Effect of strengthening nosocomial infection control on distribution of pathogenic bacteria in hospital during coronavirus disease 2019 epidemic / 第二军医大学学报

Objective To explore the effect of strengthening nosocomial infection control measures on reducing the distribution of pathogenic bacteria in hospital environment during the outbreak of coronavirus disease 2019 (COVID-19), so as to provide support for epidemic prevention and safety. Methods A total of 160 sampling sites (45 by plate sedimentation method and 115 by swab method) were randomly selected as the control group before strengthening nosocomial infection control measures (from Dec. 21, 2019 to Jan. 21, 2020). After strengthening the measures (from Jan. 24 to Feb. 24, 2020), 160 sampling sites (64 by plate sedimentation method and 96 by swab method) were selected as the observation group. The changes of pathogenic bacteria distribution in the hospital environment before and after strengthening nosocomial infection control measures were compared. Results Before strengthening nosocomial infection control measures, 39 (24.4%) of 160 sampling sites were positive for pathogenic bacterial colonies, including seven (15.6%) positive in 45 by plate sedimentation method and 32 (27.8%) positive in 115 by swab method. After strengthening nosocomial infection control measures, 18 (11.2%) of 160 sampling sites were positive, including four (6.2%) positive in 64 by plate sedimentation method and 14 (14.6%) positive in 96 by swab method. Statistical analysis showed that there was no significant difference in the positive rate of pathogenic bacteria by plate sedimentation method after strengthening nosocomial infection control measures than that before strengthening nosocomial infection control measures. However, the positive rates of swab method and total pathogenic bacterial colonies were both significantly lower than those before strengthening nosocomial infection control measures (P=0.020 and 0.002). The pathogenic bacterial colony number sampled by plate sedimentation method after strengthening nosocomial infection control measures was (0.69±0.09) CFU/cm2, which was similar when compared with that before strengthening nosocomial infection control measures ([0.85±0.15] CFU/cm2). The pathogenic bacterial colony number sampled by swab method after strengthening nosocomial infection control measures was (0.19±0.06) CFU per plate, which was significantly lower than that before strengthening nosocomial infection control measures ([0.32±0.08] CFU per plate) (P=0.001). Conclusion During the outbreak of COVID-19, strengthening disinfection and improving disinfection quality can effectively reduce the pathogenic bacterial colonies in the hospital environment, reducing the risk of infection exposure of medical staff.

Role of Ommaya reservoir in the management of neonates with post-hemorrhagic hydrocephalus / 中华儿科杂志

<p><b>OBJECTIVE</b>Intra-ventricular hemorrhage (IVH) is one of the most serious complications of preterm infants. Significant numbers of the surviving infants with severe IVH go on to develop post-hemorrhagic hydrocephalus (PHH). The management of PHH remains a very challenging problem for both neonatologists and pediatric neurosurgeons. This study aimed to evaluate the efficacy and safety of the use of Ommaya reservoirs and serial cerebrospinal fluid (CSF) drainage in the management of a series of neonates with PHH.</p><p><b>METHOD</b>Between January 1, 2003 and December 30, 2005, 15 consecutive newborn infants with IVH grades III to IV, complicated with progressive ventricular dilatation, underwent placement of an Ommaya reservoir. CSF was intermittently aspirated percutaneously from the reservoir. The amount and frequency of CSF aspiration were based on the clinical presentation and the follow-up results of serial cranial ultrasonograms or CT scans. The changes of CSF cell counts and chemistries were also followed. Patients whose progressive ventricular dilatation persisted despite serial CSF aspiration through Ommaya reservoir eventually had ventriculo-peritoneal shunts (V-P shunt) placed. All the patients were followed up in the outpatient clinic after discharge from the hospital and the neurodevelopmental outcomes were evaluated through 18-36 months of age.</p><p><b>RESULT</b>A total of 15 infants were included in this series. Of them, 11 were preterm infants who were at gestational ages of 29 to 34 weeks and 4 infants were full-term. All of the 4 full term infants presented with progressive ventricular dilatation after suffering from the intra-cranial hemorrhage (3 infants were due to vitamin K deficiency and 1 was due to birth trauma). Thirteen infants had grade III IVH, and 2 had grade IV IVH based on initial cranial ultrasonographic and CT scans. The mean age when IVH was diagnosed was (9 +/- 1) days in preterm infants and (22 +/- 7) days in full-term infants; the mean age when Ommaya reservoir was placed was (18 +/- 11) days in preterm infants and (31 +/- 7) days in full-term infants. All the infants tolerated the surgical procedure well. The Ommaya reservoir was tapped for an average of (21.5 +/- 4.6) times per patient. The mean CSF volume per tap was (10.2 +/- 1.3) ml/kg. The values of CSF protein, glucose and cell counts slowly reached normal levels at approximately 3 - 5 weeks after the placement of the reservoir. The velocity of head circumference increase per week was less than 1 cm in 13 patients in 1 - 4 weeks after the placement of the reservoir and the size of ventricles decreased gradually. By 12 - 18 months, 12 infants had normal size ventricles, and 1 patient still had mild ventricular dilation at 36 months. Two infants developed progressive hydrocephalus after serial CSF aspiration through Ommaya reservoir. One infant had a V-P shunt placed at 2 months of age and another infant died at 3 months of age at home after parents refused further therapy. Complications consisted of reservoir leaking and CSF infection at 16th day of placement in one patient after repeated tapping. By the end of 18 - 36 months of follow-up, 11 of 14 infants were considered normal, two patients had mild impairment in neurodevelopmental outcome (both had spastic bilateral lower limbs paresis, and one of whom also had amblyopia) and the other had seizure disorder.</p><p><b>CONCLUSION</b>The results from this series indicate that the placement of an Ommaya reservoir is relatively safe in newborn infants and is useful in the initial management of neonates with PHH and may be beneficial in improving their neurodevelopmental outcomes. A multicenter randomized trial may be needed to further validate the results of this report.</p>

Clinical analysis of families with generalized epilepsy with febrile seizures plus / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical phenotypes and hereditary patterns of the generalized epilepsy with febrile seizures plus (GEFS+).</p><p><b>METHODS</b>Detailed family trees were constructed by inquire and physical examinations for the probands of the 15 pedigrees of GEFS+. Some patients received electroencephalography, cranial CT or MRI examination. The seizures and epilepsy syndromes were classified according to the 2001 Seizure International Classification. The clinical data of GEFS+ were reviewed.</p><p><b>RESULTS</b>The 15 families consisted of 196 individuals. Seventy-five individuals were confirmed with epilepsy. The phenotypes of 64 out of the 75 patients with epilepsy conformed to GEFS+. The 64 patients included 38 males and 26 females (1 deceased) and there was no gender difference in the morbility of GEFS+. The age at onset was all in childhood. GEFS+ had a diversity of phenotypes. Febrile seizures (FS) were confirmed in 44 patients, FS and myoclonic seizure in 1, febrile seizures plus (FS+) in 13, FS+ and absence seizure in 2, FS+ and myoclonic seizure in 1, and FS+ and focal seizure in 3.</p><p><b>CONCLUSIONS</b>The heterogeneity of phenotypes and genetics may be the hallmarks of GEFS+. FS and FS+ are common phenotypes while FS+ and absence seizure, FS+ and myoclonic seizure, and FS+ and focal seizure are rare. If one of the parents is affected in a GEFS+ family, the susceptibility of their children to GEFS+ is the same no matter what gender of their children is. It is speculated that the hereditary pattern of GEFS+ conforms to autosomal dominant inheritance.</p>

Curative Effect of Prostaglandin E_1 in Treating Neonates with Complete Transposition of Great Arteries / 实用儿科临床杂志

Objective To study the curative effect of prostaglandin E1(PGE1)on maintaining Sa(O2) and life span in the neonates with complete transposition of the large arteries(TGA).Methods Eleven of 19 neonates complete TGA received continuous PGE1 with the dosage of 5-20 ng/(kg?min),while the other 8 cases were set as control.The body temperature,Sa(O2),heart rate and blood pressure of both groups were recorded during the trial.Results The average Sa(O2) in trial group was (82.3?3.56)%,which had significant difference compared with the control group(t=8.232 P=0.001).The life span in trial group was much longer than control group.The body temperature,heart rate and blood pressure of trial group had no significant fluctuations.Conclusion PGE1 has an compkete effect on maintaining the ope-ning of patent ductus arteriosus (PDA) in TGA patients,which can improve the Sa(O2) and prolong the life span.