Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China.

BACKGROUND: Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China. METHODS: The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD. RESULTS: A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082-4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606-3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044-1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061-2.424), DRI (OR, 2.094; 95% CI, 1.328-3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679-4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777-6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996-0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379-0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160-0.467) were preventive factors for BPD (all P < 0.05). CONCLUSION: Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.

Population pharmacokinetics and dosing optimization of azlocillin in neonates with early-onset sepsis: a real-world study.

OBJECTIVES: Nowadays, real-world data can be used to improve currently available dosing guidelines and to support regulatory approval of drugs for use in neonates by overcoming practical and ethical hurdles. This proof-of-concept study aimed to assess the population pharmacokinetics of azlocillin in neonates using real-world data, to make subsequent dose recommendations and to test these in neonates with early-onset sepsis (EOS). METHODS: This prospective, open-label, investigator-initiated study of azlocillin in neonates with EOS was conducted using an adaptive two-step design. First, a maturational pharmacokinetic-pharmacodynamic model of azlocillin was developed, using an empirical dosing regimen combined with opportunistic samples resulting from waste material. Second, a Phase II clinical trial (ClinicalTrials.gov: NCT03932123) of this newly developed model-based dosing regimen of azlocillin was conducted to assure optimized target attainment [free drug concentration above MIC during 70% of the dosing interval ('70% fT>MIC')] and to investigate the tolerance and safety in neonates. RESULTS: A one-compartment model with first-order elimination, using 167 azlocillin concentrations from 95 neonates (31.7-41.6 weeks postmenstrual age), incorporating current weight and renal maturation, fitted the data best. For the second step, 45 neonates (30.3-41.3 weeks postmenstrual age) were subsequently included to investigate target attainment, tolerance and safety of the pharmacokinetic-pharmacodynamic model-based dose regimen (100 mg/kg q8h). Forty-three (95.6%) neonates reached their pharmacokinetic target and only two neonates experienced adverse events (feeding intolerance and abnormal liver function), possibly related to azlocillin. CONCLUSIONS: Target attainment, tolerance and safety of azlocillin was shown in neonates with EOS using a pharmacokinetic-pharmacodynamic model developed with real-world data.

[Risk factors for minimally invasive surfactant administration failure in preterm infants with respiratory distress syndrome].

OBJECTIVE: To identify risk factors for minimally invasive surfactant administration (MISA) failure in the treatment of preterm infants with respiratory distress syndrome (RDS) and the influence of MISA failure on neonatal outcome. METHODS: A retrospective analysis was performed for the clinical data of 148 preterm infants with a gestational age of ≤32 weeks and a clinical diagnosis of RDS, who were admitted to the neonatal intensive care unit of eight tertiary hospitals in Beijing, Tianjin and Hebei Province from July 1, 2017 to December 31, 2018 and were treated with MISA (bovine pulmonary surfactant, PS). According to whether MISA failure (defined as the need for mechanical ventilation within 72 hours after MISA) was observed, the infants were divided into two groups: MISA failure group (n=16) and MISA success (n=132). A logistic regression analysis was used to investigate the risk factors for MISA failure and its influence on neonatal outcome. RESULTS: The MISA failure rate was 10.8% (16/148). The logistic regression analysis showed that a high incidence rate of grade >II RDS before PS administration, low mean arterial pressure and high pulse pressure before administration, a low dose of initial PS administration, and long injection time and operation time were the risk factors for MISA failure (OR=5.983, 1.210, 1.183, 1.055, 1.036, and 1.058 respectively, P<0.05). After the control for the above risk factors, the logistic regression analysis showed that the MISA failure group had a significantly higher incidence rate of bronchopulmonary dysplasia (BPD) (OR=8.537, P<0.05). CONCLUSIONS: A high grade of RDS, a low mean arterial pressure, and a high pulse pressure before administration are independent risk factors for MISA failure, and a low dose of initial PS administration, a long injection time, and a long operation time may increase the risk of MISA failure. MISA failure may increase the incidence rate of BPD in preterm infants.

[Assessment of TVOC and odor in the remediation site of contaminated soil and groundwater using electronic nose].

According to the conditions of a contaminated soil and groundwater remediation site in Shanghai, the self-built electronic nose was applied to detect VOCs and odor of previously remedied soil and groundwater, remedying soil and groundwater, and the air above and around the site. Combining the formula of TPI and OPI, the value of each point was got and was shown in figures. Results showed: 1. Comparing the determination results of previously remedied with remedying contaminated soil and groundwater, the concentration of TVOC and odor was overall declined. The result was consistent with the fact. The detection result of electronic nose was proved to be right; 2. In the remediation process of soil and groundwater, the volatilization of VOCs and odor was inflected by temperature and works of crushing, adding medicine and turning the soil on time. The concentration showed a trend of overall decline with stage rising, so the electronic noses can be used for dynamic monitoring of the whole remediation process; 3. Combined with the GIS, the electronic noses can preliminary assess space pollution situation caused by the remediation of contaminated soil and groundwater and the influence on the residence in the surrounding region. However, further study on the refined classification of the impact degree is needed.

Rapid classification of hairtail fish and pork freshness using an electronic nose based on the PCA method.

We report a method for building a simple and reproducible electronic nose based on commercially available metal oxide sensors (MOS) to monitor the freshness of hairtail fish and pork stored at 15, 10, and 5 °C. After assembly in the laboratory, the proposed product was tested by a manufacturer. Sample delivery was based on the dynamic headspace method, and two features were extracted from the transient response of each sensor using an unsupervised principal component analysis (PCA) method. The compensation method and pattern recognition based on PCA are discussed in the current paper. PCA compensation can be used for all storage temperatures, however, pattern recognition differs according to storage conditions. Total volatile basic nitrogen (TVBN) and aerobic bacterial counts of the samples were measured simultaneously with the standard indicators of hairtail fish and pork freshness. The PCA models based on TVBN and aerobic bacterial counts were used to classify hairtail fish samples as "fresh" (TVBN ≤ 25 g and microbial counts ≤ 10(6) cfu/g) or "spoiled" (TVBN ≥ 25 g and microbial counts ≥ 10(6) cfu/g) and pork samples also as "fresh" (TVBN ≤ 15 g and microbial counts ≤ 10(6) cfu/g) or "spoiled" (TVBN ≥ 15 g and microbial counts ≥ 10(6) cfu/g). Good correlation coefficients between the responses of the electronic nose and the TVBN and aerobic bacterial counts of the samples were obtained. For hairtail fish, correlation coefficients were 0.97 and 0.91, and for pork, correlation coefficients were 0.81 and 0.88, respectively. Through laboratory simulation and field application, we were able to determine that the electronic nose could help ensure the shelf life of hairtail fish and pork, especially when an instrument is needed to take measurements rapidly. The results also showed that the electronic nose could analyze the process and level of spoilage for hairtail fish and pork.

[Detection of TVOC and odor in industrial park using electronic nose].

The main volatile compounds belong to TVOC or odor which may generate from industrial park,special sensors were adopted to build electronic nose for detecting those compounds. TVOC pollution index (TPI) and odor pollution index (OPI) were designed as well as detecting method based on electronic nose in the field. On this basis, considering the pollution situation of chemical industrial of Zhapu port in Jiaxing, six detecting points were selected to be tested by electronic nose on site. Each sensor responses processed by principal components analysis (PCA), two principal components were extracted, that is, eight sensors can be divided into two groups including the types of TVOC (S1) and odor (S2-S8). Meanwhile, the on site collected samples were qualitatively analyzed with GC/ MS. At each testing point, integral area percentage of the compounds being a part of TVOC accumulated mostly over 90% and to odor, mostly was below 10%. Results show: (1) Choosing appropriate sensors combining PCA can preliminarily reflect the pollution condition of TVOC and odor in industrial park; (2) Combining pollution indexes measured with electronic nose and results of qualitative analysis with GC/MS can generally concluded the overall pollution situation of TVOC and odor in industrial park and distribution of each pollutant; (3) Application of electronic noses and GIS to detect TVOC and odor in industrial park can preliminary assess space pollution situation in industrial park.