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Objective:To explore the feasibility and safety of minimally invasive surfactant therapy(MIST) in the treatment of neonatal respiratory distress syndrome(RDS).Methods:A total of 93 preterm infants with gestational age of 32-36 weeks admitted from April 2017 to April 2019 were eligible to receive exogenous pulmonary surfactant(PS) with diagnosis as RDS.According to the random digital table method, they were randomly divided into two groups: MIST group( n=48) and intubation-surfactant-extubation(INSURE) treatment group( n=45). During nasal continuous positive airway pressure(NCPAP) ventilation, PS with thin catheter and trachea intubation were chosen, the curative effects of the two groups were compared. Results:All infants received PS successfully, the heart rate, breath rate and fraction of inspiratory oxygen(FiO 2) after treatment of the two groups were significantly lower than those before treatment, and the differences were statistically significant ( t=7.739, 6.497, 7.450, 3.992, 3.787, 4.343, all P<0.05). However, there were no statistically significant differences in heart rate, breath rate and FiO 2 between the two groups whenever before or after administration(all P>0.05). There were also no statistically significant differences in the rate of mechanical ventilation within 72 hours after birth, the time of mechanical ventilation and NCPAP, the time of oxygen inhaling and hospital stays, and the rate of pneumothorax between the two groups(all P>0.05). The incidence of drug reflux in the MIST group [20.8%(10/48)] was higher than that in the INSURE group [8.3%(4/45)](χ 2=3.876, P<0.05), but the incidences of bradycardia, transcutaneous oxygen saturation decreased(<85%) and the secondary administration had no statistically significant difference between the two groups( P>0.05). Conclusion:MIST is effective in the treatment of RDS in moderately preterm infants, but it presents not too much benefits of effectiveness and complications, as well as the disadvantage of drug reflux, thus whether it is better choice for surfanctant procedure needs more studies.
ABSTRACT
Objective To study the clinical features of the Prader－Willi syndrome ( PWS) in neonatal period, and to explore intervention methods to improve their intelligence development.Method From September 2012 to September 2017, clinical data of infants with PWS in our hospital were retrospectively analyzed.Methylation－specific multiplex ligation－dependent probe amplification (MS－MLPA) were used for genetic testing.The patients received rehabilitation training and drug treatment , and followed－up every 6 months after the diagnosis.Result A total of 11 infants with PWS (6/11 male) were included. 8 cases had fetal bradycardia before delivery , 11 cases had hypomyotonia, lethargy, feeding difficulty, no or weak crying and nasogastric tube feeding.Among them, 9 cases had facial anomalies , 8 cases whitish skin and 7 cases genital dysplasia.2 infants died shortly after discharge , 2 infants received no intervention , 3 infants were regularly trained in our rehabilitation division with oral treatment of docosahexaenoic acid (DHA), and 4 infants were trained at home with intermittent oral DHA treatment.Among 11 cases, 3 cases received growth hormone treatment at the age of 6 months and 1 case received at the age of 59 months.The survivors received intelligence test every 6 months using children′s mental behavior scale (0－6 years old). They had severe mental retardation with the scores between 20 and 70 points.5 cases had gene deletion of q11 related area in chromosome 15, 4 cases had gene deletion of q11－13 related area in chromosome 15. 1 case had abnormal demethylation of q 11－13 in chromosome 15, and 1 case had loss of heterozygosity with methylation abnormality in chromosome 15 q11－13 areas.Conclusion Children with PWS can exhibit certain characteristics during both fetal and neonatal periods.Deletion of related genes are more frequently seen than abnormal methylation in these patients.During infantile period with rapid development of nervous system, the growth and development of infants with PWS can not be obviously improved using conventional rehabilitation training and drug treatment.
ABSTRACT
Asthma is a common disease in reproductive age women,with a prevalence of 4％～8％.Pregnant women combined asthma and the newborn are affected by lots of harmful influence from asthma.This article mainly elaborated the effects of pregnancy combined asthma for newborns and described the corresponding treatment measures.