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Global variation in skin injures and skincare practices in extremely preterm infants
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Pranav Jani, Umesh Mishra, Julia Buchmayer, Rajesh Maheshwari, Daphne D*Çruz, Karen Walker, Duygu Gözen, Krista Lowe, Audrey Wright, James Marceau, Mihaela Culcer, Archana Priyadarshi, Adrienne Kirby, James E. Moore, Ju Lee Oei, Vibhuti Shah, Umesh Vaidya, Abdelmoneim Khashana, Sunit Godambe, Fook Choe Cheah, Wen-Hao Zhou, Xiao-Jing Hu, Muneerah Satardien |
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Background: Globally, are skincare practices and skin injuries in extremely preterm infants comparable? This study describes skin injuries, variation in skincare practices and investigates any association between them.
Methods: A web-based survey was conducted between February 2019 and August 2021. Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes. The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions.
Results: Responses from 848 neonatal intensive care units, representing all geographic regions and income status groups were received. Diaper dermatitis (331/840, 39%) and medical adhesive-related skin injuries (319/838, 38%) were the most common injuries. Following a local skincare guideline reduced skin injuries [medical adhesive-related injuries: adjusted odds ratios (aOR) = 0.63, 95% confidence interval (CI) = 0.45每0.88; perineal injuries: aOR = 0.66, 95% CI = 0.45每0.96; local skin infections: OR = 0.41, 95% CI = 0.26每0.65; chemical burns: OR = 0.46, 95% CI = 0.26每0.83; thermal burns: OR = 0.51, 95% CI = 0.27每0.96]. Performing skin assessments at least every four hours reduced skin injuries (abrasion: aOR = 0.48, 95% CI = 0.33每0.67; pressure: aOR = 0.51, 95% CI = 0.34每0.78; diaper dermatitis: aOR = 0.71, 95% CI = 0.51每0.99; perineal: aOR = 0.52, 95% CI = 0.36每0.75). Regional and resource settings-based variations in skin injuries and skincare practices were observed. Conclusions: Skin injuries were common in extremely preterm infants. Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries. Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations. |
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[Abstract] [Full Text] [PDF]
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Gestational age-specific neonatal mortality in Hong Kong: a population-based retrospective study
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Xue-Lian Wang, Eman Leung, Genevieve Po Gee Fung, Hugh Simon Lam |
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Background: The neonatal period is the most vulnerable period during childhood, with the risk of death being the highest even in developed countries/regions. Hong Kong*s neonatal mortality (1㏑) is among the world*s lowest and has remained similar for 15 years. This study aimed to explore neonatal deaths in Hong Kong in detail and determine whether neonatal mortality is reducible at such a low level.
Methods: Live births in public hospitals in Hong Kong during 01 Jan 2006每31 Dec 2017 were included. Relevant data were extracted from the electronic medical records. Gestational age-specific mortality was calculated, and the trends were analyzed using the Cochran每Armitage trend test. Causes of death were summarized, and risk factors were identified in multivariate logistic regression analysis.
Results: In 490,034 live births, 755 cases (1.54㏑) died during the neonatal period, and 293 (0.6㏑) died during the post-neonatal period. The neonatal mortality remained similar overall (P = 0.17) and among infants born at 24每29 weeks* gestation (P = 0.4), while it decreased in those born at 23 (P = 0.04), 30每36 (P < 0.001) and ≡ 37 (P < 0.001) weeks* gestation. Neonates born at < 27 weeks* gestation accounted for a significantly increased proportion among cases who died (27.6% to 51.9%), with hemorrhagic conditions (24%) being the leading cause of death. Congenital anomalies were the leading cause of death in neonates born ≡ 27 weeks* gestation (52%), but its cause-specific mortality decreased (P = 0.002, 0.6㏑ to 0.41㏑), with most of the decrease attributed to trisomy 13/18 and multiple anomalies. Conclusion: Reduction of neonatal mortality in developed regions may heavily rely on improved quality of perinatal and neonatal care among extremely preterm infants. |
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[Abstract] [Full Text] [PDF]
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Association of different central venous pressure levels with outcome of living-donor liver transplantation in children under 12 years
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Yi-Chen Fan, Xiao-Qiang Wang, Dan-Yan Zhu, Xiao-Rong Huai, Wei-Feng Yu, Dian-San Su, Zhi-Ying Pan |
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Background: Pediatric liver transplantation is an important modality for treating biliary atresia. The overall survival (OS) rate of pediatric liver transplantation has significantly improved compared with that of 20 years ago, but it is still unsatisfactory. The anesthesia strategy of maintaining low central venous pressure (CVP) has shown a positive effect on prognosis in adult liver transplantation. However, this relationship remains unclear in pediatric liver transplantation. Thus, this study was conducted to review the data of pediatric living-donor liver transplantation to analyze the associations of different CVP levels with the prognosis of recipients.
Methods: This was a retrospective study and the patients were divided into two groups according to CVP levels after abdominal closure: low CVP (LCVP) (≒ 10 cmH2O, n = 470) and high CVP (HCVP) (> 10 cmH2O, n = 242). The primary outcome measured in the study was the overall survival rate. The secondary outcomes included the duration of mechanical ventilation in the intensive care unit (ICU), length of stay in the ICU, and postoperative stay in the hospital. Patient demographic and perioperative data were collected and compared between the two groups. Kaplan-Meier curves were constructed to determine the associations of different CVP levels with the survival rate.
Results: In the study, 712 patients, including 470 in the LCVP group and 242 in the HCVP group, were enrolled. After propensity score matching, 212 pairs remained in the group. The LCVP group showed a higher overall survival rate than the HCVP group in the Kaplan-Meier curves and multivariate Cox regression analyses (P = 0.018), and the HCVP group had a hazard ratio of 2.445 (95% confidence interval, 1.163每5.140). Conclusion: This study confirmed that a low-CVP level at the end of surgery is associated with improved overall survival and a shorter length of hospital stay. |
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[Abstract] [Full Text] [PDF]
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Clinical characteristics and mortality risk prediction model in children with acute myocarditis
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Shi-Xin Zhuang, Peng Shi, Han Gao, Quan-Nan Zhuang, Guo-Ying Huang |
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Background: Acute myocarditis (AMC) can cause poor outcomes or even death in children. We aimed to identify AMC risk factors and create a mortality prediction model for AMC in children at hospital admission.
Methods: This was a single-center retrospective cohort study of AMC children hospitalized between January 2016 and January 2020. The demographics, clinical examinations, types of AMC, and laboratory results were collected at hospital admission. In-hospital survival or death was documented. Clinical characteristics associated with death were evaluated.
Results: Among 67 children, 51 survived, and 16 died. The most common symptom was digestive disorder (67.2%). Based on the Bayesian model averaging and Hosmer 每Lemeshow test, we created a final best mortality prediction model (acute myocarditis death risk score, AMCDRS) that included ten variables (male sex, fever, congestive heart failure, left-ventricular ejection fraction < 50%, pulmonary edema, ventricular tachycardia, lactic acid value > 4, fulminant myocarditis, abnormal creatine kinase-MB, and hypotension). Despite differences in the characteristics of the validation cohort, the model discrimination was only marginally lower, with an AUC of 0.781 (95% confidence interval = 0.675每0.852) compared with the derivation cohort. Model calibration likewise indicated acceptable fi t (Hosmer每Lemeshow goodness-of-fi t, P¼ = 0.10). Conclusions: Multiple factors were associated with increased mortality in children with AMC. The prediction model AMCDRS might be used at hospital admission to accurately identify AMC in children who are at an increased risk of death. |
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[Abstract] [Full Text] [PDF]
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