BACKGROUND & AIMS: :Recent neuroimaging findings have highlighted the impact of premature birth on subcortical development and morphological changes in the deep grey nuclei and ventricular system. To help characterize subcortical microstructural changes in preterm neonates, we recently implemented a multivariate tensor-based method (mTBM). This method allows to precisely measure local surface deformation of brain structures in infants. Here, we investigated ventricular abnormalities and their spatial relationships with surrounding subcortical structures in preterm neonates. We performed regional group comparisons on the surface morphometry and relative position of the lateral ventricles between 19 full-term and 17 preterm born neonates at term-equivalent age. Furthermore, a relative pose analysis was used to detect individual differences in translation, rotation, and scale of a given brain structure with respect to an average. Our mTBM results revealed broad areas of alterations on the frontal horn and body of the left ventricle, and narrower areas of differences on the temporal horn of the right ventricle. A significant shift in the rotation of the left ventricle was also found in preterm neonates. Furthermore, we located significant correlations between morphology and pose parameters of the lateral ventricles and that of the putamen and thalamus. These results show that regional abnormalities on the surface and pose of the ventricles are also associated with alterations on the putamen and thalamus. The complementarity of the information provided by the surface and pose analysis may help to identify abnormal white and grey matter growth, hinting toward a pattern of neural and cellular dysmaturation.

背景与目标： ：最近的神经影像学发现突显了早产对深层灰色核和心室系统皮质下发育和形态变化的影响。为了帮助表征早产儿的皮层下微结构变化，我们最近实施了基于多张量的方法（mTBM）。这种方法可以精确地测量婴儿大脑结构的局部表面变形。在这里，我们调查了早产儿的心室异常及其与周围皮层下结构的空间关系。我们对足月等效年龄的19例足月和17例早产新生儿的表面形态和侧脑室的相对位置进行了区域组比较。此外，相对姿势分析用于检测给定大脑结构相对于平均值的平移，旋转和尺度的个体差异。我们的mTBM结果显示左心室前角和身体的变化范围较宽，而右心室颞角的变化范围较窄。在早产儿中，左心室旋转也发生了显着变化。此外，我们发现侧脑室的形态和位姿参数与壳核和丘脑的位姿参数之间存在显着的相关性。这些结果表明，脑室表面和姿势的局部异常也与壳核和丘脑的改变有关。由表面和姿势分析提供的信息的互补性可能有助于识别异常的白色和灰色物质生长，暗示神经和细胞不饱和的模式。

BACKGROUND & AIMS: INTRODUCTION:Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm that impairs normal lung development, causing pulmonary hypertension (PH). PH in CDH newborns is the main determinant for morbidity and mortality. Different therapies are still mainly based on 'trial and error'. Inhaled nitric oxide (iNO) is often the drug of first choice. However, iNO does not seem to improve mortality. Intravenous sildenafil has reduced mortality in newborns with PH without CDH, but prospective data in CDH patients are lacking. METHODS AND ANALYSIS:In an open label, multicentre, international randomised controlled trial in Europe, Canada and Australia, 330 newborns with CDH and PH are recruited over a 4-year period (2018-2022). Patients are randomised for intravenous sildenafil or iNO. Sildenafil is given in a loading dose of 0.4 mg/kg in 3 hours; followed by continuous infusion of 1.6 mg/kg/day, iNO is dosed at 20 ppm. Primary outcome is absence of PH on day 14 without pulmonary vasodilator therapy and/or absence of death within the first 28 days of life. Secondary outcome measures include clinical and echocardiographic markers of PH in the first year of life. We hypothesise that sildenafil gives a 25% reduction in the primary outcome from 68% to 48% on day 14, for which a sample size of 330 patients is needed. An intention-to-treat analysis will be performed. A p-value (two-sided) <0.05 is considered significant in all analyses. ETHICS AND DISSEMINATION:Ethics approval has been granted by the ethics committee in Rotterdam (MEC-2017-324) and the central Committee on Research Involving Human Subjects (NL60229.078.17) in the Netherlands. The principles of the Declaration of Helsinki, the Medical Research Involving Human Subjects Act and the national rules and regulations on personal data protection will be used. Parental informed consent will be obtained. TRIAL REGISTRATION NUMBER:NTR6982; Pre-results.

背景与目标： 简介：先天性diaphragm肌疝（CDH）是the肌的发育缺陷，会损害正常的肺部发育，从而导致肺动脉高压（PH）。 CDH新生儿的PH是发病率和死亡率的主要决定因素。不同的疗法仍然主要基于“尝试和错误”。吸入一氧化氮（iNO）通常是首选药物。但是，iNO似乎并未提高死亡率。静脉西地那非可降低患有CDH的PH患儿的死亡率，但缺乏CDH患者的前瞻性数据。
方法和分析：在欧洲，加拿大和澳大利亚的一项开放标签，多中心，国际随机对照试验中，在4年期间（2018年至2022年）招募了330名CDH和PH新生儿。患者随机接受静脉注射西地那非或iNO治疗。西地那非在3分钟内的剂量为0.4µmg / kg；随后连续输注1.6μmg/ kg /天，iNO的剂量为20 ppm。主要结局是在没有肺血管扩张药治疗的第14天没有PH和/或在生命的前28天内没有死亡。次要结局指标包括生命第一年的PH临床和超声心动图标志。我们假设西地那非第14天的主要结局指标从68％降低到48％，降低了25％，这需要330名患者的样本量。将进行意向治疗分析。在所有分析中，p值（双面）<0.05被认为是显着的。
伦理与传播：荷兰的伦理委员会（MEC-2017-324）和涉及人类研究的中央委员会（NL60229.078.17）已获得伦理批准。将使用《赫尔辛基宣言》的原则，《涉及人类受试者的医学研究法》以及有关个人数据保护的国家法规。将获得父母的知情同意。
注册号：NTR6982;结果。

BACKGROUND & AIMS: UNLABELLED:In neonates, jaundice may be one of the initial symptoms related to urinary tract infection (UTI). The routine testing of the urine in jaundiced neonates is controversial. This study aimed to evaluate the related factors of neonatal infants with the initial presentation of hyperbilirubinemia and the final diagnosis of UTI by evaluating data that help diagnose UTI early in apparently healthy newborns with jaundice. PATIENTS AND METHODS:We retrospectively investigated the medical records of neonates who had been admitted for management of jaundice (n=26) and compared with neonates with jaundice but without UTI (n=26). RESULTS:There was a significant difference between the two groups in male gender and maternal conditions (prolonged rupture of membranes, maternal UTI). There was also a significant difference between the two groups in their age at the time jaundice started (4 ± 3 days vs 2 ± 1 days) in the UTI and non-UTI groups, respectively (P>0.05). The cases in the UTI group had significantly lower total bilirubin levels (183 ± 71 mg/l) vs (227 ± 40 mg/l) in the non-UTI group, but a higher indirect bilirubin rate than the non-UTI group (P<0.05). Type B blood group was more common in neonates with UTI (P<0.01). In the cases presented herein, none of the jaundiced infants with UTI presented conjugated hyperbilirubinemia. Therefore, urinary tests for UTI should not be absolutely excluded or neglected in neonates in the early stage with unconjugated hyperbilirubinemia. Performing urinary tests to exclude the possibility of coincidental UTI may be necessary for admitted jaundiced infants younger than if they have a high level of indirect bilirubin, especially in male newborns with group B blood and in the presence of maternal urinary infection.

背景与目标： 未加标签：在新生儿中，黄疸可能是与尿路感染（UTI）相关的最初症状之一。黄疸新生儿的常规尿液检测存在争议。这项研究旨在通过评估有助于在明显健康的黄疸新生儿中早期诊断尿路感染的数据，评估初次出现高胆红素血症和尿路感染最终诊断的新生儿的相关因素。
病人和方法：我们回顾性研究了入院治疗黄疸的新生儿的病历（n = 26），并与患有黄疸但无尿路感染的新生儿（n = 26）进行了比较。
结果：两组在男性性别和孕产妇状况方面存在显着差异（胎膜延长，孕产妇泌尿道感染）。在UTI组和非UTI组中，黄疸开始时两组的年龄也有显着差异（分别为4±3天和2±1天）（P> 0.05）。 UTI组患者的总胆红素水平显着降低（183±71 mg / l），而非UTI组为（227±40 mg / l），但间接胆红素发生率高于非UTI组（P <0.05）。 B型血型在UTI新生儿中更为常见（P <0.01）。在本文所述的情况下，UTI的黄疸婴儿均未表现出结合性高胆红素血症。因此，在未合并高胆红素血症的早期阶段，不应绝对排除或忽略尿检的尿路感染。对于比有较高间接胆红素水平高的入院黄疸婴儿，必须进行尿检以排除巧合性UTI的可能性，特别是在B组血液和存在母体尿液感染的男性新生儿中。

BACKGROUND & AIMS: BACKGROUND:Immunoglobulin products are widely used across multiple therapeutic areas such as immunodeficiency syndromes, infection and autoimmune diseases. The pharmacokinetics (PK) of immunoglobulins are well characterized in adults, but very little is known about the PK of immunoglobulins in neonates and infants (<2 years of age). OBJECTIVE:The objectives of the present study were: (1) characterize the PK of immunoglobulin intravenous preparation using model-independent (non-compartmental analysis), and (2) develop and evaluate a population PK model with extensive blood samples (8 blood samples) and sparse blood samples (2-3 blood samples). METHOD:Immunoglobulin G (IgG) concentration versus time data from very low birth weight neonates (n = 20) following intravenous administration were analyzed using nonlinear mixed effect modeling and non-compartmental approaches. Population pharmacokinetic models were developed from extensive and sparse sampling schemes. Models were evaluated based on the difference in objective function, goodness-of-fit plots and simulation based visual predictive check analysis. RESULTS:A non-compartmental analysis of IgG from neonates (bodyweight range 0.78-1.38 kg) indicated an average clearance of 3.0 ± 2.1 mL/day and volume of distribution at steady state 68 ± 25 mL. The population pharmacokinetic model from extensive sampling adequately described concentration- time data with mean clearance (2.7 mL/day), volume of central compartment (8.7 mL) and peripheral compartment (60 mL). The clearance and volume of distribution estimates using sparse sampling model (1 pre-and 2 post-dose blood samples) were comparable with extensive sampling. CONCLUSION:Our study provides important bridging data in scaling PK and dosing of immunoglobulins across a wide age range.

背景与目标： 背景：免疫球蛋白产品广泛应用于免疫缺陷综合症，感染和自身免疫性疾病等多个治疗领域。免疫球蛋白的药代动力学（PK）在成人中已得到很好的表征，但对于新生儿和婴儿（<2岁）中的免疫球蛋白PK知之甚少。
目的：本研究的目的是：（1）使用与模型无关的方法（非房室分析）表征免疫球蛋白静脉注射制剂的PK，以及（2）开发和评估具有大量血液样本（8个血液样本）的人群PK模型）和稀疏的血液样本（2-3个血液样本）。
方法：使用非线性混合效应模型和非房室方法分析静脉注射后极低出生体重新生儿（n = 20）的免疫球蛋白G（IgG）浓度与时间的关系。人群药代动力学模型是根据广泛而稀疏的抽样方案开发的。根据目标函数，拟合优度图和基于仿真的视觉预测检查分析中的差异对模型进行评估。
结果：对新生儿（体重范围0.78-1.38 kg）的IgG进行的非房室分析表明，平均清除率为3.0±2.1 mL /天，稳态时的分布体积为68±25 mL。大量采样的总体药代动力学模型充分描述了浓度-时间数据，包括平均清除率（2.7 mL /天），中心区室（8.7 mL）和外围区室（60 mL）的体积。使用稀疏采样模型（1个给药前血样和2个给药后血样）的分布估计的清除率和体积与大量采样相当。
结论：我们的研究为跨年龄范围的PK缩放和免疫球蛋白剂量提供了重要的桥梁数据。

BACKGROUND & AIMS: OBJECTIVES:Fat emulsions used in Australia for parenteral nutrition in preterm neonates have been based on either soybean oil or olive oil (OO). OO lipid Clinoleic has a high ratio of n-6 to n-3 fatty acids (9:1); this may not be ideal for long-chain polyunsaturated fatty acids supply. Newly available SMOFlipid has an appropriate ratio of n-6 to n-3 fatty acids (2.5:1). SMOFlipid also contains OO (25%), coconut oil (30%), and soybean oil (30%). The aims of the study were to evaluate the safety of the SMOFlipid and to test the hypothesis that SMOFlipid would lead to increased omega-3 long-chain polyunsaturated fatty acid levels and reduced oxidative stress as compared with Clinoleic in preterm neonates (<30 weeks). METHODS:Preterm neonates (23-30 weeks) were randomised to receive Clinoleic or SMOFlipid emulsion for 7 days. Investigators and outcome assessors were masked to allocation. Plasma F2-isoprostanes (lipid peroxidation marker), red blood cell fatty acids, and vitamin E were measured before and after the study. Blood culture positive sepsis and growth were monitored for safety. RESULTS:Thirty of 34 participants completed the study. Both emulsions were well tolerated without any adverse events. F2-isoprostane levels were reduced in the SMOFlipid group as compared with baseline. Eicosapentanoic acid and vitamin E levels were significantly increased in the SMOFlipid group. Oleic acid and linoleic acid levels were increased in both groups. No significant differences were noted in poststudy docosahexaenoic acid levels in both groups despite higher levels of docosahexaenoic acid in SMOFlipid. CONCLUSIONS:SMOFlipid was safe, well tolerated, and showed beneficial effect in terms of reduction of oxidative stress by reducing lipid peroxidation levels in high-risk preterm neonates.

背景与目标： 目的：在澳大利亚用于早产儿肠胃外营养的脂肪乳剂是基于大豆油或橄榄油（OO）的。 OO脂质亚油酸具有高比例的n-6与n-3脂肪酸（9：1）；对于长链多不饱和脂肪酸供应来说，这可能不是理想的选择。新获得的SMOFlipid具有n-6与n-3脂肪酸的适当比例（2.5：1）。 SMOFlipid还包含OO（25％），椰子油（30％）和大豆油（30％）。这项研究的目的是评估SMOFlipid的安全性，并检验以下假设：与早产儿相比，SMOFlipid与亚油酸相比，会导致omega-3长链多不饱和脂肪酸水平升高和氧化应激降低， 。
方法：将早产新生儿（23-30周）随机接受7天的亚油性或SMOF脂质乳剂治疗。研究者和结果评估者被掩盖了分配。在研究之前和之后测量血浆F2-异前列腺素（脂质过氧化标记），红细胞脂肪酸和维生素E。监测血培养阳性败血症和生长的安全性。
结果：34名参与者中有30名完成了研究。两种乳液均具有良好的耐受性，没有任何不良事件。与基线相比，SMOFlipid组的F2-异前列腺素水平降低。 SMOF脂质组的二十碳五烯酸和维生素E水平显着升高。两组的油酸和亚油酸水平均升高。尽管SMOF脂质中的二十二碳六烯酸水平较高，但两组的研究后二十二碳六烯酸水平均无显着差异。
结论：SMOF脂质安全，耐受性好，并且通过降低高危早产儿的脂质过氧化水平，在减少氧化应激方面显示出有益的作用。

BACKGROUND & AIMS: :Over an eight-year period, echocardiograms were transmitted by ISDN at 384 kbit/s for a total of 132 patients suspected of having congenital heart disease (CHD). Five transmitted scans were inadequate. Hands-on echocardiograms were performed subsequently on 116 of the remaining 127 cases (91%). Major CHD was diagnosed in 42 of the 116 infants (36%) and minor CHD in 49 (42%). The telemedicine diagnosis was accurate in 97% of the cases (kappa = 0.90). There were four diagnostic errors. Transfer to the regional unit was avoided in 95 patients (72%). The present study shows that high diagnostic accuracy is possible using a telemedicine link to transmit images obtained with the assistance of real-time guidance by a paediatric cardiologist. The results also demonstrate the importance of an expert interpreting the echocardiographic images, since the accuracy of diagnosis was considerably improved (the kappa coefficient increased from 0.14 to 0.90).

背景与目标： ：在8年的时间里，通过ISDN以384 kbit / s的速度发送了超声心动图，共计132名怀疑患有先天性心脏病（CHD）的患者。五次传输的扫描不充分。随后对其余127例病例中的116例（91％）进行了手动超声心动图检查。 116名婴儿中有42名（36％）被诊断出严重的CHD，而49名婴儿中（42％）被诊断出轻微的CHD。在97％的病例中，远程医疗诊断是准确的（kappa = 0.90）。有四个诊断错误。 95名患者（72％）避免转移到区域单位。本研究表明，使用远程医疗链接传输在儿科心脏病专家的实时指导下获得的图像可以实现较高的诊断准确性。该结果还证明了解释超声心动图图像的专家的重要性，因为诊断的准确性得到了极大的提高（卡帕系数从0.14增加到0.90）。

BACKGROUND & AIMS: :Neonates experience adverse drug reactions (ADRs), but under-reporting of suspected ADRs to national spontaneous reporting schemes in this population is particularly high. A prospective observational study collected suspected neonatal ADRs at a tertiary neonatal unit. Cases were analysed for causality by six assessors using three existing methods. Sixty-three suspected ADR cases were identified in 35/193 neonates (18.1%). The proportion of suspected ADRs where the drug was prescribed "off-label" was 30/68 (44.1%). When 34 cases were assessed for causality using three methods, global kappa scores of less than 0.3 for each tool suggested only "fair" inter-rater reliability. Neonatal ADRs can be captured and occur from a variety of drugs affecting many organ systems. The current tools for assessing causality need to be adapted before they can reliably assess neonatal ADRs.

背景与目标： ：新生儿有不良药物反应（ADR），但该人群中将可疑ADR漏报至国家自发报告计划的情况尤其高。一项前瞻性观察研究在第三级新生儿病房收集了疑似新生儿ADR。六名评估者使用三种现有方法对案例进行了因果分析。在35/193例新生儿中鉴定出63例可疑ADR病例（占18.1％）。处方药“超标”的可疑ADR比例为30/68（44.1％）。当使用三种方法评估34例因果关系时，每种工具的总体kappa得分均低于0.3，表明评分者之间的“公平”可信度。可以从影响许多器官系统的多种药物中捕获并发生新生儿ADR。当前的评估因果关系的工具需要先进行调整，然后才能可靠地评估新生儿ADR。

BACKGROUND & AIMS: :Infections are currently often responsible for neonatal morbidity and mortality. The present study examines the possibility of reducing this incidence by the early diagnosis of infections. With this in mind the early clinical signs of infection were examined as well as the results of certain quickly and easily performed blood and blood chemical tests which were scored from 0 to 2. The results showed that newborns with scores less than 5 should be considered free of sepsis, those scoring 5-7 should arouse suspicion of sepsis, while sepsis should be considered definitely present in those scoring greater than 7. This scoring system presented 100% sensitivity, 88.2% specificity as well as 100% positive and an 88.2% negative predictive value. The system is therefore considered reliable as well as easy to use.

背景与目标： ：感染通常是新生儿发病率和死亡率的原因。本研究探讨了通过早期诊断感染来减少这种情况的可能性。考虑到这一点，检查了感染的早期临床体征以及某些快速且容易进行的血液和血液化学测试的结果，其得分为0到2。结果表明，得分低于5的新生儿应被视为免费对于败血症，得分为5-7的人应该引起对败血症的怀疑，而得分大于7的人应该明确地认为败血症。该得分系统具有100％的敏感性，88.2％的特异性以及100％的阳性和88.2％的阴性预测价值。因此，该系统被认为可靠且易于使用。

BACKGROUND & AIMS: OBJECTIVE:To compare the status of infants with hypoplastic left heart syndrome (HLHS) or pulmonary atresia-hypoplastic right heart (PA-HRH) before and following transport using the validated Transport Risk Index of Physiologic Stability (TRIPS) score. METHODS:In this retrospective review of infants with HLHS or PA-HRH transported to a Children's Hospital by a pediatric transport team, an increase in TRIPS score (temperature, blood pressure, respiratory status, and response to stimuli) following transport was defined as deterioration. Statistical analyses included t-test (paired and independent), χ2, and McNemar's tests for comparisons between groups with and without deterioration and before and after transport. RESULTS:Our cohort [n = 64; 39 (61%) HLHS and 25 (39%) PA-HRH] was predominantly female (61%), black (56%), and diagnosed antenatally (78%). Median transport time was 20 (10-30) min and age was <12 h in 48 (75%) infants. TRIPS scores worsened after transport in 24 (37.5%) infants, due to temperature (n = 10) or respiratory (n = 7) dysregulation. Infants who deteriorated during transport had HLH more often (83 versus 48%) and lower pH [7.27 (0.12) versus 7.33 (0.07)]. HLH was significantly predictive of deterioration during transport [OR 5.60 (95% C.I. 1.18-26.62)]. CONCLUSIONS:The physiologic deterioration in a third of infants with single ventricle following short transports is intriguing and may have implications on their optimal place of birth.

背景与目标： 目的：使用经过验证的生理稳定性运输风险指数（TRIPS）评分，比较出生前后发育不良的左心综合征（HLHS）或肺动脉闭锁-发育不良的右心（PA-HRH）婴儿的状况。
方法：在本次回顾性回顾中，由儿科运输小组将HLHS或PA-HRH婴儿运输到儿童医院，将运输后TRIPS评分（温度，血压，呼吸状况和对刺激的反应）的升高定义为恶化。统计分析包括t检验（配对和独立），χ2和McNemar检验，用于比较运输前后有无恶化的组和没有恶化的组。
结果：我们的队列[n = 64; 39例（61％）HLHS和25例（39％）PA-HRH]以女性（61％），黑人（56％）和产前诊断（78％）为主。 48名（75％）婴儿的中位转运时间为20（10-30）min，年龄<12 h。由于温度（n = 10）或呼吸道（n = 7）失调，在24名（37.5％）的婴儿中运输后，TRIPS评分恶化。在运输过程中恶化的婴儿患HLH的频率更高（83％对48％）和较低的pH值[7.27（0.12）对7.33（0.07）]。 HLH显着预测了运输过程中的恶化[OR 5.60（95％C.I. 1.18-26.62）]。
结论：短途运输后三分之一单脑室婴儿的生理恶化是令人着迷的，并且可能对他们的最佳出生地点有影响。

BACKGROUND & AIMS: :The annual rate of Down syndrome (DS) births in Jerusalem is stable, regardless of prenatal screening, and diagnostic measures. We aimed to evaluate our historical cohort for obstetrical characteristics and the neonatal course and complications. We reviewed computerized medical files of neonates with the diagnosis of DS born in the four main hospitals in Jerusalem between the years 2000 and 2010 and evaluated for maternal history and primary neonatal hospitalization. A total of 403 neonates were diagnosed with DS. The average maternal age was 35.6 years, 73% were born via spontaneous vaginal delivery. In all gestational ages, the mean birth weight and head circumference percentiles were significantly lower than the general population (P < 0.001 for both) and at each week the HC percentile was lower than the weight percentile (P < 0.0001), worse among males. Mortality during the primary hospitalization was 3.7%. The most common anomalies were cardiac (79%) with either congenital defects or functional abnormalities, neither influenced the length of hospitalization. The main reasons for prolonged hospitalization were prematurity and anomalies of other (non-cardiac) organs. Common perinatal complications included respiratory failure or need for oxygen supplementation (32%), hyperbilirubinemia (23%), sepsis (6.4%), and feeding difficulties (13%). About 84% were fed by human milk; of those, two thirds were exclusively breast-fed and one third were supplemented with infant formula. In conclusion, infants with DS were small for gestational age with relatively reduced head circumference. Despite the increased rate of congenital anomalies and perinatal complications, most infants were discharged home in good medical condition and were exclusively breastfed.

背景与目标： ：无论进行产前筛查和诊断措施如何，耶路撒冷的唐氏综合症（DS）的年均出生率稳定。我们旨在评估我们的历史队列的产科特征，新生儿病程和并发症。我们回顾了2000年至2010年间在耶路撒冷四家主要医院出生的诊断为DS的新生儿的计算机病历，并评估了其母亲史和原发性新生儿住院治疗。共有403名新生儿被诊断患有DS。平均产妇年龄为35.6岁，其中73％是通过自然阴道分娩出生的。在所有胎龄儿，平均出生体重和头围百分位数均显着低于普通人群（两者均P <0.001），并且每周的HC百分位数均低于体重百分数（P <10.0001），在男性中更差。初次住院期间的死亡率为3.7％。最常见的异常是心脏病（79％），先天性缺陷或功能异常，均未影响住院时间。长期住院的主要原因是早产和其他（非心脏）器官异常。围产期常见的并发症包括呼吸衰竭或需要补充氧气（32％），高胆红素血症（23％），败血症（6.4％）和进食困难（13％）。约84％的人是用牛奶喂养的；其中，三分之二是纯母乳喂养的，三分之一则是婴儿配方奶粉的补充。总之，DS婴儿的胎龄较小，头围相对减少。尽管先天异常和围产期并发症的发生率增加，但大多数婴儿在良好的医疗条件下已出院回家，并且仅接受母乳喂养。

BACKGROUND & AIMS: Vitamin A is widely used in neonatal intensive care units (NICU) to prevent and reduce lung injury in premature infants who require mechanical ventilation. As part of a project to assess the management in NICU, this study was designed to establish whether vitamin A supplementation in neonates at risk for bronchopulmonary dysplasia (BPD) increased and maintained their plasma levels to at least 20 micrograms/dl. Twenty-five preterm babies, 24-34 weeks gestation, 600-1,770 g birth weight, received 1,000 IU/day of vitamin A intravenously for the first 28 days of life. At birth the majority had plasma vitamin A lower than 20 micrograms/dl which rapidly rose during supplementation. Even though expected therapeutic plasma concentrations were reached in the majority of infants without exceeding the toxic level, no association was found between vitamin A plasma concentrations and maternal or newborns characteristics at delivery and clinical status or outcome of infants. Thus, even if dosage schedule may be furtherly optimized to reach and maintain wanted therapeutic ranges, the efficacy of routine therapeutic vitamin A supplementation has to be adequately proved.

背景与目标： 维生素A被广泛用于新生儿重症监护病房（NICU）中，以预防和减少需要机械通气的早产儿的肺部伤害。作为评估新生儿重症监护病房管理的项目的一部分，该研究旨在确定在患有支气管肺发育不良（BPD）风险的新生儿中补充维生素A是否增加并将血浆水平维持在至少20微克/分升。 25名早产儿，妊娠24-34周，出生体重600-1,770 g，在出生后的头28天每天静脉内接受1,000 IU /天的维生素A。出生时大多数人血浆维生素A低于20微克/分升，在补充过程中迅速上升。即使在大多数婴儿中达到了预期的治疗性血浆浓度而不超过毒性水平，也未发现维生素A血浆浓度与分娩时的母体或新生儿特征以及婴儿的临床状况或结局之间存在关联。因此，即使可以进一步优化剂量方案以达到和维持所需的治疗范围，常规治疗性维生素A补充剂的功效也必须得到充分证明。

BACKGROUND & AIMS: :End tidal Carbon dioxide monitoring was undertaken prospectively in all Ventilated neonates in our NICU admitted from March 1995 to August 1995 irrespective of the birth weight, gestational age and indication of ventilation. The aim was to determine the correlation between ETCO2 and PaCO2 in various clinical situations. The arterial blood gases were obtained in all ventilated babies with simultaneous and continuous ETCO2 monitoring and were analysed by AVL 995 Hb blood gas analyser. ETCO2 was analysed by side stream technique by Datex Cardiocap II monitor. A total of 152 samples from in-dwelling radial artery catheters were analysed from babies with birth weight from 900 g to 3400 g, gestation age from 28 to 42 wks and were ventilated for various indications like Severe Birth Asphyxia (SBA), Meconium Aspiration Syndrome (MAS), Recurrent Apnoea and Hyaline Membrane Disease (HMD). Statistical analysis was done in 10 groups to see if the ETCO2 correlated with its corresponding PaCO2 value. The study groups comprised three groups based on birth weight being < 1.5-2.5 kg and > 2.5 kg three groups as per the gestational age being 28-31+6 wks, 32-36+6 wks and 37-41+6 wks and four groups as per the need for ventilation being Severe Birth Asphyxia, Meconium Aspiration Syndrome, Apnoea of Prematurity and Hyaline Membrane Disease. Results of the correlation analysis revealed that the correlation coefficient in the study group ranged from 0.55 to 0.96 and was statistically significant in babies > 2.5 kg and 1.5-2.5 kg, in term and preterms 32-36 wks, and in babies with MAS, SBA and Recurrent Apnoea. The correlation coefficient was lowest in babies with HMD, being 0.55. The study showed that ETCO2 correlates closely with PaCO2 in most clinical situations in neonates and we recommend its use in all level III NICUs in ventilated babies.

背景与目标： 1995年3月至1995年8月收治的新生儿重症监护病房（NICU）中所有通气的新生儿均接受了前瞻性的二氧化碳监测，无论其出生体重，胎龄和通气状况如何。目的是确定在各种临床情况下ETCO2和PaCO2之间的相关性。在所有通气婴儿中获得动脉血气，同时进行连续和连续的ETCO2监测，并通过AVL 995 Hb血气分析仪进行分析。 ETCO2用Datex Cardiocap II监测仪通过侧流技术进行了分析。从出生时体重900 g至3400 g，胎龄28至42 wks的婴儿中分析了总共152份来自from管内导管的样本，并进行了通气以检查各种适应症，例如严重出生窒息（SBA），胎粪吸入综合征（MAS），复发性呼吸暂停和透明质酸膜病（HMD）。在10组中进行了统计分析，以查看ETCO2是否与其对应的PaCO2值相关。研究组根据出生体重<1.5-2.5 kg和> 2.5 kg分为三组，根据胎龄分别为28-31 6 wks，32-36 6 wks和37-41 6 wks分为三组，按胎龄分别为28-31 6 wks和三组。严重出生窒息，胎粪吸入综合征，早产呼吸暂停和透明膜疾病需要通风。相关分析结果表明，研究组的相关系数在0.55至0.96之间，在> 2.5 kg和1.5-2.5 kg的婴儿，足月和早产的32-36 wks以及具有MAS，SBA的婴儿中具有统计学意义和复发性呼吸暂停。 HMD婴儿的相关系数最低，为0.55。该研究表明，在大多数临床情况下，新生儿中的ETCO2与PaCO2密切相关，我们建议在通气婴儿的所有III级NICU中使用ETCO2。

BACKGROUND & AIMS: OBJECTIVE:Diagnosis of neonatal catheter-related bloodstream infection (CRBSI) is currently based on isolation of identical bacterial species from bloodstream and catheter tip cultures. This requires removal of the catheter followed by the insertion of a new catheter. The objective of this study was to investigate whether differential time to positivity (DTP) of blood cultures drawn from paired peripheral vein and central vascular catheter is useful for diagnosing neonatal CRBSI, avoiding removal of the catheter. DESIGN:Retrospective observational study. SETTING:Neonatal intensive care unit, University Hospital of Antwerp, Belgium. PATIENTS:Neonates with probable and definite nosocomial bloodstream infection. INTERVENTIONS:All episodes of nosocomial bloodstream infection (NBSI) in an approximately 7.5-yr period were identified retrospectively. Definite NBSI episodes in which paired blood cultures were obtained were retained to calculate DTP, to determine the optimal DTP cutoff for the diagnosis of CRBSI, and to assess the validity of DTP for the diagnosis of CRBSI. MEASUREMENTS AND MAIN RESULTS:Of 32 NBSI episodes included in the study, 16 were CRBSI, seven were non-CRBSI, and nine were classified as "diagnosis uncertain." In CRBSI, blood cultures drawn from a central vascular catheter were positive earlier than those drawn from a peripheral vein (median 9.67 hrs vs. 21.58 hrs, p < .01). Median DTP was 10.42 hrs in CRBSI and -0.33 hrs in non-CRBSI (p = .01). The optimal DTP cutoff for the diagnosis of CRBSI was > or =1 hr (area under the receiver operating characteristic curve = 0.84 +/- 0.11), with a sensitivity of 94%, a specificity of 71%, a positive predictive value of 88%, and a negative predictive value of 83%. CONCLUSIONS:Differential time to positivity of paired blood cultures may have some potential in the diagnosis of catheter-related infections in neonatal intensive care unit patients and should be subjected to a prospective study.

背景与目标： 目的：诊断新生儿导管相关的血流感染（CRBSI）目前是基于从血流和导管尖端培养物中分离出相同的细菌。这需要移除导管，然后插入新导管。这项研究的目的是调查从成对的外周静脉和中央血管导管抽取的血液培养物的阳性反应时间（DTP）是否可用于诊断新生儿CRBSI，避免移除导管。
设计：回顾性观察研究。
地点：比利时安特卫普大学医院新生儿重症监护室。
患者：新生儿可能伴有明确的医院血流感染。
干预措施：回顾性分析了大约7.5年期间的所有医院血流感染（NBSI）事件。保留获得配对血液培养物的明确NBSI事件，以计算DTP，确定诊断CRBSI的最佳DTP截止值，并评估DTP诊断CRBSI的有效性。
测量和主要结果：在研究中包括的32例NBSI发作中，CRBSI为16例，非CRBSI为7例，其中9例被归类为“诊断不确定”。在CRBSI中，从中央血管导管抽取的血液培养物比从外周静脉抽取的血液培养物更早呈阳性（中位9.67小时vs. 21.58小时，p <0.01）。在CRBSI中，DTP的中位数为10.42小时，在非CRBSI中，DTP的中位数为-0.33小时（p = .01）。诊断CRBSI的最佳DTP截止时间>或= 1 hr（接收器工作特征曲线下的面积= 0.84 /-0.11），灵敏度为94％，特异性为71％，阳性预测值为88％ ，并且阴性预测值为83％。
结论：成对血液培养阳性时间的差异可能在新生儿重症监护病房患者的导管相关感染的诊断中具有一定的潜力，应进行前瞻性研究。

BACKGROUND & AIMS: :Manduca diuresin (MD), a 30 amino acid peptide, was isolated and identified from the type IIb median neurosecretory cells in the brain of adult Manduca sexta (Blackburn et al., Biochem. Biophys. Res. Commun., 181, 927-932, 1991). The synthetic hormone stimulates water loss in the adult moth both in vitro using isolated Malphigian tubule preparations and in vivo using decapitated adult moths as bioassay animals (Blackburn and Ma, Arch. Insect Biochem. Physiol., 27, 3-10, 1994). In the present study, MD was shown to have adverse physiological effects on neonates of Manduca sexta when fed synthetic hormone-treated leaf discs. With a sustained diet of MD-treated discs, neonates exhibited symptoms of reduced food consumption and marginal weight increases. In addition to slowed growth and reduced developmental rates, a high percentage of these neonates failed to molt into second instar larvae and death usually followed shortly thereafter. This is a first report that a synthetic insect neuropeptide has shown detrimental effect on insect larvae by ingestion. The possibility of utilizing this peptide in plant protection is discussed.

背景与目标： ：从成年曼杜卡（Manduca sexta）大脑中的IIb型中位神经分泌细胞中分离并鉴定了30个氨基酸的曼杜卡（Manduca diuresin）（MD）（Blackburn等，Biochem。Biophys。Res。Commun。，181，927- 932，1991）。合成激素在体外使用分离的Malphigian小管制剂刺激成年蛾的水分流失，在体外使用断头成年蛾作为生物测定动物刺激体内的失水（Blackburn and Ma，Arch。Insect Biochem。Physiol。，27，3-10，1994）。在本研究中，当饲喂合成激素处理过的叶盘时，MD被证明对六头蝠Man的新生儿具有不利的生理影响。持续用MD治疗的椎间盘饮食，新生儿表现出食物消耗减少和边际体重增加的症状。除了生长缓慢和发育速度降低外，这些新生儿中有很大一部分没有蜕皮成第二龄幼虫，并且通常在此后不久死亡。这是第一个报道，合成的昆虫神经肽已经显示出通过摄入对昆虫幼虫具有有害作用。讨论了在植物保护中利用该肽的可能性。

BACKGROUND & AIMS: :The aim of this study was to develop an arterial occlusion method and compare it with the venous occlusion method for measurement of peripheral oxygen utilisation in neonates using near infrared spectroscopy (NIRS). Twenty healthy neonates were studied. Arterial occlusion was produced by inflating a neonatal blood pressure cuff to 100 mmHg for 30-40 s and oxygen utilisation (VO(2)) was calculated using the HbO(2) decrement slope following occlusion. Venous occlusion was produced by inflating the cuff to 30 mmHg for 15-20 s and VO(2) was calculated by: VO(2)=HbTx4x(SaO(2)-SvO(2)), where SaO(2) is the arterial oxygen saturation measured by pulse oximetry and SvO(2) is the venous oxygen saturation measured by NIRS. Each baby had a minimum of three arterial and three venous occlusions. Criteria were developed for acceptance/rejection of an occlusion. Using the arterial method, the mean VO(2) was 1.12 mM cm(-1) O(2)/min (S.D.=0.25), (95% CI=1.00-1.24 mM cm(-1) O(2)/min). The coefficient of variation was 6.6+/-4.1%. Using the venous method, the mean VO(2) was 1.60 mM cm(-1) O(2)/min (S.D.=0.48), (95% CI=1. 38-1.82 mM cm(-1) O(2)/min). The coefficient of variation was 12. 6+/-5.7%. The correlation between the two methods was weak (r=0.28 and r(2) was 0.08). The mean difference between the two methods was 0. 47 mM cm(-1) O(2)/min (S.D.=0.51). The limits of agreement were -0. 53 to 1.47 mM cm(-1) O(2)/min. The arterial method gives more consistent results.

背景与目标： ：本研究的目的是开发一种动脉闭塞方法，并将其与静脉闭塞方法进行比较，以使用近红外光谱法（NIRS）测量新生儿的外周血氧利用率。研究了二十名健康的新生儿。通过将新生儿血压袖带充气至100 mmHg持续30-40 s来产生动脉闭塞，并在闭塞后使用HbO（2）递减斜率计算氧气利用率（VO（2））。通过将袖带充气至30 mmHg持续15-20 s来产生静脉阻塞，VO（2）的计算公式为：VO（2）= HbTx4x（SaO（2）-SvO（2）），其中SaO（2）为通过脉搏血氧饱和度和SvO（2）测量的动脉血氧饱和度是通过NIRS测量的静脉血氧饱和度。每个婴儿至少有三个动脉阻塞和三个静脉阻塞。制定了接受/拒绝阻塞的标准。使用动脉方法，平均VO（2）为1.12 mM cm（-1）O（2）/ min（SD = 0.25），（95％CI = 1.00-1.24 mM cm（-1）O（2）/分钟）。变异系数为6.6 /-4.1%。使用静脉方法，平均VO（2）为1.60 mM cm（-1）O（2）/ min（SD = 0.48），（95％CI = 1.38-1.82 mM cm（-1）O（2 ）/ min）。变异系数为12. 6 /-5.7%。两种方法之间的相关性较弱（r = 0.28和r（2）为0.08）。两种方法之间的平均差异为0. 47 mM cm（-1）O（2）/ min（S.D. = 0.51）。协议的限制为-0。 53至1.47 mM cm（-1）O（2）/ min。动脉方法可提供更一致的结果。