Neonatal pediatricians are facing relatively high risk of medical disputes since higher risk of mortality during the neonatal period caused by the increased number of premature births worldwide. However, there is little knowledge about the current status and distribution of medical disputes in Chinese neonatology. We conducted a cross-sectional survey to investigate the prevalence, potential causes, and associated risk factors of medical disputes in neonatology in the mainland of China. The statistical analysis was done by SPSS, including Chi-square test and independent samples t-test, Pearson correlation analysis and binary logistic regression analysis. Among the 12,118 participated neonatal pediatricians, 9,013 (74.4%) experienced medical disputes, and about 96% neonatal pediatricians older than 60 experienced medical disputes. A positive correlation was found between the prevalence of medical disputes and gross domestic product (GDP) per capita of the corresponding city or province. “Overestimation of treatment effects from the perspective of the patients and their families” was the primary cause of medical disputes. Gender, age, educational background, hospital level, and the number of responsible beds were independent risk factors contributing to medical disputes. Information obtained from this study may provide useful clues for reducing the occurrence of medical disputes in neonatology in the mainland of China.

Background:The relationship between neonatal early hypotension and necrotizing enterocolitis (NEC) remains uncertain, with inconsistent findings reported in previous studies. The objective of this study was to assess whether early hypotension in very/extremely preterm infants was associated with an increased risk of NEC, aiming to facilitate early detection and prevention. Methods:A retrospective cohort analysis was performed in preterm infants with gestational ages (GA) less than 32 weeks, admitted to the Seventh Medical Center of the Chinese PLA General Hospital from January 2021 through December 2023. According to the occurrence of hypotension during the first postpartum week, preterm infants were divided into hypotension group and non-hypotension groups. Statistical analysis was conducted using SPSS software (version 26.0). The association between neonatal early hypotension and subsequent NEC occurrence was analyzed using univariate and multivariate logistic regression. Results:A total of 355 very/extremely preterm infants were included, comprising 130 in the hypotension group and 225 in the non-hypotension group. Compared with the non-hypotension group, infants in the hypotension group had significantly higher rates of mortality, hemodynamically significant patent ductus arteriosus (hsPDA), NEC, and surgically treated NEC (all P>0.05). After adjusting for potential confounders, neonatal early hypotension remained significantly associated with an increased incidence of NEC [odds ratio (OR) =2.80, 95% confidence interval (CI): 1.25-6.28, P=0.01]. Conclusions:Neonatal early hypotension is associated with an increased risk of NEC.

BACKGROUND:Severe combined immunodeficiency (SCID) is the most fatal form of inherited primary immunodeficiency disease. Known molecular defect mutations occur in most children with SCID. METHODS:Herein, we report Adenosine Deaminase-SCID (ADA-SCID) using whole-exome sequencing (WES), explore exome mutational landscape and significance for 17 SCID samples, and verify the mutated exon genes using the Gene Expression Omnibus (GEO) datasets. A total of 250 patients, who were hospitalized at the Neonatal Intensive Care Unit (NICU) of The Seventh Medical Center of the PLA General Hospital for 3 years (from 2017 to 2020), were screened for SCID. We collected mutated genes from the WES data of 17 SCID children. GSE609 and GSE99176 cohorts were used to identify the expressions of mutated exon genes and molecular features in SCID. Gene set variation analyses (GSVA) and correlation analyses were performed. RESULTS:The detection rate with approximately 6.8 % (17/250) of SCID is high in the NICU. A total of 16 genes were identified among 17 SCID samples, of which the Top 2 genes (MUC6 and RP11-683L23.1) might be crucial in the progression of SCID with 94 % mutation frequency. Furthermore, CNN2 and SCGB1C1 had significant co-mutations and may cooperate to affect SCID development. Importantly, the phylogenetic tree classification results of 17 SCID samples are more correlated to MUC6 with the most significant mutations. Expression profiles of seven mutated genes and five mutated genes were documented in GSE609 and GSE99176 cohorts based on microarray, respectively. Several immune-related pathways were significantly enriched, and Foxd4, differing from the other four mutated genes, was inversely correlated with the GSVA-enriched pathway. CONCLUSION:Due to its high detection rate (6.8%) and fatality rate (100%), the inclusion of SCID in newborn screening (NBS) is urgent for children in China. The WES successfully identified several common exonic variants (e.g., MUC6) and depicted the feature of mutations and evolution, which will help develop new diagnostic methods for SCID.

BackgroundThe standardised management of neonatal critical care centres can help improve health outcomes of vulnerable newborns. Guidance is required to update evidence related to construction and management of neonatal critical care centres in China.ObjectiveTo establish expert consensus on the essential capability lists for neonatal critical care at three levels in China.Design and settingAccording to China’s administrative divisions, the Chinese guidelines stratifies neonatal critical care into three levels: county level (basic and special care), city level (intensive care) and province level (comprehensive care including neonatal surgery and more subspecialty interventions). A modified Delphi study was conducted. A group of 20 neonatologists from the Chinese Association of Neonatologists rated the importance of capability items on a 5-point Likert scale.ResultsAt county level, the list consisted of 29 items related to basic and special care, and 3 items were unanimously rated very important by all experts: neonatal resuscitation, endotracheal intubation and continuous positive airway pressure ≥72 hours. At city level, group consensus defined 38 items as essential. Besides the essential items of county level, more items for intensive care were included in city level. At province level, 64 items reached consensus, including neonatal surgery and more advanced subspecialty interventions. The Kendall’s W values showed good agreement among experts in both rounds, and an increase from round 1 to round 2.ConclusionsWe developed the capability lists for neonatal critical care at three levels in China. Neonatal resuscitation should be provided by all levels. Interventions for preterm newborns are stratified according to gestational age and birth weight. Congenital abnormalities requiring surgical services need to be managed in high-level centres.

OBJECTIVE:To elucidate the characteristics of lymphocyte subsets in bronchopulmonary dysplasia (BPD) diagnosis following Jensen's criterion to understand the spectrum of lymphocytes in different degrees of BPD. STUDY DESIGN:This single-center retrospective cohort study included 120 neonates admitted to the neonatal intensive care unit between 1 July 2014 and 30 June 2021, who had undergone peripheral blood lymphocyte subpopulation detection. RESULTS:Thirty-one neonates were included in the control group, whereas 33 infants with BPD were included in the case group. In addition, we selected 56 infants with a gestational age (GA) <37 weeks without BPD who were receiving oxygen therapy. Among the three groups, the B cell and NK cell frequencies were significantly higher and the frequencies of T cells and CD4+ cells were significantly lower in the BPD group. In newborns without BPD, the distribution of T lymphocyte subsets was similar at different GAs. Comparing different degrees of BPD, the patients in the grades 2-3 BPD group had significantly lower percentages of T lymphocytes and CD4+ T cells than those in the other groups. Remarkably, the frequencies of NK cells were significantly higher in patients with grades 2-3 BPD, and the Treg cells slightly increased with BPD severity, although the differences were not significant. CONCLUSION:Healthy neonates had similar ratios of lymphocyte subsets among different GAs; although as the GAs increased, the percentage of lymphocytes increased slightly. Severe BPD was associated with lower CD4+ T cells and higher NK cells. However, whether such changes were the cause or the consequence of BPD has not been determined.

Background. Bronchopulmonary dysplasia (BPD) has a high mortality rate. This study was aimed at identifying and analysing the risk factors associated with BPD using bioinformatic and mechanical analyses and establishing a predictive model to assess the risk of BPD in preterm infants. Methods. We identified differentially expressed RNAs via the intersection of miRNAs between datasets. Online analysis tools were used to predict genes targeted by differentially expressed miRNAs (DEmiRNAs) and to generate and visualise competing endogenous RNA (ceRNA) coexpression networks. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were subsequently performed on the DEmiRNAs. In addition, an intersection analysis was performed on mRNA and neuropeptide-related genes in the ceRNA network. DEmiRNAs associated with BPD and those involved in ceRNA networks were used to establish a diagnostic prediction model. The GSE108604 dataset was used as a validation set to verify the model. Results. A total of 26 DEmiRNAs were identified from the tracheal aspirates (TAs) of patients with BPD and healthy controls. In addition, a total of 1076 DEmRNAs were obtained from the GSE8586 dataset. Functional enrichment analysis of DEmRNAs revealed an abnormal reduction in mitochondrial-related activity and cellular responses to oxidative stress in patients with BPD. The neuropeptide-related genes OPRL1 and NPPA were found to be upregulated in BPD samples. Eventually, hsa-miR-1258, hsa-miR-298, hsa-miR-483-3p, and hsa-miR-769-5p were screened out and used to establish the prediction model. Calibration curves and detrended correspondence analysis (DCA) revealed that the model had good clinical applicability. Conclusions. The prediction model provided a simple method for individualised assessment, early diagnosis, and prevention of BPD risk in preterm infants.

Apert综合征是新生儿期罕见的遗传性疾病，因FGFR2基因变异导致，发病率1/65 000，其特征为颅缝早闭、尖头畸形、并指（趾）畸形，常合并皮肤、骨骼、大脑和其他器官异常。本文报告1例Apert综合征早产儿，以提高临床医生对此病的认识。

目的 探讨新生儿甲基丙二酸血症的临床特点,以提高对本病的认识,争取早期治疗及改善远期预后.方法 回顾性分析中国人民解放军总医院第七医学中心新生儿重症监护病房2015年1月至2021年5月应用串联质谱法和气相色谱-质谱法确诊的52例新生儿甲基丙二酸血症患儿的临床资料,总结分析其临床特征以及治疗和预后情况.结果 52例患儿中男28例,女24例,其发病年龄早,发病日龄0～28d,超半数在生后1周内发病.新生儿甲基丙二酸血症临床表现不典型,主要表现为喂养困难、呕吐、呼吸困难、意识障碍、抽搐、肌张力减低、血小板减少、反复代谢性酸中毒、高氨血症等.血串联质谱法检测提示血清丙酰肉碱和丙酰肉碱/乙酰肉碱比值增高,尿气相色谱-质谱法有机酸检测提示甲基丙二酸浓度显著增高.由于缺乏有效的治疗措施,家长担心远期预后不佳而终止治疗后,绝大多数于生后1～3个月死亡.坚持治疗的21例确诊患儿中,均接受维生素B12、左旋肉碱治疗,并辅以低蛋白饮食,其中11例临床症状完全消失,10例效果不佳,于生后4个月至1岁死亡.结论 新生儿甲基丙二酸血症缺乏特异性的临床表现,串联质谱法和气相色谱-质谱法分析可确诊本病,早期发现和治疗是改善预后的关键.

BACKGROUNDThe mechanism of PALLD, PRKCH, AKAP12, PDK4, and CHIT1 proteins in serum diagnosis of neonatal sepsis (NS) was explored.METHODSAnalysis of PALLD, PRKCH, AKAP12, PDK4, and CHIT1 expression in serum from NS patients and their correlations were manifested. Evaluation of the ability of PALLD, PRKCH, AKAP12, PDK4, and CHIT1 to identify NS was manifested. Analysis of the prognostic value of PALLD, PRKCH, AKAP12, PDK4, and CHIT1 was in NS.RESULTSElevated PALLD, PRKCH, AKAP12, PDK4, and CHIT1 were found in serum from NS patients. Serum PALLD, PRKCH, AKAP12, PDK4, and CHIT1 have diagnostic value for NS. Moreover, PALLD could predict the overall survival of NS patients.CONCLUSIONSThis study clarifies elevated PALLD, PRKCH, AKAP12, PDK4, and CHIT1 in NS patients. Meanwhile, PALLD, PRKCH, AKAP12, PDK4, and CHIT1 are available to offer brand-new non-invasive biomarkers for NS's prognosis and diagnosis.

拔管困难是经外周中心静脉置管（peripheral inserted central vein catheterization，PICC）的并发症之一，处理不当可造成严重后果。本文报道1例早产儿PICC置管不顺利后出现拔管困难，血管超声提示导管于左贵要静脉近腋窝处反折，后经皮下静脉切开取出PICC导管。

目的 评价以问题为导向(problem-based learning,PBL)联合情景模拟教学法在儿科规范化培训医师新生儿复苏培训中的应用效果.方法 选取2017年9月至2021年9月在解放军总医院第七医学中心儿科医学部轮转的67名儿科学专业规范化培训医师,采用随机数字表法分为观察组(34名)和对照组(33名).其中观察组采用PBL联合情景模拟教学法,对照组采用传统理论授课方法,通过比较两组学员培训后的理论知识和操作技能考核得分进行效果评价,并比较教学满意度情况.结果 两组规范化培训医师一般情况比较差异无显著性(P>0.05),入科前基础知识考核差异无显著性(P>0.05).复苏培训后两组理论考核分数差异无显著性(P>0.05),观察组规范化培训医师的操作技能得分高于对照组,差异有显著性(P<0.05).观察组规范化培训医师教学满意度调查得分高于对照组,差异有显著性(P<0.05).结论 PBL联合情景模拟教学法能够有效提高儿科规范化培训医师的新生儿复苏技能,并能提高教学满意度,比传统培训方法更有优越性.

Objective:To compare the clinical characteristics of congenital chylothorax in preterm and term infants.Method:From January 2011 to December 2019, the clinical data of infants with congenital chylothorax admitted to our hospital were retrospectively analyzed. The infants were assigned into preterm group (<37 weeks) and term group (≥37 weeks) according to their gestational age. The general information, clinical manifestations, laboratory results, treatment and prognosis of the two groups were compared.Result:A total of 34 infants with congenital chylothorax were included, including 11 premature infants and 23 term infants. No significant differences existed in gender, delivery mode, prenatal diagnosis of pleural effusion, congenital heart disease/chromosome abnormality, birth asphyxia, dyspnea, fetal edema, and location of effusion between the two groups ( P>0.05). Compared with term group, preterm group had significantly fewer leukocytes [3 245(1 007, 7 403)×10 6/L vs. 10 214(6 233,16 458)×10 6/L] and lower protein level [(28.1±7.6) g/L vs. (33.3±6.3) g/L] in the pleural fluid ( P<0.05). No significant differences existed in the proportion of pleural lymphocytes between the two groups ( P>0.05). The proportion of mechanical ventilation (MV) in the preterm group was statistically higher than that the term group [100%(11/11) vs. 65.2%(15/23)], and the duration of MV was statistically longer than the term group [(16(10,25) d) vs. (1(0,11) d)] ( P<0.05). No significant differences existed between the two groups in the application of other treatment options (thoracentesis/drainage, fasting, octreotide and erythromycin pleural injection), time needed for the disappearance of effusion, duration of hospital stay and cure/improvement rate ( P>0.05). Conclusion:Preterm infants may have lower leukocyte count and protein level in the pleural effusion than the term infants. Both preterm and term infants have higher proportion of lymphocytes in the pleural effusion fluid. Although most preterm infants need ventilator support after delivery, most of them achieve complete remission after conservative treatment and the overall prognosis is as good as term infants.

Objective:To study the effects of comprehensive warming intervention strategy on the body temperature of preterm infants (gestational age <32 weeks and birth weight <1 500 g) during inter-hospital transportation.Method:From October 2016 to July 2019, eligible preterm infants transported to our hospital were retrospectively analyzed. From October 2016 to March 2018, preterm infants transported with routine transportation strategy were assigned into the control group. From April 2018 to July 2019, preterm infants transported with the comprehensive warming intervention strategy were assigned into the experiment group. The body temperature, complications and prognosis before and after the transportation to our NICU were compared.Result:A total of 1 194 premature infants with gestational age <32 weeks were included with 630 cases in the control group and 564 cases in the experiment group. No significant differences existed in demographic data of the mothers, infants and the transportation time between the two groups ( P>0.05). The body temperatures before and after transportation in the experimental group were (36.8±0.5)℃ and (36.7±0.5)℃, significantly higher than the control group [(36.0±0.4)℃ and (36.3±0.6)℃] ( P<0.01). The incidences of hypoglycemia and mortality in the experimental group were 3.7% (21/564) and 4.8% (27/564), significantly lower than the control group [8.4% (53/630) and 7.9% (50/630)] ( P<0.05). Conclusion:Comprehensive warming intervention strategy in inter-hospital transport can effectively improve the body temperature of preterm infants before and after transportation, reducing the incidences of hypoglycemia and mortality.

Background: Very premature infants with cerebral hemorrhage often have decreased cerebral oxygenation (CrSO2) monitored by near-infrared spectroscopy (NIRS) in the first few days after birth. This study aimed to analyze the correlation between NIRS data of very premature infants monitored in the first 72 hours of life and clinical data, as well as their impact on cerebral oxygenation and cerebral fractional tissue oxygen extraction ( cFTOE )Methods: From July 2017 to June 2019, neonates of gestation age between 28 to 31 weeks were recruited from the Seventh medical center of Chinese PLA general hospital, Beijing, China. While arterial blood gas(ABG) analysis was monitored from neonates' admission to 72 hours after birth, data such as CrSO2, transcutaneous arterial oxygen saturation (SpO2), oxygen saturation (SaO2), heart rate(HR), and mean arterial blood pressure (MABP) were collected simultaneously. cFTOE was calculated as follows: cFTOE = [(SpO2 - CrSO2)/SpO2]. Head ultrasounds were generally obtained at 6–48 hours, 1week, and 1month of age. The linear mixed model was used to analyze the blood gas value, CrSO2, cFTOE, and other system signals. Findings: 145 newborns were included in this study. CrSO2 was significantly related to partial pressure of oxygen (PaO2), glucose (Glu) within 72 hours after birth (F=6·53 and 5·82, respectively, P<0·05). Compared with intraventricular hemorrhage (IVH) infants, CrSO2 was decreased and cFTOE was increased over time at three days old neonates without IVH. In contrast, infants with IVH had gradually increased CrSO2 and decreased cFTOE within 72 hours after birth, and compared to infants without IVH they had lower mean CrSO2 (P<0·05) and higher mean cFTOE (P<0·05). Interpretation: Newborns with lower CrSO2 and higher cFTOE, who were prone to occur hypoperfusion or hypoglycemia. Neonates with IVH had lower CrSO2 and higher cFTOE within 72 hours after birth, and the change trends of them were opposed to the infants without IVH.Funding: National Natural Science Foundation of China supported this study(81471492).Declaration of Interests: The authors declare no conflicts of interest.Ethics Approval Statement: This study was a prospective cohort study and the protocol was approved by the ethics committee of Seventh medical center of Chinese PLA general hospital.

目的 探讨X-连锁重症联合免疫缺陷病(X-linked severe combined immunodeficiency,X-SCID)的临床特征及诊治要点.方法 对解放军总医院第七医学中心八一儿童医院收治并经基因诊断的1例X-SCID患儿的临床资料进行分析并复习相关文献.结果 患儿男性,生后1个月内起病,反复感染,抗生素治疗效果不佳,血常规提示淋巴细胞计数明显减少,流式细胞仪检测结果 显示患儿体液及细胞免疫功能缺陷.基因检测示IL2RG基因c.266T>C,p.Y89>C纯合突变,其母亲及姐姐IL2RG基因均为杂合突变.家族中,母系中女性均健康,患儿哥哥及3个舅舅均在生后3～4个月时出现发热、肝脾大后死亡,考虑可能均为X-SCID.结论 本病例为男性患儿,生后不久即出现反复感染、腹泻,治疗效果不佳,体液及细胞免疫功能缺陷,绝大部分免疫分型为T-B+NK-SCID,少部分为不典型的T-B+NK+SCID,部分家族中有男婴夭折史,行相关基因检测提示IL2RG基因突变所致.早期诊断并给予免疫重建,可提高存活率.

OBJECTIVE To study the clinical features of very preterm small-for-gestational-age infants born by cesarean section due to severe preeclampsia. METHODS Forty-two small-for-gestational-age infants who were admitted from August 2017 to July 2018 and were born due to severe preeclampsia were enrolled as the observation group. Forty very preterm infants who were born to healthy mothers since uterine contractions could not be suppressed were enrolled as the control group. Perinatal features, clinical manifestations of infection, complications, and clinical outcomes were analyzed for the two groups. RESULTS Within 6 hours and 2-3 days after birth, the observation group had significantly lower white blood cell count (WBC), absolute neutrophil count (ANC), and platelet count (PLT) than the control group (P < 0.05). At 5-7 days after birth, there was no significant difference in WBC between the two groups (P > 0.05), while the observation group still had significantly lower ANC and PLT than the control group (P < 0.05). The observation group had a significantly higher C-reactive protein (CRP) level than the control group at 2-3 days and 5-7 days after birth (P < 0.05). The observation group had a significantly higher proportion of infants with severe infections than the control group (P < 0.05). The observation group had a significantly higher hemoglobin level than the control group within 6 hours after birth (P < 0.05). The observation group had a significantly higher incidence rate of bronchopulmonary dysplasia than the control group (P < 0.05). There was no significant difference between the two groups in the rate of pulmonary hemorrhage, intracranial hemorrhage, neonatal necrotizing enterocolitis, retinopathy of prematurity, and the rate of use of invasive ventilation, and clinical outcomes (P > 0.05). CONCLUSIONS Very preterm small-for-gestational-age infants born due to severe preeclampsia have a high incidence rate of infection and severe conditions. Early manifestations include reductions in the infection indicators WBC, ANC, and PLT, and CRP does not increase significantly in the early stage and gradually increases at 2-3 days after birth. Most of these infants require invasive ventilation after birth, with bronchopulmonary dysplasia as the main complication. Clinical changes should be closely observed and inflammatory indicators should be monitored for early identification of infection, timely diagnosis, and timely adjustment of antibiotic treatment, so as to improve the outcome.

Objective:To investigate the protective effects of bovine lactoferrin (bLF) supplementation on intestinal mucosal tissue and its influence on of inflammatory factors in the premature rats model of necrotizing enterocolitis(NEC), and to provide the theoretical basis for prevention of NEC by bLF supplementation.Methods:Premature SD rats were randomly divided into 4 groups, 25 cases in each group.Control group: oral feeding; model group : oral feeding with lipopolysaccharides(LPS) gavage + hypoxic stimulation; high dose bLF intervention group: daily bLF (7 g/L) + oral feeding with LPS gavage + hypoxic stimulation; low dose bLF intervention group: daily bLF (2 g/L) + oral feeding with LPS gavage + hypoxic stimulation.Histopathological analysis was performed by HE staining.The expression levels of interleukin-1β(IL-1β)and interleukin-6(IL-6)in intestinal mucosa were detected by enzyme linked immunosorbent assay (ELISA).Results:(1) Morphological observation: the intestinal wall of model group was thin, and there were different degrees of pneumoconiosis and effusion in intestinal cavity.Under the microscopy, it could be observed that the intestinal tissue necrosis was serious, the intestinal villi fell off, glands arranged disorderly, epithelial edema was significant, the lamina propria and submucosa had severely edema and were separated, and there were a large number of inflammatory cells infiltrated.The above-mentioned manifestations were alleviated in the high-dose and low-dose bLF intervention groups, and no significant abnormalities were found in the control group.(2) The expression of IL-1β and IL-6 in intestinal tissue: the tissue concentration of IL-1β and IL-6 in the model group rats [(380.89±20.25) ng/L, (485.12±31.44) ng/L]were significantly higher than those in the control group[(270.69±45.58) ng/L, (212.62±89.46) ng/L]( q =9.785, 14.030, all P<0.01). The expression of IL-1β and IL-6 in mucosal tissue of ileum was significantly inhibited in hypoxic and LPS-stimulated rats fed with bLF(IL-1β: q=9.105, 8.761, all P<0.01; IL-6: q=8.175, 8.996, all P<0.01). There was no significant difference in the expression of IL-1β and IL-6 between high dose bLF(7 g/L) and low dose bLF (2 g/L) inter vention groups (IL-1β: q=-0.084, P>0.05; IL-6: q=-1.140, P>0.05). Conclusion:Enteral bLF supplementation can alleviate the damage of intestinal tissue in NEC model of premature SD rats, inhibit the expression of IL-1β and IL-6 inflammatory factors in intestinal tissue, and have a protective effect on intestinal tissue.

目的 探讨新型敷料应用于新生儿皮肤浸渍护理中的效果.方法 选取2018年1月至2018年12月中国人民解放军总医院第七医学中心附属八一儿童医院收治的皮肤浸渍患儿120例,按入院时间顺序将2018年1月至2018年6月的60例患儿作为对照组,采用传统方法护理浸渍皮肤;将2018年7月至2018年12月的60例患儿作为观察组,针对皮肤浸渍的程度选用合适的新型敷料给予护理.比较两组患儿皮肤浸渍的治疗效果和愈合时间.结果 观察组总有效率为95.0％,皮肤愈合时间为(3.20±1.02)d,对照组总有效率为83.3％,皮肤愈合时间为(4.28±1.51)d.观察组总有效率高于对照组,皮肤愈合时间短于对照组,差异均有显著性(P<0.05).结论 新型敷料用于新生儿皮肤浸渍的护理,疗效确切,可减轻患儿痛苦,缩短了皮肤愈合时间,减少护理人员工作量.

目的 探讨综合优质护理干预在Prader-Willi综合征新生儿喂养中的应用.方法 选择2017年10月至2019年12月解放军总医院第七医学中心八一儿童医院收治的72例Prader-Willi综合征新生儿,采用随机数表法分成对照组和研究组,每组36例.对照组采用常规喂养的方法,研究组采用综合优质护理干预的方法.评估两组患儿的喂养等相关指标,并调查家长的护理满意程度.结果 研究组的出生体重恢复时间、达全胃肠营养时间、住院时间明显短于对照组,患儿家长的护理满意度明显高于对照组,差异均有显著性(P<0.05).结论 在Prader-Willi综合征新生儿喂养中采用综合优质护理干预,能提高其生存质量,增加家长对护理的满意度,可在临床推广应用.

目的 探讨早产儿急性阑尾炎的临床特点及诊治体会,以提高对该病的早期识别和救治率.方法 回顾性分析并总结解放军总医院第七医学中心八一儿童医院新生儿重症监护病房收治的4例早产儿急性阑尾炎的临床资料,包括临床表现、早期诊断、术中诊断等.同时在万方、中国知网、维普、PubMed等数据库中组合检索相关文献并分析.结果 ①病例资料:本文4例早期均以"腹胀"为首发症状,炎性指标明显升高,予以急诊手术,均术中诊断急性阑尾炎,其中2例为单纯急性阑尾炎,余2例为新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)合并阑尾炎.术后予积极抗感染、补液等治疗,4例均痊愈出院.②文献复习:经过阅读与筛选,中文文献数据库检索出早产儿急性阑尾炎文献8篇,PubMed检索出10篇.国内外近30年早产儿急性阑尾炎相关文献报道较少,文献多以病例报道、误诊分析等为主.其中国内8篇文献,共报道早产儿急性阑尾炎35例,男27例,女7例,1例文献未描述性别;症状以腹胀、吐奶为主;32例穿孔,1例未穿孔,1例为早产儿阑尾炎合并肠套叠,另1例为合并腹股沟嵌顿疝;死亡1例(2.9％),其余均积极手术治疗后治愈出院.国外文献共10篇,早产儿急性阑尾炎共11例,男9例,女2例;穿孔5例,败血症2例,血便1例,腹股沟嵌顿疝3例,无死亡病例.11例中,早期均未诊断急性阑尾炎,均为术后诊断.结论 早产儿急性阑尾炎无特异性临床表现,误诊率高,术前诊断较难,需结合腹部查体、X线片、B超及剖腹探查术明确.临床怀疑本病时应早手术探查,降低病死率.