In 1984, according to the criteria of the classifieation for congenital hand deformity which wasput out by the International Hand Surgery Committee, we had made an investigation for congenitalhand deformity among 318066 newborns in Shanghai. It was found that the inctdence of a congenitalhand malformation was 0. 0808 percent among the total newborns. The congenital malformation ofthe thumb was 37. 74 percent of all deformities of the hand. According to the statistical analysis, we ...
Objective?To investigate the role of low-dose heparin added to total nutrient admixture (TNA) solutions in the prevention of catheter related infections (CRIs). Methods?One-hundred three newborn infants with periph-erally inserted central catheter (PICC) were divided into heparin group (n=63) and control group (n=40). The patients in the heparin group received TNA with 0.5 U/ ml heparin. The patients in the control group received TNA without heparin. We retrospectively analyzed the incidence of CRTs in the two groups. Results?We found that the incidence of CRIs was 0 in the heparin group and 12.5% (5/40) in the control group. The incidence of catheter obstruction was 6.3% (4/63) in the heparin group and 20% (8/40) in the control group. The incidence of catheter-tip colonization was 1.58% (1/40) in the heparin group and 17.5% (7/40) in the control group. The incidences of CRIs, catheter obstruction, and catheter-tip colonization were signiicantly lower in the heparin group than those in the control group (Plt;0.05). Conclusion?TNA solutions with 0.5U/ml heparin have decreased catheter obstruction and CRIs.
目的 評價不同復蘇方法和不同藥物、氧療、物理療法等對新生兒窒息復蘇和復蘇后的預防措施的有效性和安全性.方法 計算機檢索Cochrane Library(2004年第3期),MEDLINE(1966～2002年) 關于新生兒窒息復蘇時不同復蘇方法、氧氣的應用、以及不同藥物、劑量、給藥途徑治療和預防新生兒窒息的系統評價、隨機和半隨機對照試驗.結果 正壓通氣時使用100%氧氣和應用室內空氣的復蘇效果并無差異.胎糞污染羊水(MSAF)與較高的新生兒缺血缺氧性腦病(HIE)的發生率有關,而氣管內有胎糞者無論稀稠均與胎糞吸入綜合征發生率無關.窒息復蘇后預防性給予亞低溫療法、抗驚厥藥、納洛酮、多巴胺等在降低新生兒病死率,繼發HIE的嚴重程度等方面與對照組相比無顯著差異.應用肺表面活性物質(PS)預防和治療新生兒呼吸窘迫綜合征(RDS),可減少死亡率和并發癥.結論 應用PS預防和治療RDS可明顯減少新生兒死亡率,且胎齡lt;32周的早產兒預防用藥比治療用藥效果更好;目前尚無充分證據證明窒息復蘇后預防性給予亞低溫療法、抗驚厥藥、納洛酮、多巴胺等治療的有效性.
ObjectiveTo investigate the effects of total parenteral nutrition in neonatal patients and study the nursing methods for these neonates. MethodsWe retrospectively analyzed the clinical data of 70 neonatal patients who accepted total parenteral nutrition in our hospital from October 2010 to October 2011. Physiological indexes were compared before and after total parenteral nutrition. ResultsSignificant improvements in the nutritional status of all children were observed. All patients achieved good efficacy and effective care. ConclusionTotal parenteral nutrition support for critically ill newborns is of great significance, and good caring also plays an important role.
ObjectiveTo study the phenotype of children with KCNQ2 gene related epilepsy.MethodsForty epilepsy children who were detected with KCNQ2 gene variants were enrolled. Their genotype and phenotype were analyzed.ResultsThirty-six KCNQ2 variants were identified. Twenty variants were novel. Twelve patients had inherited variants, and 28 patients had de novo variants. The age of seizure onset was from one day to 9 months. 80.0% patients had their seizure onset in neonates (32/40). Multiple seizure types were observed. Focal seizure was observed in 38 patients (95.0%). Epileptic spasm was observed in 10 patients (25.0%). Myoclonic seizure was observed in 4 patients. Tonic spasm seizure was observed in 3 patients. In all patients, seizures manifested in clusters. In 28 patients with de novo KCNQ2 variants, 24 had development delay (85.7%), the other 4 patients had normal development. In 12 patients with inherited KCNQ2 variants, one had development delay, the other 11 patients had normal development (91.7%). The most common interictal EEG changes were local epilepsy discharges (31/40). The MRI of brain was abnormal in 14 patients with de novo KCNQ2 variants and developmental delay. The agenesis of corpus callosum was identified in 10 patient (25.0%). Enlargement of subarachnoid spaces in the frontal and temporal region was identified in 11 patients (27.5%). Cortial dysplasia in the bilateral frontal and temporal region was identified in 2 patients. Sulus deepening was identified in 4 patients. Enlargement of bilateral lateral ventricle was identified in 3 patients. In 40 patients with KCNQ2 variants, 3 were diagnosed as benign familial neonatal epilepsy (BFNE), 2 were diagnosed as benign familial neonatal-infantile epilepsy (BFNIE), 3 were benign familial infantile epilepsy (BFIE), 3 were benign infantile epilepsy (BIE), 5 were benign neonatal epilepsy (BNE), 3 wer Ohtahara syndrome (OS), 9 were West syndrome (WS), 12 were unclassified early infantile epileptic encephalopathy (EIEE), one was epilepsy with autism. Sodium channel blockers oxcarbazepine was the most effective among antiepileptic drugs, with a effective rate of 90.9%.ConclusionsMost KCNQ2 variants are missense variants. De novo variants are more common in patients with KCNQ2 variants. The clinical features of patients with KCNQ2 variants including that mainly with seizure onset in neonate, the main seizure type is focal seizures, seizures occur in clusters. Patients with de novo KCNQ2 variants often had developmental delay, and about half of them had frontal and temporal lobe dysplasia and agenesis of corpus callosum. Sodium channel blockers are effective agents for epilepsy patients with KCNQ2 variants.
ObjectiveTo evaluate the diagnostic accuracy and efficacy of X-ray for evaluating the tip position of umbilical venous catheterization (UVC). MethodsThe PubMed, Embase, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect diagnostic tests for UVC tip localisation from inception to 1 May 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality of the studies using the QUADAS-2 tool. Then, meta-analysis was performed by using Stata 16.0 software. Results Twelve articles involving 1 055 patients were included. The sensitivity and specificity of Negar Yazdani’s study were both 100%. The results of the meta-analysis (the remaining eleven articles, n=951) indicated a pooled sensitivity of 0.7 (95%CI 0.6 to 0.8), a pooled specificity of 0.8 (95%CI 0.7 to 0.9), a positive likelihood ratio of 4.0 (95%CI 2.0 to 8.1), a negative likelihood ratio of 0.4 (95%CI 0.2 to 0.6) and a diagnostic odds ratio of 11 (95%CI 3 to 36) with an area under the cumulative receiver operating characteristic curve of 0.8 (95%CI 0.8 to 0.9). A subgroup analysis was performed according to the different methods of judging X, the 8th–9th thoracic, the 9th–10th thoracic and combined judgement of the diaphragmatic plane + the vertebral body + the heart shadow. The sensitivities of the 3 groups were 0.8 (95%CI 0.5 to 0.9), 0.5 (95%CI 0.4 to 0.7) and 0.8 (95%CI 0.6 to 0.9); the specificities of the 3 groups were 0.8 (95%CI 0.6 to 0.9), 0.76 (95%CI 0.6 to 0.9) and 0.91 (95%CI 0.79 to 0.96). The areas under the cumulative receiver operating characteristic curve were 0.9 (95%CI 0.8 to 0.9), 0.7 (95%CI 0.6 to 0.7) and 0.92 (95%CI 0.89 to 0.94). ConclusionSome error is present when determining the catheter tip position by X-ray, in which the evaluation of the umbilical vein catheter tip position through a comprehensive evaluation of the diaphragmatic plane, the heart margin and the vertebral body is more powerful than the evaluation of the vertebral body alone.
In October 2020, the American Heart Association issued the 2020 edition of guidelines for cardiopulmonary resuscitation and cardiovascular first aid, which comprehensively revised cardiopulmonary resuscitation and emergency cardiovascular care guidelines related to adults, children, newborns, resuscitation education science and treatment system. According to the latest edition of International Liaison Committee on Resuscitation’s classes of recommendation and levels of evidence, relevant suggestions are put forward. This article interprets the main updated and revised content, including children’s basic and advanced life support and neonatal resuscitation, in order to better guide emergency personnel and improve the quality of cardiopulmonary resuscitation and cardiovascular first aid.
Objective To systematically review the diseases constitution of children in Chinese medical institutions from 2010 to 2016, and to provide evidence for establishing essential medicine list for children (EMLc) of China. Methods We searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data from January 2010 to February 2016 to collect studies about diseases constitution of Chinese children. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies, then data was descriptively analyzed. Results A total of 33 studies of diseases constitution were included, involving 1 797 696 children among 0 to 18 years from 17 provinces of China. Neonatal hyperbilirubinemia, neonatal pneumonia and premature were the main diseases of inpatient newborns. The main diseases of children hospitalized were pneumonia, upper respiratory tract infection and tumor. Upper respiratory tract infection, bronchopneumonia, bronchitis and diarrhea were the main diseases of outpatients. Hyperspasmia, upper respiratory tract infection and pneumonia were the main diseases of emergency patients. Diseases constitution of different medical institution: the main diseases were pathological jaundice, neonatal asphyxia and neonatal pneumonia in both tertiary and secondary medical institution in the newborn group. In the children group, the main diseases were pneumonia, upper respiratory tract infection and bronchitis in both tertiary and secondary medical institution. Besides these diseases, indigestion and fever of unknown origin were also the main diseases of primary medical institution. Disease constitution of different areas: in the newborn group, pathological jaundice, neonatal pneumonia and neonatal hyperbilirubinemia were the main diseases in coastal areas. Neonatal pneumonia, neonatal hyperbilirubinemia and premature were the main diseases in inland areas. Neonatal hyperbilirubinemia, neonatal pneumonia and neonatal hypoxic-ischemic encephalopathy were the main diseases in remote areas. In children group, pneumonia, bronchitis and premature were the main diseases in coastal areas. Pneumonia, bronchitis and hand-foot-and-mouth disease were the main diseases in inland areas. Upper respiratory tract infection, bronchopneumonia and bronchitis were the main diseases in remote areas. Conclusion Diseases constitutions of children vary in different medical institution, and because of extreme lack of date from primary medical institution, we suggest to carry out investigation in primary medical institution to provide evidence for EMLc. Diseases constitutions of children vary in different area, additions should be made according to local conditions when essential drugs of children selected. Newborn, as a special group of children, should be considered separately when EMLc of China established.
ObjectiveTo evaluate the quality of Chinese guidelines of newborns so as to provide references for the formulation of relevant guidelines for newborns in the future.MethodsCBM, VIP, WanFang Data, CNKI and Medlive databases were systematically searched to collect clinical practice guidelines in neonatal field in China from January 1st, 2000 to June 28th, 2020. Four researchers independently screened literature, extracted data, used AGREEⅡ to evaluate the methodological quality of the guidelines, used RIGHT to evaluate the reporting quality of the guidelines, and analyzed the score and reporting rate of items in each field.ResultsA total of 35 guidelines were included, and the quantity of publications increased annually. The AGREEⅡ score showed that guidelines published after 2017 were rated higher in all areas than that prior to 2017, with clarity scoring highest (82.9%) and editorial independence scoring lowest (15.4%). The RIGHT score showed that guidelines published after 2017 had higher reporting rates in most areas than that prior to 2017. The highest proportion of reported areas was basic information (75.6% vs. 65.0%). Areas with the lowest reporting ratios in the guidelines prior to 2017 were review and quality assurance (0%), while after 2017 were other areas (4.4%).ConclusionsNeonatal guidelines in China have developed rapidly and the quality of the guideline still requires improvement.
ObjectiveTo establish a hereditary deafness genetic screening cohort and conduct prospective follow-up to evaluate the effectiveness of the Nantong newborn genetic deafness screening program. MethodsA study based on traditional screening of newborn hearing was conducted from January 2016 to June 2021. Newborns in six hospitals in Nantong were screened for 15 hotspot mutation loci in four common deafness genes. Cohort follow-up was conducted. ResultsA total of 40 403 newborns were included, with a carrier rate of 39.5 per 1 000 for the four common deafness genes. In total, 168 children with hearing loss (HL) were identified at screening and follow-up, of which 56.5% (95 cases) had severe or very severe HL. The detection rate of HL was significantly higher with combined screening than with traditional screening (3.0‰ vs. 3.9‰, P<0.001). All four carriers of pathogenic mutations with normal hearing developed late-onset HL within 2 years of age. At the end of follow-up, six of the polygenic heterozygous mutation carriers had congenital HL and five had late-onset HL. Carriers of polygenic heterozygous mutations were more common as compared to other carrier mutation populations (2.1% vs. 68.8%, P<0.001). In addition, 525 carriers of the SLC26A4 mutation and 118 carriers of the MT-RNR1 mutation were identified and their parents were counselled during the combined screening, and no children with HL was identified during the follow-up period. ConclusionGenetic screening for deafness improves the detection of HL at birth. It is recommended that carriers of pathogenic mutations with normal hearing at birth be followed up every 3 to 6 months until the age of 2 years. Carriers of polygenic heterozygous mutations should undergo extended screening for deafness genes and have their hearing monitored more intensively for early detection of late-onset or progressive HL.