The Chinese Neonatal Network(CHNN) was established in 2018 with the mission of establishing a national collaboration platform, conducting high-quality and collaborative research, and ultimately improving the quality of neonatal-perinatal care and health in China.At present, 112 hospitals across the country have joined CHNN.CHNN has established a national standardized cohort of very premature infants/very low birth weight infants with >10 000 enrollments each year, has been leading data-driven collaborative quality improvement initiatives, conducting multicenter clinical studies, and performing multi-level training programs.Guided by the principles of collaboration and sharing, data-driven, continuous improvement, and international integration, CHNN has become an important platform for clinical and research collaboration in neonatal medicine in China.

Objective: To examine the outcomes of surgical treatment in patients of type Stanford A aortic dissection with Kommerell′s diverticulum. Methods: From January 2009 to August 2017, patients of type Stanford A aortic dissection with Kommerell′s diverticulum who underwent the Sun procedure were enrolled. Patient demographic, preoperative, intraoperative, early morbidity and mortality data were collected from medical and electronic patient records. Clinical follow-up data, including late morbidity and mortality, were obtained by telephone interview with the patient. Results: A total of 13 patients (11 males and 2 females; mean age 47 years) were included. The mean maximum diameter of Kommerell′s diverticulum was (21.8±7.7) mm. The Kommerell′s diverticulum was repaired by direct suture of the orifice in 3 patients, ligation of the aberrant right subclavian artery in 9 patients, and suture and ligation in 1 patient, respectively. No perioperative death occurred. One patient underwent a reexploration for bleeding. There were 2 late deaths: unknown reason in 1 patient and septic shock secondary to renal abscess in 1 patient. Reintervention was performed in one patient for a persistent type Ⅱ endoleak. Conclusions The Sun procedure with femoral artery cannulation for cardiopulmonary bypass, unilateral carotid artery cannulation for selective cerebral perfusion and ligation of aberrant right subclavian artery on the right side of the trachea is an appropriate therapeutic strategy for patients of type Stanford A aortic dissection with Kommerell′s diverticulum.

Enterovirus is a common cause of neonatal virus infection, which is primarily transmitted by fecal-oral and respiratory routes and can cause nosocomial infection and outbreak in nursery or neonatal intensive care unit.Most infants with enterovirus infection are asymptomatic or just have mild self-limiting symptoms.Severe infection is less common but with significantly increased mortality, and may be complicated by the encephalitis/meningoencephalitis, myocarditis and/or hepatitis.Early recognition and prompt isolation of infants with enterovirus infection are important strategies for nosocomial infection control.

Objective:To investigate the expression and significance of T helper cell 17 (Th17), soluble intercellular adhesion molecule-1 (sICAM-1) and coagulation function in patients with infectious endocarditis(IE).Methods:From December 2016 to December 2018, IE patients in Beijing Anzhen Hospital Affiliated to Capital Medical University who met the inclusion criteria were selected for cardiac surgery to analyze prospectively, 38 IE patients were selected as the observation group, and 30 healthy people were selected as the control group.The concentrations of serum Th17 related factors (IL-1β, IL-6, IL-17 and IL-21), sICAM-1 and coagulation index(P selectin(sP-SLT)) were measured by enzyme-linked immunosorbent assay(ELISA) and the difference between the two groups were statistically analyzed.Results:The concentrations of serum IL-1β, IL-6, IL-17 and IL-21((29.88±6.49), (14.89±3.31), (21.89±3.01), (563.26±67.36) ng/L) in the observation group were significantly higher than those in the control group((16.56±4.11), (7.52±2.34), (12.91±1.01), (423.38±56.49) ng/L)(all P<0.05). The level of serum sICAM-1 and sP-SLT ((1 247.57(581.39, 1 794.66) μg/L, (60.29±6.61) mg/L)in the observation group were significantly higher than those in the control group((837.28(405.68, 954.47) μg/L, (27.37±5.56) mg/L), and the difference was statistically significant( Z=12.37, t=22.30, all P<0.05). The level of serum IL-1β, IL-6, IL-17 and IL-21 in patients with postoperative infective endocarditis((16.19±4.07), (7.73±2.40), (13.83±0.94), (425.33±52.12) ng/L) were significantly lower than those before operation((29.88±6.49), (14.89±2.31), (21.89±3.01), (563.26±67.36) ng/L), and the differences were statistically significant(t values were 11.02, 13.25, 15.76, 9.98, all P<0.05). The levels of sICAM-1 and sP-SLT1 in patients with postoperative infective endocarditis((901.46(472.15, 1276.58) μg/L, (30.70±5.31) mg/L) were significantly lower than those before operation((1 057.26±463.06) μg/L, (60.29±6.61) mg/L)and the differences were statistically significant( Z=11.16, t=21.51, P<0.05). Conclusion:Th17 related factors, sICAM-1 and sP-SLT were highly expressed in IE patients, and the concentrations of these factors decreased after operation, suggesting that the above factors may be used as related factors for the diagnosis and prognosis of IE patients.

Objective:To compare the clinical diagnosis and outcomes of preterm infants with bronchopulmonary dysplasia (BPD) under two different diagnostic criteria.Methods:A retrospective study was performed in 157 preterm infants who were admitted to Neonatal Intensive Care Unit of the Children′s Hospital, Zhejiang University School of Medicine from January 2015 to December 2018. Enrolled infants, with gestational age <32 weeks and survived >14 days, met the 2001 National Institute of Child Health and Human Development(NICHD) definition of moderate and severe BPD or died between 14 days of postnatal age and 36 weeks owing to persistent parenchymal lung disease and respiratory failure. The severities of BPD were revaluated according to the 2018 revised definition of BPD proposed by NICHD. Characteristics and outcomes of these infants were compared with the two different diagnostic criteria with t-test, nonparametric test or Chi-square test. Results:In the 157 enrolled infants (100 males), severities of BPD were classified as moderate in 62, severe in 84 and unclassifiable in 11 according to the 2001 NICHD criteria, while grade Ⅰ in 51, Ⅱ in 29, Ⅲ in 66 and ⅢA in 11 infants respectively according to the 2018 NICHD criteria. Duration of oxygen therapy, positive pressure ventilation and endotracheal intubation in grade Ⅱinfants of 2018 criteria were much longer than that in moderate infants of 2001 criteria (80 (65, 95) vs. 65 (59, 77) d, 52 (38, 58) vs.30 (19, 48) d, 10 (2, 17) vs.4 (0, 12) d, Z=-2.995, -3.750, -2.073, all P<0.05). Mortality of moderate and severe infants in 2001 criteria was 10.3% (15/146), while mortality of BPD in 2018 criteria was 16.6% (26/157). Mortality of grade Ⅲ and ⅢA BPD in 2018 criteria was much higher than mortality of severe BPD in 2001 criteria (33.8% (26/77) vs. 17.9%(15/84), χ 2=5.357, P<0.05). Conclusion:Definition and classification of BPD based on 2001 NICHD criteria may cause missed or unclassified cases, resulting in the underestimation of the morbidity and mortality of infants with severe BPD.

Objective To investigate the correlation between serum homocysteine(Hcy)level and left ventricular geometric patterns in essential hypertensive patients.Methods Three hundred and sixteen patients with essential hypertension attending in Shanxi Dayi Hospital from January 2013 to June 2016 were enrolled in the study.Serum Hcy levels were measured and echocardiography was performed to measure left ventricular mass index (LVMI)and relative wall thickness(RWT).According to Hcy level patients were divided into H type hypertension group(Hcy≥10 μmol/L,group A)and non-H type hypertension group(Hcy<10 μmol/L, group B).The correlation of Hcy level with RWT and LVMI was analyzed.Results The percentages of concentric remodeling and concentric hypertrophy in group A were higher than those in group B(30.7% vs.25.3% and 24.7%vs.18.7%,χ2=3.342 and 3.894, P=0.033 and 0.025).Hcy level was positively correlated with RWT and LVMI(r=0.819 and 0.725,P=0.005 and 0.008).Conclusion Serum Hcy level is associated with left ventricular geometry in patients with essential hypertension.

Objective Stanford type A aortic dissection(TAAD) involving aortic arch in following prior Bentall procedure in patients with Madfan syndrome(MFS) is uncommon.The purpose of the study was to assess the early and long-term outcomes of this kind of patients underwent total arch replacement and frozen elephant trunk (TAR + FET).Methods Between February 2009 and February 2016,141 patients with Marfan syndrome(confirmed by revised Ghent Criteria) underwent TAR + FET for TAAD,of those 11 (7.8 ％) patients (8 acute) following a prior Bentall procedure and without dissection in distal aorta.Mean age at FET was(43.2 ± 8.6) years and 10 were males.Hypertension was seen in 4 (36.4％) and family history was seen in 7 (63.6％).The interval from Bentall procedure to FET averaged (11.3 ± 5.8) years.Two groups were segregated by the maximal diameter of descending aorta more than 40 mm or not.The early and long-term outcomes were analyzed and risk factors identified for late adverse events.Results Operative mortality was 27.3 ％ (3/11).No spinal cord injury occurred.The cause of death was long time of surgery,multiorgan failure,stroke and cerebral hemorrhage and rupture of distal aorta.Follow-up was complete in 100％,averaging(5.3-± 2.0)years(range 2.1-8.1 years).Obliteration of the false lumen was seen in 100％ across the proximal FET and 75.0％ in the unstented descending aorta.Distal aortic dilation occurred in 3 patients which were waiting open thoracoabdominal aortic repair(TAAAR) but no reoperation yet.Of those 8 patients,2 died of non-cardiac reason.The DMax of FET segment has significant grow in DA more than 40ram group than less than 40mm group (P =0.01).Another segment of distal aorta has no significant different.Survival were 81.8％,72.7％ and 63.6％ at 1 month,1 year and 6 years after surgery.Conclusion Using Sun's procedure for Marfan patients for type A aortic dissection involving aortic arch following previous Bentall procedure was safe and technically feasible with good long-term outcomes,but higher early death.The DMax of descending aorta more than 40mm was at higher risk for early death,late distal aortic dilation,and reoperation.

Objective: To evaluate the effectiveness and safety of the use of noninvasive high-frequency oscillation ventilation (nHFOV) in very low birth weight infants. Method: A total of 36 cases received nHFOV between January 2016 and October 2016 in Children′s Hospital, Zhejiang University School of Medicine, including 24 males and 12 females, with the gestational age of (27.5±2.5) weeks and birth weight of(980±318)g. The data of the ventilator settings, side effects, and changes of the respiratory function before and after nHFOV were collected and analyzed retrospectively. Nonparametric tests or t tests or χ² tests were used. Result: Thirty-two (89%) out of the 36 cases successfully avoided intubation or re-intubation after using of nHFOV. nHFOV was used as the rescue treatment after failure of other noninvasive ventilation in 17 cases, and as the prophylactical treatment preventing re-intubation after extubation in the remaining 19 cases. There were significant decreases in the incidences of apnea and desaturation(SpO₂<0.85), the level of PaCO₂, and the FiO₂ 24 h after the initiation of the nHFOV as the rescue therapy((1.2±1.1)vs.(6.3±2.1)episodes , (1.1±1.2) vs.(4.3±1.5) episodes, (43±8) vs.(56±10) mmHg, 0.30±0.07 vs. 0.39±0.11, respectively; 1 mmHg=0.133 kPa, t=7.562, 8.913, 4.179, 3.437 respectively, all P<0.01). No significant changes were found in FiO₂ and PaCO₂ levels 24 h after initiation of nHFOV as the prophylactical therapy after extubation (0.42±0.12 vs.0.40±0.10, (49±8)vs.(48±7)mmHg, t=0.872 and 0.501 respectively, both P>0.05), except for the significant decreases in the mean airway pressure ((7.9±2.6)vs.(9.6±1.6)cmH₂O, 1 cmH₂0=0.098 kPa, t=2.198, P=0.041). There were 4 cases suffered from nasal septum injury, while no other nHFOV related complications were noted. Conclusion nHFOV can be applied in preterm infants as a rescue treatment after the failure of other noninvasive ventilation, or prophylactically used in patients who have high risk of re-intubation.

Objective This study aims to analyze midterm survival and to assess the midterm mortality following acute kidney failure (AKF) of patients undergoing surgical treatment of acute type A aortic dissection.Methods Clinical data of the patients who underwent Sun's procedure from February 2009 to March 2015 were collected.Patients with preoperative dialysis were excluded.Data including preoperative cardiovascular diseases,serum creatinine leve1 and CPB time were gathered.The patients were divided into the group of AKF and the group of non-AKF accounting to require dialysis.The group of AKF was follow-up by phone.Midterm mortality was studied with Cox analysis and midterm survival was estimated by Kaplan-Meier analysis.Results 524 patients underwent aortic surgeries which AKF was occurred in 51 (51/524,9.7％) patients.Hospital mortality was 23.5％ (12/51) in AKF group which seven death were strokes,three death were lower-extremity ischemia and two death were low cardio output.There were 2 patients dead with multi organ failure and paraplegia in first year.One reoperation patient because of anastomotic fistula was dead in fifth year.Only diabetes was independently associated with midterm mortality.Midterm survival for patients with AKF was 56％ during a median follow-up of 30.5 months.Survival was equal between the subgroups of Cr ＞ 200 mol/L and Cr ＜ 200 mol/L(P =0.741).Conclusion AKF after acute aortic dissection was a severe complication and the incidence was 9.7％.In patients with AKF,diabetes was associated with increased mortality across follow-up.Five years survival was 56％ not effected by preoperative Cr.

Objective Continued debates exist regarding optimal surgical approach to acute type A aortic dissection (ATAAD).This study aims to report the early and mid-to long-term outcomes of frozen elephant trunk and total arch replacement (FET + TAR) technique in patients with ATAAD involving the arch and descending aorta.Methods Between April 2003 and September 2012,we performed FET + TAR (the Sun procedure) for 456 patients with ATAAD (376 males,82.5％) at mean (5.0±3.8) days from symptom onset (median 4 days,range 4 hours to 14 days).Mean age was (46 ± 10) years.Concomitant root or valve provcedures were performed in 221 patients (48.5 ％).The outcomes were compared between patients with and without root procedures and risk factors for adverse events identified using multivariate analysis.Results Operative mortality was 8.1％ (37/456).Stroke occurred in 13 eases (2.8％),spinal cord injury in 11 (2.4％),acute renal failure in 18 (3.0％) and reexploration for bleeding in 10 (2.2％).Risk factors for operative mortality were preoperative malperfusion of the brain (odds ratio,OR 7.463,P =0.002) and spinal cord (OR 45.325,P =0.003) and time (min) of cardiopulmonary bypass (OR 1.014,P ＜0.001).Follow-up was complete in 97.6％ (409/419) averaging (5.7 ±2.4) years (range 0.2-12.0).Late death occurred in 32 patients and reoperation in 23.At 5,8 and 10 years,survival 87.7％,83.1％ and 70.5％,and freedom from reoperation was 94.8％,89.3％ and 84.3％,respectively,which did not differ with root procedure and acuity.Postoperative stroke was risk factor for late death (OR 14.452,P =0.014).The time from diagnosis to surgery (days) was risk factor for reoperation (OR 1.188,P =0.024).Patients with concomitant root procedure showed a significant trend towards lower late mortality (OR 0.377,P =0.021) and increased reoperation risk (OR 2.663,P =0.037).Competing risks analysis showed that at 3,5,8 and 10 years,mortality was 2％,5％,10％ and 23％,reoperation was 3％,5％,8％ and 10％,and reoperation-free survival was 95％,90％,82％ and 67％,respectively.Conclusion In this large series of patients with ATAAD,FET + TAR has achieved lower early mortality and morbidity and favorable late survival and freedom from reoperation.A concomitant root procedure could significantly reduce long-term survival without increasing risk for operative mortality.