Background：Transcutaneous carbon dioxide partial pressure (TcPCO2) and transcutaneous oxygen partial pressure (TcPO2) monitoring make it possible to continuously monitor neonatal PCO2/PO2 and reduce the number of blood collections. However, clinicians are very concerned about its safety and accuracy.
Objective：To reflect the consistency of TcPCO2/TcPO2 monitoring values and PaCO2/PaO2 monitoring values through a systematic review and meta-analysis.
Design：Systematic review and meta-analysis.
Methods：A systematic literature retrieval was performed in English databases of Ovid MEDLINE, Ovid Embase and Chinese databases of SinoMed, Wanfang and CNKI. Search strategy was developed using key words of neotate, TcPCO2 and TcPO2. After deduplication, the literature was first screened by reading titles and abstracts by two leading authors independently who then finished the full-text screening. A self-made excel form was used to extract the year of publication, gestational age at birth, gestational age at monitoring, birth weight, weight at monitoring, sample size and the number of monitored pairs, the probe temperature, monitoring site, duration and equipment, blood gas values difference by TcPCO2/TcPO2and PaCO2/PaO2 , correlation coefficient and adverse events. Meta-analysis was performed by Stata 17.
Main outcome measures：Difference in blood gas results between TcPCO2/TcPO2and PaCO2/PaO2.
Results：A total of 875 articles were retrieved in both Chinese and English. After deduplication, preliminary screening, and full-text screening, 40 articles were included in the analysis, including 14 in Chinese and 26 in English. The summarized differences between TcPCO2 and PaCO2 in probe temperature subgroups of 44℃ vs 43℃, 42℃, 40℃ vs 41℃, and 38℃ vs 39℃ were 2.37(95%CI: 2.17 to 2.67), 2.48(95%CI: 1.17 to 3.79), 4.47(95%CI: 3.03 to 5.92), and 5.96(95%CI: 5.27 to 6.64) respectively, and the Pearson coefficient ranged from 0.78 to 0.89 among the four subgroups. For the deviation from PaCO2, it was 5% in the 43℃ vs 44℃ subgroup, 118% to 14.8% in the 40℃ vs 41℃ subgroups, and 17% in the 38℃ vs 39℃ subgroups. The summarized difference between TcPO2 and PaO2 in probe temperature subgroups of 44℃ vs 43℃, 42℃, 40℃ vs 41℃, and 38℃ vs 39℃ were -7.28(95%CI: -12.92 to -1.63), -5.61(95%CI: -6.61 to -4.62), -28.85(95%CI: -35.12 to -22.58) and -31.42(95%CI: -35.97 to -26.88) respectively, and the Pearson coefficient was 0.35~0.91 among the four subgroups. Eight studies described mild skin redness and no adverse events of skin burns were reported.
Conclusion：Without controlling the monitoring site, duration, time point, equipment, and neonatal diseases and conditions, TcPCO2 values are strongly correlated with the PaCO2 values, which is about 7mmHg higher than PaCO2. Under standardized operations, TcPCO2 can replace PaCO2. Within 38℃ to 44℃, the commonly used clinical probe temperature, the higher the probe temperature, the more accurately TcPCO2 can reflect PaCO2, the less skin redness adverse events will occur. Since TcPO2 is weakly related to PaO2, it is not recommended to use TcPO2 to reflect PaO2.
Background：Human serum albumin infusion was empirical therapy after neonatal gastric perforation surgery. It is unclear whether excessive supplementation is beneficial.
Objective：To investigate whether prolonged human serum albumin infusion treatment in newborns with gastric perforation after abdominal surgery can improve the short-term outcomes.
Design：Retrospective cohort study.
Methods：The newborns who received intravenous infusion of albumin(1-2 g·kg-1) after gastric perforation were divided into short course group (≤5 days) and long course group (>5 days) according to the time of empirical application of albumin. The perinatal condition, main symptoms, signs, and laboratory results before operation, preoperative and postoperative complications, surgical condition (perforation site, pathological findings, etc.), postoperative treatment and hospital prognosis were collected.
Main outcome measures：Postoperative nutritional status and hospitalization outcomes.
Results：There were 37 cases in the short course group and 26 cases in the long course group. There was no significant difference in perinatal general condition, preoperative symptoms and signs, preoperative laboratory results, complications, perforation location and pathological findings between the two groups（P＞0.005）. In the short course group compared with the long-term treatment group, the gestational age was younger (P=0.005), the proportion of diabetes in pregnancy was higher(P=0.034), the age of onset was earlier (P=0.035), the age of operation was younger (P=0.035), the total amount of albumin infusion after operation was less (P=0.000), the 70% total enteral nutrition time was longer (P=0.019), the total enteral nutrition time was longer (P=0.005), and the hospital stay was shorter (P=0.012). However, there was no significant difference in secondary operation, length of stay, status of improvement or curation and weight at discharge between the two groups. Neonates with the difference of birth weight < 250 g, gestational age < 1 week and age of onset < 1 d in short course group and long course group were matched at 1:1. Twenty-two cases were included in each group. There was no significant difference in postoperative antibiotic use time, postoperative invasive respiratory support, times of plasma transfusion, gastrointestinal decompression time, fistulostomy tube indwelling time, postoperative enteral feeding time, 70% total enteral nutrition time, total enteral nutrition time, secondary operation, hospital stay and discharge weight between the two groups.
Conclusion：Prolonged treatment time of human serum albumin infusion is not beneficial to the nutritional status and hospitalization outcomes of newborns with gastric perforation.
Background：There were still few studies on the combination of real-time three-dimensional echocardiography(RT-3DE) and two-dimensional speckle tracking imaging(2D-STI) in evaluating left ventricular systolic synchronization for children with viral myocarditis(VMC).
Objective：To evaluate the value of RT-3DE and 2D-STI in predicting the prognosis of children with viral myocarditis.
Design：Retrospective cohort study.
Methods：A cohort of VMC children hospitalized in Fujian Children's Hospital from January 2019 to January 2022 was collected. The patients were followed up for half a year after discharge taken as the end point. According to the follow-up, the patients were divided into poor prognosis group and good prognosis group. The two groups were further divided into training set and verification set according to the proportion of 7∶3 by random number table. After admission, all the children were given routine treatment. Two physicians used the same ultrasound equipment to perform 2D-STI that the apical two-chamber section, apical four-chamber section, apical section and papillary muscle section of the short axis of the left ventricular posterior wall were examined to measure the peak late diastolic strain rate (Asr), systolic peak strain rate (Ssr), systolic peak strain rate (ε), early diastolic peak strain rate (Esr) in middle segment (MID), apical segment (APX) and basal segment (BAS) of left ventricular wall. RT-3DE parameters were also measured including maximum difference of minimum end-systolic volume time of 16 and 12 segments of left ventricle (Tmsv-16-Dif, Tmsv-12-Dif), measurement of standard deviation (Tmsv16-SD, Tmsv12-SD) and heart rate correction (Tmsv16-SD%, Tmsv12-SD%, Tmsv16-Dif%, Tmsv12-Dif%). Each ultrasound physician repeated the measurement for 3 times to take the average value. According to the 2D-STI, RT-3DE parameters and laboratory indexes of VMC children on admission, the predictive factors were screened by univariate analysis, Lasso and logistic regression analysis, and a model for predicting the prognosis of VMC children was constructed. The predictive effect was verified by training set and verification set.
Main outcome measures：The predictive value of 2D-STI parameters and RT-3DE parameters for the prognosis in children with VMC.
Results：A total of 157 children with VMC were included into the analysis, including 82 males and 75 females. The median age was 6.72(3.20, 10.61) years. The median follow-up duration was 8.29(7.37, 11.41) months. There were 121 cases with good prognosis, including 84 cases in the training group and 37 cases in the verification group. There were 36 cases with poor prognosis, including 26 cases in the training group and 10 cases in the verification group. Nineteen independent factors affecting the prognosis of VMC were included as follows: 2D-STI parameters in the long axis direction of left ventricular wall of posterior wall-BAS-ε, inferior wall-BAS-ε, anterior wall-MID-Esr value, posterior wall-BAS-Esr value, inferior wall-BAS-Esr value, inferior wall-APX-ε value, posterior wall-APX-Esr value, and inferior wall-APX-Esr value; RT-3DE parameters of Tmsv12-SD, Tmsv12-SD%, Tmsv12-Dif%, Tmsv16-SD, Tmsv16-SD%, Tmsv16-Dif, Tmsv16-Dif%; laboratory inspection indicators of WBC, hs-CRP, CK, cTn. The model for predicting the prognosis of children with VMC has good differentiation and calibration. The area under the curve of the training set and verification set were 0.861 (95%CI: 0.812-0.889) and 0.842 (95%CI: 0.807-0.887), and the consistency index of calibration curve of training set and verification set were 0.886 and 0.881 respectively.
Conclusion：The poor prognosis prediction model of VMC constructed in this study is of good value in predicting the prognosis of children with VMC.
Background: Platelet transfusion efficacy affects clinical outcomes and clinical decision making, and there is a lack of specific efficacy prediction models for platelet transfusion in children with acute lymphoblastic leukemia (ALL).
Objective: To develop and validate a predictive model for platelet corrected count increment (CCI) in pediatric ALL after platelet transfusion.
Design: A retrospective cohort study.
Methods: Hospitalized ALL children who had been transfused with platelets in the Department of Hematology and Oncology at Affiliated Children's Hospital of Chongqing Medical University from January 2022 to March 2023 for initial diagnosis and treatment were included, and were divided into the modeling group (before December 31, 2022 ) and the validation group (after December 31, 2022). The history data that might affect the efficacy of platelet transfusion were collected including gender, age, splenomegaly or hyper-splenism, hemorrhagic grade, degree of anemia, platelet storage days, medications, morphology, risk grouping, and treatment stage. Univariable COX regression and Lasso regression analysis were performed, followed by multivariable COX regression to determine the final predictors. The column-line graph prediction model was established built on the results. To detect the predictive efficacy, the model was then evaluated for its differentiation and calibration.
Main outcome measures: Predictive efficacy of the CCI line graph model for platelet transfusion efficacy.
Results: A total of 133 cases with 247 platelet transfusions were included in this study during the study period. There were a total of 198 transfusions in the modeling group and 49 transfusions in the validation group, and the baseline differences in the variables between the two groups were not statistically significant. Six factors, namely, gender, age, ALL risk grouping, pre-transfusion leukocyte count, splenomegaly or hypersplenism, and infection status, were finally incorporated to construct a column-line graph prediction model. When CCI was 11.4 (P25), 18.5 (P50), and 28.2 (P75), the area under curve (AUC) values were respectively 0.783, 0.695, and 0.654 in the modeling group, and 0.765, 0.714, and 0.580 in the validation group. The calibration curves showed that the model-predicted incidence rates and the actual incidence rates were basically the same in the modeling and validation group when CCI was 11.4, 18.5, and 28.2.
Conclusion: A predictive model for platelets CCI after platelet transfusion in children with ALL was established. Good predictive efficacy for platelet transfusion efficacy in children with ALL was confirmed by a column-line graph predictive model using influencing factors of gender, age, pre-transfusion leukemia count, infection, ALL risk grouping, and splenomegaly or hypersplenism.
Background: Children undergoing cancer treatment experience varying levels of symptom distress. It is crucial for clinical intervention that a scientific, rapid and accurate assessment is conducted to accurately identify the true symptoms in these children.
Objective: To introduce the Symptom Screening in Pediatrics Tool（SSPedi）and to test the reliability and validity of its Chinese version in children with cancer and their parents.
Design: Cross-sectional study.
Methods: The Brislin translation model was employed to covert the scale into Chinese. Six experts were enlisted to conduct cultural adjustments, and a pre-survey was executed to formulate the Chinese versions of SSPedi for children and parents（SSPedi-C and SSPedi-P）.The formal survey targeted children aged 8-18 undergoing cancer treatment and their parents, who were hospitalized in the Department of Pediatrics at Nanfang Hospital of Southern Medical University and the Department of Pediatric Hematology at Zhujiang Hospital of Southern Medical University from December 1, 2022, to May 26, 2023. After obtaining consent from the hospital and relevant departments, a uniformly trained investigator from each hospital entered the ward on the day of admission or the following day to distribute SSPedi-C and SSPedi-P in Chinese to the children and their parents. After the questionnaire data were entered and verified by the investigators on the same day, item analysis, reliability analysis, and validity analysis were conducted.
Main outcome measures: The reliability and validity of the Chinese versions of SSPedi-C and SSPedi-P.
Results: A total of 220 (95.65%) valid questionnaires were included in the analysis. The age of the 220 children with cancer ranged from 8 to 17 years old （11.26±2.28）, with 130 males (59.1%) and 90 females. The parents' ages ranged from 28 to 59 years （40.15±5.23）, comprising 50 fathers (22.7%) and 170 mothers. Item analysis revealed that the critical ratio for all 15 items in the Chinese versions of SSPedi-C and SSPedi-P were between 3.987-8.824 (all P<0.001) and 4.817-3.829 (all P<0.001), respectively. The correlation coefficients between each item and the total score of the Chinese versions of SSPedi-C and SSPedi-P were between 0.431-0.701 (all P<0.001) and 4.817-3.829 (all P<0.001), respectively. The correlation coefficients between each item and the total score were 0.431-0.701 (P<0.001) for the Chinese SSPedi-C and 0.482-0.787 (P<0.001) for Chinese SSPedi-P. Reliability analysis showed that the total Cronbach's α coefficients of Chinese SSPedi-C and SSPedi-P were 0.877 and 0.893, respectively, and the split-half reliability coefficients were 0.843 and 0.806, respectively. Content validity analysis showed that the item-level content validity index and averaging scale-level content validity index of Chinese SSPedi-C and SSPedi-P were both 1.000. For both two Chinese scales, confirmatory factor analysis showed that the chi-square degree of freedom ratio (χ2/df was <3.000, RMSEA was <0.080, and fitting index was >0.900.
Conclusion: The Chinese version of SSPedi demonstrates good reliability and validity among children with cancer and their parents. Its simplicity and ease of operation make it a valuable tool for evaluating the level of symptom distress in children aged 8-17 undergoing cancer treatment.
Background: The effectiveness of clinical practice and the improvement of care quality are evaluated based on the satisfaction and experience of parents whose infants have been admitted to the neonatal intensive care unit (NICU). Currently, there is a lack of a professional assessment tool in China for evaluating parental satisfaction in the NICU.
Objective: To translate the Empowerment of Parents in The Intensive Care-Neonatology (EMPATHIC-N) into Chinese to make it a family-centered parent satisfaction assessment tool appropriate for NICUs in China.
Design: Cross-sectional study.
Methods: The original version of the EMPATHIC-N scale was translated into Chinese using ten steps of scale translation and cultural adaptation summarized by Wild. The sample size was estimated to facilitate sampling methods. The parents were included for infants admitted to the NICU at Children's Hospital of Fudan University between March 2021 and June 2022，with a gestational age＜37 weeks，the birth weight＜1,500 g, and the length of stay ＞72 hours. Infants who passed away during their hospitalization were excluded. A nurse who has received training explained the purpose of the study to the parents and guided them to complete the questionnaire. Each family received one copy. The parent, either the mother or the father, filled out the questionnaire on the spot, and the data were checked by the nurse. The internal consistency reliability and Spearman-Brown split-half reliability of the Chinese version of the EMPATHIC-N scale were tested using Cronbach's α coefficients and split-half reliability coefficients. The construct validity of the Chinese version of the EMPATHIC-N scale was evaluated through exploratory factor analysis and confirmatory factor analysis.
Main outcome measuresReliability and validity of EMPATHIC-N scale in Chinese.
Results: A total of 330 questionnaires were distributed and all were effectively collected. The Chinese version of the EMPATHIC-N scale comprises 57 items. During exploratory factor analysis, principal component analysis resulted in the extraction of five factors including information provision, care and treatment, parental involvement, unit environment, and professional attitude. These factors exhibited characteristic root values exceeding 1, contributing to a cumulative variance explanation rate of 87.4%. The factor loadings for each item ranged from 0.706 to 0.953. The validation factor analysis model's fitting results revealed a chi-square degree of freedom ratio of χ2/df=6.635, with an RMSEA of 0.131, a SRMR of 0.053, a CFI of 0.807, and load factor numbers ranging from 0.792 to 0.999. The evaluation of convergent validity revealed that the average variance extracted (AVE) of the scale ranged from 0.757 to 0.964, while the composite reliability value was between 0.974 and 0.996. The discriminant validity evaluation revealed that the square root of the AVE of the five factors in the scale ranged from 0.870 to 0.982. Furthermore, the square root of each factor's AVE was greater than the absolute value of its correlation coefficient with other factors. Internal consistency test showed that the coefficients for Cronbach's alpha of the five factors and the total scale α are 0.976, 0.996, 0.975, 0.995, 0.973, and 0.982, respectively. The Spearman-Brown split-half reliability results revealed that the split-half correlation coefficients for the five factors and the total scale were 0.988, 0.998, 0.980, 0.994, 0.984, and 0.771, respectively.
Conclusion: The Chinese version of the EMPATHIC-N scale exhibits satisfactory reliability, convergent validity, and discriminant validity, however, the model fitting effect is not satisfactory. It is imperative to validate the evaluation tool for parental satisfaction in the full-time accompanying NICU setting.
Background: Intestinal microbiota can affect human health through various ways and is related to the occurrence of diseases. There are obvious differences in the composition of intestinal microbiota in different regions.
Objective: To compare the difference of intestinal microbial composition among healthy preschool child in northern and southern China by 16S rRNA gene sequencing method.
Methods: Children aged 3-7 years who underwent physical examination at the physical examination center of Foshan Chancheng Hospital in Foshan City, Guangdong Province were selected as the southern group, and children from a kindergarten in Tacheng District of Xinjiang Uygur Autonomous Region were selected as the northern group. Stool samples of all preschool children were collected by their parents after training, and intestinal flora detection and related data analysis were completed by Hangzhou Guhe Information Technology Co., LTD.
Main outcome measures: Microbial diversity, as well as differences in species composition.
Results: From February 1, 2023 to April 1, 2023, 45 children aged (4.0±1.5) years were included in the southern group. In the northern group, 45 cases were included, of which 2 were unqualified, and the remaining 43 were (4.1±1.3) years old. There were no significant differences in gender, age and ethnic composition between the two groups. The Alpha diversity indexes including Shannon, Simpson, Chao and ACE of the northern group were higher than those of the southern group with statistically significant differences between two groups. The weighted unifrac PCoA plot showed a significant separation between the two group samples. The abundance of Firmicutes in the northern group was higher than that in the southern group (55.1% vs 39.2%), and the abundance of Proteobacteria in the southern group was higher than that in the northern group (18.6% vs 7.2%). The abundance of Eubacterium-eligens-group in southern group was higher than that in northern group (11.8% vs 2.2%), and the abundance of Faecalibacterium in the northern group was higher than that in the southern group (13.9% vs 6.3%). The differences were statistically significant. LEfSe analysis and random forest intergroup prediction revealed that statistically different biomarkers were Escherichia-Shigella and Ruminococcus-gnavus group for the southern group and Faecalibacterium, Agathobacter, Lachnospira, Senegalimassilia, Subdoligranulum, Eubacterium-eligens-group,Parasutterella, Dialiste and Rseburia for the northern group.
Conclusion: There are significant differences in the intestinal flora of preschool children in the north and south of China. The regionality of the host should be fully considered in the future research on intestinal flora and diseases.
Background: Systemic juvenile idiopathic arthritis (SJIA) has a high disability rate and there are currently no specific therapeutic drugs. The efficacy of new biologic drugs developed for IL-1 or IL-6 monoclonal antibodies in some patients is not satisfactory. Further research on the pathogenesis is urgently needed to explore new treatment strategies.
Objective: To explore the role of NLRP3 inflammasome and related inflammatory mediators in the pathogenesis of SJIA.
Design: Case-control study.
Methods: The children with SJIA in the active period were included, and the healthy children who went to the hospital for physical examination during the same period were the control group. Peripheral venous blood samples were collected from children with SJIA before glucocorticoid therapy, at 2 weeks and 8 weeks after treatment, and from healthy children during physical examination, and then peripheral blood mononuclear cells (PBMCs) were extracted. The mRNA and protein expression levels of NLRP3 and related inflammatory mediators were detected by Quantitative Rea-time-PCR (qRT-PCR), enzyme-linked immunosorbent assay (ELISA), and Western blotting, respectively.
Main outcome measures: Expression levels of NLRP3 and related inflammatory mediators.
Results: A total of 33 children with SJIA were enrolled, aged (8.2±3.7) years. There were 28 healthy children, aged (7.6±2.7) years. Compared with healthy children, in active SJIA children there was no significant change in the mRNA level of NLRP3, but the protein expression decreased and the concentrations of IL-1β and IL-18 increased. After 2 weeks of treatment, the level of IL-1β, IL-18, IL-2, IL-10 and IFN-γ in children with SJIA all decreased, and at the 8th week of treatment, the level of IL-2, IFN-γ and IL-18 were still lower than those before treatment. The differences were statistically significant (P<0.05).
Conclusion: In SJIA, IL-1β and IL-18 may not be regulated through NLRP3 inflammasomes. IL-1β and IL-18 can be used as monitoring indicators of SJIA disease activity.
