ObjectiveTo explore the related factors for the influences and outcomes of mothers and infants, and further provide a basic reference for reducing maternal and prenatal mortality caused by central placenta previa, through the analysis of its clinical characteristics. MethodsWe retrospectively analyzed the clinical data of 89 patients with central placenta previa treated from January to August 2012. ResultsThere were 89 patients with central placenta previa, and the average age of these patients was (29.6±11.4) years, and the average number of pregnancy among the patients was 3.17. Nine patients had scar uterus; 8 had pernicious placenta previa (9%); 34 had prenatal anemia symptoms; 44 had prenatal vaginal bleeding with the bleeding volume ranged from 2 to 500 mL; 40 were treated before delivery. The average gestational age was 36 weeks ±4.2 days, and 28 of them were readmitted. The intraoperative bleeding in such patients as had placenta located in the anterior wall, placenta adhesion or implantation, history of uterine cavity operation or multipara was more than other patients. The postpartum hemorrhage of patients with the gestational age of 36 weeks or more was more than that of patients with the gestational age shorter than 36 weeks. The incidence of fetal distress in patients with the gestational age of 36 weeks or more is lower and the neonatal 1-minute Apgar score was higher than that in patients with the gestational age shorter than 36 weeks (P<0.05). ConclusionThe treatment of central type of placenta previa should be more active to prolong the gestational week. Patients with placenta adhesion or implantation, caesarean, multipara and placenta in the anterior wall are susceptible to intraoperative bleeding during the termination of pregnancy. Termination of pregnancy in these patients with central placenta previa should be carried out by cesarean section when gestation is more than 36 weeks to reduce postpartum hemorrhage and complications.
Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) are common and critically important diseases of preterm infants. The common feature of both conditions is altered angiogenesis and pathological changes in the case of incomplete organ development. The interaction of multiple factors leads to abnormal angiogenesis, which not only increases the possibility of comorbidity of BPO and ROP, but also reveals the potential co-pathogenesis between the two. However, the specific mechanism of this angiogenic balance in the occurrence and development of BPD or ROP is still unclear, and there are no animal models to explore the pathogenesis of both diseases. At present, effective prevention measures for BPO and ROP are still lacking, and treatment methods mainly rely on drug therapy and surgery. In the future, more studies should be conducted to find common therapeutic targets for factors affecting angiogenesis, so as to provide better treatment options for BPD and ROP and improve the effectiveness of treatment.
Objective To summarize the clinical characteristics of coarctation of the aorta (CoA) associated with intracardiac anomalies in infants. Methods The data from August 2009 to August 2017 of 86 infants who were diagnosed with CoA associated with intracardiac anomalies were analyzed. Preoperative diagnosis, surgical findings and post-operation follow-up were analyzed retrospectively. There were 56 males and 30 females at age of 1–346 (95.1±78.0)d. All the included patients underwent single-stage repair of CoA associated with intracardiac anomalies. Results Mean operative time was 279.0±56.4 min, mean cardiopulmonary bypass time was 162.3±51.0 min, and mean aorta cross-clamp time was 74.7±25.2 min. Mean length of ICU stay and ventilation time was 7.4±4.7 days and 101.1±75.4 hours, respectively. The residual transcoarctation gradient before discharge was lower than pre-operative transcoarctation gradient significantly (42.3±17.7 mm Hg vs. 22.1±9.4 mm Hg, P<0.001), and 7 early deaths were observed after surgery. The mean follow-up time of 79 hospital survivors was 31.0±27.4 months. And no late death was found. Transcoarctation gradient of hospital survivors in the last time follow-up was 21.2±11.0 mm Hg. Transcoarctation gradient of 29 patients was higher than 20 mm Hg. However, only 4 patients with significant clinical symptom of lower limbs retardation were recommended for ballon angioplasty consultant. The cumulative recoarctation-free survival in 2-year follow-up was 69.2%. Conclusions To avoid early second-stage operations, single-stage repair of CoA associated with intracardiac anomalies is effective and safe, and the outcomes of early to mid term follow-up are satisfactory.
Objective To investigate the role of low-dose heparin added to total nutrient admixture (TNA) solutions in the prevention of catheter related infections (CRIs). Methods One-hundred three newborn infants with periph-erally inserted central catheter (PICC) were divided into heparin group (n=63) and control group (n=40). The patients in the heparin group received TNA with 0.5 U/ ml heparin. The patients in the control group received TNA without heparin. We retrospectively analyzed the incidence of CRTs in the two groups. Results We found that the incidence of CRIs was 0 in the heparin group and 12.5% (5/40) in the control group. The incidence of catheter obstruction was 6.3% (4/63) in the heparin group and 20% (8/40) in the control group. The incidence of catheter-tip colonization was 1.58% (1/40) in the heparin group and 17.5% (7/40) in the control group. The incidences of CRIs, catheter obstruction, and catheter-tip colonization were signiicantly lower in the heparin group than those in the control group (Plt;0.05). Conclusion TNA solutions with 0.5U/ml heparin have decreased catheter obstruction and CRIs.
ObjectiveTo observe the clinical efficacy of non-nutritional sucking and 10% glucose water plus non-nutritional sucking in relieving the venipuncture pain for premature infants. MethodA total of 167 premature infants between April and December 2014 were selected as our study subjects, and they were randomly divided into three groups:intervention group Ⅰ (n=53), intervention group Ⅱ (n=58), and the control group (without any intervention, n=56). Two minutes before venous indwelling needle puncture, blood oxygen saturation and heart rate of the infants were recorded during their quiet state. In the process of venipuncture, the intervention group Ⅰ was given non-nutritional sucking, intervention group Ⅱ was given 10% glucose water plus non-nutritional sucking, and the control group did not accept any intervention. Premature pain rating scale (PIPP) was used to compare the three groups of infants in terms of pain score, heart rate and blood oxygen saturation 1 minute and 5 minutes after intravenous indwelling needle puncture. SPSS 17.0 software was applied for statistical analysis. ResultsOf the 167 premature infants, one-time puncture was successful in 152 infants, with 46 in intervention group Ⅰ, 54 in intervention group Ⅱ, and 52 in control group. One minute after intravenous indwelling needle puncture, PIPP score of intervention group Ⅰ and Ⅱ was significantly lower than that of the control group (P<0.05). The PIPP score of intervention group Ⅱ was significantly lower than that of intervention group Ⅰ (P<0.05). One minute and 5 minutes after intravenous indwelling needle puncture, heart rate in the intervention groups was significantly lower than that in the control group (P<0.05), blood oxygen saturation in the intervention groups was signficantly higher than that in the control group (P<0.05), and they were significantly lower in intervention group Ⅱ than in intervention group Ⅰ (P<0.05). ConclusionsNon-nutritional sucking is effective in alleviating venipuncture pain for premature infants, especially when it is used together with 10% glucose water. The method is worthy of clinical promotion.
目的 评价不同复苏方法和不同药物、氧疗、物理疗法等对新生儿窒息复苏和复苏后的预防措施的有效性和安全性.方法 计算机检索Cochrane Library(2004年第3期),MEDLINE(1966～2002年) 关于新生儿窒息复苏时不同复苏方法、氧气的应用、以及不同药物、剂量、给药途径治疗和预防新生儿窒息的系统评价、随机和半随机对照试验.结果 正压通气时使用100%氧气和应用室内空气的复苏效果并无差异.胎粪污染羊水(MSAF)与较高的新生儿缺血缺氧性脑病(HIE)的发生率有关,而气管内有胎粪者无论稀稠均与胎粪吸入综合征发生率无关.窒息复苏后预防性给予亚低温疗法、抗惊厥药、纳洛酮、多巴胺等在降低新生儿病死率,继发HIE的严重程度等方面与对照组相比无显著差异.应用肺表面活性物质(PS)预防和治疗新生儿呼吸窘迫综合征(RDS),可减少死亡率和并发症.结论 应用PS预防和治疗RDS可明显减少新生儿死亡率,且胎龄lt;32周的早产儿预防用药比治疗用药效果更好;目前尚无充分证据证明窒息复苏后预防性给予亚低温疗法、抗惊厥药、纳洛酮、多巴胺等治疗的有效性.
Objective To observe the incidence of retinopathy of prematurity (ROP) at different altitudes in Yunnan Province. MethodsA retrospective case-control study. From July 1, 2010 to June 30, 2019, 1 352 premature infants (Kunming group) and 579 premature (Dehong group) infants who received ROP screening in the Neonatology Department of Kunming Maternal and Child Health Hospital and the Neonatology Department of Dehong Dai and Jingpo Autonomous Prefecture People's Hospital were included in the study. A wide field digital retinal imaging system combined with binocular indirect ophthalmoscope and scleral oppressor was used for fundus examination. Inspection results were recorded according to the international ROP classification. The incidence of ROP in recent 10 years was retrospectively analyzed. Independent sample t test was used for comparison between groups. ResultsAmong the 1 352 preterm infants in Kunming group, 716 were males and 636 were females. The birth weight was (1 765.75±357.64) g; gestational age of birth were (32.51±2.07) weeks. The altitude of the residence was (1 920±30) m. Among 579 premature infants in Dehong group, 302 were males and 277 were females. The birth weight was (1 762.54±401.73) g; gestational age of birth were (32.10±2.36) weeks. The altitude of the residence was (920±80) m. There was no significant difference in sex composition ratio (χ2=0.10, P=0.75) and birth weight (t=0.17, P=0.87) between the two groups (P≥0.05). Gestational age and elevation of residence were compared, and the difference was statistically significant (t=3.82, 35.15; P＜0.01). ROP was detected in 72 cases 144 eyes (5.32%, 72/1 352) in Kunming group and 55 cases 110 eyes (9.5%, 55/579) in Dehong group. Both cases were binocular. There was significant difference in the detection rate of ROP between the two groups (χ2=11.49, P＜0.01). ROP stages 1 to 3 in Kunming and Dehong groups were 128 (88.89%, 128/144), 6 (4.17%, 6/144), 6 (4.17%, 6/144) eyes and 18 (16.36%, 18/110), 66 (60.00%, 66/110), 22 (20.00%, 22/110) eyes. The acute ROP (A-ROP) was 4 (2.78, 4/144) and 4 (3.63%, 4/110) eyes in Kunming and Dehong groups, respectively. There were significant differences in the detection rates of ROP in stages 1 to 3 between the two groups (χ2=11.26, 66.48, 15.86, 0.76; P＜0.05). There was no significant difference in the detection rate of A-ROP (χ2=0.76, P＞0.05). ConclusionThe detection rate of ROP in high altitude area of Yunnan Province is significantly lower than that in low altitude area.
Objective To explore the risk factors of premature infants death. Methods The medical records of hospitalized premature infants admitted to West China Second University Hospital of Sichuan University between January 2015 and December 2022 were collected. Premature infants were divided into the death group and the non-death group (control group) based on discharge diagnosis of death. Parturient and premature infants related information were collected, and the disease classification and diagnosis of premature infants were analyzed. Results A total of 13 739 premature infants were included, with 53 deaths and a mortality rate of 3.85‰ (53/13 739). The ages of death were 1-49 days, and the median age of death was (9.68±9.35) days. According to the matching method, 212 premature infants were ultimately included. Among them, there were 53 premature infants in the death group and 159 premature infants in the control group. Compared with the control group, premature infants in the death group had lower gestational age, birth weight, lower 1-minute Apgar scores, lower 5-minute Apgar scores and shorter hospital stay (P<0.05), and received more delivery interventions (P<0.05). There was no statistically significant difference in other indicators between the two groups of premature infants (P>0.05). A total of 212 parturient were included. Among them, there were 53 parturients in the death group and 159 parturients in the control group. The use rate of prenatal corticosteroids in the control group was higher than that in the death group (55.35% vs. 54.72%). There was no statistically significant difference in other related factors between the two groups of parturient (P>0.05). The results of logistic regression analysis showed that longer hospital stay [odds ratio (OR)=0.891, 95% confidence interval (CI) (0.842, 0.943), P<0.001], prenatal use of corticosteroids [OR=0.255, 95%CI (0.104, 0.628), P=0.003] reduced the risk of premature infant death. However, tracheal intubation [OR=10.738, 95%CI (2.893, 39.833), P<0.001] increased the risk of premature infant death. Conclusions Clinicians should pay attention to prenatal examination of newborns and pay attention to evaluation of newborn status. Obstetricians and neonatologists should make joint plans for women with high risk factors for preterm delivery. During the hospitalization, after the diagnosis is clear, standardized treatment should be carried out in strict accordance with the guidelines for systemic diseases and expert consensus.
ObjectiveTo compare and analyze the treatment effect of thoracoscopic surgery and traditional open surgery on infants with congenital diaphragmatic eventration, and summarize the experience of thoracoscopic surgery in infants with congenital diaphragmatic eventration.MethodsWe retrospectively analyzed the clinical data of 105 children with congenital diaphragmatic eventration who received operation in the Department of Cardiothoracic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2019. The patients were divided into an open group and a thoracoscopic group according to the operation methods. There were 41 patients in the thoracoscopic group, including 30 males and 11 females, with an average of 13.42±11.08 months (range: 1 d to 3 years). There were 64 patients in the open group, including 44 males and 20 females, with an average age of 8.21±9.33 months (range: 15.0 d to 1.6 years). The operation time, intraoperative bleeding volume, postoperative mechanical ventilation time, hospital stay and other operation indexes as well as the mortality, recurrence rate and complication rate of the two groups were observed.ResultsThe operation indexes such as operation time, intraoperative bleeding volume, postoperative mechanical ventilation time, thoracic drainage time, CCU stay and hospital stay of the thoracoscopic group were better than those in the open group (P<0.05). There was no statistical difference between two groups in postoperative diaphgram muscles descent, postoperative feeding time or patients needing thoracic drainage (P>0.05). The incidence of postoperative complications in the thoracoscopic group (19.51%) was lower than that in the open group (23.44%, P>0.05), and the difference in mortality and recurrence rate between the two groups was not statistically significant (P>0.05).ConclusionBoth thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with traditional open surgery, thoracoscopic diaphragmatic plication has the advantages of shorter operation time, less trauma, more rapid recovery and fewer complications, so it should be the first choice for children with congenital diaphragmatic eventration.
ObjectiveTo investigate the postnatal changes in urinary metabolic amino acid levels in infants with retinopathy of prematurity (ROP) and their effect on ROP, and to analyze the amino acid metabolic pathways that may be involved in the development of ROP. MethodsA retrospective cohort study. From January 2020 to December 2023, 65 premature infants with severe ROP (ROP group) who were hospitalized, born with gestational age ＜32 weeks in Children's Hospital Affiliated to Zhengzhou University were included in the study. Fifty premature infants with matched sex and gestational age and no ROP were selected as the control group. Urine amino acids and their derivatives were detected by gas chromatography-mass spectrometry. The two groups were compared by independent sample t test. The metabonomics of urinary amino acids was analyzed by orthogonal partial least squares discriminant analysis (OPLS-DA) model. The variable projection importance (VIP) score ＞1 suggested that the substance was two groups of differentially expressed amino acids. The predictive value of urinary amino acids for severe ROP was compared by using the receiver's operating characteristic (ROC) curve and the area under the curve. After t test and metabolomics analysis, the two groups of amino acids with large differences were normalized and compared by Pearson correlation analysis. The Kyoto Encyclopedia of Genes and Genomes database was used to analyze the metabolic pathways of differentially expressed amino acids involved in ROP. ResultsCompared with the control group, the concentrations of oxalic acid -2 and thiodiacetic acid-2 in urine metabolites of children in ROP group were significantly decreased, while the concentrations of 4-hydroxybutyric acid-2, 3-methylpentadienoic acid-2(1), 2-ketoglutarate-ox-2(2) and 3, 6-epoxy-dodecanedioic acid-2 were significantly increased, with statistical differences (t=0.036, 0.005, 0.038, 0.032, 0.022, 0.011; P＜0.05). The results of OPLS-DA analysis showed that amino acids of urinary metabolites in ROP group and control group were distributed in the left and right regions of the scatter plot, and there was a satisfactory separation trend between the two groups (R2Ycum=0.057 4, Q2cum=0.025 7, P＜0.05). As shown in the S-Plot, the amino acids biased towards two stages are glycolic acid-2, phosphoric acid-3, oxalic acid-2, thiodiacetic acid-2, 4-hydroxybutyric acid-2, 3-methylcrotonylglycine-1, 3-methylpentadienoic acid-2(1), 2-ketoglutarate-ox-2(2) and 3, 6-epoxy- dodecanedioic acid-2, respectively. Eleven differentially expressed amino acids with VIP score ＞1 were screened, among which the highest VIP score was oxalate-2, glycerate-3, phosphoric acid-3, 3-methylcrotonylglycine-1, uranoic acid -3 and thiodiacetic acid-2. The difference of amino acid concentration between the two groups was the highest in 4-hydroxybutyric acid-2 and thiodiacetic acid-2. The correlation between oxalic acid-2 and glycerate-3 was the highest (r=0.830, P＜0.001), and most amino acids were positive correlated. ROC curve fitting analysis showed that the combined prediction of 11 differenly-expressed amino groups had the largest area under the curve (0.816), the cutoff value was 0.531, and the sensitivity and specificity were 83.1% and 70.0%, respectively. The enrichment analysis of these 11 amino acids with significant differences suggested that the main pathways involved included butyrate metabolism, glyoxylic acid and dicarboxylic acid metabolism and lipoic acid metabolism. ConclusionAbnormal amino acid metabolism of 4-hydroxybutyrate-2, 3-methylpentadienoic acid-2(1), thiodiacetic acid-2, 2-ketoglutarate-ox-2(2), 3, 6-epoxy-dodecanedioic acid-2 may have a certain effect on the occurrence of ROP.