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Objective:To explore the effect of augmented renal clearance(ARC)on 24-hour area under the concentration-time curve to minimum inhibitory concentration ratio(AUC 24/MIC)of vancomycin and prognosis in critical children, thus to provide proposal for individual dosage regimen. Methods:Sixty-five critical children treated with vancomycin, who suffered from sepsis/septic shock, were brought into this retrospective cohort study.According to estimate glomerular filtration rate, these children were divided into ARC group ( n=27) and normal group ( n=38). The influencing factor of AUC 24/MIC of vancomycin and therapy prognosis for two groups were detected and analyzed. Results:There were no significant differences between two groups in basic setting (age, sex, weight), scores of pediatric sequential organ failure assessment and pediatric risk of mortality Ⅲ, infection markers (C-reactive protein and procalcitonin), glutamic-pyruvic transaminase, hypoproteinemia, usage of diuretic and vasoactive agent( P>0.05). The patients from ARC group showed lower levels than those from normal group in AUC 24/MIC of vancomycin[375.2(300.8, 489.4) vs. 443.6(412.3, 593.2), Z=2.263, P=0.024] and it′s target achievement ratio (TAR)(40.7% vs. 76.3%, χ2=8.440, P=0.005). When usage of diuretic and vasoactive agent, the AUC 24/MIC of ARC group was lower than that of normal group( P<0.05). But there was no significant difference between ARC group and normal group regarding hypoproteinemia( P>0.05). The days of body temperature steady at least 48 hours[7.0(5.5, 9.0)d vs. 6.0(5.0, 8.0)d], the length of hospital stay[39.0(21.0, 58.0)d vs. 20.5(16.0, 28.0)d], the length of PICU stay[14.0(9.0, 31.5)d vs. 10.0(5.0, 15.0)d] were longer than those in normal group( P<0.05). There were no significant differences between ARC group and normal group regarding days of ventilation and infectious markers decreased at least 50%, as well as 28-days mortality( P>0.05). The multivariable analysis showed that the presence of ARC, hypoproteinemia, use of diuretics and vasoactive agent were significantly associated with AUC 24/MIC of vancomycin( P<0.05). Conclusion:ARC may down regulate levels of AUC 24/MIC and TAR of vancomycin.During ARC period, the usage of diuretic and vasoactive agent could affect the AUC 24/MIC of vancomycin.Individual dosage regimen should be employed for critical children suffered with ARC.
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Objective:To analyze the early clinical features of children with coronavirus disease 2019 (COVID-19) in order to further improve the understanding of the disease.Methods:A total of 312 children with COVID-19 under 16 years old who were first diagnosed in the children′s fever clinic at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March to May 2022 were retrospectively analyzed.The epidemiology, early clinical features and blood routine results of children were described, and the blood routine results among different age groups were compared.Results:The median age of 312 children was 3.15(1.47, 6.51) years.The proportion of infection rate of children with different ages from high to low were 1~3 years old, > 6 years old, 3~6 years old and ≤ 1 year old.Only 17 (5.4%) cases had underlying diseases.Additionally, 70.2% patients had definite positive case reports in their residential communities, and 65.1% showed a familial cluster.Moreover, 96.2% patients had fever and 52.9% patients had respiratory symptoms.The main symptoms are fever (96.2%), cough (38.1%), runny nose (20.2%), vomiting (14.7%), sore throat (11.5%), poor appetite (6.7%), nasal congestion (4.5%), expectoration (4.5%), convulsion (4.2%), diarrhea (3.8%), etc.Among 309 children, 11.3% patients had increased white blood cell count, especially in children over 6 years old ( P=0.006); 31.7% patients had decreased lymphocyte count and 32.4% had increased C-reactive protein.The positive rate of point-of-care testing was as high as 99%. Conclusion:Children with COVID-19 in Shanghai had the characteristics of familial cluster.The main symptoms are fever and respiratory symptoms.Most of the blood routine leukocytes have no obvious changes, and a few have lymphopenia and C-reactive protein elevation.Point-of-care testing detection can help the children′s fever clinic to early screen COVID-19.
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Objective:To investigate the acute kidney injury(AKI) after cardiopulmonary bypass surgery for cyanotic congenital heart diseases(C-CHD) as well as and acyanotic congenital heart diseases(A-CHD)and its possible influencing factors.Methods:One hundred and three patients with CHD admitted to PICU of Xinhua Hospital Affiliated to Shanghai Jiaotong University were enrolled from July 1, 2017 to September 30, 2019.The patients were divided into C-CHD group( n=36)and A-CHD group( n=67). The preoperative general data and information related to the operation of two groups were recorded.Hemodynamic data, oxygen metabolism index, dose of vasoactive drugs during or after operation and liquid equilibrium were assessed after surgery.The incidence and stage of AKI were calculated.Multivariate Logistic regression was used to analyze the relationship between hemodynamic index and oxygen metabolism index and AKI.The predictive value of hemodynamics and oxygen metabolism for AKI after cardiac surgery was analyzed by receiver operating characteristic curve (ROC). Results:A total of one hundred and three patients were enrolled including sixty-two males and forty-one females, the median age was 7(4, 24) months old.The preoperative hemoglobin and hematocrit in the C-CHD group were higher than those in the A-CHD group( P<0.05). Compared with the A-CHD group, the C-CHD group had higher American Society of Anesthesiologists Grades and Risk Adjustment for Congenital Heart Surgery Grades, longer operation time and cardiopulmonary bypass time( P<0.05). Central venous pressure in C-CHD group was higher than that in A-CHD group, and C-CHD group had higher dose of vasoactive drugs after surgery( P<0.05). Compared with the C-CHD group, blood lactic acid was lower and arterial oxygen partial pressure was higher in the A-CHD group( P<0.05). Fifty patients developed AKI in the PICU, and the incidence of AKI in the A-CHD group was higher than that in the C-CHD, but there was no statistical significance(53.7% vs.38.9%, P>0.05). Multivariate Logistic regression analysis showed that partial arterial oxygen pressure and arterial oxygen satiety were independent risk factors for AKI( P<0.05). The large circulation index could not directly reflect the renal perfusion.Compared with using hemodynamic index or oxygen metabolism index alone to predict the occurrence of AKI 48 h after the operation, the combined application of the two methods had higher predictive value for AKI. Conclusion:Compared with patient with A-CHD, patients with C-CHD have higher tolerance to renal damage caused by surgery, and the kidney of patient with C-CHD have higher tolerance to postoperative fluid load and demand lower oxygen consumption.It is of great clinical significance to evaluate the changes of hemodynamics and oxygen metabolism after cardiac surgery for the prevention and treatment of renal injury.
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Nebulization is widely used in treating respiratory disorders in younger patients and critically ill children.Jet nebulizers,ultrasonic nebulizers and vibrating mesh nebulizers are the main types of small volume nebu-lizers used in emergency room and pediatric intensive care unit.Glucocorticoids,bronchodilators,mucolytic agents can be administered via nebulization.Different compatibilities exist among these therapeutic agents.
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Objective To identify the pathogen distribution and antibiotics resistance of blood stream infection(BSI) in the pediatric surgery intensive care unit(PSICU).Methods The clinical data of 138 pediatric patients diagnosed with BSI from January 2011 to December 2015 were collected in PSICU,and the distribution of pathogens and drug resistance were retrospectively analyzed.Results The incidence of BSI was 3.88‰(138/35.524)in the five years,the majority of the BSI cases occurred under one year old,and the mortality was 13.77%(19/138).A total of 179 strains were isolated from blood samples of 138 patients,of which gram-positive bacteria,gram-negative bacteria and fungi accounted for 60.89%(109/179),22.91%(41/179)and 16.20%(29/179)respectively.The most common gram-positive bacteria was coagulase-negative staphylococcus (84/179,46.93%).The predominant gram-negative bacteria were Acinetobacter baumannii(15/179,8.38%),Klebsiella pneumonia(12/179,6.70%) and Escherichia coli(6/179,3.35%).The rate of carbapenems-resistant Acinetobacter baumannii increased continuously in the study period.Non-albicans Candida was the most common fungi (14/179,7.82%).The resistance rate of multi-drug resistant strains to carbapenems significantly increased.Conclusion The incidence of BSI in PSICU increases,and the mortality in children younger than one year is high.Better understanding of distribution of BSI pathogen could provide more effective antibiotic prescription.
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Objective To discuss the efficacy of ulinastatin in treatment of children with severe pneumonia.Methods One hundred children with severe pneumonia were analyzed retrospectively.They were divided into two groups.One was treatment group with 48 cases of patients and another was control group with 52 cases of patients.The two groups both accepted routine treatments,while the treatment group was given ulinastatin[(20 kU/(kg·d),5 d in total] additionally.The clinical improvement of both groups was observed.Changes of clinical syndromes including temperature and lung rale were observed.The effect of treatment in following aspects were evaluated:time of oxygen therapy,the length of stay in PICU and total hospitalization day.Recovery times of infectious indicators were monitored including peripheral WBC count,C-reactive protein (CRP) and procalcitonin (PCT).Meanwhile,the clinical adverse effect of the drug was observed.Results After treatment,recovery time of temperature in treatment group was (5.81±1.26) d,while in control group was(8.04±1.38) d.There was an obvious difference between two groups(t=-8.42,P＜0.01).Compared to control group,the recovery times of infectious indicators including WBC count,CRP,and PCT were shorter[(5.35±1.39) d vs.(6.65±1.79) d,t=-4.03,P＜0.01;(6.98±1.66) d vs.(8.17±1.64) d,t=-3.60,P＜0.01;(6.13±1.72)d vs.(7.52±1.78)d,t=-3.96,P＜0.01].In the treatment group,the length of stay in PICU was (8.44±2.47) d,which was shorter than that in control group [(10.62±3.13)d,t=-3.84,P＜0.05].But there was no significant difference in both groups of time of lung rale disappearing,oxygen therapy and the total hospitalization days.No side effect was found in treatment group.Conclusion For the children with severe pneumonia,besides the treatments of anti-infection,breathing and nutrition support,the use of ulinastatin can improve the condition of patients and the index of inflammatory reaction.It also can shorten the length of stay in PICU.Since the curative effect of ulinastatin is specific and it has less adverse reactions,ulinastatin can be used as one of the effective measure in treatment of severe pneumonia in children.
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Objective To investigate the trough and peak vancomycin plasma concentrations in steady-state following regular dosage and to improve dosing regimen based on pharmacokinetic modeling, providing reference for clinical practice in children.Methods we retrospectively analyzed pharmacokinetics of vancomycin in 50 cases admitted in our PICU who had been confirmed or suspected with gram-positive bacterial infections following regular dosage[40 mg /(kg?d)].Then we tried to optimize dosing regimens with Monte Carlo simulation to evaluate different dosing regimens of vancomycin in children.Results with regular dosage of vancomycin,mean trough concentrations of vancomycin were (1 1.02 ±4.44 )mg /L, trough concentrations higher than 15 mg /L accounted for only 12%.In the actual program,the extension of a single intravenous infusion to 3 hours after administration would result in 26% of trough concentrations dis-tributing in the range above 15 mg /L.If we increased daily dose to 50 mg /kg and 60 mg /kg with simulation, the trough concentration distribution frequency above 15 mg /L would increase from 12% to 32% and 40%. If minimum inhibitory concentration of vancomycin to pathogenic bacteria (Staphylococcus aureus )was 1 mg/L,the probabilities of target attainment for pharmacokinetic/pharmacodynamic evaluation were 51.73%, 76.54% and 87.5% for three dosages [40 mg/(kg?d),50 mg/(kg?d)and 60 mg/(kg?d)]of vancomycin, respectively.we suspected that dosage of 60 mg/(kg?d)was a good choice.with this dosage regimen,we could achieve a substantial increase in the probability of target attainment.Conclusion Following regular dosages, trough concentration distribution frequency from 15 to 20 mg /kg is low.The extension of a single intravenous infusion time can not achieve a good result.According to the result of pathogenic bacteria and anti-microbial susceptibility tests,increasing daily dosage of vancomycin to 60 mg /(kg?d)will help to improve the trough concentration and get more clinic achievements.
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Objective To improve theu nderstanding of the characteristci s of death in hospitail zed hc ildren and provide clinical cautionary information to professional healthcarep rovdie rs.Methods A retro-spective analysis was undertaken on thed ata of all children aged 1 month to 11 years who died at the Xinhua H ospital between 2007 and 2014.Demographic details,main causes of deaths,and chronic underyl ingd iseases were reviewed.Results Case fatality rate was 0.58%( 451/77 838 ) .Overall, the most common causes fo deathni hospitalized childer n were pneumo nia 38.80%(175/451),tumor 13.75%(62/451),sepsis 11.97%(54/451),central nerve system infection 8.00%(36/451) and accident 7.32%(33/451).Infectious disea-ses were the maoj r causes of deathi n children younger than 5ye ars of age(66.86%,230/344).In oc ntrast, noninfectious diseases accuo tn ed for mo re deathsni children more than 5 years old(52.34%,56/107).There were 343d eath cases comp licated wiht chronic undelr ying diseases.Congentia la bnormality was the most fre-quent chronic underlying disease observed in infants(59.90%,115/192) and tumor was the main chronic nu -derlying dsi easei not ddlers and elder children(34.36%,89/259).Conclusion Infectious diseasse were the major causes of deta hs,and teh mortality in the study popual tion decreased with age.Tumors and accidents accounted for more deaths in elder children.Chronic underlying diseases were found in most deaths of children.Efficient evaluation and effective intervention of these vulnerable children might save more lives.
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Objective To explore the effects of perfluorocarbon (PFC) on the damaged type Ⅱ alveolar epithelial cells (AEC Ⅱ) induced by lipopolysaccharide (LPS),and the apoptosis and inflammatory reaction of AEC Ⅱ induced by LPS.Methods Primary AEC Ⅱ was divided into control group according to the random number table method,LPS group,PFC group and PFC + LPS group.LPS group:LPS (1 μg/ml) was added to cells.PFC group:PFC (20％) was added to cells.PFC + LPS group:PFC (20％) and LPS (1 μg/ml) were added to cells.The apoptotic rate of AEC Ⅱ was detected by flow cytometry.Morphologic change was observed by electron microscope.Concentrations of intedeukin (IL)-6 and IL-10 of supernatant were detected by ELISA.Results Apoptotic rate of AEC Ⅱ remarkably increased in LPS group than in control grouop [(10.89 ± 1.04) ％ vs (14.29 ± 1.93) ％] (P ＜ 0.05).Compared with LPS group,the apoptotic rate of AEC Ⅱ decreased remarkably in the PFC + LPS group [(12.22 ± 1.47) ％],(P ＜ 0.05).IL-6 production of AEC Ⅱ significantly increased in LPS group than in control group [(482.58 ± 26.84) vs (229.40 ± 7.61) pg/ml pg/ml] (P ＜ 0.05),while decreased in PFC + LPS group [(265.44 ± 29.95) pg/ml].IL-10 production of AEC Ⅱ significantly increased in LPS group than in control group [(1 497.29 ±191.89) pg/ml vs (725.87 ±51.83) pg/ml] (P ＜0.05),while there was no difference between LPS group and PFC + LPS group (P ＞ 0.05).Conclusion PFC can protect AEC Ⅱ against the injury induced by LPS.PFC can also release the level of inflammatory response.
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Objective To discover the clinic presentation and therapy of disseminated Penicillium marneffei infection in children.Methods We reported the clinic presenation,pathology and therapy of the disseminated Penicillium marneffei in children.Results Case one,l-year-old boy presented with fever and cough for one month.Penicillium marneffei was cultured from bone marrow and blood.Case two,8-year-old girl presented with delirium.Penicillium marneffei was cultured from blood.Treatment with voriconazole solely was successful in the first case.Conclusion Central nervous system could been infected by Penicillium marneffei.Treatment with voriconazole solely could be effective in children.