Neurodevelopmental outcomes of preterm with necrotizing enterocolitis: a systematic review and meta-analysis.

While neonatal necrotising enterocolitis (NEC) is associated with high mortality rates in newborns, survivors can face long-term sequelae. However, the relationship between NEC and neurodevelopmental impairment (NDI) in preterm infants remains unclear. To explore the relationship between neonatal NEC and neurodevelopmental outcomes in preterm infants, we searched PubMed, EMBASE, and the Cochrane Library from their inception to February 2024 for relevant studies. Studies included were cohort or case-control studies reporting neurodevelopmental outcomes of NEC in preterm infants. Two independent investigators extracted data regarding brain damage and neurodevelopmental outcomes in these infants at a corrected age exceeding 12 months. Odds ratios (ORs) were pooled using a random effects model. We included 15 cohort studies and 18 case-control studies, encompassing 60,346 infants. Meta-analysis of unadjusted and adjusted ORs demonstrated a significant association between NEC and increased odds of NDI (OR 2.15, 95% CI 1.9-2.44; aOR 1.89, 95% CI 1.46-2.46). Regarding brain injury, pooled crude ORs indicated an association of NEC with severe intraventricular haemorrhage (IVH) (OR 1.42, 95% CI 1.06-1.92) and periventricular leucomalacia (PVL) (OR 2.55, 95% CI 1.76-3.69). When compared with conservatively treated NEC, surgical NEC potentially carries a higher risk of NDI (OR 1.78, 95% CI 1.09-2.93) and severe IVH (OR 1.57, 95% CI 1.20-2.06). However, the risk of PVL did not show a significant difference (OR 1.60, 95% CI 0.47-5.40). CONCLUSIONS:  Our meta-analysis provides evidence suggesting an association between NEC and NDI. Additionally, the severity of intestinal lesions appears to correlate with a higher risk of NDI. Further high-quality studies with comprehensive adjustments for potential confounding factors are required to definitively establish whether the association with NDI is causal. WHAT IS KNOWN: • NEC is a serious intestinal disease in the neonatal period with a high mortality rate, and surviving children may have digestive system sequelae. • Compared with non-NEC preterm infants, the reported incidences of brain injury and neurodevelopmental disorders in NEC preterm infants are not the same. WHAT IS NEW: • The risk of neonatal brain injury and neurodevelopmental disorders in preterm infants with NEC is higher than that in non-NEC infants, and the risk of NDI in surgical NEC infants is higher than that in the conservative treatment group. • NEC may increase the risk of motor, cognitive, language development delays, and attention deficits in children.

Relationship Between Short-Term Blood Pressure Variability and Incidence of Acute Kidney Injury in Critically Ill Patients.

BACKGROUND/AIMS: Blood pressure (BP) variability is associated with cardiovascular events, and cerebral and renal damage. The aim of this study was to investigate any potential relationship between short-term BP variability and incidence of acute onset conditions, such as acute kidney injury (AKI), in critically ill patients. METHODS: BP was monitored to analyze its variability in critically ill patients in present study. Short-term BP variability was assessed as average real variability (ARV), standard deviation (SD) and coefficient of variation (CV) of 24-hour BP. RESULTS: A total of 565 patients were included, 41.2% (n=233) of which presented with AKI after admission (AKI stage I, n = 94; stage II, n = 37; stage III, n = 102). The mean APACHE II score was 21.5 for all patients. ARV of 24 h systolic BP was significantly higher in patients with AKI (p<0.001). This association remained (p=0.006) after adjustment for potential confounders. The incidence of AKI increased with the ARV from 14.0% (ARV ≤6 mmHg) to 73.9% (ARV >14 mmHg). A weak association was also found between BP variability and hospital mortality in critically ill patients. CONCLUSION: BP variability is correlated with the incidence of AKI in critically ill patients.

[Influence of 20% lipid emulsion on drug concentration, distribution volume and pharmacology effect of continuous infusion of propofol in rabbits].

OBJECTIVE: To investigate the influence of 20% lipid emulsion on drug plasma concentration, distribution volume and pharmacology effect of propofol administered with constant rate intravenous infusion in rabbits. METHODS: Propofol was intravenously administrated at a constant rate of 70 mg/(kg x h) in propofol group (P group, n = 8), low rate lipid group (L group, n = 8), high rate lipid group (H group, n = 8) and saline group (S group, n = 8) within 2 h. After 60 min, different agents were administrated in L group (20% lipid emulsion with rate of 0.3 mL/(kg x h)), H group (20% lipid emulsion with rate of 15 mL/(kg x h)), S group (saline with rate of 15 mL/(kg x h)) for another 60 min respectively. Blood samples were taken to measure the plasma concentration and calculate the pharmacokinetic parameters at the following time points: 30, 60, 65, 70, 80, 90, 120 min after the start of propofol infusion and 10, 20, 30, 60, 120, 180 min after the termination of propofol infusion. Brain tissues were also taken to measure propofol concentration. Related information about vital signs and pharmaceutical effects were recorded. RESULTS: High rate lipid infusion was associated with elevated propofol plasma concentration and reduced volume of distribution. The volume of distribution based on the terminal phase (V): P group, (34.56 +/- 16.11) mL; L group, (33.37 +/- 29.87) mL; H group,(7.29 +/- 3.20) mL; S group,(35.46 +/- 13.58) mL; P < 0.05). The volume of distribution at steady state (Vss): P group, (11.13 +/- 3.21) mL; L group, (13.87 +/- 4.09) mL; H group, (4.82 +/- 1.46) mL; S group, (11.61 +/- 4.11) mL P < 0.05)). Painful stimulation existences were higher at 90,120 min and the mean arterial pressure and heart rate were higher in H group (P < 0.05). The propofol concentration in brain tissue was lower in H group at 120 min (P < 0.05). CONCLUSION: Amelioration of pharmacology effect of propofol with high rate lipid infusion is associated with reduced V, Vss, elevated propofol plasma concentration and lowered propofol brain tissue concentration. 20% lipid will not influence these indice when infused with low rate, indicating that lipid in TPN will not change the sedation effects of propofol.

Continuous glucose monitoring system can improve the quality of glucose control and glucose variability compared with point-of-care measurement in critically ill patients: A randomized controlled trial.

BACKGROUND: The purpose of this study was to determine whether subcutaneous continuous glucose monitoring systems (CGMS) could improve glucose management in critically ill patients compared with frequent and conventional point-of-care (POC) glucose measurements. METHODS: A total of 144 patients with an expected length of stay in the ICU of at least 72 hours and with an admission glucose or two random glucose values of >10.0 mmol/L within 24 hours after admission, were randomly assigned to the CGMS group (n = 74) or the conventional group (C group, n = 70). Both groups used the same insulin algorithm to reach the same glucose target range (8.0-10.0 mmol/L). RESULTS: Time in range (TIR, 8.0-10.0 mmol/L), which is our primary outcome measure, was higher in the CGMS group than in the C group (51.5% vs. 29.0%, P < .001). Glucose variability (coefficient of variation, CV; standard deviation, SD; glucose lability index, and GLI) was improved by CGMS (all P < .05). Mean glucose level (MGL) (9.6 vs. 10.3 mmol/L, P = .156) and the proportion of patients with hypoglycemia did not differ between CGMS (5.4%) and C (5.7%) (P = 1.000). However, duration of hypoglycemia was reduced in the CGMS group (15 vs. 28 minutes, P = .032). Clinical outcomes were similar between groups except for the fewer usage of CRRT and lower peak plasma urea nitrogen level in the CGMS group. CONCLUSION: The use of CGMS, compared with POC glucose measurement, could improve the TIR, GV and duration of hypoglycemia.

[Clinical practice guidelines of HAP/VAP in 2016: the updates].

OBJECTIVE: Hospital acquired pneumonia (HAP) and ventilatorassociated pneumonia (VAP) are common hospital-acquired infections with higher mortality, longer hospital stay and more hospitalization expenses. With the latest research results and evidence-based guideline methodology, Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) have collaborated to create updated guidelines for the diagnosis and treatment of HAP and VAP in 2016. It is worth critically reading and thinking that most recommendations are supported by low-quality or very-low quality evidence and some strong recommendations is different from the actual clinical work in China. We will focus on these topics that are associated closely with clinical practice and inconsistent with the current implementation in China to provide better understanding of the guideline.

Safety of Moderate Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy: A Meta-analysis.

BACKGROUND: We investigated the safety of therapeutic hypothermia during intervention in infants with hypoxic-ischemic encephalopathy (HIE). METHODS: The MEDLINE, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials from onset to November 30, 2016 were searched for studies on perinatal HIE. Randomized controlled trials comparing the use of therapeutic hypothermia with normothermia for perinatal HIE were included in the study. Safety and efficacy data for therapeutic hypothermia in 1806 infants with HIE were included in this meta-analysis. The primary outcomes were safety variables, and the secondary outcomes were efficacy variables. A fixed-effect model was used to perform the meta-analysis. Risk ratios (RR), risk differences (RD), and 95% confidence intervals (CI) were calculated. RESULTS: Thirteen trials, including 1806 infants, contained information on safety and efficacy variables. Moderate hypothermia significantly increased the risk of thrombocytopenia (RR 1.18, 95% CI 1.02 to 1.37, P = 0.03; RD 0.06, 95% CI -0.02 to 0.09) and cardiac arrhythmia (RR 2.52, 95% CI 1.62 to 3.93, P < 0.0001; RD 0.19, 95% CI 0.09 to 0.03) during intervention. CONCLUSIONS: In infants with HIE, the application of therapeutic hypothermia increases the risk of thrombocytopenia and cardiac arrhythmia during intervention.

Therapeutic hypothermia increases the risk of cardiac arrhythmia for perinatal hypoxic ischaemic encephalopathy: A meta-analysis.

OBJECTIVE: To determine whether therapeutic hypothermia after hypoxic ischaemic encephalopathy (HIE) in neonates increases the risk of cardiac arrhythmia during intervention. DESIGN: A meta-analysis was conducted using a fixed-effect model. Risk ratios, risk differences, and 95% confidence intervals, were measured. DATA SOURCES: Studies identified from the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Google Scholar, previous reviews, and abstracts from onset to August, 2016. REVIEW METHODS: Reports that compared therapeutic hypothermia with normal care for neonates with HIE and that included data on safety or cardiac arrhythmia, which is of interest to patients and clinicians, were selected. RESULTS: We found seven trials, encompassing 1322 infants that included information on safety or cardiac arrhythmia during intervention. Therapeutic hypothermia considerably increased the combined rate of cardiac arrhythmia in the seven trials (risk ratio 2.42, 95% confidence interval 1.23 to 4.76. p = 0.01; risk difference 0.02, 95% CI 0.01 to 0.04) during intervention. CONCLUSIONS: In infants with hypoxic ischaemic encephalopathy, therapeutic hypothermia is associated with a consistent increase in cardiac arrhythmia during intervention.

Current epidemiology of sepsis in mainland China.

The disease burden of sepsis is a global issue. Most of the large-scale epidemiological investigations on sepsis have been carried out in developed countries. The population of 1.3 billion in mainland China accounts for approximately 1/5th of the whole world population. Thus, the knowledge of the incidence and mortality of sepsis in mainland China is vital before employing measures for its improvement. However, most of the epidemiological data of sepsis in mainland China was obtained from ICU settings, and thus lacks the population-based incidence and mortality of sepsis. In the present review, we summarized the limited literature encompassing the incidence, mortality, long-term outcome, and pathogens of sepsis in mainland China. Therefore, it might provide some valuable information regarding the sepsis disease burden and current issues in the management of sepsis in mainland China.