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Empowering the LMIC hinterlands with compatible technologies for neonatal care – the resilience of a research group 为低收入和中等收入国家腹地提供新生儿护理的兼容技术——一个研究小组的复原力
Pub Date : 2023-09-19 DOI: 10.15406/jpnc.2023.13.00512
Hippolite O. Amadi
Background: High neonatal mortality rate (NMR) in low- and middle-income countries (LMIC) might not be resolved until rural healthcare facilities are empowered with sustainable frugal technologies and procedures. Needed technologies may not rely on cutting-edge systems of the high-income countries (HIC), which require much funding and well-established public infrastructure to thrive. Rather, tailored non-conventional designs that are compatible with the deficiencies at low-income settings must take center stage. Study design: A multistage strategy was designed to identify and resolve the technology and knowledge gaps responsible for high NMR and rural community deficiencies militating against neonatal interventions within the primary healthcare settings in Nigeria. Methods: We concluded many scientific investigations and developed interventions over 25 years period to resolve the various factors militating against neonatal survival in Nigeria. Unconventional ideas relying on solar powered systems and easily available local materials were developed, trialed, and commissioned at various times across 31 tertiary hospitals spanning all regions of Nigeria. Stand-alone studies or solutions-creation, amidst discouraging situations, were individually completed, peer-reviewed, and journal-published. The full package of technologies was finally assembled to launch a community empowerment strategy – the Neonatal Rescue Scheme – to generate integrated proof of concept. Finding: The number of early neonatal deaths and overall NMR drastically reduced at participating centers. Conclusions: This Rescue-Scheme strategy could revolutionize neonatal healthcare in low-income countries and drastically reduce Nigeria’s corporate NMR if properly adopted. Clinical evidence: Recent studies of the Scheme and various combinations of its neonatal technologies have demonstrated significant clinical evidence of NMR-reduction, e.g., overall NMR fell from 90/’00 to 4/’00 as published by Amina-center Minna Nigeria 2023; early mortality fell from 81% to 0% - University of Abuja Teaching Hospital Nigeria 2017, etc.
背景:在低收入和中等收入国家(LMIC)的高新生儿死亡率(NMR)可能无法解决,直到农村卫生保健设施被赋予可持续的节俭技术和程序。所需的技术可能不依赖于高收入国家(HIC)的尖端系统,后者需要大量资金和完善的公共基础设施才能蓬勃发展。相反,与低收入环境的不足相适应的量身定制的非传统设计必须占据中心位置。研究设计:设计了一项多阶段战略,以确定和解决导致尼日利亚初级卫生保健机构内高核磁共振和农村社区缺陷妨碍新生儿干预的技术和知识差距。方法:在过去的25年里,我们总结了许多科学调查和开发干预措施,以解决影响尼日利亚新生儿生存的各种因素。依靠太阳能供电系统和易于获得的当地材料的非常规想法在尼日利亚所有地区的31家三级医院的不同时间进行了开发、试验和委托。在令人沮丧的情况下,独立的研究或解决方案的创造被单独完成,同行评审,并在期刊上发表。整套技术终于集合起来,启动了一项社区赋权战略——新生儿救援计划——以产生概念的综合证明。研究发现:在参与研究的中心,早期新生儿死亡人数和总体核磁共振率大幅下降。结论:如果采用得当,这种拯救计划战略可以彻底改变低收入国家的新生儿保健,并大大减少尼日利亚的企业核磁共振。临床证据:最近对该方案及其新生儿技术的各种组合的研究已经证明了显著的核磁共振降低的临床证据,例如,总体核磁共振从90/ 00下降到4/ 00,这是由Amina-center Minna Nigeria 2023年发布的;早期死亡率从81%降至0%——尼日利亚阿布贾大学教学医院,2017年等。
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引用次数: 0
Adolescents health issues in India 印度青少年的健康问题
Pub Date : 2023-09-11 DOI: 10.15406/jpnc.2023.13.00510
Mary Anbarasi Johnson
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引用次数: 0
Prevalence of hearing impairment and outcome of universal neonatal hearing screening program in a tertiary care hospital – in UAE 阿联酋一家三级护理医院的听力障碍患病率和新生儿听力筛查项目的结果
Pub Date : 2021-08-04 DOI: 10.15406/jpnc.2021.11.00442
Mahmoud Elhalik, S. Dash, A. Faquih, R. Mahfouz, Faseela Shejee, N. Haroon, Khaled Mahmoud ElAtawi
Background and objective: Hearing loss is one of the most common congenital anomalies, occurring in 1 to 3 per 1000 newborn infants in the well-baby nursery population, and 2 to 4 per 100 infants in the Neonatal intensive care unit graduates. The aim of the study is to identify babies with potential hearing loss and direct them to early intervention and rehabilitation. The program also initiated to create awareness about the need for detecting childhood deafness among parents and general population. An estimate of coverage, prevalence and proportion of babies defaulting newborn hearing screening program and diagnostic evaluation monitored closely to find the effectiveness of the program. Study design: This is a retrospective study and was conducted at Latifa women and children’s hospital (LWCH), a tertiary care referral hospital at Dubai, United Arab Emirates, over a period of two years from January 2018 to December 2019. Neonates admitted in Neonatal intensive care unit (NICU) and Post Natal wards (PNW) were screened. We followed three tier approach of hearing screening. All eligible neonates were subjected to Transient Evoked Oto-acoustic emission (TEOAE) prior to discharge. Automated auditory brainstem response (AABR) hearing screening was conducted in neonates who did not pass TEOAE test. Infant who failed second screening (AABR) were subjected to comprehensive hearing evaluation prior to three months of age. Results: Out of the total 7923 neonates, 7895(99.65%) were screened and 118 (1.49%) newborns referred for comprehensive audiological evaluation. Among them, 27(0.34%) were identified with various degrees of hearing loss. The prevalence of hearing loss was found to be 0.16% and 0.92% among neonates from PNW and NICU respectively. Conclusion: Implementation of Universal newborn hearing screening program is the need of the hour, as early detection of Hearing loss will aid early rehabilitation and better outcomes.
背景和目的:听力损失是最常见的先天性畸形之一,在良好的婴儿保育人群中,每1000名新生儿中就有1至3名发生听力损失,在新生儿重症监护室毕业生中,每100名婴儿中就有2至4名发生听力损失。这项研究的目的是确定有潜在听力损失的婴儿,并指导他们进行早期干预和康复。该计划还旨在提高家长和普通人群对检测儿童耳聋必要性的认识。密切监测新生儿听力筛查计划和诊断评估的覆盖率、患病率和比例估计,以发现该计划的有效性。研究设计:这是一项回顾性研究,在阿拉伯联合酋长国迪拜的三级护理转诊医院Latifa妇女儿童医院(LWCH)进行,为期两年,从2018年1月到2019年12月。对新生儿重症监护室(NICU)和产后病房(PNW)收治的新生儿进行筛查。我们采用了听力筛查的三层方法。所有符合条件的新生儿在出院前接受瞬态诱发耳声发射(TEOAE)检查。对未通过TEOAE测试的新生儿进行了自动听性脑干反应(AABR)听力筛查。未通过二次筛查(AABR)的婴儿在三个月大之前接受全面的听力评估。结果:在7923名新生儿中,7895名(99.65%)接受了筛查,118名(1.49%)新生儿接受了综合听力学评估。其中,27人(0.34%)被鉴定为不同程度的听力损失。PNW和NICU新生儿的听力损失发生率分别为0.16%和0.92%。结论:实施全民新生儿听力筛查计划是当务之急,因为早期发现听力损失将有助于早期康复和更好的结果。
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引用次数: 0
Persistent air leak (bronchopleural fistula) in neonates 新生儿持续性漏气(支气管胸膜瘘)
Pub Date : 2021-08-04 DOI: 10.15406/jpnc.2021.11.00441
S. Ojha, G. Sen, R. Bansal, Anupam Chaturvedi, Mahaveer Saini
Background: Pneumothorax is a known complication in neonates on ventilation but persistent air leak is infrequently seen in neonates and is troublesome to manage. Persistent air leak on chest tube insertion is suggestive of bronchopleural fistula, often resulting in significant mortality and morbidity. Various modalities of management like multiple chest tube insertions (thoracostomies), selective bronchial occlusion, pleurodesis using talc, tetracycline etc and urgent surgery to repair the leak have been mentioned. Islolated case reports for management of bronchopleural fistula in neonates are abound in literature but consensus and attention should be directed to improve awareness and access to clinical guidelines in management of bronchopleural fistula in neonates. Methods: Our aim was to evaluate the management and outcome of neonates with persistent air leak (bronchopleural fistula). Result: Eighteen neonates with bronchopleural fistula (BPF) were managed from 2012-2018. All neonates were managed by chest tube insertion, and slow suction (10-15cm of H2O). In those patients having persistent pneumothorax despite functioning tube with persistent air leak, second chest tube was inserted in 2nd intercostal space. Five of these patients even had cardiac arrest due to tension pneumothorax but were revived. One neonate required pleurodesis, two expired and remaining improved on multiple chest tube insertion and were discharged. None required selective bronchial intubation or surgery. Conclusion: Tension pneumothorax with persistent air leak on chest tube suggestive of Broncho-pleural fistula is a difficult and a rare problem in neonates. If not timely taken care of it can lead to cardiac arrest but despite cardiac arrest aggressive resuscitation and judicious use of multiple chest tube drainage and slow suction can help these little patients improve.
背景:胸腔积液是新生儿通气时的一种已知并发症,但新生儿很少出现持续性漏气,而且处理起来很麻烦。胸管插入时持续漏气提示支气管胸膜瘘,通常导致显著的死亡率和发病率。已经提到了多种治疗方式,如多次插入胸管(胸腔造口术)、选择性支气管闭塞、使用滑石粉、四环素等进行胸膜固定术以及紧急手术修复渗漏。文献中有大量关于新生儿支气管胸膜瘘治疗的孤立病例报告,但应提高对新生儿支气管胸膜瘘管治疗的认识,并提高对临床指南的了解。方法:我们的目的是评估新生儿持续性漏气(支气管胸膜瘘)的处理和结果。结果:2012-2018年,18例支气管胸膜瘘新生儿得到治疗。所有新生儿均通过胸管插入和缓慢抽吸(10-15cm H2O)进行管理。在那些尽管导管功能正常但仍持续漏气的患者中,将第二根胸管插入第二肋间。其中5名患者甚至因张力性肺气肿而心脏骤停,但已苏醒。一名新生儿需要胸膜固定术,两名过期,经多次胸管插入后仍有好转,出院。无需选择性支气管插管或手术。结论:张力性肺气肿合并胸管持续漏气提示支气管胸膜瘘在新生儿中是一个困难且罕见的问题。如果不及时处理,可能会导致心脏骤停,但尽管心脏骤停,积极的复苏和明智地使用多个胸管引流和缓慢抽吸可以帮助这些小患者改善。
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引用次数: 0
Childhood onset SLE- case report 儿童期SLE病例报告
Pub Date : 2021-08-04 DOI: 10.15406/jpnc.2021.11.00440
A. Alhusain, Hasan Alhashim, Wafa Almuraidif, M. Alghazal
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect any organ and may result in significant morbidity and mortality. Childhood-onset c-SLE is a rare disease with an incidence of 0.3-0.9/100,000 children-years and a prevalence of 3.3-8.8/100,000 children.1 Asians, African American, Hispanic and Native Americans have higher frequency of the disease.2,3 Similar to adult SLE, c-SLE affects mainly females with around 80% of the affected children. According to the literature, the median age of onset is 11-12 years and it is rare in children under 5 years of age. The manifestations of c-SLE are variable and most of the times are atypical compared to adult SLE which make the diagnosis of cSLE a challenge to the treating physician.4 This report shows a series of presentation in pediatric patient who finally was diagnosed with SLE.
系统性红斑狼疮(SLE)是一种慢性自身免疫性疾病,可影响任何器官,并可能导致严重的发病率和死亡率。儿童期发作的c-SLE是一种罕见疾病,发病率为0.3-0.9/10000儿童年,患病率为3.3-8.8/100000儿童。1亚洲人、非裔美国人、西班牙裔和美洲原住民的发病率较高。2,3与成人SLE类似,c-SLE主要影响女性,约80%的受影响儿童。根据文献,中位发病年龄为11-12岁,在5岁以下的儿童中很少见。c-SLE的表现多种多样,与成人SLE相比,大多数时候是非典型的,这使得cSLE的诊断对治疗医生来说是一个挑战。4本报告显示了最终被诊断为SLE的儿科患者的一系列表现。
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引用次数: 0
Setting the stage for play for children with autism 为自闭症儿童搭建玩耍的舞台
Pub Date : 2021-05-29 DOI: 10.15406/jpnc.2021.11.00439
Dean Alexander
I put these observations to the test in a research design alternating 5 minute play periods with fine-motor materials (tinker toys, blocks) with 5 minute periods of play with active gross-motor play equipment. These included a see-saw, boxes tied together to make a “train,” rubberized equipment to jump/bounce on. The children here, unfamiliar with each other, were 4-9 years of age, one child with high functioning autism, one neurotypical peer. The results confirmed my informal observations: the pairs of children, videotaped behind a one way mirror did not play together in the fine-motor condition. Attempts to initiate play by the neurotypical peer were most often ignored by the child with autism, who preferred self-stim or sat unengaged. This reversed when the children were introduced into a gross-motor setting with one piece of equipment and also videotaped behind a one way mirror. The equipment itself helped to structure the interaction: e.g., each child taking a seat on the see-saw, or crawling through the boxes. What was most exciting for us was that the dramatic increases in play here generalized back into the following fine-motor setting. The children “figured out” how to interact together, the neurotypical child often providing clear direction. For example, “hockey sticks” were fashioned out of tinker toys, and the children hit a round piece, i.e., the puck, back and forth on the floor.
我在一项研究设计中对这些观察结果进行了测试,交替使用精细运动材料(修补玩具、积木)和主动大运动游戏设备进行5分钟的游戏。其中包括一个跷跷板,绑在一起的盒子组成一个“火车”,用来跳跃/弹跳的橡胶设备。这里的孩子,彼此不熟悉,年龄在4-9岁,一个患有高功能自闭症的孩子,一个神经正常的同伴。结果证实了我非正式的观察:在单面镜子后面拍摄的成对儿童在精细运动条件下没有一起玩耍。自闭症儿童更喜欢自我刺激或闲坐不动,而那些神经正常的同伴试图发起游戏的行为往往被他们忽视。当孩子们被引入一个带有一件设备的粗大运动环境中,并在单向镜子后面进行录像时,情况正好相反。设备本身有助于构建互动:例如,每个孩子坐在跷跷板上,或者爬过盒子。最让我们兴奋的是,在这里玩耍的戏剧性增加可以追溯到下面的精细运动设置。孩子们“弄清楚”如何在一起互动,神经正常的孩子经常提供明确的方向。例如,“曲棍球棒”是用修补玩具做成的,孩子们在地板上来回击打一个圆形的物体,也就是冰球。
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引用次数: 0
Neonatal Tuberous Sclerosis: is skin really the window? 新生儿结节性硬化症:皮肤真的是窗口吗?
Pub Date : 2021-03-27 DOI: 10.15406/JPNC.2021.11.00437
T. Kulkarni, K. El-Atawi, M. Elhalik
We report a case of a neonate who was diagnosed to have intracardiac mass as a fetus and presented with white linear papules that was diagnosed to be Linear Verrucous Epidermal Nevus. Apart from the intracardiac mass, most likely rhabdomyoma, MRI Brain also showed presence of tubers and the Next Generation Sequence Analysis confirmed the diagnosis of Neonatal Tuberous Sclerosis. The neonate remained asymptomatic and was discharged home and remains under close follow up without any symptoms. It is thus suggested that Linear Verrucous Epidermal Nevus, a cutaneous manifestation not described with Tuberous Sclerosis could be considered under the ever-expanding cutaneous signs of Tuberous Sclerosis and should alert the physician toward its possibility.
我们报告了一例新生儿,他在胎儿时期被诊断为心内肿块,并出现白色线状丘疹,被诊断为线状疣状表皮痣。除了心内肿块,最有可能是横纹肌瘤,MRI大脑也显示出结节的存在,下一代序列分析证实了新生儿结节性硬化症的诊断。新生儿仍然没有症状,出院回家,仍在密切随访中,没有任何症状。因此,有人建议,线性疣状表皮痣,一种未描述为结节性硬化症的皮肤表现,可以被认为是结节性硬化病不断扩大的皮肤体征,并应提醒医生注意其可能性。
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引用次数: 0
Outcomes of intrauterine interventions for the treatment in fetal urinary tract obstructions 宫内干预治疗胎儿尿路梗阻的疗效
Pub Date : 2021-02-22 DOI: 10.15406/JPNC.2021.11.00434
M. Pavlichenko, N. Kosovtsova, N. Bashmakova
Introduction: The leading cause of chronic renal failure in newborns, which occurs soon after birth is obstructive uropathies. Objectives: To prove the effectiveness of nephroamniotic shunting based on the evaluation of perinatal outcomes of this procedure, as well as a comparative analysis of the use of the stent manufactured by "Cook" (Ireland), 3.0 Fr/100 mm and the stent “SDE–MED”, 3.0 Fr/50 mm with the original shape of pigtails. Methods: After checking the safety of the stent “SDE-MED”, 3.0 Fr/50 mm developed by FGBU Mother and Child Care Research Institute with the original shape of pigtails in an animal experiment, the stent was used in clinical practice for intrauterine shunting in cases of unilateral or bilateral hydronephrosis of grade III to IV and posterior urethral valve disorder. In the final part of the study, a comparison of the outcomes of nephroamniotic shunting using two different stents was made. Results: The “SDE–MED” 3.0 Fr/50 mm stent provided more effective fixation in the fetal kidney cavity system in comparison to the stent manufactured by “Cook” (Ireland) 3.0 Fr/100 mm. Conclusion: Intrauterine shunting surgery of the upper urinary tract is a pathogenetically justified method of treating urinary tract obstructions and can be used to correct all types of fetal renal obstructions.
引言:新生儿出生后不久发生的慢性肾功能衰竭的主要原因是阻塞性尿路病。目的:根据对该手术围产期结果的评估,以及对“Cook”(爱尔兰)制造的3.0 Fr/100 mm支架和“SDE–MED”3.0 Fr/50 mm辫子原始形状支架的使用进行比较分析,证明肾羊膜分流的有效性。方法:在动物实验中,对FGBU母婴保健研究所研制的“SDE-MED”3.0Fr/50mm辫子原始形状支架的安全性进行检查后,将该支架应用于临床,用于单侧或双侧Ⅲ~Ⅳ级肾积水和后尿道瓣膜病患者的宫内分流。在研究的最后一部分,对使用两种不同支架的肾羊膜分流的结果进行了比较。结果:与“Cook”(爱尔兰)制造的3.0 Fr/100 mm支架相比,“SDE–MED”3.0 Fr/50 mm支架在胎儿肾腔系统中提供了更有效的固定。结论:上尿路宫内分流术是治疗尿路梗阻的一种病因合理的方法,可用于纠正各种类型的胎儿肾梗阻。
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引用次数: 0
Commentary on Shwachman-Diamond Syndrome Shwachman-Diamond综合征的评论
Pub Date : 2021-01-01 DOI: 10.36648/2471-805X.21.7.73
Oleks, R. Ko
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引用次数: 0
Eating Habit and Related Disorder in Adolescence 青少年的饮食习惯和相关障碍
Pub Date : 2021-01-01 DOI: 10.36648/2471-805X.21.7.E006
N. Allam
As the body of teenager is as yet developing, it's fundamental that you eat sufficient great quality food and the right sorts to meet your energy and nourishment needs. Being a teen can be fun, yet it can likewise be troublesome as your body shape changes. These actual changes can be difficult to manage in case they aren't the thing you are anticipating. There can be pressure from companions to be or look a specific way and this may influence the food varieties you eat. It's anything but a happy chance to crash diet, as you will not get enough supplements, and you may not arrive at your maximum capacity.
由于青少年的身体还在发育,你吃足够的高质量的食物和正确的种类来满足你的能量和营养需求是很重要的。作为一个青少年可以是有趣的,但它同样可以是麻烦的,因为你的体型的变化。这些实际的变化可能很难管理,因为它们不是你所期望的。同伴可能会给你施加压力,要求你以某种特定的方式行事,这可能会影响你吃的食物种类。这绝不是一个快速节食的好机会,因为你不会得到足够的补充,你可能无法达到你的最大容量。
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引用次数: 0
期刊
Journal of pediatrics & neonatal care
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