Advances in resuscitation and intensive care have led to high rates of survival among neonates with life -threatening conditions such as asphyxia,prematurity and congenital malformations.The sequelae of neurologic con-ditions arises in the neonatal period include lifelong disabilities such as cerebral palsy,epilepsy,intellectual and beha-vioral disabilities.There is an increasing demand for resource -intense strategies for acute neurological care within neo-natal intensive care unit.Neonatal neurocritical care is a multidisciplinary subspecialty that combines expertise in neo-natology,pediatric neurology,radiology,rehabilitation,surgery,and has led to improved outcomes in newborn that have critical illnesses.Neonatal neurocritical care focus the needs of the developing newborn brain,including attention to physiology to help prevent secondary brain injury,a protocol -driven approach for common conditions such as hypoxic -ischemic encephalopathy and seizures,education of specialized teams that use brain monitoring and imaging to evaluate the effect of critical illness on brain function.

Objective To evaluate the value of amplitude-integrated EEG(aEEG)as a quantitative predictor of neurodevelopment outcome of full-term infants with hypoxic-ischemic encephalopathy(HIE).Method EMBASE,Ovid,PubMed,Cochrane Library,Springer Database,CNKI,CSJD and Wanfang Database were searched from when the database was founded to June 30,2010 for studies about aEEG as a predictor of neurodevelopment outcome in full-term infants with HIE.Characteristic information of each articles was extracted and QUADAS items were used to evaluate the qualities of included studies.Meta-disc software 1.4 was used to perform the metaanalysis.All included studies were combined with weighted quantity; sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and their 95 ％ CI were calculated.Results Eleven studies were eligible for the primary meta-analysis and totally 717 subjects were included.There was an overall sensitivity of 86％(95％ CI:81％-89％),specificity of 90％(95％ CI:86％-93％),positive likelihood ratio of 7.70(95％ CI:5.69-10.43),negative likelihood ratio of 0.17(95％ CI:0.13-0.22)and the area under the curve(AUC)of summary receiver operating characteristic curve was 0.95 for aEEG tracings to accurately predict poor outcome of HIE in full term neonates.Conclusion aEEG is a valuable bedside tool for predicting long-term neurodevelopment outcome in term infants with HIE.

Objective:To investigate the clinical and genetic features of 3-methylglutaconic aciduria, dystonia-deafness, hepatopathy, encephalopathy, Leigh-like syndrome(MEGDHEL syndrome) caused by SERAC1 gene variation. Methods:This study retrospectively described the clinical and molecular features and prognosis of a baby boy who was transferred to Children's Hospital of Fudan University and later diagnosed with MEGDHEL syndrome in August 2016. A summary of the clinical and genetic manifestations of MEGDHEL syndrome cases reported in China and foreign areas was conducted through a literature review.Results:(1) Case report: The 2-day-old patient was transferred to Children's Hospital of Fudan University due to hyperlactic acidemia after birth. Physical examination revealed scattered petechiae and ecchymoses of the skin. Laboratory examination showed coagulation disorders and cranial MRI revealed abnormal signals in both basal ganglia. A homozygous variation of c.442C>T(p.Arg148*) in the SERAC1 gene was detected in the patient, which is a pathogenic variant included in the Human Gene Mutation Database. Both of his parents were heterozygous carriers, thereby the diagnosis of MEGDHEL syndrome was confirmed. Followed up to the age of three years and 11 months, he was found to have psychomotor retardation, spasticity, dystonia, deafness, and loss of language ability. (2)Literature review: Together with the case reported in this study, a total of 88 cases were retrieved, involving 57 different variants. The clinical features were homogenous, with onset mostly in the neonatal period (72%, 62/86), and severe reversible liver dysfunction (49%, 38/77) and neonatal hypoglycemia (44%, 35/80) were the main features. Nervous system was affected since infancy and common symptoms, included hypotonia (86%, 68/79), progressive spasticity (82%, 67/82), dystonia (80%, 66/82), intellectual disability (88%, 58/66) and sensorineural hearing impairment (74%, 59/80). Furthermore, bilateral basal ganglia involvement on cranial MRI (93%,70/75) and 3-methylglutaconic aciduria (98%,80/82) were also seen. Supportive care is currently the main management, however, the prognosis is extremely poor. Conclusions:MEGDHEL syndrome should be highly suspected when reversible neonatal liver dysfunction or hypoglycemia of unknown reasons in neonatal period, followed by progressive deafness-dystonia syndrome in infancy. As the prognosis of these patients is usually poor, genetic testing may provide an early diagnosis in neonatal period.

Objective:To evaluate the effectiveness of integrated pediatric training course of extracorporeal membrane oxygenation(ECMO)based on simulation teaching.Methods:The instructors of ECMO team of Children′s Hospital of Fudan University developed the teaching curriculum.Team members as a unit were recruited to study simulation-based courses, whose theoretical knowledge, skills and teamwork were assessed, and feedback from the trainees were gathered.Results:Since May 2018, 22 teams of pediatric specialized hospitals or general hospitals have taken part in our ECMO simulation, with totally 132 participants, including 45 ICU doctors(34.1%), 60 ICU nurses(45.5%), 23 thoracic surgeons(17.4%) and four anesthesiologists(3.0%). Twelve of them(9.1%)had a little ECMO experience.After training, the trainees had a high evaluation on each part of the course, with average score more than four, of which the theoretical score was lowest.Their self-evaluation on the theory, skills, teamwork and confidence in the implementation of ECMO had been significantly improved.Most(80.3%)of the trainees were confident to carry out ECMO in their local hospitals.The trainees′ baseline score of theoretical knowledge was 55.2±7.6, and increased to 67.1±7.3 after training( P<0.001). The average teamwork score of the 22 teams was 70.2±8.2, and the qualified rate was up to 86.4%.The most prominent skill problems in operation assessment were no albumin and blood priming(90.9%), non-skill problems were extremely anxious during the overall assessment(84.8%)of the participants, poor team work(74.2%), poor leadership(68.2%). For the feedback of the whole course, 97.0% and 94.7% of the trainees thought that integrated training and simulation teaching were the highlights of the course.At present, 13(59.1%)units have successfully developed ECMO technology after the course, and the number of children treated has been up to 83, with a survival rate of discharge of 54.2%.However, it was found that the skill level of some participants decreased about 2 weeks after the course. Conclusion:As a new attempt of ECMO teaching, this curriculum has achieved certain efficiency in both teaching and clinical practice.At the same time, our study also plays a role in promoting the development of ECMO in pediatrics.

Objective To study the significance of the cerebrospinal fluid(CSF)lactate level in diagnosing neonatal bacterial meningitis(BM). Methods The CSF samples were collected from neonates admitted to Neonatal Ward of Children's Hospital of Fudan University between January 2014 and March 2015. CSF lactate and glucose con-centrations were measured with blood - gas analyzer. CSF and serum glucose levels were measured with glucometer. The enrolled neonates were divided into 2 groups based on CSF culture,CSF white blood cells(WBCs)and clinical presenta-tion:observation group(neonates with BM)and control group(neonates without BM). Statistical analysis of data was performed with Stata 12. 0. Results A total of 93 infants(16 assigned to observation group and 77 assigned to control group)met the inclusion criteria. Neonates in observation group had higher median CSF lactate level(4. 2 mmol/ L)and CSF lactate/ glucose ratio(L/ Gcsf)(2. 32 mmol/ L),than those in control group(1. 3 mmol/ L,0. 52),and there were significant differences(Z = - 6. 19,- 5. 92,all P ﹤ 0. 05). CSF glucose levels were lower in observation group(me-dian,1. 25 mmol/ L)than those in control group(median,2. 5 mmol/ L),and the difference was significant(Z = 4. 97, P ﹤ 0. 05);CSF/ serum glucose ratio(CSF/ Sglu)were lower in observation group(median,0. 44 vs 0. 81 in control group),and the difference was significant(Z = 4. 43,P ﹤ 0. 05). The optimal CSF lactate cutoff point of 2. 2 mmol/ L had a positive predictive value(PPV)of 72. 7% and negative predictive value(NPV)of 100. 0% for bacterial meningi-tis. The optimal L/ Gcsf cutoff point of 1. 24 had a PPV of 94. 1% and NPV of 100. 0% . The optimal CSF glucose cutoff point of 2. 0 mmol/ L had a PPV of 65. 0% and NPV of 95. 9% . The optimal CSF/ Sglu cutoff point of 0. 6 had a PPV of 60. 0% and a NPV of 96. 9% . Conclusion CSF lactate may be an excellent biomarker for early diagnosis of neo-natal BM.

A total of 20 normal newborns and 8 brain injured newborns were monitored for 2 hours with domestic digital amplitude integrated cerebral function monitor (CFM 3000) and similar imported products LECTROMED CFM 5330 simultaneously. 32 newborns with seizures or suspected seizures were monitored with CFM 3000 and conventional electroencephalogram (EEG) simultaneously. The tracings of amplitude integrated electroencephalogram (aEEG) monitored by CFM 3000 and LECTROMED CFM 5330 are similar to each other. The continuous electrical activity, sleep-wake cycle, the mean of lower or upper bound voltage and duration of broad and narrow band were no significant statistical difference between different machines; The pattern of aEEG tracing of 8 infants with brain injury monitored by CFM 3000 was the same as monitored by the LECTROMED CFM 5330. The detection rate of seizure with CFM 3000 and conventional EEG were no statistically significant difference, and the consistency with Kappa test was: Kappa = 0.552, P = 0.001. The CFM 3000 can reflect the change of cerebral function and identify infants with brain injury reliably.
Brain Injuries ; diagnosis ; physiopathology ; Electroencephalography ; methods ; Female ; Humans ; Infant, Newborn ; Male ; Monitoring, Physiologic ; instrumentation ; methods ; standards ; Seizures ; diagnosis ; physiopathology ; Signal Processing, Computer-Assisted

Objective To study the clinical value of neonatal arterial blood pH,base excess and lactate levels within 72 h after birth in assessing early brain injury in asphyxia neonates.Method From June 2015 to November 2016,a retrospective study was performed on the asphyxia newborn admitted to newborn department of Children's Hospital of Fudan University.The data of brain magnetic resonance imaging (MRI),video electroencephalogram (VEEG),and artery blood gas analysis (within 12 h and 72 h) were all collected.The neonates were assigned into brain injury group (severe or moderate injury) and control group (normal or mild injury) according to MRI and VEEG results.The differences of arterial blood pH,base excess and the level of lactate between the two groups were analyzed and indicators of brain injury were evaluated using ROC curves.Result A total of 63 cases were included in the study.Thirty patients were in the control group and 33 patients the brain injury group.The pH within 12 h was lower [(7.32 ±0.09) vs.(7.38 ±0.08)],and the lactic acid level in 12 h and at 24-72 h were significantly higher in the brain injury group than the control group [(7.9 ±4.2) mmol/L vs.(4.9 ±2.4) mmol/L and (3.7 ±3.2) mmol/L vs.(2.2 ± 1.1) mmol/L].The differences were statistically significant (P ＜0.05).The areas under the ROC curve of pH,lactate within 12 h and at 24-72 h were 0.323,0.715,0.643 (P =0.016,0.003,0.051).The cut-off value of lactic acid within 12 h in assessing of brain injury was 7.5 mmol/L,with the sensitivity of 0.46 and the specificity of 0.97.Conclusion The artery lactate level within 72 h after birth can be used to evaluate the severity of brain injury in neonatal asphyxia infants.

Objective To study the influence of gestational age (GA) and postnatal age on neonatal cerebrospinal fluid parameters.Method From January 2013 to December 2015,the results of WBC counts,glucose and protein concentrations of cerebro-spinal fluid(CSF) were collected from neonates admitted to neonatal department of our hospitals.The neonates were assigned into different groups according to their GA and postnatal age.The CSF parameters were compared between different groups,and the changes of CSF parameters were analyzed.STATA 12.0 software was used for statistical analysis.Result A total of 1 410 infants were included.516 (36.6％) cases were preterm infants.1 208 cases (85.7％) received antibiotics before lumbar puncture.WBC counts in CSF between preterm and term infants showed no significant differences (upper reference limit,12.5 × 106/L).CSF glucose in term infants (lower reference limit,1.8 mmol/L) was higher than preterm infants (lower reference limit,1.6 mmol/L).CSF protein in preterm infants (upper reference limit,226.6 mg/ dl) was significantly higher than term infants (upper reference limit,140.3 mg/dl).CSF WBC counts decreased with the growth of postnatal age in preterm infants (regression coefficients-0.030,P=0.035).CSF protein also declined significantly with the increase of postnatal age in term infants (regression coefficients-1.254,P＜0.001).CSF glucose showed no significant decrease with the increase of postnatal age (regression coefficients-0.009,P=0.012).Conclusion GA and postnatal age did not produce an effect on WBC counts of CSF.The preterm infants had lower glucose level and higher protein level in CSF.CSF protein declined significantly with the increase of GA and postnatal age.

Objective To explore the feasibility of Guardian real-time continuous monitoring system (GRT) in high-risk infants with hypoglycemia.Methods The glucose of 72 infants admitted to Neonatal Intensive Care Unit (NICU) of Children's Hospital of Fudan University between May 2015 and December 2016 were detected by GRT (provided by Medtronic),there were 43 males and 29 females with gestational age [(35.25 ± 4.45) weeks],and birth weight [(2 385.69 ± 1 062.63) g].At the same time,the capillary glucose was monitored intermittently detected by using ACCU-CHEK(R).Results A total of 1 134 paired glucose levels were collected.A good correlation between the paired capillary[(5.23 ± 1.96) mmol/L] and GRT continuous monitor measurements [(5.19 ± 1.99) mmol/L] was found(r =0.88,P ＜ O.05),and the value of mean absolute difference (MAD) was 11.88％.Through the Clarke error grid analysis,there were 98.24 ％ points located in region A and region B,only 20 paired(1.76％) glucose located in region D.Hypoglycemia was defined as glucose concentration ＜ 2.6 mmol/L,while hyperglycemia was defined as glucose concentration ＞ 7.0 mmol/L.A high/low blood glucose detected by peripheral blood glucose monitoring is a high/low blood glucose event,and a high/low blood glucose detected by GRT in a continuous period is a high/low blood glucose event.Twelve cases of hypoglycemia,26 episodes of hypoglycemia,29 cases of hyperglycemia,and 151 episodes of hyperglycemia were detected by using fast blood glucose meter.Twenty-six cases of hypoglycemia,88 episodes of hypoglycemia,38 cases of hyperglycemia,and 229 episodes of hyperglycemia were detected by using GRT.Sixty-two episodes of hypoglycemia were not detected by the fast blood glucose meter,with 14 episodes lasting longer than 30 min,4longer than 60 min,and 5 longer than 90 min.There were 78 hyperglycemic episodes that were not detected by the fast blood glucose meter,with 44 episodes lasting longer than 30 min,15 longer than 60 min,and 70 longer than 90 min.There were significant differences in the testing of hypoglycemia and pathoglycemia(x2 =7.00,18.60;all P ＜ 0.05),but,there was no significant difference in the testing of hyperglycemia between the 2 kinds of detection(x2 =2.26,P ＞0.05).GRT was acceptable to parents,medical staffs and children as only 3 infants bled when the continuous glucose sensor was imbedded,but there was no progressive increase in blood loss.There was no redness,edema,infections,or effusions at the insertion sites.Conclusions The use of GRT continuous monitoring system in high-risk infants of hypoglycemia was feasible.Compared with the conventional intermittent peripheral blood glucose monitoring,more abnormal blood glucose events and their duration could be detected.

Objective: To evaluate the effect of preservation of left colic artery (LCA) on postoperative anastomotic leakage in patients with rectal cancer after neoadjuvant therapy. Methods: A retrospective cohort study was conducted to collect data of rectal cancer patients at Department of Gastrointestinal Surgery of Fujian Cancer Hospital from September 2014 to August 2017. Inclusion criteria: (1) age of 18 to 79 years; (2) rectal adenocarcinoma confirmed by postoperative pathology; (3) patients without preoperative serious cardiovascular and cerebrovascular disease receiving preoperative neoadjuvant radiotherapy or chemoradiotherapy; (4) laparoscopic-assisted anterior rectal resection and distal ileostomy were performed simultaneously; (5) complete clinical data. Exclusion criteria: patients with extensive abdominal metastasis, or distant organ metastasis during operation, and combined organ resection. According to whether LCA was retained during operation, the patients were divided into two groups, then the intraoperative and postoperative clinical outcomes were compared. Moreover, univariate analysis and multivariate logistic regression were used to analyze risk factors of postoperative anastomotic leakage. Results: A total of 125 patients were included in this study, including 56 patients in the retained LCA group and 69 patients in the non-retained LCA group. Differences in baseline data, such as gender, age, diabetes mellitus, body mass index, hemoglobin, distance between tumor and anal margin, maximum diameter of tumor, preoperative neoadjuvant therapy, and ypTNM stage, between retained LCA group and non-retained LCA group were not statistically significant (all P>0.05), indicating that two groups were comparable. Meanwhile there were no significant differences in operation time, intraoperative blood loss, total number of lymph node harvested, number of harvested lymph node at the root of inferior mesenteric artery, circumferential margin, anastomotic bleeding, or postoperative hospital stay between two groups (all P>0.05). Thirteen patients in the non-retained LCA group (18.8%) developed postoperative anastomotic leakage, including 7 cases of grade A, 5 cases of grade B and 1 case of grade C, while in the retained LCA group, only 5.4% (3/56) of patients developed postoperative anastomotic leakage, including 1 case of grade A and 2 cases of grade B without case of grade C, whose difference was statistically significant (U=1674.500, P=0.028). Univariate analysis showed that preoperative hemoglobin <120 g/L and non-retained LCA were associated with postoperative anastomotic leakage (both P<0.05). Multivariate analysis cofirmed that preoperative hemoglobin < 120 g/L (OR=3.508, 95% CI: 1.158 to 10.628, P=0.017) and non-retained LCA (OR=4.065, 95%CI: 1.074 to 15.388, P=0.031) were independent risk factors for postoperative anastomotic leakage. Median follow-up time was 31 months (16 to 51 months), and no long-term complication was found. Local recurrence and distant metastasis were found in 1 case (1.8%) and 7 case (12.5%) in the retained LCA group, while those were found in 2 cases (2.9%) and 5 cases (7.2%) respectively, in the non-retained LCA group, whose differences were not statistically significant (P=1.000, P=0.321 respectively). Conclusion Preservation of left colic artery not only can ensure radical lymph node dissection efficacy under the condition of similar operation time and blood loss, but also can effectively reduce the incidence of postoperative anastomotic leakage for rectal cancer patients after neoadjuvant therapy.