Clinical features of children with severe adenovirus pneumonia and hemophagocytic syndrome: an analysis of 30 cases / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of children with severe adenovirus pneumonia (SAP) and hemophagocytic syndrome (HPS).@*METHODS@#A retrospective analysis was performed from the chart review data of 30 children with SAP and HPS who were admitted from January 2014 to June 2019. According to the prognosis, the children were divided into a good prognosis group (n=18) and a poor prognosis group (n=12).@*RESULTS@#Among the 30 children with SAP and HPS, the ratio of male to female was 2:1. The median age of onset was 1 year and 3 months (range 3 months to 5 years), and the mean course of fever was 19±7 d. Of the 30 children, 28 (93%) experienced disease onset in January to June. High-throughput gene detection of serum pathogens showed that 16 (53%) children were positive for human adenovirus type 7 (HAdV-7), and the other 14 (47%) children were positive for HAdV antigen based on immunofluorescence assay for throat swab, with unknown type. Of all 30 children, 29 (97%) had respiratory complications, 24 (80%) had cardiovascular complications, 16 (53%) had gastrointestinal complications, and 9 (30%) had toxic encephalopathy. Eighteen children (60%) improved or recovered and 12 (40%) did not recover (3 died). Compared with the good prognosis group, the poor prognosis group had a significantly longer course from onset to diagnosis of HPS (P<0.05), significantly higher levels of fibrinogen and tumor necrosis factor-α (P<0.05), and a significantly lower level of interferon-γ (P<0.05). The mean follow-up time was 6±2 months; 11 (41%) children recovered, 1 (4%) experienced recurrence of HPS, and 15 (56%) had the sequela of post-infectious bronchiolitis obliterans (PIBO).@*CONCLUSIONS@#HPS may be observed in children with SAP, and PIBO is the most common sequela of SAP.

Clinical features and prognostic factors in children with dilated cardiomyopathy / 中华实用儿科临床杂志

Objective To discuss the clinical features and prognostic factors in the children with dilated cardiomyopathy(DCM).Methods The clinical data of 45 cases of DCM,including 27 boys and 18 girls,from May 2007 to Nov.2011 in Wuhan Children's Hospital were analyzed by retrospective medical record survey methods.The average age of onset was(19.20 ± 18.98) months.Eight cases (17.8％) were of cardiac function grade Ⅰ-lⅡ,and 37 cases (82.2％) were of cardiac function grade Ⅲ-Ⅳ.The patients whose left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) increased by 10％-15％ compared with those before treatment were defined as improved group,and the patient's LVEF and LVFS levels declined persistently or those of dead cases were defined as worsened group.There were 34 cases assigned as the improved group,8 cases as the worsened group,and 5 out of 8 cases were dead.The age,occurrence of abnormal Q waves,cardiac function,LVEF and LVFS in the 2 groups were analyzed.Results The cardiac troponin,creatine kinase,creatine kinase isoenzyme in the cardiac function grade Ⅲ-Ⅳgroup were significantly higher than those in the cardiac function grade Ⅰ-Ⅱ group (all P ＜ 0.01).There were 11 patients who had abnormal Q waves by electrocardiogram when they were diagnosed.The LVEF and LVFS levels in the cardiac function grade Ⅰ-Ⅱ group were significantly higher than those in the cardiac function grade Ⅲ-Ⅳ group (all P ＜ 0.05).There were statistically significant differences in age on diagnosed,proportion of newly diagnosed cases age ≤ 1 year old,occurrence of abnormal Q waves,cardiac function in grade Ⅲ-Ⅳ,LVEF and LVFS levels between the improved group and the worsened group (all P ＜ 0.05).Conclusions Most of the children with DCM were diagnosed more when they were ≤ 1 year old,mostly with cardiac function grade Ⅲ-Ⅳ.The occurrence of abnormal Q waves,cardiac function grade,LVEF and LVFS levels could be used as important prognostic indicators for DCM.

Changes in serum insulin-like growth factor-1 and insulin-like growth factor-binding protein-3, and their significance in children with left-to-right shunt congenital heart disease associated with heart failure / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate changes in serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) and their significance in children with left-to-right shunt congenital heart disease (CHD) associated with heart failure (HF).</p><p><b>METHODS</b>Twenty healthy children (control group), 20 children with HF, without basic heart disease (HF group), 20 children with left-to-right shunt CHD, without HF (CHD group), and 30 children with left-to-right shunt CHD associated with HF (CHD+HF group) were included in the study. These groups were compared in terms of serum IGF-1 and IGFBP-3 levels. According to the New York Heart Association (NYHA) Functional Classification, the CHD+HF group was further divided into NYHA-II, NYHA-III and NYHA-IV subgroups and the subgroups were compared in terms of serum IGF-1, IGFBP-3, and cardiac troponin I (cTnI) levels. The correlation of serum IGF-1 and IGFBP-3 levels with serum cTnI level in the CHD+HF group was analyzed.</p><p><b>RESULTS</b>The CHD group showed decreased serum IGF-1 and IGFBP-3 levels compared with the control group (P<0.01). The CHD+HF group showed a significantly decreased serum IGF-1 level compared with the control group (P<0.01) and CHD group (P<0.05). The HF group had significantly increased serum IGF-1 and IGFBP-3 levels compared with other groups (P<0.01). The NYHA-II subgroup had the highest serum IGF-1 level and the NYHA-IV subgroup had the lowest serum IGF-1 level (P<0.01). In the CHD+HF group, serum IGF-1 and IGFBP-3 levels were negatively correlated with serum cTnI level (r=-0.692, P<0.05; r=-0.530, P<0.05).</p><p><b>CONCLUSIONS</b>Serum IGF-1 level can be used as an objective condition evaluation indicator for CHD, and low serum IGF-1 level is a risk factor for HF. This also provides a clinical basis for treatment of HF using exogenous IGF-1.</p>