Objective　To study the application method,intensive monitoring and treatment to complication of mild hypothermia therapy for critically ill patients.Methods　 Apply mild hypothermia therapy to 19 critically ill patients along with baseline therapy.Results　The Glasgow evaluation scores of 18 living patients increase from average 6 to 11.6 a month later.Conclusion　Mild hypothermia therapy is an important treatment method for critically ill patients with coma.From the point view of nursing care,we assess the method of temperature decrease and recovery,usage of hibernation drugs,choice of temperature,intensive monitoring and treatment of complications.

Neonatal pain is a common phenomenon. For a long time neonatal pain had not been focus on properly and managed appropriately. American Academy of Pediatrics Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine published policy statement to emphasize the necessity of neonatal pain assessment,and summarize the neonatal operability pain assessment method,drug and non-drug control measures,also update prevention and management of procedural pain in the neonate in 2016. Until today the guideline for neonatal pain management has not yet been released in China. As the reference for clinicians in domestic,the content of policy statement will be reorganized and introduced.

As a widely accepted and convenient method,the Apgar score has been applied to assess the status of the newborn infants and the response to resuscitation since 1952.But the Apgar score has also been used inappropriately in infants to predict specific neurologic outcomes in many cases.The Apgar Score produced by American Academy of Pediatrics(AAP) in collaboration with American College of Obstetricians and Gynecologists(ACOG),updated policy statements of the Apgar score in October 2015.The Apgar score has limitations,and it is not appropriate to use it alone to establish the diagnosis of asphyxia;the method does not predict individual neonatal mortality or neurologic outcome.AAP/ACOG encourages the use of an expanded Apgar score reporting form that accounts for concurrent resuscitation interventions.

Neonatal hypoxic-ischemic encephalopathy as a standard term has been used for over 30 years,but now increasingly being questioned.Most experts recommend using neonatal encephalopathy instead of hypoxic-ischemic encephalopathy.The American College of Obstetricians and Gynecologists and The American Academy of Pediatrics published separately the report of Task Force on Neonatal Encephalopathy Neonatal Encephalopathy and Neurologic Outcome,Second Edition in 2014.Definition,diagnosis and treatment of neonatal encephalopathy and other content have been updated in the report.It is recommended that a comprehensive multidimensional assessment be performed of neonatal encephalopathy.This article will introduce the controversy about neonatal encephalopathy or hypoxic-ischemic encephalopathy and contents of the report of Task Force on Neonatal Encephalopathy.

Bronchiolitis is a common lower respiratory tract viral infection in infants.Incidence of bronchiolitis is greatly increasing in recent years,and seriously affecting the health of children.In order to better manage bronchiolitis,American Academy of Pediatrics (AAP) convened a new subcommittee to review and revise the 2006 bronchiolitis guideline.This evidence-based guideline amended to provide new evidence of diagnosis,treatment and prevention bronchiolitis for the clinician.

Measles is an acute viral disease, almost all deaths cases of measles in children occur in developing countries each year.Despite the availability of a safe and effective vaccine, measles is still one of the main causes of death of children in global area.2015 report of Committee on Infectious Diseases of American provided evidence of clinical diagnosis, treatment and prevention of measles.

Blood transfusion therapy is one of the commonly used intervention in newborn infants.Red blood cell transfusion is the only treatment for most cases of neonatal anemia,but the indications of application and implementation strategy are not yet perfect,and the benefits,adverse outcomes and potential risk of transfusion remains to be evaluated.There are many uncertain problems in transfusion management.This paper mainly introduces the evidence-based recommendations of neonatal blood transfusion released by Italian Society of Transfusion Medicine and Immunohaematology and Italian Society of Neonatology Working Group for reference of domestic clinicians.

Objective To explore the effects of bilirubin on myeloid differentiation factor phospho-p38 mitogen-activated protein kinase (p-p38MAPK) and apoptosis in splenocytes of neonatal rats.Methods Seven-day-old Sprague Dawley rats (clean grade),male or female,weighting 12.0-15.0 g,were randomly assigned to 6 groups.There were blank control group (Ⅰ),lipopolysaccharide (LPS) control group (Ⅱ),15 mg/kg bilirubin control (free-LPS) group (Ⅲ),15 mg/kg group (Ⅳa),30 mg/kg group (Ⅳb) and 50 mg/kg group (Ⅳc),and then subsequently divided into 2 h,5 h and 24 h subgroups in each groups.Some of the 200 newborn rats died amid the experiment,tinally,a total of 144 cases were involved in the analysis of results,and 8 rats in each subgroups.Newborn Sprague Dawley rats were administered at various doses of bilirubin (15 mg/kg,30 mg/kg and 50 mg/kg,respectively) intravenously; 1 h after injection,the rats were administered LPS intraperitoneally at a dose of 1 mg/kg;p-p38MAPK were detected by immunohistochemistry;Apoptosis in splenocytes was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling methods at 2 h 5 h and 24 h after the injection of bilirubin.Results 1.Expression of p-p38MAPK in each group:bilirubin in low-mid concentrations of range inhibited LPS-induced p38MAPK activation (qⅣa =20.93,10.37,respectively at 2 h,and 5 h,all P ＜ 0.01 ;qⅣ b =79.97,14.79,all P ＜ 0.01).The inhibition strengthened with increasing concentration of bilirubin.The effect was observed at 2 h,strengthened at 5 h,disappeared at 24 h.Bilirubin in the high concentrations of range stimulated the expression of p-p38MAPK (qⅣc =32.55,19.23,27.72,respectively at 2 h,5 h and 24 h,all P ＜0.01),observed at 5 h,reduced at 24 h.2.Effects of bilirubin on apoptosis in splenocytes:LPS could increased the apoptosis index (AI) of splenocytes(q =54.62,P ＜ 0.01);The AI of splenocytes had no significant change in low concentrations of range of bilirubin (q =43.92,P ＞ 0.05).Low-mid concentration of bilirubin with LPS reduced the AI of splenocytes (q Ⅳ a =4.48,P ＜ 0.01 ;q Ⅳ b =2.07,P ＜ 0.05),while high concentration of bilirubin with LPS increased the AI of splenocytes (q =5.08,P ＜ 0.01).Conclusions Bilirubin in low-mid concentrations of range could inhibit the expression of LPS-induced p38MAPK,while bilirubin in high concentrations of range stimulated the expression.As the concentration of bilirubin elevated,its inhibition was prolonged.Bilirubin in high concentrations of range bilirubin could induce apoptosis in splenocytes.The immune dysfunction in neonatal hyperbilirubinemia may have something to do with the regulation of phosphorylation of p38MAPK and activation of apoptotic pathways.

Objective To analyze the clinical features of patients with traumatic brain injury in the Ya' an earthquake and discuss the treatment experiences.Methods Medical records of 69 patients admitted from April 2013 to May 2013 because of traumatic brain injury in the Ya' an earthquake were collected.Retrospective review was performed for age,gender,causes of injury,time from injury to hospitalization,types of injury,associated injury,treatment methods and outcomes.Results There were 47 males and 22 females.Forty-two patients (61％) were injured from falling objects.Fifty-eight patients (84％) were sent to the West China Hospital within 72 hours postinjury.Twenty-two cases (32％) sustained associated injuries.Twenty-nine patients (42％) were critically injured.Twenty-four patients underwent operation at the local hospital and twelve patients had operation at our hospital.Outcome measure using GOS one month after treatment showed 55 favorable recovery,5 moderate disability,4 severe disability,and 5 coma.Conclusions Main cause of injury is hit by falling objects during the Ya' an earthquake.Majority of the patients obtained effective treatment in the time window.GCS in combination with patients' general condition used in casualty triage and critical patients charged by neurosurgeons and treated with the cooperation of multiple disciplinary teams are helpful to successful treatment.

Objective To assess the effectiveness and safety of Azithromycin for preventing bronchopulmonary dysplasia(BPD) in preterm infants in order to provide reference for the clinical treatment of BPD.Methods The electronic retrieval were conducted to review randomized controlled trials (RCTs) from The Cochrane Library,PubMed,EM-Base,China Biological Medicine Database (CBM),Chinese Journals full-text Database (CNKI),Chinese Technological Journals Database(VIP) and Wan Fang Digital Journal Full-text Database by free texts and medical subject headings.The retrieval time was from inception to Dec.2012.Randomized or quasi-randomized studies were conducted by comparing Azithromycin therapy and no treatment or placebo management to prevent BPD among the preterm or low birth weight infants were included.The reference lists of relevant trials and conference proceedings were searched.Risk biases of the trials were assessed.Statistical analysis was performed by using Revman 5.1 offered by Cochrane.Results A total of 2 trials including 328 preterm infants were included.No significant difference was observed between the Azithromycin group and the control group in the incidence of BPD(RR =0.81,95％ CI 0.55-1.19).The risk ratio of death and post-natal steroid used in the Azithromycin group were lower,but there was no difference.The risk ratio of length of stay was not significantly different.The rate of BPD in preterm infants who had a positive respiratory culture of Ureaplasma between the preventative Azithromycin group and the placebo group showed that the incidence of BPD was significantly less in the Azithromycin group.Conclusions The available data are insufficient to make a recommendation regarding treatment with prophylactic Azithromycin to prevent BPD in preterm infants.More RCTs with large-scale and high-quality are required to provide more reliable evidence.