上海市2022年3至5月新型冠状病毒疫情防控中复旦大学附属儿科医院实施院区气泡式管理的实践和效果

背景：新型冠状（新冠）病毒奥密克戎变异株传染力极强,使得上海市2022年3至5月新冠病毒奥密克戎疫情（简称：本次疫情）防控之初就兼具复杂性、动态性和不确定性多重特质,使得医院的防控更具挑战。 目的：探讨实施气泡式管理策略对防控新冠病毒医院感染和职业暴露的效果。设计：观察性研究。 方法：将本次疫情复旦大学附属儿科医院（我院）院内接诊 门诊 急诊 住院 出院设计为一个大气泡,大气泡中6个疫情防控医疗关键部门设计为中气泡,中气泡的9个要隘部门设计为小气泡。①新冠门急诊中气泡接诊健康码红码患儿,五级分诊Ⅰ和Ⅱ级导入抢救室小气泡, Ⅲ~Ⅴ级导入阳性小气泡、既往感染小气泡、密切接触者（密接）小气泡,放射检查室小气泡内接诊新冠门急诊和新冠病房需进行X线/CT检查的患儿;②发热门急诊中气泡接诊绿码/黄码伴发热的患儿;③急诊中气泡接诊绿码/黄码不伴发热的患儿,根据患儿有无48 h内核酸检测阴性报告分流至缓冲区和急诊区,配备第二急诊室备用;④新冠病房中气泡接收新冠门急诊需要收治住院的患儿,重型/危重型收入新冠ICU小气泡,轻型/普通型收入新冠普通病房小气泡;⑤过渡病房中气泡接收除危重症和新生儿外的新入院患儿;⑥新生儿隔离病房中气泡接收医疗机构通过120救护车转运到我院院区的新生儿,收入新生儿隔离病房负压病室小气泡,连续3 d核酸检测,阳性即转入新冠病房,均阴性则转至非负压病室小气泡。不同风险等级的气泡间人员、物品不流动,工作人员从低一级风险进入高一级风险需上报医务科。设立气泡破泡预案。根据工作人员不同岗位制定规范的培训内容及考核要求,通过语音视频监控系统和现场督查进行检查。 主要结局指标：职业暴露和新冠病毒医院感染。 结果：我院累计收治新冠阳性患儿432例,其中轻型341例（78.9%）,普通型88例（20.4%）,危重型3例。3例危重型患儿均行有创机械通气,1例行连续肾脏替代治疗和体外膜肺氧合。无死亡病例。伴基础疾病29例。陆续有109名医务人员进入新冠门急诊和新冠病房工作,其中医生46人、护士49人、医技人员9人、医辅人员5人。未发生职业暴露,未发生新冠病毒医院感染。门急诊接诊253 571人次,在医院入口筛查,拦截红码189人次,红码患儿均顺利导入新冠门急诊,未进入普通门急诊区域。急诊接诊12 114人次,经核酸检测筛查出6例新冠阳性患儿,其中3例进入急诊区小气泡,引起急诊中气泡3次封闭消杀,启用第二急诊。发热门急诊接诊8 328人次,核酸检测阳性50例,转入新冠门急诊;新冠门急诊接诊763人次,五级分诊Ⅰ级和Ⅱ级共4例,3例为新冠肺炎危重型;收治新生儿690例,其中低危流行病史516例,高危流行病史174例;过渡病房收治693例,其中急诊入院223例,择期入院470例。所有进入隔离病区工作的医务人员均参加基础理论培训,高风险气泡专项培训29次,培训291人次,理论培训和操作培训均考核合格,视频监控和现场督查304人次。 结论：本次疫情期间在我院实施气泡式管理取得了新冠病毒医院感染和职业暴露双零效果。     

上海市2022年3至5月新型冠状病毒疫情防控中复旦大学附属儿科医院急诊实施气泡式管理的实践和效果

背景：上海市2022年3至5月发生的新型冠状（新冠）病毒Omicron疫情(简称：本次疫情)使得复旦大学附属儿科医院(我院)重症医学科急诊救治和疫情防控非常具有挑战。 目的探讨实施气泡式管理策略对急诊救治和疫情防控的效果。 设计：观察性研究。 方法：本次疫情期间我院为大气泡，急诊作为中气泡,设置缓冲、急救、诊室和留观4个小气泡。基于“四区二通道二预检”对急诊原来的布局和流程加以改造。四区：①清洁区为医务人员生活区、办公室、库房及个人防护设备(PPE)穿戴区，②潜在污染区包括个人防护用品第一脱卸间(一脱间)和第二脱卸间(二脱间)，③污染区包括第二预检区、候诊区、急救小气泡、诊室小气泡、留观室小气泡，④高风险区为第一预检区和缓冲小气泡；二通道：清洁和污染通道；二次预检：预检初筛在急诊入口处，入急诊后根据五级分诊预检。急诊缓冲小气泡接诊健康码红码、无48 h内核酸检测阴性结果、预检初筛时医生判断为危重症的患儿；抢救室小气泡接诊有48 h内核酸检测阴性结果、第二次预检五级分诊Ⅰ级和Ⅱ级患儿；诊室小气泡接诊有48 h内核酸检测阴性结果或虽无48 h内核酸检测阴性结果但现场抗原检测阴性、第二次预检Ⅲ~Ⅴ级患儿；留观小气泡收治我院当天核酸检测结果阴性、需要留观的患儿。设立第二急诊作为急诊出现新冠阳性患儿需要临时封控时的备用急诊室。建立气泡破裂预案，当患儿核酸检测结果阳性但因报告延迟而进入急诊抢救室和诊室小气泡时，暴露场所先进行环境采样以评估环境污染程度，终末消毒后再次采样以评估环境安全性，核酸检测阴性再恢复使用。必要时启用第二急诊。 主要结局指标：医护、医辅人员职业暴露和医院感染。 结果：我院急诊共接诊患儿12 114例，Ⅰ~Ⅴ级分别有15、310、8 728、2 564、497例。进行大抢救7次,中抢救32次，小抢救1 070次。58例收入PICU,急诊就诊死亡3例。未发生医院感染。陆续有急诊医生36名、护士38名、医辅人员3名参加了每5 d 1次的出入泡换防，未发生医护、医辅人员职业暴露。急诊缓冲小气泡接诊29例，其中3例核酸检测阳性，3例因疾病危重转入急诊抢救室。急诊留观室收治652例,12例因病情加重转入PICU。预检初筛引导55例至新冠门诊，其中4例核酸检测阳性。急诊共接诊6例新冠病毒感染患儿，其中3例患儿核酸检测结果阳性但报告延迟而进入急诊抢救室和诊室小气泡，造成环境污染，经终末消毒后再次采样核酸检测阴性恢复使用。 结论：调整急诊气泡布局、优化就诊流程，满足急诊急症及危重症首诊救治和疫情防控，达到医院感染和职业暴露双零是可以实现的，破泡风险是存在的，须做好预案。     

免疫抑制儿童感染新型冠状病毒Omicron变异株病毒清除时间的回顾性队列研究

背景：儿童新型冠状（新冠）病毒Omicron变异株流行期间，免疫抑制状态儿童新冠病毒清除时间定量分析研究较少。 目的：探讨新冠病毒Omicron株感染后免疫抑制和非免疫抑制儿童病毒清除的时间差别，为公共卫生政策制定和精准疫情防控措施提供临床数据。 设计：回顾性队列研究。 方法：以新冠病毒Omicron变异株感染住院患儿为队列人群，分为免疫抑制组和非免疫抑制组，免疫抑制分为绝对免疫抑制、相对免疫抑制和实施免疫抑制疗法，以免疫抑制组病例的性别、年龄和新冠病毒感染的分型与非免疫抑制组行1∶3匹配。以鼻咽拭子新冠病毒PCR检测拷贝数阈（Ct）值≥35为队列终点。 主要结局指标：新冠病毒清除时间。 结果：2022年4月12日至2022年5月12日在上海市新冠病毒感染定点收治医院符合本文共同纳入和排除标准的连续病例728例。免疫抑制组33例，其中绝对免疫抑制8例，相对免疫抑制23例，接受免疫抑制疗法2例（不包括绝对和相对免疫抑制患儿）。非免疫抑制组匹配后99例。2组临床症状、新冠病毒感染治疗和疫苗接种次数差异均无统计学意义。免疫抑制组和非免疫抑制组新冠病毒清除时间分别为（16.5±6.8）和（10.3±4.4）d，差异有统计学意义。免疫抑制组和非免疫抑制组新冠病毒感染轻型病例病毒清除时间分别为（14.0 ± 8.3）和（9.7 ± 3.1）d，普通型病例病毒清除时间分别为（18.3 ± 4.9）和（11.2 ± 5.9）d，差异均有统计学意义。2组单日病毒清除率在第9~14天时差异有统计学意义（P为0.005~0.039）。2组普通型病例单日病毒清除率在第10~15天时差异有统计学意义。免疫抑制组新冠病毒感染2周后核酸检测再次呈阳性3例（9%），临床分型均较前轻，3例均未接种新冠疫苗。 结论：Omicron株感染的免疫抑制患儿病毒清除时间较非免疫抑制患儿显著延长，主要反映在第9~14天，免疫抑制患儿病毒复阳风险高，提示需要更长的隔离时间和转阴后严格的病毒监测。     

新生儿消化道畸形62例分析

我院新生儿病房１９８５～１９９５年收治新生儿消化道畸形患儿６２例，现作一回顾性分析。临床资料：１．对象：消化道畸形６２例（男５３例，女９例），占同期住院患儿总数的１．３％。确诊方法为Ｘ线、Ｂ超、肛管测压和剖腹探查。３１例行手术治疗，手术前后诊断符合率...     

住院新生儿发病率及病死率分析

住院新生儿发病率及病死率分析中国医科大学第二临床学院（１１０００３）胡树春，吴红敏，魏克伦为探讨新生儿各种疾病的发病率、病死率及各有关因素之间的关系，现将我院１９９２年１月～１２月新生儿病房收治的１３８０例（自动退院者除外）病儿的临床资料分析报道如下...     

新生儿病毒性心肌炎16例

新生儿病毒性心肌炎１６例江苏南通市第一医院儿科（２２６００１）葛来安根据９省市心肌炎协作组关于病毒性心肌炎标准［１］，现将我院新生儿病房自１９９１年８月～１９９３年６月收治的１６例新生儿病毒性心肌炎分析如下。临床资料一、一般资料本组中男１０例，女６例...     

新型冠状病毒感染期间足月的晚期新生儿咽拭子肠道病毒核酸检测横断面研究

目的 探讨新型冠状病毒感染疫情期间住院的足月的晚期新生儿咽拭子肠道病毒（enterovirus,EV核酸检测阳性率及其临床特征。方法 该研究为单中心横断面研究，研究对象为2020年10月—2021年9月在新生儿内科病房住院的611例足月的晚期新生儿。于入院时采集咽拭子进行柯萨奇病毒A16型/EV71/EV通用型核酸检测。根据EV核酸检测结果分为EV核酸阳性组（8例）和EV核酸阴性组（603例），分析比较两组患儿的临床特征差异。结果 611例患儿中，8例EV核酸检测阳性，阳性率为13.1‰，其中7例在5—10月份入院。EV核酸阳性组与EV核酸阴性组患儿起病前与有呼吸道感染症状的家庭成员接触比例分别为75.0%和10.9%(P<0.001)。两组患儿在人口学信息、临床症状、实验室检验方面差异无统计学意义（P>0.05）。结论 新型冠状病毒感染疫情期间住院的足月的晚期新生儿仍有一定比例的咽拭子EV核酸检测呈阳性但比例较低，其临床表现和实验室常规检测结果无特异性；家庭成员之间的传播可能是新生儿感染EV的重要途径。[中国当代儿科杂志，2023,25 (4):339-343]     

新生儿李斯特菌败血症三例

新生儿李斯特菌败血症一般病情较重，病死率较高。我院儿科病房在2005年收治3例，其中早产儿2例，足月儿1例，3例均经血培养证实为李斯特菌感染（表1），符合新生儿败血症的诊断。药敏结果提示，对青霉素、氨苄西林、庆大霉素、红霉素、TMP／SMZ、万古霉素敏感。     

珠江三角洲新生儿转运网络工作报告

目的　评价珠江三角洲新生儿转运网络（ｎｅｏｎａｔａｌｔｒａｎｓｐｏｒｔｎｅｔｗｏｒｋ, ＮＴＮ） 十年工作及其效果。方法　介绍新生儿转运网络方法及分析有关效果的资料。结果　转运网络现有８７ 家医院;１０ 年共转运急危重症新生儿８ １２４ 例,转运途中死亡３５ 例,病死率为０．４３％ ;第三级新生儿监护病房（ＮＩＣＵ）收容８ ０８９ 例,共死亡３６４ 例,病死率为４．５０ ％ ,ＮＴＮ 医院中总死亡率为２．０７‰。结论　该ＮＴＮ 所实行的运转机制合理适用;促进了网络单位包括三级ＮＩＣＵ 的发展与提高;建立ＮＴＮ是降低新生儿死亡率的重要措施。     

珠江三角洲新生儿转运网络工作报告

目的　评价珠江三角洲新生儿转运网络（ｎｅｏｎａｔａｌｔｒａｎｓｐｏｒｔｎｅｔｗｏｒｋ, ＮＴＮ） 十年工作及其效果。方法　介绍新生儿转运网络方法及分析有关效果的资料。结果　转运网络现有８７ 家医院;１０ 年共转运急危重症新生儿８ １２４ 例,转运途中死亡３５ 例,病死率为０．４３％ ;第三级新生儿监护病房（ＮＩＣＵ）收容８ ０８９ 例,共死亡３６４ 例,病死率为４．５０ ％ ,ＮＴＮ 医院中总死亡率为２．０７‰。结论　该ＮＴＮ 所实行的运转机制合理适用;促进了网络单位包括三级ＮＩＣＵ 的发展与提高;建立ＮＴＮ是降低新生儿死亡率的重要措施。     

中国新生儿重症监护病房中实施家长参与早产儿住院期间综合管理与常规护理的平行对照研究

目的探讨在中国NICU实施家长参与早产儿住院期间综合管理（FICare）的可行性。方法以平行对照设计试验方案,对在中南大学湘雅三医院NICU中符合FICare组纳入标准的早产儿行FICare模式干预（建立FICare组医护团队,NICU改造,掌握六步洗手法、脐带护理、口腔护理、留置胃管管饲、婴儿洗澡、袋鼠式搂抱、称体重、皮肤护理、母乳喂养等）,选择同期NICU中符合对照组纳入标准的早产儿以常规护理模式干预。主要观察住院时间,次要观察体重增长速度、开始胃肠内喂养时间和达到全胃肠内喂养的时间、母乳喂养率、院内感染率、总氧疗时间、出院30 d内再次入院率和纠正胎龄37周时NBNA评分;附加观察FICare组家长出现在NICU后FICare医护团队工作期间心理压力、医疗费用、研究期间的医疗纠纷投诉率、病房额外开支、实施FICare后与前1年同期NICU的不良事件数量等。结果FICare组和对照组分别纳入30和60例,两组基线具可比性。FICare组和对照组NICU住院时间分别为（25.9±7.1）d和（29.2±6.0）d,差异有统计学意义（P=0.035）。两组开始胃肠内喂养日龄、院内感染率差异无统计学意义;FICare组与对照组比较,达全胃肠内喂养时间较快、母乳喂养率较高、体重增长速度较快、总的氧疗时间较短、出院30 d内再次入院率较低、纠正胎龄37周时NBNA评分较高,差异均有统计学意义。当FICare组家长出现在NICU,6/6名护士均在工作期间感觉心理压力增加）,护士自愿报名参加FICare课题组却增加了7人,没有医疗纠纷投诉, 总医疗费用减少,实施FICare后与前1年同期相比NICU的不良事件数量下降（每月2.2 vs 4次）。结论在中国NICU实施FICare具可行性,继续开展FICare的后续研究是安全的,但医护人员工作压力和NICU的额外支出有所增加。     

Outbreaks of nosocomial rotavirus gastro-enteritis in a paediatric ward

Faecal samples were collected from patients with gastro-enteritis during two winter seasons on a paediatric ward. Three outbreaks of nosocomial rotavirus gastro-enteritis were identified by latex agglutination and the virus strains were characterized by polyacrylamide gel electrophoresis of the genome nucleic acid and by subgrouping and serotyping enzyme-linked immunosorbent assays (ELISA). One outbreak was caused by serotype 1 rotavirus, one by serotype 2 and the remaining outbreak was caused by a mixture of serotypes 1 and 4. Identical electrophoretic patterns of the rotavirus genome in each outbreak combined with the ELISA results indicate that these three outbreaks were hospital-acquired cases. The index cases in the three outbreaks were community-acquired and one of two index cases in the second outbreak was hospital-acquired. On each occasion, susceptible roommates were easily infected from the index cases and then cross-infection occurred in the paediatric ward. Possible vehicles were the medical staff, especially doctors, parents of infected patients and infected patients who were moved to other rooms. One patient who had been treated with a series of antitumour therapies excreted rotaviruses in faeces for a long time period and probably played a role as a source.of the outbreak. Moreover, some patients still excreted rotaviruses in their normal stool 1 week after recovery from gastro-enteritis. These findings indicate that continual examination of stool samples for rotaviruses until they are negative may be important to prevent the spread of rotavirus infection.     

The harmful effects of noise in a children's ward

Because of concerns frequently expressed by members of staff about the annoyance caused by noise in a children's ward, noise levels were measured. These confirmed that ambient and peak levels were well in excess of levels recommended for hospital wards and were often above those recommended for average outdoor situations. The harmful effects of noise in general are discussed with regard to annoyance and the effects on hearing, performance, accident rates, social relationships and sleep. Interviews with members of ward staff confirmed a high degree of worry about noise levels and revealed that machines for ward cleaning were the most annoying noise source, followed by the crying of infants. Patients and parents probably suffer similar annoyance and distress from noise. Possible harmful effects on patients are discussed and measures to reduce noise levels in wards are suggested.     

The harmful effects of noise in a children's ward

Abstract Because of concerns frequently expressed by members of staff about the annoyance caused by noise in a children's ward, noise levels were measured. These confirmed that ambient and peak levels were well in excess of levels recommended for hospital wards and were often above those recommended for average outdoor situations.
The harmful effects of noise in general are discussed with regard to annoyance and the effects on hearing, performance, accident rates, social relationships and sleep. Interviews with members of ward staff confirmed a high degree of worry about noise levels and revealed that machines for ward cleaning were the most annoying noise source, followed by the crying of infants. Patients and parents probably suffer similar annoyance and distress from noise. Possible harmful effects on patients are discussed and measures to reduce noise levels in wards are suggested.     

Nosocomial rotavirus infections in a general pediatric ward: epidemiology, molecular typing and risk factors]

OBJECTIVES: Nosocomial rotavirus infections induce difficult problems for pediatric wards during winter epidemics. This prospective study was carried out to measure their incidence in a general pediatric ward by using epidemiological tools, clinical and molecular methods, and to examine the main factors increasing the risk of cross contamination. MATERIAL AND METHODS: The study was carried out on children, younger than three years old, hospitalized between 15 November 1996 and 1 March 1997. We examined the feces of all children for rotavirus on admission and during their hospital stay if they had developed diarrhea. The strains were typed by RNA electrophoresis. A cohort study was done to identify the factors of exposure to risk. RESULTS: Three hundred twenty-six of the 415 hospitalized infants were studied. One hundred and five were hospitalized for gastroenteritis, including 39 (37.1%) with rotavirus infection. Among 221 infants admitted without diarrhea, 11 (5.0%) had an asymptomatic community infection and nine (4.3%) developed nosocomial gastroenteritis. The only significant predisposing factor (P = 0.003) for nosocomial infection was the distance between the hospital rooms and the nurses station. Despite the low level of typing (51%), the molecular study suggested a wide diversity of nosocomial and community strains. CONCLUSION: The relatively low incidence of nosocomial infections found may be due to routine assignment to individual rooms, the isolation of infants admitted with acute diarrhea, and the policy of routine detection of asymptomatic carriers with the use of similar isolation measures for these children.     

Kangaroo mother care with limited resources

Kangaroo mother care (KMC) for low birthweight infants (LBWI) was introduced in a Mozambican hospital with limited resources and without facilities for intensive care. Six months were needed to change policies, organize the ward, train staff and overcome constraints. Facilitating factors were a KMC national policy, the commitment of health authorities, technical assistance and availability of some funds, and the perception of improved quality of care and survival. The obstacles and constraints were resistance to change by the staff, cultural problems, and managerial difficulties. Out of 32 LBWI (< or = 1.800 g) admitted in 3 months, survival was 73 per cent in 22 KMC and 20 per cent in 10 non-KMC infants (p < 0.01). KMC is a feasible and appropriate technology in hospitals with very limited resources.     

Ethanol resistive microbubble test: A modification of the stable microbubble test used to predict respiratory distress syndrome

The stable microbubble (SM) test on gastric aspirate obtained at birth proved useful in identifying infants who would develop respiratory distress syndrome (RDS). This test involves only the count of stable microbubbles of ≤ 15 μm in diameter. Larger bubbles (> 15 μm in diameter) are not necessary for the test and may interfere with stable microbubble counting. The aims of the present study were to determine: (i) if larger bubbles could be selectively removed by adding ethanol, a potent bubble breaker; and (ii) if the predictive value of this modified test, the ethanol resistive microbubble (ERM) test, on the development of RDS was similar to that of the SM test. Varying amounts of different concentrations of ethanol-water solutions were added to the top of the bubble crop generated by the SM test procedure, and the mean counts of stable microbubbles and larger bubbles in five regions were calculated. A volume of 10 μL of 47.5% ethanol was effective in defoaming larger bubbles generated by the SM test procedure without altering the stable microbubble counts. When concurrently performed on 43 samples of gastric aspirate obtained at birth from infants of less than 35 weeks gestation, the RDS predictive value of the ERM test was similar to that of the SM test. It was concluded that the ERM test may serve as an alternative to the SM test.     

Management of febrile infants younger than 2 months of age at the Emergency Care Unit: diagnosis aspects and therapeutics

82 febrile young infants were studied, prospectively, at the Emergency Service in Hospital Universitário-University of S?o Paulo. All the children were kept at the Emergency ward for 24 hours. Clinical and laboratory investigations were performed and when necessary, administration of antibiotic agents were started. 18 infants exhibited potentially severe bacterial infections (21.9%). Several important disorders were recognized in 40 infants (48.8%). All infants were followed until the end of the febrile episode: 20 children as inpatients and 62 as outpatients. 38 infants received antibiotic therapy (46.3%). Evolution was satisfactory in all patients. The authors detected in young febrile infants potentially dangerous clinical conditions that need close observation, laboratorial investigation and frequently antimicrobial therapy. The observation period at the Emergency ward was important to allow these procedures and to decide about hospitalization need.