Selective cortical alteration after hypoxic-ischemic injury in the very immature rat brain

Distinctive cerebral lesions with disruptions to the developing white matter are found in very low birth weight (VLBW) infants. Although hypoxia-ischemia (HI) is a causal pathway, the pathogenesis of cerebral white matter injury in the VLBW infant is not fully understood. Pertinent murine models would facilitate the investigation of the processes leading to these cerebral lesions and enable the evaluation of therapeutic strategies. Postnatal d 3 (P3) rats are at a stage of cortical oligodendroglial maturation and axonal outgrowth similar to very preterm infants. Our aim was to characterize the effects of a focal hypoxic-ischemic injury at P3 on subsequent cerebral development. Three groups of P3 Wistar rats were investigated: group I underwent right carotid ligation followed by 6% hypoxia for 30 min (HI), group 2 had carotid ligation only, and group 3 had no intervention. At P21, in the HI group, the right cortical area was reduced compared with controls (p < 0.01). There were no significant alterations in the size of the dorsal hippocampus, striatum, and thalamus. The cortical myelinated area was reduced in the HI animals compared with controls (p < 0.01). There was a corresponding loss of myelinated axons extending up into the cortex, with deep cortical neuronal and axonal architecture markedly disrupted. Glial fibrillary acidic protein immunohistology showed a reactive gliosis in the deep parietal cortex (p < 0.01). Moderate HI injury in the immature rat brain compromised cortical growth and led to a selective alteration of cortical myelinated axons with persistent gliosis. These alterations induced at P3 by unilateral HI share neuropathological similarities with the diffuse white matter lesions found in VLBW infants.     

Mutations of genes involved in the innate immune system as predictors of sepsis in very low birth weight infants

Mutations of genes involved in the innate immune system have been reported to be associated with an increased sepsis rate in adults. We determined the -159T mutation of the CD14 gene, the 896G mutation of the toll-like receptor 4 gene, the 3020insC mutation of the NOD2 gene (NOD2-3020insC), the IL-6 174G/C promoter polymorphism (IL6-174G/C), and the mannose-binding lectin genotype and their association to the subsequent development of neonatal sepsis in a large cohort of very low birth weight (VLBW) infants. Fifty (14%) of 356 VLBW infants developed blood culture-proven sepsis during their stay in the hospital. VLBW infants carrying the NOD2-3020insC allele (n =15) and the IL6-174G allele (n =121) had a significantly higher rate of blood culture-proven sepsis (33% and 19.8%, respectively) than VLBW infants without these genotypes (p = 0.046 and 0.035, respectively). In a multivariate logistic regression analysis, gestational age less than 28 wk (odds ratio, 3.2; 95% confidence interval, 1.7-6.0; p < 0.001) and the homozygous IL6-174G allele (odds ratio, 1.9; 95% confidence interval, 1.0-3.9; p = 0.039) were predictive for the development of sepsis, whereas the NOD2-3020insC allele was only of borderline significance (odds ratio, 3.2; 95% confidence interval, 1.0-10.4; p = 0.052). VLBW infants with repeated episodes of sepsis had higher frequencies of the NOD2-3020insC and IL6-174G allele. The increased sepsis rate of homozygous IL6-174G carriers was especially related to an increase in Gram-positive infections, and was not observed in VLBW infants who received prophylaxis with teicoplanin (frequency of Gram-positive sepsis in homozygous IL6-174G carriers without prophylaxis 16.5% versus 2.4% in homozygous IL6-174G carriers with prophylaxis; p = 0.033).     

血小板活化因子乙酰水解酶基因多态性与早产儿颅内出血的关联性

目的：本研究从基因水平探讨血小板活化因子乙酰水解酶（PAF-AH）基因第9外显子Val279Phe单核苷酸多态性与早产儿颅内出血是否具有关联性,为有效预防颅内出血的发生提供理论依据。方法：选取颅内出血早产儿58例作为出血组,无颅内出血早产儿65例作为对照组,应用聚合酶链式反应（PCR）检测PAF-AH第9外显子Val279Phe单核苷酸多态性位点的基因型及等位基因的分布情况,进行病例对照研究分析。结果：出血组和对照组PAF-AH第9外显子Val279Phe基因型分布频率差异有统计学意义（P＜0.05）,其中出血组正常基因型频率（63.8%）明显低于对照组（81.5%）;出血组突变杂合子基因型（34.5%）明显高于对照组（16.9%）。两组PAF-AH等位基因分布频率差异亦有统计学意义（P＜0.05）,其中出血组T 等位基因频率（19.0%）明显高于对照组（10.0%）。结论：PAF-AH第9外显子Val279Phe的单核苷酸基因多态性与早产儿颅内出血有关。     

Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study

OBJECTIVES: The aim of this study was to define qualitatively the nature and extent of white and gray matter abnormalities in a longitudinal population-based study of infants with very low birth weight. Perinatal factors were then related to the presence and severity of magnetic resonance imaging (MRI) abnormalities. METHODS: From November 1998 to December 2000, 100 consecutive premature infants admitted to the neonatal intensive care unit at Christchurch Women's Hospital were recruited (98% eligible) after informed parental consent to undergo an MRI scan at term equivalent. The scans were analyzed by a single neuroradiologist experienced in pediatric MRI, with a second independent scoring of the MRI using a combination of criteria for white matter (cysts, signal abnormality, loss of volume, ventriculomegaly, corpus callosal thinning, myelination) and gray matter (gray matter signal abnormality, gyration, subarachnoid space). Results were analyzed against individual item scores as well as the presence of moderate-severe white matter score, total gray matter score, and total brain score. RESULTS: The mean gestational age was 27.9+/-2.4 weeks (range, 23-32 weeks), and mean birth weight was 1063+/-292 g. The greatest univariate predictors for moderate-severe white matter abnormality were lower gestational age (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.7; P<.01), maternal fever (OR, 2.2; 95% CI, 1.1-4.6; P<.04), proven sepsis in the infant at delivery (OR, 1.8; 95% CI, 1.1-3.6; P=0.03), inotropic support (OR, 2.7; 95% CI, 1.5-4.5; P<.001), patent ductus arteriosus (OR, 2.2; 95% CI, 1.2-3.8; P=.01), grade III/IV intraventricular hemorrhage (P=.015), and the occurrence of a pneumothorax (P=.05). There was a significant protective effect of intrauterine growth restriction (OR, 0.51; 95% CI, 0.23-0.99; P=.04). Gray matter abnormality was highly related to the presence and severity of white matter abnormality. A unique pattern of cerebral abnormality consisting of significant diffuse white matter atrophy, ventriculomegaly, immature gyral development, and enlarged subarachnoid space was found in 10 of 11 infants with birth gestation <26 weeks. Given the later outcome of these infants, this pattern may have very high risk for later global neurodevelopmental disability. CONCLUSIONS: This MRI study confirms a high incidence of cerebral white matter abnormality at term in an unselected population of premature infants, which is predominantly a result of noncystic injury in the extremely immature infant. We confirm that the major perinatal risk factors for white matter abnormality are related to perinatal infection, particularly maternal fever and infant sepsis, and hypotension with inotrope use. We have defined a distinct pattern of diffuse white and gray matter abnormality in the extremely immature infant.     

Interleukin‐6 polymorphism and bronchopulmonary dysplasia risk in very low‐birthweight infants

Background: The aim of the present study was to evaluate the role of interleukin (IL)‐6‐634 polymorphism in neonatal disorders such as bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) in very low‐birthweight (VLBW) infants. Methods: This prospective cohort study included 202 infants (gestational age at birth, 23–34 weeks; birthweight, 500–1499 g). Genotypic analysis (polymerase chain reaction–restriction fragment length polymorphism) was performed with DNA extracted from whole‐blood samples. Results: Genotype distribution (66.8% CC, 28.2% CG, 5.0% GG) was similar to that in the adult Japanese population. BPD occurred in 85 infants (42.1%) among 202 VLBW infants. The duration of O₂ therapy in infants with CG/GG genotypes was significantly longer than that in infants with the CC genotype (CG/GG vs CC: 40.3 ± 52.2 days vs 28.4 ± 32.6 days, P < 0.05), but the prevalence of BPD was not associated with the CG/GG genotype (CG/GG, 40.0%; CC, 46.3%, P= 0.24). Infants with CG/GG genotypes were more likely to have received postnatal corticosteroid therapy for BPD than those with the CC genotype (CG/GG vs CC: 20.9% vs 11.1%, P= 0.05). PVL occurred in six infants (3.0%). There was no significant difference in the prevalence of PVL among IL‐6‐634 polymorphisms (CG/GG, 3.0%; CC, 3.0%, P= 0.65). Conclusions: IL‐6‐634 polymorphism is associated with duration of oxygen therapy in VLBW infants. This suggests that the IL‐6‐634 polymorphism G allele is an aggravating factor of BPD. IL‐6‐634 polymorphism is not associated with PVL.     

超早产儿脑病危险因素的病例对照研究

目的：了解超早产儿（胎龄＜28周）脑病的发生状况并探讨其发生的危险因素。方法：收集复旦大学附属儿科医院NICU 2009年1月1日至2015年12月31日期间住院的、出生胎龄＜28周的、于纠正胎龄足月时或出院前完成MRI检查的超早产儿,排除纠正胎龄或出院时MRI单纯脑出血的病例。根据头颅MRI影像学报告结果分为单纯EOP组、EOP+出血组和正常组,采集与发生EOP可能相关的母亲和新生儿影响因素,三组之间进行单因素比较。结果：115例超早产儿进入本文分析,单纯EOP 组20例,EOP+出血组15例,正常组80例。35例EOP患儿中,白质损伤31例（88.6%）,灰质损伤4例（11.4%）,小脑损伤3例（8.6%）,多发广泛损伤1例（2.9%）,白质合并小脑损伤2例（5.7%）。脑白质损伤中,脑室周围白质损伤17例,其中非囊性损伤16例,囊性PVL1例;皮层下白质损伤14例,其中额叶损伤7例。单因素分析显示,单纯EOP组、EOP+出血组、正常组3组比较,母亲因素和新生儿因素差异均无统计学意义（P均＞0.05）。结论：超早产儿EOP与早产儿脑病一样最多见于脑白质损伤,影响超早产儿脑病为非单一危险因素起作用。     

Fluconazole prophylaxis prevents invasive fungal infection in high-risk, very low birth weight infants

OBJECTIVES: To evaluate the benefit of fluconazole prophylaxis in preventing invasive fungal infection in very low birth weight (VLBW) infants with central vascular access. STUDY DESIGN: A 3-year baseline period (1998 to 2000) was compared with a subsequent 3-year period (2001 to 2003) during which a different protocol for preventing invasive fungal infection was used. All infants with a birth weight < 1500 g and with central vascular access were eligible for the study. Fluconazole (Diflucan R) was administered for 28 days at a dose of 6 mg/kg every third day during the first week and daily after the first week. RESULTS: There were no significant differences between the baseline and the fluconazole groups in demographic characteristics or risk factors for fungal infection. Fungal infection developed in 9 of the infants in the baseline group and in none of those in the fluconazole group (P=.003). A trend of decreasing mortality rate between the 2 groups (12.6% vs 8.1%; P=.32) was observed but was not statistically significant. No adverse effects of fluconazole therapy were documented. CONCLUSIONS: Fluconazole prophylaxis appeared to be beneficial in preventing invasive fungal infection in VLBW infants.     

Severe umbilical cord inflammation-a predictor of periventricular leukomalacia in very low birth weight infants

Chorioamnionitis has been associated with periventricular leukomalacia (PVL) in very low birth weight (VLBW) infants. We examined the association between the pathological severity of chorioamnionitis and PVL in VLBW infants. Thirty-four VLBW infants with PVL and 34 control infants matched for gestational age without a diagnosis of PVL or intraventricular hemorrhage were obtained from the Women and Infants' Hospital of Rhode Island's Neonatal Follow-up Clinic database. Placental samples, including the amnion/chorion, chorionic plate, and umbilical cord, were examined microscopically. Statistical analysis included Mantel-Haenszel chi-square, and Student's t-test. Severe inflammation in the umbilical cord was observed in 53% of infants with PVL and 32% without PVL (p<0.05). Severe umbilical cord inflammation is one of the risk factors associated with the development of PVL in VLBW infants.     

磁敏感加权成像在早产儿伴脑室旁白质损伤中的应用研究

目的脑室旁白质损伤是早产儿围生期窒息后常见的脑损伤类型之一,其MRI表现具有特征性,但常规序列难以区分病灶内是否合并出血,而出血与否可能影响治疗和预后。该研究应用磁敏感加权成像(SWAN)来检测存在白质损伤的早产儿脑内的出血性病变。方法对临床怀疑围生期窒息后脑损伤的75例早产儿行头颅GE HDx Twin Speed 3.0T MRI检查,扫描序列包括T1FLAIR、T2FLAIR、DWI和SWAN。结果44例(58.7%)早产儿存在脑室旁白质损伤,其中4例(9.1%)存在出血性白质损伤。在这4例中有3例合并生发基质出血-脑室内出血;4例合并小脑出血;1例合并蛛网膜下隙出血。结论脑室旁白质损伤中绝大多数为非出血性损伤,当伴有生发基质出血或脑室内出血时,脑室周围白质损伤病灶中常存在出血。     

230例极低出生体质量儿随访至纠正6月龄生存质量分析

目的分析极低出生体质量(VLBW)婴儿的短期预后。方法回顾性分析2013年12月至2014年12月收治的VLBW婴儿随访至纠正6月龄的生存质量。结果共入选230例符合标准的VLBW婴儿,出院时死亡30例(13.0%),放弃治疗40例(17.4%),好转签字出院60例(26.1%),治愈100例(43.5%)。30例死亡VLBW婴儿中,主要为新生儿呼吸窘迫综合征18例、肺出血5例、败血症3例。200例存活婴儿随访至纠正6月龄时,13例(6.5%)失访;54例(27.0%)死亡,其中40例是因经济原因放弃治疗或好转签字出院的。纠正1、3、6月龄时,继续随访的VLBW婴儿身长、体质量均随月龄增长逐渐接近儿童生长标准,但至纠正6月龄时仍明显落后于儿童生长标准;身长落后较体质量落后更明显。109例患儿行眼底筛查,其中早产儿视网膜病变Ⅰ期21例、Ⅱ期7例,眼底出血行激光光凝术6例;98例患儿行听力筛查,单侧未通过5例,双侧未通过11例;95例患儿行头颅磁共振成像(MRI)检查,颅内出血10例,早产儿脑损伤9例。49例患儿纠正胎龄42周行新生儿神经行为测定(NBNA)均≤35分;纠正3月龄时,36例患儿行Gesell发育量表评估,轻度发育迟缓11例、中度2例;纠正6月龄时,24例行Gesell发育量表评估,轻度发育迟缓2例。VLBW婴儿在适应能力、社交行为、大运动方面进步较快。结论经济条件及新生儿呼吸窘迫综合征、肺出血、败血症是影响VLBW婴儿存活及生存质量的重要因素;存活VLBW婴儿的生长发育均有逐渐好转现象。     

Granulocyte colony-stimulating factor in the cord blood of premature neonates born to mothers with pregnancy-induced hypertension.

OBJECTIVES: To estimate the cord blood levels of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in preterm infants and to study the relationship of these levels to pregnancy-induced hypertension (PIH) and absolute neutrophil counts. STUDY DESIGN: G-CSF and GM-CSF levels in the cord blood of preterm neonates (n = 74) either with or without maternal PIH were estimated by enzyme-linked immunosorbent assay. RESULTS: Infants in the PIH group had lower white blood cell, absolute neutrophil, absolute lymphocyte, and monocyte counts. The levels of G-CSF in cord blood were significantly lower in infants whose mothers had PIH (P =.04) and in infants with neutropenia (P =. 01). G-CSF levels were positively correlated with both absolute neutrophil count (P =.02) and total white blood cell count (P =.01). GM-CSF was undetectable in all subjects. According to logistic regression with neutropenia as the dependent variable, only maternal PIH (P <.001), gestational age (P <.001), and G-CSF (P =.01) were independently related. CONCLUSION: In this study maternal PIH and low gestational age were significantly associated with neutropenia in premature infants. Low G-CSF levels may contribute to the neutropenia that is commonly seen in infants born to mothers with PIH.     

Very-low-birth-weight, preterm infants with or without intracranial hemorrhage. Neurologic, cognitive and cranial MRI correlations at 4-8-year follow-up

Fourteen very-low-birth-weight (VLBW) preterm infants with and without intracranial hemorrhage (ICH) were prospectively followed from birth to 4 to 8 years for the purpose of determining neurologic and cognitive sequelae associated with ICH severity and to correlate outcomes with brain morphology as determined by Magnetic Resonance Imaging (MRI). Intracranial hemorrhage was documented by cranial ultrasonography performed in early life. Follow-up assessments included neurologic and psychometric examinations and cranial MRI scans. Of six children with no ICH, five had normal results on all three follow-up measures. Three children with Grade I-II ICH had mild to moderate neurologic and cognitive sequelae with focal white matter MRI abnormalities. Five children with Grade III-IV ICH had severe neurologic, cognitive, and MRI deficits, including MRI regional and diffuse white matter abnormalities and/or cortical atrophy. Focal and diffuse neurologic deficits correlated with the extent of MRI morphologic abnormalities. Results of this study indicate that ICH severity correlated with outcomes in children at follow-up; the more severe the ICH, the more adverse the neurologic, cognitive, and MRI results. MRI white matter abnormalities were present in all children with any degree ICH, while ventriculomegaly was seen only in severe ICH (Grade III-IV ICH). Neurologic deficits correlated with MRI structural abnormalities.     

极低出生体重儿败血症的临床分析

目的 分析极低出生体重儿败血症的发生情况及临床特征.方法 收集2019年1月至2020年6月南京医科大学附属妇产医院新生儿科收治的极低出生体重儿(出生体重<1500 g)的临床资料,分析败血症发生率、病原菌分布及危险因素.结果 共369例患儿纳入研究,其中败血症138例,包括早发型败血症(early-onset sep...     

早产儿暂时性低甲状腺素血症与脑损伤及神经行为学相关性研究

目的 通过对早产儿甲状腺素水平测定及脑、神经行为发育测评,分析甲状腺素水平与脑损伤、神经行为学的相关性.方法 选取2009年11月至2010年4月,上海交通大学附属上海市儿童医院新生儿科收治的早产儿52例,生后6 h内留取血清样本,放射免疫法测定T3、T4、TSH值.所有患儿出生后3 d行头颅B超检查,每周复查1次,出院前行头颅MRI检查.根据头颅MRI结果将患儿分为3组:无脑损伤组(33例)、脑室内出血组(10例)、脑白质损伤组(9例).所有患儿于纠正胎龄40±2周时行新生儿20项行为神经测定.结果 3组患儿TSH均正常,排除先天性甲状腺功能减低症;共8例早产儿甲状腺功能正常,占15.4%(8/52);另44例早产儿甲状腺功能均低下,占84.6%(44/52).无脑损伤组T3、T4水平高于脑室内出血组及脑白质损伤组,并以脑白质损伤组T3、T4水平最为低下,3组间比较差异有统计学意义(P＜0.05).无脑损伤组患儿行为能力、被动肌张力、主动肌张力及总分4项得分显著高于有脑损伤的两组患儿,且脑室内出血组患儿得分又高于脑白质损伤组患儿,3组间比较差异有统计学意义(P＜0.05).结论 早产儿脑损伤越严重,甲状腺素水平越低.有脑损伤的早产儿神经行为学评分较无脑损伤的早产儿低.     

应用弥散张量成像评价支气管肺发育不良早产儿脑白质发育的研究

目的 应用磁共振弥散张量成像（DTI）的各项异性分数（FA）和表观弥散系数（ADC）评价支气管肺发育不良（BPD）早产儿的脑白质发育。方法 以2016年8月至2019年4月生后24 h内收住NICU的出生胎龄≤32周、出生体重<1 500 g,且出院前完成头颅MRI及DTI检查的96例早产儿为研究对象。根据出院诊断分为BPD组（n=48）和非BPD组（n=48）,比较两组DTI相同感兴趣区的FA值和ADC值。结果 两组早产儿脑室周围-脑室内出血、脑室周围白质软化、局灶性脑白质损伤等发生率差异无统计学意义（P > 0.05）。BPD组早产儿内囊后肢、胼胝体压部、枕叶白质、小脑、大脑脚的FA值低于非BPD组（P < 0.05）,各ADC值高于非BPD组（P < 0.05）。与非BPD组相比,BPD组早产儿呼吸暂停次数更多、肺炎发生率和机械通气比例更高、辅助通气时间更长（P < 0.05）。结论 BPD对早产儿脑白质发育具有潜在影响,可导致脑白质发育延迟,因此,需关注该类患儿的神经功能。     

Racial differences in respiratory-related neonatal mortality among very low birth weight infants

OBJECTIVE: To examine racial differences in the secular trends in respiratory-related neonatal mortality among very low birth weight (VLBW) infants in the United States, temporally associated with surfactant availability. DESIGN: Comparison of time trends in African American and non-Hispanic white (NHW) VLBW infants of cause-specific neonatal mortality and neonatal and infant mortality for 2 consecutive 3-year periods. RESULTS: From 1985 to 1988 there was no racial difference in the rate of decline of each mortality outcome. From 1988 to 1991 rates of decline in neonatal mortality caused by respiratory distress syndrome and by all respiratory causes were significantly greater for NHWs compared with African Americans. However, the rate of decline in nonrespiratory neonatal mortality was similar for African Americans and NHWs. Compared with African American VLBW infants, NHWs had a greater rate of decline in both neonatal (31% vs 20%; P <.01) and infant mortality (32% vs 21%; P <.01) during this period. CONCLUSIONS: Between 1988 and 1991, declines in neonatal mortality risks caused by respiratory distress syndrome and all respiratory causes were greater for NHW infants than for African American VLBW infants. The decline in nonrespiratory mortality risk showed no racial differences. These findings suggest possible racial disparities in timely access or racial differences in the efficacy of respiratory treatments for VLBW infants.     

Symptomatic patent ductus arteriosus in very-low-birth-weight infants: 1987-1989.

Symptomatic patent ductus arteriosus (sPDA) may occur in up to 50% of very-low-birth-weight (VLBW, less than or equal to 1500 g) infants. We reported a 16% incidence in 1979-1980 in a totally inborn population, demonstrating the importance of early fluid management. Although survival of VLBW infants, especially those less than 1000 g, has increased, sPDA has not been carefully re-examined. Therefore, we sought to determine if the incidence, morbidity, treatment, or risk factors for sPDA had changed in this population. Between January 1, 1987 and December 31, 1989 all VLBW infants with sPDA surviving greater than 72 h (119/636) were identified and compared to matched controls (n = 70). Incidence and onset of sPDA were 19% and 10 +/- 6 days (+/- S.D.), respectively, the former increasing from 8% to 33% between 1251-1500 g and 500-750 g, respectively (P less than 0.001). Fluid and colloid administration were similar in sPDA and control infants. sPDA was associated with the occurrence of chronic lung disease (18% vs 7%, P = 0.005) and intracranial hemorrhage (53% vs 21%, P less than 0.001). Using stepwise logistic regression analysis we were unable to create a model that accurately predicted sPDA. Medical management and indomethacin were unsuccessful in 66% and 25%, respectively, of infants so treated; 43% required surgical ligation. Although survival of VLBW infants has increased, our incidence of sPDA remains low, with greater than 80% of infants demonstrating spontaneous closure when fluid and colloid administration are judiciously used.     

Cerebral MRI of very low birth weight children at 6 years of age compared with the findings at 1 year

Background. We have previously reported the results of cerebral MRI examinations in an unselected year cohort of very low birth weight (VLBW) infants at one year of corrected age. Twenty-one (78 %) of 27 infants had abnormal myelination, mainly in the central occipital white matter (COWM) and in the centrum semiovale (CS), seen on T2-weighted images. Twelve infants had irregular and dilated lateral ventricles. We speculated whether these findings indicated perinatal periventricular leukomalacia (PVL). Only two infants had completely normal MRI at age 1 year. Objective. To determine whether the abnormal myelination seen at 1 year of age, was still present, either as delayed myelination or as gliosis caused by perinatal PVL. Materials and methods. In the present study, we report the results of follow-up cerebral MRI in 20 of these infants at 6 years of age. Results. Most of the children with MRI deviations at 1 year still had abnormalities at 6 years. Abnormal myelination in the central occipital white matter combined with abnormalities in the CS or with ventricular dilatation at age 1 year, presented as gliosis in 12 of 13 children at 6 years of age. Abnormalities solely in the COWM at age 1 year had normalised in two of five children and persisted as delayed myelination in three at age 6 years. Gliotic changes in periventricular white matter were found in 12 of 20 children (60 %). Areas most affected were the CS (11 children) and the COWM (9 children). Delayed myelination in COWM was found in six children (30 %), combined with gliosis in CS in three children. Twelve infants had ventricular dilatation both at 1 and 6 years of age. Conclusions. The MRI correlates of PVL, i. e. gliosis and ventricular dilatation, are common findings on cerebral MRI at 6 years of age in VLBW infants. Received: 20 February 1997 Accepted: 1 December 1997     

极低/超低出生体重儿晚发败血症的临床分析

目的 分析极低/超低出生体重（VLBW/ELBW）早产儿晚发败血症（LOS）的临床特征及病原菌情况。方法 在2012年1月至2016年12月收治的VLBW/ELBW早产儿（胎龄<32周）中,选取发生LOS的患儿作为LOS组,每例LOS患儿匹配2例非败血症患儿作为对照组。根据是否发生院内死亡,将LOS组分为死亡亚组和存活亚组,分析LOS发生的危险因素、临床特征、病原菌分布、耐药情况及死亡危险因素。结果 共收治VLBW/ELBW早产儿513例,LOS组65例,对照组130例,LOS发生率为12.7%。LOS组死亡6例,存活59例。LOS组出生体重低于对照组（P < 0.05）,LOS组经外周静脉穿刺中心静脉置管（PICC）时间、机械通气时间、住院时间长于对照组（P < 0.05）。LOS组小于胎龄儿（SGA）、机械通气、新生儿坏死性小肠结肠炎、死亡比例高于对照组（P < 0.05）。低出生体重、SGA、PICC时间长为VLBW/ELBW早产儿发生LOS的危险因素（分别OR=1.396、2.550、1.068,P < 0.05）。合并化脓性脑膜炎是VLBW/ELBW早产儿LOS死亡的危险因素（OR=13.443,P < 0.05）。LOS组共培养出65株病原菌,39株（60%）为革兰阴性菌,其中15株为产超广谱β-内酰胺酶（ESBLs）菌,67%（10/15）感染ESBLs菌的LOS患儿发病2周前应用过抗生素,高于非耐药菌（29%,7/24）（P < 0.05）。结论 出生体重低、SGA、PICC时间长为VLBW/ELBW早产儿发生LOS的危险因素,合并化脓性脑膜炎的LOS患儿更容易发生死亡。LOS病原菌以革兰阴性菌多见,发病2周前应用过抗生素可能会增加ESBLs菌感染。     

HFE gene mutation and transferrin saturation in very low birthweight infants.

AIM: To determine if there is an association between high transferrin saturation and the C282Y HFE gene mutation in very low birthweight (VLBW) infants. METHODS: One hundred and forty three VLBW infants receiving recombinant erythropoietin and 3 to 9 mg/kg/day of enteral iron were studied. Genomic DNA was extracted from filter paper cards. The C282Y mutation was determined by restriction fragment length polymorphism analysis. RESULTS: Six infants were heterozygous for the mutation; none was homozygous. Ten infants had a transferrin saturation above 80% at least once. No infant was positive for both transferrin saturation above 80% and the mutation. CONCLUSIONS: The data strongly suggest that there is no association between high transferrin saturation and the HFE gene mutation in VLBW infants during the first weeks of life.