Mongolian and Han nationality, the level of anti-GBS capsular polysaccharide antibody in premature infants was significantly lower than that in term infants ( P < 0.05). (5) Regardless of the Mongolian and Han nationality, compared with GBS negative group, GBS positive rate was higher in pregnant women aged≥35 years old, with history of menstruation, miscarriage, vaginitis, floating population, and those who had not undergone pre-pregnancy examination,,which were the high risk factors for GBS-positive pregnant women during pregnancy. (6) In both Mongolian and Han nationality, the incidence of chorioamnionitis, puerperal infection, premature delivery and premature rupture of membranes in the GBS positive group was higher than that in the GBS negative group, and the incidence of fetal distress and neonatal asphyxia in the GBS positive group was also higher than that in the GBS negative group. Conclusions:The carrier rate of GBS in Mongolian pregnant women is lower than that in Han pregnant women, and positive GBS during pregnancy will increase the incidence of adverse maternal and fetal outcomes such as chorioamnionitis, puerperal infection, premature delivery, premature rupture of membranes, fetal distress, neonatal asphyxia and neonatal early-onset GBS septicemia. The high risk factors are maternal age ≥ 35 years old, history of menstruation, abortion, vaginitis, floating population, and infection without pre-pregnancy examination. We should attach great importance to the perinatal high risk factors and formulate corresponding intervention measures accordingly, and make rational use of antibiotics for prenatal prevention, so as to further reduce the incidence of early-onset GBS septicemia in newborns.

Objective:To investigate whether the synonymous variation of the ATP-binding cassette transporter A3 (ABCA3) gene may increase the risk of respiratory distress syndrome (RDS) in Mongolian and Han newborns in Inner Mongolia.Methods:From January 2018 to June 2019, the children of Mongolian and Han nationality who were hospitalized in the Department of Neonatal Pediatrics, affiliated Hospital of Inner Mongolia Medical University and the control group were sequenced by ABCA3 exon gene to analyze whether there was synonymous mutation in ABCA3 gene.Results:A total of 101 children with RDS were enrolled, including 37 children with Mongolian and 64 with Han children. There were 113 patients in the control group, including 45 Mongolian children and 68 Han children. Children with Mongolian and Han nationality RDS and control group can detect multiple synonymous mutation sites, such as: F353F, P585P, A227A, V150V, L982L, A928A, S1372S, P1653P, E1618E, and A1027A, etc, among them, four synonymous variants of p.A227A, p.F353F, p.P585P and p.S1372S are common synonymous mutants. In both Mongolian and Han nationality, the frequency of ABCA3 gene synonymous mutation in RDS group was significantly higher than that in control group (Mongolian: χ2=9.402, P=0.002; Han: χ2=9.348, P=0.002 ). The mutation rates of F353F and P585P in Mongolian and Han children with RDS were higher than those in the control group, and the difference was statistically significant(Mongolian F353F: χ2=5.270, P=0.022; Han F353F: χ2=5.532, P=0.019.Mongolian P585P: χ2=4.711, P=0.030; Han P585P: χ2=4.480, P=0.034). Conclusions:The synonymous variation of ABCA3 gene may increase the risk of RDS in Mongolian and Han newborns in Inner Mongolia, and F353F and P585P may be one of the susceptible genes of RDS in Mongolian and Han newborns in Inner Mongolia.

Objective:To evaluate the clinical efficacy of non-invasive high-frequency oscillatory ventilation (nHFOV) and nasal continuous positive airway pressure ventilation (nCPAP) as transitional breathing modes after evacuation from invasive ventilation in neonatal respiratory distress syndrome (NRDS).Methods:A randomized controlled trial was conducted using PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases to search for all published literature before July 2022 on the treatment of NRDS with nHFOV and/or nCPAP after invasive ventilation and weaning. We compared the success rates of the evacuation , as well as the incidence of pneumothorax, bronchopulmonary dysplasia, and intraventricular hemorrhage between the nHFOV group and the nCPAP group in newborns who underwent invasive ventilation with NRDS.Results:A total of 7 randomized controlled studies were included, including 598 newborns diagnosed with NRDS who underwent tracheal intubation mechanical ventilation. The success rates of evacuating invasive ventilators for children in the nHFOV and nCPAP groups included in the article were calculated. The success rates of evacuating invasive ventilators for children in the two groups were 88.5%(231/261) and 66.5%(171/257), respectively. Compared with the nCPAP group, the success rate of evacuating invasive ventilators for children with NRDS in the nHFOV group was higher ( OR=3.93, 95% CI: 2.47-6.23, P<0.001). However, there was no statistically significant difference in the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, and pneumothorax between the two groups after weaning (all P>0.05). Conclusions:After weaning NRDS patients with invasive ventilation, nHFOV has a higher success rate in weaning compared to nCPAP, which is worthy of clinical application.