Purpose brain abscess is a rare but life-threatening complication of meningitis. The purpose of this study was to identify clinical features and potentially relevant factors of brain abscess in neonates with meningitis. MethodsThis study was a propensity score-matched case-control study of neonates with brain abscess and meningitis in a tertiary pediatric hospital between January 2010 and December 2020. A total of 16 neonates with brain abscess were matched to 64 patients with meningitis. Demography, clinical characteristics, laboratory results, pathogens were collected. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors associated with brain abscess.

BackgroundFeeding intolerance is a common problem in preterm infants, which is associated with an increased risk of infections, prolonged hospitalization, and increased economic costs. When human milk is not available, formula feeding is required. Amino acid-based formula and extensively hydrolyzed formula could be considered for use for severe feeding intolerance. A recent Cochrane meta-analysis found that preterm infants fed extensively hydrolyzed formula compared with standard formula could not reduce the risk of feeding intolerance and necrotizing enterocolitis, and weight gain was slower. Some studies reported that preterm infants fed amino acid-based formula could reduce the gastric residual volume. We hypothesize that amino acid-based formula can improve feeding intolerance and establish full enteral feeding more rapidly in preterm infants compared with extensively hydrolyzed formula.MethodThe randomized, prospective, controlled trial was conducted at the Children's Hospital of Chongqing Medical University (Chongqing, China). A total of 190 preterm infants with gestational age <32 weeks or birth weight <1,500 g and with a diagnosis of feeding intolerance were included. Patients were randomized to an amino acid-based formula-fed group and an extensively hydrolyzed formula-fed group. The primary outcome is the time (days) to reach full enteral feedings. Secondary outcomes include duration of vomiting and abdominal distension, gastric residual volume, body weight, length and head circumference during hospitalization, length of hospital stay (days), cost of hospitalization, time (days) of parenteral nutrition, change of abdomen circumference, main serum parameters, and incidence of adverse events.DiscussionThe successful implementation of our study will provide robust evidence for formula alternatives in preterm infants with feeding intolerance.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT05347706.

Objective: To investigate the etiological characteristics, clinical manifestations, and early identification methods of neonatal brain abscess. Methods: The baseline characteristics, clinical manifestations, and laboratory results of 12 neonatal brain abscess cases were retrospectively analyzed. Results: The clinical manifestations were fever, convulsion, and lethargy. A small number of them had respiratory and circulatory failure. The diagnosis made was based on imaging examination. All 12 cases were confirmed by cranial enhanced computed tomography (CT) or magnetic resonance imaging (MRI). Blood cultures of 9 cases were positive, with Escherichia coli in 6 cases, ?-hemolytic Streptococcus in 1 case, methicillin-resistant Staphylococcus aureus in 1 case, and Enterococcus faecium in 1 case. However, only 3 of them had positive cerebrospinal fluid (CSF) cultures. All the 12 neonates were treated with antibiotic therapy upon admission, with only 3 cases treated with surgery. Among them, 4 recovered and were discharged, while the remaining 8 discontinued their therapy. Conclusion: Escherichia coli is the most common pathogen of neonatal brain abscess in our study. The clinical manifestations of neonatal brain abscess are atypical, and the prognosis is poor. Respiratory and circulatory failure in children with intracranial infection may indicate the presence of brain abscess. For children with suspected brain abscess, cranial enhanced CT or MRI should be performed as soon as possible to make an early diagnosis. The prevention of brain abscess should be prioritized; neonates with sepsis or meningitis should receive prompt and strong antibiotic therapy in an effort to prevent the development of brain abscess.

Introduction: Feeding intolerance (FI) is a common neonatal disease, which may badly influence infants’ health. According to previous study, massage could prevent preterm feeding intolerance, promote maturation of gastrointestinal function and weight gain, but rarely used as an adjuvant treatment of feeding intolerance. This trial aims to evaluate the effectiveness of massage on treatment of FI.Method: The randomized controlled trial is to be conducted in Chongqing, China. 104 preterm infants whose gestational age between 28-34 weeks and birth weight between 1000g-2000g with diagnosis of feeding intolerance will be involved in the study. Participants will be stratified by birth weight (1000-1499g or 1500-2000g), and randomized to either the intervention group, who will receive massage twice a day for 7 days on the basis of routine treatment, or the control group, who will not receive any intervention except for routine treatment. Researchers blinding to group allocation will be maintained. Primary outcomes include the time from the initiation of enteral nutrition to total enteral nutrition. Secondary outcomes include duration of vomiting and abdominal distension(day), gastric residual volume, weight gain, change of length and head circumference during hospitalization, length of hospital stay (day), change of abdomen circumference（cm）, duration of diarrhea. Data will be collected in CRFs, and analyzed after data for the entire sample has been collected.Discussion: This study has the potential to provide evidence to inform that massage will improve feeding tolerance, growth and development as well as metabolism of body. This will enable us to develop a convenient and efficient way for curing preterm feeding intolerance, and improve infants’ long-term health outcomes.Trial registration: Chinese Clinical Trial Registry, ChiCTR2100045033, Registered on 3rd April 2021