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。

BACKGROUND & AIMS: BACKGROUND:Although routine administration of pharmacologic sedation or analgesia during mechanical ventilation in preterm neonates is not recommended, its use in clinical practice remains common. Alpha-2 agonists, mainly clonidine and dexmedetomidine, are used as adjunctive (or alternative) sedative agents alongside opioids and benzodiazepines. Clonidine has not been systematically assessed for use in neonatal sedation during ventilation. OBJECTIVES:To assess whether clonidine administered to term and preterm newborn infants receiving mechanical ventilation reduces morbidity and mortality rates. To compare the intervention versus placebo, no treatment, and dexmedetomidine; and to assess the safety of clonidine infusion for potential harms.To perform subgroup analyses according to gestational age; birth weight; administration method (infusion or bolus therapy); dose, duration, and route of clonidine administration; and pharmacologic sedation as a co-intervention. SEARCH METHODS:We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) in the Cochrane Library, MEDLINE via PubMed (1966 to January 10, 2017), Embase (1980 to January 10, 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to January 10, 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA:We searched for randomized controlled trials, quasi-randomized controlled trials, and cluster trials comparing clonidine versus placebo, no treatment, or dexmedetomidine administered to term and preterm newborns receiving mechanical ventilation via an endotracheal tube. DATA COLLECTION AND ANALYSIS:For the included trial, two review authors independently extracted data (e.g. number of participants, birth weight, gestational age, all-cause death during initial hospitalization, duration of respiratory support, sedation scale, duration of hospital stay) and assessed risk of bias (e.g. adequacy of randomization, blinding, completeness of follow-up). This review considered primary outcomes of all-cause neonatal death, all-cause death during initial hospitalization, and duration of mechanical ventilation in days. MAIN RESULTS:One trial, which included 112 infants, met the inclusion criteria for this review. Term newborn infants on mechanical ventilation with the need for continuous analgesia and sedation with fentanyl and midazolam were eligible for enrollment during the first 96 hours of ventilation. Study authors administered clonidine 1 μg/kg/h or placebo on day 4 after intubation.We found no differences between the two groups in all-cause death during hospitalization (risk ratio [RR] 0.69, 95% confidence interval [CI] 0.12 to 3.98). The quality of the evidence supporting these findings is low owing to imprecision of the estimates (one study; few events). The median (interquartile range) duration of mechanical ventilation was 7.1 days (5.7 to 9.1 days) in the clonidine group and 5.8 days (4.9 to 7.9 days) in the placebo group, respectively (P = 0.070). Among secondary outcomes, we found no differences in terms of duration of stay in the intensive care unit. Sedation scale values (COMFORT) and analgesia scores (Hartwig) during the first 72 hours of infusion of study medication were lower in the clonidine group than in the placebo group. AUTHORS' CONCLUSIONS:At present, evidence is insufficient to show the efficacy and safety of clonidine for sedation and analgesia in term and preterm newborn infants receiving mechanical ventilation.

背景与目标： 背景：尽管不建议早产儿在机械通气期间常规使用药物镇静或镇痛，但其在临床实践中仍很普遍。 Alpha-2激动剂（主要是可乐定和右美托咪定）与阿片类药物和苯二氮卓类药物一起用作辅助（或替代）镇静剂。未对可乐定在通气期间用于新生儿镇静方面进行系统评估。
目的：评估可乐定对接受机械通气的足月和早产儿是否可降低发病率和死亡率。比较介入治疗与安慰剂，未治疗和右美托咪定；根据孕龄进行亚组分析；并评估可乐定输注对潜在危害的安全性。出生体重;给药方法（输注或推注治疗）；可乐定的剂量，给药时间和给药途径；和药物镇静作为共同干预。
搜索方法：我们使用Cochrane新生儿审查小组的标准搜索策略通过MedMed（1966年至2017年1月10日）在MEDLINE的Cochrane图书馆中搜索对照试验的Cochrane中央登记册（CENTRAL; 2016年第12期）。 （1980年至2017年1月10日），以及护理和相关健康文献的累积索引（CINAHL； 1982年至2017年1月10日）。我们还搜索了临床试验数据库，会议记录以及检索到的文章的参考文献清单，以进行随机对照试验和准随机试验。
选择标准：我们搜索了比较可乐定与安慰剂，未治疗或右美托咪定经气管插管接受机械通气的足月和早产新生儿的随机对照试验，半随机对照试验和聚类试验。
数据收集和分析：对于纳入的试验，两名评价作者独立提取数据（例如，受试者人数，出生体重，胎龄，首次住院期间的全因死亡，呼吸支持的持续时间，镇静量表，住院时间）和评估偏倚的风险（例如随机性是否足够，致盲，随访是否完整）。该评价考虑了全因新生儿死亡，初次住院期间全因死亡以及几天内的机械通气持续时间的主要结局。
主要结果：一项试验，包括112例婴儿，符合本评价的纳入标准。有机械通气的足月新生儿需要连续镇痛并用芬太尼和咪达唑仑镇静时，可在通气的前96个小时内入组。研究作者在插管后第4天给予可乐定1μg/ kg / h或安慰剂。我们发现两组住院期间全因死亡之间没有差异（风险比[RR] 0.69，95％置信区间[CI] 0.12至3.98）。由于估算的不精确性，支持这些发现的证据质量很低（一项研究；很少发生的事件）。可乐定组机械通气的中位（四分位间距）持续时间分别为7.1天（5.7至9.1天）和安慰剂组为5.8天（4.9至7.9天）（P = 0.070）。在次要结果中，我们发现重症监护病房的住院时间没有差异。可乐定组输注研究药物的前72小时内的镇静标度值（COMFORT）和镇痛评分（Hartwig）低于安慰剂组。
作者的结论：目前，没有足够的证据表明可乐定在接受机械通气的足月和早产儿镇静和镇痛中的有效性和安全性。

BACKGROUND & AIMS: :Obesity is associated with the activation of cellular responses, such as endoplasmic reticulum (ER) stress. Here, we show that leptin-deficient ob/ob mice display elevated hypothalamic ER stress as early as postnatal day 10, i.e., prior to the development of obesity in this mouse model. Neonatal treatment of ob/ob mice with the ER stress-relieving drug tauroursodeoxycholic acid (TUDCA) causes long-term amelioration of body weight, food intake, glucose homeostasis, and pro-opiomelanocortin (POMC) projections. Cells exposed to ER stress often activate autophagy. Accordingly, we report that in vitro induction of ER stress and neonatal leptin deficiency in vivo activate hypothalamic autophagy-related genes. Furthermore, genetic deletion of autophagy in pro-opiomelanocortin neurons of ob/ob mice worsens their glucose homeostasis, adiposity, hyperphagia, and POMC neuronal projections, all of which are ameliorated with neonatal TUDCA treatment. Together, our data highlight the importance of early life ER stress-autophagy pathway in influencing hypothalamic circuits and metabolic regulation.

背景与目标： 肥胖与细胞反应的激活有关，例如内质网（ER）应激。在这里，我们表明瘦素缺陷型ob / ob小鼠最早在出生后第10天，即在此小鼠模型中的肥胖发生之前，就表现出下丘脑ER应激升高。 ER缓解药物tauroursodeoxycholic acid（TUDCA）对ob / ob小鼠的新生儿治疗可长期减轻体重，食物摄入，葡萄糖稳态和促成opiomelanocortin（POMC）预测。暴露于内质网应激的细胞通常会激活自噬。因此，我们报道在体外诱导内质网应激和新生儿瘦素缺乏激活下丘脑自噬相关基因。此外，ob / ob小鼠前视紫红皮皮质素神经元中自噬的基因缺失会加重其葡萄糖稳态，肥胖，吞噬和POMC神经元的投射，所有这些都可以通过新生儿TUDCA治疗得到改善。总之，我们的数据强调了早期ER应激自噬途径在影响下丘脑回路和代谢调节中的重要性。

BACKGROUND & AIMS: : Background: There is increasing evidence that premature newborns and infants with low birth weight can benefit substantially from an exclusive human milk-based diet (EHMD), consisting of human milk supplemented with a pasteurized donor human milk-derived fortifier. However, compared with the standard infant diet, EHMD also represents a significant added cost to the hospital and/or health system, thereby raising important questions about the economic feasibility of incorporating EHMD into newborn care. Design: We conducted a cost analysis and estimated the potential cost savings to a Canadian tertiary hospital based on the attributable complications averted from EHMD among low-weight neonates. A meta-analysis was performed to derive input parameters. A probabilistic analysis was conducted to determine the probability that EHMD is cost saving and 95% confidence interval (CI) around our estimates. Results: Our findings show that providing EHMD to preterm infants under 750 g at birth and at the highest risk of developing major complications is likely to be cost saving in the amount of $107,567 (95% CI: -145,229 to 360,362) per year. Extending EHMD to higher weight classes may be economically feasible depending on the pricing of the human milk-derived fortifier and the baseline risk of complications in the hospital setting. Conclusions: This comprehensive study provides critical insight for hospital-based decision makers to evaluate the potential gains and uncertainties associated with improved nutritional care for neonatal patients.

背景与目标： ：
背景：
越来越多的证据表明，低出生体重的早产儿和婴儿可以从独家的基于人乳的饮食（EHMD）中受益，该饮食由人乳和经过巴氏灭菌的供体人乳衍生的强化剂组成。然而，与标准婴儿饮食相比，EHMD还给医院和/或卫生系统带来了可观的额外成本，从而引发了将EHMD纳入新生儿护理的经济可行性的重要问题。
设计：
我们进行了成本分析，并根据低体重新生儿EHMD避免的可归因并发症估算了加拿大三级医院的潜在成本节省。进行荟萃分析以得出输入参数。进行了概率分析，以确定EHMD节省成本的可能性和我们的估计值附近的95％置信区间（CI）。
结果：
我们的研究结果表明，为出生时体重在750μg以下且发生重大并发症的风险最高的早产儿提供EHMD可能每年可节省107,567美元（95％CI：-145,229至360,362）。将EHMD扩展到更高的体重类别在经济上是可行的，具体取决于人乳衍生的强化剂的价格以及医院环境中发生并发症的基准风险。
结论：
这项全面的研究为基于医院的决策者提供了至关重要的见解，以评估与改善新生儿患者营养护理相关的潜在收益和不确定性。

BACKGROUND & AIMS: BACKGROUND:Hypoxic ischemic encephalopathy (HIE) is one of the leading causes of neonatal mortality in developing countries and leads to some form of neuro-developmental disability in latter part of life. AIMS:The aim of this study is to evaluate the role of erythropoietin (EPO) in neuroprotection for term newborn having HIE. METHOD:The literature search was done for various trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of science, Scopus, Index Copernicus, and other database. RESULTS:A total of nine studies fulfilled inclusion criteria. EPO has shown to cause reduction in death and disability, better long-term neuro-developmental outcome, improvement in EEG, and reduction in risk of cerebral palsy. CONCLUSION:EPO treatment has neuroprotective effects against moderate/severe HIE and improves long-term behavioral neurological developments in neonates.

背景与目标： 背景：缺氧缺血性脑病（HIE）是发展中国家新生儿死亡的主要原因之一，并导致生命后期出现某种形式的神经发育障碍。
目的：本研究的目的是评估促红细胞生成素（EPO）在足月新生儿HIE中的神经保护作用。
方法：通过搜索Cochrane对照试验中央注册系统（CENTRAL），PubMed，EMBASE，Web of science，Scopus，Index Copernicus和其他数据库，对各种试验进行了文献检索。
结果：共有九项研究符合纳入标准。 EPO已显示可减少死亡和残疾，改善长期神经发育结局，改善EEG并降低脑瘫风险。
结论：EPO治疗对中度/重度HIE具有神经保护作用，并改善了新生儿的长期行为神经系统发育。

BACKGROUND & AIMS: OBJECTIVES:To summarize and differentiate abdominal ultrasound findings of necrotizing enterocolitis and food protein-induced enterocolitis syndrome. METHODS:From January 2017 to December 2018, the abdominal ultrasound results of 304 cases diagnosed necrotizing enterocolitis or food protein-induced enterocolitis syndrome were retrospectively analyzed. The presence of pneumatosis intestinalis, portal venous gas, bowel wall thickening, intestinal motility, focal fluid collections and hypoechoic change of gallbladder wall were calculated, and the results were compared and analyzed. RESULTS:Pneumatosis intestinalis, portal venous gas, bowel wall thickening, intestinal motility weakened/absent, focal fluid collections and hypoechoic change of gallbladder wall can be found in both necrotizing enterocolitis and food protein-induced enterocolitis syndrome infants. However, in infants with necrotizing enterocolitis, intestinal motility was weakened/absent in whole abdomen, and in food protein-induced enterocolitis syndrome, it only involved isolated segment of bowel. The positive rates of above signs in necrotizing enterocolitis infants were significantly higher than those in food protein-induced enterocolitis syndrome (p < 0.01). Moreover, it was observed that the rate of weakened intestinal motility besides the lesion segment of bowel in necrotizing enterocolitis infants was 100%, and in food protein-induced enterocolitis syndrome infants, it was 0%, which is supposed to be a main sign for identification. CONCLUSION:In the early stage, abdominal ultrasound can be used to differentiate necrotizing enterocolitis and food protein-induced enterocolitis syndrome.

背景与目标： 目的：总结和区分坏死性小肠结肠炎和食物蛋白引起的小肠结肠炎综合征的腹部超声检查结果。
方法：回顾性分析2017年1月至2018年12月收治的304例坏死性小肠结肠炎或食物蛋白性小肠结肠炎综合征的腹部超声检查结果。计算肠道气肿，门静脉气体，肠壁增厚，肠蠕动，局灶性液体收集和胆囊壁低回声变化的存在，并对结果进行比较和分析。
结果：在坏死性小肠结肠炎和食物蛋白诱发的小肠结肠炎综合征婴儿中均可发现肠道气肿，肠门静脉气体增厚，肠壁蠕动减弱/消失，局灶性液体收集和胆囊壁低回声改变。然而，在坏死性小肠结肠炎的婴儿中，整个腹部的肠蠕动减弱/消失，而在食物蛋白诱发的小肠结肠炎综合征中，肠蠕动仅涉及肠段。坏死性小肠结肠炎婴儿中上述体征的阳性率显着高于食物蛋白诱发的小肠结肠炎综合征（p <0.01）。此外，已观察到，在坏死性小肠结肠炎婴儿中，除肠病变段外，肠蠕动减弱的比率为100％，而在食物蛋白诱发的小肠结肠炎综合征婴儿中，肠蠕动减弱的比率为0％，这被认为是肠蠕动的主要征兆。鉴别。
结论：在早期，腹部超声可用于鉴别坏死性小肠结肠炎和食物蛋白引起的小肠结肠炎综合征。