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Objective To analyze the clinical features and risk factors of invasive fungal infections (IFI) in children with acute leukemia.Methods Ninety-six acute leukemia children complicated with IFI admitted in Guangzhou Women and Children's Medical Center during January 2005 and February 2017 were retrospectively reviewed, and 96 cases of acute leukemia without IFI admitted at the same period were randomly selected as control group.The clinical manifestations of IFI were analyzed, multivariate Logistic regression was used to study risk factors of the complication of IFI in pediatric acute leukemia.Results Among 96 children complicated with IFI, fungus were detected in samples from sputum, bronchoalveolar lavage fluid, or blood in 78 cases, in which 42 cases (43.75％) were oral infection, 36 cases (37.50％) were pulmonary infection.Candida albicans (33.33％, 26/78) was the most commonly isolated pathogen, followed by Candida parapsilosis (20.51％, 16/78) and Candida tropicalis (20.51％, 16/78).Univariate analysis revealed hormone-containing chemotherapy, neutropenia (＜ 0.5 × 109/L), time duration of neutropenia ≥ 10 days, usage of carbapenem antibiotics and combined drug administration ≥2 types were associated with fungal infection (P ＜ 0.05 or ＜0.01).Multivariate Logistic regression showed that the time duration of neutropenia ≥ 10 days (OR =11.390, 95％ CI 4.145-55.263, P ＜ 0.01),usage of carbapenem antibiotics (OR =4.825, 95％ CI 1.681-13.842, P ＜ 0.01) and hormone-containing chemotherapy (OR =2.220, 95％ CI 1.542-8.246, P ＜ 0.05) were the independent risk factors of IFI.Conclusion Rational usage of antibiotics and effective measures taken to restore the granulocytes can help to reduce the incidence of IFI in children with acute leukemia.
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Objective To investigate the influence on levels of coagulation factors in cord blood,included the physiological and pathological status of mater and the newborn.Methods We Detected the levels of F Ⅱ 、FⅤ 、FⅦ 、FⅧ 、FⅨ 、FⅩ 、FⅪ and FⅫ in cord blood by CA-1500 Automatic blood coagulation analyzer and related reagents,group results by impact factors and compared them statistically.Results (1) Factors of newborn:every coagulation factor between the male group and the female group was no statistical difference(P ＞0.05) ;F Ⅱ,F Ⅴ,FⅨ and FⅪ in the group of premature infant were less active than the normal (P =0.031,0.037,0.000,0.002) ;FⅡ and FⅦ in the group of birth weight ＞4.0 kg were more active than the normal (P =0.043,0.043) ; FⅧ in the group of cesarean section was less active than the normal (P =0.004) ; FⅧ,FⅨ and FⅪ in the group of twin pregnancy were less active than the normal (P =0.002,0.000,0.028) ;F Ⅱ and F Ⅷ in the group of intrauterine hypoxia were less active than the normal (P =0.032,0.012).(2) Factors of mater:F Ⅱ and FⅨ in the group of≥35-year-old mothers with first delivery were more active than the normal (P =0.009,0.028).Every coagulation factor between the gestational diabetes mellitus (GDM) group and the not GDM group was no statistical difference(P ＞0.05) ;FⅧ in the group of pregnancy associated with gynecologic diseases was less active than the normal (P =0.043),F Ⅱ,Ⅶ and F Ⅹ were more active than the normal (P =0.032,0.024,0.022).Conclusion Premature birth,cesarean,twins,intrauterine hypoxia,perinatal infection and other factors have greater impact on the levels of FⅡ,FⅧ,FⅨ and FⅪ in cord blood.To prevent hemorrhagic disease of the newborn,we should avoid the factors mentioned above.
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Objective To investigate the association with death for serum parameters at the time of diagnosis and its value in predicting the death in infants with hemophagocytic syndrome (HPS).Methods A retrospective case-control study was conducted on 108 children with HPS who were admitted to our center between July 2005 and July 2012.For each patient,demographic,laboratory data and outcome information were collected.The patients were divided into death and surviving groups based on the follow-up results.The relation between serum markers and death was examined using the COX proportional hazards model and decision tree.Results Of 108 infants with HPS,33 died corresponding to a fatality rate of 30.6％ and 90.3％ of deaths occurred within 8 weeks after diagnosis.Following features were significantly associated with death:white blood cells (WBC) ＜5 x 109/L (HR =9.08,95％ CI 3.07 ～ 26.87),hemoglobin ＜80 g/L (HR =6.15,95％ CI 1.68 ～ 22.49),albumin ＜ 28 g/L (HR =4.63,95％ CI 1.12 ～ 7.39),serum ferritin ＞ 1 100 μg/L (HR =3.05,95％ CI 1.28 ～ 16.75),trigeminal ganglion ≥4 mmol/L (HR =2.88,95％ CI 1.51 ～ 8.60),and prothromin time ≥ 16 s (HR =3.60,95 ％ CI 1.28 ～ 7.24),and fever for more than 2 weeks (HR =5.39,95％ CI 1.97 ～ 14.66).Decision tree demonstrated that the probability of death was as high as 100％ for infants with WBC ＜5 x 109/L and hemoglobin ＜ 80 g/L.The odds of dying was still 66.7％ for infants who had WBC≥5 × 109/L but reported trigeminal ganglion ≥4 mmol/L after having fever for more than 2 weeks.Conclusion The first 8 weeks after the onset of HPS is the critical period of treatment.There are several easily available serum predictors of early mortality in HPS infants,particularly the WBC and hemoglobin level,which may help guide treatment decisions.
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Objective To explore the clinical characters and the relationship between prognosis and treatment in childhood acute non-lymphocytic leukemia(ANLL).Method We summarized and analyzed the cases with acute non-lymphocytic leukemia in children patients from our hospital admission between Jan 2003 and Sep 2007.Results ①The M1,M2 subtype of childhood ANLL were about 37.1%;the clinical situation was various;extramedullary infiltration was not uncommon;②A totle complete remission(CR)rate was 68.6% and the CR rate of one course chemotherapy was 40.1%;③The CR rate of acute promyelocytic leukemia(APL)was 87.5% and a average of continues CR(CCR)was 33 months after the treatment of ATRA combined with As2O3;④Among five patients finished all the courses of high dose Ara-c(HDAra-c)intensification therapy,three were CCR over 36 months.Conclusion ①The CR rate of one course chemotherapy was correlated to the intensity of treatment;②The treatment of As2O3 can help to lower the relapse of APL and enhance the event-free survival(EFS);③The treatment of HDAra-c can help to increase the EFS rate of childhood ANLL.