Risk factors for death in children with septic shock / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To identify the risk factors for death in children with septic shock.</p><p><b>METHODS</b>Clinical data of 53 children with septic shock admitted to the Yuying Children's Hospital between January 2006 and July 2008 were retrospectively studied. Risk factors for death were assessed using univariate analysis and logistic regression analysis.</p><p><b>RESULTS</b>Nineteen cases died out of 53 children with septic shock. Univariate analysis and logistic regression analysis showed that arterial blood pH value<7.0 (OR=89.66), hypotension (OR=84.00), the pediatric critical illness score<70 (OR=60.00), the number of organ dysfunction>or=3 (OR=38.98), incompletion of volume resuscitation within 6 hrs after shock (OR=26.41), and no administration of effective antibiotics within 1 hr after shock (OR=11.43) and of vasoactive drugs (OR=75.68) were risk factors for death in children with septic shock.</p><p><b>CONCLUSIONS</b>A low arterial blood pH value (<7.0), hypotension, a pediatric critical illness score (<70) and the number of organ dysfunction>or=3 are related to a high mortality in children with septic shock. If the volume resuscitation can be completed within 6 hrs after shock, effective antibiotics can be administered within 1 hr after shock, and vasoactive drugs can be used properly, the outcome of children with septic shock may be improved.</p>

Three cases of enterovirus 71 infection with pulmonary edema or pulmonary hemorrhage as the early clinical manifestation / 中华儿科杂志

<p><b>OBJECTIVE</b>To recognize the clinical features of the enterovirus 71 (EV71) infection with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness.</p><p><b>METHODS</b>We retrospectively reviewed the medical records of the three cases with EV71 infection for clinical manifestation, laboratory data, medications, outcome etc.</p><p><b>RESULTS</b>All the cases were infants and they all died. These infants had no skin or mucosal lesions, however, they had sudden onset of cyanosis and tachypnea 1 to 2 days after the onset of the febrile disease with vomiting. All these 3 cases were misdiagnosed and were treated for shock on admission. Pulmonary hemorrhage was not considered in any of the cases on admission. All the cases received tracheal intubation when foamy secretions were discharged from mouth and nose of the patients and notable cyanosis was noted. After intubation, all had pink foamy fluid flew out from the endotracheal tube. The patients had hyperglycemia and limb weakness, two had tachycardia, and hypertension was found in one case. Chest X-ray showed bilateral or unilateral widespread air space opacity, but the cardiac size and shape were normal. All the patients had leucocytosis. EV71 infection was confirmed by detection of specific sequences of the virus in throat swab and tracheal secretions samples and in one case in cerebrospinal fluid sample.</p><p><b>CONCLUSION</b>Pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71-infected infants. The initial presentation was often nonspecific with fever and vomiting, and sudden appearances of cyanosis, tachypnea, tachycardia, hypertension or hypotension, limb weakness may suggest pulmonary edema or hemorrhage. Excessive fluid resuscitation may deteriorate the illness, on the contrary, fluid restriction and inotropic agents, and early intubation with positive pressure mechanical ventilation may be the proper treatment.</p>

Changes of Plasma Somatostatin in Children with Septic Shock / 实用儿科临床杂志

Objective To explore the changes of plasma somatostatin(SST) in children with septic shock.Methods The level of plasma SST in children with septic shock (test group,n=21) on an empty stomach at shock stage,blood pressure and heart rate recovery stage,recovery stage(at that time clinical symptoms and signs disappeared,infection indicators such as blood routine and CRP returned to normal,about 6-12 days after admission) were detected by competive radioimmunassay,the level of SST in healthy children(healthy control group,n=25) on an empty stomach on morning was detected,too.The levels of plasma SST between septic shock concbined with paralytic ileus group and without paralytic ileus group were compared.Results 1.Level of plasma SST of test group at shock stage[(44.60?16.83) ng/L]was significantly lower than that of control group[(123.15?6.57) ng/L](t=-12.16 P0.05).The level of plasma SST of children with paralytic ileus [(28.10?7.0) ng/L] was significantly lower than that of children without paralytic ileus [(56.98?9.44) ng/L](t=-7.70 P