Value of short-time transcutaneous carbon dioxide and oxygen pressure monitoring in critically ill preterm infants / 中华围产医学杂志

Objective:To investigate the value of short-time transcutaneous carbon dioxide pressure (TcPCO 2) and transcutaneous oxygen pressure (TcPO 2) monitoring in critically ill preterm infants. Methods:From January to December 2018, 62 critically ill neonates receiving respiratory support at Guangzhou Women and Children's Medical Center were retrospectively enrolled. A total of 348 sets of paired data including TcPCO 2/TcPO 2 and arterial carbon dioxide pressure (PaCO 2)/arterial oxygen partial pressure (PaO 2) were analyzed. The patients were divided into different groups based upon birth weight (23 cases>1 000 g-≤1 500 g, 129 sets of paired data; 18 cases≤1 000 g, 130 sets of paired data) and gestational age (16 cases born at ≤28 gestational weeks, 127 sets of paired data; 29 cases born at 28-34 gestational weeks, 159 sets of paired data) and the differences between groups were compared. The correlation and consistency of TcPCO 2/TcPO 2 and PaCO 2/PaO 2 were evaluated using Pearson's correlation and Blan-Altman scatter plots. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic efficacy of TcPCO 2 in neonates with hypercapnia. Results:There was a positive correlation between TcPCO 2 and PaCO 2 in all patients ( r=0.913, 95% CI:0.894-0.929, P<0.05). In patients whose birth weight was>1 000 g-≤1 500 g or≤1 000 g, TcPCO 2 and PaCO 2 were positively correlated and the consistency were good ( r=0.909, 95% CI:0.874-0.935; r=0.934, 95% CI:0.908-0.953; both P<0.05), and the same finding was also observed in patients born at≤28 gestational weeks or 28-34 weeks of gestation ( r=0.938, 95% CI:0.913-0.956; r=0.871, 95% CI: 0.827-0.904; both P<0.05). The sensitivity, specificity and area under curve of TcPCO 2 in the diagnosis of hypercapnia were 90.91%, 85.85%, and 0.942, respectively. There was a poor correlation between TcPO 2 and PaO 2 in all patients and those with birth weight >1 000 g-≤1 500 g or gestational age 28-34 weeks (all r<0.75, all P<0.05). There was no correlation between TcPO 2 and PaO 2 in the birth weight ≤1 000 g and gestational age ≤28 weeks groups (both P>0.05). Conclusions:Short-time TcPCO 2 monitoring can accurately assess PaCO 2 in critically ill neonates requiring respiratory support and is of high diagnostic value for hypercapnia. However, TcPO 2 has limitation in evaluating PaO 2 and other indicators may need to be involved.

Effect and security of minimally invasive surfactant therapy in neonatal respiratory distress syndrome / 中华实用儿科临床杂志

Objective@#To explore the effect and security of minimally invasive surfactant therapy (MIST) in treatment of preterm infants with neonatal respiratory distress syndrome (NRDS).@*Methods@#A total of 48 pretrm infants with gestational ages between 30-36 weeks diagnosed with NRDS in Guangzhou Women and Children′s Medical Center from January 2017 to January 2018 were randomly divided into MIST group (23 cases) and intubation-surfactant-extubation+ continuous positive airway pressure ventilation (INSURE) group (25 cases) by adopting random number table method.The patients in MIST group were put on nasal continuous positive airway pressure (nCPAP) and a thin vascular catheter was inserted through the vocal cords under direct vision with direct laryngoscope then infused pulmonary surfactant(PS) into the lung; the patients in INSURE group were endotracheally intubated and infused with PS into the lung through endotracheal tube with positive airway pressure, then extubated and put on nCPAP again.The incidences of adverse reactions and various complications related to the 2 groups were observed.@*Results@#There were no significant differences between 2 groups in oxygen saturation decrease(26.1% vs.36.0%), bradycardia (13.0% vs.24.0%) and reuse PS (8.7% vs.4.0%) (all P>0.05). There were no significant differences between 2 groups in noninvasive ventilation time [8 d (5.5-12.5 d) vs.7 d(5.0-14.0 d)], total oxygen intake time [12 d(7.0-26.5 d) vs.10 d(10.0-23.0 d)] and length of hospital stay [(34.22±16.06) d vs.(30.88±14.35) d] (all P>0.05). There was no death or intraventricular hemorrhage in both groups, and there were no significant differences between 2 groups in the incidences of pneumothorax (0 vs.4.0%), bronchopulmonary dysplasia (21.7% vs.16.0%), retinopathy of prematurity (21.7% vs.12.0%) and necrotizing enterocolitis (21.7% vs.12.0%) (all P>0.05).@*Conclusions@#MIST technique is a safe and effective method to administrate surfactant in preterm infants with NRDS.In the NRDS patients who do not need intubation and mechanical ventilation, MIST technique can be used to administrate PS.

Changes of electroencephalographic activities during fully automated simultaneous peripheral arteriovenous exchange transfusion in neonates with hyperbilirubinemia / 中华实用儿科临床杂志

Objective To analyze the changes of electroencephalographic activities during fully automated simultaneous peripheral arteriovenous exchange transfusion(ET) in neonates with hyperbilirubinemia.Methods A total of 45 neonates who suffered from severe hyperbilirubinemia and underwent fully automated simultaneous peripheral arteriovenous exchange transfusion were studied from March 2009 to March 2016 in Neonatal Intensive Care Unit of Guangzhou Women and Children's Medical Center,and 46 ETs were performed in 45 babies who were divided into 2 groups according to the severity of hyperbilirubinemia:the encephalopathy group and the none-encephalopathy group.Nineteen patients were in the encephalopathy group,in which 11 were male and 8 were female.The other 26 patients were in the none-encephalopathy group,in which 15 were male and 11 were female.Changes in amplitude integrated electroencephalogram(aEEG) during ETs were analyzed,including background activities,sleep-wake cycle (SWC)and seizures.Results Forty-five patients with hyperbilirubinemia underwent 46 fully automated simultaneous peripheral arteriovenous ETs.As a result,total bilirubin dropped from (524.90 ± 110.96)μmol/L before ETs to (245.62 ±78.97) μmol/L after ETs,with clearance rate of 53.2％.And indirect bilirubin dropped from(486.16 ±90.39) μmol/L before ETs to(222.19 ± 79.49) μmoL/L after ETs,with clearance rate of 54.3％.On the other hand,there was no significant difference in the changes of electroencephalographic activities during ETs,including background activities (x2 =0.16,P ＞ 0.05),SWC (x2 =0.71,P ＞ 0.05) and seizures (x2 =0.30,P ＞ 0.05).However,there were significant difference in suppressions on background activities between the encephalopathy group and the none-encephalopathy group(Fisher's exact test P =0.042),though there were no significant statistical differences in SWC or seizures between the 2 groups (x2 =0.65,P ＞ 0.05;x2 =2.07,P ＞ 0.05,respectively).Conclusions In neonatal hyperbilirubinemia,fully automated simultaneous peripheral arteriovenous ET is safe and efficient without significant influence on electroencephalographic activities as a whole.However,background activities are more significantly depressed in infants of bilirubin encephalopathy than that of non-encephalopathy during ET.

Clinical analysis of neonatal purulent meningitis caused by group B streptococcus / 中国小儿急救医学

Objective To explore the clinical characteristics and outcome of group B streptococcus (GBS) induced neonatal meningitis and to provide the guide for early diagnosis and appropriate treatment.Methods A retrospective chart review was performed.A total of 19 cases of neonatal purulent meningitis caused by GBS and 22 cases of neonatal purulent meningitis caused by Escherichia coli were identified in the NICU of Guangzhou Women and Children's Medical Center from Nov 1,2011 to Apr 31,2014.The clinical features,treatments and clinical turnover were analysed.Results GBS meningitis accounted for 24.7％ (19/77) of total bacterial positive cultures of blood or cerebral spinal fluid.The average time of progression to early-onset GBS meningitis of 6 early-onset cases mainly complaining of anhelation and groan,was (11.80 ± 11.34)h,and 83.3％ present within 24 hours;the main initial clinical symptoms of 13 late-onset cases[mean age (17.85 ± 7.77) d] were fever.Peripheral blood C-reactive protein concentration of GBS meningitis was significantly higher than that of Escherichia coli meningitis [(154.43 ± 88.64) mg/L vs.(67.52 ± 64.23) mg/L,P =0.001].Compared with Escherichia coli meningitis,the average length of stay in hospital and the recovery time of abnormal cerebral spinal fluid in neonates with GBS infection were both extended by more than 10 days.Conclusion The clinical manifestations of neonatal purulent meningitis caused by GBS are usually non-specific.It is associated with longer hospitalization and recovery time of abnormal cerebral spinal fluid.Antepartum prophylaxis,early diagnosis and therapy are vital for reducing the incidence of complications and mortality of neonatal GBS purulent meningitis.

Changes of the electroencephalographic background in preterm infants before and after instillation of pulmonary surfactant in different ways / 中华实用儿科临床杂志

Objective To monitor the electroencephalographic background activities of preterm infants before and after using pulmonary surfactant (PS),so as to investigate an appropriate way to endotracheally instill PS through the changes of electroencephalographic background activities.Methods Thirty-five preterm infants who were hospitalized in Neonatal Intensive Care Unit of Guangzhou Women and Children's Medical Center from Jun.2011 to Apr.2013 and treated with PS were involved.They were divided into the normal pressure group and the high pressure group,based on the peak inspiratory pressure when PS instilled.The electroencephalographic background activities of the preterm infants before using PS and 15 min,30 min,60 min and 120 min after using PS were monitored continuously by using cerebral function monitor.The changes of 2 groups were compared.Oxygen saturation and heart rate were recorded at the same time.Results 1.In normal pressure group,lower amplitude decreased and the duration of interburst interval (IBI) increased 15 min after instillation of PS compared with before using PS(t =-6.012,5.202,all P ＜0.05).However,there was no significant difference in the high pressure group(t =-0.025,0.936,all P ＞ 0.05).There were significant differences between the 2 groups(t =-4.832,4.029,all P ＜ 0.05).Thirty minutes later,lower amplitude and IBI didn't recover in the normal pressure group(t =-3.473,2.474,all P ＜0.05).At the same time,no changes in high pressure group(t =-0.019,0.063,all P ＞ 0.05).Between the 2 groups,there were significant differences in lower amplitude(t =-2.828,P ＜0.05),but no difference on IBI(t =1.715,P ＞0.05).Lower amplitude and IBI of the normal pressure group returned to the level before using PS at 60 min and 120 min after using PS(lower amplitude:t =0.557,1.849,all P ＜ 0.05,IBI:t =0.836,0.121,all P ＞ 0.05).Moreover,in the high pressure group,lower amplitude even increased at 60 min and 120 min after using PS (t =2.153,3.112,all P ＜ 0.05).2.After using PS,desaturation happened in 8 preterm infants of the normal pressure group and 2 preterm infants of the high pressure group.There was significant difference between the 2 groups(P =0.025).3.Bradycardia accompanied with desaturation happened in 2 preterm infants of the normal pressure group,but none in the high pressure group.Conclusions Instillation of PS may cause embolism and obstruct the airway,which may induce hypoxia,and then lead to the depression of the electroencephalographic background.Therefore,when instilling PS,giving high pressure can shorten or avoid the hypoxia episode,and make PS reach alveoli as soon as possible to play a role in lung compliance.

Clinical analysis of 17 cases of neonatal Kasabach-Merritt syndrome / 国际儿科学杂志

Objective To summarize the clinical characteristics and therapeutic approaches of Kasabach-Merritt syndrome (KMS).Methods The data from 17 KMS patients that had been definitely diagnosed from December,2007 to January,2012 in our tertiary center were collected retrospectively.Results We described 17 patients,13 of whom were male and 4 of whom were female,with an age range of 17 hours to 28 days.Of the 17 cases,4 cases had hemangioma of internal organs,13 on the surface of the body.All of them had thrombocytopenia and coagulation dysfunction.Seventeen cases were initially treated with corticosteroids.The responses were varied:excellent and rapid improvement (n =6),failure (n =11),recurrence (n =3).Then the cases of failure and recurrence accepted artery embolization:excellent and rapid improvement (n =8),failure (n =4),recurrence (n =1),with 1 giving up.At last,the cases resistant to artery embolization therapy accepted vincristine therapy.Four cases had rapid improvement,and 1 died from disseminated intravascular coagulation.In this study,a response rate to corticosteroids was 35.3％,and the recurrent rate was 50％.The response rate to artery embolization was 61.5％.Five patients unresponsive to hormone therapy and artery embolism were treated with vincristine,and the effective rate was 80％.Conclusion In the therapy of neonatal KMS,the resistant to corticosteroids is common.Combinative therapy of corticosteroids with artery embolization is recommended as the first-line therapy.Vincristine is suggested as a therapy when there is resistance to the other therapy.