Background: The fasting time after gastrointestinal bleeding has always been a controversial area. It is rarely to be reported for children with gastrointestinal bleeding about fasting time and diet management at home and abroad.
Objective: To explore whether children with massive gastrointestinal bleeding need early strict fasting and preliminarily explore the reasonable choice of food when starting feeding.
Design: Retrospective cohort study.
Methods: The clinical data of children with massive gastrointestinal bleeding hospitalized in West China Second Hospital of Sichuan University from October 2011 to October 2021 were collected. Patients were divided into four groups according to fasting time: less than 24 hours group, 24 to 48 hours group, 48 to 72 hours group and greater than 72 hours group. Meanwhile, patients were divided into three groups according to different diet when starting feeding: carbohydrate diet group, protein diet group and mixed diet group. The research analysed the different variables in demographic characteristics, clinical features, laboratory examinations and clinical outcomes in fasting time group and different diet group, respectively. The variables with statistically significant differences among groups were analyzed by multivariate regression analysis.
Main outcome measures: Rebleeding and hospital stay.
Results: A total of 266 patients with massive gastrointestinal hemorrhage were selected into this study, including 175 males（65.8%）and 91 females（34.2%）with the median age of 6.0(2.4, 10.9) years. As less than 24 hours group as the reference, the multivariate logistic regression analysis showed that fasting time was disassociated with rebleeding and nosocomial infection and there was no statistically significant difference(P>0.05). Multiple linear regression analysis showed that patients with fasting time greater than 72 hours had prolonged length of hospital stay(lnLOS) (0.192, 95%CI: 0.047 to 0.337, P=0.010). As carbohydrate diet group as the reference, multivariate logistic regression analysis showed that the type of diet was disassociated with rebleeding and adverse reactions after feeding and there was no statistically significant difference(P>0.05). Multiple linear regression analysis revealed that there were no statistically significant differences in lnLOS between carbohydrate diet group and protein diet group(P>0.05), while hospital stays of mixed diet group was shorter than other two groups (-0.176, 95%CI: -0.318 to -0.034, P=0.015). Conclusion: Fasting time for less than 24 hours in children with massive gastrointestinal bleeding will not increase the risk of adverse outcomes such as rebleeding and nosocomial infection, and early feeding within 24 hours tend to have shorter hospital stays. When patients began to take food after massive gastrointestinal bleeding, carbohydrate + protein mixed food which can be used as the initial diet choice, was more conducive to shorten the hospital stay and may not increase the rebleeding rate and the incidence of the adverse reaction after feeding.
Objective: To systematically analyze the survival rate and trajectory of motor function in the natural history of SMA patients so as to provide benchmark data for the intervention of SMA.
Methods: PubMed, Embase, Cochrane, CNKI, CBM and Wanfang database were searched by using the keywords of spinal muscular atrophy and natural history, from the inception to November 27th 2022.
Results: A total of 17 case series reports (n=1905) and 2 sham controls of Nusinersen in RCTs (n=83) for SMA were included in the analysis. The survival rates at the age of 6 months (4 studies), 12 months (5 studies) and 18 months (4 studies) were 86%, 52% and 32%, respectively. The meta-analysis of event-free survival rates from natural history case series reports of type 1 SMA showed that it was 76%,34% and 16% at the age of 6 months (3 studies), 12 months (4 studies) and 18 months (3 studies) respectively.
Conclusion: Natural history of SMA patients varied in different types, of which type 1 SMA showed lower survival and event-free survival rates, while type 2-3 SMA patients present with slower regression of motor function.
SU Yan, HUANG Zhen, LU Zheng, LI Miao, ZHI Tian, SUN Qing, ZHANG Zhaoxia, WANG Huanmin, GE Ming, YU Tong, HE Lejian, LIU Rong, ZHAO Weihong, HUANG Dongsheng, WU Wanshui, GONG Jian, NIU Xiaohui, MA Xiaoli
children and adults.
Objective：To summarize the clinical characteristics and prognosis of adolescent malignant solid tumors in multiple centers in Beijing.
Methods：This retrospective study analyzed the clinical characteristics and prognosis of adolescents over the age of 120 months with the initial diagnosis of malignant solid tumors in seven hospitals in Beijing from January 1, 2010 to December 31, 2019.
Main outcome measures：Three-year event free survival (EFS) and overall survival (OS).
Results：A total of 411 patients were enrolled in this study with a median age of 150 months (120-216 months). In total, 239 patients(58.2%) were males and 172(41.8%) were females. There were 183 patients(44.5%) with central nervous system tumors, 82(20%) with Ewing sarcoma, 47(11.4%) with rhabdomyosarcoma, 33(8%) with neuroblastoma, 29(7.1%) with non-rhabdomyosarcoma soft tissue sarcomas, 18(4.4%) with extracranial germ cell tumors and 19(4.6%) with other rare tumors. Among the 411 patients, the top three regions of registered residence were North China(160 cases, 38.9%), East China(97 cases, 23.6%) , South Central China(70 cases, 17%). There were 129 patients(31.4%) treated at one hospital, 180 patients(43.8%) at two hospitals, and 102 patients (24.8%) at three or more hospitals. The median follow-up time of 411 patients was 26 months(1-120 months). At the end of follow-up, 333 patients (81.0%) survived, 78 patients(19%) died, and 145 patients(35.3%) had tumor relapse or progression. The 3-year EFS rate was 60.3%, and the 3-year OS rate was 79.5%. The median survival time of 78 cases of death was 13 months(1-65 months), including 22 patients(28.2%) with central nervous system tumors, 18(23.1%) with rhabdomyosarcoma, 16(20.5%) with Ewing sarcoma, 8(10.3%) with neuroblastoma, 3(3.8%) with extracranial malignant germ cell tumors, 5(6.4%) with non-rhabdomyomatous soft tissue sarcomas and 6(7.7%) with rare tumors.
Conclusion：Center nervous system tumors are the most common malignant solid tumors in adolescents. The prognosis of neuroblastoma, rhabdomyosarcoma and extracranial malignant germ cell tumor in adolescents is poor.
Background：The differences in oxygen saturation in the early postnatal period and umbilical artery blood gas values among different altitude gradients are still needed to be explored, especially for the establishment of normal values of pulse oximetry (SpO2)and umbilical artery blood gas at high altitudes.
Objective：To compare the distribution of SpO2 within 2 hours after birth and umbilical artery blood gas analysis in well full-term neonates at different altitudes.
Methods：Healthy full-term neonates who were delivered consecutively in 4 hospitals of the Chinese High Altitude Neonatal Medicine Alliance (CHANMA) from September 7, 2022 to October 10, 2022 were included. Designated medical staff collected the baseline data of the newborn, and tested the SpO2 value of the right hand of the newborn within 10, 11 to 30, and 31 to 120 minutes after birth under the same environments with the same standard. Immediately after birth, the umbilical cord was clamped and umbilical arterial blood gas (pH, lactic acid and BE) was detected. The data was recorded in the database of the CHANMA through the computer network. According to the altitude level, they are divided into 2,000 m above sea level group, 2,400 m above sea level group and 3,500 m above sea level group. The SpO2 value of 95% was taken as the hypoxic high-risk cut-off value for comparison. Main outcome measuresSpO2 within 2 hours after birth.
Results：A total of 229 cases were included with 73 cases in the 2,000 m altitude group, 42 cases in the 2,400 m altitude group, and 114 cases in the 3,500 m altitude group. There was no significant difference in gender, gestational age, birth weight and mother's age among the three groups. Tibetan distribution was statistically significant. The SpO2 of the overall newborn population gradually increased over time. The median SpO2 at 2,000 m altitude group was 96%, 98% and 100% in three continuous periods after birth (10, 11 to 30 and 31 to 120 minutes), and the 25th quantile was equal to, 2% and 3% higher than the hypoxic high-risk cut-off value. The median SpO2 of the 2400m altitude group was 88%, 90% and 94% in the three continuous periods after birth, and the 75th quantile was 6%, 4%, and 1% lower than the hypoxic high-risk cut-off value respectively. The median SpO2 of the 3,500m altitude group in 3 consecutive periods was 84%, 89%, and 92%, respectively, and the 75th quantile was 5%, 5%, and 1% lower than the hypoxic high-risk cut-off value. There was no significant difference in the umbilical artery blood gas pH value among different altitude groups. The lactic acid was significantly higher and the BE was significantly lower in the 2,400 m altitude group and the 3,500 m altitude group than that in the 2,000 m altitude group, and the difference was significant in infants with cesarean birth as well. There was no statistically significant difference in SpO2 within 2 hours after birth and umbilical artery blood gas between newborns of Tibetan and other ethnic groups. The SpO2 of newborns of Tibetan and other ethnic groups showed an upward trend over time. The dispersion of point values was significantly narrowed, and 22.8% (26/114) of SpO2 value was higher than the hypoxic high-risk cut-off value.
Conclusion：SpO2 in healthy full-term neonates within 2 hours of birth was significantly lower than the hypoxic cut-off values in altitudes above 2,000 meters, and higher at the altitude of 2,000 m and 3,500 m. There was not significant difference in SpO2 between Tibetans and other ethnic groups at 3,500 m altitude area.
Background Baby body plethysmography is the gold standard for testing the functional residual volume and airway resistance, making it important for the evaluation of infant respiratory physiology.
Objective To explore the influence of improving the operation skills of pulmonary function test (PFT) in plethysmography on the success rate of PFT.
Design Quality improvement study.
Methods PFTs were performed using the Jaeger MasterScreen BabyBody device (Erich Jaeger GmbH, v4.65, Würzburg, Germany) to examine tidal breathing flow volume loop (TBFVL) and plethysmographic functional residual capacity (FRCP). Before the improvement, the protocol of PFT were in accordance with the recommendations published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS). On the basis of the previous protocol, improvement was described as increasing the dosage of sedatives (oral chloral hydrate) , touching or massaging the baby for 5 minutes before the test, and placing a slope pillow with 15 degree supine position. Continuous cases of PFT in pulmonary function room from January 2017 to January 2019 were included, and children with severe pneumonia caused by acute lower respiratory tract infection (ALRI) were excluded. The date of January 1, 2018 was set as the timing to differentiate before and after improvement. They were divided into neonatal pneumonia group and ALRI group. ALRI group was divided into the wheeze and non-wheezing subgroups.
Main outcome measures The success rate of TBFVL and FRCP, and the failure rate of sedation.
Results Totally 120 cases of neonatal pneumonia and 477 cases of ALRI were included. There were 31 cases failing to fall asleep after sedation, 3 cases with neonatal pneumonia and 28 cases with ALRI for both 14 cases in the wheezing and non-wheezing subgroups. Among 23 cases in the early awakening group who did not finish the PFT, there were 6 cases with neonatal pneumonia and 17 cases with ALRI for 5 cases in the wheezing and 12 cases in the non-wheezing subgroup. Although the success rate of TBFVL and FRCP had been improved with decreased rate of sedation failure in the neonatal pneumonia group, there was no significant difference compared with that before the improvement on PFT protocol. The success rate of TBFVL and FRCP had been improved with decreased rate of sedation failure in the non- wheezing and the wheezing subgroups after improvement on PFT protocol with statistical significance.
Conclusion Improving the quality of PFT protocol of Baby body plethysmography can significantly increase the success rate of FRCP and TBFVL and reduce the failure rate of sedation.
Background Pineoblastoma are rare central nervous system tumors in children, and very few reports are available about this special cohort in China.
Objective To investigate the clinical features, survival outcome and prognostic factors in pediatric pineoblastoma.
Design Retrospective cohort study.
Methods Children with pineoblastoma (confirmed by pathology) admitted to pediatric department of Beijing Shijitan Hospital from January 2017 to December 2021, were included for clinical analysis. The last follow-up was August 31, 2022 by clinic visit or telephone. The sex, age at diagnosis, clinical manifestations, imaging findings, surgical and pathological results, treatment and follow-up of the patients were included for analysis.
Main outcome measures Overall survival (OS) and progression-free survival (PFS).
Results Among 16 patients, 15 were males and 1 was female. The median age of onset was 67.6 (range, 20.7-129.4) months, with 4 cases less than 3 years old at the time of diagnosis. The main onset symptoms were intracranial hypertension, and there was no children with obvious endocrine dysfunction. MR images of the primary intracranial tumors showed space-occupying tumors in the pineal region and behind the third ventricle, and tumor spread to the fourth ventricle in one case. Supratentorial hydrocephalus was found in thirteen cases before operation. Five patients experienced metastases (M+) at the time of diagnosis, with spinal cord spread in 3 cases, brainstem and spinal cord spread in one case, and sacral spinal canal metastasis in one case. All the tumors of the sixteen patients were surgically removed with 12 cases under gross total resection and 4 cases near total resection. The surgeries were undertaken through transcallosal interforniceal approach in 15 cases, and Poppen approach in one case, with no obvious perioperative complications in these patients. Ki-67 index was less than 30% in 3 cases, 30%-60% in 5 cases and 61%-80% in 8 cases. All of the patients were treated with both radiotherapy and chemotherapy after surgery, including 9 cases receiving chemotherapy first followed by radiotherapy, and 7 cases receiving chemotherapy following radiotherapy. The median follow-up time was 47.6(36.8, 56.9)months. At last follow-up, nine patients experienced tumor recurrence or progression, and two of them died. The mean OS was 90.7±7.6 (range: 10.8-102.2) months, The 1, 3, 5-year OS were (93.8±6.1)%, (85.9±9.3)% and (85.9±9.3)%, respectively. The median PFS time was 29.5 (17.6, 50.0) months, and the 1, 3, 5-year PFS were (87.5±8.3)%, (41.5±13.8)% and (33.2%±13.3)%, respectively. Univariate analysis showed that boys had better overall survival than girls (χ2=5.405, P=0.02). The PFS of children with Ki-67 index of 30%-60% was shorter than that of <30% (χ2 =4.600, P=0.032). Multivariate COX regression analysis also showed that the risk of PFS in children with Ki-67 index of 30-60% was 3.2 times higher than that in children with Ki-67 index < 30%(HR=3.211, 95% CI: 1.027-10.037, P=0.045)
Conclusion Pineoblastoma in children are rare. Ki-67 index is a prognostic factor affecting PFS.
Background Tic disorder (TD) is a childhood-onset disease. Some TD patients even suffer from tic-related injuries in adulthood.
Objective To investigate the proportion of children with TD who still have tic symptoms in adulthood, and analyze the influencing factors of prognosis of adults with childhood-onset TD.
Design Case-control study.
Methods Telephone follow-up was conducted for adults who were diagnosed as TD in children in the pediatric outpatient department of Guang'anmen Hospital, China Academy of Chinese Medical Sciences. The patients with home contact numbers recorded in the medical records system and YGTSS rating on initial visit were considered. We divided the patients into a case group and a control group according to whether they still had tic symptoms in adulthood. Based on the self-made follow-up questionnaire, we investigated the influencing factors of TD in the follow-up population. The questionnaire had two parts of medical history and follow-up information. Contents of medical records included gender, date of birth, telephone number, age of first TD, first symptom, YGTSS score at first diagnosis and the follow-up information referred to history of childhood respiratory inflammation, family education style, parents＇ personality, family history of TD, comorborbity, Chinese medicine treatment and adjuvant therapy, current treatment status, current education level, TD symptoms at the stop of the treatment before the age of 18, and TD-related symptoms in adulthood (if there were symptoms, YGTSS score was performed and compared with the initial diagnosis in childhood). Single-factor analysis and binary logistic regression analysis were used to analyze the influencing factors.
Main outcome measures Influencing factors of prognosis of adults with childhood-onset TD.
Results Telephone follow-up was completed in 534 TD patients, with 262 (49. 1%) in the case group and 272 in the control group. Children were treated mainly with traditional Chinese medicine combined with western medicine and other treatments. Thirty-one TD adults (11.8%) were still receiving treatment at the time of follow-up. Compared with childhood, 80.2%, 6.5% and 0.8% of adult patients had remission, similarity and aggravation, respectively, and 33 cases had relapse in adulthood. The YGTSS scores of TD adults were 93.1%, 5.7%, and 1. 2%, respectively. Univariate logistic regression analysis showed that statistically significant independent variables entered the multivariate logistic regression analysis of adult prognostic factors. Multivariate logistic regression analysis showed there were five risk factors for the prognosis of adults with childhood-onset TD, including symptoms occurring at the stop of treatment in childhood (OR=20.35, 95%CI: 12.30-33.68), family history of TD (OR=3.54, 95%CI: 1.40-8.96), irritable parents (OR=3.13, 95%CI: 1.74-5. 64), moderate to severe disease at initial diagnosis in childhood (OR=2.91, 95%CI: 1.79-4.75), and recurrent respiratory tract inflammation (OR=2.34, 95%CI: 1.41-3.86).
Conclusion The prognosis of adults with childhood-onset TD is closely related to the family history of TD, the severity of the disease in childhood, the severity at initial diagnosis in childhood, tic symptoms at the stop of treatment in childhood, recurrent respiratory tract inflammation in childhood, and the personality of parents.
Background Speech sound disorder（SSD）is a common cause of communication disorders in childhood with a high prevalence. For those untreated children the symptoms can persist into adulthood and affect the social communication eventually.
Objective To analyze the clinical features of consonant errors in children with SSD.
Design Case series report.
Methods This study recruited the children who came to the department of Children's Healthcare in Chengdu Women's and Children's Central Hospital from January 1, 2020 to December 31, 2020 due to unclear pronunciation, who met the SSD diagnosis and whose language development was over 4 years old, and excluded other diseases that affected language function. Phonetic assessment was conducted by picture naming method. Consonants were classified and analyzed according to the pronunciation position and method. The formula for correct rate of consonants (PCC) was number of correct consonants /(number of correct consonants+number of wrong consonants) ×100%. 85%~100% were mild, 65%~85% were mild to moderate, 50%~65% were moderate to severe, and less than 50% were severe. Demographic characteristics such as age, gender and voice assessment results of SSD children were collected from the medical records.
Main outcome measures PCC and consonant error types.
Results A total of 222 SSD children were recruited in this study, including 67 females and 155 males. There were 111 children aged 4 to 5 years (50.0%), 66 aged 5 to 6 years (29.7%) and 45 aged 6 to 15 years (20.3%). The average PCC of male and female students was 43.3%±20.9% and 44.9%±18.9%, respectively, with no significant difference (P＞0.05). There was a linear relationship between age and the severity of SSD (P＜0.001), and the proportion of severe consonant errors decreased with age. In each age group, the average number of substitution errors was higher than that of ellipsis and distortion, and the average number of substitution errors decreased with the age, showing a low degree of correlation (P＜0.05, r=0.217). The average number of errors in pronunciation positions in a descending order was blade-palatal, blade-alveolar, supradental, velar, alveo-palatal, bilabial, and labiodental. The average number of labiodental, supradental, blade-alveolar and blade-palatal errors decreased with age. The average number of errors in pronunciation style in a descending order was affricate, fricative, plosive, nasal, and lateral. The average number of errors in affricate, fricative, and lateral in the 4-5 age group was higher than that in the other two age groups.
Conclusion SSD in children was mainly moderate to severe and severe in all age groups, and children's speech intelligibility tended to improve with age. The types of errors in all age groups were mainly substitution. The types of errors in pronunciation parts and pronunciation methods were not significantly different between the groups of 5 to 6 and 6 to 15 years old, which should be paid attention to.
Background The treatment of attention deficit hyperactivity disorder （ADHD） emphasizes multi-model treatment. For now there is no long-term comprehensive intervention method with the medical-family-school cooperation model in China.
Objective To evaluate the improvement effects of the medical-school-family cooperation model on core symptoms and learning and life function at home and school of ADHD patients.
Design Non-randomized controlled study. Methods Children with ADHD attending medical-family-school cooperation project (age range 6-10) were selected as the intervention group. The control group matched by the ratio of 1:2 consisted of ADHD outpatients from the Department of Psychology in Children's Hospital of Fudan University. During the 4-month duration of the program, all patients were allowed to receive treatment as usual at their own clinics.
Main outcome measures Changes in the scores of Chinese version of SNAP-Ⅳ scale-parent (inattention, hyperactivity/impulsivity and oppositional score).
Results Children with ADHD (n=27) in the medical-school-family treatment group did not differ from those in the control group (n=54) in age, pre-intervention drug using rate, parental age, education level of mother, family income, SNAP and WFIRS-P scores before treatment, but diffrences were significant in intelligence quotient. The scores of three subdomain of SNAP-Ⅳ scale decreased by 2 points at least from baseline to the end of treatment in medical-family-school cooperative model intervention group. After the intervention in control group, SNAP-Ⅳ inattention and hyperactivity/impulsivity scores declined by two points at least. Statistically significant differences were obtained in oppositional and total scores. There was no significant difference in the Weiss scores between the two groups before and after treatment, and the difference is close to significance in life skill scores. The scores of three subdomains of SNAP-Ⅳ scale declined by two points at least both in medical-school-family treatment subgroups of no-medication (n=10) and medication (n=11). There was no significant difference in the reduced scores between two subgroups. WFIRS-P scores decreased in the subgroup of no-medication in both two groups, and there was a statistically significant difference between them in the school domain. The medical-family-school cooperation model intervention group showed improved executive functions except shift function with a statistically significant difference.
Conclusion The medical-family-school cooperation model could reduce ADHD core symptoms, and improve executive functions.
Background This is a preliminary multi-center survey for the study on the impact of a pediatric infusion management program on the outcome of infusion therapy under a self-controlled pre-and post-experiment design. The management program is based on Clinical Practice Guideline on Infusion Therapy in Children.
Objective To investigate the current situation of pediatric nurses′ knowledge, attitude and behavior related to infusion extravasation.
Design Questionnaire survey.
Methods Based on the theory of knowledge, attitude and behavior, an initial questionnaire with 23 items in 3 sections of knowledge, attitude and behavior was drawn up. After the item analysis, there were 6, 4 and 6 items kept for knowledge, attitude and behavior respectively. The content validity of the items in the attitude and behavior sections was 0.82 to 1.00, and the content validity of the questionnaire level was 0.92. KMO test coefficient of structural validity was 0.807 in attitude and behavior. The result of Bartlett test was P＜0.01 and all items are loaded on with only one main factor ＞ 0.5. The Cronbach's α coefficients of attitude and behavior sections are 0.752 and 0.818 respectively. The nurses participating in clinical work for over 40 weeks in the past year and performing infusion independently or under guidance were recruited from the pediatric wards of 9 hospitals with close academic exchanges with the Nursing Department of Children's Hospital of Fudan University to complete an electronic questionnaire through the platform of Wenjuanxing.
Main outcome measures Scores of knowledge, attitude, and behavior.
Results Among 3,395 sent questionnaires, 2,568 were returned, and 2,210 were valid. Among 2,210 respondents, 21.8%, 15.9%, 34.9%, 11.1% and 29.8% was respectively from the children's hospital affiliated to the university, the pediatric ward of university-affiliated general hospital, the provincial children's hospital, the municipal children's hospital and the municipal maternal and child health hospital. In terms of working experience, those who have worked for ≤5 years, 5 to 10 years, 10 to 15 years and >15 years accounted for 25.6%, 35.3%, 25.6% and 13.5% respectively. For professional titles, 66.1%, 31.6% and 2.4% of them was junior, intermediate and senior titles respectively. Charge nurses, specialists and teaching nurses, and head nurses accounted for 81.0%, 14.7% and 43% respectively. Among the respondents, 2.8% did not participate in infusion training, 41.0% only participated in a training organized by departments, 45.7% participated in both department-level and institute-level training at the same time, and 9.4% participated in the infusion training by departments, institutes and higher-level organizations at the same time. In total, 22.6% of the subjects only had used peripheral intravenous catheters; 14.9% had used both peripheral intravenous catheters and midline catheters at the same time; and 62.4% had used both peripheral venous access devices and central venous access devices at the same time. There was 82.9% only with experience in inserting peripheral intravenous catheters, 11.1% in inserting both peripheral intravenous catheters and midline catheters and 5.9% in inserting both peripheral venous access devices and central venous access devices. The total score of knowledge section was (12.98±6.95) with good, medium and poor grade accounting for 8.6%, 5.5% and 75.9% respectively. The total scores of attitude and behavior were (17.23±2.58) and （23.45±4.14) respectively. There was significant difference in the correlation test between knowledge section and attitude (r=0.066) and behavior section (r=0.100) (P=0.002). Multivariate linear regression analysis showed that hospital type, number of training levels and types of venous access devices used by nurses were the influencing factors of knowledge and behavior scores. The number of training levels is the influencing factor of attitude score of the three factors.
Conclusion The knowledge, attitude and behavior of pediatric nurses about infusion extravasation did not show the trend of unity and order.
FU Weijia, WANG Yingwen, ZHANG Lan, GU Ying, GE Xiaoling, WANG Beibei, SU Ling, FENG Rui, CAO Yun, WANG Jimei, TANG Zheng, LIU Jiangqin, YE Chengjie, WANG Daoyang, TANG Liangfeng, JIANG Longquan, ZHANG Fan, ZHENG Ruyi, ZHOU Jianguo, ZHANG Xiaobo
Background A trinity of emergency referral networks consisting of transferring hospitals, medical emergency centers and receiving hospitals has been established based on 5G and blockchain so as to improve the quality of critical neonatal transfers by realizing admission on the ambulance.
Objective To construct a standardized knowledge base for drug administration under multi-scenarios during neonatal transport (NT), followed by developing a NT drug administration clinical decision support system (CDSS).
Design Quality improvement research.
Methods Through expert consensus after retrieving guidelines or consensus on the drug administration during NT under emergent and critical conditions and extracting the evidence of drug administration under different transport scenarios, a knowledge base for NT drug administration was built to help doctors in transport team standardize drug administration by the CDSS and analyze the drug usage during NT in Shanghai before (control group) and after (intervention group) the application of the CDSS.Main outcome measuresNT drug types and the frequency of drug usage.
Results A total of 149 articles were retrieved from Chinese, English literature databases and other resources. One expert consensus was included after duplication removal, primary screening, and full-text screening. Meanwhile, three authoritative monographs were added. The regimens of drug administration during NT were extracted from the above evidence sources. The consensus expert group refined the scenario settings of hypoglycemia for symptomatic and asymptomatic types and the regimens of 12 drugs administration. Finally, 16 drugs were confirmed in the knowledge base for NT drug administration. There were 30 cases in the control group and 61 cases in the intervention group. There was no significant difference in gender, disease type and gestational age between the two groups (P> 0.05), but there was significant difference in birth weight (P=0.02). Four drugs were used in the control group during NT for 33 times, and 11 drugs for 88 times in the intervention group, of which 74 (85.9%) were triggered by the CDSS and 14 (14.1%) by the subjective judgment of the doctors. The types of drugs used in the intervention group covered those in the control group. The mean of drug usage times in the control group was 1.1 (33/30), which was statistically significant compared with that of 1.4 in the intervention group (88/61). The proportion of drug usage per newborn in the control group was 25% (4/16), which was statistically significant compared with that of 62.5% in the intervention group (11/16) (P=0.031).
Conclusion The construction of the knowledge base and CDSS for drug administration during NT has promoted standardized and on-demand drug administration.
Background It is difficult to dignose mycoplasma pneumoniae encephalitis (MPE) and the available medicine is limited. Objective To summarize the clinical features, diagnosis and treatment of children diagnosed with MPE. DesignCase series report.
Methods The clinical manifestations, laboratory examination and imaging changes, treatment and outcomes in consecutively hospitalized patients diagnosed with MPE from January 2017 to December 2019 were retrospectively analyzed.
Main outcome measures Recurrence or relapse.
Results A total of 4 patients were all boys without any other underlying diseases. All of them mainly presented with fever and nervous system abnormality, 2 of whom had respiratory symptoms and 1 developed gastrointestinal symptoms. Serum mycoplasma pneumoniae (MP) IgM antibody detection was positive and other common pathogens were negative in all cases. As to cerebrospinal fluid test, 3 cases showed increased nucleated cell number, 1 case had weak positive protein and 1 case presented increased cerebrospinal fluid immunoglobulin. Multiple lesions in cranial magnetic resonance imaging (MRI) and abnormal electroencephalographic (EEG) were showed in all patients. Only one patient's condition was gradually worsened after 2 times of methylprednisolone and three times of intravenous immunoglobulin (IVIG) treatment, but the following condition was improved after three weeks of levofloxacin therapy combined with methylprednisolone pulse treatment and maintenance therapy. The other three patients' conditions were improved after receiving three weeks of levofloxacin therapy combined with IVIG pulse treatment and glucocorticoid. Follow-up after discharge showed that all patients' conditions continued to improve without recurrence or relapse.
Conclusion The diagnosis of MPE can be established based on positive serological MP-IgM and the clinical manifestations and imaging features of encephalitis after other common pathogens were excluded. Levofloxacin combined with glucocorticoid and gamma globulin can achieve obvious efficacy and improve the prognosis of MPE.