Analysis of In-hospital Neonatal Death in the Tertiary Neonatal Intensive Care Unit in China: A Multicenter Retrospective Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Globally, the proportion of child deaths that occur in the neonatal period remains a high level of 37-41%. Differences of cause in neonate death exist in different regions as well as in different economic development countries. The specific aim of this study was to investigate the causes, characteristics, and differences of death in neonates during hospitalization in the tertiary Neonatal Intensive Care Unit (NICU) of China.</p><p><b>METHODS</b>All the dead neonates admitted to 26 NICUs were included between January l, 2011, and December 31, 2011. All the data were collected retrospectively from clinical records by a designed questionnaire. Data collected from each NICU were delivered to the leading institution where the results were analyzed.</p><p><b>RESULTS</b>A total of 744 newborns died during the 1-year survey, accounting for 1.2% of all the neonates admitted to 26 NICUs and 37.6% of all the deaths in children under 5 years of age in these hospitals. Preterm neonate death accounted for 59.3% of all the death. The leading causes of death in preterm and term infants were pulmonary disease and infection, respectively. In early neonate period, pulmonary diseases (56.5%) occupied the largest proportion of preterm deaths while infection (27%) and neurologic diseases (22%) were the two main causes of term deaths. In late neonate period, infection was the leading cause of both preterm and term neonate deaths. About two-thirds of neonate death occurred after medical care withdrawal. Of the cases who might survive if receiving continuing treatment, parents' concern about the long-term outcomes was the main reason of medical care withdrawal.</p><p><b>CONCLUSIONS</b>Neonate death still accounts for a high proportion of all the deaths in children under 5 years of age. Our study showed the majority of neonate death occurred in preterm infants. Cause of death varied with the age of death and gestational age. Accurate and prompt evaluation of the long-term outcomes should be carried out to guide the critical decision.</p>

Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China: A Multi-center Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>With the progress of perinatal medicine and neonatal technology, more and more extremely low birth weight (ELBW) survived all over the world. This study was designed to investigate the short-term outcomes of ELBW infants during their Neonatal Intensive Care Unit (NICU) stay in the mainland of China.</p><p><b>METHODS</b>All infants admitted to 26 NICUs with a birth weight (BW) < l000 g were included between January l, 2011 and December 31, 2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors.</p><p><b>RESULTS</b>A total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age (GA) was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants (23.3%) died and another 69 infants (26.7%) died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas (53.6% vs. 35.3%, P = 0.019). BW < 750 g and GA < 28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization.</p><p><b>CONCLUSIONS</b>Our study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries.</p>

Treatment of senile lumbar nerve root canal stenosis with micro-endoscope discectomy / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the indication, surgical techniques and clinical effect of micro-endoscope discectomy (MED)in treating senile lumbar nerve root canal stenosis.</p><p><b>METHODS</b>From March 2007 to October 2010,56 patients with lumbar nerve root canal stenosis were treated with discectomy and decompression through micro-endoscope. There were 38 males and 18 females,aged 61 to 76 years old with an average of (64.53+/-4.43) years old. Course of disease was from 6 months to 15 years. According to JOA 29 score system,the function was evaluatd before and after operation,including subjective symptom, objective sign and bladder function. At 1,3,6,12 months after operation, according to X-rays examination to analyze, the clinical effects were analyzed.</p><p><b>RESULTS</b>Fifty-one patients were followed up from 1 to 12 months. At 1,3,6,12 months after operation,JOA score improved from preoperative 13.46+/-2.02 to 23.13+/-1.86,23.54+/-2.39,24.66+/-1.57,24.83+/-1.74,respectively;and the rate of excellent and good was 83.92% ,90.74%,95.42% ,92.15% ,respectively. There was statistical significance in JOA score between preoperative and final follow-up (P<0.05). No lumbar instability sign was found by X-rays examination.</p><p><b>CONCLUSION</b>Nerve root canal decompression through micro-endoscope discectomy for the treatment of senile lumbar nerve root canal stenosis is an effective procedure,which has the advantages of less traumatic,rapid recovery,but selection of indication and accurate operation are main keys.</p>

Which is better to resuscitate asphyxiated newborn infants: room air or pure oxygen? / 中华儿科杂志

<p><b>OBJECTIVE</b>To find out optional resuscitation gas for asphyxiated newborn infants based on a systemic review of the published studies that compared the effects of resuscitation of asphyxiated newborn infants with room air or pure oxygen.</p><p><b>METHODS</b>Inclusion criteria were randomized or pseudo-randomized studies of asphyxiated newborn infants resuscitated with room air or pure oxygen. The studies published between Jan. 1966 and June. 2005 were searched in PubMed/EMBASE/the Cochrane library databases. All identified studies that fulfilled our inclusion criteria were included. We did a systemic review and a meta-analysis of studies that compared parameters of efficacy, such as mortality, incidence of hypoxic ischemic encephalopathy (HIE) and the rate of resuscitation failure of newborn infants resuscitated with room air or pure oxygen.</p><p><b>RESULTS</b>Six identified studies were included, in which 988 infants were resuscitated with room air and 952 infants with pure oxygen. The mortality of asphyxiated newborn infants within the first week was 8.7% versus 13.4% in room air and pure oxygen groups, respectively, OR = 0.64, 95% CI 0.44 - 0.94. In 5 of the 6 studies, the mortality of term asphyxiated newborn infants was 5.9% versus 9.8% in room air and pure oxygen groups, OR = 0.59, 95% CI 0.40 - 0.87. The result for premature asphyxiated newborn infants was similar. In 4 studies, the incidence of moderate to severe neonatal HIE was 17.5% versus 20.1% in room air and pure oxygen groups, respectively, OR = 0.91, 95% CI 0.68 - 1.21. In 3 studies, the rate of resuscitation failure was 26.9% versus 29.1% in room air and pure oxygen groups, respectively, OR = 0.92, 95% CI 0.70 - 1.19.</p><p><b>CONCLUSION</b>The systemic review and the meta-analysis demonstrated that the mortality of asphyxiated newborn infants was significantly lower when resuscitated with room air, and no significant differences were found in the incidence of neonatal HIE and the rate of resuscitation failure. However, this conclusion should be used cautiously because of the limited number of studies.</p>