Objective:To study the high risk factors of hypothermia in premature infants with gestational age ≤34 weeks, and to analyze the incidence of hypothermia before and after the implementation of the quality improvement program of hypothermia in hospital and its influence on various systemic complications, aiming to improve the early identification of hypothermia and to reveal the important clinical significance of temperature management in time.Methods:Clinical data of preterm infants born in Maternal and Child Health Hospital of Hubei Province from May 2017 to December 2018, with gestational age ≤34 weeks, and admitted within 1 hour after birth were collected.According to the admission temperature, the infants were divided into normal temperature group (36.5-37.5 ℃), mild hypothermia group (36.0-36.4 ℃), moderate hypothermia gsroup (32.0-35.9 ℃), and severe hypothermia group (<32.0 ℃). The high risk factors of hypothermia in premature infants were analyzed.The incidence and degree of hypothermia and the effects on the systemic complications before and after the implementation of the hypothermia quality improvement program were compared.Results:A total of 306 premature infants were enrolled in the study, including 63(20.6%)cases in the normal temperature group, 115(37.6%) cases in the mild hypothermia group, and 128(41.8%) cases in the moderate hypothermia group, without severe hypothermia.Infants with birth asphyxia were at higher risk for hypothermia( OR=0.195, 95% CI 0.046-0.833, P=0.027); the lower the Apgar score at 1 min( r=0.123, P=0.032)and 5 min after birth( r=0.136, P=0.017), the higher the risk of admission hypothermia.After the quality improvement project, the incidence of admission hypothermia decreased from 82.3% to 73.8%( χ2=32.67, P<0.001), and the use of pulmonary surfactant in infants with respiratory distress syndrome was significantly reduced(70.0% vs. 32.0%, χ2=40.11, P<0.001), and the incidence of hypotension within 72 hours after birth decreased(11.8% vs. 4.9%, χ2=3.87, P<0.049). Conclusion:Birth asphyxia is a risk factor for admission hypothermia in premature infants, and Apgar score is associated with admission hypothermia in premature infants.Temperature management of preterm infants can significantly reduce the incidence of hypothermia and hypotension, and reduce the use of pulmonary surfactant in respiratory distress syndrome infants.

Objective:To explore the relationship between rumination and depression and suicide attempts, and the mediating effect of rumination between depression and suicide attempts in adolescents with depressive disorder.Methods:Clinical interviews and questionnaires were conducted on 331 adolescents aged 11-18 with depressive disorders.Depressive symptoms were assessed with patient health questionnaire-9 (PHQ-9). Rumination was assessed with ruminative responses scale-10 (RRS-10), and Chinese version of the sociality module of MINI5.0 was used to assess suicide.SPSS 23.0 software was applied to descriptive statistics, Chi-square test, t-test, Spearman correlation analysis and hierarchical regression analysis, and the SPSS macro program PROCESS V 3.4 was used for Bootstrap mediating effect. Results:The incidence of suicide attempts in adolescents with depressive disorder was 53.78%, which was significantly higher in girls (59.48%) than that in boys (40.40%), and the difference was significant ( χ2=10.16, P<0.01). In contrast to the non-suicide attempt group, suicide attempt group had higher scores on PHQ-9((11.08±9.26) vs (14.43±7.49), t=-3.634, P<0.01), brooding ((10.76±3.89) vs (12.44±3.87), t=-3.926, P<0.01), reflection ((10.05±3.54) vs (11.20±3.33), t=-3.044, P<0.01) and rumination total score ((20.81±6.78) vs (23.64±6.42), t=-3.898, P<0.01). Regression analysis revealed that girl ( β=0.175, t=3.228, P=0.001), depressive symptoms ( β=0.168, t=3.082, P=0.002), rumination ( β=0.138, t=2.364, P=0.019) were risk factors for suicide attempts.Rumination played a complete mediating effect between depressive symptoms and suicide attempts (effect value=0.013, 95% CI=0.003-0.027). Depression symptoms significantly and positively predicted rumination ( P<0.01), and rumination significantly and positively predicted suicide attempts ( P<0.05). Conclusion:The incidence of suicide attempts was high in adolescents with depressive disorders.Depressive symptoms affect suicide attempts mainly through rumination.Clinicians should assess the rumination of adolescents with depressive disorders.In addition, clinicians should implement concurrent psychotherapy to adjust the cognitive response and reduce rumination, in order to improve the mental health and reduce suicide attempts.

Neonates are undergoing the transition period from fetal circulation to adult circulation, and the hemodynamic changes are complex.For premature infants(especially very low birth weight infants and extremely low birth weight infants), the cardiovascular systems are immature.Therefore, they are prone to hypotension at early postnatal stage.Hypotension may lead to multiple organ perfusion insufficience, cerebral lesion, and even death.However, it is not always accompanied by hypoperfusion.Before treatment, clinicians should evaluate the hemodynamics comprehensively.At present, there is no consensus on the definition and intervention threshold about hypotension in premature infants.This review summarizes the definitions and hemodynamic monitoring methods of hypotension in premature infants at early postnatal stage to provide references for diagnosis and treatments.

Objective:To compare the analgesic effects of naborphine and desorine after surgery for supracondylar fracture of humerus in children.Methods:Eighty-seven children with supracondylar fracture of humerus who received surgical treatment in Zhoushan Hospital of Traditional Chinese Medicine between January 2019 and January 2020 were included in this study. They were randomly assigned to receive postoperative analgesia either with dezocine (control group, n = 44) or naborphine (observation group, n = 43). The postoperative agitation score, postanesthetic recovery score, postoperative visual analogue scale score, and adverse reactions were determined between the two groups. Results:The heart rate and mean arterial pressure at the time of extubation were (102 ± 7) beats/min and (83 ± 6) mmHg respectively in the observation group, which were significantly lower than those in the control group [(115 ± 8) beats/min, (92 ± 7) mmHg, t = 6.214, 8.283, P < 0.05]. In the observation group, the postoperative agitation score was (4.45 ± 0.34) points, (5.02 ± 0.38) points, and (3.65 ± 0.39) points, at the time of spontaneous eye opening, at the time of extubation and at 30 minutes after extubation respectively, which were significantly lower than those in the control group [(5.31 ± 0.48) points, (5.75 ± 0.35) points, (4.12 ± 0.37) points, t = 6.392, 7.194, 7.382, all P < 0.05]. At 30 min, 3 h and 6 h after surgery, the visual analogue scale scores in the observation group were significantly lower than those in the control group ( t = 5.345, 6.124, 7.553, P < 0.05). The time to return to spontaneous breathing, the time to spontaneous eye opening and the time to extubation in the observation group were (7.32 ± 4.17) min, (11.65 ± 3.32) min, (12.13 ± 2.41) min, respectively, which were significantly shorter than those in the control group [(10.34 ± 4.15) min, (14.43 ± 3.18) min, (15.16 ± 2.23) min, t = 7.216, 5.382, 7.319, all P < 0.05]. The incidence of adverse reactions in the observation group was significantly lower than that in the control group [6.97% (3/43) vs. 27.27% (12/44), χ2 = 6.280, P < 0.05]. Conclusion:Naborphine for analgesia after surgery for supracondylar fracture of humerus in children can effectively reduce the incidence of agitation during the recovery period, enhance postoperative analgesic effect, and lower the incidence of reverse reactions.

Objective:To investigate the postoperative analgesic efficacy of nabuprofen combined with femoral nerve block in older adult patients subjected to knee arthroplasty and its effects on cognitive function and serum S-100β protein level.Methods:Ninety-one older adult patients subjected to knee arthroplasty between March 2018 and March 2020 in Zhoushan Hospital of Traditional Chinese Medicine were included in this study. They were randomly divided into observation ( n = 45) and control ( n = 46) groups. Patients in both groups received femoral nerve block and catheterization. Naborphine and equal amount of 0.9% sodium chloride injection were intravenously administered in the observation and control groups, respectively for postoperative analgesia. Before and after surgery, Mini-Mental State Examination (MMSE) score, S-100β protein level and Visual Analogue Scale score, and adverse reactions were compared between the observation and control groups. Results:Before surgery, there was no significant difference in MMSE score between the two groups ( P > 0.05). At 3 days after surgery, MMSE score in each group was significantly decreased compared with before surgery (both P < 0.05). At 3 days after surgery, MMSE score in the observation group was significantly higher than that in the control group [(25.34 ± 1.31) points vs. (23.67 ± 1.53) points, t = 5.34, P < 0.05]. Before surgery, there was no significant difference in serum S-100β protein level between the two groups ( P > 0.05). At 1 and 3 days after surgery, serum S-100β protein level in each group was significantly increased compared with before surgery (both P < 0.05). At 7 days after surgery, serum S-100β protein level in each group recovered to pre-operative level. At 1 and 3 days after surgery, serum S-100β protein level in the observation group was significantly lower than that in the control group ( t = 10.20, 9.21, both P < 0.05). At 1, 3, 6, 12 and 24 hours after surgery, the Visual Analogue Scale score in the observation group was (1.14 ± 0.22) points, (1.43 ± 0.25) points, (1.87 ± 0.21) points, (3.56 ± 0.20) points, and (2.63 ± 0.23) points respectively, which was significantly lower than that in the control group [(2.53 ± 0.24) points, (2.53 ± 0.24) points, (3.56 ± 0.20) points, (3.98 ± 0.25) points, (4.23 ± 0.21) points, t = 5.10, 8.15, 9.41, 10.18, 11.42, all P < 0.05]. The incidence of adverse reactions in the observation group was significantly lower than that in the control group [13.33% (6/45) vs. 30.43% (14/46), χ2 = 3.88, P = 0.049]. Conclusion:Naborphine combined with femoral nerve block can effectively improve the postoperative cognitive function of older adult patients undergoing knee arthroplasty, provides good postoperative analgesia, and is highly safe.

Neonatal congenital tuberculosis is the disease caused by the vertical transmission of tuberculosis bacterium from a mother to the fetal through placenta and umbilical cord during pregnancy, or by inhaling/swallowing of the fetal during delivery.It usually initiates at late period of neonate with a rapid progress and a high mortality rate, and the lack of clinical awareness always result in misdiagnosis.This article reviews the diagnosis and treatment of neonatal congenital tuberculosis in order to improve the understanding of this disease and promote its standardized clinical diagnosis and treatment.

Objective To investigate the incidence and risk factors of neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture. Methods Live born infants, including those diagnosed with neonatal asphyxia, were recruited from 16 different hospitals in Hubei Enshi Tujia and Miao Autonomous Prefecture from January to December of 2016. The 16 hospitals included four grade A tertiary hospitals (three general hospitals and one traditional Chinese medicine hospital) and 12 grade A secondary hospitals (eight general hospitals, one maternal and child health hospital and three traditional Chinese medicine hospitals). A retrospective investigation was conducted using questionnaire to analyze the basic information, perinatal risk factors and prognosis of those infants. Chi-square test was used for statistical analysis. Results Among 22 294 recruited live born infants, 733 (3.29%) were diagnosed with neonatal asphyxia on discharge, including 627 (85.54%) mild cases and 106 (14.46%) severe cases. And neonatal asphyxia resulted in deaths of 27 cases (3.68%). The risk factors for neonatal asphyxia included multiple pregnancy, pregnancy conceived with assisted reproductive technology, premature infant, low birth weight infant, fetal malposition, congenital malformation, male infant, born during transfer, mother of Tujia nationality, low educational level (primary school or lower), living in rural area, the number of antenatal visits ≤3, history of early threatened abortion, anemia in pregnancy, hypertensive disorders of pregnancy, chorioamnionitis, abnormal pregnancy history and abnormality of umbilical cord, amniotic fluid or placenta. Conclusions The incidence of neonatal asphyxia in Enshi area is obviously higher than the national average. The main risk factors for neonatal asphyxia in this area are related to maternal background and the living condition of the mother during pregnancy, delivery as well as the newborn at birth.

Objective To understand the influence of family integrated care (FICare) model to the human breastfeeding rate of preterm infants in neonatal intensive care units (NICUs).Method It is a multicenter cluster randomized controlled trail for intervention and prognosis.According to inclusion and exclusion criteria,preterm infants with gestation age 28 ～ 35 weeks in 9 NICUs of tertiary hospitals in 8 provinces in China were enrolled and divided into FICare and control group.Mothers of FICare infants were invited to stay in NICU ward at bedside for no less than 3 hours per day.Under the supervision of nurses,FICare infants'mothers complete 13 items of infants'caring skills including Six-step Hand Washing and hand hygiene,positioning the baby,changing diapers and estimating urine output,skin and mouth caring,kangaroo care and so on.The primary outcome is the human breastfeeding rate.Secondary outcomes include feeding parameters and FICare-related parameters.SPSS 20.0 software is used for the data analysis.Result (1) There were 212 infants and 215 infants enrolled in FICare group and control group,respectively.There was no significant difference between 2 groups in gender,gestational age,birth weight (BW),Z-score of BW,singleton percentage,antenatal steroid completion,diagnosis,day of life (DOL) for starting feeds (P ＞ 0.05).(2) There was no significant difference between 2 groups in DOL for full feeding (P ＞ 0.05).The median age of starting breastfed in both groups was DOL 4.There were 202 cases (87.3％) in FICare group and 80 cases (34.9％) in control group be successfully breastfed.The rate of formula feeding,incidence of nosocomial infection,DOL for regaining BW,decrease of BW AZ score in FICare group was significantly lower than the control group,and the weight gain velocity after regaining BW in FICare group was significantly higher than the control group (P ＜ 0.05).(3) The implementation of FICare and completion of antenatal steroid were the independent protective factors for breastfeeding (OR =27.703,95％ CI 14.531 ～ 52.816;OR =9.496,95％ CI 4.768 ～ 18.912),while nosocomial infection and delayed DOL for starting breastfeeding were the independent risk factors for breastfeeding (OR =0.380,95％CI 0.182 ～0.795;OR =0.847,95％ CI 0.734 ～0.977).Conclusion FICare is significantly beneficial to the breastfeeding rate of preterm infants in NICUs.FICare may decrease the severity of extrauterine growth retardation.

Objective: To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China. Method: A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis. Result: A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children′s hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%). Conclusion The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.

Objective To analyze the survival rate and hospitalization information for 81 2 cases of very low birth weight (VLBW)and extremely low birth weight (ELBW)infants.Methods The retrospective study was con-ducted in a single center,Department of Neonatology,Hubei Women and Children Hospital,from January 2009 to De-cember 201 4,where the data of 81 2 infants with birth weight(BW)less than 1 500 g was analyzed in regard to perinatal condition,treatment and complications of these in relation to prognosis.Results (1 )A total of 621 cases(76.5%) had favorable prognosis.(2)There was a significant difference in the favorable prognosis rate between different BW groups (χ2 =28.87,P <0.05)and different gestational age(GA)groups (χ2 =1 4.77,P <0.05).The favorable prog-nosis rate for the male infants(χ2 =4.69,P <0.05),puerpera age between 1 7 -25 and 36 -46 years old (χ2 =1 1 .1 9, P <0.05),usage of prenatal hormones(χ2 =8.02,P <0.05),the infants without intrauterine infection (χ2 =8.61 ,P <0.05),the mother without gestational hypertension (χ2 =7.20,P <0.05)and gestational diabetes mellitus(χ2 =1 9.2, P <0.05)were different compared to the control groups.(3)Infants with peripherally inserted central catheter (PICC) (χ2 =33.31 ,P <0.05)and recovery birth weight within 1 0 days(χ2 =29.65,P <0.05)had higher favorable prognosis rate compared to the control groups,which had significant differences.(4)Infants with intraventricular haemorrhage (IVH)(χ2 =1 3.1 6,P <0.05),respiratory distress syndrome (RDS)(χ2 =7.59,P <0.05),necrotizing enterocolitis (NEC)(χ2 =1 3.02,P <0.05)and serious asphyxia (χ2 =6.05,P <0.05)had lower favorable prognosis rates than those did not,with significant differences.(5)Logistic analysis:the lower BW,smaller GA,earlier birth,unused PICC, serious asphyxia,IVH,RDS were risk factors for poor prognosis(all P <0.05).Conclusions The favorable prognosis rate of VLBW and ELBW infants has improved gradually,and is closely related to GA,BW,maternal age,perinatal care,prevention complication,treatment of disease and social factors etc.