ABSTRACT
Objective To analyze the safety of indwelling neonatal umbilical vein catheter (UVC) at high or low tip positions.Methods We retrospectively analyzed 155 neonates with indwelling UVC in Guangdong Women and Children Hospital from March 2015 to May 2016.According to the position of the catheter tip,these infants were divided into high position group (the tip was at the same level as the central vein) or low position (the tip was below the portal vein) group.Several parameters including indwelling time,liver function,liver B-ultrasound and catheter-related bloodstream infections in the two groups were analyzed.Data were statistically analyzed using Mann-Whitney U test,Wilcoxon signed rank sum test or Chi-square test.Results (1) A total of 155 infants were enrolled in this study.Their gestational age ranged from 25 to 41 weeks and their birth weight were 700 g to 4 690 g.UCV was inserted at the age of 0.5-8.0 d for 0-12 d.In the low position group,seven cases ended in early extubation due to fluid extravasation caused by shallow insertion.The indwelling time of the low position group was shorter than that of the high position group [M (P25-P75),6 (4-7) d and 7 (5-7) d,Z=-2.580,P=0.010].There were no significant differences in gender,gestational age,birth weight,and age at catheterization between the two groups.(2) No abnormality in the two groups was revealed by liver ultrasound.Complications such as neonatal necrotizing enterocolitis,thrombosis and embolism,air embolism and liver abscess were not reported.The proportion of liver function abnormalities in the high group was 6.9％ (6/87),which was not statistically significant as compared with 4.4％ (3/68) in the low position group (3x2=0.431,P=0.512).(3) Blood culture was performed for all cases,of which 116 (74.8％) were catheter culture (including 71 in the high position group and 45 in the low position group).The incidence of catheter-related bloodstream infection in the high position group was 5.6％ (4/71) and the infection rate was 7.4 per thousand catheter days,while in the low position group these figures were 6.7％ (3/45) and 8.0 per thousand catheter days,respectively.There was no significant difference between the two groups (x2=0.052,P=0.820).(4) Results of catheter culture showed that seven cases were positive,including three for Staphylococcus haemolyticus (two in low position group and one in high position group),one for yeast-like fungus (high position group),one for Enterococcus faecium (high position group),one for Staphylococcus aureus (high position group) and one for Candida albicans (low position group).Conclusions The indwelling time of UVC at high tip position is longer than that at low position,and although there are no differences between the complications and the incidence of catheter-related bloodstream infection in the two groups,but its safety needs further study.
ABSTRACT
Objective To explore the clinical characteristics of neonatal dengue fever. Methods The clinical data from 4 neonates with dengue fever who were admitted and treated in 2014 were retrospectively analyzed and the related literatures had been reviewed. Results Four cases of neonatal dengue fever were all males. Three cases were mother to child transmission, the age at onset was 1 to 7 days after birth, and their mothers suffered with prenatal fever and were diagnozed of dengue fever during perinatal period. One case was community acquired, the age at onset was day 21 after birth and the neonate was bit by mosquito the day before. All four neonates had fever, two cases had rash, and one case had hemorrhagic spot. None of them had jaundice or cough. All of them had thrombocytopenia ( 30-125 )× 109/L, prolonged activated partial thromboplastin time ( 44 . 0-89 . 8 s), and increased aspartate aminotransferase (AST) ( 46-71 U/L). Three cases had declined ifbrinogen ( 1 . 36-2 . 53 g/L). Two cases had increased CK-MB ( 29-86 U/L). Two cases had increased CRP ( 3 . 00-46 . 05 mg/L). After the treatment of anti-infection and intravenous immunoglobulin, all of them were cured and discharged. The duration of hospital stay was 4-17 days. Conclusion The clinical manifestations of neonatal dengue fever were mainly fever and blood coagulation dysfunction, clinical symptoms are mild and lack of speciifcity, and prognosis are good. Mother to child transmission is one of the ways of dengue virus infection.