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.

Objective To compare the efficacy and safety of caffeine combined with humidified high-flow nasal cannula(HHHFNC) and nasal continuous positive airway pressure(nCPAP) on the treatment of apnea in very low birth weight (VLBW) preterm infants.Methods Totally 80 VLBW preterm infants with neonatal apnea,who were enrolled in the NICU of Hebei Province Children Hospital from September 2013 to March 2014,were randomly assigned to either HHHFNC group(39 cases) or nCPAP group(41 cases) according to respiratory support mode by random number table method,both groups were given caffeine.The incidence of severe apnea,incidence of reintubation,oxygen exposure time,duration of non-invasive ventilation time,feeding conditions and incidence of adverse events were compared.Results There were no significant differences in male/female ratio,gestational age,age at randomization and birth weight between the two groups(P ＞0.05).There were no significant differences in the incidence of severe apnea[15.4％ (6/39) vs 12.2 ％ (5/41)],incidence of reintubation [17.9 ％ (7/39) vs 19.5 ％ (8/41)],oxygen exposure time [(183.1 ± 31.2) h vs (175.9 ± 32.1) h],duration of non-invasive ventilation time [(163.3 ± 25.1) h v s (153.0 ± 26.2) h] between the two groups (P ＞ 0.05).The occurrence of abdominal distention [7.7 ％ (3/39) vs 24.4％ (10/41)],nasal trauma[2.6％ (1/39) vs 19.5 ％ (8/41)],head shaping [0.0％ (0/39)vs 29.3％ (12/41)] during treatment were lower in HHHFNC group than those of nCPAP group (P ＜ 0.05).Age began feeding was earlier in HHHFNC group than nCPAP group [(67.5 ± 19.1) h vs (96.3 ± 18.7) h,P ＜ 0.05],and day to full oral feeding was reduced in HHHFNC group than nCPAP group [(346.8±28.6) h vs (371.0 ±29.4),P ＜0.05].Conclusion HHHFNC combined with caffeine is effective on the treatment of apnea in VLBW preterm infants,and easier to make newborn tolerated.HHHFNC is an effective non-invasive respiratory support mode with few side effects.

OBJECTIVE To discuss the disinfection effect of Laoken KDSJ-Y multi-purpose air disinfecting machine using in the newborn hospital ward for air sterilization.METHODS Standard sample were carried on separately before starting,the starting 60 minutes later,the engine off latter 60 minutes and 120 minutes,after raising and the bacteria number were calculated.RESULTS Dynamic disinfection in room temperature 30-31℃,humidity 68-72%.Room population 10.7,and does not limit in the undertake transfer of personnel situation,starting disinfects 60 minutes to be able to achieveⅡ The kind of disinfection ambient air contains the fungus quantity standard;After before starting disinfection,and engine off,colony quantity continues to increase,cannot achieve toⅡ The kind of disinfection ambient air including the fungus quantity request after 120 minutes,must starting disinfect once more.CONCLUSIONS Laoken KDSJ-Y multi-purpose air disinfecting machine under some person of conditions the dynamic disinfection to be possible in the control air the bacterial content,conforms to the newborn hospital ward 2 kind of ambient air disinfection sanitation standard,suits the promotion.

Objective To investigate the correlation analysis of amplitude-integrated electroencephalogram (aEEG) and magnetic resonance imaging (MRI) in infants with hypoxic-ischemic encephalopathy (HIE) to early evaluate the severity of HIE.Methods Ninety term infants with HIE were selected.They were detected by aEEG within 12 hours after birth,and accepted cranial MRI 3 to 7 days after birth.The infants were divided into 3 groups (aEEG normal,mild abnormality and severe abnormality) according to the result of aEEG.The Spearman correlation analysis was completed in infants with HIE between aEEG clinical grading and cranial MRI grading.Results In 90 infants with HIE,the clinical grading:mild HIE 44 cases (48.9％),midrange HiE 29 cases (32.2％) and severe HIE 17 cases (18.9％).Cranial MRI grading:mild 49 cases (54.4％),midrange 23 cases (25.6％) and severe 18 cases (20.0％).The result of aEEG:aEEG normal 43 cases (47.8％),aEEG mild abnormality 25 cases (27.8％) and aEEG sever abnormality 22 cases (24.4％).The result of correlation analysis showed that aEEG grading was positive correlation with the HIE clinical grading (r =0.970 7,P ＜ 0.01) and MRI grading (r=0.933 5,P ＜ 0.01).Conclusion The aEEG can early evaluate the severity of HIE.

OBJECTIVE To inspect the condition of hands-washing among medical staff in order to improve it accordingly.METHODS Direct inspection on the effect of hands-washing among medical staff from all departments within hospital at a fixed interval and make statistics as well as analysis retrospectively.RESULTS The qualified rate of hands-washing respectively was 90.03%,91.47%,91.54%,and 93.55% during the years of 2003 through 2006.The rate had risen steadily.The qualified rate of hands-washing in key departmeuts and in others was 89.15% and 87.87%.respectively,without significatnt differences.However,the qualified rate among nurses and doctors was 93.80% and 87.17%,respectively.The qualified rate among nurses was obviousely higher than among doctors in this regard with significant differences between them.CONCLUSIONS Intensifying training and standardizing hands-washing methods by means of choosing suitable hands-detergents are important in order to improve the compliance of hands-washing among medical staff.

OBJECTIVE To explore the distribution,bacterial types and antibiotic-resistance in a children hospital.METHODS The methods of combining objective investigation with the(doctor′s) report were adopted.RESULTS In our hospital,the rate of upper airway infections was in the first accounted for 42.4%,mainly ocourred in internal neurology,hematology and nephrology departments and gastrointestinal and cardiosurgery departments.(Among) Gram-negative robs,Pseudomonas aeruginosa was the principle of the upper airway infections,it was(sensitive) to ceftazidime.Among Gram-positive cocci,the Staphylococcus aureus and Enteroccoccus were the main pathogens concerned, which were(sensitive) to vancomycin and nitrofurantoin.CONCLUSIONS Long-hospitalization,unreasonable use of hormone and(antibiotic).invasive operation and various diseases in the same department are the main risk factors,for the correspondent(measures) must apply to prevent and control the hospital infection.

Objective To evaluate the efficacy of nasal intermittent positive pressure ventilation (nIPPV) in preventing extubation failure in very low birth weight infants (VLBWI) compared with nasal continuous positive airway pressure (nCPAP).Methods A single-center randomized controlled trial was conducted from Jun 2012 to Jun 2013 in the NICU of Children's Hospital of Hebei Province.Eighty-four cases of VLBWI (birth weight 700 ～ 1 500 g,gestational age 27 ～ 32 weeks) with respiratory failure and subjected to mechanical ventilation were eligible for the study if they needed non-invasive,assisted ventilation at the time of first extubation attempt.They were randomly assigned to receive nIPPV (40 cases) or nCPAP (44 cases) according to random number table method,using the rate of successful extubation as primary outcome.Blood gas data were obtained and PaO2,PaCO2,FiO2,PaO2/FiO2 were monitored at 0 h,24 h,48 h and 72 h after extubation as enrollment for oxygenation and duration,the rate of successful extubation and the incidence of adverse events including frequent apnea,bronchopulmonary dysplasia,intraventricular hemorrhage,periventricular leukomalacia and retinopathy of prematurity and mortality as secondary outcomes.Results There were no significant differences in the baseline characteristics including the proportion of primary disease,sex,weight,gestational age,score for neonatal acute physiology and application of pulmonary surfactant between nIPPV group and nCPAP group (P ＞ 0.05).There were no significant differences in PaO2,PaCO2 and PaO2/FiO2 ratio between the two groups at 0 h of enrollment (P ＞ 0.05).The values of PaO2 and PaO2/FiO2 ratio in nIPPV group were significantly higher[48 h:PaO2:(63.2 ± 3.6) mmHg vs (52.3 ±6.7) mmHg,PaO2/FiO2:(243.2 ±32.8) mmHg vs (187.6 ±34.0) mmHg;72 h:PaO2:(66.4 ±5.8) mmHg vs (51.8±5.9) mmHg,PaO2/EO2:(280.6 ± 16.8) mmHg vs (245.2 ±40.5) mrnHg;1 rnmHg =0.133 kPa],whereas PaCO2 lower[48 h:(40.3 ±4.8) mmHg vs (49.2 ±6.6) mmHg,72 h:(42.2 ±5.6) mmHg vs (57.3 ± 6.9) mmHg],than nCPAP group at 48 h and 72 h after extubation (P ＜ 0.05).The oxygenation status in nIPPV group were significantly improved at 48 h and 72 h after extubation compared with the intra-group data at 0 h (P ＜ 0.05).The total ventilation time was shorter in nIPPV group than nCPAP group[(130.9 ±46.7) h vs (180.5 ±50.1) h,P ＜0.05],but the oxygen exposure time had no significant difference[(190.6 ± 45.2) h vs (216.8 ± 54.4) h,P ＞ 0.05].The rate of successful extubation in nIPPV group was significantly higher as compared with nCPAP group[92.5％ (37/40) vs 75.0％ (33/44),P ＜ 0.05].The incidence of frequent apnea and bronchopulmonary dysplasia in nIPPV was lower than nCPAP group[15.0％ (6/40) vs 34.1％ (15/44) ;2.5％ (1/40) vs 15.9％ (7/44),P ＜ 0.05].There were no significant differences in the incidence of severe intraventricular hemorrhage,perivenwicular leukomalacia,retinopathy of prematurity,late of infections,necrotizing enterocolitis,patent ductus arteriosus,patent ductus arteriosus operation and mortality before discharge between the two groups (P ＞ 0.05).Conclusion nIPPV after extubation in VLBWI has beneficial effects as compared with nCPAP in improving oxygenation,shortening noninvasive ventilation time,improving the rate of successful extubation,and can reduce the incidence of frequent apnea and bronchial pulmonary dysplasia in VLBWI.

Objective To evaluate the clinical efficacy and safety of flexible fiberoptic bronchoscopy (FFB) and bronchoalveolar lavage (BAL) in treatment of neonatal atelectasis.Methods Eligible patients, who were diagnosed as neonatal pulmonary atelectasis and admitted consecutively to the neonatal intensive care unit of the Children's Hospital of Hebei Province from January 2013 to January 2015, were included in the study.They were randomly assigned to FFB group (n=30) and control group (n=28).Newborns in the FFB group received BAL under FFB, while those controls received tracheal irrigation after intubation.The duration of lung recruitment, oxygen exposure and antibiotic administration, hospital stay, culture results of respiratory secretions, prognosis and total expenses during hospitalization were compared between the two groups.Complications of FFB were also recorded.Chi-square test and t-test were performed for statistical analysis.Results (1) In the FFB group, atelectasis occurred in the upper fight lobe (n=26), upper lobes of both sides (n=1), lower right lobe (n=2) and lower left lobe (n=1), while in the control group, atelectasis occurred in the upper right lobe (n=26), lower left lobe (n=1) and middle right lobe (n=2) (x2=0.094, P ＞ 0.05).(2) The positive rate of bacteria culture results showed no difference between bronchoalveolar lavage fluid in FFB group and tracheal secretions in the controls [43％(13/30) vs 32％(9/28), x2=0.770, P ＞ 0.05].(3) The duration of lung recruitment, antibiotic administration and hospital stay of the FFB group were all shorter than those of the control group [(4.7±3.4) vs (7.4±6.6) d, (14.0±4.5) vs (20.3±10.9) d, (15.1±4.7) vs (21.8±12.3) d, t=-5.718, 8.604 and 7.733, all P ＜ 0.05].(4) Among babies in the FFB group, nine experienced fever and returned to normal after physical cooling;three showed more shadow in chest X-ray with aggravated dyspnea during a short period, and relieved 12 hours later;two had minimal hemorrhage from tracheal mucous membrane;one showed crying hoarse.Serious complications, such as pneumothorax, massive bleeding or cardiac arrest, did not occurred.No death or refuse of treatment was reported.Conclusion FFB and BAL is much more effective than tracheal irrigation after intubation in treatment of neonatal atelectasis without any severe complications.

Objective To analyze the changes of WBC classification,sugar and protein in cerebro-spinal fluid(CSF)and pathogenic bacteria of neonatal purulent meningitis.Methods Thirty-one neonates with bacterial meningitis in our department of neonatology from June 201 1 to June 2013 were enrolled,and the clinical features,pathogenic bacteria,laboratory examination of CSF were analyzed.Results Fever (90.3%),convulsions(67.7%)and changed consciousness(58.1 %)were common clinical symptoms.The incidences of other nervous system abnormal signs such as gastrointestinal dysfunction(25.8%),abnormal breathing(16.1 %),cervical resistance(16.1 %),bulging fontanel(9.7%)were lower.The Gram -negative bacteria was more than Gram -positive in both blood and CSF culture.The escherichia coli was the most common bacteria,with positive rate of 38.1 %(8 /21 )in blood culture and 55.5%(5 /9)in CSF culture.The germiculture positive rate in CSF was lower than in blood culture (29.0% vs.67.7%).Polymorphonuclear leukocyte(PMN)[(79.61 ±12.06)%]was the most predominant cell of the leukocyte classification in CSF within 1 week in all cases,PMN was still predominant in 1 to 2 weeks in 7 cases,while only 2 cases in 2 to 3 weeks still dominated by PMN,PMN was not the predominant cell 3 weeks later.Conclusion In the typi-cal neonatal purulent meningitis,PMN was the predominant cell in CSF within the first week,but the propor-tion of monocyte gradually increased and was dominant later.Escherichia coli was a common bacteria caused by this disease.

Objective To observe the effects of modified Liujunzi Decoction on improving isletβ-cell function of patients with the syndrome of spleen-deficiency and phlegm-stagnation of type2 diabetes mellitus.Methods Totally 72 patients were selected and divided into treatment group and control group randomly, with 36 cases in each group. Both groups were under diet adjustment and appropriate exercise and were given metformin hydrochloricle tablets, 0.5 g each time (1.0 g each time after 2 weeks), twice a day; acarbose, 50 mg each time, three times a day. The treatment group was given modified Liujunzi Decoction additionally, 200 mL each time, three times a day, orally. The course of treatment of the two groups was three months. Blood glucose, C peptide, INS, HbA1c, HOMA-IR, HOMA-β andΔI30/ΔG30 after 30 minutes of glucagon loading was recorded.Results Compared with before treatment, FBG, 30 min PBG, 2h PBG, HbA1c, FINS, fasting C-peptide, and HOMA-IR decreased in both groups, and the 30 min INS, 30 min C peptide, andΔI30/ΔG30 increased in the treatment group, with statistical significance (P<0.05). After treatment, there was statistical significance in FBG, 30 min PBG, 2 h PBG, HbA1c, fasting C-peptide, FINS, 30 min INS, 30 min C peptide, HOMA-IR, andΔI30/ΔG30 between the two groups (P<0.05).Conclusion Modified Liujunzi Decoction combined with Western medicine can better improve isletβ-cell function of patients with the syndrome of spleen-deficiency and phlegm-stagnation of type2 diabetes mellitus than Western medicine merely.