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Objective:To explore the value of ultrasonic cardiac output monitor(USCOM) in guiding perioperative hemodynamic management of neonatal gastrointestinal surgery.Methods:Seventy-five neonates with hemodynamic changes after gastrointestinal surgery admitted to the Department of Neonatology, Xiamen Children′s Hospital from January 2017 to December 2020 were enrolled, of which the non-USCOM group had 34 cases from January 2017 to December 2018, mainly based on clinical indicators such as heart rate, blood pressure, blood lactate acid to evaluate the hemodynamic status of children after surgery.The USCOM group had 41 cases from January 2019 to December 2020, used USCOM to assist in the evaluation of hemodynamics of children after surgery dynamic state.Another 40 cases were set up as the control group, included neonates with hyperbilirubinemia.The USCOM group and the control group were examined by USCOM to record cardiac output(CO), cardiac index(CI), and systemic vascular resistance(SVR). The changes in CO, CI, SVR between the USCOM group and the control group, the changes in USCOM group before and after the operation were compared, respectively.Changes in heart rate, blood pressure, and lactic acid in the USCOM group before and after the operation were compared.And the differences of vasoactive drug dosage and time of first use after operation, postoperative first expansion time, volume expansion, incidence of anuria or oliguria within 24 hours after operation, and length of hospital stay between USCOM group and non-USCOM group were analyzed.Results:The CO, CI, SVR, heart rate, blood pressure before operation in USCOM group were not significantly different compared with those in the control group and 12 h after the operation.The CO and CI in USCOM group at 1 h after operation were lower than those before operation, and the lactic acid increased, the differences were statistically significant( P<0.05). The SVR of USCOM group at 1 h after operation was higher than that before operation, but there was no significant difference ( P>0.05). The CO and CI at 12 h after operation in USCOM group were higher than those at 1 h after operation, and the SVR at 12 h was lower than that at 1 h after operation , the differences were all statistically significant( P<0.05). There were no significant differences in heart rate and blood pressure in USCOM group before and 1 h after operation ( P>0.05). The blood pressure at 12 h after operation was significantly higher than that at 1 h after operation( P<0.05). The time of first volume expansion and use of vasoactive drugs in USCOM group were significantly earlier than those in non-USCOM group[0.75(0.50, 1.37)h vs.7.00(5.00, 13.25)h, Z=-7.041, P<0.001; (1.39±1.33)h vs.(8.61±5.15)h, t=-7.917, P<0.001], the total volume of expansion was significantly reduced[17.50(10.00, 30.00)mL vs.30.00(20.00, 30.00)mL, t=-3.045, P=0.002], the dosage of dopamine was significantly reduced[8.40(6.20, 10.40)mg/kg vs.8.90(7.20, 14.40)mg/kg, Z=-2.475, P=0.013], the incidence of oliguria or anuria within 24 hours after operation was significantly reduced(12.2% vs.32.3%, t=4.500, P=0.034), the length of hospital stay was significantly shortened[25.00(15.50, 31.00)d vs.28.00(21.75, 34.00)d, Z=-1.985, P=0.047], and the dosage of dobutamine and epinephrine was not significantly changed( P>0.05). Conclusion:Non-invasive hemodynamic monitoring can monitor the hemodynamic changes of the neonatal gastrointestinal tract in real time during the perioperative period, which is helpful to guide the management of vasoactive drugs and fluids after surgery.
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We report the diagnosis and treatment of a neonate with primary pulmonary hypertension. The full-term baby was delivered vaginally in good condition at birth and admitted eight days after birth due to intermittent cyanosis. The chest X-ray showed a scattered sheet-like shadow in both lungs, and the cardiac color doppler studies suggested patent ductus arteriosus. Following admission, the neonate was given three days of anti-infection and headbox oxygen treatment. Despite subsequent high-frequency ventilator assisted ventilation combined with nitric oxide inhalation and continuous intravenous milrinone and oral sildenafil, the baby's condition worsened, and she died fifteen minutes after withdrawing resuscitation. Genetic studies revealed a chr13:37446983 mutation in SMAD9.
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We reported the diagnosis and treatment of a male infant with congenital tuberculosis. He was a small for gestational age (SGA) and formula-fed baby born virginally at the gestational age of 36 weeks. He was admitted to hospital at the age of 28 days for fever. His mother experienced untreated low fever and cough at 24-28 gestational weeks and was postnatally diagnosed as having pulmonary tuberculosis and tuberculosis encephalitis. Physical examination of the baby found hepatomegaly and splenomegaly on admission and the lab results indicated anaemia, elevated C-reactive protein (CRP) and impaired liver function. Acid-fast Bacillus was detected in gastric fluid smear test using acid-fast staining. The detection of T-cell ELIspots in tuberculosis infection (T-SPOT.TB) test was positive. Chest/abdominal X-rays showed multiple nodular and linear shadows in both lungs. Abdominal MRI revealed abnormal signals of diffuse nodular lesions in the liver and spleen. X-rays of the long bones showed few periosteal reactions in both femurs. Quadruple anti-tuberculosis therapy with isoniazid, rifampicin, pyrazinamide and amikacin was initiated on admission and the patient experienced fluctuating body temperature, poor weight gain and CRP level ranging from 15 to 22 mg/L. Though the pulmonary lesion subsided after the treatment, no significant change occured in hepatic or splenic lesions. The baby boy was discharged from the hospital at the request of his parents on 39 d and lost to follow-up.
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Objective To explore the application effect of intelligent assistant decision-making in the five-level triage of pediatric emergency department. Methods The patients treated in the pediatric emergency department of Xiamen Children′s Hospital using the intelligent assistant decision-making system were divided into two groups before and after one month. In March 2018,17 900 cases were in the traditional group,and in April 2018,18 590 cases were in the intelligent group. The traditional group conducted manual triage accord-ing to the five-level pre-screening and triage standard. The intelligent group conducted triage based on the self-developed intelligent assistant decision-making system. Intelligent assistant decision-making included au-tomatic identification of whether vital signs data was abnormal and automatic provision of basis for triage lev-el to help nurses confirm two major functions. The patients′information were collected according to the estab-lished content,and the system would automatically identify and present according to the corresponding triage basis to determine the triage level. The two groups of children were compared and analyzed in terms of dis-ease distribution,triage level,triage accuracy. The clinical application effect of the emergency pediatric pre-check triage system was evaluated. Results There was no significant difference in disease distribution be-tween the two groups. The top three were respiratory diseases,infectious diseases and digestive diseases. In the comparison of waiting time between the two groups,the waiting time of grade Ⅲ,Ⅳ and Ⅴ patients in the intelligent group was shorter than that in the traditional group,the difference was statistically significant (P<0. 05). The consistency of triage grade in the intelligent group was higher than that in the traditional group. The family satisfaction of children in the intelligent group ofⅢ,Ⅳ,andⅤgrade was higher than that in the traditional group. Conclusion The application of intelligent assistant decision-making could improve the efficiency and accuracy of the pre-examination of the nurses,ensure the effectiveness of the triage and the safety of the children,and improve the satisfaction of family members.
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Objective@#To explore the application effect of intelligent assistant decision-making in the five-level triage of pediatric emergency department.@*Methods@#The patients treated in the pediatric emergency department of Xiamen Children′s Hospital using the intelligent assistant decision-making system were divided into two groups before and after one month.In March 2018, 17 900 cases were in the traditional group, and in April 2018, 18 590 cases were in the intelligent group.The traditional group conducted manual triage according to the five-level pre-screening and triage standard.The intelligent group conducted triage based on the self-developed intelligent assistant decision-making system.Intelligent assistant decision-making included automatic identification of whether vital signs data was abnormal and automatic provision of basis for triage level to help nurses confirm two major functions.The patients′ information were collected according to the established content, and the system would automatically identify and present according to the corresponding triage basis to determine the triage level.The two groups of children were compared and analyzed in terms of disease distribution, triage level, triage accuracy.The clinical application effect of the emergency pediatric pre-check triage system was evaluated.@*Results@#There was no significant difference in disease distribution between the two groups.The top three were respiratory diseases, infectious diseases and digestive diseases.In the comparison of waiting time between the two groups, the waiting time of grade Ⅲ, Ⅳ and Ⅴ patients in the intelligent group was shorter than that in the traditional group, the difference was statistically significant (P<0.05). The consistency of triage grade in the intelligent group was higher than that in the traditional group.The family satisfaction of children in the intelligent group of Ⅲ, Ⅳ, and Ⅴ grade was higher than that in the traditional group.@*Conclusion@#The application of intelligent assistant decision-making could improve the efficiency and accuracy of the pre-examination of the nurses, ensure the effectiveness of the triage and the safety of the children, and improve the satisfaction of family members.
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We reported the diagnosis and treatment of a male infant with congenital tuberculosis. He was a small for gestational age (SGA) and formula-fed baby born virginally at the gestational age of 36 weeks. He was admitted to hospital at the age of 28 days for fever. His mother experienced untreated low fever and cough at 24-28 gestational weeks and was postnatally diagnosed as having pulmonary tuberculosis and tuberculosis encephalitis. Physical examination of the baby found hepatomegaly and splenomegaly on admission and the lab results indicated anaemia, elevated C-reactive protein (CRP) and impaired liver function. Acid-fast Bacillus was detected in gastric fluid smear test using acid-fast staining. The detection of T-cell ELIspots in tuberculosis infection (T-SPOT.TB) test was positive. Chest/abdominal X-rays showed multiple nodular and linear shadows in both lungs. Abdominal MRI revealed abnormal signals of diffuse nodular lesions in the liver and spleen. X-rays of the long bones showed few periosteal reactions in both femurs. Quadruple anti-tuberculosis therapy with isoniazid, rifampicin, pyrazinamide and amikacin was initiated on admission and the patient experienced fluctuating body temperature, poor weight gain and CRP level ranging from 15 to 22 mg/L. Though the pulmonary lesion subsided after the treatment, no significant change occured in hepatic or splenic lesions. The baby boy was discharged from the hospital at the request of his parents on 39 d and lost to follow-up.
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Objective To analyze the reasonable and suitable level of serum 25 hydroxy vitamin D [25 (OH) D] and Vitamin D(Vit D) supplement of premature infants born less than 32 weeks in the neo-natal intensive care unit. Methods For eligible premature infants hospitalized in our department from March 2016 to December 2017,Vit D 900 IU/d was supplemented one week after birth under the conditions of es-tablishing enteral feeding. The selected cases were divided into two groups based on different blood concentra-tion of serum 25(OH)D at four weeks after birth,for 38 cases≥25 ng/ml as group A and 24 cases 15 to 25 ng/ml as group B. Their bone mass density( BMD) were tested at correct gestational age of 40 weeks and compared with 40 term infants as control group at the same period. Results The serum concentrations of 25(OH) D in group A were (29.23 ±3.08)ng/ml at 4 weeks and (35.13 ±4.67)ng/ml at 8 weeks after birth respectively. At correct gestational age of 40 weeks,13. 2％(5/38) cases demonstrated the lower BMD. The serum concentrations of 25(OH) D in group B were (20. 12 ± 3. 95)ng/ml at 4 weeks and (22. 36 ± 4. 82)ng/ml at 8 weeks after birth respectively. At correct gestational age of 40 weeks,75. 0％(18/24) cases demonstrated the lower BMD. The differences between group A and control group were not statistically sig-nificant(χ2 =0. 06,P>0. 05),and differences between group B and control group were statistically signifi-cant(χ2 =25. 45,P<0. 001). Conclusion Premature should be given Vit D 900 IU/day or more with rea-sonable and sufficient calcium and phosphorus to maintain their concentration of serum 25(OH)D at about 29. 23 ng/ml and re-check their concentration of serum 25 ( OH) D every four weeks.
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Objective To evaluate the values of amplitude-integrated electroencephalogram(aEEG) on the diagnosis of hypoxic ischemic encephalopathy(HIE),and the changes of aEEG in HIE with hypother-mia treatment.And to assess the therapeutic effect of hypothermia.Methods The changes of aEEG were continuously monitored before and after hypothermia treatment,and the proportions of various waveforms ap-pearing in aEEG were analyzed.Results A total of 90 cases were enrolled in this study,the changes of aEEG were monitored,including aEEG normal in 43 cases,mild abnormalities in 33 cases and severe abnor-malities in 14 cases.aEEG monitoring had a higher consistency with HIE grade and cranial MRI examination (Kappa ﹦0.584,P 〈0.001 ;Kappa ﹦0.590,P 〈0.001 ).The sensitivity,specificity,positive predictive val-ue,and negative predictive values of aEEG were high in predicting the severity of HIE.The index of with mild and severe abnormalities of aEEG was significant difference before and after the treatment of hypother-mia(P 〈0.05).Conclusion aEEG has a better evaluation effect on early diagnosis and severity assessing of HIE.Hypothermia can significantly reduce the proportion of abnormal aEEG after HIE,have a neuroprotective effect on the treatment of mild to moderate HIE.
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Objective To study the safety and efficacy of selective head cooling (SHC) with mild systemic hypotherrnia in neonates with HIE. Methods Fifty-four term infants with severe neonatal HIE were randomly assigned to the head cooling group (n=27) and control group (n=27). Forty-one infants in 96 h after admission were eligible for the study(SHC group n=21, control group n=20). In SHC group, the naso-pharyngeal temperature was maintained at (34.0±0.2) ℃ and rectal temperature maintained at 34～35 ℃ for 72 h, then rewarmed spontaneously. In control group, normal rectal temperature was maintained. During the period of the study, the infants of two groups were monitored on nasopharyngeal temperature, heart rate, respiratory rate,transcutaneous arterial oxygen saturation and blood pressure. Primary adverse effects inclu-ding severe arrhythmia, venous thrombosis or hemorrhage and severe hypotension were observed. The efficacy indicators including rate of death and severe disability, exercise and cognition development index were as-sessed. Results Severe arrhythmia, hypotension and renal failure were not found in both groups. Follow-up was conducted until postnatal 18 months and was not available in 6 babies (3 in SHC group and 3 in control group respectively). Death and severe disability occurred in 4 of 18 infants (22.2%)in SHC group and in 9 of 17 infants(52.9% ) in the control group respectively (P<0.05). Conclusion SHC for 72 h with mild systemic hypothermia in neonates with HIE is safe and effective. The therapy could reduce the risk of disabili-ty and handicap significantly.