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 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 explore the clinical effect of delayed sternal closure (DSC) after neonatal cardiac operations. MethodsWe retrospectively analyzed the clinical data of 347 neonates who underwent cardiac operations through midterm sternotomy in Shanghai Children's Medical Center between January 2008 and December 2012. There were 273 male and 74 female patients with mean age of 14.8±8.4 days and mean weight at 3.4±0.5 kg. We analyzed the influencing factors of delayed sternal closure and the relationship between delayed sternal closure and mortality. A total of 127 patients had DSC (36.6%). Ninety-two patients were of primary DSC because of hemodynamic instability in the operation room, and 35 were of the secondary DSC because that the sternum was reopened in intensive care unit during the early postoperative period. The diagnosis of complex congenital heart defects had a high risk of DSC. The incidence of DSC for great artery (TGA), corctation of aorta (CoA), interruption of aortic arch (IAA), total anormalous pulmonary vein drainage (TAPVD), Taussig-Bing malformation, hypoplastic left heart syndrome (HLHS) was 43.2%, 83.3%, 62.5%, 15.6%, 71.4%, and 66.7% respectively. The DSC patients had longer duration of CPB time (141.4±51.7 min versus 108.5±51.9 min) and clamping time (79.3±29.2 min versus 65.4±25.5 min). In 113 patients the sternums were closed 1-11 days after the initial operation. Sixteen patients died ultimately including 2 deaths after the closure of sternum with a mortality of 12.6%. Surgical site infection occurred in 5 patients including 2 severe patients with surgical intervention. ConclusionDSC has been an essential part of neonatal heart surgery. It provides an opportunity for the recovery of cardiac function.
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.
ObjectiveTo investigate the distribution and drug resistance of pathogens in neonates with lower respiratory tract infection, and provide evidence for clinical rational antibiotic use. MethodsA retrospective analysis on 998 strains isolated from 5 486 sputum samples during January 1, 2009 to December 31, 2012 collected from hospitalized neonates was performed. ResultsOf the 998 isolated strains, the common pathogens were Klebsiella pneumoniae (23.1%), Escherichia coli (E. coli) (21.2%), Staphylococcus aureus (19.4%), and Enterobacter cloacae (8.4%). Klebsiella pneumonia, E. coli and Enterobacter cloacae were generally resistant to penicillin, but enzyme inhibitors could reduce the resistance rate. A large proportion of Klebsiella pneumonia was resistant to the third generation cephalosporins (78.4%), while E. coli and Enterobacter cloacae had a lower resistance rate (46.7% and 46.5%, respectively). There were 7 strains (3.0%) of Klebsiella pneumoniae and 1 (1.2%) strain of Enterobacter cloacae resistant to imipenem. Twenty-three strains (13.6%) of Klebsiella pneumoniae, 1 strain (0.7%) of E.coli and 1 strain (2.5%) of Enterobacter cloacae were resistant to ertapenem. A total of 97.0% of Staphylococcus aureus was resistant to penicillin, but only 11.0% was resistant to oxacillin, and all the isolates were sensitive to vancomycin. ConclusionGram negative bacteria are the common pathogens in the hospitalized neonates in our hospital. Klebsiella pneumonia, E. coli and Staphylococcus aureus are the common pathogens. The common pathogens show a high resistant level to antibiotics. Clinicians should evaluate the potential pathogens of infections based on the results presented in our study, in order to select antibiotics rationally when treating infections.
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.
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.
ObjectiveTo explore the incidence, treatment and prognosis of neonatal respiratory failure (NRF). MethodsThe clinical data of 421 neonates with NRF treated between January 2011 and December 2013 were retrospectively analyzed. ResultsThe incidence and the mortality of NRF was 4.8% and 14.5%, respectively. The main primary disease of NRF was neonatal respiratory distress syndrome (36.1%) and aspiration pneumonia (29.0%). Mechanical ventilation was the main treatment for NRF (77.2%). Premature (χ2=12.216, P<0.001), low birth weight (χ2=8.932, P=0.003) and the neonatal asphyxia (χ2=6.199, P=0.013) were closely related to the prognosis of NRF, which were the risk factors of the death of NRF. ConclusionNRF is a disease with high incidence and high mortality; make effective prevention and treatment measures are important to improve the success rate of therapy for NRF.
ObjectiveTo discuss the evaluation of clinical grading for neonates with hypoxic-ischemic encephalopathy (HIE) by diffusion weighted imaging (DWI). MethodsWe retrospectively analyzed the DWI findings of 39 neonates with HIE diagnosed by clinical criteria from December 2009 to July 2013. Abnormal signals were observed for 23 neonates (59%). These neonates were divided into three groups (group A, B and C) according to the shape and range of abnormal signals. Then Kappa test was performed between groups of different clinical grading (light, medium, severe). ResultsFor groups arranged based on abnormal signals and clinical grading, the Kappa value of the consistency test was 0.797 (P < 0.001). ConclusionsDWI negativity cannot exclude the existence of HIE. However, when abnormal signals occur, we can infer the severity in neonates with HIE according to the shape and range of abnormal signals by DWI.
ObjectivesTo systematically review the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort or case-control studies on the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies, and meta-analysis was performed by RevMan5.3 software.ResultsA total of 9 case-control studies involving 759 patients were included. The results of meta-analysis showed that, maternal factors like placental abruption (OR=6.25, 95%CI 1.47 to 26.61, P=0.01), premature rupture of fetal membranes of parturient (OR=5.62, 95%CI 2.63 to 12.00, P<0.000 01), pregnancy-induced hypertension (OR=2.04, 95%CI 1.49 to 2.80, P<0.000 01), carbapenem antibiotics used in mothers (OR=1.77, 95%CI 1.10 to 2.81, P=0.017), neonatal factors like premature delivery (OR=1.96, 95%CI 1.06 to 3.61, P=0.03), mechanical ventilation (OR=2.14, 95%CI 1.01 to 4.55, P=0.05), surgical procedure (OR=14.17, 95%CI 2.46 to 81.70, P=0.003), umbilical vein catheter (OR=1.93, 95%CI 1.20 to 3.11, P=0.007), peripherally inserted central catheter (OR=4.30, 95%CI 1.86 to 9.93, P=0.000 6), nasogastric feeding (OR=4.37, 95%CI 1.44 to 13.29, P=0.009), use of carbapenems (OR=3.04, 95%CI 1.91 to 4.84, P<0.000 01), and admission to NICU (OR=2.78, 95%CI 1.79 to 4.33, P<0.000 01) were the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Breastfeeding (OR=0.30, 95%CI 0.13 to 0.70, P=0.005) was the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.ConclusionsThe current evidence shows that maternal factors like placental abruption, premature rupture of fetal membranes, pregnancy-induced hypertension, carbapenem antibiotics used in mothers, and neonatal factors like premature delivery, mechanical ventilation, surgical procedure, umbilical vein catheter, peripherally inserted central catheter, nasogastric feeding, use of carbapenems, and admission to NICU are the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates; while breastfeeding is the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the conclusions.