不同胎龄新生儿心电图T波的特点

Objective To evaluated T-wave characteristics in newborn infants with different gestational age. Methods One hundred and forty-two newborn infants were divided into four groups based on the gestation age consisting of the 28～30 weeks group,31～33 weeks group,34～36 weeks group and 37～40weeks group, respectively. The T-wave characteristics of electrocardiogram were compared among the newborn infants of four groups. Results TV1 amplitudes ( mV, median ( interquartile range) ) of 4 groups were -0. 10( -0. 30～0. 10), -0. 10( -0. 30～0. 15), -0. 10( -0. 45～0. 25 ) and 0. 10( -0. 30～0. 70) ,respectively. There was a statistical elevation of TV1 amplitude with the increase of the gestational age. TV5 amplitudes( mV, median ( interquartile range ) ) of 4 groups were 0. 10 ( - 0. 10～0. 30), 0. 10 ( - 0. 20～0. 30) ,0. 15( -0. 05～0. 25) and 0. 10( -0. 10～0. 50) ,respectively. No significant differences of TV5 amplitudes were found among 4 groups. The incidences of low or inverted T-waves in leads I and aVL, or low and flat T-waves in all leads reduced significantly with the increase of the gestational age. Conclusion The TV1 amplitude and the incidence of abnormal T-wave in newborn infants are correlated to the gestational age,and TV5 amplitude is not correlated to the gestational age.     

口服氟康唑在预防早产儿深静脉置管时真菌感染中的临床意义

Objective With the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions. Method This study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions ( alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis. Result Except for the proportion of infants bom via vaginal delivery in the control group (56/118, 47. 5% ) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either.Nine infants developed invasive fungal infection in control group (7. 6% ), while no invasive fungal infection was found in prophylaxis group (0%, P=0.01 ). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8. 5%(10/118) and6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks ( P = 0. 47 and 0. 63 ); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5%(9/106) in prophylaxis group after 4 weeks (P = 0. 62 and 0. 15). Conclusion For infants with PICC insertions and gestational ages at birth ≤32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.     

口服氟康唑在预防早产儿深静脉置管时真菌感染中的临床意义

Objective With the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions. Method This study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions ( alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis. Result Except for the proportion of infants bom via vaginal delivery in the control group (56/118, 47. 5% ) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either.Nine infants developed invasive fungal infection in control group (7. 6% ), while no invasive fungal infection was found in prophylaxis group (0%, P=0.01 ). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8. 5%(10/118) and6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks ( P = 0. 47 and 0. 63 ); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5%(9/106) in prophylaxis group after 4 weeks (P = 0. 62 and 0. 15). Conclusion For infants with PICC insertions and gestational ages at birth ≤32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.     

Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units

Background This study aimed to describe length of stay(LOS)to discharge and site variations among very preterm infants(VPIs)admitted to 57 Chinese neonatal intensive care units(NICUs)and to investigate factors associated with LOS for VPIs.Methods This retrospective multicenter cohort study enrolled all infants<32 weeks’gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network,within 7 days after birth in 2019.Exclusion criteria included major congenital anomalies,NICU deaths,discharge against medical advice,transfer to non-participating hospitals,and missing discharge date.Two multivariable linear models were used to estimate the association of infant characteristics and LOS.Results A total of 6580 infants were included in our study.The overall median LOS was 46 days[interquartile range(IQR):35-60],and the median corrected gestational age at discharge was 36 weeks(IQR:35-38).LOS and corrected gestational age at discharge increased with decreasing gestational age.The median corrected gestational age at discharge for infants at 24 weeks,25 weeks,26 weeks,27-28 weeks,and 29-31 weeks were 41 weeks,39 weeks,38 weeks,37 weeks and 36 weeks,respectively.Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals.Conclusions The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents.Large variation of LOS independent of infant characteristics existed,indicating variation of care practices requiring further investigation and quality improvement.     

影响早产儿20项行为神经评分的危险因素分析

Objective To analyze the characteristic of twenty-item premature behavioral neurological assessment,and to assess the risk factors of neonatal behavioral neurological assessment(NBNA) in premature infants. Methods Total two hundred and seventy-four premature infants hospitalized in Guangzhou Children's Hospital were assessed with the NBNA after correcting age 40 weeks,premature infants were divided into two groups:normal group (n =221 ) and abnormal group (n =53) according to NBNA. The birth history, mother pregnancy situation, the disease during neonatal period and results in hospital were reviewed,and the risk factors of NBNA in premature infants were assessed. Results There were significant differences in gestational age, birth weight, head circumference, body height, Apgar score, resuscitation time, hospitalization time and total gastrointestinal nutrition time between the two groups( P ＜ 0. 05 ). The incidences of superfoetation,hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease were different between the two groups( P ＜ 0. 05 ). There were no differences in gender, antenatal hormone use, anaemia, hypotension and evoked potential abnormality (P ＞0. 05 ). Multivariate logistic regression analysis showed that the risk factors of NBNA score in premature infants would include low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease. Conclusion Although the premature infants corrected age 40 weeks,but the capability and initiative muscular tension are still lower than term infant. Low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury ,severe infection ,hyperbilirubinemia,hypoglycemia and chronic lung disease are important risk factors related to premature behavioral neurological assessment.     

Changes and significance of type 2 innate lymphoid cells and their related factors in bronchopulmonary dysplasia北大核心CSCD

Objective To investigate the changes and significance of type 2 innate lymphoid cells (ILC2), interleukin-33 (IL-33), interleukin-25 (IL-25), thymic stromal lymphopoietin (TSLP), interleukin-5 (IL-5), and interleukin-13 (IL-13) in peripheral blood of preterm infants with bronchopulmonary dysplasia (BPD). Methods A total of 76 preterm infants with a gestational age of <32 weeks and a length of hospital stay of ≥14 days who were admitted to the Department of Pediatrics of the Affiliated Hospital of Jiangsu University from September 2020 to December 2021 were enrolled. According to the diagnostic criteria for BPD, they were divided into a BPD group with 30 infants and a non-BPD group with 46 infants. The two groups were compared in terms of the percentage of ILC2 and the levels of IL-33, IL-25, TSLP, IL-5, and IL-13 in peripheral blood on days 1, 7, and 14 after birth. Results The BPD group had significantly lower birth weight and gestational age than the non-BPD group (P<0.05). On days 7 and 14 after birth, the BPD group had significantly higher levels of ILC2, IL-33, TSLP, and IL-5 than the non-BPD group (P<0.05), and these indices had an area under the curve of >0.7 in predicting the devolpment of BPD (P<0.05). Multivariate logistic regression analysis showed that after adjusting for gestational age and birth weight, peripheral blood IL-33, TSLP and IL-5 on days 7 and 14 after birth were closely related to the devolpment of BPD (P<0.05). Conclusions Early innate immune activation and upregulated expression of related factors may be observed in preterm infants with BPD. ILC2, IL-33, TSLP, and IL-5 may be used as biological indicators for early diagnosis of BPD. © 2023 Xiangya Hospital of CSU. All rights reserved.     

Influencing factors for the development and severity of bronchopulmonary dysplasia in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g北大核心CSCD

Objective To study the influencing factors for the development and severity of bronchopulmonary dysplasia (BPD) in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g. Methods A retrospective analysis was performed on the medical data of preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g who were admitted to Women and Children's Hospital Affiliated to Xiamen University from January 1, 2017 to December 31, 2021. According to oxygen dependence on day 28 after birth, they were divided into two groups: BPD (n=218) and non-BPD (n=142). According to disease severity based on oxygen concentration required at the corrected age of 36 weeks or at discharge, the infants with BPD were divided into two groups: mild BPD (n=154) and moderate/severe BPD (n=64). Indices such as perinatal data and nutritional status were compared between groups. The multivariate logistic regression analysis was used to determine the influencing factors for BPD and its severity. Results The incidence rate and severity of BPD increased with the reduction in gestational age and birth weight (P<0.05). The multivariate logistic regression analysis showed that a long duration of invasive mechanical ventilation (OR=1.320, P <0.05), hemodynamically significant patent ductus arteriosus (OR=2.032, P<0.05), and a prolonged time to reach oral calorie goal of 110 kcal/(kg·d) (OR=1.041, P<0.05) were risk factors for BPD, while an older gestational age was a protective factor against BPD (OR=0.535, P<0.05). Early-onset sepsis (OR=2.524, P<0.05) and a prolonged time to reach oral calorie goal of 110 kcal/(kg·d) (OR=1.029, P<0.05) were risk factors for moderate/severe BPD, while a high mean weight growth velocity was a protective factor against moderate/severe BPD (OR=0.906, P<0.05). Conclusions The incidence rate and severity of BPD in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g can be reduced by shortening the duration of invasive mechanical ventilation, giving early treatment of early-onset sepsis and hemodynamically significant patent ductus arteriosus, adopting active enteral nutritional strategies, and increasing mean weight growth velocity. © 2022 Xiangya Hospital of CSU. All rights reserved.     

极低出生体质量儿闪光视觉诱发电位检测的临床意义

Objective To study the clinical significance of flash visual evoked potential(FVEP)detection in very low birth weight infants.Methods FVEP was performed in group of 43 very low birth weight infants with Medelecsynergy evoked potential instrument(Oxford Company,UK) comparing with the group of 56 term infants.Results The mean latency periods of N1,P1 and N2 waves in very low birth weight infant group were(181.43±26.73) ms,(217.27±26.54) ms,(249.21±26.49) ms respectively,while in term infant group were(159.51±18.27) ms,(200.26±13.94) ms,(231.56±15.72) ms.There were significant differences between two groups(P＜0.05,P＜0,001).The abnormal rates of main wave P1 were 75.6% and 0 respectively in very low birth weight infant group and term infant group.Furthermore,the major effect model for related influencing factors in very low birth weight infants with abnormal main wave was 3.898-2.861 intracranial lesion.Intracranial lesion was the independent risk factor for abnormal FVEP (0R=0.057,95% CI 0.006～0.579,P=0.015).Conclusion The abnormal rate of FVEP is higher in the very low birth weight infants,which is closely related to the intraeranial lesion.It is recomraended that FVEP is detected at least twice in the first month after birth or achieving the corrected gestational age of 42 weeks for dynamic observation.     

极低出生体质量儿闪光视觉诱发电位检测的临床意义

Objective To study the clinical significance of flash visual evoked potential(FVEP)detection in very low birth weight infants.Methods FVEP was performed in group of 43 very low birth weight infants with Medelecsynergy evoked potential instrument(Oxford Company,UK) comparing with the group of 56 term infants.Results The mean latency periods of N1,P1 and N2 waves in very low birth weight infant group were(181.43±26.73) ms,(217.27±26.54) ms,(249.21±26.49) ms respectively,while in term infant group were(159.51±18.27) ms,(200.26±13.94) ms,(231.56±15.72) ms.There were significant differences between two groups(P＜0.05,P＜0,001).The abnormal rates of main wave P1 were 75.6% and 0 respectively in very low birth weight infant group and term infant group.Furthermore,the major effect model for related influencing factors in very low birth weight infants with abnormal main wave was 3.898-2.861 intracranial lesion.Intracranial lesion was the independent risk factor for abnormal FVEP (0R=0.057,95% CI 0.006～0.579,P=0.015).Conclusion The abnormal rate of FVEP is higher in the very low birth weight infants,which is closely related to the intraeranial lesion.It is recomraended that FVEP is detected at least twice in the first month after birth or achieving the corrected gestational age of 42 weeks for dynamic observation.     

Factors affecting survival of children after abdominal trauma in Lebanese civil war

To evaluate the risk factors affecting the survival of children with war injuries involving the abdomen, 270 children under 16 years of age with abdominal injuries during the civil war in Lebanon were studied. One hundred and ninety (70%) sustained penetrating injuries and 80 (30%) blunt trauma. The overall infection rate was 7.8%. There were 13 deaths (4.8%), 7 early and 6 late. Mortality was higher in patients with shock on admission than in those without shock (P = .009). Multiple logistic-regression analysis showed that inadequate initial treatment requiring a second laparotomy (P = .01), severe hypovolemia requiring large blood transfusions (P = .0001), and multiple intra-abdominal injuries (P = .001) were the three independent risk factors that influenced the outcome of treatment. Wound infection was associated with a higher mortality in patients with penetrating injuries (P = .0001). This study suggests that in children with war injuries involving the abdomen, multiple injuries associated with excessive bleeding led to early death and wound infection in penetrating injuries to late death.M. S. Slim was previously Professor and Chief of Pediatric Surgery, American University of Beirut Medical Center, Beirut, Lebanon. This paper was presented in part at the 35th Annual International Congress of the British Association of Pediatric Surgery, Held in Athens, Greece, September 21–23, 1988 Offprint requests to: M. S. Slim     

New advances in the pathophysiologic and radiologic basis of the exstrophy spectrum

The exstrophy–epispadias complex is a rare spectrum of anomalies affecting the genitourinary system, anterior abdominal wall, and pelvis. Recent advances in the repair of classic bladder exstrophy (CBE) and cloacal exstrophy (CE) have resulted in significant changes in outcomes of surgical management (including higher continence rate, fewer surgical complications, and better cosmesis) and health-related quality of life in these patients. These noteworthy changes resulted from advances in the pathophysiological and genetic backgrounds of this disease and better radiologic assessment of the three-dimensional anatomy of the bony pelvis and its musculature. A PubMed search was performed with the keyword exstrophy. The resulting literature pertaining to genetics, stem cells, imaging, tissue engineering, epidemiology, and endocrinology was reviewed. The following represents an overview of the advances in basic science understanding and imaging of the exstrophy–epispadias spectrum and discusses their possible and future effects on the management of CBE and CE.     

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目的 观察脑苷肌肽注射液(国产神经节苷脂GM1)治疗新生儿缺氧缺血性脑病(HIE)的疗效.方法 2004年8月至2006年4月北京朝阳医院儿科对MCU收治的70例新生儿HIE患儿随机分为两组,治疗组(n=36)使用脑苷肌肽治疗,与对照组(n=34)使用胞二磷胆碱或1,6-二磷酸果糖治疗,通过比较两组患儿临床神经症状恢复时间及新生儿行为神经评分(NBNA)来判断药物的疗效.结果 脑苷肌肽与胞二磷胆碱或1,6-二磷酸果糖治疗新生儿HIE的疗效差异无显著性意义(P＞0.05),均能在7～10 d使神经症状恢复正常,在生后2周NBNA评分绝大多数在正常范围内.结论 早期应用脑苷肌肽治疗新生儿HIE有良好疗效.