Comparation on the ability of the step-by-step approach and the lab-score method in early identification of non-bacterial infection in febrile infants with less than 90 days old / 中华危重病急救医学

OBJECTIVE@#To compare the ability of the step-by-step approach and the lab-score method in early identification of non-bacterial infection in febrile infants with less than 90 days old.@*METHODS@#A prospective study was conducted. The febrile infants with less than 90 days old hospitalized in the department of pediatrics of Xuzhou Central Hospital from August 2019 to November 2021 were enrolled. The basic data of the infants were recorded. The infants with high risk or low risk of bacterial infection was evaluated by the step-by-step approach and the lab-score method, respectively. The step-by-step approach was based on clinical manifestations, age, blood neutrophil absolute value or C-reactive protein (CRP), urine white blood cells, blood venous blood procalcitonin (PCT) or interleukin-6 (IL-6) to gradually assess the high risk or low risk of bacterial infection in infants with fever. The lab-score method was based on the levels of laboratory indicators such as blood PCT, CRP and urine white blood cells, which were assigned different scores to evaluate the high risk or low risk of bacterial infection in febrile infants according to the total score. Using clinical bacterial culture results as the "gold standard", the negative predictive value (NPV), positive predictive value (PPV), negative likelihood ratio, positive likelihood ratio, sensitivity, specificity, and accuracy of the two methods were calculated. The consistency of the two evaluation methods was tested by Kappa.@*RESULTS@#A total of 246 patients were enrolled in the analysis, and ultimately confirmed by bacterial culture as non-bacterial infections in 173 cases (70.3%), bacterial infection in 72 cases (29.3%), and unclear in 1 case (0.4%). There were 105 cases with low risk evaluated by the step-by-step approach, and 98 cases (93.3%) were ultimately confirmed as non-bacterial infection; 181 cases with low risk evaluated by the lab-score method, and 140 cases (77.4%) were ultimately confirmed as non-bacterial infection. The consistency of the two evaluation methods was poor (Kappa value = 0.253, P < 0.001). The ability of the step-by-step approach in early identification of non-bacterial infection in febrile infants with less than 90 days old was superior to the lab-score method (NPV: 0.933 vs. 0.773, negative likelihood ratio: 5.835 vs. 1.421), but the sensitivity of the former was lower than that of the latter (0.566 vs. 0.809). The ability of the step-by-step approach in early identification of bacterial infection in febrile infants with less than 90 days old was similar to the lab-score method (PPV: 0.464 vs. 0.484, positive likelihood ratio: 0.481 vs. 0.443), but the specificity of the former was higher than that of the latter (0.903 vs. 0.431). The overall accuracy of the step-by-step approach and the lab-score method was similar (66.5% vs. 69.8%).@*CONCLUSIONS@#The ability of the step-by-step approach in early identification of non-bacterial infections in febrile infants with less than 90 days old is superior to the lab-score method.

The application value of respiratory intervention training in feeding of preterm infants / 中国实用护理杂志

Objective:To investigate the clinical effect of respiratory intervention training in feeding of preterm infants, so as to provide reference for feeding interventions in preterm infants.Methods:From March 2021 to October 2021, the 80 preterm infants hospitalized in the Neonatal Intensive Care Unit of Xuzhou Central Hospital were selected and divided into intervention group (40 cases) and control group (40 cases) according to the random table method in a prospective study. The common nursing was given in the control group, the respiratory intervention training was given on this basis in the intervention group, once a day for two weeks. The intervention effect was evaluated by the time of indwelling gastric tube, hospital stay, feeding reaction, feeding related complications and satisfaction rate of catch-up growth. The oral feeding ability of preterm infants was evaluated by the non-nutritive sucking (NNS) score and preterm infants oral feeding readiness assessment scale (PIOFRAS) score.Results:The time of indwelling gastric tube and hospital stay was (15.3 ± 8.7), (28.9 ± 9.8) d in the intervention group and (21.7 ± 9.8), (34.6 ± 12.2) d in the control group, the difference was significant ( t=3.12, 2.32, both P<0.05). After intervention, the differences of respiratory number, heart rate and pulse oxygen saturation were (6.5 ± 1.3) beats/min, (11.2 ± 1.5) beats/min, 0.048 ± 0.015 in the intervention group and (11.2 ± 1.2) beats/min, (16.5 ± 1.3) beats/min, 0.082 ± 0.018 in the control group, the differences were significant ( t=16.39, 16.40, 9.35, all P<0.05). The incidence of feeding-related complications was 25.0% (10/40) in the intervention group and 55.0% (22/40) in the control group, the difference was significant ( χ2=7.50, P<0.05). The satisfaction rate of catch-up growth was 77.5%(31/40) in the intervention group and 40.0%(16/40) in the control group, the difference was significant ( χ2=12.78, P<0.05). The scores of NNS and PIOFRAS at 7 d, 10 d and 14 d after intervention were (13.73 ± 2.24), (29.98 ± 6.67), (49.08 ± 16.37) points and (15.28 ± 1.41), (25.08 ± 3.10), (31.03 ± 3.00) points in the intervention group and (10.30 ± 2.18), (15.68 ± 2.42), (28.60 ± 3.61) points and (12.60 ± 1.22), (17.15 ± 1.51), (23.75 ± 3.87) points in the control group, the differences were significant ( t values were -14.53--6.94, all P<0.05). Conclusions:The respiratory intervention training can effectively shorten the transition time from tube feeding to complete oral feeding in preterm infants, reduce feeding reaction and the incidence of feeding-related complications, and promote the coordination of feeding behavior, so as to improve oral feeding ability and catch-up growth of preterm infants.

Oral acetaminophen or high-dose ibuprofen as rescue treatment for very preterm infants with patent ductus arteriosus / 中国新生儿科杂志

Objective:To study the efficacy and safety of oral acetaminophen or high-dose ibuprofen as rescue treatment after failure of conservative management in very preterm infants (VPIs) with haemodynamically significant patent ductus arteriosus (hsPDA).Methods:From May 2020 to November 2022, VPIs with hsPDA (gestational age<32 weeks and age 4~6 d) admitted to NICU of our hospital were prospectively enrolled. The rescue treatment was initiated if hsPDA still exist after 3~4 d of conservative management. The infants were randomly assigned into acetaminophen group (oral acetaminophen 15 mg/kg, once every 6 h for 3 d) and high-dose ibuprofen group (oral ibuprofen 20 mg/kg for the first dose, 10 mg/kg each dose after 24 h and 48 h). Before and after rescue treatment, the following were recorded: echocardiography, complete blood count, biochemistry, B-type natriuretic peptide (BNP), fecal occult blood test (FOBT) and transcranial Doppler ultrasound. Urine output and complications were also examined. SPSS 20.0 was used for statistical analysis.Results:A total of 36 cases were in the acetaminophen group and 37 in the high-dose ibuprofen group. The two groups showed similar efficacy as rescue treatment [80.6% (29/36) vs. 78.4% (29/37), P>0.05]. No significant differences existed in the incidences of upper gastrointestinal bleeding, positive FOBT, oliguria, stage Ⅱ-Ⅲ necrotizing enterocolitis and stage Ⅲ-Ⅳ intraventricular hemorrhage between the two groups ( P>0.05). After rescue treatment, the serum cystatin C in high-dose ibuprofen group was higher [(1.72±0.29) mg/L vs. (1.58±0.26) mg/L] and 24-hours urine output was lower [(3.1±1.0) ml/(kg·h) vs. (3.7±0.7) ml/(kg·h)] than the acetaminophen group (all P<0.05). No significant differences existed in serum creatinine, platelet count, BNP, alanine aminotransferase and total serum bilirubin between the two groups ( P>0.05). Conclusions:After failure of early conservative management in VPIs with hsPDA, when initiated within 7-10 d after birth, rescue treatment with oral acetaminophen or high-dose ibuprofen has a similar efficacy of 80%, and both drugs are safe. Oral high-dose ibuprofen may have a greater effect on renal function than acetaminophen.

Risk factors, diagnosis and treatment of transient hyperinsulinemic hypoglycemia in newborns / 中国新生儿科杂志

Objective:To study the risk factors, diagnosis and treatment of transient hyperinsulinemic hypoglycemia (HH) in newborns.Methods:From January 2016 to December 2020, newborns with transient HH (HH group) admitted to our hospital were enrolled in this retrospective nested case-control study. Newborns with similar gestational age (GA) (differences of GA<2 w) without HH were matched with 1∶2 ratio as the non-HH group. Clinical characteristics of the two groups were compared and the risk factors and therapeutic results of HH in newborns were analyzed using SPSS 20.0 statistical software.Results:A total of 39 cases were included in the HH group and 75 cases were matched in the non-HH group. The proportion of small for gestational age (SGA) [51.3%(20/39) vs. 32.0%(24/75)], the amount of amino acids (AA) in intravenous infusion[1.0(0.0,1.0) g/(kg·d) vs. 0.0(0.0,1.0) g/(kg·d)], the incidence of hypoglycemia [(4.3±1.9) times vs. (3.6±1.3) times] and the maximum glucose infusion rate (GIR)[(8.3±2.5) mg/(kg·min) vs. (7.4±1.1) mg/(kg·min)] in the HH group were higher than the non-HH group (all P<0.05). The platelet count in the HH group were lower than the non-HH group [(186.9±60.9)×10 9/L vs. (215.3±61.7)×10 9/L, P<0.05]. SGA ( OR=2.535, 95% CI 1.077~5.971), the amount of intravenous AA ( OR=2.180, 95% CI 1.029~4.619) and the maximum GIR ( OR=1.405, 95% CI 1.088~1.815) were independent risk factors for transient HH. In the HH group, 28/39 cases were treated with Diazoxide or Octreotide and the therapeutic effects were good with few adverse drug reactions (ADR). 37/39 cases were recovered within 28 d of birth and the other 2 cases were recovered at 2.5 m and 3.5 m, respectively. Conclusions:SGA, the amount of intravenous AA and higher GIR are risk factors for transient HH in newborns. Diazoxide or Octreotide are effective with few ADR in the treatment of transient HH. Most patients will recover from transient HH in 2 w to 3 m.

Clinical effects of bi-level positive airway pressure and heated humidified high flow nasal cannula ventilation as initial treatment for premature infants with respiratory distress syndrome / 中国新生儿科杂志

Objective:To compare the efficacy and safety of bi-level positive airway pressure (BiPAP) ventilation and heated humidified high flow nasal cannula (HHHFNC) ventilation as initial respiratory support for premature infants with respiratory distress syndrome (RDS).Methods:From January 2019 to June 2021, premature infants [gestational age (GA) 28~35 weeks)] with grade Ⅰ to Ⅲ RDS admitted to Suining County People's Hospital were prospectively enrolled. The infants were randomly assigned into BiPAP group and HHHFNC group. The clinical characteristics, ventilation efficacy and complications were analyzed.Results:A total of 33 infants were in BiPAP group and 32 in HHHFNC group. No significant differences existed between the two groups in the following items: the frequency of apnea within 24 h of ventilation, FiO 2 and PaCO 2 at 24 h, the use of pulmonary surfactant (PS), the incidence of non-invasive ventilation failure within 72 h, non-invasive ventilation duration and the age achieving total enteral nutrition. HHHFNC group had lower score in premature infants pain profile (PIPP) than BiPAP group at 24 h of non-invasive ventilation [4 (3, 6) vs. 8 (6, 11), P<0.001]. No significant differences existed in nasal injury, pneumothorax, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and mortality rate between the two groups ( P>0.05). Conclusions:As the initial treatment for premature infants with grade Ⅰ to Ⅲ RDS, BiPAP and HHHFNC has similar rates of non-invasive ventilation failure within 72 h,non-invasive ventilation duration and adverse events. HHHFNC may ease the pain of the infants.

The application of bladder stimulation technique in clean-catch urine collection of late newborns / 中国新生儿科杂志

Objective:To study the clinical value of bladder stimulation technique (BST) for clean-catch urine collection in late newborns.Methods:From November 2020 to March 2022, relatively stable late newborns hospitalized in the Department of Neonatology of our hospital were enrolled in the prospective randomized controlled trial. The newborns were assigned into BST group and control group. In BST group, urine was collected using BST (suprapubic tapping alternating with lumbosacral massage for 5 min) 20~30 min after feeding and specimen were collected using urine bag before and after BST. In the control group, urine was collected using urine bag method. The urine collection was considered successful if >1 ml of urine not contaminated by faeces were collected within 60 min. The t-test and χ 2 test were used for data analysis. Results:A total of 231 late newborns were included with 117 cases in BST group and 114 in control group. The rate of successful urine collection in BST group was higher than control group (65.8% vs. 39.4%).The time needed for successful urine collection [(30.2±8.5) min vs. (40.7±12.9) min], the incidences of faeces contamination (2.5% vs. 21.1%) and urine contamination (11.7% vs. 26.7%) in BST group were all significantly lower than control group(all P<0.05). Male and female newborns in BST group had similar success rates of urine collection (65.6% vs. 66.0%). Male newborns in BST group had similar urine contamination rate with control group (9.5% vs. 11.5%) and female newborns in BST group had significantly lower urine contamination rate than control group (14.3% vs. 47.4%, P<0.05). Urine was successfully collected in 71 newborns in BST group with median duration of BST for 81 (61,132) s. No adverse effects were observed except for transient consolable crying. Conclusions:Compared with urine bag collection method, BST improves successful urine collection rates and reduces the time needed for urine collection and urine contamination rates (especially for females).

The effects of hyperbilirubinemia on the myocardium of newborn rats / 中国新生儿科杂志

Objective:To study the influences of different levels of hyperbilirubinemia on the myocardium of newborn rats.Methods:Ninety-six 7-day-old newborn SD rats were selected and randomly assigned into control group (n=32, intraperitoneal injection of normal saline 0.5 ml), test group 1 (n=32, intraperitoneal injection of bilirubin solution 100 mg/kg) and test group 2 (n=32, intraperitoneal injection of bilirubin solution 200 mg/kg). Four time points were set at 0 h, 8 h, 24 h and 48 h. The general conditions of 8 rats from every group at each time point were recorded. The total serum bilirubin (TSB), cardiac troponin I (cTnI),heart fatty acid-binding protein (H-FABP) and B-type natriuretic peptide (BNP) were examined. The heart was removed and the pathological changes of the myocardium were observed under microscope. The caspase-3, B-cell lymphoma-2 protein (bcl-2) and bcl-2-associated X protein (bax) were tested. Using SPSS 20.0 statistical software, two-way ANOVA analysis of variance was conducted.Results:The TSB in test group 1 and 2 at 8~48 h were 2.5~4.4 times and 3.5~7.4 times higher than at 0 h [(20.8±3.0~36.5±10.4) μmol/L and (31.9±12.3~67.4±19.0) μmol/L vs. (8.4±2.1) μmol/L and (9.1±2.9) μmol/L]. No significant changes existed in cardiac histopathology at each time point among the three groups. At 48 h, as TSB level increased, the expression of apoptosis-related proteins caspase-3 and bax increased and the expression of bcl-2 decreased. Significant differences existed in the protein levels between any two groups (all P<0.05), except that bcl-2 in test group 1 was similar to control group ( P=0.255). With the prolonged duration of hyperbilirubinemia in test group 2, the expression of caspase-3 and bax increased, while the expression of bcl-2 decreased. Statistically significant differences existed in the protein levels between any two time points (all P<0.05), except that bax in 8 h subgroup was similar to 12 h subgroup ( P=0.820), and bcl-2 in 8 h subgroup was similar to 0 h subgroup ( P=0.064). The cTnI at 8 h, 24 h and 48 h in test group 1 and 2 were all significantly higher than the control group (all P<0.05),however, no significant differences existed between test group 1 and 2 (all P>0.05). H-FABP and BNP showed no significant differences among the three groups at any time point (all P>0.05). Conclusions:Hyperbilirubinemia can induce apoptosis of myocardial cells in newborn rats in a concentration- and time-dependent manner. Hyperbilirubinemia shows no significant effects on cardiac tissue pathology. Hyperbilirubinemia may cause mild injury to myocardium of newborn rats. The injury shows no correlation with TSB level and BNP level was not influenced.

Relationship between central line-associated bloodstream infection and catheter dwell time in neonates / 中华危重病急救医学

The central line-associated bloodstream infection (CLABSI) is a common and serious complication of central venous catheterization, which can lead to various short-term and long-term adverse outcomes. Neonatal CLABSI did not increase linearly with the prolongation of peripherally inserted central catheter (PICC). When the umbilical venous catheter (UVC) is retained for more than 1-2 weeks, the incidence of neonatal CLABSI may increase significantly; PICC replacement at 7-10 days after UVC indwelling may reduce the incidence of CLABSI, but it has not been supported by evidence-based medicine. This article reviews the related studies between neonatal CLABSI and catheter dwell time, in order to plan the indwelling time more reasonably and prevent CLABSI better.

Effects of non-invasive positive pressure ventilation on plasma B-type natriuretic peptide level and Tei index of right ventricle in preterm infants / 中华全科医师杂志

Objective:To investigate the effects of non-invasive positive pressure ventilation (NPPV) on plasma B-type natriuretic peptide (BNP) level and Tei index of right ventricle in preterm infants.Methods:Premature infants of gestational age<34 weeks with respiratory distress syndrome who were admitted in Neonatal Intensive Care Unit of Xuzhou Central Hospital and requiring for NPPV from December 2018 to October 2020, were enrolled in the study. Patients were randomly divided into two groups 46 patients received nasal continuous positive airway pressure ventilation (NCPAP group) and 49 patients received bi-level positive airway pressure ventilation (BiPAP group); 42 preterm infants of gestational age<34 weeks and without NPPV were selected as the control group. The plasma BNP, Tei index of right ventricle, mean airway pressure and oxygen index at 0-12 h and 48-60 h after NPPV were monitored in NCPAP group and BiPAP group. The plasma BNP and Tei index of right ventricle at 0-12 h and 48-60 h after admission were monitored in the control group. SPSS 20.0 statistical software was used for data analysis.Results:(1)The plasma BNP and Tei index of right ventricle at 48-60 h after NPPV were significantly higher than those at 0-12 h after NPPV in NCPAP group and BiPAP group [NCPAP group: (287.5±155.5) vs. (179.9±102.3) ng/L, (0.43±0.08) vs. (0.38±0.06); BiPAP group: (303.1±135.4) vs. (186.5±95.6) ng/L, (0.45±0.08) vs. (0.39±0.06); t=6.00, 3.34, 7.47, 4.48; all P<0.05]. There were no significant differences in the plasma BNP and Tei index of right ventricle at 48-60 h and 0-12 h after admission in the control group [(181.9±86.8) vs. (169.5±78.9) ng/L, (0.34±0.05) vs. (0.36±0.05); t=0.83, -1.59; all P>0.05].(2) There were no significant differences in the plasma BNP and Tei index of right ventricle at 48-60 h after NPPV between NCPAP group-and BiPAP group (all P>0.05), but they were significantly higher than those in control group at 48-60 h after admission(all P<0.05). (3)The mean airway pressure and oxygen index at 48-60 h after NPPV in NCPAP group and BiPAP group showed a decrease trend compared to those at 0-12 h after NPPV, but the differences were not significant [NCPAP group: (6.8±1.2) vs. (7.0±1.3) cmH 2O(1 cmH 2O=0.098 kPa), (5.7±2.1) vs. (6.1±2.3); BiPAP group: (7.0±1.3) vs. (7.2±1.2) cmH 2O, (5.5±2.0) vs. (5.8±2.1); t=-1.05, -0.80, -1.88, -0.67; all P>0.05]; while there were no significant differences between the two groups (all P>0.05). (4)There was a positive correlation between the plasma BNP and mean airway pressure ( r=0.48, P<0.001), but no correlation between Tei index of right ventricle and mean airway pressure ( r=0.17, P=0.119) at 48-60 h after NPPV. Conclusion:The cardiac function indexes such as plasma BNP and Tei index of right ventricle in preterm infants are increased at 48-60 h after NPPV. When mean airway pressure is the same, the effects of NCPAP and BiPAP on plasma BNP and Tei index of right ventricle in preterm infants are similar.

Effects of noninvasive positive pressure ventilation on cardiac function in premature infants using Tei index combined with correction of QT dispersion and B-type natriuretic peptide: a prospective study / 中华围产医学杂志

Objective:To assess the effects of noninvasive positive pressure ventilation on premature infants' cardiac function using Tei index combined with corrected QT dispersion (QTcd) and B- type natriuretic peptide (BNP).Methods:This prospective study involved premature infants from 28 to 32 weeks of gestational age diagnosed with respiratory distress syndrome (RDS) and treated with noninvasive positive pressure ventilation in the Neonatal Intensive Care Unit of Xuzhou Central Hospital from December 2017 to December 2020. According to the mean airway pressure (MAP) during noninvasive positive pressure ventilation, the patients were divided into the low-pressure group (≤6 cmH 2O, 1 cmH 2O=0.098 kPa), medium-pressure group (>6-<9 cmH 2O), and high-pressure group (≥9 cmH 2O). The right ventricular Tei index, QTcd, and blood BNP were monitored during the first 2 h of noninvasive positive pressure ventilation and 12 h after continuous ventilation with stable MAP. Chi-square test, one-way analysis of variance, paired t-test, and Pearson product-moment correlation coefficient were adopted for statistical analysis. Results:Totally 178 premature infants were enrolled, including 75 in the low-pressure, 62 in the medium-pressure, and 41 in the high-pressure group. After continuous ventilation with stable MAP for 12 h, the right ventricle Tei index and QTcd in the high-pressure group were higher than those in the medium- and low-pressure group [Tei index: (0.38±0.05) vs (0.33±0.04) and (0.33±0.04), F=29.18; QTcd: (27.6±4.2) vs (22.8±4.4) and (22.2±4.2) ms, F=23.26, all P<0.001], and the comparison between the medium- and the low-pressure group did not differ significantly. No significant difference was observed in blood BNP levels among the three groups ( F=1.33, P=0.267). The right ventricle Tei index and QTcd increased in the high-pressure group after continuous ventilation with stable MAP for 12 h as compared with those within the first 2 h of noninvasive positive pressure ventilation [Tei index: (0.38±0.05) vs (0.34±0.04), t=－6.61; QTcd: (27.6±4.2) vs (23.4±4.4) ms, t=－5.06, all P<0.001]. However, the figures did not change significantly in the medium- or the low-pressure group (all P>0.05). There were no significant changes in blood BNP in the three groups (all P>0.05). The right ventricle Tei index and QTcd were moderately positively correlated with MAP ( r=0.56 and 0.50, both P<0.001). Conclusions:For the premature infants with RDS, noninvasive positive pressure ventilation has no significant effect on the cardiac function when MAP is less than 9 cmH 2O, but would have a certain effect on the right ventricular function when used at higher pressure (MAP≥9 cmH 2O) and for longer time (>12 h).

Efficacy and safety of initial treatment with ibuprofen or paracetamol and rescue treatment with high-dose ibuprofen in preterm infants with patent ductus arteriosus / 中华全科医师杂志

Objective:To investigate the efficacy and safety of initial treatment with ibuprofen or paracetamol and rescue treatment with high-dose ibuprofen in preterm infants with haemodynamically significant patent ductus arteriosus (hsPDA).Methods:The preterm infants (gestational age ≤ 32 weeks) with hsPDA who were admitted to neonatal intensive care unit (NICU) of Xuzhou Central Hospital from October 2016 to November 2019 were enrolled in the study. A total of 110 eligible cases were included and randomly divided into three groups for initial treatment: 38 cases received oral ibuprofen 10 mg/kg, and 5 mg/kg after 24 h and 48 h (ibuprofen group), 37 cases received oral paracetamol 15 mg/kg, q.8.h for 3 d (paracetamol group) and 35 cases received oral injection water 1 ml/kg, and 0.5 ml/kg after 24 h and 48 h (conservative management group). The preterm infants who failed in the initial treatment were given high-dose ibuprofen for rescue treatment (oral ibuprofen 20mg/kg, and 10 mg/kg after 24 h and 48 h). Serum creatinine, cystatin C, glutamic-pyruvic transaminase (GPT), total bilirubin, fecal occult blood and urinary prostaglandin E 2 were measured; echocardiography and brain color Doppler ultrasonography examinations were performed before and after treatment. Urine output and complications were recorded. The data were analyzed by ANOVA, t-test, non-parametric test, chi-square test and Pearson correlation coefficient with SPSS 20.0 statistical software. Results:During initial treatment, the success rates of ibuprofen group and paracetamol group were higher than that of conservative management group [71.1% (27/38) and 70.3%(26/37) vs. 40.0% (14/35), P=0.008 and 0.010]. Thirty one patients, who failed in initial treatment, received rescue treatment (8, 7, 16 cases from ibuprofen, paracetamol and conservative groups, respectively). The success rate of rescue treatment with high-dose ibuprofen was 58.1% (18/31). During initial treatment, there were no significant differences in the incidence of oliguria, upper gastrointestinal bleeding, positive fecal occult blood tests, Ⅲ-Ⅳ grade intraventricular hemorrhage, and ≥Ⅱ stage necrotizing enterocolitis among the three groups (all P>0.05). There were no significant differences in the incidence of above complications between rescue treatment and initial treatment [6.5% (2/31) vs. 6.4%(7/110), 3.2%(1/31) vs. 4.5%(5/110), 12.9%(4/31) vs. 6.4%(7/110), 0 vs. 4.5%(5/110), 3.2%(1/31) vs. 1.8%(2/110), all P>0.05]. The changes of serum creatinine and GPT before and after treatment were not significant in all groups ( P>0.05). Serum cystatin C were increased in both ibuprofen group[(0.44±0.17)μmol/L] and paracetamol group [(0.18±0.09)μmol/L] after treatment ( t=-15.70, -14.64; P<0.001), and the increase in ibuprofen group was greater than that in paracetamol group ( P<0.001). Urinary prostaglandin E 2 were decreased in both ibuprofen group [(-11.63±3.70)ng/L] and paracetamol group[(-4.89±1.91)ng/L] after treatment ( t=15.57, 7.03; P<0.001), and the decrease in ibuprofen group was greater than that in paracetamol group ( P<0.001). Serum cystatin C was not significantly increased after high dose ibuprofen rescue treatment [(1.67±0.17)mg/L vs.(1.71±0.21)mg/L; t=-1.12, P=0.273]. Conclusion:Both initial treatment with ibuprofen or paracetamol and rescue treatment with high-dose ibuprofen can effectively promote hsPDA closure in preterm infants without increase of complications. However, renal function indexes such as urine output and serum cystatin C should be monitored. The high-dose ibuprofen is relatively safe, and can be used as one of rescue treatment.

Comparison of left and right ventricular Tei indexes in newborns of different gestational age and birth weight / 中国新生儿科杂志

Objective:To compare left and right ventricular Tei indexes and to determine the reference range in newborns of different gestational age (GA) and birth weight (BW).Methods:From February 2019 to June 2021, newborns admitted to the Neonatal Intensive Care Unit of our hospital were enrolled. Tei indexes were measured and calculated during 24 h~7 d after birth and reexamined 1~2 weeks later in some of the newborns. The newborns were assigned into <32 w group, 32~36 w group and ≥ 37 w group according to their GA, < 1 500 g group, 1 500~2 499 g group and ≥2 500 g group according to their BW, and early newborn group (1~7 d) and late newborn group (>7 d) according to their age of evaluation. The data were analyzed using t test, one-way analysis of variance (ANOVA) and correlation analysis with SPSS 20.0 statistical software. Results:A total of 128 cases were included. 42 cases in <32 w group, 43 in 32~36 w group and 43 in ≥37 w group. 42 cases in <1 500 g group, 42 in 1 500 ~ 2 499 g group and 44 in ≥2 500 g group. Tei indexes were reexamined after 7 d of age in 63 preterm infants and in 31 full-term infants. The left and right ventricular Tei indexes of the ≥37 w group were less than the 32~36 w group and the <32 w group in early newborns (left ventricular: 0.382±0.069 vs. 0.431±0.069 and 0.439±0.060, right ventricular: 0.373±0.038 vs. 0.431±0.035 and 0.452±0.064); the right ventricular Tei index of the 32~36 w group was significantly less than the <32 w group ( P<0.05). No significant differences existed in the left ventricular Tei index between the 32 ~ 36 w group and the < 32 w group ( P>0.05). The left and right ventricular Tei indexes of the ≥2 500 g group were significantly less than the 1 500~2 499 g group and the <1 500 g group (left ventricular: 0.385±0.069 vs. 0.434±0.067 and 0.434±0.064, right ventricular: 0.376±0.039 vs. 0.431±0.043 and 0.450±0.061) ( P<0.05).No significant differences existed between the 1 500~2 499 g group and the <1 500 g group ( P>0.05). No significant differences existed in the left and right ventricular Tei indexes between the late newborn group and early newborn group ( P>0.05). For early newborns (1~7 d of age), the reference range of Tei index gradually decreased along with the increase of GA and BW. Conclusions:The left and right ventricular Tei indexes of full-term infants and infants with BW ≥2 500 g are less than preterm and low birth weight infants. The reference range of Tei index in early newborns shows negative correlation with GA and BW.

Role of platelets aggregation in the process of ductus arteriosus closure of newborn pups / 中华危重病急救医学

Objective:To investigate the role of platelets aggregation in the developing process of ductus arteriosus closure of newborn pups, and the effect of platelet membrane glycoprotein Ⅱb-Ⅲa (GPⅡb-Ⅲa) receptor antagonist (tirofiban).Methods:Four 24-month-old Beagle bitches were selected and numbered 1, 2, 3, and 4 respectively, and their pups were removed by cesarean section in two batches 1-2 days before the expected date of delivery. Bitches 1 and 2 were the first batch. Eighteen newborn pups were removed after cesarean section as the control group. They were divided into three subgroups: 1-hour subgroup, 4-hour subgroup, and 12-hour subgroup according to postnatal time point, with 6 pups in each subgroup. The newborn pups were injected with normal saline 10 mL/kg via jugular vein immediately after birth. Bitches 3 and 4 were the second batch. Nineteen newborn pups were removed by cesarean section as tirofiban group. They were also divided into three subgroups: 1-hour subgroup ( n = 6), 4-hour subgroup ( n = 6), and 12-hour subgroup ( n = 7) according to the postnatal time point. The newborn pups were injected with tirofiban hydrochloride injection 10 mL/kg (10 mL injection including 2.5 mg of tirofiban) via jugular vein immediately after birth. The diameter of ductus arteriosus was measured by echocardiography. Ductus arteriosus was removed by surgical dissection and divided into two parts. Western blotting and immunohistochemistry were used to detect the expression of platelet membrane GPⅡb-Ⅲa, respectively. Results:In the control group, 1 newborn pup died at 0.5 hour after birth in the 1-hour subgroup. The experiment was completed by 19 in the tirofiban group. Ductus arteriosus of all pups were not closed in 1-hour subgroups of the two groups, and there was no significant difference in the diameter of ductus arteriosus between the control group and the tirofiban group (mm: 1.72±0.08 vs. 1.70±0.11, P > 0.05). Ductus arteriosus of 1 newborn pup in 4-hour subgroup of the control group was closed, but the ductus arteriosus of all the newborn pups in 4-hour subgroup of the tirofiban group were not closed. The diameter of ductus arteriosus of the tirofiban group was significantly larger than that of the control group (mm: 1.52±0.15 vs. 0.95±0.48, P < 0.05). Ductus arteriosus of all pups were closed in 12-hour subgroup of the control group, but the ductus arteriosus of 2 pups of the tirofiban group were still not closed, with the diameter of ductus arteriosus of 1.0 mm and 1.1 mm, respectively. Western blotting showed that at 1-hour, 4-hour and 12-hour after birth, the expression of platelet membrane GPⅡb-Ⅲa was gradually increased in ductus arteriosus of newborn pups of the two groups. The expression of GPⅡb-Ⅲa in 1-hour subgroup of the tirofiban group was significantly lower than that in the control group (GPⅡb-Ⅲa/β-actin: 0.67±0.07 vs. 0.84±0.16, P < 0.05). The expression of GPⅡb-Ⅲa in 4-hour and 12-hour subgroups of the tirofiban group were slightly lower than those in the control group (GPⅡb-Ⅲa/β-action: 0.85±0.12 vs. 0.95±0.11 in 4-hour subgroup, 1.04±0.16 vs. 1.09±0.17 in 12-hour subgroup, both P > 0.05). Immunohistochemistry showed that the change trend of platelet membrane GPⅡb-Ⅲa in ductus arteriosus of newborn pups in both groups was similar to the results of Western blotting. Conclusions:The ductus arteriosus of newborn pups begin to close 1-4 hours after birth, and all closed at 12 hours after birth. The expression of platelet membrane GPⅡb-Ⅲa in ductus arteriosus increase gradually after birth, and the platelet aggregation may participate in and promote ductus arteriosus closure to some extent. Tirofiban, a platelet membrane GPⅡb-Ⅲa receptor antagonist, may delay ductus arteriosus closure of newborn pups to some extent by inhibiting platelet aggregation.

Effects of different concentrations of bilirubin on neonatal kidney / 中华实用儿科临床杂志

Hyperbilirubinemia is the most common clinical symptom in neonates that requires evaluation and treatment.It has been confirmed that free indirect bilirubin of high concentration have direct toxic effect on nerve tissue and impair its function, but its effect on extraneural organs or systems (such as kidney, heart, liver, intestine, lung, blood coagulation and immune function) is still controversial.This present study reviewed the previous relevant research in recent years to understand the effect of bilirubin of different concentrations on neonatal kidney.

Analysis of clinical cross-control trial results of an smartphone application in screening neonatal jaundice / 中华实用儿科临床杂志

Objective:To evaluate the correlation, consistency and safety of an smartphone application (APP) in screening neonatal jaundice using the smartphone based on the image-based bilirubin (IBB) and transcutaneous bilirubin (TcB).Methods:From July to October 2018, neonates with the age ≤28 d and gestational age ≥35 weeks who were admitted to Department of Neonatal and Obstetrics, Xuzhou Central Hospital without blue light phototherapy were recruited.They were randomly divided into two groups to measure the jaundice value of skin in front of sternum by a cross-control analysis.Jaundice level in group Ⅰ was first measured using the Nezhabaobei? APP in iPhone 6, and then measured using the JM-103 transcutaneous jaundice instrument as the control device.In group Ⅱ, jaundice level was sequencially measured by the control device and the Nezhabaobei? APP.Sex, age, gestational age, birth weight and the mean value of three consecutive tests were recorded.The Pearson′s correlation analysis, Bland-Altman plots consistency analysis, t test and receiver operating characteristic (ROC) curve were used for statistical analysis. Results:A total of 185 eligible neonates were enrolled, including 99 males and 86 females, with the median age of 5 d (3-8 d), gestational age of (37.6 ± 1.7) weeks, and birth weight of (2 950 ± 645) g. There were good correlation ( r=0.860, P<0.05) and consistency (95.1% of the samples fall within the 95% consistency interval) between IBB and TcB.Good correlation and consistency were also yielded in subgroup analyses based on the sex, age, gestational age and birth weight.The consistency was better in subgroups of ≤7 d, >37 weeks and>2 500 g. The ability of IBB to predict TcB>256.5 μmol/L was better than that of TcB>171.0 μmol/L.The area under the ROC curve was 0.93, the cut-off value was 232.6 μmol/L, the sensitivity was 96.7%, and the specificity was 82.6%.The difference of the mean values of IBB and TcB detected for 3 times was significantly lower than that obtained in the first measurement of IBB and TcB [(12.0 ± 34.4) μmol/L vs.(14.4 ± 38.6) μmol/L, P=0.038]. There were no adverse events and no defects in the device itself. Conclusions:There are good correlation and consistency between IBB and TcB.The ability of IBB to predict TcB>256.5 μmol/L is better than that of TcB>171.0 μmol/L, which is safe in clinical use.

The role of polyomavirus enhancer activator 3 in hyperoxic-induced alveolar epithelial cells type Ⅱ injury / 中华实用儿科临床杂志

Objective:To investigate the role of polyomavirus enhancer activator 3 (PEA3) in hyperoxia-induced injury of type Ⅱ alveolar epithelial cells (AEC Ⅱ) and the underlying mechanism.Methods:AEC Ⅱ cells were cultured in vitro and divided into hyperoxia group and normoxia group.After 24 h, 48 h and 72 h of hyperoxia or air treatment, cells were collected and the best treatment time was selected at 48 h. AEC Ⅱ cells were divided into 3 groups: control group, negative control group (transfected with negative control) and PEA3 over expression group (transfected with PEA3 overexpression plasmid). Each group was further divided into hyperoxia subgroup and normoxia subgroup.Cells were harvested at 48 h after hyperoxia or normoxia treatment.Reactive oxygen species (ROS), Nod-like receptor domain 3 (NLRP3), monocyte chemoattractant protein-1 (MCP-1), interleukin(IL)-1β, IL-6, IL-8, IL-18, surfactant protein C (SP-C), aquaporins 5 (AQP5), PEA3 and manganese superoxide dismutase (MnSOD) levels were detected.Differences were compared by the t-test and repeated measures analysis of variance using SPSS 20.0 statistical software. Results:The interaction of grouping and treatment duration had significant effects on ROS, IL-1β, IL-6, IL-8, IL-18, SP-C and AQP5 levels in AEC Ⅱ cells ( F=19.857, 20.132, 23.133, 18.673, 28.341, 27.333 and 34.217, respectively, all P<0.05). At 24 h, 48 h and 72 h, ROS level in hyperoxia group was 1.78, 1.94 and 2.26 times higher than that in normoxia group ( t=18.649, 17.486 and 19.385, respectively all P<0.05). NLRP3 and MCP-1 levels were significantly upregulated in hyperoxia group.IL-1β level was 1.33, 1.69, and 1.65 times higher in hypoxia group at 24 h, 48 h and 72 h than that of normoxia group; IL-6 level was 1.26, 1.56 and 2.12 timers higher; IL-8 level was 1.13, 1.47 and 2.34 times higher; and IL-18 level was 1.46, 1.72 and 1.95 times higher, respectively (all P<0.05). The protein expression of SP-C was downregulated, while that of AQP5 was significantly upregulated in hypoxia group.The RNA expression of SP-C was 22%, 63% and 72% lower in hypoxia group than that in normoxia group at 24 h, 48 h and 72 h ( t=3.982, 16.328 and 20.259, P<0.05, respectively), and that of AQP5 was 1.92, 5.23 and 7.36 times higher ( t=14.631, 18.945 and 19.521, respectively, all P<0.05). There were significant differences in ROS, IL-1β, IL-6, IL-8, IL-18, SP-C and AQP5 levels at 24 h, 48 h and 72 h in hyperoxia group ( F=22.343, 20.566, 23.701, 19.222, 32.146, 40.278 and 37.107, respectively, all P<0.05). After 48 h of PEA3 overexpression, compared with the hyperoxic negative control group, ROS level in hyperoxic AEC Ⅱ cells overexpressing PEA3 decreased by 34% ( t=14.635, P<0.05). NLRP3 and MCP-1 were downregulated in hyperoxic AEC Ⅱ cells after overexpression of PEA3.IL-1β, IL-6, IL-8 and IL-18 levels decreased by 29%, 22%, 27% and 18%, respectively ( t=15.895, 17.872, 18.749 and 15.274, all P=0.000). SP-C was upre-gulated and AQP5 was downregulated by overexpression of PEA3 in hyperoxic AEC Ⅱ cells.In addition, PEA3 and MnSOD levels were significantly enhanced. Conclusions:Overexpression of PEA3 can alleviate the increase of ROS level in AEC Ⅱ cells, block the activation of various inflammatory pathways and reduce the transformation from AEC Ⅱ to AEC Ⅰ cells via enhancing MnSOD level.

The association between the frequency of prenatal care in childbearing aged women and risk of small for gestational age among neonatal twins in Shaanxi Province / 中华预防医学杂志

Objective@#To explore the association between the frequency of prenatal care in childbearing aged women and risk of small for gestational age (SGA) among neonatal twins in Shaanxi Province.@*Methods@#From July to December 2013, a total of 30 027 childbearing aged women, who were pregnant from January 2010 to November 2013 and had definite outcomes, were selected from 30 districts (counties) of Shaanxi Province by using the multi-stage random sampling method. The questionnaires with a face-to-face survey method were used to retrospectively collect demographic information, pregnancy history, lifestyle during pregnancy, disease history, nutritional supplements, and health care during pregnancy. Information on the gestational age and birth weight of the newborn were obtained by consulting the medical certificate of birth and were registered as twin A and twin B by birth order. Finally, 356 childbearing aged women and their twin babies with complete data were included in the analysis. A generalized estimation equation model was used to analyze the association between the frequency of prenatal care and the risk of SGA among neonatal twins.@*Results@#The age of childbearing aged women was (27.44±4.68) years old, of which 79.49% (283 women) were rural residents and 44.38% (158 women) had seven or more times prenatal care. The gestational age and birth weight were (37.64±2.51) weeks and (2 510±497) g, respectively. The prevalence of SGA was 51.40% (183/356) for twin A and 53.37% (190/356) for twin B, respectively. The prevalence of SGA was 44.30% (70/158) for twin A with seven or more times prenatal care and 42.41% (67/158) for twin B with seven or more times prenatal care, which was lower than that for twins with less than seven times prenatal care, respectively [57.07% (113/198) and 62.12% (123/198)] (P values were 0.017 and <0.001). The results of generalized estimation equation model suggested that compared to those with less than seven times prenatal care, after adjusting for parity, birth order, place of residence, maternal age, occupation, education, family wealth index, passive smoking, pregnancy-induced hypertension syndrome, folic acid, and iron supplement during perinatal period, and gender of the newborn, the OR (95%CI) of risk of SGA among childbearing aged women with seven or more times prenatal care was 0.60 (0.40-0.91).@*Conclusion@#Seven or more times prenatal care could reduce the risk of SGA among neonatal twins in Shanxi Province.

Caffeine combined with heated humidified high-flow nasal cannula in the treatment of respiratory distress syndrome in preterm infants / 中华急诊医学杂志

Objective To observe the clinical efficacy and safety of caffeine citrate combined with heated humidified high-flow nasal cannula (HHHFNC) in the treatment of respiratory distress syndrome (RDS) in preterm infants.Methods From June 2017 to December 2018,a total of 82 preterm infants with RDS (28 weeks ≤ gestational age＜32 weeks) who were hospitalized in Neonatal Intensive Care Unit of the Affiliated Xuzhou Hospital of Southeast University were chosen as research subjects.They were randomly (random number table method) divided into two groups:the combined treatment group (n=42) and the control group (n=40).Infants in the combined treatment group were given caffeine citrate combined with HHHFNC,while infants in the control group were given nasal continuous positive airway pressure (NCPAP) without caffeine citrate.The general clinical data,results of blood gas analysis at 6 h and 24 h after breath support therapy,clinical efficacy,related complications and adverse drug reactions between the two groups were compared statistically by LSD-t test,Chi-square test and Kruskal-Wallis H rank sum test.Results ① No significant differences were found between the two groups in the general clinical data (all P＞0.05).② The results of intra-groups comparison within the combined treatment group or control group showed that the pH value,partial pressure of arterial carbon dioxide (PaCO2),partial pressure of arterial oxygen (PaO2) of blood gas analysis and PaO2/fraction of inspired oxygen (P/F) at 6 h and 24 h after breath support therapy were all significantly improved compared to those of before treatment (all P＜0.05);The PaO2 and P/F of premature infants in the combined treatment group at 6 h and 24 h after breath support therapy were significantly higher than those in the control group,while PaCO2 were significantly lower than that in the control group (all P＜0.05).③ The duration of noninvasive ventilation,total oxygen inhaling,failure rate of machine withdrawal,use of pulmonary surfactants,the rate of tracheal intubation within 72 h and the times of apnea in combined treatment group were 3.0 d (1.0,18.0)d,5.5 d (3.0,21.0)d,4 case(9.5％),10 case(23.8％),3 case(7.1％) and 6.0 times(3.0,21.0)times,which were significant shorter,or lower,or less than those in control group,which were 7.0 d (2.0,22.0),10.0 d (4.0,28.0),11 case(27.5％),19 case(47.5％),12 case(30.0％)and 15.0 times(4.0,28.0)times,and the differences were all statistically significant (all P＜0.05).④ The occurrence of nasal trauma,abdominal distention and head shaping in the combined treatment group were significantly lower than those in the control group (all P＜0.05).⑤ There were no significant differences between the two groups of premature infants in related complication and caffeine associated adverse reactions (all P＞0.05).Conclusions Caffeine citrate combined with HHHFNC treatment strategy for premature infants with RDS can effectively improve oxygenation,shorten the duration of noninvasive mechanical ventilation,increase the success rate of machine withdrawal,and reduce the incidence of nasal trauma and abdominal distention.

The relationship between the continuous opening of arterial catheters and platelet parameters in preterm infants / 中华实用儿科临床杂志

Objective To analyze the correlation between the continuous opening of patent ductus arteriosus (PDA) in preterm infants and platelet parameters in the first 24 hours of life.Methods The preterm infants (gestational age ＜ 34 weeks) admitted to Neonatal Intensive Care Unit(NICU) of the Affiliated Xuzhou Hospital of Southeast University from November 2012 to July 2018 were enrolled.The following data were collected retrospectively:the platelet parameters in the first 24 hours of life,clinical factors possibly related to continuous opening of PDA,and echocardiography examination fin-dings on the 4th-7th day after birth.According to the diagnostic criteria of PDA,all preterm infants were divided into symptomatic PDA (sPDA) group,non-sPDA (nsPDA) group,and non-PDA (nPDA) group.SPSS 20.0 software was used for data analysis.Data were analyzed by Chi-square test,LSD or Tambane's T2 of One-Way analysis of variance,and binary Logistic regression analysis of the receiver operating characteristic (ROC) curve.Results Totally 760 preterm infants were chosen,and among them there were 67 cases (8.8％) in sPDA group,106 cases (14.0％) in nsPDA group,and 587 cases (77.2％) in nPDA group.There were significant differences in the terms of gestation age,birth weight,platelet counts (PLT),and plateletcrit (PCT) in the first 24 hours of life among 3 groups (all P ＜ 0.05).The smaller gestation age,the lower birth weight,the lower PLT and PCT in the first 24 hours of life,and the higher incidence of PDA in preterm infants.There were no significant differences in the platelet distribution width,mean platelet volume,and platelet large cell ratio in the first 24 hours of life among 3 groups (all P ＞ 0.05).The low lower birth weight and PCT in the first 24 hours of life were independent risk factors for the occurrence of sPDA in preterm infants (P =0.013,0.000).The risk of occurrence of sPDA in preterm infants will be increased by 3.279-fold (95 ％ CI:2.369-4.479) if PCT in the first 24 hours of life is decreased by 0.10％.The area under the ROC curves of PCT and PLT in the first 24 hours of life for prediction of sPDA in preterm infants was 0.757 (95 ％ CI:0.712-0.814) and 0.718 (95 ％ CI:0.671-0.768),respectively.The best cutoff values of PCT and PLT were 0.178％ (sensitivity was 75.7％,specificity was 71.9％) and 207.5 × 109/L (sensitivity was 71.4％,specificity was 63.2％).Conclusions The continuous opening of PDA in preterm infants may have correlation with the platelet.The low PCT,rather than PLT,in the first 24 hours of life was an independent risk factor and has medium predictive value for the occurrence of sPDA in preterm infants on the 4th-7th day after birth.

Relationship between preterm birth of infant and medication during pregnancy in women of childbearing age in Shaanxi / 中华流行病学杂志

Objective@#To understand the relationship between medication during pregnancy and single live preterm birth of infant in women of childbearing age in Shaanxi province.@*Methods@#A cross-sectional design was used in this study and stratified multistage random sampling method was used. A questionnaire survey was conducted in the childbearing-aged women selected through multi stage stratified random sampling in Shaanxi during 2010 to 2013. Qualitative datum was described by percentage and measurement datum was described by mean±standard deviation. Logistic regression analysis was done to evaluate the relationship between medication during pregnancy and preterm birth of infant.@*Results@#The overall incidence rate of premature birth was 2.7% in Shaanxi. Among the 28 841 mothers participating in this study, the proportion of medication use at any time during pregnancy was 15.8%, and the most commonly used drug was cold medicine (5.9%). After adjusting all confounding factors, the multivariable logistic regression analysis results showed that taking hormone medicine (OR=2.23, 95%CI: 1.19-4.18), antihypertensive medicine (OR=7.74, 95%CI: 4.28-13.95) and other medicines (OR=2.15, 95%CI: 1.60-2.89) during early pregnancy were the risk factors for preterm delivery, the risk was 2.23 times, 7.74 times and 2.15 times higher compared with those taking no these medicines.@*Conclusion@#Using hormone medicine, antihypertensive medicine and other medicines during pregnancy increased the risk for preterm delivery in women of childbearing age in Shaanxi.