二维斑点追踪显像技术评估窒息新生儿左心室纵向收缩功能与心肌损害的相关性

【摘要】目的 探讨二维斑点追踪显像技术(2D-STI)评估新生儿窒息合并心肌损害后左心室整体及局部心肌的纵向收缩功能在早期诊断窒息新生儿心肌损害中的临床价值。方法 选择2019年07月至2020年12月期间在右江民族医学院附属医院新生儿科住院的足月窒息新生儿61例，经临床确诊合并心肌损害，根据Apgar评分分为轻度组31例和重度组30例，选择同期住院出生的正常足月新生儿30例作为对照组。检测受检者的血清肌酸激酶同工酶（CK-MB）、肌钙蛋白（cTnT）、左室舒张期前后径（LVDId）、左室射血分数（LVEF）、左室短轴缩短率（LVFS）、辛普森法左室射血分数（Simpson EF）、左室三腔心整体应变（GLS-LAX）、左室四腔心整体应变（GLS-A4C）、左室两腔心整体应变（GLS-A2C）、左室整体应变（GLS-AVG）,分析GLS-AVG和CK-MB、cTnT三者的相关性。结果 三组间CK-MB和cTnT比较差异有统计学意义（P<0.05）。三组间性别、体重、胎龄均无统计学差异（P>0.05）。三组间LVDId、LVEF、LVFS、Simpson EF比较差异无统计学意义（P>0.05）。GLS-AVG与CK-MB呈负性相关（r=-0.515，P=0.000），GLS-AVG与cTnT呈负性相关（r=-0.912，P=0.000）。结论 GLS-AVG与CK-MB、cTnT具有相关性，GLS-AVG可作为窒息新生儿心肌损害早期诊断指标。     

原发性免疫缺陷病和脊髓性肌萎缩症临床特点及新生儿早期联合筛查实践

原发性免疫缺陷病(PID)及脊髓性肌萎缩症(SMA)均是由基因突变引起的能严重影响儿童健康甚至导致死亡的遗传性出生缺陷,早期发现和及时诊断治疗是影响预后的关键,新生儿筛查是目前实现早期诊断和干预的有效手段。近年来部分国家和地区已将SMA和PID中最为严重的重症联合免疫缺陷病(SCID)和最常见的B细胞缺乏症X连锁无丙种球蛋白血症(XLA)纳入新生儿筛查范围。浙江省在国内首次开展对SCID、XLA和SMA三种遗传性疾病的新生儿早期联合筛查实践,极大地提高了筛查效率,使出生缺陷三级预防关口前移,有助于显著改善患者的预后、提高生活质量、降低死亡率。     

Systematic Review of the Effectiveness of Involving Parents During Painful Interventions for Their Preterm Infants

ObjectiveTo systematically review the literature related to the effectiveness of parents’ active involvement during painful interventions for their preterm infants.Data SourcesWe performed a systematic search of PubMed, EMBASE/Ovid, CINAHL, Livivio, and PsycInfo using the keywords “preterm infants,” “pain,” and “parents.”Study SelectionArticles were eligible for inclusion if they were published between 2000 and 2021 and reported randomized controlled trials (RCTs) in which preterm infants underwent painful interventions, and parents were present and actively involved in pain-reducing measures.Data ExtractionWe used the Consolidated Standards of Reporting Trials (CONSORT) checklist for RCTs for data extraction. We assessed methodologic quality using critical appraisal for RCTs according to the Joanna Briggs Institute.Data SynthesisIn total, 22 articles met the inclusion criteria. These articles reported 19 studies focused on kangaroo/skin-to-skin care, one focused on breastfeeding, and two focused on facilitated tucking. The methods used to evaluate pain in the infant varied substantially. Overall, kangaroo/skin-to-skin care and facilitated tucking resulted in clinically and statistically significant decreases in pain. For breastfeeding, effectiveness was linked to a more mature sucking pattern of the preterm infant.ConclusionThe current evidence suggests that involving parents in pain-reducing measures during painful interventions for their preterm infants is beneficial. However, more research is needed for the different methods of involving parents in pain-reducing measures.     

Vaccination rates and adherence in pneumococcal conjugate vaccination in mature born infants before and after vaccination schedule change – A claims database analysis

BackgroundIn August 2015, the German Standing Committee on Vaccination (STIKO) changed the pneumococcal conjugate vaccination (PCV) schedule for mature infants from a 3+1 scheme to a 2+1 scheme. It was expected that a reduction of doses would be associated with a higher acceptance of the vaccination. Aim of this study was to assess vaccination rates and adherence for PCV after the change of recommendation based on real-world data.MethodsA retrospective claims data analysis using the InGef Research Database was conducted. The study population consisted of all mature infants born in 2013 (last birth cohort completely under 3+1 recommendation) or 2016 (first birth cohort completely under 2+1 recommendation) with an individual follow-up of 24 months. Hexavalent combination vaccination (HEXA) with a consistent 3+1 recommendation was analyzed as reference.ResultsAfter follow-up of 24 months, 90.9% (91.2%) of the 2016 (2013) cohort received at least one dose of PCV. At the same age, 67.7% of the 2013 cohort received a booster dose according to the 3+1 schedule and 75.6% of the 2016 cohort received a booster dose presumably either according to the 2+1 (71.7%) or 3+1 (3.9%) schedule. Of those receiving the booster dose, only 46.3% (2016) and 45.1% (2013) received the booster dose on time as recommended. The HEXA vaccination rate increased from 88.9% (2013) to 91.6% (2016) with a full series completion in 69.1% (2013) vs 72.9% (2016). The proportion of infants receiving the booster vaccination on time rose to 50.0% in 2016 (47.8% in 2013).ConclusionsAlthough the rate for the PCV booster dose slightly increased, nearly a quarter of the infants born in 2016 did not receive a booster dose at all. Furthermore, vaccinations were still frequently delayed, and the rate of unvaccinated infants remained constant.     

Vaccination rates and adherence in premature infants before and after pneumococcal conjugate vaccine schedule change for term infants – A claims database analysis in Germany

BackgroundIn 2015, the German Standing Committee on Vaccination (STIKO) changed the pneumococcal conjugate vaccination (PCV) schedule for mature infants from a 3+1 scheme (2, 3, 4, and 11–14 months of age) to a 2+1 scheme (2, 4, and 11–14 months of age). For premature infants, the 3+1 scheme remained. The aim of this study was to assess vaccination rates, completeness, and timeliness for PCV in premature infants before and after the modified recommendation.MethodsA retrospective claims data analysis using the “Institut für angewandte Gesundheitsforschung Berlin” Research Database was conducted. Premature infants born in 2013 and 2016 with an individual follow-up of 24 months were included. Hexavalent combination (HEXA) vaccination with a consistent 3+1 recommendation for mature and premature infants was analyzed as reference vaccination.ResultsAfter 24 months, the PCV rate for at least one dose remained stable in premature newborns of 2016 compared to 2013, while the HEXA vaccination rate increased slightly. However, a significant decrease of a completed PCV schedule (4 doses) in premature infants was noted, whereas the completeness of HEXA vaccination did not change. The timeliness of PCV in premature newborns increased for the first and the booster PCV, while the timeliness of HEXA immunization did not change from 2013 to 2016.ConclusionAlthough STIKO still recommends a 3+1 PCV schedule for premature infants in Germany, premature infants were vaccinated according to the changed recommendations for mature born infants. A substantial share of premature infants remained unvaccinated, and their vaccinations were often delayed.     

Patent ductus arteriosus in preterm newborns: A tertiary hospital experience

IntroductionPatent ductus arteriosus (PDA) in preterm infants has been associated with increased mortality and comorbidities. This study aimed to characterize the population of preterm infants diagnosed with PDA and to identify predictive factors of response to medical treatment of PDA.MethodsAn eight-year retrospective observational study was carried out, which included all preterm infants with a gestational age (GA) between 23 and 32 weeks diagnosed with PDA, admitted to the Neonatal Unit of the CHUSJ. Univariate comparative analysis was performed, and models for predicting the effectiveness of PDA treatment with ibuprofen were explored by multivariate logistic regression analysis.Results115 cases were included and 34 were excluded, with a final sample of 81 preterm infants with PDA. The univariate analysis revealed significant differences in the closure efficacy via medical treatment with ibuprofen in several variables, and a multivariate logistic regression model was obtained (discriminative capacity 72.2%, sensitivity 98.1%, specificity 57.1%), taking into account the effect of GA, type of delivery, need for diuretics treatment and platelet transfusion.ConclusionThis study enabled the population of preterm infants diagnosed with PDA to be characterized and the identification of a predictive model that can help predict the efficacy of medical treatment and thus contribute to optimizing the medical approach to the non-responders.     

羊水粪染对新生儿的影响

羊水粪染主要见于足月产及过期妊娠,胎便排入羊水是胎儿成熟的表征或胎儿宫内窘迫的征象已得到公认。胎盘清理胎便能力降低是近年来提出的新的观点,作为羊水粪染主要的发病机制之一备受关注。胎儿羊水粪染可损伤多个系统,可通过直接观察、超声等及时诊断羊水粪染,及时对胎儿及新生儿进行干预,尽可能的降低对围产儿的不利影响,提高其生命质量。     

男童性腺功能低下的诊治进展

男童性腺功能低下在儿科内分泌临床较为常见,主要表现为青春期延迟,性发育不良和下丘脑-垂体-性腺轴功能低下。按病因分为两大类:原发性性腺功能低下和继发性性腺功能低下(低促性腺激素性性腺功能低下)。男性儿童及青少年常因性腺功能低下就诊于儿科内分泌临床,而新生儿期及婴幼儿期的性腺功能低下却往往被忽视。目前对男童性腺功能低下的诊断和处理存在不少争议和困难,本文就此问题进行讨论,期望对儿科临床医生有所帮助。