Intralipid infusion in neonates: effects on polymorphonuclear leukocyte function

In vivo and in vitro studies were done to assess the effects of Intralipid (IL) on neonatal polymorphonuclear leukocyte (PMNL) function. No significant abnormalities of chemotactic (CT) or chemiluminescent (CL) activities were noted in cord or adult PMNLs incubated with IL (10 mg/ml) when compared with paired controls incubated with buffer. In 14 premature and term neonates, IL was infused at 1 g/kg/24 h. Postinfusion CL activity of PMNLs was not significantly different from preinfusion CL activity. Although previous animal and human studies have shown abnormalities of PMNL function using higher infusion rates, slow infusion of IL at 1 g/kg/24 h produced no detectable alteration in PMNL oxidative function. The safety of long-term therapy with higher doses of IL remains to be proven.     

不同剂量脂肪乳剂全胃肠外营养对儿童术后一周内免疫功能的影响

对６３例创伤儿童进行了随机性、前瞻性研究以期了解不同剂量脂肪乳剂全胃肠外营养（ＴＰＮ）对创伤儿童免疫功能的影响。按随机原则将患儿分为对照组（２１例），低脂ＴＰＮ组（２２例），高脂ＴＰＮ组（２０例），７天为一研究期。结果表明儿童术后１周应用不同脂肪乳剂含量的ＴＰＮ营养支持后有助于免疫功能的恢复。对ＴＰＮ对免疫功能影响的因素也作了探讨。     

A Prospective Study of Intrapulmonary Fat Accumulation in the Newborn Lung Following Intralipid Infusion

In order to assess the safety and stability of a parenteral fat emulsion (Intralipid⁸) in total parenteral nutrition (TPN), 29 infants were infused Vamin glucose and Dextrose electrolyte solution as well as one of two isocaloric regimens; either 25 % Dextrose (Group I) or 10 % Intralipid (Group II). Regular biochemical monitoring was performed in all cases and no infants became lipaemic nor developed abnormally high levels of total free fatty acid. Eight infants died and only those who had received fat emulsion had lipid staining material distending the pulmonary vessels. One infant having low infusion rates of Intralipid had massive fat accumulation in the lungs, but biochemistry during life had been normal. We speculate that in ill infants the emulsion becomes less stable and agglomeration of fat particles occurs which are then fully filtered out by the lungs before metabolism of the exogenous fat can occur.     

Effects of intralipid infusion on blood viscosity and other haemorheological parameters in neonates and children

Aim: To study acute haemorheological effects of intralipid in preterm and full-term neonates and children. Circulatory complications of intralipid infusion, such as increases in pulmonary and peripheral flow resistance, have been associated with impaired blood rheology. Methods: During total parenteral nutrition, 10 preterm infants, 10 full-term neonates and 10 children received an initial dose of intralipid as continuous infusion (0.6 g/kg) over 4 h. Additionally, blood of 10 healthy preterm infants, 10 full-term neonates and 10 adults was incubated with intralipid. Whole blood and plasma viscosity (capillary viscometer), red blood cell (RBC) deformability (rheoscope) and RBC aggregation (Myrenne aggregometer) were measured before and after intralipid infusion and before and after in vitro incubation of blood with intralipid. Results: During intralipid infusion, plasma triglyceride levels increased from 0.13 ± 0.27 to 2.16 ± 0.68 g/l in the preterm infants, from 0.14 ± 0.21 to 1.64 ± 0.54 g/l in the full-term neonates and from 0.65 ± 0.31 to 2.26 ± 0.60 g/l in the children. Whole blood viscosity decreased by about 10% after intralipid in all three groups due to similar decreases in haematocrit. RBC aggregation decreased by about 20% after intralipid infusion. Plasma proteins, plasma viscosity and RBC deformation were not affected by intralipid. In vitro incubation of blood with intralipid resulted in a marked reduction of RBC aggregation that was related to the intralipid concentration. At intralipid concentrations of 4 and 8 mg/ml, no RBC aggregation was noted in preterm and full-term neonates. In adults, RBC aggregation decreased by 50%.

Conclusions: Previously described deleterious effects of intralipid on circulation can not be explained by changes in haemorheological properties.     

Haemolysis in adult and neonatal erythrocytes caused by autoxidation of lipid emulsion (Intralipid)

Lipid emulsion (Intralipid) causes free radical-mediated damage to human cells in vitro. Incubation with 0.44% Intralipid for 17 h caused 40.3 ± 3.8% haemolysis in adult human erythrocytes and 26.5 ± 8.1 % in erythrocytes from term newborns ( p = 0.0001). In adult erythrocytes mean corpuscular volume increased 68.7 ± 8.20%, and in newborn erythrocytes 54.8 ± 10.4% ( p = 0.0012). Initial concentrations of reduced glutathione in adult and newborn erythrocytes were 65.1 ± 2.5 and 62.1 ± 4.0 mg/dl, respectively (ns); after incubation, glutathione concentrations were 21.0 ± 4.0 and in 25.7 ± 5.2 mg/dl in adult and newborn erythrocytes, respectively ( p = 0.0004). After incubation the concentrations of thiobarbituric acid reactive material and conjugated dienes in newborn erythrocytes (2.8 ± 0.2 μM and 0.223 ± 0.019 OD 233, respectively) were higher than those of adult erythrocytes (2.1 ± 0.4 μM and 0.138 ± 0.012 OD 233) ( p = 0.0001). In both adult and newborn erythrocytes, the effects of Intralipid were significantly inhibited by 0.6 mM desferoxamine or 8 mM sodium etidronate. Despite higher susceptibility to lipid peroxidation of the cell membrane, newborn erythrocytes are more resistant than adult erythrocytes to free radical-mediated effects such as depletion of intracellular glutathione, cell swelling and haemolysis.     

新生儿危重先天性心脏病的手术及围术期处理

目的分析本院心血管外科1990,2009年收治的480例新生儿危重先天性心脏病患儿的治疗过程,总结新生儿危重先天性心脏病的手术及围术期处理经验。方法本院于1990～1999年以及2000～2009年两个时间段分别收治41例和439例新生儿危重先天性心脏病患儿,比较两组术后严重并发症的发生率和死亡率、术后呼吸机辅助时间、CICU监护及总住院时间的差别。结果后十年病例数及复杂病例所占百分比较前十年明显增加,而术后并发症的发生率、死亡率均有所降低,呼吸机辅助时间、CICU监护时间及住院时间均缩短（P〈0．05）。结论近10年来,新生儿危重先天性心脏病在术前诊断、外科手术、体外循环技术、心肌保护及术后监护技术等方面均得到显著提高。     

异丙酚持续静滴治疗小儿癫癎持续状态的临床观察

目的总结异丙酚持续静滴治疗小儿癫癎持续状态的疗效.方法对2001年4月至2003年10月唐山工人医院儿科8例继发性癫癎持续状态患儿的治疗进行分析,本组8例均为常规抗癫癎药物不能控制的继发性癫癎所致癫癎持续状态.在使用常规止惊药物失败后开始异丙酚静滴.结果8例患儿全部抽搐停止.结论癫癎持续状态是儿科急症之一,如何在短时间内控制癫癎持续状态是治疗成败的关键,在正确常规治疗无逆转时,应用异丙酚持续静滴可以有效控制癫癎持续状态且未见严重不良反应.     

Effects of dopamine infusion on plasma catecholamines in preterm and term newborn infants

Newborn infants (21 preterm and 13 term) received dopamine infusions at a low (2.5–3.4 g/kg per min) and/or high (5–10 g/kg per min) infusion rate and changes in plasma catecholamines were monitored. The mean baseline values for dopamine, noradrenaline and adrenaline were between 240 and 560, 125 and 144 and 62 and 82 pg/ml, respectively. During low-rate infusion of dopamine, there was a significant increase in plasma dopamine (20–100fold), noradrenaline (three- to five-fold) and adrenaline (threefold). Administration of dopamine at the high rate resulted in an even larger increase in the plasma catecholamines (dopamine, 100–300fold; noradrenaline, seven- to eightfold; adrenaline, four- to sixfold). In a double-log plot, there was a highly significant correlation between the plasma concentrations of dopamine and noradrenaline (r=0.77;P<0.001). In conclusion, infusion of dopamine in term and preterm newborn infants is accompanied by an enhanced sympatho-adrenal tone which may contribute to the cardiovascular effects of dopamine in these patients.     

The etiology of peripheral lymphadenopathy in children

This prospective study evaluated 382 pediatric patients with peripheral lymphadenopathy (LA) presenting at the Pediatric Oncology and Hematology Departments of Social Security Children's Hospital and Gazi University Medical Faculty Hospital. The ages of the patients ranged between 2 months and 16 years (median 7 years); 72% of the patients were male. Of the 382 patients, 138 had localized LA (a single anatomic area involved), 171 had limited LA (two or three areas involved), and 73 had generalized LA ( four or more anatomic areas involved). The specific etiology (either benign or malign) was defined in 79% of patients with generalized LA. However, in patients with localized LA and limited LA, specific etiology could be identified only in 43 and 53% of patients, respectively. Based on this study, BCG-LA and pyogenic infections are more frequently manifested by localized LA; LA of unknown origin, Hodgkin's disease, tuberculosis, nasopharyngeal carcinoma, and toxoplasmosis are frequently manifested by localized or limited LA; and cytomegalovirus infection (CMV), infectious mononucleous, rubella, acute leukemia, non-Hodgkin's lymphoma are frequently manifested by limited or generalized LA. Out of 382 patients, 196 patients had a maximum lymph node diameter of less than 2 cm. A benign etiology was shown in 159/196 of these patients. In 37/196 of these patients LA was due to a malignancy, and these cases almost invariably had some apparent additional diagnostic clinical and laboratory findings. Based on this observation a maximum lymph node size of 2 cm was considered an appropriate limit to distinguish malignant disease from benign causes except when there is other evidence of an underlying malignant disease. However, lymphadenopathies located at supraclavicular region (27 patients) either localized or as part of generalized LA had a specific benign or malignant disease in etiology (malignancy in 20, tuberculosis in 3, CMV in 2, sarcoidosis in 1, and lipoma in 1) even though they were less than 2 cm in diameter.     

Gut intraepithelial lymphocyte counts in neonates, infants and children

Intraepithelial lymphocyte (IEL) counts were histologically assessed in the jejunum, ileum and appendix of 39 neonates (0–28 days), 32 infants (1–9 months) and 13 children (1–9 years). Small intestinal mucosa samples were obtained from 73 autopsies, and from 8 surgical and 3 aspirative biopsies. IEL counts of specimens from the jejunum, ileum and appendix gave similar results in the same patient. The number of IEL counts was significantly lower in neonates for all three segments. The difference between infants and children was more marked in the jejunum than in the ileum, although this was not significant. In the appendix, there was no difference between the different age groups. Our results indicate that postnatal expansion of IEL occurs homogeneously along the gut after the neonatal period.     

促红细胞生成素对新生儿缺氧缺血性脑病患儿血清NSE和S-100B的影响

目的 探讨促红细胞生成素（EPO）对缺氧缺血性脑病（HIE）患儿血清NSE、S-100B 水平的影响及其作用机制。方法 40 例HIE 患儿随机分为常规治疗组（20 例）和EPO 治疗组（20 例）,EPO 治疗组在常规治疗基础上于生后第2 天加用EPO,每日200 IU/kg 静脉注入,疗程7 d。另选择健康足月新生儿20 例作为正常对照组。检测3 组新生儿血清中NSE、S-100B 的水平。结果 治疗前2 组HIE 患儿血清中NSE、S-100B的水平高于正常新生儿（PP>0.05）。3 组新生儿生后第9 天血清NSE、S-100B 水平均低于第1 天水平（PP结论 动态检测血清中NSE、S-100B 的水平,可能有助于HIE 的早期诊断和判断HIE 脑损伤的修复程度;EPO 可能对神经元及神经胶质细胞均有修复作用。     

咖啡因在新生儿的临床应用进展

咖啡因为甲基黄嘌呤生物碱化合物,目前认为,与茶碱类相比,用于预防和治疗早产儿呼吸暂停,该药不仅疗效显著且安全,不需要监测血药浓度.近年来报道,咖啡因对提高拔管撤机成功率、降低早产儿支气管肺发育不良发生率、减少手术关闭动脉导管的风险,以及改善早产儿远期神经系统预后均有一定的益处.     

儿童自体外周血干细胞动员和采集的临床研究

目的　评价环磷酰胺、长春新碱、依托泊苷、泼尼松 (COEP) /吡柔比星、长春新碱、依托泊苷、泼尼松(DOEP)动员方案对儿童急性淋巴细胞白血病和淋巴瘤自体外周血造血干细胞移植动员采集的临床效果。方法　以COEP方案和DOEP方案为动员化疗方案 ,观察采集干细胞效果。结果　 13例 (6例非霍奇金淋巴瘤和 7例急性淋巴细胞白血病 )儿童采用COEP/DOEP方案动员 (8例用COEP方案 ,5例用DOEP方案 ) ,化疗后第 4～10d(平均 6d)白细胞数 <2× 10 9/L ,用粒细胞集落刺激因子后第 4～ 19d(平均 8d)开始采集外周血造血干细胞 ,采集单个核细胞数 (4 19～ 9 96 )× 10 8/kg(平均 6 78× 10 8/kg) ,CD34+细胞数 (2 90～ 12 78)× 10 6/kg(平均 8 90× 10 6/kg) ,粒单造血祖细胞数 (3 4 9～ 4 1 72 )× 10 4/kg(平均 15 5 7× 10 4/kg)。动员的并发症较轻 ,患儿均能耐受。自体外周血干细胞移植后均获快速造血功能重建 ,白细胞开始回升 (中性粒细胞绝对值 >0 5× 10 9/L)的时间为移植后 10～ 2 2d(平均 14d) ,血红蛋白恢复 (>80 g/L)的时间为移植后 10～ 2 8d(平均 17d) ,血小板恢复 (>2 0× 10 9/L)的时间为移植后 10～ 2 0d(平均 19d)。结论　COEP/DOEP方案可以安全高效地完成儿童白血病和淋巴瘤自体外周血干细胞的动     

Variability of actual and potential fibrin-stabilizing factor (FSF) activity of blood plasma in healthy children

Actual and potential fibrin-stabilizing factor (FSF) activity in the blood plasma of children in various are groups and in adults was estimated. Differences in blood plasma activities regarding desmofibrin formation were revealed, which depended upon the changes in enzyme concentration varying with age and upon the changes in thiol group concentration.Investigation partly subsidized by Department VI of the Polish Academy of Sciences.     

住院新生儿鼻腔和体表定植金黄色葡萄球菌的分子特征及耐药性

背景：金黄色葡萄球菌（SA）在鼻腔和体表的定植可增加新生儿SA感染的风险,了解住院新生儿的SA定植状况、菌株分子型及耐药性有助于制定合理的治疗方案。 目的：探讨NICU患儿入院时体表的SA定植、菌株分子特征及耐药性。 设计：横断面研究。 方法：纳入2020年8月1日至2021年1月31日入住首都医科大学附属北京儿童医院NICU时入院日龄≤28 d且胎龄≥28周的新生儿,收集临床信息。并对入院后12 h 内体表部位采集的拭子进行细菌培养和菌落计数,采用Staphytect Plus试剂盒及PCR扩增nuc基因进行SA菌株鉴定,并分别进行抗生素耐药性检测。 主要结局指标：NICU住院新生儿体表定植的SA分子特征及耐药性。 结果：共纳入766例NICU住院新生儿,其中257例（33.6%）存在≥1个部位的SA定植,单部位、2个部位、≥3个部位SA定植组分别为135例（52.5%）、65例（25.2%）和57例（22.3%）,各组间的临床特征（男婴、入院日龄、剖宫产、入院前纯母乳喂养、入院前应用抗生素、入院时气管插管常频机械通气、住院天数）、菌株分型（MRSA、MSSA）、sarA基因状态差异均无统计学意义,PVL 阳性差异有统计学意义。≥2个部位定植组与1个部位定植组比较,PVL阳性 ［39（32.0%）vs 23(17.0%) ,P=0.005］和sarA 阳性［83（68.0%） vs 56 (41.5%),P<0.01］差异有统计学意义。鼻前庭、脐根部、腋下和腹股沟分别培养出176株、124株、72株和76株,MSSA占比分别为82.4%、77.4%、80.6%和80.3%,各部位SA菌株的MRSA和MSSA占比差异均无统计学意义。MSSA菌株最常见的克隆型为ST398- t309型,MRSA菌株最常见的克隆型为ST59-SCCmecIV-t437。PVL 、sarA和PVL+sarA基因检测阳性株,MRSA和MSSA阳性率差异均无统计学意义。所有的288株SA均对莫匹罗星、利奈唑胺及万古霉素敏感;15株美罗培南不敏感株,其中MRSA 14株（1株耐药,13株中介）,MSSA 1株（中介）;耐药率从高到低依次为青霉素、红霉素、头孢曲松和苯唑西林。 结论：NICU相对病情稳定的新生儿鼻腔和体表皮肤SA定植率为33.6%。≥2个部位定植与1个部位定植相比,PVL和sarA阳性更高。MSSA菌株最常见的克隆型为ST398-t309,MRSA菌株最常见的克隆型为ST59-SCCmecIV-t437。本次研究中所有定植的SA菌株均对莫匹罗星、利奈唑胺及万古霉素敏感,有对美罗培南耐药MRSA分子型菌株检出。     

Percutaneous US-guided biopsies of peripheral pulmonary lesions in children

Background: A wide variety of diseases in children can present with peripheral lung lesions. Minimally invasive percutaneous techniques are preferred diagnostic tools when thoracoscopic resection is not indicated. Significant improvements in US resolution have increased the range of its applications for many diagnostic and therapeutic purposes. Objective: To determine the adequacy and safety of US-guided biopsy of peripheral pulmonary lesions in children. Materials and methods: A retrospective review was performed of the clinical, imaging and pathology records of 33 children (13 females and 20 males) in whom 38 US-guided percutaneous lung lesion biopsies had been performed between January 1996 and March 2004. Their mean age was 8.3 years (range 1–19 years, median 6.6 years). All procedures were done under general anesthesia and controlled respiration. Two techniques were used: a single-needle technique and a coaxial-needle technique. In each case, the data recorded included age, sex, lesion’s location and size, number of cores, pathology results (adequate, inadequate and indeterminate), and complications. In order to categorize the sample, the lesions were divided into four groups based on the size of the pleural surface: group 1 1–5 mm, group 2 6–10 mm, group 3 11–20 mm, and group 4 21 mm or more. Results: The mean pleural surface size of the lesions was 12 mm (range 2.3–24 mm). The coaxial-needle technique was used for 13 biopsies and the single-needle technique for 25 biopsies. Of the 38 biopsies, 32 were considered adequate (technical success 84%), 4 were truly inadequate, and 2 were indeterminate at the time of the biopsy, requiring surgical biopsy for confirmation. Minor complications occurred following 44% of the procedures, including: pain (n=5), small pneumothorax (n=4), pulmonary hematoma (n=4), atelectasis (n=4), small hemothorax (n=3), respiratory distress (n=1) and hemoptysis (n=1). No major complications occurred. No significant correlation was found between the size of the pleural surface and technical success (P=0.106) or the incidence of complications (P=0.23). Minor complications occurred following 6 out of 13 procedures using the coaxial-needle technique (16% of total) and following 11 out of 25 procedures using the single-needle technique (28% of total), with no statistically significant difference (P=0.1081). Conclusion: This small retrospective study suggests that US-guided lung biopsies are a safe and adequate method to sample peripheral pulmonary lesions in children, with a high rate of technical success and low morbidity, even for lesions with a small pleural surface (<5 mm).     

Thoracoscopic repair of diaphragmatic hernia in neonates and children: a new simplified technique

Needlescopic techniques have been used recently in different pediatric procedures, which made this type of surgery more feasible and less invasive with decreased hospital stay and improved cosmetic results. The technique is being developed further. New techniques with minor modifications are evolving every day. The objective of this study was to describe and assess the results that can be achieved by using a new simplified technique [Reverdin needle (RN)] in thoracoscopic repair of diaphragmatic hernia in neonates and children. Eighteen patients with symptomatic congenital diaphragmatic hernia (CDH), from Al-Azhar University Hospitals, Cairo, Egypt were assigned to elective thoracoscopic repair using RN to insert mattress sutures between the edges of diaphragmatic defects. The technique will be described in detail. A total of 18 diaphragmatic defects were repaired successfully; there were 12 males and 6 females with a mean age of 1.58 ± 21 months (range, 5 days–9 months). Left-sided CDH was present in 12 cases (67%) and right-sided CDH in 6 cases (33%). The mean operative time was 30.7 ± 1.18 min (range, 25–60 min) for each CDH repair. There were no intra or postoperative complications. There was one case of conversion and minimal blood loss. The mean postoperative hospital stay was 5.6 days (range, 2–10 days). There was only one case of mortality on the 10th postoperative day. There was no single case of recurrence. The new technique had all the advantages of thoracoscopy in children (less invasive, less pain, shorter hospital stay) combined with the advantages of reduced operating time, simplicity and feasibility. It may be preferable to intracorporeal suturing and knot tying.     

Increasing incidence of respiratory distress in neonates

AIM: To document the change in the incidence of respiratory distress (RD), related interventions and mortality in neonates admitted to primary, secondary and tertiary neonatal units within a geographically defined population over a period of 30 years. METHODS: RD was defined as a clinical picture irrespective of the etiology. Information was collected retrospectively for 1974, 1984, 1994 and 2004 from all neonatal units in Switzerland. RESULTS: In the 30 years studied the proportion of infants hospitalized with RD increased from 1.9% to 3.8% of the whole neonatal population and from 30% to 53% of all infants admitted to a neonatal unit. Treatment of RD changed significantly. Mechanical ventilation decreased from 31% to 16%, nasal CPAP increased from almost 0% to 26% and surfactant administration increased from 0% to 53% in infants with hyaline membrane disease. Overall mortality decreased in infants with RD from 15.5% to 3.5%. CONCLUSIONS: The incidence of RD in infants admitted to neonatal units doubled over the last 30 years in a geographically defined neonatal population. This rise can predominantly be ascribed to infants with birth weight >2500 g and may reflect the corresponding increase in the rate of caesarean section.