Effect of exchange blood transfusion on oxygen saturation of neonates with severe neonatal jaundice by pulse oximetry

Objective:To determine if there was any difference in SpO2 readings during exchange blood transfusion(EBT).Methods:A prospective cross-sectional study of neonates with severe neonatal jaundice requiring EBT was conducted.Oxygen saturation was recorded before,immediately and 15 minutes after EBT by using a pulse oximeter.Results:This study included 30 neonates with 20 males and 10 females.The age ranged from 1 to 12 days with a mean of(5.4±2.9)days.Pre-EBT SpO2 ranged from 90%to 98%with a mean value of(94.3±2.2)%;SpO2 in the end of EBT ranged from 85%to 99%with a mean value of(94.1±3.2)%;SpO2 at 15 minutes after EBT ranged from 77%to 99%with a mean value of(94.8±4.1)%.There was no significant difference between SpO2 values at onset of EBT and either immediately or 15 minutes after EBT(P=0.770 and 0.422,respectively).SpO2 showed no significant difference between neonates who were infused with blood of different storage times(<24 h or≥24 h)at the onset of EBT(P=0.584),immediately(P>0.999)and 15 minutes after EBT(P=0.887).Besides,SpO2 values were compariable in neonates with hematocrit<45%or≥45%at the onset of EBT(P=0.284),immediately(P=0.118)and 15 minutes after EBT(P=0.868).Conclusions:EBT does not affect SpO2 in neonates.

Percentile analysis of plasma total bilirubin—How different will the rate of phototherapy for jaundice of neonates be by different standards?

Phototherapy of a jaundiced neonate is usually started when bilirubin exceeds a threshold in the standard. There are several standards used in the developed countries even though the guideline of American Academy of Pediatrics is considered to be a global standard. Although the purpose of phototherapy is the prevention of kernicterus, nowadays the prevalence of kernicterus in otherwise healthy term neonates in the developed countries is rare. Meanwhile several potential adverse effects of phototherapy have been reported. In the present study we tried to estimate how different the rate of phototherapy for the jaundice of neonates at lower risk of kernicterus would be by different standards. For this purpose, we utilized the records of plasma total bilirubin (TB) values of 1893 healthy neonates of 38 weeks and more which were measured on day 6 for the percentile analysis. However, this database did not include the TB values of the neonates who received phototherapy by day 6. Then the database was corrected with an assumption that TB on day 6 would have been normally distributed if no phototherapy had been performed. The mean and the standard deviation (SD) of corrected database were 11.29 mg/dl (193 μmol/l) and 3.63 mg/dl (62 μmol/l), respectively. Using a standard distribution with these mean and SD, the percents of TB values which exceed 18.0, 19.0, 20.0 and 21.0 mg/dl on day 6 were estimated 3.22%, 1.70%, 0.82% and 0.35%, respectively. Results of the present report would help to estimate the relative rate of phototherapy that is performed for the neonates who are term and otherwise healthy by different standards.

Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice

BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.

Audit of Neonatal Jaundice as Experienced at a Mission Hospital in Western Nigeria

Introduction: Neonatal jaundice (NNJ) is a common disorder in neonates that can impact negatively on the brain and cause death. The peculiarities in aetiology and solutions for different settings are a knowledge gap. This informed the desire to determine local aetiology and solutions for neonatal jaundice in a missionary hospital in Abeokuta, Southwestern Nigeria. Methods: Consecutive consenting babies diagnosed with significant neonatal jaundice were studied between July 2016 and June 2019. Institutional ethical consent was obtained. A proforma was used to obtain socio-demographic data and other relevant information such as age, sex, birthweight, gestational age and history regarding the jaundice. All the information obtained was inputted into a computer and analysed with SPSS version 16. Results: A total of 179 babies with neonatal jaundice comprising of 120 (67.0%) boys and 59 (33.0%) girls with ages ranging between 1 and 12 days (mean 2.7 ± 2.9) were studied. Prematurity, ABO incompatibility, neonatal sepsis and glucose-6-phosphate enzyme deficiency accounted for over 80% of the causes of significant NNJ. Sixty (33.5%) of the 179 babies studied developed acute bilirubin encephalopathy and 11 (6.1%) mortalities were recorded. Higher proportions of babies that were out-born with spontaneous vaginal delivery modes had acute bilirubin encephalopathy (p < 0.05). Mothers with formal education had better outcome compared to mothers without, in terms of mortalities (p < 0.05). Conclusion: Neonatal jaundice is still a significant cause of morbidity and mortality in the neonatal age group. Maternal education is key to good outcome in neonatal jaundice.

Surgical Repair of Ventricular Septal Defect in Neonates: Indications and Outcomes

Background:The optimal surgical timing and clinical outcomes of ventricular septal defect(VSD)closure in neo-nates remain unclear.We aimed to evaluate the clinical outcomes of VSD closure in neonates(age≤30 days).Methods:We retrospectively reviewed 50 consecutive neonates who underwent VSD closure for isolated VSDs between August 2003 and June 2021.Indications for the procedure included congestive heart failure/failure to thrive and pulmonary hypertension.Major adverse events(MAEs)were defined as the composite of all-cause mortality,reoperation,persistent atrioventricular block,and significant(≥grade 2)valvular dysfunction.Results:The median age and body weight at operation were 26.0 days(interquartile range[IQR],18.8–28.3)and 3.7 kg(IQR,3.3–4.2),respectively.The median follow-up duration was 110.4 months(IQR,56.8–165.0).Seven patients required preoperative respiratory support,andfive had significant(≥grade 2)preoperative valvular dysfunction.One early mortality occurred due to irreversible cardiogenic shock;no late mortality was observed.One reopera-tion was due to hemodynamically significant residual VSD at 103.8 months postoperatively.The overall survival,freedom from reoperation,and freedom from MAE at 15-years were 98.0%,96.3%,and 94.4%,respectively.Pre-operative mechanical ventilation was associated with a longer duration of postoperative mechanical ventilation(p<0.001)and a longer length of intensive care unit stay(p<0.001).Conclusions:VSD closure with favorable outcomes without morbidities is feasible even in neonates.However,neonates requiring preoperative respiratory support may require careful postoperative management considering the long-term postoperative risks.Overall,surgical VSD closure might be indicated earlier in neonates with respiratory compromise.

Prevalence and outcomes of neonates with severe COVID-19:An observational study at Children’s Hospital 1 in Ho Chi Minh City,Vietnam

Objective:To evaluate the impact of the severe COVID-19 pandemic on neonates and develop strategies to improve their outcomes.Methods:We conducted an observational cross-sectional study at Children's Hospital 1(CH1)from July 25,2021,to May 31,2022.All neonates who had fever or respiratory symptoms or were born from mothers with COVID-19 and had a positive RT-PCR SARS-CoV-2 result would be included.We classified neonates with COVID-19 into 2 groups:mild/moderate and severe for analysis.Differences between groups were analyzed using Fisher's exact test/Chi-square test for categorical variables and Student's t-test/Wilcoxon Rank Sum test for continuous variables.Results:This study included 88 newborns who had positive RT-PCR SARS-CoV-2 results.The severity COVID-19 rate among neonatal cases was found to be 13.6%(12/88),with a corresponding mortality rate of 1.1%(1/88).All severe cases showed lung abnormalities as evident on chest X-ray images.In addition to respiratory symptoms,a higher incidence of gastrointestinal manifestations,such as vomiting and diarrhea,was observed in the severe group,indicating a compelling association.The administration of anticoagulant and anti-inflammatory drugs in the study group resulted in a satisfactory outcome with no significant complications.Conclusions:The COVID-19 pandemic has had a substantial impact on the well-being of neonates.The management of COVID-19 in this population presents significant challenges.

Measurement of Transcutaneous Bilirubin with Bilicheck as a Jaundice Screening Method in Neonates in Pediatric Emergency Departments

Objectives: To study the reliability of a transcutaneous bilirubinometer (Bilicheck) to determine bilirubin levels in neonates consulting for jaundice in a Paediatric Emergency Department (ED), and to evaluate its usefulness as a screening method. Methods: Prospective observational study realized between June of 2005 and December of2005 inneonates consulting at a paediatric emergency department for jaundice, in whom we realized both transcutaneous and total serum bilirubin measurements (TcB and TSB). We collected demographic variables, analytical variables (serum and transcutaneous bilirubin levels), length of stay in the ED, and need for treatment. Results: 66 children were included aged 2 to 31 days (81% of the sample were 2 to 7 days old). There was a close and statistically significant correlation between TcB and TSB (r = 0.81, p < 0.001). The area under the ROC curve was of 0.90, allowing detecting newborns with jaundice susceptible of treatment with TcB levels ≥ 13 mg/dL (sensitivity 92%, specificity 63, 5%, a positive predictive value 39% and a negative predictive value 97%). The number of venous punctures could be reduced in 50%. The medium stay in the ED was of 2 hours when performing serum measurements. Conclusions: A linear correlation exists between TcB-TSB. TcB measurement cannot replace that of TsB, however it could be used as a screening method in an ED to determine which neonates need confirmation by TsB measurement. The use of transcutaneous bilirubinometer would reduce both the number of painful interventions in neonates and the medium length of stay in ED, consequently reducing iatrogenesis.

Analysis of TORCH results of retinal exudative changes in neonates

AIM:To explore the relationship between retinal exudative changes in neonates and perinatal toxoplasmosis,others,rubella,cytomegalovirus,and herpes simplex virus(TORCH)infections,as well as the characteristics of TORCH infection in neonates with retinal exudative changes.METHODS:Retrospective study.A total of 612 neonates with retinal exudative changes detected during ophthalmic screening in our hospital from May 2019 to March 2023 were selected.TORCH tests were performed on these neonates,and the results were subjected to statistical analysis to determine the infection characteristics.The neonates with retinal exudative changes were grouped by sex and age,the characteristics of TORCH infection were analyzed,and the positive rates were compared.RESULTS:Among the 612 neonates with retinal exudative changes,the highest positive rate was observed for cytomegalovirus(CMV-IgG)(96.7%),followed by rubella virus(RV-IgG)(73.9%).Mixed infections with two or three viruses were also observed,with the highest positive rate for mixed infection of RV-IgG and CMV-IgG reaching 71.2%.There was no statistically significant difference in TORCH infection among neonates of different sex(P>0.05).However,there were statistically significant differences in RV-IgG and CMV-IgM infections with retinal exudative changes among neonates of different age groups(P<0.05).CONCLUSION:Perinatal TORCH infection may be an important factor causing retinal exudative changes in neonates.The differences in various infections are not related to sex but are related to different age groups.

Evaluation of Procedural Pain in Neonates in Cameroon

Introduction: Acute pain associated with caregiving is a major cause of pain among neonates. Left untreated, it can lead to long-term neurosensory and psychoaffective consequences. In Cameroon, this subject has been scarcely explored, thus constituting an impediment to the management of care-induced pain. Objective: Assess procedural pain in neonates in Yaoundé. Material and Methods: We conducted a cross sectional study with prospective data collection over a period of eight months (October 2022 to May 2023) in three hospitals. We included neonates who were being cared for and were not crying prior to the onset of healthcare, whose parents consented to the study. Assessments were done using the DAN scale, which is specific to care-induced pain. Data was entered and analyzed using SPSS 23.0 software. Results: A total of 161 newborns were included. The hospital prevalence of care-induced pain in neonates was 85%. Neonatal sepsis was the main cause for admission (96.6%). The most common procedures were venous blood sampling (94.4%) and insertion of peripheral venous lines (93.8%). The pain intensity for these procedures was severe (83.9%). The most painful procedure was lumbar tap, followed by venous access procedures. Conclusion: Neonates in hospitals are subjected to many painful procedures. The pain experienced during these procedures is severe. The most nociceptive procedure is a lumbar puncture.

A Comparison between Late Preterm and Term Infants with Respiratory Distress Syndrome, Early-Onset Sepsis, and Neonatal Jaundice in Ecuadorian Newborns

Background: To examine the differences in prevalence of respiratory distress syndrome, early-onset sepsis and jaundice, between late preterm infants versus term infants in Ecuadorian newborns. Methods: Study design: Epidemiological, observational, and cross-sectional, with two cohorts of patients. Settings: IESS Quito Sur Hospital at Quito, Ecuador, from February to April of 2020. Participants: This study included 204 newborns, 102 preterm infants, 102 term infants. Results: There are significant differences between late preterm infants and term infants, with a p-value of 0.000 in the prevalence of early sepsis, 70.59% vs. 35.29%. In respiratory distress syndrome between late and term premature infants, significant differences were observed with a p-value of 0.000, the proportion being 55.58% vs. 24.51% respectively. The prevalence of jaundice is higher in term infants with a p value of 0.002, 72.55%, versus 51.96% in late preterm infants, and the mean value of bilirubins in mg/dL was higher in term infants 14.32 versus 12.33 in late preterm infants;this difference is statistically significant with a p value of 0.004. Admission to the NICU is more frequent in late preterm infants with a p-value of 0.000, being 42.16% for late preterm infants vs. 7.84% in term infants;the mean of the hospital days with p-value 0.005, was higher in late preterm infants 4.97 days vs. 3.55 days for term newborns. Conclusion: Due to the conditions of their immaturity, late preterm infants are 2.86 times more likely to present early sepsis than full-term newborns. It is shown that late preterm infants are 2.69 times more likely to have respiratory distress syndrome compared to term infants, therefore, late preterm infants have a longer hospital stay of 4.97 days versus 3.55 days in term infants. Jaundice and mean bilirubin levels are higher in term infants due to blood group incompatibility and insufficient breastfeeding.

Bacteriological Profile, Antimicrobial Susceptibility Patterns and Predictors of Bacteremia in Neonates with Clinical Sepsis at KCMC Hospital, Northern Tanzania

Background: Despite a significant decline in neonatal deaths in the last 20 years (5 million in 1990 to 2.4 million in 2019), the risk of death is still high, especially in developing countries. In Tanzania, neonatal sepsis is the third leading cause of neonatal death, accounting for 25% of all deaths. The rising global threat of antimicrobial resistance and the rising burden of neonatal death due to neonatal sepsis have been of great concern and have delayed progress toward reaching SDG goal 3.2 by 2030. This study aims to determine the bacteriological profile, antibiotic susceptibility patterns, and predictors of bacteremia among neonates with clinical sepsis at KCMC Hospital in Northern Tanzania. Methodology: This study had a cross-sectional design conducted at KCMC Hospital, Northern Tanzania. The study population was neonates admitted to the neonatal unit at KCMC Hospital. Data were collected using questionnaires and blood cultures from neonates. Frequencies and proportions were used to summarize categorical variables, while continuous variables were summarized using mean and standard deviation. The frequencies and proportions of bacteria isolated and the antimicrobial susceptibility results were analyzed and compared using Pearson’s chi-square test and Fisher’s exact test where applicable. Modified Poisson regression model was used to determine factors associated with positive blood culture. Results: Out of 411 neonates with a clinical diagnosis of neonatal sepsis, 175 (42.9%) had positive blood cultures. Gram-positive bacteria were most frequently isolated at 52.3%, and gram-negative bacteria were 47.7%. Coagulase-negative Staphylococcus (30.7%) and Staphylococcus aureus (19.9%) were the predominant gram-positive isolates. Gram-negative isolates were Klebsiella spp 47 (26.7%), E. coli 10 (5.7%), and Citrobacter spp 10 (5.1%). The gram-positive isolates were sensitive to vancomycin, piperacillin/tazobactam, and ceftazidime, whereas the gram-negative were sensitive to amikacin, meropenem, and vancomycin. The study did not find statistically significant associations between clinical factors and positive blood cultures in bacteremia. Conclusion: Gram-positive bacteria are the dominant pathogens in early-onset and late-onset neonatal sepsis. High levels of resistance to ampicillin and ceftriaxone and moderate resistance to gentamycin were observed in both gram-positive and gram-negative bacteria. Gram-positive organisms exhibit better susceptibility rates to vancomycin and ciprofloxacin, while gram-negative micro-organisms are more sensitive to amikacin and meropenem. An effective initial treatment approach for neonatal sepsis would involve a combination of drugs.

Respiratory Distress in Neonates at the Teaching Hospitals of Lomé, Togo

Introduction: Respiratory distress in neonates is a neonatal emergency that can lead to serious complications if not treated appropriately. The aim of this study was to describe the epidemiology, the diagnostic, and the outcomes of neonatal respiratory distress. Methods: This was a cross-sectional study carried out in the pediatric wards of Lomé Teaching Hospitals (CHU Sylvanus Olympio and CHU Campus), including neonates treated for respiratory distress (dyspnea associated with the use of accessory muscles of respiration, noisy breathing and with or without cyanosis) from January 1, 2021 to December 31, 2021. Data were entered using Epi Data 3.1 and SPSS software version 12.0. Results: The total number of neonates hospitalized for respiratory distress was 353, with a frequency of 12.5% and a sex ratio of 1.5. The mean age was 0.82 ± 3.20 days;the 0 - 6-day age group accounted for 92.4% of cases. Neonates had been resuscitated at birth in 46.7% of cases. Dyspnea was tachypnea in 94% of cases and bradypnea in 6%. Dyspnea was associated with cyanosis in 21.5% of cases. The severity of the respiratory distress was moderate in 64.9% of cases. Perinatal asphyxia (49.1%), inhalation pneumonitis (17.1%) and neonatal bacterial infection (14.1%) were the main etiologies. The mortality rate was 20.4%. Age greater than or equal to seven days, no neonatal resuscitation were protective factors against death. Prematurity, no antenatal consultations follow up, neonatal resuscitation, severe respiratory distress were risk factors of death. Conclusion: Neonatal respiratory distress was common in the early neonatal period and its mortality was high.

Hepatomegaly and jaundice as the presenting symptoms of systemic light-chain amyloidosis: A case report

BACKGROUND Light chain(AL)amyloidosis is a plasma cell dyscrasia characterized by the pathologic production and extracellular tissue deposition of fibrillar proteins derived from immunoglobulin AL fragments secreted by a clone of plasma cells,which leads to progressive dysfunction of the affected organs.The two most commonly affected organs are the heart and kidneys,and liver is rarely the dominant affected organ with only 3.9%of cases,making them prone to misdia-gnosis and missed diagnosis.CASE SUMMARY A 65-year-old woman was admitted with a 3-mo history of progressive jaundice and marked hepatomegaly.Initially,based on enhanced computed tomography scan and angiography,Budd-Chiari syndrome was considered and balloon dilatation of significant hepatic vein stenoses was performed.However,addi-tional diagnostic procedures,including liver biopsy and bone marrow-exami-nation,revealed immunoglobulin kapa AL amyloidosis with extensive liver involvement and hepatic vascular compression.The disease course was progre-ssive and fatal,and the patient eventually died 5 mo after initial presentation of symptoms.CONCLUSION AL amyloidosis with isolated liver involvement is very rare,and can be easily misdiagnosed as a vascular disease.

Efficacy of 25% dextrose versus breast milk on pain and duration of cry during heel prick in neonates: A systematic review and meta-analysis

Neonates,especially admitted to neonatal intensive care unit,frequently need various medical interventions in their early days.A common procedure is the heel prick for blood sampling.Although necessary for diagnosis,this procedure can be stressful for neonates,causing pain,extended crying,and discomfort.Reducing distress in neonates during such procedures is important for the well‐being of neonates and the satisfaction of caregivers and healthcare providers.Therefore,this review aims to identify and compare the efficacy of 25%dextrose and breast milk on pain and duration of cry among neonates during heel-lance.As part of its review process,the article examined widely used databases,including PubMed,EMBASE,Cochrane,Academia,and Google Scholar.For the meta-analysis,the authors utilized RevMan 5.4.All eligible trials were analyzed using the Cochrane Risk of Bias Tool to assess the quality of the included studies and evaluate the risk of bias.Out of 131 studies reviewed,seven studies were included in meta-analysis of pain,and four studies were included in duration of cry.The results show that 25%dextrose is more effective to reduce pain among neonates during minor invasive procedure like heel prick(P<0.00001),whereas both interventions are effective in the reduction of crying duration.This review highlights that dextrose is more effective in reducing pain in comparison to breast milk.However,additional well-designed studies with larger sample sizes and extended follow-up periods are needed to validate and build upon the current findings.Hence,this review underscores the importance of utilizing effective pain management strategies,such as 25%dextrose,to enhance neonatal care and improve the overall well-being of newborns during invasive procedures.

Clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to NICU in a tertiary care center: A cross-sectional study

Objective:To investigate the clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to a neonatal intensive care unit in a tertiary care center.Methods:The prospective observational study was conducted in a tertiary care center in the Specialty Department of Pediatric.196 Newborn babies with blood glucose levels<45 mg/dL were examined with a simple random sampling method between December 2019 and November 2021.Maternal and neonatal risk factors and clinical signs were recorded and compared between symptomatic and asymptomatic cases.Results:The proportion of symptomatic hypoglycemia neonates born to gestational diabetes mellitus mothers was significantly higher(23.4%vs.8.4%)(P<0.05).Small for gestational age,low birth weight,respiratory distress syndrome,hypothermia,and endocrine disorders were risk factors.The death rate in asymptomatic hypoglycemia neonates was significantly higher(58%vs.39%)(P<0.05).Conclusions:The study indicates that maternal gestational diabetes mellitus is associated with symptomatic hypoglycemia and asymptomatic hypoglycemia is associated with neonatal mortality.It is important to take vigilance and timely interventions to address associated symptoms,particularly poor feeding,in the management of neonatal hypoglycemia.

Advances in minimally invasive treatment of malignant obstructive jaundice

Malignant obstructive jaundice(MOJ)encompasses a range of diseases stemming from malignant tumors such as cholangiocarcinoma,pancreatic cancer,and primary liver cancer,among others,which cause obstruction in both intra-and extra-hepatic bile ducts.This obstruction may lead to elevated bilirubin levels,hepatic function impairment,and a low rate of successful surgical resection in clinical settings.There are various minimally invasive treatment options for MOJ,including endoscopic biliary drainage,ultrasound-guided procedures,and percutaneous biliary tract puncture drainage.

Changes over time in treatment for obstructive jaundice

This editorial discusses an article by Peng et al.This study reviewed the efficacy and safety of a new approach for treating obstructive jaundice.Although the pathophysiology of obstructive jaundice has not yet been fully elucidated,pro-gress has been made in its management.There are two aspects of obstructive jaundice:Cholestatic status and absence of bile in the intestinal lumen.Internal biliary drainage resolved both the conditions.Clinically,endoscopic retrograde biliary drainage(ERBD)has replaced percutaneous transhepatic biliary drainage,and ERBD is transitioning to endoscopic ultrasound guided biliary drainage.This editorial briefly explains the mechanism and treatment of obstructive jaundice and the prospects of this new internal biliary drainage technique.

Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome

BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal death in hospitals in China.The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant AIM To explore the effect of pulmonary surfactant(PS)combined with noninvasive positive pressure ventilation on keratin-14(KRT-14)and endothelin-1(ET-1)levels in peripheral blood and the effectiveness in treating NRDS.METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included.Of these,64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation.The expression of KRT-14 and ET-1 in the two groups was compared.The deaths,complications,and PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)blood gas indexes in the two groups were compared.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.RESULTS The observation group had a significantly higher effectiveness rate than the control group.There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions,such as bronchial dysplasia,cyanosis,and shortness of breath.After treatment,the levels of PaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly higher than before treatment,while the level of PaCO_(2)was significantly lower.After treatment,the observation group had significantly higher levels of PaO_(2)and PaO_(2)/FiO_(2)than the control group,while PaCO_(2)was notably lower in the observation group.After treatment,the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels.The observation group had a reduction of KRT-14 and ET-1 levels than the control group.ROC curve analysis showed that the area under the curve(AUC)of KRT-14 was 0.791,and the AUC of ET-1 was 0.816.CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy.KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.

Endoscopic ultrasound-guided biliary drainage vs percutaneous transhepatic bile duct drainage in the management of malignant obstructive jaundice

BACKGROUND Malignant obstructive jaundice(MOJ)is a condition characterized by varying degrees of bile duct stenosis and obstruction,accompanied by the progressive development of malignant tumors,leading to high morbidity and mortality rates.Currently,the two most commonly employed methods for its management are percutaneous transhepatic bile duct drainage(PTBD)and endoscopic ultrasound-guided biliary drainage(EUS-BD).While both methods have demonstrated favorable outcomes,additional research needs to be performed to determine their relative efficacy.To compare the therapeutic effectiveness of EUS-BD and PTBD in treating MOJ.METHODS This retrospective analysis,conducted between September 2015 and April 2023 at The Third Affiliated Hospital of Soochow University(The First People’s Hospital of Changzhou),involved 68 patients with MOJ.The patients were divided into two groups on the basis of surgical procedure received:EUS-BD subgroup(n=33)and PTBD subgroup(n=35).Variables such as general data,preoperative and postoperative indices,blood routine,liver function indices,myocardial function indices,operative success rate,clinical effectiveness,and complication rate were analyzed and compared between the subgroups.RESULTS In the EUS-BD subgroup,hospital stay duration,bile drainage volume,effective catheter time,and clinical effect-iveness rate were superior to those in the PTBD subgroup,although the differences were not statistically significant(P>0.05).The puncture time for the EUS-BD subgroup was shorter than that for the PTBD subgroup(P<0.05).Postoperative blood routine,liver function index,and myocardial function index in the EUS-BD subgroup were significantly lower than those in the PTBD subgroup(P<0.05).Additionally,the complication rate in the EUS-BD subgroup was lower than in the PTBD subgroup(P<0.05).CONCLUSION EUS-BD may reduce the number of punctures,improve liver and myocardial functions,alleviate traumatic stress,and decrease complication rates in MOJ treatment.

Impact of Zika virus non-structural protein mutations on hippocampal damage

The Zika virus(ZIKV),a member of the Flaviviridae family,attracted worldwide attention for its connection to severe neurological effects,notably microcephaly in newborns,first reported during the 2015 epidemic in Brazil.Yet,its impact goes beyond fetal and neonatal abnormalities,also affecting the central nervous system(CNS)in both children and adults,leading to enduring cognitive and behavioral impairments.