Objective:To explore the feasibility and application effect of Mini-CEX in pediatric clinical practice.Methods:Residents who received standardized residency training in pediatrics department of Peking University Third Hospital from March 2016 to September 2017 were selected as research objects. The clinical ability of the residents were evaluated by application of the Mini-CEX structured form. Its effectiveness as a training guide and assessment method was also evaluated. SPSS 25.0 was used for t test. Results:The Mini-CEX scale was refined according to the characteristics of pediatrics. In this study, a total of 36 residents participated in the evaluation and 110 cases were completed by introducing Mini-CEX structured form in 7 examinations. Compared with 2016, the Mini-CEX scores of the residents in the 2017 showed different degrees of improvement in information gathering [(7.4±0.9) vs. (7.7±0.7)], clinical examination [(7.5±1.1) vs. (7.6±0.9)], clinical judgment [(7.5±0.9) vs. (7.6±0.9)], organizational effectiveness [(7.4±0.9) vs. (7.7±0.9)], and overall clinical competency [(7.5±0.9) vs. (7.7±0.9)], without significant differences ( P > 0.05). A total of 17 residents completed the assessments more than or equal to 3 times. Compared with 2016, the mean scores of the 17 individuals' Mini-CEX scales in 2017 were significantly improved in terms of information gathering, organizational effectiveness, and overall clinical competency. Conclusion:The results have shown that the Mini-CEX scale is simple and easy to operate, it maybe helpful to improve the clinical ability of pediatric residents, and it can be used as a method to evaluate the clinical ability of pediatric residents.

During the treatment of pediatric critical cases,the mechanical ventilation support is one of the most important factors.Neonatologists are trying to find a better mode of ventilation support.Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation controlled by diaphragmatic electrical signals.Because the mechanism of ventilation support is different from the conventional ventilators,NAVA provides a different effect of respiratory support varying with the needs of the newborn.Pediatric studies had been review to provide more information of NAVA to pediatrics.

Objective:To investigate the application of umbilical vein catheterization in neonates.Methods:The patients who underwent umbilical vein catheterization from November 2007 to September 2019 in neonatal intensive care unit (NICU) at Peking University Third Hospital were selected consecutively.Clinical data were collected retrospectively to investigate the application time of umbilical vein catheterization in neonates, the incidence of catheter-related bloodstream infection, pathogenic bacteria and the causes of extubation.Results:A total of 835 newborns were enrolled, including 435 males (52.1%) and 400 females (47.9%). The average gestational age was (30.6±2.4) weeks.The median birth weight was 1 310(1 080, 1 520)g.The average indwelling time of umbilical vein catheterization was (4.850±1.893) days.Catheter related bloodstream infection occurred in ten (1.2%) neonates.The main pathogens were Staphylococcus epidermidis, Staphylococcus wallichi, Staphylococcus haemolyticus and Enterococcus faecium.A total of 770 (92.2%) newborns were extubated in a planned manner, and 65 (7.8%) were unplanned extubation.The top three causes of unplanned extubation were umbilical wheel swelling, clinical diagnosis of sepsis, catheter-related bloodstream infection and tube blockage.Conclusion:Umbilical vein catheterization is simple, high success rate, safe and can be used in NICU for a short time.If possible, abdominal B-ultrasound and echocardiography should be monitored and catheter related complications should be noted.

Objective To study the risk factors,clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection in NICU.Method Preterm infants diagnosed to have infection of aerogenes in our NICU during July 2014 to October 2014 were selected as the infection group in our study.Uninfected preterm infants whose gestational age and birth weight were similar to the infants in infection group were selected as the control group.The ratio of number of infants in infection group and control group was 1 ∶ 2.The basic situation,clinical application of antibiotics before infection,defecation times,invasive manipulations,and parenteral nutrition time of the two groups were retrospectively collected.The clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection were analyzed.Result There were 8 infants in infection group (male:female =3∶5).The birth weight ranged from 780 to 2 760 g;and gestational age from 28 to 33 w.There were 16 infants in the control group (male:female =1 ∶ 1).The birth weight ranged from 1 070 to 1 780 g,and gestational age,from 29 to 33 w.The incidence of prenatal infection in infection group was higher than that in the control group (3/8 vs.4/16,P ＜ 0.05).Comparing the two study groups,there were statistical differences between them in the following aspects (all P ＜ 0.05):non-invasive respiratory support time [11 (6,36) d vs.4 (0,6) d] and invasive mechanical ventilation time [(1 (0,6) d vs.0 (0,0) d].All the 8 infants in infection group had pneumonia,3 of them with sepsis (1 case was extremely low birth weight infant,and 2 cases were very low birth weight infants),and one of them died from septic shock.Drug sensitivity analysis showed that aerogenes were resistant to all the third generation cephalosporins,and were sensitive to Meropenem and Piperacillin/Tazobactam.The resistance rates of Imipenem were 1/6 in the first month,2/6 in the second month,9/11 in the third month,and 2/4 in the fourth month,respectively.Conclusion Avoidance of prenatal infection and shortening of the application of ventilator may reduce the incidence of aerogenes infection.Most of infants with aerogenes infection have favourable prognosis.The resistance rate of third generation cephalosporins is very high.Aerogenes could develop resistance quickly to the antibiotics which is sensitive initially.

Objective To investigate polymorphism in the promoter region of insulin-like growth factor-1(IGF-1) gene.Methods Five hundred and sixty-one neonates admitted to Peking University Third Hospital from June 1st,2010 to June 30th,2012 were recruited into the study.Gender,gestational age,birth weight and birth length were collected.Heel blood samples were collected on 3-5 days after birth.DNA was extracted to analyze the polymorphism in the promoter region of IGF-1 gene.Chi-square test,independent-sample t-test,analysis of variance and HardyWeinberg equilibrium were performed.Results Among the 561 neonates,413 were full term,and 148 were preterm; 92 were large for gestational age (LGA),433 were appropriate for gestional age (AGA),and 36 were small for gestional age (SGA).Seven different alleles and 23 genotypes in the promoter region of IGF-1 gene were identified in the population.The seven alleles were 188,190,192,194,196,198 and 200 bp respectively.The three most common genotypes were 190-192 bp,192-196 bp and 192-192 bp,whose frequencies were 23.2％ (130/561),15.0％ (84/561) and 12.8％(72/561).There were no significant differences of cytosine-adenosine (CA)19/CA19,CA19/CAno19and CAno19/CAno19 genotypes between full term and preterm infants [11.4％ (47/413) vs 16.9％(25/148),55.9％ (231/413) vs 50.7％ (75/148) and 32.7％ (135/413) vs 32.4％ (48/148)respectively,x2=2.96,1.21 and 0.00,all P＞0.05].There was no difference in the gestional age among infants with CA19/CA19,CA19/CAno19 and CAno19/CAno19 genotypes [(37.1±2.9),(37.6±3.1) and (37.4±3.1) weeks respectively,F=0.54,P=0.58].The frequency of CA19/CA19 in SGA neonates was higher than that in LGA and AGA neonates [25.0％ (9/36) vs 7.6％(7/92) and 12.9％ (56/433),x2 =7.01,P=0.03],but there were no differences in the frequency of CA19/CAno19 and CAno19/CAno19 among LGA,AGA and SGA neonates (CA19/CAno19:x2 =1.13,P=0.57; CAno19/CAno19:x2 =0.58,P=0.75).Conclusions Polymorphism exists in the promoter region of IGF-1 gene.The gestational age is not associated with the frequency of CA19 allele.

Objective To investigate the epidemiological and clinical characteristics, risk factors, outcome and prevention strategy of very low birth weight infant (VLBWI) with nosocomial infection in neonatal intensive care unit (NICU). Methods The VLBWIs whose birth weight were less than 1500 g and hospital stays were more than 48 hours in NICU of Peking University Third Hospital from January 1, 1998 to December 31, 2008 were selected in this study. They were divided into nosocomial infection group and non-infection group. The clinical features and outcomes of nosocomial infection were summarized and the risk factors of which were analyzed with Logistic regression. Results There were 158 VLBWIs who fit for the criteria of our study during the eleven years, the mean birth weight was (1263.8± 155.5) g and the mean gestational age was (30.4±2.1) weeks. There were 70 times and 56 cases suffered from nosocomial infections. The incidence of nosocomial infection was 35.4% and hospital stay-related incidence was 14.4‰. Among 70 times of infections, there were 40(57.1%) pneumonia, 22(31.4%) septicemia, 4(5.8%) thrush, 1(1.4%)conjunctivitis, 1 ( 1.4%) upper respiratory tract infection and 2 (2.9%) unknown site infections.Forty-one strains of bacteria were isolated from 121 specimens, among which gram-negative bacillus accounted for 56.1% and gram-positive cocci for 46.3%. The duration of hospital stay of VLBWIs with nosocomial infection was significantly longer than that without [(43.7±15.5) d vs (26.3±14.4) d] (t = -7.058, P＜0.01). The fatality rate of VLBWIs with and without nosocomial infection was 3.6% (2/56) and 3.9% (4/102), and there was no significant difference (x2 = 0.012,P＞0.05). Logistic regression showed that mechanical ventilation (OR = 3.388, 95% CI: 1.656-6.932, P=0.001) and parenteral nutrition (OR= 7.054, 95%CI: 2.005-24.813, P=0.002) were risk factors of nosocomial infection. Conclusions The incidence of nosocomial infection in VLBWIs in NICU is high. Mechanical ventilation and parenteral nutrition should be avoided and the duration of invasive operation and treatment should be shortened as much as possible to minimize the chances of nosocomial infection in VLBWIs.

ObjectiveTo investigate the relationship between fractional exhaled nitric oxide (FeNO) and bronchopulmonary dysplasia (BPD) in extremely/very low birth weight infant (ELBWI/VLBWI). MethodsThirty-five ELBWI/VLBWI (gestational age <34 weeks at birth and birth weight <1 500 g), who were admitted to neonatal intensive care unit of Peking University Third Hospital from October 2014 to March 2015 with respiratory distress soon after birth, were enrolled into the study, and divided into BPD group (n=11) and non-BPD group 1 (n=24) according to the diagnosis at discharge. One day before they left the hospital, FeNO level was determined with Exhalyzer D, an equipment for pulmonary function test. Difference of FeNO and nitric oxide (NO) production between the two groups was compared witht-test or Fisher exact test, and the value of FeNO in predicting BPD was tested by receiver-operating characteristic (ROC) curve.ResultsThe mean gestational age at birth in BPD group was significantly less than that in non-BPD group [(29.7±1.9) vs (32.0±1.5) weeks,t=4.005,P=0.000], and the duration of invasive ventilation [(53.0±91.3) vs (15.0±30.2) h, t=1.598,P=0.002] and oxygenation was longer [(42.1±7.8) vs (8.2±6.4) d,t=13.567,P=0.000]. There were more babies required surfactant treatment, prenatal cortisone administration, and inhalation of cortisone and bronchodilator during hospital stay in BPD group than in non-BPD group[10/11 vs 38%(9/24), 11/11 vs 58%(14/24) and 11/11 vs 21%(5/24), Fisher exact test, allP<0.05]. The age and body weight of the babies at the time of FeNO determination in BPD group were older or higher than those in non-BPD group [(46.4±16.3) vs (20.9±11.7) d,t=5.278,P=0.000; (2 090±164) vs (1 892±153) g,t=3.498,P=0.001], but the corrected gestational age was similar [(36.3±3.1) vs (35.0±2.3) weeks,t=1.407,P=0.169]. Both the mean FeNO level and NO production in BPD group were significantly higher than those in non-BPD group [(13.6±6.9) vs (8.0±3.6) ppb (1 ppb=1×10-9 mol/L), (25.6±10.1) vs (18.1±9.0) nl/min,t=2.967 and 2.478,P=0.006 and 0.018]. The area under the ROC curve was 0.749 (P=0.021, 95%CI: 0.539-0.953) which implied that FeNO provided medium power for discrimination of ELBWI/VLBWI with BPD from those without, with a sensitivity of 72.7% and specificity of 75.0% at the cut-off value of 11.55 ppb.ConclusionsFeNO and NO production in BPD infants are significantly higher than non-BPD infants. Measurement of FeNO for ELBWI/VLBWI through mask before discharge is a simple, safe and invasive procedure to objectively evaluate pulmonary function early after birth.

Objective To investigate the regular pattern of dynamic changes of insulin sensitivity in fetal growth restriction (FGR) rats. Methods Twenty pregnant female rats were randomly divided into two groups as normal-protein group (NP) and low-protein group (LP), which respectively received normal protein diet (20% protein) and low protein diet (8% protein) during pregnancy. Weights of newborns were measured within 6 hours after birth, and the LP offspring whose birth weights were at least 2 standard deviations below the mean of NP offspring (≤2 standard deviations) were defined as FGR rats. At day 3, 7, 14, 30, 60 and 90 after birth, rats were fasted for 12 hours and then angular vein blood was collected to measure fasting plasma glucose (FPG) and fasting serum insulin (FINS) level. At 90 days of age, intraperitoneal glucose tolerance test (IPGTT)was performed; and blood triglyceride ( TG ), low-density lipoprotein cholesterol ( LDL-C ),high-density lipoprotein cholesterol (HDL-C) and glycosylated hemoglobin Alc (HbAlc) were measured. Insulin sensitivity was evaluated by FINS, insulin resistance index (HOMA-IR), insulin sensitivity index (ISI) and IPGTT. Results (1) Birth weights of LP offspring [(4. 92 ± 0. 36) g]were significantly lower than those of NP ones [(6. 43 ± 0. 59) g] (t = 14. 73, P＜0. 05). The incidence of FGR in LP was 88. 2% ; and for the male and female rats, the FGR rate was 94. 1% and 83. 1%, respectively. (2) FPG levels in the male FGR rats were significantly higher than in the NP from the age of 60 days [(9.38 ± 1.57) mmol/L vs (5. 58 ± 1.24) mmol/L] to 90 days [(8. 95 ±1.83) mmol/L vs (6. 21± 1.14) mmol/L] (t=-3. 291, P＜0. 05), while FPG levels in female FGR rats increased significantly only at 90 days of age [(9. 08±1.65) mmol/L vs (6.73±0. 67) mmol/L](t=-3. 226,P＜0. 05). FINS levels were significantly higher in FGR rats than in the NP from the age of 30 days (male FGR rats) or 60 days (female FGR rats) to 90 days (P＜0. 05, respectively).Similarly, HOMA-IR was significantly higher in FGR rats than in the NP at the age of 30 days (male FGR rats) or 60 days (female FGR rats) to 90 days (P＜0. 05, respectively). ISI in male FGR rats showed a reduction in comparison with the NP from the age of 30 to 90 days, while as to the female FGR rats it was significantly lower than in the NP only at 60 days of age and continued to 90 days (P＜0. 05, respectively). IPGTT showed that after injection of glucose, blood glucose at all four points (from 0 min to 120 min) in both male and female FGR rats were higher than that in the NP (P＜0. 05). (3) No significant difference was observed in TG, LDL-C and HDL-C at 90 days of age between the FGR rats and NP ones, while HbA1c in the male FGR rats was significantly higher than that in the NP [(7. 03±0. 54) % vs (4. 37±0. 64)%,t= -8. 028, P＜0. 05]. Conclusions FGR rats are able to maintain glucose balance and normal insulin levels during their earlier age, while insulin sensitivity decreased from adolescence to adulthood. The change of insulin sensitivity is different between male and female FGR rats, and male FGR rats are more likely to develop insulin resistance.

ObjectiveTo evaluate the relationship between waist to stature ratio (WSR) and hypertension,diabetes,dyslipidemia in Qingdao. MethodsData were collected from a 2001 - 2007 Qingdao area diabetes survey,population-based cross-sectional study,and 30 712 Chinese adults aged ＞ 18 years old were enrolled.Correlation analysis of BMI,WSR,hip circumference,waist circumference,waist to hip ratio (WHR) with blood glucose,blood pressure,blood lipid were conducted.ROC curve analysis in diabetes,bypertension,dyslipidemia and multivariate logistic regression analysis were also conducted.ResultsAnthropometric indicators were related with hypertension,diabetes and dyslipidemia in both men and women.Comparing with other anthropometric indicators,WSR was found to have the largest area under the ROC curve and the best cut-off point of WSR was 0.52.Multivariate logistic regression analysis showed that, after controlling age, disease history, physicalactivity, sex, thediabeteshypertension and dyslipidemia risk OR of WSR≥0.52 were largest.ConclusionsAnthropometric indicators intimately related with cardiovascular risk factors in Qingdao region,and may predict and evaluate the risk of cardiovascular disease.WSR may be the best index for predicting cardiovascular risk factors in Qingdao area.The optimal WSR cut off point for identifying cardiovascular risk factors clustering is 0.52.

Objective To explore the effects of folic acid and vitamin B12 supplement in maternal lactation on insulin resistance in fetal growth restriction (FGR) in rat offspring.Methods Eighteen Sprague-Dawley female rats and male rats were used.Pregnant rats were randomly divided into two groups at 12 days:normal-protein group (NP,n=6) and low-protein group (LP,n=12).The were 84 FGR newborn pups in LP group (93.3％,84/90).Forty-eight FGR newborn pups were randomly selected and divided into two groups (24 in each group):intervention group and non-intervention group.The intervention group was fed with high folate and vitamin B12 in the diet;and non-intervention group and NP group were fed normal diet.All of the newborn pups were weaned at 21 days after birth and then fed with normal diet.At days 21,60 and 120 d after birth,eight pups were randomly selected from each group and fasting plasma glucose (FPG),fasting insulin (FINS),blood diglyceride (TG) and cholesterol (TC) were measured.The insulin resistance index (IRI) and insulin sensitivity index (ISI) were calculated to evaluate insulin sensitivity.Variance and Student-Newman-Keuls tests were used for statistical analysis.Results (1) The incidence of FGR:Birth weight of LP offspring [(4.44±0.58) g] was significantly lower than that of NP ones [(7.03±0.56) g] (t=15.75,P ＜ 0.05).(2) FPG and FINS:at day 21 after birth,FPG of the non-intervention group,intervention group and NP group was (4.8±0.3),(4.8±0.4) and (4.6±0.3) mmol/L (F=0.57),respectively;FINS was (4.2± 0.2),(4.5 ±0.4) and (4.3 ±0.1) mU/L (F=0.31),respectively;and there was no significant difference among the three groups (both P ＞ 0.05).At day 60,FPG of the three groups was (7.5±0.4),(6.9± 1.0) and (5.5±0.6) mmol/L (F=17.14);FINS was (14.7± 1.9),(10.7± 1.0) and (9.2± 0.7) mU/L (F=38.34),respectively.At day 120,FPG was (8.9±0.9),(8.0±0.8) and (6.4±0.7) mmol/L (F=21.60);FINS was (56.3±2.8),(38.2±2.5) and (33.1 ±2.8) mU/L (F=164.46).FPG and FINS were highest in the non-intervention group,and lowest in NP group,with significant differences among the three groups of pups (all P ＜ 0.05).(3) IRI and ISI:at day 21,IRI of the non-intervention group,intervention group and the control group was 0.9±0.1,0.9±0.1 and 0.9±0.2 (F=0.49);ISI was-(3.0±0.7),-(3.0±0.1) and-(3.0±0.3) (F=0.69);and there was no significant difference among the three groups (both P ＞ 0.05).At day 60,IRI of the three groups was 4.9±0.8,3.3±0.3 and 2.2±0.3 (F=49.48);ISI was-(4.7±0.2),-(4.3±0.1) and-(3.9±0.1) (F=63.47).At day 120,IRI of the three groups was 22.4±3.1,13.6±2.0 and 9.3±0.9 (F=75.15);ISI was -(6.2 ± 0.1),-(5.7 ± 0.1) and-(5.3 ± 0.1) (F=104.42);and there were significant differences among the three groups (all P ＜ 0.05).(4) TC and TG:at day 21,TC of the non-intervention group,intervention group and the control group was (2.0±0.1),(2.0±0.1) and (2.0±0.1) mmol/L (F=0.10);TG was (0.75±0.1),(0.77±0.1) and (0.74±0.1) mmol/L (F=0.33);and there was no significant difference among the three groups (both P ＞ 0.05).At day 60,TC of the three groups was (2.3 ± 0.1),(2.2 ± 0.1) and (2.0± 0.2) mmol/L (F=8.34);TG was (1.5 ± 0.2),(1.2±0.1) and (1.0±0.2) mmol/L (F=17.93).At day 120,TC was (2.4±0.2),(2.2±0.1) and (2.1 ±0.1) mmol/L (F=6.12);TG was (1.7±0.5),(1.2±0.3) and (l.0±0.1) mmol/L (F=9.80).The TC and TG were highest in the non-intervention group and the lowest in the control group;and there were significant differences among the three groups (all P ＜ 0.05).Conclusion Supplementing folic acid and vitamin B12 in maternal lactation can improve in some extent insulin resistance in FGR rats,but not sufficient enough to completely repair glucose and lipid metabolism.