ABSTRACT
Objective To investigate,through a survey on hospitals,the disciplinary development of pediatric nutrition and the present situation of clinical nutritional support in China,in an effort to inform and promote development of pediatric clinical nutrition.Methods A questionnaire was designed by the group of clinical nutrition,Chinese Pediatric Society,Chinese Medical Association.Respondents were 45 hospitals where members of the group work.The survey included 8 aspects in clinical work.Results Of all the 45 hospitals,40 were grade-A tertiary hospitals;4 were grade-B tertiary hospitals;and one was a secondary hospital.25 (55.6％) of the surveyed hospitals were children's hospitals,and 20 (44.4％) were general hospitals.All the hospitals were divided into 8 groups according to their geographical distribution in China,and East China hosted the most while Northeast China had the least.Nutritional support team (NST) was set up in 32 (71.1％) hospitals,with head of the team majoring in the specialty/subspecialty of pediatric gastroenterology or clinical nutrition.In 39 (86.7％) hospitals,physicians working in the nutrition department were attending or above,and in 38 (84.4％) tertiary hospitals,chief of the nutrition department held an academic title of associate chief or above.39 (86.7％) hospitals had nutrition clinics,42 (93.3％) provided nutritional counseling,40 (88.9％) involved nutritionists in consultations,25 (55.6％) had independent nutritional rounds.Screening tools for nutritional risk and dysplasia in children (STRONGkids) and screening tool for the assessment of malnutrition in pediatrics (STAMP) were the most widely used tools for malnutrition screening,and the same with self-rating depression scale (SDS) and percentile for nutritional status evaluation.In the most surveyed hospitals,key institutional requirement and procedural protocol were put in place for the nutritional department.Conclusions Pediatric clinical nutrition was developing well in tertiary hospitals in China.NST was established in most institutions.There was strong toolkit for clinical nutritional support and sound administrative institutions.There is room,though,for further improvement.
ABSTRACT
Objective@#To evaluate the effectiveness and safety of the use of noninvasive high-frequency oscillation ventilation (nHFOV) in very low birth weight infants.@*Method@#A total of 36 cases received nHFOV between January 2016 and October 2016 in Children′s Hospital, Zhejiang University School of Medicine, including 24 males and 12 females, with the gestational age of (27.5±2.5) weeks and birth weight of(980±318)g. The data of the ventilator settings, side effects, and changes of the respiratory function before and after nHFOV were collected and analyzed retrospectively. Nonparametric tests or t tests or χ2 tests were used.@*Result@#Thirty-two (89%) out of the 36 cases successfully avoided intubation or re-intubation after using of nHFOV. nHFOV was used as the rescue treatment after failure of other noninvasive ventilation in 17 cases, and as the prophylactical treatment preventing re-intubation after extubation in the remaining 19 cases. There were significant decreases in the incidences of apnea and desaturation(SpO2<0.85), the level of PaCO2, and the FiO2 24 h after the initiation of the nHFOV as the rescue therapy((1.2±1.1)vs.(6.3±2.1)episodes , (1.1±1.2) vs.(4.3±1.5) episodes, (43±8) vs.(56±10) mmHg, 0.30±0.07 vs. 0.39±0.11, respectively; 1 mmHg=0.133 kPa, t=7.562, 8.913, 4.179, 3.437 respectively, all P<0.01). No significant changes were found in FiO2 and PaCO2 levels 24 h after initiation of nHFOV as the prophylactical therapy after extubation (0.42±0.12 vs.0.40±0.10, (49±8)vs.(48±7)mmHg, t=0.872 and 0.501 respectively, both P>0.05), except for the significant decreases in the mean airway pressure ((7.9±2.6)vs.(9.6±1.6)cmH2O, 1 cmH20=0.098 kPa, t=2.198, P=0.041). There were 4 cases suffered from nasal septum injury, while no other nHFOV related complications were noted.@*Conclusion@#nHFOV can be applied in preterm infants as a rescue treatment after the failure of other noninvasive ventilation, or prophylactically used in patients who have high risk of re-intubation.