Objective To investigate the application of Alberta Infant Motor Scale(AIMS） in screening motor development delay in the follow-up of high risk infants who were discharged from NICU, for the sake of using AIMS results to explain the state of infants′ motor development and propose early individualized intervention.Methods The AIMS and Peabody Developmental Motor Scale-2(PDMS-2) data of Shanghai Jiangao Outpatient Department of Pediatrics from November 2013 to January 2015 were collected. The score of AIMS and gross motor quotient (GMQ) to the corresponding percentiles were converted and their correlation was analyzed. As the GMQ≥90 of PDMS-2 was used as normal motor development, the ROC curve of AIMS percentiles to predict the outcome was performed, the AUC and optimal cutoff were analyzed. According to the cut-off point, the accuracy of the AIMS in predicting motor development delay was discussed.Results There were 170 times data of 70 infants which fulfilled with the inclusion criteria ,in which, the correlation coefficient (r) of data in infants younger than 3 months age was 0.09, P=0.69, 4-6 months age was 0.68, P＜0.0001，＞6 months age was 0.76，P＜000 01. Then the correlation analysis was performed on the all data without which in infants aged younger than 3 months, r=0.73(P＜0.001). The area under curve (AUC) of ROC curve was 0.929, standard error was 0.027, 95% credibility interval was 0.876 to 0.982，the cut-off point was P17.5.The sensitivity, specificity, false negative rate, true negative rate, positive predictive value and negative predictive value of AIMS in screening motor development delay were 87.6%(95%CI: 68.4% to 95.4%), 88.1%(95%CI:80.6% to 93.1%) ,65.0%(95%CI:48.3% to 78.9%), 96.3% (95%CI:90.2% to 98.8%) respectively.Conclusion AIMS has good performance in predicting development delay in high risk infants over 3 months age, the application of which will improve early the hypernomic diagnosis and intervention.
Objective To investigate the safety of therapeutic hypothermia (TH) conjunction with erythropoietin injection in the treatment of moderate to severe hypoxic ischemic encephalopathy (HIE) in term neonates and to lay the foundation for the multi-center study of the efficacy of combination therapy.Methods Term neonates who were admitted to NICU of Children′s Hospital of Fudan University from February 2012 to March 2015 and met the TH treatment criteria were included and grouped by randomization after signing the informed consent. The trial group received TH treatment (72 h) combined with EPO (1 000 U·kg-1, ivgtt. QOD×14 d); and the control group received TH treatment (72 h) and placebo (saline) with the same dosage and usage as EPO. Vital signs, homological and biochemical index, serious adverse events (severe arrhythmia, major vein thrombosis，refractory hypotension and death) and HIE complications of the treatments were recorded and analyzed between two groups.Results Forty-four term neonates with HIE were admitted for TH treatment with 25 patients received added EPO and the rest received placebo. No statistical significance in the levels of hemoglobin, red blood cells, hematocrit and platelet between the two groups was observed. There was no statistical significance in the serious adverse events and HIE complications either.Conclusion Serious adverse events related to the treatment were not found with the treatment of TH conjunction with EPO for HIE. It is safe and feasible to start a multi-center study on the efficacy of TH combined with EPO in HIE treatment.
Abstract ObjectiveTo study whether the neonates can distinguish different kinds of emotional (angry and fearful) vocal，utilizing the method of event-related potential (ERP).Methods Neonates born in the first 7 days were selected and tested during sleep. The oddball paradigm was used to distribute the fearful (the frequency of occurrence was 80%) and angry(the frequency of occurrence was 20%) vocal (“dada”). The electroencephalogram was recorded at frontocentral area of cerebrum (FC3/FC4) and centroparietal area (CP3/CP4) in accordance with the method of electrode placement of international standard 10-20 system. Meanwhile, the amplitude-integrated electroencephalography (aEEG) technique was used to monitor the sleep cycle. Finally，the influence of mood/sleep cycle/electrode position on the ERP amplitude, the latency and amplitude of mismatch response (MMR) peak were analyzed.Results A total of 31 cases of neonates with normal neurological outcome at 6 months were examined (16 boys and 15 girls）. The ERP emerged at different electrode locations during different sleep cycle, after angry and fearful vocal stimuli in the 31 cases. The MMR wave was observed in active sleep(AS) state at FC3/FC4, after 300 to 500 ms of the different emotional stimulations. And the amplitude of MMR for (1.64±0.55) μV FC3, (2.70±0.62)μV for FC4 (η2≥0.14, P<0.01). There was no obviously different response during quiet sleep (QS) period or at CP3/CP4.Conclusion The neonates could distinguish different kinds of emotional vocal at their frontocentral cortex in AS state, while couldn′t in QS state. It implies that the cerebral cortex of term newborns may exist the ability to distinguish different kinds of emotional vocal.
Objective To evaluate neonatal intracranial hemorrhage with susceptibility weighted imaging (SWI), and to explore the value and limitation of SWI compared with conventional magnetic resonance imaging (MRI).Methods A study was conducted including 596 neonates who were suspected injury of brain. All MR examinations were performed at 1.5 Tesla unit including conventional MR(T1WI and T2WI) and SWI. Among 596 neonates there were 134 neonates with intracranial hemorrhage detected on routine MRI sequence and/or SWI. Among 134 cases， there were 81 preterm and 53 term neonates. The numbers and areas of hemorrhage on conventional MRI sequences and SWI were compared.Results Among 134 neonates with intracranial hemorrhage , there were only 19 cases showed extracerebral hemorrhage (17 cases subdural hemorrhage, and 1 case extradural hemorrhage with subarachnoid hemorrhage, and 1 case extradural hemorrhage), all 19 cases showed on SWI, and 1 case with subdural hemorrhage without showing on conventional MRI sequences. 115 cases were detected with parenchymal hemorrhage, and among them 16 cases missed on conventional MRI sequences. The maximal areas of 98 cases with parenchymal hemorrhage were measured. The maximal areas of hemorrhage were larger on SWI than those on conventional MRI sequences （Z＝-8.337，P＜0.01）. In six areas of germinal matrix hemorrhage/intraventricular hemorrhage, except the hemorrhage of aqueduct of mesencephalon, other 5 areas with hemorrhage were detected more on SWI than conventional MRI sequences （P＜0.05）.More cases with subarachnoid hemorrhage were detected by SWI than by conventional MRI sequences. There was no significant difference when compared subdural hemorrhage and extradural hemorrhage detected on SWI and conventional MRI.Conclusion SWI is a potent examination for cerebral bleeding displaying due to the higher sensitivity compared with the other conventional MRI sequences, and has predominant advantage over conventional MRI sequences in detecting intracranial hemorrhage of neonate.
Objective To investigate the value of a semi-quantitative MRI-based-score system in predicting outcomes at discharge in infants with neonatal bacterial meningitis.Methods Newborns with a final diagnosis of neonatal meningitis were included in this study. The severities of thirteen patterns of brain injuries on cranial MR images of the infants were graded, which included ventricular dilatation, periventricular white matter volume loss, cystic abnormality, abnormal myelination of the posterior limb of the internal capsule, cortical gray matter signal abnormality, intracranial extracerebral space abnormality, basal ganglia signal abnormality, non-cystic white matter signal abnormality, intraventricular hemorrhage, pyocephalus, abnormal meningeal enhancement, abnormal ependymal enhancement and encephalopyosis. Except for encephalopyosis, the frequencies of white matter abnormality (WMA), gray matter abnormality (GMA), and non-brain-parenchyma abnormality (NPA) were also calculated. Four time factors and outcomes at discharge were collected from the clinical history of each patient. The patients were divided into preterm and term groups followed by cured and adverse outcome subgroups. The severity and spectrum of different part of cerebral injuries and time factors were compared between two subgroups of each group by using chi-square test, Mann-Whitney U test and student t-test. Results Sixty-three newborns including 18 preterm infants and 45 term ones were recruited in this study. There were significant differences in the scores of ventricular dilatation and periventricular white matter volume loss between cured and adverse outcome subgroups in preterm group (P value was 0.012 and 0.004, respectively). There were significant differences in the scores of ventricular dilatation, periventricular white matter volume loss, intracranial extracerebral space abnormality, and intraventricular hemorrhage between cured and adverse outcome subgroups in term group (P value was 0.002, 0.040, 0.005 and 0.038, respectively). There were significant differences in the scores of WMA, NPA in preterm group and NPA in term group between two outcome subgroups (P value was 0.001, 0.039 and 0.018, respectively). There was no significant difference with clinical value in time factors between outcome subgroups whether in preterm or term group.Conclusion Ventricular dilatation and periventricular white matter volume loss could predict adverse outcomes at discharge in preterm infants with neonatal bacterial meningitis. Ventricular dilatation, periventricular white matter volume loss, intracranial extracerebral space abnormality, and intraventricular hemorrhage could predict adverse outcomes at discharge in term infants with neonatal bacterial meningitis. Regarding to the significance of WMA, GMA and NPA types, high NPA scores could predict adverse outcomes at discharge in both preterm and term infants, while WMA scores could predict adverse outcomes at discharge in preterm ones.
Objective To investigate the effect of amplitude integrated electroencephalogram (aEEG) on monitoring extrauterine life in healthy preterm infants with 28 to 36 weeks gestational age (GA).Methods The trail group was the preterm neonates without asphyxia, and the control group was the normal term neonates with GA over 37 weeks. Weekly aEEG recordings were performed on the trail group starting within 3 days after birth until discharged or up to 37 weeks postmenstrual age (PMA). In the control group, aEEG recording was performed on the third day after birth. All the aEEG recordings were continuously monitored for at least 4 hours. Analysis the influence of GA and PMA on the maturation process of aEEG patterns, including the continuity of background potential, the sleep-wake cycling (SWC), the lower border voltage a the bandwidth. The 5 hospitals in research used the same aEEG monitor brand, and received the unified operation training before the study. The data of clinical characteristics and aEEG images were analyzed by Children′s Hospital of Fudan University.Results From May 1, 2008 to August 31, 2009, 135 preterm infants and 20 term infants from 5 hospitals met the inclusion and exclusion criteria. With the increasing GA and PMA, the proportions of aEEG continuity and cycling increased, and appeared the continuous voltage gradually(χ2=26.865,P<0.01), almost all the preterm with GA≥34 weeks had the mature SWC （χ2=192.4，P<0.01）, the lower border of narrow bandwidth was increased （F＝11.4，P<0.01） and the bandwidth narrowing down（F＝8.731,P<0.01）. Compared with the infants with the same GA, the aEEG tracing showed significant increase in the proportions of continuity, the occurrence rate of SWC, the lower border and narrowing bandwidth. The preterm infants with GA≥34 weeks had significant SWC at birth, while the percentage of cycling had reached 100% in the infants with the PMA of 32 weeks. After a PMA of 34 weeks, there was no significant difference between the two groups.Conclusion The maturity of aEEG patterns for preterm infants is related to GA and PMA. The extrauterine life accelerates brain maturation in preterm infants.
Abstract Objective According to the criterion of brain death (BD)for children, through the diagnosis of neonatal BD cases analysis to summarize the characteristics of the neonatal BD. Methods One case of neonatal BD was reported and the literatures about neonatal BD were reviewed. Results A 39+4 weeks gestational age male was delivered spontaneously and birth weight was 3 370 g. He was apnea, hypotonic, unresponsive and without pulse or heart sound on auscultation after birth. Advanced cardiopulmonary resuscitation was performed. Apgar score at 1, 5, 10 and 15 min was 1, 2, 2, and 2, respectively . He regained spontaneous circulation and sigh breath after 20 min. The first neurological exam showed coma, large bilateral pupils and unresponsive to light, no primitive reflex, marked hypotonic and dependent on mechanical ventilation 2 h after birth when transferred to our NICU. The same findings repeated during hospital stay. The blood gas showed severe metabolic acidosis which was corrected by bicarbonate infusion 24 h later. The blood pressure was stable by fluid resuscitation and inotropic support. aEEG was continuously monitored and showed a silent background activity pattern for 4 d. BAER, SEP and VEP could not be drawn out at d5. The video EEG showed electrocortical silence at d6 and d12. TCD at d13 and d14 showed bilateral low peak systolic velocities. 13 d after admission the CT scan showed bilateral cerebral diffuse low density, ventricle enlargement. Spontaneous breathing test was terminated 7 min late due to severe slow heart rate. The diagnosis of BD was done according neurological exam and the EEG result. Searching on PubMed as the "brain death" and "Newborn" OR "neonatal" OR "neonate" ,29 neonatal BD cases were retrieved. The causes of BD for 8 premature babies were the meningitis (2 cases), severe intraventricular hemorrhage (5 cases) and maternal-fetal blood transfusion (1 case); BD was confirmed 2-7 d after admission and observation period was 2-9 d; The causes of BD for 21 term babies were severe asphyxia (11 cases), sudden infant death syndrome(4 cases), severe infection (3 cases), acute intracranial hemorrhage (2 cases), withdrawal syndrome(1 case). BD was confirmed 1-6 d after admission and observation period was 1-73 d. All neonatal BD was diagnosed according to neurological exam as the following criteria: coma, no response to stimuli, losing brainstem function including pupil dilation and unresponsive to light, corneal reflection and disappeared eye brain reflection, without spontaneous breathing. EEG was done for 24 cases and 17 cases (premature infants 3 cases, full term 14 cases) showed cortical electrical silence. Seven cases showed low voltage on the first monitoring and 6 cases progressed to cortical electrical silence. TCD was done for 28 cases, 25 of which showed disappearance of CBF. BAER was checked in 3 cases, 1 case was not elicited. Conclusion Neurological function evaluation should consider the characteristics of neonatal brain development. According to the criterion of BD for children, diagnosis of neonatal BD should be more cautious and needs a longer observation period. aEEG may play an important role in evaluation of neonatal BD.
Abstract Objective To develop an patient-and-family-centered care scale, and assess its reliability and validity. Methods The initial inventory combining with the core concept of patient-and-family-centered care, literature review and in-depth interview was developed. After two rounds of experts evaluation and parents consultant, the new scale was developed. Major caregivers of inpatients from two Shanghai third-grade-A children′s hospitals from November to December in 2013 were selected as investigators. Sample 1 was selected by purposive sampling, and pre-tested. Items were selected by project analysis and the dimensions were tested by exploratory factor analysis. Sample 2 was selected by the same purposive sampling and investigated. The reliability and validity of this scale were tested by factor analysis and reliability analysis and correlation analysis. Results 230 parents were included in sample 1, 32 questionnaires were invalid, 198 questionnaires (86.1%) were included in the final analysis. 450 parents were included in sample 2, excluding 71 invalid questionnaires, 379 questionnaires (84.2%) were included in the final analysis. The pilot scale contained 59 items and the formal scale consisted of 40 items. Five common factors were extracted by exploratory factor analysis and factor loading of each item ranged between 0.419 and 0.729. The 5 factors explained for 58.797% of total variance. The indicators had reached the ideal level or acceptable level by confirmatory factor analysis. The correlations between the subscales and the total scale ranged from 0.841 to 0.956（P<0.01）. The scale was reliable (α=0.966), and the subscales Cronbach α ranged from 0.776 to 0.966. Conclusion The newly developed patient-and-family-centered care scale has shown acceptable reliability and validity, which can be used as a useful tool for nurses in identifying and assessing parents′ hospitalization care process.
Abstract Objective To evaluate the utility of predicting nosocomial infection (NI) by monitoring dynamically the serum concentrations of C-reactive protein（CRP）, procalcitonin (PCT) and plamsa proadrenomedullin (pro-ADM) and find the time-point liable for NI development in PICU. Methods Pediatric cases without infection were enrolled, and divided into two groups, the NI group was refered to the cases developing NI during the PICU stay, and the others were divided into non-NI group. The serum inflammatory mediators including CRP，PCT and plasma pro-ADM were detected at four time-points and were used to predict the occurrence of NI. Results A total of 75 pediatric cases in PICU of Children′s Hospital of Fudan University were enrolled from October 1, 2014 to February 28, 2015. Twenty-three cases were in NI group and other 52 cases were in non-NI group. There was no statistical difference for general features, primary diseases and invasive procedures between the two groups (P>0.05). A total of 238 blood CRP, PCT and pro-ADM specimens were respectively obtained for the two groups. There were statistical differences in the three inflammatory mediators between NI group and non-NI group, showing predicting significance for noscomial infection. The best cut-off values were 21.3 mg·L-1,0.85 ng·mL-1 and 0.86 nmol·L-1 ,respectively and ROC curve areas were 0.739, 0.767 and 0.839, respectively. The period from admission to PICU to diagnosis of NI was（118.9±70.8）h, the period from diagnosis of NI to the nearest detecting time-point was（23.6±21.9）h, and the nearest detecting time-point of NI to the admission time was（96.5±66.4）h. The ROC curve areas of CRP+PCT+pro-ADM, CRP+PCT, CRP+pro-ADM and PCT+pro-ADM were 0.891, 0.885, 0.882 and 0.879, respectively and sensitivity was 91.3% and specificity ranged from 44.2% to 63.5%. Conclusion Single and combined inflammatory mediators (CRP, PCT and pro-ADM) both have good value to predict NI in PICU. The 4th day admitted to PICU is the appropriate time-point to predict NI through detecting inflammatory mediators in blood.
Abstract Objective To improve the prenatal diagnosis accuracy of isolated total anomalous pulmonary venous connection (TAPVC) by analyzing and accumulating fetal echocardiography features accurately diagnosed by fetal echocardiography. Methods Fetal echocardiographic signs and accumulated fetal echocardiography features were retrospectively analyzed in 8 cases with prenatal diagnosis of isolated TAPVC which was confirmed by neonatal echocardiography, surgery or autopsy from May 2011 to February 2014. Results Diagnosis of TAPVC was made in 8 fetuses, including 5 with supracardiac connection, 2 with infracardiac connection and 1 with cardiac connection. Only 2 fetuses were diagnosed TAPVC in other hospitals before, including 1 fetus diagnosed as abnormal vessel in liver and infracardiac TAPVC, 1 fetus diagnosed as infracardiac TAPVC combined with descending vertical vein obstruction. Other 6 fetuses were all misdiagnosed, including 2 with hypoplastic left heart syndrome and coarctation of aorta, 1 with dilated coronary sinus and left superior vena cava, 1 with abnormal vessal nearby superior vena cava combined with stenosis, 1 with left superior vena cava and 1 with small diameter of left heart. Stenosis along the vertical vein pathway or the connection of the vertical vein to pulmonary venous confluence was identified in 5 fetuses. In 1 terminated of pregnancy case with infracardiac connection, autopsy confirmed the prenatal diagnosis. Other 7 fetuses were born and performed surgery after birth, 1 case with infracardiac connection died in 1 week after surgery and other cases recovered well. The echocardiography characters of fetuses diagnosed with TAPVC：① The normal shape of left atrium disappeared and left atrium became round or oral and narrow especially in the latter phase of pregnancy. ② The distance was increased between left atrium and the descending aorta (Dao) and an abnormal pulmonary venous confluence presented posterior to the left atrium in most cases, and the ascending vertical vein or descending vertical vein could be seen. ③ The ventricular proportion was normal at the earliest gestation, but the right heart was dilated after 26 weeks. ④ A dilated coronary sinus could be seen in fetuses with cardiac TAPVC and a dilated superior vena cava in the fetus with supracardiac TAPVC and the dilated hepatic vessel in infracardiac TAPVC fetuses as well. ⑤ Color Doppler imaging could show the draining trace and whether existed vertical vein obstruction. Conclusion The isolated TAPVC is easy to be misdiagnosed when the ventricular proportion is normal at the earliest gestation. More attention should be paid on more angle and more exam views when performing fetal echocardiography. The fetal echocardiography can reduce misdiagnosis at the latter phase of pregnancy.
Abstract Objective To compare the efficacy and compliance of body-worn, bell, alarm device and desmopressin treatment for primary nocturnal enuresis (PNE) in children. Methods A 6-month cilinical trial was performed with patients aged from 6 to 14 years with PNE in Beijing Children′s Hospital from April 2012 to August 2013. Patients were divided into body-worn, bell, alarm device and desmopressin treatment groups according to the visiting sequence. History was taken for all included children. Corresponding treatments were given on the basis of basic intervention and enuresis diary. Efficacy, compliance and safety were analyzed after follow-up at 1,3,6 months of the treatments by intent-to-analysis. Efficacy was evaluated by the decrease of wetting nights. Group differences in efficacy and compliance and adjustment of family history, functional bladder capacity and other characteristics were analyzed by logistic regression. Results A total of 120 patients were recruited in the clinical controlled trial according to the inclusive and exclusive criteria , thirty for each group. ①The efficacy of desmopressin, alarm device, body-worn and bell was 76.7%, 93.3%, 56.7% and 76.7% at 6 months follow-up. The efficacy with alarm device was better than bell at the 6 months of follow-up (P<0.0125). There was no difference between body-worn, alarm device and desmopressin (P≥0.0125). ②27/30（90%）of alarm device group, 24/30（80%）of desmopressin , 18/30（60%）of body-worn, 16/30（53.3%）of bell group could insist on the treatment. The compliance of alarm device was better than body-worn（P=0.007）and bell groups（P=0.002）. There was no difference between alarm device and desmopressin groups in compliance.③Logistic regression analysis which analyzed factors affecting curative effect showed that family history was a risk factor（P=0.007，OR=0.204，95%CI: 0.064-0.652）.④ No adverse affairs were observed in body-worn and bell groups. One child in alarm device group had eczema in inner side of the right thigh and groin because he could not wake up in time. One case of epistaxis and two cases of hyponatremia were observed in desmopressin group. Conclusion Both of the alarm device and desmopressin have a high cure rate and good compliance and safety. Therefore, the alarm device and desmopressin can be chosen as the first-line treatment.
