The management of neonates with high risk congenital diaphragmatic hernia (CDH) which gives rise to respiratory distress syndrome in 6 hours after born is so troublesome that the mortality is very high. The past advocation that CDH should accept emergency operation has been called in question. Another therapeutic procedure is recommended that CDH repair operation should be performed after the respiration and circulation has been stabilized. This procedure has presented better effect than before. The present advances in the management including general measures, mechanical ventilation, extracorporal membranous oxygenator (ECMO), nitric oxide (NO) inhalation, glucocorticoid, pulmonary surfactant, CDH repair and so on were reviewed.
Objective To evaluate the efficacy and safety of Shengmai injection for hypoxic-ischemic encephalopathy (HIE). Methods We searched MEDLINE (1966 to February 2007), EMBASE (1980 to February 2007), CBM (1978 to 2006), CNKI (1979 to February 2007), VIP (1989 to February 2007), and handsearched five Journals on Pediatrics. We evaluated features of quality of included studies, including randomization, blinding, allocation concealment and loss of follow-up. Meta-analyses were performed using The Cochrane Collaboration’s RevMan 4.2.8. Results Seven randomized controlled trials were included. The cure rate on day 5 in the Shengmai injection group was higher than in the control group (RR 1.55, 95%CI 1.25 to 1.93), but this rate was similar on day 10 (RR 0.74, 95%CI 0.43 to 1.29). No significant difference in cure rate was noted between the Shengmai injection group and naloxone group (RR 0.88, 95%CI 0.53 to 1.46). No significant differences were observed in mortality (RR0.44, 95%CI 0.16 to 1.19) and mutilation rate (RR 0.58, 95%CI 0.21 to 1.56) between the Shengmai injection group and the control group. For those babies suffering from HIE combined with myocardial damage, Shengmai injection could speed up the recovery of ECG (WMD=–2.02, 95%CI –2.76 to –1.28) and myocardial enzymogram (CK-MB: WMD= –4.78, 95%CI –6.77 to –2.79; CK-BB: WMD=–2.68, 95%CI –4.58 to –0.78). Significant differences in NBNA score were noted between the Shengmai injection group and the control group on day 5 (WMD=4.05, 95%CI 2.47 to 5.63) and day 10 (WMD=3.50, 95%CI 2.26 to 4.74). No fatal side effects were reported. Conclusions Shengmai injection has certain therapeutic values in treating HIE. Shengmai injection can speed up the recovery ECG, CK-BM and CK-BB of HIE patients, especially in those who have myocardial damage. Shengmai injection can also improve the NBNA score. However, because of the low statistical power and high risks for selection bias, performance bias and measurement bias in the included trials, these conclusions need to be interpreted cautiously.
ObjectiveTo explore the risk factors for neonatal nosocomial infection and the pathogen resistance, in order to provide the basis for hospital infection control. MethodsSurveillance of hospital infection in newborns hospitalized for more than 48 hours were carried out from January to December 2012, and the risk factors for hospital infection were analyzed. ResultsThere were 54 newborn cases with neonatal nosocomial infection, and the infection rate of newborns was 1.25%. The major infection sites were respiratory tract (66.7%), gastrointestinal tract (18.5%), skin and soft tissues (9.2%). Birth weight (χ2Trend=126.88, P<0.001), hospitalization days (χ2Trend=106.89, P<0.001), invasive operation (χ2=5.338, P=0.021) were the major risk factors. A total of 54 strains of pathogenic bacteria were isolated from 54 newborn cases with neonatal nosocomial infection. Twenty-three strains of gram-positive bacteria accounted for 42.6%, which were generally resistant to penicillin and large ring lactone class antibiotic drugs. Thirty-one strains of gram-negative bacteria accounted for 57.4%, which were mainly resistant to the three generations of cephalosporins. ConclusionThe hospital infection rate of newborns is low. Birth weight, hospitalization days and invasive operation are the major risk factors for neonatal nosocomial infection.
Objective To evaluate the relationship between the severity of neonatal infection and the activity change of cardiac enzyme. Methods A total of 102 infectious neonates in NICU were evaluated with neonatal serious illness scoring system and then divided into non-critical, critical, and extremely-critical groups. The activity of such serum myocardial enzymes as AST, ALT, LDH, CK, and CKMB was tested in the first 24 hours on admission. Comparison between groups and analyses were conducted. Resultes Myocardial enzyme of the critical and extremely-critical groups was obviously higher than that of the non-critical group (Plt;0.01). Conclusion The serious illness score of infectious neonates is closely associated with the activity change of myocardial enzyme and the level of serum myocardial enzymes has certain advantages in judging the myocardial injury and the disease severity of neonatal infection.
Omphalocele is a less common congenitalmalformation in neonates and belongs to the realm of emergent surgical treatment. Early repair is of crucial importance for saving the patient s life. Ten neonates with omphalocele have undergone early surgical repair since 1988. The overall result was satisfactory. There were 8boys and 2 girls. The time of operation ranged from one to fortyeight hours after birth (24 hours in 8 cases). All of them were term neonates, except in onecase being premature. None of them had rupture of the sac membrane. The minor and major omphalocele were in 8 and 2 cases, respectively. Five cases accompaniedwith other congenital malformations (1 to 3 kinds). One case of them was complicated by exompholos-macroglossia-gigantism (EMG syndrome). Nine cases were treated by primary stage of surgical repair. One case with major omphalocelehad undergone two-staged operation. Nine neonates were survived and only onedied of pneumonia and scleroderma postoperatively. The patients were followed up for 3 months to 5 years, 9 cases were satisfactory. Early surgical repairwas essential to successful treatment. The choice of surgical methods, the management of concomittant malformation in the alimentary tract and the factors influencing the prognosis were discussed.
Volume-targeted ventilation has been widely used in neonates requiring mechanical ventilation in recent years. However, as a novel method, its application involves risks. Based on domestic and international evidence, we developed a guideline for the use of volume-targeted ventilation in neonatal respiratory support using the grading of recommendations for assessment, development and evaluation of evidence (GRADE) method, to help neonatal healthcare professionals standardize the use of volume target ventilation.
ObjectiveTo analyze the effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates.MethodsThe clinical data of 33 neonates undergoing modified Blalock-Taussig shunt between January 1, 2013 and December 31, 2017 were reviewed, including 28 males and 5 females with the age of 3.0-28.0 (18.0±6.1) d and weight of 1.9-3.7 (2.9±0.5) kg.ResultsThere were 3 (9.1%) in-hospital deaths. Ten (30.3%) patients required early unplanned reoperations after surgery. Five (15.2%) patients were lost to follow-up. In the multivariate analysis, preoperative acidosis, emergency operation and postoperative bedside thoracotomy were independent risk factors of early death. During the follow-up of 18.0-93.0 (40.2±22.5) months, there was no death and 9 (36.0%) survival patients underwent corrective surgery and stage-two palliative surgery. In the multivariate analysis, preoperative hyperhemoglobinemia was an independent risk factor of nonadministration of the corrective surgery and stage-two palliative surgery. Receiver operating characteristic curve showed that preoperative hyperhemoglobinemia was significant in determining whether secondary surgery was possible.ConclusionThe modified Blalock-Taussig shunt is effective in promoting development of pulmonary arteries and preparing for the secondary surgery. The rate of mortality and postoperative complications after the neonatal modified Blalock-Taussig shunt remains high. The rate of secondary surgery is still low during follow-up.
Objective To summarize the clinical characteristics, diagnosis and treatment of Bochdalek hernia in neonates and infants. Methods The data of 15 neonates and 10 infants with Bochdalek hernia，undergoing the normal diagnosis and surgical repair from August 1983 to June 2004, were retrospectively reviewed. Location was left in 22 cases and right in 3 cases. Twenty-four cases were treated by operation and 1 case died of respiratory failurebefore operation.Results Before April 1998，7 of 8 (5 neonates，3 infants) cases of Bochdalek hernia stayed healthy and respiratory symptomfree 1 year after operation; they were followed up 1 year and 3 months to 11 years. One premature neonate with Bochdalek hernia died of respiratory failure before operation, and his lung volume was found to be dysplasia. From April 1998 to June 2004, 15（8 neonates，7 infants） of 17 （10 neonates，7 infants）cases of Bochdalek hernia survived postoperatively, while 2 neonates died of respiratory failure. Conclusion The earlier dyspnoea of neonates ofBochdalek hernia occur，the worse their healthy status appear. The standard andtimely surgical repairs could improve the curative ratio. Whether the operationwas suspended depended on the healthy states of babies.
ObjectiveTo investigate the caring method for neonatal chylothorax. MethodsWe retrospectively analyzed the clinical data of four hospitalized patients admitted from December 2011 to February 2013. ResultsThe treatment course lasted from 7 to 43 days, averaging 25 days. Three patients were cured and discharged from the hospital; one patient with ineffective outcome by conservative treatment was turned into surgical operation. ConclusionIn order to facilitate the recovery of the neonates suffering from neonatal chylothorax, it is important for us to ensure appropriate dietary management, total parental nutrition support, observation and care of closed drainage tube of thoracic cavity, accurate medication, safe intravenous fluids access and infection control.
Objective To explore the levels and the clinical significance of serum soluble Endoglin (sEng) and soluble Fms-like tyrosine kinase (sFlt-1) in patients with preeclampsia (PE). Methods Ninety-six patients with PE were included from June 2009 to June 2014. The patients were divided into mild PE group (n=54) and severe PE group (n=42), while 40 healthy pregnant women were in the control group. The general situation and laboratory testing were recorded and the serum levels of sEng and sFlt-1 were detected. All patients were routinely followed up with the recording of delivery and neonatal situation. Results The sEng and sFlt-1 levels were highest in the severe PE group [(7345.02±772.73) and (866.08±203.24) ng/L], which was followed by mild PE [(5 547.08±564.06) and (603.99±138.37) ng/L] and control group [(1 840.93±300.71) and (252.68±83.03) ng/L] (P<0.01). Levels of sEng were significantly correlated with sFlt-1 in both mild and severe PE groups. There were significantly correlations between sEng and sFlt-1 in mild or severe PE group respectively. The level of sEng and sFlt-1 was considerably positively correlated with mean arterial pressure, 24-hour urinary protein, serum creatinine, fibrinogen, umbilical artery shrink/diastole and resistance index value, but negatively correlated with prothrombin time, birth weight and the placenta weight (P<0.05). PE patients with sEng of <5 000 ng/L and sFlt-1 levels of <700 ng/L had the risk of severe complications of 6.8% and 14.0%; while patients with sEng of ≥5 000 ng/L and sFlt-1 of ≥700 ng/L had the ratio fo 40.4% and 37.0% respectively (P<0.01). Conclusion Serum levels of sEng and sFlt-1 in PE patients indicate that the severity of disease and outcomes of pregnancy.