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Objective:To investigate the prognosis of severe hyperbilirubinemia in full-term infants who met the exchange transfusion criteria and were treated by blood exchange transfusion and phototherapy.Methods:A total of 168 full-term infants with severe hyperbilirubinemia who met the criteria for exchange transfusion and were hospitalized in the Neonatology Department of seven tertiary hospitals in Hebei Province from June 2017 to December 2018 were retrospectively included. According to the treatment protocol, they were divided into two groups: exchange transfusion group (38 cases) and phototherapy group (130 cases). Two independent sample t-test and Chi-square test were used to compare the clinical manifestations and follow-up results between the two groups. Multivariate logistic regression was used to analyze the risk factors for poor prognosis. Results:Neonatal severe hyperbilirubinemia in the exchange transfusion and phototherapy group were both mainly caused by hemolytic disease [42.1%(16/38) and 29.2%(38/130)], sepsis [28.9%(11/38) and 11.5%(15/130)] and early-onset breastfeeding jaundice [15.8%(6/38) and 11.5%(15/130)]. Total serum bilirubin level on admission in the exchange transfusion group was significantly higher than that in the phototherapy group [(531.7±141.3) vs (440.0±67.4) μmol/L, t=3.870, P<0.001]. Moreover, the percentage of patients with mild, moderate and severe acute bilirubin encephalopathy in the exchange transfusion group were higher than those in the phototherapy group [15.8%(6/38) vs 3.8%(5/130), 7.9%(3/38) vs 0.8%(1/130), 13.2%(5/38) vs 0.0%(0/130); χ2=29.119, P<0.001]. Among the 168 patients, 135 were followed up to 18-36 months of age and 12 showed poor prognosis (developmental retardation or hearing impairment) with four in the exchange transfusion group (12.9%, 4/31) and eight in the phototherapy group (7.7%, 8/104). Multivariate logistic regression analysis showed that for full-term infants with severe hyperbilirubinemia who met the exchange transfusion criteria, phototherapy alone without blood exchange transfusion as well as severe ABE were risk factors for poor prognosis ( OR=14.407, 95% CI: 1.101-88.528, P=0.042; OR=16.561, 95% CI: 4.042-67.850, P<0.001). Conclusions:Full-term infants who have severe hyperbilirubinemia and meet the exchange transfusion criteria should be actively treated with blood exchange transfusion, especially for those with severe ABE, so as to improve the prognosis.
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Objective To explore the roles of serum TLR-4, TNF-αand IL-6 in neonates with preterm birth. Methods A total of 120 neonates from neonatology department in the Xingtai People's Hospital were selected and divided into full-term group (n=40), premature rupture of fetal membranes (n=40) and idiopathic preterm group (n=40) based on the gestational age. The peripheral venous blood was collected within 30 minutes when the infants were born, and the supernatant was reserved after centrifuged. The levels of serum TLR-4, TNF-αand IL-6 were detected by enzyme-linked immunosorbent assay. Results The levels of TLR-4, TNF-αand IL-6 in idiopathic preterm and premature rupture of fetal membranes were signiifcantly higher than that in full-term group and showed positive correlation. Conclusion Cytokines TLR-4, TNF-αand IL-6 maybe closely related to the preterm birth.
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Objective To explore the effect of gestational hypertension on multiple organ system in neonates. Methods A total of 100 newborns whose mother had pregnancy complicating primary hypertension admitted to our hospital from December 2011 to December 2012 were selected and divided into preeclampsia group (n=53), gestational hypertension group (n=47) according to the blood pressure during pregnancy. Meanwhile, 100 newborns with healthy mother were selected as control group including 12 term infants and 88 premature infants. Data including birth weight, length and head circumference, Apgar score, the percentage of amniotic lfuid pollution, placental abruption and fetal distress, Neonatal Behavioral Neurological Assessment (NABA) score, serum level of creatine kinase, pulmonary arterial pressure, thyroid function, blood glucose, blood routine, cranial MRI parameters were collected and compared among three groups. Results In preeclampsia group, the gestational age, birth weight and head circumference, 1-min and 5-min Apgar scores were lowest while the ratio of low birth weight infants was highest among three groups, and the differences were signiifcant (P<0.05). In preeclampsia group, the rates of antenatal abnormalities (amniotic lfuid meconium III degree pollution, placental abruption and fetal distress) and complications (severe infection, myocardial damage, neonatal polycythemia, liver and kidney damage, hypoglycemia, hypothyroidism and respiratory failure) were highest among three groups, and the differences were signiifcant (P<0.01). In preeclampsia group, the red blood cell count, the levels of hemoglobin, hematocrit and thyroid stimulating hormone were signiifcantly higher than those in the other two groups ( P<0.05 ), and the white blood cell and platelet count was signiifcantly lower than that in the control group (P<0.05). The passive muscle tension scores in preeclampsia group were signiifcantly lower than those in the other two groups (P<0.05).The abnormity rate of cranial MRI in preeclampsia group was highest among three groups, and the difference was signiifcant (P<0.01). Conclusions Gestational hypertension may cause multisystem disorders in newborns, such as fetal intrauterine growth restriction, endocrine system disorders, heart dysfunction, increased blood viscosity, delayed neurodevelopment. The severity of gestational hypertension is associated with the adverse impact on the multiple systems in neonates.
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Objective To evaluate the effectiveness of the supportive group therapy on the psychological traumatic in the nurses who experienced a violence event.Methods 58 nurses were enrolled in this study and randomly arranged to therapy group and control group.Ninety minutes group psychotherapy was used in the therapy group once weekly and last 6 weeks,and no any intervention method was used in the control group.For both groups,evaluations were conducted at three time points that was baseline,immediately after the completion of the intervention and 3 months after the completion of psychotherapy.Evaluations were conducted using the Impact of Event Scale-Revised (IES-R) and Profile of Mood States (POMS).Results The reduction of the total scores of ISE-R and flashback factor,hyper-arousal factor,avoidance behavior factor in the therapy group were higher than those in control group (-5.00 (3.89) vs-1.48 (3.05),P ＜ 0.01 ;-1.53 (1.46) vs-0.60 (1.90),P ＜ 0.05 ;-1.97 (2.71) vs-0.18 (1.76),P ＜ 0.01 ;-1.50 (2.60) vs-0.70 (2.08),P ＜ 0.01,respectively).Both the reduction of total scores of PMOS and the tension-anxiety factor and depression-dejection factor scores on the POMS differed significantly between the two groups(-2.80 (19.40) vs-0.41 (14.05),P ＜ 0.01 ;-1.85 (3.64) vs 0.37(3.40),P＜0.01 ;-1.10(6.52) vs 0.13(4.30),P＜0.01,respectively).All these effects maintained 3 months after the psychotherapy completion.Conclusion The group psychotherapy can alleviate the psychological traumatic of nurses experienced violence events,and it can be used to protect the mental health of these nurses.
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Objective To investigate the relationship between coexisting depression and anxiety (CDA)and quality of life of female nurses in general hospitals.Methods Seven hundred and ninety-three female nurses completed Zung' s Self-rating Depression Scale (SDS),Zung' s Self-rating Anxiety Scale (SAS) and the World Health Organization' s Quality of Life Questionnaire-Brief Version (WHOQOL-BREF).According to the cut-off scores of SDS and SAS,all subjects were divided into 4 groups (non-depression and non-anxiety,pure depression,pure anxiety,and CDA).Group differences in SDS,SAS and WHOQOL-BREF scores were compared.Results Of these 4 groups,CDA group had the highest SDS and SAS scores (P ＜ 0.001) (SDS scores:(34.3 ±5.4),(47.1 ±4.0),(39.4 ± 2.4) and (49.7 ±4.2)) and the lowest WHOQOL-BREF scores (P≤0.033)(WHOQOL-BREF physical domain scores:(15.6 ± 2.0),(13.8 ± 2.0),(13.6 ± 1.6) and (12.1 ± 2.0)).The corresponding stratification analysis (controlling for confounding factors) showed consistent results.Conclusion CDA nurses have the most severe depressive and anxious symptoms and the worst quality of life,and thus are the key target population of mental health service.