White matter damage, characterized by demyelination due to the damage of oligodendrocyte precursor cells (OPCs), is the most common type of brain damage in preterm infants. Survivors are often subject to long-term neurodevelopmental sequelae because of the lack of effective treatment. In recent years, it has been found that cell transplantation has the potential for the treatment of white matter damage. OPCs are frequently used cells in cell transplantation therapy. With abilities of migration and myelinization, OPCs are the best seed cells for the treatment of white matter damage. Several studies have found that OPCs may not only replace impaired cells to reconstruct the structure and function of white matter, but also inhibit neuronal apoptosis, promote the proliferation of endogenous neural stem cells, and enhance the repairment of the blood-brain barrier. However, the clinical application of OPC transplantation therapy faces many challenges, such as the effectiveness, risk of tumorigenesis and immune rejection. With reference to these studies, this article reviewed the development of myelination, the obtainment of OPCs, the therapeutic mechanism as well as application research, and analyzed the current challenges of OPC transplantation, in order to provide a new direction for clinical treatment of white matter damage in preterm infants.
Cell Separation ; Demyelinating Diseases ; therapy ; Humans ; Infant, Newborn ; Infant, Premature ; Oligodendrocyte Precursor Cells ; transplantation ; White Matter ; pathology

OBJECTIVETo observe the effect of intrapartum and postpartum factors on abnormal neurological findings in the extremely preterm infants.

METHODClinical data of 62 premature infants (33 of male, 29 of female) were retrospectively analyzed. None of the premature infants had birth defect; their gestational ages were all less than 28 weeks (23(+ 6)-27(+ 6) weeks). They were hospitalized within 12 hours after birth in the neonatal intensive care unit (NICU) of BAYI Children's Hospital from November 2010 to June 2013. The blood gas, birth condition, complications, the mechanical ventilation and the ultrasonic encephalography were recorded. The 62 cases were divided into 2 groups, alive group and died group. Meanwhile, all cases of survial were divided into brain injuries group and normal brain group. Data were analyzed with t-test, Chi square test and Spearman correlation analysis.

RESULTFifty-six cases were alive, and 6 cases died (3 were during the treatment and 3 were after parents gave up). The average birth weight of brain injuries group was (954 ± 182) g; and that of the normal brain group was (1 071 ± 136) g. There were significant differences between the two groups in gender (χ(2) = 4.314, P = 0.038), gestational age (χ(2) = 11.622, P = 0.001), birth weight (t = 2.728, P = 0.009), which had significant correlation with neurological outcomes. The Spearman correlative coefficients were -0.278, 0.456 and 0.364 respectively. And P values were 0.038, 0.000 and 0.006. The rates of multiple pregnancy, lung hemorrhage and surgical operation in brain injuries group were 45%(9/20), 55%(11/20), 40%(8/20), which were significantly higher than those in normal brain group, 3%(1/36), 17%(6/36), 11%(4/36)(χ(2) = 12.800, 8.936, 4.773, P all < 0.05). These three factors were the high risk factors for adverse neurological outcomes, the odds ratios were 28.64, 6.11 and 5.33 respectively. There was no significant difference in delivery mode, amniotic fluid, maternal infection, asphyxia, necrotizing enterocolitis, patent ductus arteriosus, sepsis, mechanical ventilation, inhaled nitric oxide therapy, blood glucose, blood gas analysis, doses of dopamine between brain injuries group and normal brain group. The birth weight in alive group was (1 029 ± 163) g, which was significantly higher than those in died group (870 ± 144)g (r=0.29, P=0.022). There was no significant difference in other factors between alive group and died group(P all>0.05).

CONCLUSIONGender, gestational age and birth weight may have relation with the neurological outcomes of extremely preterm infants. Multiple pregnancy, pulmonary hemorrhage and surgical operation are the risk factors of brain injuries. Birth weight is related to the survival of extremely preterm infants.

Birth Weight ; Brain Injuries ; physiopathology ; Female ; Gestational Age ; Humans ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Premature, Diseases ; Lung ; pathology ; Male ; Pregnancy ; Pregnancy, Multiple ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the effect of premature rupture of the membrane (PROM) on neonatal complications in premature infants.

METHODSThe registration information of 7684 preterm infants with gestational age <37 weeks were collected from the cooperative units in the task group between January 1, 2014 to December 31, 2014. Specially trained personnel from each cooperative units filled in the unified form in a standardized format to record the gender, gestational age, birth weight, PROM, placental abruption, antenatal corticosteroid, Apgar score, amniotic fluid pollution, and complications of the infants. The data were analyzed comparatively between the cases with PROM and those without (control).

RESULTSThe preterm mortality rate was significantly lower but the incidences of ICH, NEC, ROP and BPD were significantly higher in PROM group than in the control group (P<0.05). The 95% confidence interval of the OR value was <1 for mortality, and was >1 for ICH, NEC, ROP and BPD. After adjustment for gestational age, birth weight, gender, mode of delivery, placental abruption, placenta previa, prenatal hormones, gestational diabetes mellitus (GDM), gestational period hypertension and 5-min Apgar score <7, the incidences of NEC, ROP and BPD were significantly different between the two groups (P<0.05) with 95% confidence interval of OR value >1, but the mortality rate and incidence of ICH were not significantly different between the two groups (P>0.05).

CONCLUSIONPROM is a risk factor for NEC, ROP and BPD in preterm infants, and adequate intervention of PROM can reduce the incidences of such complications as NEC, ROP and BPD in the infants.

Apgar Score ; Birth Weight ; Female ; Fetal Membranes, Premature Rupture ; pathology ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Newborn, Diseases ; etiology ; Infant, Premature ; Pregnancy ; Risk Factors

This study was aimed to provide data on the use of medical resources by preterm infants following discharge from the neonatal intensive care unit (NICU). The cohort included preterm infants (n=2,351) born at 22-32 weeks' gestation who were discharged from the NICUs of 44 Korean hospitals between April 2009 to March 2010. Mean duration of post-discharge follow-up was 425+/-237 days. After discharge from the NICU, 94.5% of total infants visited a pediatric outpatient clinic (11.5+/-9.8 mean visits), 42.9% visited a pediatric clinic for respiratory problems irregularly (4.9+/-6.6 mean visits), and 31.1% utilized emergency center at least once. Among all visits to the emergency center, 24.7% resulted in readmission and 50.8% of those visits were due to respiratory problems. At least one episode of readmission was required by 33.6% (788/2,346) of total infants, and 18.4% (431/2,346) of total infants were readmitted with respiratory problems at least once. Among all infants readmitted for respiratory problems, 16.2% (70/341) were diagnosed with respiratory syncytial virus infection which accounted for 30.3% of viral etiologies confirmed by laboratory testing. Infants born at <30 weeks' gestation had more frequent total readmission and respiratory readmission than those > or =30 weeks' gestation (2+/-1.7 vs. 1.7+/-1.2, P=0.009, 1.8+/-1.2 vs. 1.5+/-1.1, 0.027, respectively). Overall, use of medical resources is common, and respiratory problems are the leading cause of use of medical resources. Total readmissions and respiratory readmissions are more frequent in more immature infants.
Cohort Studies ; Databases, Factual ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/*pathology ; Intensive Care Units, Neonatal ; Male ; Patient Readmission ; Republic of Korea ; Respiratory Distress Syndrome, Newborn/*pathology ; Retrospective Studies

Hypernatremic dehydration is an important cause of intracranial hemorrhage. A possible association of intraventricular hemorrhage (IVH) with hypernatremia and/or high sodium intake has been suggested in preterm infants. To investigate the associations of early fluid and sodium intake or serum sodium concentrations with severe intraventricular hemorrhage (IVH) in extremely low birth weight (ELBW) infants, we reviewed the medical records of 169 inborn ELBW infants. Daily fluid and sodium intake, urine output, weight loss and serum sodium concentration during the first 4 days of life were obtained. Patients were divided into the severe IVH (grade 3/4) and the control (no or grade 1/2 IVH) group. The maximum serum sodium concentration and the incidence of hypernatremia did not differ between the two groups. Related to the fluid balance and sodium intake, the risk for severe IVH was strongly associated with total fluid and sodium intake during the initial four days of life. With respect to the fluids other than transfusion, severe IVH can be discriminated only by sodium intake but not by fluid intake. Large randomized controlled trials are required to clarify the causal relationship between the early sodium intake and severe IVH in ELBW infants.
Birth Weight ; Dehydration ; Drinking ; Heart Ventricles/*pathology ; Hemorrhage/mortality/*pathology ; Humans ; Hypernatremia/*blood ; Infant ; Infant Mortality ; Infant, Extremely Low Birth Weight/*blood ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/epidemiology ; Retrospective Studies ; Sodium/*blood ; Sodium, Dietary

Hypernatremic dehydration is an important cause of intracranial hemorrhage. A possible association of intraventricular hemorrhage (IVH) with hypernatremia and/or high sodium intake has been suggested in preterm infants. To investigate the associations of early fluid and sodium intake or serum sodium concentrations with severe intraventricular hemorrhage (IVH) in extremely low birth weight (ELBW) infants, we reviewed the medical records of 169 inborn ELBW infants. Daily fluid and sodium intake, urine output, weight loss and serum sodium concentration during the first 4 days of life were obtained. Patients were divided into the severe IVH (grade 3/4) and the control (no or grade 1/2 IVH) group. The maximum serum sodium concentration and the incidence of hypernatremia did not differ between the two groups. Related to the fluid balance and sodium intake, the risk for severe IVH was strongly associated with total fluid and sodium intake during the initial four days of life. With respect to the fluids other than transfusion, severe IVH can be discriminated only by sodium intake but not by fluid intake. Large randomized controlled trials are required to clarify the causal relationship between the early sodium intake and severe IVH in ELBW infants.
Birth Weight ; Dehydration ; Drinking ; Heart Ventricles/*pathology ; Hemorrhage/mortality/*pathology ; Humans ; Hypernatremia/*blood ; Infant ; Infant Mortality ; Infant, Extremely Low Birth Weight/*blood ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/epidemiology ; Retrospective Studies ; Sodium/*blood ; Sodium, Dietary

Acute atherosis is unique vascular changes of the placenta associated with poor placentation. It is characterized by subendothelial lipid-filled foam cells, fibrinoid necrosis of the arterial wall, perivascular lymphocytic infiltration, and it is histologically similar to early-stage atherosclerosis. Acute atherosis is rare in normal pregnancies, but is frequently observed in non- transformed spiral arteries in abnormal pregnancies, such as preeclampsia, small for gestational age (SGA), fetal death, spontaneous preterm labor and preterm premature rupture of membranes. In preeclampsia, spiral arteries fail to develop physiologic transformation and retain thick walls and a narrow lumen. Failure of physiologic transformation of spiral arteries is believed to be the main cause of uteroplacental ischemia, which can lead to the production of anti-angiogenic factors and induce endothelial dysfunction and eventually predispose the pregnancy to preeclampsia. Acute atherosis is more frequently observed in the spiral arteries of the decidua of the placenta (parietalis or basalis) than in the decidual or myometrial segments of the placental bed. The presence and deeper location of acute atherosis is associated with poorer pregnancy outcomes, more severe disease, earlier onset of preeclampsia, and a greater frequency of SGA neonates in patients with preeclampsia. Moreover, the idea that the presence of acute atherosis in the placenta may increase the risk of future cardiovascular disease in women with a history of preeclampsia is of growing concern. Therefore, placental examination is crucial for retrospective investigation of pregnancy complications and outcomes, and accurate placental pathology based on universal diagnostic criteria in patients with abnormal pregnancies is essential for clinicopathologic correlation.
Arteries* ; Atherosclerosis ; Cardiovascular Diseases ; Cholesterol ; Decidua ; Female ; Fetal Death ; Foam Cells ; Gestational Age ; Humans ; Infant, Newborn ; Ischemia ; Membranes ; Necrosis ; Obstetric Labor, Premature ; Pathology ; Placenta ; Placentation ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Retrospective Studies ; Rupture

OBJECTIVETo observe the dynamic changes of MRI in the preterm infants with punctate white matter damage (PWMD), and to explore the clinical significance of apparent diffusion coefficient (ADC) values by continuously measuring the lesions and surrounding region by applying diffusion weighted imaging (DWI).

METHODMRI, using conventional and diffusion weighted imaging, was performed in 151 preterm infants within 7 days after birth between October 2010 to June 2011 in NICU. Twenty-four preterm infants with PWMD and 24 controls were obtained according to their MRI results. The control group infants were those with normal MRI results and at the same gestational age as those with PWMDs. The ADC value was measured for the lesions and their surrounding regions, and for the same sites of the controls. All the PWMD were followed up for 2-5 weeks, and apparent diffusion coefficients were measured at the same regions. The variation of magnetic resonance imaging was observed and the apparent diffusion coefficients were compared.

RESULTThe first MRI scanning: in the 24 cases with PWMD, high signals on DWI were seen in all patients (100%), increased signal intensity on T1-weighted images were seen in 19 (79.2%) patients, increased signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images were seen in 4 (16.6%) patients. The second MRI scanning: in the 24 cases with PWMD, The high signal on DWI vanished in all patients (100%), the increased signal intensity on T1-weighted images vanished in 9 (39.1%) patients, the increased signal intensity on T1-weighted images did not vanish but was smaller than before in 14 (60.9%) patients. The measurement of ADC values: the mean ADC value of the lesions in the group of PWMD was (942 ± 170)×10(-3)mm(2)/s, significantly lower than the area surrounding (1 554 ± 116)×10(-3)mm(2)/s and the same area of the control group (1 524 ± 116)×10(-3)mm(2)/s ( P < 0.05). The second MRI scanning: the mean ADC of the lesions in the PWMD group was up to (1 468 ± 195)×10(-3)mm(2)/s, which is significantly higher than before, but still lower than the areas surrounding the lesion (1 586 ± 97)×10(-3)mm(2)/s (P < 0.05).

CONCLUSIONContinuous measurement of ADC values in the lesions and surrounding areas is important to describe the micro-change of PWMD.

Apnea ; diagnosis ; pathology ; Birth Weight ; Brain ; pathology ; Brain Diseases ; diagnosis ; pathology ; Case-Control Studies ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Image Enhancement ; methods ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; pathology ; Male

OBJECTIVETo investigate the early diagnosis with MRI changes, MRI types and short-term neurodevelopmental outcome of preterm infants with punctate white matter damage (PWMD).

METHODThere were 44 preterm infants with PWMD (group A) from March 2009 to August 2010 at the neonatal ward of Shengjing Hospital of China Medical University, according to the number, shape and distribution of the lesions, group A was divided into dot injury group (A1), clusters group (A2) and linear group (A3), the first MRI and DWI scan of all cases were within 14 days after birth, and 17 subjects received re-examination with the MRI in the hospital. Twenty preterm infants with normal MRI (group B) received the follow-up, according to the age, 20 normal full-term infants were selected (group C) as the control group using paired design. Mental development index (MDI) and psychomotor development index (PDI) were determined using Bayley scales of infant development-II.

RESULTFirst MRI scan:in 44 infants with PWMD, group A1, A2, A3 separately had, 10, and 9 infants. MRI follow up in 17 cases showed that in 4 cases of A1 group the dot lesions disappeared; in 3 of 4 cases in clusters group who received re-examination, the lesions disappeared, 1 case had periventricular leukomalacia (PVL); in 5 of the 9 cases who had re-examination in linear group the lesions disappeared, while in 4 cases the lesions evolved into PVL. MDI and PDI: Group A [MDI (102.9 ± 15.5) , PDI (107.7 ± 17.5) ] was lower than that of group B[MDI (114.0 ± 13.1) , PDI (120.8 ± 9.4) ], group C [MDI (114.2 ± 12.2) , PDI (119.5 ± 10.7) ] (P < 0.05) . There were no significant differences between group B and group C. Group A1 [MDI (112.2 ± 8.1) , PDI (116.4 ± 8.5) ] had no significant differences compared with group B and group C. Group A2 [MDI (100.8 ± 12.5) , PDI (105.0 ± 12.1) ] showed significantly reduced values compared with group B, Group C, Group A1 (P < 0.05) ,Group A3 [MDI (75.8 ± 11.6) , PDI (79.1 ± 16.2) ] had lower values than group B, Group C, Group A1, and Group A2 (P < 0.05) .

CONCLUSIONPremature infants with PWMD mainly showed dot-like and clustered injury that are easy to be absorbed and disappear, but the linear lesions are likely to evolve into PVL. In addition, the cluster-like and linear injury have an influence on short-term cognition and motion development, especially the outcome of linear injury was the worst.

Brain ; pathology ; Brain Damage, Chronic ; diagnosis ; pathology ; Child, Preschool ; Developmental Disabilities ; diagnosis ; etiology ; pathology ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Premature ; physiology ; Infant, Premature, Diseases ; diagnosis ; pathology ; Leukomalacia, Periventricular ; diagnosis ; pathology ; Magnetic Resonance Imaging ; Male ; Nervous System ; growth & development ; Neurologic Examination ; Retrospective Studies

OBJECTIVETo improve the understanding of recognizing and diagnosis of neonatal necrotizing enterocolitis (NEC), imaging assessment of neonates with NEC was analyzed retrospectively.

METHODData of 211 cases of NEC were retrospectively collected from the Department of Neonatology, Children's Hospital of Chongqing Medical University between Jan.1(st) 2006-Dec.31(st) 2011.

RESULTAnalysis of abdominal X-ray of 211 cases showed that there were 40 cases (19.0%) who had no changes on each X-ray, 47 cases (22.3%) had improvement and 23 cases (10.9%) became worse. In the group of no changes, positive rate with good prognosis was 97.5% and with poor prognosis, it was 2.5%. In the group of improvement, positive rate with good prognosis was 97.9%, and the contrary was 2.1%. Positive rate with good prognosis was 56.5%, and the contrary was 43.5% in worse group. Chi-square analysis of the three groups showed χ(2) = 31.742, P < 0.01. Comparison of detection rate of pneumoperitoneum on abdominal X-ray (16.0%, 12/75) and Doppler US (1.3%, 1/75), χ(2) = 10.191, P < 0.05, portal pneumatosis on abdominal X-ray(1.3%, 1/75) versus Doppler US (12.0%,9/75), χ(2) = 6.857, P < 0.05. Surgical timing mostly corresponded to pneumoperitoneum (OR = 19.543) and intestinal obstruction (OR = 19.527) of abdominal X-ray. The logistic regression equation is y = -2.915-1.588x1+2.972x4+2.973x7 + 1.711x9 (χ(2) = 101.705, P < 0.01).

CONCLUSIONAbdominal X-ray is the most important method of diagnosis of NEC, the group of deterioration of abdominal X-ray has obvious bad prognosis differ from no change group and better group. Comparison with abdominal X-ray and Doppler US, the former in pneumoperitoneum positive rate was higher than the latter, at the same time, portal pneumatosis on Doppler US is more sensitive to abdominal X-ray, the value of two imaging assessments both supplement each other. Surgical timing mostly corresponds to pneumoperitoneum and intestinal obstruction.

Abdomen ; diagnostic imaging ; surgery ; Birth Weight ; Enterocolitis, Necrotizing ; diagnosis ; pathology ; surgery ; Female ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; diagnosis ; pathology ; surgery ; Infant, Premature ; Intestinal Perforation ; diagnostic imaging ; surgery ; Logistic Models ; Male ; Pneumoperitoneum ; diagnosis ; diagnostic imaging ; Portal Vein ; diagnostic imaging ; pathology ; Predictive Value of Tests ; Prognosis ; Radiography, Abdominal ; Retrospective Studies ; Severity of Illness Index ; Ultrasonography, Doppler, Color