1.Value of fasting plasma glucose in oral glucose tolerance test on gestational diabetes mellitus diagnosis
Liying ZOU ; Ling FAN ; Yanhong ZHAI
Chinese Journal of Perinatal Medicine 2012;(11):660-663
Objective To investigate the value of fasting plasma glucose (FPG) in 75 g oral glucose tolerance test (OGTT) on the diagnosis of gestational diabetes mellitus (GDM).Methods Data of 6516 pregnant women who accepted prenatal cares from Beijing Obstetrics and Gynecology Hospital,Capital Medical University between Jan.2010 and Dec.2010 were collected.All patients had normal FPG at first trimester,and accepted 75 g OGTT after abnormal 50 g glucose challenge test (≥7.8 mmol/L).According to the result of OGTT,they were divided into 12 groups,and Chisquare test was used to analyze the role of FPG of OGTT in GDM diagnosis.Results According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria,15.0% (980/ 6516) of this group of pregnant women was diagnosed with GDM by FPG (≥5.1 mmol/L) of OGTT in this study.Then,the rest 5536 pregnant women with normal FPG of OGTT were divided into 12 groups according to FPG level (FPG level interval 0.1 mmol/L).As FPG level rose,the incidence of GDM also rose (X2 =282.175,P =0.000).Similar results also appeared when the interval was 0.2 mmol/L and the FPG level was between 4.0 and 4.8 mmol/L (X2 =274.364,P=0.000).When FPG level was lower than 4.2 mmol/L(22.1%,1226/5536),the incidence of GDM diagnosed by OGTT was 3.6% (44/1226).And when FPG level of OGTT was higher than 4.8 mmol/L,the incidence of GDM was 26.2% (298/1138).Conclusions FPG screening is recommended between 24 and 28 gestational weeks before OGTT,and GDM low-risk women whose FPG ≤4.2 mmol/L do not need OGTT.
2.Clinical epidemiological characteristics of neonatal respiratory failure in Children's Hospital of Hebei Province
Chinese Journal of Perinatal Medicine 2012;(11):670-675
Objective To investigate the incidence,treatment and prognosis of neonatal respiratory failure (NRF) in the Neonatal Intensive Care Unit of Children's Hospital of Hebei Province.Methods The medical data of 626 NRF newborns admitted to the Neonatal Intensive Care Unit of Children's Hospital of Hebei Province from January 1st,2008 to December 31st,2008 were collected,and the pathogenesis of NRF,management,risk factors of their deaths and cost for the disease were studied.The results were compared with the national study in the same period and the local study of 2004-2005 by Chi-square test.Results During the 12 consecutive months,the incidence of NRF in neonatal intensive care unit was 38.9% (626/1608).The mortality in hospital was 22.5% (141/626),among which,most deaths (134,95.0%) occured after early discharge required by the parents.The mortality decreased by 14.7% compared with that during 2004 2005 (37.2%,113/304),and was also lower than that (24.7%,1683/6864) in the national study at the same period.Pneumonia/sepsis ( 34.8 %,218/626 ),neonatal respiratory distress syndrome ( 31.6 %,198/626 ),and meconium aspiration syndrome (10.7%,67/626) were leading primary causes of NRF.The major complications were pneumonia/sepsis (5.4 %,34/626),intracranial hemorrhage (4.6 %,29/626) and persistent pulmonary hypertension (3.2%,20/626 ).The percentage of NRF babies requiring pulmonary surfactant rose from 14.1% (43/304) during 2004-2005 to 23.6% (149/626) in 2008,which almost reached the national level of 26.8% (1840/6864).Pulmonary surfactant treatment was accepted by 70.2% (139/198) patients with neonatal respiratory distress syndrome.12.1% (24/198)of neonatal respiratory distress syndrome infant was administered immediate intubation-surfactant-extubation.Seventeen (2.7%) patients accepted nitric oxygen treatment.Nasal continuous positive airway pressure was given to 76.5%(479/626) patients,which was higher than before (47.1%,143/304).Conventional mechanical ventilation rate decreased from 72.7% (221/304) to 49.8% (312/626),and high frequency oscillatory rate increased from 0.7% (2/304) to 10.5% (66/626),which were similar to the national level.Of the 480 patients discharged after recovery,the mean time of hospital stay was (15.1 ± 4.0) days,and the mean medical cost was (12752 ± 5148) CNY.Conclusions The patient number increases and the medical skills and treatment methods of our hospital improve a lot.Utilization of pulmonary surfactant,nasal continuous positive airway pressure and high frequency oscillatory ventilation increase significantly.However,the burden of NRF is still heavy.
3.Clinical features of sepsis caused by different types of pathogens in preterm infants
Qiuping LI ; Jianying DONG ; Xizhong ZHOU ; Li ZHOU ; Lu YANG ; Zhichun FENG
Chinese Journal of Perinatal Medicine 2012;(11):676-682
Objective To investigate the clinical features of sepsis caused by gram negative or positive pathogens and funguses in preterm infants.Methods The clinical data of 140 premature infants with sepsis admitted to preterm neonatal intensive care unit of Bayi Children's Hospital from October 2008 to June 2011 were collected and analyzed retrospectively.The clinical features of sepsis caused by different types of pathogens in preterm infants were compared by SPSS 18.0 software.Comparison of measurement data was conducted by one way ANOVA,and comparison between groups was performed by LSD method.Rates among groups were compared by Chi-square test or Fisher's exact test.Results Of 140 preterm infants with sepsis,70 cases were caused by gramnegative bacteria,36 by gram positive bacteria,and 34 by funguses.The top three gram negative sepsis pathogens were Klebsiella pneumonia (55.7 %,n =39),Escherichia coli (20.0 %,n =14) and Acinetobacter baumannii (12.9%,n =9).The top three gram positive sepsis pathogens were Staphylococcus epidermidis (36.1%, n =13), Staphylococcus hominis (22.2%, n =8) and Staphylococcus haemolyticus (19.4%,n=7).The top four fungus sepsis pathogens were Candida parapsilosis (44.1%,n=15),Candida albicans (23.5%,n=8),Candida famata (8.8%,n=3)and Cryptococcus laurentii (8.8%,n=3).There were no significant differences in delivery mode,fetal distress, asphyxia, fetal growth restriction, meconium-stained amniotic fluid, maternal infection,hypertensive disorder complicating pregnancy,gestational diabetes mellitus,peripherally inserted central venous catheter,mechanical ventilation before infection,cortical hormon(e) (e)xposure,intraventricular hemorrhage, periventricular leukomalacia, peripheral blood immature-to-total neutrophil ratio,recovery time of platelet,the time of infection onset,fever and hypothermia among the three groups (P>0.05).While there were differences in gestational age [(30.4 ± 2.3) weeks,(31.0±2.4) weeks and (29.5±1.8) weeks,F=4.317,P=0.015],birth weight [(1512.5±406.0) g,(1563.8±485.4) g and (1328.8±303.2) g,F=3.190,P=0.044],premature rupture of membranes rate [24.3% (17/70),16.7% (6/36) and 44.1% (15/34),X2 =7.241,P=0.034],rate of surgery during neonatal period [12.9% (9/70),38.9% (14/36) and 11.8% (4/34),X2 =10.430,P=0.005],the incidence of lowperfusion [64.3% (45/70),30.6% (11/36) and 50.0% (17/34),X2 =10.922,P=0.004],rate of frequent apnea [67.1% (47/70),36.1% (13/36) and 55.9% (19/34),X2=9.341,P=0.009],incidence of low white blood cell [21.4% (15/70),8.3% (3/36) and 32.4% (11/34),X2=6.267,P=0.042],thrombocytopenia rate [64.3% (45/70),16.7% (6/36)and 67.6% (23/34),X2 =25.576,P=0.000],white blood cell count [(19.9± 17.8) × 109/L,(19.9±14.3) ×109/L and (12.0±8.1)×109/L,F=3.553,P=0.031],platelet count [(159.1±169.1) ×109/L,(311.8±179.7) ×109/L and (121.4±123.4) ×109/L,F=14.140,P=0.000],C-reactive protein [(76.8±70.1) mg/L,(16.6±27.2) mg/L and (31.8±27.5) mg/L,F=17.248,P=0.000],incidence of central nervous system infections [1.4% (1/70),2.8% (1/36) and 11.8%(4/34),X2 =5.066,P=0.043],retinopathy rate of premature infants [38.6% (27/70),50.0%(18/36) and 67.7% (23/34),X2 =8.780,P=0.012],bronchopulmonary dysplasia rate [8.6% (6/70),11.1% (4/36) and 26.5% (9/34),X2=5.837,P=0.044] and mortality [11.4% (8/70),0.0% (0/36) and 2.9% (1/34),X2 =5.361,P =0.042] among the three groups.Conclusions There are significant differences among sepsis caused by different types of pathogens in risk factors (gestational age,birth weight,premature rupture of membranes and neonatal surgical procedures),clinical manifestations,infection indexes and prognosis in preterm infants.Sepsis caused by gram negative bacilli liked to present shock with obvious increasing of C-reactive protein; and the prognosis is the worst.Central nervous system infection is more common in fungal infection; and the rates of retinopathy of prematurity and bronchopulmonary dysplasia are higher.Sepsis caused by gram positive cocci have mild clinical manifestations and infection indexes variations and better prognosis.
4.DNA methylation of peroxisome proliferator-activated receptor γ promoter region and down-regulation of its mRNA expression in liver decrease insulin sensitivity of fetal growth restricted rats
Yan XING ; Jing QI ; Xinli WANG ; Yuhong GUAN ; Jin ZHANG ; Xiaomei TONG ; Meihua PIAO
Chinese Journal of Perinatal Medicine 2012;(11):683-688
Objective To explore the effect of methylation of peroxisome proliferator-activated receptor γ(PPARy) gene promoter in liver and its mRNA expression changes on decreasing of insulin sensitivity in fetal growth restriction (FGR) rats.Methods Twenty pregnant rats were randomly divided into two groups on their first day of pregnancy:normal-protein group (NP) and low-protein group (LP),ten in each.During pregnancy the LP group rats were fed with low-protein diet (8.00% protein),while the NP group rats were fed with normal-protein diet (20.00% protein).The offspring rats were fed with standard feed after 21 days of birth.Male offsprings in NP group were as control offsprings,and male FGR offsprings in LP group ware as FGR offsprings.At day 3,7,14,30,60 and 90,fasting blood of offsprings was collected to measure fasting plasma glucose (FPG) and fasting insulin(FINS).Then insulin resistance index of homeostasis model assessment (HOMA-IR) and insulin sensitivity index (ISI) were calculated to evaluate insulin sensitivity.At day 7 and 90,liver tissue of male offsprings was collected to extract DNA and total RNA.The methylation level of PPARγ gene promoter and its mRNA expression were detected by methylation specific-polymerase chain reaction (MS-PCR) and reverse transcription-RCR,respectively.The relationships between methylation of PPARγ gene promoter and mRNA expression and insulin sensitivity were analyzed by Pearson correlation and nonparametric test method.Results (1) The mean offspring birth-weight of LP group was (4.92±0.36) g,which was lower than that [(6.43±0.59) g] of control group (t=14.73,P<0.05).In LP group,the incidence of FGR offspring was 88.2% (97/110) and the FGR incidence of male ones was 94.1% (48/51).(2) At day 90,compared with control offsprings,FPG [(8.95±1.83) mmol/L vs (6.21±1.14) mmol/L,t=-3.291,P<0.05],FINS [(59.57±9.89) mU/Lvs (36.10±7.32) mU/L,t=-4.916,P<0.05] and HOMA-IR (0.967±0.297 vs 0.410±0.135,t=-4.472,P<0.05) of FGR offsprings were significantly higher; while ISI of FGR offspring was lower than that of control offsprings (-3.043±0.294 vs -2.172±0.354,t=4.774,P<0.05).(3) There was no significant difference in methylation degree of PPARγ gene promoter in liver between FGR and control offsprings at day 7 (0/8 vs 2/8,Fisher exact test,P>0.05).The methylation degree of PPARγ gene promoter in liver in FGR offsprings was significantly higher than that of control offsprings at day 90 (8/8 vs 2/8,Fisher exact test,P<0.05).Compared with control offsprings,PPARγ gene mRNA expression level of FGR offsprings decreased significantly at day 90 (4.3.07±7.51 vs 146.72± 40.66,t=7.09,P<0.05).mRNA expression of PPARγ gene was the lowest in exhaustive methylation offsprings (27.2± 1.6),and then in partial methylation ones (47.3±33.0),the highest in no methylation ones (144.6 ± 21.2) (P<0.05).(4) The correlation analysis showed that PPARγ mRNA expression level negatively correlated to the level of FPG (r=-0.819),FINS (r=-0.906) and HOMA-IR (r=-0.860),P<0.05 respectively; but positively correlated to ISI level (r=0.947,P<0.05).Conclusions Hypermethylation in promoter region of PPARγ gene might inhibit gene transcription,and be involved in the occurrence of insulin resistance in FGR rats.
5.Induction of preeclamptic rat model by injection of ultra-low-dose lipopolysaccharide in early pregnancy
Jinmei WANG ; Mingming ZHENG ; Jianjun ZHOU ; Zhenyu DIAO ; Yali HU
Chinese Journal of Perinatal Medicine 2012;(11):689-695
Objective To establish an animal model of preeclampsia by injecting ultra-low-dose lipopolysaccharide (LPS) to rats in early pregnancy,and to lay the foundation for further study on mechanisms of preeclampsia.Methods Twenty-four pregnant rats were divided into six groups according to the random number table and were injected with LPS 0.3,0.5,0.7,1.0,2.0 μg/kg or saline 2 ml respectively through tail veins on day 5 of pregnancy.The differences in blood pressure,urinary protein and pathological changes in placenta among groups were compared to confirm the suitable dose of LPS for establishing preeclamptic model.Then another 19 pregnant rats were injected with the chosen dose of LPS slowly through tail veins on day 5 of pregnancy; 15 of which were chosen as model group; the other four were chosen as postpartum group.Three non-pregnant rats were as non-pregnant group.Besides,another 15 pregnant rats were injected with saline as pregnant control group.Systolic blood pressure,urinary protein excretion,placental weight,fetal weight,serum white blood cell counts,blood platelet counts,plasma anti-thrombin-Ⅲ content,D-dimer content were examined and compared among groups with one way analysis of variance; histopathologic studies were also done on the placentas,kidneys and aortas of the rats.Results (1) Placental weight of LPS 0.3 μg/kg group increased compared with control group.One pregnant rats(1/4) in LPS 1.0 μg/kg group and LPS 2.0 μg/kg group died on day 16 of pregnancy as a result of vaginal bleeding.Systolic blood pressure of LPS 0.5 μg/kg group rose steadily,while no significant changes were found in other groups.Urinary protein increased in all LPS groups,while urinary protein of LPS 0.7 μg/kg group and LPS 1.0 μg/kg group peaked on day 12 of pregnancy and then decreased; urinary protein of LPS 0.5 μg/kg group increased most significantly,and fetus in LPS 0.5,0.7 and 2.0 μg/kg groups had lighter body weight.So LPS 0.5 μg/kg was chosen as the suitable dose to establish preeclamptic model.(2)Compared with pregnant control group,model group had higher systolic blood pressure [(124.89±1.79) mm Hg vs (119.02±1.80) mm Hg,LSD test,P=0.03] from day 6 of pregnancy,more urinary protein [(2.02±0.29) mg vs (1.11±0.18) mg,LSD test,P=0.00] from day 9 of pregnancy,more absorbed embryos [3.6% (7/194) vs 0.0% (0/200),Fisher exact test,P=0.01] at day 20 of pregnancy,higher incidence of placenta bleeding [4.1% (8/194) vs 0.0% (0/200),Fisher exact test,P=0.00] and fetal growth restriction [13.9% (27/194) vs 6.0% (12/200),X2=6.92,Fisher exacttest,P=0.01].Model group showed more inflammatory cells infiltration in the placenta,more glomerular mesangial cells,swelling and desquamated of renal tubular epithelial cells compared to control group.Blood pressure and urinary protein of the model group recovered to the baseline at the sixth day of postpartum,and no changes in blood pressure and urinary protein were found in non-pregnant rats.Conclusions Injection of LPS 0.5 μg/kg on day 5 of pregnancy through tail veins could induce the clinical symptoms of preeclampsia in rats,which might be an ideal model for further preeclampsia research.
6.Relationship between maternal red cell index in early pregnancy and gestational diabetes mellitus in Kunming
Jing WANG ; Zhuo CHEN ; Runmei MA ; Minghui YANG ; Rong YIN ; Yonghu SUN ; Qian SUN ; Lan ZHANG
Chinese Journal of Perinatal Medicine 2012;(12):705-709
Objective To investigate the role of hemoglobin (Hb),red blood cell count (RBC) and hematocrit (HCT) during the first trimester in predicting the occurrence of gestational diabetes mellitus (GDM) in the third trimester in nonanemic women in Kunming.Methods A prospective study was carried out.Routine blood tests were performed in 1189 nondiabetic singleton pregnant Chinese women at their initial prenatal healthcare before 14 gestational weeks in the First Affiliated Hospital of Kunming Medical University from January 1,2008 to December 31,2009.They were divided into four groups by quartiles of Hb,RBC and HCT levels respectively.Differences of GDM incidence at the third trimester were compared among groups.Kollmogorov Smirnov test was used to detect normal distribution of Hb,RBC and HCT results.Differences between rates of groups were detected by Chi-square test.Independent risk factors of GDM were screened by Logistic regression analysis.Results The incidence of GDM at the third trimester increased as quartile categories of Hb,RBC and HCT ascended.The GDM incidence (13.1 %,34/259) of ≥75th Hb group was higher than that of < 25th group (5.9 %,18/304,x2 =8.53,P< 0.0 1),25th ~ group (9.2 %,30/326,x2=4.18,P<0.05) and 50th~ group (9.3%,28/300,x2=3.96,P<0.05).The GDM incidence (11.7 %,34/290) of 50th~ RBC group (RBC≥4.44 × 1012/L) was higher than that of <25th group (6.3%,19/304,x2=5.30,P<0.05),25th~ group (7.0%,21/298,x2 =3.93,P<0.05); and the GDM incidence (12.1%,36/297) of ≥75th group was also higher than that of <25th group (6.3%,19/304,x2 =6.49,P<0.05),25th~ group (7.0%,21/298,x2=3.85,P<0.05).The GDM incidence of <25th HCT group (5.3%,16/303) was lower than that of 25th~ group (9.3%,29/311,x2=7.04,P<0.01),50th~ group (10.8%,31/287,x2=3.93,P<0.05) and ≥75th group (11.8%,34/288,x2=6.49,P<0.05).Logistic regression analysis showed that Hb (OR=1.031,95% CI:1.010-1.052),RBC (OR=2.286,95%CI:1.318-3.963) and HCT (OR=1.106,95% CI:1.037-1.179) were independent risk factors of GDM (all P<0.05).Conclusions High maternal Hb,RBC and HCT levels in the first trimester could be used in predicting GDM in pregnant women in Kunming area.
7.Physiological and neuropsychological development in children born after assisted reproductive technology
Sirui ZHENG ; Rongna REN ; Yun LIU
Chinese Journal of Perinatal Medicine 2012;(12):710-715
Objective To analysis newborn stage and long-term physiological and neuropsychological development in children born after assisted reproductive technology(ART),and to evaluate the safety of ART.Methods Eighty-four 6-month-old to 6-year-old children born after ART performed from January 1st,2006 to June 30th,2011 in Reproduction Center of Fuzhou General Hospital were taken as ART group; and 84 matched children born after spontaneous conception were as control group.The physiological and neuropsychological states of these children in their newborn stage and 6-month-old to 6-year-old duration were compared with Chi-square or t test.Results There was no statistical difference in childbearing age of mothers,the prevalence of gestational diabetes mellitus and hypcrtensive disorder complicating pregnancy,delivery mode,living environment,parents' education level,newborn birth length,birth weight,the rate of premature birth,low birth weight,asphyxia and hospitalized to neonatal intensive care unit between two groups (P>0.05).In ART group,the incidence of growth retardation and abnormal social life skills was 6.0 % (5/84) and 1.2 % (1/84),and no statistical difference were found comparing with control guoup [4.8%(4/84) and 1.2%(1/84),x2 =0.12 and 0.00,P>0.05],neither the developmental quotient (95.9±6.1 vs 94.8±5.1,t=1.25,P=0.21).Twins had higher rates of preterm birth [41.8% (33/79) vs 10.1%(9/89),x2 =22.37,OR=6.38,95%CI:2.81-14.50,P=0.00],low birth weight [51.9%(41/79) vs 6.7%(6/89),x2=42.35,OR=14.93,95% CI:5.84-38.16,P=0.00],asphyxia [10.1 % (8/79) vs 1.1 %(1/89),x2 =6.69,OR=9.92,95% CI:1.21~81.15,P=0.01],hospitalized to neonatal intensive care unit [36.7 % (29/79) vs 14.6 % (13/89),x2 =10.90,OR =3.39,95%CI:1.61-7.14,P=0.00] and growth retardation [11.4%(9/79) vs 0.0%(0/89),x2=10.71,RR=0.11,P=0.00] than singleton.Conclusions ART has no negative effects on children's physical and neuropsychological development.It could increase the incidence of twins,so that it might increase the incidences of preterm labor and low birth weight,which might affect the long-term physical and neuropsychological development of the offspring.
8.Effect of hypoxic myocardial injury on neonatal cerebral hemodynamics and brain tissue oxygen saturation
Zezhong TANG ; Congle ZHOU ; Yi JIANG ; Xinlin HOU ; Hongmei WANG
Chinese Journal of Perinatal Medicine 2012;(12):716-719
Objective To investigate the effect of neonatal hypoxic myocardial injury and bradycardia on cerebral hemodynamics and brain tissue regional oxygen saturation (rSO2),and to provide patho-physiological evidence for treatment of neonatal hypoxic-ischemic encephalopathy (HIE) in acute phase.Methods Ninety nine full-term newborns admitted into Department of Neonatology,Peking University First Hospital from December,2005 to December,2008 were enrolled in this study.There were 18 newborns with both myocardial injury and HIE (group 1),31 newborns with HIE but without myocardial injury (group 2) and 50 cases of neonatal jaundice (control group).From 3 to 7 days after birth,Doppler ultrasound was used to measure systolic velocity (Vs),diastolic velocity (Vd) and resistance index (RI) of the anterior cerebral artery; and brain tissue rSO2 was detected by near infrared spectroscopy.The differences among groups were compared by variance analysis and LSD test.Brain tissue rSO2 before and after treatment of 20 newborns with bradycardia for various causes were detected and the difference was compared by paired t test.Results (1) Vs of group 1,group 2 and the control group was (19.35±5.13),(29.35±4.28) and (32.62±7.47) cm/s respectively; Vd was (6.43±2.98),(11.21±3.16) and (11.50±3.03) cm/s; RI was 0.68±0.10,0.62±0.03 and 0.64±0.06; brain tissue rSO2 was (52.4± 2.8)%,(54.6±3.1)% and (62.1±1.9)%.There were significant differences among the three group(F=29.999,19.393,5.283 and 137.952,P<0.01).Vs,Vd and rSO2 of group 1 were lower than that of group 2 and the control group (P<0.05).RI of group 1 was higher than that of group 2 and the control group (P<0.05).Vs and rSO2 of group 2 were lower than that of control group,but there were no differences between the two groups in Vd and RI.(2) The brain tissue rSO2 of newborns with bradycardia after treatment was higher than that before treatment [(58.7±4.6)% vs (50.9±3.2)%,t=6.239,P<0.01].Conclusions The disturbance of cerebral hemodynamics and cerebral oxygenation in HIE newborns are aggravated by hypoxic myocardial injury.Stable heart rate might be very important to early treatment for HIE.
9.Diagnostic value of two-channel amplitude-integrated electroencephalogram in neonatal seizures with simultaneous video electroencephalogram
Xiaomei ZHU ; Pengling QIU ; Guoqiang CHENG ; Yiyun SHI ; Qiufang GU ; Yun CAO ; Tianlan CHEN ; Daokai SUN ; Yi WANG
Chinese Journal of Perinatal Medicine 2012;(12):720-726
Objective To characterize contemporary electrographic neonatal seizures by video electroencephalogram (VEEG) and to assess the value and the limitations of two-channel (C3-C4/T3-T4) amplitude-integrated electroencephalogram (aEEG) plus original EEG signals used to diagnose neonatal seizure with video EEG as a golden standard.Methods Sixty-six neonates admitted to Children's Hospital of Fudan University from January 2011 to July 2011 with clinical or suspected clinical seizure were investigated and bedside VEEG were recorded for more than 3 hours.VEEG signals were transformed into three kinds of aEEG signals by Galileo NT PMS software:one-channel aEEG (C3-C4),one-channel aEEG (C3-C4) plus original EEG,two-channel aEEG (C3-C4/T3-T4) plus original EEG.Electrical seizure activity on VEEG was signed out with respect to its occurrence,duration and localization of seizure onset; while aEEG seizure was recorded only with its occurrence.The relationship between aEEG and VEEG was analyzed by Spearman analysis.The value and the limitations of aEEG to diagnose neonatal seizure were evaluated by sensitivity,specificity,positive predictive value and negative predictive value.Results A total of 62 traces were suitable for analysis.(1) VEEG showed 39 seizure activities,among which 8 status epilepticus; and the rest 31 neonates had 352 non-status epilepticus electrical seizures,79.3% (279/352) of which occurred over the centrotemporal region.(2) Eight cases with status epilepticus on VEEG were all diagnosed as status epilepticus on aEEG.For non-status epilepticus electrical seizures,the sensitivity of aEEG for detection of electrical seizures was as followed:49.1% (173/352) for one-channel aEEG,54.5 % (192/352) for one-channel aEEG plus original EEG,81.2% (286/353) for two-channel aEEG plus original EEG.Results from one-channel aEEG,one-channel aEEG plus original EEG and two-channel aEEG plus original EEG were all related to VEEG (ρ =0.790,0.907 and 0.953,respectively,P< 0.01).(3) Sensitivity of seizure detection was 66.7% (26/39,95% CI:0.62-0.81) for one-channel aEEG,74.4%(29/39,95% CI:0.78-0.96) for one-channel aEEG(C3-C4) plus original EEG and 89.7% (35/39,95% CI:0.89-1.00) for two-channel aEEG(C3-C4/T3-T4) plus original EEG.Conclusions VEEG might help aEEG in diagnosis of neonatal seizure.two-channel aEEG (C3-C4/T3-T4) plus original EEG could significantly increase the sensitivity of neonatal seizures indentification.
10.Emergency bedside-echocardiography in neonatal intensive care unit
Ziyu TAO ; Lijian XIE ; Jie SHEN ; Tingting XIAO ; Yongwei ZHANG ; Rufang ZHANG ; Gang QIU ; Xiaohui GONG ; Hailan LU
Chinese Journal of Perinatal Medicine 2012;(12):727-731
Objective To evaluate the clinical value of emergency bedside-echocardiography in neonatal intensive care unit.Methods Six hundred and sixty-eight infants with cardiac pathological murmurs,cyanosis and shortness of breath were detected by emergency bedside echocardiography (Sonosite Micromax 1 portable ultrasound or Philips iE33 ultrasonic systems) during January 2007 to July 2011.The accuracy of emergency bedside-echocardiography in the diagnosis of neonatal heart diseases was evaluated according to the results of surgical exploration.Results Among 668 enrolled neonates with the mean age of (7.2±1.3) d,there were 347 males and 321 females,and 309 term infants [mean gestational age (39.1±0.6) weeks (37.0~42.1 weeks)] and 359 premature infants [mean gestational age (33.7±0.91) weeks (28.9~36.9 weeks)].Totally,507 cases were found cardiac abnormality by emergency bedside-echocardiography,including 268 cases of patent ductus arteriosus (232 premature and 36 term infants),115 congenital heart disease,99 persistent fetal circulation and 25 arrythmia.Surgeries were performed on 54 infants and invasive therapy was performed on one infant,and none of them received CT,magnetic resonance imaging or invasive examinations before operation; among which,51 surgeries successed and 4 infants died.Other 452 infants were treated with medications,392 infants recovered and discharged,26 infants did not recover,14 cases died and 20 cases left the hospital before recovery.The accuracy rate of Micromax 1 portable ultrasound in diagnosing congenital heart diseases was 94.5% (52/55),while 96.4 % (53/55) for philips iE33 ultrasonic systems.Conclusions Emergency bedside-echocardiography could provide instant and valuable information of cardiovascular system,which would be helpful in making quick clinical decisions.