Chao Chen

The University of Warwick, Coventry, England, United Kingdom

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Publications (48)112.09 Total impact

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    ABSTRACT: AimHypoglycaemia is a significant problem in high-risk neonates and predominant parieto-occipital lobe involvement has been observed after severe hypoglycaemic insult. We explored the use of flash visual evoked potentials (FVEP) in detecting parieto-occipital lobe involvement after significant hypoglycaemia.Methods Full-term neonates (n=15) who underwent FVEP from January 2008 to May 2013 were compared with infants (n=11) without hypoglycaemia or parietal-occipital lobe injury. Significant hypoglycaemia was defined as being symptomatic or needing steroids, glucagon or a glucose infusion rate of ≥12mg/kg/min.ResultsThe hypoglycaemia group exhibited delayed latency of the first positive waveform on FVEP. The initial detected time for hypoglycaemia was later in the eight subjects with seizures (median 51-hours-old) than those without (median 22- hours-old) (P=0.003). Magnetic Resonance Imaging showed that 80% of the hypoglycaemia group exhibited occipital-lobe injuries and they were more likely to exhibit abnormal FVEP morphology (P=0.007) than the controls. FVEP exhibited 100% sensitivity, but only 25% specificity, for detecting injuries to the parieto-occipital lobes.Conclusion Flash visual evoked potential (FVEP) was sensitive, but not sufficiently specific, in identifying parieto-occipital lobe injuries among term neonates exposed to significant hypoglycaemia. Larger studies exploring the potential role of FVEP in neonatal hypoglycaemia are required.This article is protected by copyright. All rights reserved.
    Acta Paediatrica 05/2014; · 1.97 Impact Factor
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    ABSTRACT: To explore the changes of outcome and morbidity in extremely low birth weight (ELBW) infants. A retrospective study was performed for ELBW infants admitted into Children's Hospital, Fudan University within 24 hours after birth from January 2007 to December 2011. The maternal and neonatal data were collected by reviewing the medical charts and entered into the dataset. A total of 105 ELBW infants (54 males, 51 females) were enrolled. The average gestational age was (28.4 ± 2.6)weeks and birth weight was (860 ± 121)g. Neonatal respiratory syndrome (NRDS) (n = 89, 84.8%), apnea(n = 58, 55.2%), sepsis (n = 47, 44.8%) and patent ductus arteriosus (n = 46, 43.8%) remained their major complications.Sepsis was the commonest cause of mortality (7/17) excluding social factors. The incidence of extrauterine growth restriction (46/51, 90.2%) was significantly high at discharge. And the use of antenatal steroids was merely 40.8% (42/103) in ELBW infants at a gestation age under 34 weeks. The number of ELBW infants has increased dramatically. Antenatal steroids, noninvasive respiratory support, prevention of infections and optimal nutrition supports are key factors of improving the survival rate, short and long-term outcomes of ELBW infants.
    Zhonghua yi xue za zhi 02/2014; 94(6):446-8.
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    ABSTRACT: Objetivo validar de forma prospectiva um nomograma de bilirrubina transcutânea (BTc) para identificar hiperbilirrubinemia grave em neonatos a termo e pré‐termo tardios saudáveis na China. Métodos foi realizado um estudo multicêntrico que incluiu 9174 neonatos a termo e pré‐termo tardios saudáveis em oito unidades da China. Foram realizadas dosagens de BTc utilizando um bilirrubinômetro. Os valores de BTc foram traçados em um nomograma de BTc para identificar a capacidade de predição de hiperbilirrubinemia significativa. Resultados 972 recém‐nascidos (10,6%) desenvolveram hiperbilirrubinemia significativa. O percentil 40 de nosso nomograma pode identificar todos os recém‐nascidos com risco de hiperbilirrubinemia significativa, porém com baixo valor preditivo positivo (VPP) (18,9%). De 453 recém‐nascidos acima do percentil 95, 275 recém‐nascidos desenvolveram posteriormente hiperbilirrubinemia significativa, com VPP elevado (60,7%), porém com baixa sensibilidade (28,3%). O percentil de 75 foi altamente específico (81,9%) e moderadamente sensível (79,8%). A área sob a curva (ASC) de nosso nomograma de BTc foi de 0,875. Conclusões este estudo validou o nomograma de BTc, que pode ser utilizado para prever hiperbilirrubinemia significativa em neonatos a termo e pré‐termo tardios saudáveis na China. Contudo, combinar o nomograma de BTc e fatores de risco clínicos pode melhorar a precisão de predição da hiperbilirrubinemia grave, o que não foi avaliado neste estudo. São necessários estudos adicionais para confirmar essa combinação.
    Jornal de pediatria 01/2014; · 1.07 Impact Factor
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    ABSTRACT: This paper considers the scenario where multiple clusters of Virtual Machines (i.e., termed Virtual Clusters) are hosted in a Cloud system consisting of a cluster of physical nodes. Multiple Virtual Clusters (VCs) cohabit in the physical cluster, with each VC offering a particular type of service for the incoming requests. In this context, VM consolidation, which strives to use a minimal number of nodes to accommodate all VMs in the system, plays an important role in saving resource consumption. Most existing consolidation methods proposed in the literature regard VMs as “rigid” during consolidation, i.e., VMs’ resource capacities remain unchanged. In VC environments, QoS is usually delivered by a VC as a single entity. Therefore, there is no reason why VMs’ resource capacity cannot be adjusted as long as the whole VC is still able to maintain the desired QoS. Treating VMs as “moldable” during consolidation may be able to further consolidate VMs into an even fewer number of nodes. This paper investigates this issue and develops a Genetic Algorithm (GA) to consolidate moldable VMs. The GA is able to evolve an optimized system state, which represents the VM-to-node mapping and the resource capacity allocated to each VM. After the new system state is calculated by the GA, the Cloud will transit from the current system state to the new one. The transition time represents overhead and should be minimized. In this paper, a cost model is formalized to capture the transition overhead, and a reconfiguration algorithm is developed to transit the Cloud to the optimized system state with low transition overhead. Experiments have been conducted to evaluate the performance of the GA and the reconfiguration algorithm.
    Future Generation Computer Systems 01/2014; 32:69–81. · 2.64 Impact Factor
  • Pediatrics & Neonatology. 01/2014;
  • Ze D Jiang, Chao Chen
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    ABSTRACT: To test the hypothesis that neural conduction in the auditory brainstem is impaired in high-risk very preterm infants. Eighty-two very preterm infants (gestation 28-32weeks) with various perinatal problems or complications were studied at term using maximum length sequence (MLS) brainstem auditory evoked response (BAER) with click rates 91-910/s. The data were compared with those in 31 age-matched low-risk very preterm infants and 44 normal gestation (term) infants. High-risk very preterm infants showed a general increase in MLS BAER wave latencies and interpeak intervals. Wave V latency, and III-V and I-V intervals in high-risk very preterm infants were significantly longer than in normal term infants at all click rates, particularly higher rates. I-III interval was significantly longer, and III-V/I-III interval ratio was significantly greater at higher rates. These latency and intervals in high-risk very preterm infants were also longer, though relatively less significantly, than in low-risk very preterm infants. Click rate-related changes in major MLS BAER variables in high-risk infants were more significant than in the two groups of controls. There were major abnormalities in MLS BAER variables that mainly reflect central neural conduction in high-risk very preterm infants. The abnormalities were relatively less significant when compared with low-risk very preterm infants than with normal term infants. Neural conduction in the auditory brainstem, mainly the more central regions, is impaired in high-risk very preterm infants. The impairment is largely attributed to the associated perinatal problems, and partially related to very preterm birth.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 11/2013; · 3.12 Impact Factor
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    ABSTRACT: Knowledge of essential amino acid requirements in infants is important because excessive intake of protein can lead to increased long-term morbidity such as obesity. A deficient intake may lead to suboptimal growth and impaired neurodevelopment. The current recommended branched-chain amino acid requirements in infants aged 0-1 mo are based on the amino acid content of human milk. We quantified the requirements for isoleucine, leucine, and valine for term neonates by using the indicator amino acid oxidation method with [1-(13)C]phenylalanine as the indicator. Fully enterally fed term infants received randomly graded amounts of isoleucine (5-216 mg ⋅ kg(-1) ⋅ d(-1)), leucine (5-370 mg ⋅ kg(-1) ⋅ d(-1)), or valine (5-236 mg ⋅ kg(-1) ⋅ d(-1)) as part of an elemental formula. Data are expressed as means ± SDs. Eighty-three Asian, term neonates (birth weight: 3.3 ± 0.4 kg; gestational age 39.4 ± 1.3 wk) were studied at a postnatal age of 13 ± 5 d. Mean requirements for isoleucine, leucine, and valine (measured in boys only) were 105 mg ⋅ kg(-1) ⋅ d(-1) (r(2) = 0.61, P < 0.001), 140 mg ⋅ kg(-1) ⋅ d(-1) (r(2) = 0.26, P < 0.01), and 110 mg ⋅ kg(-1) ⋅ d(-1) (r(2) = 0.35, P = 0.001), respectively. Current human milk-based recommendations for isoleucine and valine in term infants aged 0-1 mo are correct. However, the current recommendation for leucine (166 mg ⋅ kg(-1) ⋅ d(-1)) is higher than the mean requirement of 140 mg ⋅ kg(-1) ⋅ d(-1) that we determined in this study. This trial was registered at www.trialregister.nl as NTR1610.
    American Journal of Clinical Nutrition 11/2013; · 6.50 Impact Factor
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    ABSTRACT: Purpose: To analyze the incidence and severity of retinopathy of prematurity (ROP) in China, and to explore the workload implications of applying different criteria. Methods: A prospective, neonatal units based study undertaken in two tertiary level hospitals in Shanghai, China, from January 1, 2010 to December 31, 2012. All infants with birth weight (BW) of 2000 g or less and/or gestational age (GA) of 34 weeks or less were screened for ROP. ROP was classified using the international classification, and was treated in accordance with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. Results: A total of 2825 (93.7%) of 3014 eligible infants were screened and ROP was diagnosed in 503 infants (17.8%). 191 infants (6.8%) had type 1 or worse ROP and were treated with laser or vitrectomy. The mean GA of ROP patients was 29.9±2.1 weeks and their mean BW was 1425±266 g. Infants who needed treatment for ROP had a mean GA of 29.3±2.1 weeks and mean BW of 1331±330 g. Among these treated infants, 18 infants (9.4%) exceeded the UK's screening criteria, and 28 (14.7%) exceeded the criteria used in the US. If narrower criteria as GA≤33w and/or BW≤1750g were adopted, almost 16.9% fewer infants would not have been examined without missing any infant that required treatment. Conclusions: Larger, older infants are at risk in China and screening criteria used in the US and UK may not be suitable for China. Further population-based studies are recommended to determine the necessity of modifying the current ROP screening protocol.
    Investigative ophthalmology & visual science 11/2013; · 3.43 Impact Factor
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    ABSTRACT: Candida species is an important cause of nosocomial infection in neonatal intensive care units (NICUs). However, most reports in China have been limited to single institutions. The aim of this study is to investigate the epidemiology of invasive candidiasis in multiple NICUs across China. We retrospectively collected demographic data, clinical characteristics, microbiological results and outcome of preterm infants with invasive candidiasis discharged from 11 academic tertiary NICUs during January 2009 - December 2011. There were 30,045 preterm infants discharged from 11 NICUs during the study period. We detected 223 infants with invasive candidiasis, resulting in an incidence of 0.74 cases per 100 preterm discharges from NICUs. In very low birth weight infants, the incidence was 3.42 cases per 100 VLBW discharges. Mean gestational age of infected infants was 31.4 weeks and median birth weight 1410 gram. Among the cohort of infants with invasive candidiasis, 214 (96.0%) infants had positive blood culture for fungus, 5 infants had positive urine culture, 3 from cerebrospinal fluid (CSF) and 1 from articular effusion in the shoulder joint. Among the cohort of infants with candidemia, 48 (22.4%) infants had fungal meningitis. Candida albicans accounted for 57.4% of total positive cultures. Overall mortality attributable to invasive candidiasis was 19.3%. Invasive candidiasis is a common problem among preterm neonates in China, especially among VLBW infants and it is associated with a high mortality. The preponderance of infections was due to Candida albicans.
    The Pediatric Infectious Disease Journal 10/2013; · 3.57 Impact Factor
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    ABSTRACT: Cortical GABAergic inhibitory interneurons have crucial roles in the development and function of the cerebral cortex. In rodents, nearly all neocortical interneurons are generated from the subcortical ganglionic eminences. In humans and nonhuman primates, however, the developmental origin of neocortical GABAergic interneurons remains unclear. Here we show that the expression patterns of several key transcription factors in the developing primate telencephalon are very similar to those in rodents, delineating the three main subcortical progenitor domains (the medial, lateral and caudal ganglionic eminences) and the interneurons tangentially migrating from them. On the basis of the continuity of Sox6, COUP-TFII and Sp8 transcription factor expression and evidence from cell migration and cell fate analyses, we propose that the majority of primate neocortical GABAergic interneurons originate from ganglionic eminences of the ventral telencephalon. Our findings reveal that the mammalian neocortex shares basic rules for interneuron development, substantially reshaping our understanding of the origin and classification of primate neocortical interneurons.
    Nature Neuroscience 10/2013; · 15.25 Impact Factor
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    ABSTRACT: Measures employed in preventing ventilator-associated pneumonia (VAP) in developing countries are rarely reported. This study evaluates the efficacy of an infection control program in reducing VAP in a neonatal intensive care unit (NICU) in China. All neonates who received mechanical ventilation for at least 48 hours and were hospitalized in the NICU for ≥5 days during 3 epochs were included. The hospital relocated to a new site during phase 2 and a bundle of comprehensive preventive measures against VAP were gradually implemented using the evidence-based practice for improving quality method. Research physicians recorded associated information of patients diagnosed with VAP. Of 491 patients receiving mechanical ventilation, 92 (18.7%) developed VAP corresponding to 27.33 per 1,000 ventilator-days. The rate decreased from 48.84 per 1,000 ventilator-days in phase 1 to 25.73 per 1,000 ventilator-days in phase 2 and further diminished to 18.50 per 1,000 ventilator-days in phase 3 (P < .001). Overall mortality rate of admitted neonates significantly decreased from 14.0% in phase 1 to 2.9% in phase 2 and 2.7% in phase 3 (P = .000). Gram-negative bacteria (95.5%) were the predominant organisms in VAP and Acinetobacter baumannii (65.2%) was the most frequently isolated microorganism. Implementing a multifaceted infection control program resulted in a significant reduction in VAP rate with long-term effects. Such interventions could be extended to other low-income countries.
    American journal of infection control 09/2013; · 3.01 Impact Factor
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    ABSTRACT: We set out to delineate the phenotypic and genotypic characteristics of Prader-Willi syndrome (PWS), a congenital neurodevelopmental disorder caused by the lack of expression of the paternally inherited imprinted genes on chromosome 15q11-13 in 31 Chinese patients. They were genotyped to identify deletions using methylation-specific polymerase chain reaction analysis and subsequent methylation-specific multiplex ligation-dependent probe amplification analysis. Microsatellite linkage analysis was performed to distinguish maternal uniparental disomy (UPD) from imprinting defect. Clinical manifestations were recorded and compared between patients with paternal 15q11-13 deletion and UPD. Deletions in the 15q11-13 region were present in 26 (83.9 %) patients, and UPD was observed in 5 (16.1 %) patients. The mean maternal age at the time of childbirth for mUPD children (32.8 ± 5.1 years) was significantly higher than that of children with paternal 15q11-13 deletion (27.1±3.2 years, P < 0.05). All patients had neonatal hypotonia, feeding difficulties in infancy, and decreased fetal activity, but only 12.9 % of the patients showed short stature, 54.8 % presented typical facial features, and 35.5 % showed skin picking lesions. Conclusion: Significant heterogeneity in clinical phenotypes and genotypes in PWS were observed between Chinese and Western populations in this study. This suggests that ethnic differences may be relevant to the diagnostic criteria for PWS.
    European Journal of Pediatrics 08/2013; · 1.91 Impact Factor
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    ABSTRACT: Background:We determined the effect of adaptation to the study diet on the oxidation of the indicator amino acid and the required tracer washout time in preterms.Methods:Subjects received a study diet for 6d that entailed a 50% reduction in leucine. Tracer studies using enterally infused [(13)C]bicarbonate and [1-(13)C]phenylalanine were performed on days 1, 2, 4 and 6. Breath samples containing (13)CO(2) were collected during steady state, measured by infrared spectrometric analysis and the fraction of (13)CO(2) recovery from (13)C oxidation (F(13)CO(2)) was calculated.Results:Preterm infants (n=11, birth weight 1.9 ± 0.1 kg, gestational age 32.6 ± 1.5 wks) received 166 mg∙kg(-1)∙d(-1) of leucine. Baseline enrichment changed significantly at day 1 of the study diet. F(13)CO(2) did not change significantly between days 2 and 4 but was significantly lower at day 6. The tracer washout time was determined 7.5 h using a biphasic regression analysis.Conclusion:One day of adaptation to a new diet is necessary to adapt to the (13)C enrichment of the study formula before starting infant requirement studies. Adaptation for a period of 5 d results in a protein sparing response. The minimal time between two studies within the same subject is 7.5 h.Pediatric Research (2013); doi:10.1038/pr.2013.31.
    Pediatric Research 02/2013; · 2.67 Impact Factor
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    ABSTRACT: OBJECTIVES: To develop population pharmacokinetic (PK) models for piperacillin/tazobactam in neonates and infants of less than 2 months of age in order to determine the appropriate dosing regimen and provide a rational basis for the development of preliminary dosing guidelines suitable for this population. METHODS: A two-stage, open-label study was conducted in neonates and infants less than 2 months of age in the neonatal intensive care unit (NICU). A total of 207 piperacillin and 204 tazobactam concentration-time data sets from 71 patients were analyzed using a nonlinear mixed-effect modeling approach (NONMEM VII). PK models were developed for piperacillin and tazobactam. The final models were evaluated using both bootstrap and visual predictive checks. External model evaluations were made in 20 additional patients. RESULTS: For neonates and young infants less than 2 months of age, the median central clearance was 0.133 and 0.149 L/h/kg for piperacillin and tazobactam, respectively. Postmenstrual age (PMA) was identified as the most significant covariate on central clearance of piperacillin and tazobactam. However, the combination of current bodyweight (BW) and postnatal age proved to be superior to PMA alone. BW was the most important covariate for apparent central volume of distribution. Both internal and external evaluations supported the prediction of the final piperacillin and tazobactam PK models. The dosing strategy 44.44/5.56 mg/kg/dose piperacillin/tazobactam every 8 or 12 h evaluated in this study achieved the pharmacodynamic target (free piperacillin concentrations >4 mg/L for more than 50 % of the dosing interval) in about 67 % of infants. CONCLUSIONS: Population PK models accurately described the PK profiles of piperacillin/tazobactam in infants less than 2 months of age. The results indicated that higher doses or more frequent dosing regimens may be required for controlling infection in this population in NICU.
    European Journal of Clinical Pharmacology 01/2013; · 2.74 Impact Factor
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    ABSTRACT: Impairment of endothelial progenitor cells (EPCs) has been shown to contribute to the development of bronchopulmonary dysplasia (BPD). In the current study, the relationship between EPC changes of after birth and the development of BPD was investigated, and the effects of inhaled nitric oxide (iNO) on EPCs were evaluated. Sixty infants with a gestational age of less than 32 weeks and a birth weight of less than 1500 g were studied. NO was administered to infants who were receiving mechanical ventilation or CPAP for at least 2 days between the ages of 7 and 21 days. EPC level was determined by flow cytometry at birth, 7, 21 and 28 days of age and 36 weeks' postmenstrual age (PMA), before and after the iNO treatment. Plasma concentrations of vascular endothelial growth factor (VEGF), stromal cell-derived factor-1 and granulocyte-macrophage colony-stimulating factor were determined via immunochemical assay. Twenty-five neonates developed BPD, 35 neonates survived and did not develop BPD. EPC level was decreased on day 7 and 21 in infants who later developed BPD compared with infants that did not develop BPD. From birth to 21 days of age, BPD infants had a persistently lower VEGF concentration compared with non-BPD infants. No difference was found between the two groups at day 28 or 36 weeks PMA. In infants that later developed BPD, iNO raised the KDR(+)CD133(+) and CD34(+)KDR(+)CD133(+) EPC numbers along with increasing the level of plasma VEGF. EPC level was reduced at 7 days of age in infants with BPD, and iNO increased the EPC number along with increasing the level of VEGF. Further studies are needed to elucidate the mechanism leading to the decrease of EPCs in infants with BPD and to investigate the role of iNO treatment in the prevention of BPD.
    PLoS ONE 01/2013; 8(11):e79060. · 3.73 Impact Factor
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    ABSTRACT: In a Cloud system, a number of services are often deployed with each service being hosted by a collection of Virtual Machines (VM). The services may interact with each other and the interaction patterns may be dynamic, varying according to the system information at runtime. These impose a challenge in determining the amount of resources required to deliver a desired level of QoS for each service. In this paper, we present a method to determine the sufficient number of VMs for the interacting Cloud services. The proposed method borrows the ideas from the Leontief Open Production Model in economy. Further, this paper develops a communication-aware strategy to place the VMs to Physical Machines (PM), aiming to minimize the communication costs incurred by the service interactions. The developed communication-aware placement strategy is formalized in a way that it does not need to the specific communication pattern between individual VMs. A genetic algorithm is developed to find a VM-to-PM placement with low communication costs. Simulation experiments have been conducted to evaluate the performance of the developed communication-aware placement framework. The results show that compared with the placement framework aiming to use the minimal number of PMs to host VMs, the proposed communication-aware framework is able to reduce the communication cost significantly with only a very little increase in the PM usage.
    Cluster Computing (CLUSTER), 2013 IEEE International Conference on; 01/2013
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    ABSTRACT: Objectives: Whether term infants in neonatal intensive care unit (NICU) have brainstem auditory abnormalities remains to be determined. This study aimed to detect any abnormality in brainstem auditory function in term neonates who are admitted to NICU. Methods: From a NICU, we recruited 55 term neonates with various perinatal problems. They were studied during the first week after birth using brainstem auditory evoked response (BAER), and the results were compared with normal term controls. Results: Wave I and III latencies and I-III interpeak interval of the evoked response in the NICU term neonates were similar to those in the controls. Wave V latency and I-V and III-V interpeak intervals tended to be increased at 21/s clicks. The increase was more obvious at higher rates 51 and 91/s. Analysis of variance revealed that at 21/s clicks only III-V interval was significantly increased (p < 0.05). At 51 and 91/s clicks, wave V latency and III-V and I-V intervals were significantly increased (p < 0.05-0.01). The rates of the abnormalities were seen more at higher than at lower click rates. The amplitudes of waves I, III, and V in the NICU neonates were all slightly reduced, but none differed significantly from the controls. Conclusions: There are some abnormalities in BAER in term neonates in NICU, suggesting functional abnormality in the auditory brainstem in NICU infants.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 08/2012; · 1.36 Impact Factor
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    ABSTRACT: The early clinical manifestations of congenital syphilis (CS) vary from asymptomatic to florid lesions, involving multisystem damage. But little is known about the differences of early clinical features between preterm and term neonates with CS. To compare the clinical characteristics between preterm and term neonates with CS and analyze the possible underlying reasons for the differences. Consecutive medical charts of infants at risk for CS from January 1999 to December 2009 were retrospectively reviewed. Neonates with positive 19S-IgM in serum were included in the study. Among the 1,670 cases at risk for CS, 130 neonatal cases with positive 19S-IgM in serum were included in the analysis, including 58 preterm ones and 72 full-term ones. Compared with term neonates with CS, preterm ones were more likely to have characteristic skin rash (36.2 vs. 9.7%, p < 0.001), hepatomegaly (51.7 vs. 25%, p = 0.02), splenomegaly (32.8 vs. 15.4%, p = 0.02), PRP titer ≥1:8 (96.6 vs. 70.8%, p < 0.001), thrombocytopenia (43.1 vs. 23.6%, p = 0.018), elevated CRP (65.5 vs. 36.5%, p = 0.002), and abnormal long bone X-ray results (94.6 vs. 68.1%, p < 0.001). Fewer mothers of preterm neonates with CS received treatment for syphilis (15.5 vs. 40.3%, p = 0.003). The rate of withdrawal of care was higher in preterm neonates with CS (31 vs.12.5%, p = 0.036). Preterm neonates with CS had more clinical evidences and suffered more than term ones.
    Neonatology 07/2012; 102(2):152-6. · 2.57 Impact Factor
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    ABSTRACT: The essential amino acid methionine can be used for protein synthesis but also serves as a precursor for homocysteine and cysteine. The objective of this study was to determine the minimal obligatory methionine requirement of infants in the presence of excess cysteine (91 mg ⋅ kg(-1) ⋅ d(-1)) by using the indicator amino acid oxidation (IAAO) method with l-[1-(13)C]phenylalanine as the indicator. Fully enterally fed term infants <1 mo of age were randomly assigned to methionine intakes that ranged from 3 to 59 mg ⋅ kg(-1) ⋅ d(-1) as part of an elemental formula. After 1 d of adaptation to the test diet, [(13)C]bicarbonate and l-[1-(13)C]phenylalanine tracers were given enterally. Breath samples were collected at baseline and during isotopic plateaus. The mean methionine requirement was determined by using biphasic linear regression crossover analysis on the fraction of (13)CO(2) recovery from l-[1-(13)C]phenylalanine oxidation (F(13)CO(2)). Data are presented as means ± SDs. Thirty-three neonates (gestational age: 39 ± 1 wk) were studied at 13 ± 6 d. With increasing methionine intakes, F(13)CO(2) decreased until a methionine intake of 38 mg ⋅ kg(-1) ⋅ d(-1); additional increases in methionine intake did not affect F(13)CO(2). The mean methionine requirement was determined at 38 mg ⋅ kg(-1) ⋅ d(-1), and the upper and lower CIs were 48 and 27 mg ⋅ kg(-1) ⋅ d(-11), respectively (P < 0.0001, r(2) = 0.59). Although the current recommended methionine intake of 28 mg ⋅ kg(-1) ⋅ d(-1) is within the CIs of our study, the estimated mean requirement is substantially higher. However, most of the infant formulas provide a methionine intake of 49-80 mg ⋅ kg(-1) ⋅ d(-1), which is above the upper CI of our study. This trial was registered at www.trialregister.nl as NTR1610.
    American Journal of Clinical Nutrition 04/2012; 95(5):1048-54. · 6.50 Impact Factor
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    ABSTRACT: We retrospectively investigated incidence, morbidity, and mortality of neonatal respiratory failure (NRF) in China, with special emphasis on surfactant treated very immature infants. NRF was defined as respiratory hypoxemia requiring mechanical ventilation and/or nasal continuous positive airway pressure for at least 24 hours. There were 6864 cases of NRF, composing 19.7% of total admissions to 55 NICUs in 2008. Of these cases, 62.8% were preterm, and 16.4% of very low birth weight (VLBW, <1500 g). The primary diseases were respiratory distress syndrome (RDS, 43.9%), pneumonia/sepsis (21.7%), transient respiratory insufficiency (14.7%), transient tachypnea (8.1%), and meconium aspiration syndrome (7.0%). Surfactant was given to 26.8% of infants with NRF and 54.8% infants with RDS. The survival rate of surfactant-treated RDS was 79.9% compared to 71.8% in those not receiving surfactant (P < .001). This was also true in those of VLBW, 59.8% vs 52.2% (P = .035), respectively. The overall survival rate in NRF cases was 75.3%, but it was 58.1% among VLBW infants; for those infants of 25, 26, and 27 to 28 weeks' gestational age, the survival rates were ∼6%, 30%, and 50%, respectively; and the survival rates for infants with meconium aspiration syndrome and pneumonia/sepsis were 70.3% and 71.4%, respectively. The care burden was associated with high treatment withdrawal and death rate. The outcomes of NRF, especially in extremely premature infants, reflect both progress and persistent limitations in providing respiratory support in the emerging NICUs of China, but overall survival for sick newborns had improved steadily.
    PEDIATRICS 03/2012; 129(3):e731-40. · 4.47 Impact Factor

Publication Stats

164 Citations
112.09 Total Impact Points

Institutions

  • 2014
    • The University of Warwick
      • Department of Computer Science
      Coventry, England, United Kingdom
  • 2008–2014
    • Fudan University
      • School of Pharmacy
      Shanghai, Shanghai Shi, China
  • 2009–2013
    • Erasmus MC
      • Department of Neonatology
      Rotterdam, South Holland, Netherlands