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Objective:To study the predictive value of total serum bilirubin (TSB) and the ratio of bilirubin to albumin (B/A) in neonatal acute bilirubin encephalopathy (ABE).Methods:Neonates with extremely severe hyperbilirubinemia (TSB≥425 μmol/L) treated in the Nanjing Maternal and Child Health Hospital, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Northwest Women and Children's Hospital, Yinchuan Maternal and Child Health Hospital and Liaocheng People's Hospital from March 2018 to August 2019 were selected as prospective subjects for this study. According to the score of brain injury induced by bilirubin, the subjects were divided into ABE group and non-ABE group, and the predictive value of TSB peak and B/A for neonatal ABE were analyzed.Results:A total of 194 infants with extremely severe hyperbilirubinemia were recruited in this study, including 20 in ABE group and 174 in non-ABE group. The peak value of bilirubin ranged from 427 to 979 μmol/L. The optimal critical values of TSB peak value and B/A for ABE prediction were 530 μmol/L and 9.48, respectively. The sensitivity and specificity of ABE prediction were 85.0% and 92.8% when combined with TSB peak and B/A values.Conclusions:TSB peak combined with B/A value can effectively identify neonatal ABE. When the TSB peak value was greater than 530 μmol/L and the B/A value was greater than 9.48, the neonates had a higher risk of neonatal ABE.
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Objective To study the efficacy of T-piece resuscitator on the very preterm infants in the delivery room.Method Very preterm infants (gestational age 28 ～ 31 weeks) who needed positive pressure ventilation during delivery room resuscitation were included in the study between January 2010 and December 2015.Enrolled infants were randomly assigned to self-inflating bag group and T-piece group.Tracheal intubation ratio,duration of mechanical ventilation,continuous positive airway pressure (CPAP),supplementary oxygen through a nasal cannula and total oxygen requirement were compared between groups.The percentages of pneumothorax,sepsis,necrotizing enterocolitis (NEC),bronchopulmonary dysplasia (BPD),retinopathy of prematurity (ROP),intracranial hemorrhage and patent ductus arteriosus (PDA) between groups were also compared.Data were analyzed using independent sample t test and chi-square test.Result A total of 51 preterm infants were enrolled in this study,with 25 infants in the self-inflating bag group and 26 in the T-piece group.There was no statistically significant difference in the gender,gestational age,birth weight,Apgar scores,delivery mode and antenatal glucocorticoids between the two groups (P ＞ 0.05).The ratio of intubation in T-piece group was significantly lower than that in self-inflating bag group (15.4％ vs.44.0％,P ＜ 0.05).Further more,duration of mechanical ventilation and total oxygen requirement in the T-piece group were significantly shorter than those in the self-inflating bag group [(4.2±2.8) dvs.(10.1 ±4.3) d,(36.2±14.7) dvs.(47.2±19.2) d,P＜0.05].However,the duration of nasal CPAP and supplementary oxygen through a nasal cannula,the rate of pneumothorax,sepsis,NEC,BPD,ROP,intracranial hemorrhage and PDA did not differ significantly between groups (P ＞ 0.05).Conclusion Compared with the self-inflating bag group,the use of the T-piece in delivery room decrease the rate of tracheal intubation and the duration of mechanical ventilation and total oxygen requirement.
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Objective To explore the positive rates on HIV among men who have sex with men (MSM) who took bathhouse as the major place for sexual practice in China,between 2010 and 2015.Methods Articles published between 2010 and 2015 from CNKI,Wanfang Data,CJFD and PubMed were collected and Stata 12.0 software was used for Meta-analysis.Results A total of 14 articles were selected.Random effects model was employed to calculate the pooled positive rate according to statistical tests for homogeneity with the result f=88.1％.The pooled positive rate appeared as 10.3％,with 95％CI as 7.7％-13.0％.Publication bias was assessed by Egger's test and funnel plot.After stratified analysis on factors as:sample size,year,region and methods on recruitment,the pooled positive rate of HIV appeared higher in people living in the coastal provinces than those in the inland provinces.Conclusion The pooled positive rate of HIV identified from the bathhouses appeared higher than that from other places through,the national HIV sentinel surveillance data,with coastal higher than that in the inland provinces.Bathhouse was recognized as the key place to be caried on intervention programs for the MSM population.
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Objective To explore the positive rates on HIV among men who have sex with men (MSM) who took bathhouse as the major place for sexual practice in China,between 2010 and 2015.Methods Articles published between 2010 and 2015 from CNKI,Wanfang Data,CJFD and PubMed were collected and Stata 12.0 software was used for Meta-analysis.Results A total of 14 articles were selected.Random effects model was employed to calculate the pooled positive rate according to statistical tests for homogeneity with the result f=88.1％.The pooled positive rate appeared as 10.3％,with 95％CI as 7.7％-13.0％.Publication bias was assessed by Egger's test and funnel plot.After stratified analysis on factors as:sample size,year,region and methods on recruitment,the pooled positive rate of HIV appeared higher in people living in the coastal provinces than those in the inland provinces.Conclusion The pooled positive rate of HIV identified from the bathhouses appeared higher than that from other places through,the national HIV sentinel surveillance data,with coastal higher than that in the inland provinces.Bathhouse was recognized as the key place to be caried on intervention programs for the MSM population.
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Objective To systematically evaluate the effectiveness of delayed cord clamping (DCC) in term infants. Methods The data of the Cochrane library, PubMed, EMBASE, CNKI , VIP, Wanfang from 1 January 1970 to 30 April 2013 were searched. Randomized controlled trials (RCT) of DCC in term infants were included.RevMan 5.1.0 was used in the statis-tical analysis. Results Ten studies involving 1623 participants were included. Meta-analysis based on included studies showed that:compared with immediate cord clamping (ICC), DCC improved the hemoglobin levels at birth (MD=2.19, 95%CI:0.36, 4.02) and increased the incidence of polycythaemia (RR=2.87, 95%CI:1.24, 6.62). Compared with ICC, DCC showed no signi-ficant difference in the phototherapy for hyperbilirubinemia (RR=2.46, 95%CI: 0.93, 6.52), the hemoglobin levels within 6 months (MD=0.29, 95%CI:-0.17, 0.75), and the incidence of anemia (RR=0.71, 95%CI:0.45, 1.12). Conclusions DCC can improve the hemoglobin level in term infants after birth. However, the appropriate time of cord clamping has not been deter-mined. It is necessary to undertake further studies with higher quality and larger scale to evaluate the optimal time of cord clam-ping.
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Objective To determine the effects of feeding donor human milk versus formula milk on very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI).Methods The Cochrane library,PubMed,EMBASE,Wanfang,CNKI and VIP database were searched for the randomized controlled trials (RCT) that compare donor human milk with formula milk in VLBWI and ELBWI from the establishment of database up to February 2014.The quality of the included studies was assessed.Meta analysis was performed using RevMan 5.2.9 software.The results were expressed by mean difference (MD) and 95％CI for continuous variables,RR and 95％CI for categorical variables.Results Only five trials were included:in quality evaluation,two trials were graded B,and the other three were graded C.Meta-analysis showed that,compared with the formula milk,feeding of donor human milk could reduce the risk ofnecrotizing enterocolitis (RR=0.36,95％CI:0.18-0.73,P＜0.01),but not the risks of sepsis (RR=0.92,95％CI:0.50 1.72,P=0.80),retinopathy of prematurity (RR=1.21,95％CI:0.84-1.74,P=0.31) and in-hospital mortality (RR=0.66,95％CI:0.18-2.37,P=0.52).The significantly lower rates in weight gains in neonatal period (MD=-6.58,95％CI:-11.19 to-1.98,P＜0.01) and body length (MD=-0.30,95％CI:-0.41 to-0.20,P＜0.01)were found in donor human milk compared with formula milk.No significant difference in head circumference (MD=-0.16,95％CI:-0.33 to 0.01,P=0.13) was seen in comparison of donor human milk with formula milk.Conclusions Feeding with donor human milk can reduce the risk ofnecrotizing enterocolitis in VLBWI and ELBWI,but its effects on neonatal growth need to be further studied in large scale RCT.
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Objective To evaluate the predictive accuracy of several risk-assessment strategies to predict the risk of significant neonatal hyperbilirubinemia, and to establish the best prediction model.Methods The transcutancous bilirubin (TcB) levels of 4907 term and near-team infants were measured.Trace blood bilirubin levels of the infants whose TcB levels ≥250 μmol/L were detected. Clinical data of newborns and their mothers were collected and were analyzed with Logistic regression model to investigate its correlation with signifrcant hyperbilirubinemia. Clinical high risk factors of significant neonatal hyperbilirubinemia were determined. Accuracy of three prediction methods for significant hyperbilirubinemia was compared by receiver operating characteristic (ROC) curve. The three methods included: whether predischarge bilirubin level (within 72 hours after birth) expressed in risk zone on an hour-specific bilirubin nomogram; clinical risk factors other than predischarge bilirubin level; and combination of the predischarge bilirubin risk zone and other clinical risk factors. Results Two hundred and eighty-six newborns (5.8%) were found with significant hyperbilirubinemia. The risk factors of significant neonatal hyperbilirubinemia were divided into three groups according to OR: (1) Major risk factors:predischarge (within 72 hours after birth) bilirubin level in the high risk-zone (OR=96. 39, 95% CI:53.32-174.27, P = 0. 000), large cephalohematoma (OR = 36.45, 95% CI: 10. 02-132.56,P=0. 0076), gestational age 35-36+6 weeks (OR= 30. 72, 95% CI 14.47-65.23, P=0. 0001) and exclusive breast feeding and weight loss was ＞9% of birth-weight (OR=22.44, 95% CI: 4.42-114. 03, P=0. 0016). (2) Minor risk factors: gestational age 37-37+6 weeks (OR=3.26, 95% CI:1.92-5. 55, P=0. 0232), predischarge bilirubin level in P76-P95(OR=13. 64, 95% CI: 8. 10-22.97,P=0. 0001) and bruising (OR = 2.32, 95% CI: 1.14-4.71, P = 0. 0497). (3)Protective factors (those factors associated with decreased risk of hyperbilirubinemia): predischarge bilirubin level in low-risk zone (≤P40) (OR=0. 00), gestational age ≥40 weeks (OR=0.21, 95% CI: 0.09-0.44,P=0. 0402) and mixed breeding (OR=0. 75, 95% CI: 0. 58-0.95, P=0.0059). The area under the ROC curve of predischarge bilirubin level was 0. 8687 and 0. 7375 for clinical risk factors other than predischarge bilirubin level. The area under the ROC curve of a combination of the predischarge bilirubin risk zone and additional clinical risk factors was 0. 9367. Conclusions The risk of significant neonatal hyperbilirubinemia could be simply and accurately predicted by infant's predischarge bilirubin level and the combination of predischarge bilirubin level, and clinical risk factors might improve the accuracy of prediction significantly.