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25 July 2005, Volume 20 Issue 07 Previous Issue    Next Issue
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Early diagnosis and therapy for neonatal cyanotic congental heart disease. Bei Fei,Bu Jun,Huang Ping 2005, 20(07): 404-406 .  Abstract ( )   Abstract Objective To investigate the clinical manifestation,distribution,treatment and prognosis of congenital heart disease in neonatal period.Methods Analyze 156 cases of neonatal cyanotic congenital heart disease clinically.Results ① Neonatal cyanotic CHD was manifested with central cyanosis,heart failure,and arrhythmia occasionally.② DTGA stand first on the list of neonatal cyanotic CHD and the others ordinal was PA,TAPVC and PS.③ Internal medical therapy included using of cardiotonic,diuretic and prostaglandin E157 patients were given surgical operations and TGA lead the first.Conclusion For complex anomaly and critical condition in most cases,neonatal cyanotic CHD should be diagnosed as soon as possible and treated appropriately in order to improve the viability and prognosis of these neonates.

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Presence of ica A and ica D genes in a collection of coagulasenegative staphylococcal strains in neonatal blood cultures. Wang Yajuan,Shen Xuzhuang,Gao Wei 2005, 20(07): 407-409 .  Abstract ( )   Abstract Objective The purpose of this study was to assess whether the person making the clinical decision may benefit from the detection of icaA and icaD genes encoding putative virulent factors.Methods From Nov.2001 to Mar.2003,we detected the icaA and icaD genes in 80 neonates with a collection of clinical isolates from blood cultures by using a simple,rapid,and reliable PCR method.Results An overall total of 80 neonates with CNS strains from blood cultures were identified.There were 27 cases(33.8%)diagnosed neonatal sepsis clinically according to the standard,of which 7 were premature,2 were small for gestational age of full term infants.The distribution of species among the clinical CNS strains,18(66.7%)cases were Staphylococcus epidermidis,which was the leading cause,and then S.hemolyticus (n=7),S.hominis (n=2).There was a statistical difference in them.Of the 90 strains,eight were positive to icaA and icaD genes,with PCR products being obtained for the icaA and icaD genes in all of these strains,a 814bp band for the icaA gene and a 282bp band for the icaD gene.All of them were Staphylococcus epidermidis.Among 8 cases with positive ica genes,7 were diagnosed as sepsis clinically.The coincidence rate was 87.5%.Positive predictive value of the ica genes were 25.9%，and negative predictive value were 98.1%.Conclusion Ica genes may potentiate the clinical criteria used for the diagnosis of neonatal sepsis,and may discriminate between contamination and infections.

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The risk factors for bronchopulmonary dysplasia in premature. Liu Meina,Zhuang Siqi,Qin Zhaoyuan 2005, 20(07): 410-412 .  Abstract ( )   Abstract Objective To study the incidence,risk factors,prophylaxis and treatment for bronchopulmonary dysplasia (BPD) in premature.Methods From June 1999 to June 2004 seventytwo prematures with gestational age less than 32 weeks,birth weight less than 2000 grams and surviving more than 28 days were enrolled in the study.Fifteen prematures with BPD were compared to thirty one prematures without BPD in terms of sex,gestational age,birth weight，usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,duration of mechanical ventilation,supportive conditions for ventilation,gastroesophageal reflux,patent ductus arteriosus,fluid intake in the first few days and recurrent pneumonia.Results The overall incidence of BPD in preterm newborns was 20.83%,and 38.71% in those infants weighting <1500g at birth；Fio2,PIP,PEEP and MAP were all not statistically significant between BPD group and control (P>0.05)；Multivariate logistic analysis revealed that gestational age less than 30 weeks,birth weight less than 1250 grams,prolonged mechanical ventilation (≥10days) and recurrent pneumonia were independent risk factors for BPD (P<0.05).Other factors including sex,usage of prenatal steroids,usage of postnatal surfactant,hyaline membrane disease,gastroesophageal reflux and excessive fluid intake in the first few days of life were not statistically significant (P>0.05).Conclusion Preventing small gestational age and low birth weight prematurity,shortening the duration of mechanical ventilation and controlling pneumonia were effective in preventing BPD.

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Observation on thyroid function in premature infants. Chen Zhihong,Li Tang. 2005, 20(07): 413-415 .  Abstract ( )   Abstract ObjectiveTo investigate the thyroid function in the premature infants.MethodsFrom Oct.2004 to Oct.2005 serum free triodothyrorine (FT3),free thyroxine (FT4) and thyrotropin (TSH) in 60 premature infants on the 1st,7th days after birth were detected by radioimmunoassay (RIA) and were compared with those in 30 normal neonate controls.The 60 premature infants were divided into two groups according to the gestational age:the very premature infants (the group A,less than 34 weeks of gestational age,n1=30) and the older gestational age infants (the group B,34~41 weeks of gestational age,n2=30).ResultsThe serum concentrations of FT3,FT4,TSH showed a declining tendency in all neonates from the 1st day to the 7th day after birth.The serum concentrations of FT3，FT4 on the 1st and 7th day after birth were significantly higher in the controls than those in group A and group B,and those in group B were also significantly higher than those in group A.The serum TSH on the 1st and 7th day after birth were significantly higher in the controls than those in both group A and B,and those in group A were also significantly higher than those in group B.On the 7th day after birth,the serum TSH in group A were higher than those in group B and controls,whereas the serum TSH were not significantly different between group B and controls.ConclusionThe thyroid function in the premature infants is transiently low.The shorter the gestational age,the lower the thyroid function and the longer the stress reaction.

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The change and clinical significance of the molecule CD in the newborns with infection. Zhang Jinping,Chen Chao,Yang Yi. 2005, 20(07): 415-417 .  Abstract ( )   Abstract ObjectiveTo evaluate the change and the clinical significance of the cell CD on the surface of T,B,NK and Neutrophils cells.MethodsFrom Feb. to June 2004,50 preterms and 49 terms with infection or noninfection were sturied.The level of peripherical blood CD3,CD4,CD8,CD19,CD16CD56 and CD64 were measured by flow cytometry.Results① The level of CD3 in terms(76.89±2.52)% with infection was higher than that in terms without infection(64.40±5.69)%.The level of CD3 in preterms without infection(80.93±9.13)%was significantly higher than that in terms without infection.The level of CD4 in preterms without infection(61.20±2.21)% was significantly higher than that in terms without infection(47.60±4.27)%.The level CD4 in preterms with infection (53.63±3.23)% was significantly lower than that in preterms without infection ；The level of CD8 was not different in all groups.②The level of CD19 has no difference in all groups.③The level of CD56CD16 in terms with infection(5.88±0.62)% was significantly lower than that in terms without infection(13.00±5.31)%，the level of CD56CD16in terms without infection was significantly higher than that in preterms without infection(6.13±1.25)%.④ The level of CD64 in terms with infecton (5056.92±1255.58)Molecule/Unit was higher than that in terms without infection (2112.60±1157.21)M/U.The level of CD64(4619.67±1395.99)M/U in preterms with infection was significantly higher than that in the preterms without infection(2407.45±1247.16)M/U.⑤The level of CD64 in patients with sepsis,pneumonia and other infections were higher than that in those patients without infection.If the positive standard of CD64 was over 3000 M/U,then the sensitivity was 79.6% and the specificity was 75.1%.If the positive standard of CD64 was over 2000 M/U,then the sensitivity was 88.9% and the specificity was 60%.The sensitivity of CRP was 65.3% and the specificity was 86%.Conclusion The level of CD3、CD4、CD16CD56 in preterms with or without infection differs from those in terms,which is probably due to the low immunity function of preterms.CD64 may be a kind of new diagnosis guideline.

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Concentrations of bronchoalveolar lavage pulmonary surfactant protein A and its significance in newborn infants with lung disease. Lü Hui,Huang Xiaohong,Zhao Ning 2005, 20(07): 418-420 .  Abstract ( )   Abstract ObjectiveTo investigate the bronchoalveolar lavage (BAL) SP-A concentrations from newborn infants with lung disease,and to study the relationship between BAL SP-A and clinical outcome.Methods 57 cases of newborn infants with lung disease were admitted in our NICU between Jan.2000 and Feb.2003.BAL SP-A concentrations,PO2 value,PCO2 value,and PaO2/FiO2 ratio were measured.ResultsBAL SP-A concentrations did not differ between severe pneumonia group and MAS group,but the value of PaO2、PaCO2 and PaO2/FiO2 ratio in MAS group were significantly lower than that in severe pneumonia group (p respectively<0.001,<0.05,<0.05).BAL SP-A concentrations in RDS and ARDS groups were significantly lower than that in aforesaid groups ( all P<0.05).BAL SP-A concentrations in RDS group were significantly lower than that in ARDS group,but PaO2 value in ARDS group was lower significantly than that in RDS group( P<0.05).The mortality of infants treated with PS was significantly lower than that of infants treated without PS (P=0.049).PaO2/FiO2 ratio for the cohort was related to their BAL SPA concentrations ( r=0.741,P=0.000).Conclusion Surfactant protein A content in MAS is not different from that of severe pneumonia.BAL SP-A concentrations of neonates with ARDS or RDS decrease significantly.BAL SP-A concentrations can evaluate the severity of lung injury and the prognosis of neonatal lung disease.

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Research on the diagnosis value of procalcitonin in neonates with severe bacterial infectious diseases. Zhao Meijian,Wang Dan,Guo Jing 2005, 20(07): 421-423 .  Abstract ( )   Abstract Objective The aim of this research is to evaluate the diagnostic value of PCT in neonates with severe bacterial infectious disease.Methods 229 neonates admitted to Neonatology Department,Tianjin Children’s Hospital since March to December 2002 were divided into 4 groups:noninfection control(116),systemic bacterial infection (39),localized bacterial infection (51) and viral infection (23).Serum PCT and CRP were measured on admission;leucocyte count and differentiation was measured within 24 hours after admission.A serial measurement of PCT and CRP were taken during the course when necessary.Analyze data using SPSS 10.0 for Windows.Results Although both PCT and CRP significantly elevated in neonates with systemic bacterial infection,PCT revealed more sensitivity in systemic bacterial infection (P<0.001).The sensitivity and specificity of PCT to diagnose neonatal systemic bacterial infection using a cut off level 2 (μg/L) was 0.804 and 0.824,respectively.Conclusion PCT is a better diagnostic marker of neonatal systemic bacterial infection than CRP and leucocyte count.

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Study on the changes in blood gas and neurologic injury in newborn infants with perinatal asphyxia. Xiao Chunxiang. 2005, 20(07): 425-426 .  Abstract ( )   Abstract Objective To explore the relationship between the rapid changes in CO2 and pH value and neurologic injury in asphyxia infants in presence of severe academia. Methods Umbilical arterial blood and radial arterial blood at postnatal 1,2h were checked in 55 infants.These infants were categortized in three groups:Ⅰ,pH>7.00,normal neurologic examination without respiration support;Ⅱ,identification to Ⅰexcept pH≤7.00;Ⅲ,pH≤7.00,abnormal neurologic examination with mechanical ventilation. Results Umbilical arterial blood pH was significantly different in Ⅲ vs Ⅰ and in Ⅱ vs Ⅲ.PaCO2 was significantly different in Ⅲ vs Ⅱ vs Ⅰ.At postnatal 1h pH increased and PaCO2 decreased in all groups,significant differences in three group remained.At postnatal 2h,no differences were observed for pH and PaCO2 in Ⅱand Ⅲ,there was different neurologic prognosis among groups.Apgar score was lower in Ⅲ. Conclusion After delivery pH and PaCO2 have rapid changes in presence of severe academia.Lower pH and Apgar score with mechanical ventilation are poor prognosis factors of neurologic result.

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Effects of low dose fentanyl infusion in preterm infants with mechanical ventilation. Yang Jie,Liu Ying,Wu Kaifeng. 2005, 20(07): 427-428 .  Abstract ( )   Abstract Objective To evaluate the effects of low dose fentanyl infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in ventilated preterm infants.Methods From Oct.2000 to 2003,18 ventilated preterm infants were randomly assigned to receive a mean fentanyl infusion of (1.1±0.06)μg/(kg·h) for (65±5) hours,and 18 untreated infants were considered as the control groupA behavioural sedation score was used to assess the infants' behaviour.Outcome data and ventilatory indexes were recorded for each infant.Results The fentanyl group showed significantly lower behavioural stress scores than controls.The two groups showed no significant difference in ventilatory variables or short term outcome.Conclusion A short course of low dose fentanyl infusion reduces behavioural sedation scores and neuroendocrine stress response in preterm ventilated infants.

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The clinical value of reticulocyte hemoglobin content in children’s iron deficiency anemia. Lü Ping，Zhang Meihe，Song Wenqi. 2005, 20(07): 429-430 .  Abstract ( )   Abstract Objective To discuss the clinical value of reticulocyte hemoglobin content in children’s iron deficiency anemia. Methods Blood cell and CHr were counted by automated hematology analyzer (ADVIA120) in 50 healthy children and 59 IDA children,SF were tested by automated biochemistry analyzer (BeckmanCx9).Results Hb,MCV,CHr and SF were lower in IDA children than healthy children;RDW were higher in IDA children than healthy children.Conclusion CHr has important clinical value in diagnosing children’s iron deficiency anemia.

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Threedimensional echocardiographic quantitative study in ventricular septal defect of conotruncal defect. Chen Guozhen,Sun Kun,Chen Shubao 2005, 20(07): 431-432 .  Abstract ( )   Abstract Objective To evaluate the accuracy and clinical value of transthoracic threedimensional echocardiographic (3DE) quantitative analysis in ventricular septal defect (VSD) of conotruncal defects (CTD).Methods From May 2000 to November 2003 in Shanghai Children Medical Center,there were 63 inpatients of CTD with all quantitative findings measured by 3DE,twodimensional echocardiography (2DE),angiocardiography and surgical findings.Their measurements of VSD sizes and areas with 3DE were compared with those with 2DE,angiocardiography and surgical findings.Results From the analysis of variance,StudentNewmanKeuls (SNK) test and correlation analysis,the measurements of VSD long diameter (mean 1.69cm in enface view of ventricular septa from right ventricle and 1.63 cm in enface view of ventricular septa from left ventricle) with 3DE was less than the measurements of VSD diameter (mean 1.84 cm) with surgical findings,but they were better correlated with those with surgical findings (r=0.74) than the measurements of VSD diameter (mean 1.27 cm) with 2DE (r=0.39) and those (mean 1.12 cm) with angiocardiography (r=0.25).However,the measurements of VSD short diameter with 3DE was close to those with angiocardiography,and there was no significant difference (P>0.05) between them.The measurements of VSD short diameter with 3DE were better correlated with those with 2DE and angiocardiography than the measurements of VSD long diameter with 3DE.Meanwhile,the measurements of VSD area with 3DE were well correlated with the measurements of VSD diameter with surgical findings (r=0.57).Conclusion 3DE can provide more accurate quantitative diagnosis in CTD VSD than 2DE.

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Treatment of acute lung injury after the surgical correction of tetralogy of Fallot. Zhu Limin,Xu Zhuoming,Chen Ling 2005, 20(07): 433-435 .  Abstract ( )   Abstract Objective To analyse the reasons of acute lung injury (ALI) after the surgical correction of tetralogy of Fallot (TOF) and summarize the postoperative treatment skill.Methods There were 161 cases of patients with TOF who underwent corrective repair operation in the Department of Cardiovascular Surgery of Xinhua Hospital/ Shanghai Children’s Medical Center from Jul.2003 to Jun.2004,in which there were 5 patients who developed ALI after the surgical correction of TOF.The mean age was 13.8±3.06 months (7~24 months) and the mean body weight was (8.20±0.46)kg (7~9.5kg).Before operation,their mean SpO2 was (72.8±2.2)% (67%~80%),mean HCT was (49.0±5.5)%,mean McGoon ratio was (1.27±0.05) and mean PAI was (136.0±16.8)mm2/m2.The total cardiopulmonary bypass (CPB) time and aortic clamp time were (67.2±3.9) min and (43.6±2.4) min,respectively.The modified ultrafiltration was used throughout the CPB.The treatment and the blood analysis were recorded when the ALI developed.The parameters of pulmonary function and lung injury score were calculated.Results ALI developed (30.0±9.7) hrs after the operation and the incidence of ALI after the surgical correction of TOF was 3.1%.Two cases died within 48 hrs.Peritoneal dialysis (PD) was performed on all the cases.Meanwhile,2 cases were given inhaled nitric oxide (NO) and 1 case was given pulmonary surfactant (PS).The parameters of pulmonary function were improved step by step and the differences were statistically significant at the latest stage of treatment (P<0.05).Conclusion The treatment of ALI after surgical correction of TOF includes reasonable mechanical ventilation and maintaining the balance of fluid.Inhaling NO and using PS will be benefitial to improve the pulmonary function and to stop the vicious circle which results in the hypoxemia and refractory acidosis.