Necrotizing enterocolitis (NEC) is the most common and serious acute intestinal necrotizing disease in newborns, especially in preterm infants.Infants with smaller gestational age are more prone to NEC.NEC-related mortality reaches up to 20%-30%, and 25% of the survivors suffer from serious sequelae such as the short bowel syndrome, growth restriction and long-lasting neurological dysplasia.Due to the atypical symptoms, early diagnosis of NEC is difficult, and the patient′s condition has already been serious at the time of diagnosis in general.Ultrasound and abdominal X-ray are traditional tools for the diagnosis of NEC.Serum, urine and fecal biomarkers have been gradually applied to clinical practice in recent years.Through integrating traditional tests with biological markers and optimizing the clinical decision-making system for NEC, precise clinical diagnosis and individualized treatment can be achieved.

In recent years, the use of broad-spectrum antibiotics in clinical practice has led to an increase in the detection of Carbapenem-resistant Klebsiella pneumoniae(CrKP)in neonatal intensive care units.CrKP infection in newborns usually lacks specific clinical manifestations and can lead to bacteremia, meningitis and abdominal infections, which can be life-threatening.Combination of carbapenem antibiotics or newer drugs such as ceftazidime/avibactam, tigecycline and polymyxin are currently effective treatment options for CrKP infection in neonates.In addition to rational drug use, strict antimicrobial stewardship, hospital infection prevention and control measures are needed to reduce the colonisation and spread of CrKP in the neonatal ward.

Necrotizing enterocolitis(NEC)is a serious gastrointestinal disease in the neonatal period and one of the main causes of death in premature infants.In recent years, with the advancement of neonatal intensive care, the survival rate of children with NEC has been improved.However, the survivors are often accompanied by poor neurological prognoses, such as periventricular leukomalacia, intraventricular hemorrhage, neurodevelopmental disorders.The pathogenesis of NEC has not been fully elucidated.This review discusses the factors that may influence NEC related brain injury, such as hypoxia and ischemia, inflammatory response, nutrition, and brain-gut axis, in order to provide an overview on the pathogenesis of NEC.

Objective:To explore the expression of fructose bisphosphate aldolase A (ALDOA) in the bone marrow of patients with acute myeloid leukemia (AML) and the correlation with clinical features and prognosis.Methods:The bone marrow samples of 90 newly diagnosed AML (non-acute promyelocytic leukemia) patients and 18 allogeneic hematopoietic stem cell transplantation donors who were treated from January 2013 to December 2015 in the First Affiliated Hospital of Zhengzhou University and the Children's Hospital Affiliated to Zhengzhou University were collected. The relative expression level of ALDOA mRNA in bone marrow samples was detected by using real-time quantitative polymerase chain reaction (qRT-PCR). Clinical data of these patients were retrospectively analyzed, and the patients were divided into continuous complete remission (CR) group and refractory recurrent (RR) group according to the clinical response and follow-up results. The differences of the relative expression level of ALDOA mRNA between AML group and the normal control group, CR group and RR group were analyzed. Univariate and multivariate Cox regression risk model were used for analysis of factors influencing prognosis of AML patients.Results:The relative expression level of ALDOA mRNA in AML group was higher than that in normal control group [(5.71±0.44) vs. (1.10±0.08), t = 4.74, P<0.001]. The relative expression level of ALDOA mRNA in the RR group was higher than that in the CR group [(6.69±0.67) vs. (4.30±0.36) , t = 2.79, P < 0.001]. In addition, there were statistically significant differences in the proportion of patients with ALDOA mRNA high expression and those with ALDOA mRNA low expression stratified by the number of white blood cell, the proportion of bone marrow blasts and whether complete remission could be achieved or not after 1 course of induction therapy (all P < 0.05). Overall survival in patients with ALDOA high expression was worse than that in patients with ALDOA low expression ( χ2 = 5.59, P = 0.018). Multivariate analysis showed that white blood cell count, prognosis stratification, whether complete remission could be achieved or not after 1 course of induction therapy and ALDOA expression were the independent prognostic factors for the death of AML patients (all P < 0.05). Conclusions:ALDOA may play an important role in the development and progression of AML, and the expression level of ALDOA in the bone marrow can be used as an index for the prognosis assessment of AML patients and may be a potential therapeutic target for AML.

Necrotizing enterocolitis(NEC)is an acute inflammatory disease of the intestine which is related to gut dysbiosis.Gut microbiota of NEC patients in meconium or feces are different from those of healthy infants.Although the pathogenic bacteria and metabolites of NEC have not been specified, short-chain fatty acids, lithocholic acid and tryptophan derived metabolites may play protective or aggravating roles in NEC.Probiotics and fecal microbiota transplantation that target on gut microbiota may optimize the composition of gut microbiota and thereby decrease the incidence of NEC.Besides, the early diagnosis of NEC is challenging due to its unspecific presentations.Once diagnosed, it is often severe.More research about disease biomarkers based on gut microbiota is needed.

As a critical bowel disease in neonates and preterm births, neonatal necrotizing enterocolitis(NEC)is hard to diagnose and treat in time, leaving bad outcomes.With the development of perinatal medicine, the survival rate of premature infants has gradually increased.NEC has become a major digestive system disease that seriously affects the morbidity and compromised life quality of premature infants.Abdominal ultrasound examination has been widely used in the early diagnosis, treatment guidance and outcome assessment of NEC.It is non-invasive and in real time, with high sensitivity and specificity.This review summarizes recent progress on the application of abdominal sonography in the prediction, diagnosis, assessment and treatment guidance of NEC.

Intravenous immunoglobulin(IVIG) contains multiple-antigen-specific IgGs and may protect the host from a wide spectrum of pathogens including but not limited to virus and bacteria.With a low IgG level, neonates, especially preterm infants are prone to infection.IVIG can rapidly increase the concentration of serum IgG level, and enhance the anti-infectious and immune-regulatory functions.It has been widely used as a common treatment against neonatal infections.However, there has been inadequate evidence to support the routine usage of IVIG.While prolonged IVIG usage may be beneficial to the extremely or very low birth weight with sepsis, the prophylactic usage of IVIG to decrease the risk of late-onset sepsis in preterm infants depends on the situation of nosocomial infections in different NICUs and the cost-effect efficiency.

Ureaplasma urealyticum (UU) is an opportunistic pathogenic microorganism, widely colonized in the reproductive tract of women in childbearing age, and can cause fetal infection through vertical transmission.UU infections in neonates can cause damages to multiple systems, such as pneumonia, bronchopulmonary dysplasia, necroti-zing enterocolitis, intracranial hemorrhage, meningitis, and retinopathy of prematurity.Therefore, it is of important signi-ficance to avoid serious consequences in the neonatal period and improve long-term adverse outcomes by understan-ding the biological characteristics and epidemiological characteristics of UU and the neonatal diseases associated with UU infections, attaching great importance to the early screening and early intervention of UU infections and grasping the optimal treatment opportunity.

Objective:To compare the head magnetic resonance imaging (MRI) changes and the distribution of pathogens of purulent meningitis in premature and full term infants.Methods:This retrospective study assessed clinical data in 43 cases of neonatal purulent meningitis with positive blood or cerebrospinal fluid bacterial culture admitted to the Neonatal Ward of Shengjing Hospital of China Medical University from January 2012 to November 2019.According to the gestational age, those patients were divided into the premature infant group and the full term infant group.The general situation, head MRI and pathogen characteristics of both groups were compared.Results:The incidence of premature rupture of fetal membranes in the premature infant group was higher than that in the full term infant group [50.00%(13/26 cases) vs.5.88%(1/17 cases)], the rate of cesarean section in the premature infant group was higher than that in the term infant group [61.54%(16/26 cases) vs.23.53%(4/17 cases)], and there were significant difference between the 2 groups ( χ2=9.011 and 5.969, respectively, all P<0.05). There was no significant difference between 2 groups in age of onset [(9.8±7.0) d vs.(8.9±5.5) d], diagnosis[(13.0±7.1) d vs.(10.2±6.1) d] and examination [(16.1±7.9) d vs.(13.1±6.5) d] (all P>0.05). The top 3 pathogens were Klebsiella pneumonia ( K. pneumoniae) in 14 cases, Escherichia coli ( E. coli) in 11 cases and Streptococcus agalactiae (GBS) in 7 cases. K. pneumoniae was the most common pathogen in premature infants, and GBS was the most common pathogen in term infants.In the first MRI, white matter injury (WMI) was the most common disease (19 cases), the abnormal rate of MRI in the premature infant group was 65.38% (17/26 cases), the incidence of intracranial hemorrhage in the premature infant group was higher than that in the term infant group, the abnormal rate of MRI in the term infant group was 52.94% (9/17 cases), and the incidence of cerebral infarction in the term infant group was higher than that in the premature infant group.The MRI positive rates of meningitis caused by K. pneumoniae, E. coli and GBS were 57.14% (8/14 cases), 72.73% (8/11 cases) and 71.43% (5/7 cases), respectively.Infants with K. pneumoniae infections suffered from the main complications of WMI and intracranial hemorrhage.Infants infected with E. coli were prone to WMI in the early stage and hydrocephalus in the late stage.Infants with GBS were prone to WMI and cerebral infarction in the early stage and cerebromalacia in the late stage. Conclusions:There were some differences in the distribution of pathogenic bacteria and head MRI changes between premature infants and term infants, and head MRI of purulent meningitis caused by different pathogenic bacteria.A thorough understanding of the distribution of pathogens and the characteristics of head MRI in premature and full term infants contributed to the early diagnosis, treatment and prognosis of this disease.

Objective To investigate the association between serum 25(OH) D levels and the inci-dence of early-onset sepsis(EOS) in the very low birth weight infants(VLBWI) and the gestational age be-low 34 weeks. Methods The cord blood of 159 VLBWI were collected between January and December 2017,including 31 clinically diagnosed EOS and 128 non-EOS patients. Serum 25(OH)D<10 ng/ml was de-fined as severe vitamin D deficiency,25(OH)D 10 to 20 ng/ml as vitamin D deficiency,25(OH)D 20 to 30 ng/ml as vitamin D insufficiency and 25(OH)D >30 ng/ml as vitamin D sufficiency. Results There were no differences in gender,gestational age,birth weight and Apgar score between the EOS group and the non-EOS group(P>0. 05). Serum 25(OH) D was(9. 08 ± 4. 21) ng/ml in the EOS group and(11. 91 ± 5. 37) ng/ml in the non-EOS group(P＝0. 007). The rate of severe vitamin D deficiency was 67. 7%(21/31)in the EOS group and 41. 4%(53/128) in the non-EOS group. The rate of vitamin D deficiency was 32. 3%(10/31)in the EOS group and 52. 3%(67/128)in the non-EOS group. But there was no difference of vitamin D deficiency distribution in the two groups(P＝0. 152). The cut-off value of serum 25(OH)D level in predic-ting EOS was 10. 06 ng/ml. Conclusion The incidence of vitamin D deficiency is as high as 95%,calling for urgent attention on vitamin D supplementation in those VLBWI. Low 25(OH)D level( <10 ng/ml)might be predictive of EOS.