Syndrome Infants Research Articles

The Relationship between Serum Lipid Profile and Respiratory Distress Syndrome in Preterm Infants

The Relationship between Serum Lipid Profile and Respiratory Distress Syndrome in Preterm Infants

Frequency of Respiratory Distress Syndrome in Preterm Infants Delivered at Pak Emirates Military Hospital, Rawalpindi

Objective: To determine the frequency of Respiratory Distress Syndrome among preterm neonates born at the Pak Emirates Military Hospital.
 Study Design: Cross-Sectional Study.
 Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Aug 2020 to Mar 2021.
 Methodology: One hundred and sixty-nine neonates with a gestational age of ≤34 weeks of either gender were included in this study. RDS was confirmed by reviewing neonatal medical charts. The frequency of RDS was seen in different groups according to gestational age, gender, weight, hypothermia, sepsis and jaundice.
 Results: There were 169 patients; among them were 94 (55.6%) males and 75 (44.4%) females. 105 (62.1%) were born by caesarean section, and 64 (37.9%) were normal vaginal delivery. There were 26 (15.4%) neonates, with RDS, and 143 (84.6%) did not have RDS. Among our 169 sample, 26 (15.4%) were in <28 weeks, 96 (56.8%) were in the 28 to 32 weeks and 47 (27.8%) were in >32 week gestational groups. There were 34 (20.1%) who were <1000 g, there were 96 (56.8%) were between 1000 to 1500 g, and 39 (23.1%) were > 1500 g. Hypothermia was found in 43 (25.4%) of neonates; 126 (74.6%) did not have hypothermia. 63 (37.3%) neonates had sepsis, and 39 (23.1%) had jaundice.
 Conclusion: RDS is a serious problem in our country. Health care providers must plan cost-effective and efficient strategies to detect and treat RDS in the developing world.

Gastric aspiration in sudden unexpected infant death of Prader–Willi syndrome: immunohistochemical detection of feeding components

Prader–Willi syndrome (PWS) in infants is characterized by hypotonia and poor sucking with feeding difficulties. Two autopsy cases of sudden unexpected death during sleep after tube feeding are described herein. For one, gastric aspiration caused by the possible milk regurgitation was suspected. Immunohistochemical examination of lung sections was performed using three antibodies to human α-lactalbumin, human gross cystic disease fluid protein 15, and cow whey β-lactoglobulin. Five cases of sudden unexpected infant death occurring earlier than at 6 months old were selected as controls. Marked immune-staining for infant formula in one PWS subject was evident within terminal bronchioles and alveoli with granular and amorphous features. However, no positive staining was apparent in the other subject, who exhibited contrasting features in milk distribution. Among control cases, one showed mild staining in the bronchiole, but the others did not. The antibody to β-lactoglobulin reacted specifically with formula, with no nonspecific background. Gastric contents in the airway can be a difficult issue because of the consequent terminal gasping. However, because of an episode of antemortem symptoms of potential regurgitation, and from findings at autopsy such as petechiae, we inferred that fatal regurgitation occurred in this PWS infant after tube feeding. Several clinical reports have described milk aspiration, but this pathological report is the first related to aspiration in PWS during tube feeding.

Treatment results of respiratory distress syndrome in preterm infants at the pediatric center of Hue Central Hospital

ABSTRACT Background: Acute respiratory distress syndrome (ARDS) in premature infants is one of the leading causes of death. Surfactant replacement therapy has been the mainstay of treatment for preterm infants with RDS. This study aimed to evaluate the results of surfactant therapy for premature infants with RDS at the Pediatric Center of Hue Central Hospital. Methods: A prospective, descriptive, and comparative study was conducted on 52 preterm infants with RDS based on clinical and chest radiographic findings before and after intervention. All infants received conventional surfactant therapy or INSURE. Evaluation of treatment results after 6 hours based on: SpO2, FiO2, a/APO2, and chest X-ray. Results: Surfactant treatment markedly reduced the need for FiO2 and Surfactant treatment markedly reduced FiO2. requirement and improved SpO2. The average SpO2 of 91.15% increased to 95.67%. The average FiO2 of 51.54% decreased to 40.5%. Lung lesions on X-ray have markedly improved after treatment, as shown in the improvement of lesions. Alveolar and arterial oxygen rates (a/APO2) improved significantly after surfactant administration. 33/52 (63.5%) cases eventually improved within 6 hours after treatment without any complications. Conclusion: A surfactant replacement that counterbalances surfactant inactivation seems to improve oxygenation and lung function in many preterm infants with respiratory distress syndrome without any apparent negative side effects.

Different corticosteroids and regimens for accelerating fetal lung maturation for babies at risk of preterm birth.

Different corticosteroids and regimens for accelerating fetal lung maturation for babies at risk of preterm birth.

Beneficial effects of starting oral cysteamine treatment in the first 2 months of life on glomerular and tubular kidney function in infantile nephropathic cystinosis.

Nephropathic cystinosis is a rare lysosomal storage disease whose basic defect, impaired transport of cystine out of lysosomes, results in intracellular cystine storage. Affected individuals exhibit renal Fanconi Syndrome in infancy, end-stage kidney disease at approximately 10 years of age, and many other systemic complications. Oral cysteamine therapy mitigates the detrimental effects on glomerular function and prevents most of the late complications of the disease but has not shown benefit with respect to the early tubular damage of cystinosis. This is because cystinosis is generally diagnosed in the second year of life, after the damage to kidney tubular function has already occurred. We longitudinally evaluated 6 infants diagnosed and treated with cysteamine from before 2 months of age. The 4 infants with good compliance with cysteamine and consistently low leucocyte cystine levels maintained normal eGFR values, exhibited only minor degrees of renal Fanconi Syndrome, and maintained normal serum levels of potassium, bicarbonate, phosphate, and calcium without electrolyte or mineral supplementation through 2, 4, 10 and 16 years of age. Thus, renal Fanconi syndrome can be attenuated by early administration of cysteamine and renew the call for molecular-based newborn screening for cystinosis.

Effect of sleep position in term healthy newborns on sudden infant death syndrome and other infant outcomes: A systematic review.

BackgroundThough recommended by numerous guidelines, adherence to supine sleep position during the first year of life is variable across the globe.MethodsThis systematic review of randomized trials and observational studies assessed the effect of the supine compared to non-supine (prone or side) sleep position on healthy newborns. Key outcomes were neonatal mortality, sudden infant death syndrome (SIDS), sudden unexpected death in infancy (SUDI), acute life-threatening event (ALTE), neurodevelopment, and positional plagiocephaly. We searched MEDLINE via PubMed, Cochrane CENTRAL, EMBASE, and CINAHL (updated till November 2021). Two authors separately evaluated the risk of bias, extracted data, and synthesised effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence.ResultsWe included 54 studies (43 observational studies and 11 intervention trials) involving 474 672 participants. A single study meeting the inclusion criteria suggested that the supine sleep position might reduce the risk of SUDI (0-1 year; OR = 0.39, 95% confidence interval (CI) = 0.23-0.65; 384 infants), compared to non-supine position. Supine sleep position might reduce the risk of SIDS (0-1 year; OR = 0.51, 95% CI = 0.42-0.61; 26 studies, 59332 infants) and unexplained SIDS/severe ALTE (neonatal period; OR = 0.16, 95% CI = 0.03-0.82; 1 study, 119 newborns), but the evidence was very uncertain. Supine sleep position probably increased the odds of being 0.5 standard deviation (SD) below mean on Gross Motor Scale at 6 months (OR = 1.67, 95% CI = 1.22-2.27; 1 study, 2097 participants), but might have little to no effect at 18 months of age (OR = 1.16, 95% CI = 0.96, 1.43; 1 study, 1919 participants). An increase in positional plagiocephaly at 2-7 months of age with supine sleep position is possible (OR = 2.77, 95% CI = 2.06-3.72; 6 studies, 1774 participants).ConclusionsLow- to very low-certainty evidence suggests that supine sleep position may reduce the risk of SUDI (0-1 year) and SIDS (0-1 year). Limited evidence suggests that supine sleeping probably delays short-term ‘gross motor’ development at 6 months, but the effect on long-term neurodevelopment at 18 months may be negligible.

Retrospective Evaluation of Patients with Infantile Spasm Diagnosis

Introduction: Infantile spasm (West Syndrome) (IS) is an age-dependent epileptic encephalopathy clinic specific to the first two years of life. Infantile spasm is the most known epileptic syndrome of infancy with typical seizures in the form of spasm, psychomotor retardation and hypsarrhythmia on electroencephalography. Typical spasms are in the form of flexor/extensor contractions that last for about 2-5 seconds, which usually symmetrically involves all muscle groups in the body. Material and Method: In this study, the data of patients, who were followed up with the diagnosis of "infantile spasm" in the Pediatric Neurology Clinic of Mersin City Training and Research Hospital between 2020 and 2022, were retrospectively analyzed. Demographic characteristics, clinical, EEG and MRI findings of the patients were analyzed. Results: Eighteen patients were included in the study. Ten (55.5%) of our patients were male and 8 (44.5%) were female. The mean age of patients was ……. years. 11 (61.1%) patients were in the symptomatic group, 5 (27.7%) patients were in the cryptogenic group, and 2 (11.1%) patients were in the idiopathic group. At the time of diagnosis, there was flexor spasm, extensor spasm, mixt spasm, tonic seizure, myoclonic seizure in 5 (27,7%), 4 (22,2%), 4 (22,2%), 3 (16,6%), and 2 (11,1%) patients, respectively. Hypsarrhythmia, suppression-burst pattern, focal epileptic abnormality and generalized epileptic abnormality was observed in 8 (44,4%), 4 (22,2%), 3 (16,6%), and 3 (16,6%) patients, respectively. Of the 14 patients who were first diagnosed, 8 (57.1%) were treated with ACTH, 4 (28.6%) with phenobarbital, 2 (14.3%) with vigabatrin. Conclusion: Infantile spasm is an important age-related encephalopathy with severe neurological sequelae, resistant seizures, and high morbidity and mortality all over the world and in our country. Spasms cause further damage to the central nervous system, which continues to develop. For this reason, a positive contribution can be made in terms of prognosis with early and appropriate treatment.

Expert consensus on the diagnosis of functional dyspepsia syndrome in infant and toddler

婴幼儿胃肠功能紊乱表现多样，儿童功能性胃肠病罗马Ⅳ标准不能诊断所有的婴幼儿相关功能性消化道问题，中国中药协会儿童健康与药物研究专业委员会消化学组、中华医学会儿科学分会消化学组及中华儿科杂志编辑委员会联合提出“婴幼儿功能性消化不良综合征”的概念，并制定此共识，以期提高婴幼儿功能性消化不良综合征诊断的规范性及科学性，指导临床实践。.

Improve the understanding of functional dyspepsia syndrome in infant and toddler

罗马Ⅳ标准规范了婴幼儿功能性胃肠病的诊断，但临床上常可见未达到罗马Ⅳ诊断标准的婴幼儿，部分被误诊为牛奶蛋白过敏等疾病，并给予了不恰当的干预。应提高对婴幼儿功能性消化不良综合征的管理水平。.

Zika Virus Induces Sex-Dependent Metabolic Changes in Drosophila melanogaster to Promote Viral Replication.

Zika is a member of the Flaviviridae virus family that poses some of the most significant global health risks, causing neurologic complications that range from sensory neuropathy and seizures to congenital Zika syndrome (microcephaly) in infants born to mothers infected during pregnancy. The recent outbreak of Zika virus (ZIKV) and its serious health threats calls for the characterization and understanding of Zika pathogenesis, as well as host antiviral immune functions. Although ZIKV has been associated with activating the RNA interference (RNAi) immune pathway and altering host metabolism, in-depth studies are still required to uncover the specifics of the complex host-virus interactions and provide additional insights into the molecular components that determine the outcome of this disease. Previous research establishes the fruit fly Drosophila melanogaster as a reliable model for studying viral pathogens, as it shares significant similarities with that of vertebrate animal systems. Here, we have developed an in vivo Drosophila model to investigate ZIKV-mediated perturbed metabolism in correlation to the RNAi central mediator Dicer-2. We report that ZIKV infection reprograms glucose and glycogen metabolism in Dicer-2 mutants to maintain efficient replication and successful propagation. Flies that exhibit these metabolic effects also show reduced food intake, which highlights the complicated neurological defects associated with ZIKV. We show that ZIKV infection significantly reduces insulin gene expression in Dicer-2 mutants, suggesting an insulin antiviral role against ZIKV and a direct connection to RNAi immunity. Moreover, we find that the insulin receptor substrate chico is crucial to the survival of ZIKV-infected flies. These observations are remarkably more severe in adult female flies compared to males, indicating possible sex differences in the rates of infection and susceptibility to the development of disease. Such findings not only demonstrate that metabolic alterations can be potentially exploited for developing immune therapeutic strategies but also that preventive measures for disease development may require sex-specific approaches. Therefore, further studies are urgently needed to explore the molecular factors that could be considered as targets to inhibit ZIKV manipulation of host cell metabolism in females and males.

Association of umbilical cord blood miR-375 with neonatal respiratory distress syndrome and adverse neonatal outcomes in premature infants.

Neonatal respiratory distress syndrome (NRDS) is a common respiratory disorder occurring in premature infants, and some microRNAs (miRNAs) have been demonstrated to play critical roles in NRDS progression. This study aimed to measure relative expression of miR-375 in infants with NRDS, and further evaluate the clinical significance of miR-375 in predicting the onset and clinical prognosis of NRDS in infants. This study collected umbilical cord blood from 180 premature neonates, including 90 neonates with NRDS and 90 non-NRDS neonates. Quantitative real-time PCR was used to detect relative expression level of miR-375. The diagnostic value of miR-375 in screening NRDS neonates from control neonates and its predictive accuracy for clinical prognosis were evaluated by receiver operating characteristic analysis. The relationship of miR-475 with disease onset and clinical outcomes in NRDS infants was assessed by univariate and multivariate logistic regression analyses. Relative miR-375 expression was upregulated in NRDS neonates, and high levels of miR-375 were observed in NRDS grade III-IV cases compared to those early-stage neonates. miR-375 had relatively high diagnostic accuracy to screen NRDS neonates and was independently associated with NRDS onset in infants. Moreover, relative miR-375 expression was upregulated in NRDS neonates with poor prognosis and could independently predict the clinical outcomes of NRDS neonates with considerable predictive accuracy. Umbilical cord serum miR-375 is elevated and associated with NRDS onset and clinical outcomes in NRDS neonates. Thus, miR-375 may serve as a biomarker for the diagnosis and prognosis of infants with NRDS.

A prediction nomogram for neonatal acute respiratory distress syndrome in late-preterm infants and full-term infants: A retrospective study.

SummaryBackgroundNeonatal acute respiratory distress syndrome (ARDS) is a critical clinical disease with high disability and mortality rates. Early identification and treatment of neonatal ARDS is critical. This study aimed to build a perinatal prediction nomogram for early prediction of neonatal ARDS.MethodsA prediction model was built including 243 late-preterm and full-term infants from Daping Hospital in Chongqing, China, hospitalised between Jan 1, 2018 and Dec 31, 2019. 80 patients from the Children's Hospital in Chongqing, China, hospitalised between Jan 1, 2018 and June 30, 2018 were considered for external validation. Multivariate logistic regression was performed to identify independent predictors and establish a nomogram to predict the occurrence of neonatal ARDS. Both discrimination and calibration were assessed by bootstrapping with 1000 resamples.FindingsMultivariate logistic regression demonstrated that mother's education level (odds ratio [OR] 0·478, 95% confidence interval [CI] 0·324–0·704), premature rupture of membrane (OR 0·296, 95% CI 0·133–0·655), infectious disease within 7 days before delivery (OR 0·275, 95% CI 0·083–0·909), hospital level (OR 2·479, 95% CI 1·260–4·877), and Apgar 5-min score (OR 0·717, 95% CI 0·563–0·913) were independent predictors for neonatal ARDS in late-preterm and full-term infants, who experienced dyspnoea within 24 h after birth and required mechanical ventilation. The area under the curve and concordance index of the nomogram constructed from the above five factors were 0·760 and 0·757, respectively. The Hosmer–Lemeshow test showed that the model was a good fit (P = 0.320). The calibration curve of the nomogram was close to the ideal diagonal line. Furthermore, the decision curve analysis demonstrated significantly better net benefit in the model. The external validation proved the reliability of the prediction nomogram.InterpretationA nomogram based on perinatal factors was developed to predict the occurrence of neonatal ARDS in late-preterm and full-term infants who experienced dyspnoea within 24 h after birth and required mechanical ventilation. It provided clinicians with an accurate and effective tool for the early prediction and timely management of neonatal ARDS.FundingNo funding was associated with this study.

Plasma apelin and vascular endothelial growth factor levels in preterm infants: relationship to neonatal respiratory distress syndrome

Aim The study aimed to determine the association between cord plasma levels of apelin and vascular endothelial growth factor (VEGF) with respiratory distress syndrome (RDS) in preterm infants. Methods This case-control study included 120 preterm infants admitted to the neonatal intensive care unit of our hospital between January 2019 and January 2020. The infants were divided into RDS (n = 60) and non-RDS groups (n = 60). The cord plasma apelin and VEGF levels, perinatal characteristics, and neonatal complications were compared between the two groups. Results The plasma apelin levels in the RDS group were significantly higher than in the non-RDS group (158.9 ± 24.8 vs. 125.2 ± 18.2 pg/mL, respectively), whereas VEGF levels in the non-RDS group were significantly higher than in the RDS group (187.4 ± 28.5 vs. 245.1 ± 44.8 pg/mL, respectively) (both p < .001). Infants with more severe RDS had higher plasma apelin levels and lower plasma VEGF levels. In the receiver operating characteristic curve analysis for the prediction of RDS, a cutoff of 148.4 pg/mL for apelin level yielded a sensitivity of 63.3% and a specificity of 95.0%, whereas a cutoff of 214.2 pg/mL for VEGF level showed a sensitivity of 86.7% and a specificity of 75.0%. Apelin levels were negatively correlated with VEGF levels in infants with RDS (r = 0.84, p < .001). Conclusion Differences in cord plasma apelin and VEGF levels may aid in the early diagnosis and treatment of RDS in preterm infants.

Effect of Beclomethasone Atomization Combined with Azithromycin on Pertussis-Like Syndrome in Infants

Effect of Beclomethasone Atomization Combined with Azithromycin on Pertussis-Like Syndrome in Infants

КЛИНИЧЕСКИЕ И МОЛЕКУЛЯРНО-ГЕНЕТИЧЕСКИЕ ОСНОВЫ ВНЕЗАПНОЙ СЕРДЕЧНОЙ СМЕРТИ ПРИ ПЕРВИЧНЫХ ЭЛЕКТРИЧЕСКИХ ЗАБОЛЕВАНИЯХ СЕРДЦА У ДЕТЕЙ

Primary electrical heart diseases (PEHDs) are hereditary orphan life-threatening conditions leading to a sudden cardiac death in young adults in the absence of structural heart disease. Among the most common and studied diseases of this group are: long QT syndrome (LQTS), catecholaminergic ventricular tachycardia, Brugada syndrome, short QT syndrome, early ventricular repolarization syndrome. Also, this group of diseases includes congenital sick sinus syndrome, progressive cardiac conduction defect, idiopathic ventricular fibrillation, familial atrial fibrillation and a number of cases (from 5 to 10%) of the sudden cardiac death syndrome in infants. The total prevalence of PEHDs in the pediatric population is quite high and is about 1:2000, mainly due to long QT syndrome. PEHDs are poorly identified by the standard clinical approach, at the same time a delay in diagnosing and prescribing specific therapy may lead to fatal consequences and sudden cardiac death of the child at the first-ever syncope. The vast majority of PEHDs genes identified to date encode subunits of cardiac ion channels or proteins, which interact with ion channels and regulate their functions. The advent of the next generation sequencing led to a shift in most DNA diagnostics laboratories from screening single genes or small gene panels to examining of whole exome or whole genome data. These diseases, especially LQTS, have become unique cardiological models for clinical and genetic studies, analysis of genotype-phenotype correlations and the development of a modern strategy of multi-level hybrid therapy and the prevention of sudden cardiac death (SCD) in people of young age. The most PEHDs can and should be diagnosed in childhood, which now makes it possible to effectively prevent life-threatening arrhythmias. More and more patients are surviving into adulthood, as yet, and patients are interacting with traditional risk factors and obviously should have higher cardiovascular risks. Due to the high prevalence in the population, the association with the SCD, the polymorphism of clinical and genetic manifestations, high technology medicine, the research of PEHDs has become one of the priority places in both pediatric and adult cardiology, and the diseases have now become models for development of gene therapies. The paper outlines the clinical and genetic characteristics, the basics of diagnostics and up-to-date therapeutic, interventional and surgical technologies for the treatment of the most common PEHDs in childhood.

Epilepsy and other comorbidities in Down syndrome

AbstractDown syndrome (DS) is the most common cause of intellectual disability. Due to many genetic and biochemical aberrations, people with DS suffer from several somatic disorders and concomitant diseases. Epilepsies occur more often than in the normal population, but less often than with intellectual disability of other causes. Epilepsies in DS have a trimodal distribution with age-related phenotypes, etiologies, and prognosis. The most common epilepsy syndrome in infancy is the often-self-limiting West syndrome; if Lennox–Gastaut syndrome occurs in the later course of development, the seizure prognosis worsens significantly. From the fourth decade of life, myoclonic epilepsy often occurs, which in combination with rapidly progressive Alzheimer’s dementia is life-limiting within a few years.

Pathogenesis and Manifestations of Zika Virus-Associated Ocular Diseases.

Zika virus (ZIKV) is mosquito-borne flavivirus that caused a significant public health concern in French Polynesia and South America. The two major complications that gained the most media attention during the ZIKV outbreak were Guillain–Barré syndrome (GBS) and microcephaly in newborn infants. The two modes of ZIKV transmission are the vector-borne and non-vector borne modes of transmission. Aedes aegypti and Aedes albopictus are the most important vectors of ZIKV. ZIKV binds to surface receptors on permissive cells that support infection and replication, such as neural progenitor cells, dendritic cells, dermal fibroblasts, retinal pigment epithelial cells, endothelial cells, macrophages, epidermal keratinocytes, and trophoblasts to cause infection. The innate immune response to ZIKV infection is mediated by interferons and natural killer cells, whereas the adaptive immune response is mediated by CD8+T cells, Th1 cells, and neutralizing antibodies. The non-structural proteins of ZIKV, such as non-structural protein 5, are involved in the evasion of the host’s immune defense mechanisms. Ocular manifestations of ZIKV arise from the virus’ ability to cross both the blood–brain barrier and blood-retinal barrier, as well as the blood-aqueous barrier. Most notably, this results in the development of GBS, a rare neurological complication in acute ZIKV infection. This can yield ocular symptoms and signs. Additionally, infants to whom ZIKV is transmitted congenitally develop congenital Zika syndrome (CZS). The ocular manifestations are widely variable, and include nonpurulent conjunctivitis, anterior uveitis, keratitis, trabeculitis, congenital glaucoma, microphthalmia, hypoplastic optic disc, and optic nerve pallor. There are currently no FDA approved therapeutic agents for treating ZIKV infections and, as such, a meticulous ocular examination is an important aspect of the diagnosis. This review utilized several published articles regarding the ocular findings of ZIKV, antiviral immune responses to ZIKV infection, and the pathogenesis of ocular manifestations in individuals with ZIKV infection. This review summarizes the current knowledge on the viral immunology of ZIKV, interactions between ZIKV and the host’s immune defense mechanism, pathological mechanisms, as well as anterior and posterior segment findings associated with ZIKV infection.

Membrane Stretch Gates NMDA Receptors.

NMDARs are ionotropic glutamate receptors widely expressed in the CNS, where they mediate phenomena as diverse as neurotransmission, information processing, synaptogenesis, and cellular toxicity. They function as glutamate-gated Ca2+-permeable channels, which require glycine as coagonist, and can be modulated by many diffusible ligands and cellular cues, including mechanical stimuli. Previously, we found that, in cultured astrocytes, shear stress initiates NMDAR-mediated Ca2+ entry in the absence of added agonists, suggesting that more than being mechanosensitive, NMDARs may be mechanically activated. Here, we used controlled expression of rat recombinant receptors and noninvasive on-cell single-channel current recordings to show that mild membrane stretch can substitute for the neurotransmitter glutamate in gating NMDAR currents. Notably, stretch-activated currents maintained the hallmark features of the glutamate-gated currents, including glycine-requirement, large unitary conductance, high Ca2+ permeability, and voltage-dependent Mg2+ blockade. Further, we found that the stretch-gated current required the receptor's intracellular domain. Our results are consistent with the hypothesis that mechanical forces can gate endogenous NMDAR currents even in the absence of synaptic glutamate release, which has important implications for understanding mechanotransduction and the physiological and pathologic effects of mechanical forces on cells of the CNS.SIGNIFICANCE STATEMENT We show that, in addition to enhancing currents elicited with low agonist concentrations, membrane stretch can gate NMDARs in the absence of the neurotransmitter glutamate. Stretch-gated currents have the principal hallmarks of the glutamate-gated currents, including requirement for glycine, large Na+ conductance, high Ca2+ permeability, and voltage-dependent Mg2+ block. Therefore, results suggest that mechanical forces can initiate cellular processes presently attributed to glutamatergic neurotransmission, such as synaptic plasticity and cytotoxicity. Given the ubiquitous presence of mechanical forces in the CNS, this discovery identifies NMDARs as possibly important mechanotransducers during development and across the lifespan, and during pathologic processes, such as those associated with traumatic brain injuries, shaken infant syndrome, and chronic traumatic encephalopathy.

Clinical analysis of Terson syndrome in infants

Objective: To observe the clinical features, intervention and outcomes of anatomic and visual functions of Terson syndrome in infants, and to explore the appropriate timing for surgery. Methods: This retrospective study included 23 eyes of 14 infants diagnosed with vitreous hemorrhage related to Terson syndrome between May 2008 and March 2021 in Department of Ophthalmology, Peking University People's Hospital. There were 7 males (11 eyes) and 7 females (12 eyes). The age at the initial visit was (4.59±3.96) months. No obvious abnormality was observed in the anterior segment of both eyes of each patient. Data were collected, including demographics, causes of intracranial hemorrhage, characteristics of intraocular hemorrhage, intervention, outcomes of anatomic and visual functions. Results: The causes were craniocerebral trauma in 3 patients, idiopathic cysts in 8 patients, ependymal cyst rupture in 1 patient and respiratory distress in 2 patients. The chief complaint was behavior change in 9 patients, and hemorrhage was found in 5 patients on fundus examination. The rate of complications related to intraocular bleeding was 12/16 when the duration was less than 3 months and 6/7 when the duration was more than 3 months. Twenty eyes (86.96%) were treated by vitrectomy. The follow-up ranged from 6 to 160 months. Three eyes were atrophied, anatomical success was recorded in 18 eyes, and retinal detachment developed in 2 eyes. The visual acuity was improved in 12 eyes (60%), unchanged in 5 eyes (25%), and deteriorated in 3 eyes (15%), except 3 eyes that did not comply with visual acuity examination. Ten eyes showed an obvious myopic shift. Conclusions: The vitreous hemorrhage related to Terson syndrome can occlude the macula and cause severe structural and functional impairments in infants. Vitrectomy is an effective intervention technique, which can quickly remove blood accumulation and restore the anatomical structure, providing better conditions for the visual development of infants.