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The pathophysiology of neonatal necrotizing enterocolitis (NEC) is not clear, but is considered to be multifactorial.Immaturity of the gut, hypoxia-ischemia, formula feeding and microbial dysbiosis play roles in inducing intestinal inflammatory response.This review discussed the development process of infant gut microbiota, the factors affecting neonatal intestinal colonization, the roles of gut microbiome in the pathogenesis of NEC, and the manifestations of early microecology disorder in NEC.In addition, studies on the use of probiotics to prevent NEC and the risks of using probiotics in preterm infants were also summarized.
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Objective:To illustrate the onset of epileptic seizures in children with brain injury admitted in pediatric intensive care unit (PICU), and to explore the risk factors and the correlation between epileptic seizures and the prognosis.Methods:Clinical data of pediatric patients with brain injury who were admitted to PICU of Peking University First Hospital from January 2013 to December 2019, and monitored by video electroencephalography (VEEG) were retrospectively collected, including general demographic information, etiological data, clinical seizures prior to VEEG performing, in-hospital mortality, brain function score, VEEG manifestations, etc.Seizures detected by VEEG were the primary outcome, and prognosis when discharged from PICU was the secondary outcome. Logistic regression was used to analyze the factors associated with seizures and poor outcome. Results:A total of 284 children were included, involving 54.9%(156/284) males.The median age of included children was 1.7(0.5, 5.0) years.Stratified by the cause of disease, 45.1%(128/284) had epilepsy, 26.1%(74/128) had genetic metabolic disease, and 14.4%(41/284) had central nervous system infection.A total of 82.0%(233/284) children had abnormal VEEG background activities, and 59.5%(169/284) had interictal epileptic discharges.Seizures were detected in 106 cases, including 39.6%(42/106) of non-convulsive seizures and 24.5%(26/106) of non-convulsive epileptic states.There were 12.0% (34/284) had poor prognosis at discharge, including 24 patients died in-hospital, and Pediatric Cerebral Performance Category scores were increased in 10 survivors.Multivariate Logistic regression analysis showed that seizures existed before VEEG monitoring and interictal epileptiform discharge were the independent risk factors for seizure.Besides, mental retardation, sepsis related encephalopathy, consciousness abnormality during VEEG, abnormal VEEG background activity, and epileptic status were significantly correlated with the poor prognosis of children with brain injury in PICU. Conclusions:The incidence of electrographic seizure is higher in children with brain injury in PICU, and VEEG monitoring is beneficial to children with brain injury that achieves an early identification of seizures and prediction of prognosis.
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Objective:To evaluate the value of conventional ultrasound, shear wave elastic parameters and immunohistochemistry in predicting axillary lymph node metastasis of breast cancer.Methods:The ultrasonographic features and pathological results of 172 masses in 152 breast cancer patients who underwent surgery in the First Affiliated Hospital of Shihezi University Medical College from May to October 2020 were analyzed retrospectively. The patients were divided into metastatic group and non-metastatic group according to the status of axillary lymph nodes. The conventional ultrasound characteristics, shear wave velocity (SWV) and immunohistochemical indexes (ER, PR, HER-2, Ki-67) of 2 groups of breast cancer masses were analyzed. Finally, the parameters with statistically significant difference between groups were selected and the Logistic regression model was established.Results:There were significant differences in the aspect ratio, calcification, SWVmean and HER-2 expression between metastatic group and non-metastatic group (all P<0.05). A prediction model was constructed with aspect ratio >1, calcification, high SWVmean and HER-2(+ ). The area under receiver operating characteristic curve (AUC) of the subjects was 0.891, which was larger than the single parameter (all P<0.05), and was in good agreement with pathological results (Kappa=0.731). Conclusions:The joint prediction model can be used to predict the status of lymph nodes, and the axillary lymph node metastasis is more likely to occur in breast cancer with the aspect ratio >1, calcification, high SWVmean and HER-2(+ ).
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Objective:To investigate the incidence of hypothyroxinemia in very low birth weight infant (VLBWI) and its effect on early postnatal feeding and weight gain.Methods:This retrospective study analyzed 164 cases of VLBWIs admitted to the Neonatal Intensive Care Unit of Peking University First Hospital from January 2017 to December 2018. According to the gestational age, these VLBWIs were divided into <30 weeks group ( n=85) or ≥30 weeks group ( n=79), and the basic data and thyroid function were compared. According to the levels of serum tetraiodothyronine and free tetraiodothyronine at the first thyroid function test, the subjects were further assigned into normal thyroxine group and hypothyroxinemia group. The risk factors of hypothyroxinemia identified at the first detection were analyzed by single and multiple-facter analysis. The results of the second detection of thyroxine were also analyzed. On the basis of the first detection and receiving treatment or not, the <30 weeks and ≥30 weeks groups were divided into normal thyroxine, hypothyroxinemia treated and hypothyroxinemia untreated subgroups, and differences in the tolerance of early feeding and weight gain were compared between different groups. Two independent samples/paired t-test, rank sum test, Chi-square test and logistic regression were used for statistical analysis. Results:Out of the 164 VLBWIs with the gestational age of (29.7±2.0) weeks and birth weight of (1 210±210) g, 27 cases (16.5%) were extremely low birth weight infants. The age at their first detection was (10.7±3.1) d and the incidence of hypothyroxinemia was 45.1% (74/164), including 71 mild and three severe cases, with a higher incidence in the ≥30 weeks group comparing to the <30 weeks group [55.7%(44/79) vs 35.5%(30/85), χ 2= 6.883, P=0.009]. All the three severe cases were in the ≥30 weeks group. The gestational age ( OR=1.413, 95% CI:1.044-1.912, P=0.025) and male infant ( OR=2.082, 95% CI: 1.047-4.143, P=0.037) were the risk factors of hypothyroxinemia. At the second detection, the incidence of hypothyroxinemia in VLBWIs with normal thyroid function at their first test was 47.6% (39/82), which is higher in the ≥30 weeks group than in the <30 weeks group [64.5%(20/31) vs 37.3%(19/51), χ 2= 5.745, P=0.017]. Among the infants with hypothyroxinemia at the first detection, those untreated had a significantly higher incidence of hypothyroxinemia at the second detection than those treated [81.3%(26/32) vs 38.7%(12/31), χ 2= 11.905, P=0.001]. The incidence of abdominal distension within 21 days, feeding volume on day 7, 14, and 21, and neonatal weight gain within 7, 14, and 21 days were similar between normal thyroxine, hypothyroxinemia treated and hypothyroxinemia untreated subgroups within the ≥30 weeks or the <30 weeks groups (all P>0.05). Conclusions:VLBWI is at high risk of hypothyroxinemia. Two times of postnatal thyroid function tests can help to detect the delayed hypothyroxinemia. Thyroxine level and receiving treatment or not may have no significant effect on the early postnatal feeding and weight gain.
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Objective To compare the short-term outcomes of less invasive surfactant administration (LISA) with traditional intubate-surfactant-extubate (INSURE) method for respiratory distress syndrome (RDS) in premature infants.Method From January 2017 to December 2018,premature infants (gestational age ≤32 weeks) diagnosed with RDS who needed pulmonary surfactant (PS) administration were prospectively enrolled and randomly assigned into LISA group and INSURE group.The duration of oxygen supply,side effects during PS administration,the outcome and severe adverse events,bronchopulmonary dysplasia (BPD),necrotizing enterocolitis (NEC),3 ～ 4° periventricular intraventricular hemorrhage (PIVH),periventricular leukomalacia (PVL) and death were compared.Result A total of 67 cases were enrolled including 34 in LISA group and 33 in INSURE group.No significant differences existed between the two group on mechanical ventilation rates,oxygen therapy duration and the incidences of severe adverse events.However,the duration of noninvasive ventilation in LISA group was significantly longer than INSURE group [(10.5 ± 8.7) d vs.(7.1 ± 2.6) d,P ＜ 0.05].The LISA group had significantly higher PS reflux rate than INSURE group [41.2％ (14/34)vs.18.2％ (6/33),P ＜0.05].Conclusion LISA has similar clinical effects and severe adverse events as INSURE,but with higher rates of PS reflux and longer duration of noninvasive ventilation.
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Objective To study the role of sequential cranial ultrasound (cUS) in the early prognosis of neurodevelopmental outcome in the very low birth weight and extremely low birth weight preterm infants.Method Clinical and examination data of premature infants with birth weight less than 1 500 g,who were admitted to the neonatal intensive care unit of our hospital within 24 hours after birth from January 2012 to December 2016 were analyzed retrospectively.Early cranial ultrasound refers to the cUS scans during the period of 0 to 14 days after birth.Classification was applied to the whole set of early cUS scans based on the most severe lesion observed.Index 1 was periventricular-intraventricular hemorrhage (PVH-IVH),which was divided into none and grade 1 to 4 according to the severity.Index 2 was paraventricular white matter echo,which was divided into normal,slightly enhanced and significantly enhanced.The cUS scan repeated at term-equivalent age (corrected gestational age 37 ～ 44 weeks) was referred to as term cUS.Term cUS was evaluated according to paraventricular leukomalacia (PVL) and enlargement of ventricle.Data were analyzed using IBM SPSS Statistics version 16.0.Result A total of 200 premature infants were collected.The gestational age was (30.1 ± 1.9) weeks,and the birth weight was (1 203 ± 186) g.The median time of cUS scans during hospitalization was 3 times.The age at which the Gesell Development Diagnosis Scale was completed was (11.8 ±4.0) months,the corrected age was (9.7 ±4.0) months.The development quotient (DQ) of gross motor was lower than that of the other four items,and the difference was statistically signi icant.Analysis of data suggested that PVH-IVH grade 3 or grade 4,significantly enhanced paraventricular white matter echo found in early cUS,and PVL or enlargement of ventricle found in term cUS were all associated to lower gross motor DQ (P ＜ 0.05).PVL was also significantly correlated with lower DQ of adaptability,fine motor,language and personal-social (P ＜ 0.05).Conclusion Compared to adaptability,fine motor,language and personal-social,gross motor has the lowest DQ among very low or extremely low birth weight infants.PVH-IVH grade 3 or worse,significantly enhanced paraventricular white matter echo found in early cUS,and PVL or enlargement of ventricle found in term cUS are high risk factors for adverse outcome of gross motor.Among them,PVL found in term cUS suggests poor neurodevelopmental outcome.
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Objective To study the video-electroencephalography (vEEG) background activities of very premature infants within the first 7 days after birth.Method The inclusion criteria were gestational age (GA) within 31 weeks and bedside vEEG monitoring within first 7 days of birth.Those with severe cranial ultrasound (CUS) findings,refused treatment,dead and with seizures on vEEG were excluded.The clinical information of included cases were reviewed and the continuity and sleep-wake cycle (SWC) on their EEG background activities were analysed.Result From June 2017 to April 2018,a total of 56 cases were included.Their GA were (29.4 ± 1.6) weeks,and birth weight were (1 306 ± 316) g.A total of 31 cases were diagnosed with asphyxia(1 min Apgar score less than 8),and no one with 5 min Apgar score below 5.Their umbilical artery blood pHs were 7.29 ± 0.07.Their first CUS and the CUS at corrected gestational age (cGA) full term were all within the normal range.The Gesell neurological assessment at cGA 6 months were all within the normal range.As the cGA increased,the continuity of EEG background activities became more continuous as the normal continuous/discontinuous pattern.The 95％ confidence interval of max interburst interval was 95 s.The SWC first occurred at GA 26 w,but was immature,then became mature as the cGA increased.Conclusion The EEG background activity analysis of relatively normal very premature infants within first week shows that interburst interval can be longer than the previous report,and the SWC first appear at GA 26 w.
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Objective To study the early physical growth pattern,catch-up growth situation,and the influencing factors of early growth in small for gestational age (SGA) preterm infants.Method Our study was a single center,retrospective study.Criteria for infant inclusion were prematurity,SGA (birth weight less than the 10th percentile of related gender and gestational week,according to Fenton curve 2013),born between January 2012 to October 2015,admitted to our neonatal intensive care unit (NICU) within 24 h after birth,hospitalization more than 7 days,and discharged with complete oral feeding.Corrected age (CA) was used to evaluate growth.According to our follow up plan,anthropometric data (weight,length,head circumference) were collected at corrected full term (40 ± 4 weeks),CA (3 ± 1.5) months and CA (6 ± 1.5) months.Catch-up growth was defined as ΔZ greater than 0.67 compared with that at birth,successful catch-up was defined as anthropometric data higher than 10th percentile in target population.The characteristics and influencing factors were compared between infants with and without catch-up growth.Result Eighty-one SGA preterm infants were involved,45 boys and 36 girls.The average gestational age was (34.6 ± 1.7) weeks,birthweightwas(1617 ± 348) g,birthlengthwas(41.0 ±3.2)cm and head circumference was (29.7 ± 2.0) cm.At corrected gestational age (40 ± 4) weeks,CA (3 ± 1.5) months and CA (6 ± 1.5) months,follow-up rate was 86.4％,66.7％ and 58.0％;catch-up growth in weight was 32.9％,55.6％ and 66.0％;successful catch-up growth in weight was 52.9％,64.8％ and 66.0％.At CA (40 ±4) weeks,there were more boys,sooner recover birth weight,and less patent ductus arteriosus (PDA) in catch-up infants (P ＜ 0.05).At CA (3 ± 1.5) months,catch-up infants had large gestational age,and they were longer at discharge,shorter hospital stay,less PDA,and greater body weight at CA 40 weeks,the difference was statistically significant (P ＜ 0.05).At CA (6 ± 1.5) months,there were difference in hospitalization days,percentile of body weight at CA 40 weeks and percentile of all three anthropometrics at CA (3 ± 1.5) months between catch-up and no catch-up growth infants (P ＜ 0.05).Multiple factor analysis showed that percentile of weight at CA 3 months was the independent risk factor of catch-up growth in weight at CA 6 months (P =0.002,OR =1.221,95％ CI 1.076 ～ 1.385).For every 5 percentile increase in body weight percentile at CA (3 ± 1.5) months of age,the likelihood of complete body weight catch-up growth at CA (6 ± 1.5) months increased 2.965 times (95％ CI 1.480 ～ 5.942).Conclusion Both weight and length of SGA preterm infants showed a trend of rapid gain between corrected gestational age (40 ± 4) weeks to CA (3 ± 1.5) months.The factors that influencing the completion of catch-up growth are different at different age.The weight,length,and head circumference percentile at CA about 3 months are good predictors of growth pattern and situation at CA 6 months for the SGA preterm infants.
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Objective To study the influence of continuous blood purification(CBP) on cardiac out-put of pediatric patients using bioreactance. Methods Patients underwent CBP in PICU and nephrology ward from March 2014 were prospectively enrolled after approval by ethics committee. CBP therapies were all performed by Fresenius Medical Care hemodialysis machine. Cardiac output values were obtained using the non-invasive cardiac output monitoring ( NICOM) device ( Cheetah Medical). Blood pressure, heart rate, cardiac index(CI) and stroke volume index(SVI) were recorded before the therapy,at the beginning of ther-apy,during the course of therapy,and at the end of each therapy. Results Twenty-one pediatric patients (from 1. 0 year to 15. 5 years) were recruited and 69 treatments were recorded from March 2014 to Decem-ber 2016. The basic CI was 3. 4 (2. 4,6. 1) L/(min·m2),basic SVI was 43 (26,75) ml/(m2·beat). Dur-ing the beginning of therapy,mean arterial pressure(MAP),CI and SVI all dropped from the baseline ( P<0. 001),whereas heart rate increased. During the course of CBP,CI and SVI (were both recorded every 4 hours) kept on dropping and stayed at a relatively lower level. Course CI was 3. 0 (2. 4,4. 6) L/(min·m2) and course SVI was 28 (21,57) ml/(m2·beat). At the end of therapy,CI was 3. 4 (2. 5,5. 3) L/(min· m2),with no significant difference from the baseline CI (P＝0. 073). However,the SVI at the end of therapy was 35 (25,67) ml/(m2·beat),higher than the course SVI but still lower than the basic SVI,the differences were statistically significant ( P<0. 05). Conclusion CI and SVI continue to decline at the beginning of CBP treatment and remain at a lower level throughout the course of treatment. After the therapy, CI has returned to the basic level whereas SVI has not recovered.
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Objective:To study the characteristics of neonatal fungal sepsis and the difference between bacterial sepsis and fungal sepsis.To improve the understanding of neonatal fungal sepsis.Methods:Clinical data of neonatal fungal sepsis in neonatal intensive care unit (NICU) were collected from 2011 to 2016 in Peking University first Hospital.The clinical characteristics were analyzed retrospectively.The difference between neonatal fungal sepsis and bacterial sepsis was also analyzed.Results:Fifteen cases of neonatal fungal sepsis were recruited.Over the study period,the incidence of neonatal fungal sepsis was 0.52％,while it was 2.5％ in very low birth weight infants.Clinical characteristics were nonspecific.All the infants were treated with parenteral nutrition and broad spectrum antibiotics.Peripheral inserted central catheter (PICC) was placed in thirteen patients.Pathogenic analyses indicated Candida glabrata was the main pathogen in our study.All the pathogens were sensitive to amphotericin B.Only one Candida glabrata was resistant to fluconazole.Thirty-four cases of bacterial sepsis were included.The clinical characteristics and laboratory examination results were compared.The platelet count was 61 × 109/L in fungal group,while the platelet count was 178 × 109/L in bacterial group.There was statistical difference between the fungal group and bacterial group (P =0.004).The rate of thrombocytopenia was 80.0％ in fungal group,while it was 29.4％ in bacterial group.It was much higher in fungal group than in bacterial group (P =0.001).The rate of PICC placement was 86.7％ in fungal group,while it was 55.7％ in bacterial group.It was much higher in fungal group than in bacterial group (P =0.037).Receiver operating characteristic (ROC) curve analysis showed that the cut-off value of the platelet count for the diagnosis of neonatal fungal sepsis was 145 × 109/L (sensitivity 61.8％,specificity 92.9％).All the patients were cured after standardized antifungal therapy.The indicators of liver and renal function were also measured before and after antifungal therapy.No significant difference was observed before and after treatment.Conclusion:The clinical characteristics of neonatal fungal sepsis was nonspecific.Candida glabrata was the main pathogen in our NICU.It can be cured as the result of standardized treatment.Decreased platelet count and PICC placement may indicate the possibility of fungal sepsis in neonates.
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With the promotion of precision medicine , tumor targeted therapy has entered into a new stage .Developments in molecular biotechnology have contributed to the discovery of numerous novel molecular targets .The advent of new targeted drugs and continuous updating data from large clinical research have provided more options for the precise treatments of lung cancer .This article aims to review the latest progress about targeted therapy and precision medicine in lung cancer .
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In this review, we have briefly described the concept, status quo and relevant variables of worldwide nurses′ professional identity. Moreover, there has been a detailed summary of promotion strategies on foreign nurses. The introduction mentioned above aims at exploring more effective and comprehensive promotion strategy, which might provide the theoretical basis for Chinese nursing identity studies.
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Objective To study the clinical presentations,radiologic features,prognosis,and possible causes of liver injury associated umbilical venous catheter (UVC ).Methods We reviewed database of our NICU from December 2012 to November 2015 and identified preterm infants with liver injury while UVC in place.The gestational age,birth weight,gender,days of UVC in place prior to liver injury, the depth of UVC (cm),UVC tip position,ultrasound findings of liver injury,laboratory tests,treatment and outcomes were collected.Results During study period,322 infants received UVC insertion.Ten cases (3.1 %)of liver injury associated with UVC were diagnosed.Of the ten infants,nine were diagnosed as extravasation of fluid to liver parenchyma,and one was diagnosed as liver hematoma.The mean birth weight was (1184 ±207)g,mean gestational age was (28.5 ±1.7)weeks.The UVC tip was at thoracic (T) vertebrae T 9 to T 11 level,nine UVC tips were below the right diaphragm level.All UVCs were used for total parenteral nutrition before liver injury was diagnosed.Six infants had clinical manifestations,and four infants were free of clinical manifestations.The most prominent clinical signs were abdominal distension (n =5),weak bowel sounds (n =5)and hepatomegaly (n =4).One infant who was diagnosed with liver hematoma also had progressive hemoglobin decline (minimum 34 g/L)and shock.Abdominal ultrasound showed well-limited,irregular,hyperechoic rimmed lesions with heterogeneously hypoechoic centers or anechoic liquid dark space.Extravasation of fluid to liver parenchyma will restorate within one week after the UVC was remove.One baby who was diagnosed as liver hematoma passed away at 9 days of life.Liver ultrasound of eight returned to normal in 52 days to 3.5 months,and one had calcified lesions at 9 months of age.Conclusions Liver injury is an unusual complication of UVC insertion and usage.Proper positioning of the UVC tip may help to avoid this complication.Early recognition,prompt diagnosis with liver ultrasound examination and timely treatment can lead to better outcome in newborns with extravasation of fluid to liver parenchyma.
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Objective To determine the extent of off-label antiepileptic drugs (AEDs) use in a tertiary pediatric epileptic center in China,so as to provide baseline data for getting acquainted with the extent of off-label AEDs use for the future.Methods Collected demographic information and prescriptions related to AEDs of all hospitalized children diagnosed with epilepsy from April 1st to September 30th 2016 were collected in Peking University First Hospital.According to person-time,prescriptions,different AEDs,various categories of off-label use,the incidence of off-label AEDs use was calculated respectively.Risk factors (age,gender,number of drug use,type of seizure and status epilepticus) were analyzed through the methods of single factor chi-square and muhi-factor Logistic regression analysis.Results A total of 291 person-times,749 prescriptions and involving 12 kinds of AEDs were collected.The rates of off-label drug use were 35.11％ (263/749 items) and 66.32％ (193/291 person-times) in prescriptions and person-times respectively.The main categories of off-label drug use were seizure types (38.40％,101/263 items),dosage (10.27％,27/263 items),mono/multidrug therapy (9.89％,26/263 items),scope of disease (0.76％,2/263 items) and age (72.62％,191/263 items),while 30.30％ (79/263 items) prescriptions were equal or more than 2 different categories of off-label drug use.The incidences of different drugs were different,with 100％ in Nitrazepam,Vigabatrin,Clobazam,Zonisamide,1.78％ (3/169 items) in Valproate but 0 in Clonazepam,Phenobarbital.According to the results of single factor chi-square and multi-factor Logistic regression,ages and seizure types were correlated with off-label AEDs use.The groups of infants and preschoolers had higher incidences of off-label AEDs use than the group of school and adolescence.The group of focal seizures only had lower incidences of off-label AEDs use.Conclusions Off-label AEDs use in the tertiary pediatric epileptic center in China is common.Younger patients (infant and preschool) have higher incidences of off-label AEDs use,while patients with focal seizures have lower incidences of off-label AEDs use.
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Objective To investigate the value of measurement of cardiac output in children by bio-reactance versus echocardiography.Methods Pediatric patients admitted in pediatric department of Peking University First Hospital from September to December 2012 who needed hemodynamic monitoring were enrolled prospectively.Cardiac index(CI)and stroke volume(SV)were measured by echocardiography and non-invasive cardiac output measurement(NICOM)and compared by Spearman correlation and Bland-Alt-man analysis.Results Thirty patients were included.The median age was 7.25 years.CI[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated significantly[3.42(2.28,4.92)L /(min?m2 ) vs.3.51 (2.94,4.85 )L/(min?m2 ),R =0.385,P =0.035 ].Bland-Altman analysis revealed a bias of-0.22 L/(min?m2 )(P =0.051 ),limits of agreement of -1.40 to 0.95 L/(min?m2 ).SV[M(P5 ,P95 )] measured by NICOM and echocardiography were correlated more significantly [36.3 (12.6,87.8 )ml vs.39.4(14.7,86.9)ml,R =0.768,P ﹤0.001 ].Bland-Altman analysis revealed a bias of -3.1 ml(P =0.176),limits of agreement of -27.4 to 21.2 ml.Conclusion There is no significant difference between NICOM and echocardiography for the measurement of CI and SV in pediatric patients.Further validation studies need to be conducted before routine clinical use.
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Neonatal respiratory distress syndrome (RDS) is most common in premature infants,the smaller the gestational age,the higher the incidence.Continuous positive airway pressure (CPAP) started in the delivery room has been shown in multicentre randomized controlled trials to reduce the need for mechanical ventilation (MV) and surfactant.The European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants-2013 Update recommended that CPAP should be started from birth in all babies at risk of RDS and a starting pressure of at least 6 cmH2O(1 cmH2O =0.098 kPa)should be applied.CPAP with early rescue surfactant should be considered the optimal management for babies with RDS.Using CPAP immediately after birth with subsequent selective surfactant administration may be considered as an alternative to routine intubation with prophylactic or early surfactant administration in preterm infants.If endotracheal intubation is needed,early administration of surfactant is preferable.Nasal intermittent positive pressure ventilation may reduce the risk of extubation failure in babies failing on CPAP.Several strategies have been employed specifically to improve the success of noninvasive ventilation and shorten the duration of MV.Caffeine should be used to facilitate weaning from MV and to reduce bronchopulmonary dysplasia.A short tapering course of low-or very low-dose dexamethasone should be considered to facilitate extubation in babies who remain on MV after 1 ～ 2 weeks.Very early steroid treatment and treatment with high doses cannot be recommended.
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Sepsis is systemic inflammatory response syndrome associated with infection.Early recognition of severe sepsis or septic shock,early hemodynamic resuscitation and the immediate initiation of effective intravenous anti-infective therapy are the cornerstones in the management of patients with sepsis.The infectious microorganisms associated with sepsis in pediatric patients vary with the patient's age and immune status.Initial empirical antimicrobial therapy should include one or more drugs that have activity against all likely pathogens and that penetrate in adequate concentrations into the presumed source of sepsis.Empirically therapy should be de-escalated to the most appropriate single therapy as soon as the susceptibility agent is known.