Most existing neonatal sleep staging appro- aches applied multiple EEG channels to obtain good performance. However, it potentially increased the computational complexity and led to an increased risk ...of skin disruption to neonates during data acquisition. In this paper, a multi-scale hierarchical neural network (MS-HNN) with a squeeze and excitation (SE) block for neonatal sleep staging is presented in this study on the basis of a single EEG channel. MS-HNN composes of multi-scale convolutional neural network (MSCNN), temporal information learning (TIL) module, and squeeze and excitation (SE) block. MSCNN can extract features from different scales and frequencies, and TIL module can acquire the transition information among adjacent stages. In addition, for these extracted features, SE block can selectively concentrate on informative features and weaken redundant features for achieving better performance. The proposed approach was validated on a clinical dataset involving 64 neonates from the Children's Hospital of Fudan University (CHFU). The proposed network achieves an accuracy of 75.4% and 76.5% for three-class automatic neonatal sleep staging with the single-EEG channel and the eight-EEG channels, respectively. The experimental results show that the proposed method can maintain good performance by making full use of the information in the single channel while reducing the channels to control the computational overhead.
Background Though there has been an increase in the number of neonates with hypoxic-ischemic encephalopathy (HIE) treated by therapeutic hypothermia (TH) in recent years, the effect of therapeutic ...hypothermia on mild HIE neonates is still uncertain. Objectives This study aims to explore the safety and efficacy of therapeutic hypothermia in neonates with mild HIE. Methods Retrospectively collected between January 2010 to December 2022 at Children's Hospital of Fudan University, neonates with mild HIE were divided into TH and non-TH groups. Clinical data of the mild HIE neonates and their mothers' general information during pregnancy were collected. SPSS 23.0 was used to compare the general condition, the incidence of adverse events, and efficacy in the two groups. Results A total of 71 neonates with mild HIE were included, including 31 in the TH group and 40 in the non-TH group. Compared with the non-TH group, the TH group had significantly lower 5-minute Apgar scores 6 (5-7) points vs. 7 (5-8) points, p = 0.033 , but a higher rate of tracheal intubation at birth (68%, 21/31 vs. 40%, 16/40, p = 0.02), a higher rate of chest compressions > 30 s (39%, 12/31 vs. 15%, 6/40, p = 0.023), the later initiation enteral feeding 4 (3-4) days vs. 1 (1-2) days, p < 0.001, a higher usage rate of analgesic and sedative drugs (45%, 14/31 vs. 18%, 7/40, p = 0.011) and the longer hospital stay 12.5 (11-14) days vs. 9 (7-13.9) days, p = 0.003. There was no death in 71 mild HIE neonates. TH group had lower incidence of brain injury (16%, 5/31 vs. 43%, 17/40, p = 0.017) and encephalopathy progression (10%, 3/31 vs. 45%, 18/40, p = 0.001) than the non-TH group. There was no statistical significance in the incidence of adverse events between the two groups. Conclusion Therapeutic hypothermia can reduce the incidence of brain injury in neonates with mild HIE. Keywords: Neonatal, Mild, Hypoxic-ischemic encephalopathy, Therapeutic hypothermia
Humans have the ability to appreciate and create music. However, why and how humans have this distinctive ability to perceive music remains unclear. Additionally, the investigation of the innate ...perceiving skill in humans is compounded by the fact that we have been actively and passively exposed to auditory stimuli or have systematically learnt music after birth. Therefore, to explore the innate musical perceiving ability, infants with preterm birth may be the most suitable population. In this study, the auditory brain networks were explored using dynamic functional connectivity-based reliable component analysis (RCA) in preterm infants during music listening. The brain activation was captured by portable functional near-infrared spectroscopy (fNIRS) to simulate a natural environment for preterm infants. The components with the maximum inter-subject correlation were extracted. The generated spatial filters identified the shared spatial structural features of functional brain connectivity across subjects during listening to the common music, exhibiting a functional synchronization between the right temporal region and the frontal and motor cortex, and synchronization between the bilateral temporal regions. The specific pattern is responsible for the functions involving music comprehension, emotion generation, language processing, memory, and sensory. The fluctuation of the extracted components and the phase variation demonstrates the interactions between the extracted brain networks to encode musical information. These results are critically important for our understanding of the underlying mechanisms of the innate perceiving skills at early ages of human during naturalistic music listening.
Carbapenem-resistant gram-negative bacilli (CR-GNB) have been increasingly reported in China. However, dynamic monitoring data on molecular epidemiology of CR-GNB are limited in pediatric patients.
...300 CR-GNB isolates (200 Carbapenem-resistant K. pneumoniae (CRKP), 50 carbapenem-resistant A.baumannii (CRAB) and 50 carbapenem-resistant P. aeruginosa (CRPA)) were investigated. The predominant carbapenemase gene was bla
(73%) and bla
(65%) in neonates and non-neonates. Meanwhile, the predominant STs were ST11 (54%) in neonates and ST17 (27.0%) and ST278 (20.0%) in non-neonates. Notably, a shift in the dominant sequence type of CRKP infections from ST17 /ST278-NDM-1 to ST11-KPC-2 was observed during the years 2017-2021 and KPC-KP showed relatively higher resistance to aminoglycosides and quinolones than NDM-KP.Bla
was isolated from all the CRAB isolates while only one isolate expressing bla
and 2 isolates expressing bla
were found in CRPA isolates. ST195 (22.0%) and ST244 (24.0%) were the most common in CRAB and CRPA isolates and all the STs of CRAB belonged to CC92 while CRPA presents ST types with diversity distribution.
CRKP showed different molecular phenotypes in neonates and non-neonates and was changing dynamically and high-risk clone of ST11 KPC-KP should be paid more attention. Most CRKP and CRAB strains shared the same CCs, suggesting that intrahospital transmission may occur, and large-scale screening and more effective measures are urgently needed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
...developmental disabilities place a huge burden on families, health systems, and society (estimated lifetime costs per person: ~1 million dollars), emphasizing the urgent need for identifying the ...causes and mechanisms underlying HIE and improved prevention/treatment strategies to reduce perinatal brain damage (Honeycutt et al., 2004). ...targeting SFKs could provide an additional neuroprotective approach to treating preterm infants. Furthermore, Singh-Mallah et al. used N-acetyl cysteine (NAC), which is an antioxidant and has been previously shown to reduce lipopolysaccharide (LPS)-sensitized HI brain injury (Wang et al., 2007), to further confirm that SIRT6 has protective effects on HIE, which is at least partially associated with the regulation of HMGB1 extracellular release since NAC restores SIRT6 and decreases HMGB1 release in LPS-sensitized neonatal brain following HI injury (Singh-Mallah et al.). ...targeting HMGB1 and its attendant sterile inflammatory responses could represent a novel adjunctive therapeutic approach to treat HIE. Interestingly, sildenafil has been demonstrated to cross the blood-brain barrier and has been shown to exert neuroprotective effects based on the evidence of restoring neuronal development, preventing neuronal cell death, reducing neuro-inflammation via reducing reactive astrogliosis and macrophage/microglial activation, promoting functional recovery and mediating blood-flow redistribution after neonatal HI (Charriaut-Marlangue et al., 2014; Gomez-Vallejo et al., 2016; Moretti et al., 2016; Yazdani et al., 2016, 2021; Engels et al., 2017). ...maternal treatment with sildenafil is anti-oxidative and prevents neuronal death in an animal model of fetal ischemia (Ozdegirmenci et al., 2011).
According to our experience, the typical phenotypes, such as special facial features or multiple congenital anomalies (MCAs), indicate a high risk of genetic disease and lead physicians to perform ...genetic testing in neonates as early as possible. ...in practice, infants without typical phenotypes typically undergo a long and costly diagnostic process before genetic diagnoses are confirmed. ...a recent survey by the American College of Medical Genetics and Genomics (ACMG) and other national professional organizations indicated that there are insufficient numbers of qualified geneticists to fulfil genetic service needs. 5 However, to our knowledge, clinical findings are variable and documented based on the physician's experience and training. ...the massive expressions of clinical findings hamper the analysis of character phenotypes in genetic diseases. ...in addition to structural malformations and special facial features, these three phenotypes could be considered as the clinical indicators to perform further genetic testing.
Hypoxic-ischemic (HI) injury is one of the initial factors contributing to neonatal brain injury. Src family kinases (SFKs) are considered to act as molecular hubs for
-methyl-d-aspartate receptor ...(NMDAR) regulation and participate in the HI injury process. The objectives of this study were to evaluate the levels of phospho-Src (p-Src), the relationship between NMDARs and SFKs, and the effects of SFK inhibition on an immature rat HI brain injury model. The model was induced in 3-day-old Sprague-Dawley rats using the Rice-Vannucci model operation. The level of p-Src was evaluated using Western blotting. The association of NMDARs with SFKs was detected using Western blotting and coimmunoprecipitation. After intraperitoneal injection of 4-amino-5-(4-chlorophenyl)-7-(
-butyl) pyrazolo 3,4-
pyrimidine (PP2), an SFK-selective inhibitor, neuropathological changes were observed by performing H&E and immunofluorescence staining, and the neurological functions were assessed using the following behavioral tests: modified neurological severity score, open field test, and Morris water maze test. The levels of p-Src first decreased at 0 h after injury, increased at 2 h after injury, and continuously decreased from 6 h to 3 days. Along with the increased p-Src levels observed at 2 h after injury, the phosphorylation of NMDAR subunit NR2B at tyrosine 1472 was increased. Following the administration of PP2, the increased p-Src and NMDAR-2B levels detected at 2 h after injury were decreased, and tissue injury and myelin basic protein expression were improved at 7 days after injury. The PP2 intervention improved the performance of injured rats on behavioral tests. In conclusion, we determined the patterns of p-Src expression after HI brain injury in immature rats and showed a relationship with the activated NMDA receptor. The inhibition of p-Src ameliorates neuropathological changes and damages neurological functions induced by HI injury.
•Galectin-3 (Gal-3) was upregulated after postnatal day 3 hypoxic-ischemic brain injury.•Gal-3 was distributed in cortex, thalamus, corpus callosum and hippocampus area.•Gal-3 was co-located with ...astrocyte, microglia, neuron, endotheliocyte and OPCs marker.
In this research, we intended to evaluate the expression pattern, distribution and sources of Galectin-3 (Gal-3) in perinatal hypoxic-ischemic brain injury rat model. Postnatal day 3 Sprague-Dawley rat pups were subjected to right carotid artery ligation followed by 2.5 h of hypoxia (6% oxygen). Expression and distribution of Gal-3 were evaluated by western blotting and immunofluorescence. Sources of Gal-3 were evaluated by double staining with neuronic, oligodendrocytic, astrocytic, microglial and endotheliocytic markers. Our results indicated Gal-3 significantly upregulated from 12 h and maintained an increasing tendency within 72 h post injury. Although the relative expression of Gal-3 decreased after 72 h, we detected significant differences until 14d. We found Gal-3 started to distribute in cortex and thalamus area and maintained an increasing tendency. Gal-3 could be detected in cortex, thalamus, corpus callosum and hippocampus area at 72 h post injury. After that, expression of Gal-3 in cortex and thalamus area downregulated, the expression in corpus callosum and hippocampus area vanished. We found astrocyte, microglia, neuron and endotheliocyte were sources of Gal-3 in cortex area; astrocyte, microglia and endotheliocyte were sources of Gal-3 in thalamus area; oligodendrocyte precursor cell and endotheliocyte were sources of Gal-3 in corpus callosum; neuron, microglia and endotheliocyte were sources of Gal-3 in hippocampus. In conclusion, we demonstrated spatiotemporal expression patterns of Galectin-3 post perinatal hypoxic-ischemic brain injury in this research.
Objectives
Central nervous system (CNS) infection has a high incidence and mortality in neonates, but conventional tests are time-consuming and have a low sensitivity. Some rare genetic diseases may ...have some similar clinical manifestations as CNS infection. Therefore, we aimed to evaluate the performance of metagenomic next-generation sequencing (mNGS) in diagnosing neonatal CNS infection and to explore the etiology of neonatal suspected CNS infection by combining mNGS with whole exome sequencing (WES).
Methods
We prospectively enrolled neonates with a suspected CNS infection who were admitted to the neonatal intensive care unit(NICU) from September 1, 2019, to May 31, 2020. Cerebrospinal fluid (CSF) samples collected from all patients were tested by using conventional methods and mNGS. For patients with a confirmed CNS infection and patients with an unclear clinical diagnosis, WES was performed on blood samples.
Results
Eighty-eight neonatal patients were enrolled, and 101 CSF samples were collected. Fourty-three blood samples were collected for WES. mNGS showed a sample diagnostic yield of 19.8% (20/101) compared to 4.95% (5/101) for the conventional methods. In the empirical treatment group, the detection rate of mNGS was significantly higher than that of conventional methods 27% vs. 6.3%, p=0.002. Among the 88 patients, 15 patients were etiologically diagnosed by mNGS alone, five patients were etiologically identified by WES alone, and one patient was diagnosed by both mNGS and WES. Twelve of 13 diagnoses based solely on mNGS had a likely clinical effect. Six patients diagnosed by WES also experienced clinical effect.
Conclusions
For patients with a suspected CNS infections, mNGS combined with WES might significantly improve the diagnostic rate of the etiology and effectively guide clinical strategies.
Objective
To explore the clinical characteristics and prognosis of febrile seizure in children with COVID-19.
Methods
This study is a single-center retrospective cohort study. The cases included ...febrile seizures in children with COVID-19 admitted to the Renji Hospital from April 7th, 2022 to June 2nd, 2022. We compared children with and without febrile seizures in their clinical characteristics such as sex, age, symptoms, seizure manifestation, COVID-19 severity, and SARS-CoV-2 nucleic acid test results. The children with febrile seizures were followed up by telephone and outpatient service about one month after the nucleic acid turned negative and discharged from the hospital.
Results
A total of 585 cases of children with COVID-19 were included in the analysis. There were 15 children (1.8%) with febrile seizures, age from six months to three years old, nine boys (60.0%) and six girls (40.0%). The manifestations of febrile seizures were all generalized tonic-clonic seizures. The median nucleic acid negative conversion time was 11 (IQR:10.75,13) days. Our first comparison involved comparing children without underlying diseases; there was no significant difference in sex, COVID-19 severity, and clinical manifestations, but there was an age difference (2 vs. 1.3,
P
= 0.047). There was no difference in SARS-CoV-2 nucleic acid negative time between the two groups (11d vs. 13d,
P
= 0.128). One child had new clinical manifestations during the follow-up, but his EEG and MRI were normal.
Conclusion
Febrile seizure may be children's primary neurological manifestation of COVID-19. It may occur in children with no history of epilepsy and is not associated with severe illness. The long-term neurological outcomes of these children should be followed up.
PDF
