Objective To study transforming growth factor ?_1 (TGF-?_1) expression in the lung of neonatal premature rats exposed to hyperoxia at different time. Methods 99 neonatal premature rats were assigned to hyperoxic group and air group randomly They were sacrificed at the postnatal 3 rd ,7 th and 14 th day,then their lungs were achieved for H.E staining and immunohistochemistry to measure the expression of TGF-?_1. The difference of TGF ?_1 expression were tested by rank-sum test. Results TGF-?_1 expression in hyperoxic group was always wider than that of air group at the corresponding period,and its expression in alveolar and bronchi epithelial cells as well as mesenchymal was stronger than that of control group(u respectively is: 49.0、14.0、63.0 at the 3 rd day;34.0、2.0、45.0 at 7 th day;and 32.0、13.5、33.0 at 14 th day (all P

Objective To analyze the risk factors of aggressive posterior retinopathy of prematurity (AP-ROP). Methods A retrospective case-control study was applied. Questionnaire was designed through literature research to collect data of AP-ROP and ordinary ROP(except for AP-ROP)from March,2012 to September, 2014 in the department of neonatology in Guangdong Women and Children′s Hospital. Based on the ratio of 1:2 , the two groups were selected with the matching conditions:the closest date of admission in hospital,ordinary ROP children,collection and analysis of the data. Results Univariate analysis:gestational age(P<0.05),birth weight(P<0.05),oxygen therapy days(P<0.05),days of mechanical ventilation(P<0.05),gestational age<32 w(P<0.05),birth weight<1250 g(P<0.05),oxygen(P<0.05),oxygen≥14 d(P<0.05),mechanical ven-tilation(P < 0.05),mechanical ventilation ≥ 14 d(P < 0.05),PS(P < 0.05),neonatal anemia(P < 0.05), blood transfusion≥2 times(P<0.05),RDS(P<0.05),neonatal pneumonia(P<0.05),apnea(P<0.05), BPD(P < 0.05),intracranial hemorrhage(P < 0.05),metabolic acidosis(P < 0.05),and retinal hemorrhage (P < 0.05) were related to AP-ROP. Multivariate analysis with conditional logistic regression analysis indicated that blood transfusion ≥2 times(OR:14.956,95%CI:4.328~51.684)and apnea(OR:7.590,95%CI:2.507~22.978)were regarded as the independent risk factors for AP-ROP. Conclusions AP-ROP is associated with low gestational age,low birth weight,oxygen therapy and related complications including RDS and retinal hemorrhage. Blood transfusion and apnea are important independent risk factors of AP-ROP.

Objective To study the differentially expressed genes and analyze its functional pathways of retinopathy of prematurity(ROP),in order to discover the pathogenesis and provide the theoretical basis for the prevention and treatment of ROP.Methods Fetal eyeballs of induced labor were obtained and retinal microvascular endothelial cells were isolated and cultured.The endothelial cells were divided into 7 groups according to the medium of cobalt chloride (CoC12) concentration (0 μ mol/L,100 μ mol/L,150 pμmol/L,200 μmol/L,250 pμmol/L,300 μmol/L,350 μmol/L),and 150 μmol/L CoCl2 was finally used to induce ROP model in vitro.Retinal microvascular endothelial cells were verified by adopting Ⅷ factor and CD31 antibody fluorescence staining.RNA purification,gene chip hybridization and signi-ficant analysis of microarrays were performed to screen differentially expressed genes.Genes functional pathways were studied by using gene ontology analysis software.Results (1) The proliferation activity of vascular endothelial cells decreased when CoCl2 ≥ 150 μmol/L(F =21,P ＜ 0.05).(2) In 150 μmol/L CoC]2 group,blue nucleus and green cytoplasm were visible in the second and the third generation vascular endothelial cells stained by factor Ⅷ antibody,and red fluorescence could also be observed in the cytoplasm by means of CD31 monoclonal antibody staining.However,only blue nucleus was detected in the group without CoCl2.(3)There were 326 genes differently expressed in retinal micro vascular endothelial cells induced by CoCl2 in vitro,among whom,198 genes were up-regulated and 128 genes were down-regulated.Up-regulated expression genes were 1.5 times more than those of the down-regulated genes.(4)Ten biological pathways including cell hypoxia,angiogenesis suppression and iron ion transport etc.may play important roles in ROP pathogenesis.Conclusions Hypoxic retinal microvascular endothelial cells induced by CoCl2 can successfully be used to induce cell model of ROP in vitro.Differentially expressed genes may play an important role in ROP development.Functional pathway such as hypoxic cells,inhibition of angiogenesis,iron ion transport may be associated with ROP pathogenesis.

ObjectiveTo investigate the effects of nasal continuous positive airway pressure (nCPAP) and intubation in very low birth weight preterm infants. Methods One hundred and twenty-three very low birth weight preterm infants with respiratory distress within 60 minutes after birth were randomly assigned to nCPAP (n=63) or intubation group (n=60).Outcomes at 7,28 days and 36 corrected gestational weeks were assessed with x2 or t-test. ResultsThere were no significant difference in fatality rate and incidence of bronchopulmonary dysplasia between nCPAP group and intubation group [7.9％ (5/63) vs 6.6％(4/60),4.8％(3/63) vs 3.3％(2/60),x2 =0.07and 0.16,P＞0.05].In nCPAP group,the use of pulmonary sulfactant was 27.0％ (17/63),lower than that (83.3 ％,50/60) in intubation group (x2 =39.34,OR=0.3,90 ％ CI:0.2-0.6,P＜0.05) ;The nCPAP group had fewer ventilation support in 28 days [17.5％ (11/63) vs 25.0％ (15/60),OR=0.7,90％ CI:0.4-1.4] and 36 weeks [6.3％ (4/63) vs 8.3％ (5/60),OR=0.8,90％ CI:0.2-2.4] than those in intubation group but without statistical difference (x2=1.05 and 0.01,P＞0.05,respectively).The incidence of air leak in nCPAP group were lower than intubation group [11.1％ (7/63) vs 33.3％ (20/60),x2 =8.86,OR=0.3,90％00 CI:0.2-0.7,P＜0.05].There was no significant difference for other complications between two groups. ConclusionsIn very low birth weight preterm infants,early nCPAP dose not significantly reduce the fatality rate and the incidence of bronchopulmonary dysplasia as compared with intubation ventilation,but shorten the time of ventilation and lower the incidence of air leak.

Objective To determine the risk factors for imipenem-resistant Pseudomonas aeruginosa (IRPA) infections in neonatal intensive care unit (NICU).Methods One hundred and eighty-eight Pseudomonas aeruginosa infected children (confirmed by pathogenic examination) in the NICU of Maternal and Child Health Hospital of Guangdong from January 1,2008 to December 31,2011,were chosen as the objects of study,and were divided into two groups.The first group included 73 children that had been isolated with IRPA strains(IRPA group),and the second group included 115 children that only had imipenem-sensitive Pseudo monas aeruginosa (ISPA) strains (ISPA group).Chi-square test or t-test was applied.The risk factors were investigated by univariate or multivariate Logistic regression analysis.Results Data from univariate analysis showed that the gestational age and birth weight of neonates were lower than those in ISPA group [(34.0±3.5) weeks vs (35.6±2.8)weeks,t=3.413,P＜0.01; (1848.1±276.4) g vs (2110.7±345.6) g,t=5.472,P＜0.01].There were more neonates with gestational age ≤ 32 weeks [67.1％ (49/73) vs 45.2 ％ (52/115)],birth weight ＜1500 g [73.9％ (54/73) vs 33.0％(38/115)],small for gestational age [68.5％ (50/73) vs 29.6％ (34/115)],receiving imipenem [72.6％ (53/73) vs 27.0％ (31/115)] or the third generation cephalosporins [65.8％ (48/73) vs 33.0％ (38/115)] two weeks before the isolation of Pseudomonas aeruginosa,and mechanical ventilation [78.1％ (57/73) vs 61.7 ％ (71/115)],deep vein catheterization [83.6％(61/73) vs 65.2％(75/115)] in the IRPA group than in the ISPA group (all P＜0.05 or 0.01).The multivariate Logistic regression analysis revealed that imipenem treatment within two weeks before the isolation of Pseudomonas aeruginosa (OR=6.409; 95％ CI:1.926-21.333,P =0.002) was an independent risk factor.Conclusions IRPA infection in NICU hospitalized infants is strongly related to their gestational age and birth weight.History of imipenem administration could be an independent risk factor.

Objective To investigate the effects of early nasal intermittent positive pressure ventilation (NIPPV) compared with early continuous positive airway pressure (NCPAP) in low birth weight preterm infants with respiratory distress syndrome (RDS).Methods We performed a prospective,randomized controlled trial involving 364 low birth weight preterm infants with respiratory distress syndrome within 6 hours of birth.The infants were randomly assigned to NIPPV (n=188) or NCPAP (n=176) groups.Non invasive ventilation was initiated in the neonatal intensive care unit (NICU).The rate of mechanical intubation (within 3 days or 7 days),the use of pulmonary surfactant (PS),the rate of complications and mortality were compared between the two groups.Mann Whitney U,t and Chi-square tests were used for statistical analysis.Results The average time of invasive mechanical ventilation in NIPPV group were lower than that in NCPAP group[2.0 (1.0-4.0) d vs 7.0 (3.0-8.5) d,U=-3.457,P=0.001].The need for intubation and mechanical ventilation by day 3 and day 7 in the NIPPV group were less than those in the NCPAP group [day 3:4.8％ (9/188) vs 10.8％ (19/176),x2=4.621,P=0.032; day 7:9.0％ (17/188) vs 16.5％ (29/176),x2=4.551,P=0.033].In the NIPPV group,infants who got PS therapy was less than that in the NCPAP group [3.2％ (6/188) vs 8.5％ (15/176),x2=4.752,P=0.029].There was no significant difference in the fatality rate between the NIPPV and the NCPAP group [12.8％ (24/188) vs 10.8％ (19/176),P ＞ 0.05].There were no significant difference in the incidence of air leak,intracranial hemorrhage,periventricular leukomalacia,retinopathy of prematurity,necrotizing enterocolitis,patent ductus arteriosus,and bronchopulmonary dysplasia between the NIPPV group and the NCPAP group.Conclusion Among low birth weight prcterm infants with RDS,the early use of NIPPV reduces the need for PS,intubation and invasive ventilation compared with NCPAP.

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.

Objective To investigate the effectiveness and safety of peritoneal dialysis(PD) in premature infants with acute renal failure(ARF).Methods In the neonatal intensive care unit (NICU) of Guangdong Province Maternal and Children Hospital, 12 premature infants underwent continuous PD due to ARF from March 2012 to March 2015, without using any antibiotics in the dialysis fluid.Before and after dialysis, the changes of serum urea nitrogen, creatinine, potassium and pH were compared.The complications (blockage, leakage, infection and necrotizing enterocolitis) and gastrointestinal nutrition situation were observed.Wilcoxon signed rank sum test was used for statistical analysis.Results Among the 12 premature infants, the underlying causes of ARF were sepsis (n=9), perinatal asphyxia (n=2), twin twin transfusion syndrome (n=l).The average gestational age was (30.9±3.2) weeks, the average body weight (before PD) was (1 461 ±525) g, the duration of PD was (3.8±2.6) d.Complications associated with PD included leakage (n=3) and peritonitis (n=2) in which Candids albicans and Klebsiella pneumonia were identified in ascites.Gastrointestinal nutrition was built up in six cases within one to four days after dialysis, among which one developing necrotizing enterocolitis on the 7th d after feeding.Finally, eight babies died (six died after initiative discontinued treatment and two died because of critically illness) and four patients were cured and discharged.Lower serum urea nitrogen and potassium levels and higher pH value were shown after dialysis than before [(9.16 ± 3.15) vs (12.71 ±6.98) mmol/L;(4.36±0.82) vs (6.24± 1.72) mmol/L;7.32±0.17 vs 7.21 ±0.17;Z=-2.118,-2.197 and-2.981, all P ＜ 0.05).Conclusion PD is an alternative safe and effective treatment for premature infants with ARF due to its simplicity both in manipulation and equipment requirement.

Objective To investigate the present situation of retinopathy of the prematurity(ROP)in Guang-dong Province.Methods A total of 1 52 hospitals engaged in neonatal medical service were selected from 1 3 cities in Guangdong Province by stratified random sampling method.The questionnaires of present situation and influential factors for ROP in Guangdong Province were distributed to the hospital officers to survey the special equipment in the Neonato-logy Department,ROP specialists and their training collected,the collected related equipment and the present situation of the disease,et al.Eventually,1 22 questionnaires was collected,and the return rate was 80.26%.One hundred and twenty -two hospitals entered into the study,including 50 tertiary hospitals,72 secondary and primary hospitals.Statisti-cal analysis was done with SPSS 1 9.0.Results Tertiary hospitals were better than secondary and primary hospitals in terms of conducting the oxygen monitoring (χ2 =1 8.639,P <0.01 ),ROP screening (χ2 =40.054,P <0.01 )and ROP treatment(χ2 =8.262,P <0.05).The restriction factors in the present situation of ROP were lack of specialists,tech-nology and equipment,especially the first two factors.The difference in lack of specialists and technology between tertia-ry hospitals and the lower -level hospitals was significant(χ2 =4.520,P <0.05).There were 63 hospitals able to con-duct ROP screening,and 1 6 hospitals without equipment could carry out ROP screening through referral or inviting the experts from other hospitals.Fifty -nine hospitals which couldn′t carry out ROP screening had to refer patients to other hsopitals or invite the experts from other hospitals for consultation of high risk patients.Conclusions The present situation of ROP in the tertiary hospitals in Guangdong Province is generally satisfactory,while that in the secondary and primary hospitals stays behind.The constraints for present situation of ROP examination and treatment were lack of spe-cialists,technology and equipment.The hospitals that can′t implement ROP screening should establish regional co -operation by referral and resource sharing to improve the present situation of ROP in Guangdong Province.

Objective To explore the effects of perinatal infection on retinopathy of prematurity (ROP).Methods A retrospective cohort study was performed to analyzed the clinical data of 238 preterm infants at gestational age ≤32 weeks who were delivered in Guangdong Women and Children Hospital from November 2014 to October 2015 and ROP screening examinations.Observation was not terminated until they were 45 weeks of corrected gestational age.Mild ROP was defined as having stage 1 or stage 2 ROP in zone Ⅱ or Ⅲ without additional disease,and severe ROP was defined as stage 3 or higher,any ROP in zone Ⅰ,prethreshold/threshold,with additional disease,and aggressive posterior retinopathy of prematurity (AP-ROP).Medical records of eligible preterm infants were retrospectively reviewed and analyzed.Occurrences of ROP,severe ROP,and clinically significant ROP requiring surgical treatment were assessed.Results The mean gestational age of the cohort was (30.10 ± 1.34) weeks (25.29-32.00 weeks) and the mean birth weight was (1 373 ± 272) g(720 ～2 330 g).ROP was diagnosed in 76 of 238 infants (31.9％),including 39 cases with mild ROP (16.4％) and 37 cases with severe ROP (15.5％).Surgical treatment was performed on 22 infants (9.2％).In the patients with ROP,the time to develop ROP from birth was (35.16 ± 14.26) d and the mean time of its most serious stage was (44.62 ± 18.99) d.In 22 patients with ROP who required surgical treatment,the time of surgical treatment was (50.27 ± 17.24) d.In univariate analysis,maternal perinatal infection disease was found to be associated with ROP occurrence (x2 =7.891,P =0.005) and ROP progression requiring surgical treatment (x2 =4.494,P =0.034).Small gestational age,low birth weight and long-term oxygen therapy were found to be asso ciated with ROP occurrence and severe ROP (gestational age:t =-5.803,P ＜ 0.001;t =-5.290,P ＜ 0.001;t =-4.150,P ＜ 0.001;birth weight:t =-4.942,P ＜ 0.001;t =-4.058,P ＜ 0.001;t =-3.126,P =0.002;the duration of oxygen therapy:t =2.351,P =0.020;t =2.473,P =0.018).Apgar scores ≤ 7 at 1 min and 5 min were found to be associated with severe ROP (x2 =4.803,P =0.028).Neonatal sepsis and neonatal fungal infection were found to be associated with ROP occurrence (x2 =6.071,P =0.014;x2 =4.070,P =0.044).Neonatal fungal infection was also found to be associated with severe ROP (x2 =5.479,P =0.019).Multivariate regression analysis indicated that maternal perinatal infection disease was associated with an increased risk of ROP and ROP progression requiring surgical treatment (OR =2.837,P =0.023;OR =4.087,P =0.012).Maternal preeclampsia was also associated with an increased risk of ROP (OR =2.506,P =0.040).Gestational age was an important risk factor for the development of ROP.The smaller the gestational age was,the higher the rate of occurring ROP and severe ROP (OR =0.518,0.508,0.520,all P ＜ 0.001).Conclusions Both fetal and neonatal exposure to infection appear to contribute to the increase of ROP risk in the preterm infants at gestational age ≤ 32 weeks.Maternal perinatal infection disease and maternal preeclampsia were independently associated with ROP occurrence and ROP progression in the preterm infants at gestational age ≤32 weeks.