不同矫正胎龄早产儿使用更昔洛韦的安全性观察

目的观察早产儿使用更昔洛韦治疗巨细胞病毒感染的安全性。方法回顾分析2017年10月1日—2021年10月1日在复旦大学附属儿科医院新生儿科住院且使用更昔洛韦治疗巨细胞病毒感染的早产儿临床资料,比较矫正胎龄(PMA)<37周或≥37周患儿使用更昔洛韦后中性粒细胞绝对值、血小板数、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血清肌酐(SCr)等安全性指标的变化。结果共纳入40例患儿,开始治疗时PMA<37周的25例,PMA≥37周的15例。23例更昔洛韦剂量为6 mg·kg^(-1),q12h,17例更昔洛韦剂量为5 mg·kg^(-1),q12h。不同PMA组患儿中性粒细胞减少发生风险差异无统计学意义(P>0.05),但3~4级中性粒细胞减少症发生风险差异显著[发生率分别为24.0%(6/25)和0%(0/15),P<0.05]。不同PMA组患儿血小板减少发生风险无明显差异(P>0.05),但PMA<37周的患儿发生1例严重血小板减少,而PMA≥37周组无;PMA<37周的患儿,更昔洛韦剂量6 mg·kg^(-1)发生血小板下降风险更高。不同PMA患儿肝酶升高发生风险无显著差异(P>0.05)。1例PMA<37周患儿SCr明显上升,但可能由合并的失血性休克引起。不同PMA患儿SCr上升发生风险差异无统计学意义(P>0.05)。结论不同PMA的早产儿使用更昔洛韦过程中,发生中性粒细胞减少、血小板降低和肝酶升高的风险无显著差异。开始治疗时,PMA<37周患儿重度及以上中性粒细胞减少发生风险高于PMA≥37周者。且PMA<37周患儿给予6 mg·kg^(-1)剂量相比5 mg·kg^(-1)发生血小板降低的风险更高。因此,在密切监测不良反应的同时,仍需优化更昔洛韦在不同PMA早产儿中的给药方案,以确保用药的安全性。

Delivery room resuscitation intensity and associated neonatal outcomes of 24^(+0)-31^(+6) weeks'preterm infants in China:a retrospective cross-sectional study

Background The aim of this study was to review current delivery room(DR)resuscitation intensity in Chinese tertiary neonatal intensive care units and to investigate the association between DR resuscitation intensity and short-term outcomes in preterm infants born at 24+0_31+6 weeks gestation age(GA).Methods This was a retrospective cross-sectional study.The source population was infants born at 24+0_31+6 weeks'GA who were enrolled in the Chinese Neonatal Network 2019 cohort.Eligible infants were categorized into five groups:(1)regular care;(2)oxygen supplementation and/or continuous positive airway pressure(O2/CPAP);(3)mask ventilation;(4)endotracheal intubation;and(5)cardiopulmonary resuscitation(CPR).The association between DR resuscitation and shortterm outcomes was evaluated by inverse propensity score-weighted logistic regression.Results Of 7939 infants included in this cohort,2419(30.5%)received regular care,1994(25.1%)received O,/CPAP,1436(18.1%)received mask ventilation,1769(22.3%)received endotracheal intubation,and 321(4.0%)received CPR in the DR.Advanced maternal age and maternal hypertension correlated with a higher need for resuscitation,and antenatal steroid use tended to be associated with a lower need for resuscitation(P<0.001).Severe brain impairment increased significantly with increasing amounts of resuscitation in DR after adjusting for perinatal factors.Resuscitation strategies vary widely between centers,with over 50%of preterm infants in eight centers requiring higher intensity resuscitation.Conclusions Increased intensity of DR interventions was associated with increased mortality and morbidities in very preterm infants in China.There is wide variation in resuscitative approaches across delivery centers,and ongoing quality improvement to standardize resuscitation practices is needed.

Characteristics of home oxygen therapy for preterm infants with bronchopulmonary dysplasia in China:results of a multicenter cohort

Background Home oxygen therapy(HOT)is indicated upon discharge in some preterm infants with severe bronchopulmonary dysplasia(BPD).There is a lack of evidence-based consensus on the indication for HOT among these infants.Because wide variation in the institutional use of HOT exists,little is known about the role of regional social-economic level in the wide variation of HOT.Methods This was a secondary analysis of Chinese Neonatal Network(CHNN)data from January 1,2019 to December 31,2019.Infants at gestational ages<32 weeks,with a birth weight<1500 g,and with moderate or severe BPD who survived to discharge from tertiary hospitals located in 25 provinces were included in this study.Infants with major congenital anomalies and those who were discharged against medical advice were excluded.Results Of 1768 preterm infants with BPD,474 infants(26.8%)were discharged to home with oxygen.The proportion of HOT use in participating member hospitals varied from 0 to 89%,with five of 52 hospitals’observing proportions of HOT use that were significantly greater than expected,with 14 hospitals with observing proportions significantly less than expected,and with 33 hospitals with appropriate proportions.We noted a negative correlation between different performance groups of HOT and median GDP per capita(P=0.04).Conclusions The use of HOT varied across China and was negatively correlated with the levels of provincial economic levels.A local HOT guideline is needed to address the wide variation in HOT use with respect to different regional economic levels in countries like China.

PSA density in the diagnosis of prostate cancer in the Chinese population: results from the Chinese Prostate Cancer Consortium

We performed this study to investigate the diagnostic performance of prostate-specific antigen density(PSAD)in a multicenter cohort of the Chinese Prostate Cancer Consortium.Outpatients with prostate-specific antigen(PSA)levels≥4.0 ng ml^(-1) regardless of digital rectal examination(DRE)results or PSA levels<4.0 ng ml^(-1)and abnormal DRE results were included from 18 large referral hospitals in China.The diagnostic performance of PSAD and the sensitivity and specificity for the diagnosis of prostate cancer(PCa)and high-grade prostate cancer(HGPCa)at different cutoff values were evaluated.A total of 5220 patients were included in the study,and 2014(38.6%)of them were diagnosed with PCa.In patients with PSA levels ranging from 4.0 to 10.0 ng ml^(-1),PSAD was associated with PCa and HGPCa in both univariate(odds ratio[OR]=45.15,P<0.0001 and OR=25.38,P<0.0001,respectively)and multivariate analyses(OR=52.55,P<0.0001 and OR=26.05,P<0.0001,respectively).The areas under the receiver operating characteristic curves(AUCs)of PSAD in predicting PCa and HGPCa were 0.627 and 0.630,respectively.With the PSAD cutoff of 0.10 ng ml^(-2),we obtained a sensitivity of 88.7%for PCa,and nearly all(89.9%)HGPCa cases could be detected and biopsies could be avoided in 20.2%of the patients(359/1776 cases).Among these patients who avoided biopsies,only 30 cases had HGPCa.We recommend 0.10 ng ml^(-2) as the proper cutoff value of PSAD,which will obtain a sensitivity of nearly 90%for both PCa and HGPCa.The results of this study should be validated in prospective,population-based multicenter studies.

Group B Streptococcus causes severe sepsis in term neonates:8 years experience of a major Chinese neonatal unit

Background:In contrast to industrialized countries,the clinical characteristics of neonatal sepsis caused by Group B Streptococcus (GBS) are largely unexplored in China.Methods:A retrospective case series study was performed at a high-capacity neonatal unit in Shanghai,China from January 2008 to December 2015.Clinical characteristics of neonates with culture-proven GBS sepsis and antibiotic susceptibility of isolated strains were analyzed.Results:Forty-three term neonates were included during the study period.The majority (74.4%) had early-onset sepsis with symptoms of respiratory distress.Meningitis was significantly more common in lateonset sepsis than in early-onset sepsis (81.5% vs.18.8%,P<0.0001).Approximately one third of all patients (n=16)developed severe sepsis,defined as sepsis with organ dysfunctions,and respiratory dysfunction/failure was the most common (32.6%).The in-hospital mortality rate of GBS sepsis was 4.7%.Neonates who progressed to severe sepsis had significantly lower pH level at the onset of symptoms than those who did not (7.26±0.12 vs.7.39±0.05,P=-0.006).Treatment of severe GBS sepsis required lots of medical resources including extracorporeal membrane oxygenation.All tested GBS strains were susceptible to penicillin,but the rate of resistance to clindamycin (84.0%) and erythromycin (88.0%) was high.Conclusions:GBS as a pathogen for neonatal sepsis has been receiving little attention in China.Our data demonstrated that GBS sepsis was likely to be fulminant.Early recognition followed by antibiotics and adequate supportive therapies was critical for successful treatment.Chinese clinicians should be aware of GBS infection when treating neonatal sepsis,especially in the absence of universal maternal GBS screening.

Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units

Background This study aimed to describe length of stay(LOS)to discharge and site variations among very preterm infants(VPIs)admitted to 57 Chinese neonatal intensive care units(NICUs)and to investigate factors associated with LOS for VPIs.Methods This retrospective multicenter cohort study enrolled all infants<32 weeks’gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network,within 7 days after birth in 2019.Exclusion criteria included major congenital anomalies,NICU deaths,discharge against medical advice,transfer to non-participating hospitals,and missing discharge date.Two multivariable linear models were used to estimate the association of infant characteristics and LOS.Results A total of 6580 infants were included in our study.The overall median LOS was 46 days[interquartile range(IQR):35-60],and the median corrected gestational age at discharge was 36 weeks(IQR:35-38).LOS and corrected gestational age at discharge increased with decreasing gestational age.The median corrected gestational age at discharge for infants at 24 weeks,25 weeks,26 weeks,27-28 weeks,and 29-31 weeks were 41 weeks,39 weeks,38 weeks,37 weeks and 36 weeks,respectively.Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals.Conclusions The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents.Large variation of LOS independent of infant characteristics existed,indicating variation of care practices requiring further investigation and quality improvement.