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Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.
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Objective:To investigate the risk factors and establish a risk scoring system for bronchopulmonary dysplasia (BPD) in very and extremely preterm infants.Methods:From December 2013 to December 2018, 254 very and extremely preterm infants with less than 32 weeks of gestation hospitalized for 28 d and above in the Third Staff Hospital of Baotou Steel Group were retrospectively enrolled. According to the diagnostic criteria of BPD, they were divided into the BPD group ( n=129) or the non-BPD group ( n=125). Clinical data and the risk factors for BPD were analyzed with univariate t-test, Chi-square test, rank-sum test, and multivariate logistic regression analysis. Based on the results, the risk scoring system was evaluated by receiver operating characteristic (ROC) curve, sensitivity, and specificity. Results:Logistic regression analysis showed that gestational age, neonatal respiratory distress syndrome (NRDS), ventilator-associated pneumonia (VAP), and duration of ventilation >7 d were the risk factors for BPD (all P<0.05). When the area under the ROC curve was 0.868 (95% CI: 0.823-0.913, P<0.001) and the maximum Youden index was 0.644, the sensitivity of the scoring systems for BPD was 0.884 (95% CI: 0.812-0.931), and the specificity was 0.760 (95% CI: 0.674-0.830). Conclusions:Gestational age, NRDS, VAP, and prolonged duration of ventilation were the risk factors for BPD. The risk scoring system established has the prediction value on BPD in very and extremely preterm infants.
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Objective To investigate the diagnosis and treatment status of neonatal respiratory dis-tress syndrome (NRDS) in Inner Mongolia and explore the problems and countermeasures for NRDS diagno-sis and treatment. Methods Data of infants with NRDS in 4 hospitals(3 hospitals were in the west,which were the Affiliated Hospital of Inner Mongolia Medical University,Baotou Steel Three Hospital and Ordos Central Hospital,1 hospital was in the east,which was the Affiliated Hospital of Chifeng Institute) participat-ing in the study during the period from 1th January,2016 to 30th June,2018 were investigated retrospectively with descriptive epidemiological survey,including basic situation,perinatal period, clinical manifestations, treatment,complications and prognosis. Results Among 11406 newborns admitted in 4 hospitals during the study period,748 infants were diagnosed with NRDS,accounting for 6. 56％ . In the eastern region,279 infants were diagnosed with NRDS,the rate was 9. 30％ ,and in the western region were 469(5. 58％ ). The average hospitalization time in the eastern region was longer than that in the western region,and the age of motherswas higher than that in the western region. There were significant differences between the two groups(P <0. 05). The antenatal hormone use,cesarean delivery,multiple gestation,low Apgar score,premature rupture of membrane in the western region were higher than those in the eastern region(P < 0. 05). The proportion of NRDS grade Ⅰ and gradeⅢ,pulmonary surfactant(PS) utilization ratio and INSURE technology usage in the eastern region were higher than those in the western region. The ratio of NRDS(grade Ⅱ) and the first dose of PS in the western region were higher than those in the eastern region(P < 0. 05). The total mortality of neonates with NRDS was 6. 15％ (46 / 748). The incidence rates of patent ductus arteriosus,bronchopulmo-nary dysplasia,necrotizing enterocolitis,ventilator-associated pneumonia in the western region were higher than those in the eastern region(P < 0. 05). Conclusion The level of diagnosis and treatment of NRDS in four hospitals in two districts of Inner Mongolia varies widely. But overall compared with other areas,the treatment of NRDS in Inner Mongolia has the problems of low antenatal hormone use,insufficient use of PS and INSURE technology,and late use of PS. The treatment of NRDS should continue to standardize antenatal hormone use,early and sufficient use of PS,the promotion of the use of INSURE technology.
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Objetive To explore bacteriological changes and susceptible factor of nosocomial infection in neonatal intensive care unit (NICU). Methods The clinical data from 5543 hospitalized neonates during January 2010 to December 2015 were retrospectively analyzed. Results Nosocomial infection rate during the study period was 8 . 75 %. The most common pathogen of nosocomial infection was Staphylococcus epidermidis, followed by Escherichia coli and Klebsiella pneumoniae. Respiratory infection accounted for 37.73% and blood infection 37.53%. 36.74% blood samples were tested to be positive, and 32.67% sputum were positive. In the first three years, the main pathogens of nosocomial infection were Candida albicans, Klebsiella pneumonia, and Staphylococcus aureus; in the last three years, the main pathogens were Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. The susceptible factors of nosocomial infection in NICU were gestational age?
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Objective To analyze and investigate dopamine combined with milrinone treatment effect on elderly patients with intractable heart failure and N-terminal B-type natriuretic peptide level and cardiac function.Methods 80 cases of elderly patients with heart failure according to the number table method randomly divided into two groups: control group and experimental group, and control group was given conventional drugs.The patients in experimental group were received dopamine +Milrinone on the basis of control group.Clinical efficacy, N-terminal pro-B-type natriuretic peptide levels ( NT proBNP ) and heart function condition between two groups are compared and analyzed.Results The total effective rate of experimental group (95.00%) was higher than that of control group (70.00%) (P<0.05).NT-proBNP(2013.31 ±295.84)ng/L、LVEDD(61.48 ± 10.11)mm、LVEF(59.69 ±8.44)% in the experimental group was significantly better than the control group(P <0.05).Conclusion Dopamine combined with milrinone in the treatment of elderly patients with intractable heart failure is remarkable, can relieve the level of NT proBNP, and promote the recovery of cardiac function.
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<p><b>OBJECTIVE</b>Since 1986, the reference of birth weight for gestational age has not been updated. The aim of this study was to set up Chinese neonatal network to investigate the current situation of birth weight in China, especially preterm birth weight, to develop the new reference for birth weight for gestational age and birth weight curve.</p><p><b>METHOD</b>A nationwide neonatology network was established in China. This survey was carried out in 63 hospitals of 23 provinces, municipalities and autonomous regions. We continuously collected the information of live births in participating hospitals during the study period of 2011-2014. Data describing birth weight and gestational age were collected prospectively. Newborn's birth weight was measured by electronic scale within 2 hours after birth when baby was undressed. The evaluation of gestational age was based on the combination of mother's last menstrual period, ultrasound in first trimester and gestational age estimation by gestational age scoring system.</p><p><b>STATISTICAL ANALYSIS</b>the growth curve was drawn by using LMSP method, which was conducted in GAMLSS 1.9-4 software package in R software 2.11.1.</p><p><b>RESULT</b>A total of 159 334 newborn infants were enrolled in this study. There were 84 447 male and 74 907 female. The mean birth weight was (3 232 ± 555) g, the mean birth weight of male newborn was (3 271 ± 576) g, the mean weight of female newborn was (3 188 ± 528) g. The test of the variables' distribution suggested that the distribution of gestational age and birth weight did not fit the normal distribution, the optimal distribution for them was BCT distribution. The Q-Q plot test and worm plot test suggested that this curve fitted the distribution optimally. The male and female neonatal birth weight curve was developed using the same method.</p><p><b>CONCLUSION</b>Using GAMLSS method to establish nationwide neonatal birth weight curve, and the first time to update the birth weight reference in recent 28 years.</p>
الموضوعات
Female , Humans , Infant, Newborn , Male , Birth Weight , China , Gestational Age , Infant, Low Birth Weightالملخص
Objective To evaluate the clinical application of human serum albumin for inpatients and provide evidence to its rational administration in our hospital .Methods 172 cases were randomly selected from the inpatients that treated with human serum albumin during the period from January to December 2010 by Mei-Kang clinical pharmacy workstation .To get the relating clinical ap-plication information from the choosing cases which were retrospectively analyzed .A comprehensive analysis was performed on age , sex, clinical departments, diagnosis, course of treatment, reasons of use, albumin concentration before using drugs etc.Results Most dosages of human serum albumin were used in the liver and gall surgery (26.1%), mainly for critical patients and cancer , Common individual consumption quantity ranged from 10 to 20 g.Most of patients adopted this drug for hypoproteinemia (38.9%), and most of them had a baseline serum albumin level at 10~30 g/L before using human serum albumin .Conclusion The application of human albumin in our hospital was far from perfect .The principle of effective , safe, economical and rational use of drugs should be adhere to reach the best efficacy application of human albumin .
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AIM:To prepare ophiopogonin enteric microsphere and to carry out the comprehensive evaluation.METHODS:The microsphere was prepared by spray-drying technology,it was evaluated by common index、 enteric index and physical index.RESULTS:Yield was(81.7? 2.1)%,embedding ratio was(86.55? 0.86)%,drug loading was(23.1? 0.2)%.The drug released degree in artificial gastric juice within 2 hours was(9.18? 0.08)%.The drug released rate in artificial intestinal juice within 45 minutes was(73.79? 0.29)%.The equilibrium moisture content decreased from 12.9% to 5.8%.CONCLUSION:An comprehensive evaluation was established.