Evaluation and management of neonatal anemia and blood transfusion / 中国小儿急救医学

Anemia and blood transfusion are common clinical problems in newborns, especially premature infants.What are the definition and influencing factors of neonatal anemia? What is the difference between anemia in preterm infants and full-term infants? What are the changes of pathophysiology and their effects on tissues and cells during neonatal anemia? What are the prevention strategies and treatment methods of neonatal anemia? Is there a uniform hemoglobin threshold for neonatal transfusion of red blood cells? What are the risks of blood transfusion? In view of the above problems, this review proposed that the definition of anemia should consider the effects of gestational age, day age, intrauterine or postnatal development status(such as growth retardation), nutrition and so on. "Physiological anemia of infancy" can occur in healthy term infants; "anemia of prematurity" can not be considered as a physiologic and benign event, which is related to the low level of endogenous erythropoietin and iatrogenic blood loss.It is emphasized that neonatal anemia(especially premature infants) is preventable and can be prevented, and prevention is more important than treatment.Neonates lack a uniform hemoglobin threshold and are at risk of blood transfusion during red blood cell transfusion.

Management of neonatal hyperbilirubinemia: interpretation of the clinical management guidelines drafted by the American Academy of Pediatrics and other countries / 中华实用儿科临床杂志

Neonatal hyperbilirubinaemia, clinically presenting as jaundice, is a ubiquitous and commonly a benign metabolic condition in newborn infants.It is a leading cause of hospitalization of neonates in the first week of life.Serum bilirubin has been considered as the most potent superoxide with the peroxyl radical scavenger activity.However, uncontrolled hyperbilirubinaemia or rapidly rising bilirubin can reach a neurotoxic concentration, potentially leading to central nervous system sequelae.Thus, the health status of jaundiced newborn infants is dependent on striking an appropriate balance between the protective effects of serum bilirubin and the risk of bilirubin neurotoxicity.In order to standardize the management of neonatal hyperbilirubinemia (jaundice), many countries have developed clinical practice management guidelines.This review sorted out and briefly interpreted the main contents of clinical management guidelines for neonatal hyperbilirubinemia drafted by the American Academy of Pediatrics and other countries, aiming to provide references of clinical diagnosis and treatment practice to domestic pediatrician.

Evidence-based management of bronchiolitis: A brief introduction of Australasian bronchiolitis guideline / 中国小儿急救医学

Bronchiolitis is the most common lower respiratory tract disorder in infants less than 12 months of age.Wide variation in the management of bronchiolitis exists between Australia and New Zealand, with up to 48% of infants admitted into hospital receiving treatment which is proved by high quality(Cochrane-level) evidence to be no benefit.For this reason, the Australian Guidelines Development Committee has developed the first high-quality Australian guidelines for bronchiolitis.The guideline provide suggestions for the management of children with bronchiolitis in emergency departments and general pediatric wards, and provide evidence for clinical practice.

Diagnosis and management of infectious diarrhea in children: 2017 Infectious Diseases Society of America Cli-nical Practice Guidelines for Diagnosis and Management of Infectious Diarrhea / 中华实用儿科临床杂志

Diarrhea is one of the main disease types of illness and death in children in developing countries, and infectious diarrhea is especially harmful to children′s health.A panel of multidisciplinary experts in management of infectious diarrhea in children and adults was convened in 2012.Panel participants included representatives from the Society for Healthcare Epidemiology of America (SHEA), Center for Disease Control and Prevention(CDC), and the Infectious Disease Society of America(IDSA) Standards and Practice Guidelines Committee (SPGC). In 2017, the panel issued a guideline for the diagnosis and treatment of infectious diarrhea, which was validated and recommended for the management of infectious diarrhea.Now, the part of the content on children in the guide was described.

Diagnosis and management of infectious diarrhea in children:2017 Infectious Diseases Society of America Clinical Practice Guidelines for Diagnosis and Management of Infectious Diarrhea / 中华实用儿科临床杂志

Diarrhea is one of the main disease types of illness and death in children in developing countries,and infectious diarrhea is especially harmful to children's health.A panel of multidisciplinary experts in management of infectious diarrhea in children and adults was convened in 2012.Panel participants included representatives from the Society for Healthcare Epidemiology of America (SHEA),Center for Disease Control and Prevention (CDC),and the Infectious Disease Society of America (IDSA) Standards and Practice Guidelines Committee (SPGC).In 2017,the panel issued a guideline for the diagnosis and treatment of infectious diarrhea,which was validated and recommended for the management of infectious diarrhea.Now,the part of the content on children in the guide was described.

The management of neonatal transfusion therapy: brief introduction of evidence-based recommendations of neonatal transfusion therapy in Italy / 中华实用儿科临床杂志

Blood transfusion therapy is one of the commonly used intervention in newborn infants.Red blood cell transfusion is the only treatment for most cases of neonatal anemia,but the indications of application and implementation strategy are not yet perfect,and the benefits,adverse outcomes and potential risk of transfusion remains to be evaluated.There are many uncertain problems in transfusion management.This paper mainly introduces the evidence-based recommendations of neonatal blood transfusion released by Italian Society of Transfusion Medicine and Immunohaematology and Italian Society of Neonatology Working Group for reference of domestic clinicians.

Clinical management of procedural pain in the neonate:policy statement of prevention and management of procedural pain in the neonate by American Academy of Pediatrics Committee on Fetus and New-born and Section on Anesthesiology and Pain Medicine / 中国小儿急救医学

Neonatal pain is a common phenomenon. For a long time neonatal pain had not been focus on properly and managed appropriately. American Academy of Pediatrics Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine published policy statement to emphasize the necessity of neonatal pain assessment,and summarize the neonatal operability pain assessment method,drug and non-drug control measures,also update prevention and management of procedural pain in the neonate in 2016. Until today the guideline for neonatal pain management has not yet been released in China. As the reference for clinicians in domestic,the content of policy statement will be reorganized and introduced.

Management of pediatric acute gastroenteritis in the outpatient setting——Introduction of "Clinical Practice Guideline for the Treatment of Pediatric Acute Gastroenteritis in the Outpatient Setting" of Children's National Medical Center, Washington, District of Columbia / 中华实用儿科临床杂志

Acute gastroenteritis is a common illness in childhood that usually can be treated in the outpatient setting.Despite suggestion that acute gastroenteritis children with mild to moderate dehydration receive oral rehydration therapy as the main treatment,but there are still many children were given unnecessary tests and intravenous fluids.Children's National Medical Center,Washington,District of Columbia published practice guideline to clarify the basic principles of the evaluation and management of illness.The guideline for pediatric acute gastroenteritis management has not yet been released in China.As the reference for clinicians in domestic,the content of this practice guideline will be reorganized and introduced.

Re-evaluation of Apgar score:introduction of policy statements of the Apgar score by American Academy of Pediatrics and American College of Obstetricians and Gynecologists / 中华实用儿科临床杂志

As a widely accepted and convenient method,the Apgar score has been applied to assess the status of the newborn infants and the response to resuscitation since 1952.But the Apgar score has also been used inappropriately in infants to predict specific neurologic outcomes in many cases.The Apgar Score produced by American Academy of Pediatrics(AAP) in collaboration with American College of Obstetricians and Gynecologists(ACOG),updated policy statements of the Apgar score in October 2015.The Apgar score has limitations,and it is not appropriate to use it alone to establish the diagnosis of asphyxia;the method does not predict individual neonatal mortality or neurologic outcome.AAP/ACOG encourages the use of an expanded Apgar score reporting form that accounts for concurrent resuscitation interventions.

Clinical management of bronchiolitis——clinical practice guidelines by American Academy of Pediatrics / 中华实用儿科临床杂志

Bronchiolitis is a common lower respiratory tract viral infection in infants.Incidence of bronchiolitis is greatly increasing in recent years,and seriously affecting the health of children.In order to better manage bronchiolitis,American Academy of Pediatrics (AAP) convened a new subcommittee to review and revise the 2006 bronchiolitis guideline.This evidence-based guideline amended to provide new evidence of diagnosis,treatment and prevention bronchiolitis for the clinician.

"Is the term ""neonatal encephalopathy"" better than ""hypoxic-ischemic encephalopathy ?——Introduction of the report of Task Force on Neonatal Encephalopathy published by the American College of Obstetricians and Gynecologists and the American Academy of Pe" / 国际儿科学杂志

Neonatal hypoxic-ischemic encephalopathy as a standard term has been used for over 30 years,but now increasingly being questioned.Most experts recommend using neonatal encephalopathy instead of hypoxic-ischemic encephalopathy.The American College of Obstetricians and Gynecologists and The American Academy of Pediatrics published separately the report of Task Force on Neonatal Encephalopathy Neonatal Encephalopathy and Neurologic Outcome,Second Edition in 2014.Definition,diagnosis and treatment of neonatal encephalopathy and other content have been updated in the report.It is recommended that a comprehensive multidimensional assessment be performed of neonatal encephalopathy.This article will introduce the controversy about neonatal encephalopathy or hypoxic-ischemic encephalopathy and contents of the report of Task Force on Neonatal Encephalopathy.

Clinical management of measles in children—2015 report of the Committee on Infectious Diseases of American / 中华实用儿科临床杂志

Measles is an acute viral disease, almost all deaths cases of measles in children occur in developing countries each year.Despite the availability of a safe and effective vaccine, measles is still one of the main causes of death of children in global area.2015 report of Committee on Infectious Diseases of American provided evidence of clinical diagnosis, treatment and prevention of measles.

Effects of intravenous infusion of bilirubin on the expression of myeloid differentiation factor 88 and in-terleukin-1 receptor associated kinase-4 in splenocytes with neonatal rats / 中国小儿急救医学

Objective To explore the effects of bilirubin on myeloid differentiation factor 88 (MyD88)and interleukin-1 receptor associated kinase-4(IRAK-4).Methods Seven-day-old Sprague Daw-ley rats (clean grade),male or female,weighing 12.0 to 15.0 g,were randomly assigned to 6 groups.There were normal saline group(Ⅰ),lipopolysaccharide(LPS)control group (LPS,Ⅱ),15 mg /kg bilirubin con-trol (free-LPS)group (Ⅲ),15 mg /kg group (Ⅳa),30 mg /kg group (Ⅳb)and 50 mg /kg group (Ⅳc), and then subsequently divided into 2 h,5 h and 24 h subgroups in each groups.Some of the 200 newborn rats died amid the experiment.Finally a total of 144 were involved in the analysis of results,and 8 rats in each subgroups.Newborn Sprague Dawley rats were administered at various doses of bilirubin (15 mg /kg, 30 mg /kg and 50 mg /kg respectively)intravenously;1 h after injection,the rats were administered LPS intrap-eritoneally at a dose of 1 mg /kg;MyD88 and IRAK-4 were detected by immunohistochemistry at 2 h,5 h and 24 h after the injection of bilirubin.Results (1 )LPS could stimulate the expression of MyD88 and IRAK-4 in spleen cells (qMyD88 2 h =49.89,qMyD88 5 h =139.54,qIRAK-4 2 h =7.93,qIRAK-4 5 h =24.30,qIRAK-4 24 h =6.97 ,P 0.05).Effects of medium and high concentration of bilirubin on LPS stim-ulation MyD88 were inhibitory(qⅣb 2 h =42.87,qⅣc 2 h =51.38,qⅣb 5 h =103.61 ,qⅣc 5 h =1 15.44,qⅣb 24 h =1.18,qⅣc 24 h =1 1.66,P <0.01 ).(4)Effects of low,medium and high concentration of bilirubin on LPS stimulation IRAK-4 were inhibitory(qⅣa 2 h =9.52,qⅣb 2 h =14.39,qⅣc 2 h =25.55,qⅣa 5 h =38.83,qⅣb 5 h =54.62,qⅣc 5 h =60.51 ,qⅣa 24 h =2.41 ,qⅣb 24 h =1.47,qⅣc 24 h =7.61 ,P <0.01 ).(5)The inhibition of biliru-bin to MyD88 and IRAK-4 was observed at 2 h,strengthened at 5 h,disappeared at 24 h in low-mid concen-trations of bilirubin(P <0.01 )while still visible at 24 h in high concentration of bilirubin.(6)There was neg-atively correlation between the expression level of MyD88,IRAK-4 and bilirubin concentration(rsMyD88 2 h =-0.86, rsMyD88 5 h =-0.92,rsMyD88 24 h =-0.53,rsIRAK-4 2 h =-0.82,rsIRAK-4 5 h =-0.86,rsIRAK-4 24 h =-0.57,P <0.01).(7) Under the effect of bilirubin and LPS,there were positively correlation between the expression levels of MyD88 and IRAK-4 of spleen cells(r2 h =0.77,r5 h =0.9,r24 h =0.67,P <0.01).Conclusion Bilirubin could inhibit the expression of MyD88 and IRAK-4.As the concentration of bilirubin increasing,its inhibition is more obvious and prolonged.The mechanism that bilirubin affects immune function of newborn rat may be related to regulation of expression of MyD88 and IRAK-4 at toll-like receptor 4 signal pathway.

Azithromycin for preventing bronchopulmonary dysplasia in preterm infants:a systematic review / 中华实用儿科临床杂志

Objective To assess the effectiveness and safety of Azithromycin for preventing bronchopulmonary dysplasia(BPD) in preterm infants in order to provide reference for the clinical treatment of BPD.Methods The electronic retrieval were conducted to review randomized controlled trials (RCTs) from The Cochrane Library,PubMed,EM-Base,China Biological Medicine Database (CBM),Chinese Journals full-text Database (CNKI),Chinese Technological Journals Database(VIP) and Wan Fang Digital Journal Full-text Database by free texts and medical subject headings.The retrieval time was from inception to Dec.2012.Randomized or quasi-randomized studies were conducted by comparing Azithromycin therapy and no treatment or placebo management to prevent BPD among the preterm or low birth weight infants were included.The reference lists of relevant trials and conference proceedings were searched.Risk biases of the trials were assessed.Statistical analysis was performed by using Revman 5.1 offered by Cochrane.Results A total of 2 trials including 328 preterm infants were included.No significant difference was observed between the Azithromycin group and the control group in the incidence of BPD(RR =0.81,95％ CI 0.55-1.19).The risk ratio of death and post-natal steroid used in the Azithromycin group were lower,but there was no difference.The risk ratio of length of stay was not significantly different.The rate of BPD in preterm infants who had a positive respiratory culture of Ureaplasma between the preventative Azithromycin group and the placebo group showed that the incidence of BPD was significantly less in the Azithromycin group.Conclusions The available data are insufficient to make a recommendation regarding treatment with prophylactic Azithromycin to prevent BPD in preterm infants.More RCTs with large-scale and high-quality are required to provide more reliable evidence.

Effects of intravenous infusion of bilirubin on the expression of phospho-p38 mitogen-activated protein kinase and the apoptosis in splenocytes of neonatal rats / 中华实用儿科临床杂志

Objective To explore the effects of bilirubin on myeloid differentiation factor phospho-p38 mitogen-activated protein kinase (p-p38MAPK) and apoptosis in splenocytes of neonatal rats.Methods Seven-day-old Sprague Dawley rats (clean grade),male or female,weighting 12.0-15.0 g,were randomly assigned to 6 groups.There were blank control group (Ⅰ),lipopolysaccharide (LPS) control group (Ⅱ),15 mg/kg bilirubin control (free-LPS) group (Ⅲ),15 mg/kg group (Ⅳa),30 mg/kg group (Ⅳb) and 50 mg/kg group (Ⅳc),and then subsequently divided into 2 h,5 h and 24 h subgroups in each groups.Some of the 200 newborn rats died amid the experiment,tinally,a total of 144 cases were involved in the analysis of results,and 8 rats in each subgroups.Newborn Sprague Dawley rats were administered at various doses of bilirubin (15 mg/kg,30 mg/kg and 50 mg/kg,respectively) intravenously; 1 h after injection,the rats were administered LPS intraperitoneally at a dose of 1 mg/kg;p-p38MAPK were detected by immunohistochemistry;Apoptosis in splenocytes was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling methods at 2 h 5 h and 24 h after the injection of bilirubin.Results 1.Expression of p-p38MAPK in each group:bilirubin in low-mid concentrations of range inhibited LPS-induced p38MAPK activation (qⅣa =20.93,10.37,respectively at 2 h,and 5 h,all P ＜ 0.01 ;qⅣ b =79.97,14.79,all P ＜ 0.01).The inhibition strengthened with increasing concentration of bilirubin.The effect was observed at 2 h,strengthened at 5 h,disappeared at 24 h.Bilirubin in the high concentrations of range stimulated the expression of p-p38MAPK (qⅣc =32.55,19.23,27.72,respectively at 2 h,5 h and 24 h,all P ＜0.01),observed at 5 h,reduced at 24 h.2.Effects of bilirubin on apoptosis in splenocytes:LPS could increased the apoptosis index (AI) of splenocytes(q =54.62,P ＜ 0.01);The AI of splenocytes had no significant change in low concentrations of range of bilirubin (q =43.92,P ＞ 0.05).Low-mid concentration of bilirubin with LPS reduced the AI of splenocytes (q Ⅳ a =4.48,P ＜ 0.01 ;q Ⅳ b =2.07,P ＜ 0.05),while high concentration of bilirubin with LPS increased the AI of splenocytes (q =5.08,P ＜ 0.01).Conclusions Bilirubin in low-mid concentrations of range could inhibit the expression of LPS-induced p38MAPK,while bilirubin in high concentrations of range stimulated the expression.As the concentration of bilirubin elevated,its inhibition was prolonged.Bilirubin in high concentrations of range bilirubin could induce apoptosis in splenocytes.The immune dysfunction in neonatal hyperbilirubinemia may have something to do with the regulation of phosphorylation of p38MAPK and activation of apoptotic pathways.