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Objective:To prospectively investigate the prevalence of heparin-induced thrombocytopenia (HIT) in critically ill children during extracorporeal membrane oxygenation(ECMO) and explore the clinical characteristics and prognosis of HIT during ECMO.Methods:A total of 22 critically ill children, who had received ECMO support for more than 96 hours in the Intensive Care Unit at the Children′s Hospital of Fudan University from March 2019 to December 2020, were enrolled.According to the 4T score and the heparin/platelet factor 4(PF4) antibody, children whose 4T scores were not less than 6 and heparin/ PF4 antibodies were positive, were classified into HIT group ( n=6), and non-HIT group ( n=16). The clinical outcomes and the incidence of thrombotic events were compared between two groups. Results:The incidence of HIT during ECMO in critically ill children was 27% in this study.The incidence of thrombosis in the ECMO circuit in the HIT group was higher (100% vs.63%, P=0.133), and the average time to the first thrombosis in ECMO circuit in the HIT group was shorter than that in the non-HIT group (3.70 d vs.5.44 d, P=0.06). During the first 14 days of ECMO, the proportion of children with thrombotic events no less than twice was higher in the HIT group (67% vs.19%, P=0.054). There was no significant difference regarding the survival rate at 28 days after ECMO withdrawal between two groups (33% vs.50%, P=0.664). Conclusion:The prevalence of HIT during ECMO in critically ill children is high.Thrombosis events tend to occur earlier and more extensively in children with HIT during ECMO.No significant effect of HIT on the survival rate of children during ECMO is found.Whether HIT has effect on the survival rate of children with ECMO requires a prospective and large clinical study.
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Objective:To study the pathogenic distribution of bronchoalveolar lavage fluid in children with severe pneumonia from Children′s Hospital Affiliated to Soochow University, and to investigate the drug resistance of major pathogenic bacteria.Methods:A total of 177 children with severe pneumonia undergoing fiberoptic bronchoscopy in Children′s Hospital Affiliated to Soochow University from January 2014 to December 2018 were enrolled.Their bronchoalveolar lavage fluid was collected for pathogen identification, pathogen culture and drug sensitivity analysis.The pathogens were detected by direct immunofluorescence quantitative PCR.Results:Of 177 cases enrolled, 100 children had at least one pathogen detected, and the positive rate was 58.13%.Among all the pathogens detected, Mycoplasma pneumonia (MP) had the highest detection rate, which was found in 41 cases.The top three bacteria detected included Streptococcus pneumoniae (9 cases, 10.59%), Staphylococcus aureus (8 cases, 9.41%), and Pseudomonas aeruginosa (6 cases, 7.06%). The top three viruses detected were cytomegalo virus (CMV) (14 cases, 33.33%), human bocavirus (HBoV) (10 cases, 23.81%), and respiratory syncytial virus (RSV) (8 cases, 19.05%). The drug sensitive test indicated that main kinds of Gram-negative bacteria had low resistance to quinolones, aminoglycosides, carbapenems, and enzymatic beta-lactams.Main kinds of Gram-positive bacteria had low resistance to Linezolid and vancomycin.The virus detection rate and MP detection rate in severe pneumonia children under 5 years old were about 30.00% and 20.00%, respectively.The MP detection rate in children above 5 years old exceeded 30.00%.The bacteria detection rates in children under and above 2 years old were over 20.00% and about 15.00%, respectively.Airway abnormalities were common in children with severe pneumonia, mainly including tracheobronchial malacia and stenosis. Conclusions:The most common pathogen of bronchoalveolar lavage fluid in severe pneumonia children under 5 years old in Suzhou is viruses.The bacteria detection rate is high in children under 2 years old.Common Gram-positive bacteria show high susceptibility to vancomycin and Linezolid. Pseudomonas aeruginosa is highly sensitive to quinolones, aminoglycosides, carbapenems, and enzymatic beta-lactams.Importance should be attached to the airway abnormalities in children, especially infants, with severe pneumonia.
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Objective To discuss the mode of onset,clinical characteristics,treatment and prognosis of children with granulocyte sarcoma (GS),in order to provide guidance for early diagnosis and effective treatment of GS.Methods Six cases of children with GS diagnosed at the Department of Hematology,Children's Hospital Affiliated to Soochow University between June 2009 and June 2014 were analyzed,the data including the mode of onset,clinical manifestation,diagnosis,treatment and outcome.Results There were 2 cases with a painless mass onset (1 case was 2 years old,characterized by right waist mass,about 10 cm × 5 cm;the other case was 6 years old,characterized by axillary lump,about 2 cm × 3 cm),and both of them received surgical removal of the tumor,then the postoperative tumor was examined by pathologic and immunohistochemical method,and at last the primary granulocyte sarcoma was diagnosed.The third case was a 7 years old girl,she was onset characterized by scalp lump,about 2 cm × 3 cm,and was diagnosed by the pathologic and immunohistochemical method,and changes in hematological system appeared a month later and acute myeloid leukemia(AML) was confirmed by bone marrow examination.The onset ages of other 3 cases were in 10 months,1 year and 7 months,13 years and 3 months old respectively,characterized by scalp lump (about 2 cm × 3 cm),spinal canal tumor (about 1.0 cm × 1.5 cm),intracranial tumors (6.0 cm × 4.9 cm),with AML occurring at the same time,which was confirmed by surgical pathology,immunohistochemistry and bone marrow cell morphology,immune classification,chromosome,and fusion gene diagnosis.Four cases were hematopoietic malignancies by pathology,2 cases of then belonging to small round cell tumor.The immune pathology showed 5 cases of myeloperoxidase positive,CD68-positive,3 cases of CD43-positive,CD123-positive.All children CD3,CD20 levels in all children were negative.Four cases underwent surgery combined with chemotherapy,other 2 cases received surgery and then gave up treatment,1 case discontinued follow-up 3 months later,and the other case died of intracranial hemorrhage after 3 months,which induced by thrombocytopenia.The treated 4 cases were followed up 3 to 58 months,and all had disease-free survival.Conclusions Children with GS have low incidence and non-specific diagnostic criteria,its diagnosis depends on immune pathology,and the treatment is mainly in accordance with AML program for high-dose chemotherapy.The systematic chemotherapy helps to prolong overall survival;at the same time,the hematopoietic stem cell transplantation with bone marrow may help to improve the prognosis.