摘要:目的：觀察小兒反復性肺炎的發生與血微量元素的關系。方法:選擇56例反復性肺炎患兒為觀察組，與60例健康兒童作對照，分別測定血鎘、鉛、銅、鋅、鈣、鎂、鐵含量。結果:56例反復性肺炎患兒血鋅、鐵含量較對照組減低，差異有統計學意義（Plt;0.05）。結論:部分反復性肺炎的發生與血微量元素鋅、鐵缺乏有關。應對反復性肺炎患兒常規行血微量元素檢測，對血微量元素缺乏者應予相應補充治療。Abstract: Objective: To observe the relationship to the occurrence of repeated pneumonia and the microelement in blood. Methods: We chose the 56 infant patients who suffered from repeated pneumonia as the observe group while the 60 health infants as the comprise group, then test the content of cadmium， plumbum， cuprum， zinc， calcium， magnesium and ferrum in blood. Results: The content of zinc and ferrum in the patient’s blood was lower than the comparison group, and the P value was Plt;0.01 and Plt;0.05 respectively, there was obvious differentiation between the two groups. Conclusion: Occurence of part repeated pneumonia is related to the deficiency of the microelements zinc and ferrum in blood. We should detect the common content of microelement to the infant patients who suffer the repeated pneumonia, and give a complement treatment to the microelements’ deficiency infant patients.
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 explore the related factors for the influences and outcomes of mothers and infants, and further provide a basic reference for reducing maternal and prenatal mortality caused by central placenta previa, through the analysis of its clinical characteristics. MethodsWe retrospectively analyzed the clinical data of 89 patients with central placenta previa treated from January to August 2012. ResultsThere were 89 patients with central placenta previa, and the average age of these patients was (29.6±11.4) years, and the average number of pregnancy among the patients was 3.17. Nine patients had scar uterus; 8 had pernicious placenta previa (9%); 34 had prenatal anemia symptoms; 44 had prenatal vaginal bleeding with the bleeding volume ranged from 2 to 500 mL; 40 were treated before delivery. The average gestational age was 36 weeks ±4.2 days, and 28 of them were readmitted. The intraoperative bleeding in such patients as had placenta located in the anterior wall, placenta adhesion or implantation, history of uterine cavity operation or multipara was more than other patients. The postpartum hemorrhage of patients with the gestational age of 36 weeks or more was more than that of patients with the gestational age shorter than 36 weeks. The incidence of fetal distress in patients with the gestational age of 36 weeks or more is lower and the neonatal 1-minute Apgar score was higher than that in patients with the gestational age shorter than 36 weeks (P<0.05). ConclusionThe treatment of central type of placenta previa should be more active to prolong the gestational week. Patients with placenta adhesion or implantation, caesarean, multipara and placenta in the anterior wall are susceptible to intraoperative bleeding during the termination of pregnancy. Termination of pregnancy in these patients with central placenta previa should be carried out by cesarean section when gestation is more than 36 weeks to reduce postpartum hemorrhage and complications.
Objective To assess the growth station, the upper respiratory infection frequency and consultation frequency of the geographically defined high risk neonatal population at 1-year-old based on both birthweight and gestational age. Methods All infants admitted in our hospital from May in 2008 to May in 2009 were divided into three groups according to gestational age and birth weight, that were, group 1: born lt;32 completed gestational weeks and weighing ≥1 500 g; group 2: born after 32 completed gestational weeks and weighing lt;1 500 g; and group 3: born lt;32 completed gestational weeks and weighing lt;1 500 g. Information at 12 months corrected age about growth, the upper respiratory infection frequency and consultation frequency was collected. Results The growth rate of weight and head circumference in group 3 were lower than that in group 1, and the length growth rate was lower than that in group 1 and group 2. Infants in group 3 suffered from more airway infections (median: 15.5) than in group 1 (12.5) and group 2 (8.5). Infants in group 3 needed more medical consultations (median: 27.5) than those in group 1(17.5) and group 2 (15.5). Conclusions This study gives estimates for growth outcome, airway infection and consultation frequency at 12 months corrected age for very low birthweight infants (lt;1 500 g) and for very preterm infants (lt;32 completed gestational weeks). Gestational age and birth weight are the same important for predicting infants’ outcome and should therefore be integrated into clinical statistics.
We applied resting-state functional magnetic resonance imaging (rfMRI) combined with graph theory to analyze 90 regions of the infantile small world neural network of the whole brain. We tried to get the following two points clear:① whether the parameters of the node property of the infantile small world neural network are correlated with the level of infantile intelligence development; ② whether the parameters of the infantile small world neural network are correlated with the children's baseline parameters, i.e., the demographic parameters such as gender, age, parents' education level, etc. Twelve cases of healthy infants were included in the investigation (9 males and 3 females with the average age of 33.42±8.42 months.) We then evaluated the level of infantile intelligence of all the cases and graded by Gesell Development Scale Test. We used a Siemens 3.0T Trio imaging system to perform resting-state (rs) EPI scans, and collected the BOLD functional Magnetic Resonance Imaging (fMRI) data. We performed the data processing with Statistical Parametric Mapping 5(SPM5) based on Matlab environment. Furthermore, we got the attributes of the whole brain small world and node attributes of 90 encephalic regions of templates of Anatomatic Automatic Labeling (ALL). At last, we carried out correlation study between the above-mentioned attitudes, intelligence scale parameters and demographic data. The results showed that many node attributes of small world neural network were closely correlated with intelligence scale parameters. Betweeness was mainly centered in thalamus, superior frontal gyrus, and occipital lobe (negative correlation). The r value of superior occipital gyrus associated with the individual and social intelligent scale was -0.729 (P=0.007); degree was mainly centered in amygdaloid nucleus, superior frontal gyrus, and inferior parietal gyrus (positive correlation). The r value of inferior parietal gyrus associated with the gross motor intelligent scale was 0.725 (P=0.008); efficiency was mainly centered in inferior frontal gyrus, inferior parietal gyrus, and insular lobe (positive correlation). The r value of inferior parietal gyrus associated with the language intelligent scale was 0.738 (P=0.006); Anoda cluster coefficient (anodalCp) was centered in frontal lobe, inferior parietal gyrus, and paracentral lobule (positive correlation); Node shortest path length (nlp) was centered in frontal lobe, inferior parietal gyrus, and insular lobe. The distribution of the encephalic regions in the left and right brain was different. However, no statistical significance was found between the correlation of monolithic attributes of small world and intelligence scale. The encephalic regions, in which node attributes of small world were related to other demographic indices, were mainly centered in temporal lobe, cuneus, cingulated gyrus, angular gyrus, and paracentral lobule areas. Most of them belong to the default mode network (DMN). The node attributes of small world neural network are widely related to infantile intelligence level, moreover the distribution is characteristic in different encephalic regions. The distribution of dominant encephalic is in accordance the related functions. The existing correlations reflect the ever changing small world nervous network during infantile development.
Objective To investigate the safety and effect of same-day discharge in injection sclerotherapy for children with hemangioma (IJCH) and tension-free hernioplasty for adults with inguinal herinia (TFHA). Methods A retrospective analysis was conducted on patients undergoing IJCH or TFHA in the Day Surgery Center of West China Hospital of Sichuan University between November 2020 and October 2021. According to the patient’s condition and willingness, they were divided into same-day discharge group (162 children and 180 adults) and overnight hospitalization group (68 children and 271 adults). The amount of intraoperative bleeding, length of hospital stay, hospitalization expenses, pain before discharge, and short-term postoperative complications were compared between the two groups. Visual analogue scale was used for pain assessment in adults and children over 6 years old, and smiley face score was used in children below 6 years old. Results Compared with those in the overnight discharge group, the amount of intraoperative bleeding in the same-day discharge group was less [IJCH: (0.45±0.05) vs. (2.76±1.21) mL, P<0.05; TFHA: (1.20±0.05) vs. (6.76±2.30) mL, P<0.05], length of hospital stay was shorter [IJCH: (7.99±1.22) vs. (23.10±1.42) h, P<0.05; TFHA: (6.13±1.79) vs. (22.75±1.80) h, P<0.05], hospitalization cost was lower [IJCH: (5094.00±1320.14) vs. (6263.52±1220.20) yuan, P<0.05; TFHA: (7199.21±1535.84) vs. (7976.82±1967.82) yuan, P<0.05], pain before discharge was milder (IJCH: 0.05±0.02 vs. 0.50±0.01, P<0.05; TFHA: 1.20±0.01 vs. 2.01±0.20, P<0.05). There was no significant difference in the incidence of postoperative complications or unplanned revisit within 30 days between the two modes (P>0.05). Conclusions The same-day surgery mode is safe and feasible in IJCH and TFHA, and can shorten the length of hospital stay and reduce the cost of hospitalization. It is suggested to popularize this mode in clinical practice.
A case of a 4-month-old child with an aortopulmonary fenestration weighing 6.6 kg who underwent successful transthoracic minimally invasive occlusion in our hospital was reported in this article. The child was transferred from the intensive care unit (ICU) to the general ward 1 day after surgery and discharged 5 days later. Compared with conventional ligation or repair of extracorporeal circulation for the aortopulmonary fenestration, the transthoracic minimally invasive occlusion is characterized by less trauma and faster recovery. However, it requires strict surgical indications and is not suitable for all patients with aortopulmonary fenestration.
ObjectiveTo investigate the relationship between peripheral blood inflammatory markers and the development of retinopathy of prematurity (ROP) in extremely low birth weight infants (ELBWI), and to preliminarily evaluate their predictive value for ROP. MethodsA retrospective clinical study. A total of 191 ELBWI who were born at The Affiliated Hospital of Qingdao University and admitted to the neonatal intensive care unit between January 2018 and December 2023 were enrolled. According to the presence or absence of inflammation-related diseases (necrotizing enterocolitis, bronchopulmonary dysplasia, neonatal sepsis), infants were divided into an inflammation-related disease group (144 cases) and a non-inflammation-related disease group (47 cases). Clinical data and peripheral blood inflammatory markers at 7, 14, and 28 days after birth, including white blood cell count (WBC), C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) that were compared between the two groups, as well as between infants with and without ROP within the inflammation-related disease group. Logistic regression analysis was used to identify variables associated with the occurrence of ROP. A receiver operating characteristic (ROC) curve was constructed to assess the predictive performance of the combined model, and decision curve analysis (DCA) was applied to evaluate its potential clinical utility. ResultsAmong the 191 infants included, 80 cases were diagnosed with ROP (41.9%, 80/191). The incidence of ROP was 68/144 (47.22%) in the inflammation-related disease group and 12/47 (25.53%) in the non-inflammation-related disease group, with a statistically significant difference between the two groups (χ2=6.849, P=0.010). In the inflammation-related disease group, compared with infants without ROP, those with ROP had lower birth weight (Z=?2.591) and gestational age (Z=?2.942), a lower proportion of cesarean delivery (χ2=5.846), longer durations of invasive and noninvasive mechanical ventilation (Z=?2.500, ?2.057), and a higher incidence of patent ductus arteriosus (χ2=4.598) (P＜0.05). Levels of inflammatory markers were significantly higher in the ROP group, including WBC and SII at 7 days (Z=?2.85, ?2.565), SII at 14 days (Z=?2.531), and WBC, NLR, and SII at 28 days after birth (Z=?2.385, ?3.051, ?2.719; P＜0.05). In contrast, CRP levels at 7, 14, and 28 days did not differ significantly between ROP and non-ROP infants (Z=?1.550, ?0.796, ?0.132; P＞0.05). Multivariate logistic regression analysis showed that decreased birth weight [95% confidence interval (CI) 0.990-0.998] and increased WBC at 7 days (95%CI 1.004-1.129) and SII at 28 days (95%CI 1.001-1.006) after birth were independent related factors for the occurrence of ROP (P＜0.05). ROC curve analysis indicated that the area under the curve for predicting ROP by combining birth weight, WBC at 7 days after birth, and SII at 28 days was 0.71, with a sensitivity of 91% and a specificity of 44%. DCA shows that when the risk threshold is 31% to 98%, this combined prediction model has a positive net clinical benefit. In the non-inflammation-related disease group, only birth weight was negatively correlated with the occurrence of ROP (95%CI 0.975-0.996, P=0.005). ConclusionsIn ELBWI patients with inflammation-related diseases, the levels of peripheral blood WBC and SII are associated with the occurrence of ROP. The combination of birth weight and inflammatory indicators at specific time points has certain predictive value for ROP.
Objective To guide blood glucose management during pregnancy and reduce the incidence of long-term complications of the fetus by exploring the long-term growth condition of offspring of pregnant women with gestational diabetes mellitus. Methods A total of 180 cases full-term newborns of pregnant women with gestational diabetes mellitus from December 25th, 2011 to December 25th, 2012 were selected as the diabetes group. Another 200 newborns of pregnant women without any complications were randomly collected as the control group. Birth weight, gestational age, sex, blood glucose, and 24-, 48-, 72- and 120-hour transcutaneous bilirubin value after the birth of the newborns were recorded; weight, height, body mass index (BMI), triglycerides, total cholesterol, high density lipoprotein (HDL), low density lipoprotein, blood pressure and fasting plasma glucose quota between the two groups were contrasted when the children were three years old. Results There were no significant difference in the birth weight, gestational age and sex between the diabetic and the control group. The blood glucose levels of the newborns in the diabetic group was significantly lower than that in the control group (P<0.05). The 24-, 48-, 72- and 120-hour transcutaneous bilirubin values of the newborns in the diabetic group were significantly higher than those of the control group (P<0.05). The weight, height and BMI of the three years old offspring in the diabetic group were significantly higher than those in the control group (P<0.05). There were no significant difference in triglycerides, total cholesterol, HDL, Low density lipoprotein, fasting plasma glucose quota, and systolic blood pressure between the diabetic group and the control group (P>0.05), but the diastolic blood pressure in the diabetic group was much higher than that in the control group (P<0.05). Conclusion The impact of gestational diabetes mellitus on offspring of pregnant women was not only in the fetus and newborn period, but also in the future, which should be timely intervened.
ObjectiveTo systematically review the effectiveness and safety of interventions which target to improve the rate of successful extubation in preterm infants.MethodsPubMed, Web of Science, Cochrane Library, Chongqing VIP database, China National Knowledge Infrastructure, and Wanfang Database were searched for articles published from the dates of establishment of databases to August 2020, which compared different noninvasive respiratory support models or different doses of caffeine to improve the rate of successful extubation in preterm infants in randomized controlled trials. The references of included articles were also retrieved. And then a meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 33 randomized controlled trials involving 4 536 preterm infants were included. Compared with nasal continuous positive airway pressure (NCPAP), high-flow nasal cannula (HFNC) reduced the nose injury rate [odds ratio (OR)=0.29, 95% confidence interval (CI) (0.15, 0.57), P=0.000 3] and the pneumothorax rate [OR=0.18, 95%CI (0.06, 0.55), P=0.003]; nasal intermittent positive pressure ventilation (NIPPV) reduced the extubation failure rate [OR=0.33, 95%CI (0.23, 0.48), P<0.000 01], the reintubation rate [OR=0.36, 95%CI (0.20, 0.65), P=0.000 7], the respiratory failure rate [OR=0.33, 95%CI (0.17, 0.64), P=0.000 9], and the pneumothorax rate [OR=0.29, 95%CI (0.12, 0.70), P=0.006]; and biphasic positive airway pressure (BiPAP) reduced the reintubation rate [OR=0.21, 95%CI (0.09, 0.46), P=0.000 1]. Compared with low-dose caffeine, high-dose caffeine reduced the extubation failure rate [OR=0.44, 95%CI (0.32, 0.60), P<0.000 01] and the bronchopulmonary dysplasia rate [OR=0.69, 95%CI (0.48, 0.99), P=0.04], but increased the rate of tachycardia [OR=1.99, 95%CI (1.22, 3.25), P=0.006].ConclusionAccording to the current evidence, compared with NCPAP, NIPPV and BiPAP could be used to improve the rate of successful extubation in preterm infants, HFNC could be used to decrease the risk of nose injury and pneumothorax; the optimal dose of caffeine should be chosen after evaluating the risk of adverse reactions such as tachycardia.