Objective To formulate strategies for the construction of clinical specialty capabilities in hospitals,providing relevant experiences for peers to enhance clinical specialty capability development.Methods Taking a public hospital in Shenz-hen as an example,this study employs SWOT-PEST analysis to explore the external environment(opportunities and challenges)and internal environment(strengths and weaknesses)facing clinical specialty capability construction from four aspects:policy en-vironment,economic environment,social environment,and technological environment.Results The hospital's strengths include opportunities such as the construction of a national science city in the region,an aging population,and increased governmental fo-cus on the healthcare industry.Additional strengths include the integration of the hospital with community health services,strong support for key disciplines,and a deeply ingrained commitment to public welfare services.However,weaknesses include intense regional competition,the development of external internet hospitals,and increasingly strained doctor-patient relationships.The hospital also faces challenges due to inadequate research capabilities and levels,insufficient information technology infrastructure,and an incomplete internal incentive mechanism.Conclusion Based on the results of the SWOT-PEST analysis,the following strategies are proposed:SO Strategies(Strengths+Opportunities):Collaborate between the hospital and community health cen-ters;attract and cultivate talent to develop specialty clusters and key disciplines;and implement a comprehensive health manage-ment plan for the entire population and lifecycle in the region.ST Strategies(Strengths+Threats):Integrate management across various campuses and community health services,and pursue differentiated development.WO Strategies(Weaknesses+Opportu-nities):Engage in school-local collaborations for cross-disciplinary research innovation and translation;and deepen performance distribution reforms.WT Strategies(Weaknesses+Threats):Strengthen clinical research;enhance the hospital's information technology capabilities;and improve patient experience.Ultimately,these strategies aim to support the construction of clinical specialty capabilities within the hospital.

Two pediatric heart failure patients were treated with pulmonary artery banding(PAB)at Fuwai Hospital,from December 2021 to January 2022.In the first case,an 8-month-old patient presented with left ventricular non-compaction cardiomyopathy(LVNC),left ventricular systolic dysfunction,ventricular septal defect,and atrial septal defect.The second case was a 4-month-old patient with LVNC,left ventricular systolic dysfunction,and coarctation of the aorta.After PAB,the left ventricular function and shape of both patients were significantly improved,without serious surgery-related complications.In these individual cases of pediatric heart failure,pulmonary artery banding exhibited a more satisfactory efficacy and safety compared to pharmacological treatment,especially for those with unsatisfactory medication results.Future clinical data are needed to promote the rational and broader application of this therapeutic option for indicated patients.

Newborn screening (NBS) plays a significant role in reducing the risk of birth defects. NBS in China began in the early 1980s. Under the protection of laws and regulations and the leadership of the national health administration, approved screening centers in public hospitals took the responsibility for publicity, screening, diagnosis, treatment, follow-up and management of birth defects. As of 2022, 31 provinces (autonomous regions and municipalities directly under the central government) have carried out NBS for phenylketonuria, congenital hypothyroidism, and hearing loss, 23 provinces have carried out screening for glucose-6-phosphate dehydrogenase (with a screening rate of 89.24%), and 24 provinces have carried out screening for congenital adrenal cortical hyperplasia (91.45% screening rate). Over the past four decades, screening techniques have evolved from bacterial inhibition, fluorescence analysis, and tandem mass spectrometry for the detection of biochemical markers to genetic testing, which has greatly contributed to the expansion of the types of diseases screened for. The combined use of metabolomics and genomics is currently being explored. Effective management and rigorous quality control of NBS are prerequisites for improving the quality and ensuring the accuracy of screening. The Quality Management System for Newborn Screening System Network (QMS-NBS), established by the National Center for Clinical Laboratories, covers all screening centers and related blood collection agencies. The operation of the QMS-NBS allows the quality and performance of screening to be transparent and measurable, ensuring the quality and efficiency of screening. This article provides an overview of the history of NBS, especially the evolution of policies for the NBS in China, the construction of screening institutions, the number of newborns screened, the incidence rates of screened diseases, the changes in screening technology, the expansion of new diseases screened for, and the quality control of NBS. Overall, the progress in NBS in China has not only benefited from the development and standardization at the technological level, but also benefited from the construction of policies, regulations and ethics.
Infant, Newborn ; Humans ; Neonatal Screening ; Phenylketonurias ; Genetic Testing ; Congenital Hypothyroidism ; China

Objective:To study the clinical features and drug resistance profile of neonatal sepsis caused by different species of Klebsiella.Methods:From January 2009 to December 2018, cryopreserved Klebsiella strains from blood culture of neonatal sepsis cases in NICU of our hospital were reactivated. Molecular identification and antimicrobial susceptibility tests were performed. Clinical features, laboratory tests, drug resistance profile and prognosis of these patients were analyzed retrospectively.Results:A total of 29 strains of Klebsiella were reactivated. Molecular identification assigned 22 cases (75.9%) into Klebsiella pneumoniae (Kpn) group and 7 cases (24.1%) into Klebsiella quasipneumoniae (Kqu) group. Gestational age and birth weight of Kpn group were higher than Kqu group [(33.1±3.2) weeks vs. (30.6±0.9) weeks, (1 847±677) g vs. (1 416±121) g] ( P<0.05). Abdominal distension was more common in Kqu group than Kpn group [42.9% (3/7) vs. 4.5% (1/22), P<0.05]. No significant differences existed in the laboratory tests including white blood cell count, platelet count, hypersensitive C-reactive protein and procalcitonin between the two groups ( P>0.05). Kpn was 100.0% sensitive to Cefazolin-Tazobactam and Amikacinto and less sensitive to Imipenem and Cefperazone-Sulbactam, Meropenem and Ertapenem. Kqu was generally more sensitive than Kpn and the sensitivity of Kqu to Imipenem was 100.0%. No significant differences existed of the prognosis between the two groups ( P>0.05). Conclusions:Kpn is the main pathogen of neonatal Klebsiella sepsis. Kqu sepsis is more common in neonates with smaller gestational age and lower birth weight. Abdominal distention is common presenting symptom in Kpn sepsis and sensitive antibiotics should be used early.

Objective:To study the differences of clinical features between aggressive posterior retinopathy of prematurity (APROP) and general retinopathy of prematurity (GROP) and to find the risk factors of APROP.Method:From January 2014 to December 2018, newborns with retinopathy of prematurity (ROP) hospitalized in our hospital were retrospectively studied. According to the diagnosis criteria of APROP, the newborns were assigned into GROP group and APROP group. Their clinical data, treatment and perinatal data were collected. SPSS 18.0 was used to compare the differences between the two groups.Result:A total of 127 newborns were included in the study, 107 in the GROP group and 20 in the APROP group. 91.6% (98/107) infants with gestational age (GA) <32 w were in the GROP group and 95.0% (19/20) in the APROP group. 84.1% (90/107) infants with birth weight (BW) <1 500 g were in the GROP group and 90.0% (18/20) in the APROP group. No significant differences existed of GA and BW between the two groups. 53.3% (57/107) infants in the GROP group received ≥2 times of blood transfusion, significantly lower than 85.0% (17/20) in the APROP group ( P<0.05). Mechanical ventilation (MV) was used in 81.3% (87/107) infants in the GROP group with most duration less than 7 days (69.2%, 74/107). MV was used in all infants in the APROP group with most duration longer than 7 days (65.0%, 13/20). The APROP group had significantly longer MV duration than the GROP group ( P<0.05). Some of the GROP group received laser photocoagulation therapy and all had good prognosis. Most of the APROP group received intravitreal injection and some of them combined with laser photocoagulation. The majority of them had favorable prognosis. Conclusion:The APROP group and the GROP group have similar general clinical characteristics. Increased blood transfusion and elongated MV duration may be risk factors for APROP.

Neonate is undergoing the transition from fetal circulation to adult circulation in the early period after birth, always accompanied by complex hemodynamic changes.Critical illness in neonates can cause a series of hemodynamic changes.In this article, the main parameters for evaluating neonatal hemodynamics, common methods for monitoring neonatal hemodynamics, and hemodynamic monitoring of common neonatal critical illness were described.

Objective: To evaluate the consistency of ultrasonic cardiac output monitor (USCOM) and electric impedance (ICON) in cardiac function monitoring in preterm infants compared with echocardiography (ECHO). Methods: All enrolled children were monitored with ECHO, USCOM and ICON on the 2nd and 7th day after birth.Heart rate (HR) and cardiac index (CI) were recorded. Results: On the second day after birth, the CI measured by ECHO was (3.26±0.68) L/(min·m²), the CI measured by USCOM was (3.21±0.66) L/(min·m²), and the CI measured by ICON was (3.67 ±0.69) L/(min·m²), with an average percent error of 27.9% and 42.3%, respectively.On the 7th day after birth, the CI measured by ECHO was (3.53±0.57) L/(min·m²), the CI measured by USCOM was (3.47±0.59) L/(min·m²), and the CI measured by ICON was (3.73±0.67)L/(min·m²), with an average percent error of 25.8% and 28.3%, respectively. Conclusion Comparing USCOM with ECHO in cardiac output monitoring of preterm infants, the consistency is good at each time point after birth.Compared with ECHO, ICON has poor consistency in early postnatal cardiac index monitoring, but dynamic monitoring has a certain reference value after one week of birth.

Objective To study the heart function,risk factors and associated complications caused by patent ductus arteriosus( PDA)in preterm infants. Methods A retrospective analysis Was conducted at Neonatal Intensive Care Unit of Shenzhen People＇s Hospital from October 2016 to August 2017 to study the cardiac functions of infants less than 3 days after birth betWeen PDA group and non－PDA group(1: 1 paired study according to gestational age and Weight). MeanWhile their clinical data Were collected by case－control analysis method,to explore the risk factors and complications caused by PDA in preterm infants. Results There Were 50 cases in PDA group,and 50 cases in non－PDA group. The physical data betWeen 2 groups had no statistically significant difference(all P＞0. 05). The heart rate (HR),cardiac output(CO)and cardiac output index(CI)in 2 groups Were(148. 36 ± 12. 98)times／min,(0. 52 ± 0. 21)L／min,(0. 44 ± 0. 19)L／( min·m2 )and(142. 52 ± 18. 07)times／min,(3. 48 ± 0. 92)L／min,(2. 99 ± 0. 80)L／(min·m2 ),respectively;the levels of PDA group Were higher than those of the non－PDA group,and the differences Were significant(P﹦0. 021,0. 020,0. 027). Single factor analysis shoWed that PDA in the preterm infants Was significantly associated With asphyxia,premature rupture of membranes and the use of prenatal hormone( P﹦0. 001,0. 009,0. 004). Ventilation time,pneumonia,feeding intolerance,and bronchial pulmonary dysplasia Were asso﹣ciated With PDA in preterm infants(P﹦0. 010,0. 010,0. 000,0. 026). The Logistic regression analysis shoWed that asphyxia Was independent risk factor for PDA in preterm infants(OR﹦7. 280),and prenatal antenatal corticosteroids Was independent protective factor( OR ﹦0. 008). Conclusions In preterm infants With PDA,the HR,CO and CI increase and electronic heart monitoring could identify the hemodynamic changes in preterm infants With PDA. Asphyxia is major high risk factor in PDA in preterm infants,While the use of prenatal antenatal corticosteroids is seen as the pro﹣tective factor. PDA in preterm infants can prolong the ventilation times and increase the pneumonia,feeding intolerance and BPD.

Objective To investigate whether the therapy of combining budesonide with pulmonary surfactant,compared with only surfactant,has an effect on the incidence of bronchopulmonary dysplasia,mortality and other complications in preterm infants.Methods The preterm infants in accordance with the inclusion criteria,who were born during from 12/2016 and 2/2018,were randomly divided into the combination treatment group (treated with the combination of budesonide and pulmonary surfactant) and control group (treated with only surfactant).Ninety eight preterm infants were enrolled this trial,48 of whom are in budesonide group and 50 are in control group.The basic data were not have statistic significant between two groups except for birth weight (P ＞ 0.05).The incidence of bronchopulmonary dysplasia,the mortality and other complication of premature were compared.Results There was a statistic significance in the incidence of bronchopulmonary dysplasia between the budesonide group and control group (42％ vs 66％,P＜0.05);The severity of bronchopulmonary dysplasia and case fatality rate between two groups have no satistical difference.The complications of preterm infants in two groups also have no statistical difference apart from the incidence of PDA (15％ vs 38％,P ＜ 0.05).Conclusion Budesonide combined with pulmonary surfactant can reduce the incidence of bronchopulmonary dysplasia and does not increase mortality and the rate of other complications in preterm infants.

The clinical manifestations of neonatal shock are atypical so that the early identification was important.Heart rate variability analysis and pulse oximetry for perfusion index monitoring are great help for early identification of neonatal shock.Much attention should be given to the treatment of neonatal special type of shock in addition to follow the general principles of shock treatment.