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Objective To examine the effectiveness of simulation newborn simulator in neona-tal resuscitation training for pediatric residents. Methods From June 2011 to June 2012, 11 residents working in neonatal ward of the Third Hospital of Peking University were enrolled into the study. Eval-uation on the residents was made before the training. Training of simulated teaching using simulation newborn simulator was conducted and evaluation was made after the training. SPSS 18.0 was used for statistical analysis. Comparison was made between pre- and post-training test by paired t test. P<0.05 was considered statistical significant. Questionnaire survey was conduct to acquire residents' feedback. Results A total of 11 participants completed the training and finished the questionnaire. The score of pre-training was 37.82±1.17 versus that of post-training 39.18±0.87(t=4.89, P<0.01). All residents were satisfied with the simulation-based training. Conclusion Simulation training can improve pedi-atric residents' knowledge and skills in neonatal resuscitation.
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ObjectiveTo study the feasibility,efficacy and safety of u tilizing the laryngeal mask airway (LMA) ventilation compared with the endotracheal intubation ( ET ) in neonatal resuscitation for moderate and severe asphyxiated neonates.MethodsNeonates requiring positive pressure ventilation with heartrate ＜60 beats/min were collected and grouped quasi-randomizedly into LMA(36 cases) or ET(32 cases)ventilation.Differences of resuscitation effect,inserting time,successful once insertion rate and adverse reactions between the two groups were observed and compared.Results( 1 ) No significant difference was observed in Apgar scores at 1 min and 5 min between the two groups ( P＞0.05 ).(2) Success rate of once insertion was 94.4％ with average inserting time ( 7.58±1.16 ) s for LMP group,while it was 90.6％ and ( 7.89 ± 1.52) s for ET group.( 3 ) Successful resuscitation rate of LMA group ( 86.11％ ) was slightly lower than ET group (96.88％ ),but there was no statistical difference (P＞0.05).(4) Mean response time of LMA group [ (34.06 ± 10.56) s] was slightly lower than that of ET group [ (41.38 ±27.19) s],also ventilation time of LMA group [( 137.19 ±80.14) s] was slightly lower than that of ET group [ ( 171.09±84.28 ) s ],but neither showed statistical difference ( P＞0.05 ).(5) Adverse reactions were found in LMA group including nausea( 2 cases )and abdominal distention (1 cases),while there were laryngeal edema( 1 cases),pneumothorax(2 cases),respiratory tract bleeding( 1 cases) in ET group.ConclusionThe LMA ventilation is much easier to operate,with its effect no less than that of ET ventilation on resuscitation for moderate and severe asphyxiated cases,even it seems more safe.LMA ventilation can be a good substitute for ET ventilation,especially for those medical staffs who are unfamiliar with ET operation and primary hospital doctors in case of emergency.
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Objective To evaluate the effect of a pilot intervention on setting up a hospital-based neonatal resuscitation leading group in 12 hospitals. Methods One provincial-level, two prefecturelevel and one county-level hospitals in Jiangxi, Liaoning and Hunan province were selected to participate in the intervention. A neonatal resuscitation leading group was set up in each hospital to investigate the mode of resuscitation practice training and re-training, improve and carry on the cooperation between obstetricians and pediatricians, record the steps of neonatal resuscitation of asphyxia cases and lead the exploration of the problems occurred during the process in their own hospital. The changes of asphyxia incidence and neonatal resuscitation process were analyzed to evaluate the effect of the intervention. Results (1) Incidence of neonatal asphyxia during intervention period: 315 neonatal asphyxia cases were recorded, among which 89.5 % (n = 282) were mild and 10. 5% (n=33) cases were severe asphyxia. The mean one-minute Apgar score was the lowest in county-level hospitals (5. 40±1.56), followed by provincial-level hospitals (5.63 ±1.67)and prefecture-level hospitals (6.03 ± 1.41). (2) Resuscitation was not performed according to the guidelines in 47. 9% (151/315) of asphyxia cases. Bag and mask ventilation was not performed according to guideline in 36. 5% (115/315) of cases. (3) Changes of asphyxia incidence after the intervention: the incidence of asphyxia in provincial-level (4.23 % vs 2.66 %, χ2 = 5. 021, P＜0.05)and prefecture-level (2.83% vs 1.67%, χ2 = 4. 948, P＜0.05) hospitals decreased significantly after the intervention. The incidence of severe asphyxia in both provincial-level (χ2 =3. 001, P＞0.05) and prefecture-level (χ2= 0. 966, P＞ 0. 05) hospitals decreased with no statistical significance. The asphyxia incidence in county-level hospitals decreased from 2. 48% to 1. 22% (χ2 = 2. 989, P =0. 084). The incidence of severe asphyxia in county-level hospitals decreased from 0.39% to 0. 00%(χ2=2. 567, P= 0. 035). Conclusions Setting up a hospital-based neonatal resuscitation leading group is an effective method to strengthen resuscitation practice training, promote the cooperation between departments, improve the level of neonatal resuscitation practice and therefore decrease the incidence of neonatal asphyxia in the hospital.
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Objective To study the feasibility, efficacy and safety of laryngeal mask airway (LMA) in neonatal resuscitation. Methods Totally, 369 neonates requiring positive pressure ventilation at birth were randomized into two groups by offering either LMA resuscitation (205 cases) or bag-mask ventilation (BMV) resuscitation (164 cases). The effect in the two groups were observed. Results (1) No significant difference was observed in Apgar scores at 1 min between LMA group and BMV group, but the neonates having higher Apgar scores at 5 min in LMA group were more than in BMV group (x2 =-3. 39,P=0. 001). The successful resuscitation rate of LMA group was higher than that of BMV group (99.02%vs 84. 15% ,x2 =28. 76, P＜0. 01), the total ventilation time of LMA group was shorter than that of BMV group [(36.4±23.7) s vs (66.2±35.4) s] (t=-8.66, P＜0. 01). Among severe asphyxia neonates,seven of nine were successfully resuscitated by LMA, while in BMV group six neonates with severe asphyxia were all switched to endotracheal intubation ventilation. In neonates with Apgar score of 4 to 5 at 1 min after birth, the successful resuscitation rate of LMA group was higher than that of BMV group (100% vs 42. 86%, x2 =23.04, P＜0.01), the ventilation time of LMA group was shorter than that of BMV group [(54.6±33.6) s vs (136.4±42.0) s] (t= -4. 45, P＜0.01). In neonates with Apgar score of 6 to 7 at 1 min after birth, there was no significant difference in the successful resuscitation rate between LMA and BMV group. (2) The successful rate of LMA insertion at first attempt was 98.54% (202/205) and the average insertion time was (7.8 ± 2. 2) s. The adverse effects included vomiting(4 cases)and regurgitation (3 cases). Conclusions In neonatal resuscitation, LMA can be easily inserted. Compared to BMV, LMA is a better choice in resuscitation for neonates with moderate or severe asphyxia and preferable for those medical staffs who are unfamiliar with endotracheal intubation, or even as a substitute of endotracheal intubation ventilation.
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OBJECTIVE To analyze 28 cases in an outbreak of neonatal enterovirus nosocomial infection during summer of 2006.METHODS Demographic characteristics,clinical manifestations,laboratory data and outcome were analyzed to reveal the clinical severity.RESULTS The outbreak lasted more than one month and the nosocomial infection rate increased to 6.4%.There were 22 cases(78.6%) first presented with fever.Half of the patients were detected enterovirus from blood or cerebrospinal fluid by PCR.All of the 28 cases were diagnosed enterovirus infection based on the contact history,clinical signs and laboratory results.Among them,ten cases had viral meningitis.All patients discharged home after hospitalization with no sequelae.CONCLUSIONS Although this group of neonatal enterovirus infection developed viral meningitis,they had relatively mild illness with benign clinical course.Extreme vigilance is required in interrupting the spread of nosocomial enterovirus infections in neonatal units.This includes respect of strict hygiene measures and meticulous hand-washing.
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Objective To investigation the relation of leptin to birth weight and insulin in preterm and term neonates and to explore whether a functional “adipoinsular axis” might exist in preterm and term neonates. Methods A total of 264 preterm and term newborns were recruited and categorised according to gestation length. Anthropometric measurements were performed at birth. Leptin, fasting glucose and insulin were measured at 3 days of life. Results Serum leptin was significantly higher in term than in preterm. The relation between serum leptin and gestation followed a non-linear pattern; The slope of the curve began to increase after 34 weeks gestation. Serum leptin was associated with birth weight and insulin in newborn more than 32 weeks gestation(r=0.240, 0.227, P
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Objective To explore the reason of low incidence of neonatal GBS infection in China. Methods The serum level of GBS type III specific antibody in 102 randomly selected prenatal mother and their neonatal cord blood were measured using ELISA method. Sixty-two neonates less than 7 days old and 32 children between 2 months and 13 years old served as control. Results The average level of GBS type III specific antibody in the mother was 21.59 mg/L, and that in the paired cord serum was 17.90 mg/L, which was correlate with their mother(r=0.83,P
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Objective To investigate the relationship between angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and the severe morbidity of neonates. Methods According to the Neonatal Critical Score (draft), neonates were divided into three groups:control group (n=116), non-critical group (n=237) and critical group (n=98). ACE genotype was determined by PCR. Results The DD genotype was significantly higher in critical group compared with the other two. The critical score on first day of hospitalization was significantly lower in DD genotype than ID or II (93.52?6.99 vs 96.43?5.80 and 96.22?6.41, P
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Objective To study the serum and gastric juice levels of epidermal growth factor (EGF) in response to early minimal enteral nutrition (MEN) in premature infants with severe illness and evaluate the clinical significance of early MEN. Methods Premature infants with critical score
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Objective To explore the relationship between maternal homocysteine (HCY), folic acid, 5, 10 methylenetetrahydrofolate reductase (MTHFR) genotypes(677C→T) and occurrence of congenital heart disease (CHD) in offspring. Methods HPLC technique was used to measure the level of total plasma HCY in 32 mothers of CHD children and 23 mothers of normal children, radio immunoassay was used to measure folic acid, and MTHFR genotypes were detected by PCR RELP analysis. Results The incidence of hyperhomocysteinemia(Hhe) (34%,11 cases) in CHD maternal group was significantly higher than that in normal maternal group( P
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Objective To investigate the relationship between serum prolactin(PRL) level and neonatal seizures and to evaluate the clinical significance of PRL as a neonatal seizures marker to diagnose neonatal seizures. Methods Thirty five newborn infants with acute encephalopathy were divided into two groups: the ictal group included infants with typical clinical symptom and/or electrographic seizures and the nonictal group are those without electrographic seizures or clinical behaviors. The control group included 17 newborns. Serum PRL levels were determinded by immulite assay system at 15～30 min postictally; 2 h postictally and 2～4 days after the end of seizures. Results In the ictal group, serum PRL levels were significantly higher at 15～30 min[(302.6?93.5) ?g/L] than that of 2 h [(128.1?71.4) ?g/L], nonictal[(101.2?31.4)?g/L and (89.9?36.2) ?g/L] and control group[(73.3?20.7) ?g/L and (68.6?29.5)?g/L], P
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Objective To study the level of umbilical plasma erythropoietin (EPO) in normal and abnormal pregnancy and analyze the influence factors of EPO. Methods EPO concentration in 106 umbilical plasma were measured by enzyme immonoassay. Samples were divided into four groups: control group with healthy full term newborns; hypertension group with neonates born to mothers with hypertension; diabetiec group with neonates born to mothers with diabetes; asphyxia group with neonates with fetal distress or asphyxia. The relationship between the concentration of EPO and gestational age, mode of delivery and pregnant complications were analysed. Results Mothers with hypertension, diabetes, fetal distress or neonatal asphyxia were important factors influencing umbilical blood EPO production ( P
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Objective To Discuss the influence of intrauterine environment to neonatal insulin sensitivity. Methods Two hundred and eight new borns were selected into our study and divided into 4 groups, they are full term adequate for gestational age(AGA) group(133 cases), full term small for gestational age(SGA) group(30 cases), preterm AGA group(87 cases) and preterm SGA group(30 cases). In the morning of the 3rd day after birth their serum glucose, insulin and lipid concentration were examined before milk, and the ratio of insulin to glucose were calculated. Statistical analysis was performed with the SPSS 9.0 software. Results The mean ratio of insulin to glucose are 1.243?0.703 in full term SGA group and 0.259?0.837 in full term AGA group, while in preterm SGA group and preterm AGA group the mean ratio of insulin to glucose are 1.190?0.683 and 0.497? 0.080, it shows that each SGA group has significantly higher insulin to glucose ratio than the AGA group( P
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Objective To assess the preventive effects of recombinant human erythropoietin (rHu EPO) on the anemia of premature birth infant. To determine whether prophylactic treatment with rHu EPO and iron would reduce the postnatal hemoglobin (Hb) decline and blood transfusion of premature infants. Methods Fifty one infants of less than 35 weeks of gestation and 2000 g of birth weight from multicenter were randomly assigned to EPO group ( n =31) and control group ( n =20). Infants in EPO group received rHuEPO 250 IU/(kg?t) intravenously or subcutaneously once every second day, started between 2 and 10 days of age, maintained for 4 weeks. Oral iron and vitamin E supplements were given to all infants. Hb, hematocrit (Hct), reticulocyte counts (Ret), serum iron and erythropoietin (EPO) were detected in both groups. Results Postnatal decline of Hb and Hct were less in EPO group than that in the control group at the end of study (129.9?21.0 vs 103.2?14.3, P