新生儿B族链球菌感染现状的多中心前瞻性研究

目的 了解孕妇B族链球菌（group B Streptococcus,GBS）定植及新生儿早发型GBS疾病（early-onset GBS disease,GBS-EOD）的发生情况,并探讨GBS定植孕妇的子代发生GBS-EOD的影响因素。 方法 前瞻性纳入2019年5月1日至2020年4月30日在厦门市妇幼保健院、首都医科大学附属北京妇产医院和漳州正兴医院建档的16 384例孕妇及其分娩的16 634例新生儿作为研究对象。各研究中心采用统一的GBS筛查时间、培养方法和产时抗生素预防（intrapartum antibiotic prophylaxis,IAP）适应证,调查孕妇GBS定植率和新生儿GBS-EOD发生率,并应用多因素logistic回归分析评估GBS定植孕妇的子代发生GBS-EOD的影响因素。 结果 3所医院妊娠晚期孕妇GBS培养阳性率为11.29%（1 850/16 384）,新生儿GBS-EOD发生率为0.96‰（16/16 634）。GBS阳性组孕妇分娩活产儿收住院率高于GBS阴性组（P<0.05）。GBS阳性组孕妇分娩活产儿的GBS-EOD发生率［6.38‰（12/1 881）］高于GBS阴性组［0.27‰（4/14 725）］（P<0.05）。多因素logistic回归分析显示,胎盘拭子培养GBS阳性和新生儿出生时胃液培养GBS阳性是GBS定植孕妇子代发生GBS-EOD的独立预测因素（P<0.05）,而充分IAP为保护因素（P<0.05）。 结论 孕妇妊娠晚期GBS定植对其子代有不良影响。明确孕妇产前GBS定植状态,并依据IAP适应证给予充分IAP是减少其子代发生GBS-EOD的重要措施。 引用格式:     

青少年抑郁情绪及自杀意念与父母教养方式之间的关联研究

目的 研究青少年抑郁情绪及自杀意念与父母教养方式之间的关系。 方法 采用整群抽样法,于2014~2018年抽取河南省新乡市6 195名初高中生进行调查研究。调查工具包括一般社会资料问卷、父母教养方式问卷及Kutcher青少年抑郁量表（11项）。采用多因素logistic回归分析评估青少年抑郁情绪及自杀意念与父母教养方式之间的关联。 结果 有效问卷为6 194份,其中男性2 586名（41.75%）,女性3 608（58.25%）;年龄（16.4±1.9）岁（范围：11~20岁）。在6 194名青少年中,1 333名（21.52%）青少年有抑郁情绪,508名（8.20%）青少年有自杀意念。青少年的抑郁情绪与母亲的控制（OR=1.059,P<0.001）和父亲的控制呈明显正关联（OR=1.061,P<0.001）,而与母亲的关爱（OR=0.937,P<0.001）和父亲的关爱（OR=0.917,P<0.001）呈明显负关联。青少年的自杀意念与母亲的控制（OR=1.110,P<0.001）和父亲的控制（OR=1.076,P<0.001）呈明显正关联,而与母亲的关爱（OR=0.895,P<0.001）和父亲的关爱（OR=0.914,P<0.001）呈明显负关联。 结论 父母的关爱可降低青少年抑郁情绪的发生风险,而父母控制性可增加青少年抑郁情绪及自杀意念的发生风险。 引用格式:     

儿科医护人员对儿童疼痛认知和管理现状的调查

目的了解儿科医护人员对儿童疼痛认知及临床疼痛管理的现状。方法对南京地区部分三级甲等医院118名儿科医师和158名儿科护士进行儿童疼痛认知及临床疼痛管理现状调查,调查表参考McCaffery M"疼痛知识与态度调查表"和RenneManworren"儿科护士疼痛知识和态度调查表"制定。应用SPSS 17.0和Epicalc 2000进行统计学分析。结果医师和护士有关儿童疼痛知识正确率分别为(57.00±2.95)%和(56.19±3.01)%,对新生儿能否用吗啡止痛及止痛剂能否真正控制疼痛等问题,医护人员的正确率均<36.00%,最低达14.56%。接受疼痛相关知识培训的医师对儿童疼痛认识得分显著高于未接受培训者(P<0.05)。儿童专科医院医师对儿童疼痛认识的得分显著高于综合性医院儿科医师(P<0.05)。认为新生儿较年长儿生理反应不明显的医师较多认为新生儿不能用吗啡止痛(P<0.05)。结论医护人员对儿童疼痛认识不足,尤其是对儿童疼痛治疗的认识。亟需加强对医护人员有关儿童疼痛知识的专项培训,这将有助于积极推进临床儿童疼痛管理。     

中国新生儿疼痛管理循证指南（2023年）

疼痛不仅扰乱新生儿的生命体征和内环境稳态,影响康复进程,反复疼痛刺激更是神经发育障碍和部分慢性疾病的重要危险因素之一。为规范和标准化我国新生儿病房的疼痛管理实践,进而有效预防和减轻疼痛对新生儿身心发育的不良影响,国家儿童健康与疾病临床医学研究中心(重庆医科大学附属儿童医院)遵循世界卫生组织指南制订的原则和方法,组织多学科专家制定了《中国新生儿疼痛管理循证指南(2023年)》。该指南针对新生儿疼痛的分类及定义、常见致痛源、疼痛评估原则、疼痛评估方法、镇痛原则、非药物镇痛方法、药物镇痛方法、家属参与疼痛管理方法,以及疼痛管理记录方法9个临床问题,基于最佳证据和专家共识形成了26条推荐意见,以期为医护人员实施新生儿疼痛评估与镇痛管理提供指导与决策依据。[中国当代儿科杂志,2023,25 (2):109-127]     

窒息新生儿糖代谢紊乱对近期预后的影响：一项湖北省多中心研究

目的 分析窒息新生儿糖代谢紊乱对近期预后的影响。 方法 回顾性纳入湖北省52家医院2018年1~12月收治的生后12 h内有血糖数据的窒息患儿,收集病历资料及生后1、2、6、12 h的血糖数据,允许时间误差为0.5 h。根据住院期间是否诊断脑损伤和/或死亡分为预后不良组（693例）及预后良好组（779例）。分析两组患儿生后12 h内糖代谢紊乱情况及其对近期预后的影响。 结果 预后不良组中来自二级医院（48.5% vs 42.6%）、重度窒息（19.8% vs 8.1%）、亚低温治疗（4.8% vs 1.5%）的比例及糖代谢紊乱发生率（18.8% vs 12.5%）均高于预后良好组（P<0.05）;预后不良组生后1、2、6 h糖代谢紊乱发生率均高于预后良好组（P<0.05）。多因素logistic回归分析显示,反复高血糖为窒息患儿预后不良的独立危险因素（校正后OR=2.380,95%CI：1.275~4.442,P<0.05）。 结论 窒息患儿合并反复高血糖可能提示近期预后不良,应加强对该类患儿的早期神经系统监测与管理。     

117例儿童脊髓性肌萎缩症自然病史分析

目的 对重庆及周边地区脊髓性肌萎缩症（spinal muscular atrophy,SMA）的自然病史进行分析,为开展SMA的综合管理、基因修饰治疗提供临床依据。 方法 回顾性分析117例SMA患儿的临床资料及生存现状。 结果 117例患儿中,1型SMA 62例（53.0%）、2型45例（38.5%）、3型10例（8.5%）,中位起病年龄分别为2、10、15月龄。1型SMA起病、就诊、确诊时间均早于2、3型SMA（P<0.05）,1型SMA就诊时间窗（起病年龄至就诊年龄）短于2、3型SMA（P<0.05）。肺炎为首发症状、抬头无力、哭声无力、进食费力多见于1型SMA（P<0.05）,2型SMA脊柱侧弯和下肢关节挛缩发生率高于1型（P<0.05）。117例（100%）SMA患儿均为SMN1基因纯合缺失,其中以7号外显子纯合缺失最常见（68.4%,80/117）。1型SMA的6年生存率仅为10%±5%,低于2、3型SMA（P<0.05）。起病年龄≤3月龄、肺炎为首发症状、抬头无力为1型SMA死亡的危险因素（P<0.05）。2型SMA运动能力可呈非线性倒退。 结论 各型SMA患儿临床表现、生存率均存在异质性,1型SMA生存率低,2型SMA运动能力可呈非线性倒退,临床上应早期识别及管理SMA。     

新生儿缺氧缺血性脑病脑电背景演变与脑损伤程度的相关性研究

目的 探讨新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy,HIE）患儿脑电图（electroencephalogram,EEG）背景演变与脑损伤程度之间的相关性。 方法 回顾性研究56例确诊为HIE并完善了连续视频脑电监测（continuous video electroencephalogram,cVEEG）与头部磁共振（magnetic resonance imaging,MRI）的患儿,根据临床症状分为轻度组（3例）、中度组（36例）、重度组（17例）,各组进行EEG背景分度及MRI脑损伤评分,分析EEG背景演变与脑损伤程度之间的关系。 结果 与中度组患儿相比,重度组胎龄小、生后5 min Apgar评分低、复苏评分高、脐动脉血或生后1 h内动脉血剩余碱低、机械通气比例高及短期不良结局发生率高（P<0.05）。轻中度组患儿头部MRI以无脑损伤（67%,2/3）和分水岭区损伤（67%,16/24）为主,62%（13/21）EEG在生后第3天内改善至轻度异常;重度组患儿头部MRI以基底节/丘脑+脑干（24%,4/17）和全脑型损伤（71%,12/17）为主,至生后第3天仍均为中重度异常。在生后第1天、第2天、第3天及第7~14天4个时间段EEG背景分度与临床症状分度、MRI评分及短期结局均具有相关性（P<0.01）。EEG分度与MRI评分的相关系数在生后第3天最高（r_s=0.751,P<0.001）,与临床症状分度（r_s=0.592,P=0.002）及短期结局（r_s=0.737,P<0.001）的相关系数在生后第7~14天最高;重度异常EEG患儿中无脑电活动者MRI评分最高,惊厥持续状态者次之,持续低电压者最低,差异有统计学意义（P<0.05）。 结论 HIE患儿的EEG背景分度与脑损伤程度之间有良好的相关性,可帮助早期评估脑损伤程度及预后。     

上海380例家庭聚集性感染Omicron变异株的儿童及其家属临床特征分析（英文翻译）

目的 分析亲子病房收治模式下,家庭聚集性感染Omicron变异株的儿童及其家属的临床特点及转归。 方法 回顾性收集上海市第六人民医院新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）定点医院于2022年4月8日至5月10日收治确诊的感染Omicron变异株患儿190例及其家属190例的临床资料,进行分析总结。 结果 儿童组和成人组均以轻型为主,儿童组轻型比例高于成人组（P<0.05）;2组临床表现均以上呼吸道症状为主,儿童组发热、腹痛腹泻、喘息发生率高于成人组（P<0.05）,鼻塞流涕咳嗽、咽干咽痒咽痛发生率低于成人组（P<0.05）;成人组治疗连花清瘟颗粒/小儿豉翘清热颗粒、中药汤剂、重组人干扰素α2b喷雾剂、止咳化痰药、奈玛特韦/利托那韦片使用率均高于儿童组（P<0.05）;儿童组疫苗接种率（30.5%）较成人组（71.1%）低（P<0.001）,而儿童组严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome coronavirus 2,SARS-CoV-2）核酸阳性持续时间短于成人组（P<0.05）。2组临床轻型者SARS-CoV-2核酸阳性持续时间短于普通型者（P<0.05）。2组有基础疾病者SARS-CoV-2核酸阳性持续时间长于无基础疾病者（P<0.05）。 结论 家庭聚集性Omicron变异株感染儿童和成人的临床分型均以轻型为主。尽管儿童疫苗接种率较低,但在亲子病房收治模式中,疾病恢复较快,SARS-CoV-2核酸阳性持续时间短于成人。     

专业人员指导下孤独症谱系障碍儿童家长执行的家庭康复疗效观察的前瞻性研究

目的 探讨专业人员指导下,由家长执行的家庭康复对孤独症谱系障碍（autism spectrum disorder,ASD）儿童的治疗作用。 方法 前瞻性选取ASD儿童60例（月龄24~60个月）,随机分为观察组和常规组。常规组儿童仅对家长进行线上理论培训。观察组儿童家长,除线上理论培训外,还进行专业人员团队指导下由家长执行的家庭康复。采用心理教育评估第3版（Psycho-Education Profile Third Edition,PEP-3）、儿童期孤独症评定量表（Childhood Autism Rating Scale,CARS）评估两组儿童干预前、干预后能力变化情况。 结果 经6个月干预后,观察组PEP-3量表各维度和常规组大部分维度得分较干预前提高（P<0.01）;两组CARS量表得分较干预前降低（P<0.05）。与常规组相比,干预后观察组儿童PEP-3量表语言理解、语言表达、大肌肉、小肌肉、个人自理、适应行为维度得分提高（P<0.05）,CARS量表得分降低（P<0.05）。 结论 对家长培训,由家长执行的干预可以提升ASD儿童的能力,改善其核心临床症状;但以专业人员组成的团队为资源平台,以家长为主要干预力量的家庭康复服务模式,对提升ASD儿童语言、运动等能力,改善其症状严重程度的效果更为显著。     

34例小儿自身免疫性胶质纤维酸性蛋白星形胶质细胞病的临床特征分析

目的 探讨儿童哮喘管理与哮喘控制水平的影响因素。 方法 选取202例哮喘患儿,通过哮喘控制水平与家长管理调查问卷,收集儿童哮喘控制水平影响因素与家庭生活管理项目,分析家长对儿童哮喘的认识与管理意识,以及对儿童哮喘控制水平的影响,并分析两者的相关性。 结果 完全控制组哮喘病程、治疗时间均比未完全控制组长（P<0.05）;完全控制组1年内哮喘发作次数≥3次者、因哮喘发作需要雾化治疗>3次者的比例均低于未完全控制组（P<0.05）;完全控制组呼吸道感染频繁者、呼吸道感染时发生喘息者及有家族过敏性疾病史的比例均低于未完全控制组（P<0.05）;完全控制组的家长呼吸道感染短期升级哮喘用药意识与维持用药的管理明显增强（P<0.05）;未完全控制组初始肺功能异常者比例高于完全控制组（P<0.05）。哮喘控制水平与呼吸道感染时短期升级哮喘用药及初始肺功能相关（P<0.05）。 结论 儿童哮喘控制水平与哮喘严重程度、儿童哮喘综合管理密切相关,早期治疗和家庭管理特别是呼吸道感染早期短期升级治疗对哮喘控制有重要意义。 ［中国当代儿科杂志,2023,25（1）：73-79］     

The physiology,assessment, and treatment of neonatal pain

Studies have clearly shown that development of pain receptors starts as early as 20-weeks’ gestation. Despite contrary belief, the human fetus develops a similar number of receptive pain fibers as seen in adults. These receptors' maturation is based on response to sensory stimuli received after birth which makes the NICU a critical place for developing central nervous system's pain perception. In practice, the assessment of pain relies mostly on bedside staff. In this review we will discuss the various developing features of pain pathways in the neonatal brain and the modification of pain perception secondary to various interactions immediately after birth. We also discuss the various tools utilized in the NICU for pain assessment that rely on physiological and behavioral patterns. Finally, we address the management of pain in the NICU by either pharmacological or non-pharmacological intervention while highlighting potential benefits, disadvantages, and situations where one may be preferred over another.     

新型冠状病毒感染流行期间NICU的应急准备方案（第二版）

2019年12月开始，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染在中国暴发流行并波及世界多个国家。为有效应对可能出现的新生儿SARS-CoV-2感染，2020年1月底，中国人民解放军儿科学专业委员会和中国当代儿科杂志编辑委员会制定和发布了关于新生儿重症监护病房（NICU）新生SARS-CoV-2感染应对策略和应急准备方案。随着对SARS-CoV-2认识的深入，尤其是新生儿SARS-CoV-2感染病例的出现，中国人民解放军儿科学专业委员会、中国当代儿科杂志编辑委员会和中华医学会儿科学分会灾害儿科学筹备学组根据现有的证据更新了相关内容，以便更好的指导NICU应对SARS-CoV-2感染。     

Pain management and the effect of guidelines in neonatal units in Austria, Germany and Switzerland

BACKGROUND: Painful invasive procedures are frequently performed on preterm infants admitted to a neonatal intensive care unit (NICU). The aim of the present study was to investigate current pain management in Austrian, German and Swiss NICU and to identify factors associated with improved pain management in preterm infants. METHODS: A questionnaire was sent to all Austrian, German and Swiss pediatric hospitals with an NICU (n = 370). Pain assessment and documentation, use of analgesics for 13 painful procedures, presence of written guidelines for pain management and the use of 12 analgesics and sedatives were examined. RESULTS: A total of 225 units responded (61%). Pain assessment and documentation and frequent analgesic therapy for painful procedures were performed more often in units using written guidelines for pain management and in those treating >50 preterm infants at <32 weeks of gestation per year. This was also the case for the use of opioid analgesics and sucrose solution. Non-opioid analgesics were used more often in smaller units and in units with written guidelines. There was a broad variation in dosage of analgesics and sedatives within all groups. CONCLUSION: Pain assessment, documentation of pain and analgesic therapy are more frequently performed in NICU with written guidelines for pain management and in larger units with more than 50 preterm infants at <32 weeks of gestation per year.     

Reducing medication errors in the neonatal intensive care unit

BACKGROUND: Medication errors are common in the neonatal intensive care unit (NICU). Various strategies to reduce errors have been described in adult and paediatric patients but there are few published data on their effect in the NICU. AIM: To describe the medication errors occurring within an NICU, and assess the impact of a combined risk management/clinical pharmacist led education programme on these errors. METHODS: Medication errors were identified prospectively over one year by critical incident reporting. Four months into the study, a pharmacist led education programme was instituted. This involved a daily, cot side, pharmacist led review of medication orders. Each new member of pharmacy, nursing, or medical staff was also required to successfully complete a series of dose calculations. In addition, a risk management approach was used to make several changes in practice during the study period. RESULTS: A total of 105 errors were identified, four serious, 45 potentially serious, and 56 minor. The four serious errors included two tenfold dose miscalculations. Most (71%) of the errors were due to poor prescribing. After the introduction of our interventions, monthly medication errors fell from a mean (SD) of 24.1 (1.7) per 1000 neonatal activity days to 5.1 (3.6) per 1000 days (p < 0.001) in the following three months. The subsequent change over of junior medical staff was associated with a significant increase in medication errors to 12.2 (3.6) per 1000 neonatal activity days (p = 0.037). However, the number remained significantly less than before our interventions (p < 0.001). Three serious errors occurred in the first four months compared with one in the second eight month period, the latter corresponding to the six monthly change over of junior medical staff. CONCLUSIONS: Medication errors are common in NICUs. Fortunately, actual harm to an infant is rare. Interventions to reduce errors, particularly within the context of a risk management programme, are effective.     

Knowledge, attitude and practices about neonatal hypothermia among medical and paramedical staff

The present study was undertaken to evaluate the knowledge, attitude and practices about neonatal hypothermia among medical and paramedical staff dealing with newborn care. A total of 160 subjects were assessed (40 pediatric medicine residents, 40 obstetric residents, 40 private practitioners and 40 paramedical staff working in labor room and postnatal wards) A pre-tested structured questionnaire was used. Only 47.8% of the subjects defined neonatal hypothermia correctly. As many as 52.2% of the interviewees considered it to be an uncommon problem. Lethargy, refusal for feed and cold to touch were mentioned as common symptoms of neonatal hypothermia by 97.5%, 80% and 77.5% of the respondents respectively. Decreased body temperature, cyanosis, apnea and edema of feet were found as common signs. Only 18.6% of the interviewees had knowledge about correct method of recording the temperature in a newborn. The present study reveals the gross lacunae in the knowledge regarding various aspects of neonatal hypothermia among pediatric and obstetric residents and paramedical staff working in labor room and postnatal wards. To reduce the neonatal morbidity and mortality due to neonatal hypothermia, greater emphasis should be laid on this problem while designing curriculum for training of undergraduate and postgraduate doctors, paramedical staff and traditional birth attendants.     

Wound care in the neonatal intensive care unit

The skin is a vital organ with key protective functions. Infants in the NICU are at risk for skin injury because of developmental immaturity and intensive care treatments. When skin injury occurs, the neonatal nurse is challenged to provide wound care to optimize functional and cosmetic healing. Optimal wound care requires basic knowledge of the mechanisms of injury, physiology of wound healing, host factors affecting wound healing, and wound assessment. This knowledge provides the basis for determining appropriate wound treatment, including dressing selection. Attention to pain issues associated with wound care is difficult because of the infant's developmental stage, but is essential because of the potentially negative life-long impact of pain. The premature infant's propensity for skin stripping limits the selection of appropriate dressing, as does the paucity of research examining wound care products in this population.     

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.     

Postsurgery analgesic and sedative drug use in a French neonatal intensive care unit: A single-center retrospective cohort study

Objective

To describe pain assessment, the pattern of analgesic and sedative drug use, and adverse drug reactions in a neonatal intensive care unit (NICU) during the postsurgery phase.

Multicentric study on neonatal medical pain management in the Nord-Pas-de-Calais]

The aim of this study was to describe pain management for newborn infants in neonatal intensive care units and neonatal units in the Nord-Pas-de-Calais. PATIENTS AND METHODS: A questionnaire was distributed to the 52 physicians practising in the six neonatal intensive care units and six neonatal units. The questions were in reference to pain assessment, treatment and prevention. RESULTS: Forty questionnaires were completed (77%). Eleven units proclaimed an interest in neonatal pain management. The tool for assessing pain was the EDIN scale (Echelle Douleur Inconfort Nouveau-né, neonatal pain and discomfort scale). Analgesic treatment was administered in 100% of cases for the insertion of chest tube, in 92% of cases for the insertion of percutaneous central catheter in a ventilated newborn infant and in 91% of cases for necrotizing enterocolitis requiring a mechanical ventilation. Prescribed analgesic drugs were propacetamol, nalbuphin or fentanyl; a sedation by midazolam or diazepam was occasionally associated. Emla cream was used before lumbar puncture in 80% of cases in the neonatal intensive care units and in 92% of cases in the neonatal units. Three neonatal intensive care units and four neonatal units administered a sucrose solution for blood samples. CONCLUSION: At the time of study, the interest in the pain of the physicians working in neonatal intensive care units and neonatal units was inadequate to guarantee an optimum management of pain in newborn infants. Physicians' approach remained heterogeneous.