ObjectiveTo analyze the early outcomes of 203 neonates with low birth weight (<2 500 g) undergoing cardiac surgery, and to analyze the causes of death during hospitalization.MethodsFrom June 2003 to June 2017, medical records of 203 neonates with low birth weight undergoing congenital heart surgery in Guangdong General Hospital were reviewed retrospectively. There were 124 males and 79 females, including 151 premature infants. The average birth weight was 1 719±515 g, the average age at operation was 32.7±20.2 d and the average weight at operation was 1 994±486 g. The causes of death during hospitalization (including neonates given up on treatments) were analyzed.ResultsTotally 103 patients had pneumonia, 98 patients needed mechanical ventilation to support breathing and 26 patients needed emergency operation before operation. All patients undergoing congenital heart surgery were treated with general anesthesia with tracheal intubation, including 107 patients under non cardiopulmonary bypass (CPB) and 96 patients under CPB with a mean CPB time of 96.5±71.7 min and a mean aorta cross-clamp time of 51.8±45.5 min. The average postoperative mechanical ventilation time was 9.1±21.5 d and the average postoperative length of stay was 26.7±19.3 d. The major postoperative complications included pneumonia, anemia, atelectasis, septicemia, intrapleural hemorrhage, diaphragm paralysis and cardiac dysfunction. Twenty-nine patients died during hospitalization and the overall mortality rate was 14.3%. Four patients died in the operation room, 14 patients died 72 hours after operation and 2 patients were given up. The main causes of hospitalized death were low cardiac output syndrome, severe infection, disseminated intravascular coagulation disorder, acute renal failure and pulmonary hypertension crisis.ConclusionOverall, early cardiac surgery for low birth weight neonates is safe and effective. The difficulty of the cardiac surgery is the key to the prognosis. Strengthening perioperative management can improve the quality of operation and reduce the risk of mortality and morbidity during hospitalization.
Objective To explore the levels and the clinical significance of serum soluble Endoglin (sEng) and soluble Fms-like tyrosine kinase (sFlt-1) in patients with preeclampsia (PE). Methods Ninety-six patients with PE were included from June 2009 to June 2014. The patients were divided into mild PE group (n=54) and severe PE group (n=42), while 40 healthy pregnant women were in the control group. The general situation and laboratory testing were recorded and the serum levels of sEng and sFlt-1 were detected. All patients were routinely followed up with the recording of delivery and neonatal situation. Results The sEng and sFlt-1 levels were highest in the severe PE group [(7345.02±772.73) and (866.08±203.24) ng/L], which was followed by mild PE [(5 547.08±564.06) and (603.99±138.37) ng/L] and control group [(1 840.93±300.71) and (252.68±83.03) ng/L] (P<0.01). Levels of sEng were significantly correlated with sFlt-1 in both mild and severe PE groups. There were significantly correlations between sEng and sFlt-1 in mild or severe PE group respectively. The level of sEng and sFlt-1 was considerably positively correlated with mean arterial pressure, 24-hour urinary protein, serum creatinine, fibrinogen, umbilical artery shrink/diastole and resistance index value, but negatively correlated with prothrombin time, birth weight and the placenta weight (P<0.05). PE patients with sEng of <5 000 ng/L and sFlt-1 levels of <700 ng/L had the risk of severe complications of 6.8% and 14.0%; while patients with sEng of ≥5 000 ng/L and sFlt-1 of ≥700 ng/L had the ratio fo 40.4% and 37.0% respectively (P<0.01). Conclusion Serum levels of sEng and sFlt-1 in PE patients indicate that the severity of disease and outcomes of pregnancy.
Objective To evaluate the relationship between the severity of neonatal infection and the activity change of cardiac enzyme. Methods A total of 102 infectious neonates in NICU were evaluated with neonatal serious illness scoring system and then divided into non-critical, critical, and extremely-critical groups. The activity of such serum myocardial enzymes as AST, ALT, LDH, CK, and CKMB was tested in the first 24 hours on admission. Comparison between groups and analyses were conducted. Resultes Myocardial enzyme of the critical and extremely-critical groups was obviously higher than that of the non-critical group (Plt;0.01). Conclusion The serious illness score of infectious neonates is closely associated with the activity change of myocardial enzyme and the level of serum myocardial enzymes has certain advantages in judging the myocardial injury and the disease severity of neonatal infection.
Objective To evaluate the efficacy and safety of Shengmai injection for hypoxic-ischemic encephalopathy (HIE). Methods We searched MEDLINE (1966 to February 2007), EMBASE (1980 to February 2007), CBM (1978 to 2006), CNKI (1979 to February 2007), VIP (1989 to February 2007), and handsearched five Journals on Pediatrics. We evaluated features of quality of included studies, including randomization, blinding, allocation concealment and loss of follow-up. Meta-analyses were performed using The Cochrane Collaboration’s RevMan 4.2.8. Results Seven randomized controlled trials were included. The cure rate on day 5 in the Shengmai injection group was higher than in the control group (RR 1.55, 95%CI 1.25 to 1.93), but this rate was similar on day 10 (RR 0.74, 95%CI 0.43 to 1.29). No significant difference in cure rate was noted between the Shengmai injection group and naloxone group (RR 0.88, 95%CI 0.53 to 1.46). No significant differences were observed in mortality (RR0.44, 95%CI 0.16 to 1.19) and mutilation rate (RR 0.58, 95%CI 0.21 to 1.56) between the Shengmai injection group and the control group. For those babies suffering from HIE combined with myocardial damage, Shengmai injection could speed up the recovery of ECG (WMD=–2.02, 95%CI –2.76 to –1.28) and myocardial enzymogram (CK-MB: WMD= –4.78, 95%CI –6.77 to –2.79; CK-BB: WMD=–2.68, 95%CI –4.58 to –0.78). Significant differences in NBNA score were noted between the Shengmai injection group and the control group on day 5 (WMD=4.05, 95%CI 2.47 to 5.63) and day 10 (WMD=3.50, 95%CI 2.26 to 4.74). No fatal side effects were reported. Conclusions Shengmai injection has certain therapeutic values in treating HIE. Shengmai injection can speed up the recovery ECG, CK-BM and CK-BB of HIE patients, especially in those who have myocardial damage. Shengmai injection can also improve the NBNA score. However, because of the low statistical power and high risks for selection bias, performance bias and measurement bias in the included trials, these conclusions need to be interpreted cautiously.
Objective Application of auditory brainstem response (ABR) in the study on the relationship of neonates with hypoxic-ischemic encephalopathy (HIE) and the children with hearing loss and auxiliary determine the prognosis of encephalopathy. Methods We prospectively selected neonates diagnosed as HIE in the department of neonatology of the Chengdu Women and Children Central Hospital from January, 2006 to June, 2008. Neonatal ABR was tested and the prognosis of neonates were observed through 3-year followed up in order to analyze the relationship between HIE severity and the severity of hearing handicap and the relationship between the severity of hearing handicap and prognosis. Statistical analysis was performed using SPSS 18.0. χ2 test was used to compare the rate between groups. Results 40 cases involving 80 ears were included, of which 33 cases accomplished the 3-year follow-up for prognosis. The results showed that, 86.3% HIE neonates had hearing handicap (mainly mild hearing loss, 40.0%). Medium-severe HIE groups had more serious hearing handicap than Mild HIE group with a statistical significance (continuity correction χ2=7.383, P=0.007). ABR results showed that, mild HIE is mainly manifested as I wave PL prolonged or poorly differentiated, accounting for 78.1%; medium - severe HIE are mainly manifested as III and V wave PL prolonged central segment abnormalities, accounting for 95.8%; the hearing threshold no more than 60 dB group had better prognosis than the hearing threshold more than 60 dB group prognosis (Fisher exact probability P=0.001). Conclusion ABR reflects that HIE severity and was positively related to the severity of hearing handicap. The more serious hearing loss in neonates is, the worse prognosis the neonates have. ABR can be used to assist the assessment of the prognosis of neonatal HIE.
ObjectiveTo compare and analyze the effect of myocardial protection between HTK and del Nido cardioplegia solutions in neonates with surgeries for transposition of the great arteries. MethodsThe clinical data of 208 neonates with complete transposition of the great arteries in our institution from 2014 to 2020 were retrospectively analyzed. According to the cardioplegia solutions utilized in the operations, the patients were divided into two groups: a HTK group and a del Nido group. Propensity score matching was conducted to eliminate the biases. The cardiopulmonary bypass time, aortic cross-clamping time, total amount of cardioplegia solutions, transfusion frequency of cardioplegia, ICU stay time, mechanical support time, inotropic score, hospital stay, left ventricular ejection fraction, N-terminal proBNP and troponin I were compared and analyzed between the two groups after matching. ResultsAfter 1:1 propensity score matching, a total of 54 patients were analyzed with 27 patients in each group. In the HTK group, there were 22 males and 5 females with a median age of 7.0 (2.0, 11.0) d. In the del Nido group, there were 23 males and 4 females with a median age of 8.0 (3.0, 11.0) d. A total of 3 children died after the surgery: 2 (7.4%) patients in the HTK group and 1 (3.7%) patient in the del Nido group. There was no significant difference in hospital mortality between the two groups (P=1.000). The total amount of cardioplegia solutions in the HTK group was significantly higher than that of del Nido group (P<0.001). Transfusion frequency of cardioplegia in del Nido group was significantly higher than that of the HTK group (P=0.043). There was no significant difference in the postoperative ICU time, mechanical support time, length of hospital stay, inotropic score, left ventricular ejection fraction, N-terminal B-type natriuretic peptide precursor or troponin I between the two groups (P>0.05). ConclusionFor neonates with surgeries for complete transposition of the great arteries, HTK cardioplegia solutions can provide effective and safe myocardial protection, which is similar to del Nido cardioplegia solutions.
The management of neonates with high risk congenital diaphragmatic hernia (CDH) which gives rise to respiratory distress syndrome in 6 hours after born is so troublesome that the mortality is very high. The past advocation that CDH should accept emergency operation has been called in question. Another therapeutic procedure is recommended that CDH repair operation should be performed after the respiration and circulation has been stabilized. This procedure has presented better effect than before. The present advances in the management including general measures, mechanical ventilation, extracorporal membranous oxygenator (ECMO), nitric oxide (NO) inhalation, glucocorticoid, pulmonary surfactant, CDH repair and so on were reviewed.
Objective To summarize the clinical characteristics, diagnosis and treatment of Bochdalek hernia in neonates and infants. Methods The data of 15 neonates and 10 infants with Bochdalek hernia，undergoing the normal diagnosis and surgical repair from August 1983 to June 2004, were retrospectively reviewed. Location was left in 22 cases and right in 3 cases. Twenty-four cases were treated by operation and 1 case died of respiratory failurebefore operation.Results Before April 1998，7 of 8 (5 neonates，3 infants) cases of Bochdalek hernia stayed healthy and respiratory symptomfree 1 year after operation; they were followed up 1 year and 3 months to 11 years. One premature neonate with Bochdalek hernia died of respiratory failure before operation, and his lung volume was found to be dysplasia. From April 1998 to June 2004, 15（8 neonates，7 infants） of 17 （10 neonates，7 infants）cases of Bochdalek hernia survived postoperatively, while 2 neonates died of respiratory failure. Conclusion The earlier dyspnoea of neonates ofBochdalek hernia occur，the worse their healthy status appear. The standard andtimely surgical repairs could improve the curative ratio. Whether the operationwas suspended depended on the healthy states of babies.
ObjectiveTo objectively evaluate the effect and safety of naloxone for the treatment of moderate and severe neonatal hypoxia-ischemic encephalopathy (HIE). MethodsResearch articles published from inception to June 2015 on Cochrane library, PubMed, Web of science, Chinese Science and Technology Journal Full-text Database, Digital Full-text Journal Database and Chinese Journal Full-text Database were searched, which were relevant to naloxone in the treatment of moderate and severe neonatal HIE. And two authors extracted information via standardized data extraction form and assessed the quality of included studies independently. RevMan 5.2 software was used for Meta-analysis. ResultsAt last, 20 randomized controlled trials (involving 1 519 neonates; 783 in the treatment group and 736 in the control group) were included. The results of meta-analysis showed that the effect of naloxone for moderate and severe HIE was significantly superior to the control group[OR=5.07, 95%CI (3.61, 7.12), P < 0.000 01]. The neurobehavioral scores in neonates treated by naloxone after 5, 7, 10, and 14 days were higher than those in the control group[WMD=6.61 points, 95%CI (5.70, 7.51) points, P < 0.000 01; WMD=4.27 points, 95%CI (2.63, 5.91) points, P < 0.000 01; WMD=2.40 points, 95%CI (1.47, 3.34) points, P < 0.000 01; WMD=2.58 points, 95%CI (1.00, 4.16) points, P=0.001], respectively; while the neurobehavioral scores after 3-day treatment between the two groups had no statistically difference[WMD=0.00 points, 95%CI(-0.76, 0.77) points, P=0.99]. What's more, the disappeared time of clinical symptoms and signs (breathing improvement time, recovery time, convulsions disappearance time, and signs disappearance time) in naloxone group was superior to the control groups[WMD=-3.78 hours, 95%CI (-6.93, -0.64) hours, P=0.02; WMD=-9.66 hours, 95%CI (-14.25, -5.06) hours, P < 0.001; WMD=-2.81 hours, 95%CI (-5.28, -0.35) hours, P=0.03; WMD=-1.02 days, 95%CI (-1.84, -0.20) days, P=0.01], respectively. ConclusionsNaloxone has certain therapeutic on moderate and severe HIE. Further high-quality randomized controlled trials should be carried out to provide more reliable evidence.
Omphalocele is a less common congenitalmalformation in neonates and belongs to the realm of emergent surgical treatment. Early repair is of crucial importance for saving the patient s life. Ten neonates with omphalocele have undergone early surgical repair since 1988. The overall result was satisfactory. There were 8boys and 2 girls. The time of operation ranged from one to fortyeight hours after birth (24 hours in 8 cases). All of them were term neonates, except in onecase being premature. None of them had rupture of the sac membrane. The minor and major omphalocele were in 8 and 2 cases, respectively. Five cases accompaniedwith other congenital malformations (1 to 3 kinds). One case of them was complicated by exompholos-macroglossia-gigantism (EMG syndrome). Nine cases were treated by primary stage of surgical repair. One case with major omphalocelehad undergone two-staged operation. Nine neonates were survived and only onedied of pneumonia and scleroderma postoperatively. The patients were followed up for 3 months to 5 years, 9 cases were satisfactory. Early surgical repairwas essential to successful treatment. The choice of surgical methods, the management of concomittant malformation in the alimentary tract and the factors influencing the prognosis were discussed.