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Challenges and improvement in management of neonates born to mothers with COVID-19 in China
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作者 Jie Yang Zhuxiao Ren +29 位作者 Lingkong Zeng Shiwen Xia Lin Wang Jiayu Miao Zhe Zhao Chuanzhong Yang Xiuyong Cheng Huayan Zhang Yuanfang Zhu Li Liu Xirong Gao Bin Yi Zhenlang Lin Wei Liu Xiaoyu Zhou Benqing Wu Ling Chen Zhankui Li Xuefeng Zhang Wei Lu Lianhong Zhang Xiao Chen xiaoyun zhong Falin Xu Jinhui Wu Yong Ji Jiahua Pan Yanxiang Chen Carine Ronsmans Zhichun Feng 《Frigid Zone Medicine》 2022年第2期94-102,共9页
Objective:China was the first country suffering from the SARS-CoV-2 pandemic and one of the countries with stringent mother-neonate isolation measure implemented.Now increasing evidence suggests that coronavirus disea... Objective:China was the first country suffering from the SARS-CoV-2 pandemic and one of the countries with stringent mother-neonate isolation measure implemented.Now increasing evidence suggests that coronavirus disease 2019(COVID-19)should not be taken as an indication for formula feeding or isolation of the infant from the mother.Methods:We conducted a retrospective cohort study in 44 hospitals from 14 provinces in China to investigate the management of neonates whose mothers have confirmed or suspected COVID-19.In addition,65 members of Chinese Neonatologist Association(CNA)were invited to give their comments and suggestions on the clinical management guidelines for high-risk neonates.Results:There were 121 neonates born to 118 mothers suspected with COVID-19 including 42 mothers with SARS-CoV-2 positive results and 76 mothers with SARS-CoV-2 negative results.All neonates were born by caesarean section,isolated from their mothers immediately after birth and were formula-fed.Five neonates were positive for SARSCoV-2 at initial testing between 36 and 46 h after birth.Regarding the confusion on the clinical management guidelines,58.78%of the newborns were put into isolation,32.22%were subject to PCR tests,and 5.16%and 2.75%received breastfeeding and vaccination,respectively.Conclusion:The clinical symptoms of neonates born to mothers with confirmed SARS-CoV-2 were mild,though five neonates might have been infected in utero or during delivery.Given the favorable outcomes of neonates born to COVID-confirmed mothers,full isolation may not be warranted.Rather,separation of the mother and her newborn should be assessed on a case-by-case basis,considering local facilities and risk factors for adverse outcomes,such as prematurity and fetal distress. 展开更多
关键词 coronavirus disease 2019 NEONATES pregnant women infection control
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“早产儿过渡期干预措施”改进对超早产儿结局的影响 被引量:6
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作者 吴艳 钟晓云 +1 位作者 周利刚 龚华 《中华围产医学杂志》 CAS CSCD 北大核心 2022年第4期263-270,共8页
目的总结分析"早产儿过渡期干预措施"实施和质量持续改进对超早产儿(extremely preterm infant, EPI)住院期间结局及死亡的影响因素。方法回顾性纳入2014年7月1日至2021年6月30日在重庆市妇幼保健院出生并入住新生儿重症监护... 目的总结分析"早产儿过渡期干预措施"实施和质量持续改进对超早产儿(extremely preterm infant, EPI)住院期间结局及死亡的影响因素。方法回顾性纳入2014年7月1日至2021年6月30日在重庆市妇幼保健院出生并入住新生儿重症监护病房(neonatal intensive care unit, NICU)的185例EPI, 根据2018年1月在本院实施"早产儿过渡期干预措施"改进前后分为改进前组(2014年7月至2017年12月, n=45)和改进后组(2018年1月至2021年6月, n=140), 使用t检验、Mann-WhitneyU检验和χ^(2)检验比较2组存活率和并发症发生情况;通过单因素筛选和logistic回归分析EPI死亡的影响因素。结果 (1)185例EPI的中位胎龄26周+6, 范围23周+3~27周+6, 中位出生体重950 g, 范围390~1 290 g。(2)改进后, 新生儿科医生参与产前会诊比例、母亲产前足疗程糖皮质激素和硫酸镁使用比例、剖宫产娩出比例及转入NICU体温均提高[分别为77.1%(108/140)与8.9%(4/45)、67.9%(95/140)与35.6%(16/45)、67.1%(94/140)与48.9%(22/45)、44.3%(62/140)与17.8%(8/45)及36.6 ℃(36.3~36.9 ℃)与35.2 ℃(35.0~35.3 ℃), χ^(2)或Z值分别为66.41、14.81、4.85、10.17及-9.34, P值均<0.05], 且延迟脐带结扎(delayed cord clamping, DCC)和出生后经鼻持续气道正压通气(nasal continuous positive airway pressure, nCPAP)呼吸支持比例分别由改进前的无病例至改进后的67.9%(95/140)和89.3%(125/140);而生后1 min Apgar评分≤3分、产房内气管插管及72 h内有创呼吸机使用等比例均较降低[分别为7.1%(10/140)与17.8%(8/45)、37.1%(52/140)与73.3%(33/45)、38.6%(54/140)与57.8%(26/45), χ^(2)值分别为4.39、17.96及5.12, P值均<0.05]。(3)改进后, EPI总体救治存活率及胎龄27~27周+6的存活率均明显提升[分别为72.9%(102/140)与53.3%(24/45), OR=2.349, P=0.015;84.1%(53/63)与56.6%(13/23), OR=4.077, P=0.007];虽然早产儿脑室周围-脑室内出血、晚发型败血症和早产儿视网膜病变的发生率呈下降趋势, 但差异均无统计学意义(P值均>0.05)。(4)多因素logistic回归分析显示, 1 min Apgar评分≤3分(OR=8.890, 95%CI:2.005~39.412), 5 min Apgar评分低(OR=1.468, 95%CI:1.103~1.953)和72 h内有创呼吸机使用比例高(OR=7.165, 95%CI:2.942~17.449)为EPI死亡的危险因素;而产房内使用nCPAP(OR=0.314, 95%CI:0.137~0.719)和体重(OR=0.996, 95%CI:0.993~0.999)为保护因素。结论 "早产儿过渡期干预措施"改进将EPI救治技术的关注度提前至产前和产时, 特别是产时开展体温管理、DCC和nCPAP 等"支持"技术, 将有助于提高EPI的救治存活率和改善存活质量。 展开更多
关键词 婴儿 极度早产 存活率 死亡率 早期医疗干预
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