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Objective:To investigate the application of extracorporeal membrane oxygenation(ECMO)bridging heart transplantation in critically ill children.Methods:The clinical data of two cases of critical infants with venous-arterial ECMO(VA-ECMO)bridging heart transplantation and literature review were retrospectively analyzed.Results:Two cases received orthotopic heart allograft with VA-ECMO support, and were discharged uneventfully without significant postoperative complications.On the 13th day of ECMO assistance, the first child was treated with orthotopic heart transplantation in a hospital qualified for heart transplantation, and the ECMO was evacuated during the operation.After 21 days of the heart transplantation, the patient was discharged from the hospital.The patient was followed up to be healthy after heart transplantation, and had the same development as children of the same age, and had been taking anti-rejection drugs for a long time.On the 10th day of VA-ECMO treatment, the second case received awake ECMO after cardiac function improved.On the 12th day of VA-ECMO treatment, the patient was successfully evacuated from VA-ECMO and waited for heart transplantation.Cardiac orthotopic transplantation was performed after the 17 days after VA-ECMO evacuation.The patient was transferred to the general ward after 6 days of hospitalization in the intensive care unit, and was discharged 23 days after transplantation with conventional anti-rejection therapy.Discharge follow-up in good health, normal school life.Conclusion:When VA-ECMO cannot be withdrawn from the heart of the critically ill children and the end-stage heart, VA-ECMO bridging heart transplantation should be selected at the right time for the children who meet the indications for heart transplantation to create survival opportunity for the previously hopeless children, save the life of the end-stage children, and improve the quality of life.
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Extremely preterm infants (EPIs) are extremely immature in organ development, vulnerable to various comorbidities after birth, and may result in high mortality and disability rates. The short- and long-term prognosis of EPIs is closely related to early management. In-depth collaboration between obstetricians and pediatricians is the key to improving their quality of life. Compared to developed countries, there is much to improve in the Chinese mainland, especially in perinatal collaboration. The attitude towards EPI treatment, prenatal prophylaxis, intrauterine transport, delivery room warmth, respiratory management in the delivery room, breastfeeding, family integrated care, cord blood stem cell therapy, and other issues in the field of perinatal collaboration in China is discussed in this article, to promote the collaborative work in related fields further.
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Objective:To summarize the experience of transthoracic epicardial insertion pacemaker for isolated congenital third-degree atrioventricular block (CAVB), and explore the necessity and feasibility of permanent pacemaker in the treatment of CAVB in neonates and infants.Methods:The clinical data and follow-up of four children with CAVB admitted to the Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital from September 2010 to February 2022 were analyzed retrospectively.Two patients were implanted with permanent cardiac pacemakers during an early stage (less than one year old), and two patients were implanted during the non-early stage (one year old and above). All patients were diagnosed based on clinical symptoms, electrocardiogram and echocardiographic examination.After treatment, the pacing threshold, atrial sensing function, clinical symptoms, electrocardiogram and echocardiography examination of four patients were followed up.Results:All patients were successfully implanted with permanent cardiac pacemakers.One patient of non-early implantation was died of severe pneumonia and sepsis.During the follow-up period, pacing threshold, amplitude, impedance, minute ventilation and sensor function indicated pacemakers worked well in other three patients.Heart rates in these patients were significantly recovered, and showed growth trends in line with percentile curves for Chinese children and good movement skills.Conclusion:A pacemaker implantation performed by an experienced operator is a safe and feasible treatment for children with CAVB diagnosed in neonates and infants period with good prognosis.
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Objective:To investigate the attitude of neonatologists toward the treatment of extremely preterm infants (EPIs) in China.Methods:A cross-sectional survey was conducted using a questionnaire designed and posted on Wenjuanxing, a web-based survey platform, from June to July 2021. The respondents were neonatal physicians in various provinces and cities in China. The questionnaire covered the basic information, treatment experience and attitude towards EPIs, and opinions on the current definition of the preterm infant in China. The results were described or analyzed using the Chi-square test.Results:A total of 1 066 valid replies were collected. The respondents included 322 males and 744 females, among whom 78.1% (832/1 066) were assistant director physicians or director physicians, 82.8% (882/1 066) were from tertiary hospitals, and 83.0% (885/1 066) had the experiences of treating EPIs. In terms of the attitude toward the treatment of EPIs, 63.0% (672/1 066) of the respondents suggested that the lower limit of gestational age for EPIs requiring active resuscitation should be defined at 25 gestational weeks or less. Moreover, 57.1% (609/1 066) considered that the current domestic definition of preterm infants as 28 gestational age or above was inappropriate, and 75.2% (458/609) considered that the lower limit defined as preterm infants should be 25 gestational weeks or less. Concerning the treatment experience in EPIs, 54.3% (579/1 066) of the respondents suggested that in their hospital, withdrawing treatment in EPIs was common or very common, and 83.3% (888/1 066) considered that the main reason for withdrawing treatment was family members' concerns about the prognosis. Those who hesitated about treating the EPIs accounted for 71.6% (763/1 066), and 83.9% (640/763) hesitated due to the poor prognosis and possible medical disputes. Moreover, 32.7% (349/1 066) of the respondents or their colleagues had been involved in medical disputes about whether to treat EPIs, and 74.8% (797/1 066) believed that the patients should be the decision-maker on whether to treat EPIs or not.Conclusion:Most neonatal physicians in this survey hold a positive attitude toward the treatment of EPIs and believe that the lower limit of gestational age for preterm infants should be lowered. However, a hesitating attitude to the care of EPIs is still common, and uncertainty about the prognosis of EPIs remains a concern.
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Bronchopulmonary dysplasia (BPD) is a disease that affects the prognosis and long-term life quality of preterm infants after discharge. The definition of BPD has constantly changed with the advances in knowledge and treatment techniques. However, the morbidity of BPD varies in different countries and areas due to the heterogeneity of the diagnostic standard, which greatly hindered the research process of clinical trials of drugs. Therefore, we should revisit the definition of BPD. It is urgent to make a consensus on the diagnostic standard of BPD so that the therapy will be targeted appropriately and iatrogenic injury can also be avoided.
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Extremely premature infants with <28 weeks of gestational age are at higher risk of various complications after birth and have higher mortality and disability rate due to the extremely immature organs. In recent years, with the rapid development of the perinatal medical system and related therapeutic technology, extremely preterm infants' short- and long-term prognosis has been significantly improved. Since the new century, with the rapid social and economic development, the number of treated extremely premature infants and its survival rate in China has also significantly increased. However, compared with the developed countries, the gap still exists. Here we outline the current situation of the management of extremely premature infants in China and abroad and the challenges we faced.
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Objective:To investigate the expression of nicotinamide adenine dinucleotide (NAD +) digestive enzyme CD38 in normal and endotoxin-tolerant human monocyte THP-1 cell lines treated with lipopolysaccharide (LPS). Methods:(1) Normal THP-1 cells: The experiment and control group were treated with 100 ng/ml LPS for 1, 3, 6, 12 and 24 h or phosphate buffer for 24 h, respectively. Quantitative polymerase chain reaction (PCR) and Western blot were used to measure the expression of interleukin-6 (IL-6) and tumor necrosis factor (TNF) mRNA, CD38 mRNA and protein. (2) The induced endotoxin-tolerant THP-1 cells: ①The model of endotoxin-tolerant cells was established firstly by treating the THP-1 cells with 100 ng/ml LPS for 24 h. THP-1 cells treated with phosphate buffer were set as blank group. After further stimulating the two groups with LPS (100 ng/ml) for 3 h, mRNA levels of IL-6 and TNF were measured by quantitative PCR to determine whether the modeling was successful or not. ②In addition, the expression of CD38 mRNA were detected by quantitative PCR before and 12 h after LPS stimulation, and the expression of CD38 protein of these two groups were detected by western blotting before and 1, 6 h after LPS stimulation. Two independent samples t-test and repeated measurement analysis of variance were used for statistical analysis. Results:(1) In normal THP-1 cells, the mRNA expression levels of IL-6 and TNF in the LPS-stimulated cells were significantly higher than those of the control at all time points. And a higher expression level of CD38 mRNA and protein was observed in LPS-stimulated cells from 3 to 24 h compared with the control (mRNA at 3 h: 2.27±0.03 vs 1.00±0.18; protein at 3 h: 1.47±0.14 vs 1.00±0.16, both P<0.05). (2) Endotoxin-tolerant THP-1 cells: ①IL-6 and TNF mRNA levels in the model group were significantly lower than those in the blank group (both P<0.05), indicating that the endotoxin-tolerant THP-1 cell model was established successfully. ②Compared with the same points in the blank group, CD38 mRNA expression was upregulated in the model group before stimulating by LPS (14.18±1.19 vs 1.00±0.13, t=19.007) and 12 h after LPS stimulation (28.33±3.98 vs 7.61±0.88, t=8.803). Moreover, CD38 protein levels before stimulating by LPS (1.54±0.06 vs 1.00±0.10, t=7.796) and 1 h (1.59±0.09 vs 1.07±0.17, t=4.721), 6 h after LPS stimulation (2.48±0.09 vs 1.43±0.12, t=12.233) in the model group were all higher than those in the control group (all P<0.05). The intra-group comparison showed that in the model group the levels of CD38 mRNA at 12 h and CD38 protein at 6 h after LPS stimulation were significantly higher than those before (both P< 0.05). Conclusions:In both normal and endotoxin-tolerant THP-1 cells, LPS upregulates the expression of CD38, which is an NAD + digestive enzyme, and an indirect indicator of NAD + level in monocyte reinfection at the stage of immunosuppression. This study provides a preliminary reference for further investigation on the applicability of CD38 as a potential biological marker in the clinical diagnosis of neonatal sepsis.
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The Montreux definition established in 2017 made it clear that the neonates can not be excluded from the diagnosis of acute respiratory distress syndrome (ARDS), which supported the urge of emphasizing the specificity and importance of neonatal ARDS (nARDS) in the past ten years in China. Neonatal idiopathic respiratory distress syndrome is caused primarily by insufficient pulmonary surfactant system, which pathologically and clinically presented as typical respiratory distress syndrome. While the causes of nARDS often coexisted with underlying conditions, and its pathological and clinical features are a superposition of both respiratory distress syndrome and underlying conditions. Therefore, superimposition is the key to understanding the etiology, pathology, diagnosis, and treatment of nARDS, which is crucial for optimizing the clinical practice of nARDS.
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This article reviews the present situation, progress, challenges, and the future developments for the screening and diagnosis of inherited metabolic disease (IMD) in both domestic and abroad in clinical practice, aiming to improve the screening and diagnosis system of IMD in China and to provide a reference for clinicians to increase the diagnosis and cure rate of treatable IMD, and promote the development of this field.
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Extracorporeal membrane oxygenation(ECMO)is more and more widely used in children as a supporting technology for cardiopulmonary organ failure, but bleeding and thrombus are still the most common and serious complications during the use of ECMO.Heparin is the most commonly used anticoagulant in children with ECMO.Activated clotting time, activated partial thromboplastin time, and anti-Ⅹa activity are often monitored to guide the dosage of heparin.However, the optimal dosage of heparin and the appropriate monitoring method are still unclear.This study aimed to summarize the research progress of anticoagulation and monitoring methods in children′s ECMO.
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Objective:To detect the genes of common genetic diseases in newborns with the high-throughput sequencing technology based on target gene capture, to study the incidence rate of such diseases, the carrying rate and variant types of pathogenic mutations related to such diseases, and to explore the application value of the high-throughput sequencing technology in screening genetic diseases of newborns.Methods:The heel blood of 1 793 newborns born in Guangdong province from June 2019 to April 2020 were collected, and the exon regions of 138 common genetic disease-related genes in neonates were detected using the high-throughput sequencing technology based on target gene capture.The pathogenicity of the mutations was interpreted according to the " Classification Criteria and Guidelines for Genetic Variation(2017)" , in which known disease and probable disease were considered as positive mutations.The positive mutations were verified by Sanger sequencing technology, and the test results were analyzed with statistical methods.Results:Among the 1 793 newborns, 978 were male and 815 were female.A total of 158 positive cases were screened(8.81%), and 11 positive diseases were detected.Among the positive diseases, there were 41 cases(2.29%)of autosomal recessive deafness type 1A, 40 cases(2.23%)of Gilbert syndrome or Crigler-Najjar syndrome, and 33 cases(1.84%)of glucose-6-phosphate dehydrogenase deficiency(1.84%), 19 cases(1.06%)of familial hypercho-lesterolemia, 18 cases(1.00%) of sodium taurocholate cotransporter peptide deficiency disease, 2 cases(0.11%)of mitochondrial non-syndromic deafness, 2 cases(0.11%)of Citrin deficiency, 1 case(0.06%)of holocarboxylase synthase deficiency, 1 case(0.06%)of β-thalassemia and 1 case(0.06%)of metachromatic leukodystrophies.Of all studied cases, 972 carried one or more positive mutations, involving 85 kinds of diseases in total.The diseases with a high carrying rate were Gilbert syndrome or Crigler-Najjar syndrome(359 cases, 20.02%), autosomal recessive deafness type 1A(302 cases, 16.84%), and sodium taurocholate cotransport peptide deficiency disease(291 cases, 16.22%). The high-frequency mutation sites were UGT1A1 gene c. 211G> A, GJB2 gene c .109G> A and SLC10A1 gene c. 800C> T. Conclusions:The common genetic diseases detected in neonates from Guangdong province are autosomal recessive deafness type 1A, Gilbert syndrome or Crigler-Najjar syndrome, glucose-6-phosphate dehydrogenase deficiency, familial hypercholesterolemia, and sodium taurocholate cotransport peptide deficiency.There are high-frequency carrying mutation sites in the population.Preliminary genetic screening of common neonatal genetic diseases can accumulate data and experience for the development of newborn genetic screening.
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Novel Coronavirus Pneumonia (NCP) is a class B infectious disease, which is prevented and controlled according to class A infectious diseases.Recently, children′s NCP cases have gradually increased, and children′s fever outpatient department has become the first strategic pass to stop the epidemic.Strengthening the management of the fever diagnosis process is very important for early detection of suspected children, early isolation, early treatment and prevention of cross-infection.This article proposes prevention and control strategies for fever diagnosis, optimizes processes, prevents cross-infection, health protection and disinfection of medical staff, based on the relevant diagnosis, treatment, prevention and control programs of the National Health and Health Commission and on the diagnosis and treatment experience of experts in various provinces and cities.The present guidance summarizes current strategies on pre-diagnosis; triage, diagnosis, treatment, and prevention of 2019-nCoV infection in common fever, suspected and confirmed children, which provide practical suggestions on strengthening the management processes of children′s fever in outpatient department during the novel coronavirus pneumonia epidemic period.
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Objective:To investigate the protective effects of bovine lactoferrin (bLF) supplementation on intestinal mucosal tissue and its influence on of inflammatory factors in the premature rats model of necrotizing enterocolitis(NEC), and to provide the theoretical basis for prevention of NEC by bLF supplementation.Methods:Premature SD rats were randomly divided into 4 groups, 25 cases in each group.Control group: oral feeding; model group : oral feeding with lipopolysaccharides(LPS) gavage + hypoxic stimulation; high dose bLF intervention group: daily bLF (7 g/L) + oral feeding with LPS gavage + hypoxic stimulation; low dose bLF intervention group: daily bLF (2 g/L) + oral feeding with LPS gavage + hypoxic stimulation.Histopathological analysis was performed by HE staining.The expression levels of interleukin-1β(IL-1β)and interleukin-6(IL-6)in intestinal mucosa were detected by enzyme linked immunosorbent assay (ELISA).Results:(1) Morphological observation: the intestinal wall of model group was thin, and there were different degrees of pneumoconiosis and effusion in intestinal cavity.Under the microscopy, it could be observed that the intestinal tissue necrosis was serious, the intestinal villi fell off, glands arranged disorderly, epithelial edema was significant, the lamina propria and submucosa had severely edema and were separated, and there were a large number of inflammatory cells infiltrated.The above-mentioned manifestations were alleviated in the high-dose and low-dose bLF intervention groups, and no significant abnormalities were found in the control group.(2) The expression of IL-1β and IL-6 in intestinal tissue: the tissue concentration of IL-1β and IL-6 in the model group rats [(380.89±20.25) ng/L, (485.12±31.44) ng/L]were significantly higher than those in the control group[(270.69±45.58) ng/L, (212.62±89.46) ng/L]( q =9.785, 14.030, all P<0.01). The expression of IL-1β and IL-6 in mucosal tissue of ileum was significantly inhibited in hypoxic and LPS-stimulated rats fed with bLF(IL-1β: q=9.105, 8.761, all P<0.01; IL-6: q=8.175, 8.996, all P<0.01). There was no significant difference in the expression of IL-1β and IL-6 between high dose bLF(7 g/L) and low dose bLF (2 g/L) inter vention groups (IL-1β: q=-0.084, P>0.05; IL-6: q=-1.140, P>0.05). Conclusion:Enteral bLF supplementation can alleviate the damage of intestinal tissue in NEC model of premature SD rats, inhibit the expression of IL-1β and IL-6 inflammatory factors in intestinal tissue, and have a protective effect on intestinal tissue.
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Novel Coronavirus Pneumonia (NCP) is a class B infectious disease, which is prevented and controlled according to class A infectious diseases. Recently, children′s NCP cases have gradually increased, and children′s fever outpatient department has become the first strategic pass to stop the epidemic. Strengthening the management of the fever diagnosis process is very important for early detection of suspected children, early isolation, early treatment and prevention of cross-infection. This article proposes prevention and control strategies for fever diagnosis, optimizes processes, prevents cross-infection, health protection and disinfection of medical staff, based on the relevant diagnosis, treatment, prevention and control programs of the National Health and Health Commission and on the diagnosis and treatment experience of experts in various provinces and cities. The present guidance summarizes current strategies on pre-diagnosis; triage, diagnosis, treatment, and prevention of 2019-nCoV infection in common fever, suspected and confirmed children, which provide practical suggestions on strengthening the management processes of children′s fever in outpatient department during the novel coronavirus pneumonia epidemic period.
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Extremely premature infants(EPI), especially those under 25 weeks of gestational age, are difficult to manage clinically and have high mortality and disability rates.It is difficult to solve the bottleneck problem fundamentally in the treatment of EPI.Artificial placenta is a fascinating alternative therapy for neonatal lung failure and is expected to maintain the normal development of EPI after delivery.This article briefly introduces the research history, current situation, difficulties to be overcome and future prospects of artificial placenta.
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Pediatric acute respiratory distress syndrome (PARDS) is the most leading cause of death in Pediatric Intensive Care Unit.PARDS can be classified as mild, moderate, and severe according to the oxygenation index.In recent years, because of the application of lung protection ventilation strategy, the outcome of PARDS has been greatly improved, but the mortality of severe PARDS still remains high.Therefore, it is of great clinical significance to understand the definition, diagnosis, and the application of lung protective ventilation strategy and the application of extracorporeal membrane oxygenation in severe PARDS.
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Objective@#To study the threshold values of lactic acid (Lac)and buffuer excess (BE) when neonatal umbilical arterial blood gas is at pH <7.20.@*Methods@#A total of 2 518 pregnant women admitted in Beijing New Century Women and Children′s Hospital from January 2017 to February 2019 were enrolled.The general conditions in perinatal period and labor methods were counted.Umbilical cord arterial blood was immediately collected before the first cry of newborn and was detected on the Abbott I-STAT automatic blood gas analyzer from the United States, and then the umbilical arterial blood gas was measured.We analyzed the perinatal factors affecting umbilical arterial blood gas.We studied the threshold values of Lac and BE for neonal asphyxia by receiver operating characteristic curve.@*Results@#(1)Maternal anemia, Streptococcus agalactiae infection, precipitate labour, placenta abnormalities had no significant impact on neonatal umbilical artery blood gas.The Lac value in blood gas was higher in the group of premature rupture of fetal membranes and fetal intrauterine distress.The value of BE was lower in the group with premature rupture of fetal membranes and fetal distress (P<0.05). The Lac value in cesarean section group was the lowest[(1.79±1.25) mmol/L], while that in midwifery group was the highest[(4.45±1.58) mmol/L]. pH value was the lowest (7.25±0.07) in the midwifery group and the highest (7.31±0.06) in the cesarean section group.The value of BE was the lowest in the midwifery group[-(5.66±2.52) mmol/L], and the highest in the cesarean section group[-(2.99±2.28) mmol/L], with statistically significant differences among the three groups (P<0.05). (2) Multiple linear regression analysis showed that fetal delivery mode, fetal intrauterine distress, premature rupture of membranes, and gestational diabetes were the factors affecting Lac level in umbilical artery blood gas of newborns.Methods of delivery, intrauterine distress, premature rupture of membranes and placental abnormalities were the factors that affected the BE value of umbilical artery blood gas in newborns.(3) A total of 199 cases with pH value <7.2 were diagnosed as asphyxia, and the receiver operating characteristic curve of Lac and BE values of neonatal umbilical artery blood gas for the diagnosis of asphyxia was drawn.When Lac was >3.97 mmol/L, the sensitivity and specificity of the diagnosis of asphyxia were 0.864 and 0.791, respectively.When BE was ≤-6 mmol/L, the diagnostic sensitivity and specificity of asphyxia were 0.613 and 0.756, respectively.@*Conclusion@#Neonatal umbilical arterial blood gas is affected by many factors.The effect of accouche on umbilical arterial blood gas is large.When there is asphyxia with pH <7.2, the cut points of Lac and BE are >3.97 mmol/L and ≤-6 mmol/L, respectively.
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Objective@#To investigate the effects of neonatal intensive care unit (NICU)-centered regional neonatal transport network (NTN) on the treatment of retinopathy of prematurity (ROP).@*Methods@#A retrospective analysis was conducted to analyze the transfer, treatment and outcomes of 406 preterm infants with ROP who were transferred to the Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital via the NTN from July 2008 to December 2014. Independent sample t-test, Chi-square test and Mann-Whitney nonparametric test were used for statistical analysis.@*Results@#Among the 406 premature infants who were transferred to our hospital because of ROP, there were 257 males and 149 females with the gestational age of (29.5±1.9) weeks (24+5-36 weeks) and the birth weight of (1 234.8± 268.9) g (580-2 400 g). The age at transfer was (48.9±18.5) d (15-78 d) and the transport distance was (216.5±78.6) km (10-625 km). No death was reported during the transportation. Very preterm births and very low birth weight infants (VLBWI) accounted for 88.7% (360 cases) and 82.5% (335 cases), respectively. Lesions occurred in 1, 2 and 3 zones were detected in 98 (24.1%), 286 (70.4%) and 22 (5.4%) cases, respectively. Lesions of stage 1-5 were observed in 51 (12.6%), 156 (38.4%), 183 (45.1%), 12 (3.0%) and 4 (1.0%) cases. There were 186 cases (45.8%) with Plus lesions. A total of 252 cases (62.1%) underwent surgery which were achieving treatment standards, including 165 (65.5%) undergoing laser therapy, 93 (36.9%) receiving anti-vascular endothelial growth factor (VEGF) therapy, 16 (6.4%) having vitrectomy and two (0.8%) having scleral buckling. Eighteen infants were diagnosed with retinal structural abnormalities, among which 16 had retinal detachment before admission (12 in phase 4 and four in phase 5). Two without retinal detachment on admission developed to phase 4 after surgery. The incidence of retinal structural dysplasia was 0.9% (2/236) in infants receiving laser and/or anti-VEGF therapy in our hospital. Compared with the cured patients (n=234), those with retinal structural dysplasia (n=18) had a late transfer time [80 (38-270) vs 50 (19-150) d, Z=3.387, P<0.001].@*Conclusions@#The NICU-centered and regional transfer-based ROP treatment network provides timely and effective treatment for infants with ROP.
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Objective@#To investigate application and safety of pediatric interfacility-transport with extracorporeal membrane oxygenation (ECMO) in China.@*Methods@#The data of 48 patients transported inter-hospital from February 2016 to May 2018 were collected from the following 4 centers: pediatric intensive care unit (PICU) of Bayi Children′s Hospital Affiliated to the 7th Medical Center of PLA General Hospital, Pediatric Hospital of Fudan University, Henan Provincial People′s Hospital and Children′s Hospital of Zhejiang University School of Medicine. The data of patients′ characteristics, ECMO mode and wean rate, and mortality were reviewed, which was further compared with the data of 57 compatible inner-hospital ECMO cases with t test, Rank sum test or chi-square test.@*Results@#All the 48 interfacility-transports were accomplished by ambulance on land, with an average transfer distance of (435±422) km. The incidence of ECMO complications was 13% (6 case), without death. There were no significant differences in lactic acid, PaO2 or SaO2 before and after transport (4.0 (2.0, 7.5) vs. 3.0 (1.5, 6.0) mmol/L, Z=-1.579, P>0.05; 112(47, 405) vs. 166(122, 240) mmHg (1 mmHg=0.133 kPa), Z=-0.104, P>0.05; 0.97±0.02 vs. 0.96±0.03, t=1.570, P>0.05). Instead, PaCO2 and pH were significantly different ((47±8) vs. (42±5) mmHg, t=2.687, P<0.05; 7.3±0.2 vs. 7.5±0.2, t=3.379, P<0.05). The total ECMO weaned rate was 73% (35/48) and the survival rate was 67% (32/48). No significant differences in demographic characteristics, ECMO mode or duration, transport distance or duration, or complications existed between the survival group and the death group (7/25 vs. 2/14, χ2=0.615, P>0.05; 4/28 vs. 2/14, χ2=0, P>0.05; (405±404) vs. (493±465) km, t=0.525, P>0.05; (5±4) vs. (5±5) h, t=0.388, P>0.05; 166 (128, 239) vs. 187(52, 405) h, Z=-0.104, P>0.05; 3/32 vs. 3/16, χ2=0.734, P>0.05). The lowest lactate value in survival group before ECMO transport was significantly lower than that in the death group ((5±5) vs. (8±6) mmol/L, t=2.151, P<0.05). There were neither significant differences in age, ECMO mode or support pattern (9/39 vs. 15/42, χ2=0.845, P>0.05; 6/42 vs. 7/50, χ2=0.001, P>0.05; 29/19 vs. 38/19, χ2=0.441, P>0.05), nor in ECMO weaned rate, survival rate or complications between interfacility-transport group and inner-hospital group (35/48 vs. 37/57, χ2=0.775, P>0.05; 32/48 vs. 35/57, χ2=0.313, P>0.05; 20/48 vs. 22/57, χ2=0.102, P>0.05).@*Conclusion@#With appropriate transport equipment and mature teams who handle problems timely during the transport, critically ill children could be safely transported to the destination with ECMO.
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Objective To study the clinical features of early-onset Group B streptococcal(GBS) sepsis to improve the management of early-onset GBS sepsis.Method To review the clinical data of 27 cases of early-onset GBS sepsis in the Hospital over the past 5 years (January 2013 to November 2017),and analyze its clinical features,laboratory results,complications,prognosis and perinatal characteristics.Result A total of 27 cases of early-onset GBS sepsis were enrolled within 5 years,accounting for 0.85‰ (27/31 936) of total hospitalized patients over the same period.Among them,6 were premature infants and 21 full-term infants.The time of onset was within 24 hours.In all the cases,except for one full-term infant with fever as the initial symptom,the remainder had dyspnea as the initial symptom,accompanied by poor response and low poor muscle tone.Among them,17 patients required assisted ventilation.One of the full-term infant treated with ECMO within 48 hours after birth because of dyspnea,pulmonary hypertension and persistent hypoxemia,etc.,and improved and discharged;another 10 patients needed hood oxygen supply.5 cases (18.5％,5/27) diagnosed with purulent meningitis.In complete blood count,white blood cells ranged from (0.8～34.2)× 109/L,the minimum platelets counts was 16× 109/L,the maximum CRP was 249 mg/L,and maximum procalcitonin was＞ 100 ng/ml.All blood cultures were sensitive to penicillin.of the 27 patients,2 died despite of medical treatment,and 5 patients died as their parents worried about possible sequelae and discharged against medical advice.Therefore,tlhe total mortality rate was 25.9％ (7/27).All children were administered penicillin after the blood culture results were known,meropenem was subsequently added or replaced with vancomycin according to the clinical progress of the child.The remaining 20 patients recovered and discharged.Conclusion The clinical manifestation of early onset GBS septicemia is critically ill,with early onset,rapid progress,and high mortality.Special attention should be paid to high-risk cases during perinatal period,and early recognition with effective treatment would reduce morbidity and mortality.