Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China / 中华医学杂志(英文版)

BACKGROUND@#Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.@*METHODS@#The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD.@*RESULTS@#A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082-4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606-3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044-1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061-2.424), DRI (OR, 2.094; 95% CI, 1.328-3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679-4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777-6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996-0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379-0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160-0.467) were preventive factors for BPD (all P < 0.05).@*CONCLUSION@#Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.

Perinatal conditions of late preterm twins versus early term twins / 中国当代儿科杂志

OBJECTIVE@#To study the perinatal complications of late preterm twins (LPTs) versus early term twins (ETTs).@*METHODS@#A retrospective analysis was performed for the complications of 246 LPTs, 496 ETTs, and their mothers. The risk factors for late preterm birth were analyzed. According to gestational age, the twins were divided into five groups: 34-34@*RESULTS@#Maternal hypertension, maternal thrombocytopenia, placenta previa, and premature rupture of membranes were independent risk factors for late preterm birth in twins (@*CONCLUSIONS@#Compared with ETTs, LPTs have an increased incidence of perinatal complications. The incidence of perinatal complications is associated with gestational ages in the LPTs and ETTs.

Effect and safety of intensive phototherapy in treatment of neonatal hyperbilirubinemia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect and safety of intensive phototherapy in the treatment of neonatal hyperbilirubinemia.</p><p><b>METHODS</b>A total of 144 neonates with neonatal hyperbilirubinemia were randomly and prospectively divided into intensive phototherapy group and conventional phototherapy group, with 72 neonates in each group. The therapeutic effect and incidence of complications were compared between the two groups.</p><p><b>RESULTS</b>Within 12 hours after phototherapy, the total serum bilirubin level in the intensive phototherapy group was significantly lower than in the conventional phototherapy group (P<0.05), and the intensive phototherapy group had a significantly greater reduction in serum bilirubin level than the conventional phototherapy group (P<0.05). The intensives phototherapy group had a significantly shorter time of phototherapy than the conventional phototherapy group (P<0.05). The incidence rates of fever, diarrhea, rash, and hypocalcemia and reductions in blood calcium and hemoglobin levels after phototherapy showed no significant differences between the two groups.</p><p><b>CONCLUSIONS</b>During the initial stage of phototherapy, intensive phototherapy can quickly and effectively reduce the serum level of bilirubin in neonates with neonatal hyperbilirubinemia. It can also shorten the total phototherapy time, and does not increase the incidence of adverse events. Therefore, it is superior to conventional phototherapy.</p>

Perinatal risk factors and neonatal complications in discordant twins admitted to the neonatal intensive care unit / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many studies have shown a relationship between birth weight discordance and adverse perinatal outcomes. This study aimed to investigate the perinatal risk factors and neonatal complications of discordant twins who are admitted to the neonatal intensive care unit.</p><p><b>METHODS</b>A total of 87 sets of twins were enrolled in this retrospective study, of which 22 sets were discordant twins and 65 sets were concordant twins. Binary Logistic regression analysis was used to identify the risk factors associated with the occurrence of discordant twins. The common neonatal complications of discordant twins were also investigated.</p><p><b>RESULTS</b>Multivariate analysis showed that the use of assisted reproductive techniques, pregnancy-induced hypertension, and unequal placental sharing were risk factors for the occurrence of discordant twins. The incidence of small for gestational age infants and very low birth weight infants of discordant twins was significantly higher, while the birth weight of discordant twins was significantly lower than those of concordant twins. The duration of hospitalization of discordant twins was longer than that of concordant twins. The incidence of several neonatal complications, such as neonatal respiratory distress syndrome and intracranial hemorrhage, was higher in discordant twins than that in concordant twins. The percentage of those requiring pulmonary surfactant and mechanical ventilation was significantly higher in discordant twins than that in concordant twins.</p><p><b>CONCLUSIONS</b>Use of assisted reproductive techniques, pregnancy-induced hypertension, and unequal placental sharing are perinatal risk factors of discordant twins who are admitted to the neonatal intensive care unit. These infants are also much more likely to suffer from various neonatal complications, especially respiratory and central nervous system diseases. It is important to prevent the occurrence of discordant twins by decreasing these risk factors and timely treatment should be given to discordant twins.</p>

Study on lipid and protein metabolism status of preterm infants whose mothers suffered from pregnancy induced hypertension / 中华实用儿科临床杂志

Objective To investigate the lipid and protein metabolism status of preterm infants whose mothers suffered from pregnancy induced hypertension.Methods One hundred and nineteen premature neonates in accordance with inclusion criteria,who were admitted to the Department of Pediatrics,Peking University People's Hospital from Jan.2010 to Dec.2011,were chosen as study samples.The preterm infants were divided into 2 groups,that was mothers with pregnancy induced hypertension group (observation group) and mothers without pregnancy complications group (control group).Then the general condition as well as the lipid and protein levels,which were tested within 24 h after birth,and which of preterm newborns in 2 groups were compared.Results The percent of 26.5 of the preterm infants in observation group were small for gestational age,while the ratio was 11.8％ for ones in control group,there was significant difference (P ＜ 0.05).The rate of fetal distress and neonatal asphyxia was 29.4％ in observation group,however,the ratio was 12.9％ for ones in control group,there was significant difference (P ＜ 0.05).The levels of low density lipoprotein [(1.20 ± 0.66) mmol/L],cholesterol [(2.80 ± 1.07) mmol/L] and total protein [(51.51 ± 6.88) mmol/L] in observation group were higher than those [(0.88 ± 0.37) mmol/L,(2.26 ± 0.66) mmol/L,(48.66 ±6.86) mmol/L] of ones in control group(all P ＜0.05,0.01).However,there were no significant difference of the levels of high density lipoprotein[(0.86 ± 0.26)mmol/L vs (0.82 ± 0.24) mmol/L],triglyceride [(0.29 ± 0.15)mmol/L vs (0.27 ±0.18) mmol/L] and albumin[(34.63 ±3.33) mmol/L vs (33.13 ±5.64) mmol/L] between the 2 groups(all P ＞0.05).Conclusions Mothers with pregnancy induced hypertension can affect the intrauterine growth,levels of lipid and total protein of their offsprings.At the same time,it also increases the possibility of perinatal hypoxia.

The influence of preventive iron supplementation to iron nutritional status in breastfed infants / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the effects to iron status who were given preventive iron supplements for two months from when they were breast-fed to four-month-old.</p><p><b>METHODS</b>A total of 123 infants in four-month-old age who were breast-fed were randomly divided into iron supplementation group (63 cases) and control group (60 cases), iron supplementation group was supplied with low-dose iron (1 mg×kg⁻¹×d⁻¹) for two months with no intervention for control group. Blood samples were collected to test C reactive protein and iron status indicators in six-month-old age group infants, and the growth indices were measured and compared on the gender difference of iron status at and 6 months.</p><p><b>RESULTS</b>After 2 months of low-dose iron supplementation, the hemoglobin of iron supplementation group (26 cases) increased about 5.5 g/L while the control group (34 cases) increases about 0.0 g/L (median), 95% confidence intervals were -7.0 - 13.0 g/L and -9.0 - 15.0 g/L, respectively. The hemoglobin increase of iron supplementation group was higher than the control group, the difference was statistically significant (u = -2.326, P < 0.05). The other iron nutritional status and the growth did not show any significant difference between iron supplementation group and control group (P > 0.05). At age 6 month, the MCV of the boys were (75.89 ± 3.34) fl, while the girls were (77.20 ± 3.17) fl. The boys had lower values of MCV than the girls, and the gender difference was statistically significant (t = 4.73, P < 0.05). The other iron nutritional status did not show any significant gender difference (P > 0.05).</p><p><b>CONCLUSION</b>Low-dose iron supplementation of breast-fed infants at 4-month-old can increase the hemoglobin level when they were 6-month-old, and had no measurable side effect on growth.</p>

Risk factors for preterm birth and complications in 287 late preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors for preterm birth and complications in late preterm infants.</p><p><b>METHODS</b>The clinical data of 287 late preterm infants were retrospectively studied. Two hundred and eighty-eight term infants served as the control group. Logistic regression analysis was used to identify risk factors associated with late preterm birth. The common complications in late preterm infants were investigated.</p><p><b>RESULTS</b>Several significant risk factors for late preterm birth were identified by logistic regression analysis: twin pregnancy, gestational diabetes mellitus, eclampsia or preeclampsia, placenta previa, placental abruption and premature rupture of membranes. The duration of hospitalization in late preterm infants was longer than that in term infants. The complications were common in late preterm infants, with a high prevalence of anemia, aspiration pneumonia, hypoglycemia and intracranial hemorrhage.</p><p><b>CONCLUSIONS</b>The late preterm infants are much more likely to suffer various complications. It is important to reduce the incidence of late preterm births by decreasing perinatal risk factors above mentioned.</p>

Thrombocytopenia in pregnancy and neonatal outcomes / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between thrombocytopenia in pregnancy associated with various causes and neonatal outcomes.</p><p><b>METHODS</b>Medical records of 140 pregnant women with thrombocytopenia in pregnancy and the neonatal outcomes from January 2009 to December 2010 were reviewed retrospectively. The pregnant women were classified into four groups according to the causes of thrombocytopenia: gestational thrombocytopenia (GT; n=94), pregnancy with immune thrombocytopenic purpura (ITP; n=30), pregnancy with other hematological disease (aplastic anemia or myelodysplastic syndrome; n=12), and other causes (n=4): pregnancy induced hypertension syndrome, pregnancy with systemic lupus erythematosus, and pregnancy with alcoholic cirrhosis. The neonatal outcomes in the four groups were compared.</p><p><b>RESULTS</b>The premature birth rates in the GT and the ITP groups were 11.3% and 16.7%, respectively. There was no significant difference between the two groups. The premature birth rate in the other hematological disease group was 53.8%, which was significantly higher than that in the GT (P<0.01) and the ITP groups (P<0.05). Congenital passive immune thrombocytopenia was found in 2 neonates (2%) in the GT group and in 4 neonates (13%) in the ITP group (P<0.05). In addition, other diseases were also observed in neonates in the ITP group, including 1 case (3%) of ITP and 1 case (3%) of Evans syndrome. Intracranial hemorrhage occurred in one neonate (8%) in the other hematological disease group. Neonatal lupus syndrome was found in 1 case (25%) in the other causes group.</p><p><b>CONCLUSIONS</b>Thrombocytopenia in pregnancy associated with different causes may result in different neonatal outcomes.</p>

Exploration of pediatrics clinical probation teaching methods for eight-year program medical students / 中华医学教育探索杂志

To improve the effect of pediatrics clinical probation teaching for eight-year program medical students,the exploration and practice of case-based instruction teaching with symptoms as main line,reading reports,and application of high quality counterfeit baby simulator-assisted instruction were carried out,which could inspire students' learning interest,and contribute to the training of students'clinical and scientific thought,their self-education and clinical skills.

Gaseous Signal Molecules and Pathogenesis of Pulmonary Artery Hypertension / 实用儿科临床杂志

The 4 kinds of gaseous signal molecules——nitric oxide,carbon monoxide,hydrogen sulfide and sulfur dioxide,which were discovered by people consecutively,all played significant pathophysiological roles in the cardiovascular system.With the pathogenesis of pulmonary artery hypertension(PAH) being illuminated uninterruptedly,gaseous transmitters and the interaction between them become the hot issue in the domain.This article summarized the mechanism of gaseous signal molecules in the formation process of PAH,in order to identify that during the morbidity process of PAH gaseous transmitters took effect in network regulating model.It also possessed great significance to comprehend the pathophysiological variation of PAH profoundly.

Endoplasmic Reticulum Stress and Atherosclerosis / 实用儿科临床杂志

Endoplasmic reticulum stress is another kind of sub-cell level stress which is discovered after nuclear stress and mitochond-rial stress.Endothelial cells,macrophages and smooth muscle cells play important roles in the formation of atherosclerosis.Endoplasmic reticulum stress participate the occurrence and development of atherosclerosis by regulating the inflammatory response,lipid metabolism and apoptosis of the above cells.

Clinical study of organic impairment in neonates with asphyxia / 实用儿科临床杂志

Objective To evaluate the incidence and degree of organic impairment after neonatal asphyxia,analyze the high risk factors of this and find a new approach to lower the mortality of asphyxia.Methods Two hundred and twenty-two newborns with asphyxia were studied. They were divided into mild asphyxia group and severe asphyxia group, and the function of main organs were classified as mild and severe, too. Chi-square tests were conducted for statistical analysis.Results The incidences of organic impairment and multi-organ impairment with asphyxia were 90.1 % and 71.6 % respectively. The frequency of organ dysfunction in severe asphyxia was significantly higher than that of mild group(P