ObjectiveTo evaluate the value of fetal echocardiography for the prenatal diagnosis of congenital heart disease. MethodsA search in Cochrane Library, PubMed, OVID, Springer, China National Knowledge Infrastructure (CNKI), Wanfang Chinese Periodical Database and Chinese Bio-medicine Database（CBM）was performed to identify relevant English and Chinese language articles from Jan 1990 to Jan 2009. Inclusion criteria were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles were extracted. Statistical analysis was performed by employing Meta-DiSc 1.4 and SPSS 12.0 software. Heterogeneity of the included articles was tested, which was used to select proper effect model to calculate pooled weighted sensitivity and specificity. Summary receiver operating characteristic (SROC) curve was made and the area under the curve (AUC) was calculated. Finally, sensitivity analysis was performed. ResultsEighteen articles were included, with a total of 77 939 fetuses. Seven articles meeting with inclusion criteria were analyzed for the value of basic cardiac echocardiographic examination (BCEE) for the prenatal diagnosis of congenital heart disease. The pooled sensitivity and specificity were 41.7% and 99.9% respectively, AUC=0.978 7. Twelve articles meeting with inclusion criteria were analyzed for the value of extended cardiac echocardiographic examination (ECEE). The pooled sensitivity and specificity were 66.9% and 99.9% respectively, AUC=0.995 6. The sensitivity of ECEE was significantly higher than that of BCEE（χ2=63.93，P<0.05）.The random-effect model was used in the analysis because of the heterogeneity. The layering research and sensitivity analysis were performed on the BCEE and ECEE. The sensitivity of BCEE and ECEE for the prenatal diagnosis of congenital heart disease during the second to third trimester was significantly higher than that during the second trimester（χ2= 5.47，39.37，P<0.05）;The sensitivity of ECEE for the prenatal diagnosis of congenital heart disease for the fetuses of low-risk pregnant women was lower than that of the unselected or high-risk pregnant women（χ2=81.82，156.58，P<0.05）；The sensitivity of ECEE for the prenatal diagnosis of congenital heart disease for the fetuses of unselected pregnant women was not different from that of high-risk pregnant women（χ2=1.67，P>0.05）. ConclusionsThe results suggested that fetal echocardiography was highly accurate and suitable for the prenatal diagnosis of congenital heart disease. Further multicentre and prospective studies are still needed to optimize the ultrasound section and screening subjects by a cost-effectiveness analysis, and develop an operation guideline on fetal echocardiography for the prenatal diagnosis of congenital heart disease suitable for China.
ObjectiveTo evaluate the efficacy of therapeutic hypothermia on mortality,long-term neurodevelopmental disability and clinical major side effects in encephalopathic asphyxiated newborn infants.We summarized the data of hypoxic ischemic encephalopathy (HIE) newborns who were treated with mild hypothermia using meta-analysis method. MethodsThe standard search strategy of the Neonatal Review Group as outlined in the Cochrane Library (Issue 2, 2007) was used. RCTs evaluating therapeutic hypothermia in newborns with hypoxic ischemic encephalopathy were identified by searching the PubMed, EMBASE, Ovid, Springer and CNKI database with the terms "Infant or neonate and asphyxia or hypoxic-ischemic encephalopathy and hypothermia". No language restrictions were applied. RCTs comparing the usage of therapeutic hypothermia with standard care in encephalopathic newborn infants with evidence of peripartum asphyxia and without recognizable major congenital anomalies were included. The primary outcome measure was death or long-term major neurodevelopmental disability. Other outcomes included adverse effects of cooling and other indicators of neurodevelopmental outcome. Two review authors independently selected, assessed the quality of the included studies and extracted data . Authors were contacted for further information. Meta-analysis was performed using relative risk and risk difference for dichotomous data with 95% confidence intervals. ResultsNine trials involving 785 neonates were included in the analysis. Cooling techniques and the definition and severity of neurodevelopmental disability differed among studies. Overall, there was evidence of a significant effect of therapeutic hypothermia on the outcomes of mortality (RR=0.73, 95%CI: 0.58-0.91) and neurodevelopmental disability at 18 to 22 months (RR=0.70,95%CI: 0.53-0.92). Moreover, hypothermia significantly decreased the incidence of disabling cerebral palsy (RR=0.72, 95%CI: 0.53-0.98). However, hypothermia had no effect on developmental delay (RR=0.73, 95%CI: 0.53-0.99), blindness (RR=0.57, 95%CI: 0.30-1.08) and hearing loss (RR=1.52, 95%CI: 0.71-3.25) in newborns with HIE. Adverse effects included benign sinus bradycardia (RR＝6.35, 95% CI: 2.16-18.68) and thrombocytopenia (RR＝1.55, 95% CI: 1.14-2.11) without deleterious consequences. ConclusionsIn general, therapeutic hypothermia seemed to have a beneficial effect on the outcome of neonates with moderate to severe hypoxic ischemic encephalopathy. Despite the methodological differences between trials, wide confidence intervals, and the lack of follow-up data beyond the second year of life, the consistency of the results is encouraging. Further research is necessary to minimize the uncertainty regarding efficacy and safety of any specific technique of cooling for any specific population.
ObjectiveTo investigate the rules of cerebral oxygen saturation (rSO2) changes in neonates with different diseases using near infrared spectroscopy (NIRS) and give useful information for clinical application. MethodsA multicenter randomized clinical trial was conducted in nine regional large hospitals participated from Jan 2007 to Oct 2008.223 term neonates without special diseases were enrolled as the normal group and the cerebral rSO2 was detected at 1, 2 and 3 days after birth respectively using the NIRS human tissue oximeter (TSAH-100).At the same time,196 neonates with diseases possibly effectting the changes of cerebral oxygenation were enrolled as the disease group and the cerebral rSO2 was detected during acute periods.The statistical differences of the cerebral rSO2 between two groups were analyzed. The disease group was further divided into 3 subgroups: respiration disease subgroup (n=97), circulation disease subgroup (n=44) and brain injury subgroup(n=55).The differences of the cerebral rSO2 among different severities of illness were tested.The relationship between cerebral rSO2 and arterial oxygen pressure (PO2) was discussed in respiration disease subgroup. In addition, the relationship between cerebral rSO2 and heart rates was also investigated in circulation disease subgroup.The relationship between cerebral rSO2 and the mean velocity (Vm) and resistent index (RI) in anterior cerebral artery was also investigated in brain injury subgroup. Results①In disease group the cerebral rSO2 was (56±6)%, which was significantly lower than the normal group (t=21.729，P<0.05). ②The cerebral rSO2 of the neonates with serious respiratory disease was (54±6)%, which was significantly lower than those with mild abnormality (60±3) ％( P<0.05). The cerebral rSO2 of the neonates with serious circulation disease was (53±6)%, which was significantly lower than those with mild abnormality (59±3) ％( P<0.05). The cerebral rSO2 of the neonates with severe brain injury was (54±4)%, which was significantly lower than those with mild injury (59±3)％ ( P<0.05).③In the respiratory disease subgroup the cerebral rSO2 was positively correlated with PO2（y=-62.93+4.75x-0.059x2+0.00024x3）.When PO2 was above 60 mmHg,rSO2 was about 62%,cerebral oxygenation was normal. When PO2 was under 50 mmHg,rSO2 was lower than 57%,cerebral hypoxia happened.In the circulation disease subgroup cerebral rSO2 was positively correlated with the heart rates of neonates（y=1.11+0.8241x-0.0027x2）. When heart rates were from 105 to 200 per minute,rSO2 was above 58%,cerebral oxygenation was normal. when heart rate were under 105 or above 200 per minute,the rSO2 decreased to 58% ,there would be cerebral hypoxia. In the brain injury subgroup,when rSO2 was below 58%, the mean velocity (Vm) in cerebral anterior artery was compensatively increased and resistent index (RI) was decreased,and the brain injury was serious. ConclusionsThe cerebral hypoxia may happen in patients with serious diseases.NIRS objectively reflected the cerebral oxygenation alteration,and therefore was a valuable and reliable method for monitoring cerebral hypoxia of neonates in clinic and possibly helpful to find cerebral hypoxia in neonates.
ObjectiveTo investigate the relationship between melamine-contaminated powdered formula and urolithiasis of children in China. MethodsWe administered a questionnaire including sex,age,melamine content,physical examination, urinalysis, ultrasonography in urinary system,renal function, liver function,blood,urinary tests for biochemical markers and so on to the doctors and parents of children aged from 0 to 14 years who were screened for a history of exposure to melamine-contaminated powdered formula.Symptoms and possible predisposing factors of urinary tract stones were collected as well. Melamine-contaminated powdered formulas were classified as having a high melamine content (＞150 mg·kg-1 or exposing to a 2 563 mg·kg-1 melamine content formula before) and low melamine content(≤150 mg·kg-1)groups. According to the period of feeding melamine-contaminated powdered formula,the children were divided into two groups,more than 30 days group and less than 30 days group.The morbidity of urolithiasis was analyzed in different melamine content and different feeding period children including less than 1 year old, -2 years old, -3 years old, -6 years old and -14 years old.The clinical symptoms, laboratory results and recovery rate were also analyzed.SPSS 11.5 was used for statistical analysis. Results22 091 children were screened and urinary stones were found in 374 children,including 223 boys and 151 girls(P<0.001). The high melamine content group had a higher morbidity of urinary tract stones than the low melamine content group in children less than 3 years old children(P<0.001).Similar trend was seen in children aged 3 to 6 years old children(P<0.05), but no difference in children aged from 6 to 14 years old children(P>0.05). Within the high melamine content group, the morbidity of urinary tract stones was similar with each other at different ages(P>0.05). Within the low melamine content group, the morbidity of urinary tract stones was also similar with each other at different ages(P>0.05) except for children aged less than 12 months and 12 to 24 months old children(P>0.05). Among the total of 374 cases that were found urinary tract stones,369 were kidney stones(309 in one side and 60 in both sides),8 were ureter stones(6 in one side and 2 in both sides),4 were cystolith and 2 were urethral calculus.93 patients were admitted to the hospital,of them 8 cases had hematuria (8.6%), 7 cases had leukocyturia, 3 cases had proteinuria (3.2%), 5 cases had crying on urination (5.4%), 2 cases had edema (2.2%) . Laboratory tests:25 cases had elevated blood β2-MG (26.9%), 4 had elevated urine β2-MG(4.3%) , 2 had elevated serum creatinine and urea nitrogen(2.2%). There was no patient with elevated levels of CK-MB and ALT. 9 of the 93 patients received surgical treatment. 34 patients were cured, 55 got better, and 2 were unrecovered. ConclusionsMelamine-contaminated powdered formula was associated with urinary tract stones in children.The morbidity of urolithiasis might not be associated with age.The urolithiasis was probable harmful to kidney function.
Objective：To assess the effects of donor breast milk on preterm infants’growth and neurodevelopment. Methods: Systematic review and meta-analysis of randomized controlled trials or quasi-randomized controlled trials. The standard search strategy of our systematic review included electronic search and manual search. Electronic search was carried out in our library’s databases including PUBMED/MEDLINE, SCIENCEDIRECT (1997-2009), EBSCOHOST (1965-2009), EMBASE (1974-2009), OVID (1993-2009), Cochrane Library, VIP（full-text, 2001－2009）and CNKI (1994－2009). There was no language restriction. As supplement, manual search had also been undertaken, references in studies identified as relevant, and in previous reviews and textbooks of neonatal medicine and nutrition were examined. Results：In our systematic review and meta-analysis only five trials fulfilled the pre-specified inclusion criteria. All the included studies described the methods of randomization and allocation concealment, but no one mentioned whether blindness was used. Statistically significant differences in short-term weight gain(WMD: 5.47; 95％CI: 1.87～9.06; p=0.003) and head circumference increase(WMD: 1.87; 95％CI: 0.06～3.68; p=0.04) were found in preterm infants feeding with preterm formula milk compared with donor breast milk in our meta-analysis, the total effect favored preterm formula milk. But no significant difference was seen in comparisons of short-term length increase, long-term growth and neurodevelopment in this meta-analysis. Conclusion：The evidences to date indicated that preterm infants fed with donor breast milk could result in a lower rate of short-term growth. Due to the limits of this meta-analysis, future scientifically designed trials are still needed to evaluate the effects of fortified donor breast milk/expressed maternal milk on preterm infants’ growth and neurodevelopment.
ObjectiveThe purpose of this study was to summarize the diagnosis and treatment of systemic artery-pulmonary artery fistula (or systemic artery-pulmonary artery malformation) in children. Methods The clinical data of four cases with systemic artery-pulmonary artery fistula who were diagnosed from March 2007 to February 2008 were summarized,including present history, past history, family history, physical examination, complete blood count (CBC), percutaneous oxygen saturation (SpO2)/artery blood gas, chest X-ray (CXR), contrast 64- multidetector-row CT (MDCT), 3D-volume rendering (VR), digital subtraction angiography(DSA) for bronchial arteriography and treatment.All cases were still under follow-up until May 2009. ResultsAll cases were diagnosed as bronchial artery to pulmonary artery fistula,including 1 boy and 3 girls,aged from 2 months old to 11 years old. The major symptom was hemoptysis. Three cases had massive hemoptysis.Case 2 had chest pain and case 4 had dyspnea as accompanied symptom. All cases had no specific signs of this disease except case 2 with clubbing.CXR showed atelectasis or infiltration caused by hemoptysis in three cases.CXR of case 3 was negative.Contrast MDCT and 3D-VR of case 1 showed tortuous bronchial artery and no shunt between systemic artery and pulmonary vessels. Contrast MDCT and 3D-VR of case 2 after transcatheter embolization (TCE) showed tortuous right bronchial artery and probable shunt to pulmonary artery.Contrast MDCT and 3D-VR of case 3 showed bronchial artery to pulmonary artery shunt.Contrast MDCT and 3D-VR of case 4 was negative.Three cases with bronchial artery to pulmonary artery fistula were confirmed by DSA bronchial arteriography and were treated by TCE. Case 3 didn′t receive TCE for the very young age, and had medical treatment instead. There was no evidence of pulmonary artery to pulmonary vein fistula (PAVF) in case 2 although he had clubbing. In follow-up,the disease recurred in case 1 indicated by the recurrence of bloody sputum and did not recur in the other three cases.Three cases were highly suspected as hereditary hemorrhagic telangiectasia(HHT) and the other was higher risk. ConclusionsSystemic artery (bronchial artery)-pulmonary artery fistula could be a rare cause for massive hemoptysis in children. It had no specific signs on CXR. Contrast MDCT and 3D-VR could show the lesion. It was confirmed by DSA. TCE could be used for treatment. Follow-up should be recommanded to understand the natural history and the long- term effects of TCE.
ObjectiveTo evaluate the clinical value and safety of CT-guided percutaneous transthoracic needle biopsy in pediatric patients with pulmonary peripheral lesions. Methods7 cases in respiratory department and 1 case in thoracic surgery were selected as research subjects,who were patients with pulmonary peripheral lesions. All of them were scanned by CT before puncture and intravenous combined anesthesia (propofol and ketamine) were implemented. The puncture point,angle and length were selected according to lesion location, size and posture. The body surface was irradiated by laser light of CT according to selected levels (cross- section location), marked with labels and scanned again. The operator selected the puncture point (vertical section location) up to the requirement, punctured with biopsy needle and obtained lesion tissues (2-3 strips) for pathological examination. ResultsAmong 8 cases,3 were diagnosed malignant sarcomas, 2 benign tumors,2 pulmonary tuberculosis and 1 pulmonary abscess with pleural effusion. Hemoptysis, pneumothorax,or pulmonary hemorrhage was not seen.No complication or death was attributed to percutaneous transthoracic needle biopsy. All cases were diagnosed clearly. ConclusionsCT-guided transthoracic needle biopsy has great value for diagnosis of pediatric pulmonary peripheral lesions.
ObjectiveTo investigate the effect of lead exposure during various gestational periods on the expression of rat placental nitric oxide (NO) and matrix metalloproteinase-9(MMP-9),and their relationship with the placenta cytoarchitecture. Methods108 Wistar rats were randomly divided into four groups and fed with respective drinking solutions with or without 0.025% lead acetate during various gestational periods. Controls were given distilled water without lead; Group A was given distilled water containing 0.025% lead acetate throughout days 1 to 10 of gestation. Both group B and group C were fed with the same lead acetate water during days 11 to 20 or 1 to 20 of gestation, respectively. Blood lead levels were determined by atomic absorption spectrophotometry. The levels of NO were determined by nitrate reductase test. The expression of MMP-9 in placenta was determined by immunohistochemistry. Five microscopic fields (×400) in each placenta were randomly selected. The total cells positive for MMP -9 were counted by same observer for the entire study and verified by a second observer blinded to the study.Five random fields per placenta were scored. The immunoreactive intensity was determined according to immunoreactive cell scores and the immunoreactive chromatosis scores. The immunoreactive cells were scored according to the number of positive cells in each field：0(≤5%),1(-25%),2(-50%),3(-75%) and 4 (>75%). The immunoreactive chromatosis scores were classified into three grades: hadro-chromatosis was scored 3,superficial- chromatosis was scored 1 and that between 1 and 3 was scored 2. The immunoreactive intensity was classified into four grades: 0(-,negative),-2(+,weakly positive),-4(++,moderately positive) and >5(+++,strongly positive).Placenta cytoarchitecture was examined by an unmasked observer with a transmission electron microscope (TEM, Model JEM- 1200EX, Jeol Jem, Tokyo). Pieces of placenta were fixed with 2.5% glutaraldehyde and 1% osmium tetroxide, dehydrated in ethanol of gradient concentrations, and permeated using EPON812 embedding solution. Ultrathin sections were prepared and stained with uranyl acetate and lead citrate. Results① The NO levels of the lead-exposed rat placenta were significantly higher compared to controls (P<0.01). ② The expressions of MMP-9 were detected as yellow-brown pigment localizing in the langhans cells and zoarium trophoblastic cells of placental villus, mesenchymal fibroblasts,vascular endothelial cells and contractile fiber cells of vessel wall. The expression of MMP-9 in lead-exposed rats was significantly higher than that in controls（H= 39.226, P<0.01).The expressions of NF-B between any two groups showed significantly differences. The highest level of expression of MMP-9 was observed in group B, while group C showed the lowest level. ③ In group C, swollen placental microangium endotheliocytes, basal membrane thickening and microvilli evagination were observed under electronic microscopy. In group B, trophoblast giant corpuscles and vacuolization cells were increased in number. In group C, rat placental trophoblast showed cell necrosis, rough endoplasmic reticula appeared distended, mitochondria decreased in number and microvilli quantity decreased. ConclusionsThe expressions of rat placental NO and MMP-9 were associated with placenta cytoarchitectural changes.
