OBJECTIVE To explore the clinical characteristics of the neonates with early-onset sepsis caused by Listeria monocytogenes and analyze the risk factors for adverse treatment outcomes.METHODS A total of 16 neo-nates with early-onset sepsis caused by L.monocytogenes who were treated in neonatology department of the Affili-ated Suzhou Hospital of Nanjing Medical University from Jan.2012 to Dec.2023 were recruited as the research subjects.The clinical data and the results of laboratory test and drug susceptibility testing were collected from the neonates,and the risk factors for the adverse prognosis were analyzed.RESULTS Totally 14 neonates were born in the hospital,and the incidence rate was 6.7/100,000;13 cases were preterm infants,accounting for 81.25％.The peak of the onset ranged between May and November.Most of the 16 neonates showed clinical symptoms instantly after the birth,and the major manifestations included gasping and moaning(12 cases),hypotonia(11 cases),pale skin(10 cases)and poor response(9 cases).Totally 14 neonates showed the rise of C-reactive protein(CRP)in varying degree within 6 hours after the birth.In terms of the treatment outcomes,9 cases were cured and dis-charged,2 cases were improved and discharged,and 4 cases died.One of another cases was improved and died due to poor prognosis after against-advice discharge.There were significant differences in the decline of base excess,septic shock,use of sensitive antibiotics in early stage,invasive mechanical ventilation and peak value of CRP be-tween the survival group and the death group(P＜0.05).All of the L.monocytogenes were tested resistant to ce-foxitin,6 to ampicillin,6 to vancomycin,8 to linezolid.CONCLUSIONS The early-onset sepsis caused by L.mono-cytogenes is common among the preterm neonates and is prevalent in summer and autumn.Most of the cases show the symptoms instantly after the birth,the clinical manifestations are usually severe,and the mortality rate is high.The pregnant women who are suspected for L.monocytogenes infection before the delivery can be treated with penicillin,the neonates can be treated with the first choice of penicillin or ampicillin,and the severe cases can be treated with combination of vancomycin and linezolid.

Objective:To investigate the value of vasoactive inotropic score (VIS) in assessing adverse outcomes in neonates with early-onset sepsis (EOS).Methods:A retrospective study was conducted on 110 neonates with EOS admitted to the Affiliated Suzhou Hospital of Nanjing Medical University from January 2020 to March 2024. The patients were divided into a survival group ( n=88) and a death group ( n=22). Perinatal factor, and complications were compared between the two groups using t test, Mann-Whitney U test, and Chi-square test. Logistic regression analysis was used to identify the risk factors for death in patients with EOS, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of VIS for death in EOS patients. Results:The gestational age and birth weight of the death group were lower than those of the survival group [29.4 (26.8-35.3) weeks vs. 32.8 (30.1-37.2) weeks, 1 050.0 (737.5-2 162.5) g vs. 1 700.0 (1 212.5-2 587.5) g, Z values were－2.16 and－2.30, both P<0.05]. Compared with the survival group, the proportion of asphyxia [45.5% (10/22) vs. 21.6% (19/88)], low temperature [27.3% (6/22) vs. 8.0% (7/88)], mechanical ventilation [100.0% (22/22) vs. 54.5% (48/88)], disseminated intravascular coagulation [22.7% (5/22) vs. 3.4% (3/88)], persistent pulmonary hypertension [36.4% (8/22) vs. 11.4% (10/88)] and pulmonary hemorrhage [40.9% (9/22) vs. 8.0% (7/88)] were higher in the death group ( χ2=5.16, 4.59, 15.71, 7.09, 6.32 and 12.84, all P<0.05). The VIS values at 24 hours and 48 hours after admission in the death group were 15.0 (10.0-18.1) and 18.8 (12.8-30.0), respectively, which were higher than those in the survival group [10.0 (7.5-10.0) and 10.0 (7.5-10.0), Z values were－4.60 and－4.94, respectively, both P<0.05].Logistic regression analysis showed that 24-h VIS value ( OR=1.163, 95% CI: 1.018-1.328), 48-h VIS value ( OR=1.114, 95% CI: 1.031-1.204), birth asphyxia ( OR=3.815, 95% CI: 1.017-14.310), and pulmonary hemorrhage ( OR=4.470, 95% CI: 1.174-17.017) were independent risk factors for death (all P<0.05). ROC curve analysis showed that the optimal cutoff value for predicting death was 11 for 24-h VIS, with an area under the curve (AUC) of 0.807, Youden's index of 0.466, sensitivity of 68.2%, and specificity of 78.4%, and 12.5 for 48-h VIS, with an AUC of 0.851, Youden's index of 0.659, sensitivity of 95.5%, and specificity of 70.5%. Conclusions:The VIS value after the onset of EOS is closely related to the outcome. A 48-h VIS value exceeding 12.5 is associated with a high risk of death.

OBJECTIVE To explore the clinical characteristics of the neonates with early-onset sepsis caused by Listeria monocytogenes and analyze the risk factors for adverse treatment outcomes.METHODS A total of 16 neo-nates with early-onset sepsis caused by L.monocytogenes who were treated in neonatology department of the Affili-ated Suzhou Hospital of Nanjing Medical University from Jan.2012 to Dec.2023 were recruited as the research subjects.The clinical data and the results of laboratory test and drug susceptibility testing were collected from the neonates,and the risk factors for the adverse prognosis were analyzed.RESULTS Totally 14 neonates were born in the hospital,and the incidence rate was 6.7/100,000;13 cases were preterm infants,accounting for 81.25％.The peak of the onset ranged between May and November.Most of the 16 neonates showed clinical symptoms instantly after the birth,and the major manifestations included gasping and moaning(12 cases),hypotonia(11 cases),pale skin(10 cases)and poor response(9 cases).Totally 14 neonates showed the rise of C-reactive protein(CRP)in varying degree within 6 hours after the birth.In terms of the treatment outcomes,9 cases were cured and dis-charged,2 cases were improved and discharged,and 4 cases died.One of another cases was improved and died due to poor prognosis after against-advice discharge.There were significant differences in the decline of base excess,septic shock,use of sensitive antibiotics in early stage,invasive mechanical ventilation and peak value of CRP be-tween the survival group and the death group(P＜0.05).All of the L.monocytogenes were tested resistant to ce-foxitin,6 to ampicillin,6 to vancomycin,8 to linezolid.CONCLUSIONS The early-onset sepsis caused by L.mono-cytogenes is common among the preterm neonates and is prevalent in summer and autumn.Most of the cases show the symptoms instantly after the birth,the clinical manifestations are usually severe,and the mortality rate is high.The pregnant women who are suspected for L.monocytogenes infection before the delivery can be treated with penicillin,the neonates can be treated with the first choice of penicillin or ampicillin,and the severe cases can be treated with combination of vancomycin and linezolid.

Objective:To investigate the value of vasoactive inotropic score (VIS) in assessing adverse outcomes in neonates with early-onset sepsis (EOS).Methods:A retrospective study was conducted on 110 neonates with EOS admitted to the Affiliated Suzhou Hospital of Nanjing Medical University from January 2020 to March 2024. The patients were divided into a survival group ( n=88) and a death group ( n=22). Perinatal factor, and complications were compared between the two groups using t test, Mann-Whitney U test, and Chi-square test. Logistic regression analysis was used to identify the risk factors for death in patients with EOS, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of VIS for death in EOS patients. Results:The gestational age and birth weight of the death group were lower than those of the survival group [29.4 (26.8-35.3) weeks vs. 32.8 (30.1-37.2) weeks, 1 050.0 (737.5-2 162.5) g vs. 1 700.0 (1 212.5-2 587.5) g, Z values were－2.16 and－2.30, both P<0.05]. Compared with the survival group, the proportion of asphyxia [45.5% (10/22) vs. 21.6% (19/88)], low temperature [27.3% (6/22) vs. 8.0% (7/88)], mechanical ventilation [100.0% (22/22) vs. 54.5% (48/88)], disseminated intravascular coagulation [22.7% (5/22) vs. 3.4% (3/88)], persistent pulmonary hypertension [36.4% (8/22) vs. 11.4% (10/88)] and pulmonary hemorrhage [40.9% (9/22) vs. 8.0% (7/88)] were higher in the death group ( χ2=5.16, 4.59, 15.71, 7.09, 6.32 and 12.84, all P<0.05). The VIS values at 24 hours and 48 hours after admission in the death group were 15.0 (10.0-18.1) and 18.8 (12.8-30.0), respectively, which were higher than those in the survival group [10.0 (7.5-10.0) and 10.0 (7.5-10.0), Z values were－4.60 and－4.94, respectively, both P<0.05].Logistic regression analysis showed that 24-h VIS value ( OR=1.163, 95% CI: 1.018-1.328), 48-h VIS value ( OR=1.114, 95% CI: 1.031-1.204), birth asphyxia ( OR=3.815, 95% CI: 1.017-14.310), and pulmonary hemorrhage ( OR=4.470, 95% CI: 1.174-17.017) were independent risk factors for death (all P<0.05). ROC curve analysis showed that the optimal cutoff value for predicting death was 11 for 24-h VIS, with an area under the curve (AUC) of 0.807, Youden's index of 0.466, sensitivity of 68.2%, and specificity of 78.4%, and 12.5 for 48-h VIS, with an AUC of 0.851, Youden's index of 0.659, sensitivity of 95.5%, and specificity of 70.5%. Conclusions:The VIS value after the onset of EOS is closely related to the outcome. A 48-h VIS value exceeding 12.5 is associated with a high risk of death.

Objective:To study the clinical features and genotypes of neonatal Glanzmann thrombasthenia(NGT).Methods:A male neonate with NGT admitted to the Department of Neonatology of our hospital was retrospectively reviewed. CNKI, Wangfang database, VIP, the Chinese Medical Journal Full Text database, PubMed and Embase database were searched using key words '(neonate OR newborn) AND (Glanzmann thrombasthenia)' both in English and Chinese. The clinical features and genotypes of NGT were summarized and analyzed.Results:A male full-term neonate was admitted to our hospital for mass on the forehead and ecchymosis and petechiae on the body within half an hour after birth. He gradually developed subgaleal hemorrhage and severe anemia. Platelet count, mean platelet volume and coagulation functions were normal. The platelet aggregation test indicated decreased platelet aggregation rate induced by arachidonic acid and adenosine diphosphate. Genetic testing revealed two heterozygous mutations in the patient's ITGA2B gene: NM_000419.4: c.886G>A(p.Gly296Arg) and NM_000419.4: c.2855dup(p.Phe953Valfs*83). A total of 42 literature involving 44 patients (our case included) with NGT were retrieved. 33 cases (75.0%) of NGT showed ecchymosis or petechiae on the first day after birth. For 13 cases with detailed information, 5 cases with severe anemia were given erythrocyte and plasma transfusion and platelet transfusion was given in 1 case. 4 cases had homozygous variants and 4 cases showed compound heterozygous variants. 10 cases had follow-up records, including 2 cases without any bleeding and 8 cases with varying degrees of bleeding during follow-up. No deaths were reported.Conclusions:Neonates with ecchymosis and petechiae in the early postnatal period should be suspected of NGT. Blood transfusion is preferred when the indication for transfusion is met.

BACKGROUND: Antenatal corticosteroids (ACS) can significantly improve the outcomes of preterm infants. This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units (NICU) and to explore perinatal factors associated with ACS use, using the largest contemporary cohort of very preterm infants in China. METHODS: This cross-sectional study enrolled all infants born at 24 +0 to 31 +6 weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st, 2019 to December 30th, 2019. The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery. Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage. RESULTS: A total of 7828 infants were enrolled, among which 6103 (78.0%) infants received ACS. ACS use rates increased with increasing gestational age (GA), from 177/259 (68.3%) at 24 to 25 weeks' gestation to 3120/3960 (78.8%) at 30 to 31 weeks' gestation. Among infants exposed to ACS, 2999 of 6103 (49.1%) infants received a single complete course, and 33.4% (2039/6103) infants received a partial course. ACS use rates varied from 30.2% to 100% among different hospitals. Multivariate regression showed that increasing GA, born in hospital (inborn), increasing maternal age, maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS. CONCLUSIONS The use rate of ACS remained low for infants at 24 to 31 weeks' gestation admitted to Chinese NICUs, with fewer infants receiving a complete course. The use rates varied significantly among different hospitals. Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.
Humans ; Infant, Newborn ; Infant ; Pregnancy ; Female ; Gestational Age ; Infant, Premature ; Intensive Care Units, Neonatal ; Cross-Sectional Studies ; Adrenal Cortex Hormones/therapeutic use*

Objective:To summarize the clinical characteristics of neonatal late-onset sepsis (LOS) caused by Leclercia adecarboxylata, and provide evidence for its diagnosis and treatment. Methods:We report a case of Leclercia adecarboxylata induced LOS in a male preterm neonate diagnosed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) at the Affiliated Suzhou Hospital of Nanjing Medical University. Relavant literature was retrieved from Wanfang, VIP, CNKI, and PubMed databases up to April 2021, using terms including "neonate" "sepsis" and " Leclercia adecarboxylata". Results:The patient presented with dyspnea immediately after birth with gestational age of 34 +3 weeks and birth weight of 2 050 g. After admission at 14 min after birth, he was incubated at temperature of 33-35 ℃ and humidity of 50%-60% and received active treatment, consisting of nasal continuous positive airway pressure, tracheal intubation, intratracheal injection of pulmonary surfactant, invasive mechanical ventilation, and anti-infective treatment with piperacillin, cefoperazone/sulbactam, and meropenem. However, the patient developed LOS on day 11 of life and eventually died of disseminated intravascular coagulation and multiple organs failure despite volume expansion, anti-infective therapy, and respiratory support. The blood culture was positive for Gram-negative rod and confirmed as a multi-drug resistant strain of Leclercia adecarboxylata. Two cases of LOS caused by sensitive strain of Leclercia adecarboxylata in premature female infants were retrieved in the literature with atypical symptoms, of whom one was successfully treated and one died after active treatment. Conclusions:Leclercia adecarboxylata infection alone can lead to LOS in preterm infants without typical manifestations. MALDI-TOF MS is helpful for the diagnosis and rational application of antibiotics.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

Objective:To study the changes of plasma receptor interacting protein 3 (RIP3) levels in neonatal late-onset sepsis (LOS) and to determine its clinical value.Methods:From October 2019 to April 2021, plasma samples and clinical data of LOS infants admitted to our hospital were prospectively studied. Infants with similar gestational ages admitted for non-infectious diseases were assigned into the control group. Enzyme-linked immunoassay was used to determine plasma RIP3 levels. The clinical value of plasma RIP3 in the diagnosis and treatment of neonatal LOS were analyzed.Results:A total of 152 cases (76 in the LOS group and 76 in the control group) were included in the study. No significant differences existed in the baseline data between the two groups. A total of 226 plasma samples were collected (76 samples from the LOS group before treatment, 74 samples after treatment and 76 samples from the control group). The plasma RIP3 level of LOS group before treatment (19.9±6.3 ng/ml) was significantly higher than the control group (11.4±3.5 ng/ml) and the after treatment group (11.9±3.5 ng/ml) ( P<0.05). The plasma RIP3 level had good diagnostic value for neonatal LOS (AUC=0.884). With cut-off value of 15.5 ng/ml, the plasma RIP3 showed the best diagnostic efficacy (Youden index 0.658, sensitivity 72.4%, specificity 93.4%, positive likelihood ratio 11.0, negative likelihood ratio 0.3). Conclusions:Plasma RIP3 level is closely related with neonatal LOS and may be used for the early diagnosis and therapeutic evaluation of neonatal LOS.

Objective To study the diagnostic value of serologic intestinal-fatty acid binding protein (i-FABP) in neonatal necrotizing enterocolitis (NEC).Method The standard search strategy included electronic search and manual search.Electronic search was carried out in databases including PubMed,Ovid,Cochrane Library,Chinese Biomedicine Database (CBM),CNKI,WANFANG DATA and VIP database.As a supplement,relevant references from previous reviews and studies were examined by manual search.Two independent reviewers assessed the quality of included studies and extracted data,and performed further meta-analysis.RevManS.3.5 and Meta-Disc1.4 and Stata12.0 were used in the statistical analysis.Result A total of 11 studies with 700 cases were identified,including 308 NEC cases and 392 control cases.The blood samples collected at the time of suspected NEC stage showed pooled sensitivity 0.56 (95％ CI 0.44 ～ 0.67),pooled specificity 0.93 (95 ％ CI0.87 ～ 0.97),area under curve (AUC) =0.8282,and Q* =0.7610,respectively.The blood samples collected after clinical diagnosis of NEC showed pooled sensitivity 0.78 (95％ CI 0.72 ～ 0.83),pooled specificity 0.81 (95％ CI 0.76 ～ 0.86),AUC =0.8680,and Q* =0.7985,respectively.Conclusion i-FABP is a valid serologic biomarker for early diagnosis of NEC in neonatal infants.