Objective To investigate the risk factors and clinical characteristics of asphyxia-related acute kidney injury (AKI) in neonates. Methods A retrospective analysis was conducted on the clinical data of neonates with asphyxia-related AKI (AKI group, n=100) and asphyxia withont AKI neonates (control group, n=228) admitted to the neonatal intensive care unit (NICU) of the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2023. Laboratory indicators and clinical data from both groups were collected to analyze the risk factors and clinical characteristics of asphyxia-related AKI in neonates. Results Statistically significant differences were observed in levels of lactate, base excess (BE), serum potassium, serum creatinine, and urea nitrogen between the AKI and control groups (P < 0.05). Multivariate Logistic regression analysis revealed that low 5-minute Apgar score, high lactate level, and hyperglycemia were independent risk factors for asphyxia-related AKI in neonates. The areas under the curve (AUCs) for the 5-minute Apgar score, lactate, and blood glucose in predicting AKI were 0.825(95%CI, 0.767 to 0.882), 0.968(95%CI, 0.942 to 0.993), and 0.845(95%CI, 0.795 to 0.894), respectively. The incidence of maternal hypertension during pregnancy also showed a significant difference between the two groups (P < 0.05). Significant differences were also noted in 1-minute and 5-minute Apgar scores, as well as the incidence of intrauterine distress between the AKI and control groups (P < 0.05). Furthermore, the AKI group exhibited statistically significant differences in respiratory distress syndrome (RDS), respiratory failure, necrotizing enterocolitis (NEC), severe intracranial hemorrhage, pulmonary hemorrhage, use of diuretics, and blood purification etc. compared to the control group (P < 0.05). There were 24 deaths in the AKI group, with 16 cases in AKI stage 3 and 8 cases in AKI stage 2, while only 3 deaths occurred in the control group. The difference in mortality rate between the two groups was statistically significant (P < 0.05). Conclusion Low 5-minute Apgar score, high lactate levels, and hyperglycemia are independent risk factors for AKI in neonates. Neonates with AKI are prone to developing multi-organ dysfunction, and asphyxia-related AKI can increase mortality rates. Therefore, comprehensive prevention and treatment measures are crucial.

Objective:To study the clinical application of ultrasound-guided puncture and catheter tip positioning in peripherally inserted central catheter (PICC) among very/extremely low birth weight infants (VLBWI/ELBWI).Method:From January 2019 to August 2020, VLBWI/ELBWI admitted to NICU of our hospital and received PICC were prospectively enrolled in the study. Based on the last digit of medical record number was odd or even, the infants were assigned into ultrasound group and X-ray group. In the ultrasound group, puncture and catheter tip positioning were performed at bedside guided by ultrasound, while in the X-ray group, these procedures were performed empirically. The differences of catheterization procedure duration, first-time success rate, the visibility of catheter tip, primary dislocation rate, secondary dislocation rate and complication rate were compared between the two groups using SPSS 25.0.Result:A total of 118 premature infants were enrolled, including 57 cases in ultrasound group (50 cases VLBWI and 7 cases ELBWI) and 61 cases in X-ray group (54 cases VLBWI and 7 cases ELBWI). The catheterization procedure duration [(23.2±7.1) min vs. (34.1±7.5) min], first-time success rate (93.0% vs. 65.6%), the visibility of catheter tip (96.5% vs. 83.6%), primary dislocation rate (7.0% vs. 24.6%) and complication rate (7.0% vs. 21.3%) in ultrasound group were all better than X-ray group ( P<0.05). For ELBWI, the above five indexes in the ultrasound group were better than the X-ray subgroup ( P<0.05). For VLBWI, only the catheterization procedure duration and first-time success rate were better in the ultrasound group than the X-ray group ( P<0.05). Conclusion:Ultrasound-guided PICC catheterization in VLBWI/ELBWI is convenient and accurate, which can improve success rate, reduce radiation exposure and repeated catheterization injury. Timely tracking and adjustment of the catheter under ultrasound can reduce complications after catheterization. This technique is worth popularizing among VLBWI/ELBWI.

Objective:To investigate the dynamic changes of thyroid function and risk factors of hypothyroidism and delayed thyroid stimulating hormone (TSH) elevation in late preterm infants.Methods:This study retrospectively recruited 782 late preterm infants admitted to Nanjing Medical University First Affiliated Hospital and performed thyroid function monitoring from January 2017 and December 2019. Thyroid function test was performed in all cases at 4-7 d after birth and repeated at 2-4 weeks of age for those with normal results or two weeks after the first test for those with abnormal. The test would be continued if the second test was abnormal and stopped until the thyroid function became normal or hypothyroidism was diagnosed, based on which, these infants were divided into hypothyroidism ( n=11) and non-hypothyroidism groups ( n=771), or delayed TSH elevation ( n=71) and normal thyroid function groups ( n=450). The characteristics of thyroid hormone changes and perinatal data were compared between different groups using two independent sample t-test and Chi-square test, and risk factors of hypothyroidism and delayed TSH elevation were analyzed using logistic regression tests. Results:(1) Dynamic changes of thyroid function: among these 782 late preterm infants, five infants were found with transient hypothyroxinemia at the first test, and became normal at the second test; 249 (31.8%) exhibited hyperthyrotropinemia, and four of them were diagnosed with hypothyroidism based on the second and the third results; 71(9.1%) with delayed TSH elevation all became normal later; 11(1.4%) were diagnosed with hypothyroidism and treated with thyroxine, among which, seven cases were diagnosed at the first test, three at the second test and one at the third test. (2) Risk factors for hypothyroidism: lower birth weight was noted for infants with hypothyroidism compared with those without [(2 140.9±455.1) vs (2 464.1±474.0) g, t=-2.247, P=0.025]. Multivariate logistic regression analysis found that for every one gram reduction in birth weight, the risk of hypothyroidism elevated by 0.002 times ( OR=1.002, 95% CI: 1.000-1.004, P=0.045). (3) Risk factors for delayed TSH elevation: the birth weight was lower [(2 395.4±420.9) vs (2 523.6±462.3) g, t=-2.200, P=0.028], and the proportion of small for gestational age and twin pregnancy were higher in the delayed TSH elevation group than those in the normal thyroid function group [15.5% (11/71) vs 7.1% (32/450), χ2=5.690, P=0.017; 29.6% (21/71) vs 18.7% (84/450), χ2=4.537, P=0.033]. Multivariate logistic regression analysis found that small for gestational age ( OR=4.366, 95% CI: 1.649-11.564, P=0.003) and twin pregnancy ( OR=1.943, 95% CI: 1.048-3.600, P=0.035) were independent risk factors for delayed TSH elevation. Conclusions:Late preterm infants have a high incidence of different kinds of thyroid dysfunction. Thyroid function monitoring is necessary for late preterm infants because those with lower birth weight are more susceptible to develop hypothyroidism, and those small for gestational age infants and twins are more susceptible to develop delayed TSH elevation.

We report a case of a 2 200 g premature male baby born through cesarean section under maternal endotracheal intubation mechanical ventilation combined with extracorporeal membrane oxygenation at 34 +1 gestational weeks, while his mother was infected with influenza A in late pregnancy. Due to neonatal pneumonia, neonatal respiratory distress syndrome, prematurity, and low birth weight, the neonate was transferred to the neonatal intensive care unit for body temperature maintenance, respiratory support, maintenance of perfusion and internal environment, and nutritional management. The infant was discharged 17 days after birth and was well at six-month-old follow-up. His mother was discharged at 20 days post-delivery.

Objective:To improve the quality of Yangxueyufa granules and establish the quality standard. Methods:A TLC method was used for the qualitative identification of Radix Polygoni Multiflori,Fruetus Lyeii,Radix Rehmanniae,Radix Salviae Miltiorrhizae and Fruetus Ligustri Lucidui. Moreover,peoniflorin was determined by HPLC. Results:The TLC spots were clear with highly specificity. The linear relationship of peoniflorin content was good within the range of 14. 3- 286. 0μg·ml-1(r =0. 999 4),and the average recovery was 96. 61%(RSD = 0. 86% ,n = 9). Conclusion:The method is simple,accurate and reliable with good reproducibility,which can be used for the quality control of Yangxueyufa granule.

Objective Former standards for Yishen Pills only identify angelica root , astragalus root and ligustrum lucidum by thin layer chromatography ( TLC) and there is no test for the content of effective components .The study was to improve the quality of Yishen Pills by perfecting the quality standards . Methods We determined the content of specnuezhenide in Yishen Pills by high-per-formance liquid chromatography(HPLC), with a mobile phase of MeOH-Water, a chromatography column of Agilent TC-C18(2) (4.6 × 250 mm, 5μm), a flow rate of 1.0 mL/min, a column temperature of 25℃, a detection wavelength of 224 nm, and a sample loop volume of 10μL. Results The linear relationship of specnuezhenide content was good in the range of 15.375μg/mL~246.000μg/mL.The relative standard deviation of precision experiment , stablity experiment and repeatablity experiment was 0.44%, 0.95%and 2.65%re-spectively.The average recovery was 99.60%.The qualified standard for specnuezhenide in Yishen Pills was ≥0.3 mg/g. Conclusion The method is simple , accurate and reliable , with good reproducibility , and it is applicable for the quality control of Yishen Pills .

Objective To evaluate the relative efficacy of different dosages of Calf Pulmonary Surfactant (Calsurf) administration in premature infants with established respiratory distress syndrome (NRDS).Methods Four neonatal intensive care units in Jiangsu province were enrolled.Premature infants,birth weight ＜ 2 500 g,with NRDS,received 70 mg/kg (61 cases)or 100 mg/kg (69 cases)Calsurf.Clinical and respiratory parameters were recorded.The primary outcome measures were blood gas analysis of 1 h,12 h and 36 h after administration,the need for oxygenation and ventilatory requirements and the adverse events of NRDS.Results Arterial oxygen tension[pa (O2)] results in a significant improvement(80.27-±36.81) mmHg,(73.03 ±24.94) mmHg and (72.35 ± 24.72) mmHg at 1 h,12 h and 24 h in higher dose group(P ＜ 0.05),(67.95 ± 23.79) mmHg,(72.35 ± 24.72) mmHg in 24 h,as compared with the lower dose group at the same time [(67.07 ± 19.94) mmHg,(62.93 ± 21.71) mmHg,(67.95 ±-23.79) mmHg] (P ＞ 0.05).Inspired oxygen (FiO2) and pa (O2) decreased after administration in two groups and the duration of FiO2 decline lasted to 48 h (all P ＜ 0.05).The oxygen index (OI) was improved after Calsurf administration,especially in the infants who received 100 mg/kg of Calsurf with 6.1 ± 2.8,5.6 ± 3.3,5.5 ± 3.5,5.8 ± 4.5,5.3 ± 3.1 in 1 h,12 h,24 h,36 h,48 h,respectively(P ＜ 0.01).The arterial-to-alveolar oxygen tension ratio (a/APO2) of 100 mg/kg group was reduced significantly in 1 h,12 h,24 h,36 h,48 h with 0.39 ±0.22,0.42 ±0.20,0.45 ± 0.22,0.44 ± 0.22,0.46 ± 0.21 as compared with 0.27 ± 0.18 which was at the time point before administration (P ＜ 0.01).Although not statistically significant,the mean time of duration of mechanical ventilation and oxygen inhalation of higher dose group were decreased as compared to the lower dose group [(94.54 ± 113.44) h vs (109.27 ± 124.87) h (P＞0.05) and (259.10 ±280.45) vs (372.31 ±398.08) h(P ＞0.05)].There were no significant differences in the rates of other adverse events such as pneumonia,pneumothorax,intracranial hemorrhage,patent ductus arteriosus (PDA),pneumorrhagia,necrotizing enterocolitis,septicemia between two groups (P ＞ 0.05).Conclusions Calsurf given to preterm infants with NRDS at a dose of 100 mg/kg resulted in a higher Pa (O2),a/APO2,better OI and lower FiO2 as compared with those receiving 70 mg/kg.The need for mechanical ventilation and oxygen supplement were reduced with higher-dose administration.Large dose of Calsurf did not increase the risk of complications as mentioned above.

Objective To study the baseline level of fraction anisotropy (FA) and the normal value of apparent diffusion coefficient (ADC) in deep white matter of preterm and its application.Methods From Oct.2010 to Dec.2013,in Department of Neonatology,Jiangsu Province Hospital,magnetic resonance imaging (MRI) (T1,T2) and diffusion tensor imaging (DTI) were done on 13 preterm infants of less than 37 weeks of corrected gestational age (CA),42 preterm infants of term-matched age,and 15 term infants.ADC and FA were measured in genu and splenium of corpus callosum (CC),anterior limb and posterior limb of internal capsule (IC).Results 1.The ADC values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were higher than those in term-matched infants and in term infants.The ADC values in the 6 regions in term-matched infants and in term infants were significantly different with those in CA ＜ 37 weeks infant(F =5.559,5.775,21.948,19.462,30.586,15.452,all P ＜ 0.01).The differences of ADC values between CA ＜ 37 weeks infants and term-matched infants,between CA ＜37 weeks infants and term infants were significant(all P ＜0.05),except that in CC between CA ＜ 37 weeks infants and term-matched infants.2 The FA values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were lower than those in term-matched infants and in term infants.The FA values in the 6 regions in term-matched infants and in term infants were significantly different from those in CA ＜ 37 weeks infants (F =9.835,7.500,4.811,11.430,8.674,12.666,all P ＜ 0.01).The differences of FA values between CA ＜ 37 weeks infants and term-matched infants (P ＜ 0.05),between CA ＜ 37 weeks infants and term infants were significant (all P ＜ 0.05).Conclusions The baseline values of FA and ADC in different deep white matters were obtained.As corrected gestational age of preterm babies' increased,FA values in brain white matter increased,while ADC values decreased.The myelination in most white matter of preterm infants at matched term can catch up with that of term infants.The diagnostic value of ADC and FA needs to be studied further.

ObjectiveTo explore the clinical manifestations of infant cytomegalovirus infection in different age. MethodThe clinical data of 237 infants who suffered from cytomegalovirus infection was analyzed retrospectively and divided into three groups: 0-3 months old (77 cases,group A) ,4-6 months old ( 65 cases , group B ) , 7-12 months old ( 95 cases , group C ). ResultsThe incidence of respiratory infection was the highest among all infectious organs in three groups, the numbers of patients who had wheeze in group A was less than that in the other two groups[24.7％(19/77) vs. 61.5％ (40/65), 61.1％( 58/95 )](P ＜ 0.01 ).The incidence of jaundice decreased gradually as the babies grew up[23.4％( 18/77 )→7.7％(5/65 )→1.1％( 1/95 )](P ＜ 0.05). There was no significant difference in diarrhoea and bleeding among three groups (P＞0.05 ). The proportion of alanine aminotransferase], aspartate amino transferase increasing was similar among three groups, but gamma-glutamyl transferase (GGT) was different, the proportion of GGT increasing was 77.9％ (60/77) in group A which was higher than that in the other two groups[10.8％ ( 7/65 ), 2.1％ ( 2/95 )].Granulocytopenia in group B was obviously decreased compared with the other two groups (P ＜ 0.05 ), anemia was easily occurred in group C (P ＜ 0.05 ). ConclusionThe injury of cytomegalovirus infection may be related to month old.

Objective To define the effect and mechanism of hyperkalemic solution on atrial natriuretic peptide (ANP) secretion in rabbits. Methods Eighteen rabbits were selected and the chest was opened under anes-thetization to remove the heart. The left atrium was isolated and fixed in the atrial perfusion system with proper electric stimulation for beating. The following experiments were carried out on beating rabbit atria: ①The atrium was perfused for 60 min to stabilize parameters of ANP secretion and atrial dynamics. The control period (12 min as an experimental cycle) was followed by an infusion of hyperkalemic solution (K+ concentration of hyperkalemic solution was 5.64 mmol/L and the osmolarity of hyperkalemic solution was unchanged) for three cycles, then normal K+ cancentration was recovered for two cycles;②The control period was followed by an infusion of L type Ca2+ channel blocker nifedipine (1.0 μmol/L) for three cycles;③L type Ca2+ channel inhibitor nifedipine (1.0 μmol/L) was infused for 36 rain prior (three cycles) to infusion of hyperkalemic solution. Atrial stroke volume was determined and the ANP secretion was measured by radioimmtmoaasay. Results (1)Hyperkalemic solution increased atrial ANP secretion (P<0.01) and reduced the atrial stroke volume,hut the difference was not statistically significant as compared with that of the control cycle(P>0.05). The recovery trend was to the normal level of ANP secretion and atrial stroke volume was to become normal gradually when solution level recovered to normal ,which was not significantly different from that of the control cycle (P>0.05) ;②Nifedipine (1.0 μmol/L) also increased the atrial ANP secretion (P<0.01 or P <0.05) while decreasing atrial stroke volume (P<0.01 or P < 0.05 ) ; ③Nifodipine (1.0μmol/L) completely blocked the effect of hyperkalemic solution so to increase the ANP secretion (P <0.01 ). Conclusion Hyperkalemic solution significantly increases atrial ANP secretion via extracellular high K+ competitive inhibition of extracellular Ca2+ inflow in beating rabbit atria.