ABSTRACT
Objective:To analyze the mortality of extremely preterm infants(EPIs) born at 22 +0-25 +6 weeks of gestation in Tianjin Central Hospital of Obstetrics and Gynecology and then compare it with data from other countries to provide evidence for better healthcare for this population. Methods:Clinical data of EPIs born at 22 +0-25 +6 gestational weeks in our center from January 2011 to December 2017 were retrospectively collected. The enrolled patients were grouped based on their gestational age, birth weight, and admission time in order to analyze the mortality in different groups. According to the inclusion and exclusion criteria, five sets of data regarding the mortality of EPIs born at 22 +0-25 +6 gestational weeks during the same period were retrieved from a multicenter survey involving 15 centers in China, the National Institute of Child Health and Human Development Neonatal Research Network (NICHD-NRN) in the United States, Canadian Neonatal Network TM, Australian and New Zealand Neonatal Network (ANZNN) and Korean Neonatal Network (KNN). The mortality rate among data from different sources was compared using Chi-square test on the condition that the definition of death was the same. Besides, the causes of neonatal death were analyzed. Results:A total of 64 EPIs were enrolled in our center. The total mortality rate was 42.2% (27/64), and were 1/1, 8/10, 50.0%(10/20) and 24.2%(8/33) in EPIs of gestational age of 22 +0-22 +6, 23 +0-23 +6, 24 +0-24 +6 and 25 +0-25 +6 weeks, 5/6, 50.0%(16/32), 25.0%(6/24) and 0/2 in those with birth weight of ≤600 g, >600-≤800 g, >800-≤1 000 g and >1 000 g, respectively. In the 27 death cases in our center, the causes of death were as follows: neonatal respiratory distress syndrome (16 cases, 59.3%), sepsis (two cases, 7.4%), necrotizing enterocolitis (three cases, 11.1%), severe intraventricular hemorrhage (three cases, 11.1%) and others (three cases, 11.1%). The mortality rate was 57.1%(12/21) before 2016(2011-2015), 45.0%(9/20) in 2016 and 26.1%(6/23) in 2017. The total mortality of EPIs in our center was higher than that in Canada [42.2% vs 26.6%(165/621), χ2=7.015, P=0.008], as well as in Australia and New Zealand [42.2% vs 28.2%(140/497), χ2=5.330, P=0.021], while there was no statistically significant difference when compared with that in South Korea [42.2% vs 42.1%(218/518), χ2<0.001, P=0.988]. Conclusions:The mortality of EPIs born at 22 +0-25 +6 gestational weeks is higher in our center when compared with that in some developed countries such as Canada and Australia. Therefore, we should pay more efforts to reduce the mortality of EPIs through quality improvement.
ABSTRACT
Meconium-stained amniotic fluid is one of the main risk factors for neonatal meconium aspiration syndrome, and can even cause death, which is a dangerous emergency to handle during neonatal resuscitation. Routine intubation and endotracheal suction are not recommended for non-vigorous newborns born through meconium-stained amniotic fluid in the latest international neonatal resuscitation guideline. But it is controversial due to lacking high-level evidence. We review the recent evidence for the rationale for endotracheal suction in non-vigorous neonates born through meconium-stained amniotic fluid.
ABSTRACT
Objective To explore the effect of acteoside (one of the ingredients of Total Glycosides Extracted from Rehmannia capsules) on treatment of proteinuria and protection of podocytes.Methods In this study,puromycin nephropathy rat model was successfully established.After detecting the degree of proteinuria,the expression of podocyte injury markers and the degree of podocyte foot process fusion were investigated by electron microscope.In addition,puromycin treated podocyte injury model was also successfully established in vitro.Podocyte viability,migration,cytoskeleton and injury marker were detected.Results In vivo study showed that acteoside could effectively reduce proteinuria (P ＜ 0.05),restore the expression of podocyte injury markers such as nephrin and synaptopodin (all P ＜ 0.05),and alleviate the degree of podocyte foot process fusion.In vitro study showed that acteoside could effectively restored podocyte viability (P ＜ 0.05),reduce abnormal migration ability (P ＜ 0.05),protecte cytoskeleton and restore the expression of podocyte injury marker nephrin (P ＜ 0.05).Conclusions This study confirms that acteoside can reduce the degree of proteinuria in puromycin nephropathy rat model in vivo and alleviate the degree of podocyte injury in vitro as well as enrich the molecular mechanism of Total Glycosides Extracted from Rehmannia capsules in treatment of proteinuria.