Effects of hypothermia on NSE and S-100 protein levels in CSF in neonates following hypoxic/ischaemic brain damage

Aim: The aim of the study was to evaluate the effects of hypothermia on neuron‐specific enolase (NSE) and S‐100 protein levels in cerebrospinal fluid (CSF) in neonates with hypoxic/ischaemic encephalopathy (HIE). Methods: Fifty‐one enrolled neonates with HIE were divided into two groups: hypothermia (n = 23) and control (n = 28). NSE and S‐100 protein were measured with immunoradiometric assays. Amino acid neurotransmitters were also measured by reversed‐phase high‐performance liquid chromatography. Neurodevelopmental assessments were performed at 3 and 12 months of age. Results: Neuron‐specific enolase and S‐100 levels were lower, and neurodevelopment outcome was better in the hypothermia group compared with the control group. Among the infants who received hypothermia, CSF NSE and S‐100 were significantly higher in those who developed severe neurological impairment (mental development index or physical development index <70). There were no significant differences between the two groups in amino acid neurotransmitters. Conclusion: These results indicated that hypothermia was associated with decreased CSF NSE and S‐100 level and correlated with neurodevelopmental outcome in infants with HIE.     

Cardiac troponin I concentrations in neonates with hypoxic-ischaemic encephalopathy

Aim: Myocardial dysfunction is a frequent sequel of perinatal asphyxia. Cardiac troponin I (cTnI) is a marker of myocardial injury and a surrogate marker of myocardial dysfunction in adults, but there are few data in neonates. Our aim was to compare serum cTnI concentrations with clinical severity of encephalopathy and with duration of inotropic support in asphyxiated neonates. Methods: Retrospective study of 60 neonates admitted with hypoxic‐ischaemic encephalopathy (HIE). cTnI concentrations measured within 36 h of birth were compared with clinical grade of HIE (Sarnat‐Sarnat classification) and with duration of inotropic support. Results: Serum cTnI concentrations and duration of inotropic support were significantly greater with increasing severity of HIE. Median (95% CI) cTnI concentrations were 0.04 μg/L (0.02–0.07 μg/L) in grade 1 HIE, 0.12 μg/L (0.08–0.20 μg/L) in grade 2 HIE and 0.67 μg/L (0.41–1.35 μg/L) in grade 3 HIE. Median (95% CI) duration of inotropic support required was 0 h (0–24 h) in grade 1 HIE, 28 h (0–118 h) in grade 2 HIE and 48 h (0–140 h) in grade 3 HIE. Conclusion: In asphyxiated neonates, cTnI concentrations within 36 h of birth correlate strongly with clinical grade of HIE and with duration of inotropic support. Early cTnI concentrations may provide a useful proxy marker for the anticipated severity of myocardial dysfunction.     

新生儿缺氧缺血性脑病血浆及脑脊液血管内皮生长因子和一氧化氮的变化

目的：观察新生儿缺氧缺血性脑病 (HIE)血浆与脑脊液(CSF)中血管内皮生长因子 (VEGF)与一氧化氮(NO)含量的变化及与HIE严重程度的关系。方法：检测 38例HIE患儿轻度(16例,中度13例,重度9例)早期 (生后 2 4h内 )血浆与CSF中VEGF与NO含量 ,并与 13例非神经系统疾病对照组比较。分析VEGF与NO的相关性及其意义。结果：中、重度HIE组CSF中NO含量 (12 .6 5± 1.4 4 μmol/L,14 .82± 1.91μmol/L)与对照组 (8.11± 1.33μmol/L)及轻度HIE组 (9.2 1± 1.74 μmol/L)相比显著升高 (均P <0 .0 1),且重度HIE组NO的含量大于中度HIE组(P <0 .0 1),而轻度HIE组与对照组无显著性差异;轻、中、重度HIE患儿CSF中VEGF含量 (12 .30± 1.2 4 pg/ml,13.6 0± 0 .85 pg/ml,14 .79± 1.6 3pg/ml)均明显高于对照组(10 .94± 1.4 8pg/ml)(P <0 .0 1) ,且VEGF含量随病情严重程度增加而增加。HIE患儿CSF中VEGF与NO的含量呈显著正相关(r =0 .6 17,P <0 .0 1)。HIE各组血浆中VEGF与NO含量未见显著性差异。结论：VEGF在早期HIE患儿CSF中明显升高,检则CSFVEGF水平将可能有助于HIE的早期诊断及疾病严重程度的判断。     

The role of TNF‐α in eosinophilic inflammation associated with RSV bronchiolitis

Choi J, Callaway Z, Kim HB, Fujisawa T, Kim CK. The role of TNF‐α in eosinophilic inflammation associated with RSV bronchiolitis.
Pediatr Allergy Immunol 2010: 21: 474–479.
© 2009 John Wiley & Sons A/S The purpose of our study was to investigate whether tumor necrosis factor (TNF)‐α correlates with eosinophilic inflammation that occurs during a lower respiratory tract infection with the respiratory syncytial virus (RSV) in children. Sixty children with RSV bronchiolitis (RSV group) and 20 healthy children with no respiratory symptoms (Control group) were enrolled. We measured the nasal lavage fluid (NLF) Th2 cytokine (IL‐5), proinflammatory cytokine (TNF‐α, IL‐8), eosinophil‐active cytokine [granulocyte‐macrophage colony stimulating factor (GM‐CSF), IFN‐γ], and eosinophil‐active chemokine (eotaxin, regulated on activation normal T cell excreted and secreted) levels for both groups. We also measured serum eosinophil‐degranulation product (eosinophil‐derived neurotoxin; EDN, eosinophil cationic protein; ECP) levels from RSV group. TNF‐α, IL‐8, GM‐CSF, IFN‐γ, and eotaxin levels were significantly higher in the RSV group compared with the Control group. TNF‐α correlated with GM‐CSF (r = 0.87, p < 0.0001), IFN‐γ (r = 0.92, p < 0.0001), eotaxin (r = 0.64, p < 0.0001), and IL‐8 (r = 0.84, p < 0.0001). TNF‐α may have an important role in eosinophilic inflammation of airways in children with RSV bronchiolitis.     

缺氧缺血性心肌损伤新生儿血浆心肌营养素-1的变化及意义

目的 观察血浆心肌营养素-1(CT-1)在新生儿缺氧缺血性脑病(HIE)合并心肌损伤中的变化及临床意义.方法 选择HIE患儿45例(轻度15例、中度24例、重度6例)为观察组,根据有无心肌损伤分为心肌损伤组(19例)和无心肌损伤(26例)两个亚组.20例正常新生儿为对照组.采用双抗体夹心酶标免疫分析法检测血浆CT-1水平.同时检测血清肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白I(CTnI)水平.结果 轻度、中/重度HIE组血浆 CT-1水平分别为169±20、287±44 pg/mL,均 高于对照组(30±8 pg/mL)(P<0.01),且中/重度HIE组高于轻度HIE组(P<0.01).HIE患儿急性期血浆CT-1水平与血清CK-MB、CTnI均呈显著正相关(r分别为0.565、0.621,均P<0.01).心肌损伤亚组血浆CT-1水平较非心肌损伤亚组升高(249±35 pg/mL vs 177±26 pg/mL;P<0.01).心肌损伤亚组急性期血浆CT-1水平(249±35 pg/mL)明显高于恢复期(157±19 pg/mL)(P<0.01).结论 检测HIE患儿血浆CT-1水平有助于HIE新生儿心肌损伤的诊断,且有助于判断HIE病情.     

新生儿缺氧缺血性脑病脑脊液环磷酸腺苷变化及其临床意义

目的 探讨新生儿缺血缺氧性脑病(HIE)脑脊液(CSF)环磷酸腺苷(cAMP)变化及其临床意义。方法 采用法国:Immunotech公司提供的125I-cAMP放免药盒对86例HIE患儿进行脑脊液cAMP。结果 中、重度HIE组CSI-cAMP值较非HIE组明显降低,有显著差异(P<0.05);重度HIE患儿CSI-cAMP值较轻、中度患儿降低,差异具有显著性(P<0.05);恢复期较急性期CSF-cAMP值都有所升高,但无显著差异。结论 HIE时CSF-cAMP降低,病情愈重,降低愈明显。CSF-cAMP测定可作为HIE患儿判断病情的辅助指标。     

Apparent diffusion coefficient histogram analysis of neonatal hypoxic–ischemic encephalopathy

Background

Diffusion-weighted imaging is a valuable tool in the assessment of the neonatal brain, and changes in diffusion are seen in normal development as well as in pathological states such as hypoxic–ischemic encephalopathy (HIE). Various methods of quantitative assessment of diffusion values have been reported. Global ischemic injury occurring during the time of rapid developmental changes in brain myelination can complicate the imaging diagnosis of neonatal HIE.

Objective

To compare a quantitative method of histographic analysis of brain apparent coefficient (ADC) maps to the qualitative interpretation of routine brain MR imaging studies. We correlate changes in diffusion values with gestational age in radiographically normal neonates, and we investigate the sensitivity of the method as a quantitative measure of hypoxic–ischemic encephalopathy.

Materials and methods

We reviewed all brain MRI studies from the neonatal intensive care unit (NICU) at our university medical center over a 4-year period to identify cases that were radiographically normal (23 cases) and those with diffuse, global hypoxic–ischemic encephalopathy (12 cases). We histographically displayed ADC values of a single brain slice at the level of the basal ganglia and correlated peak (s-sD_av) and lowest histogram values (s-sD_lowest) with gestational age.

Results

Normative s-sD_av values correlated significantly with gestational age and declined linearly through the neonatal period (r ²?=?0.477, P?<?0.01). Six of 12 cases of known HIE demonstrated significantly lower s-sD_av and s-sD_lowest ADC values than were reflected in the normative distribution; several cases of HIE fell within a 95% confidence interval for normative studies, and one case demonstrated higher-than-normal s-sD_av.

Conclusion

Single-slice histographic display of ADC values is a rapid and clinically feasible method of quantitative analysis of diffusion. In this study normative values derived from consecutive neonates without radiographic evidence of ischemic injury are correlated with gestational age, declining linearly throughout the perinatal period. This method does identify cases of HIE, though the overall sensitivity of the method is low.     

新生儿缺氧缺血性脑病脑脊液和血浆IL-6水平的变化及临床意义

目的 研究新生氧缺血性脑病（ＨＩＥ）患儿脑脊液和血浆ＩＬ－６水平变化,探讨ＩＬ－６水平与ＨＩＥ和脑损伤程度之间的关系。方法 采用ＥＬＩＳＡ法测定新生儿脑脊液和血浆ＩＬ－６水平。结果 重度ＨＩＥ患儿急性期脑脊液ＩＬ－６水平中位数为１３．６ｎｇ／Ｌ,明显高于对照组的１．８ｎｇ／Ｌ及轻、中度ＨＩＥ组的２．１、３．６ｎｇ／Ｌ;血浆ＩＬ－６水平各组间差异无显著性。结论 新生儿ＨＩＥ脑脊液ＩＬ－６水平变化与Ｈ     

新生儿缺氧缺血性脑病血清神经元特异性烯醇化酶和头颅CT的变化

目的探讨血清神经元特异性烯醇化酶（ＮＳＥ）和头颅ＣＴ在新生儿缺氧缺血性脑病（ＨＩＥ）诊断中的作用。方法ＨＩＲ患儿２０例，用酶联免疫法测定生后８天、７天血清ＮＳＥ浓度。生后１周内行头颅ＣＴ检查。结果ＨＩＥ患儿血清ＮＳＥ在生后３天均升高，尤以中、重度明显，与临床分度一致。重度ＨＩＥ患儿头颅ＣＴ分度与临床一致，轻、中度头颅ＣＴ分度与临床不平行。结论血清ＮＳＥ测定是早期诊断ＨＩＥ及判断脑损伤的有效指标，头颅ＣＴ检查结合血清ＮＳＥ测定可更为准确地帮助ＨＩＥ的诊断和治疗。     

Contribution of the blood glucose level in perinatal asphyxia

This is a comparative study between 60 asphyxiated newborns (cases) and 60 normal neonates (controls) in respect of their plasma glucose and uric acid levels and also their clinical and neurological status. The mean plasma glucose level was significantly lower (35.1 ± 11.4 mg/dl vs. 56.9 ± 5.5 mg/dl; P < 0.001) and the mean serum uric acid level was higher (8.0 ± 1.2 mg/dl vs. 4.5 ± 0.83 mg/dl; P < 0.001) in the asphyxiated group when compared to the controls. Within the perinatal asphyxia group, the plasma glucose level and Apgar scores showed a significant positive linear correlation (r = 0.740, P < 0.001), whereas a significant negative linear correlation was observed between the glucose level and different stages of hypoxic ischemic encephalopathy (HIE) (r = −0.875, P < 0.001). Although a strong positive linear correlation was found between uric acid and HIE stages (r = 0.734, P ≤ 0.001), the linear correlation between uric acid and Apgar scores (r = −0.885, P < 0.001) and uric acid and the plasma glucose level (r = −0.725, P < 0.001) were found to be significantly negative among the cases. Conclusion: The severity of encephalopathy and cellular damage varies with the severity of hypoglycemia.     

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。     

Serum neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury in asphyxiated neonates

Objective

To determine the clinical utility of serum neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in asphyxiated neonates with hypoxic ischemic encephalopathy (HIE).

Design

Cohort study.

Settings

National Intensive Care Unit of Maternity Hospital, Ain Shams University, Cairo, Egypt.

Patients

The study included 30 term asphyxiated neonates (8 with mild, 13 with moderate and 9 with severe HIE) and 20 control neonates.

Intervention

Serum NGAL level was measured within 6 hours after birth using an enzyme linked immunosorbent assay.

Main outcome measures

Patients were subsequently discriminated into AKI (n=12) and no-AKI (n=18) groups.

Results

The median (Interquartile range) serum NGAL concentration was 95.0 (70.75–180.00) ng/mL in asphyxiated neonates, and 39.75 (6.0–48.0) ng/mL in control neonates; (P<0.001). Serum NGAL correlated with HIE severity: mean (SD) was 65.50 (3.77) ng/mL in infants with mild HIE, 115.07 (45.83) ng/mL in infants with moderate HIE and 229.66 (79.50) ng/mL in infants with severe HIE; (P<0.01). The median (Interquartiles) serum NGAL level was 182.50 (166.25–301.75) ng/mL in patients with AKI, 74.00 (66.00–78.75) ng/mL in those without AKI; (P<0.001). A cutoff value 157 ng/mL for serum NGAL could detect AKI in asphyxiated neonates with a sensitivity of 83.3% and a specificity of 94.4%.

Conclusion

Elevated serum NGAL measured within 6 hours after birth reliably indicates acute kidney injury in asphyxiated neonates.     

内皮素-1在新生儿缺氧缺血性脑病中的变化及意义

目的　探讨内皮素 - 1(ET - 1)在新生儿缺氧缺血性脑病 (HIE)中的变化及意义。方法　采用放射免疫法测定 2 0例正常小儿和 5 2例HIE患儿的血清及脑脊液 (CSF)中ET 1水平 ,并将HIE患儿分为轻、中、重 3组。结果　正常对照组血清ET 1为 6 8.71± 12 .0 3ng/L。轻、中、重度HIE血清ET 1在急性期分别为 98.38±12 .82ng/L ,10 7.2 1± 18.5 6ng/L ,119.5 6± 14.6 9ng/L ;恢复期分别为73.44± 11.79ng/L ,75 .73± 11.38ng/L ,83.92± 15 .99ng/L。HIE患儿急性期血清ET 1水平显著高于恢复期及正常对照组 ,P <0 .0 1。轻、中、重度HIE患儿急性期CSF中ET 1水平分别为 43.79± 7.14ng/L ,5 1.0 7± 11.19ng/L ,6 1.86± 13.5 5ng/L ;恢复期CSF中ET 1水平分别为 30 .79± 4.42ng/L ,33.0 7± 4.84ng/L ,39.5 0± 5 .5 6ng/L。急性期CSF中ET 1水平显著高于恢复期 ,均P <0 .0 1,且血清及CSF中ET 1水平与病情轻重密切相关。急性期HIE患儿血清和CSF中ET 1水平 ,重度组明显高于正常对照组P <0 .0 1及P <0 .0 5 ,尤以重度组升高显著 ;恢复期轻 ,中度组ET 1水平降至正常 ,而重度组仍维持在较高水平 ,且血清及CSF中ET 1水平与病情轻重密切相关。血清和CSF中ET 1水平与 1分钟Apgar评分呈显著负相关。 结论　ET 1在HIE的发     

Creatine kinase isoenzyme BB concentrations in cerebrospinal fluid in asphyxiated preterm neonates

Creatine kinase isoenzyme BB was determined in cerebrospinal fluid (CSF) in 79 preterm neonates using an original enzyme-linked immunosorbent assay. The criterion for inclusion was an Apgar score of 7 or less at 5 min of life. Neurological examination was performed on day 2 and day 5 of life. CSF was obtained on the same days. Lumbar puncture was performed on 41 of these babies on day 2 and in 39 on day 5 of life (one baby underwent lumbar puncture twice). All babies had clinical features of hypoxic-ischemic encephalopathy (HIF) which was classified according to Sarnat and Sarnat. The control group consisted of 90 asphyxiated term babies and 30 adults without CNS pathology. The concentration of CK-BB in cerebrospinal fluid (meanSD) was significantly higher ( p < 0.0005) in preterm (168.0 2) than in term babies (29.0 3.1) and healthy adults (5.3 1.2). Our results demonstrate the possibility of using the classification system of Sarnat and Sarnat for assessment of the severity of brain damage not only in term, but also in preterm babies. Neonates with HIE stages II and III showed markedly higher CK-BB values than those with HIE I on day 2 ( p < 0.025) and day 5 ( p < 0.05) of life. CK-BB values were markedly higher in preterm babies with none of some primitive responses (head turning, Babkin's reflex, palmar grasp). The mean concentration of CK-BB was higher in neonates with retarded psychomotor development compared with those with normal development ( p < 0.05) on day 3, and after 6 and 9 months. At 12 months of age no significant difference in median CK-BB concentration was detected between neonates with normal and developmental disturbances. Asphyxia, cerebrospinal fluid, creatine kinase BB isoenzyme, hypoxic-ischemic encephalopathy, neonates     

亚低温治疗对缺氧缺血性脑病新生儿血清神经胶质酸性蛋白和泛素羧基末端水解酶L1的影响

目的 研究缺氧缺血性脑病(HIE)新生儿亚低温治疗后血清神经胶质酸性蛋白(GFAP)和泛素羧基末端水解酶L1(UCH-L1)的表达水平并探讨其价值.方法 选取64例HIE新生儿,其中33例轻度患儿采取一般治疗,31例中、重度患儿给予一般治疗和亚低温治疗,采用ELISA检测患儿治疗前和治疗后(6~12 h)血清GFAP和UCH-L1的水平.结果 治疗前中、重度HIE组患儿血IL-6、IL-8、GFAP以及UCH-L1水平高于轻度HIE组(P<0.01).相关性分析显示血GFAP水平与IL-6、IL-8呈正相关(分别r=0.54、0.63,P<0.05),与Apgar评分呈负相关(r=-0.47,P<0.05).治疗后,中、重度组患儿血IL-6、IL-8、UCH-L1水平低于治疗前(P<0.05),但GFAP水平高于治疗前(P<0.01).生后15~18个月后的随访发现神经发育不良的患儿血GFAP水平高于预后良好的患儿(P<0.01).ROC曲线显示GFAP和UCH-L1的诊断曲线下面积为0.714和0.703;当GFAP的诊断阈值为0.07 ng/mL时,其诊断的敏感性为77%,特异性为78%.结论 亚低温治疗可致HIE患儿血清UCH-L1水平降低,GFAP水平升高;血清GFAP、UCH-L1水平可反映HIE患儿治疗前后脑细胞的变化,有望成为新的HIE的血清学辅助诊断指标.     

Predictive value of plasma and cerebrospinal fluid tumour necrosis factor-alpha and interleukin-1 beta concentrations on outcome of full term infants with hypoxic-ischaemic encephalopathy

AIM: To determine the predictive value of plasma and cerebrospinal fluid (CSF) tumour necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) concentrations on the outcome of hypoxic-ischaemic encephalopathy (HIE) in full term infants. METHODS: Thirty term infants with HIE were included in the study. HIE was classified according to the criteria of Sarnat and Sarnat. Blood and CSF were obtained within the first 24 hours of life and stored until assay. Five infants died soon after hypoxic insult. Neurological examinations and Denver Developmental Screening Test (DDST) were performed at 12 months in the survivors. RESULTS: At the age of 12 months neurological examination and DDST showed that 11 infants were normal; 14 had abnormal neurological findings and/or an abnormal DDST result. Eleven normal infants were classified as group 1 and 19 infants (14 with abnormal neurological findings and/or an abnormal DDST and five who died) as group 2. CSF IL-1 beta and TNF-alpha concentrations in group 2 were significantly higher than those in group 1. Plasma IL-1 beta and TNF-alpha concentrations were not significantly different between the two groups. IL-1 beta, but not TNF-alpha concentrations, in group 2 were even higher than those in group 1, although non-survivors were excluded from group 2. When the patients were evaluated according to the stages of Sarnat, the difference in the three groups was again significant. Patients whose CSF samples were taken within 6 hours of the hypoxic insult had higher IL-1 beta and TNF-alpha concentrations than the patients whose samples were taken after 6 hours. CONCLUSIONS: Both cytokines probably contribute to the damage sustained by the central nervous system after hypoxic insult. IL-1 beta seems to be a better predictor of HIE than TNF-alpha.     

Chromogranin A and neuron-specific enolase in neuroblastoma: Correlation to stage and prognostic factors

Chromogranin A (CgA) and neuron specific enolase (NSE) are important markers in adult neuroendocrine tumors (NET). Neuroblastoma (NB) has certain neuroendocrine properties. The aim of this study was to correlate blood concentrations of CgA, chromogranin B (CgB), and NSE to prognostic factors and outcome in children with NB. Blood samples from 92 patients with NB, 12 patients with benign ganglioneuroma (GN), 21 patients with non-NB solid tumors, 10 patients with acute leukemias, and 69 healthy children, were analyzed. CgA concentrations were higher in neonates vs. children older than one month in the control group (p < 0.0001), and in neonates with NB vs. the control group (p < 0.01). CgA and NSE concentrations were higher in patients with stages 3 and 4 disease (p < 0.05 and p < 0.05), in patients having tumors with amplification of MYCN (p < 0.05 and p < 0.001), or chromosome 1 p deletion (p < 0.05 and p < 0.05). NSE correlated to the tumor size at diagnosis (p < 0.001) and to tumor related death (p < 0.01) in NB. CgA and NSE concentrations were elevated in patients with NB and especially in those with advanced disease. Both CgA and NSE correlated to genetic markers, while only NSE correlated to primary tumor size and outcome in NB. We found that CgA and NSE are clinically valuable tumor markers in NB and they merit prospective clinical evaluations as such.     

Increased granulocyte-colony stimulating factor (G-CSF) levels in neonates with perinatal complications

We have investigated cord blood granulocyte-colony stimulating factor (G-CSF) levels in neonates with or without neonatal complications to examine some changes in the G-CSF levels in the neonatal period. The G-CSF levels were measured in 613 neonates by enzyme immunoassay. The results showed that G-CSF levels were distributed in a broad range from the level under the cutting point (31 pg/mL) to over the measurable range (2000 pg/mL). Normal neonates without perinatal complications were 322. In normal neonates, the G-CSF level correlated with the gestational age (r = 0.255, P < 0.01) and cord blood leukocyte count (r = 0.210, P < 0.01). The G-CSF values were under 100 pg/mL in 95% of normal neonates with a median of 35.0 pg/mL. We divided the neonates into two groups: a lower (< 100 pg/mL) and a higher (≥ 100 pg/mL), based on the G-CSF level. The percentage of neonates with higher G-CSF levels (≥ 100 pg/mL) was greater in neonates with perinatal complications than in normal neonates (< 100 pg/mL; P < 0.01). Compared with normal neonates, the percentages of the higher group were greater in neonates with infections (P < 0.01), fetal distress (P < 0.01), premature rupture of membranes (P < 0.05), neonatal asphyxia (P < 0.01) and meconium staining of amniotic fluid (P < 0.01). Neonates with higher G-CSF levels had larger numbers of peripheral leukocytes (P < 0.05) than did those with the lower G-CSF levels. Counts of leukocytes were parallel with those of neutrophils. In conclusion, cord G-CSF levels in neonates can be increased in response to, not only infections, but also to such stress states as fetal distress, premature rupture of membranes, neonatal asphyxia and meconium staining of the amniotic fluid, which may result in increased numbers of neutrophils.     

新生儿缺氧缺血性脑病血清及脑脊液中促红细胞生成素的变化(英文)

目的：探讨缺氧缺血性脑病(HIE)患儿血清和脑脊液(CSF)中促红细胞生成素（Epo）的变化,观察Epo与脑损伤的关系。方法：对26例HIE患儿（轻度8例,中度10例,重度8例）和8例正常对照组进行研究,在生后0~24 h、48~72h 及7~10 d抽取静脉血,HIE组在生后48~72 h腰穿取CSF,放射免疫法测定血清和CSF Epo含量,HIE组生后7~10d做头部MRI检查。结果：对照组血清Epo随日龄增加呈下降趋势,有统计学差异(P 0.05)。头部MRI为重度改变的HIE患儿CSF中Epo水平均较头部MRI为轻、中度改变的HIE患儿显著升高(F = 8.56, P < 0.01)。结论：HIE患儿血清Epo显著升高,持续不降是病情危重的标志。CSF中Epo显著升高提示HIE患儿脑损伤严重,预后不良。重度HIE患儿可能存在着血脑屏障的破坏,Epo可能透过血脑屏障。［中国当代儿科杂志,2005, 7(2): 107-111］     

新生儿缺氧缺血性脑病磁共振影像学评分与临床分度的相关性研究

目的 探讨新生儿缺氧缺血性脑病（HIE）磁共振成像（MRI）影像学评分与临床分度的相关性。方法 依据HIE临床分度标准对61例HIE患儿进行分度,应用改良的MRI评分系统进行不同MRI序列的损伤评分,分析HIE影像学评分与临床严重程度之间的关系。结果 中度HIE的MRI影像学评分低于重度HIE,差异有统计学意义（P < 0.01）;0~7 d新生儿的MRI弥散加权成像（DWI）评分与MRI综合评分的相关系数最高（r > 0.9）;>7 d新生儿的MRI T1加权成像评分与MRI综合评分的相关系数最高（r=0.963）;重度HIE脑损伤的头部MRI表现主要以基底节/丘脑+脑干和全脑型损伤为主,而中度HIE以分水岭损伤为主、脑干很少受累,差异有统计学意义（P < 0.01）。结论 MRI影像学评分系统与HIE临床分度之间有较好的相关性,可协助HIE临床诊断及分度。