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Wu R.,Yangzhou University | Li N.,Yangzhou University | Hu J.,Yangzhou University | Zha L.,Yangzhou University | And 4 more authors.
Zhonghua er ke za zhi. Chinese journal of pediatrics | Year: 2014

OBJECTIVE: To understand the effect of lung recruitment maneuver (LRM) with positive end-expiratory pressure (PEEP) on oxygenation and outcomes in preterm infants with respiratory distress syndrome (RDS) ventilated by proportional assist ventilation (PAV).METHOD: From January 2012 to June 2013, thirty neonates with a diagnosis of RDS who required mechanical ventilation were divided randomly into LRM group (n=15, received an LRM and surport by PAV) and control group (n=15, only surport by PAV). There were no statistically significant differences in female (7 vs. 6); gestational age [(29.3±1.2) vs. (29.5±1.1) weeks]; body weight[(1,319±97) vs. (1,295±85) g]; Silverman Anderson(SA) score for babies at start of ventilation (7.3±1.2 vs. 6.9±1.4); initial FiO2 (0.54±0.12 vs. 0.50±0.10) between the two groups (all P>0.05). LRM entailed increments of 0.2 cmH2O (1 cmH2O=0.098 kPa) PEEP every 5 minutes, until fraction of inspired oxygen (FiO2)=0.25. Then PEEP was reduced and the lung volume was set on the deflation limb of the pressure/volume curve.When saturation of peripheral oxygen fell and FiO2 rose, we reincremented PEEP until SpO2 became stable. The related clinical indicators of the two group were observed.RESULT: The doses of surfactant administered (1.1±0.3 vs. 1.5±0.5, P=0.027), Lowest FiO2 (0.29±0.05 vs. 0.39±0.06, P=0.000), time to lowest FiO2[ (103±18) vs. (368±138) min, P=0.000] and O2 dependency [(7.6±1.0) vs.( 8.8±1.3) days, P=0.021] in LRM group were lower than that in control group (all P<0.05). The maximum PEEP during the first 12 hours of life [(8.4±0.8) vs. (6.8±0.8) cmH2O, P=0.000] in LRM group were higher than that in control group (P<0.05). FiO2 levels progressively decreased (F=35.681, P=0.000) and a/AO2 Gradually increased (F=37.654, P=0.000). No adverse events and no significant differences in the outcomes were observed.CONCLUSION: LRM can reduce the doses of pulmonary surfactant administered, time of the respiratory support and the oxygen therapy in preterm children with RDS.

Wu R.,Yangzhou University | Tian Z.-F.,Nanjing Medical University | Zheng G.-F.,Yangzhou University | Din S.-F.,Yangzhou University | And 2 more authors.
Minerva Pediatrica | Year: 2016

Background: This study aimed to compare the relevant clinical parameters of neonates with MAS who are supported by proportion assisted ventilation (PAV) and synchronized intermittent mandatory ventilation (SIMV). METHODS: Forty neonates diagnosed as MAS who required mechanical ventilation were divided randomly into PAV group and SIMV group (N.=20). The respiratory rate (RR), heart rate (HR), peak inspiratory pressure (PIP), mean arterial blood pressure (MABP), arterial-to-alveolar oxygen tension ratio (a/APO2), fraction of inspiration oxygen (FiO2), mean airway pressure (MAP) and tidal volume (VT) were measured before the ventilation, 1,12, 24, 48 hours after the ventilation and before weaning. RESULTS: We observed no significant differences in the mechanical ventilation time, oxygen supply time, hospital stay between PAV and SIMV groups. In addition, we found no significant differences in HR, MABP, a/APO2 and FiO2 at every time point between two groups (P>0.05). However, we observed significant differences in RR, MAP, PIP and VT at every time point between two groups (P<0.05). CONCLUSIONS: PAV and SIMV might be a useful ventilator mode to support the neonates with MAS who require ventilation. To achieve the same effect, PAV adopts rapid shallow breathing pattern, with smaller tidal volume and lower MAP and PIP. © 2014 Edizioni Minerva Medica.

Roberge S.,Laval University | Roberge S.,University of Quebec | Lacasse Y.,Laval University | Tapp S.,University of Quebec | And 9 more authors.
Journal of Obstetrics and Gynaecology Canada | Year: 2011

Background: Antenatal glucocorticoid (AGC) therapy has been associated with a decrease in respiratory distress syndrome (RDS). While preterm males remain at greater risk of RDS than females, the role of fetal sex in AGC response is not well known. Objectives: To review the available evidence regarding the effect of fetal sex in the prevention of RDS using AGC. Method: We conducted a systematic review and meta-analysis of RCTs to compare the effect of AGC in male and female infants with regard to the rates of RDS, intra-ventricular hemorrhage (IVH) grades III and IV, and neonatal mortality. Random effects with 95% confidence intervals were assessed in both groups and relative risks were compared using mixed regression. Results: From 248 potentially eligible articles, we included eight in the analysis for a total of 1109 male and 968 female infants. Both male and female infants had a significant decrease in the risks, but no difference between the sexes was observed in terms of reduction in RDS (RR 0.50; 95% CI 0.33 to 0.77 for males, and RR 0.57; 95% CI 0.43 to 0.75 for females, P = 0.99), reduction in IVH (P = 0.98), and reduction in neonatal mortality (P = 0.43). In a sub-analysis, use of betamethasone was associated with a significant decrease in the rate of RDS in males (RR 0.29; 95% CI 0.15 to 0.57) but dexamethasone was not (RR 0.78; 95% CI 0.57 to 1.07). Conversely, dexamethasone use was significantly helpful in females (RR 0.51; 95% CI 0.32 to 0.81) but betamethasone was not (RR 0.62; 95% CI 0.38 to 1.00). Conclusion: The effect of AGC for prevention of RDS is similar in females and males. However, futures studies should investigate the type of AGC according to fetal/neonatal sex. © 2011 Society of Obstetricians and Gynaecologists of Canada.

Si Y.,Bayi Childrens Hospital Affiliated to General Hospital of Beijing Military Command | Yang K.,Beijing Military General Hospital | Qin M.,Bayi Childrens Hospital Affiliated to General Hospital of Beijing Military Command | Zhang C.,Bayi Childrens Hospital Affiliated to General Hospital of Beijing Military Command | And 5 more authors.
Pediatric Hematology and Oncology | Year: 2014

The treatment of pediatric severe aplastic anemia (SAA) with allogeneic hematopoietic stem cell transplantation (allo-HSCT), presents major challenges including the risks of graft failure, septic complications, and graft-versus-host disease (GVHD). Additive infusions of human umbilical cord derived mesenchymal stem cell (hUC-MSC) may be administered to improve patient survival. We retrospectively examined 37 pediatric patients with SAA who received allo-HSCT and subsequent infusions of hUC-MSC suspension at a dose of 1.0 × 106/kg. The times and doses of hUC-MSC infusions were increased in patients with severe GVHD. All patients received hUC-MSC infusions. The median time to post-transplantation neutrophil count of greater than 0.5 × 109/L was 14 days (range, 11-20 days) and time to post-transplantation platelet count of greater than 20 × 109/L was 19 days (14-29 days). The overall frequency of acute GVHD (aGVHD) was 45.9% (17/37). These aGVHD episodes occurred at a median time of post-transplantation 47 days (15-83 days). The frequency of chronic GVHD (cGVHD) was 18.9% (7/37); cGVHD developed from aGVHD in 10.8% (4/37) of patients. The GVHD-associated mortality rate was 18.9% (7/37) and aGVHD-specific mortality rate was 8.1% (3/37). The median overall survival time was 35 months (9-67 months) and the three-year overall survival rate was 74.2% (28/37). Seven patients died of GVHD, one patient died of a severe invasive fungal infection, and one patient died of renal failure. In conclusion, post-transplantation hUC-MSC infusions seemed to be safely infused in children with SAA who have previously received allo-HSCT. © 2014 Informa Healthcare USA, Inc.

Li L.,Bayi Childrens Hospital Affiliated to General Hospital of Beijing Military Command | Yin X.,Bayi Childrens Hospital Affiliated to General Hospital of Beijing Military Command | Ma N.,Peking University | Lin F.,Bayi Childrens Hospital Affiliated to General Hospital of Beijing Military Command | And 3 more authors.
American Journal of Translational Research | Year: 2014

Hypoxia-inducible factor 1α (HIF-1α) promotes cell survival after hypoxia-ischemia by regulating its target genes. Desferrioxamine (DFO) has been found to up-regulate HIF-1α expression in ischemia brain injury. However, the signaling pathway to mediate this regulation remains unclear in neonatal hypoxia-ischemia brain damage (HIBD). Since phosphoinositide 3-kinase (PI3K/Akt) pathway and extracellular signal-related protein kinase pathway (Erk1/2 MAPK) have proven to be involved in the regulation of HIF-1α in neonatal rat brain after hypoxia-ischemia (HI), we hypothesized that DFO might regulate HIF-1α by activating PI3K/Akt and Erk1/2 MAPK pathways in developing rat brain after HI. To test this hypothesis, we subjected postnatal day 10 rats to DFO intraperitoneal injection 30 min before HI. Rat brains were collected to detect the expression of HIF-1α and its target gene VEGF, as well as PI3K/Akt and Erk1/2 MAPK using Western blot analysis. We found that the expression of HIF-1α, VEGF, and p-Erk1/2 was significantly up regulated and peaked at 4 h after HI in DFO treated group, with higher level and earlier peak time than control group. However, the expression of p-Akt was unchanged in DFO treated group compared with control group. Our findings suggest that DFO might up-regulate HIF-1α and its target gene VEGF through Erk1/2 MAPK pathway in the developing rat brain after HI.

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