肺脏超声对新生儿肺炎诊断价值的Meta分析

目的　采用 Meta 分析方法来评价肺脏超声对新生儿肺炎的诊断价值。方法　检索PubMed、Cochrane library、Embase、CNKI 和万方数据库，按照诊断性试验的纳入和排除标准，获取符合本研究要求的文献，检索时间为建库至 2018年9月。共检索到907篇文献，选取其中8篇进一步分析，并对文献质量进行QUADAS2标准评价，采用Q检验和I 2统计量进行异质性检验，采用 Meta-Disc 1.4 软件进行统计学分析，评价肺脏超声对新生儿肺炎的诊断价值。 结果　共纳入8篇文献、1078例。采用随机效应模型对纳入的研究进行统计分析，合并敏感度为0.96（95%CI：0.95～0.98），合并特异度为0.98（95%CI：0.95～0.99），合并阳性似然比为19.52（95%CI：5.00～76.15），合并阴性似然比为0.04（95%CI：0.01～0.16），合并诊断优势比为565.45（81.80～3908.58），拟合ROC 曲线下面积0.9950。结论　肺脏超声诊断新生儿肺炎的敏感度和特异度较X线高。鉴于其相对容易操作、实时可用、低成本和无电离辐射，目前的证据支持超声作为新生儿肺炎诊断的替代手段。     

肺表面活性物质在防治早产儿肺透明膜病中的应用

目的 观察肺表面活性物质(PS)在防治早产儿呼吸窘迫综合征(NRDS),改善其生存质量中的作用.方法 生后立即气管内滴注单剂PS28例,并与同期未用PS的20例早产儿进行临床对照研究.结果 治疗组在吸氧方式,吸氧时间,经皮血氧饱和度监测,血气分析值,以及其他并发症的产生都优于对照组.结论 早期应用对早产儿改善缺氧,减少并发症,最终提高其生存质量有积极作用.     

Assessment and Management of Procedural Pain During the Entire Neonatal Intensive Care Unit Hospitalization

BackgroundDespite strong evidence that repeated pain exposure in neonates is associated with adverse outcomes, pain assessment and management continues to be less than optimal in most neonatal intensive care units (NICUs).AimsTo evaluate current pain assessment and management practices, and identify factors associated with optimal treatment throughout a cohort of preterm neonates over the entire hospital stay.DesignA secondary analysis of study data collected from 2012 to 2016 as part of a larger clinical trial and supplemental chart review.SettingsTertiary level neonatal intensive care unit.Participants/Subjects242 stable preterm neonates born at less than 37 weeks gestational age.MethodsData were analyzed quantitatively using R for statistics.ResultsThe 242 neonates underwent a total of 10,469 painful procedures (4,801 tissue breaking and 5,667 non–tissue breaking, with only 56.6% and 12.2% having a documented pain score using the Premature Infant Pain Profile, respectively). Average pain exposure was 43 with a median of 32(10-576) per entire hospital stay. Documented pain score and greater postnatal age were associated with higher use of a pain reducing intervention and lower gestational age, first day, first week, higher illness severity, non tissue breaking and night time procedures were associated with lower. Use of a pain relieving intervention was documented in 58.5% of procedures. Sucrose was most commonly used pharmacologic and non nutritive sucking the most common non pharmacologic interventions.ConclusionsIncreased efforts are needed to promote consistent pain assessment and management to ensure optimal outcomes for vulnerable at risk neonates.     

思美泰与还原型谷胱甘肽治疗新生儿胃肠外营养相关性胆汁淤积的临床疗效研究

目的:探讨思美泰与还原型谷胱甘肽治疗新生儿胃肠外营养相关性胆汁淤积(PNAC)的临床疗效。方法:将2006年2月～2010年8月诊断为胃肠外营养相关性胆汁淤积的新生儿随机分为治疗组和对照组,治疗组44例采用抗感染、肝酶诱导、思美泰、还原型谷胱甘肽治疗,对照组43例采用抗感染、肝酶诱导、肝泰乐护肝传统治疗,比较两组的疗效。结果:治疗组退黄、降酶作用明显,总有效率为95.4%,对照组总有效率为69.7%,差异有统计学意义(χ2=15.6,P<0.05)。结论:思美泰与还原型谷胱甘肽治疗PNAC能有效退黄、降酶,作用明显,未见明显不良反应。     

微型培训模式提高ICU护士应急能力的效果

目的：探讨微型培训模式提高ICU低年资护士应急能力的效果。方法选取ICU低年资护士98例,对所有ICU护士采用微型培训模式进行专科培训,记录并比较培训前后护士的病情观察、应急配合、规范抢救程序的掌握情况等指标。结果培训后ICU护士病情观察、应急配合、抢救程序测评得分分别为（90．35±3．62）,（89．87±3．32）,（89．59±3．44）分,高于培训前的（86．20±3．38）,（85．28±3．29）,（85．24±3．68）分,差异有统计学意义（t值分别为8．533,10．766,8．048;P＜0．05）。培训后ICU护士在病情观察、应急配合以及抢救程序环节中各方面得分均显著优于培训前,差异均有统计学意义（P＜0．05）。结论采用微型培训模式进行专科培训对理论及实际操作水平的提高具有显著效果,大大加强了低年资护士的应急能力。     

Contributing to Content Validity of the Infant-Driven Feeding Scales© through Delphi surveys

The Infant-Driven Feeding Scales© (IDFS) assess a preterm infant’s readiness for oral feeding, evaluate the infant’s quality of feeding, provide a guide for intervention, and provide a standardized format for documentation (Ludwig and Waitzman, 2007). Since its inception, the IDFS have evolved over time with changes in language and clarity founded on clinical experience, best-practice information from the literature, and knowledge of existing infant feeding assessments. This paper presents additional evidence to support the content validity of the IDFS by reporting opinions collected from neonatal feeding experts by way of the Delphi Technique. Updates to the IDFS are presented.     

Knowledge,practice and attitudes towards breastfeeding among mothers of infants with retinopathy of prematurity (ROP)

BackgroundBreastfeeding has several benefits for both the infants and mothers. This study assessed breastfeeding knowledge, attitudes, and practices (KAP) among mothers of infants with Retinopathy of Prematurity (ROP).MethodsA cross-sectional study was conducted among mothers of infants with ROP visiting the ROP clinic in a selected tertiary care centre. A total of 100 mothers were selected through the convenience sampling method and interviewed using a structured questionnaire.ResultA significant number of mothers had average to poor knowledge (81%) with a mean score of 8.32 ± 2.7. More than half of the mothers had poor practices related to breastfeeding with a mean score of 7.6 ± 2.4. The attitudes of the mothers towards breastfeeding was either neutral or positive towards formula feeding.ConclusionThe KAPs of mothers regarding breastfeeding were inadequate. Intervention measures are recommended for promoting breastfeeding practices among the mothers of infants with ROP.