Objective To explore the causes and adverse effects of hypocarbia in newborns during mechanical ventilation. Methods Two hundred and forty-six newborns received assisted ventilation from Jan. 1994 to Dec. 2003 were retrospectively reviewed. Results The morbidity of hypocarbia was 14. 2%. It is common in preterm infants and the onset time of which were (31. 6?26. 9) hours after mechanical ventilation. The common primary disease was respiratory distress syndrome (RDS) (22. 6%). The mortality (32. 9%) and incidence of intracranial hemorrhage (20%) in hypocarbia cases were higher than those of the control group (7. 1 % and 5. 7%) (P

Objective To evaluate the neonatal outcomes and the prevalence of congenital malformations in children born after in-vitro fertilization(IVF). Methods IVF children (211 cases) born of 156 mothers from July 1994 to October 2003 and 218 controls were studied. Those controls were randomly chosen from the same hospital matched for the time and season of birth and maternal age. Results The incidence of multi-gestation (37.2% vs 2.3%, OR =24.62, 95% CI : 9.1~72), preterm birth (37.2% vs 8.5%, OR =6.41, 95% CI : 3.5~12.0), cesarean section (97.0% vs 71.8%, OR =14.9,95% CI :5.0~49.5), pregnancy-induced hypetension (22.4% vs 10.8%, OR = 2.39, 95% CI :1.3~4.9), threatened abortion (4.5% vs 0%, OR =3.11,95% CI :2.0~4.8) were significantly higher in the IVF group, but the prevalcnce of fetal distress (14.6% vs 4.5%) was lower comparing with control group( P

Humans ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma ; complications ; Pulmonary Embolism ; complications

Objective To examine the effectiveness of simulation newborn simulator in neona-tal resuscitation training for pediatric residents. Methods From June 2011 to June 2012, 11 residents working in neonatal ward of the Third Hospital of Peking University were enrolled into the study. Eval-uation on the residents was made before the training. Training of simulated teaching using simulation newborn simulator was conducted and evaluation was made after the training. SPSS 18.0 was used for statistical analysis. Comparison was made between pre- and post-training test by paired t test. P<0.05 was considered statistical significant. Questionnaire survey was conduct to acquire residents' feedback. Results A total of 11 participants completed the training and finished the questionnaire. The score of pre-training was 37.82±1.17 versus that of post-training 39.18±0.87(t=4.89, P<0.01). All residents were satisfied with the simulation-based training. Conclusion Simulation training can improve pedi-atric residents' knowledge and skills in neonatal resuscitation.

Objective To investigate the relationships between low one-minute Apgar score and the prognosis of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI). Methods Altogether 50 EPI and ELBWI who had a low one-minute Apgar score ( ≤ 7) and were admitted to the Neonatal Intensive Care Unit (NICU) of Peking University Third Hospital from January 1,2010 to December 31, 2015 were enrolled in this study. All of them were divided into two groups according to their Apgar score: mild group (4-7) and severe group (0-3). Medical records of the subjects were reviewed and an at least 18 months follow up study was conducted. Conditions of all subjects during perinatal period and hospitalization were summarized. Outcomes and follow-up results were compared between the two groups by using Fisher exact test. Results (1) General information: Fifty infants were involved, among which 37 had a mild low Apgar score and 13 had a severe low Apgar score. The mean gestational age was (27.7±2.1) weeks and the mean birth weight was (884.4±174.3) grams. (2) Main complications (some infants with more than one complication): There were 42 cases of neonatal respiratory distress syndrome, 12 cases of pulmonary hemorrhage, 21 cases of bronchopulmonary dysplasia, 31 cases of patent ductus arteriosus, 36 cases of intraventricular hemorrhage, 22 cases of white matter damage and six cases of retinopathy of prematurity. (3) Outcomes: The survival rate was 48% (24/50) and the mortality rate was 52% (26/50). Among the 26 infants, five died despite treatment and 21 died within 72 hours after their parents giving up treatment. There were no significant differences in the survival rates, mortality rates and rates of abandon treatment between the two groups [43% (16/37) vs 8/13; 11%(4/37) vs 1/13; 46% (17/37) vs 4/13; Fisher exact test, all P>0.05]. (4) Follow-up results: Twenty-one infants were followed-up to at least 18 months of age, among which four were normal, 10 had growth retardation and recurrent respiratory tract infection and seven had motor development retardation. The incidence of motor development retardation in severe group was higher than that in mild group, and the difference between them was statistically significant (5/8 vs 2/13, Fisher exact test, P=0.046). Conclusions EPI or ELBWI with a low one-minute Apgar score have many nosocomial complications, resulting in high mortality and high incidence of motor development retardation.

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.

Objective:To determine the gestational weight gain and its risk factors and adverse effects among pregnant women in Beijing.Methods:Between June 2018 and June 2019, all registered infants and their mothers in a child care center of a third-tier-class hospital in Beijing were selected. A self-made questionnaire was used to collect the basic information of the maternal mothers. Chi-square test and analysis of variance were used to describe the basic characteristics of the study subjects and clarify the harmful effect of gestational weight gain for maternal and infant health. Multiple logistic regression analysis was used to analyze the risk factors of both insufficient and excessive weight gain during pregnancy.Results:A total of 3732 maternal mothers and their babies were included. The average weight gain of maternal mothers during pregnancy was 13.0 kg. The results of this study showed that the proportion of insufficient weight gain during pregnancy was 31.8% and the proportion of excessive weight gain was 24.1%. It was further found that young age, pre-pregnancy body mass index indicating overweight and obesity, primipara, and low education were independent risk factors for excessive weight gain during pregnancy. The risk of excessive weight gain of pre-pregnancy overweight and obesity was 2.40 times ( OR=2.40, 95% CI=1.91-3.03, P<0.001) and 2.90 times higher, respectively, ( OR=2.90, 95% CI=1.59-5.27, P<0.001) when compared with that of pre-pregnancy normal weight. In addition, our results suggested that excessive weight gain significantly increased the risk of macrosomia for the infant and the risk of cesarean section, gestational hypertension, and postpartum weight retention for maternal mothers. Conclusions:Age, pre-pregnancy BMI, primipara, and education level were the influencing factors for gestational weight gain. Considering the serious harmful effects of both insufficient and excessive weight gain for maternal and infant health, weight management during pregnancy should be strengthened for these high-risk populations in the future.

Objective:To investigate the clinical features and risk factors of feeding intolerance in premature infants.Methods:This is a retrospective study involving premature infants who were hospitalized in Peking University Third Hospital from January to December 2017. Those in the feeding intolerance group (FI group) were further divided into subgroups of gestational age (GA) < 31 weeks group and GA ≥ 31 weeks group, as well as birth weight (BW)<1 250 g group and BW≥1 250 g group. Medical records of all subjects were reviewed to retrieve relevant clinical information. Independent-samples t-test, Chi-square test, and logistic regression tests were used for statistical analysis. Results:There were 612 eligible subjects with 182 (29.7%) in the FI group and 430 (70.3%) in the feeding tolerance (FT) group. (1) In the FI group, there were 103 (56.6%) males and 79 (43.4%) females with an average GA of (30.6±2.3) weeks and BW of (1 298±417) g, and 134 (73.6%) were very low birth weight premature infants. Among the patients with FI, there were 93 in the GA<31 weeks group and 89 in the GA≥31 weeks group, and 93 in the BW<1 250 g group and 89 in the BW≥1 250 g group. The FI infants accounted for 63.2% of very low birth weight premature infants in the same period. (2) The age at diagnosis was (2.7±0.9) d and (13.2±6.9) d at recovery. And the duration of FI was (10.5±6.7) d. The main symptoms were gastric retention (100.0%, 182/182), abdominal distention (54.4%, 98/182) and vomiting (17.0%, 31/182). (3) FI in preterm infants with GA <31 weeks or BW <1 250 g occurred and disappeared later [GA subgroups: (2.4±0.8) vs (2.9±0.9) d, t=3.977 and (10.4±5.2) vs (16.0±7.3) d, t=5.935; BW subgroups: (2.5±0.9) vs (2.8±0.9) d, t=2.540 and (10.0±4.5) vs (16.3±7.4) d, t=6.951; all P<0.05] and had a longer duration than those with GA≥31 weeks or BW≥1 250 g [GA subgroups: (8.0±5.0) vs (13.0±7.3) d, t=5.450; BW subgroups: (7.5±4.3) vs (13.5±7.3) d, t=6.690; both P<0.05]. Premature infants with smaller GA took longer time to regain their birth weight [(9.4±4.1) vs (12.0±5.1) d, t=3.672, P<0.05] and those with lower BW were less likely to have symptom of vomiting [23.6% (21/89) vs 10.8% (10/93), χ2=5.308, P<0.05]. (4) Multivariate logistic regression analysis showed that BW was a protective factor for FI in premature infants ( OR=0.998, 95% CI: 0.997-0.998, P<0.001) and the independent risk factors for FI were neonatal respiratory distress syndrome ( OR=2.129, 95% CI: 1.163-3.897, P=0.014), multifetation ( OR=1.812, 95% CI: 1.116-2.941, P=0.016), caffeine citrate exposure within 48 h after birth ( OR=2.663, 95% CI: 1.619-4.381, P<0.001), continuous positive airway pressure (CPAP) treatment within 48 h after birth ( OR=5.211, 95% CI: 2.861-9.489, P<0.001) and intrauterine infection ( OR=1.988, 95% CI: 1.060-3.728, P=0.032). Conclusions:The incidence of feeding intolerance in premature infants is high. Premature infants with GA <31 weeks or BW <1 250 g may develop FI and recover at an older age, and suffer longer. Low BW, neonatal respiratory distress syndrome, multifetation, caffeine citrate exposure, or CPAP treatment within 48 h after birth and intrauterine infection are risk factors for FI in premature infants.

A male patient aged 1 year and 8 months with type 2 spondyloepimetaphyseal dysplasia with joint laxity (SEMDJL2) was reported. The clinical characteristics included short stature, flat middle face, hypotonia, limb joint relaxation, hyperextension of metacarpophalangeal articulation, etc. In addition, the patient had a history of congenital laryngeal stridor. Thus, SEMDJL2 was determined according to the above symptoms and medical history. Sanger sequencing showed that the child carried a c.443C>T missense mutation in the KIF22 gene, which resulted in an amino acid variation namely p.Pro148Leu. This phenotype was preliminarily determined as a pathogenic mutation. Therefore, it is suggested that next-generation sequencing genetic testing could be helpful for genetic diagnosis in children with congenital laryngeal stridor, systemic joint relaxation, and excessive joint extension.

OBJECTIVE: To explore the cause for the failure of non-invasive prenatal testing (NIPT) and feasibility of repeated testing. METHODS: Clinical data, test results and pregnancy outcomes of 40 311 pregnant women who received NIPT test from January 2011 to December 2018 were reviewed. RESULTS: Among all the pregnant women, 1116 cases failed in the first test, 9 cases (0.81%) had fetal free DNA concentration lower than 4%, 663 cases (59.41%) were retested after the establishment of Z value gray area, and the remainder 444 cases (39.78%) needed to be retested after the blood collection due to the fetal free DNA concentration lower than 4%. After retesting, 1069 cases (95.78%) obtained effective NIPT results. The results showed that 53 cases were at high risk (6 cases for trisomy 21, 6 cases for trisomy 18, 13 cases for trisomy 13, 16 cases for sex chromosomal abnormality, 12 cases for chromosomal copy number variation). Forty-eight cases were selected for invasive prenatal diagnosis, and 2 cases of 47, XXY and 2 CNV were confirmed. A total of 47 cases (0.12%) did not obtain results because the concentration of fetal free DNA was lower than 4%. Only 16 cases (34%) chose invasive prenatal diagnosis. CONCLUSION Repeated detection of the gray area of Z value can reduce the false positive rate of NIPT and invasive prenatal diagnosis, and the feasibility of repeated detection is high. In the case of fetal free DNA concentration lower than 4%, the success rate of obtaining effective NIPT results by re-sampling and re-detection increases with the increase of gestational age, but may delay the diagnosis for fetal aneuploidies. Therefore, personalized estimation should be made according to gestational age and clinical indications. It is suggested that pregnant women should choose invasive prenatal diagnosis when they have failed in the retest.