Zhenghong Li

Background and aims: To evaluate short- and long-term outcomes of preterm infants from a previous RCT on individualized fortification (IF). Methods: Preterm infants from the Peking Union Medical College Hospital (PUMCH) IF study were enrolled. Data before age 2 were collected from medical records. Long-term follow-up was conducted at ages 6–10 years. Growth and development outcomes as well as biochemical indexes were compared between IF and standard fortification (SF) groups. Results: Fifty-one infants completed 2-year follow-up. The IF group showed significantly better outcomes in head circumference z-scores at CA 6 months ( p = 0.035), hemoglobin at CA 12 months ( p = 0.044), and weight z -scores at CA 24 months ( p = 0.027). Twenty-five children completed long-term follow-up. No significant differences were found in lung function, cognitive scores, ferritin, hemoglobin, IGF, 25-OH-vitamin D, bone age, or metabolic parameters including BMI and lipid profile. Conclusion: PUMCH IF improved early growth outcomes, but no significant long-term health differences were observed.

Purpose There is a scarcity of long-term follow-up studies on the offspring of mothers with systemic lupus erythematosus (SLE) in mainland China, due to the limited number of live births over the past decade. This study aims to report the long-term health of SLE offspring and the factors to affect health. Methods This is an observational study of an ambispective cohort. We collected data through questionnaires and medical records. Peripheral venous blood samples were collected to test autoimmune parameters. The Wechsler Intelligence Scale was used to evaluate the neurological and psychiatric development. Children were born between August 1, 2007, and April 30, 2013, in Peking Union Medical College Hospital. Their mothers were diagnosed with SLE. Children were 12–16 years old during the follow-up period. We analyzed the occurrence rates of diseases and risk factors. Results A total of 63 children were recruited. The ratio of males to females was 1.25:1, and 79.4% were born via cesarean sections. Preterm babies accounted for 25.4%. About 71.2% of them were fed with formula exclusively. The follow-up age was 13.1 ± 1.0 (12.0–16.9) years old. The occurrence rates of childhood-onset SLE, allergic diseases, attention-deficit hyperactivity disorder, and anxiety and depression were 3.2%, 39.7%, 4.8%, and 4.8% respectively. The proportion of allergic diseases is positively related (OR = 29.95, 95% CI 1.06–846.90) to the titers of anti-Sjögren's syndrome A (SSA) antibodies in mothers. Conclusions The probability of allergic diseases is positively related to the titers of anti-SSA in SLE mothers. SLE offspring have high proportions of childhood-onset SLE and allergic diseases. Key Points • The maternal disease of systemic lupus erythematosus (SLE) might affect the long-term health of their offspring, but there is little research data on their long-term complications in China. • Our hospital tried earlier to manage pregnant women with SLE in mainland China, with the earliest offspring having reached their adolescence. • Not counting children before adolescence as in previous studies, the long-term proportion of childhood-onset SLE is genuinely high. Meanwhile, the proportion of allergic disease is also higher than that of the general population. • The titer of maternal anti-SSA is positively associated with the risk of allergic diseases in offspring.

To explore the measures to improve the follow-up rate of preterm infants after discharge, and to evaluate the effectiveness of these measures using quality improvement methodology. The follow-up status of preterm infants discharged from March to May 2017 was used as the baseline before quality improvement, and a specific quality improvement goal for the follow-up rate was proposed. The Pareto chart was used to analyze the causes of follow-up failure, and a key driver diagram was constructed based on the links involved in improving follow-up rate. The causes of failure were analyzed to determine the key links and intervention measures for quality improvement, and the follow-up rate was monitored weekly using a control chart until the quality improvement goal was achieved. The follow-up rate of preterm infants after discharge was 57.92% (117/202) at baseline before quality improvement, and the quality improvement goal was set to increase the follow-up rate of preterm infants from baseline to more than 80% within 12 months. The Pareto chart analysis showed that the main causes of follow-up failure were deficiencies in follow-up file management and irregular follow-up times (33.70%, 31/92), insufficient follow-up education and poor communication (25.00%, 23/92), and the inability to meet the diverse needs of parents (18.48%, 17/92). Based on the key links for quality improvement and the main causes of follow-up failure, the following intervention measures were adopted: (1) strengthen follow-up publicity and education; (2) build a follow-up team; and (3) establish a follow-up platform and system. The control chart indicated that with the implementation of the above intervention measures, the weekly follow-up rate increased to 74.09% (306/413) in July 2017 and 83.09% (511/615) in December 2017, finally achieving the quality improvement goal. During the COVID-19 pandemic, the follow-up rate of preterm infants fluctuated between 23.54% (460/1 954) and 70.97% (1 931/2 721), and subsequently, it returned to pre-pandemic levels starting in February 2023. The application of quality improvement methodology can help to formulate intervention measures based on the main causes of follow-up failure, thereby improving the follow-up rate of preterm infants after discharge. This quality improvement method is feasible and practical and thus holds promise for clinical application.

To develop effective measures to reduce antibiotic use duration in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit through quality improvement methods. The study population consisted of hospitalized VLBW preterm infants, with the percentage of hospitalization time during which antibiotics were used from November 2020 to June 2021 serving as the baseline. The specific quality improvement goal was to reduce the duration of antibiotic use. Factors affecting antibiotic use duration in preterm infants were analyzed using Pareto charts. Key drivers were identified, and specific interventions were formulated based on the stages of antibiotic use. Changes in the percentage of antibiotic use duration were monitored with run charts until the quality improvement target was achieved. From November 2020 to June 2021, the baseline antibiotic use duration percentage was 49%, with a quality improvement target to reduce this by 10% within 12 months. The Pareto analysis indicated that major factors influencing antibiotic duration included non-standard antibiotic use; delayed cessation of antibiotics when no infection evidence was present; prolonged central venous catheter placement; insufficient application of kangaroo care; and delayed progress in enteral nutrition. The interventions implemented included: (1) establishing sepsis evaluation and management standards; (2) educating medical staff on the rational use of antibiotics for preterm infants; (3) supervising the enforcement of antibiotic use standards during ward rounds; (4) for those without clear signs of infection and with negative blood cultures, discontinued the use of antibiotics 36 hours after initiation; (5) reducing the duration of central venous catheterization and parenteral nutrition to lower the risk of infection in preterm infants. The control chart showed that with continuous implementation of interventions, the percentage of antibiotic use duration was reduced from 49% to 32%, a statistically significant decrease. The application of quality improvement tools based on statistical principles and process control may significantly reduce the antibiotic use duration in VLBW preterm infants. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(7): 736-742.

This study aims to analyze the clinical characteristics and risk factors of high-risk groups of neonatal lupus erythematosus (NLE) in term infants. High-risk groups of NLE infants whose mothers were positive for anti-SSA, anti-SSB or anti-U1RNP antibodies during pregnancy were enrolled. They were born between February 2013 and February 2020, with a gestational age not less than 37 weeks. We analyzed their clinical data from birth to 24 months after birth. A total of 105 patients in the NLE high-risk group were included. Among them, 30 patients were diagnosed with NLE (NLE group), and 75 patients were not (non-NLE group). The affected systems of the NLE group included the dermal (13.3%), hepatic (76.0%), and hematological systems (43.3%). Hepatic involvement, anemia and thrombocytopenia did not emerge until 60 days, 41 days and 22 days after birth, respectively, in some cases. Systemic involvement could be cured within 3 to 12 months after birth. The clearance time of specific autoantibodies was 12 months after birth. There was no significant difference in the clinical characteristics of babies and their mothers between the two groups, neither in the positive rate nor in the clearance time of specific autoantibodies. Conclusion: After standardized prenatal health care, there is still a high risk of dermal, hepatic, or hematological system involvement for high-risk groups of NLE. There are no specific indicators for the prediction of whether babies will develop NLE. All of these patients need to be followed up closely within one year after birth. What is Known: • Neonatal lupus erythematosus (NLEs) can affect the cardiac, dermal, hepatic, and hematological systems of infants. What is New: • After standardized prenatal health care employing good multidepartment cooperation in our center, no neonates had cardiac block in this study. However, dermal, hepatic, and hematological system involvement of NLE can still gradually appear (as long as 60 days after birth in some cases) during follow-up, and some of these conditions are serious and require timely and active intervention. No single factor has been found to predict whether offspring at high-risk of NLE whose mothers are positive for anti-SSA, SSB and/or RNP will develop NLE.

Objectives To verify whether nutritional support is associated with Bronchopulmonary Dysplasia (BPD) by mediating serum cytokines. Methods We recorded in a retrospective cohort study the intake of enteral nutrition (EN) and parenteral nutrition (PN) in the first week, serum cytokines on Day 2–7 and Day 14–28 by examining the nutritional and clinical history of 34 newborns born at gestational age ≤ 32 weeks admitted to the neonatal intensive care unit from January 2018 to October 2019. Results Non-BPD group (24 infants) had a significantly higher gestational age and higher birth weight than the BPD group (14 infants). Among the infants with non-BPD, total proteins, total energy and EN carbohydrates, EN proteins, EN lipids, and EN energy in the first week intake and IL-4, IL-6, IL-8 on Day 14–28 and FiO₂ on Day 28 were significantly lower, and IL-10 on Day 2–7 and IL-13 on Day 14–28 was significantly higher. Pearson correlation analysis showed a negative correlation between total protein, total energy and EN proteins, EN carbohydrates, EN lipids, and EN energy in the first week with IL-4, IL-6, and IL-8 on Day 14–28. In mediation analyses, total protein, EN proteins, EN carbohydrates, EN lipid, EN energy, total energy in the first week were related to FiO2 on day 28 partly mediated by IL-6 and IL-8 on Day 14–28. Conclusions Our results showed that inefficient nutrition, especially EN nutrition intake in the first week of life were associated with BPD by mediating proinflammatory cytokines on Day 14–28.

The breastfeeding rates of late preterm infants are lower than both term and extremely preterm infants. To explore the interventions of increasing full breast milk feeding rate of hospitalized late preterm infants on the 7th day after birth (D7) and evaluate the effect of these quality improvement (QI) interventions. The full breast milk feeding (amount of enteral breast milk reached 120ml/kg/d on D7) rate of hospitalized late preterm infants during May 2017 and November 2017 was set as the baseline before intervention, and the specific aim of promoting breast milk feeding was put forward. The Pareto Chart was used to analyze the factors that affect breast milk feeding process, as well as the discussion of multidisciplinary experts. Key drivers were constructed, including informational materials and education about breast milk feeding, consultations and support on optimal breast milk initiation, initiating breast milk expression within one hour after birth, accurate measurement and recording of expressed breast milk, stimulating continuous and effective lactation, proper breast pump selection in and out of hospital and sending and preserving of expressed milk to NICU. Control chart was used to monitor the monthly change of full breast milk feeding rate until the aim was achieved and sustained. The baseline of full breast milk feeding rate of late preterm infants was 10%, and the aim of QI was to increase the rate to 60% within a two-year period. Control chart dynamically showed the full breast milk feeding rate increased to 80% with the implementation of the interventions, achieved and made the aim of QI sustained. QI interventions including breast milk feeding education, early postpartum breast milk pumping, kangaroo care to stimulate breast milk secretion, and convenient way of transporting breast milk to NICU, could significantly improve the full breast milk feeding rate of hospitalized late preterm infants.

Purpose: This study aims to analyse the clinical characteristics and risk factors of high-risk groups of neonatal lupus erythematosus (NLE) in term infants. Methods: The high-risk groups of NLE whose mothers were positive of anti-SSA, SSB or U1RNP antibodies during pregnancy were enrolled. They were born from February 2013 to February 2020, with a gestational age not less than 37 weeks. We analyzed their clinical data from birth to 24 months after birth. Results: A total number of 105 cases of NLE high-risk groups were included. Among them, 30 cases were diagnosed with NLE (NLE group) and 75 cases were not (non-NLE group). The affected systems of the NLE group included dermal (13.3%), hepatic (76.0%), and hematological system (43.3%). Hepatic involvement, anemia and thrombocytopenia could not emerge until 60 days, 41 days and 22 days after birth in some cases. The systems involvement could be cured within 3 to 12 months after birth. The clearance time of specific autoantibodies was 12 months after birth. There was no significant difference in clinical characteristics of babies and their mothers between the two groups, neither of the positive rate or clearance time of specific autoantibodies. Conclusion: After standardized prenatal health care, there is still a high risk of dermal, hepatic, or hematological system involvement for high-risk groups of NLE. There are no specific indicators to predict whether the babies will develop to NLE or not. All of them need to be followed up closely within one year after birth.

Objective Adopting the methodology of quality improvement (QI) to explore the multiple interventions to increasing the follow-up rate of preterm infants and evaluate the effect of these QI interventions. Methods The quality improvement method based on statistical process control was used in this project. The baseline was measured per week from March to May 2017 according to the follow-up rate of preterm infants before the interventions, further, the specific aim of improvement was determined. The Pareto analysis of follow-up failure and the key driving diagram was constructed. The intervention measures were synchronized to monitor the change of weekly follow-up rate through the control chart until the QI goal was achieved. Results The baseline of follow-up rate was 57.92%, and the aim of the QI project was to increase the follow-up rate to 80% within 12 months. Major interventions included optimizing follow-up platform, strengthening family follow-up education and improving follow-up clinic service ability. The control chart showed that the follow-up rate increased to 74.09% in July 2017 and to 83.09% in December 2017 with a series of interventions and achieved the aim of QI. This improvement had been sustained for 6 months. Conclusion Our QI project increased the follow-up rate of preterm infants significantly. Interventions according to analysis of follow-up failure, such as strengthening family follow-up education and improving follow-up clinic service ability, could improve follow-up of preterm infants.