Objective To describe the clinical features of pediatric chronic granulomatous disease (CGD) and incidence of infection after treatment program (combine rhIFN-γ and TMP-SMX). Methods The follow-up study of clinical features, including the site of infection, the pathogen of infection, noninfectious inflammatory response and drug treatment, etc., was performed in CGD patients diagnosed in Children′s Hospital of Fudan University from January 2004 to December 2011. The incidence of infection calculated as per patient-year was compared between patients who received combination treatment program or separated TMP-SMX treatment. The clinical efficacy and safety of rhIFN-γ treatment were analyzed. Results A total of 29 cases were recruited into the study. The mean age of onset and diagnosis was 2.5 months and 2.4 years respectively. Mean duration of per follow-up patient was 2.9 years. ① The incidence of all infections, severe infections and non-severe infections was 1.8, 0.48 and 0.80 per patient-year. Lung infection and lymphadenitis were the most frequent manifestations both prior to diagnosis (49 and 26) and during follow-up (26 and 37). Mycobacteria species was the leading cause of infection (34/61) and death (3/4) in our cohort. ② Combined treatment program was used in 21 cases while separated TMP-SMX treatment was performed in 8 cases because of drug adverse reaction or self-withdrawal. After combined treatment, the incidence of total and severe infection was significantly lower than that prior to treatment(total infection: 1.986 vs 1.098, P=0.002; severe infection:1.290 vs 0.452, P=0.001）, the most remarkable to the lung (0.758 vs 0.275, P=0.004), the incidence of infection did not significantly differ from separated TMP-SMX treatment. The incidence of total and non-severe infection in combined treatment program was significant lower than that in separated TMP-SMX treatment (total infection: 1.098 vs 1.823, P=0.015; non-serious infection: 0.646 vs 1.248, P=0.047), serious infection had no significant difference (0.452 vs 0.576, P=0.254). ③ 14/29（48.3%）cases reported an adverse event after the use of rhIFN-γ, the commonest was fever (12/29). There was no life-threatening rhIFN-γ-related adverse events. Conclusions Combined treatment program significantly reduced the incidence of infection. The use of rhIFN-γ in patients with CGD appeared to be effective and safe. Mycobacteria species was the first cause of infection and death in our cohort.
Objective To summarize the removal indications for children with congenital heart disease (CHD) combined with bronchial stenosis after tracheal stenting. Methods Clinical data of CHD children with bronchial stenosis whose tracheal stenting was still remained or removed were compared and analyzed. Results Nine cases of stenting patients were severe airway obstruction. Four children were alive and well with stents remained, with an average age of 13.75 months and average weight of 870 kg. During follow-up bronchoscopy in those patients, the stents had become almost fully covered by respiratory mucosa, without any evidence of granulation. Stents were placed for 68 to 96 days and were removed in 5 patients, with an average age of 48 months and average weight of 4.96 kg. The removed stents had good shape without collapse. It didn't affect ventilatory function in children and there were no complications related to stent insertion, no more airway restenosis, no additional stent insertion and no death occurrence. On the basis of the literature review, the indications of stent removal were made: ① Stent has been placed for 2 to 3 months under the control of good follow-up system. ② The airway was unobstructed and confirmed by bronchoscopy, CT and its three-dimensional airway reconstruction to be without any granulation tissue. ③ There was no sign of dyspnea or infection. Blood gas analysis showed no lung through ventilation dysfunction with normal X-ray and echocardiography examination. ④ Tracheal stent border could be clearly seen under bronchoscopy and no epithelialization was growing in the entire open bracket in the airway surface. ⑤ The stents could be pasted pushing and pulling gently up and down a slight under the bronchoscopy.Conclusions The removal of metallic stents placed for 2 to 3 months is safe under the control of good follow-up system and with no adverse impact on the quality of life in children. It is the best choice for small babies to remove tracheal stent from a long-term perspective.
Objective To improve the diagnostic accuracy of congenital atresia of the left main coronary artery by analyzing echocardiography results. Methods Three cases with congenital atresia of the left main coronary artery were diagnosed by coronary arteriongraphy. The echocardiography characteristics were summarized by reviewing the related literatures. Results The specific echocardiography characteristics include: ①There was no left main coronary artery ostium in the left coronary artery sinus. The proximal part of left main coronary artery was atretic and the far part was narrow and dysplasia. ② The diameter of right main coronary arteries was widened. ③There was no anomalous origin of the left coronary artery from the pulmonary artery. The non-specific echocardiography characteristics include: ①The left ventricular chamber was enlarged significantly and the left ventricular systolic function was normal or reduced. ②The echo of mitral chordae tendineae and papillary muscle was enhanced and associated with mitral valve prolapsed. The color Doppler echocardiography characteristics include: ①Color Doppler showed moderate or severe mitral valve regurgitation. ② The small and thin collateral vessels were established between the left coronary artery and right coronary artery. ③The flow of left coronary descending and circumflex branch was inversive. ④Although the dysplasia left coronary artery was distributed around the pulmonary artery, color Doppler did not show the exact inversive flow where left coronary artery connected with pulmonary artery. Conclusions Congenital atresia of the left main coronary artery has specific echocardiography characteristics. The comprehensive understanding for this anormaly is the keypoint to make acurate diagnosis.
Objective To study ECG-parameters pre- and post-six-minute walking test (6MWT)among children after congenital heart disease (CHD) surgery. Methods Children after CHD surgery (complicated or simple CHD) and followed up over 6 months from Children's Hospital of Fudan University were enrolled in CHD group, and healthy children were enrolled in control group, both groups were categorized into 4 subgroups by age at testing: 3-5, -8, -12 and -15 years age-subgroups. ECG-parameters including P wave dispersion (Pwd), QRS duration and QT dispersion (QTd) were studied before and after 6MWT between the two groups. Results Eighty-nine children with CHD including 29 complicated CHD and 60 simple CHD cases were enrolled in CHD group, whose average surgery age and follow-up time were (30±23) years (36 d to 11 years) and (36±32) (05-142) years, respectively. The number of cases in 4 agegroups were 39 (3-5 years), 27 (-8 years), 11 (-12 years) and 12 (-15 years), and were 26, 39, 39 and 29 respectively for the control group. The height, body weight and body mass index (BMI) of the 133 control subjects matched the cases by age groups. ① The Pwd, QRS duration and QTd tended to decrease after 6MWT but did not reach significant level. ② The QTd before 6MWT in CHD group was higher than that in the control group by all agegroups, however the difference in the 3-5 and -12 agegroups reached significant level ［(0025±0018) vs (0012±0011) s, P＝0004; (0029±0014) vs (0019±0012) s, P＝0019］. No significant difference was observed after 6MWT. And there were no differences after 6MWT（P>005）. ③ QRS duration tended to be prolonged after 6MWT, only the difference in -8 and -15 agegroup reached significant level (P<001). ④Compared with the simple CHD subgroup, the QRS duration in complex CHD subgroup became wide before ［(0102± 0025) vs (0080 ± 0021) s, P=0000］ and after ［(0103 ± 0026) vs (0080 ± 0021) s, P=0000］ 6MWT. But there were no significant differences in Pwd and QTd before and after 6MWT performed between two subgroups. Conclusions The electric activity was still unstable during mid- or long-term follow-up in children after CHD surgery. The alteration of Pwd, QRS duration and QTd pre- and post-6MWT in postoperative CHD children were consistent with those in healthy children, suggesting that sub-maximal exercise test of 6MWT might improve the stability of heart electric activities.
Objective To evaluate the diagnostic value of Xpert MTB/RIF assay to tuberculosis systematically. Methods Studies about the diagnostic value of Xpert MTB/RIF assay to tuberculosis were searched in PubMed, Medline, CNKI and Wangfang database from establishment to June 2012. Two researchers fetched the data from included studies independently, and then Meta-Disc software（version 1.4）was used for meta-analysis. Results A total of 26 studies were recruited in the analysis, including 13 270 sediments from clinical patients. In all kinds of tuberculosis, the pooled sensitivity and specificity of Xpert MTB/RIF were 87%（95％CI:86%-88%）and 97%（95％CI:97%-97%）respectively. Then subgroup analysis was made by the types of tuberculosis and the patients′ age, showing that Xpert MTB/RIF assay was more sensitive in diagnosing pulmonary tuberculosis than in extrapulmonary tuberculosis, and in smear-negative tuberculosis. The pooled sensitivity of Xpert MTB/RIF assay reached 74%（95％CI:71%-76%）, and the sensitivity in diagnosing pediatric tuberculosis was lower than adult tuberculosis. In multi-drug resistant tuberculosis, the pooled sensitivity and specificity were 96%（95％CI:94%-97%）and 98%（95％CI:98%-99%）, respectively. Conclusions The diagnostic value of Xpert MTB/RIF assay to tuberculosis was very high, especially in adult tuberculosis. Because studies on pediatric tuberculosis were very few, the diagnostic value of Xpert MTB/RIF assay to pediatric tuberculosis should be confirmed by performing prospective cohort studies further.
Objective To investigate whether early corticosteriod administration can reduce the rate of renal complications in children with Henoch Schonlein purpura (HSP). Methods Cochrane library, Medline, EMBASE, CNKI, VIP and Wanfang database were searched for the randomized controlled trials (RCTs) about the effect of corticosteriod administration on preventing renal disease in pediatric HSP published from January 1990 to June 2012. All included RCTs were graded in term of randomization, allocation concealment and blinding independently by two authors.The useful data were retrieved and summarized by two authors. RevMan 4.3 software was used for meta-analysis and the corresponding effect model was selected based on heterogeneity test. Descriptive method was used to analyze and summarize the data when meta-analysis was not achievable. Moreover, the sensitivity analysis was performed if nessccary. Results Five RCTs and one quasi-RCT were included, four of them discribed the specific randomized method and adopted adequate allocation concealment and blinding, and all of them reported loss of follow-up and retrievement.Four studies had low risk of bias,while two had high risk of bias. The results showed that the incidence of renal complication in treatment group and control group was 222%(42/189) and 263%(50/190) respectively (pooled relative risk:067, 95%CI:017-262) within six months, and the incidence was 109%(41/373) and 126%(46/364) respectively (pooled relative risk :085，95％CI：044-164) over six months, none of them was significant(P=057 and 065 respectively). In sensitivity analysis, two trials with high risk of bias were excluded to remove heterogeneity among studies and the same result was found as above. Conclusions There was no sufficient evidence showing that corticosteroid administration could siginificantly reduce the rate of complications in children with HSP. The results suggested that pediatricians should cautiously use corticosteroid ,or use it with anti-coagulation,anti-anaphylacty therapy according to specific clinical and experimental inspections.
Objective To evaluate the association between allele, genotypes and haplotype of vascular endothelial growth factor (VEGF) polymorphisms and congenital heart disease (CHD). Methods Cochrane library, PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wangfang Database and Chinese Biology medicine disc (CBM) were searched for controlled trials and transmission disequilibrium test from establishment of the database to December 2011. Manual retrospective search had been done for important references. According to the inclusion criteria, articles were evaluated by two individual investigators. The quality of included studies were assessed. Cochrane Collaboration′s RevMan 5.1.1 software was used for data analysis in fixed/random models. Results Six articles including 10 independent studies were enrolled into this analysis, and there was publication bias among the studies. The results of meta-analysis showed, ①C-2578A′s allele C significantly increased the susceptibility of CHD in subjects with DiGeorge syndrome(OR=1.40, 95%CI:1.04-1.16); G-1154A′s allele G had the same effect in subjects with DiGeorge syndrome(OR=1.87, 95%CI:1.27-2.75); whereas G-634C′s allele G significantly increased the susceptibility of CHD in normal subjects(OR=1.29, 95%CI:1.02-1.62). ②G-1154A′s genotype (AA+AG) was the risk factor increasing the susceptibility of CHD in subjects with DiGeorge syndrome significantly(OR=2.10, 95%CI:1.32-3.34). ③Haplotype AAG significantly increased the susceptibility of CHD in subjects with DiGeorge syndrome(OR=1.82, 95%CI:1.31-2.54); however, haplotype CGC significantly decreased the susceptibility of CHD in population without DiGeorge syndrome(OR=0.79, 95%CI:0.63-0.99). Conclusions The allele, genotype and haplotype of vascular endothelial growth factor were identified out the association with susceptibility of CHD, and there were differences between CHD with or without DiGeorge syndrome. Specific haplotype (CGC) had significant protective effects of reducing the risk for CHD in the population without DiGeorge syndrome, but its underlying mechanisms need futher investigation.
Objective To evaluate the measurement difference in Wechsler Intelligence Scale for Children (WISC) testing for Chinese children with learning difficulties and normal children. Methods PubMed, MD Consult, cnpiec LINK service, YZ365.com and Wanfang database were searched from the database establishment to May 2012. Studies comparing Chinese Version of WISC-Ⅲ testing (modified by Beijing normal University or Hunan Medical University ) between children with learning difficulties and normal children were recruited. The full intelligence quotient (FIQ), verbal IQ (VIQ) and practical IQ (PIQ) were selected as outcomes for meta analysis with RevMan 5.0. According to the heterogeneity results, corresponding effect model was chosen to conduct the meta-analysis. Results 23 articles were included into the meta-analysis. The research was all carried out in east-central cities of China. 10 of them used the WISC-CR, 13 used C-WISC. Thirteen studies were school-based, whereas 12 studies were carried out among hospital outpatients. The control group subjects without leaning difficulties were selected from the corresponding places. ①The heterogeneity tests of FIQ, VIQ and PIQ showed significant heterogeneity. All analyses used random effect model. Meta-analysis results showed that WMD was -16.23 (95% CI: -18.20 to -14.25), -18.90 (95% CI: -21.04 to -16.77) , and -11.92 (95% CI: -13.90 to -9.94), respectively in LD (learning difficulty) group and they were lower than those of the control group significantly (P< 0.000 01). ②The cause of heterogeneity was analyzed by diagnosis, research field (schools or hospitals), WISC version (WISC-CR or C-WISC) and showed its existing. ③The subgroup analysis showed significant heterogeneity in information(I), classification(SD), arithmetic(A), vocabulary(V), comprehension(C), digit span(D) of 6 subtests of VIQ, and picture completion(PC), picture arrangement(PA), block design(BD), object assembly(OA) and coding(CD) of 5 subtests of PIQ. The results of meta-analysis showed that all kinds of scores of the LD group were significantly lower than those of the control group (P< 0.001). Conclusions FIQ, VIQ and PIQ of Chinese children with learning difficulties were lower than the normal ones, VIQ development was more delayed. The development of I, SD, A and V of all subtests were delayed significantly.
Objective The aim of this study was to assess the quality of clinical practice guidelines(CPGs)using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ) instrument, and to provide a reference for promotion, development and adaptation of the guidelines. The recommendations were compared among guidelines for children and adolescents vitamin D supplementation, and the basic consensus and dispute were focused. Methods PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Chinese Periodical Database, VIP Chinese Periodical Database, National Guideline Clearinghouse and relevant web sites were searched for the guidelines on children and adolescent vitamin D supplementation. The common characteristics of guideline were descriptively analyzed. AGREE Ⅱinstrument was used to evaluate the quality of CPGs. Intraclass correlation coefficient (ICC) was used to examine the conformance of the raters′ evaluation scores. The recommendations of the included guidelines were extracted, analyzed and compared to find the similarities and differences. Results A total of 9 CPGs were identified from the United States, China, Canada, France, Poland and Australia/ New Zealand. The guidelines were published from 2006 to 2012, 3 of them were evidence-based (EB) and 2 used GRADE method, 1 used AHRQ evidence grading system, the rest of 6 were non-EB CPGs made by consensus of experts and article review. ①The AGREEⅡinstrument rated CPGs among 6 domains. "Scope and purpose", "clarity and presentation", and "applicability"were averagely scored ≥50%, "stakeholder involvement", "rigor of development" and "editorial independence" were scored 48%, 42% and 28% respectively and needed improved. EB CPGs had higher quality scores compared with non-EB CPGs for “rigor of development” and “editorial independence”. ② The main recommendations of CPGs were similar. However, there were 5 main differences summarized among CPGs. For prevention of VD deficiency, 400 IU·d-1 of VD was considered as a safe dose for 0-1 year-old group and therefore worthy to be recommended. For treatment of VD deficiency, America(ES) CPGs recommend 2 000 IU·d-1 of VD for at least 6 weeks(1-18 years group). For sun exposure, America and Australia/New Zealand CPGs held different recommendations. For supplement of VD2 or VD3, there was no consensus among included CPGs. For 25OHD level, nearly all CPGs agreed to the increased prevalence of rickets when 25OHD <30 nmol·L-1. For pregnant and lactating women, CPGs recommend that this group should pay attention on VD supplementation, or maintain appropriate 25OHD level. Conclusions ①The overall quality of the included CPGs is still to be improved, and EB CPGs have higher quality scores for “rigor of development”. ②400 IU·d-1 of VD is considered as a safe dose to preventing VD deficiency for all 0-18 years-old groups and therefore worthy to be recommended. ③The recommendations of China CPGs have absorbed the high quality CPGs from other countries, so adaptation and development of Chinese own high-quality CPGs is urgently needed.
Objective To investigate the mRNA expression of growth differentiation factor 15 (GDF15) in peripheral blood from children with newly diagnosed hemophagocytic lymphohistiocytosi (HLH), and to explore the underlying mechanism and clinical implication. Methods Eighteen children with newly diagnosed HLH according to the HLH-2004 diagnostic criteria of the Histiocyte Society and 19 age- and sex-matched healthy children as controls were enrolled in this study. Total RNA was extracted from trace peripheral blood using commercial Omega Blood RNA Kit. Expression of GDF15 mRNA together with ferritin heavy chain (Fn-H) and hypoxic inducible factor （HIF）1α and 2α was determined by EvaGreen real-time RT-PCR, with each sample run in duplicates. Relative expression of target gene was calculated via △△Ct protocol against house-keeping β-actin gene. Complete blood count, serum ferritin and other hemochemical parameters were determined by routine methods. Results Relative expression level of GDF15 mRNA in HLH group was significantly higher than that in control group, with medians of expression being 4.584 and 1.490 respectively (P=0.039). Similarly, Fn-H expression was markedly upregulated in HLH group than that in control group, with median expressions of 3.955 and 1.690 respectively (P=0.008). In addition, GDF15 expression was positively correlated with Fn-H expression (r=0.573, P=0.013), and negatively correlated with the lowest Hb concentration at diagnosis in HLH group (r=-0.576, P=0.015). Nevertheless, GDF15 expression was not correlated to serum ferritin level and other biochemical indeces in HLH group. There were no significantly difference in terms of HIF1α and HIF2α expressions between HLH and control groups. Conclusions Our findings that GDF15 mRNA was remarkably upregulated and independent of HIF-mediated oxygen sensing pathway in children with HLH, strongly suggested GDF15 induction was most probably triggered by sustained and excessive macrophage activation, the hallmark of HLH, and helped suppress further activation of macrophages.
ObjectiveTo investigate the relationship between serum HBV cccDNA，serum fibrosis markers and genotypes of hepatitis B virus and liver tissue pathology to guide the treatment and prognosis. Methods Outpatient and inpatient children with chronic hepatitis B and HBV carriers in the People′s Hospital of Gansu Province and the First Hospital of Lanzhou University from April 2008 to August 2011 were recruited as chronic hepatitis B group and HBV carriers group, healthy children receiving physical examination in the same hospital in the same period were chosen as control group. Serum HA, LN, PC Ⅲ and C Ⅳ were examined in three groups. Based on the severity of the disease, chronic hepatitis B group was further divided into mild, moderate and severe subgroups. Serum HBV cccDNA and HBV genotypes were also detected in chronic hepatitis B group and HBV carriers group. The correlation of HBV cccDNA, liver fibrosis markers, HBV genotypes and degree of liver fibrosis and inflammatory activity was analyzed. ResultsA total of 46 HBV-DNA positive chidren with chronic hepatitis B were enrolled, including 20 cases in HBV carriers group, 26 cases in chronic hepatitis B group (mild in 13 cases, moderate in 8 cases and severe in 5 cases), and 20 children in control group. In chronic hepatitis B group the serum hepatic fibrosis indicator levels were higher than that in the carriers and the mild groups, with the liver tissue inflammation grade and fibrosis degree increased, four liver fiber indexes increased gradually, especially in over grade 2 patients. HA, PC Ⅲ levels in the carrier group were higher than the normal group,there was no obvious correlation between serum HBV cccDNA and the liver tissue inflammatory activity or fibrosis. Liver tissue inflammatory activity and fibrosis degree were more severe in C genotype than in B genotype. ConclusionsThere is no significant direct correlation between the serum HBV cccDNA levels and grade of inflammation or degree of fibrosis.There is good relation between the index of liver fibrosis or hepatitis B virus genotypes and grade of inflammation or degree of fibrosis. The levels of viral replication, alanine transaminase, liver fibrosis and hepatitis B virus genotypes may be very important for the assessment of liver damage.
ObjectiveTo investigate the effect of Astragalus polysaccharide (APS) on the expression of NFATC4 and the regulation of intestinal mucosal immune system in a rat model of inflammatory bowel disease (IBD). Methods The IBD rat model was induced by trinitrobenzene sulfonic acid. Forty five rats were randomly divided into 5 groups: sharm group, IBD group, low-dose APS group (100 mg·kg-1), high-dose APS group (200 mg·kg-1) and dexamethasone control group (dexamethasone 0.3 mg·kg-1). The medications were administrated by intraperitoneal injection once a day for 7 days. Under anesthesia by ether, all animals were sacrificed. The colonic tissue morphological and histopathological changes were estimated by a numerical injury score system, the expression of NFATC4 mRNA was assessed by real time PCR, and the protein expression of NFATC4 was measured by an enzyme linked immunosorbent assay. ResultsThe scores of colonic tissue morphology were: sharm group (0), IBD group (5.67±0.87), low-dose APS group (3.56±0.89), high-dose APS group (1.56±0.53), dexamethasone control group (0.89±0.78). The scores of colonic tissue histopathology were: sharm group (0.11±0.08), IBD group (5.67±1.15), low-dose APS group (3.33±0.58), high-dose APS group (1.33±1.15), dexamethasone control group (1.67±1.52). Both the morphological and histological scores among groups were significantly different (morphology: F=69.195, P<0.001; histology: F=13.34, P<0.01). Histopathological exam confirmed that APS at low and high doses significantly improved mucosal injuries of colon. Compared with IBD group, the expressions of NFATC4 mRNA were increased significantly in high-dose APS group, low-dose APS group and dexamethasone control group (P<0.01), but the protein expressions of NFATC4 were significant increased only in high-dose APS group and dexamethasone control group (P<0.001). ConclusionsAPS improved colonic mucosal injuries by increasing the expression of NFATC4 in a rat model of IBD. Further studies would be needed to investigate the underlying regulatory mechanism of APS-induced NFATC4 change.
ObjectiveTo discuss the risk factors and clinical characteristics of respiratory distress syndrome (RDS) in full-term newborns. Methods Retrospective analysis was conducted among full-term infants with RDS from January 2007 to December 2011, and was compared with the hospitalized full-term newborns without RDS in the same period. The risk factors were studied such as asphyxia, maternal gestational hypertension, diabetes, premature rupture of membranes and were compared between the two groups and one-way ANOVA and multivariate logistic regression were performed. The clinical outcome and complications were also compared between patients using pulmonary surfactant(PS) or not. Results①82.1% (87 cases) of RDS in full-term infants occurred within 6 h after birth, 15.1%(16 cases) occurred within 6-12 h after birth, 2.8%(3 cases) occurred after 12 h after birth, no case occurred after 24 h after birth. The X-ray grades of Ⅰ,Ⅱ,Ⅲ,Ⅳ were in 28 cases（26.4%），36 cases（34.0%），23 cases（21.7%），and 19 cases（17.9%）, respectively. ② In the respects of male, gestational age less than 39 weeks, cesarean section, especially elective cesarean section without medical indications, birth asphyxia, the ratios of RDS group were higher than control group(P<0.05). Logistic regression analysis further suggested that the factors mentioned above were related to full-term newborns with RDS(P<0.05). ③The use of PS reduced the chances of mechanical ventilation, shortened the days of mechanical ventilation, duration of oxygen therapy and hospitalization days, and reduced the incidence of ventilator-associated pneumonia(VAP) (P<0.05) in the RDS group. Compared with the group without use of PS, there was no significant difference between the two groups in the incidence of pneumothorax, pulmonary hemorrhage, persistent pulmonary hypertension of newborn, patent ductus arteriosus did not significantly differ (P>0.05). ConclusionsMale,gestational age less than 39 weeks, cesarean section, especially elective cesarean section without medical indications and neonatal asphyxia are risk factors of RDS in full-term newborns.The using of PS has positive effect on reducing mechanical ventilation chance, delay-on time of mechanical ventilation, the number of days with mechanical ventilation and oxygen therapy days, VAP incidence and hospitalization time of RDS in full-term newborns.
