ARCHIVES OF DISEASE IN CHILDHOOD 是一份国际同行评审期刊，旨在让儿科医生和其他人了解儿童疾病诊断和治疗方面的最新进展，以及儿童保护等宣传问题。它侧重于从围产期（胎儿和新生儿版）到青春期的儿童健康和疾病的各个方面。 ADC 包括原始研究报告、评论、临床和政策问题评论以及证据报告。涵盖的领域包括：社区儿童健康、公共卫生、流行病学、急性儿科、宣传和伦理。

The Archives of Disease in Childhood: Fetal and Neonatal Edition is an international peer-reviewed journal aimed at keeping pediatricians and others informed about the latest advances in the diagnosis and treatment of childhood diseases, as well as issues related to child protection. The journal focuses on all aspects of child health and disease from the perinatal period (fetal and neonatal) to adolescence. It includes original research reports, reviews, discussions on clinical and policy issues, and evidence reports, covering areas such as community child health, public health, epidemiology, acute pediatrics, advocacy, and ethics.

《Archives of Disease in Childhood: Fetal and Neonatal Edition》是一本国际同行评审的学术期刊，旨在为儿科医生及其他相关人员提供儿童疾病诊断和治疗的最新进展，以及儿童保护等相关问题的宣传。期刊内容涵盖从围产期（胎儿和新生儿）到青春期的儿童健康与疾病的各个方面。期刊包括原始研究报告、评论、临床和政策问题的讨论以及证据报告，涉及的领域包括社区儿童健康、公共卫生、流行病学、急性儿科、宣传和伦理等。

Archives of Disease in Childhood: Fetal and Neonatal Edition

<h3>Context</h3> In spontaneously breathing preterm infants with respiratory distress syndrome (RDS) receiving nasal continuous positive airway pressure, a method of less invasive surfactant administration (LISA) using a thin catheter has been described as an alternative to endotracheal intubation for surfactant delivery to reduce lung injury. <h3>Objective</h3> A systematic review of randomised controlled trials (RCTs) comparing LISA with the standard method of surfactant delivery for clinical outcomes. <h3>Methods</h3> Medline, CENTRAL and Embase databases were searched (until 29 October 2015). Additional citations were identified from trial registries, conference proceedings and the bibliographies of selected articles. The included studies were RCTs enrolling preterm infants with RDS and compared LISA technique with intubation for surfactant delivery for any of the prespecified clinical outcomes. <h3>Results</h3> Six RCTs were identified, enrolling a total of 895 infants. The use of LISA technique reduced the composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 weeks (risk ratio (RR)=0.75 (95% CI 0.59 to 0.94), p=0.01), BPD<sub>36</sub> among survivors (RR=0.72 (0.53 to 0.97), p=0.03), need for mechanical ventilation within 72 hours of birth (RR=0.71 (0.53 to 0.96), p=0.02) or need for mechanical ventilation anytime during the neonatal intensive care unit stay (RR=0.66 (0.47 to 0.93), p=0.02). There were no differences noted for the outcome of death and other neonatal morbidities. Procedure failure rate on the first attempt and the need for additional doses of surfactant were not different between the intervention groups. <h3>Conclusions</h3> LISA technique for surfactant delivery results in a lesser need for mechanical ventilation in infants with RDS, reduction in the composite outcome of death or BPD at 36 weeks, and BPD<sub>36</sub> among survivors.

Jose C Aldana-Aguirre

Merlin Pinto

Robin M Featherstone

Manoj Kumar

Archives of Disease in Childhood Fetal & Neonatal

Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis

早产儿呼吸窘迫综合征中无创表面活性物质给药与插管给药的比较：系统评价与meta分析

To determine the impact of supplemental bovine lactoferrin on the gut microbiome and metabolome of preterm infants.Cohort study nested within a randomised controlled trial (RCT). Infants across different trial arms were matched on several clinical variables. Bacteria and metabolite compositions of longitudinal stool and urine samples were analysed to investigate the impact of lactoferrin supplementation.Thirteen UK hospitals participating in a RCT of lactoferrin.479 infants born <32 weeks' gestation between June 2016 and September 2017.10 990 stool and 22 341 urine samples were collected. Analyses of gut microbiome (1304 stools, 201 infants), metabolites (171 stools, 83 infants; 225 urines, 90 infants) and volatile organic compounds (314 stools, 117 infants) were performed. Gut microbiome Shannon diversity at 34 weeks corrected age was not significantly different between infants in the lactoferrin (mean=1.24) or placebo (mean=1.06) groups (p=0.11). Lactoferrin receipt explained less than 1% variance in microbiome compositions between groups. Metabolomic analysis identified six discriminative features between trial groups. Hospital site (16%) and postnatal age (6%) explained the greatest variation in microbiome composition.This multiomic study identified minimal impacts of lactoferrin but much larger impacts of hospital site and postnatal age. This may be due to the specific lactoferrin product used, but more likely supports the findings of the RCT in which this study was nested, which showed no impact of lactoferrin on reducing rates of sepsis. Multisite mechanistic studies nested within RCTs are feasible and help inform trial interpretation and future trial design.

Greg Young

Janet E Berrington

Stephen Cummings

Jon Dorling

Andrew K Ewer

Alessandra Frau

Lauren Lett

Chris Probert

Ed Juszczak

John Kirby

Lauren C Beck

Victoria L Renwick

Christopher Lamb

Clare V Lanyon

William McGuire

Christopher Stewart

Nicholas Embleton

Mechanisms affecting the gut of preterm infants in enteral feeding trials: a nested cohort within a randomised controlled trial of lactoferrin

早产儿肠内喂养试验中影响肠道的机制：一项随机对照试验中的嵌套队列研究

Objective During interhospital transfer, critically ill neonates frequently require mechanical ventilation and are exposed to physical forces related to movement of the ambulance. In an observational study, we investigated acceleration during emergency transfers and if they result from changes in ambulance speed and direction or from vibration due to road conditions. We also studied how these forces impact on performance of the fabian+nCPAP evolution neonatal ventilator and on patient-ventilator interactions. Methods We downloaded ventilator parameters at 125 Hz and acceleration data at 100 Hz sampling rates, respectively, during the emergency transfer of 109 infants. Study subjects included term, preterm and extremely preterm infants. We computationally analysed the magnitude, direction and frequency of ambulance acceleration. We also analysed maintenance and variability of ventilator parameters and the shape of pressure-volume loops. Results While acceleration was &lt;1 m/s 2 most of the time, most babies were occasionally exposed to accelerations&gt;5 m/s 2 . Vibration was responsible for most of the acceleration, rather than speed change or vehicle turning. There was no significant difference between periods of high or low vibration in ventilation parameters, their variability and how well targeted parameters were kept close to their target. Speed change or vehicle turning did not affect ventilator parameters or performance. However, during periods of intense vibration, pressure-volume ventilator loops became significantly more irregular. Conclusions Infants are exposed to significant acceleration and vibration during emergency transport. While these forces do not interfere with overall maintenance of ventilator parameters, they make the pressure-volume loops more irregular.

Lajos Lantos

András Széll

David Chong

Zsolt Somogyvári

Gusztav Belteki

Acceleration during neonatal transport and its impact on mechanical ventilation

新生儿转运过程中的加速及其对机械通气的影响

Postnatal cytomegalovirus (pCMV) infection is a common viral infection typically occurring within the first months of life. pCMV refers to postnatal acquisition of CMV rather than postnatal manifestations of antenatal or perinatal acquired CMV. pCMV is usually asymptomatic in term infants, but can cause symptomatic disease in preterm (gestational age &lt;32 weeks) and very low birth weight (&lt;1500 g) infants resulting in sepsis, pneumonia, thrombocytopaenia, neutropaenia, hepatitis, colitis and occasionally death. There are significant uncertainties regarding the management of premature infants with pCMV disease which is in part due to our limited understanding of the natural history of this disease. This review describes the current epidemiology and clinical manifestations of pCMV disease which should alert clinicians to test for CMV and also outlines a strategy to manage the condition.

Seilesh Kadambari

Elizabeth Whittaker

Hermione Lyall

Postnatally acquired cytomegalovirus infection in extremely premature infants: how best to manage?

极早产儿出生后获得性巨细胞病毒感染：如何最佳管理？

Background: Multiorgan dysfunction (MOD) is one of four consensus based criteria for the diagnosis of intrapartum asphyxia. The theoretical concept behind MOD is the diving reflex (conservation of blood flow to vital organs at the cost of non-vital organs). Objectives: To assess the patterns of involvement of each major organ/system and combinations of involvement in infants with post-asphyxial hypoxic-ischaemic encephalopathy (HIE), and to describe this in relation to long term outcome. Design: Retrospective cohort study. Setting: Regional tertiary neonatal intensive care unit at the Hospital for Sick Children, Toronto, Canada. Patients: Term neonates with post-intrapartal asphyxial HIE assessed for kidney, cardiovascular system, lung, and liver function. Outcome: Death and presence or absence of severe neurodevelopmental disability. Results: Out of 130 of 144 eligible infants with outcome data, 80 (62%) had severe adverse outcome and 50 (38%) had good outcome. All infants had evidence of MOD (at least one organ dysfunction in addition to HIE). Renal, cardiovascular, pulmonary, and hepatic dysfunction was present in 58–88% of infants with good outcome and 64–86% of infants with adverse outcome. Conclusions: MOD was present in all the infants with severe post-asphyxial HIE. However, there was no association between MOD and outcome in these infants. No relation between individual or combinations of organ involvements and long term outcomes was observed.

P Shah

Archives of Disease in Childhood - Fetal and Neonatal Edition

Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy

婴儿缺氧缺血性脑病后多器官功能障碍

Objective To evaluate if postnatal treatment with betamethasone in extremely preterm infants was associated with neurodevelopmental impairment (NDI) at 6.5 years of age. Design Prospective cohort study. Setting Extremely Preterm Infants in Sweden Study (gestational age &lt;27 weeks, born 2004–2007). Patients 428 children born extremely preterm were assessed at 6.5 years of age, 115 treated with betamethasone and 313 not treated. Main outcome measures NDI at 6.5 years of age. Evaluation at 6.5 years included cognitive testing with the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), neurological examination and a medical record review. Exposure Treatment with postnatal betamethasone. Main outcome Moderate to severe NDI at 6.5 years of age, defined as a composite including cerebral palsy, and/or impairment in cognition, hearing and vision. Results Moderate to severe NDI was more prevalent in children treated with postnatal betamethasone (49% treated vs 26% not treated, p&lt;0.001). Betamethasone-treated children had worse cognitive development with mean WISC-IV score of 75 (SD 13.7) vs 87 (SD 14.0, p&lt;0.001). The effect was dose dependent: 1.35 mg/kg vs 1.0 mg/kg (p=0.01) in betamethasone-treated children with moderate to severe versus no or mild NDI, respectively. The differences remained after adjustment for potential confounders with logistic regression (adjusted OR (aOR) 1.80, 95% CI 1.14 to 3.21). The difference in NDI also remained after propensity score matching, with crude OR 2.82 (95% CI 1.42 to 5.61, p=0.003) and aOR 2.17 (95% CI 1.07 to 4.69, p=0.04). Conclusion Postnatal treatment with betamethasone is associated with increased risk of NDI at 6.5 years.

Linn Löfberg

Fredrik Serenius

Lena Hellstrom-Westas

Elisabeth Olhager

David Ley

Aijaz Farooqi

Olof Stephansson

Thomas Abrahamsson

Postnatal betamethasone treatment in extremely preterm infants and risk of neurodevelopmental impairment: a cohort study

极早产儿出生后使用倍他米松治疗与神经发育障碍风险：一项队列研究

Background and aim Unplanned extubation (UE) is an adverse event that can occur for neonates that are intubated and mechanically ventilated. UE is recognised as an important quality measure in the neonatal intensive care unit (NICU) due to the negative impact these events may have on the neonate. We aimed to use quality improvement (QI) methodology to reduce the rate of UE to the global standard of &lt;1/100 ventilation days. Methods A 12-month retrospective audit on mechanically ventilated neonates in our NICU identified a mean UE rate of 1.78/100 ventilation days. A clinical guideline focusing on best practice was introduced with key interventions identified by a review of the literature as those which were thought to reduce UE rates. The key interventions in the clinical guideline were introduced sequentially. UE rates were analysed monthly using control charts and the reported cause of each UE event was analysed. Three 12-month periods were included: preintroduction of QI interventions (period 1), during introduction of QI interventions (period 2), and after introduction of QI interventions (period 3). Results The introduced interventions reduced the mean rate of UE from 1.78/100 ventilation days in period 1 to 0.8/100 ventilation days in period 3 of the QI project. Conclusions The key interventions introduced in this QI project were successful in reducing rates of UE by 55%, allowing achievement of the global standard of &lt;1/100 ventilation days.

Samantha Tyrer

Risha Bhatia

Anna Kidman

Riannah Fitzgerald

Calum T Roberts

Reducing unplanned extubation in the neonatal intensive care unit: a quality improvement project

降低新生儿重症监护室非计划性拔管率：一项质量改进项目

Sarah A Coggins

Karen M Puopolo

Arch Dis Child Fetal Neonatal Ed

Intrapartum antibiotic prophylaxis for group B<i>Streptococcus</i>: what exactly is adequate?

B族链球菌分娩期抗生素预防：究竟何为充分？

Katherine Jane Pettinger

R Spencer

Sam J Oddie

Perinatal medicine’s best treatment: how should we be using antenatal steroids?

围产医学的最佳治疗：我们应如何使用产前类固醇？

Aarti Mistry

Rosalind B Simpson

Shalini Ojha

Don Sharkey

Increasing availability of active therapeutic hypothermia for neonatal hypoxic ischaemic encephalopathy in the UK

英国新生儿缺氧缺血性脑病主动治疗性低温可用性增加

Abbreviation	Arch Dis Child Fetal Neonatal Ed
Journal Impact	3.79
Quartiles(Global)	PEDIATRICS(Q1)

ISSN	1359-2998, 1468-2052
h-index	133

Publication Information	Publisher: BMJ Publishing Group，Publishing cycle: Bimonthly，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1994，Proportion of original research papers: 81.33%，Self Citation Rate:7.70%， Gold OA Rate: 24.23%
Average review cycle	网友分享经验：较慢,6-12周
Average recruitment ratio	网友分享经验：一般

Archives of Disease in Childhood: Fetal and Neonatal Edition

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