In recent years, with the increase of elective cesarean section rate and other factors,the rate of neonatal respiratory distress in full-term neonates is rising,which has aroused widespread concern.The risk factors and related mechanisms of respiratory distress syndrome in full-term infants were reviewed from two aspects of maternal and infant.Selective cesarean section, gestational age, fetal sex and some pregnancy complications can affect the rate of respiratory distress syndrome in full-term infants.Timely use of respiratory support and early use of pulmonary surfactant, and the combined use of comprehensive measures can reduce the mortality of neonatal respiratory distress syndrome rate.

0.05). The birth weight and the number of machanical ventilation between the two groups were singnificant difference (P

Objective To evaluate the value of procalcitonin(PCT)in different periods for diagno-sis of early-onset of neonatal bacterial infection.Methods One hundred and ninety-five newborns with intra-uterine infection risk factors were divided into two groups:infection group(24cases)and non-infection group(171cases).The levels of PCT,C-reactive protein(CRP)and WBC were measured in 2hours,6to 12hours,12to 36hours and more than 48hours after birth.The sensitivity and specificity of PCT in different periods in the diagnosis of early-onset infection were analyzed.Results There were no significant differ-ences in the positive rate of PCT,CRP and WBC in infection group in 2hours after birth(P﹥0.05).The sensitivity and specificity for diagnosis of early-onset infection of PCT were 91.7% and 86.5% at 6to 12hours after birth,which were higher than those of CRP and WBC.After birth in 12to 36hours was the physiologic peak of PCT,so it couldn′t have higher sensitivity and specificity.According to threshold of 0.5ng/ml,2ng/ml,and 10ng/ml for PCT,the sensitivity was 100%,91.7% and 100% respectively,and the specificity was 5.8%,53.8%and 95.9%respectively.Conclusion PCT in 6to12hours after birth,ac-cording to threshold of 2ng/ml,can reach higher sensitivity and specificity for diagnosis of early-onset neo-natal bacterial infection.

ObjectiveTo investigate the incidence and pathogen distribution of neonatal early-onset sepsis (EOS) following exposure to antenatal antibiotics.MethodsOne hundred and eighty-four neonates who were admitted to Maternal and Child Care Hospital of Xiamen and identified as having EOS from January 2010 to December 2015 were enrolled. The clinical data were retrospectively analyzed. According to antenatal antibiotic exposure time, the infants were divided into the antibiotics group (≥4 hours) and the control group (<4 hours). Women in late pregnancy (35-37 weeks of gestation) underwent group BStreptococcus (GBS) screening using standard bacterial culture beginning from Janaury 2014 as screening group. Intrapartum antibiotic prophylaxis was given if the GBS culture was positive. Infants delivered before January 2014 were included in the no-screening group. Pathogen distribution and the difference in drug resistance between the two groups were compared by a two-independent samplest-test andChi-square test.ResultsIn the antibiotics group, the percentages of birth weight lower than 2 500 g, preterm infants, asphyxia, and positive rates of GBS and blood culture were 24.3%(17/70), 14.3% (10/70), 2.9% (2/70), 7.1% (5/70) and 70.0% (49/70), respectively, and were significantly lower than those in the control group [39.5%(45/114), 28.1% (32/114), 14.9% (17/114), 19.3%(22/114) and 88.6% (101/114), respectively] (χ2=4.478, 4.678, 6.807, 5.118 and 9.957, allP<0.05). There was no difference in the positive rate of coagulase-negativeStaphylococci andE. coli culture, or in the incidence of purulent meningitis, septic shock, disseminated intravascular coagulation, hospital stay and fatality rate between the antibiotics group and control group (allP>0.05). Compared with the no-screening group, the positive rate of GBS decreased [7.6% (5/66) vs 18.6% (22/118)] and the positive rate of fungal infection increased [7.6%(5/66) vs 1.7% (2/118)] in the screening group (χ2=4.141,P=0.042;χ2=4.000,P=0.046). The distribution of other pathogenic bacteria such as coagulase-negativeStaphylococci andE. coli was not significantly different between the two groups (P>0.05, respectively). Drug resistance rates ofStaphylococcus (Staphylococcus aureus and coagulase-negativeStaphylococcus) to oxacillin and piperacillin-sulbactam were higher in the screening group than in the no-screening group [82.6% (19/23) vs 52.9% (18/34),χ2=5.302; 78.3% (18/23) vs 47.1% (16/34),χ2=5.549; bothP<0.05], and no vancomycin resistant bacterial strains were found.ConclusionsAntenatal antibiotic exposure may be effective in reducing the occurrence of prematurity, asphyxia,and GBS infection, but it increases the rate of fungal infection, and is not effective in reducing the incidence of complications and mortality or in changing the distribution of the other pathogens in EOS. Rational indications and timing of antenatal antibiotic exposure should be taken into consideration to reduce drug resistance.

Objective To investigate the clinical and etiologic characteristics and drug-resistance features of ventilator-associated pneumonia(VAP)in neonatal intensive care unit.Methods A retrospective study was conducted in 712 newborns with VAP who were admitted to the NICU from January 2007 to December 2010 and had received mechanical ventilation.The pathogenic bacteria spectrum of hospital infection were statistically analyzed.Results VAP was occurred in 69 out of 712 newborns with mechanical ventilation (incidence rate of 9.7％).The top four pathogens were saccharomyces albicans(39.2％),stenotrophomonas maltophilia(20.3％),staphylococcus epidermidis(13.5％)and klebsiella pneumoniae(9.5％),respectively.Conclusion Implementing strict measures to control the nosocomial infection can significantly reduce the incidence of VAP.Saccharomyces albicans,stenotrophomonas maltophilia,staphylococcus epidermidis and klebsiella pneumoniae were the pathogens most commonly involved.

Objective To investigate the association between high-frequency oscillatory ventilation (HFOV) and the incidence of brain injury in premature infants(BIPI) with respiratory distress syndrome (RDS).Methods A total of 136 premature infants who were diagnosed as RDS and treated with mechanical ventilation between January 1,2014 and June 30,2016 were enrolled.Atter stratified by gestational age of 36-34 weeks,33-32 weeks,31-28 weeks and ≤ 27 weeks,the neonates were randomly divided into two groups (68 cases each):conventional mechanical ventilation (CMV) and HFOV groups.Duration of ventilation and changes in blood gas parameters following 24,48 and 72 hours of ventilation were monitored and compared between the two groups.Incidences of BIPI and complications in the two groups were calculated and their associations with gestational age and birth weight were analyzed.Moreover,incidences of cure rates in the two groups were comparatively analyzed.Independent samples t-test,two-way analysis of variance,Chi-square test or Fisher's exact test was used for statistical analysis.Results (1)Significant difference was observed neither in the perinatal factors (prenatal glucocorticoid usage,and incidences of premature rupture of membrane and gestational diabetes mellitus),nor in the severity of RDS between the two groups (all P＞0.05).(2) The average duration of ventilation in the CMV group was higher than that of the HFOV group [(68.44±10.3) vs (64.7±8.5) h,t=2.285,P＜0.05].No significant difference in the values of pH,partial pressure of carbon dioxide (PaCO2) or partial pressure of oxygen (PaO2) before and after 24,48 or 72 hours of ventilation treatment was found between the two groups (all P＞0.05).(3) Neither the incidence of hemorrhagic brain injury nor that of non-hemorrhagic brain injury showed any significant difference between the CMV and HFOV groups [36.8％ (25/68) vs 39.7％ (27/68);16.2％ (11/68)vs 14.7％ (10/68),both P＞0.05].The total incidence of BIPI showed no significant difference [44.1％(30/68) vs 45.8％(33/68),22=0.266,P=0.606].The smaller gestational age at birth and the lower birth weight,the higher incidence of BIPI,although no significant difference was shown in the incidence of BIPI when compared among different gestational age groups and different birth weight groups (all P＞0.05).(4) The incidence of complications in the CMV group was higher than that in HFOV group [25.0％(17/68) vs 11.8％(8/68),22=3.970,P=0.044],while the cure rate of RDS was similar [94.1％(64/68) vs 95.6％(65/68),x2=0.151,P=0.703].Conclusions HFOV is a safe and reliable therapy for preterm infants with RDS.Compared with CMV,HFOV can shorten the duration of ventilation and reduce the incidence of complications without increasing the risk of BIPI.However,the cure rate of RDS is not increased by HFOV.

Objective: To analyze clinical features, treatment, prognosis and risk factors for death of capillary leak syndrome (CLS) in neonates. Methods: This retrospective study involved 68 neonates with CLS treated in the Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University from January 2013 to December 2017. Clinical data, including features, causes, treatment and outcomes of those CLS cases were analyzed. Chi-square test and multivariate logistic regression analysis were performed. Results: Among the 68 cases consisting of 49 males and 19 females, 86.7% (59/68) were born at ≥ 35 gestational weeks. Fifty-three neonates (77.9%) developed symptoms within three days after admission. Forty-two cases (61.8%) had respiratory distress syndrome and 35 (51.5%) had septicemia. The mortality rate was 23.5% (16/68). Among the survivors, 38.5% (20/52) showed abnormal cranial MRI. Univariate analysis with Chi-square test showed that neonatal death due to CLS was associated with the lactic acid level >10 mmol/L, oliguria lasting for 12 h or anuria for 8 h, no negative fluid balance occured within seven days, adrenaline infusion >0.6 μg/(kg·min) and administration of 3% sodium chloride. Multivariate logistic regression analysis showed that lactic acid level, oliguria/anuria duration and the time achieve negative fluid balance were independent risk factors for neonatal death of CLS. Conclusions Neonatal CLS is a condition with high fatality rate and poor prognosis. Respiratory distress syndrome and septicemia are the common causes. The prognosis of CLS might be improved by treatment with 3% sodium chloride. Lactic acid level, oliguria/anuria duration and the time achieve negative fluid balance are independent risk factors for neonatal death due to CLS.

Group B Streptococcus (GBS) is an important pathogen which may result in miscarriage, intrauterine infection and puerperal infection. Neonatal GBS infection may lead to septicemia, pneumonia and meningitis. GBS can be divided into a variety of serotypes according to the antigenic structure of capsular polysaccharide, and different serotypes of GBS vary in ethnicity, geographical distribution, pathogen virulence and pathogenic species. The distribution and identification of GBS serotypes, and their relationships with genotypes, drug resistance, virulence factors and vaccine preparation of GBS were reviewed.

ObjectiveTo study the effects of group BStreptococcus (GBS) colonization in late pregnancies on neonatal GBS infection.MethodsA total of 17 019 pregnant women who received antenatal care and delivered in Xiamen Maternal and Child Care Hospital from June 1, 2014 to May 31, 2015 were enrolled in this study. Secretions from the lower third of the vagina in the pregnant women at 35-37 weeks of gestation or having premature baby(regardless of gestational age) were obtained to test GBS by standard bacterial culture, and 1 472 cases underwent GBS DNA test by real-time fluorescent quantitative-polymerase chain reaction (PCR) meanwhile. The pregnant women colonized with GBS (GBS culture and/or PCR DNA test positive) were given intrapartum antibiotic prophylaxis (IAP) during parturition or rupture of fetal membranes. Detection rate of the two methods was compared, and the effects of GBS colonization and IAP on neonatal GBS infection were analyzed to identify the risk factors of neonatal early-onset GBS disease (GBS-EOD). Two independent samplest-test,Chi-square test and Logistic regression analysis were used for statistical analysis. ResultsThe detection rate of GBS culture and PCR DNA test was 14.43% (2 456/17 019) and 14.13%(288/1 472), respectively. The total colonization rate was 14.52%(2 472/17 019). Based on the culture results as golden criteria, the sensitivity, specificity, positive predictive value and negative predictive value of PCR assay were 95.05%, 98.74%, 92.31% and 99.21%, respectively. There were 17 332 deliveries from the 17 019 pregnant women, of which 31 cases had GBS-EOD. The incidence of neonatal GBS-EOD in maternal GBS colonization [1.05%(26/2 472)] was 31 times higher than in pregnant women without GBS colonization [0.34‰(5/14 547)]. Among the 31 infants with GBS-EOD, 24 had pneumonia, five had sepsis, and two had meningitis. The case fatality rate was 6.45%(2/31). Logistic regression analysis found that chorioamnionitis was an independent risk factor of neonatal GBS-EOD (OR=40.425, 95%CI: 7.514-379.782,P=0.000). Compared with the non-IAP group,IAP group had a lower incidence of GBS-EOD among the pregnant women colonized with GBS [0.94%(23/2 443) vs 10.34%(3/29),χ2=24.350,P<0.01].ConclusionsGBS colonization in late pregnant women has adverse effects. Therefore, routine maternal rectovaginal culture of GBS may be necessary and IAP should be applied in those with GBS colonization.