Objective To investigate the clinical effect of three kinds of dose of pulmonary surfactant (PS) in neonatal respiratory distress syndrome (NRDS), and to determine the optimal dose. Methods One hundred and seventy-four cases of NRDS were divided into A group (59 cases), B group (57 cases) and C group (58 cases) according random digits table. Based on the conventional treatment, children in A group were given large dose of poractant alfa injection 250 mg/kg, children in B group were given 200 mg/kg, and children in C group were given 100 mg/kg. After treatment for 1, 6, 12 and 24 h, the arterial oxygen saturation (SaO2), inspired oxygen concentration (FiO2), arterial oxygen tension (PaO2), oxygenation index (OI), arterial/alveolar oxygen tension ratio (a/APO 2), ventilator using and oxygen using time and the incidence of complication were compared. Results After treatment for 12,and 24 h, the levels of SaO 2 in A group and B group were significantly higher than those in C group: 0.936 ± 0.018, 0.935 ±0.019 vs. 0.857 ±0.027;0.941 ±0.017, 0.946 ±0.015 vs. 0.847 ±0.053, and there were significant differences (P<0.01). After treatment for 12 and 24 h, the levels of SaO 2 in A group and B group had no significant differences ( P>0.05). After treatment for 1, 6, 12, and 24 h, the levels of FiO 2 and OI in A group and B group were significantly lower than those in C group, and the levels of PaO 2 and a/APO2 in A group and B group were significantly higher than those in C group. There were significant differences (P<0.01). The levels of FiO2, OI, PaO2 and a/APO2 in A group and B group had no significant differences ( P>0.05). The ventilator using time in A, B and C group were (108.6±23.5) , (119.6±32.8), (156.3±27.3) h, and there were significant differences (P<0.05 or<0.01). The oxygen using time in A and B group had no significant difference ( P>0.05). The oxygen using time in C group was significantly longer than that in A and B group: (186.5 ± 52.8) h vs. (148.7 ±24.4), (154.6±28.2), P<0.01. The incidence of complication in A and B group had no significant difference ( P>0.05).The incidence of complication in C group was significantly higher than that in A and B group:29.31%(17/58) vs. 13.56%(8/59), 12.28%(7/57), P<0.05. Conclusions Poractant alfa injection 200 mg/kg is optimal dosage for poractant alfa injection in the treatment of NRDS, and it can effectively improve oxygenation and ventilation function, reduce the incidence of complication, shorten the course of disease and improve the prognosis and increase the cure rate. Excessive dose is waste, and little dose can not get effective treatment.

【Objective】 To investigate the physical and neuropsychological development of the offspring born to mothers with gestational diabetes mellitus (GDM) at 2 years of age, and to provide evidence to enhance the physical and neuropsychological development of GDM offspring. 【Methods】 A retrospective analysis was conducted on neonates born in the Department of Obstetrics at Qinzhou Maternal and Child Health Hospital from January 2018 to December 2018 and regularly followed at the outpatient service. The neonates were categorized into two groups based on whether their mothers were diagnosed with GDM during pregnancy: the GDM group (n=243) and the control group (n=362). The general clinical data, follow-up information on physical development and neuropsychological development at 1 year and 2 years of age for all children were collected. Their height, head circumference, body weight, BMI, and Gesell developmental quotients (DQs) at 1 year and 2 years of age for both groups were analyzed. 【Results】 1) There were no significant differences in height, head circumference, body weight, and body mass index (BMI) between the two groups at 1 year and 2 years of age during the follow-up period (P>0.05). 2) At 1 year of age, the GDM group exhibited higher rates of abnormal language development (8.6% vs. 3.3%, χ²=7.854), adaptive behavior(11.4% vs. 5.0%,χ²=8.605), and personal social behavior(8.2% vs. 3.0%, χ²=8.062) compared to the control group (P<0.05), and lower DQs for these Gesell subscales (language development 87.6±7.7 vs. 89.4±9.2, t=2.591; adaptive behavior: 88.4±7.8 vs. 90.5±8.9, t=2.957; personal social behavior: 89.1±7.0 vs. 91.2±7.5, t=3.495, P<0.05). 3) At 2 year of age, the GDM group also showed higher rates of adaptive behavior (8.2% vs. 4.1%, χ²=3.927) and personal social behavior (7.3% vs. 3.0%, χ²=4.093) compared to the control group (P<0.05), and lower DQs for these Gesell subscales (adaptive behavior: 89.5±6.5 vs. 91.9±6.9, t=3.878; personal social behavior: 89.9±7.1 vs. 92.1±6.9, t=3.311, P<0.05). 【Conclusions】 The development of adaptive behavior and personal social behavior in offspring born to mothers with GDM remains delayed. Follow-up for GDM offspring should prioritize achieving a balanced development of adaptive behavior and personal social behavior.