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The clinical data of 2 children with early graft liver dysfunction (EAD) admitted to the Pediatric Intensive Care Unit, Shanghai Children′s Medical Center, Shanghai Jiaotong University School of Medicine were retrospectively analyzed to discussed the therapeutic significance of non-biological artificial liver technology, such as intermittent plasma exchange (PE) combined with continuous veno-venous hemodiafiltration (CVVHDF) in children with EAD.Case 1 was suffering from biliary atresia, and case 2 was suffering from Niemann-Pick disease.Graft liver dysfunction and multiple organ dysfunction occurred in 2 children after liver transplantation.PE and CVVHDF were initiated early in the first two days after liver transplantation.After one-week therapy with intermittent PE plus CVVHDF, acute multiple organ dysfunction were reversed with liver function remarkably improved in the 2 cases.Therefore non-biological artificial liver technique can be tried after liver transplantation in children.This technique contributes to the recovery of liver function and can improve the secondary multi-organ insufficiency.
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Objective To explore the characteristics and value for predicting prognosis of cytokines in septic children with or without neutropenia.Methods Totally 138 septic children were divided into the neutropenia and non-neutropenia groups according to absolute neutropenic count.Septic children were divided into the shock and non-shock groups according to circulation function and organ perfusion.The levels of C-reactive protein,procalcitonin,cytokines,PRISM-Ⅲ and clinical outcomes were analyzed between the relative groups.Results (1) Totally 138 septic children were recruited,64 with neutropenia and 74 without neutropenia.The level of PRISM-Ⅲ of the neutropenia group was significantly higher than that of the non-neutropenia group (P=0.048).Mortality showed no significant difference between the two groups,but hospital stay in the neutropenia group was longer than that in the non-neutropenia group.The levels of C-reactive protein,IL-6,and IL-10 ihe neutropenia group were significantly higher than those of the non-neutropenia group (P=0.001;P=0.001;P=0.032).The level of TNF-α in the neutropenia group was significantly lower than that of the non-neutropenia group (P=0.032).(2)Among the 64 septic children with neutropenia,23 were combined with shock.The PRISM-Ⅲ level of the shock group was significantly higher than that of the non-shock group (P=0.001).The mortality of the shock group (43.5％,10/23) was significantly higher than the non-shock group (2.4％,1/41) (P=0.001).C-reactive protein,procalcitonin,IL-6,IL-10 and TNF-α in the shock group elevated obviously than those in the non-shock group (P=0.001;P=0.001;P=0.001;P=0.005;P=0.019).The area under receiver operating characteristic curve was 0.8 for IL-6 (cut-offvalue 315.38 pg/mL),0.8 for IL-10 (cutoff value 45.18 pg/mL),and 0.85 for TNF-α (cut-off value 1.95 pg/mL).(3) Among the 74 septic children without neutropenia,19 were combined with shock The PRISM-Ⅲ level of the shock group was significantly higher than that of the non-shock group (P=0.022).There was no significant difference of mortality between the two groups (P=0.3).IL-10 level in the shock group elevated obviously than that in the non-shock group (P=0.015).(4) Among the 42 children with sepsis shock,23 were combined with neutropenia.The PRISM-Ⅲ level of the neutropenia group was significantly higher than that of the non-neutropenia group (P=0.005).There was no significant difference of mortality between the two groups (P=0.29).The levels of C-reactive protein,procalcitonin,IL-6 and IL-10 in the neutropenia group were significantly higher than those in the non-neutropenia group (P=0.001;P=0.001;P=0.001;P=0.035).There was no difference of TNF-α level between the two groups.(5) Among the 96 children without sepsis shock,41 were combined with neutropenia.No difference of PRISM-Ⅲ level was observed between the neutropenia and nonneutropenia groups.The mortality of the neutropenia group was significantly lower than that in the non-neutropenia group (2.4％ vs 20％,P=0.02).The levels of C-reactive protein and IL-6 in the neutropenia group were significantly higher than those in the non-neutropenia group (P=0.005;P=0.033).The TNF-α level was significantly lower than that in the non-neutropenia group (P=0.007).Conclusions Compared to children without neutropenia,septic children combined with neutropenia have longer hospital stay,and septic shock children combined with neutropenia have higher mortality,and levels of IL-6,IL-10 and TNF-α were also significantly increased.The levels of IL-6,IL-10 and TNF-α can help to predict prognosis of children with sepsis.
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Objective To investigate the efficacy and safety of leukoreduction therapy in severe per-tussis in infants. Methods Therapeutic processes of 3 cases of severe pertussis in PICU of Shanghai Children′s Medical Center were retrospectively studied from October 2017 to May 2018. We reviewed the related literatures and summarized the time and effectiveness of leukoreduction therapy in severe pertussis. Results All 3 cases had leukocytosis,respiratory faliure,pulmonary hypertension and right heart failure. One case had multiple organ failure before undergoing exchange transfusion therapy and eventually died. Two cases that had pulmonary hypertension during the period of WBC′s rising accepted leukopheresis therapy before multiple organ failure,and eventually survived. We reviewed the foreign literatures which was almost case reports,leukoreduction therapy might improve the prognosis of severe pertussis in infants,but the time of using it had no conclusion. Conclusion This is the first report of leukoreduction therapy for the severe per-tussis in infants in China. It provides a new method for the treatment of severe pertussis in infants. It is worth looking forward to use this method combined with continuous renal replacement therapy and extracorporeal membrane oxygenation technology. In the future,multicenter clinical research should be done to explore the effectiveness and safety of leukoreduction therapy in the severe pertussis in infants.
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Objective To assess the association between vitamin D levels during pregnancy and the risk of offspring's wheeze.Methods We searched electronic databases of PubMed and EMbasefrom published studies until July 2017.A random-effects meta-analysis was conducted among 11 birth cohort studies.Results Eleven studies on the association between maternal vitamin D status and childhood wheeze met our inclusion criteria.Maternal vitamin D status during pregnancy was associated with childhood wheeze(OR =0.97,95％ CI:0.96 ～ 0.99).Maternal intake of vitamin D(pooled OR =0.51,95 ％ CI:0.37 ～ 0.64),cord blood 25 (OH)D levels at birth (pooled OR =0.94,95％ CI:0.9 ～ 0.98) were associated with childhood wheeze.Furthermore,maternal vitamin D stasus were only associated with childhood early wheeze(OR =0.92,95％ CI:0.89 ～0.96),but not with late-onset or persistent wheeze.Conclusion High levels of vitamin D during pregnancy are inversely associated with the risk of wheeze during childhood.