Neonates are undergoing the transition period from fetal circulation to adult circulation, and the hemodynamic changes are complex.For premature infants(especially very low birth weight infants and extremely low birth weight infants), the cardiovascular systems are immature.Therefore, they are prone to hypotension at early postnatal stage.Hypotension may lead to multiple organ perfusion insufficience, cerebral lesion, and even death.However, it is not always accompanied by hypoperfusion.Before treatment, clinicians should evaluate the hemodynamics comprehensively.At present, there is no consensus on the definition and intervention threshold about hypotension in premature infants.This review summarizes the definitions and hemodynamic monitoring methods of hypotension in premature infants at early postnatal stage to provide references for diagnosis and treatments.

ObjectiveTo investigate the common pathogenic bacteria and antimicrobial resistance status in neonatal ward to provide guidance for rational clinical medication. MethodsData of 2306 cases in neonatal ward from July 2008 to June 2010 whose body fluid were cultured with positive results of common bacteria were collected. The change of the bacteria and drug resistance was analyzed. Results Among 10 017 body fluid samples, 80 species consisted of 2306 strains of bacteria were found. Enterobacteria accounted for about 53.8％ (1241/2306), Klebsiella pneumoniae subsp. pneumoniae (430/1241, 34.6％) and Escherichia coli (341/1241, 27.5％) were the most common ones,and among which 68.1％(293/430)strains of Klebsiella pneumoniaesubsp.pneumoniae and 59.5 ％ (203/341 ) strains of Escherichia coli were extended-spectrum β-lactamases (ESBLs) producing strains, which were significantly lower than those[78.1％ (118/151) and 82.6％(76/92) respectively]during 2003 to 2005 (U=-2.32 and -4.11, P＜0.05 respectively).Methicillin-resistant Staphylococcus aureus(MRSA)detectionrate was 8. 5％(23/272)in Staphylococcus, which was lower than that (17.7％, 15/85) in year 2004 to 2006 (U= -2.4, P＜0. 05). Methicillin-resistant coagulase-negative Staphulococcus (MRCNS) detection rate was 63.5％(157/247), which was higher than that (32.6％, 97/298) in year 2004 to 2006(U=7.54,P＜0.05).The common pathogens of nosocomial infection were Klebsiella pneumoniae subsp.pneumoniae,Escherichia coli , Acinetobacter baumannii and Pseudomonas aeruginosa ; while common pathogens of community infection were Staphylococcus aureus, Klebsiella pneumoniae subsp.pneumoniae and Escherichia coli. Multiple drug-resistant infections in hospital were significantly higher than those in community. Drug susceptibility results showed that the resistance of Staphylococcus haemolyticus,Acinetobacter baumannii and Klebsiella pneumoniae subsp.pneumoniae were especially severe.ConclusionsOpportunistic infections and drug resistant strains increased. The increasing of MRCNS and drug-resistant of Acinetobacter baumanniishouldbepaidmore attention.Comprehensive measures might reduce the production of ESBLs bacteria. The choice of antibiotics should be based on drug susceptibility test.

BACKGROUND: Bacterial cellulose, a new nanometer biomaterial, benefits the growth of skin tissue and limits the infection. It may provide advantageous conditions for the biomaterials dressing and temporary skin in the burnt patients and chronic ulcer patients. OBJECTIVE: To study the possibility of bacterial cellulose in the treatment of deep second-degree burn in rats. DESIGN, TIME AND SETTING: An observational experiment was perforemd at the Central Laboratory of Sixth People's Hospital of Shanghai Jiao Tong University from June to November 2008. MATERIALS: M12 was used to produce non-soluble gel membrane when it was cultured for 6 days at a constant temperature of 30℃, and then the sample was boiled for 20 minutes in 0.1 mol/L NaOH solution. Ivory semitransparent bacterial cellulose was obtained following the removals of thallus in liquid membrane and residual culture medium. METHODS: Skin burn in a size of 2.0 cm×2.0 cm was made in bilateral sides of spinal cord on back with self-made wound meter. One side was treated with bacterial cellulose dressing and sutured, taking as experimental side. While the other side served as control side without dressing. MAIN OUTCOME MEASURES: At days 4, 7, 14, 21 and 28 after operation, the healing rate of skin burn in rats was calculated, and the skin wound and healing were observed under light microscope. RESULTS: All animals were alive normally without the presence of wound infection. Compared with control side, the wound healing rate of treated side significantly improved at day 21 after operation; there was no significant difference between the treated side and control side at other time points (P < 0.01). The histological results indicated that the pathological lesion and healing had no significant differences between the two sides. CONCLUSION: Bacterial cellulose can promote the healing of skin burn wound to a certain degree.

OBJECTIVE To investigate the distribution of drug resistance of Pseudomonas aeruginosa(PAE) among neonates and analyze the characteristic of the PAE infection.METHODS API system was used for the identification of 131 PAE clinical isolates and the resistance to 17 kinds antibiotics was determined by K-B method.RESULTS Most of 131 strains were isolated from sputum(42.0%) and gastric juice(32.8%).All strains were mainly isolated from neonate intensive care unit(NICU).The sensitivity to amikacin,levofloxacin,ofloxacin,ciprofloxacin,piperacillin/tazobactam,cefoperazone/sulbactam,imipenem and meropenem was respectively over 70.0%.PAE was inferior sensitivity to piperacillin,mezlocillin,cefoperazone,ceftriaxone,ceftazidime and aztreonam.CONCLUSIONS PAE is one of the most common pathogens causing nosocomial infection especially for neonates.Its susceptibility to antibiotics showed multidrug resistance.In order to reduce or prevent the occurrence of resistant isolate,we should rationally choose and use antibiotics combining with trait of neonate.

Objective To investigate the therapeutic mechanism of dexamethasone in hyperoxia-induced lung injury. Methods Use bronchoalveolar lavage (BAL) method to gain alveolar macrophages (AM) from newborn SD rats. AM were adherence purified for 24 hours, then randomly assigned to four groups: Ⅰ. hyperoxia group, Ⅱ. hyperoxia plus LPS group, Ⅲ. hyperoxia plus dexamethasone group, Ⅳ. hyperoxia plus LPS plus dexamethasone group. Every group contains 7 samples. After cultured for 48 hours, supernatants were harvested. L-lactate dehydrogenase (LDH) activity? hydrogen peroxide (H 2O 2) and IL-8 contents of supernatants were examined in all groups. Results (1)48 h after culture, the content of IL-8 in groupⅠandⅡwas (46?15)pg/ml?(145?27)pg/ml respectively, in groupⅢandⅣwas(29?4)pg/ml?(39?8)pg/ml respectively, IL-8 content was decreased in group Ⅲ and Ⅳcompared with group Ⅰand Ⅱ(P

Objective To analyze the survival rate and hospitalization information for 81 2 cases of very low birth weight (VLBW)and extremely low birth weight (ELBW)infants.Methods The retrospective study was con-ducted in a single center,Department of Neonatology,Hubei Women and Children Hospital,from January 2009 to De-cember 201 4,where the data of 81 2 infants with birth weight(BW)less than 1 500 g was analyzed in regard to perinatal condition,treatment and complications of these in relation to prognosis.Results (1 )A total of 621 cases(76.5%) had favorable prognosis.(2)There was a significant difference in the favorable prognosis rate between different BW groups (χ2 =28.87,P <0.05)and different gestational age(GA)groups (χ2 =1 4.77,P <0.05).The favorable prog-nosis rate for the male infants(χ2 =4.69,P <0.05),puerpera age between 1 7 -25 and 36 -46 years old (χ2 =1 1 .1 9, P <0.05),usage of prenatal hormones(χ2 =8.02,P <0.05),the infants without intrauterine infection (χ2 =8.61 ,P <0.05),the mother without gestational hypertension (χ2 =7.20,P <0.05)and gestational diabetes mellitus(χ2 =1 9.2, P <0.05)were different compared to the control groups.(3)Infants with peripherally inserted central catheter (PICC) (χ2 =33.31 ,P <0.05)and recovery birth weight within 1 0 days(χ2 =29.65,P <0.05)had higher favorable prognosis rate compared to the control groups,which had significant differences.(4)Infants with intraventricular haemorrhage (IVH)(χ2 =1 3.1 6,P <0.05),respiratory distress syndrome (RDS)(χ2 =7.59,P <0.05),necrotizing enterocolitis (NEC)(χ2 =1 3.02,P <0.05)and serious asphyxia (χ2 =6.05,P <0.05)had lower favorable prognosis rates than those did not,with significant differences.(5)Logistic analysis:the lower BW,smaller GA,earlier birth,unused PICC, serious asphyxia,IVH,RDS were risk factors for poor prognosis(all P <0.05).Conclusions The favorable prognosis rate of VLBW and ELBW infants has improved gradually,and is closely related to GA,BW,maternal age,perinatal care,prevention complication,treatment of disease and social factors etc.

Objective To analyze the characteristics of newborns in occurrence of adverse outcomes that transferred from other hospitals during the past four years,in order to improve the province's perinatal survival quality and reduce mortality.Methods The clinical data of 255 cases in occurrence of adverse outcomes in transit during January 2008 to December 2011 were analyzed retrospectively.According chronologically 255 cases were divided into group A (124 cases,January 2008 to December 2009) and group B (131 cases,January 2010 to December 2011).We analyzed the basic data,perinatal factors and major diseases of the newborns,and compared the changes of related characteristics in different periods.Results Adverse outcomes in male patients were significantly higher than female patients (male:female 3.05:1,192:63) ; there were higher proportion of premature infants (73.3％,187/255) and cesarean section (49％,125/255).The major diseases were respiratory system diseases (71.4％,182/255),followed by circulatory system diseases (40.4％,103/255),and severe congenital abnormalities (26.3 ％,67/255).Group B compared with group A:(1) the proportion of hospitalization time ＜ 24 hours increased (73/131 vs 50/124,P ＜ 0.05) ; (2) the proportion of more than two referrals increased (41 / 131 vs 23/124,P ＜ 0.05) ; (3) the proportion of very low birth weight infants (including extremely low birth weight) increased significantly (75/131 vs 43/124,P ＜ 0.05) ; (4) the proportion of respiratory system diseased (131 / 131 vs 124/124),asphyxia (9/131 vs 22/124) and hypoxic ischemic encephalopathy (6/131 vs 16/124) decreased significantly (P ＜ 0.05) ;(5) the proportion of circulation system diseased (60/131 vs 31 / 124) and congenital developmental abnormalities (51/131 vs 23/124) increased significantly (P ＜ 0.05) ;(6) the application of mechanical ventilation (115/131 vs 88/124) and pulmonary surfactant (85/131 vs 52/124) increased significantly (P ＜ 0.05) ;(7) the usage of blood products decreased significantly (39/131 vs 53/124,P ＜ 0.05) ; (8) giving up treatment due to economic reasons reduced significantly (22/131 vs 37/124,P ＜ 0.05).Conclusion For the grassroots medical institutions,the choice of transport time and referral hospital may affect the incidence of adverse outcomes; the high rate of cesarean section may increase the incidence of adverse outcomes; the treatment capacity of extremely low and very low birth weight infants may directly affect the incidence of adverse outcomes ; the respiratory system diseases greatly impact on adverse outcomes,but the accompanied circulatory system diseases impact on adverse outcomes increased in recent years.

Objective To observe the effect of GPR30 agonist G1 on high glucose-induced endoplasmic reticulum stress ( ERS) in endothelial EA .hy926 cells.Methods EA.hy926 endothelial cells were divided into three groups:nor-mal control group (Con, 17.51 mmol /L glucose), high glucose (HG, 33.3 mmol /L), high glucose +G1 group (HG+G1, HG +1 μmol/L G1).The apoptosis rate of endothelial cells was measured by flow cytometry , the protein expres-sion changes of ERS related molecules Bip , IRE1, PERK and apoptotic molecules Bax , Bcl-2 were measured by Western blot, the mRNA expressions of Bip and CHOP were measured by RT-PCR assay.Results Compared with Con group , the apoptosis in HG group was significantly increased (P <0.01), Bip, IRE1, PERK and apoptotic molecule Bax were upreg-ulateded (P <0.05, P<0.01 or P <0.001), Bcl-2 downregulatted (P <0.01) and Bip mRNA, CHOP mRNA expres-sion were upregulated (P <0.001 and P<0.01).Compared with the HG group, apoptosis rate in HG +G1 group was significantly lower (P <0.05), BIP, IRE1, PERK and apoptotic molecules Ba.0 downregulated ( P <0.05 or P <0.01), Bcl-2 expressions was increased (P <0.05), Bip mRNA and CHOP mRNA expression were decreased (P<0.001 or P<0.01).Conclusion GPR30 agonist G-1 inhibits EA.hy926 ERS in endothelial cells.

Objective To identify risk factors associated with repeat use of pulmonary surfactant ( PS) in the treatment of respiratory distress syndrome ( RDS ) in the term and near-term neonate. Methods There were 130term and near-term new borns with RDS who were treated with pulmonary surfactant were enrolled. These infants were categorized into two groups: single-dose group (85 cases) and repeat-dose group (45 cases). The differences in basic information were compared between the two groups, and logistic regression analysis was used to identify the risk factors for repeat use of pulmonary surfactant.Results TherepeatutilizationrateofPSwas34.6℅.The incidence of asphyxia,maternal gestational hypertension, X-ray RDS grade 3-4, the age of first dose PS,respiratory support time in the repeat-dose group was significantly higher than in the single-dose group (P<0. 05). PaO2/FiO2 and the cure rate in the repeat-dose group were significantly lower than in single-dose group ( P<0. 05 ) . The incidence of sepsis, pulmonary hemorrhage, shock and patent ductus arteriosus ( PDA) in the repeat-dose group was significantly higher than in the single-dose group ( P<0. 05). Further logistic regression analysis showed that birth asphyxia ( OR=5. 674 , 95℅CI 1. 378 -23. 354 , the age of first dose of PS (OR=1.092, 95℅CI 1.002 -1.191)and PDA(OR =23.499, 95℅CI 2.348 -235.152)were the independent risk factors for repeat use of pulmonary surfactant.Conclusions Birth asphyxia,the age of first dose PS and PDA are the risk factors for repeat use of pulmonary surfactant in the treatment of RDS in the term and near -term neonate.

Objective To study the association between neonatal asphyxia and blood glucose disorder. Methods A total of 134 cases of neonatal asphyxia born in the Maternal and Child Hospital of Hubei Province between January 2013 and January 2015 were included in this study. Blood glucose levels were determined within 30 min after birth and before glucose infusion. The infants were divided into the mild asphyxia group (Apgar score 4 to 7) and severe asphyxia group (Apgar score 0 to 3) according to the Apgar score at 5 min after birth. Statistical analyses were performed using the two-sample t-test and Chi-square test. Results The incidence of asphyxia was 3.2‰(134/41 875). Hypoglycemia was the main blood glucose disorder in the mild asphyxia group [12% (13/112)], and hyperglycemia was the main blood glucose disorder in the severe asphyxia group [32%(7/22)]. The average blood glucose level was higher in the severe asphyxia group than in the mild asphyxia group [(5.8±3.4) vs (5.0±2.3) mmol/L, t=21.979, P=0.001]. In the severe asphyxia group, the incidence of hypoglycemia was higher [18% (4/22) vs 12% (13/112), χ2=7.464, P=0.006] and the average blood glucose level was lower [(1.8±0.7) vs (2.1±0.4) mmol/L, t=5.247, P=0.042],and the incidence of hyperglycemia was also higher [32% (7/22) vs 9% (10/112), χ2=11.679, P=0.001] and the blood glucose level was higher [(11.6±3.8) vs (9.3±2.0) mmol/L, t=1.106, P=0.048]. Conclusion Neonatal asphyxia can lead to blood glucose disorders. The incidence and the severity of these disorders were higher in neonates with severe asphyxia.