الملخص
Objective To establish a Nomogram predictive model for Neonatal Sepsis(NS)based on the general characteristics and initial complete blood count of neonates.Methods Retrospective analysis was conducted on the clinical data of newborns who were admitted for the first time to NICU and completed blood routine examination after admission in the MIMIC Ⅲ database.The LASSO-Logistic regression was used to investigate the prediction factors of NS,and then Nomogram prediction model was established.Internal validation was performed using boot-strap resampling with 1000 iterations.External validation of the model was performed using the data from newborns admitted to the First Affiliated Hospital of Zhengzhou University.We evaluated the predictive performance by Area Under the Receiver Operating Characteristic Curve(AUROC),C-index,calibration curve,and decision curve analysis(DCA).Results Among the 3,001 neonates,185 were diagnosed with NS.The Nomogram model was con-structed based on indicators such as respiratory distress syndrome,gestational age,birthweight,and initial hemato-logical parameters(red blood cell count,white blood cell count,lymphocyte percentage,neutrophil percentage),exhibiting good predictive performance with an AUROC of 0.860.Satisfactory predictive abilities were confirmed through both internal and external validation.Conclusion This study developed and validated a well-performing Nomogram prediction model.With simple parameters,it can help clinicians identify newborns at high risk early.
الملخص
Objective:Extracorporeal carbon dioxide removal(ECCO 2R) is a technique that aims to decarboxylate the blood and thus to correct hypercapnia and respiratory acidosis in acute respiratory failure, but is rarely used in children.We successfully completed the ECCO 2R treatment for a pediatric case with adenovirus pneumonia, severe acute respiratory distress syndrome(ARDS) and hypercapnia in PICU, which provided clinical references for the use of ECCO 2R in acute respiratory failure for children. Methods:A patient with adenovirus pneumonia and severe ARDS was successfully treated with ECCO 2R-continuous renal replacement therapy(CRRT)combined system after weaning from extracorporeal membrane oxygenation(ECMO). We reported the treatment process, ECCO 2R treatment effect and side effects, so as to provide clinical reference for ECCO 2R treatment of children with ARDS. Results:One-year and four-month-old boy was treated with mechanical ventilation and venous-arterial ECMO due to adenovirus pneumonia and severe ARDS.After ECMO treatment for 25 days, he developed severe hypercapnia after weaning from ECMO.ECCO 2R was initiated.The pH value increased by 11.2%(from 7.222 to 7.303) 1 hour after ECCO 2R treatment, partial pressure of blood carbon dioxide(PCO 2)decreased by 29.1%(from 72.6 mmHg to 51.5 mmHg, 1 mmHg=0.133 kPa) and the average airway pressure of high-frequency ventilation decreased by 5 cmH 2O(from 20 cmH 2O to 15 cmH 2O, 1 cmH 2O=0.098 kPa) after 6 hours of ECCO 2R.The CO 2 removal rate of ECCO 2R system was 29.1 mL/min.It was stopped because of ECCO 2R-membrane clotting after 72 h. There was no increase of PCO 2.Extubation was successfully after undergoing invasive mechanical ventilation for 39 days and with noninvasive ventilation for 5 days.The boy was hospitalized in PICU for 54 days, improved and discharged from the hospital.Followed up for 2 years after discharge, the growth and development were good, but the strenuous exercise endurance was still poor. Conclusion:ECCO 2R is effective in improving gas exchange, reducing PCO 2 and lowering ventilator pressure in children with ARDS and hypercapnia, which allow more protective ventilation.ECCO 2R provide transitional treatment for ECMO weaning and provide meaningful clinical reference for the use of ECCO 2R as part of respiratory support in children with respiratory failure.