Neonatal intubation is one of the most common but also one of the most dangerous and complicated procedures in neonatological practice, which may cause adverse events, including bradycardia and severe oxygen desaturations. Concerning clinical situations, we review the critical points in the procedure of neonatal intubation. The new technique that recommended in neonatal intubation may improve success rates and decrease morbidity.

Objective To investigate the relationship between angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and the severe morbidity of neonates. Methods According to the Neonatal Critical Score (draft), neonates were divided into three groups:control group (n=116), non-critical group (n=237) and critical group (n=98). ACE genotype was determined by PCR. Results The DD genotype was significantly higher in critical group compared with the other two. The critical score on first day of hospitalization was significantly lower in DD genotype than ID or II (93.52?6.99 vs 96.43?5.80 and 96.22?6.41, P

Objective To analyze the causes of non-elective removal of pereutaneously inserted central venous catheters (PICC) in premature infants. Methods We retrospectively collected the clinical data of 104 premature infants and analyzed the causes of non-elective removal of PICC. Results PICC was removed when the treatment was finished (n = 93, elective removal group) or due to complications ( n = 7, non-elective removal group). In non-elective removal group, the percentage of catheter tip located in the subclavian jugular was signifi-cantly higher in non-elective removal group than in the elective removal group (X2 = 24.931, P = 0. 000 ). The length of inserted catheter was ( 8.4 + 2.2 ) cm in the non-elective removal group and ( ( 10.2:1:1.6) cm in the elective removal group ( t = 3. 391, P = 0. 001 ). Conclusion The main cause of non-elective removal of cathe-ters in premature infants may be that catheter tip fails to reach the vena cava.

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.

Objective To investigate the effects of total intravenous anesthesia (TIVA) and combined intravenous and inhalation anesthesia on blood glucose and cortisol in spinal neurosurgery.Methods Forty-four spinal neurosurgery patients were divided into propofol combined with remifentanil group (PR group) and sevoflurane combined with remifentanil group (SR group ), 22 cases in each group,they were induced with propofol, sufentanil and rocuronium. Anesthesia was maintained with sevoflurane in SR group while propofol in PR group. Depth of anesthesia adaption according to bispectral index (BIS)(45 -55). Blood glucose, cortisol, haemodynamics were observed at different time points. Results The mean arterial pressure(MAP) was higher after induction in PR group than that in SR group(P ＜ 0.05 ). Sixty minutes after induction, MAP was lower than that before induction in PR group (P ＜ 0.05 ). Heart rate ( HR )in both SR group and PR group were lower at 60 and 120 minutes after induction than those before induction (P ＜ 0.05). HR was lower at 5 minutes after induction in PR group than that in SR group (P ＜ 0.05). No significant difference was showed in blood glucose and cortisol between the two groups (P ＞ 0.05 ). Cortisol level was significantly lower at 120 minutes after induction than that before induction [(40.6 ± 18.3) μg/L vs. ( 129.7 ± 36.7 ) μg/L, P ＜ 0.05 ] and at 24 hours postoperative [ (93.6 ± 19.8 ) μg/L ] recovered to the level before induction in PR group. Cortisol level was significantly higher before induction than 120 minutes after induction [ ( 130.5 ± 32.1 ) μg/L vs. (51.6 ± 16.8 ) μg/L, P ＜ 0.05 ] and 24 hours postoperative was (75.9 ± 18.2) μg/L in SR group. Conclusions Two anesthetic regimens are compatible during spinal neurosurgery, with no apparent fluctuations of perioperative blood glucose. However, longer cortisol inhibition is probably happened when using sevoflurane.

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 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.

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.