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Comparative Study on the Clinical Characteristics of Transient Tachypnea of Newborns according to the Need for Invasive Mechanical Ventilation 根据有创机械通气需要对新生儿短暂性呼吸急促临床特征的比较研究
Pub Date : 2023-08-31 DOI: 10.5385/nm.2023.30.3.69
Ho Jun Yoon, Seung Hyun Lee
Purpose: Transient tachypnea of the newborn (TTN) is the most prevalent respiratory disease worldwide. Many neonates with TTN generally demonstrate spontaneous improvement. However, only few patients present with severe complications. This study aimed to investigate the differences in clinical features to identify neonates at risk for further complications.Methods: Between January 2015 and December 2020, 267 neonates who developed dyspnea within 6 h of birth were delivered at a gestational age of at least 37 weeks. The experimental group (group E) included 44 neonates who required invasive mechanical ventilation, whereas the control group (group C) included 223 neonates who required only observation or non-invasive respiratory support. We analyzed the differences in clinical and perinatal factors between the two groups.Results: Gestational age and pH on arterial blood gas analysis at admission were significantly lower in group E (p<0.05). Clinical findings, such as moaning, tachypnea (>90 breaths/min), and pneumothorax, were more frequently observed in group E (p<0.05).Conclusion: Moaning, tachypnea (>90 breaths/min), and need for respiratory assistance (fraction of inspired oxygen concentration ≥0.25) are predictive factors for increased risk of progression to a more severe disease course in neonates with TTN. Additional studies are needed to identify definitive factors that can differentiate TTN that improves spontaneously from TTN that requires intensive care.
目的:新生儿短暂性呼吸急促(TTN)是全球最常见的呼吸道疾病。许多患有TTN的新生儿通常表现出自发的改善。然而,只有少数患者出现严重并发症。本研究旨在调查临床特征的差异,以确定有进一步并发症风险的新生儿。方法:2015年1月至2020年12月,267名出生后6小时内出现呼吸困难的新生儿在孕龄至少37周时分娩。实验组(E组)包括44名需要有创机械通气的新生儿,而对照组(C组)包括223名只需要观察或无创呼吸支持的新生儿。我们分析了两组患者在临床和围产期因素方面的差异。结果:妊娠年龄和入院时动脉血气分析的pH值在E组显著降低(p90次呼吸/分钟),并且在E组更频繁地观察到肺气肿(p90次/分钟),和呼吸辅助需求(吸入氧气浓度≥0.25)是TTN新生儿进展为更严重疾病的风险增加的预测因素。需要进一步的研究来确定可以区分自发改善的TTN和需要重症监护的TTN的决定性因素。
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引用次数: 0
What Factors Delay Interatrial Communications Closure in the Oval Fossa? 什么因素延迟卵圆窝房间通讯的关闭?
Pub Date : 2023-05-31 DOI: 10.5385/nm.2023.30.2.21
Sun Hyang Lee, Min Kyu Seo, G. Park, Sung Shin Kim
Purpose: In most neonatal intensive care units, echocardiography is performed at the bedside. The lack of closure of interatrial communications (IACs) in the oval fossa can affect mortality and morbidity. This study aimed to establish the rate of spontaneous closure of IACs diagnosed in the neonatal period and predict the need for subsequent evaluation according to various factors, including defect size and shape. Methods: The study group comprised 1,242 newborns admitted between March 2017 and December 2020. We judged the closure of the IACs and evaluated the risk factors of each. Patients were classified into the absence or presence of IACs. The morphology of the IACs was classified into atrial septal defects, patent foramen ovale, and multiple holes. Results: A total of 317 patients (131 female, 186 male) were enrolled in the study, and the average defect size was 3.0±1.0 mm. An overall spontaneous closure rate of 89.9% was observed during an average follow-up interval of 5.1±1.1 months. When multiple Cox regression analyses were performed to analyze the risk factors for spontaneous closure, initial defect size was a significant factor. The optimal cut-off value for predicting spontaneous closure of the IAC was 3.05 mm, and the area under the receiver operating characteristic curve was 0.625 (95% confidence interval, 0.520 to 0.729). Preterm infants had a larger defect size corrected for birth weight and a higher closure rate than term infants. Conclusion: Other than large defect size, no factors delayed spontaneous closure. When defects in the oval fossa measure ≤3 mm, most patients experience spon-taneous closure by 7 months of age.
目的:在大多数新生儿重症监护病房,超声心动图是在床边进行的。卵圆窝房间交通关闭不足会影响死亡率和发病率。本研究旨在建立在新生儿期诊断的IACs的自发关闭率,并根据各种因素,包括缺陷的大小和形状,预测后续评估的需要。方法:研究组纳入2017年3月至2020年12月入院的1242名新生儿。我们对IACs的闭合进行判断,并对每个IACs的危险因素进行评估。将患者分为有无IACs两类。其形态分为房间隔缺损、卵圆孔未闭和多孔型。结果:共纳入317例患者,其中女性131例,男性186例,平均缺损尺寸为3.0±1.0 mm。在平均5.1±1.1个月的随访时间内,总自发愈合率为89.9%。当进行多重Cox回归分析来分析自发闭合的危险因素时,初始缺陷大小是重要因素。预测IAC自发闭合的最佳截止值为3.05 mm,受试者工作特征曲线下面积为0.625(95%可信区间为0.520 ~ 0.729)。早产儿比足月儿有更大的缺陷尺寸和更高的闭合率。结论:除缺损尺寸较大外,无其他因素影响缺损的自然愈合。当卵圆窝缺损≤3mm时,大多数患者在7个月大时自发闭合。
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引用次数: 0
Association of Moderate Hypothermia at Admission with Short-Term and Long-Term Outcomes in Extremely Low Birth Weight Infants 极低出生体重婴儿入院时的中低温与短期和长期结局的关系
Pub Date : 2023-05-31 DOI: 10.5385/nm.2023.30.2.28
S. Kim, Jihye Hwang, Jiyoon Jeong, Jeong Min Lee, Ha Na Lee, S. Park, B. Lee, Euiseok Jung
Purpose: Extremely low birth weight (ELBW) infants exhibit immature thermoregulation and are easily exposed to hypothermia. We investigated the association between hypothermia on admission with short- and long-term outcomes.Methods: Medical records of ELBW infants admitted to the neonatal intensive care unit of a tertiary medical center between June 2012 and February 2017 were retrospectively analyzed. Upon admission, the axillary body temperature was measured. Moderate hypothermia was defined as admission temperature below 36 ℃.Results: A total of 208 infants with gestational age of 26.4±2.3 weeks and birth weight of 746.7±154.9 g were included. Admission temperature ranged from 33.5 to 36.8 ℃ (median 36.1 ℃). Univariate analyses of maternal and infant characteristics were performed for moderately hypothermic and control (normothermic to mildly hypothermic) infants. Lower gestational age, lower birth weight, and vaginal delivery correlated with moderate hypothermia. Logistic regression analyses adjusted for confounders revealed that the incidence of hemodynamically significant patent ductus arteriosus (hsPDA) was associated with moderate hypothermia in ELBW infants. Moreover, abnormal mental developmental index scores on the Bayley Scales of Infant Development II at a corrected age of 18 to 24 months were associated with moderate hypothermia, but not with the psychomotor developmental index, incidence of blindness, deafness, or cerebral palsy.Conclusion: Moderate hypothermia at admission is not only correlated with short-term neonatal morbidities such as hsPDA, but may also be associated with long-term neurodevelopmental impairment in ELBW infants. Future large-scale studies are required to clarify the long-term consequences of hypothermia upon admission.
目的:极低出生体重(ELBW)婴儿表现出不成熟的体温调节,很容易暴露在体温过低的环境中。我们研究了入院时体温过低与短期和长期结果之间的关系。方法:回顾性分析2012年6月至2017年2月入住某三级医疗中心新生儿重症监护室的ELBW婴儿的病历。入院后,测量腋窝体温。结果:共纳入208例胎龄26.4±2.3周、出生体重746.7±154.9g的婴儿。入院温度为33.5~36.8℃(中位数36.1℃)。对中度体温过低和对照(常温至轻度体温过低)婴儿的母婴特征进行单变量分析。低胎龄、低出生体重和阴道分娩与中度低温相关。经混杂因素调整后的Logistic回归分析显示,在ELBW婴儿中,血液动力学显著的动脉导管未闭(hsPDA)的发生率与中度体温过低有关。此外,在18至24个月的校正年龄,Bayley婴儿发育量表II的异常心理发育指数得分与中度体温过低有关,但与心理运动发育指数、失明、耳聋或脑瘫的发生率无关。结论:入院时的亚低温不仅与hsPDA等短期新生儿疾病有关,而且可能与ELBW婴儿的长期神经发育障碍有关。未来需要进行大规模研究,以阐明入院时体温过低的长期后果。
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引用次数: 0
Effects of Recombinant Human Erythropoietin Administration in Premature Infants with Severe Intraventricular Hemorrhage: A Single-Center Experience 重组人红细胞生成素给药对早产儿严重脑室内出血的影响:单中心经验
Pub Date : 2023-05-31 DOI: 10.5385/nm.2023.30.2.34
Ha Na Lee, Jeong Min Lee, S. H. Kim, S. Park, Jiyoon Jeong, Euiseok Jung, B. Lee
Purpose: We investigated the effects of early postnatal administration of erythropoietin (EPO) on neurodevelopmental outcomes and morbidities in preterm infants with severe grades of intraventricular hemorrhage (IVH).Methods: We retrospectively reviewed the medical records of preterm infants of gestational age 23+0 weeks to 31+6 weeks, who were diagnosed with severe grades of IVH and received EPO over at least 2 weeks. We compared clinical characteristics, major complications, and neurodevelopmental impairment between the two groups. The primary outcome was severe neurodevelopmental impairment at 18 to 26 months of corrected age. Severe neurodevelopmental impairment was defined as a mental developmental index or psychomotor developmental index of <70 on the Bayley Scales of Infant Development II or diagnosis of cerebral palsy.Results: The study included 33 preterm infants (mean gestational age 25.2±1.6 weeks and mean birth weight 775.1±224.5 g). EPO was administered at a dose of 400 or 1,000 IU/kg thrice weekly and was maintained over a mean period of 58.6± 25.9 days beginning from 10.7±6.9 days after birth. We observed no difference in perinatal characteristics between the EPO (n=14) and the control group (n=19). Similarly, severe neurodevelopmental impairment rates did not differ between the EPO (85.7%) and control groups (78.9%). The incidence of neonatal morbidities including bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity was also similar between the EPO and control groups.Conclusion: Early administration of EPO did not reduce the risk of severe neurodevelopmental impairment in preterm infants with severe IVH.
目的:研究产后早期给予促红细胞生成素(EPO)对重度脑室内出血(IVH)早产儿神经发育结局和发病率的影响。方法:回顾性分析孕龄23+0周至31+6周的诊断为重度IVH并接受EPO治疗至少2周的早产儿的医疗记录。我们比较了两组患者的临床特征、主要并发症和神经发育障碍。主要结果是矫正年龄18至26个月时严重的神经发育障碍。重度神经发育障碍定义为贝利婴儿发育量表II智力发育指数或精神运动发育指数<70或诊断为脑瘫。结果:研究纳入33例早产儿(平均胎龄25.2±1.6周,平均出生体重775.1±224.5 g), EPO按400或1000 IU/kg剂量给予,每周3次,从出生后10.7±6.9天开始,平均维持58.6±25.9天。我们观察到EPO组(n=14)和对照组(n=19)的围产期特征无差异。同样,EPO组(85.7%)和对照组(78.9%)的严重神经发育障碍率也没有差异。新生儿发病率包括支气管肺发育不良、坏死性小肠结肠炎和早产儿视网膜病变在EPO组和对照组之间也相似。结论:早期应用EPO并不能降低重度IVH早产儿发生严重神经发育障碍的风险。
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引用次数: 0
A Neonate Diagnosed with Megalencephaly-Capillary Malformation-Polymicrogyria Syndrome with PIK3CA Mutation 一例PIK3CA突变新生儿诊断为巨脑毛细血管畸形多小盖综合征
Pub Date : 2023-05-31 DOI: 10.5385/nm.2023.30.2.55
Young Mi Park, Yoon-Myung Kim, S. Oh, Hyun-Seung Jin
Megalencephaly-capillary malformation-polymicrogyria syndrome (MCAP) is a rare genetic disorder characterized by megalencephaly, polymicrogyria, body overgrowth, and cutaneous capillary malformations. It has been reported recently that MCAP is related to a somatic mosaic mutation in the phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene. We report a case of hemimegalencephaly with polymicrogyria and cutaneous capillary malformations diagnosed by genetic evaluation of MCAP in the neonatal period. The PIK3CA mutation [c.1635G>T (p. Glu545Asp)] was determined by Sanger sequencing. The patient was treated with a ventriculoperitoneal shunt for progressive hydrocephalus. Because of the dynamic, progressive clinical manifestations and tumor-prone traits of MCAP, early diagnosis is important. Moreover, since the phosphoinositide 3-kinase (PI3K)-specific inhibitor, a targeted therapy for the PI3K/AKT/mTOR signaling pathway is emerging as a new therapy, early genetic diagnosis is becoming increasingly important.
巨脑-毛细血管畸形-多小回畸形综合征(MCAP)是一种罕见的遗传性疾病,以巨脑畸形、多小回畸形、身体过度生长和皮肤毛细血管畸形为特征。最近有报道称,MCAP与磷脂酰肌醇-4,5-二磷酸3-激酶催化亚单位α (PIK3CA)基因的体细胞镶嵌突变有关。我们报告一例半巨脑畸形,多小回畸形和皮肤毛细血管畸形诊断的遗传评估MCAP在新生儿时期。PIK3CA突变[c]。Sanger测序法测定1635G>T (p. Glu545Asp)]。患者接受脑室腹腔分流术治疗进行性脑积水。由于MCAP的临床表现是动态的、进行性的,且易发生肿瘤,因此早期诊断非常重要。此外,由于磷酸肌肽3-激酶(PI3K)特异性抑制剂,针对PI3K/AKT/mTOR信号通路的靶向治疗正在成为一种新的治疗方法,因此早期基因诊断变得越来越重要。
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引用次数: 0
Neurodevelopmental Outcomes and Brain Volumetric Analysis of Low-Grade Intraventricular Hemorrhage 低度脑室内出血的神经发育结局和脑容量分析
Pub Date : 2023-05-31 DOI: 10.5385/nm.2023.30.2.42
Seul Gi Park, Hyojun Yang, S. Lim, S. Kim, S. Shin, E. Kim, Han-Suk Kim
Purpose: Extremely preterm infants are prone to brain injury and underdevelopment. Intraventricular hemorrhage (IVH) is the most common cause of brain injury and a significant risk factor for neurodevelopmental delay in preterm infants. Severe IVH is known to have a poor outcome; however, the outcomes of low-grade IVH remain controversial. This study aimed to evaluate neurodevelopmental outcomes and brain segmental volumes of preterm infants with low-grade IVH.Methods: This retrospective cohort study included 109 extremely preterm infants who underwent term equivalent age-magnetic resonance imaging and neurodevelopmental evaluation at a corrected age of 18 to 24 months. We compared infants with and without low-grade IVH.Results: Among the 109 extremely preterm infants, 25 had low-grade IVH and 84 had no IVH. There were no significant differences in the neurodevelopmental outcomes between the low-grade and no IVH groups. In multivariate analysis, low-grade IVH was associated with a smaller medullary volume (adjusted odds ratio, 0.575; 95% confidence interval, 0.346 to 0.957; P=0.034).Conclusion: We found no significant differences in the neurodevelopmental outcomes of extremely preterm infants at a corrected age of 18 to 24 months between those with low-grade IVH and those without IVH. Low-grade IVH was associated with a smaller medullary volume.
目的:极早产儿易发生脑损伤和发育不全。脑室内出血(IVH)是脑损伤最常见的原因,也是早产儿神经发育迟缓的重要危险因素。已知严重IVH的预后较差;然而,低级别IVH的结果仍然存在争议。本研究旨在评估低级别IVH早产儿的神经发育结果和脑节段体积。方法:本回顾性队列研究包括109名极早产儿,他们在18至24个月的校正年龄接受了足月等年龄磁共振成像和神经发育评估。我们比较了有和没有低级别IVH的婴儿。结果:在109名极早产儿中,25名有低级别IVH.84名没有IVH。低级别和无IVH组的神经发育结果没有显著差异。在多变量分析中,低级别IVH与较小的髓质体积有关(校正比值比为0.575;95%置信区间为0.346至0.957;P=0.034)。低级别IVH与较小的髓质体积有关。
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引用次数: 0
The Impact of Slow Infusion Intermittent Feeding on Gavage Feeding-Associated Cardiorespiratory Deterioration in Neonatal Intensive Care Unit Infants 慢速输液间歇喂养对新生儿重症监护病房婴儿灌胃喂养相关心肺功能恶化的影响
Pub Date : 2023-05-31 DOI: 10.5385/nm.2023.30.2.49
Mi Jin Kim, H. S. Kim, Y. Jung, Changwon Choi
Purpose: Infants in the neonatal intensive care unit (NICU) often show cardiorespiratory deterioration during gavage feeding. We aimed to determine whether slow infusion intermittent feeding (SIIF) can reduce respiratory deterioration during gavage feeding in preterm infants in the NICU.Methods: Data on preterm infants whose gavage feeding method was changed to SIIF (1-­­hour infusion with an infusion pump and 2-­hour rest within a 3­-hour interval) from bolus gravity feeding (2-­ or 3-­hour interval) due to feeding­-associated cardiorespiratory deterioration were retrospectively reviewed. A significant cardiorespiratory event was defined as a saturation level below 80% or heart rate below 80 bpm. We compared the frequency of cardiorespiratory events and the level of respiratory support 24 hours before and after the application of SIIF.Results: A total of 34 infants were enrolled and analyzed. The total frequency of desaturation or bradycardia significantly decreased after SIIF application (8.94 vs. 5.03, P=0.001). The frequency of feeding­related bradycardia and desaturation also significantly decreased (4.15 vs. 1.68, P=0.008). Out of 34 patients, 11 (32.4%) had a decreased level of ventilator support within 1 day after SIIF. The respiratory severity scores of the 10 patients who received invasive ventilator support decreased significantly after SIIF (5.24 vs. 4.59, P=0.032).Conclusion: SIIF significantly decreased gavage feeding­associated cardiorespiratory events and reduced respiratory support in approximately one­third of subjects. Therefore, SIIF may be a therapeutic option for gavage feed­associated respiratory deterioration in preterm infants in the NICU.
目的:新生儿重症监护室(NICU)的婴儿在灌胃喂养过程中经常表现出心肺功能恶化。我们的目的是确定在新生儿重症监护室中,缓慢输注间歇喂养(SIIF)是否可以减少早产儿灌胃喂养期间的呼吸恶化。方法:回顾性分析因喂养相关心肺功能恶化而从推注重力喂养(2或3小时间隔)改为SIIF(用输液泵输注1小时,间隔3小时休息2小时)的早产儿的数据。显著的心肺事件被定义为饱和度低于80%或心率低于80 bpm。我们比较了应用SIIF前后24小时心肺事件的频率和呼吸支持水平。结果:共有34名婴儿被纳入研究并进行分析。应用SIIF后,去饱和或心动过缓的总频率显著降低(8.94 vs.5.03,P=0.001)。与喂养相关的心动过缓和去饱和的频率也显著降低(4.15 vs.1.68,P=0.008)。在34名患者中,11名(32.4%)患者在SIIF后1天内呼吸机支持水平下降。接受有创呼吸机支持的10名患者的呼吸严重程度评分在SIIF后显著下降(5.24对4.59,P=0.032)。结论:SIIF显著降低了约三分之一受试者的管饲相关心肺事件和呼吸支持。因此,SIIF可能是新生儿重症监护室早产儿灌胃喂养相关呼吸恶化的治疗选择。
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引用次数: 0
On the 10th Anniversary of the Korean Neonatal Network 韩国新生儿网络成立十周年纪念
Pub Date : 2023-02-28 DOI: 10.5385/nm.2023.30.1.1
S. Ahn, H. Song, Y. Chang
The Korean Neonatal Network (KNN), which is celebrating its 10th anniversary, currently has more than 100 staff and researchers from >70 neonatal intensive care units nationwide in Korea. More than 85% to 90% of the population of very low birth weight infants in Korea are registered yearly, and more than half are followed up for up to 3 years at the KNN. A total of >19,000 cases have been accumulated through a strict data quality management process of the KNN. Based on this, >100 research projects have been proposed, >70 peer-reviewed papers have been published in leading international journals, and the cornerstone of the quality improvement project has been launched. In addition, we recently expanded the number of subjects for registration to very premature infants <32 weeks of age and continue to provide essential evidence data for establishing national health policies, such as linking with government policy projects of the Ministry of Health and Welfare for preterm infants. In such manner, the KNN is confident to be successfully and actively moving toward reaching the ultimate goal of standardizing neonatal intensive care and management of preterm infants in Korea by providing essential data for national health policy establishment along with quality improvement through evidence-based interactive data.
韩国新生儿网络(KNN)正在庆祝成立10周年,目前有来自韩国全国70多个新生儿重症监护室的100多名工作人员和研究人员。韩国85%至90%以上的极低出生体重婴儿每年都会登记,超过一半的婴儿在KNN接受长达3年的随访。通过KNN严格的数据质量管理流程,累计病例超过19000例。在此基础上,提出了100多个研究项目,在国际领先期刊上发表了70多篇同行评审论文,并启动了质量改进项目的基石。此外,我们最近将注册对象的数量扩大到<32周龄的极早产儿,并继续为制定国家卫生政策提供必要的证据数据,例如与卫生福利部针对早产儿的政府政策项目挂钩。通过这种方式,KNN有信心通过为国家卫生政策制定提供基本数据以及通过循证互动数据提高质量,成功并积极地实现韩国新生儿重症监护和早产儿管理标准化的最终目标。
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引用次数: 0
Neonatal Research Network of Japan and Neonatal Database 日本新生儿研究网络与新生儿数据库
Pub Date : 2023-02-28 DOI: 10.5385/nm.2023.30.1.10
S. Kusuda
In 2004, the Neonatal Research Network of Japan initiated a database registration system for high-risk infants in Japan. Currently, 65% of all very low the birth weight infants or infants born at <32 weeks of gestation are registered in the database. Approximately 4,000 new cases are registered annually. A unique feature of the database is that it includes outcome data at 1.5, 3, and 6 years after discharge from neonatal intensive care units. All registered data are fed back annually to the participating hospitals and used to benchmark neonatal care. Results from this database have also been published in many international journals. With the development of this database, neonatal medicine in Japan has progressed.
2004年,日本新生儿研究网络启动了日本高危婴儿数据库登记系统。目前,65%的极低出生体重婴儿或妊娠<32周出生的婴儿都登记在数据库中。每年登记的新病例约为4000例。该数据库的一个独特之处在于,它包括新生儿重症监护室出院后1.5年、3年和6年的结果数据。所有登记的数据每年都会反馈给参与的医院,并用于衡量新生儿护理的基准。该数据库的结果也发表在许多国际期刊上。随着这个数据库的发展,日本的新生儿医学取得了进展。
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引用次数: 0
Corrigendum: A Case of Epidermolysis Bullosa Simplex (Dowling-Meara 1 Type) in Newborn 勘误:1例新生儿单纯大疱性表皮松解症(Dowling-Meara 1型)
Pub Date : 2023-02-28 DOI: 10.5385/nm.2023.30.1.20
Gahyun Hong, Min Seon Choi
This corrects the article "A Case of Epidermolysis Bullosa Simplex (Dowling-Meara 1 Type) in Newborn" on page 130.
这是对第130页文章“新生儿单纯大疱性表皮松解症1例(Dowling-Meara 1型)”的更正。
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引用次数: 0
期刊
Neonatal Medicine
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