Hepatic portal venous gas without definite clinical manifestations of necrotizing enterocolitis in a 3-day-old full-term neonate: A case report

BACKGROUNDNeonatal hepatic portal venous gas (HPVG) is associated with a high risk of necrotizing enterocolitis (NEC) and was previously believed to be associated with an increased risk of surgery.CASE SUMMARYA 3-day-old full-term male infant was admitted to the pediatrics department after presenting with “low blood glucose for 10 min”. Hypoglycemia was corrected by intravenous glucose administration and oral breast milk. On the 3^rd d after admission, an ultrasound examination showed gas accumulation in the hepatic portal vein; this increased on the next day. Abdominal vertical radiograph showed intestinal pneumatosis. Routine blood examination showed that the total number of white blood cells was normal, but neutrophilia was related to age. There was a significant increase in C-reactive protein (CRP). The child was diagnosed with neonatal NEC (early-stage). With nil per os, rehydration, parenteral nutritional support, and anti-infection treatment with no sodium, his hepatic portal vein pneumatosis resolved. In addition, routine blood examination and CRP examination showed significant improvement and his symptoms resolved. The patient was given timely refeeding and gradually transitioned to full milk feeding and was subsequently discharged. Follow-up examination after discharge showed that the general condition of the patient was stable.CONCLUSIONThe presence of HPVG in neonates indicates early NEC. Early active anti-infective treatment is effective in treating NEC, minimizes the risk of severe NEC, and reduces the need for surgery. The findings of this study imply that early examination of the liver by ultrasound in a sick neonate can help with the early diagnosis of conditions such as NEC.     

Portal Venous Gas on Point-of-Care Ultrasound in a Case of Cecal Ischemia

BackgroundPortal venous gas has mainly been studied in pediatrics and seen in cases of necrotizing enterocolitis. It is a rare finding in adults and is typically associated with underlying intestinal ischemia or other malignant intra-abdominal pathology. Portal venous gas is seen more readily on ultrasound compared to radiographs in both pediatric and adult patients. Findings include lucencies extending to the periphery of the liver, echogenic bubbles flowing centrifugally throughout the portal venous system, and bidirectional spikes interrupting the monophasic portal venous waveform on spectral analysis.Case ReportWe present a case of a 36-year-old female who presented with abdominal pain. She had findings consistent with portal venous gas on point-of-care ultrasound, prompting computed tomography of her abdomen and surgical consultation. She was ultimately found to have cecal ischemia from cecal volvulus, had surgical resection and anastomosis, and was able to be discharged from the hospital following recovery.Why Should an Emergency Physician Be Aware of This?With the ever-increasing use of point-of-care ultrasound, emergency physicians should be aware of the findings consistent with portal venous gas as well as its implications. Emergency physicians should know portal venous gas is associated with intestinal ischemia and other malignant pathologies and should prompt more advanced imaging or surgical consultation when observed. Emergency physicians should also understand the distinctions between portal venous gas and pneumobilia found on point-of-care ultrasound, given that portal venous gas is typically a malignant finding and pneumobilia is most frequently benign.     

极低出生体重儿父母照顾体验的质性研究

[目的]了解极低出生体重儿照顾者在照顾期间内心深处的感受,以探索促进照顾者心身健康的方法。[方法]采用质性研究中的现象学研究方法对11名极低出生体重儿的照顾者进行半结构性访谈,并采用现象学分析法进行资料分析。[结果]采用类属分析法升华出5个关于照顾者感受的主题:心理负担过重、承受压力和痛苦、个人生活的影响、不断适应角色、在照顾活动中实现自我价值。[结论]在研究和关注极低出生体重儿健康时不应忽视照顾者所承受的压力及相关问题,应提供行之有效的干预措施帮助照顾者。     

Hepatic portal venous gas in a patient with intestinal necrosis

This report describes a case of hepatic portal venous gas (HPVG) in a patient with intestinal ischaemia and necrosis resulting from an obstructing lesion in the sigmoid colon. CT images demonstrating a large amount of HPVG are presented.     

Expert consensus to weight an adherence score for audit and feedback of practices that prevent necrotizing enterocolitis in very low birth weight infants

ObjectiveNecrotizing enterocolitis (NEC) is a catastrophic abdominal complication threatening the life of premature infants, but adoption of prevention and early recognition practices differs as do NEC rates in Neonatal Intensive Care Units (NICUs). The purpose of this research was to validate and weight an evidence-based adherence score (aka NEC-Zero Adherence Score) to prevent and foster timely recognition of NEC.Study designAn electronic Delphi (e-Delphi) approach was used to identify consensus. NEC experts were recruited via the NEC Society and surveyed until consensus and stability criteria for the Delphi were met (≥ 70% consensus and mean responses changed < 15% between rounds).ResultsExpert panelists (n = 22) were experienced (M = 17.6, SD 11 years) and predominately physicians (68%) or neonatal nurse practitioners (18%). Consensus (> 70% by item) supported a 10 point score. Points were distributed across 1) an exclusive human milk diet (5 points), 2) standardized feeding protocols (3 points), 3) antibiotic stewardship (1 point), and 4) a unit-specified approach to early recognition (1 point). Withholding feeding during transfusion was controversial (M = 0.50, SD 0.73) and met consensus criteria to drop from the score.ConclusionsHolding feeding during transfusion was dropped from the score. Relationships between the score and unit NEC rates as well as its utility for use in audit and feedback should be studied in the future.     

自制血气标本装置在极低体质量儿中的临床应用

目的 观察自制简易采血装置用于极低体质量儿（体质量＜1．5kg)血气分析检验效果。方法 随机将188例极低体质量儿分为两组,各94例,分别采用自制简易采血装置和传统采血法采血进行血气分析检验。结果 两组不同装置采血法1、4、8次的采血量有显性差异,分别P＜0．05、＜0．01、＜0．05。而0．1ml与0．5ml采血量血气分析结果比较,无显性差异,P＞0．05。结论 自制血气标本采集法在极低体质量儿应用中优于传统采血法,值得推广。     

极低出生体重儿合并先天性结核的护理

极低出生体重儿合并先天性结核较为罕见,预后差,病死率高,护理问题较多,难度大.从消毒隔离、病情观察、用药护理、气道管理及早产儿支持、健康教育方面叙述对1例极低出生体重儿合并先天性结核患儿的护理.患儿护理过程顺利,取得较好效果.     

Transthoracic pacing in a very low birth weight infant with congenital complete atrioventricular block

We report our experience of pacemaker treatment in a premature infant of 830 g with congenital complete atrioventricular block due to maternal Sjogren's Syndrome. The infant was delivered by cesarean section at an estimated gestational age of 26 weeks because of fetal bradycardia, decreasing fetal movements, and hydrops. Immediate postnatal transesophageal ventricular pacing was not successful, whereas transthoracic pacing with self‐adhesive patch electrodes adapted to body size resulted in an effective increase of the infant's heart rate until operative application of temporary epimyocardial pacing wires allowed external stimulation of the heart.     

“三合一”护理法在极低出生体重儿喂养中的应用

目的：探讨音乐疗法、抚触法、非营养性吸吮法联合应用的“三合一”护理法对预防极低出生体重儿早期肠内喂养不耐受的效果。方法选择2010年1月-2013年1月收治的极低出生体重儿120例,按随机数字表法分为干预组和对照组,各60例。两组均给予同质胃肠外营养加微量配方奶肠内喂养,对照组同时给予抚触法、非营养性吸吮法辅助喂养;干预组给予“三合一”护理法辅助喂养,即按规定程序将音乐疗法、抚触法、非营养性吸吮法结合进行应用。比较两组喂养效果。结果干预组采用“三合一”护理法,极低出生体重儿恢复出生体质量所用时间（2．9±2．1）d,体质量增长（17．8±7．9）g,胃肠外营养时间为（7．7±3．1）d,达足量肠内喂养时间（17．4±6．3）d,住院时间（19．6±5．9）d,均优于对照组,差异有统计学意义（t值分别为7．685,9．001,7．061,11．047,17．438,14．225;P＜0．05）。干预组喂养不耐受发生率为6．67％,对照组为20．00％,两组比较差异有统计学意义（χ2＝12．005,P＜0．01）。结论“三合一”护理法可以使极低出生体重儿的早期肠内喂养效果更为优质,有效提高常规抚触法、非营养性吸吮法的作用,降低喂养不耐受发生率。     

Establishing normal values of central venous pressure in very low birth weight infants

The objective of this paper is to establish a reference range of central venous pressure (CVP) values during the first 4 days of life in very low birth weight (VLBW) infants. A prospective observational study with continuous monitoring of CVP in VLBW newborns who had an umbilical venous catheter (UVC) positioned in or near the right atrium is conducted. All UVCs were inserted as part of normal care of the infants. The mean CVP (mCVP) was monitored for 72 h from recruitment, or until the UVC was removed. The mean mCVP was calculated for each infant. The median of the mean mCVPs was then calculated. Data were analysed in 17 infants. The median gestational age was 27 weeks and median birth weight was 940 g. Sixteen were mechanically ventilated and of these, six also received continuous positive airway pressure (CPAP) during the study period. One infant received no respiratory support. One infant died during the study period. The lowest mean mCVP was 2.8 mmHg and the highest was 13.9 mmHg. The median mean mCVP was 4.9 mmHg (interquartile range 4.4-6.1). The normal range of CVP in VLBW infants during the first 4 days of life is wider than previously suggested.     

Detection of Intestinal Pneumatosis Location by Following Hyperechoic Foci in the Portal Vein Along Its Branches With Real‐time Ultrasound

Portal venous gas is occasionally encountered in children with intestinal pneumatosis, identified on real‐time ultrasound imaging as hyperechoic foci with quick movement. The origin of the portal venous gas can be identified by following the hyperechoic foci along the branches of the portal vein, providing an estimate of the location of intestinal pneumatosis. This approach may be useful for predicting the patient's prognosis. Our report describes 2 cases of portal venous gas while estimating the area of intestinal pneumatosis, which were evaluated with real‐time ultrasound.     

集束化干预在极低出生体重儿PICC置管中的应用

[目的]观察集束化干预应用于极低出生体重儿经外周静脉置入中心静脉导管(PICC)置管中的效果。[方法]将85例行PICC置管的极低出生体重儿随机分为观察组43例和对照组42例,对照组患儿行常规置管护理,观察组在对照组的基础上行集束化干预,对比分析两组患儿一次性置管成功率、并发症、置管时间、住院时间的差异。[结果]观察组患儿一次性置管成功率高于对照组,导管异位率、堵管、机械性静脉炎发生率、导管感染率低于对照组,经比较差异有统计学意义(P0.05)。观察组置管时间长于对照组、住院时间少于对照组,经比较差异有统计学意义(P0.05)。[结论]集束化干预能有效提高极低出生体重儿一次性置管成功率、延长患儿置管时间、减少置管相关并发症、缩短住院时间。     

Central adjudication of venous ultrasound in VTE screening trials: reasons for failure

Summary. Background: The accuracy of screening ultrasound for venous thrombosis in asymptomatic patients is still a matter of debate. The VENUS study evaluated the accuracy of centrally adjudicated venous ultrasound against venography in patients after major orthopedic surgery and found the sensitivity of ultrasound to be poor for both proximal and distal deep vein thrombus (DVT). Objectives: To evaluate whether thrombus characteristics such as location or size influence the diagnostic performance of centrally adjudicated venous ultrasound. Methods: All false negative sonograms of the VENUS study were re‐evaluated against the corresponding venograms. Discrepancies were categorized into types of diagnostic failures. Within these categories, thrombus characteristics such as location, length or size of thrombus were evaluated. Results: One hundred and twelve pairs of discrepant ultrasound and venography documents were compared with 28 pairs with concordant results. Discrepancies were caused by local documentation failure (37.5%), failure of the ultrasound method (43.7%) and failure of the central adjudication process (18.7%). The overall size of thrombi was small, which caused about 40% of all sonographic failures with a detection threshold of five Marder points, a thrombus length of 9.5 cm and a number of 3.5 pathological compression manoeuvres. Proximal or distal location of DVT did not affect thrombus detection. Conclusion: If centrally adjudicated ultrasound is to be used in future VTE screening trials, training of local sonographers and central adjudicators needs to be intensified, because asymptomatic DVTs seem to be small and ultrasound sensitivity depends on the number of pathological compression manoeuvres documented in the ultrasound document. In contrast, distal or proximal thrombus location itself does not influence sensitivity.     

Assuring the integrity of the family: being the father of a very low birth weight infant

Aim. The purpose of this study was to explore the paternal role of fathers of very low birth weight infants during their first year of life. Background. Following birth, very low birth weight infants often require extended hospitalisation and long‐term care. The birth experience and the infant’s hospitalisation often overwhelm parents and may hinder the development of their parental roles. The father is known to be an important supporting figure for the mother, but most studies in Taiwan have focussed on mothers. Design. A qualitative design using a grounded theory approach was employed in this study. Methods. In‐depth interviews were conducted with a purposive sample of fathers during home visits. Each father was interviewed twice at one to three months and seven to nine months after his very low birth weight infant’s discharge from the hospital. Data were analysed using constant comparison and repeated verification. Results. Twelve fathers were included in the study. During the first year of life of their very low birth weight infants, the fathers experienced ‘protecting the wife–baby dyad’, ‘concentrating on the child’s health and growth’, and ‘possessing a complete family’. Subcategories within each major category also emerged. Conclusion. In this study, Taiwanese fathers of very low birth weight infants learned different and broader dimensions of the paternal role and continually made adjustments to assure their family’s integrity. Relevance to clinical practice. These findings can help nurses understand paternal perceptions and behaviours related to having a very low birth weight infant and in turn help fathers adjust to their role.     

湿性疗法治愈极低体重儿腹部切口裂开

目的 观察湿性疗法在1例极低体重儿腹部全层裂开切口治疗中的作用.方法 持续评估患儿一般情况和局部伤口情况,在伤口愈合的不同时期采用相应的湿性疗法进行伤口护理.结果 该例极低体重儿腹部全层裂开的伤口经湿性疗法治疗后获得痊愈,愈合时间仅20d.结论 湿性疗法治疗极低体重儿腹部切口全层裂开是安全、有效的.     

成人急性缺血坏死性小肠炎并肝-门静脉系统多发积气1例

患者男，50岁，因“腹痛、腹胀进行性加重1天，伴高热”入院。查体：全腹膨隆，张力较高，上腹部散在压痛、轻度反跳痛及肌紧张，扣诊呈鼓音，震水音阳性，肠鸣音减弱。实验室检查：白细胞18.44×109/L，血小板803.0×109/L，CRP173.86 mg/L，凝血酶原时间延长。腹部CT平扫提示肝外周、包膜下2cm内枯树枝样积气，肠系膜上静脉积气（图1A、1B所示）；小肠肠腔扩张、积气、积液并散在液气平征象，肠壁间多发气体密度影（图1B、1C）；诊断：急性缺血坏死性小肠炎并肝-门静脉系统多发积气。临床急诊行剖腹探查术，术中见腹腔大量淡黄色脓性腹水约500ml，小肠明显扩张，部分浆肌层裂开，距屈氏韧带20cm-220cm该段小肠缺血坏死，肠壁呈“花斑”样改变，水肿明显，全段小肠系膜未见坏死及血栓样改变，结肠扩张，未见明显缺血坏死，遂行小肠切除吻合、肠外减压，术后患者恢复良好。