Short-term clinical outcomes of different courses of antenatal corticosteroids for preterm twins / 中国新生儿科杂志

Objective:To study the short-term clinical outcomes of different courses of antenatal corticosteroids (ACS) for preterm twins.Methods:From January 2017 to December 2021, preterm twins with gestational age (GA) 24-34 weeks admitted to the neonatal ward of our hospital and received ACS were retrospectively studied. The infants were assigned into single-course group, partial-course group and multiple-course group according to ACS courses. The short-term clinical outcomes were compared among the groups. SPSS software version 25.0 was used for statistical analysis.Results:A total of 286 infants were enrolled in this study, including 128 in single-course group, 89 in partial-course group and 69 in multiple-course group. Compared with single-course group, the risks of neonatal respiratory distress syndrome (RDS) in both partial-course group ( OR=2.332, 95% CI 1.028-5.293, P=0.043) and multiple-course group ( OR=3.872, 95% CI 1.104-13.584, P=0.034) were higher. The birth length in multiple-course group ( β=-0.016, 95% CI -0.029 - -0.002, P=0.024) was lower than single-course group. Conclusions:The risks of neonatal RDS in preterm twins are higher in partial-course and multiple-course of ACS. A full course of ACS should be used to prevent neonatal RDS until further evidence of effectiveness is available.

Clinical characteristics of children with SARS-CoV-2 Omicron variant infection in Kunming / 中华儿科杂志

Objective: To investigate the clinical characteristics of hospitalized children infected with the Omicron variant in Kunming after the withdrawal of non-pharmaceutical interventions (NPI) and analyze the risk factors of severe cases. Methods: Clinical data was retrospectively collected from 1 145 children with SARS-CoV-2 Omicron infection who were hospitalized in six tertiary grade A hospitals in Kunming from December 10th, 2022 to January 9th, 2023. According to clinical severity, these patients were divided into the general and severe SARS-CoV-2 groups, and their clinical and laboratory data were compared. Between-group comparison was performed using t-test, chi-square test and Mann-Whitney U test. Spearman correlation test and multivariate Logistic regression analysis were used to determine the risk factors of severe illness. Results: A total of 1 145 hospitalized patients were included, of whom 677 were male and 468 female. The age of these patients at visit was 1.7 (0.5, 4.1) years. Specifically, there were 758 patients (66.2%) aged ≤3 years at visit and 387 patients (33.8%) aged >3 years. Of these children, 89 cases (7.8%) had underline diseases and the remaining 1 056 cases (92.2%) had no combined diseases. Additionally, of all the patients, 319 cases (27.9%) were vaccinated with one or two doses of SARS-CoV-2 vaccine, 748 cases (65.3%) had acute upper respiratory tract infection (AURTI), and six cases died (0.5%). A total of 1 051 cases (91.8%) were grouped into general SARS-CoV-2 group and 94 cases (8.2%) were grouped into severe SARS-CoV-2 group. Compared with the general cases, the severe cases showed a lower rate of SARS-CoV-2 vaccination and younger median age, lower lymphocyte count, as well as proportions of CD8+T lymphocyte (36 cases (38.3%) vs. 283 cases (26.9%), 0.5 (2.6, 8.0) vs. 1.6 (0.5, 3.9) years, 1.3 (1.0, 2.7) ×109 vs. 2.7 (1.3,4.4)×109/L, 0.17 (0.12, 0.24) vs. 0.21 (0.15, 0.16), respectively, χ2=4.88, Z=-2.21,-5.03,-2.53, all P<0.05). On the other hand, the length of hospital stay, proportion of underline diseases, ALT, AST, creatine kinase isoenzyme, and troponin T were higher in the severe group compared to those in the general group ((11.6±5.9) vs. (5.3±1.8) d, 41 cases (43.6%) vs. 48 cases (4.6%), 67 (26,120) vs. 20 (15, 32) U/L, 51 (33, 123) vs. 44 (34, 58) U/L、56.9 (23.0, 219.3) vs. 3.6 (1.9, 17.9) U/L, 12.0 (4.9, 56.5) vs. 3.0 (3.0, 7.0) ×10-3 pg/L,respectively, t=-20.43, χ2=183.52, Z=-9.14,-3.12,-6.38,-3.81, all P<0.05). Multivariate regression analysis indicated that increased leukocyte count (OR=1.88, 95%CI 1.18-2.97, P<0.01), CRP (OR=1.18, 95%CI 1.06-1.31, P<0.01), ferritin (OR=1.01, 95%CI 1.00-1.00, P<0.01), interleukin (IL)-6 (OR=1.05, 95%CI 1.01-1.08, P=0.012), D-dimer (OR=2.56, 95%CI 1.44-4.56, P<0.01) and decreased CD4+T lymphocyte (OR=0.84, 95%CI 0.73-0.98, P=0.030) were independently associated with the risk of severe SARS-CoV-2 in hospitalized children with Omicron infection. Conclusions: After the withdrawal of NPI, the pediatric inpatients with Omicron infection in Kunming were predominantly children younger than 3 years of age, and mainly manifested as AURTI with relatively low rate of severe SARS-CoV-2 infection and mortality. Elevated leukocyte counts, CRP, ferritin, IL-6, D-dimer, and decreased CD4+T lymphocytes are significant risk factors for developing severe SARS-CoV-2 infection.

Controversies about glucocorticoid for prevention and treatment of bronchopulmonary dysplasia in premature infants / 中国小儿急救医学

Bronchopulmonary dysplasia(BPD) is an important cause of premature infant mortality and long-term organ dysfunction in survivors.There is currently no fundamental treatment for BPD, and glucocorticoids are often used clinically to reduce the risk and severity of BPD.There are systemic administration, inhalation administration and transtracheal administration of glucocorticoids for the prevention and treatment of BPD.Glucocorticoids provide benefits such as anti-inflammatory, but may also cause side effects such as neurodevelopmental impairment.There are various schemes for the dosage form, timing of administration, and cumulative dose of glucocorticoids administration.The clinical advantages and disadvantages of different schemes are inconsistent and controversial.Higher quality clinical trials are needed to provide evidence to support the use of glucocorticoids for the prevention and treatment of BPD.

Clinical application of whole exome sequencing in monogenic hereditary disorders in critically ill newborns / 中国当代儿科杂志

OBJECTIVE@#To explore the value and significance of the clinical application of whole exome sequencing (WES) in monogenic hereditary disorders in critically ill newborns.@*METHODS@#The critically ill newborns in the neonatal intensive care unit with suspected hereditary diseases or unclear clinical diagnosis from June 2016 to December 2018 were enrolled. The whole blood samples from both newborns and parents were collected for WES. The detected genetic mutations were classified, the mutations associated with clinical phenotypes were searched for, and Sanger sequencing was performed to verify the mutations.@*RESULTS@#A total of 45 newborns were enrolled, including 22 males and 23 females, and the median age of onset was 2.0 days. Of the 45 newborns, 12 (27%) were confirmed with monogenic hereditary disorders by molecular diagnostics, and the median age at diagnosis was 31.5 days. Of the 12 newborns with monogenic hereditary disorders, 5 (42%) were partially associated with clinical phenotypes but confirmed with monogenic hereditary disorders by additional information supplement and analysis. The improvement rate of newborns with monogenic hereditary disorders was 67% (8/12) after treatment.@*CONCLUSIONS@#WES technology is a powerful tool for finding genetic mutations in monogenic hereditary disorders in critically ill newborns and can play a crucial role in clinical decision-making. However, a comprehensive interpretation of sequence data requires physicians to take the clinical phenotypes and the results of WES into consideration simultaneously.

A clinical study of growth and metabolism of small for gestational age infants / 中国当代儿科杂志

OBJECTIVE@#To study the differences in growth and metabolism between small for gestational age (SGA) infants and appropriate for gestational age (AGA) infants.@*METHODS@#A total of 1 370 preterm infants were enrolled in this study. According to the association between gestational age and birth weight, they were divided into SGA group with 675 infants and AGA group with 695 infants. The two groups were compared in terms of general conditions, physical growth and blood biochemical parameters.@*RESULTS@#The SGA group had a significantly longer length of hospital stay than the AGA group (P<0.05). Compared with the AGA group, the SGA group had significantly lower body weight, body weight Z score, and body length at discharge and significantly higher incidence rate of extrauterine growth retardation and growth rate of head circumference (P<0.05). Compared with the AGA group, the SGA group had significantly longer time to full enteral nutrition and duration of parenteral nutrition (P<0.05). Compared with the AGA group, the SGA group had significantly higher levels of albumin, prealbumin, and serum phosphorus on admission and total bile acid before discharge, as well as a significantly lower albumin level before discharge (P<0.05). The incidence rates of asphyxia, neonatal respiratory distress syndrome, myocardial damage, feeding intolerance, pneumonia, sepsis, hypoglycemia and hypothyroxinemia in the SGA group were significantly higher than in the AGA group (P<0.05).@*CONCLUSIONS@#Compared with AGA infants, SGA infants have significantly delayed physical development during hospitalization and significantly higher incidence rates of extrauterine growth retardation and related complications.

Levels of blood free carnitine in preterm infants with different gestational ages and birth weights / 中国当代儿科杂志

OBJECTIVE@#To examine blood concentrations of free carnitine (FC) in preterm infants with different gestational ages (GA) and birth weights (BW).@*METHODS@#A total of 3 368 preterm infants were enrolled as subjects. According to GA, they were divided into extremely preterm birth (EPTB) group (GA <28 weeks; n=39), very preterm birth (VPTB) group (28 ≤GA <32 weeks; n=405), moderately preterm birth (MPTB) group (32 ≤GA <34 weeks; n=507), and late preterm birth (LPTB) group (34 ≤GA <37 weeks; n=2 417); according to BW, they were divided into extremely low birth weight (ELBW) group (BW <1 000 g; n=36), very low birth weight (VLBW) group (1 000 g ≤BW <1 500 g; n=387), low birth weight (LBW) group (1 500 g ≤BW <2 500 g; n=1 873), and normal birth weight (NBW) group (2 500 g ≤ BW <4 000 g; n=1 072). Blood concentrations of FC were measured between 72 hours and 7 days after birth.@*RESULTS@#The EPTB and VPTB groups had significantly higher FC concentrations than the MPTB and LPTB groups (P<0.05), and the MPTB group had significantly higher FC concentrations than the LPTB group (P<0.05). The lower limit of the 95% medical reference range of FC increased with the reduction in GA. The ELBW and VLBW groups had significantly higher FC concentrations than the LBW and NBW groups (P<0.05). The LBW group had significantly higher FC concentrations than the NBW group (P<0.05). The lower limit of the 95% medical reference range of FC increased with the reduction in BW.@*CONCLUSIONS@#There is a significant increase in blood FC concentrations in very/extremely preterm infants and very/extremely low birth weight infants, and tend to decrease with the increases in GA and BW.

The Determination of Cut-off Value of TSH during Screening of Congenital Hypothyroidism in 6 Prefecture/City of Yunnan Province / 昆明医科大学学报

Objective To explore the positive cut-off value in neonatal screening for congenital hypothyroidism(CH)in the center of Neonatal Screening , so as to improve screening efficiency and reduce false positive rate. Methods Heel blood samples were taken from the newborns born after72 hours,dropped in special S&S903 filter paper and delivered to the neonatal screening center within the prescribed period of time.DELFIA was applied to detect the concentration of thyroid-stimulating hormone(TSH).Result Totally 529918 blood sample were screened from the 2012 to the 2016.Among them 529645 newborns were normal, 203 neonates were diagnosed with CH, 70 with high TSH hyperlipidemia, the total detection rate was 1:1941, and the incidence of CH was 1:2610. According to the results, the cut-off value of the screening of CH in the center of Neonatal Screening was 9.0 mIU/L, the sensitivity was 100％and specifility was 98.38％, misdiagnosis rate was 0％. Conclusion The cut-off value of CH was 9.0 mIU/L in the center of Neonatal Screening ,which is suitable for the people in 6 Prefecture/City of Yunnan Province , and also provides the basis for neonatal scree of CH in the future.

Effect of prone positioning on respiratory function in very preterm infants undergoing mechanical ventilation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To explore the effect of prone positioning on respiratory function in very preterm infants undergoing mechanical ventilation.</p><p><b>METHODS</b>A total of 83 very preterm infants treated with mechanical ventilation were enrolled in the study and were randomly assigned to supine group and prone group. Four infants withdrew from the study and 79 infants completed treatment and observation (37 in the supine group and 42 in the prone group). Infants in both groups were mechanically ventilated in a volume assist-control mode. Infants in the prone group were ventilated in the supine position for 4 hours and in the prone position for 2 hours. Ventilator parameters, arterial blood gas analysis, and vital signs were recorded before grouping, every 6 hours in the supine group, and every hour after conversion into the prone position in the prone group, respectively.</p><p><b>RESULTS</b>Fraction of inspired oxygen (FiO), peak inspiratory pressure, mean inspiratory pressure, and duration of ventilation were significantly lower in the prone group than in the supine group (P<0.05); there were no significant differences in tidal volume or positive end-expiratory pressure between the two groups (P>0.05). The prone group had a significantly higher PO/FiO ratio but significantly lower oxygenation index and respiratory rate than the supine group (P<0.05). There were no significant differences in arterial oxygen tension, pH, base excess, heart rate, or mean blood pressure between the two groups (P>0.05).</p><p><b>CONCLUSIONS</b>Alternating ventilation between the prone position and supine position can improve oxygenation function, decrease the fraction of inspired oxygen, and shorten the duration of mechanical ventilation in very preterm infants undergoing mechanical ventilation.</p>

Reassessment of Echocardiography for Diagnosing Infectious Endocarditis / 中国循环杂志

Objective:To explore the value of echocardiography for diagnosing infectious endocarditis (IE).Methods:A total of 487 patients with cardiovascular implantable electronic devices (CIED) infection treated in our hospital from 2013-01 to 2015-06 were enrolled.Based on symptoms,blood culture and echocardiography,9 patients with suspected IE were further examined by 18F-FDG PET-CT to confirm their diagnosis and classification.Definitive therapy was conducted and the patients were followed-up for 1 year to confirm the diagnostic accuracy of echocardiography on CIED induced IE.Results:3 patients were preliminarily diagnosed for bacteremia since no vegetation was found by echocardiography,while IE was finally diagnosed by PET-CT.2 patients were preliminarily diagnosed for IE by echocardiography presented valvular vegetation,while PET-CT showed no evidence of vegetation;then one of them was diagnosed as bacteremia by positive blood culture and another was diagnosed as non-infection.4 patients were preliminarily diagnosed for IE by echocardiography indicated existing vegetation after CIED lead extraction,while PET-CT demonstrated no infection sign in heart chamber and the finally diagnosed was as "non-infectious fibrous residual tissue".According to final diagnosis,definitive therapies were performed to specific patients with at least 1 year follow-up study,no one had new and recurrent infection.Conclusion:Echocardiography had deficiency for diagnosing vegetation in heart chamber especially in suspicious IE patients after CIED lead extraction.It is necessary to make accurate diagnosis with other method for guiding appropriate therapy.

Reassessment of Echocardiography for Diagnosing Infectious Endocarditis / 中国循环杂志

Objective:To explore the value of echocardiography for diagnosing infectious endocarditis (IE).Methods:A total of 487 patients with cardiovascular implantable electronic devices (CIED) infection treated in our hospital from 2013-01 to 2015-06 were enrolled.Based on symptoms,blood culture and echocardiography,9 patients with suspected IE were further examined by 18F-FDG PET-CT to confirm their diagnosis and classification.Definitive therapy was conducted and the patients were followed-up for 1 year to confirm the diagnostic accuracy of echocardiography on CIED induced IE.Results:3 patients were preliminarily diagnosed for bacteremia since no vegetation was found by echocardiography,while IE was finally diagnosed by PET-CT.2 patients were preliminarily diagnosed for IE by echocardiography presented valvular vegetation,while PET-CT showed no evidence of vegetation;then one of them was diagnosed as bacteremia by positive blood culture and another was diagnosed as non-infection.4 patients were preliminarily diagnosed for IE by echocardiography indicated existing vegetation after CIED lead extraction,while PET-CT demonstrated no infection sign in heart chamber and the finally diagnosed was as "non-infectious fibrous residual tissue".According to final diagnosis,definitive therapies were performed to specific patients with at least 1 year follow-up study,no one had new and recurrent infection.Conclusion:Echocardiography had deficiency for diagnosing vegetation in heart chamber especially in suspicious IE patients after CIED lead extraction.It is necessary to make accurate diagnosis with other method for guiding appropriate therapy.

Detection of Th17, Treg cells and IL-17, IL-23 levels in children with Henoch-Schonlein purpura / 中国免疫学杂志

Objective:To study the changes of Th17,regulatory T(Treg) cells and IL-17,IL-23 levels at acute phase and recovery phase in children with Henoch-Schonlein purpura(HSP) in order to further understand the immunological pathogenesis and provide help for treating HSP. Methods:The vein blood samples were collected from 65 children with HSP and 30 normal children. The proportion of Th17 cells and regulatory T cells were tested by FCM and concentration of IL-17 and IL-23 in plasma were tested by ELISA. Results:Compared with normal children,the levels of Th17,Th17/Treg and IL-17,IL-23 were in increase at acute phase in children with HSP(P0. 05 ) . At acute phase in children with HSP, Th17 cells percentage had positively correlated with IL-17 levels ( r=0. 880,P<0. 01),IL-23 levels had positively correlated with Th17 cells percentage and IL-17 levels (r=0. 838 or 0. 877,P<0. 01). Conclusion:Th17,Treg,Th17/Treg,IL-17 and IL-23 are involved in the course of the immunological pathogenesis in children with HSP,but the levels of that have no significant difference among simplex,abdominal and other types,further researches need to be done.

Significance of detection of biomarker fecal bile acids in the diagnosis and treatment of childhood Henoch-Schönlein purpura / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the changes and clinical significance of biomarker fecal bile acids (BA) in children with Henoch-Schönlein purpura (HSP).</p><p><b>METHODS</b>Nineteen children with HSP and twenty-seven healthy children were enrolled in this study. The stool samples were obtained at the acute and remission phases. Fecal BA levels were measured by high performance liquid chromatography mass spectrometry (HPLC-MS).</p><p><b>RESULTS</b>The fecal cholic acid level in the HSP remission group was significantly higher than in the HSP acute group and the healthy control group (P<0.016). The fecal chenodeoxycholic acid level in the HSP remission group was significantly higher than in the healthy control group (P<0.016). The levels of fecal secondary colonic bile acids, deoxycholic acid and lithocholic acid, in the HSP acute and remission groups were significantly lower than in the healthy control group(P<0.05, P<0.016 respectively). No significant differences were found in the levels of fecal urosodeoxycholic acid among the three groups (P>0.05).</p><p><b>CONCLUSIONS</b>Fecal secondary colonic bile acids, deoxycholic acid and lithocholic acid, are in decrease in children with HSP at the acute stage, which may be involved in the pathogenesis and treatment outcomes of HSP.</p>

Clinical characteristics in twin premature infants / 中华实用儿科临床杂志

Objective To explore the clinical characteristics in twin premature infants in order to provide some guidance for clinical work in future.Methods The clinical data of 593 premature infants hospitalized in Department of Pediatrics,the Affiliated Hospital of Kunming Medical University were collected from June 2010 to June 2012,in terms of gestational age,birth weight and neonatal complications.A retrospective analysis was performed for the data.The premature infants were divided into 2 groups:study group of 131 twin premature infants and control group of 462 singleton premature infants.The 131 twin premature infants in study group were divided into large double group(n =64) and small double group(n =67) according to delivery time.The clinical data of premature infants in each group were statistically analyzed.Results The gestational age of study group was (34.23 ± 1.90) weeks,which in control group was (33.91 ± 1.82) weeks,and there was no significant difference between the 2 groups(t =1.689,P =0.092).The birth weight in study group [(1 921.64 ± 414.05)g] had statistically significant difference compared with control group [(2 164.98 ± 495.85) g] (t =-5.209,P =0.000).The study group of incidence of premature rupture of membranes was 16.79％ (22/131 cases)and which in the control group was 32.68％ (151/462 cases),and there was statistically significant difference between the 2 groups (x2 =12.472,P =0.000) ;the incidence of neonatal asphyxia of study group was 9.92％ (13/131 cases) and that of the control group was 17.10％ (79/462 cases),there was statistically significant difference between the 2 groups (x2 =4.010,P =0.045) ; the incidence of respiratory distress syndrome in study group was 6.87％ (9/131 cases) and that in the control group was 3.03 ％ (14/462 cases),the difference was statistically significant between the 2 groups (x2 =4.037,P =0.045) ; the incidence of apnea in study group was 4.58％ (6/131 cases) and that in the control group was 0.65％ (3/462 cases),the difference was statistically significant between the 2 groups(x2 =8.085,P =0.004) ; the incidence of meconium aspiration syndrome of study group was 0 and that of the control group was 3.90％ (18/462 cases),there was statistically significant difference (P =0.018) ;the incidence of neonatal hypoglycemia of study group was 27.48％ (36/131 cases) and that of the control group was 16.67％ (77/462 cases),the difference was statistically significant between the 2 groups (x2 =7.738,P =0.005) ;the incidence of sepsis of study group [16.79％ (22/131 cases)] was significantly higher than that of the control group [8.44％ (39/462 cases)],and the difference was statistically significant between the 2 groups (x2 =7.715,P =0.005) ;the incidence of extrauterine growth retardation of study group was 6.10％ (8/131 cases) and that of the control group was 2.38％ (11/462 cases),the difference was statistically significant between the both groups (x2 =4.568,P =0.033).In the study group,the incidence of neonatal sepsis in big double group was 29.68％ (19/64 cases),and that in small double was 14.93％ (10/67 cases),there was statistically significant difference between the 2 groups(x2 =4.138,P =0.042).The other complications between the big double group and small double group had no significant difference.Conclusions The incidence rates of acute respiratory distress syndrome,apnea,neonatal hypoglycemia,sepsis and extrauterine growth retardation of twin premature infants are higher than the singleton premature infants in the neonatal period.But the incidence rate of meconium aspiration syndrome is a higher in singleton premature infants.

Clinical application of proportional assist ventilation in very low birth weight infants with ventilator dependence / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of proportional assist ventilation (PAV) on physiology and respiratory mechanics in very low birth weight (VLBW) infants with ventilator dependence by comparison with conventional assist/control (A/C) ventilation.</p><p><b>METHODS</b>Forty-six infants with ventilator dependence were randomly divided into two groups according to the ventilation model: PAV (n=23) and A/C (n=23). The gain of resistive and elastic unloading was set based on the runway method in the PAV group. Ventilation parameters were set based on the conventional method in the A/C group. Infants were observed for 30 minutes three times per day for three consecutive days. Arterial gas analysis results, transcutaneous saturation of oxygen (SPO2), heart rate, blood pressure (BP), respiratory rate (RR), mean airway pressure (MAP), peak inspiratory pressure (PIP), tide volume (VT), minute volume (MV) and oxygenation index (OI), were compared between the two groups.</p><p><b>RESULTS</b>Compared with the A/C group, PaO2 and OI in the PAV group were significantly higher while PIP and MAP were significantly lower. There were no significant differences in FiO2, SPO2, pH, PaCO2, PEEP, VT, MV and RR between the two groups. Although mean arterial blood pressure and heart rate in the PAV group were not different from the A/C group, beat-to-beat variabilities in systolic and diastolic arterial blood pressure were significantly lower in the PAV group than in the A/C group.</p><p><b>CONCLUSIONS</b>PAV may safely maintain gas exchange at lower airway pressures compared with A/C ventilation in VLBW infants. It can also improve oxygenation and infant-ventilator synchronization.</p>