Premature infant born to a convalescent mother with COVID-19 in mid-term pregnancy

Objective To evaluate the efficacy of tebivudine in the treatment for maternal-infant blockade of pregnant women with both serum hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive and high load of hepatitis B virus (HBV) infection in late pregnancy. Methods From July 1st, 2007 to June 30th, 2017, pregnant women with chronic HBV infection in late pregnancy (28 weeks of pregnancy) and babies delivered in the outpatient Department of Gynaecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University were selected. Total of 250 pregnant women with both HBsAg and hepatitis B e antigen (HBeAg) positive, normal liver function, HBV DNA ≥ 1 × 106 copies/ml and with complete follow-up data were collected. The pregnant women were fully informed of the advantages and disadvantages of the maternal-infant blocking of the anti-viral medication during pregnancy. According to the voluntary principle, the pregnant women were divided into tebivudine group (150 cases) and control group (100 cases) according to whether treated with tebivudine. The pregnant women in tebivudine group received oral tebivudine 600 mg/d, from 28 weeks of pregnancy to 42 days after delivery. The control group did not use antiviral drugs. The serum HBV DNA load were detected in both groups at 28 weeks and at the time of delivery. The adverse reactions of pregnant women in tebivudine group after taking medicine were observed. The infants of both groups were immunized with active and passive immunization after birth; hepatitis B vaccine was injected intramuscularly within 6 hours, 1 month and 6 months, respectively, while intramuscular injection of hepatitis B immunoglobulin for 200 IU. The positive rate of HBsAg and the load of HBV DNA in 6 hours after the bith and at 7-month of the baby were detected (venous blood was drawn before passive immunization). Results Compared with the control group, the average HBV DNA load was significantly lower in tebivudine group after treatment and before delivery, with significant difference (t = 31.07, P < 0.001). The positive rate of serum HBV DNA in tebivudine group was significantly higher than that of control group within 6 hours of the babies birth, with significant difference (0.00% vs. 17.00%; χ2 = 27.36, P < 0.001). At the age of 7 months, the HBV DNA load of the infants in tebivudine group were all lower than the limit of detection, and the positive rate of HBV DNA in the control group was 10.00%. Fisher accurate test showed that the intrauterine infection rate of control group was significantly higher than that of tebivudine group (12.00% vs. 0.00%), with significant difference (P < 0.001). No serious adverse reactions were found during the follow-up period of tebivudine use, and no birth defects were found. Conclusions With the increase of serum HBV DNA load in pregnant women before delivery, the risk of HBV intrauterine infection increases. Normal liver function, both HBsAg and HBeAg positive, high HBV DNA load with tebivudine antiviral therapy in late of pregnancy could significantly reduce the serum HBV DNA load of pregnant women and block HBV intrauterine infection of effectively. It is safe for both mothers and infants to use tebivudine in late pregnancy. Key words: Telbivudine; Hepatitis B immunoglobulin; Hepatitis virus B; Hepatitis B surface antigen; Hepatitis B e antigen; Maternal-infant blockade; Intrauterine infection

Objective To investigate the clinical features of varicella and the prognosis in pregnant women and their newborns. Methods Clinical data of pregnant women with varicella zoster virus (VZV) infection (n=25) and their newborns hospitalized in Beijing Ditan Hospital from 1st Jan. 2008 to 31st Dec. 2014 were retrospectively analyzed and randomly compared to non-pregnant women with VZV infection (n=50). Clinical features and prognosis of varicella in pregnant women and their infants were analyzed. Chi-square test was used for categorical data and t test was used for quantitative data. Results Time to rash scab of varicella in pregnant women was longer than non-pregnant women ([10.1±2.1] d vs [5.6±1.4] d, t=10.941, P<0.05). The rate of bacterial infection in pregnant women was higher than non-pregnant varicella women (72.0%[18/25] vs 32.0%[16/50], χ2=10.761, P<0.05), with statistical significance. Among 25 cases of varicella pregnant women, the pregnancy complications were observed in 3 cases of diabetes, 2 cases of premature rupture of membranes, 5 cases of anemia and 1 case of oligoamnios. Seven cases out of 25 pregnant women underwent parturition during fever and varicella period, and 3 cases (12.0%) were complicated with intrapartum hemorrhage. Twenty five varicella pregnant women were all cured after antiviral and supportive treatment and gave birth to their babies, with no abortion, stillbirth or birth defects. No congenital varicella was observed in newborns. Of the 25 infants, 4 developed (16.0%) varicella within 2 weeks after birth and they were all born from mothers who developed varicella around delivery time. The clinical features of neonatal varicella presented with classic rash with no fever. The time to rash scab was longer (11.0±2.1) d and antibody test for VZV was negative. All neonates were cured after antiviral and immunoglobulin treatment. Conclusions Longer duration of skin rash scab and higher rate of bacterial infections are the features of varicella in pregnant women. Intrapartum hemorrhage occurrs more commonly in pregnant women with varicella onset around delivery time. Varicella occurring during mid-pregnancy may not increase the risk of neonatal birth defects after treatment. The newborns whose mothers with varicella onset during perinatal time especially around delivery time may suffer from varicella. The prognosis of neonatal period varicella is good after treatment. Key words: Chickenpox; Pregnancy; Pregnant women; Infant, newborn; Clinical features; Prognosis

Objective To investigate the efficacy and safety of tenofovir in interrupting mother-to-infant transmission of pregnant women with high-load hepatitis B virus (HBV) infection. Methods Sixty-five pregnant women with high-load HBV infection admitted to the Department of Infectious Diseases of the First Affiliated Hospital of Zhengzhou University from October 2016 to October 2018 were selected as research subjects. Under the premise of voluntary selection, they were divided into treatment group (35 cases) and control group (30 cases). The treatment group started oral anti-viral treatment from the 24th to 28th week of pregnancy, 300 mg once daily, until 1 month after delivery. The pregnant women in control group were not given antiviral therapy. All newborns received combination immunization. The changes of serum alanine aminotransferase (ALT), creatinine and HBV DNA levels in the two groups were observed. The levels of hepatitis B surface antigen (HBsAg) in all infants at age of 7 months were measured. The length, weight, head circumference, neonatal congenital abnormalities of the newborns and the adverse reactions of the pregnant women after medication were recorded. Results Bfore delivery, the content of HBV DNA (log10) was (2.688±0.871)IU/ml in treatment group, lower than the (8.052±0.594)IU/ml in control group, and the difference was statistically significant (P<0.01). The ALT level before delivery of pregnant women in treatment group was significantly lower than that before treatment, and the difference was statistically significant (P<0.05). All of the infants in the treatment group were negative at age of 7 months, and the prevention rate was 100.0%; compared with the prevention rate of control group (86.7%), the difference was statistically significant (P<0.05). There was no congenital abnormality in the two groups of newborns, and they grew and developed well. One patient in the treatment group suffered mild nausea and vomiting, one patient developed fatigue and dizziness after taking tenofovir, but all of the adverse reactions could be tolerable without drug withdrawal. Conclusions The use of tenofovir in pregnant women with high-load HBV infection can effectively reduce the rate of mother-to-child transmission and it is safe. Key words: Tenofovir; Chronic hepatitis B; Mother-to-infant transmission

Objective To examine the effects of kangaroo mother care on breastfeeding by women who delivered via cesarean section and on neonatal jaundice. Methods The study sample consisted of 120 pairs of women who delivered via cesarean section and newborns born by cesarean delivery between August 2017 and February 2018 in the Second Hospital of Shanxi Medical University. They were randomly divided into a conventional nursing group and a kangaroo mother care group by random number table method. A total of 120 pairs of newborns and mothers met the exclusion criteria. The conventional nursing group received routine nursing, while the kangaroo mother care group was given routine nursing and received the kangaroo mother care. By determining the lactation start time, and using the Breastfeeding Assessment Tool (BAT) and Breastfeeding Self-Efficacy Scale (BSES), we evaluated the condition of breastfeeding by the women who delivered via cesarean section. We measured the transcutaneous bilirubin level using the jaundice measuring instrument to evaluate neonatal jaundice. Results The subjects in both groups were of Han nationality and delivered via cesarean section at a gestational age of >37 weeks. No statistically significant differences were found between the two groups in terms of age, occupation, number of pregnancies, and educational background (P>0.05). No statistically significant differences were found between the two groups in terms of the newborns’ sex, birth weight, Apgar score, and birth length (P>0.05). The lactation start time in the kangaroo mother care group (42.1±10.9 h) was earlier than that in the conventional nursing group (52.7±12.8 h), with a statistically significant difference (t=4.880, P<0.001). The success rate of the initial breastfeeding in the kangaroo mother care group reached 80%, which is significantly higher than that in the conventional nursing group by 43% (χ2=17.062, P<0.001). The breastfeeding self-efficacy score (117.0±13.7) in the kangaroo mother care group was significantly higher than that in the conventional nursing group (111.3±15.9, t=2.126, P=0.036). The transcutaneous bilirubin levels in the forehead, chest, and legs (173.7±39.3, 174.1±40.1, and 120.4±32.7 μmol/L, respectively) at 72 h after birth in the kangaroo mother care group were lower than those in the conventional nursing group (194.3±43.9, 193.1±39.0, and 138.0±34.6 μmol/L, respectively), with statistically significant differences (t=-2.706, -2.640, and -2.852, respectively, P<0.05). The newborns’ defecation frequencies at 24, 48, and 72 h after birth in the kangaroo mother care group (5.5±1.7, 5.2±1.9, and 5.2±2.3, respectively) were higher than those in the conventional nursing group (4.5±1.7, 4.3±1.9, and 4.3±1.6, respectively), with statistically significant differences (t=3.122, 2.631, and 2.332, P<0.05). Conclusion The kangaroo mother care method can effectively improve the success rate of first breastfeeding and early lactation initiation time, and increase breastfeeding confidence in women who undergo cesarean section, and reduce the incidence of neonatal jaundice. Key words: Nursing Care; Cesarean section; Kangaroo mother care method; Breastfeeding; Neonatal jaundice

Objective To investigate the effects of vaginal delivery and cesarean section on maternal and perinatal outcomes in low-risk puerperant. Methods A total of 948 cases of low-risk puerperant delivering in the labor room of Southwest Hospital, First Affiliated Hospital of the Third Military Medical University from December 2014 to December 2015 were studied. According to the modes of delivery, they were divided into vaginal delivery group (n=474) and cesarean section group (n=474). Termination of pregnancy was done by vaginal spontaneous labor in vaginal delivery group and by lower segment cesarean section in cesarean section group. The amount of bleeding within 24 h after birth, incidence of postpartum hemorrhage (PPH), Apgar score of newborns, incidence of neonatal asphyxia and the levels of immunoglobulin (Ig)A, IgG, IgM and C-reactive protein (CPR) in newborns′ cord blood were statistically compared. Process of this study followed the standard of ethics formulated by committee on human trials in Southwest Hospital, First Affiliated Hospital of the Third Military Medical University. All puerperants and their families signed the informed consent before study. Results ①There were no statistically significant differences between two groups in maternal age, gestational age, birth weight of newborns and constituent ratio of newborns gender and so on (P>0.05). ②The amount of bleeding within 24 h after birth and the incidence of PPH in vaginal delivery group both were significantly lower than those in cesarean section group, and both the differences were statistically significant (t=7.261, P=0.016; χ2=4.934, P=0.021). ③There were no statistically significant differences between two groups in Apgar score of newborns and incidence of neonatal asphyxia at 1 min or 5 min after birth (P>0.05). The levels of IgG and IgM in cord blood of newborns in vaginal delivery group both were significantly higher than those in cesarean section group, and the level of CRP was significantly lower than that in cesarean section group, and all the differences were statistically significant (t=2.973, P=0.043; t=3.755, P=0.039; t=4.825, P=0.006). There was no statistically significant difference between two groups in the level of IgA in cord blood of newborns (P>0.05). In cesarean section group, the level of IgG in cord blood between male newborns was significantly lower than that of female newborns, and the difference was statistically significant (t=3.852, P=0.040), but there were no statistically significant differences between male and female newborns in the levels of IgA, IgM and CRP (P>0.05). In vaginal delivery group, there were no statistically significant differences in the levels of IgA, IgG, IgM and CRP in cord blood between male and female newborns (P>0.05). Conclusions Compared with cesarean section, vaginal delivery can reduce the amount of bleeding within 24 h after birth and the incidence of PPH, strengthen immunologic function of newborns, and it is good for maternal and fetal health in low-risk puerperant. Key words: Vaginal delivery; Cesarean section; Perinatal outcome; Postpartum hemorrhage; Immunologic function

Objective To analyze the effect of cervical canal length on maternal and neonatal outcomes in placenta previa and the predictive value of transvaginal ultrasound measurement of cervical canal length for emergency early cesarean section. Methods From January 2014 to December 2017, 63 pregnant women with placenta previa in the General Hospital of Changzhi Lu'an Group were selected in this study.The length of the cervical tube was measured by vaginal ultrasound in the late pregnancy.According to the length of cervical canal during delivery, 63 cases were divided into control group (cervical canal length >25cm, 39 cases) and study group(cervical canal length ≤ 25cm, 24 cases). The maternal and infant outcomes of the two groups were compared, and the diagnostic efficacy of the cervical canal length to the early cesarean section of the placenta preg before 36 weeks of pregnancy was assessed by drawing the receiver operating characteristic curve to evaluate the area and the best diagnostic threshold under the curve, and calculated the sensitivity and specificity. Results The gestational weeks of delivery in the study group was significantly shorter than that in the control group(t=5.95, P 0.05). The birth weight and the 5 min Apgar score in the study group were significantly lower than those in the control group(t=5.48, 4.65, all P<0.05). The incidence rate of neonatal asphyxia in the study group was significantly higher than that in the control group(χ2=5.19, P<0.05). The area of the cervical canal length was 0.87, with the sensitivity of 84.62%, the specificity was 78.38%, and the best diagnostic threshold was 26.5 mm for the pregnant women who was predicted the placenta previa before 36 weeks of pregnancy. Conclusion The incidence rates of adverse outcomes, such as premature birth, prenatal bleeding and neonatal asphyxia, are higher in pregnant women with shorter cervical tube length.The measurement of cervical canal length by vaginal ultrasound for pregnant women with placenta previa can be used as an important evaluation method to predict the early cesarean section of pregnant women, and help to strengthen the clinical intervention, take management to prevent serious perinatal complications. Key words: Cervical length measurement; Placenta previa; Ultrasonography; Vagina; Cesarean section; Pregnant women; Infant, newborn; Pregnancy outcome

Objective To investigate the related factors of preterm birth and neonatal outcomes in single pregnancy after in vitro fertilization and embryo transfer (IVF-ET). Method A retrospective analysis was conducted in 250 pregnant women in the Sun Yat-sen Memorial Hospital from August 2013 to August 2015. The patients were divided into preterm birth of single pregnancy after IVF-ET (group A, 50 cases), preterm birth of single pregnancy after natural pregnancy (group B, 100 cases) and full-term birth of single pregnancy after IVF-ET (group C, 100 cases). By recording the incidence of gestational diabetes mellitus, gestational hypertension, premature rupture of membranes, placenta praevia or low-positioned placenta, as well as neonatal outcome, analyze the factors related to preterm delivery of single pregnancy after IVF-ET. Results There were no significant differences in pregnancy complications, birth weight of premature infants and gestational weeks between group A and group B. The incidences of gestational hypertension in group A and group C were (14% and 3%), premature rupture of membranes (42% and 14%), placenta praevia or low-positioned placenta (12% and 2%), birth weight of newborn [(2225±622) g and (3231±482) g], 1 min Apgar score [(8.61±1.77) and (9.49±0.94)], 5 min Apgar score [(9.66±0.94) and (9.93±0.29)], and the differences between the two groups were statistically significant (P<0.05). Logistic regression analysis showed that gestational hypertension, premature rupture of membranes, placenta praevia or low-positioned placenta, cervical incompetence were associated with preterm birth of single pregnancy after IVF-ET. The incidences of cervical cerclage in pregnancies due to cervical incompetence were 22%, 9% and 4% in group A, group B and group C, respectively. There were significant difference between group A and group B, group C (P<0.05), respectively. Conclusions Gestational hypertension, premature rupture of membranes, placenta praevia or low-positioned placenta and cervical incompetence are high risk factors for preterm birth of single pregnancy after IVF-ET. The birth weight, Apgar score at 1 min and 5 min were all worse in preterm infants than in full term infants of single pregnancy after IVF-ET. Key words: Reproductive techniques, assisted; Premature birth; Pregnancy complications; Uterine cervical incompetence

Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by erythrocyte allo‑antibodies present in the maternal plasma dur‑ing pregnancy, which cross the placental barrier and enter the fetal bloodstream, bind to fetal erythrocyte antigens and cause destruction of fetal erytrhocytes. Hemolysis leads to fetal anemia, which can cause fetal death if not treated. Case report: We report a case of HDFN in a multiparous female with multiple erythrocyte alloantibodies of anti‑C+G, anti‑E, anti‑Kp(a) and anti‑Kn(a) specificity. In her third preg‑nancy we found erythrocyte alloantibodies of anti‑C+G and anti‑Kp(a) specificity for the first time. Erythrocyte alloantibodies titers were low and fetal hemolysis was not expected. However, in the 30th week of pregnancy obstetricians observed rapid development of fetal anemia, which was due to hemolysis. The pregnancy was ter‑minated. Despite an exchange transfusion, the newborn died a few days after birth because of HDFN. In the following pregnancy, titers of al‑ready known erythrocyte alloantibodies were high and very severe hemolysis was predicted. In the 22nd week obstetricians found fetal hydrops. Despite intrauterine transfusion (IUT), the preg‑nancy ended with intrauterine fetal death. The fifth pregnancy ended with miscarriage in the 11th week of pregnancy. In the last pregnancy, titers of known erythrocyte alloantibody were high and again very severe hemolysis was predicted. In the 17th and 20th week of pregnancy, erythrocyte alloantibody titers increased. In the 22nd week of pregnancy, obstetricians observed fetal anemia and decided to perform an IUT. The fetus received seven IUTs. After the second IUT, additional erythrocyte alloantibodies of anti‑E and anti‑Kn(a) specificity were found in the ma‑ternal plasma. In the 34th week of pregnancy, ob‑stetricians terminated the pregnancy with elec‑tive caesarean section. The child was born with no signs of hemolytic anemia. Conclusion: HDFN is still considered an unpredictable disease. By the help of modern pro‑cedures for monitoring of immunised pregnant women also those pregnant women with mulip‑le, clinically significant erythrocyte alloantibod‑ies can be successfully managed in the course of pregnancy.

Objective To observe the changes of amplitude-integrated electroencephalogram (aEEG)of neonatal asphyxia with different Apgar scores,and to investigate the diagnostic value of aEEG for hypoxicischemic encephalopathy(HIE) in neonatal asphyxia.Methods aEEG monitoring were detected on 56 fullterm asphyxia neonates who were hospitalized in our neonatal department from Dec 2010 to Oct 2011.According to 1 minute Apgar score after birth,56 cases were divided into two groups:observation group in which 36 cases with Apgar score 0～7,and control group in which 20 cases with Apgar score 8～10.aEEG monitoring was done within 6 h,2 d,3 d,7 d of each neonates after birth,and the changes of aEEG were analyzed and the diagnostic value on HIE were evaluated.Results Among 20 cases in the control group,the aEEG results in 6 hours after birth were 17 cases (85％) had normal aEEG results,3 cases( 15％ ) mildly abnormal,nd no one severely abnormal.The aEEG results of patients in observation group(36 cases) were 18 cases(50％ ) had normal aEEG results,13 cases(36.1％ ) mildly abnormal,and 5 cases( 13.9％ ) severely abnormal.The abnormal rate in observation group was significantly higher than that of the control group ( x2=5.3,P＜0.001 ).There were 34 HIE patients in the total 36 cases of observation group,whose aEEG monitoring results in 6 hours after birth were associated with HIE clinical grading( Spearman's rank correlation coefficient was 0.867,P＜0.01 ).Dynamic aEEG monitoring for 56 patients showed that 21 cases had abnormal aEEG in 6 hours after birth,in whom 15 cases(71.4％ ) could returned to normal after 48～72 hours after birth,and there were only 4 case (7.1％ ) still had severely abnormal aEEG results in the seventh day after birth.Conclusion The aEEG dynamic monitoring for full-term HIE neonates after birth enhances early prediction of HIE. Key words: Apgar score; Neonatal asphyxia; Amplitude-integrated electroencephalogram; Hypoxicischemic encephalopathy ; Infant, newborn

Objective To investigate clinical predictors in early pregnancy for adverse pregnancy outcomes in women complicated with chronic nephropathy. Methods One hundred and eighty-four pregnancies complicated with chronic nephropathy who delivered between January, 2005 and January, 2014 in Peking University First Hospital were retrospectively analyzed. Two hundred pregnant women without chronic nephropathy were selected as the control group. Pregnancy outcomes were compared between the two groups. Relationships between clinical predictors in early pregnancy [age, history of kidney disease, drugs used before pregnancy (in three months), results of renal biopsy, blood pressure, serum creatinine, urea nitrogen, 24 h urinary protein, estimated glomerular filtration rate, stage of chronic nephropathy] and adverse pregnancy outcomes [maternal mortality; pregnancy complicated by severe preeclampsia; renal function decline, early preterm birth, very low birth weight infants, fetal loss after 20 weeks of pregnancy] were assessed by logistic regression analysis. T-test, Chi-square test and multivariate regressions were used for statistical analysis. Results There were 174 and 197 livebirths in the study and the control groups, respectively. The most popular type of chronic nephropathy in pregnant women was IgA nephropathy (38.6%, 71/184). Compared with the control group, the risk of premature labor [9.8%(17/174) vs 3.0%(6/197), χ2=7.184], low birth weight infants[18.4%(32/174) vs 7.1%(14/197), χ2=9.813], very low birth weight infants [5.7%(10/174) vs 1.5%(3/197), χ2=4.536], fetal loss after 20 weeks of pregnancy [5.7%(10/184) vs 1.5%(3/200), χ2=4.536] and severe preeclampsia [17.9%(33/184) vs 1.5%(3/200), χ2=33.544] increased significantly in the study group (all P<0.05). Twenty-four-hour urinary protein content (OR=1.84, 95%CI: 1.36-2.50, P=0.001) and mean arterial pressure (OR=1.04, 95%CI: 1.00-1.07, P=0.027) in early pregnancy were risk factors for adverse pregnancy outcomes. The risk of renal function decline increased significantly in patients with higher stages of chronic nephropathy in early pregnancy (OR=6.50, 95%CI: 3.34-8.21, P<0.01). Mother complicated by preeclampsia during pregnancy was an independent risk factor (OR=11.10, 95%CI: 4.48-27.20, P<0.01). Compared with women whose 24 h urinary protein content less than 1g in early pregnancy (122 livebirths within 126 cases), the risk of premature labor [17.3%(9/52) vs 6.6%(8/122), χ2=4.780], increased significantly in women whose 24 h urinary protein content were more than or equal to 1 g in early pregnancy (52 livebirths within 58 cases) (P<0.05). Conclusions Elevated urinary protein level and mean arterial pressure in early pregnancy were risk factors of adverse pregnancy outcomes. The risk of renal function decline increased in patients with higher stages of chronic nephropathy in early pregnancy. Mother complicated by preeclampsia during pregnancy was an independent risk factor for poor prognosis of the fetus. Key words: Pregnancy outcomes; Prognosis; Pregnancy complications; Renal insufficiency, chronic; Pregnancy trimester, first

To analyze the therapeutic effect of human neural precursor cells transplantation in treatment of neonates with severe brain injury. The transplantation was performed on 6 newborns, one of them was diagnosed as extremely severe carbon monoxide poisoning at 5(th) day after birth; one of them was diagnosed as severe hypoglycemia; the others had asphyxia at birth with Apgar scores from 1 to 3 and were diagnosed as severe neonatal asphyxia, severe hypoxic ischemic encephalopathy according to images, electroencephalogram, biochemical examination and clinical manifestation. With the approval of hospital ethics committee and informed consent of the family members, the newborns received human neural precursor cells transplantation at the 4(th) to 20(th) day after birth. With the agreement of a pregnant woman, forebrain cells were obtained from the forebrain of her 12-week old fetus after spontaneous abortion. The cells from the fetal brain were amplified into human neural precursor cells in vitro and were injected into the cerebral ventricle of the patients. On the 2(nd) day after transplantation, sucking and swallowing reflexes gradually appeared in all the patients, muscular tension was also improved, and convulsion stopped. NBNA scoring in 3 of the patients reached normal level on the 28(th) day after birth. The 6 patients were followed up for 12 months. Four patients were normal in psychomotor development and scores of each scale reached normal level. Two patients have cerebral palsy. hNPCs transplantation is safe and effective in treatment of severe neonatal brain injury. More clinical trials and further observation are needed.

To study the differential facial responses to four basic tastes of the newborns and the gender-related different taste sensitivity. Sixty-two newborns (31 females and 31 males) born in the Department of Obstetrics, First Hospital of the Chongqing University of Medical Sciences were tested for responses to four solutions, including 25% sucrose (sweet), 5% sodium chloride (salt), 1.43% citric acid (sour), and 0.025% berberine (bitter) 90 minutes after birth. The inclusion criteria were: (1) medically uncomplicated full-term pregnancy; (2) medically uncomplicated spontaneous vaginal delivery; (3) Apgar score of at least 8 at 1 and 5 min. All the infants were found to be normal and healthy on pediatric examination. The facial responses of the newborns were recorded by video. The facial responses were divided into nine facial action units and expressions from A1 to C3, which are also expressed as the 1 - 9 grades of intensity, crying was included as grade 9 and nausea was defined as grade 10 intensity. The distinctions of the facial responses were analyzed by chi-square test. The distinctions of sex in the facial responses were analyzed by the Wilcoxon test. All the newborns were full term, excluding the medical conditions. The average birth weight of the newborns was 3324.3 g. The data from the study indicated that absence of distinctive mouth action or sucking was the major facial response of the infants to sucrose solution (P < 0.01). There were no special expressions when the newborns were given the salt solution (P > 0.01). The lip pursing with negative brow and middle face actions were major response of the infants to the sour solution (citric acid) (P < 0.01). The expressions in response to the bitter solution of the infants were the mouth gaping with negative brow and middle face actions (P < 0.01). The facial responses to the sweet and bitter solutions in the boys were more sensitive than those in the girls (P < 0.01). There was no sex difference in the intensities of the facial responses to the salt and sour solutions (P > 0.05). The newborns had distinct responses to the four solutions shortly after birth. The facial expression to sweet and bitter solutions in the boys were more sensitive than in the girls.

Objective To explore the effect of pregnancy with acute pancreatitis on maternal and infant outcomes, thus to provide reference for the development of clinical intervention programs. Methods From January 2012 to January 2018, 62 pregnant patients with acute pancreatitis in the Maternal and Child Health Hospital of Jiaxing were selected as study objects.All of them were singletons.The patients were grouped according to the cause of acute pancreatitis and the severity of the disease.The pregnancy outcomes and neonatal conditions were analyzed. Results Of 62 patients with acute pancreatitis, 40 cases (64.52%) had full-term delivery, 20 cases (32.26%) had premature delivery, and 2 cases(3.22%) had intrauterine fetal death.The newborns included in the study were 60 cases.There were no statistically significant differences in the proportion of premature infants between different morbidity factors, neonatal birth weight and neonatal disease composition (the premature infants: F=0.691, P=0.352; birth weight: F=1.042, P=0.382; biliary erythremia: F=1.382, P=0.521; respiratory distress syndrome: F=0.496, P=0.584; hypoglycemia: F=3.102, P=0.165; infectious disease: F=0.895, P=0.124; intracranial hemorrhage: F=0.004, P=0.932). The difference of termination pregnancy rate was statistically significant (biliary 57.69%, hyperlipidemia 82.14%, other 25.00%) (F=12.541, P=0.000), and the rate of the lipemia group was the highest (82.14%). The proportion of premature infants with moderate pregnancy and acute pancreatitis was the highest (75.0%), and the birth weight was the lowest (F=8.142, 4.581, P=0.000, 0.001). The proportion of termination of pregnancy among different degrees of disease had no statistically significant difference (mild 12.19%, moderate 75.0%, and severe 69.23%) (F=1.251, P=0.4125). The intracranial hemorrhage (0.00%), neonatal respiratory distress syndrome (2.44%) and infectious disease rate (4.88%) were the lowest in mild pregnancy with acute pancreatitis (F=8.641, 7.362, 6.982, P=0.000, 0.000, 0.000). Conclusion Pregnancy with acute pancreatitis can cause adverse pregnancy outcomes and affect the health of newborns.As the patients' condition worsens, the adverse outcome will be more serious. Key words: Pregnancy outcome; Pancreatitis; Infant, premature; Pregnancy complications; Respiratory distress syndrome, newborn

In order to provide further information about canine perinatology, and because of the scarce knowledge about fetal fluids composition in dogs, the present study was aimed to assess the cortisol concentrations in fetal fluids collected from small-sized purebred newborn puppies born by elective cesarean section, at term of pregnancy (Meloni et al, 2014), and to assess possible effects of amniotic and allantoic cortisol concentrations and newborn outcome at 24 hours of age and on newborn gender . Fetal fluids cortisol concentrations were also evaluated for correlation with maternal parity, litter-size, neonatal gender, birth weight and Apgar score (Veronesi et al, 2009). The study, performed on 50 born alive, normal weighed puppies, without gross physical malformation, showed that cortisol concentration was higher in allantoic than in amniotic fluid (p&lt;0.01), even if a strong positive correlation between the two fluids cortisol concentration was found (p&lt;0.0001; R=0.83). Interestingly, higher amniotic (p&lt;0.05) cortisol concentrations were associated to puppies not surviving at 24 hours after birth. Therefore it could be suggested that this parameter may be useful for the recognition, at birth, of puppies needing special surveillance in the first day of age. In relation to the other evaluated parameters, no correlations with amniotic or allantoic cortisol concentrations were found. In conclusion, the present results showed that in small-sized purebred puppies, born at term by elective caesarean section, the evaluation of amniotic cortisol concentration seems useful for the detection of puppies that need special surveillance during the first 24 hours of age, and should be coupled to the newborn evaluation by Apgar score.

Influence of Naked Body Contact Between Mother and Newborn on Effective Breastfeeding