As a challenging complication of neonatal jaundice, bilirubin encephalopathy can be subdivided into acute and chronic isoforms with the latter also named kernicterus. Its mechanism remains unclear. Its main sequelaes lie in auditory deficiency and dyskinesis. Brain stem auditory evoked potentials test is highly valued in the early diagnosis of kernicterus and the screening of auditory deficiency. MRI manifests symmetrical Tl-weighted signals on pallidum in acute phase and T2-weighted signals in chronic phase. The practical value of magnetic resonance spectrum yet demands further exploration.

Objective To compare the efficacy and safety of caffeine combined with humidified high-flow nasal cannula(HHHFNC) and nasal continuous positive airway pressure(nCPAP) on the treatment of apnea in very low birth weight (VLBW) preterm infants.Methods Totally 80 VLBW preterm infants with neonatal apnea,who were enrolled in the NICU of Hebei Province Children Hospital from September 2013 to March 2014,were randomly assigned to either HHHFNC group(39 cases) or nCPAP group(41 cases) according to respiratory support mode by random number table method,both groups were given caffeine.The incidence of severe apnea,incidence of reintubation,oxygen exposure time,duration of non-invasive ventilation time,feeding conditions and incidence of adverse events were compared.Results There were no significant differences in male/female ratio,gestational age,age at randomization and birth weight between the two groups(P ＞0.05).There were no significant differences in the incidence of severe apnea[15.4％ (6/39) vs 12.2 ％ (5/41)],incidence of reintubation [17.9 ％ (7/39) vs 19.5 ％ (8/41)],oxygen exposure time [(183.1 ± 31.2) h vs (175.9 ± 32.1) h],duration of non-invasive ventilation time [(163.3 ± 25.1) h v s (153.0 ± 26.2) h] between the two groups (P ＞ 0.05).The occurrence of abdominal distention [7.7 ％ (3/39) vs 24.4％ (10/41)],nasal trauma[2.6％ (1/39) vs 19.5 ％ (8/41)],head shaping [0.0％ (0/39)vs 29.3％ (12/41)] during treatment were lower in HHHFNC group than those of nCPAP group (P ＜ 0.05).Age began feeding was earlier in HHHFNC group than nCPAP group [(67.5 ± 19.1) h vs (96.3 ± 18.7) h,P ＜ 0.05],and day to full oral feeding was reduced in HHHFNC group than nCPAP group [(346.8±28.6) h vs (371.0 ±29.4),P ＜0.05].Conclusion HHHFNC combined with caffeine is effective on the treatment of apnea in VLBW preterm infants,and easier to make newborn tolerated.HHHFNC is an effective non-invasive respiratory support mode with few side effects.

Objective:To explore the clinical features, treatment, prognosis and genetic mutation in neonatal congenital hyperinsulinemia(CHI).Methods:Neonates with CHI admitted to the neonatal intensive care unit of Hebei Provincial Children′s Hospital from February 2017 to August 2020 were selected, and their clinical characteristics, diagnosis and treatment, prognosis and genetic mutation were retrospectively analyzed.Results:A total of seven neonates were enrolled.The average gestational age was(38.1±1.5)weeks with two cases gestational age<37 weeks.The mean birth weight was(3 608±906)g with three cases birth weight>4 000 g. The common clinical manifestations included lethargy, poor feeding, cyanosis, seizures, and tremble.Non-specific manifestations were observed in two premature infants, whose blood glucose were found very low during the routine monitoring at 1 hour and 3 hours after birth respectively.Among the seven cases, six cases needed high glucose infusion rate(GIR)[>10 mg/(kg·min)] to maintain the serum glucose at the normal level from the beginning.Only one case needed lower GIR[3-5 mg/(kg·min)] on admission while gradually increased to 8 mg/(kg·min) maximumly during hospitalization.All seven neonates were treated with diazoxide orally, and two cases(2/7) were effective, including one case who discontinued the drug at six months after birth with normal blood glucose level.The remaining five neonates(5/7) were diazoxide resistant due to mutations in the ABCC8 gene encoding the K ATP+ -channel of the pancreatic beta cell and then treated with octreotide.Two cases(2/5) of them were effective to octreotide and the other three cases(3/5) were both diazoxide and octreotide resistant.One case died after withdrawal from the treatment and the other one lost follow-up.The other five cases were followed up until now.Normal neurological development were found in three cases.Two cases were found with epilepsy and moderate developmental delay in language and social competence ability during the follow up.Mutations in ABCC8 were the most common in seven cases, of which six cases were heterozygous mutation of ABCC8 and one case was heterozygous mutation of GLUDI. Conclusion:The clinical manifestations of CHI are non-specific.The blood glucose level of the high-risk neonates should be timely monitored.Neonates who needs lower GIR[<8 mg/(kg·min)] at the early stage can not be completely excluded CHI.Some CHI cases may self-resolved after several months.Molecular diagnosis can identify the pathogenic genes, which is important to achieve accurate diagnosis and treatment, and thus improve the prognosis of patients with CHI.

Objective:To study the clinical features of neonatal hyperthyroidism.Methods:From September 2013 to September 2020, clinical data of neonates with hyperthyroidism admitted to the neonatal intense care unit of our hospital were retrospectively collected and analyzed.Results:A total of 7 neonates were included. The average gestation age was (35.8±2.3) weeks with 5 cases had GA<37 weeks. The median age of diagnostic was 16 d (7~18 d). The common clinical manifestations included tachycardia, irritability, low-grade fever, hyperhidrosis, bulimia, poor weight gain, diarrhea and jaundice. The levels of serum free triiodothyronine (FT 3) and thyroxine (FT 4) were elevated in all 7 cases and thyroid stimulating hormone (TSH) were decreased. The Doppler ultrasound of thyroid gland in two neonates revealed enlarged thyroid gland with abundant blood flow. All 7 mothers had hyperthyroidism with 4 mothers provided the history of hyperthyroidism and the other 3 were also confirmed after their infants were diagnosed. All 7 infants were treated with anti-thyroid drugs (ATD) and 2 were additionally given β-blockers to control heart rate. The median ATD duration was 40 d (7~58 d). 2 cases (both preterm infants) had slight decrease in FT 4 during medication. FT 4 of all 7 cases returned to normal before TSH. Conclusions:Neonatal hyperthyroidism has various and nonspecific clinical manifestations. Early diagnosis and timely treatment are important to prevent short-term and long-term adverse outcomes. Whether their mothers provide definite history of thyroid disorder or not, the thyroid function of the suspected neonates should be carefully monitored.

Objective:To analyze the clinical features and etiological results of neonatal central nervous system(CNS) infection and provide basis for optimization of pathogen detection strategy for CNS infection.Methods:We collected the clinical and laboratory data of hospitalized neonates with clinical diagnosis of CNS infection in the neonatal department at Hebei Provincial Children′s Hospital, from January 1, 2020 to August 31, 2021.The clinical manifestations of the enrolled neonates, as well as the cerebrospinal fluid(CSF)pathogens detected by conventional and molecular biological detection techniques were analyzed.Laboratory characteristics of different kinds of pathogen were compared.Results:A total of 101 eligible neonates were enrolled.The median gestational age was 38.8(36.2, 39.6)weeks, with a prematurity rate 26.7%.There were 68 boys.The median age of onset was 9(2, 14)days.Blood culture was positive in 19(18.8%) cases, including 17 cases of bacteria and two cases of fungus.Positive findings were found in CSF specimens of 33(32.7%)cases by various methods including 13 bacteria, 19 viruses and one fungi.Streptococcus group B and Escherichia coli were the first two bacteria in CSF.Enterovirus was the most common virus in CSF.In terms of detection methods of CSF pathogens, seven cases(7/101, 6.9%) were detected by CSF culture, two cases(2/21, 9.5%)by smear, 22 cases(22/45, 48.9%)by single-virus targeted/multiplex polymerase chain reaction and four cases(4/7, 57.1%)by metagenomic next-generation sequencing.The CSF white blood cell counts, protein levels and blood C-reactive protein levels were higher in the cases with bacteria/fungi detection from CNS infection than in those with virus detection( P<0.05). Almost all neonates(98/101, 97.0%)were clinically cured or significantly improved before discharge.Two neonates were discharged against medical advice and one neonate was transferred to the other hospital after clinical improvement. Conclusion:Combined use of conventional and molecular biological detection techniques can significantly improve the etiological positive rate of neonatal CNS infection.Viral infection is not rare in the neonatal population.Our study demonstrated the spectrum of organism causing neonatal CNS infection, which provided a basis for the optimization of pathogen detection strategy.