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Challenges and improvement in management of neonates born to mothers with COVID-19 in China

Frigid Zone Medicine 2022年第2期2卷 94-102页

作者： Jie Yang Zhuxiao Ren Lingkong Zeng Shiwen Xia Lin Wang Jiayu Miao Zhe Zhao Chuanzhong Yang Xiuyong Cheng Huayan Zhang Yuanfang Zhu Li Liu Xirong Gao Bin Yi Zhenlang Lin Wei Liu Xiaoyu Zhou Benqing Wu Ling Chen Zhankui Li Xuefeng Zhang Wei Lu Lianhong Zhang Xiao Chen Xiaoyun Zhong Falin Xu Jinhui Wu Yong Ji Jiahua Pan Yanxiang Chen Carine Ronsmans Zhichun Feng Department of Neonatology Guangdong Women and Children HospitalGuangzhou 510000China Department of Neonatology Wuhan Children’s HospitalTongji Medical CollegeHuazhong University of Science&TechnologyWuhan 430000China Department of Neonatology Hubei Women and Children HospitalWuhan 430000China Department of Neonatology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430000China Department of Neonatology Seventh Medical CenterPeople’s Liberation Army General HospitalBeijing 100010China Department of Neonatology Affiliated Shenzhen Maternity&Child Healthcare HospitalSouthern Medical UniversityShenzhen 518000China Department of Neonatology the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450000China Division of Neonatology and Center for Newborn care Guangzhou Women and Children’s HospitalGuangzhou 510000China Division of Neonatology Children’s Hospital of PhiladelphiaPhiladelphiaPennsylvania 19104United States Department of Obstetrics Shenzhen Baoan Women’s and Children’s HospitalJinan UniversityShenzhen 518000China Department of Neonatology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi'an 710000China Department of Neonatology Hunan Children's HospitalChangsha410000China Department of Neonatology Gansu Provincial Maternal and Child Health HospitalLanzhou 730000China Department of Neonatology Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhou 325000China Department of Pediatrics Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430000China Neonatal Medical Centre Children's Hospital of Nanjing Medical UniversityNanjing 210000China Department of Neonatology The University of Chinese Academy of Science-Shenzhen HospitalShenzhen 518000China Department of Neonatology Northwest Women and Children's HospitalXi’an 730000China Department of Neonatology The Fifth Medical CenterPeople’s Liberation Army General HospitalBeijing 100010China Neonatal intensive care

Objective:China was the first country suffering from the SARS-CoV-2 pandemic and one of the countries with stringent mother-neonate isolation measure *** increasing evidence suggests that coronavirus disease 2019(COVID-19)should not be taken as an indication for formula feeding or isolation of the infant from the ***:We conducted a retrospective cohort study in 44 hospitals from 14 provinces in China to investigate the management of neonates whose mothers have confirmed or suspected *** addition,65 members of Chinese Neonatologist Association(CNA)were invited to give their comments and suggestions on the clinical management guidelines for high-risk ***:There were 121 neonates born to 118 mothers suspected with COVID-19 including 42 mothers with SARS-CoV-2 positive results and 76 mothers with SARS-CoV-2 negative *** neonates were born by caesarean section,isolated from their mothers immediately after birth and were *** neonates were positive for SARSCoV-2 at initial testing between 36 and 46 h after *** the confusion on the clinical management guidelines,58.78%of the newborns were put into isolation,32.22%were subject to PCR tests,and 5.16%and 2.75%received breastfeeding and vaccination,***:The clinical symptoms of neonates born to mothers with confirmed SARS-CoV-2 were mild,though five neonates might have been infected in utero or during *** the favorable outcomes of neonates born to COVID-confirmed mothers,full isolation may not be ***,separation of the mother and her newborn should be assessed on a case-by-case basis,considering local facilities and risk factors for adverse outcomes,such as prematurity and fetal distress.

关键词： coronavirus disease 2019 neonates pregnant women infection control

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《中华危重病急救医学》杂志稿约

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中华危重病急救医学 2021年第1期33卷 126-128页

作者： Nannan D. Li Y. Zhigang Z. Liping Y. Lingjie J. Biantong J. Yuchen W. Caiyun Z. Jinhui T. Department of intensive care Unit The First Hospital of Lanzhou University Lanzhou Gansu 730000 China Department of Nursing The First Hospital of Lanzhou University Lanzhou Gansu 730000 China Evidence-Based Medicine Center Lanzhou University Lanzhou Gansu 730000 China

本刊为中华医学会主办的重症医学专业性学术期刊,从2013年起由《中国危重病急救医学》更名为《中华危重病急救医学》,月刊.每月28日出刊,国内外公开发行。本刊把“关注学科发展、服务学科发展、促进学科发展、引领学科发展”作为办刊宗... 详细信息

本刊为中华医学会主办的重症医学专业性学术期刊,从2013年起由《中国危重病急救医学》更名为《中华危重病急救医学》,月刊.每月28日出刊,国内外公开发行。本刊把“关注学科发展、服务学科发展、促进学科发展、引领学科发展”作为办刊宗旨,以服务广大医药卫生科技人员,促进国内外医学学术交流和发展,全面反映我国重症医学基础理论及临床科研成果,快速传递国内外重症医学前沿信息,推广现代重症医学先进技术,及时交流危重病患者的诊治经验,大力普及医学科技新知识为己任。

关键词：办刊宗旨医学基础理论重症医学中华医学会危重病患者学术交流医学科技专业性学术期刊

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Impact of initial fluid resuscitation volume on clinical outcomes in patientswith heart failure and septic shock

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Journal of intensive Medicine 2023年第3期3卷 254-260页

作者： Adam L.Wiss Bruce A.Doepker Brittany Hoyte Logan M.Olson Kathryn A.Disney Eric M.McLaughlin Vincent Esguerra Jessica L.Elefritz Department of Pharmacy Ascension Saint Thomas Hospital WestNashvilleTN 37205USA Department of Pharmacy The Ohio State University Wexner Medical CenterColumbusOH 43210USA Department of Pharmacy Corewell HealthGrand RapidsMI 49503USA Department of Pharmacy Nebraska MedicineOmahaNE 68105USA Department of Pharmacy Huntsman Cancer Institute at the University of UtahSalt Lake CityUT 84112USA Center for Biostatistics The Ohio State UniversityColumbusOH 43210USA Division of Pulmonary AllergyCritical Careand Sleep Medicine.The Ohio State University Wexner Medical CenterColumbusOH 43210USA

Background:Fluid resuscitation is a key treatment for sepsis,but limited data exists in patients with existing heartfailure(HF)and septic *** objective of this study was to determine the impact of initial fluid resuscitationvolume on outcomes in HF patients with reduced or mildly reduced left ventricular ejection fraction(LVEF)withseptic ***:This multicenter,retrospective,cohort study included patients with known HF(LVEF≤50%)presentingwith septic *** were divided into two groups based on the volume of fluid resuscitation in the first 6 h;<30 mL/kg or≥30 mL/*** primary outcome was a composite of in-hospital mortality or renal replacementtherapy(RRT)within 7 *** outcomes included acute kidney injury(AKI),initiation of mechanicalventilation,and length of stay(LOS).All related data were collected and compared between the two groups.A generalized logistic mixed model was used to assess the association between fluid groups and the primaryoutcome while adjusting for baseline LVEF,Acute Physiology and Chronic Health Evaluation(APACHE)II score,inappropriate empiric antibiotics,and receipt of ***:One hundred and fifty-four patients were included(93 patients in<30 mL/kg group and 61 patientsin≥30 mL/kg group).The median weight-based volume in the first 6 h was 17.7(12.2–23.0)mL/kg in the<30 mL/kg group vs.40.5(34.2–53.1)mL/kg in the≥30 mL/kg group(P<0.01).No statistical difference was detected in the composite of in-hospital mortality or RRT between the<30 mL/kg group compared to the≥30 mL/kggroup(55.9%vs.45.9%,P=0.25),***<30 mL/kg group had a higher incidence of AKI,mechanicalventilation,and longer hospital ***:In patients with known reduced or mildly reduced LVEF presenting with septic shock,no differencewas detected for in-hospital mortality or RRT in patients who received≥30 mL/kg of resuscitation fluid comparedto less fluid,although this study was underpowered to detect a ***

关键词： Sepsis Septic shock Heart failure Fluid resuscitation

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Aggressive versus controlled fluid resuscitation in acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials

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Chinese Medical Journal 2023年第10期136卷 1166-1173页

作者： Kun He Lin Gao Zihan Yang Yuelun Zhang Tianrui Hua Wenmo Hu Dong Wu Lu Ke Department of Gastroenterology State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Critical care Medicine Center of Severe Acute Pancreatitis(CSAP)Jinling HospitalMedical School of Nanjing UniversityNanjingJiangsu 210010China Department of Internal Medicine Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Medical Research Center State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China National Institute of Healthcare Data Science Nanjing UniversityNanjingJiangsu 210010China

Background:Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis(AP),but there is no consensus on the optimal fluid *** systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive *** fluid resuscitation(CFR)in ***:The Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE,Embase,and Web of Science databases were searched up to September 30,2022,for randomized controlled trials(RCTs)comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on *** following keywords were used in the search strategy:"pancreatitis,""fluid therapy,""fluid resuscitation,"and"randomized controlled trial."There was no language *** Grading of Recommendations Assessment,Development and Evaluation(GRADE)framework was used to assess the certainty of *** sequential analysis(TSA)was used to control the risk of random errors and assess the ***:A total of five RCTs,involving 481 participants,were included in this *** primary outcomes,there was no significant difference in the development of severe AP(relative risk[RR]:1.87,95%confidence interval[CI]0.95-3.68;P=0.07;n=437;moderate quality of evidence)or hypovolemia(RR:0.98,95%CI:0.32-2.97;P=0.97;n=437;moderate quality of evidence)between the aggressive and CFR groups.A significantly higher risk of fluid overload(RR:3.25,95%CI:1.53-6.93;Pintensive care unit admission(P=0.02)and the length of hospital stay(P<0.01)as partial secondary outcomes were higher in the AFR *** suggested that more studies were required to draw precise ***:For AP patients without organ failure on admission,CFR may be superior to AFR with respect to both efficacy and safety ***:PROSPERO;https:

关键词： Acute pancreatitis Aggressive fluid resuscitation Controlled fluid resuscitation Efficacy Safety Systemic review

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Brain-lung crosstalk: Implications for neurocritical care patients

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World Journal of Critical care Medicine 2015年第3期4卷 163-178页

作者： Ségolène Mrozek Jean-Michel Constantin Thomas Geeraerts Anesthesiology and Critical care Department Equipe d’accueil "Modélisation de l’agression tissulaire et nociceptive" University Hospital of Toulouse Department of Anesthesiology and Critical care Medicine Estaing Hospital University Hospital of Clermont-Ferrand

Major pulmonary disorders may occur after brain injuries as ventilator-associated pneumonia, acute respiratory distress syndrome or neurogenic pulmonary edema. They are key points for the management of brain-injured patients because respiratory failure and mechanical ventilation seem to be a risk factor for increased mortality, poor neurological outcome and longer intensive care unit or hospital length of stay. Brain and lung strongly interact via complex pathways from the brain to the lung but also from the lung to the brain. Several hypotheses have been proposed with a particular interest for the recently described "double hit" model. Ventilator setting in brain-injured patients with lung injuries has been poorly studied and intensivists are often fearful to use some parts of protective ventilation in patients with brain injury. This review aims to describe the epidemiology and pathophysiology of lung injuries in brain-injured patients, but also the impact of different modalities of mechanical ventilation on the brain in the context of acute brain injury.

关键词： Brain-lung crosstalk Brain injury Lung injury Protective ventilation Double hit model

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Glycemic management in critically ill patients

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World Journal of Surgical Procedures 2016年第3期6卷 30-39页

作者： Eden A Nohra Jarot J Guerra Grant V Bochicchio Section of Acute and Critical care Surgery Department of SurgeryWashington University in St.Louis

Hyperglycemia associated with critical illness,also called "stress hyperglycemia" or "stress diabetes",is a consequence of many pathophysiologic hormonal responses including increased catecholamines,cortisol,glucagon,and growth *** in multiple biochemical pathways result in increased hepatic and peripheral insulin resistance with an uncontrolled activation of gluconeogenesis and *** has a negative impact on the function of the immune system,on the host response to illness or injury,and on infectious and overall *** degree of glucose elevation is associated with increased disease *** randomized controlled trials including the Van den Berghe study,the NICE-SUGAR trial,VISEP and GLUCONTROL have shown that the control of glucose levels in critically ill patients has implications on outcome and that both hyperglycemia and hypoglycemia are detrimental and should be *** variability has also been shown to be *** glucose control strategies have changed due to the concerns of hypoglycemia and therefore intermediate target glucose control strategies are most often *** patient populations may vary with regards to optimal glucose targets,timing and approach for glucose control,and with regards to the prognostic significance of glucose excursions and ***,surgical,and trauma patients may benefit at different rates from glucose control and the approach may need to be adapted to various medical settings and to correspond to the workflow of health *** modifiers for the success of insulin therapy for hyperglycemia include the methods of nutritional supplementation and exogenous glucose *** research is required to improve insulin protocols for glucose control,to further define glucose targets,and to enhance the accuracy of glucose measuring technologies.

关键词： Hyperglycemia Hypoglycemia Critically ill intensive care unit Glucose control

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在加利福尼亚Kaiser早产儿医疗护理规划中的中度早产儿的出院时间早于与之相匹配的马萨诸塞州及英国婴儿

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世界核心医学期刊文摘（儿科学分册） 2006年第12期2卷 9-10页

作者： Profit J. Zupancic J.A.F. McCormick M.C. 李开 Houston Center for Quality of care and Utilization Studies Division of Health Policy and QualityVAHSR and D (152)2002 Holcombe BoulevardHoustonTX 77030United States Dr.

Objective:To compare gestational age at discharge between infants born at 30-34+6 weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California,Massachusetts,and the United Kingdom. Design:Prospective observational cohort study. Setting:Fifty four United Kingdom,five California,and five Massachusetts NICUs. Subjects:A total of 4359 infants who survived to discharge home after admission to an NICU. Main outcome measures:Gestational age at discharge home. Results:The mean (SD) postmenstrual age at discharge of the infants in California,Massachusetts,and the United Kingdom were 35.9 (1.3),36.3 (1.3),and 36.3(1.9)weeks respectively (p = 0.001). Compared with the United Kingdom,adjusted discharge of infants occurred 3.9 (95%confidence interval (CI) 1.4 to 6.5) days earlier in California,and 0.9 (95%CI -1.2 to 3.0) days earlier in Massachusetts. Conclusions:Infants of 30-34+6 weeks gestation at birth admitted and cared for in hospitals in California have a shorter length of stay than those in the United Kingdom. Certain characteristics of the integrated healthcare approach pursued by the health maintenance organisation of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants.

关键词： Kaiser 马萨诸塞州尼亚健康护理前瞻性队列研究受试对象住院治疗实践验证

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Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes

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中国医学科学杂志（英文版） 2016年第4期 213-220页

作者： Ming-chao Fan Qiao-ling Wang Wei Fang Yun-xia Jiang Lian-di Li Peng Sun Zhi-hong Wang Department of Neurological intensive care Unit the Affiliated Hospital of Qingdao University Community Medical Service Center of Shuiqinggou Street Nursing School Medical College of Qingdao University Department of Neurosurgery the Affiliated Hospital of Qingdao University Department of Geriatric Medicine the Affiliated Hospital of Qingdao University

Objective To compare the conjoint effect of enteral nutrition(EN) and parenteral nutrition(PN) with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patients with severe traumatic brain injury(STBI). Methods A prospective randomized control trial was carried out from January 2009 to May 2012 in Neurological intensive care Unit(NICU). Patients of STBI who met the enrolment criteria(Glasgow Coma Scale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administrated EN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function, complications and clinical outcomes were examined and compared statistically. Results There were 120 patients enrolled in the study, with 40 pationts in each group. In EN+PN group, T lymthocyte subsets CD3+%, CD4+%, ratio of CD3+/CD25+, ratio of CD4+/CD8+, the plasma levels of IgA, IgM, and Ig G at 20 days after nutritional treatment were significantly increased compared to the baseline(t=4.32-30.00, P<0.01), and they were significantly higher than those of PN group(t=2.44-14.70;P<0.05,or P<0.01) with exception of CD4+/CD8+, higher than those of EN group(t=2.49-13.31, P<0.05, or P<0.01) with exceptions of CD3+/CD25+, CD4+/CD8+, Ig G and Ig M. For the nutritional status, the serum total protein, albumin, prealbumin and hemoglobin were significantly higher in the EN(t=5.87-11.91; P<0.01) and EN+PN groups(t=6.12-13.12; P<0.01) than those in PN group after nutrition treatment. The serum prealbumin was higher in EN+PN group than that in EN group(t=2.08; P<0.05). Compared to the PN group, the complication occurrence rates of EN+PN group were significantly lower in stress ulcer(22.5% vs. 47.5%; χ~2= 8.24, P<0.01), intracranial infection(12.5% vs 32.5%;χ~2= 6.88, P<0.01) and pyemia(25.0% vs. 47.5%; χ~2= 6.57, P<0.05). Compared to the EN group, the complication occurrence rates of EN+PN group were significantly lower in aspirated pneumonia(27.5

关键词： enteral nutrition parenteral nutrition severe traumatic brain injury immune function complication

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Clinical and Evolutionary Characteristics of Pregnant and Postpartum Women with COVID-19 Admitted to a Hospital in the Central Region of Brazil

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Open Journal of Obstetrics and Gynecology 2022年第8期12卷 770-783页

作者： Eloísa Helena Kubiszeski Maria Aparecida Mazzutti Verlangieri Do Carmo Anselmo Verlangieri Do Carmo Marcial Francis Galera Federal University of Mato Grosso Postgraduate Program in Health Sciences Faculty of Medicine Cuiabá Brazil Women’s Health care Unit Júlio Müller University Hospital UFMT EBSERH Cuiabá Brazil Federal University of Mato Grosso Department of Gynecology and Obstetrics Faculty of Medicine Cuiabá Brazil Federal University of Mato Grosso Department of Pediatrics Faculty of Medicine Cuiabá Brazil

Objective: To describe the demographic and evolutionary characteristics of pregnant and postpartum women with coronavirus disease 2019 (COVID-19) admitted to a medium-sized hospital in Brazil. Method: This is a descriptive and retrospective study, collected from medical records, from March 2020 to October 2021 in a hospital located in Cuiabá (MT). Results: Pregnant and puerperal women with COVID-19 who needed hospitalization were mixed-race, from the metropolitan area, and carriers of moderate and severe forms of the disease. The primary risk condition found was overweight/obesity, and pre-gestational diabetes, hypertension, asthma, and autoimmune disease were the most prevalent comorbidities in the group. Elevated lactate dehydrogenase (LDH), c-reactive protein (CRP), and D-dimer were relevant laboratory findings in this group of patients. The most frequent maternal outcomes were respiratory failure, invasive ventilatory support, thromboembolic phenomena, sepsis, and preterm labor. Maternal death occurred in 6.4% of pregnant women. Most maternal deaths were of women who lived in the interior of the state, and the minority arrived on adequate ventilatory support. Prematurity and the need for neonatal intensive care unit (NICU) were significant complications for neonates. Stillbirth/neonatal mortality occurred in 11.0%. Conclusion: The clinical conditions at hospitalization were associated with worse living conditions and lack of access to health care, resulting in increased chances of severity and worsening outcomes in this group of women and neonates.

关键词： Analysis of Consequences Coagulation Disorders Coronavirus Disease 2019 intensive care Maternal Mortality Neonatal Outcomes Pregnancy SARS-CoV-2

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Artificial intelligence in critically ill diabetic patients:current status and future prospects

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Artificial Intelligence in Gastroenterology 2022年第2期3卷 66-79页

作者： Deven Juneja Anish Gupta Omender Singh Institute of Critical care Medicine Max Super Speciality HospitalSaketNew Delhi 110092India

Recent years have witnessed increasing numbers of artificial intelligence(AI)based applications and devices being tested and approved for medical *** is arguably the most common chronic disorder worldwide and AI is now being used for making an early diagnosis,to predict and diagnose early complications,increase adherence to therapy,and even motivate patients to manage diabetes and maintain glycemic ***,these AI applications have largely been tested in non-critically ill patients and aid in managing chronic *** care units(ICUs)have a dynamic environment generating huge data,which AI can extract and organize simultaneously,thus analysing many variables for diagnostic and/or therapeutic purposes in order to predict outcomes of *** non-diabetic ICU patients are at risk of developing hypo or hyperglycemia,complicating their ICU course and affecting *** addition,to maintain glycemic control frequent blood sampling and insulin dose adjustments are required,increasing nursing workload and chances of *** has the potential to improve glycemic control while reducing the nursing workload and *** glucose monitoring(CGM)devices,which are Food and Drug Administration(FDA)approved for use in non-critically ill patients,are now being recommended for use in specific ICU populations with increased *** based devices including artificial pancreas and CGM regulated insulin infusion system have shown promise as comprehensive glycemic control solutions in critically ill *** though many of these AI applications have shown potential,these devices need to be tested in larger number of ICU patients,have wider availability,show favorable cost-benefit ratio and be amenable for easy integration into the existing healthcare systems,before they become acceptable to ICU physicians for routine use.

关键词： Artificial intelligence Blood glucose Critical care Diabetes mellitus intensive care unit Machine learning

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