Changes of the peripapillary vascular parameters inpremature infants without retinopathy of prematurityusing U-net segmentation

AIM:To quantitatively assess the changes in mean vascular tortuosity(mVT)and mean vascular width(mVW)around the optic disc and their correlation with gestational age(GA)and birth weight(BW)in premature infants without retinopathy of prematurity(ROP).METHODS:A single-center retrospective study included a total of 133(133 eyes)premature infants[mean corrected gestational age(CGA)43.6wk]without ROP as the premature group and 130(130 eyes)CGA-matched fullterm infants as the control group.The peripapillary mVT and mVW were quantitatively measured using computerassisted techniques.RESULTS:Premature infants had significantly higher mVT(P=0.0032)and lower mVW(P=0.0086)by 2.68(10^(4) cm^(-3))and 1.85μm,respectively.Subgroup analysis with GA showed significant differences(P=0.0244)in mVT between the early preterm and middle to late preterm groups,but the differences between mVW were not significant(P=0.6652).The results of the multiple linear regression model showed a significant negative correlation between GA and BW with mVT after adjusting sex and CGA(P=0.0211 and P=0.0006,respectively).For each day increase in GA at birth,mVT decreased by 0.1281(10^(4) cm^(-3))and for each 1 g increase in BW,mVT decreased by 0.006(10^(4) cm^(-3)).However,GA(P=0.9402)and BW(P=0.7275)were not significantly correlated with mVW.CONCLUSION:Preterm birth significantly affects the peripapillary vascular parameters that indicate higher mVT and narrower mVW in premature infants without ROP.Alterations in these parameters may provide new insights into the pathogenesis of ocular vascular disease.

Acquired methemoglobinemia in a third trimester puerpera and her premature infant with sodium nitrite poisoning:A case report

BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit.The subsequent formation of methemoglobin(MetHb)restricts oxygen transport and utilization in the body,resulting in functional hypoxia at the tissue level.In clinical practice,a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia.Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.CASE SUMMARY A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission.Subsequently,she developed vomiting and cyanotic skin.The woman underwent orotracheal intubation,invasive mechanical ventilation(IMV),and correction of internal environment disturbance in the ICU.Her premature infant was born with a higher-than-normal MetHb level of 3.3%,and received detoxification with methylene blue and vitamin C,supplemental vitamin K1,an infusion of fresh frozen plasma,as well as respiratory support via orotracheal intubation and IMV.On day 3 after admission,the puerpera regained consciousness,evacuated the IMV,and resumed enteral nutrition.She was then transferred to the maternity ward 24 h later.On day 7 after admission,the woman recovered and was discharged without any sequelae.CONCLUSION MetHb can cross through the placental barrier.Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.

Research Progress on the Prevention of Premature Infant Lung Injury and Neonatal Respiratory Support

In the past 40 years,advances in neonatal intensive care unit(NICU)technology have enabled premature infants with lower birth weight and younger gestational age to survive.But with it comes an increase in the incidence of long-term respiratory dysfunction,mainly in the form of bronchopulmonary dysplasia(BPD).Preventing lung injury is crucial for preventing BPD and improving the long-term prognosis of premature infants.Therefore,how to avoid ventilator-associated lung injury has become a focus of clinical and scientific research in premature infants in recent years.This article will elaborate on the susceptibility and pathophysiology of premature infant lung injury,ventilation strategies for preventing lung injury,and new advances in neonatal respiratory support.

Ultrasound measurement of the corpus callosum and neural development of premature infants

Length and thickness of 152 corpus callosa Using ultrasonic diagnostic equipment with a were measured in neonates within 24 hours ot b^rtn. neonatal brain-specific probe, corpus callosum length and thickness of the genu, body, and splenium were measured on the standard mid-sagittal plane, and the anteroposterior diameter of the genu was measured in the coronal plane. Results showed that corpus callosum length as well as thickness of the genu and splenium increased with gesta- tional age and birth weight, while other measures did not. These three factors on the standard mid-sagittal plane are therefore likely to be suitable for real-time evaluation of corpus callosum de- velopment in premature infants using cranial ultrasound. Further analysis revealed that thickness of the body and splenium and the anteroposterior diameter of the genu were greater in male infants than in female infants, suggesting that there are sex differences in corpus callosum size during the neonatal period. A second set of measurements were taken from 40 premature infants whose ges- tational age was 34 weeks or less. Corpus callosum measurements were corrected to a gestational age of 40 weeks, and infants were grouped for analysis depending on the outcome of a neonatal behavioral neurological assessment. Compared with infants with a normal neurological assessment, corpus callosum length and genu and splenium thicknesses were less in those with abnormalities, indicating that corpus callosum growth in premature infants is associated with neurobehavioral development during the early extrauterine stage.

Application of FICare mode in premature infants of NICU:A meta-analysis

infants.Methods:Systematic searches in PubMed,EMBASE,The Cochrane Library,Web of Science,Chinese biomedical literature database,China National Knowledge Infrastructure,Wanfang medical and VIP database were performed for randomized controlled trials(RCTs)or quasi-RCTs which explored the effects of FICare mode on growth and development of premature infants in neonatal intensive care unit.Then,meta-analysis was performed by RevMan 5.3 after two independent investigators screened the literature,extracted the data and evaluated the risk of bias of all included studies.Results:A total of 14 articles were included,including 3120 preterm infants and their families.Meta-analysis showed that compared with the traditional management mode,FICare mode can effectively improve the growth rate of premature infants'weight[Weight mean difference(WMD)=4.02,95%CI(2.47,5.56),P<0.001],increase sleep time[WMD=3.25,95%CI(2.05,4.44),P<0.001],improve breastfeeding rate[RR=1.38,95%CI(1.15,1.64),P<0.001],reduce readmission rate[Relative risk(RR)=0.49,95%CI(0.33,0.71),P<0.001],promote the development of the nervous system[WMD=3.96,95%CI(3.18,4.74),P<0.001],improve nursing skills of Premature infants'parents[WMD=17.40,95%CI(13.64,21.1),P<0.001],reduce the influence of maternal and infant separation on parents'emotions.Conclusion:FICare mode can effectively promote the growth and development of premature infants and alleviate the harm caused by the separation of mother and infants.Limited by the quality and region of the included studies,the appeal conclusion still needs to be tested by more high-quality studies.

Predictors of caring behaviors of mothers of premature infants based on the health belief model

Objective:To investigate predictors of caring behaviors of mothers of premature infants based on the health belief model.Methods:This cross-sectional study was conducted by using the structural equation modeling on 168 mothers of premature infants,who were selected by convenience sampling method from October 2017 to February 2018 in Iran.Data were collected by using a standard scale.Validity and reliability of all data collection tools were approved.Data were analyzed by using SPSS V.16 and Mplus6 software.Results:The structural equation modeling of the initial health belief model did not have a good fit,but the fitness of model 2 obtaining from the modified initial model was confirmed by changes in locations of constructs.None of constructs of model 2 had a significant positive association with the caring behavior of mothers of premature infants and only 2.8%of variance of caring behaviors in mothers could be predicted by the sum of variables of demographic characteristics and the modified health belief model constructs.Conclusions:Given that the findings do not approve the use of the health belief model in predicting determinants of caring behavior of mothers of premature infants,it is suggested to apply this model to investigate the effect of educational intervention based on the health belief model on the caring behavior of mothers.

The Issue of Care Given to Premature Infants in the Provincial Hospital Center of Missour

Background: Preterm birth is common in Morocco and it’s around 8%. Several management rules of taking care of preterm infants have been developed but have not been put into action. The geo-graphical inaccessibility to specialized hospitals and the weakness of the reception capacity of the care centers hinder the management of the complications associated with preterm birth. Purpose: The present study is designed to present some epidemiological data of preterm births within the Provincial Hospital Center of Missour during 2012 and to discuss the various problems emerging in the management of treatment and care. Materials and Methods: Retrospective study of preterm births in the maternity ward in the Hospital of Missour during 2012. Results: 37 preterm births among 1121 (3.3%) have been analyzed (51.3% severe premature infants, 45.9% late preterm infants and 2.7% extremely premature infants). 64.2% are originally from difficult areas to reach during winter. All mothers have received upon arrival at the maternity a corticosteroid and calcium antagonists (Adalate*) and an antibiotic treatment to those with a positive infectious anamnesis found in half of the women. We have recorded 3 twin pregnancies and 2 gravidic toxemias. Only 21 babies have been given back to their mothers (namely 56.7%). 5 premature infants (namely 13%) have been referred to the university hospital center of Fez (2 respiratory distress, a malformation and 2 severe premature births) given that there is an absence of a specialized care unit at the hospital, knowing that no baby has received neither surfactant nor caffeine at birth. 14 premature babies (namely 37.8%) have been transferred to the pediatric unit with a total death rate of 16.2% (6 premature) mainly related to neonatal infection and to suffering of the hyaline membranes disease. Conclusion: We emphasize the interest of prevention programs which demand an early diagnosis of preterm birth threats and monitoring high-risk pregnancies, improving the medical care given to low-weight premature by creating “Kangaroo” units at a regional level and the targeting of measures for rural and under-covered areas.

Preventive Effect of Different Dosage of Recombinant Human Erythropoietin on Anemia of Premature Infants

To assess the efficacy and the optimum dose of recombinant human erythropoietin (rhEpo) on the anemia of premature, 45 preterm infants with a gestational age of less than 35 weeks and birth weight of less 1 800 g were randomly assigned to treatment group 1 (n = 15, receiving subcutaneous rhEpo 150 U/kg·time), treatment group 2 (n = 15, receiving 250 U/kg·time), three times a week for 6 weeks, and control group (n = 15, no treatment was given). All preterm infants received supplements of vitamin E (20 IU) and iron (20 mg) each day. Our results showed that postnatal decline of hemoglobin (Hb) and hematocrit (Hct) were lessened in the treatment groups, particularly in the group 2 and the differences were very significant (P<0. 0001 for all). Treated infants had significantly higher reticulocyte counts (Ret) (P<0. 000] for all), but there was no significant difference between the two treatment groups (P>0. 05). Serum iron dropped significantly in the treatment groups as compared with control group (P<0. 01 for all), but no dose-dependent relationship was observed in treated infants (P>0. 05). After treatment, serum levels of erythropoietin was higher in group 2 than those in group 1 and control group (P<0. 0001, P<0. 01 and P<0. 05, respectively). There was no significant difference between group 1 and control group (P>0. 05). No side effects related to rhEpo therapy were observed. Our study suggested that rhEpo therapy stimulates endogenous erythro-poiesis and enhances Ret, Hct and level of Hb in a dose-dependent manner in premature infants. The therapy is more efficient when given in higher dosages.

Effect of parenteral glutamine supplementation in premature infants

Background Glutamine, proposed to be conditionally essential for critically ill patients, is not added routinely to parenteral amino acid formulations for premature infants and is provided in only small quantities by the enteral route when enteral feeding is low. Parenteral feeding is the basic way of nutrition in the first days of life of premature infants. In this study, we evaluated the effects of glutamine supplemented parenteral nutrition for premature infants on growth and development, feeding toleration, and infective episodes. Methods From December 2002 to July 2006, 53 premature infants were given either standard or glutamine supplemented parenteral nutrition for more than 2 weeks. Twenty-eight infants were in glutamine supplemented group, whose gestational age （31.4±2.0） weeks, birth weight range （1386±251） g; twenty-five infants were in control group, gestational age （31.1±1.7） weeks, with birth weight range （1346±199） g. There were no differences between the two groups. Various growth and biochemical indices were monitored throughout the duration of hospital stay. Data between groups were analyzed with Student＇s t test. Nonparametric data were analyzed using a Chi-square test. A two-tailed P value 〈 0.05 was considered statistically significant. Results The level of serum albumin was lower in the glutamine groups on the second week （3.0 vs 3.2 g/dl,P=-0.028）, and blood urea nitrogen was higher in glutamine groups on the fourth week （8.1 vs 4.9 mg/dl, P=0.014）, but normal. Glutamine group infants took fewer days to regain birth weight （8.1 vs 10.4 days, P=0.017）, required fewer days on parenteral nutrition （24.8 vs 30.8 days, P=0.035）, with shorter stays in hospital （32.1 vs 38.6 days, P=0.047）. Episodes of hospital acquired infection in glutamine supplemented infants were lower than that in control group （0.96 vs 1.84 times, P=0.000）. Conclusion Parenteral glutamine supplementation in premature infants can shorten days on parenteral nutrition and length of stay in hospital, and decrease hospital acquired infection episodes.

Clinical Observation of Yinzhihuang Oral Liquid(茵栀黄口服液) on Prevention of the Premature Infantile Jaundice

Objective:To observe the clinical efficacy of Yinzhihuang Oral Liquid(YOL,茵栀黄口服液)to prevent the premature infantile jaundice.Methods:After excluded hemolytic,suffocation,infection,and the very low birth weight,242 cases of premature infants were randomly assigned to two groups,the treatment group and the control group.Both groups were taken conventional procedures,such as warmth,feeding,and blood glucose monitoring,and the treated group was administered YOL 5 mL each time,twice daily additionally,and the co...

Cardiovascular characteristics of premature infants with Klebsiella Pneumoniae septicemia and shock

Background The cardiovascular characteristics during septic shock in premature neonates are characterized by elevated ventricular output and normal ejection fraction.However,there is little knowledge about other variables in premature infants with Klebsiella Pneumoniae(KPN)septicemia and shock.This study aimed to investigate the characteristics of cardiovascular changes in premature infants diagnosed with Klebsiella pneumonia(KPN)septicemia and shock.Methods Our study included premature infants(gestational age≤34 weeks)in the neonatal intensive care unit(NICU)of Guangdong Provincial People.s Hospital from November 1 st,2013 to November 31 st,2016.17 participants diagnosed with KPN septicemia complicated with shock and 17 healthy premature infants were respectively enrolled in study group and control group for analysis.All the infants underwent non-invasive ultrasound cardiac output monitor examinations in normal time,early stage of shock and cured time.Results Compared with the control group,higher values of heart rate(HR)(P<0.001),cardiac output index(CI)(P<0.001),Smith-Madigan inotropy index(SMII)(P<0.001)and oxygen delivery(DO2)(P<0.001),and lower levels of systemic vascular resistance index(SVRI)(P<0.001)were observed in the study group.The difference of mean blood pressure(MBP)was not statistically significant(P=0.943).In the study group,the values of HR(P=0.004),CI(P=0.004),SMII(P=0.004)and DO2(P=0.004)in the early stage of septic shock were significantly higher when compared with the values in the normal time,while the value of SVRI(P<0.001)was significantly lower.HR(P<0.001)and DO2(P=0.009)decreased from the early stage of septic shock to the cured time,while SVRI(P<0.001)increased.There were no significant changes in CI(P>0.999)and SMII(P=0.646)from early stage of septic shock to improvement in the study group.Conclusions Systemic vascular resistance index decreased and oxygen deliver elevated in preterm infants with gestational age less than 34 weeks with Klebsiella Pneumoniae septicemia and shock.Vasoregulatory failure may be the main cause of Klebsiella Pneumoniae septicemia and shock.Vasoactive drugs may be needed during shock.The increase of oxygen deliver level in the early stage of shock indicates that timely and effective vasoactive infusion can prevent the deterioration of the disease.

The trajectories of physical growth in 4 months postnatal corrected age among preterm infants discharged from neonatal intensive care units and associated factors: A prospective study

Objectives Growth retardation is a risk for premature infants.In addition to demographic and perinatal factors,preterm infants’physical growth may be affected by neonatal intensive care unit(NICU)stress,maternal postpartum depression,and mother-infant interaction.This study aimed to investigate the trajectories of physical growth in 4 months corrected age among preterm infants discharged from the NICU and the impactors on these trajectories.Methods A prospective study was conducted among 318 preterm infants from September 2019 to April 2021 in Shanghai,China.Latent growth modeling was applied to identify the weight,length,and head circumference growth trajectories in 4 months corrected age and explore the effects of demographic and medical characteristics,infant stress during NICU stay,maternal postpartum depression,and mother-infant interaction on each trajectory.Results Unconditional latent growth models showed curve trajectories with increasingly slower growth in weight,length,and head circumference until 4 months of corrected age.Conditional latent growth models showed that a longer length of stay in the NICU and more skin punctures were negatively associated with weight at 40 weeks corrected gestational age(β=−0.43 and−0.19,respectively,P<0.05).The maternal postpartum depression between 40 weeks corrected gestational age and 1 month corrected postnatal age was associated with a lower growth rate of length(β=−0.17,P=0.040),while between 2 and 3 months corrected postnatal age,there were lower growth rates of weight and head circumference(β=−0.15 and−0.19,respectively,P<0.05).The mother-infant interaction scores between 40 weeks corrected gestational age and 1 month corrected postnatal age negatively predicted the growth rate of weight(β=−0.19,P=0.020).Conclusion The physical growth trajectories of preterm infants discharged from the NICU were influenced by infant stress during the NICU stay,maternal postpartum depression and mother-infant interaction.

Clinical observation of Tiao Shen Tong Du Tuina in promoting neuropsychological development of premature infants

Objective To observe the impact of Tiao Shen Tong Du(regulating the mind and unblocking the Governor Vessel)Tuina(Chinese therapeutic massage)on neuropsychological development of premature infants,discover effective early-stage intervention techniques,and improve the prognosis of premature infants.Methods A total of 115 eligible premature infants were recruited and divided into a control group of 59 cases and an observation group of 56 cases based on different interventions.The control group received three-month physical therapy(PT)and conventional early-stage intervention,and the observation group received additional Tiao Shen Tong Du Tuina treatment.Before and after treatment and at the one-year follow-up,the Gesell developmental schedule was adopted to evaluate neuropsychological development.Results After treatment,the gross motor development quotient(DQ)was higher in the observation group than in the control group,and the difference was statistically significant(P<0.05);there were no significant differences in the other four domains between the two groups(P>0.05).At the one-year follow-up,the observation group showed more notable improvements in all five domains’DQs than the control group,and the between-group differences were statistically significant(P<0.05 or P<0.01).Conclusion Based on conventional intervention,Tiao Shen Tong Du Tuina can significantly improve the gross motor function of premature infants in the short term,alongside valid long-term efficacy for gross motor function,fine motor function,adaptive behaviors,language,and personal-social behaviors.

Nurses’experiences of caring for preterm infants in pain:A metaethnography

Objective:Preterm infants are subjected to numerous painful procedures during their neonatal intensive care unit(NICU)hospitalization.Despite advancements in pain alleviation,nurses remain challenged to provide timely and effective pain management for preterm infants.Greater understanding of the lived experience of nurses caring for preterm infants in pain could provide novel insights to improve pain management for this vulnerable population.The aim of this meta-ethnography was to synthesize and interpret qualitative findings of nurses’experiences of taking care of preterm infants in pain.Methods:An extensive literature search in PubMed,CINAHL,PsycINFO,Scopus,BIOSIS and ProQuest Dissertation and Theses Database was conducted,including studies within the past 10 years.Two nursing researchers conducted data extraction and analysis independently.Inclusion criteria were applied to search for qualitative studies of nurse participants who worked in the NICU taking care of preterm infants.Studies published in a language other than English,articles that did not include qualitative data and qualitative data that could not be extracted from the findings or did not discuss nurses’experiences were excluded.Critical Appraisal Skills Programme was used for literature quality evaluation.Results:Eight studies remained after further screening according to inclusion and exclusion criteria.These eight studies were conducted from 2013 to 2018 and totally enrolled 205 nurses from Iran,Canada,the United States,Finland,Sweden,Switzerland,and Australia.Five themes emerged on the nurses’perspectives of taking care of preterm infants in pain:1)They sense the neonatal pain;2)Adverse consequences of unrelieved pain;3)Barriers of managing pain;4)Concerns of available approaches for pain relief;5)Failure to work with parents.Conclusions:This meta-ethnography identified nurses’understanding of pain in preterm infants that can be assessed,and they acknowledged that unrelieved pain could cause developmental deficits in infants.The barriers are lack of training and support on pain assessment and intervention in preterm infants.Optimizing workload and environment,developing age-specified pain assessment and intervention,receiving emotional support and training,and building up a rapport with parents are urgent needs for nurses to provide better care to infants having pain.

The Role of Nitric Oxide in Hyperoxic Lung Injury in Premature Rats

To investigate the role of nitric oxide (NO) in hyperoxic lung injury, the 3 day old preterm rats were randomly assigned to four groups: group I (hyperoxia group), group Ⅱ (hyperoxia+N w nitro L arginine methyl ester (L NAME) group), group Ⅲ (air group), and group Ⅳ (air+L NAME) group. Group Ⅰ and Ⅱ were exposed to ≥90 % O 2 for 3 or 7 days. Group Ⅱ and Ⅳ received subcutaneous L NAMEy on daily basis (20 mg/kg). After 3 day or 7 day exposure, the lung wet weight/dry weight ratio (W/D), total protein and malondialdehyde (MDA) in bronchoalveolar lavage fluid (BALF) and lung pathology were examined in all groups. NO content, expression of endothelial NOS (eNOS) and inducible NOS (iNOS) in lungs were measured in group Ⅰ and Ⅲ. Our results showed that after 3 day exposure, group Ⅰ appeared acute lung injury characterized by the increase of MDA content ( P <0.01) and the presence of hyperaemia, red cell extravasation and inflammatory infiltration; after 7 day exposure, except MDA, total protein and W/D were also increased in comparison with group Ⅲ ( P <0.01, 0.05), pathological changes were more severe than those after 3 day exposure. After 3 and 7 day exposure, total protein in group Ⅱ was significantly increased as compared with group Ⅰ ( P <0.01 for both). The pulmonary acute inflammatory changes were more obvious in group Ⅱ than in group Ⅰ. Occasionally, mild hemorrhage was detected in the lungs of group Ⅳ. BALF protein content in group IV was higher than that in group Ⅲ after 7 day exposure ( P <0.01). After 3 and 7 day exposure, NO content in BALF were all significantly elevated in group Ⅰ as compared with group Ⅲ ( P <0.01 for all). In the lungs of group Ⅰ, strong immunostaining for iNOS was observed in airway and alveolar epithelia, inflammatory cells, which were stronger than those in group Ⅲ. Expression of iNOS in rats after 7 day hyperoxic exposure was stronger than that after 3 day exposure. Shortly after 7 day exposure, stronger immunostaining for eNOS in airway epithelia in group Ⅰ than that in group Ⅲ was seen. Our study suggested that treatment with L NAME worsened acute hyperoxic lung injury in preterm rats and also had a deleterious effect on the rats exposed to air, indicating that endogenous nitric oxide may play a protective role in rats under both physiological and hyperoxic status. Hyperoxia can significantly upregulate the expression of iNOS and eNOS in inflammatory cells, epithelia in the lungs of preterm rats, promote NO generation, which suggests that endogenous NO may mediate the hyperoxic pulmonary damage. Over stimulation of iNOS may contribute to the pathogenesis of hyperoxic lung injury. NO may have dual roles in pulmonary oxygen toxicity.

Current Situation and Influencing Factors of Preterm Infants Breastfeeding in Jingzhou 3A Hospital

Background: Breast milk is the best source of nutrition for premature infants and a “good medicine” for disease treatment. However, the rate of exclusive breastfeeding of premature infants in China still needs to be improved at present, and the factors affecting breastfeeding are different in different places. Objective: To investigate the current status and influencing factors of preterm infants breastfeeding in Jingzhou 3A hospitals. Methods: A cross-sectional study was conducted to collect breastfeeding information of premature infants in neonatal intensive care unit (NICU) from May to August in 2019 in Jingzhou 3A Hospital, and 152 premature infants’ related information were collected. A questionnaire survey was conducted among the mothers who failed to breastfeed. Results: The rate of exclusive breastfeeding among premature infants in NICU was 9.87%. The rates of first breastfeeding and exclusive breastfeeding at discharge were 13.16% and 32.89% respectively. Not producing enough milk and knowing the right way to pump breast milk contributed a lot to the failure of exclusive breastfeeding. Conclusion: More attention should be paid to the health education and management to improve the rate of breastfeeding in NICU.

Neonatal hemorrhage stroke and severe coagulopathy in a late preterm infant after receiving umbilical cord milking:A case report

BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.

Efficacy and safety of the heated gel mattress for prevention of hypothermia in preterm infants during intra-hospital transport： a meta-analysis

Objective： To evaluate the efficacy and safety of the heated gel mattress for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively. Methods： Systematic searches on PubMed, EM- BASE, Cochrane Library, Web of Science, CBM, CNKI, Wanfang and VIP were performed for randomized controlled trials （RCTs） or quasi-RCTs which explored the effects of heated gel mattress on prevention of hypothermia in premature infants relative to conventional alternatives. Studies were screened according to inclusion and exclusion criteria, extracted data and assessed quality. Then, meta-analysis and trial sequential analysis were performed by RevMan 5.3 and TSA vO.9 software developed at the Copenhagen Clinical Trials Center in Denmark, independently. Results： This systematic review included 10 studies which comprised 7 RCTs and 3 quasi-RCTs, encompassing 773 patients. The results of meta-analysis showed that in heated gel mattress group admission temperature on neonatal intensive care unit （SMD, 0.63; 95% CI, 0.40 to 0.87; P = 0.00）, incidence of hypothermia （RR, 0.73; 95% CI, 0.57 to 0.93; P = 0.01） and hyperthermia （RR, 1.82; 95% CI, 1.31 to 2.541 P = 0.00） compared with the control group had significantly statistical difference; however, there was no significant difference in admission temperature on exothermic mattresses or TransWarmer mattress group, mortality, sepsis, retinopathy of prematurity, intraventricular hemorrhage Ⅲ/Ⅳ between two groups, trial sequential analysis confirmed that the pooled results of admission temperature on neonatal intensive care unit and hyperthermia were stable and reliable; but the combination of low-temperature incidence and mortality indicators suggested that the sample size was insufficient. Conclusion： Heated gel mattress is a safe and effective re- warming intervention that can improve body temperature of hypothermic preterm infants during transport, reduce the incidence of hypothermia and does not increase the incidence of morbidity and complications. However, it is recommended that clinical monitoring of body temperature should be performed dynamically to decrease the potential risk of high fever. In addition, due to the limitation of quantity and quality of included studies, its cost-effectiveness and far-reaching influence on long-term follow-up outcomes need further evaluation through clinical multicenter, large sample, and high-quality research.

The evolution of refractive status in Chinese infants during the first year of life and its affected factors

AIM： To study the evolution of the refractive status and examine the affected factors in infants during the first year of life in a large sample size in China. METHODS： A total of 1258 babies （2516 eyes） aged 32wk gestational age to ty participated in the study, including 766 premature and 492 full-term infants. First, each baby received an orthoptic examination, slit-lamp checking and fundus imaging. Patients with diseases which might affect refractive status were excluded from the cohort. The cycloplegia retinoscopy was performed. Their neonatal histories were reviewed. Each measurement contained the refractive status and calculation of the spherical equivalent （SE）. RESULTS： Refractive state showed an average hyperopia of ＋0.94_＋1.63 D at early ages, followed by a trend toward more hyperopia. The refractive state reached the top （＋2.431.46 D） at the age of one to two months. Then gliding till one year old when the refractive state reached ＋0.59：1.41 D. The prevalence of astigmatism was 42.17% in the study, being 2.82% myopic astigmatism and 39.35% hyperopic astigmatism. The 94.1% of hyperopic astigmatism was with-the-rule astigmatism and 71.83% of myopic astigmatism was with-the-rule astigmatism. Refractive state between boys and girls was different. The mean SE of boys was ＋1.97＋1.57 D, while that of girls was ＋1.79＋1.46 D, and the difference was significant. CONCLUSION： Before one year old, the change of refractive status is associated with checking age and sex. At the age of one to two months, the degree of hyperopia reaches the top. Boys have more hyperopic degree than girls, and with- the-rule astigmatism is predominant. Excluding premature infants with advanced retinopathy of prematurity, premature and full-term children have same refraction status.

A delayed diagnosis of unsuspected retinoblastoma in an in vitro fertilisation infant with retinopathy of prematurity

Dear Editor,I am Dr.Tian Tian,from the Department of Ophthalmology,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China.I write to present a rare case report of a delayed diagnosis of unsuspected retinoblastoma（RB）in an in vitro fertilisation（IVF）infant with retinopathy of prematurity.