2014年 · 第52卷第10期

Jaundice is a common clinical manifestation in the neonatal period in China. More than 2/3 of term infants or late premature infants have hyperbilirubinemia in the early postpartum period, and bilirubin encephalopathy is not uncommon. One of the main reasons is that at present, the average postpartum hospital stay in obstetrics in China is obviously shortened, and there is a lack of systematic follow-up of bilirubin level or insufficient understanding of high risk factors of hyperbilirubinemia after neonatal discharge. On the other hand, for physiological hyperbilirubinemia, there is still the problem of clinical over-intervention, and these emerging problems need to be solved by formulating a new neonatal jaundice intervention plan again. Internationally, similar situations have occurred in developed countries, and in recent years, the management guidelines of neonatal jaundice have been adjusted accordingly^[1]。 For bilirubin encephalopathy, an early preventable and interveneable disease, the international community has put forward a goal in recent years, and it should no longer become a problem in the 21st century. Unfortunately, we are still far from this goal.

Neonatal hyperbilirubinemia, mainly with increased unconjugated bilirubin, is a very common clinical problem, and bilirubin encephalopathy is not uncommon in China^[1]。 The monitoring of hyperbilirubinemia, the assessment of high risk factors and the correct and timely management are of great significance for the prevention of severe hyperbilirubinemia and bilirubin encephalopathy. The harmfulness of serum total bilirubin (TSB) levels to individuals is affected by various factors such as body state and internal environment, so a fixed cut-off value cannot be simply used as the intervention standard. In 2001, the Neonatology Group of Pediatrics Branch of Chinese Medical Association drafted and formulated the "Recommended Intervention Program for Neonatal Jaundice"^[2]In 2009, it was revised on this basis and put forward the "Expert Consensus on the Principles of Diagnosis and Treatment of Neonatal Jaundice"^[3]。 In view of the general shortening of neonatal hospitalization in obstetrics in recent years, the insufficient popularization of routine bilirubin follow-up monitoring, and the frequent occurrence of neonatal bilirubin encephalopathy and kernel jaundice, it is necessary to supplement and revise the 2009 "Expert Consensus". This revision refers to the "Guidelines for the Management of Hyperbilirubinemia in Newborns with Gestational Age ≥35 Weeks" published by the American Academy of Pediatrics (AAP) in 2004^[4]It is more suitable for the actual situation of our country.

This guidance update includes the most recent evidence from the Cochrane Systematic Review and medical literature since 2010 and adopts a new Evidence Assessment Grading System (GRADE). Previous recommendations for early pulmonary surfactant and continuous positive airway pressure therapy now have a stronger evidence-based basis. The contents of delivery room resuscitation and stabilization of vital signs have been greatly expanded. Oxygen therapy after stabilization of vital signs is still controversial, but until more evidence is obtained, the target range of blood oxygen saturation should not be less than 90%, and supportive therapy is still extremely important for premature infants. Other considerations are scaled back in the guidelines.

The applicable age range of the judgment criteria for brain death in children: 29 days to 18 years old.

With the improvement of the survival rate of premature infants, the number of cases of retinopathy of prematurity (ROP) has increased significantly, which has become the first blinding disease in children in developed countries and an important blinding disease in children in developing countries. There are 250 000 very low birth weight infants born in China every year, and about 30 000 premature infants have ROP. It is very urgent to improve the prevention and treatment level of ROP^[1]。 At present, the main treatment for ROP is laser and surgery, but after these treatments, the retinal blood vessels no longer continue to develop, resulting in long-term visual impairment. Therefore, drug therapy has become the development direction of ROP research. With the continuous deepening of research on the pathogenesis of ROP, the research of anti-vascular endothelial growth factor (VEGF) drug therapy for ROP has gradually become a research hotspot in recent years. The methods of use, efficacy and safety of anti-VEGF drugs in the treatment of ROP are reviewed.

Oxygen therapy is an indispensable and important measure in the treatment of premature infants, especially gestational age<Most ultra-premature infants at 28 weeks need oxygen therapy, but their organs are immature and their tolerance to oxygen is poor^[1]Oxygen injury can cause retinopathy in premature infants (retinopathy of prematurity, ROP)^[2,3,4,5,6]Bronchopulmonary dysplasia^[7,8,9](bronchopulmonary dysplasia, BPD), Growth retardation^[3,8]and brain injury^[10]and other poor prognosis. Many studies suggest that the incidence of ROP and BPD is significantly reduced but the mortality rate is not significantly increased after appropriate control of blood oxygen saturation^[6,11,12]The reference value of blood oxygen saturation of premature infants has also been studied internationally^[13,14,15]However, previous studies lacked large-sample randomized controlled studies, and small-sample studies did not have enough efficacy to test small differences in case mortality. Therefore, the appropriate oxygen saturation range of premature infants and how to achieve the appropriate oxygen therapy have been controversial^[16]。 In recent years, a large sample randomized controlled study on the appropriate oxygen saturation range of ultra-premature infants has been conducted internationally.

transbronchial needle aspiration (TBNA) is a new technique, which uses a special puncture needle with flexible catheter to enter the airway through the bronchoscopic biopsy channel, penetrate the airway wall to puncture and aspirate the trachea and bronchial extraluminal lesions, and obtain cytological, histological or microbiological specimens of airway wall, lung parenchyma and adjacent lesions in the mediastinum of bronchial tree. In 1949, Argentine doctor Schieppati aspirated a 1mm diameter steel needle through a rigid bronchoscope to aspirate the subprotuberant lymph node for biopsy to assist in the diagnosis of esophageal cancer or bronchial cancer. At that time, it had not attracted the world's attention. Until 1978, Professor Ko-Pen Wang (Wang Guoben) and his colleagues from Johns Hopkins Hospital in the United States used a 25G vascular puncture needle under a rigid bronchoscope to obtain good biopsy specimens and then confirm the diagnosis of small cell undifferentiated lung cancer, which opened the prelude to the clinical application of TBNA. In 1983, Professor Wang invented Wang's transbronchial cell needle and pioneered its application in soft bronchoscopy for the diagnosis and staging of lung cancer. In 1984, he extended the clamping range from mediastinum to peripheral primary lesions. The following year, he invented Wang's transbronchial tissue needle. In 1989, it confirmed its value in the diagnosis of benign diseases such as sarcoidosis and tuberculosis^[1,2]So that the technology can be widely applied. In 2002, the birth of transbronchial needle aspiration biopsy (EBUS-TBNA) guided by endobronchial ultrasonography (EBUS) brought a breakthrough in respiratory intervention and pushed TBNA technology to a new height^[3]。

The child was male, 5 d. He was admitted to the Department of Neonatology of Hunan Children's Hospital in June 2013 due to "fever for 3 days and abdominal distension for 2 days". The child developed fever without obvious trigger 3 days before admission, with the highest body temperature of 40.2℃, accompanied by crying and restlessness, occasional vomiting, significantly reduced feeding, and yellow stool, about 10 times a day, with a small amount, fishy smell and no convulsions. Immediately go to the local hospital for hospitalization (46 h after birth), and give supportive symptomatic treatment such as cefoperazone anti-infection and fluid rehydration, and do blood culture and other examinations. On the second day of admission, abdominal distension occurred and progressively aggravated. On the third day, the chest and abdomen upright X-ray was considered to be digestive tract perforation, and he was immediately transferred to our hospital. The child was the first birth, the first birth, vaginal delivery at full term, denied history of intrauterine distress and asphyxia, birth weight 3 530 g, and was breastfed after birth. The parents were in good health and had no special medical history.

The working meeting of editor-in-chief, deputy editor-in-chief and special experts of Chinese Journal of Pediatrics was successfully held in Beijing on August 8, 2014. Professor Yang Xiqiang, honorary editor-in-chief, Professor Hu Yiji and Director Teng Shuying of the Academic Steering Committee, eight deputy editors-in-chief Du Lizhong, Du Junbao, Li Guicun, Shen Xiaoming, Lu Quan, Feng Zhichun, Qian Yuan and Zhao Rigetu, Ding Jie, Fang Feng, Luo Xiaoping, Qin Jiong, Shen Kunling, Sun Kun, Wang Li, Wang Tianyou, Zhao Zhengyan and other journal editorial board members who serve in the Pediatrics Branch of Chinese Medical Association attended the meeting. Jiang Yongmao, president and editor-in-chief of Chinese Medical Association Magazine, Wei Junmin, vice president, and Huang Yibin, head of the fourth branch, also attended the meeting. Editor-in-chief Professor Gui Yonghao was unable to attend the meeting due to temporary work arrangement, so he specially submitted a written speech to the conference. Professor Wu Xiru, the former editor-in-chief, and Professor Jiang Fan, the editorial board member, also specially submitted written suggestions for the magazine to this working meeting.