Objective To investigate the current status of nurses’ knowledge，attitude and practice regarding sleep management of critically ill children in pediatric ICU，and to analyze its impact factors. Methods A self-designed questionnaire on general information and a questionnaire on knowledge and practical behaviors of pediatric ICU nurses on child’s sleep management were used. In March 2023，902 pediatric ICU nurses from 24 hospitals in China were surveyed using a convenient sampling method，and the impact factors were analyzed using multiple stepwise linear regression. Results 893 valid questionnaires were collected and the recovery rate of valid questionnaires was 99.00%. Nurses in pediatric ICU scored（33.71±7.76） in knowledge dimension，（37.38±4.86） in attitude dimension and（80.60±16.78） in practice dimension，with a total score of（151.78±24.27）. The scores of knowledge and attitude，knowledge and practice，attitude and practice are all positively correlated （r=0.393，P<0.001；r=0.495，P<0.001；r=0.320，P<0.001）. The results of multiple stepwise linear regression analysis showed that gender，region，whether they had received sleep management training were the influencing factors of pediatric ICU nurses’ total score of knowledge，attitude and practice towards children’s sleep management（P<0.05）. Conclusion Nurses in pediatric ICU are positive about sleep management for critically ill children，but their knowledge and practice levels need to improve. Nursing managers should strengthen the theoretical knowledge and practical behavioral training of pediatric ICU nurses on child sleep management，develop scientific sleep management plans，and guide nurses to make reasonable evaluation and interventions to improve children’s sleep quality.

This article summarized the nursing care experience of a pediatric patient with kawasaki disease after off-pump coronary artery bypass grafting. The key points of nursing care include：①the emergency treatment plan of chest pain was formulated before operation to prevent and identify myocardial infarction as soon as possible；early respiratory function training was carried out to improve cardiopulmonary function；risk management was improved to prevent rupture of coronary artery aneurysm. ②The circulatory system was closely monitored to ensure stable hemodynamic performance during operation；fluid balance was maintained to prevent renal function injury.③Posto-perative pain and irritation were managed to prevent atrial fibrillation；the coagulation function was monitored，and coagulation associated complications，such as epistaxis，should be treated timely；non-pharmacological intervention measures were taken to relieve postoperative delirium；individualized exercise rehabilitation care plan was made to enhance recovery；individualized diet plan was made to improve the nutritional status；structural education was enhanced to make the patient and his parents more cooperative. After careful treatment and nursing care，the patient recovered and was discharged from the hospital at 16 days after the surgery without any complications in one-year follow up.

Objective To investigate the feasibility and effectiveness of the prone position ventilation technique for the pulmonary protection strategies of pulmonary injury in children with congenital heart disease（CHD） received cardiac surgery. Methods 68 children hospitalized in the CICU of Children’s Hospital of Fudan University from April 2020 to December 2021 were selected as the study participants by convenience sampling. A block randomization method was employed to assign these children into a study group and a control group. The study group received routine nursing care and prone position ventilation for 8 h，while the control group only received routine nursing care after CHD surgery. The respiratory mechanic indexes“percutaneous oxygen saturation（SpO₂），oxygenation index （OI），dynamic pulmonary compliance” and hemodynamic indexes“HR，SBP，DBP and blood lactic acid” at 4 h，8 h and 16 h were compared between 2 groups；mechanical ventilation duration and CICU duration were compared；unplanned extubation，insufficient wound healing，pressure-related injury，Braden Q pressure-related injury risk score，surgical incision classification and healing grade between 2 groups were also be compared after mechanical ventilation was finished. Results None of a case dropped out. There were interactive effects on groups and times for respiratory mechanic indicators and blood lactic acid（P<0.05）. Simple effect analysis results showed that the SpO₂，dynamic pulmonary compliance and OI in the study group were higher than those in the control group at 4 h，8 h and 16 h，and the differences have statistical significance（P<0.001）. Blood lactic acid in the study group were lower than it in the control group，and the difference have statistical differences（P<0.05）. The mechanical ventilation duration and ICU days in the study group were lower than it in the control group，and the differences have statistical significance（P<0.05）. No pressure-related injury，unplanned intubation and insufficient wound healing occurred during the process. The Braden Q pressure-related injury score have no statistical difference between 2 groups（P=0.907）. All the surgical incision sites were type I incision and class A healing. Conclusion Prone position ventilation is a suitable ventilation strategy for clinical application in CHD children who received cardiac surgery with a postoperative acute pulmonary injury. It was beneficial to improve the respiratory and circulation function of patients with good safety and feasibility.

Objective To retrieve，appraise and integrate the relevant evidence of non-pharmacological sleep management measures in critically ill children. Methods We conducted a systematical search on the topic of non-pharmacological sleep management measures in critically ill children across multiple databases，including BMJ best practice，UpToDate，International Guidelines International Network，National Institute for Health and Care Excellence，Scottish Intercollegiate Guidelines Network，Registered Nurses’ Association of Ontario，Joanna Briggs Institute Library，the American Academy of Sleep Medicine，International Pediatric Sleep Association，CNKI，WanFang database，VIP database，SinoMed，Cochrane Library，PubMed，Web of Science，and CINAHL. The literature retrieval time limit was from the establishment of the database to February 2023. The study design includes clinical practice guideline，evidence summary，clinical decision-making，expert consensus，and systematic review. The evidence was extracted and summarized according to the subject after the independent literature quality evaluation by 2 researchers. Results 10 relevant pieces of literature were identified，including 2 guidelines，1 consensus statement，4 systematic reviews，2 evidence summaries，and 1 top clinical decision. These sources provided a total of 28 pieces of evidence across 5 key themes，including sleep assessment，management principles and education，environmental management and sleep promotion. Conclusion This study summarizes the best available evidence on non-pharmacological sleep management measures in critically ill children. It is recommended that healthcare professionals should consider the clinical context when implementing evidence-based interventions，aiming to reduce nocturnal awakenings，extend sleep duration，and improve sleep quality in critically ill children.

Objective To develop an evidence-based，localized practice protocol for the interhospital transfer of critically ill children. Methods Through a comprehensive evidence summary and semi-structured interviews，a preliminary inter-hospital transfer practice protocol for critically ill children was formulated. A panel of 31 experts from 12 hospitals in China participated in 2 rounds of expert correspondence between May and July 2022，facilitating meticulous revision of the protocol entries. Results The response rate for both rounds of questionnaires was 100%，and the expert authority coefficients ranged from 0.926 to 0.931. In the second round of consultation，the coefficient of variation for the importance score of each entry ranged from 0.036 to 0.226，and the Kendall’s W was determined to be 0.201（P<0.001）. Additionally，the coefficient of variation for the feasibility score of each entry fell within the range of 0.070 to 0.314，with Kendall’s W of 0.124（P<0.001）. Ultimately，the final interhospital transfer protocol for critically ill children comprised 8 level Ⅰ entries，16 level Ⅱ entries，and 75 level Ⅲ entries. Conclusion The interhospital transfer protocol constructed in this study is grounded in scientific evidence and exhibits practical feasibility. It serves as a valuable reference for organizing and implementing interhospital transfers of critically ill children.

Objective To retrieve，evaluate and integrate evidence related to subcutaneous injection technique of low molecular weight heparin. Methods The clinical decisions，recommended practices，evidence summaries，technical reports，guidelines，expert consensuses，and systematic evaluations on the subcutaneous injection of low molecular weight heparin in domestic and foreign databases and related professional websites were searched by computer. The evidence was extracted and summarized according to the subject after the independent literature quality evaluation by 2 researchers. The literature retrieval time limit was from the establishment of the database to November 2021. Results According to the inclusion criteria，9 pieces of literature were screened，including 2 evidence summaries，2 expert consensuses，and 5 systematic reviews. Through literature reading，evidence extraction and classification，a total of 12 pieces of evidence were summarized，including preparation before injection，skills during injection，and post-injection disposal. Conclusion This study summarized the best evidence of subcutaneous injection techniques of low molecular weight heparin，so as to provide references for nurses to carry out clinical practice. Nurses should carefully select and apply evidence in combination with clinical situations and patients’ wishes，so as to ensure injection safety and reduce the incidence of related complications.

To summarize the perioperative nursing care of a patient with laryngeal cleft complicated with laryngomalacia after endoscopic laryngeal cleft repaired. The key aspects concerning nursing included the impose of importance on nutrition management to improve preoperative nutritional status，the implementation of aspiration risk assessment and prevention strategies to reduce the risk of aspiration pneumonia before surgery， the strengthening of postoperative care to prevent anastomotic rupture，the strengthening of airway management to improve postoperative pulmonary complications，the development of a care plan to improve discharge readiness. Following appropriate and successful perioperative treatment and nursing care，the patient was recovered and discharged from hospital 28 days after operation，and showed good recovery after 1 year of following up.

Objective To develop an evidence-based decision support system for nutritional risk screening and assessment in children with congenital heart disease（CHD），and to evaluate its clinical effect. Methods The best evidence for nutritional risk screening and assessment in CHD children was summarized，and an evidence-based decision support system was developed. A before-and-after study design was adopted，and the medical staff and children with CHD admitted to the Cardiac Intensive Care Unit of a tertiary A-level hospital for children in Shanghai were selected as the research subjects. The data of the experimental group was collected from September to December 2021，while the data of the control group was collected from September to December 2020. The outcome measurement were the consistency of nutritional risk screening results of the responsible nurses and nutrition specialist nurses，the time-consuming of nutritional risk screening，the proportion of children receiving nutritional assessment and intervention，the response time of high-risk warning value of nutritional screening，and the satisfaction of medical staff with the use of information system. Results 191 children were included in the experimental group，and 193 were in the control group. The consistency coefficient of the nutritional risk screening results was 0.890 in the experimental group，and it was 0.689 in the control group. The nutritional risk screening time was（2.97±1.05） min in the experimental group，and it was（4.05±1.01） min in the control group. The proportion of infants who received nutritional assessment in the experimental group was 95.29%，compared with 89.64% in the control group；the proportion of infants receiving nutritional intervention was 69.11% in the experimental group，and 54.92% in the control group. The response time of the high-risk warning value of nutritional screening in the experimental group was（4.73±2.31） min，while the control group was（41.53±9.13） min. The satisfaction score of medical staff on the use of the clinical nursing information system was（108.04±11.31） points，and it was（92.89±9.37） points in the control group. The above data were compared between the 2 groups，and all the difference were statistically significant（P<0.05）. Conclusion Using the evidence-based decision support system for nutritional risk screening and assessment of CHD children can improve the consistency of nutritional risk screening results，shorten the time-consuming of nutritional risk screening，promote nutritional assessment and nutritional intervention by medical staff，and improve satisfaction with the use of information system.

Objective To explore the trajectory of oral sucking function of premature infants with gestational age and its relationship with oral feeding progression. Methods From April 2018 to April 2019，we conveniently selected premature infants from a tertiary children’s hospital in Shanghai，and used a self-developed oral sucking evaluation tool to measure the oral sucking function of premature infants when their corrected gestational age was 32~36 weeks. The measurement parameters included average sucking negative pressure peak，average sucking positive pressure peak，average sucking peak interval of negative pressure，average sucking peak interval of positive pressure，average sucking peak interval of positive pressure to negative pressure，number of sucking negative pressure，number of sucking positive pressure. At the same time，the time for premature infants to start and complete oral feeding was recorded，and the correlation between oral sucking function and corrected gestational age at 32 weeks was analyzed. Results A total of 132 premature infants completed the evaluation of oral sucking function and were finally included. The results showed that with the increase of gestational age，the amplitude and number of positive and negative sucking pressure of premature infants increased significantly（P<0.001），and the interval duration decreased significantly（P<0.001）. At the same time，the positive sucking pressure amplitude at the time of correcting the gestational age of 32w was negatively correlated with the gestational age of starting oral feeding（r=-0.217，P=0.040），and the negative sucking pressure duration at the time of correcting the gestational age of 32w was positively correlated with the gestational age of complete oral feeding（r=0.334，P=0.002）. Conclusion The positive sucking pressure and negative sucking pressure of premature infants showed the same trend with the increase of gestational age. The average sucking peak of negative pressure at 32 weeks of gestational age was negatively correlated with the time to start oral feeding，and the average sucking negative pressure peak interval was positively correlated with full oral feeding. Caregivers should pay attention to the peak of positive sucking pressure at the beginning of oral feeding readiness assessment and its effect on sucking frequency when performing oral motor interventions to promote full oral feeding.

Objective To develop a data table system for monitoring the quality of pediatric intravenous infusion process and to evaluate its clinical effectiveness. Methods The data table system was designed to monitor the whole process of intravenous infusion by automatically capturing data from administration,inspection to completion,followed by the generation of personal digital assistant（PDA） scan identification data table and infusion inspection data table. The data table system was put into use since December,2020 in a tertiary children’s hospital in Shanghai. Data collected from October to November,2020 were compared with that from March to April,2021 in terms of PDA scanning rates at the beginning and end of intravenous administration,qualified rate of the number of intravenous infusion inspection,and accuracy rate of intravenous infusion inspection timing. The Effectiveness Evaluation Scale of Clinical Nursing Information System was used to evaluate nursing managers’ satisfaction. Results The PDA scanning rate at the beginning of intravenous administration was improved from 96.76% to 99.96%（P<0.001）;the PDA scanning rate at the end of intravenous administration was improved from 97.88% to 98.82%（P<0.001）;the qualified rate of the number of intravenous infusion inspection was improved from 57.96% to 66.85%（P<0.001）;the accuracy of intravenous infusion inspection time was improved from 95.68% to 96.79%（P<0.001）. The satisfaction score of nursing managers with the data table system was（95.25±0.08）. Conclusion The development of the data table system could help nursing management departments facilitate the use of the clinical data in order to continuously improve the nursing quality and nurses’ behavior. With the help of information service,the data table system for monitoring nursing quality provided a better user experience.

Objective To construct an early progressive exercise program for critically ill children,and to verify its effect. Methods Combining the theoretical framework derived from post-intensive care syndrome in pediatrics（PICS-p） and literature review,under 2 rounds of expert consultations from January to February 2021,an early progressive exercise program was established for critically ill children. To evaluate the safety and intervention effects of the program,the preliminary application was carried out in 5 critically ill children admitted to a tertiary children’s hospital in Shanghai in March 2021. Results The active and authority coefficient were 100% and 0.82;the importance and feasibility score of each item were all >3.5;the variation coefficients were <0.25;the Kendal harmony coefficients were between 0.312 and 0.330（P<0.001）. The final draft of the early progressive exercise program for critically ill children included 3 first-level items,10 second-level items,and 28 third-level items. The preliminary application results showed that no adverse events occurred during the implementation of the program,and the difference of biceps brachii cross-sectional area in the experimental group was smaller than that in the control group （P=0.047）. Conclusion The early progressive exercise program for critically ill children is scientific,reliable,safe,and feasible,but its clinical effect needs to be further verified by a larger sample size.

Objective To translate the Psychosocial Risk Assessment in Pediatrics （PRAP） into the Chinese version,and to test its reliability and validity. Methods The Chinese version of PRAP was formed after translation and cultural adjustment authorized by the original author. 167 children from Children’s Hospital in Shanghai from March to May 2021 were selected by convenience sampling method to evaluate the reliability and validity of the scale. Results The Chinese version of PRAP included 8 items,namely temperament,anxiety and coping during healthcare context,past health experience,developmental impact,special needs,communication,invasive procedure/experience and parent/caregiver stress. The Cronbach’s α was 0.711 and the half reliability was 0.626;the inter rater reliability of 5 investigators showed that the Kendall coefficient was 0.963 and the chi square value was 43.325;the difference was statistically significant（P<0.001）. The content validity index of each item is 0.90~1.00. The average content validity index of the scale is 0.95. There were 3 common factors being extracted by exploratory factor analysis,and the cumulative variance contribution rate is 62.686%. Conclusion The Chinese version of PRAP has good reliability and validity,and it can be used as an evaluation tool to evaluate the psychosocial risks of pediatric patients regarding to medical procedure in China.

Objective To construct a decision support system for pain management in hospitalized children and to evaluate its effects. Methods Based on the theory of pain management and clinical decision support technology,a new pain management information system was constructed,integrating all aspects of nursing procedure,order processing and nursing task list. The system was trial-run in a tertiary comprehensive pediatric hospital from September 2018 to November 2019. The application effect of the new system was evaluated and compared through the quality of nursing document writing,the timeliness of doctor’s order processing and the experience of nurses before and after the use of the new system. Results After the application of the decision support system for pain management of hospitalized children,the quality of nursing document writing was significantly improved（P<0.05）;the timeliness of medical order processing before and after the use was 100%,and the difference was not statistically significant（χ²=0.012,P=0.913）;in the using experience of clinical nurses,the dimensions of "information quality","service quality","user satisfaction" and "net income" were improved. The differences were statistically significant（P<0.05）. Conclusion The new pain management decision support system improves the homogeneity,continuity,integrity and timeliness of pain management for hospitalized children,and nurses have good overall experience of this system.

Objective To build a knowledge base of nursing procedures in pediatric hyperthermia based on Clinical Care Classification（CCC） 2.5 version. Methods With the common symptoms of pediatrics “axillary temperature≥37.5 ℃” as the research content,the research team summarized all the specific nursing measures related to "axillary temperature≥37.5 ℃" combined with clinical nursing routine and hospital management system based on CCC 2.5 version by evidence-based nursing method. Based on the definition of "axillary temperature≥37.5℃" related nursing diagnosis,core nursing interventions,modifiers of nursing activity types and modifiers of nursing outcomes in CCC 2.5,the first draft of knowledge base of "pediatric hyperthermia" nursing procedures was constructed.According to the coding rules of "code of specific nursing measures=code of core nursing interventions +code of modifiers of nursing activity type" and "code of nursing outcomes=code of nursing diagnosis+code of nursing outcome modifiers" in CCC 2.5,the first draft of the knowledge base was coded. After that,the expert consultation meeting was held to evaluate,discuss and revise the draft content and code of the knowledge base,and the final draft of the knowledge base was determined. Results The final draft of the knowledge base of pediatric "hyperthermia" nursing procedures includes 1 nursing diagnosis,19 specific nursing measures and 4 nursing outcomes. Conclusion The knowledge base of pediatric "hyperthermia" nursing procedures is professional,scientific and practical,which standardizes nursing language and facilitates information sharing.

Objective To construct the nursing monitoring data collection model of pediatric intensive care units and carry out clinical application,so as to improve the recording quality of medical and nursing data of critically ill children in ICU and the working efficiency of medical staff. Methods On the basis of the clinical information system（CIS）,a modern,informationalized and integrated mobile nursing system was established for the process construction of rescue mode,resuscitation mode,blood transfusion mode and special mode. Data collection patterns and nurses’ satisfaction were investigated from January 1,2019 to January 1,2020 in the ICU in different clinical scenarios. Results The rescue mode was started for 328 times;blood transfusion mode was started for 8 014 times;recovery mode was started for 1 622 times. A total of 4 323 cases were recorded by electronic medical records,including 1 793 cases of PICU,1 600 cases of NICU and 930 cases of CICU. The overall satisfaction score of nurses to the nursing monitoring data acquisition mode system was 92.47±1.62 scores. Conclusion The construction of different data collection modes of the PICU effectively integrates the document writing workflow for handling first aid,resuscitation and blood transfusion. The manual and informatic double-checking process ensures the scientific and effective bedside data collection in the ICU. The work procedures of nurses were simplified;the quality of nursing documents was improved;the nurse’s satisfaction with the working environment was improved.

Objective To implement evidence-based practice of breast milk expression behaviors among postpartum women with neonatal-maternal separation and explore its influences on lactation. Methods Evidence-based nursing was used to obtain best evidence. The model of evidence-based continuous quality improvement was adopted as the theoretical framework. From May to December 2018,the best evidence was applied to separated mothers according to four stages：evidence acquisition,current situation review,evidence introduction and effect evaluation. The changes of breast milk expression compliance and lactation volume were observed before and after the application of evidence. Results A total of 12 items of evidence were applied. Breast milk expression compliance was improved after evidence implementation. The number of women who transported breast milk to neonatology department increased. The initial time of breast milk transportation after delivery was brought forward. The total estimated lactation volume per woman in the first seven days after delivery was increased. Conclusion Evidence-based nursing is useful to manage breast milk expression behaviors among postpartum women with neonatal-maternal separation,optimize lactation success and increase the amount of milk,which can provide references for breastfeeding management for women with neonatal-maternal separation.

This article summarized nursing experience of procedural feeding for five pediatric patients with complicated congenital heart disease underwent post-operative delayed chest closure. Key nursing points included: a procedural feeding program was developed together with pediatric cardiologists,cardiac surgeons,cardiac specialist nurse,nutritionists,gastroenterologists and rehabilitation specialists; minimal feeding was performed to maintain intestinal function; enteral nutrition was initiated as early as possible after full assessment of intestinal function,and initial feeding volume was set at 1 to 2 ml/（kg·h）; feeding intolerance was assessed by abdominal circumference measurement（once/12 h）,bowel sounds and gastrointestinal symptoms; implementation of enteral nutrition was advanced in an orderly and regular manner,and nutritional status of pediatric patients was continuously monitored,weight was assessed twice a week,and length of body was assessed once a week. All pediatric patients in this group successfully received chest closure,and all reached the full amount of oral feeding,who were discharged after the disease was relieved.

Objective To establish a scientific and clinical hospice care model for critical pediatric patients. Methods Twenty-four experts from eight children's hospitals in China were selected for two rounds of inquiries,and relevant experts in the fields of medicine,nursing,psychology,nutrition and social work were invited to conduct focus group interviews. Results Through two rounds of inquiries and expert focus group interviews,the hospice care model for critical pediatric patients was initially determined,including the initiation of hospice care,and holistic care of hospice children which further included pain management,nutrition management,comfort care and psychological intervention,and hospice care of hospice children. Conclusion The model of hospice care for critical pediatric patients is scientific and reliable,which provides a reference for nursing of critically ill children.