T-piece resuscitator versus self-inflating bag for positive pressure ventilation during neonatal resuscitation / 中华围产医学杂志

To compare the performance of self-inflating bag (SIB) with T-piece resuscitator (TPR) in neonatal resuscitation.Methods:This study involved the trainees participating in a Neonatal Resuscitation Simulation Camp (NRSC) organized by Shanghai First Maternity and Infant Hospital in December 2019. They were trained to provide positive pressure ventilation with the two devices on artificial lungs. Ventilation parameters including peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), PIP in pulmonary alveoli (PIP alv), mean airway pressure (MAP), frequency, inspiratory time (Ti), tidal volume and minute ventilation volume were recorded and analyzed by independent sample t-test or rank sum test. Results:The PIP alv, PIP, oxygen flow rate, tidal volume and minute ventilation volume delivered by TPR were significantly lower than those by SIB [(17.18±1.61) vs (24.05±4.29) cmH 2O (1 cmH 2O=0.098 kPa), t=－6.87; (17.91±1.35) vs (29.97±4.50) cmH 2O, t=－14.06; (3.65±0.25) vs (6.88±1.59) L/min, t=－11.33; (15.90±1.81) vs (24.02±4.29) ml/min, t=－10.99; (664.71±88.94) vs (1 069.49±205.68) ml/min, t=－9.89; all P<0.001]. However, compared with SIB, the PEEP in pulmonary alveoli, Ti, duration of ventilation, inspiratory to expiratory ratio were increased when using TPR [(4.76(4.69-5.57) vs 0.19(0.12-4.10) cmH 2O, T=1 190.00; (0.59±0.15) vs (0.43±0.09) s, t=5.01; (1.46±0.23) vs (1.36±0.11) s, t=2.15; 0.71±0.22 vs 0.47±0.13, t=5.14; all P<0.05]. Conclusion:TPR could deliver more stable and safer PIP, PEEP and tidal volume than SIB and keeping MAP at a stable level during positive pressure ventilation on artificial lungs.

Monochorionic diamnionic twins: a study of perinatal outcomes / 中国新生儿科杂志

Objective To study the perinatal outcomes of monochorionic diamnionic ( MCDA ) twins.Method A retrospective study had been conducted to analyze the outcomes of MCDA twins delivered in Hospital from Jan 2011 to Dec 2012.According to whether complicated with twin to twin transfusion syndrome ( TTTS, n=14 ) and/or selective intrauterine growth restriction ( sIUGR, n=41 ) , the infants enrolled in the study were assigned into complicated group (n=55) and uncomplicated group (n=90).The infants with sIUGR were further subdivided into three groups .The outcomes of the neonates were compared between the groups.Result A total of 145 pairs of MCDA twins were delivered , 285 neonates (12 of them died after birth ) and 5 cases of stillbirth. The gestational age at delivery in complicated group were significantly lower than those in uncomplicated group (33.8 ±2.8weeks vs.35.5 ±1.6weeks, P<0.001);The birth weight in complicated group ( the birth weight of the bigger baby was 2072 ±460 g vs.2520 ± 383 g, the smaller one 1620 ±477 g vs.2320 ±373 g ) were significantly lighter than those in uncomplicated group;The incidence of fetal death in complicated MCDA twin pregnancies (7.3% vs.0) was significantly higher than controls .Neonatal outcomes of fetuses complicated with sIUGRⅠ ( n=23 ) were similar to controls.Neonates complicated with TTTS, sIUGRⅡ(n =6) or sIUGRⅢ (n =12) had significantly increased incidence of respiratory distress syndrome , asphyxia, cardiac disorders, retinopathy of prematurity and neonatal death compared with controls .Conclusion Neonates of MCDA with TTTS or sIUGR had more complications compared with uncomplicated MCDA twins .The fetuses with abnormal umbilical artery Doppler blood flow are more vulnerable to stillbirth , neonatal death and other serious adverse outcomes .

Cardiac hemodynamics in early term neonates born with maternal gestational diabetes mellitus / 中华围产医学杂志

Objective To investigate the early changes of cardiac output and vital signs in term neonates shortly after born from gestational diabetic women.Methods From January 2015 to April 2015, 22 term neonates of gestational diabetes mellitus (GDM) women with euglycemia during pregnancy (GDM group) and 20 term neonates of non complicated gravidas (control group) in Shanghai First Maternity and Infant Hospital were enrolled.Neonates in both groups were measured by ultrasonic cardiac output monitor (USCOM) for cardiac hemodynamics index, including aortic peak flow velocity, pulmonary artery peak flow velocity, left cardiac output, right cardiac output and Smith Madigan inotropy index at one and two hours after birth.Vital signs including heart rate, respiratory rate, blood pressure and peripheral blood glucose were measured as well.Two independent sample t-test and Chi square test were used for statistical analysis.Results The peripheral blood glucose of neonates in GDM group was significantly lower than that of the control [(3.0±0.4) vs (4.0± 0.4) mmol/L, t=8.400, P ＜ 0.01), but all within normal range.Vital signs including heart rate, respiratory rate, mean blood pressure showed no differences between the groups (all P ＞ 0.05).In GDM group, aortic peak flow velocity were (1.230±0.160) and (1.210±0.220) m/s, left ventricle cardiac output was (0.867±0.196) and (0.859±0.193) L/min, Smith Madigan inotropy index was (0.846±0.180) and (0.823±0.189) W/m2 at one and two hours after birth, respectively, which were significantly higher than those in the control group [aortic peak flow velocity: (1.080±0.130) and (1.090± 0.120) m/s;left ventricle cardiac output: (0.754±0.098) and (0.757 ± 0.099) L/min;Smith Madigan inotropy index: (0.746 ± 0.097) and (0.725 ± 0.086) W/m2;t=3.464, 2.265, 2.296, 2.187, 2.263 and 2.202, respectively, all P ＜ 0.05].But no statistically significant differences was found on pulmonary artery peak flow velocity and right cardiac output between the two groups.Cardiac hemodynamics index had no difference between one and two hours within each group (all P ＞ 0.05).Conclusion The left ventricular contractility and left cardiac work are increased in neonates of gestational diabetes mellims women with good sugar control during pregnancy.

Application of ambulatory blood pressure monitoring in stroke prevention / 国际脑血管病杂志

Ambulatorybloodpressuremonitoring(ABPM)providesmoreextensiveclinical information than clinical casual blood pressure. It can effectively identify w hite coat hypertension and masked hypertension and is superior to clinical casual blood pressure in predicting stroke risk. Both daytime and nighttime systolic blood pressures are the independent predictors of stroke, and the predictive value of nighttime systolic blood pressure is higher. In addition, ABPM can also be used to evaluate the blood pressure response and control during the primary and secondary stroke prevention. This article review s the application of ABPM in stroke prevention.

Evaluation of characteristics of cerebral vascular lesion in hypertensive patients by transcranial Doppler / 解放军医学杂志

Objective To investigate the degree of vascular damage in patients with hypertension in various stages with transcranial Doppler (TCD), so as to provide references for the prevention and treatment of obstructive cerebral vascular disease. Methods TCD was adopted to examine bilateral anterior cerebral arteries (ACA), terminal internal carotid arteries (TICA), vertebral arteries (VA) and basal arteries (BA) in patients with hypertension (n=176) and normotensive individuals as control group (n=60). The hemodynamic data of two groups were analyzed statistically. Results In patients with stage Ⅰ hypertension, the blood stream velocity was increased in all intracranial vessels, especially in MCM and TICA. In patients with stage Ⅱ and Ⅲ hypertension, the elevation of blood pressure was followed by the decrease of blood stream velocity, especially in MCA, TICA and BA. The rate of abnormality as detected by TCD was 90 and 96 in patients with stage Ⅱ and Ⅲof hypertension, respectively. Conclusions The abnormal findings of cerebral vessels as detected by TCD seem to coincide with the clinical characters of stroke. TCD findings may be used as an early forewarning index of obstructive cerebral disease.