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Objective To summarize the clinical characteristics of neonatal asplenia syndrome to improve the understanding of the disorder. Methods Newborns with neonatal asplenia syndrome admitted to the neonatal department of our Hospital from June 2008 to July 2015 were recruited and their gender, birth weight, gestational age, clinical manifestations, imaging features, laboratory examinations, treatments and prognosis were analyzed. Results A total of 8 newborns with asplenia syndrome were studied. All the patients presented with cyanosis at birth, 5 of them with heart murmur, 3 with apical impulse in the right ( dextrocardia) thorax and complex congenital heart diseases were found in all of them by echocardiogram examinations. 2 of them were diagnosed congenital heart diseases before birth by the fetal ultrasound. 2 cases combined with congenital imperforate anus and cutaneous fistulas. 1 case was found right renal agenesis and Howell-Jolly was seen in another case. All the 8 patientsˊ parents refused medical advices about continuing treatments and left hospital. Among them, 4 patients died in the neonatal period, 2 lost in follow-up and only 2 survived, one for 19 months and the other for 4 years. Conclusions Patients with asplenia syndrome presented absence of spleen, visceral inversion, severe cardiovascular malformations and other malformations. When the cyanosis, heart murmur and abnormal position of apical impulse were found in the newborns, asplenia syndrome should be considered and imaging examinations such as chest X-ray, ultrasound, visceral angiography and more should be ordered immediately, in order to make an early diagnosis of the disease.
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10.3969/j.issn.1000-3606.2013.06.008
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Objective To compare the clinical characteristics and antibiotics resistance of neonatal sepsis caused by Klebsiella pneumoniae and Escherichia coli in order to provide guidance for early diagnosis and appropriate treatment. Methods Forty-two newborns with Klebsiella pneumoniae sepsis and 50 newborns with Escherichia coli sepsis in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical College from January 2000 to October 2009 were enrolled into this study. The clinical data, laboratory examinations and prognosis of these newborns were retrospectively analyzed and compared. The antibiotic resistance data of different onset age of the two diseases were compared. Early-onset sepsis was defined as the age at the onset ≤3 days, and late-onset sepsis was defined as the age at the onset ＞3 days. Results (1) Comparison of clinical characteristics: Klebsiella pneumoniae sepsis caused higher incidence of apnea or gasp compared with Escherichia coli sepsis (61.9% vs 6.0% ,x2= 17. 34, P＜0. 05); the time of developing to multiple organ dysfunction syndrome or disseminated intravascular coagulation of the newborns with Klebsiella pneumoniae sepsis [(40±28) h] was shorter than that of the newborns with Escherichia coli sepsis [(89±26) h] (t= -3.17, P＜0.05); while the incidence of purulent meningitis of Klebsiella pneumoniae sepsis was lower ( 4. 8% vs 30. 0 %, x2 = 9.65, P ＜ 0. 05 ). ( 2 ) Comparison of non-specific laboratory examinations: compared with Escherichia coli sepsis, Klebsiella pneumoniae sepsis caused higher incidence of the leucocyte count ＞ 25 × 109/L (42. 9% vs 22.0%, x2 = 4. 60,P＜0. 05), platelet count ＜ 100 × 109/L (52.4% vs 18.0%, x2 = 12.07, P＜0. 05) and C-reaction protein ＞8 mg/L (95.2% vs 76.0% ,x2 =6. 55, P＜0. 05). (3) Comparison of results of antibiotic resistance: the resistance rate of Klebsiella pneumoniae (81.8%00-100. 0%) to Cephalosporins was higher than that of Escherichia coli (17. 2%-63. 2%) (x2 =6.97-11.92, P＜0. 05); the resistance rates of late-onset sepsis of Klebsiella pneumoniae to Amoxicillin/clavulanic-acid and Cefoperazone/sulbactam were higher than those of Escherichia coli (75.0% vs 0.0%, x2 =26.67, P＜0. 05;83. 3%vs 0. 0%, x2 = 12.53, P＜0. 05 respectively); no resistance to Imipenem were found. The percentages of extended spectrum β-lactamases (ESBLs) positive Escherichia coli and Klebsiella pneumoniae were obviously higher in neonates with late-onset sepsis than those early-onset ones (65.0% vs 17. 8%,x2 = 11.06, P＜0. 05; 100. 0 % vs 30. 0 %, x2 = 20. 22, P＜0. 05 respectively); and positive ESBLs rate of the late-onset Klebsiella pneumoniae sepsis was higher than that of Escherichia coli sepsis (100. 0% vs 65.0%, x2 =9.16, P＜0. 05). (4) Comparison of mortality rate: the mortality rate of Klebsiella pneumoniae sepsis was higher than that of Escherichia coli sepsis (21.4% vs 4. 0%,x2=6.59, P ＜ 0. 05 ) . Conclusions Compared with Escherichia coli septicemia, Klebsiella pneumoniae septicemia has more severe symptoms, developed to multiple organ dysfunction syndrome or disseminated intravascular coagulation quicker, and has higher mortality rate. The percentage of ESBLs positive Escherichia coli and Klebsiella pneumoniae increased rapidly. The clinical use of antibiotics should be rationale.
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Objective To explore the effect of valium and barbitone in the treatment of convulsion in neonate. Methods 156 children with convul sion were randomly divided into two groups, 77 cases in control group and 78 cases in treatment group. Results The instant and total effective rates of treatment group and control group were companed, respectively. There were significant difference between these two groups.Conclusion Valium and Barbitone is effective in treating neonate with convusion.