Association between anemia and postoperative complications in infants undergoing pyloromyotomy

BackgroundAlthough preoperative anemia has been suggested to predict postsurgical morbidity and mortality among infants < 1 year of age, the data were drawn from heterogeneous patient cohorts including severely ill infants undergoing complex, high-risk procedures. We aimed to determine whether untreated preoperative anemia was associated with increased risk of postoperative complications in infants < 1 year of age who underwent pyloromyotomy, a common and relatively simple surgery.MethodsInfants < 1 year of age undergoing pyloromyotomy were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric database. Preoperative anemia was defined as a hematocrit ≤ 40% for infants 0–30 days of age and ≤ 30% for infants more than 30 days of age. Patients who received pre- or postoperative blood transfusions were excluded.ResultsWe identified 2948 patients who met our inclusion criteria, of whom 843 were anemic (29%). The overall rate of complications in this cohort was 6%. The most common postoperative complications were readmission (97 cases), surgical site infection (43), reoperation (39), prolonged hospital stay (24), urinary tract infection (3), 30-day mortality (3) and cardiac arrest (2). We found no differences in the incidence of complications in anemic versus nonanemic patients on bivariate analysis or multivariable logistic regression (adjusted odds ratio = 1.2; 95% confidence interval: 0.8–1.7; P = 0.319).ConclusionsIn relatively healthy infants undergoing pyloromyotomy, untreated preoperative anemia was not associated with postoperative compilations and should not be considered a significant risk factor.Level of evidence III.     

Path to impact: A report from the Bill and Melinda Gates Foundation convening on maternal immunization in resource-limited settings; Berlin – January 29–30, 2015

Global initiatives such as the Millennium Development Goals have led to major improvements in the health of women and children, and significant reductions in childhood mortality. Worldwide, maternal mortality has decreased by 45% and under-five mortality has fallen by over 50% over the past two decades [1]. However, improvements have not been achieved evenly across all ages; since 1990, under-five mortality has declined by ∼5% annually, but the average decrease in neonatal mortality is only ∼3% per year.Against this background, the Bill and Melinda Gates Foundation (BMGF) convened a meeting in Berlin on January 29–30, 2015 of global health stakeholders, representing funders, academia, regulatory agencies, non-governmental organizations, vaccine manufacturers, and Ministries of Health from Africa and Asia. The topic of discussion was the potential of maternal immunization (MI) to achieve further improvements in under-five morbidity and mortality rates in children, and particularly neonates and young infants, through targeting infectious diseases that are not preventable by other interventions in these age groups. The meeting focused on effective and appropriately priced MI vaccines against influenza, pertussis, and tetanus, as well as against respiratory syncytial virus, and the group B Streptococcus, for which no licensed vaccines currently exist.The primary goals of the BMGF 2015 convening were to bring together the global stakeholders in vaccine development, policy and delivery together with the Maternal, Newborn and Child Health (MNCH) community, to get recognition that MI is a strategy shared between these groups and so encourage increased collaboration, and obtain alignment on the next steps toward achieving a significant health impact through implementation of a MI program.     

TLR9在不同胎龄新生儿脐血中的表达变化

目的 通过观察早产儿不同胎龄Toll样受体9（TLR9）的表达，探讨早产儿免疫功能低下的机制。方法 采集2010年7月至2014年6月在上海市嘉定区妇幼保健院产科出生的活产新生儿的脐血229份，按胎龄分为4组，28~31周组，31~34周组，34~37周组，≥37周组，采用流式细胞术和实时荧光定量PCR方法，分别检测其TLR9的蛋白和mRNA表达情况，了解其与胎龄之间的关系，并分析mRNA和蛋白表达间的相关性。结果 TLR9阳性细胞率在28~31周组，31~34周组，34~37周组，≥37周组分别为（15.93±6.23）%，（11.63±6.70）%，（13.66±6.88）%，（20.51±12.06）%；其在胎龄28~31周较高，至31~34周逐渐下降至最低，两组差异有统计学意义（P<0.05）；34~37周后TLR9阳性细胞率表达逐渐升高，至≥37周达最高，两胎龄组比较，差异具有统计学意义（P<0.05）。31~37周间新生儿脐血TLR9阳性细胞率与胎龄呈正相关（r=0.273，P=0.006）。TLR9 mRNA表达在28~31周组，31~34周组，34~37周组，≥37周组分别为（4.95±3.44）%，（8.89±8.49）%，（13.91±10.92）%，（7.19±7.11）%；其在28~36周逐渐升高，与胎龄呈正相关（r=0.355，P< 0.001）。≥37周TLR9 mRNA表达量下降，该值虽高于28~31周，但差异无统计学意义（P>0.05）。相关性分析表明，同胎龄时期同样本新生儿的TLR9 mRNA和TLR9阳性细胞率之间存在负相关（r=-0.227，P=0.011）。结论 TLR9阳性细胞率和TLR9 mRNA表达在不同胎龄组新生儿间有差异，TLR9阳性细胞率表达在31~37周间随着胎龄的增加而增加，TLR9 mRNA在28~36周间随着胎龄的增加而增加。     

Extrapolation for a pharmacokinetic model for acetaminophen from adults to neonates: A Latin Hypercube Sampling analysis

Physiological and drug-specific parameters need to be adjusted when extrapolating a pharmacokinetic (PK) model from adults to neonates, so as to reproduce the time profiles of the studied drug(s) consistent with clinical, in vivo data or in vitro cell line measurements. In this paper we present a parameter analysis method, i.e. the Latin Hypercube Sampling (LHS) method for an acetaminophen (APAP) PK model. The original model consists of two compartments (the blood and the urine) with Michaelis-Menten kinetic parameters determined for APAP and its metabolites. The physiological parameters are scaled through allometric laws from adults to neonates, and APAP-specific parameters are adjusted for enzymatic maturational changes. The LHS method is used to statistically investigate the interplay between these parameters. The results for the extrapolated APAP model are consistent with published APAP PK data in neonates. We found the sulphation clearance parameter played a crucial role in the neonatal PK model, but its influence was weakened if the volume of distribution parameters were included. We suggest that this kind of in silico experiment could be valuable as the first step in PK model extrapolation between different ages.     

Massage therapy as a non-pharmacological analgesia for procedural pain in neonates: A scoping review

IntroductionNeonates who undergo painful medical procedures should be given analgesics to reduce future adverse risks. The evidence for massage therapy (MT) as an analgesic method still varies, both in its terminology and implementation. Only a few studies on this topic have been conducted using a standardised trial approach. This review can thus become the basis for better future research.ObjectiveThis review aims to identify literature on MT practices as a method to manage or control pain in neonates undergoing painful procedures.MethodsThe methodology for this review followed the JBI scoping review methodology guidelines. Searches were performed in several databases: MEDLINE (PubMed), CINAHL (EBSCO), Scopus (Elsevier) and EMBASE. Data collected were then extracted by two independent reviewers, synthesised and presented in the form of tables and narratives.ResultsFifteen studies involving a total of 1,058 neonates in nine countries were identified in the search as meeting the criteria set for this review. One study was a comparative study, five were quasi-experiment studies and nine were randomised control trials (RCT).ConclusionThe implementation of massage as a non-pharmacological analgesic method for neonates undergoing painful procedures varied among the reviewed studies. Differences were identified in terms of the body part massaged, the duration and intensity of the massage, the level of pressure and the combination of massage with other methods. All studies presented positive results for reducing pain intensity in neonates undergoing procedural pain. Therefore, it is crucial that the method used for giving massage should be practical, accurate and safe.     

How to optimize the evaluation and use of antibiotics in neonates

Early and late-onset neonatal sepsis has specific pathogen distribution and infection rates in neonates with different gestational and postnatal ages. Despite the fact that early-onset sepsis is relatively rare (<1% of total deliveries), it is a major cause of mortality and morbidity. The known immunological immaturity of the neonate combined with non-specific clinical symptoms of infection has resulted in the frequent overuse of antibiotics in neonatal intensive care units (NICUs). In addition to this overuse there is a huge variability in the choice of antibacterial agents and dosing regimens used in NICUs across the world. Therefore, a more rational approach in the neonatal use of antibiotics is needed because of two major reasons: the emergence of multi-resistant bacteria in NICUs, and short- and long-term side effects of frequently used antibacterial agents in the neonatal population. This paper will focus on the optimal use of aminoglycosides (both used in early and late onset sepsis) and vancomycin (primarily used in late onset infections) in NICUs, and will underscore the need for specialists in neonatal medicine and pediatric pharmacology to work closely together to reach the most effective and safe way of using medicines in the NICU.     

出院后营养管理对新生儿肠道手术后生长速度的影响

目的：探讨出院后科学的营养管理对新生儿肠道术后生长速度的影响。方法通过营养门诊对113例肠道手术后患儿进行出院后营养喂养指导,统计每月生长速度（体质量、身长和头围）,对照正常参考值,分析落后的体格何时出现生长加速。结果新生儿肠道手术后1月时出现体格增长速度低于正常参考值,以男性为著（体质量P＝0．000;身长P＝0．041;头围P＝0．010）。生长加速出现在术后2～3月,男性出现身长的生长加速（月增长值[（4．53±1．22） cm比（3．1±0．4） cm, P＝0．013],女性出现体质量[（1．51±0．76） kg比（0．83±0．39） kg, P＝0．028]和头围[（2．50±0．93） cm比（1．2±0．7） cm, P＝0．021]的生长加速。结论科学的出院后营养管理有助新生儿术后体格生长加速,术后2～3月是生长加速的关键时期。     

连续性血液净化与新生儿急性肾损伤

新生儿急性肾损伤（ acute kidney injury,AKI）是新生儿危重症之一,在新生儿重症监护病房中的发生率高达23％,病死率25％～50％。新生儿AKI是指新生儿在低血容量、窒息、休克、缺氧、溶血、低体温等各种不利因素导致肾功能受到损害,出现少尿或无尿、电解质紊乱、酸碱平衡失调及血浆中肾排出的代谢产物（尿素、肌酐等）浓度增高。目前,新生儿AKI暂无有效的防治措施。近年来,随着血液净化技术进步,连续性血液净化（ continuous blood purification,CBP）应用范围已从儿童AKI已发展到新生儿AKI。由于新生儿血液动力学不稳定及血容量小等特点,CBP在新生儿AKI中应用仍然面临诸多问题。该文就新生儿AKI的高危因素、诊断标准、新生儿CBP治疗相关问题等进行综述。     

新生儿单肺通气的麻醉管理(附20例报告)

目的探讨新生儿食管端端吻合手术中单肺通气(OLV)麻醉的可行性和安全性.方法对20例日龄4h～17d、体重1.5～3.2kg的食管闭锁及气管食管瘘患儿,快速诱导后,在正气管插入单腔气管导管,右侧开胸,使术侧肺脏压迫萎陷造成左侧单肺通气(OLV).术中连续监测心率(HR)、动脉压(ABP)、心电图(ECG)、脉搏血氧饱和度(SpO2)、呼气末CO2分压(PETCO2)、体温(T);记录诱导前后OLV10min、OLV30min,术毕的SpO2、PETCO2、HR值,比较各时段呼吸循环参数变化.结果全部患儿单肺通气后SpO2均有下降,经适当处理,14例患儿SpO2维持在95%以上.3例患儿应用呼气末正压通气(PEEP),可维持SpO2在94%以上.另3例患儿在暂停手术操作、恢复双肺通气后,SpO2恢复正常.与诱导后相比,PETCO2在单肺通气后10min及30min分别为(30.2±3.6)、(29.5±4.8)mmHg,显著低于诱导后的(35.1±0.6)mmHg(P＜0.05).HR在单肺通气后各时段呈显著降低趋势(P＜0.05).结论采用正气管插管技术,应用合理的呼吸管理,适当的麻醉用药,新生儿单肺通气行类似于食管端端吻合手术是安全可行的.