ABSTRACT
Objective To survey on the condition of critically ill children in emergency room (ER) for improving the care for them.Methods Data of 374 critically ill children in emergency intensive care unit (EICU) were recorded in the respects of mode of sending them to ER,rescue during transport,length of stay in ER,blood gas,electrolytes,accuracy of assessing pediatric critical illness score/neonate critical illness score (PCIS/NCIS) and Glasgow Coma Scale (GCS),correctness of determining SIRS,sepsis and septic shock.Results Of 374 patients,neonates were 29.9％,and the mean age of children patients not including neonate was 37.4 months.The mean length of ER stay was 4.7 hours (0.42-96 hours).Of 374 patients,those with infection diseases were 47.6％,and the main vehicles for transportation of patient sent to ER were Taxi (38.3％),ambulance (28.4％) and private cars (21.5％).Total fatality was 12.3％ and ER fatality ( 15.6％ ) was higher than in - hospital fatality ( 10.3％,P ＜0.01 ).The mean PCIS/NCIS of 374 patients were 81.92 ± 9.66,and the PCIS/NCIS ≤ 90 accounted for 81％.Of assessed GCSs of 172 patients,GCS≤8,GCS 9-12 and GCS 13-15 accounted for 35.5％,21.5％ and 43.0％ respectively,and fatalities were 26.23％,10.81％ and 5.41％ correspondingly (P ＜0.01 ).The PCIS values of GCS≤8 and GCS 9-12 patients were lower than those of GCS 13-15 patients (P ＜ 0.01 ).There was no significant difference in PCIS between GCS≤8 and GCS 9-12 ( P ＞ 0.05 ).PCIS and GCS were positively correlated (r=0.454,P=0.01).Of374 patients,41.7％ had SIRS,and 25.7％ had sepsis.Of 262 children not including neonates,43.5％ had shock,and 61.4％ of these shock children were septic shock.In 374 patients,those with hyponatremia accounted for 37.2％,and those with hyperkaliemia accounted for 22.0％.The rate of hypoglycemia found in neonates was 20.91％ and rate of hyperglycemia occurred in neonates was 29.1％.The rate of hypoglycemia found in children patients was 9％ and hyperglycemia was 66.7％.Patients with pH ＜ 7.35 accounted for 67.8％ and those with pH ＜ 7.2 were 33.1％.Conclusions The majority of children patients in pediatric ER were neonates and infants.The length of ER stay was short with mean value of 4.7 hours (0.42-96 hours).ER fatality was higher than in - hospital fatality,suggesting the critically ill children patients should be admitted as early as possible.The rate of using ambulance was only 28.4％.The Emergency Medical Service (EMS) should be improved to enhance the public sense of the EMS available.PCIS/NCIS can be used in ER for assessing the conditions and prognosis of critically ill children.GCS ≤8 and GCS 8-12 patients accounted for 57％ with majority of nontrauma brain injury.The values of PCIS in GCS≤8 and GCS 9-12 patients were much lower than those in GCS 13-15 patients.Patients with GCS ＜ 13 might be in critical settings.Majority of shock patients were septic shock (61.4％).Hyponatremia,hyperkalemia,hyperglycemia and hypoglycemia often occurred in critically ill pediatric patients and hypoglycemia not excepted in the neonates should have attention paid to.The main factor of acid -base balance disorder in critically ill children was acidosis (67.8％).
ABSTRACT
Objective To discuss the clinical application of simplified neonatal critical illness score (sNCTS)in comparison with original neonatal critical illness score(oNCIS)published in 2001.Method A total of 705 neonates referred to neonate ICU(NICU)from 1 st January 2007 to 31th December 2009 were prospectively studied with control.The patients were scored by oNCIS on admission day,3rd,7th days after admission and on the day of discharge or dead.At the first scoring on admission,2 items of the PaO2 and pH were excluded from oNCIS's 10 items,and the remaining 8 items were used.Three items of plasma sodium,potassium and creatinine or BUN were scored out from 8 items and the still remained 5 items were used for the subsequent 3 scorings.The remaining 8 and 5 items were used as a simplified neonatal critical illness score.The simplified NCIS was evaluated by comparing the patients'condition that was assessed by the originat NCIS.The consistency rate between oNCIS and sNCIS should be over 80%.Results There were 8 items were used to evaluate the severity of disease on admission, and the consistence rate was 86.7%with the original NCIS.The 5 items selected from the original NCIS were used on the 3rd,the 7th days and the day of discharge or death.the consistence rate with original NCIS were 86.6%to 95.7%.A close correlation existed between the original NCIS and simplified NCIS(P0.05).Conclusions Compared with the original NCIS.the simplified NCIS is consistent to a large extent in disease assessment,which is a concise way to evaluate the critical ill neonates objectively and can be easily applied to clinical practice.
ABSTRACT
Objective To investigate the prevalence of influenza virus infections in infants and young children during the pandemic period of 2009 influenza A(H1N1)in Beijing.Methods Throat swabs were collected from children visited the affiliated Children's Hospital to Capital Institute of Pediatrics for influenza-like illness from June 1,2009 to February 28,2010.The specific gene segments of 2009 pandemic influenza H1N1 and seasonal influenza viruses were amplified from samples by real-time RT-PCR recommended by WHO and National Influenza Reference Center of China.Results Out of 4363 clinical samples tested by real-time RT-PCR,the total positive rate of influenza A viruses was 29.3%,including 623(14.3%)identified as 2009 pandemic influenza A(H1N1)and 657(15.1%)influenza A viruses without subtype identity.Among those pandemic influenza H1N1 positive,23 were severe cases with 5 deaths.The ages for 618 pandemic influenza H1N1 infected children with completed information were from 14 days to 16 years.The ratio of male to female wag 1.3:1.Among them,25.2% were patients in age group of 1 to 3 years old and distribution of children in age groups of 3 to 6 years old and 6 to 12 years old were similar(about 30.0%).During the survey period,it appeared only one prevalence wave of pandemic influenza H1N1.The positive rate of pandemic H1N1 increased in September and the peak(36.5%of positive rate)was in November and then declined to 2.7%in February 2010.The data from routine influenza virus surveillance from 20-30 clinical samples collected each week indicated an alternative prevalence of seasonal H3N2,pandemic H1N1 and influenza B during this study period.Respiratory syncytial virus(RSV)became predominant in children after the circulating of pandemic H1N1.Conclusion There was an epidemic of pandemic influenza H1N1 in children in Beijing from June 2009 to February 2010,especially in those of preschool and school aged children.Seasonal influenza viruses and pandemic influenza H1N1 were contributed alternatively.