Pub Date : 2020-01-16DOI: 10.3760/CMA.J.ISSN.1007-9408.2020.01.012
Jingna Li
Symptoms and prognosis of infants with congenital diaphragmatic hernia (CDH) are various, as all mild cases might survive while those severe ones have higher mortality. Therefore, an applicable tool that can screen out high-risk CDH children may help clinicians develop an individualized treatment plan and increase the survival rate. A growing number of international studies for CDH postnatal prediction tools, including single factor index and five score models, have been conducted in recent years, whereas few in China. We hereby summarized the advances in postnatal evaluation tools to predict the outcomes of CDH. Key words: Hernias, diaphragmatic, congenital; Postpartum period; Severity of illness index; Prognosis
{"title":"Postnatal prognosis prediction tools for infants with congenital diaphragmatic hernia","authors":"Jingna Li","doi":"10.3760/CMA.J.ISSN.1007-9408.2020.01.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2020.01.012","url":null,"abstract":"Symptoms and prognosis of infants with congenital diaphragmatic hernia (CDH) are various, as all mild cases might survive while those severe ones have higher mortality. Therefore, an applicable tool that can screen out high-risk CDH children may help clinicians develop an individualized treatment plan and increase the survival rate. A growing number of international studies for CDH postnatal prediction tools, including single factor index and five score models, have been conducted in recent years, whereas few in China. We hereby summarized the advances in postnatal evaluation tools to predict the outcomes of CDH. \u0000 \u0000 \u0000Key words: \u0000Hernias, diaphragmatic, congenital; Postpartum period; Severity of illness index; Prognosis","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"23 1","pages":"61-64"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44235685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-16DOI: 10.3760/CMA.J.ISSN.1007-9408.2020.01.007
L. Qu, T. Yin, Yang Wu
A case of amniotic band syndrome (ABS) was reported here. No obvious fetal abnormality was revealed by systematic ultrasound at 22+4 weeks of gestation. At 30 weeks of gestation, the pregnant woman was found to have excessive amniotic fluid and possible fetal edema according to ultrasound images and admitted to the First Affiliated Hospital of Nanjing Medical University. After admission, she received diet control to lower blood glucose and amniotic fluid reduction. The dynamic amniotic fluid index was measured by ultrasound, and the electrical fetal heart rate was monitored daily. Since 32 weeks of gestation, progressive reduction in fetal movement with sinusoidal fetal heart rate pattern was observed. An emergent cesarean section was performed due to fetal distress at a gestational age of 32+3 weeks. During the operation, a porous amniotic membrane was found, from the umbilical cord insertion of the placenta to the ankle of the left lower limb of the fetus. Amniotic band constricting left ankle of newborn and the edema of the left foot was obvious, then ABS was diagnosed. This amniotic band affected the left foot of the fetus directly, while there was not enough evidence whether the flake amniotic membrane near the umbilical cord insertion of the placenta could affect the fetus. This premature infant died of neonatal asphyxia 24 hours after birth. Key words: Amniotic band syndrome; Ultrasonography, prenatal; Abnormalities, multiple
{"title":"Amniotic band syndrome: a case report","authors":"L. Qu, T. Yin, Yang Wu","doi":"10.3760/CMA.J.ISSN.1007-9408.2020.01.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2020.01.007","url":null,"abstract":"A case of amniotic band syndrome (ABS) was reported here. No obvious fetal abnormality was revealed by systematic ultrasound at 22+4 weeks of gestation. At 30 weeks of gestation, the pregnant woman was found to have excessive amniotic fluid and possible fetal edema according to ultrasound images and admitted to the First Affiliated Hospital of Nanjing Medical University. After admission, she received diet control to lower blood glucose and amniotic fluid reduction. The dynamic amniotic fluid index was measured by ultrasound, and the electrical fetal heart rate was monitored daily. Since 32 weeks of gestation, progressive reduction in fetal movement with sinusoidal fetal heart rate pattern was observed. An emergent cesarean section was performed due to fetal distress at a gestational age of 32+3 weeks. During the operation, a porous amniotic membrane was found, from the umbilical cord insertion of the placenta to the ankle of the left lower limb of the fetus. Amniotic band constricting left ankle of newborn and the edema of the left foot was obvious, then ABS was diagnosed. This amniotic band affected the left foot of the fetus directly, while there was not enough evidence whether the flake amniotic membrane near the umbilical cord insertion of the placenta could affect the fetus. This premature infant died of neonatal asphyxia 24 hours after birth. \u0000 \u0000 \u0000Key words: \u0000Amniotic band syndrome; Ultrasonography, prenatal; Abnormalities, multiple","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"23 1","pages":"35-38"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48646647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-16DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.12.001
Yang Li
During the first few months of life, preterm infants and critically ill term infants may be admitted to neonatal intensive care unit (NICU) and require various treatments and support. The rapid development of Neonatology in the last decade allowed more of these infants to survive and could be discharged. Therefore, this group of babies are also name as "NICU graduates". Considering that NICU graduates may encounter a variety of ongoing medical problems including growth, nutrition, feeding problems, bronchopulmonary dysplasia, and neurologic injury which might take days, months or even years to recover. The follow-up doctors must equip with relevant knowledge of possible complications and rehabilitations in order to provide comprehensive post-discharge management, because prompt and proactive management and interventions can improve the long-term outcome of these babies. Key words: Intensive care units, neonatal; Patient discharge; Continuity of patient care; Follow-up studies
{"title":"Emphasis on follow-ups of discharged neonates from neonatal intensive care units","authors":"Yang Li","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.12.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.12.001","url":null,"abstract":"During the first few months of life, preterm infants and critically ill term infants may be admitted to neonatal intensive care unit (NICU) and require various treatments and support. The rapid development of Neonatology in the last decade allowed more of these infants to survive and could be discharged. Therefore, this group of babies are also name as \"NICU graduates\". Considering that NICU graduates may encounter a variety of ongoing medical problems including growth, nutrition, feeding problems, bronchopulmonary dysplasia, and neurologic injury which might take days, months or even years to recover. The follow-up doctors must equip with relevant knowledge of possible complications and rehabilitations in order to provide comprehensive post-discharge management, because prompt and proactive management and interventions can improve the long-term outcome of these babies. \u0000 \u0000 \u0000Key words: \u0000Intensive care units, neonatal; Patient discharge; Continuity of patient care; Follow-up studies","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"833-837"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41668203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-16DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.12.011
Xiaoming Zhang
Hyperglycemia during pregnancy is associated with many maternal and infant complications, hence strict blood glucose control during pregnancy is of great importance. Glycosylated hemoglobin Alc (HbA1c), glycated albumin (GA), self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) are four main measures to assess sugar level during pregnancy. GA level is a reflection of blood sugar level in the past 2-3 weeks and is unlikely influenced by various factors, therefore holds great potential in better control of blood glucose to help improve maternal and fetal outcomes. Key words: Diabetes, gestational; Serum albumin; Glycated hemoglobin A; Blood glucose self-monitoring
{"title":"Application of serum glycated albumin in pregnancy","authors":"Xiaoming Zhang","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.12.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.12.011","url":null,"abstract":"Hyperglycemia during pregnancy is associated with many maternal and infant complications, hence strict blood glucose control during pregnancy is of great importance. Glycosylated hemoglobin Alc (HbA1c), glycated albumin (GA), self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) are four main measures to assess sugar level during pregnancy. GA level is a reflection of blood sugar level in the past 2-3 weeks and is unlikely influenced by various factors, therefore holds great potential in better control of blood glucose to help improve maternal and fetal outcomes. \u0000 \u0000 \u0000Key words: \u0000Diabetes, gestational; Serum albumin; Glycated hemoglobin A; Blood glucose self-monitoring","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"894-898"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46777986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-16DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.12.008
Yanli Shi, Junwen Yang, Chunyan Gao, M. Jiao, Shulan Zuo, Jingzhen Liu, Jianning Wu, B. Ma, Shuchen Zhang, Xue-Qin Li, Dong Li, B. Lu
Objective To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment. Methods A retrospective analysis of 26 cases of listeriosis, including their demographic and clinical features, was conducted, involving 16 pregnant women from Civil Aviation General Hospital, Xiamen Humanity Hospital, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing Tiantan Hospital, Tangshan Maternal and Child Health Hospital, the Fourth Hospital of Tianshui City from October, 2011 to May, 2018, and 10 newborns from the Fourth Hospital of Tianshui City, Tangshan Maternal and Child Health Hospital, Zhengzhou Children's Hospital from February, 2016 to April 2018. Descriptive methods were used for data analysis. Results (1) Among the 16 gravidas, one, five and 10 developed the infection in the 1st, 2nd and 3rd trimester of pregnancy, respectively, and eight had pregnancy complications. Furthermore, all of them developed fever [(38.9±0.5) ℃]. Symptoms such as cough, nasal congestion, runny nose, sore throat, dizziness, headache and other flu-like symptoms were observed in six cases. Gastrointestinal symptoms and flu-like symptoms were presented in four. Fetal distress, tachycardia and decreased fetal movement occurred in 11 cases. Elevated C-reactive protein and white blood cell count were detected in 16 and 14, respectively. Eight underwent placental pathological examination which shown various degrees of pathological changes, including neutrophil infiltration, acute chorioamnionitis and inflammatory necrosis. The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes. Only two delivered at term, while the others (14/16) ended in miscarriage, premature delivery or stillbirth. (2) Among the 10 newborns with listeriosis, there were eight early-onset infections and two late-onset infections. All of them were febrile [(38.6±0.6)℃]. Six had cyanosis, groaning, foaming and three concave sign; five showed shortness of breath; meningitis and skin rash were found in one, respectively. All had elevated white blood cell and C-reactive protein. Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment. Four were treated with cephalosporins alone, one of which died after the treatment was withdrawn. One was cured by initial treatment with meropenem alone, while eight recovered after adjustment of treatment with ampicillin, penicillin, meropenem, vancomycin alone, or meropenem combined with ampicillin or vancomycin. (3) The isolates that were susceptible to penicillin, ampicillin and meropenem accounted for 96.1% (25/26) all together and 88.5% (23/26) were susceptible to compound sulfamethoxazole. Conclusions There is no specific clinical manifestations of maternal or neonatal listeriosis. Maternal listeriosis is often characterized by acute onset and high incidence of adverse p
{"title":"Clinical analysis of 26 cases of maternal or neonatal listeriosis","authors":"Yanli Shi, Junwen Yang, Chunyan Gao, M. Jiao, Shulan Zuo, Jingzhen Liu, Jianning Wu, B. Ma, Shuchen Zhang, Xue-Qin Li, Dong Li, B. Lu","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.12.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.12.008","url":null,"abstract":"Objective \u0000To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis of 26 cases of listeriosis, including their demographic and clinical features, was conducted, involving 16 pregnant women from Civil Aviation General Hospital, Xiamen Humanity Hospital, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing Tiantan Hospital, Tangshan Maternal and Child Health Hospital, the Fourth Hospital of Tianshui City from October, 2011 to May, 2018, and 10 newborns from the Fourth Hospital of Tianshui City, Tangshan Maternal and Child Health Hospital, Zhengzhou Children's Hospital from February, 2016 to April 2018. Descriptive methods were used for data analysis. \u0000 \u0000 \u0000Results \u0000(1) Among the 16 gravidas, one, five and 10 developed the infection in the 1st, 2nd and 3rd trimester of pregnancy, respectively, and eight had pregnancy complications. Furthermore, all of them developed fever [(38.9±0.5) ℃]. Symptoms such as cough, nasal congestion, runny nose, sore throat, dizziness, headache and other flu-like symptoms were observed in six cases. Gastrointestinal symptoms and flu-like symptoms were presented in four. Fetal distress, tachycardia and decreased fetal movement occurred in 11 cases. Elevated C-reactive protein and white blood cell count were detected in 16 and 14, respectively. Eight underwent placental pathological examination which shown various degrees of pathological changes, including neutrophil infiltration, acute chorioamnionitis and inflammatory necrosis. The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes. Only two delivered at term, while the others (14/16) ended in miscarriage, premature delivery or stillbirth. (2) Among the 10 newborns with listeriosis, there were eight early-onset infections and two late-onset infections. All of them were febrile [(38.6±0.6)℃]. Six had cyanosis, groaning, foaming and three concave sign; five showed shortness of breath; meningitis and skin rash were found in one, respectively. All had elevated white blood cell and C-reactive protein. Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment. Four were treated with cephalosporins alone, one of which died after the treatment was withdrawn. One was cured by initial treatment with meropenem alone, while eight recovered after adjustment of treatment with ampicillin, penicillin, meropenem, vancomycin alone, or meropenem combined with ampicillin or vancomycin. (3) The isolates that were susceptible to penicillin, ampicillin and meropenem accounted for 96.1% (25/26) all together and 88.5% (23/26) were susceptible to compound sulfamethoxazole. \u0000 \u0000 \u0000Conclusions \u0000There is no specific clinical manifestations of maternal or neonatal listeriosis. Maternal listeriosis is often characterized by acute onset and high incidence of adverse p","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"878-884"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43208375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the pregnancy and neonatal outcomes in twin pregnancies and the association with chorionicity and modes of conception in order to provide evidence for early prevention and reduction of complications and life quality improvement of twin neonates. Methods This study retrospectively enrolled 756 women with twin pregnancies who gave birth at Peking University Third Hospital from January 1, 2014 to December 31, 2015. Clinical features of the mothers and newborns were collected, the pregnancy and neonatal outcomes were analyzed. Impacts of chorionicity and different modes of conception on the outcomes were also evaluated. Two independent-sample t test and Chi-square test were used as statistical methods. Results Twin pregnancies accounted for 6.7% (756/11 169) of all deliveries in the hospital during the study period and the preterm birth rate was 59.4% (449/756). Twenty five women underwent fetal reduction (3.3%, 25/756) and intrauterine death occurred in 85 pregnancies (11.2%, 85/756). Eventually 1 400 babies were born alive (92.6%, 1 400/1 512). Subgroup analysis suggested that compared with dichorionic diamniotic (DCDA) pregnancies, monochorionic diamniotic (MCDA) cases showed younger maternal age at conception [(30.5±4.2) vs (32.9±4.0) years, t=-7.412], smaller gestational age at delivery [(34.1±3.1) vs (35.7±2.2) weeks, t=-7.325] and higher preterm birth rate [78.4% (174/222) vs 51.5% (263/511), χ2=46.554], all P<0.05. Moreover, the incidence of neonatal complications, including respiratory distress syndrome [18.3% (40/219) vs 8.0% (21/261), χ2=11.210], neonatal pneumonia [18.3% (40/219) vs 8.8% (23/261), χ2=9.331] and sepsis [6.8% (15/219) vs 1.5% (4/261), χ2=8.854], etc. was higher in the MCDA group than those in the DCDA group, resulting in a higher mortality rate [7.8% (17/219) vs 1.1% (3/261), χ2=13.042] in the MCDA pregnancies, all P<0.05. Compared with spontaneously conceived twin pregnancies, women underwent in vitro fertilization-embryo transfer were older at conception [(33.4±3.8) vs (30.6±4.4) years, t=-6.095], delivered at a greater gestational age [(35.8±2.1) vs (35.2±2.6) weeks, t=-2.452] and had a lower preterm birth rate [49.2% (206/419) vs 63.5% (54/85), χ2=5.838] in the DCDA group, all P<0.05. No significant differences in the incidence of neonatal diseases were observed between the two subgroups. Conclusions The incidence of preterm birth is high in twin pregnancies. Compared with DCDA twin pregnancies, MCDA twin pregnancies are associated with more adverse outcomes due to higher incidence of neonatal diseases. In vitro fertilization-embryo transfer does not increase the incidence of preterm birth and the neonatal outcomes were comparable to those of spontaneously conceived ones. Key words: Pregnancy, twin; Pregnancy outcome; Premature birth; Infant, newborn, diseases; Incidence; Fertilization in vitro; Embryo transfer
{"title":"Outcomes of twin neonates and association with chorionicity and modes of conception","authors":"L. Hou, Wei Zhu, Hui Zhang, Ziyuan Liu, Yangyu Zhao, Mei-hua Piao","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.12.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.12.004","url":null,"abstract":"Objective \u0000To investigate the pregnancy and neonatal outcomes in twin pregnancies and the association with chorionicity and modes of conception in order to provide evidence for early prevention and reduction of complications and life quality improvement of twin neonates. \u0000 \u0000 \u0000Methods \u0000This study retrospectively enrolled 756 women with twin pregnancies who gave birth at Peking University Third Hospital from January 1, 2014 to December 31, 2015. Clinical features of the mothers and newborns were collected, the pregnancy and neonatal outcomes were analyzed. Impacts of chorionicity and different modes of conception on the outcomes were also evaluated. Two independent-sample t test and Chi-square test were used as statistical methods. \u0000 \u0000 \u0000Results \u0000Twin pregnancies accounted for 6.7% (756/11 169) of all deliveries in the hospital during the study period and the preterm birth rate was 59.4% (449/756). Twenty five women underwent fetal reduction (3.3%, 25/756) and intrauterine death occurred in 85 pregnancies (11.2%, 85/756). Eventually 1 400 babies were born alive (92.6%, 1 400/1 512). Subgroup analysis suggested that compared with dichorionic diamniotic (DCDA) pregnancies, monochorionic diamniotic (MCDA) cases showed younger maternal age at conception [(30.5±4.2) vs (32.9±4.0) years, t=-7.412], smaller gestational age at delivery [(34.1±3.1) vs (35.7±2.2) weeks, t=-7.325] and higher preterm birth rate [78.4% (174/222) vs 51.5% (263/511), χ2=46.554], all P<0.05. Moreover, the incidence of neonatal complications, including respiratory distress syndrome [18.3% (40/219) vs 8.0% (21/261), χ2=11.210], neonatal pneumonia [18.3% (40/219) vs 8.8% (23/261), χ2=9.331] and sepsis [6.8% (15/219) vs 1.5% (4/261), χ2=8.854], etc. was higher in the MCDA group than those in the DCDA group, resulting in a higher mortality rate [7.8% (17/219) vs 1.1% (3/261), χ2=13.042] in the MCDA pregnancies, all P<0.05. Compared with spontaneously conceived twin pregnancies, women underwent in vitro fertilization-embryo transfer were older at conception [(33.4±3.8) vs (30.6±4.4) years, t=-6.095], delivered at a greater gestational age [(35.8±2.1) vs (35.2±2.6) weeks, t=-2.452] and had a lower preterm birth rate [49.2% (206/419) vs 63.5% (54/85), χ2=5.838] in the DCDA group, all P<0.05. No significant differences in the incidence of neonatal diseases were observed between the two subgroups. \u0000 \u0000 \u0000Conclusions \u0000The incidence of preterm birth is high in twin pregnancies. Compared with DCDA twin pregnancies, MCDA twin pregnancies are associated with more adverse outcomes due to higher incidence of neonatal diseases. In vitro fertilization-embryo transfer does not increase the incidence of preterm birth and the neonatal outcomes were comparable to those of spontaneously conceived ones. \u0000 \u0000 \u0000Key words: \u0000Pregnancy, twin; Pregnancy outcome; Premature birth; Infant, newborn, diseases; Incidence; Fertilization in vitro; Embryo transfer","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"849-858"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45286405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-16DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.12.009
Rong Yin, Rong-Juan Zhang, G. Lu, Xiangang Yan, Lin Yuan, Jianguo Zhou, Lin Yang, Laishuan Wang, Chao Chen, Yun Cao
Objective To assess the performance of extracorporeal membrane oxygenation (ECMO) in the treatment of neonates with critical diseases. Methods This study retrospectively analyzed the clinical data of nine critically ill neonates treated with ECMO because of cardiopulmonary failure due to respiratory disorders in Children's Hospital of Fudan University from August 2015 to April 2018. General information, diagnosis, indications and approaches of ECMO, clinical procedure of ECMO, laboratory results, weaning time, survival rate before discharge, length of stay, and mechanical and neurological complications were collected and described. Results (1) There were six male and three female patients with an average gestational age and body weight of 39.6 weeks (35-41 weeks) and 3 600 g (2 580-4 650 g), respectively. Out of them, six cases survived after successfully weaning from ECMO. (2) Sepsis (two cases), meconium aspiration (two cases), pulmonary hypertension (three cases), diaphragmatic hernia (one case) and pulmonary dysplasia (one case) were diagnosed in the patients. All underwent veno-arterial (VA) ECMO using centrifugal pump. The median age to initiate ECMO was 40 h (23-100 h) after birth, and the median duration of ECMO support was 240 h (70-370 h). During the treatment with ECMO, cholestasis, intracranial hemorrhage and vocal cord paralysis occurred in three cases, and mechanical complications (mainly were bleeding, hemolysis, oxygenated membrane leakage and embolization) occurred in five cases. The mean length of hospital stay for the six survivors was 24 d (20-49 d), and two of them developed neurological complications mainly manifested as cerebral infarction. There were three died cases. One was a baby with diaphragmatic hernia who received hernia repair during ECMO after which celiac space syndrome and necrotizing enterocolitis were developed and his parents refused further treatment. In the second case, the parents gave up treatment when no improvement was achieved after two weeks of ECMO support. While the last case was complicated by severe cerebral hemorrhage during ECMO and died after receiving no further treatment. Conclusions ECMO is newly applied in the treatment of neonates in China and of great significance for critically ill neonates. However, much need to be learned about its utilization in this population considering the mortality and disability rate are still high. Key words: Critical illness; Extracorporeal membrane oxygenation; Infant, newborn
{"title":"Management of critically ill neonates with extracorporeal membrane oxygenation: analysis of nine cases","authors":"Rong Yin, Rong-Juan Zhang, G. Lu, Xiangang Yan, Lin Yuan, Jianguo Zhou, Lin Yang, Laishuan Wang, Chao Chen, Yun Cao","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.12.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.12.009","url":null,"abstract":"Objective \u0000To assess the performance of extracorporeal membrane oxygenation (ECMO) in the treatment of neonates with critical diseases. \u0000 \u0000 \u0000Methods \u0000This study retrospectively analyzed the clinical data of nine critically ill neonates treated with ECMO because of cardiopulmonary failure due to respiratory disorders in Children's Hospital of Fudan University from August 2015 to April 2018. General information, diagnosis, indications and approaches of ECMO, clinical procedure of ECMO, laboratory results, weaning time, survival rate before discharge, length of stay, and mechanical and neurological complications were collected and described. \u0000 \u0000 \u0000Results \u0000(1) There were six male and three female patients with an average gestational age and body weight of 39.6 weeks (35-41 weeks) and 3 600 g (2 580-4 650 g), respectively. Out of them, six cases survived after successfully weaning from ECMO. (2) Sepsis (two cases), meconium aspiration (two cases), pulmonary hypertension (three cases), diaphragmatic hernia (one case) and pulmonary dysplasia (one case) were diagnosed in the patients. All underwent veno-arterial (VA) ECMO using centrifugal pump. The median age to initiate ECMO was 40 h (23-100 h) after birth, and the median duration of ECMO support was 240 h (70-370 h). During the treatment with ECMO, cholestasis, intracranial hemorrhage and vocal cord paralysis occurred in three cases, and mechanical complications (mainly were bleeding, hemolysis, oxygenated membrane leakage and embolization) occurred in five cases. The mean length of hospital stay for the six survivors was 24 d (20-49 d), and two of them developed neurological complications mainly manifested as cerebral infarction. There were three died cases. One was a baby with diaphragmatic hernia who received hernia repair during ECMO after which celiac space syndrome and necrotizing enterocolitis were developed and his parents refused further treatment. In the second case, the parents gave up treatment when no improvement was achieved after two weeks of ECMO support. While the last case was complicated by severe cerebral hemorrhage during ECMO and died after receiving no further treatment. \u0000 \u0000 \u0000Conclusions \u0000ECMO is newly applied in the treatment of neonates in China and of great significance for critically ill neonates. However, much need to be learned about its utilization in this population considering the mortality and disability rate are still high. \u0000 \u0000 \u0000Key words: \u0000Critical illness; Extracorporeal membrane oxygenation; Infant, newborn","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"885-890"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42132770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-16DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.12.002
Huijing Zhang, Shuxian Wang, Huixia Yang, Yu Sun, Xiao Sun, Junya Chen, Xiao-xiao Zhang, Jie Fu, Li Yu, H. Pan
Objective To investigate the tendency and safety of percutaneous umbilical cord blood sampling (PUBS) in prenatal screening and diagnosis, and the possibilities of avoiding unnecessary PUBS. Methods This was a retrospective study of pregnant women who underwent PUBS for prenatal diagnosis in Peking University First Hospital from January 2015 to December 2017. Clinical indications, timing of PUBS, further investigations (chromosome karyotype, molecular genetics and pathogen testing), results, and pregnancy outcomes were collected and analyzed. One-way analysis of variance (ANOVA), Chi-square test for linear trend, Fisher's exact probability test/Cochran-Armitage analysis and Cruskal-Wallis rank-sum test were used for statistical analysis. Results (1) A total of 412 singleton pregnancies underwent PUBS at 20-38 gestational weeks during the study period, and 379 (92.2%) of them received PUBS before 34 gestational weeks. The positive test results accounted for 10.4% (43/412). There were six (1.5%) miscarriages after PUBS. In vitro cell culture failure occurred in two cases, one in 2015 and the other in 2016. (2) Among the 412 cases, 304 (73.8%) had only one indication. Fourteen cases could be identified as high risk in the first trimester, such as advanced maternal age (AMA, >35 years), pregnant history with chromosomal abnormal fetus and one of the couples carrying abnormal genes. There were four, zero and one case receiving PUBS only for AMA in 2015, 2016 and 2017, respectively. Indications, including high risk suggested by serum screening and fetal abnormality found by ultrasound were identified in 290 cases (70.4%) in the second or third trimester. Other than AMA, there were no statistically significant differences in single indicators. The proportion PUBS with double indicators increased from 2015 to 2017 but without significant difference. AMA and positive serum screening as indicators of aneuploidy screening accounted for 7.6% (8/105) in double-indicator group and 1.9% (8/412) in all. (3) There were 363 PUBS (88.1%) performed for ultrasound abnormalities. Among them, 76.9% (280/363) only had abnormal ultrasound findings, and the percentage was decreased year by year. The other 83 cases (80 with double indicators and three with triple indicators) also presented with other indicators, including AMA, adverse pregnancy history and positive serum screening. The proportion of PUBS performed with the presence of multiple indicators tended to increase recently, but no statistically significant difference was found. All the 18 cases with abnormality diagnosed by molecular genetic testing had abnormal ultrasound findings. Conclusions Although PUBS's complications are rare, it carries some risks. The constitution of single indication has been declined every year. With the improvement of prenatal screening system and application of molecular karyotyping, the necessity of invasive prenatal diagnosis with PUBS is greatly reduced. An impro
{"title":"Indications of percutaneous umbilical cord blood sampling in prenatal diagnosis","authors":"Huijing Zhang, Shuxian Wang, Huixia Yang, Yu Sun, Xiao Sun, Junya Chen, Xiao-xiao Zhang, Jie Fu, Li Yu, H. Pan","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.12.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.12.002","url":null,"abstract":"Objective \u0000To investigate the tendency and safety of percutaneous umbilical cord blood sampling (PUBS) in prenatal screening and diagnosis, and the possibilities of avoiding unnecessary PUBS. \u0000 \u0000 \u0000Methods \u0000This was a retrospective study of pregnant women who underwent PUBS for prenatal diagnosis in Peking University First Hospital from January 2015 to December 2017. Clinical indications, timing of PUBS, further investigations (chromosome karyotype, molecular genetics and pathogen testing), results, and pregnancy outcomes were collected and analyzed. One-way analysis of variance (ANOVA), Chi-square test for linear trend, Fisher's exact probability test/Cochran-Armitage analysis and Cruskal-Wallis rank-sum test were used for statistical analysis. \u0000 \u0000 \u0000Results \u0000(1) A total of 412 singleton pregnancies underwent PUBS at 20-38 gestational weeks during the study period, and 379 (92.2%) of them received PUBS before 34 gestational weeks. The positive test results accounted for 10.4% (43/412). There were six (1.5%) miscarriages after PUBS. In vitro cell culture failure occurred in two cases, one in 2015 and the other in 2016. (2) Among the 412 cases, 304 (73.8%) had only one indication. Fourteen cases could be identified as high risk in the first trimester, such as advanced maternal age (AMA, >35 years), pregnant history with chromosomal abnormal fetus and one of the couples carrying abnormal genes. There were four, zero and one case receiving PUBS only for AMA in 2015, 2016 and 2017, respectively. Indications, including high risk suggested by serum screening and fetal abnormality found by ultrasound were identified in 290 cases (70.4%) in the second or third trimester. Other than AMA, there were no statistically significant differences in single indicators. The proportion PUBS with double indicators increased from 2015 to 2017 but without significant difference. AMA and positive serum screening as indicators of aneuploidy screening accounted for 7.6% (8/105) in double-indicator group and 1.9% (8/412) in all. (3) There were 363 PUBS (88.1%) performed for ultrasound abnormalities. Among them, 76.9% (280/363) only had abnormal ultrasound findings, and the percentage was decreased year by year. The other 83 cases (80 with double indicators and three with triple indicators) also presented with other indicators, including AMA, adverse pregnancy history and positive serum screening. The proportion of PUBS performed with the presence of multiple indicators tended to increase recently, but no statistically significant difference was found. All the 18 cases with abnormality diagnosed by molecular genetic testing had abnormal ultrasound findings. \u0000 \u0000 \u0000Conclusions \u0000Although PUBS's complications are rare, it carries some risks. The constitution of single indication has been declined every year. With the improvement of prenatal screening system and application of molecular karyotyping, the necessity of invasive prenatal diagnosis with PUBS is greatly reduced. An impro","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"838-843"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41745424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-16DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.12.005
Hanxiao Zuo, Xiaohong Xu, C. Ren, Ming-Feng Cui, Dongming Huang, Rong Mi, Li Li, Q. Xiu, Y. Lyu
Objective To investigate the incidence and risk factors of peripartum mood disorder (PPMD) in order to improve clinical prevention and intervention of this condition. Methods This was a prospective cohort study recruiting first-trimester pregnant women (<13 gestational weeks) from Beijing Daxing Maternal and Child Care Hospital from October 1, 2016 to December 31, 2017. Zung Self-rating Anxiety Scale (SAS) and Zung Self-rating Depression Scale (SDS) were used to evaluate the anxiety and depression status in the second and third trimesters, respectively. Their life styles, social and environmental factors exposure during pregnancy were also collected. Statistical analysis was conducted using Chi-square test, student's t test, Mann-Whitney U test and multivariate logistic regression. Results (1) A total of 478 subjects were enrolled in early pregnancy and 460 (96.2%) and 431 (90.2%) of them completed SAS and SDS assessment in the second and third trimesters, respectively, and 413 (86.4%) of the subjects finished both assessments on two occasions. (2) The prevalence of anxiety and depression was 7.1% (30/425) and 13.9% (59/425) in the second trimester, and 11.2% (44/392) and 21.5% (84/390) in the third. The incidence of anxiety and depression in the third trimester was 7.7% (26/336) and 9.6% (30/313). (3) Cross-sectional data analysis showed that prolonged television watching was a risk factor of anxiety in the second (OR=1.216, 95%CI: 1.055-1.402) and third (OR=1.166, 95%CI: 1.044-1.303) trimester, while exercise was a protect factor (OR=0.238, 95%CI: 0.105-0.541; OR=0.432, 95%CI: 0.212-0.879). Pregnant women with longer sleeping time had lower risks of depression in the second trimester (OR=0.725, 95%CI: 0.554-0.950); those who did exercise had lower risks of depression in the third trimester (OR=0.450, 95%CI: 0.252-0.803). (4) Longitudinal-data analysis revealed that longer television watching time in the second trimester was a risk factor for anxiety (OR=1.264, 95%CI: 1.117-1.432) and depression (OR=1.119, 95%CI: 1.005-1.246) in the third trimester. Conclusions The prevalence of anxiety and depression in the third trimester is higher than that in the second trimester. The incidence of depression is higher than that of anxiety in the third trimester. Prolonged television viewing time in the second trimester is a risk factor for both anxiety and depression in the third trimester. Key words: Mood disorders; Peripartum period; Incidence; Risk factors; Cohort studies
{"title":"Incidence and risk factors of peripartum mood disorder: a prospective cohort study","authors":"Hanxiao Zuo, Xiaohong Xu, C. Ren, Ming-Feng Cui, Dongming Huang, Rong Mi, Li Li, Q. Xiu, Y. Lyu","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.12.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.12.005","url":null,"abstract":"Objective \u0000To investigate the incidence and risk factors of peripartum mood disorder (PPMD) in order to improve clinical prevention and intervention of this condition. \u0000 \u0000 \u0000Methods \u0000This was a prospective cohort study recruiting first-trimester pregnant women (<13 gestational weeks) from Beijing Daxing Maternal and Child Care Hospital from October 1, 2016 to December 31, 2017. Zung Self-rating Anxiety Scale (SAS) and Zung Self-rating Depression Scale (SDS) were used to evaluate the anxiety and depression status in the second and third trimesters, respectively. Their life styles, social and environmental factors exposure during pregnancy were also collected. Statistical analysis was conducted using Chi-square test, student's t test, Mann-Whitney U test and multivariate logistic regression. \u0000 \u0000 \u0000Results \u0000(1) A total of 478 subjects were enrolled in early pregnancy and 460 (96.2%) and 431 (90.2%) of them completed SAS and SDS assessment in the second and third trimesters, respectively, and 413 (86.4%) of the subjects finished both assessments on two occasions. (2) The prevalence of anxiety and depression was 7.1% (30/425) and 13.9% (59/425) in the second trimester, and 11.2% (44/392) and 21.5% (84/390) in the third. The incidence of anxiety and depression in the third trimester was 7.7% (26/336) and 9.6% (30/313). (3) Cross-sectional data analysis showed that prolonged television watching was a risk factor of anxiety in the second (OR=1.216, 95%CI: 1.055-1.402) and third (OR=1.166, 95%CI: 1.044-1.303) trimester, while exercise was a protect factor (OR=0.238, 95%CI: 0.105-0.541; OR=0.432, 95%CI: 0.212-0.879). Pregnant women with longer sleeping time had lower risks of depression in the second trimester (OR=0.725, 95%CI: 0.554-0.950); those who did exercise had lower risks of depression in the third trimester (OR=0.450, 95%CI: 0.252-0.803). (4) Longitudinal-data analysis revealed that longer television watching time in the second trimester was a risk factor for anxiety (OR=1.264, 95%CI: 1.117-1.432) and depression (OR=1.119, 95%CI: 1.005-1.246) in the third trimester. \u0000 \u0000 \u0000Conclusions \u0000The prevalence of anxiety and depression in the third trimester is higher than that in the second trimester. The incidence of depression is higher than that of anxiety in the third trimester. Prolonged television viewing time in the second trimester is a risk factor for both anxiety and depression in the third trimester. \u0000 \u0000 \u0000Key words: \u0000Mood disorders; Peripartum period; Incidence; Risk factors; Cohort studies","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"859-866"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47255275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-16DOI: 10.3760/CMA.J.ISSN.1007-9408.2019.12.010
Hui-ping Shi, L. Tao, Ning Zhao
This study reported a postterm female infant born at 43+2 weeks of gestation via cesarean section with a birth weight of 2 950 g. Cyanosis was presented around 14 h after birth. Laboratory test results showed that the blood glucose was 1.4 mmol/L and the levels of free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyrotropin (TSH), growth hormone (GH) and insulin-like growth factor-1 (IGF-1) were significantly reduced. Cranial MRI confirmed the diagnosis of pituitary stalk interruption syndrome. The baby girl was treated with hydrocortisone and levothyroxine and discharged following clinical symptoms improvement and blood glucose normalization. Follow-up data showed unstable blood glucose and hypothyroidism at six and 10 months after birth and growth retardation at 15 months. Key words: Pituitary diseases; Hypoglycemia; Hypothyroidism; Infant, newborn
{"title":"Pituitary stalk interruption syndrome in newborn: a case report","authors":"Hui-ping Shi, L. Tao, Ning Zhao","doi":"10.3760/CMA.J.ISSN.1007-9408.2019.12.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2019.12.010","url":null,"abstract":"This study reported a postterm female infant born at 43+2 weeks of gestation via cesarean section with a birth weight of 2 950 g. Cyanosis was presented around 14 h after birth. Laboratory test results showed that the blood glucose was 1.4 mmol/L and the levels of free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyrotropin (TSH), growth hormone (GH) and insulin-like growth factor-1 (IGF-1) were significantly reduced. Cranial MRI confirmed the diagnosis of pituitary stalk interruption syndrome. The baby girl was treated with hydrocortisone and levothyroxine and discharged following clinical symptoms improvement and blood glucose normalization. Follow-up data showed unstable blood glucose and hypothyroidism at six and 10 months after birth and growth retardation at 15 months. \u0000 \u0000 \u0000Key words: \u0000Pituitary diseases; Hypoglycemia; Hypothyroidism; Infant, newborn","PeriodicalId":52320,"journal":{"name":"Chinese Journal of Perinatal Medicine","volume":"22 1","pages":"891-893"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45155722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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