In 1984, according to the criteria of the classifieation for congenital hand deformity which wasput out by the International Hand Surgery Committee, we had made an investigation for congenitalhand deformity among 318066 newborns in Shanghai. It was found that the inctdence of a congenitalhand malformation was 0. 0808 percent among the total newborns. The congenital malformation ofthe thumb was 37. 74 percent of all deformities of the hand. According to the statistical analysis, we ...
In November 2019, the American Heart Association updated guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care. This update is not a comprehensive revision of the 2015 version. The updates for children and newborns mainly include three aspects: ① Pediatric basic life support: A. It is recommended that emergency medical dispatch centers offer dispatcher-assisted CPR instructions for presumed pediatric cardiac arrest. B. It is recommended that emergency dispatchers provide CPR instructions for pediatric cardiac arrest when no bystander CPR is in progress. ② Pediatric advanced life support: A. The bag-mask ventilation is reasonable compared with advanced airway interventions (endotracheal intubation or supraglottic airway) in the management of children during out-of-hospital cardiac arrest (OHCA). B. The extracorporeal CPR may be considered for pediatric patients with cardiac diagnoses who have in-hospital cardiac arrest (IHCA) in settings with existing extracorporeal membrane oxygenation protocols, expertise, and equipment. C. Continuous measurement of core temperature during targeted temperature management is recommended; for infants or children between 24 hours and 18 years of age who remain comatose after OHCA or IHCA, targeted temperature management is recommened. ③ Neonatal resuscitation: A. In term and late-preterm newborns (≥35 weeks of gestation) receiving respiratory support at birth, the initial use of 21% oxygen is reasonable. B. One hundred percent oxygen should not be used to initiate resuscitation because it is associated with excess mortality. C. In preterm newborns (<35 weeks of gestation) receiving respiratory support at birth, it may be reasonable to begin with 21% to 30% oxygen.
ObjectiveTo sum up experiences of precaution and provide evidence to prevent such accidents in the future via analyzing the nosocomial infection in newborn babies who were infected by rotavirus. MethodsWe investigated and monitored the 8 cases of nosocomial infection occurred between July 7th and July 14th, 2012 by epidemiologic and environmental hygienic methods, and analyzed the existing risk factors and took measures to control. ResultsThere were 8 nosocomial infected cases among the 45 newborn babies who were hospitalized. The infection rate was 17.8% and the accident lasted for 7 days. The distribution of space, time and population was clustered. Environment and hands were the main media to spread the virus. ConclusionThe accident was a suspected nosocomial infection caused by rotavirus in the hospital. It can be controlled effectively through intensive cleaning and sterilizing, isolated touching, and improving the medical staff's compliance and accuracy rate of hand sanitation.
ObjectivesUsing systematic literature review to analyze the effects of levetiracetam (LEV) on neonatal safety during early pregnancy.MethodsThe scope of the literature must be English literature, published from 1997 to 2018. Meta-analysis was performed by random effects models.ResultsSeven literatures were included. A total of 672 cases exposed to LEV in treatment group and 772 234 cases in control groups were selected for meta-analysis. There was no significant difference in neonatal malignancy between treatment group and control group［OR=1.05, 95% CI (0.54, 2.02), P=0.37］. Further, we evaluated the effect of LEV monotherapy and polytherapy on neonatal safety, a total of 464 monotherapy cases and 632 polytherapy cases respectively were selected for meta-analysis. The results showed that there was no significant difference between these two therapies in neonatal malignancy ［OR=0.54, 95% CI(0.31, 0.96), P=0.32］.ConclusionsAs the papers we included, levetiracetam in the treatment of epilepsy during pregnancy is relatively safe for newborn.
ObjectivesTo systematically review the clinical characteristics of pregnant females, newborns, children and adolescents with SARS infection.MethodsThe clinical characteristics of patients with SARS infection were searched using PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases. Descriptive analysis was performed to analyze the clinical characteristics of the patients, clinical manifestations, treatment and prognosis.ResultsA total of 13 studies including 19 pregnant females, 14 newborns, and 81 children and adolescents were identified. The ratio of male to female was 1 to 1.2 in children and adolescents patients aged 56 days to 17.5 years. Children under 12 years old accounted for 58.3% (28/48). Of the child patients, 34.0% (16/47) had close contact with patients with SARS. Fever (93.8%, 76/81) and cough (49.4%, 40/81) were the most common symptoms in children and adolescents with SARS infection, and 17.5% (11/63) occurred with shortness of breath or dyspnea. The positive ratio of nucleic acid detection for SARS-CoV was 9.2% (14/48), and the positive ratio of serum antibody was 92.9% (13/14). Peripheral blood lymphocyte reduction was approximately 65.7% (44/67). Approximately 70.8% (51/72) unilateral and 29.2% (21/72) bilateral lesions were found by thoracic X-ray or CT scan. No child fatalities were reported. As of maternal patients, aged 23 to 44 years, 10 cases (52.6%) were infected during early and middle pregnancy, and 9 cases (47.4%) during late pregnancy. Fever (100.0%, 19/19) and cough (78.9%, 15/19) were the main clinical symptoms, and shortness of breath/dyspnea occurred in 36.8% (7/19) of infected pregnant females. The positive ratio of nucleic acid detection for SARS-CoV was 50.0% (8/16), whereas the positive ratio of serum antibody was 93.3% (14/15). The ratios of thrombocytopenia, lymphopenia, and liver enzymes abnormalities were 38.9% (7/18), 61.1% (11/18) and 50.0% (3/6). All patients were identified for lesions by thoracic X-ray or CT scan examination. Seven cases were severe (36.8%). Five patients were treated with mechanical ventilation (26.3%). Three patients died (15.8%). Four patients were spontaneous abortion (40.0%, 4/10). Nine patients were cesarean sectioned (75.0%, 9/12). Six fetuses (46.2%, 6/13) with fetal distress, 7 cases (53.8%, 7/13) with premature delivery were identified. Three fetuses (23.1%) had intrauterine growth retardation. None of the fourteen newborns was diagnosed as SARS infection.ConclusionsThe clinical symptoms such as fever and cough in children and adolescents with SARS infection are similar to that of adult patients. However, children and adolescents are usually manifested as mild infection without reported death. There is no evidence to support that SARS-CoV could transmit vertically from infected mother to their fetuses.
ObjectiveTo study the phenotype of children with KCNQ2 gene related epilepsy.MethodsForty epilepsy children who were detected with KCNQ2 gene variants were enrolled. Their genotype and phenotype were analyzed.ResultsThirty-six KCNQ2 variants were identified. Twenty variants were novel. Twelve patients had inherited variants, and 28 patients had de novo variants. The age of seizure onset was from one day to 9 months. 80.0% patients had their seizure onset in neonates (32/40). Multiple seizure types were observed. Focal seizure was observed in 38 patients (95.0%). Epileptic spasm was observed in 10 patients (25.0%). Myoclonic seizure was observed in 4 patients. Tonic spasm seizure was observed in 3 patients. In all patients, seizures manifested in clusters. In 28 patients with de novo KCNQ2 variants, 24 had development delay (85.7%), the other 4 patients had normal development. In 12 patients with inherited KCNQ2 variants, one had development delay, the other 11 patients had normal development (91.7%). The most common interictal EEG changes were local epilepsy discharges (31/40). The MRI of brain was abnormal in 14 patients with de novo KCNQ2 variants and developmental delay. The agenesis of corpus callosum was identified in 10 patient (25.0%). Enlargement of subarachnoid spaces in the frontal and temporal region was identified in 11 patients (27.5%). Cortial dysplasia in the bilateral frontal and temporal region was identified in 2 patients. Sulus deepening was identified in 4 patients. Enlargement of bilateral lateral ventricle was identified in 3 patients. In 40 patients with KCNQ2 variants, 3 were diagnosed as benign familial neonatal epilepsy (BFNE), 2 were diagnosed as benign familial neonatal-infantile epilepsy (BFNIE), 3 were benign familial infantile epilepsy (BFIE), 3 were benign infantile epilepsy (BIE), 5 were benign neonatal epilepsy (BNE), 3 wer Ohtahara syndrome (OS), 9 were West syndrome (WS), 12 were unclassified early infantile epileptic encephalopathy (EIEE), one was epilepsy with autism. Sodium channel blockers oxcarbazepine was the most effective among antiepileptic drugs, with a effective rate of 90.9%.ConclusionsMost KCNQ2 variants are missense variants. De novo variants are more common in patients with KCNQ2 variants. The clinical features of patients with KCNQ2 variants including that mainly with seizure onset in neonate, the main seizure type is focal seizures, seizures occur in clusters. Patients with de novo KCNQ2 variants often had developmental delay, and about half of them had frontal and temporal lobe dysplasia and agenesis of corpus callosum. Sodium channel blockers are effective agents for epilepsy patients with KCNQ2 variants.
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.
ObjectiveTo summarize our experience of critical congenital heart diseases treatment system for the newborn and to report its surgical results.MethodsWe reviewed the clinical data of 97 neonates with congenital heart diseases who admitted to pediatric cardiac center from January 2019 to August 2020 in our hospital. The patients were divided into a prenatal and postnatal diagnosis and treatment integration group (integrated group, n=41), and a postnatal diagnosis and rapid admission by green channel group (non-integrated group, n=56).ResultsThe age of admission in the integrated group was younger than that in the non-integrated group (3.0 d vs. 11.0 d, P<0.001), and the weight was lighter (3.3±0.4 kg vs. 3.6±0.6 kg, P=0.006), operation age was younger (13.0 d vs. 17.5 d, P=0.004), proportion of palliative surgery was smaller (2.4% vs. 8.9%, P=0.396), time for ventilator assistance was longer (153.0 h vs. 65.0 h, P=0.020), hospital mortality was lower (0.0% vs. 7.1%, P=0.135). There was no significant difference in the follow-up (11.0 months vs. 12 months, P=1.000), out-of-hospital mortality (2.4% vs. 1.8%, P=1.000) and total mortality (2.4% vs. 8.9%, P=0.396) between the two groups.ConclusionPrenatal and postnatal diagnosis and treatment integration can significantly shorten the diagnosis and the hospitalization interval of newborn, that surgical intervention could be performed timely. It can reduce the risk of death before surgery but need longer time for recovery after surgery. Patients with postnatal diagnosis and admitted hospital through green channel also can get perfect results if surgical intervention is performed timely.
In October 2020, the American Heart Association issued the 2020 edition of guidelines for cardiopulmonary resuscitation and cardiovascular first aid, which comprehensively revised cardiopulmonary resuscitation and emergency cardiovascular care guidelines related to adults, children, newborns, resuscitation education science and treatment system. According to the latest edition of International Liaison Committee on Resuscitation’s classes of recommendation and levels of evidence, relevant suggestions are put forward. This article interprets the main updated and revised content, including children’s basic and advanced life support and neonatal resuscitation, in order to better guide emergency personnel and improve the quality of cardiopulmonary resuscitation and cardiovascular first aid.
ObjectiveTo evaluate the diagnostic accuracy and efficacy of X-ray for evaluating the tip position of umbilical venous catheterization (UVC). MethodsThe PubMed, Embase, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect diagnostic tests for UVC tip localisation from inception to 1 May 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality of the studies using the QUADAS-2 tool. Then, meta-analysis was performed by using Stata 16.0 software. Results Twelve articles involving 1 055 patients were included. The sensitivity and specificity of Negar Yazdani’s study were both 100%. The results of the meta-analysis (the remaining eleven articles, n=951) indicated a pooled sensitivity of 0.7 (95%CI 0.6 to 0.8), a pooled specificity of 0.8 (95%CI 0.7 to 0.9), a positive likelihood ratio of 4.0 (95%CI 2.0 to 8.1), a negative likelihood ratio of 0.4 (95%CI 0.2 to 0.6) and a diagnostic odds ratio of 11 (95%CI 3 to 36) with an area under the cumulative receiver operating characteristic curve of 0.8 (95%CI 0.8 to 0.9). A subgroup analysis was performed according to the different methods of judging X, the 8th–9th thoracic, the 9th–10th thoracic and combined judgement of the diaphragmatic plane + the vertebral body + the heart shadow. The sensitivities of the 3 groups were 0.8 (95%CI 0.5 to 0.9), 0.5 (95%CI 0.4 to 0.7) and 0.8 (95%CI 0.6 to 0.9); the specificities of the 3 groups were 0.8 (95%CI 0.6 to 0.9), 0.76 (95%CI 0.6 to 0.9) and 0.91 (95%CI 0.79 to 0.96). The areas under the cumulative receiver operating characteristic curve were 0.9 (95%CI 0.8 to 0.9), 0.7 (95%CI 0.6 to 0.7) and 0.92 (95%CI 0.89 to 0.94). ConclusionSome error is present when determining the catheter tip position by X-ray, in which the evaluation of the umbilical vein catheter tip position through a comprehensive evaluation of the diaphragmatic plane, the heart margin and the vertebral body is more powerful than the evaluation of the vertebral body alone.