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Aspects in the neurological localization of intrapartum infections 产时感染的神经定位方面
Q4 Medicine Pub Date : 2022-11-30 DOI: 10.37897/rjp.2022.s2.19
D. Botezatu, R. Bohîlțea, B. Mihai, T. Salmen, Vlad Dima
There are many infectious diseases that the newborn can acquire during the passage through the birth canal. Since the evolution of the medical world, the transmission risk during childbirth has declined severely but it’s not non-existent. We included several studies discussing the most important infections that can be transmitted intrapartum and that can have neurological outcomes. These studies have proven a correlation between newborn intrapartum infections and neurological disorders, as well as long-term neurological sequelae in some cases.
新生儿在通过产道的过程中可能会感染许多传染病。自从医学界的发展以来,分娩期间的传播风险已经严重下降,但这并非不存在。我们纳入了几项研究,讨论了最重要的感染,这些感染可以在分娩时传播,并可能产生神经系统后果。这些研究已经证明了新生儿产时感染与神经系统疾病之间的相关性,在某些情况下还存在长期的神经系统后遗症。
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引用次数: 0
Umbilical cord abnormalities in newborns with birth asphyxia 新生儿出生窒息时脐带异常
Q4 Medicine Pub Date : 2022-11-30 DOI: 10.37897/rjp.2022.s2.2
Andreea Calomfirescu-Avramescu, Vlad Dima, Mihaela Demetrian, A. Stancu, A. Bălănescu, P. Bălănescu, I. Gherghina
Introduction. Birth asphyxia is a serious condition that causes neurologic sequelae due to decreased blood flow and oxygen to the fetus. We aimed to identify and describe specific macroscopic and microscopic umbilical cord abnormalities in neonates with asphyxia. Materials and methods. We conducted an observational prospective study over a period of 3 years. 80 patients diagnosed with birth asphyxia which had umbilical cord examination performed were enrolled. The control group consisted in 48 newborns that required neonatal intensive care for at least one week, in the same period of time, for any other reason and that also had available umbilical cord exam. Results. We analyzed data gathered from both groups by applying specific statistical tests for each type of variable and hypothesis. Thus, umbilical cord abnormalities were associated with the hypoxic-ischemic encephalopathy in a statistically significant manner when comparing the asphyxia group of newborns with the control one (p = .00). Conclusion. Marginal or velamentous insertion of the umbilical cord was associated with high risk of birth asphyxia.
介绍出生窒息是一种严重的情况,由于胎儿的血流量和氧气减少,会导致神经系统后遗症。我们的目的是识别和描述窒息新生儿的特定宏观和微观脐带异常。材料和方法。我们进行了一项为期3年的观察性前瞻性研究。80例经脐带检查诊断为出生窒息的患者被纳入研究。对照组包括48名新生儿,他们在同一时间段内因任何其他原因需要新生儿重症监护至少一周,并且还可以进行脐带检查。我们通过对每种类型的变量和假设应用特定的统计检验来分析从两组中收集的数据。因此,新生儿窒息组和对照组相比,脐带异常与缺氧缺血性脑病有统计学意义(p=0.00)。脐带边缘或绒毛状插入与出生窒息的高风险相关。
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引用次数: 0
COVID-19 in pregnancy – a possible risk factor for the poor neurological outcome of the infant 妊娠期新冠肺炎——婴儿神经功能不良的可能危险因素
Q4 Medicine Pub Date : 2022-11-30 DOI: 10.37897/rjp.2022.s2.18
Vlad Dima, G. Iancu, R. Bohîlțea, Raluca Mariana Stanescu, Andreea Avramescu-Calomfirescu, V. Varlas, A. Davitoiu
1Department of Neonatology, Filantropia Clinical Hospital, Bucharest, Romania 2Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania 3Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 4National Institute for Mother and Child Health “Alessandrescu-Rusescu”, Bucharest, Romania 5“Victor Gomoiu” Clinical Hospital, Bucharest, Romania Ref: Ro J Pediatr. 2022;71(Suppl2) DOI: 10.37897/RJP.2022.S2.18
1罗马尼亚布加勒斯特Filantropia临床医院新生儿科2罗马尼亚布加勒斯特Filantropia医院妇产科3罗马尼亚布加勒斯特“Carol Davila”医科大学妇产科4罗马尼亚国家妇幼保健研究所“Alessandrescu Rusescu”,罗马尼亚5“Victor Gomoiu”临床医院,布加勒斯特,罗马尼亚参考:Ro J Pediatr。2022年;71(增刊2)DOI:10.37897/RJP.2022.S2.18
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引用次数: 0
Practical guidelines in the treatment of septic shock in children 儿童感染性休克治疗实用指南
Q4 Medicine Pub Date : 2022-09-30 DOI: 10.37897/rjp.2022.3.3
S. Buzinschi
The article focuses on the clinical recognition of septic shock, the basic investigations and the hierarchical treatment based on recent international therapeutic protocols, being especially useful in services that do not have pediatric intensive care units.
本文着重介绍了感染性休克的临床认识、基础调查和基于最新国际治疗方案的分级治疗,对没有儿科重症监护病房的地区特别有帮助。
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引用次数: 0
Different aspects of umbilical cord insertion in twin pregnancies 双胎妊娠脐带插入的不同方面
Q4 Medicine Pub Date : 2022-09-30 DOI: 10.37897/rjp.2022.3.8
M. Plotogea, C. Mehedințu, V. Varlas, Francesca Frîncu, R. Mateescu, A. Edu, Vlad Dima, C. Andreescu, C. Berceanu, Rudolf-Florian Mihai
Cord insertion during pregnancy may take and arise different series of characteristics. Intrapartum fetal assessment depends in a significant matter on the umbilical cord, amniotic fluid and placenta. It is also obvious that the umbilical cord may cause problems that can influence labor and pregnancy altogether. There are many concerns about umbilical cord pathology in the past few years, now more than ever because of high morbidity and mortality in both mother and fetus. This high rate of such concern is because of the fetal hypoxia, neonatal asphyxia and hypoxic-ischemic injury at birth. Modern approach and justified interventions are skills required by any young obstetrician and physician who works in Ob-gyn field. The faster the diagnostic and the proper care are embedded, the quicker and better the outcome of the newborn will be, under the circumstances. Multiple gestation involve some risks and they need to be recognized; preterm birth, growth restriction, fetal demise and perinatal mortality nowadays are associated with unfavorable results and traumatized or touching events. The labor and delivery anomalies which might occur is the only clear objective about studying the umbilical cord pathologies and make sure of improving the perinatal outcomes.
妊娠期间的脐带插入可能会产生一系列不同的特征。对胎儿的评估在很大程度上取决于脐带、羊水和胎盘。同样显而易见的是,脐带可能会导致问题,从而影响分娩和怀孕。在过去的几年里,人们对脐带病理有很多担忧,现在比以往任何时候都更担心,因为母亲和胎儿的发病率和死亡率都很高。这种高关注率是因为出生时胎儿缺氧、新生儿窒息和缺氧缺血性损伤。现代方法和合理的干预措施是任何在妇产科工作的年轻妇产科医生所需要的技能。在这种情况下,诊断和适当护理的速度越快,新生儿的预后就越快越好。多胎妊娠涉及一些风险,需要认识到这些风险;目前,早产、生长受限、胎儿死亡和围产期死亡率与不良结果和创伤或触摸事件有关。可能发生的分娩异常是研究脐带病理并确保改善围产期结果的唯一明确目标。
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引用次数: 0
Is it possible to use the Toll-like receptors as biomarkers for neonatal sepsis? Review of the recent literature 有可能使用Toll样受体作为新生儿败血症的生物标志物吗?近期文献综述
Q4 Medicine Pub Date : 2022-09-30 DOI: 10.37897/rjp.2022.3.1
Irina Melinda Baizat, Corina Gabriela Zaharie, M. Hăşmăşanu, M. Matyas, L. Procopciuc
Background. Sepsis continues to be one of the main death causes in the neonate population. The toll-like receptors are molecules that express in the plasma or endosomal membrane and recognize endosomal or microorganism components. While aiming at the identification of new neonatal sepsis biomarkers, the toll-like receptors (TLR) have been considered that some of them overexpress in contact with the bacterial components. Methods. Research in the PubMed database has been made by the following criteria: Inclusion criteria (PubMed database, Period 2005-2022, English & Humans, generated 29, Meta-Analysis - 0, Review - 6, Systematic Review - 0), Exclusion criteria (Studies on animal models, Articles with merely didactical content, Articles regarding only one of the words researched either only neonatal sepsis or TLR in another context than together, Articles that are not directly connected with the topic). Based on the above-mentioned criteria 13 articles were consulted, of which 7 articles included in vivo studies, 6 with in vitro studies. Conclusions. The data of the present review and the current diagnostic method point at the fact that TLRs increase in the conditions of the presence of the inflammatory syndrome. Their dosing during in the neonatal sepsis is possible, but the non-specific overexpression is not a diagnostic.
背景败血症仍然是新生儿死亡的主要原因之一。toll样受体是在血浆或内体膜中表达并识别内体或微生物成分的分子。在旨在鉴定新的新生儿败血症生物标志物的同时,toll样受体(TLR)被认为其中一些在与细菌成分接触时过度表达。方法。PubMed数据库中的研究是根据以下标准进行的:纳入标准(PubMed数据库,2005-2022年,英语与人类,生成29,荟萃分析-0,综述-6,系统综述-0),排除标准(关于动物模型的研究,仅具有教学内容的文章,仅关于其中一个词的文章,或者仅研究新生儿败血症或TLR,而不是在另一个上下文中一起研究,与主题没有直接联系的文章)。根据上述标准,查阅了13篇文章,其中7篇包含体内研究,6篇包含体外研究。结论。本综述的数据和当前的诊断方法指出,TLRs在炎症综合征存在的条件下增加。在新生儿败血症期间给药是可能的,但非特异性过表达不能诊断。
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引用次数: 0
Current systematic reviews of the burden of COVID-19 pandemic in children and adolescents 新冠肺炎流行病对儿童和青少年负担的系统评价
Q4 Medicine Pub Date : 2022-09-30 DOI: 10.37897/rjp.2022.3.9
D. Pleșca, C. Rădulescu, Alexandra Vilaia, Vlad Pleşca, Anca Cristina Dragnescu
The coronavirus disease 2019 (COVID-19) is profoundly affecting life of the children and adolescents around the globe. The authors present a synthesis of the characteristics of SARS CoV-2 infection in the pediatric population. The role played by children in the transmission of infection as well as the changes related to the clinical picture and the severity of symptoms that changed during the 5 pandemic waves. Another objectives of this review was to describe the diverse facets of the burden of COVID-19 in children and adolescents. The authors presented the direct effects of hospitalization during the acute phase of the disease, multisystem inflammatory syndrome in children, long COVID and the sequelae after infection with the new coronavirus. In addition, the indirect effects of social isolation and interruption in education are discussed. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. Mental health problems among children and adolescents are increasingly reported amidst the coronavirus disease (COVID-19) pandemic. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. The burden of the COVID-19 pandemic manifested in various ways: there was an increase in poverty, a major crisis arose in education, and new threats concerning children’s health and even survival emerged.
2019冠状病毒病(新冠肺炎)正在深刻影响全球儿童和青少年的生活。作者综合介绍了儿童人群中严重急性呼吸系统综合征冠状病毒2型感染的特点。儿童在感染传播中所起的作用,以及在5波疫情期间发生变化的与临床情况和症状严重程度相关的变化。本次审查的另一个目标是描述新冠肺炎对儿童和青少年负担的不同方面。作者介绍了疾病急性期住院的直接影响、儿童多系统炎症综合征、长期新冠肺炎以及感染新冠病毒后的后遗症。此外,还讨论了社会孤立和教育中断的间接影响。隔离、接触限制和经济停摆彻底改变了受影响国家的心理社会环境。在冠状病毒疾病(新冠肺炎)大流行期间,儿童和青少年的心理健康问题越来越多地被报道。焦虑、缺乏同伴接触和压力调节机会减少是主要问题。另一个主要威胁是父母精神疾病、家庭暴力和虐待儿童的风险增加。新冠肺炎疫情的负担表现在多种方面:贫困加剧,教育出现重大危机,儿童健康甚至生存面临新的威胁。
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引用次数: 0
The effectiveness of 13-valent pneumococcal vaccine against community acquired pneumonia in young children: a systematic review and meta-analysis 13价肺炎球菌疫苗对幼儿社区获得性肺炎的有效性:系统综述和荟萃分析
Q4 Medicine Pub Date : 2022-09-30 DOI: 10.37897/rjp.2022.3.5
N. Revenco, A. Balanuta, Dina Bujor, A. Horodisteanu-Banuh, O. Cirstea
Objective. The present meta-analysis study aimed to evaluate the effectiveness of 13-valent pneumococcal conjugate vaccine (PCV) in reducing the morbidity from pneumonia among children under 5 years old. Material and methods. Cochrane and Medline electronic databases were systematically searched for studies reporting effectiveness of 13-valent pneumococcal conjugate vaccine against pneumonia among children of the foreseen age group. To assess the effect measure, we used the odds ratio (OR) with 95% confidence intervals (95% CI) for dichotomous outcomes. The heterogeneity of the studies was assessed using I2 and Chi2 statistics. Outcomes. The meta-analysis found a non-significant association between vaccinated children and the development of community-acquired pneumonia (OR=0.50; CI 95%: 0.44-0.57; Chi2=6.07; I2=18%). Vaccine effectiveness (VE) of 13-valent PCV was calculated as (1 – Mantel-Haenszel OR in vaccinated children compared to unvaccinated children) x100%. Thus, the VE of PCV 13 valent was estimated to be about 50%, according to the meta-analysis of the included studies. Conclusions. Our study showed that the group of vaccinated children experienced 50% fewer cases of pneumonia than they would have had if they had not been vaccinated. These data bring additional evidence that vaccination is an effective strategy to prevent community acquired pneumonia in young children.
客观的本荟萃分析研究旨在评估13价肺炎球菌结合疫苗(PCV)在降低5岁以下儿童肺炎发病率方面的有效性。材料和方法。系统地检索了Cochrane和Medline电子数据库中报告13价肺炎球菌结合疫苗对预期年龄组儿童肺炎有效性的研究。为了评估效果测量,我们使用优势比(OR)和95%置信区间(95%CI)来评估二分结果。使用I2和Chi2统计数据评估研究的异质性。结果。荟萃分析发现,接种疫苗的儿童与社区获得性肺炎的发展之间没有显著关联(OR=0.50;CI95%CI:0.44-0.57;Chi2=6.07;I2=18%)。13价PCV的疫苗有效性(VE)计算为(接种疫苗儿童与未接种疫苗儿童的Mantel Haenszel OR)x100%。因此,根据纳入研究的荟萃分析,PCV 13价的VE估计约为50%。结论。我们的研究表明,与未接种疫苗的儿童相比,接种疫苗的这组儿童的肺炎病例减少了50%。这些数据进一步证明,接种疫苗是预防幼儿社区获得性肺炎的有效策略。
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引用次数: 0
New insights regarding Helicobacter pylori infection in children 儿童幽门螺杆菌感染的新认识
Q4 Medicine Pub Date : 2022-09-30 DOI: 10.37897/rjp.2022.3.2
A. Dincă, L. Meliț, C. Mărginean
Helicobacter pylori (H. pylori) are one of the most common infections during childhood, and if left untreated it might persist lifelong resulting in severe complications such as gastric malignancies. The epidemiology of this infection has wide variations along the continents, countries and sub-regions being related mainly to the socio-economic status, hygiene and sanitary conditions. Nevertheless, a descending trend of H. pylori prevalence was noticed worldwide during the last decades, fact that might decrease in time the incidence of gastric cancer in adults. The diagnosis of this infection remains tricky in children and the selection of the most effective diagnostic tool is essential in order to early diagnose H. pylori associated gastropathies and extraintestinal manifestations. In spite of the lack of symptoms which occurs especially in pediatric subjects, H. pylori infection might result in severe damage to the gastric mucosa and further complications requiring close monitoring after the eradication regimen. Therefore, multiple non-invasive and invasive methods were designed to identify properly the presence of this bacterium within the individual’s stomach and for enabling the clinician to use to most adequate method based on its sensitivity and specificity, but also based on the specific clinical situations. Aside from the well-known standard triple therapy used for the eradication of this infection, multiple other regimens were lately proposed in order to prevent failure of eradication. Moreover, probiotics were recently proved to improve the eradication rate, and at the same time to decrease the side effects of the antibiotics therapy. The proper eradication of H. pylori infection during childhood remains the cornerstone in preventing gastric cancer during adulthood.
幽门螺杆菌(h.p ylori)是儿童时期最常见的感染之一,如果不及时治疗,它可能会持续一生,导致严重的并发症,如胃恶性肿瘤。这种感染的流行病学在各大洲、国家和分区域有很大差异,主要与社会经济地位、卫生和卫生条件有关。然而,在过去的几十年里,幽门螺杆菌的患病率在世界范围内呈下降趋势,这一事实可能会随着时间的推移而降低成人胃癌的发病率。这种感染的诊断在儿童中仍然很棘手,选择最有效的诊断工具对于早期诊断幽门螺杆菌相关胃病和肠外表现至关重要。尽管幽门螺杆菌感染没有症状,特别是在儿童中,但可能导致胃粘膜严重损伤,并在根除方案后需要密切监测进一步的并发症。因此,设计了多种非侵入性和侵入性方法来正确识别个体胃内是否存在这种细菌,使临床医生能够根据其敏感性和特异性,同时根据具体的临床情况,使用最适当的方法。除了众所周知的用于根除这种感染的标准三联疗法外,最近还提出了多种其他方案,以防止根除失败。此外,益生菌最近被证明可以提高根除率,同时减少抗生素治疗的副作用。儿童期适当根除幽门螺杆菌感染仍然是预防成年期胃癌的基石。
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引用次数: 0
A successful interdisciplinary collaboration for the management of pneumoperitoneum and pericardial effusion in a premature newborn 一个成功的跨学科合作管理气腹和心包积液在早产儿
Q4 Medicine Pub Date : 2022-09-30 DOI: 10.37897/rjp.2022.3.7
Ioana-Luciana Constantin, E. Rotaru, Delia Stratone, Ioana-Georgia Oglinda, A. Avasilcai, Vlad Dima, A. Tuta, Livica Frăţiman, Irina Franciuc
Objectives. Percutaneously central catheters are typically used in neonatal intensive care units (NICU) to provide parenteral nutrition and drug therapy administration. Their use is associated with specific complications: occlusions, infections, thrombosis, rupture, and migration, including rare life-threatening conditions such as pericardial effusion and cardiac tamponade. Material and methods. We present the case of a patient hospitalized in the Neonatology Department of “Sf. Andrei” County Clinical Emergency Hospital of Constanta, diagnosed with cardiac tamponade at 18 days of life. Outcomes. Premature male newborn, gestational age (GA) of 33 weeks, birth weight (BW) 2380 g, Apgar score 5/7, issuing from pregnancy without prenatal care, admitted in NICU with Continuous Positive Airway Pressure (CPAP) respiratory support. He required intensive care during the neonatal period and presented with sudden cardiac instability 18 days after the insertion of a peripherally inserted central catheter (PIC-Line). The echocardiography demonstrated severe pericardial effusion with evidence of cardiac tamponade. Successful urgent subxiphoid pericardiocentesis was performed. Totally 20 ml of fluid was collected, consistent with the composition of the hyperosmolar solution infused. Conclusions. Despite the fact that it is a rare complication, cardiac tamponade should be considered in any newborn with a PIC-Line who presents with sudden suggestive deterioration (cardiorespiratory instability, bradycardia, cyanosis and metabolic acidosis), which does not respond to resuscitation maneuvers, when lines are considered to be placed correctly. Implementing a modern algorithm, who is easy to learn and quick to perform, with the help of ultrasonography, represents the key of success for detecting urgent neonatal complications leading to sudden deterioration.
目标。经皮中央导管通常用于新生儿重症监护室(NICU),以提供胃肠外营养和药物治疗。它们的使用与特定的并发症有关:闭塞、感染、血栓形成、破裂和迁移,包括罕见的危及生命的情况,如心包积液和心脏压塞。材料和方法。我们介绍了一名患者的病例,该患者在康斯坦察“安德烈斯”县临床急诊医院新生儿科住院,在出生18天时被诊断为心脏压塞。结果。早产男性新生儿,胎龄(GA)33周,出生体重(BW)2380 g,Apgar评分5/7,妊娠期未经产前护理,在新生儿重症监护室接受持续气道正压(CPAP)呼吸支持。他在新生儿期需要重症监护,并在插入外周插入的中心导管(PIC线)18天后出现突发性心脏不稳定。超声心动图显示有严重的心包积液,并有心包填塞的证据。成功地进行了剑突下心包穿刺术。总共收集了20ml液体,与所输注的高渗溶液的组成一致。结论。尽管这是一种罕见的并发症,但对于任何患有PIC线的新生儿,如果出现突然的提示性恶化(心肺不稳定、心动过缓、发绀和代谢性酸中毒),如果认为线放置正确,对复苏操作没有反应,则应考虑使用心脏压塞。在超声检查的帮助下,实现一种易于学习、快速执行的现代算法,是成功检测导致病情突然恶化的新生儿紧急并发症的关键。
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引用次数: 0
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Revista Romana de Pediatrie
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