Clinical features of pertussis in 248 hospitalized children and risk factors of severe pertussis / 中华实用儿科临床杂志

Objective:To investigate the clinical features of pertussis in children and analyze the risk factors of severe pertussis.Methods:The clinical data of 248 children with pertussis hospitalized in Hunan Children′s Hospital from March 2018 to March 2022 were analyzed retrospectively.According to the age at admission, the patients were divided into two groups: ≤3 months and > 3 months.According to the patient′s condition, they were classified into ordinary group and severe group.According to the pathogens detected, the children were divided into single infection group and mixed infection group.The independent sample t-test, chi- square test were used to analyze the clinical indexes of the infants in above groups. Results:(1)Of 248 hospitalized children with pertussis, 204 cases (82.2%) were less than 1 year old, 92 cases (37.0%) had contact with a coughing family member before, and 169 cases (68.1%) were unvaccinated.Among 248 children, 193 cases (77.8%) had an elevated white blood cell count, and 145 cases (58.4%) had mixed infections.The most common pathogen was respiratory syncytial virus [29/248(11.6%)]. About 173 cases (69.7%) had concurrent pneumonia, and 35 cases (14.1%) had pulmonary consolidation.(2)Compared with the group > 3 months of age, more patients in the group ≤3 months of age had contact with a coughing family member before, and suffered from cyanosis, dyspnea, respiratory failure, heart failure and pertussis encephalopathy ( χ2=4.612, 20.810, 7.882, 16.617, 13.740, 7.846, all P<0.05). The proportions of patients in the group ≤3 months of age required intensive care unit(ICU) hospitalization and mechanical ventilation were higher than those in the group > 3 months of age ( χ2=14.810, 21.436, all P<0.05). The mortality of the group ≤3 months of age was higher than that of the group >3 months of age ( χ2=12.016, P<0.05). Children ≤3 months of age had a higher WBC level [(27.83±27.70)×10 9/L vs.(23.34±15.28)×10 9/L, t=22.244, P<0.001], longer duration of spasmodic cough [(16.56±9.33) d vs.(15.06±6.16) d, t=10.145, P=0.002] and longer hospitalization time [(11.47±10.48) d vs.(9.48±4.80) d, t=20.050, P<0.001] than those >3 months of age.(3)Compared with the ordinary group, a higher proportion of children in the severe pertussis group were under 3 months old, and had not been vaccinated against pertussis vaccine ( χ2=14.803, 4.475, all P<0.05). The ratio of patients with dyspnea, an lymphocyte count/neutral cell(LC/NC) ratio <1, mixed infections, lung consolidation and pleural effusion in the severe pertussis group was higher than that in the ordinary group ( χ2=116.940, 43.625, 13.253, 106.370, 11.874, all P<0.05). The patients in the severe pertussis group had a higher WBC [(61.66±29.63)×10 9/L vs.(18.83±10.00)×10 9/L, t=112.580, P<0.001] and a lower LC (0.494±0.186 vs.0.676±0.132, t=13.752, P<0.001) than those in the ordinary group.(4)Compared with the single infection group, the proportions of children with fever, dyspnea, fine moist lung rales, an LC/NC ratio <1, and lung consolidation were higher in the mixed infection group ( χ2=8.909, 6.804, 7.563, 8.420, 12.458, all P<0.05). More children in the mixed infection group required ICU hospitalization and mechanical ventilation than those in the single infection group ( χ2=11.677, 7.397, all P<0.05). The mixed infection group had higher respiratory failure and death rates than the single infection group ( χ2=7.980, 4.267, all P<0.05). Compared with the single infection group, the mixed infection group had a higher WBC level [(27.73±24.13)×10 9/L vs.(21.25±14.65)×10 9/L, t=13.318, P<0.001], longer hospitalization time [(11.593±9.010) d vs.(8.339±4.047) d, t=17.283, P<0.001], and a smaller LC ratio (0.626±0.165 vs.0.684±0.132, t=7.997, P=0.005). (5) Logistic regression analysis showed that age ≤3 months, peak WBC and dyspnea were risk factors of severe pertussis. Conclusions:Hospitalized pertussis children are prone to pneumonia and pulmonary consolidation.Patients aged ≤3 months with a large WBC and dyspnea easily develop into severe pertussis.Monitoring blood routine is helpful for judging the severity of the disease.Mixed infections increase the incidence of complications and can impair the treatment effect.

A Comparative Study of Phototherapy Versus Phototherapy Plus Ursodeoxycholic Acid in the Treatment of Indirect Hyperbilirubinemia in Neonate

Background: Hyperbilirubinemia is a common neonatal problem. Phototherapy and exchange transfusion is the conventional treatment for indirect hyperbilirubinemia. In the treatment of cholestatic liver disorders, Ursodeoxycholic acid (UDCA) is a bile acid widely used. Few studies have been conducted using UDCA in indirect hyperbilirubinemia. Aim of the study: This study was planned to assess the additive effect of UDCA on reducing indirect hyperbilirubinemia in neonates receiving phototherapy. Material & Methods:This prospective randomized controlled trial was conducted among neonates with indirect hyperbilirubinemia in the neonatal wards of Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh from June 2018 to July 2020. Finally, 140 neonates were included in the study. Eligible cases were randomized into two groups by the lottery method. Group A (n=70) received phototherapy and Group B (n=70) received UDCA at a dose of 10 mg/kg/day orally twice daily in addition to phototherapy. Total serum bilirubin levels were measured every 12 hours until serumbilirubinlevel falls below 10 mg/dl and then phototherapy was stopped. Demographic data, clinical features, laboratory parameters, outcome variables, and complications were recorded in a pre-format sheet. CBC with PBF, Total and indirect bilirubin, Blood grouping and Rh and typing, CRP, Reticulocyte count, and Coombs test were obtained at enrolment. Comparison of parameters among themselves was done by unpaired t-test and chi-square test. Analyzed outcomes were: time for resolution of jaundice, total duration of phototherapy, length of hospital stays, and adverse effects of the drug. The two groups did not differ statistically in age, sex or weight. The mean total serum bilirubin level measured at 12, 24, 36, 48, and 60 hours of treatment in group A was 16.10±1.43, 14.76±1.45, 13.34±1.68, 11.84±1.35, and, 10.57±0.74 respectively, and in the group, B was,15.18±1.63, 13.18±2.25, 11.39±1.56, 9.84±0.81 and, 9.44±0.46 respectively (p<0.001). The mean duration of phototherapy (64.11±10.8 vs. 47.18±7.51 hours, p<0.001) and length of hospital stay (2.80 ±0.40 vs. 2.19±0.39 days, p=<0.001).Conclusion:The inclusion of UDCA as an adjuvant to phototherapy is more effective in reducing indirect hyperbilirubinemia in neonates.

Advances in research related to severe pertussis in infants and young children / 中华实用儿科临床杂志

Pertussis is a highly contagious respiratory disease.Although widespread vaccination has greatly reduced the incidence of pertussis, there was a " recurrence of pertussis" in the past 30 years, and pertussis outbreaks occurred in some areas.Infants who have not been vaccinated or have not completed the full course of immunization suffer from more severe pertussis infections.Because of the atypical symptoms of young infants, missed diagnosis and misdiagnosis often occur, and pertussis cannot be diagnosed and treated in time.As a result, they can easily develop into severe pertussis or even die.In this article, recently published research on severe pertussis are summarized, so as to provide guidance for the clinical diagnosis, treatment, prevention and basic scientific research of severe pertussis.

Recambio de Hematíes en gestante con Anemia de Células Falciformes: reporte de un caso en el Hospital Regional de Talca / Red blood cell exchange in pregnant women with Sickle Cell Anemia: report of a case in the Regional Hospital of Talca

Sickle cell anemia or sickle cell disease is an autosomal recessive disease, caused by a mutation in the hemoglobin gene, where glutamic acid is substituted for valine at position 6 of the beta chain of hemoglobin, resulting in hemoglobin S The diagnosis is made with electrophoresis. The clinical manifestations are varied, the most frequent being the vaso-occlusive crisis, which can increase in pregnancy, during which sickle cell disease also increases the risk of maternal-fetal complications, caused by pre-eclampsia infections, intrauterine growth restriction, and premature delivery. and miscarriage. The usual treatment for the management of seizures is hydroxyurea, a drug that is teratogenic, so its use is contraindicated during pregnancy. Other treatment alternatives are red blood cell transfusion and red blood cell exchange. Next, the first case of red blood cell exchange or exchange transfusion in a pregnant patient with sickle cell anemia at the Hospital Regional de Talca is presented.

The effect of neonatal with very severely hyperbilirubinemia treated by plasma exchange / 中国小儿急救医学

Objective:To explore the effectiveness and safety of plasma exchange in the treatment of neonatal extremely severe hyperbilirubinemia.Methods:A retrospective analysis was performed on the data of 18 cases, who were all newborns with extremely severe hyperbilirubinemia and treated with plasma exchange in the NICU at Xi ′an Children′s Hospital from April 2019 to December 2019.The changes of serum total bilirubin, indirect bilirubin, albumin, white blood cells, red blood cells, platelets, hematocrit, hemoglobin, serum sodium, serum potassium, serum calcium, blood glucose, blood coagulation and mean arterial pressure were compared before and after plasma exchange.Results:A total of 18 eligible children were included.The peak value of total bilirubin was (571.2±113.3) μmol/L before treatment, and the value after treatment was (235.8±66.7) μmol/L, whose difference was statistically significant ( P<0.05). The exchange rate of bilirubin was (58.5±8.4)%.There were no statistically significant differences in the changes of white blood cells, platelets, hemoglobin, hematocrit, serum sodium, serum potassium, serum chloride, serum calcium, serum glucose, and albumin before and after plasma exchange (all P>0.05). There were no allergic reactions, hypotension, plasma separator or pipeline coagulation and other adverse reactions during plasma exchange. Conclusion:Plasma exchange therapy can remove serum bilirubin quickly, effectively and safely, and may be a new treatment for neonatal hyperbilirubinemia.

The therapeutic effects of stored blood with low glucose 6-phosphate dehydrogenase activity for exchange transfusion in neonatal hyperbilirubinemia / 中国新生儿科杂志

Objective To study the effects of stored blood with low glucose 6-phosphate dehydrogenase (G6PD) activity for exchange transfusion (ET) in neonate hyperbilirubinemia.Method From January 2017 to December 2018,all neonates receiving ET for neonatal hyperbilirubinemia in neonatology department of our hospital were prospectively enrolled.G6PD activity in stored blood and in these neonates were examined.Their demographic information and other clinical data including post-ET total serum bilirubin (TSB) decrease,post-ET phototherapy duration and total hospital stay duration were collected.Result A total of 99 cases were enrolled,51 cases with normal G6PD and 48 G6PD deficiency.Among normal G6PDneonates,those receiving low G6PD activity blood had less decrease of post-ET TSB [(56.9 ± 8.4) ％ vs.(72.5 ± 14.4) ％],longer hospital stay and longer post-ET phototherapy duration [(6.4 ± 2.3) d vs.(4.9 ± 1.3) d,(70.8 ± 36.2) h vs.(52.3 ± 16.3) h] (P ＜ 0.05) than those receiving normal G6PD blood.Among G6PD deficiency neonates,those receiving low G6PD activity blood had less decrease of post-ET TSB [(58.8 ±6.2)％ vs.(67.3 ± 13.9)％],longer hospital stay and longer post-ET phototherapy duration [(5.5 ± 2.2) d vs.(4.4 ± 1.4) d,(60.6 ± 25.9) h vs.(47.9 ± 27.9) h] (P ＜ 0.05) than those receiving normal G6PD blood.The G6PD activity in stored blood had significant influences on duration of phototherapy (F =7.695,P =0.007),duration of hospital stay (F =12.528,P =0.001) and decrease of post-ET TSB (F =29.025,P ＜ 0.001).Conclusion ET with low G6PD activity stored blood has less favourable effects with less post-ET TSB decrease and prolonged duration of phototherapy and hospital stay.

Sex-wise changes in haematological and biochemical parameters before and after exchange transfusion in neonatal hyperbilirubinemia

Background: Exchange transfusion (ET) is required in hyperbilirubinemic hospitalized neonates.Methods: The study center at SMS and associated hospitals. The blood bank is licensed and fully equipped. Fall in serum bilirubin minimum of 40 cases was required as the sample size of the present study.Results: The Sex ratio in the neonates undergoing Exchange transfusion was 65% (26) Males and 35% (14) females. The mean values of Hb (g/dl), Hematocrit and Direct bilirubin (mg/dl) of male and female before and after exchange transfusion, were non-significant.Conclusion: Exchange transfusion was required more commonly in male neonates.  The mean values of change in Hb (g/dl), Hematocrit and Direct bilirubin (mg/dl) of males and females before and after exchange transfusion, were non-significant. The mean values of change in Indirect bilirubin (mg/dl) in both males and females before and after exchange transfusion was highly significant.  The mean values of change in Total bilirubin (mg/dl) in males and in females were significant.

Clinical profiles and outcomes of neonates with neonatal hyperbilirubinemia and treated with double volume exchange transfusion: a retrospective study

Background: Double volume exchange transfusion (DVET) for severe unconjugated hyperbilirubinemia has become less common events now days in pediatric practices. But kernicterus is still common in low income country like India. The aim of the study was to determine the clinical profile and outcome in neonates who were treated with DVET.Methods: This was a retrospective study in neonate's ?34 weeks of gestation that were treated with DVET for severe neonatal hyperbilirubinemia over a period of four years.Results: In our study, 37 neonates underwent DVET. Male neonates (62.13%) and normal vaginal delivery (NVD) (70.2%) are common. ABO Isoimmunisation was commonest cause (56.75%) of exchange transfusion.' The mean TSBR at pre exchange and Post Exchange were 27.39 ' 5.99mg/dl and 15.16 ' 4.00mg/dl (p<0.05). Ten neonates (27%) among 37 neonates required twice DVET.Thrombocytopenia14 (37.83%); Seizure 5(13.5%) and Hypocalcaemia 3(8.1%) were common complication noted among total 17 (45.94%) neonates. BIND occurred in 15 neonates (40.5%) at the time of admission and seven (18.9%) neonates had persistent neurological abnormality at discharge. Neonate with BIND had early onset of jaundice (44.13'15.37 hours vs. 61.22'28.23hrs, p<0.05), with' higher' pre exchange TSBR value(28.96 '8.5mg/dl vs. 26.22'3.17mg/dl). Neonates admitted with BIND had higher percentage of persistent encephalopathy (40% vs. 4.5%,p<0.05), abnormal tone (33.3% vs. 4.5%,p<0.05), abnormal feeding (33.3% vs. 4.5%,p<0.05) and abnormal posture (26.6% vs. 0%,p<0.05)' at discharge as compared to those without BIND. No death occurred in this study population.Conclusions: Early detection and aggressive therapy with DVET can prevent neonates from brain injury.

Frequency of Exchange Transfusion in Newborns with Neonatal Hyperbilirubinemia

Background: Almost all newborn infants develop some degree of hyperbilirubinemia as a normal transition in physiology. High levels of unbound unconjugated bilirubin can cross the blood-brain barrier and cause neurological symptoms. Objectives: To determine the frequency of exchange transfusion in neonates with hyperbilirubinemia and to describe the characteristics of neonates with hyperbilirubinemia including those who underwent exchange transfusion. Methods: A retrospective study was conducted to know the frequency of exchange transfusion in neonates admitted to hospital with hyperbilirubinemia and to study selected characteristics of these babies including; sex, gestational age, body weight, type of feeding, and mode of delivery, and to identify the causes of hyperbilirubinemia. Results: A total of 120 neonates were enrolled in the study, 70 males and 50 females. Most of them (67%) were fullterm, weighing more than 2.5 kg. The majority (77%) was delivered vaginally, and mixed feeding with breast and artificial milk formula was the main source of feeding. The mean value of serum bilirubin at time of admission was 14.7 mg/dl and for those underwent exchange transfusion was 22 mg/dl at the time of exchange. In 92 babies (77%), the cause of hyperbilirubinemia was unknown. Hemolytic anemia due to Rh and ABO incompatibility was identified in 16% of babies, and G6PD deficiency was identified in 7%. Exchange transfusion was performed in 16.6% of patients. Conclusion: Although neonatal jaundice is a benign condition in most cases, pathologic harmful hyperbilirubinemia can occur, and despite the benefits of phototherapy, exchange transfusion is still performed and kernicterus is still occurring. Recommendation: Newborn babies should be screened for hyperbilirubinemia and correctly managed to reduce the frequency of exchange transfusion which carries many risks for newborns, and to prevent kernicterus.

Anemia neonatal grave secundaria a transfusion feto-materna: a proposito de un caso / Severe neonatal anemia due to fetomaternal hemorrhage: an ilustrative case

La transfusión feto-materna es el paso de eritrocitos fetales a la circulación materna. Cuando es masiva, tiene una incidencia aproximada del 0,2-0,9 %. Generalmente, se desconoce el agente desencadenante, pero, en ocasiones, se pueden identificar factores de riesgo. En el embarazo, suele ser asintomática; el síntoma más frecuente es la disminución de los movimientos fetales (el 26 %) en relación con la anemia grave. Se diagnostica mediante la detección de hemoglobina fetal en la sangre materna (test de Kleihauer o citometría de flujo). Se presenta a un recién nacido con anemia crónica secundaria a la transfusión fetomaterna, que, después del tratamiento con transfusión de concentrado de hematíes, tuvo como complicación síntomas de sobrecarga de volumen y empeoramiento clínico. Tras la realización de una exanguinotransfusión, evolucionó favorablemente, sin secuelas.

Fetomaternal transfusion (FMT) is defined by the transfer of fetal blood into the maternal circulation. The incidence of massive FMT is estimated to be approximately 0.2-0.9 % of births. Although a number of etiologies have been associated with FMT, most causes remain unidentified and the pregnancy is usually asymptomatic. The most frequent symptom is the decrease in fetal movements (26 %) in relation to severe anemia. Several diagnostic modalities for FMT are described (Kleihauer stain, flow cytometry). We describe a case of a newborn with chronic anemia secondary to FMT who, after treatment with transfusions of red blood cells, presented volume overload and clinical worsening as a complication. In this case, our patient needed exchange transfusion for definitive improvement without disability.

Study of Exchange Transfusion by Reconstituted Blood in Hemolytic Disease of Fetus & New Born

Introduction: In newborns with hemolytic disease of fetusand newborn, exchange transfusion is one of the treatments.The main objective of this study was to review and establishthe practice of exchange transfusion with reconstituted bloodin neonates and to observe fall of bilirubin and also rise inhemoglobin and its comparison with related studies.Material and methods: Total 31 neonates with hemolyticdisease of fetus and newborn were included in thisstudy and exchange transfusion was carried out to treathyperbilirubinemia. Exchange transfusion with O Rh negativecells suspended in AB plasma were done for neonates havingRh hemolytic disease of fetus and newborn and O Rh positivecells suspended in AB plasma were used for exchangetransfusion to ABO hemolytic disease of fetus and newborn.The pre and post exchange transfusion blood samples weretested for serum bilirubin and hemoglobin.Result: Out of the 31 cases, 20 were of Rhesus (Rh) hemolyticdisease of fetus and newborn, while ABO and other bloodgroups constituted 08 and 03 hemolytic disease of fetus andnewborn cases respectively. The average post-exchange fallin serum indirect bilirubin was (53.47%) and average rise inhemoglobin level was 3.06 gm/dl in all 31 cases.Conclusion: The reconstituted blood is immunologically muchsafer and better than whole blood for purpose of exchangetransfusion in hemolytic disease of fetus and newborn becauseof its superiority in minimizing transfusion reactions and inachieving all the therapeutic effects of exchange transfusionin better way

Comparison of JSS Formula with Modified Shukla’s Formula for Insertion of Umbilical Venous Catheter: A Randomized Controlled Study

Objective: To compare the rate of optimal position of UVC between modified Shukla’sformula and JSS formula. Methods: Babies requiring umbilical vein catheterization wererandomized to either Shukla or JSS formula group. Post-procedure X-ray was taken tocheck the tip position. Tip of the UVC just above the diaphragm (T9 - T10) was consideredoptimal. Success rate in achieving optimal position between the two groups werecompared. Results: Out of 104 babies recruited, 50 were randomized for Shukla’s formulaand 54 for JSS formula. Catheter tips were in acceptable positions in 39.6% of Shukla groupas compared to 56% in JSS group (P=0.02). Conclusion: The JSS Formula resulted in moreoptimal placement of UVC than the modified Shukla formula.

Advances in the diagnosis of severe pertussis and in the research of mortality risk factors from pertussis / 中华实用儿科临床杂志

Pertussis is an acute highly contagious respiratory disease, which is associated with high rate of hospitalization and death in infants and young children.The pathogenesis of severe pertussis has not been elucidated, and there has not been a consistent universal definition in severe pertussis.This article summarizes the present clinical de-finitions of severe pertussis related diagnosis, and the risk factors for death from pertussis.This text could benefit the clinical practice and the further researches, and to contribute to establish a regulation of the diagnosis and treatment of severe pertussis early.

Advances in the diagnosis of severe pertussis and in the research of mortality risk factors from pertussis / 中华实用儿科临床杂志

Pertussis is an acute highly contagious respiratory disease,which is associated with high rate of hospitalization and death in infants and young children.The pathogenesis of severe pertussis has not been elucidated,and there has not been a consistent universal definition in severe pertussis.This article summarizes the present clinical definitions of severe pertussis related diagnosis,and the risk factors for death from pertussis.This text could benefit the clinical practice and the further researches,and to contribute to establish a regulation of the diagnosis and treatment of severe pertussis early.

A clinical study on the effects of exchange transfusion and intensive phototherapy on neurodevelopment in neonates with severe hyperbilirubinemia / 中国新生儿科杂志

Objective To study the effects of exchange transfusion(ET) and intensive phototherapy (IPT) on neurodevelopment in neonates with severe hyperbilirubinemia reaching ET criteria.Method From January 2015 to March 2016,neonates with severe hyperbilirubinemia reaching ET criteria with gestational age ≥35 weeks,and hospitalized in the Department of Neonatology of our hospital were enrolled in the study.The parents were informed of the risks of acute bilirubin encephalopathy (ABE) and both the advantages and disadvantages of IPT and ET.Based on the different choices of their parents,the neonates were assigned into the ET group and the IPT group.General conditions,treatment effects,the incidences of ABE and the prognosis were recorded and analyzed.Result A total of 335 patients were included in this study,147 in the ET group and 188 in the IPT group.Before intervention,the peak of total serum bilirubin (TSB) in ET group (475.8± 100.6 μmol/L) was higher than IPT group (398.3±39.8 μmol/L) (the difference of TSB between two groups was 77.4 μmol/L,P＜0.001),and the incidences of high risk factors such as blood incompatibilities,sepsis,cranial hematoma and intracranial hemorrhage in ET group were higher than IPT group (P＜0.05).Compared with at admission,the incidence of ABE in the ET group increased from 32.0％ to 34.0％ at discharge,mainly due to moderate and severe ABE (the ratio of moderate ABE increased from 2.7％ to 10.2％,and severe ABE increase from 2.7％ to 4.8％).Statistically significant differences existed in the proportion of ABE with different severity at admission and discharge in ET group (P＜0.05),while that in IPT group wasn't statistically significant.241 patients were followed up (follow-up rate 71.9％),with the age ranging from 20 to 36 months.6 cases (5.7％,6/106) in the ET group showed hearing disorder while none (0％,0/135) in the IPT group (P＜0.05).The incidences of neuromotor dyskinesia,language development disorder and spasm in ET group were higher than IPT group(7.5％ vs.3.7％,3.8％ vs.1.5％,4.7％ vs.4.4％,respectively),but the differences weren't statistically significant(P＞ 0.05).No deaths were observed in both groups.Conclusion In neonates with severe hyperbilirubinemia whose TSB exceeding the upper limit of current ET criteria (and within upper limit+5 mg/dl),if the neonates have no risk factors nor clinical symptoms of moderate or severe ABE,only IPT and without ET does not increase the incidence of unfavourable prognosis of central nervous system.

Severe adverse events associated with exchange transfusion for extreme hyperbilirubinemia / 中国新生儿科杂志

Objective To study the risk factors of severe complications possibly associated with exchange transfusion (ET) for patients with extreme hyperbilirubinemia.Method From May 2001 to May 2018,neonates with severe complications of ET were assigned into adverse event group.The propensity score principle was used to match adverse event group/the control group with the ratio of 1 ∶ 3.The neonates in the control group received ET without any severe complications.The demographic characteristics of patients,and other clinical data were reviewed.The Logistic regression analysis was used to determine the risk factors of severe complications of ET.Result Among the 1 535 neonates who received ET during the past 17 years,71 neonates (4.6％) were identified with severe adverse events,including apnea (30.6％),necrotizing enterocolitis (18.8％),heart failure (14.1％),respiratory failure (12.9％),and shock (8.2％).The Logistic regression analysis showed that acute bilirubin encephalopathy (ABE) score ≥ 3 (OR=6.383,95％CI 2.550～15.979),ETs ≥ 2 times (OR=11.825,95％CI 2.464～56.755),cardiac murmur ≥ grade Ⅲ (OR=20.417,95％CI 4.705～40.590),and dramatic blood pressure fluctuation during ET ≥ 30 mmHg (OR=13.612,95％CI 1.795～43.342) were risk factors of ET related severe complications (all P＜0.05).Conclusion The indications should be carefully assessed before ET.The patients with ABE score ≥ 3,ETs ≥ 2 times,cardiac murmur ≥ grade Ⅲ,or dramatic blood pressure fluctuation during ET ≥ 30 mmHg should be monitored carefully and ET should be stopped in time if necessary.

Effects of Exchange Transfusion on Renal Function, Inflammatory Factors and Blood Internal Environment in Children with Hyperbilirubinemia / 昆明医科大学学报

Objective To study the effects of exchange transfusion on renal function, inflammatory factors and blood internal environment in children with hyperbilirubinemia. Methods Neonates with hyperbilirubinemia treated in neonatal intensive care unit of the hospital between February 2015 and March 2017 were selected as the research subjects and divided into two groups by random number table method. Combined group received exchange transfusion combined with blue ray irradiation, and control group received blue ray irradiation. The serum levels of bilirubin, renal function indexes, inflammatory response indexes and oxidative stress response indexes were measured 24 hours after the treatment. Results 24 hours after the treatment,serum TBIL,BUN,Cr,β2-MG, CysC, TRF, CRP, IL-6, TNF-α, MDA and AOPP levels of combined group were greatly lower than those of control group whereas SOD, CAT and GSH-Px contents were greatly higher than those of control group. Conclusion Exchange transfusion can improve the renal function and inhibit the inflammatory and oxidative stress response in children with hyperbilirubinemia.

Application of leukoreduction therapy in severe pertussis with leukocytosis and pulmonary hyperten-sion:3 infant cases reports and literatures review / 中国小儿急救医学

Objective To investigate the efficacy and safety of leukoreduction therapy in severe per-tussis in infants. Methods Therapeutic processes of 3 cases of severe pertussis in PICU of Shanghai Children′s Medical Center were retrospectively studied from October 2017 to May 2018. We reviewed the related literatures and summarized the time and effectiveness of leukoreduction therapy in severe pertussis. Results All 3 cases had leukocytosis,respiratory faliure,pulmonary hypertension and right heart failure. One case had multiple organ failure before undergoing exchange transfusion therapy and eventually died. Two cases that had pulmonary hypertension during the period of WBC′s rising accepted leukopheresis therapy before multiple organ failure,and eventually survived. We reviewed the foreign literatures which was almost case reports,leukoreduction therapy might improve the prognosis of severe pertussis in infants,but the time of using it had no conclusion. Conclusion This is the first report of leukoreduction therapy for the severe per-tussis in infants in China. It provides a new method for the treatment of severe pertussis in infants. It is worth looking forward to use this method combined with continuous renal replacement therapy and extracorporeal membrane oxygenation technology. In the future,multicenter clinical research should be done to explore the effectiveness and safety of leukoreduction therapy in the severe pertussis in infants.

Analysis of short-term clinical outcomes in 98 newborns with severe hyperbilirubinemia treated by peripheral arteriovenous synchronous exchange transfusion / 中国小儿急救医学

Objective To study the type of disease,the optimal time and clinical effect of peripheral arteriovenous synchronous exchange transfusion in the treatment of newborns with hyperbilirubinemia. Methods The clinical data of admitted neonates with severe hyperbilirubinemia who received peripheral ar-teriovenous synchronous exchange transfusion were retrospectively analyzed from January 2015 to December 2016. Results Ninety-eight neonates were enrolled and the mean gestational age was(38. 7 ± 1. 2)weeks,the mean birth weight was(3275. 1 ± 483. 7) grams,76 cases were term infants,20 cases were preterm infants and 2 cases were post term infants. The causes of hyperbilirubinemia included 39 cases of ABO incompatibili-ty(39. 8％),16 cases of Rh incompatibility(16. 3％),3 cases of C3d incompatibility(3. 1％),2 cases of infection(2. 0％),2 cases of cranial hematoma(2. 0％),2 cases of adrenal hematoma(2. 0％) and 34 cases of unknown hyperbilirubinemia ( 34. 7％) . The mean age of exchange transfusion was ( 5. 8 ± 4. 4 ) days. Exchange transfusion removed 45. 0％ of total body bilirubin. After exchange transfusion,the total serum bili-rubin,platelet level decreased as compared with those of pre-exchange levels,the differences were statistically significant(t=15. 85,P<0. 05;t=13. 75,P<0. 05). The white blood cell counts and hemoglobin increased, the differences were statistically significant(t=4. 06,P<0. 05;t=4. 41,P<0. 05). A total of 44 cases who had bilirubin encephalopathy were compared to other 54 cases who didn't have bilirubin encephalopathy,there were no significant differences in fetal age, age of onset, bilirubin before and after blood exchange. There were significantly differences at time of exchange transfusion and the grade of hospital which the patient ad-mitted at first time(t=2. 46,P<0. 05;t=6. 15,P<0. 05). Conclusion Hemorrhagic disease is the mostimportant cause of neonatal severe hyperbilirubinemia. Clinical effect of peripheral arteriovenous synchronous exchange transfusion in the treatment of newborns with hyperbilirubinemia is obvious. Timely exchange trans-fusion can reduce the occurrence of bilirubinencephalopathy. For basic-level hospitals,it is still necessary to strengthen the implementation of hour-specific bilirubin to predict the risk of neonatal hyperbilirubinemia.

Construction of nursing quality evaluation system for neonatal blood exchange transfusion / 中国实用护理杂志

Objective To compose a scientific, systematic and operative nursing quality evaluation system for neonatal blood exchange transfusion, and to provide a reference for quality control of clinical nursing practice. Methods Semi-structured interviews were conducted, the related literature was reviewed, and a preliminary Delphi enquiry questionnaire with the frame of structure quality, process quality and outcome quality was ultimately formed. Through Delphi enquiry questionnaires and analytic hierarchy processing method, all the indictors and the weights were affirmed. Results Totally 19 experts participated in the inquiry, the authority coefficients in the 2 rounds were 0.91 and 0.93 respectively, theχ2 test of Kendall′s W coefficients was significance with P<0.01. The nursing quality evaluation system for neonatal blood exchange transfusion was finalized with 3 level-1 indicators, 9 level-2 indicators and 39 level-3 indicators. Conclusions The nursing quality evaluation system developed through this study can provide practical reference to clinical nursing practice.