Effective neonatal resuscitation is critical to reducing the mortality and morbidity of neonatal asphyxia. The standardized implementation of neonatal resuscitation is described and emphasized in this article from the three following aspects: neonatal resuscitation program from experience- to evidence-based, the unchanged sequence of each step in resuscitation, and reonatal resuscitation from theory to practice in order to achieve a highly effective and efficient resuscitation.

Objective To explore the correlated factors of bilirubin neurotoxicity. Methods From July 2007 to October 2007, 53 hospitalized patients with jaundice in neonatal ward of Peking University Third Hospital were enrolled in the study. The relationship between serum free bilirubin and parameters of brainstem auditory evoked potential(BAEP) was analyzed to screen the sensitive index of bilirubin neurotoxicity. Multivariate analysis was conducted between the sensitive parameter and various factors. Results Partial correlation analysis showed that the wave Ⅴ latency was positively correlated to serum free bilirubin(r=0. 228, P= 0. 020) after the corrected gestational age was controlled. There were no correlation between other latencies or interwave intervals and serum free bilirubin. Linear regression showed the equation was wave Ⅴ latency= 9.721-0. 082 × corrected gestational age+0. 064 × bilirubin/albumin+ 0. 504 × acidemia(F= 7. 534, P＜0.01). Conclusions Wave Ⅴ latency is the sensitive indicator of bilirubin neurotoxicity, which is correlated with the value of bilirubin/albumin and acidemia.

Objective To investigate the insulin sensitivity in children born small for gestational age without catch-up growth.Methods We investigated 439 outpatients in pediatric department of the Third Hospital of Peking University with diagnosis of short stature from August 2008 to August 2016.Two groups were divided based on their diagnosis as born small for gestational age group(SGA)with 218 patients and idiopathic short stature group(ISS)with 221 patients.Fasting blood-glucose,fasting insulin,fasting insulin/fasting blood-glucose,islet beta-cell function(HOMA%),homeostasis model assessment-insulin resistance(HOMA-IR)were analyzed in two groups.Results Hierarchy based on age and sex in SGA and ISS.No significant difference was observed in preadolescent boys with fasting blood-glucose(4.7±0.6 vs 4.8±0.6,P=0.678),fasting insulin(5.1±4.0 vs 4.3±4.7,P=0.345),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.No significant difference was observed in preadolescent girls with fasting blood-glucose(4.5±0.5 vs 4.6±0.5,P=0.828),fasting insulin(4.7±3.5 vs 4.5±3.3,P=0.603),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.No significant difference was observed in adolescent boys with fasting insulin(5.9±4.3 vs 6.0±4.5,P=0.958),fasting blood-glucose(5.0±0.8 vs 4.9±0.5,P=0.176),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.No significant difference was observed in adolescent girls with fasting blood-glucose(4.9±0.6 vs 4.8±0.4,P=0.141),fasting insulin(7.5±6.4 vs 7.4±8.6,P=0.448),fasting insulin/fasting blood-glucose,HOMA%,HOMA-IR.Conclusion The insulin sensitivity were in good condition in children born small for gestational age without catch-up growth.

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.

BACKGROUND: Up to now, few studies related to the mechanism of low-frequency transcutaneous electrical nerve stimulation (TENS) in relieving pain, and the effect of low-frequency TENS on the activity potential of dorsal horn cells in rats after peripheral nerve injury. OBJECTIVE: To observe the effects of low-frequency TENS on the activity potential of dorsal horn cells induced by mechanical allodynia and thermal allodynia by using animal models of peripheral nerve injury, and observe the efficacy after interfering of naloxone. DESIGN: A randomized control animal study. SETTING: Department of Neurology, Affiliated Hospital of Medical College, Yanbian University. MATERIALS: The experiment was carried out in the central laboratory of Medical College, Yanbian University between February and October 2004. Eighty male Sprague-Dawley rats were used, and 60 random selected ones were operated to separate sciatic nerve, two branch tibial nerves and sural nerves of sciatic nerve were amputated after ligation, and peroneal nerve was left as the experimental group; the other 20 rats were placed at the origin after sciatic nerve was separated, and then the skin was sutured as the control group. METHODS: ① Pain detection (Behavioral test): At 1 week postoperatively, the rats were given mechanical allodynia and thermal allodynia once every 5 seconds for 10 times, and then the frequency of foot withdrawal was detected (0%-40% for mild pain, 40%-70% for moderate pain; 70% and above for severe pain). ② The spontaneous activity potential of dorsal horn cells and that induced by mechanical allodynia and thermal allodynia were detected among the rats with moderate and severe pain in the control group and study group. ③ Low-frequency TENS of 3 mA and 10 Hz was applied to the legs of rats in the experimental group with annular electrode for 10 minute, and the membrane potential of dorsal horn cell was detected before and after stimulation. ④ At the same time of low-frequency TENS was given, rats in the experimental group were injected with naloxone via audal vein, and the membrane potential of dorsal horn cell was detected before and at 10 minutes after naloxone injection.RESULTS: Finally 80 rats were involved in the analysis of results after compensation. ① The foot withdrawal frequencies induced by mechanical allodynia and thermal allodynia in the experimental group were obviously higher than those in the control group (P ＜ 0.01). ② The membrane potential of dorsal horn cell by mechanical allodynia and thermal allodynia in the experimental group were obviously higher than those in the control group (P ＜ 0.01). ③ The membrane potential of dorsal horn cell by mechanical allodynia and thermal allodynia at 10 minutes after low-frequency TENS in the experimental group were obviously higher than those in the control group [(102.6±0.9), (136.9±1.46) impulses per 10 seconds; (175.2±1.28), (240.8±1.51) impulses per 10 seconds, P ＜ 0.01]. ④ In the experimental group, the membrane potential of dorsal horn cell by mechanical allodynia and thermal allodynia at 10 minutes after naloxone injection were obviously higher than those before injection [(174.5±0.4), (235.4±1.4) impulses per 10 seconds, P ＜ 0.01].CONCLUSION: Low-frequency TENS can effectively inhibit the activity potential of spinal dorsal horn cells induced by non-noxious stimulation,and the intravenous injection of naloxone (8 mg/kg) can recover it to the pretreatment level, indicating that low-frequency TENS may alleviate pain by stimulating central nervous system to make it secrete endogenous opium system, and acting on spinal dorsal horn cells to reduce the activity.

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 assess the preventive effects of recombinant human erythropoietin (rHu EPO) on the anemia of premature birth infant. To determine whether prophylactic treatment with rHu EPO and iron would reduce the postnatal hemoglobin (Hb) decline and blood transfusion of premature infants. Methods Fifty one infants of less than 35 weeks of gestation and 2000 g of birth weight from multicenter were randomly assigned to EPO group ( n =31) and control group ( n =20). Infants in EPO group received rHuEPO 250 IU/(kg?t) intravenously or subcutaneously once every second day, started between 2 and 10 days of age, maintained for 4 weeks. Oral iron and vitamin E supplements were given to all infants. Hb, hematocrit (Hct), reticulocyte counts (Ret), serum iron and erythropoietin (EPO) were detected in both groups. Results Postnatal decline of Hb and Hct were less in EPO group than that in the control group at the end of study (129.9?21.0 vs 103.2?14.3, P

Objective:To observe the influence of inhaled anesthetic isoflurane in the neuronal protein damage and aggregation in the APP transgenic mouse hippocampus,and to investigate the intervention effect of trehalose. Methods:Sixty APP transgenic mice aged 12 months were divided into control group,isoflurane group (Iso group) and trehalose group (Tre group)(n=20).The rats in control group were not given any drugs and were put into the anesthetic box with continuonsly entering 2 L·min-1 oxygen for 2 h;the rats in Iso group and Tre group were respectively injected intraperitoneally with 2 mL saline or trehalose (400 μg·kg-1 )30 min before anesthesia,and then inhalated 1.4% isoflurane for 2 h.6 h after anesthesia,the hippocampus tissue of the mice was prepared,and DCFH-DA fluorescence was applied to detect the reactive oxygen species (ROS)level; 24 h after anesthesia, immunohistochemical method and Western blotting method were used to detect the contents of carbonyl compounds and nitrotyrosine and the Aβ1-42 protein expression level in hippocampus;TEM was applied to observe the formation of protein aggregates; TUNEL staining was performed to observe the apoptotic rate of hippocampal neurons. Results:Compared with control group, the ROS level, the expression levels of oxidative protein carbonyl compounds and nitrotyrosine,the expression level of Aβ1-42 protein,and the apoptotic rate of hippocampal neurons in Iso group were significantly increased (P < 0.05);compared with Iso group,the ROS level,the expression levels of oxidative protein carbonyl compounds and nitrotyrosine,the Aβ1-42 protein expression level, and the apoptotic rate of hippocampal neurons in Tre group were significantly decreased (P < 0.05).Conclusion:Isoflurane can induce the protein damage and aggregation,the apoptotic rate of hippocampal neurons,aggravate oxidative stress reaction,increase the apoptotic rate of brain hippocampal neurons in the APP transgenic mice;trehalose can intervene the neurotoxicity induced by inhaled anesthetics.

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 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.