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Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 838-843, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412754


OBJECTIVE: To evaluate the dynamic changes of pulmonary arterial pressure (PAP) and cardiac function in neonates with pulmonary or extra-pulmonary acute respiratory distress syndrome (ARDSp/ARDSexp). METHODS: An observational study was conducted. A total of 128 neonates with ARDS admitted to neonatology department of the Affiliated Yancheng Hospital of Southeast University Medical College from January 2016 to December 2020 were enrolled, with 67 neonates in ARDSp group and 61 neonates in ARDSexp group. After starting mechanical ventilation, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO2)/arterial partial pressure of oxygen (PaO2)×100], PAP, cardiac function parameters [cardiac index (CI), left ventricular ejection fraction (LVEF), right ventricular Tei (RV-Tei)], and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) were compared between the two groups; the incidence of pulmonary arterial hypertension [PAH, pulmonary artery systolic pressure (PASP) was more than 35 mmHg (1 mmHg = 0.133 kPa) or more than 2/3 of the systolic blood pressure of the body circulation] of neonates was recorded. The correlation between PAP and NT-proBNP was analyzed by Pearson correlation method. The dynamically changes in PAP and RV-Tei before and after using Milrinone in neonates with ARDSp and ARDSexp combined with moderate-severe PAH (PASP 50-69 mmHg was moderate, and PASP ≥ 70 mmHg was severe) were observed. The duration of mechanical ventilation, total length of hospital stay and prognosis were recorded; Kaplan-Meier survival curve was drawn to analyze the 28-day survival of the two groups. RESULTS: The occurrence rate of PAH in ARDSp group was significantly higher than that in ARDSexp group (97.01% vs. 70.49%, P < 0.01). OI, PAP, NT-proBNP and RV-Tei were also higher [OI: 17.61±6.12 vs. 11.04±5.35, PAP (mmHg): 64.27±9.54 vs. 53.61±6.47, NT-proBNP (ng/L): 23 126.32±1 485.14 vs. 18 624.24±1 647.15, RV-Tei: 0.61±0.22 vs. 0.52±0.19, all P < 0.05], but there was no significant difference in CI or LVEF between the two groups. Pearson correlation analysis showed that PAP was significantly positively correlated with NT-proBNP (r = 0.918, P < 0.01). There were 97 ARDS neonates with moderate-severe PAH with 63 in ARDSp group and 34 in ARDSexp group. Both PAP and RV-Tei in the two group showed a decreasing trend with the prolongation of Milrinone treatment, the decrease was more significant in the ARDSexp group compared with ARDSp group, the difference was statistically significant at 72 hours of treatment [PAP (mmHg): 38.42±8.95 vs. 45.67±13.32, RV-Tei: 0.58±0.19 vs. 0.61±0.13, both P < 0.05]; there was no significant difference in PAP or RV-Tei before extubation between the two groups. The duration of mechanical ventilation and the total length of hospital stay in ARDSp group were significantly longer than those in ARDSexp group [duration of mechanical ventilation (days): 10.12±1.36 vs. 6.31±1.31, total length of hospital stay (days): 16.52±3.25 vs. 13.12±3.57, both P < 0.01]. Kaplan-Meier survival curve showed that neonate in ARDSp group had a significantly lower 28-day cumulative survival rate as compared with ARDSexp group (82.09% vs. 95.01%; Log-Rank test: χ2 = 5.062, P = 0.025). CONCLUSIONS: Both PAP and RV-Tei were significantly increased in neonates with ARDS, PAP in neonates with ARDSp were significantly higher than that in neonates with ARDSexp. Dynamic monitoring of PAP and RV-Tei can reflect the severity of ARDS in neonates, and targeted intervention of pulmonary surfactant combined with Milinone for improving oxygenation and reducing PAP is one of the effective methods for the treatment of PAH.

Síndrome do Desconforto Respiratório , Pressão Arterial , Humanos , Recém-Nascido , Pulmão , Volume Sistólico , Função Ventricular Esquerda
PeerJ ; 9: e11109, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33868812


Background: Due to the lack of effective and feasible viral biomarkers to distinguish viral infection from bacterial infection, children often receive unnecessary antibiotic treatment. To identify serum ß2-microglobulin that distinguishes bacterial upper respiratory tract infection from viral upper respiratory tract infection and exanthem subitum in children. Methods: This retrospective study was conducted from January 1, 2019 to September 30, 2020 in Yancheng Third People's Hospital. Children with upper respiratory tract infection and exanthem subitum were recruited. The concentration of serum ß2-microglobulin in the viral and bacterial infection groups were statistically analyzed. Results: A total of 291 children included 36 with bacterial upper respiratory tract infection (median age, 13 months; 44.4% female), 197 with viral upper respiratory tract infection (median age, 12 months; 43.7% female) and 58 with exanthem subitum (median age, 13 months; 37.9% female). When the concentration of ß2-microglobulin was 2.4mg/L, the sensitivity to distinguish viral from bacterial upper respiratory tract infection was 81.2% (95% CI [75.1-86.4%]), and the specificity was 80.6% (95% CI [64.0-91.8]%). When the cutoff was 2.91 mg/L, the sensitivity of ß2-microglobulin to distinguish exanthem subitum from bacterial upper respiratory tract infection was 94.8% (95% CI [85.6-98.9]%), and the specificity was 100% (95% CI [90.3-100]%). Conclusions: Serum ß2-microglobulin may be a significant biological indicator in children with upper respiratory tract infection and exanthem subitum.

Medicine (Baltimore) ; 98(11): e14830, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882668


This study aims to explore the dynamic changes of pulmonary arterial pressure (PAP) and its clinical significance in prenatal neonates with pulmonary and extra-pulmonary acute lung injury/respiratory distress syndrome (ALI/ARDS).A prospective study was conducted in the Neonate Intensive Care Unit (NICU) between May 2015 and April 2017. A total of 78 prenatal neonates with ALI/ARDS were selected and divided into 2 groups: pulmonary group (n = 37) and extra-pulmonary group (n = 41). These neonates were further divided into 3 groups according to the OSI index: mild, moderate, and severe groups. The dynamic changes of PAP were observed in these neonates. In the moderate and severe groups, PAP was significantly higher in neonates with pulmonary ALI/ADDS (ALI/ARDSp) than in neonates with extrapulmonary ALI/ARDS(ALI/ARDSexp) (62.5 ±â€Š5.4 vs 68.0 ±â€Š6.5, 54.7 ±â€Š5.9 vs 64.2 ±â€Š4.9; t = 3.264, 3.123; P = .004,.039). Furthermore, PAP was higher in neonates with ALI/ADDSp in the severe group, compared with those in the moderate group (t = 2.420, P < .05). There was significant difference among the 3 subgroups of neonates with ALI/ADDSexp (F = 60.100, P = .000). PAP was positively correlated with the OSI index (r = 0.823). The overall dynamic PAP monitoring results revealed that PAP was higher in the pulmonary group than that in the extrapulmonary group, and this exhibited a gradually decreasing trend as the condition of the subject improved.PAP in perinatal neonates with ALI/ARDS increases in varying degrees, and its extent was related to the severity of the illness. PAP was significantly higher in neonates with ALI/ADDSp than in neonates with ALI/ADDSexp. This can be used as a monitoring indicator for the severity of illness.

Lesão Pulmonar Aguda , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar , Síndrome do Desconforto Respiratório do Recém-Nascido , Lesão Pulmonar Aguda/diagnóstico , Lesão Pulmonar Aguda/fisiopatologia , Pressão Arterial , China , Correlação de Dados , Feminino , Humanos , Recém-Nascido , Masculino , Monitorização Fisiológica/métodos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Ultrassonografia Doppler em Cores/métodos