Ning Li

Background: Unexpected distal airway obstruction is a critical challenge during neonatal resuscitation. Aspiration of intrauterine tissue is an uncommon cause that may not respond to standard algorithms. Through comparative analysis with three previously documented cases, this report aims to clarify the clinical features, diagnostic pitfalls, and key outcomes for this entity, emphasizing the need for heightened clinical awareness and technological advances. Case presentation: A male infant was born at 30⁺⁵ weeks via vaginal breech delivery due to spontaneous preterm labor. The mother completed antenatal corticosteroids for lung maturation 4 days prior. The infant exhibited apnea and bradycardia. Standard neonatal resuscitation failed. A DOPE assessment revealed no correctable problems; a suction catheter passed easily, creating a deceptive “False-Patency” sign. Deeper suctioning yielded only scant secretions. Chest compressions began at 18 min after birth. Simultaneously, intravenous epinephrine (1:10,000) was administered every three minutes, and a resuscitation bag delivered positive-pressure ventilation. These measures continued for 42 min (until one hour of life). Approximately 60 min after delivery, with chest compressions and ventilation still in progress, two bean-sized tissue fragments were pushed out of the trachea. After removal via endotracheal tube exchange, the infant achieved return of spontaneous circulation (ROSC). Within two minutes, heart rate rose to 140 beats/minute, and SpO₂ reached 93%. Chest compressions were then halted. Histopathology confirmed decidual tissue. Despite maximal support, the infant died from irreversible multi-organ failure. Conclusion: This case illustrates that aspiration of intrauterine decidual tissue is a rare but devastating cause of unexpected distal airway obstruction in preterm infants. Findings from all four reported cases indicate that standard algorithms (MRSOPA/DOPE) are ineffective. The “False-Patency” sign—easy passage of a suction catheter despite absent chest rise and breath sounds—is a major diagnostic trap, delaying identification of a solid, peripherally impacted foreign body. A strong suspicion for this condition is critical. While specialized airway visualization instruments for preterm neonates remain a long-term goal, the primary solution lies in cognitive vigilance—specifically, recognizing this unusual condition and its misleading “False-Patency” indicator.

Background: Osteogenesis Imperfecta (OI) poses a unique challenge in pediatric trauma and critical care, where the fragility of bone intersects with life-threatening systemic complications, such as neonatal respiratory failure. The early postnatal period is particularly precarious, demanding a delicate balance between life support and fracture prevention. Case presentation: A 9-day-old male neonate with prenatally diagnosed COL1A2 (c.1459G > A, p.Gly487Arg) mutation was admitted to our NICU for respiratory distress and pneumonia. He was the progeny of a father with OI, delivered via cesarean section at 34 weeks due to fetal skeletal deformities. Management and outcomes: A proactive, multidisciplinary team (MDT) protocol was immediately implemented, focusing on non-invasive respiratory support, meticulous handling to prevent iatrogenic injury, and optimized nutrition. This approach successfully resolved his respiratory failure without any new fractures during the NICU stay. However, on the 16th day post-discharge, the infant sustained a spontaneous fracture of the right proximal femur. This was managed conservatively with a Pavlik harness. Follow-up revealed rapid callus formation by day 52 and complete union by day 136, showcasing the characteristic hyperplastic healing pattern of OI. Conclusion: This case underscores that a coordinated MDT approach is vital for stabilizing critically ill neonates with OI. The occurrence of a fracture shortly after discharge highlights the transition to home care as a period of extreme vulnerability. Empowering families with comprehensive education and ensuring continuity of care are as crucial as in-hospital management for improving long-term outcomes in these fragile infants.

Background: Necrotizing enterocolitis (NEC) is a disease with prevalent and serious intestinal inflammation that poses a significant threat to the lives of newborns. Human milk has been shown to prevent and treat the occurrence of NEC; however, the underlying mechanisms remain unclear. MAMP-1 is a significantly overexpressed endogenous peptide derived from β-casein extracted from the human milk of premature mothers, which is resistant to gastrointestinal conditions and exhibits favorable physicochemical properties. This study aims to investigate the mechanism by which the human milk-derived peptide MAMP-1 mitigates NEC in mice, offering new insights for clinical treatment. Methods: The C57BL/6 mice were categorized into three distinct groups randomly on the 7th day after birth, with 40 mice in each group. The NEC model was established using “artificial feeding + hypoxia + cold”, and the MAMP-1 group received daily MAMP-1 gavage during NEC modeling. Ileum tissues and feces were collected. Pathological damage in the intestines was evaluated by H&E staining. ZO-1 expression was analyzed through immunofluorescence staining and western blot. Apoptosis in the intestine was assessed using western blot and TUNEL staining. The effects of signaling pathways were confirmed through western blot and RNA sequencing. The expression of inflammatory factors was assessed using RT-PCR. 16S high-throughput sequencing was used to determine the diversity and abundance of the gut microbiota. Results: MAMP-1 reduced the mortality rate of NEC mice, alleviated ileum injury, increased the ZO-1 expression of the intestinal barrier, reduced the apoptotic protein expression, lowered the TUNEL positive area, increased anti-apoptotic protein expression, and reduced the levels of TLR4, P-PI3K, P-AKT, and NF-κB, leading to a reduction in the release of inflammatory cytokines. Furthermore, MAMP-1 decreased the abundance of harmful bacteria and increased the abundance of beneficial bacteria at both the phylum and genus levels. Conclusion: MAMP-1 might inhibit the TLR4-PI3K-AKT-NF-κB signaling pathways, further reducing inflammation factor release, and might decrease intestinal cell apoptosis. Results indicated that MAMP-1 might alleviate intestinal damage in NEC mice. Meanwhile, MAMP-1 might positively modulate the composition of the microbiota of NEC mice and further achieve the preventive and therapeutic effect of MAMP-1 on NEC.

Objective: This study sought to analyze the value of point of care ultrasound (POCUS) in early diagnosis and monitoring of deep abscess in newborns.Methods: Retrospective analysis of the clinical data of two newborns admitted to the Neonatal Intensive Care Unit (NICU) of our hospital and diagnosed with deep abscess of the newborn. Combined with literature analysis, the value of POCUS in early diagnosis and monitoring of deep abscess of the newborn was evaluated.Results: The two newborns reported in this article were all admitted to NICU due to” “fever”. POCUS was used to assist in early diagnosis of “liver abscess” and “lung abscess”. Subsequently, POCUS was used to monitor lesion changes and adjust treatment plans. All patients were cured and discharged with a good prognosis.Conclusions: Deep abscesses in newborns are very rare and often life-threatening, but apart from fever, they often have no specific clinical manifestations and are easily misdiagnosed or missed. POCUS, as a bedside auxiliary examination tool, has high accuracy, radiation free, non-invasive, and convenient, and has high diagnostic and monitoring value in early diagnosis and monitoring of deep abscess in newborns.

Background: Point-of-care ultrasound (POCUS) can guide umbilical vein catheter placement in real time and monitor catheter tip position, allowing avoidance of severe complications due to catheter malposition. This study aims to explore the effectiveness of POCUS in guiding venous catheter insertion and monitoring complications.Methods: Sixty-eight neonates with ultrasound-guided venous catheter insertion at the Neonatal Department of Dongguan Children's Hospital between December 2020 and February 2022 were included. POCUS was applied to monitor catheter tip location daily until catheter removal. A displacement range exceeding the intersection of the inferior vena cava and right atrium by ±0.5 cm was considered misalignment.Results: Sixty-four neonates had a displaced catheter tip (94.1%, 64/68), with a median displacement distance of 0.4 cm (minimum −0.2 cm, maximum 1.2 cm). Ten neonates had a misalignment (14.7%, 10/68) caused by displacement. Displacement usually occurs within 2–4 days after placement, with displacement rates of 94.1% (64/68), 90.6% (58/64), and 98.3% (59/60) on days 2, 3, and 4, respectively, and could still occur on day 9 post-placement. In addition, misalignment mainly occurs on the second day after placement. During the monitoring process, 58 neonates had catheter tip displacement ≥2 times, resulting in 252 displacement and 22 misalignment incidents. Among them, the catheter tip migrated outward from the inferior vena cava seven times, all of which were removed in time. Ultrasound was used for positioning 486 times, and x-ray was indirectly avoided 486 times.Conclusion: The catheter tip is prone to displacement and misalignment after umbilical vein catheterization, which most commonly occurs on days 2–4. POCUS is recommended for daily monitoring of the tip location during umbilical vein catheterization until catheter removal.

Background: Necrotizing enterocolitis (NEC) is a severe inflammatory bowel disease that may lead to perforation, causing high morbidity and mortality in preterm infants. Abdominal ultrasound (AUS) has been shown to provide benefits in diagnosing and managing NEC in recent years.Objective: This study focused on the utility of AUS in the diagnosis and evaluation of surgical NEC.Patients and methods: In this retrospective study, available data of the patients diagnosed from January 2019 to June 2022 were reviewed. The sensitivity and specificity of AUS in diagnosing a perforation were analyzed. Typical cases for the application of AUS in monitoring and evaluating the progression, complications, and sequela of NEC were described.Results: There were 69 neonates diagnosed with NEC and examined by AUS, of whom eight patients developed a perforation. AUS was used for diagnosing a perforation in eight patients with key features of pneumoperitoneum and/or complex ascites, allowing us to find four locations of perforation, with a sensitivity and specificity of 100%.Conclusion: AUS plays an important role in diagnosing and evaluating surgical NEC in newborn infants, with good sensitivity and specificity.

Lung ultrasound (LUS) can be used to diagnose various neonatal lung diseases. It more sensitively diagnoses pulmonary edema, pneumothorax, pulmonary consolidation, and atelectasis than traditional X-ray and quickly determines the cause of dyspnea. As a component of severe ultrasound, LUS enables rapid bedside visualization of lung diseases and plays a major role in guiding the differential diagnosis of disease, ventilator treatment, and lung recruitment. This study introduced the application of LUS in the diagnosis and treatment of critically ill neonates with lung diseases.

To investigate the anti-inflammatory effects of specific small interfering RNA targeting NF-κB on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in rats. Acute lung injury was induced in Sprague-Dawley rats by intraperitoneal injection with LPS (5 mg/kg), followed by immediate intratracheal instillation of siRNA targeting NF-κB p65 (40 μg/ml). Animals in each group were sacrificed at 1 h or 8 h after the instillation. Pulmonary histological changes were evaluated by hematoxylin-eosin staining. The levels of NF-κB and TNF-α were measured by qRT-PCR. Expressions of NF-κB in lung cells and TNF-α in bronchoalveolar lavage fluid (BALF) were determined by western blot analysis and enzyme-linked immunosorbent assay (ELISA) respectively. LPS administration reduced the rectal temperature and white blood cell counts at 1 h, increased lung wet/dry weight ratios, caused evident lung histopathological injury, and increased the detectable transcript and cytokine levels of TNF-α in lung tissue in BALF. siRNA targeting of NF-κB p65 effectively abrogated the expression of NF-κB p65 in lung cells and, aside from rectal temperatures, ameliorated all changes induced by LPS. NF-κB knockdown exerts anti-inflammatory effects on LPS-induced ALI especially in the initial phase, which may be due in part to reduced levels of the proinflammatory cytokine TNF-α. NF-κB siRNA’s rapidity and effectiveness to abrogate ALI development may provide an effective therapeutic method with future clinical applications.