新生儿重症监护室噪音的危害与控制

新生儿重症监护室(NICU)内噪音对新生儿具有潜在性危害.该文总结了噪音对新生儿的生理和心理的影响,同时指出提高医务人员对噪音危害的认识、加强NICU管理、科学设计和建设NICU、更新设备及改进医疗过程等,可减少NICU的噪音污染.     

PDCA循环模式应用于新生儿重症监护病房感染管理的效果研究

目的 通过改变新生儿重症监护病房(NICU)感染管理模式,探索提高NICU医院感染管理质量的有效途径.方法 本院2010年开始将计划、实施、检查、处理(PDCA)循环模式引入NICU的感染管理工作,通过目标性监测,及时发现感染隐患,制定针对性的感染控制干预措施和标准操作规程,并对干预措施的落实加以巩固.观察2009年和2010年NICU医院感染率及相关质控指标的变化.结果 2009年NICU医院感染率16.9%,2010年NICU医院感染率9.6%,两年比较差异有统计学意义(χ2=7.936,P＜0.05);2010年NICU环境卫生学监测合格率及工作人员的手卫生依从性明显提高,与2009年比较差异均有统计学意义(P均<0.05).结论 NICU引进PDCA循环管理模式,能够提高感染管理质量,降低医院感染率.     

新生儿重症监护病房噪音对新生儿听力影响的临床观察

新生儿重症监护病房(NICU)中患儿听力损伤近年来受到越来越多的关注,Roizent[1]根据在NICU调研的结果,认为NICU噪音是耳聋发生的高危因素之一.国外文献报道[2]NICU中新生儿听力下降发生率20%～40%.孙建华等[3]报道新生儿重症监护室(NICU)中接受机械通气重症患儿及高危儿听力障碍发生牢为40.00%.美国第五次新生儿重症监护病房没计报告提出:建议NICU持续噪音限制在≤50dB(A),脉冲噪音限制在≤55 dB(A),国内尚无此方面标准或建议.     

新生儿轮状病毒性NEC:暴发流行期间的监测

轮状病毒(RV)引起新生儿疾病的作用是有争议的。1983年5月,一例坏死性小肠结肠炎(NEC)患儿转我们新生儿抢救室(NICU)行肠切除。5天后,一例以前无胃肠炎症状的新生儿发展成暴发性NEC,并发肠穿孔于24小时死亡。经粪便、肠病理等多种检查证实为轮状病毒。血清学检查证实两例均为RV感染。我们立即开始进行RV在NICU中流行的监测及严重胃肠道感染的易感因素对照研究。方法对NICU中每一例患儿均进行了历时18周     

新生儿重症监护病房医院内感染高危因素及防治策略

随着新生儿重症监护病房(neonatal intensive care unit,NICU)诊治技术的不断发展,医院内感染逐渐增多.做好NICU院内感染的监控工作,对提高新生儿的存活率及NICU的管理水平至关重要.该文分析探讨医院内感染的原因,并讨论医院内感染的防治对策.     

新生儿呼吸衰竭的机械通气治疗

应用呼吸机的机械通气治疗是新生儿重症监护病房(NICU)的主要工作之一,我院NICU用呼吸机治疗新生儿呼吸衰竭,取得满意效果,现报告如下.     

NICU中128例新生儿酸碱平衡紊乱及血液阴离子间隙状态分析

阴离子间隙(Anion Gap AG)是临床评价体液酸碱状态的重要指标,在新生儿重症监护室(NICU)中危重新生儿常伴有酸碱代谢紊乱.本文对我科NICU中128例新生儿进行血气分析、电解质测定及计算AG值,对其AG状态及其特点进行分析.     

新生儿症状性高血压的流行病学和处理

作者对Rainbou儿童医院1980年全年收入新生儿监护病房(NICU)的988例新生儿,进行了血压监测(每3小时一次,脐动脉插管者每半小时一次)。高血压的标准定为:至少有三次(不在同一天)平均动脉血     

新生儿重症监护室的手消毒顺应性观察

随着各种生命支持技术的进步和广泛应用,危重新生儿,尤其是早产儿的存活率大大提高.与之相应地长的住院时间和侵人性操作的大量使用,造成了新生儿重症监护室(NICU)内感染率的上升.在控制NICU感染的措施中,手卫生管理是一个重要环节.     

鼻塞持续气道正压和沐舒坦联合治疗新生儿呼吸窘迫综合征

新生儿呼吸窘迫综合征(NRDS)因缺乏肺表面活性物质(PS)所致,是新生儿重症监护室(NICU)中早产儿死亡的主要原因之一.     

数字视频脑电图在儿科重症监护室的应用

儿科重症监护室(NICU、PICU)的患儿常存在各种原因导致脑损伤,数字视频脑电图检查可为病因诊断、病情变化监测、评估、预后等提供帮助,现将数字视频脑电图在 NICU 和 PICU 中常见疾病中的应用进行综述。     

The role of critical incident monitoring in detection and prevention of human breast milk confusions

Feeding a mother’s expressed breast milk to the wrong infant is a well-known misidentification error in neonatal intermediate care units (NICU) with potential harmful consequences for the neonate. In this study, we aimed to analyze the role of critical incident monitoring on detection and prevention of human breast milk confusions. The critical incident monitoring made us aware of this misidentification error on our NICU. Despite the implementation of system changes to make breast milk application clearer and safer, we failed to reduce the incidence of breast milk confusions.     

Neonatal sepsis and infection control policies in Australia

The pattern of neonatal bacterial infection, its management and the types of infection control policy were ascertained in 20 neonatal intensive care units (NICU) in Australia by questionnaire survey. Group B Streptococcus and Escherichia coli were the predominant organisms responsible for perinatally acquired infection for which the most common antibiotic combination used was Penicillin and Gentamicin. Staphylococcus epidermidis and aureus (majority Methicillin resistant) were the predominant organisms responsible for nosocomial infection for which the most common antibiotic combination used was Vancomycin and Cefotaxime. A Serratia epidemic was experienced in four NICU. Lumbar and suprapubic punctures were frequently done as part of the diagnostic workup in nosocomial infections but not with perinatally acquired infections. Haematological indices considered useful as a diagnosis aid varied between NICU and acute phase reactants were rarely relied upon for diagnosis or for monitoring treatment response. Granulocyte transfusion and intravenous immunoglobulins were infrequently used in therapy. No consensus was found on infection control policies. Eight NICU required routine gowning on entry, two restricted sibling visiting and four restricted visiting by relatives and friends. Although routine bacteriological surveillance on staff or equipment was uncommon, serial cultures were carried out in infants from the body surface in six NICU and from the endotracheal aspirate in 17 NICU. Antiseptics used with technical procedures included iodine, chlorhexidine and alcohol used singly or in combination. Skin and umbilical cord care also varied between NICU. The literature was reviewed to determine the effectiveness or otherwise of some of the existing policies in the prevention or management of neonatal infection to encourage consensus towards a more rational approach to neonatal infection in Australia.     

Survey of the definition and screening of neonatal hypoglycaemia in Australia

Objective : To determine the approach to identifying neonatal hypoglycaemia and the definition of neonatal hypoglycaemia used by neonatal paediatricians in Australian Level 3 neonatal intensive care units (NICU).
Methodology : A questionnaire was sent to the 101 neonatal paediatricians in the 22 Level 3 NICU in Australia asking their method of screening for, and definition of, neonatal hypoglycaemia.
Results : Responses were received from 70 neonatal paediatricians, including all 22 directors. A bedside glucose meter is used in 19 of 22 NICU to screen for hypoglycaemia, whilst one NICU uses a glucose analyzer and another NICU uses a visual colour comparison method. One NICU does not screen, but has blood glucose measured in a satellite laboratory. If the screening method suggests hypoglycaemia, 62 of 63 neonatal paediatricians proceed to blood glucose determination in a laboratory, mostly using plasma samples. Based on the laboratory measurement, the definition of neonatal hypoglycaemia ranged from <1.1 to 3.0 mmol/L.
Conclusions : The majority of neonatal paediatricians in Australian NICU screen for neonatal hypoglycaemia using a bedside glucose meter. There is a wide range in the definition of neonatal hypoglycaemia from <1.1 to 3.0mmol/L.     

Intersociety policy statement on the use of whole-exome sequencing in the critically ill newborn infant

The rapid advancement of next-generation sequencing (NGS) technology and the decrease in costs for whole-exome sequencing (WES) and whole-genome sequening (WGS), has prompted its clinical application in several fields of medicine. Currently, there are no specific guidelines for the use of NGS in the field of neonatal medicine and in the diagnosis of genetic diseases in critically ill newborn infants. As a consequence, NGS may be underused with reduced diagnostic success rate, or overused, with increased costs for the healthcare system. Most genetic diseases may be already expressed during the neonatal age, but their identification may be complicated by nonspecific presentation, especially in the setting of critical clinical conditions. The differential diagnosis process in the neonatal intensive care unit (NICU) may be time-consuming, uncomfortable for the patient due to repeated sampling, and ineffective in reaching a molecular diagnosis during NICU stay. Serial gene sequencing (Sanger sequencing) may be successful only for conditions for which the clinical phenotype strongly suggests a diagnostic hypothesis and for genetically homogeneous diseases. Newborn screenings with Guthrie cards, which vary from country to country, are designed to only test for a few dozen genetic diseases out of the more than 6000 diseases for which a genetic characterization is available. The use of WES in selected cases in the NICU may overcome these issues. We present an intersociety document that aims to define the best indications for the use of WES in different clinical scenarios in the NICU. We propose that WES is used in the NICU for critically ill newborn infants when an early diagnosis is desirable to guide the clinical management during NICU stay, when a strong hypothesis cannot be formulated based on the clinical phenotype or the disease is genetically heterogeneous, and when specific non-genetic laboratory tests are not available. The use of WES may reduce the time for diagnosis in infants during NICU stay and may eventually result in cost-effectiveness.     

Arrhythmia in the Neonatal Intensive Care Unit

A random sample of 457 neonates was prospectively studied in order to identify the incidence, common types, and risk factors for arrhythmias in the neonatal intensive care unit (NICU). A 12-lead EKG was studied in all neonates (n = 457). A total of 139 Holter studies was done in every fourth baby with a normal EKG (n = 100) and in all babies with an abnormal EKG (n = 39). Of the 100 infants who were thought to be arrhythmia-free by EKG, nine infants demonstrated an arrhythmia on Holter studies. When we correlated screening results with maternal, obstetrical, and neonatal risk factors; arrhythmias were significantly associated with male gender, more mature gestational age, lower glucose levels, maternal smoking, high umbilical artery lines, and the use of the nebulized β-2 adrenergic treatment, whereas umbilical venous lines and dopamine infusion did not relate to arrhythmia. We conclude that arrhythmias are more common in the NICU than in the general neonatal population. Compared to Holter monitoring, the sensitivity of the EKG was only 89%.     

经鼻间歇正压通气治疗新生儿呼吸衰竭的随机对照研究

目的比较经鼻间歇正压通气(nIPPV)与经鼻持续气道正压通气（nCPAP）在新生儿呼吸衰竭中的疗效。方法采用RCT研究的方法,选择2008年1 ~12月在第三军医大学大坪医院NICU住院的呼吸衰竭新生儿作为研究对象,按随机数字表法将研究对象随机分为nIPPV组和nCPAP组,分别实施nIPPV 或nCPAP干预,观察患儿动脉血气分析、应用nIPPV和nCPAP时间、并发症和预后等指标,比较nIPPV组和nCPAP组治疗后需气管插管行机械通气的比例及其预后结局。结果研究期间nIPPV组纳入48例,nCPAP组纳入53例。两组在性别构成比、胎龄、年龄、出生体重、出生后5 min Apgar评分、新生儿急性生理学评分和应用肺表面活性物质比例等方面差异无统计学意义（P均>0.05）。两组呼吸衰竭原发病分布差异无统计学意义（P>0.05）。两组治疗前血气分析指标差异均无统计学意义（P均>0.05）,nIPPV组治疗后1 h血气分析pH和PaO2显著高于nCPAP组（P<0.05）。nIPPV组治疗成功率为77.1%(37/48例),nCPAP组为62.3%（33/53例）,nIPPV组显著高于nCPAP组（P<0.05）。nIPPV组和nCPAP组治疗成功的患儿平均应用nIPPV和nCPAP的时间差异无统计学意义（P均>0.05）。nIPPV组的预后结局中治愈和好转出院45/48例（93.8%）, nCPAP组为46/53例（86.8%）,两组差异无统计学意义（P>0.05）。结论与nCPAP相比,nIPPV治疗可显著降低呼吸衰竭新生儿气管插管行机械通气的比例。     

新生儿抗生素合理使用研究进展

抗生素是新生儿重症监护病房（NICU）的常用药物。然而,在生后早期,不必要地或长时间地暴露于抗生素,可增加新生儿发生不良预后的风险。NICU中的抗生素治疗大多始于经验性治疗。新生儿经验性抗生素治疗的启动标准及治疗疗程尚不统一。针对细菌培养阴性且临床表现稳定的新生儿,及时终止经验性抗生素治疗已成为共识。目前NICU中抗生素的使用存在较大差异。采取针对性的抗生素管理措施,是优化NICU抗生素使用方案的有效途径。     

An ounce of prevention: decreasing painful interventions in the NICU

Despite a proliferation of literature relative to pain physiology, assessment, and treatment, pain management in NICUs remains inconsistent--most often focused on assessment and treatment rather than prevention. The acceptance of pain as an inevitable part of NICU hospitalization is part of the culture in many NICUs. This article is intended to encourage discussion of pain prevention in the NICU, with a goal of creating a new "minimal-pain" NICU culture. The focus of NICU pain management programs should be on decreasing the number of painful events the NICU patient experiences. Areas for consideration include assessing the performance of procedures by novice versus experienced NICU personnel, reevaluating the role of pediatric residents in the treatment of NICU patients, evaluating the use of umbilical lines and peripherally inserted central catheters to reduce the frequency of peripheral punctures, and evaluating the admission process for ways to reduce neonatal pain and stress. This article discusses the physiology of pain in the neonate, identifies adverse outcomes related to repeated pain, and proposes practice changes that can prevent unnecessary pain in neonatal care.