Analysis of risk factors of mortality in infants and toddlers with moderate to severe pediatric acute respiratory distress syndrome / 中华儿科杂志

Objective: To identify the risk factors in mortality of pediatric acute respiratory distress syndrome (PARDS) in pediatric intensive care unit (PICU). Methods: Second analysis of the data collected in the "efficacy of pulmonary surfactant (PS) in the treatment of children with moderate to severe PARDS" program. Retrospective case summary of the risk factors of mortality of children with moderate to severe PARDS who admitted in 14 participating tertiary PICU between December 2016 to December 2021. Differences in general condition, underlying diseases, oxygenation index, and mechanical ventilation were compared after the group was divided by survival at PICU discharge. When comparing between groups, the Mann-Whitney U test was used for measurement data, and the chi-square test was used for counting data. Receiver Operating Characteristic (ROC) curves were used to assess the accuracy of oxygen index (OI) in predicting mortality. Multivariate Logistic regression analysis was used to identify the risk factors for mortality. Results: Among 101 children with moderate to severe PARDS, 63 (62.4%) were males, 38 (37.6%) were females, aged (12±8) months. There were 23 cases in the non-survival group and 78 cases in the survival group. The combined rates of underlying diseases (52.2% (12/23) vs. 29.5% (23/78), χ2=4.04, P=0.045) and immune deficiency (30.4% (7/23) vs. 11.5% (9/78), χ2=4.76, P=0.029) in non-survival patients were significantly higher than those in survival patients, while the use of pulmonary surfactant (PS) was significantly lower (8.7% (2/23) vs. 41.0% (32/78), χ2=8.31, P=0.004). No significant differences existed in age, sex, pediatric critical illness score, etiology of PARDS, mechanical ventilation mode and fluid balance within 72 h (all P>0.05). OI on the first day (11.9(8.3, 17.1) vs.15.5(11.7, 23.0)), the second day (10.1(7.6, 16.6) vs.14.8(9.3, 26.2)) and the third day (9.2(6.6, 16.6) vs. 16.7(11.2, 31.4)) after PARDS identified were all higher in non-survival group compared to survival group (Z=-2.70, -2.52, -3.79 respectively, all P<0.05), and the improvement of OI in non-survival group was worse (0.03(-0.32, 0.31) vs. 0.32(-0.02, 0.56), Z=-2.49, P=0.013). ROC curve analysis showed that the OI on the thind day was more appropriate in predicting in-hospital mortality (area under the curve= 0.76, standard error 0.05,95%CI 0.65-0.87,P<0.001). When OI was set at 11.1, the sensitivity was 78.3% (95%CI 58.1%-90.3%), and the specificity was 60.3% (95%CI 49.2%-70.4%). Multivariate Logistic regression analysis showed that after adjusting for age, sex, pediatric critical illness score and fluid load within 72 h, no use of PS (OR=11.26, 95%CI 2.19-57.95, P=0.004), OI value on the third day (OR=7.93, 95%CI 1.51-41.69, P=0.014), and companied with immunodeficiency (OR=4.72, 95%CI 1.17-19.02, P=0.029) were independent risk factors for mortality in children with PARDS. Conclusions: The mortality of patients with moderate to severe PARDS is high, and immunodeficiency, no use of PS and OI on the third day after PARDS identified are the independent risk factors related to mortality. The OI on the third day after PARDS identified could be used to predict mortality.

Expression patterns of Th1 and Th2 cytokine genes in childhood acute idiopathic thrombocytopenic purpura / 中华实用儿科临床杂志

Objective To study the expression patterns of Th1 and Th2 cytokine genes in childhood acute idiopathic thrombocytopenic purpura(ITP) and its clinical value.Methods Peripheral blood samples from 30 patients with acute ITP before and after treatment (ITP group) and those from 20 normal healthy subjects (healthy control group) were collected (healthy control group),and reverse transcriptases polymerase chain reaction was performed to determine the mRNA expressions of Th1 and Th2 cytokine genes before and after treatment,which were compared with those of the health controls.Results The positive rate of expression levels of Th1 cytokine genes in samples from ITP patients (3.3％,3.3％) were significantly lower than those from healthy control group (all P ＜ 0.05) and increased to normal level after treatment(16.7％,23.3％).In contrast,Th2 cytokine genes (IL-4,IL-6,IL-10)in the samples from the ITP patients(33.3％,43.3％,40.0％) were significantly higher than those from the healthy control group (all P ＜0.05) and decreased after treatment(10.0％,23.3％,20.0％).Conclusions Such data indicate that ITP is a Th2 cell predominant autoimmune disease,and the abnormal immunity due to Th1/Th2 shift is significant in the pathogenesis of ITP.

Argon plasma coagulation combined with cryotherapy via bronchoscopy for the treatment of one child with severe post-intubation tracheal stenosis and literature review / 中华儿科杂志

<p><b>OBJECTIVE</b>To observe the short term effect of argon plasma coagulation (APC) combined with cryotherapy via bronchoscopy for treatment of severe post-intubation tracheal stenosis in a child.</p><p><b>METHOD</b>A 3-year old boy was admitted for cephalothorax abdominal compound trauma and dyspnea, who had severe post-incubation tracheal stenosis. The agreement about the operation risk was signed by the parents. Endotracheal APC procedure was performed with a bronchoscope under general anesthesia. The APC probe was put into the working channel of the bronchoscope. The stenotic lesion was endoscopically visualized and then coagulated by argon plasma. Such coagulation was carried out several times at the stenotic site until it gradually became dilated. The devitalized tissue was mechanically removed with grasping forceps. Thereafter, bronchoscopic cryosurgery was repeatedly performed at the stenotic site. Clinical symptoms, signs and bronchoscopic manifestations were observed right after operation, after 1 day, 10 days, 1 month and 6 months separately.</p><p><b>RESULT</b>Tracheal tissue hyperplasia and cyanosis disappeared, laryngeal stridor and dyspnea improved obviously right after the operation. General condition of the patient was well, there was no laryngeal stridor and dyspnea 10 days after operation. The mucosa of the surgical site was smooth and no tracheostenosis was seen under bronchoscope at 1 month and 6 months after the operation.</p><p><b>CONCLUSION</b>Argon plasma coagulation combined with cryotherapy via bronchoscope is an effective method to treat tracheal stenosis of children, which needs further exploration for the application.</p>

Clinical features and management outcomes of severe hand, foot and mouth disease

This study was designed to describe the clinical features and management outcomes of severe hand, foot and mouth disease [HFMD]. Data on 147 severe HFMD patients during an outbreak in 2009 were analyzed. Most patients were under 3 years of age; 102 [69.4%] were boys. All had skin rashes and fever of ?38°C. All [n = 147, 100%] showed signs of central nervous system involvement, such as lethargy [n = 124, 84.4%], myoclonic jerks [n = 76, 51.7%], or drowsiness [n = 34, 23.1%]. Respiratory symptoms were mainly tachypnea [n = 112, 76.2%] or bradypnea [n = 21, 14.3%]. Common cardiovascular symptoms included tachycardia [n = 134, 91.2%] and hypertension [n = 23, 15.5%]. Chest X-ray showed increased markings in 76 [51.7%] or consolidation in 44 [29.9%]. Hyperglycemia and elevated blood lactic acid levels were found in 127 [86.4%] and 130 [88.4%], respectively. Positive enterovirus EV71-PCR was found in 113 [76.9%]. All patients were treated with mechanical ventilation for 61.2 +/- 12.8 h [range, 40-96 h], as well as mannitol, dexamethasone, gamma globulin and ribavirin. Dopamine, dobutamine or amrinone was administered in 58.5, 51.0 and 21.8%, respectively. Three patients [2%] died during hospitalization. All others had a full recovery and were discharged after 14.2 +/- 1.6 days [range, 12-17 days]. Central nervous and cardiorespiratory systems were involved in the patients with severe HFMD. Fasting blood glucose and lactic acid levels increased in the majority of patients. Mechanical ventilation and supportive pharmacotherapy were associated with a good clinical outcome in these patients

Plasma thromboxane A2 and prostaglandin I2 levels and their ratio in children with Henoch-Schonlein purpura nephritis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the changes and roles of plasma thromboxane A2 (TXA2) and prostaglandin I2 (PGT2) levels and their ratio in Henoch-Schonlein purpura nephritis (HSPN) in children.</p><p><b>METHODS</b>Plasma levels of TXA2 and PGI2 were measured using ELISA in 45 children with HSPN and 20 healthy children.</p><p><b>RESULTS</b>Plasma TXA2 level was significantly higher, while plasma PGI2 level was significantly lower in HSPN children in the acute phase than in the control (P<0.01). The ratio of TXA2/PGI2 in HSPN children in the acute phase was statistically higher than in the control (9.55+/-3.56 vs 0.87+/-0.21; P<0.01). In the convalescence phase, plasma TXA2 level remained higher and plasma PGI2 level was elevated and higher than in the control, so the ratio of TXA2/PGI2 was reduced to normal level.</p><p><b>CONCLUSIONS</b>The imbalance of TXA2 and PGI2 may be involved in the development of renal damage in children with HSPN. The balance of TXA2 and PGI2 contributes to renal recovery.</p>

Changes of Serum Cardiac Troponin I and Brain Natriuretic Peptide in Pediatric Heart Failure with Pneumonia and Their Relationship with Heart Function / 实用儿科临床杂志

Objective To investigate the changes of serum cardiac troponin I(cTnI)and brain natriuretic peptide(BNP)in heart failure of children with pneumonia and their relationship with heart function.Methods Thirty healthy children aged from 5 months to 3 years old were randomly selected with 17 male and 13 female(healthy group).Thirty children with severe heart failure aged from 3 months to 2 years old were selected at the same time with 21 male and 9 female(heart failure group).Thirty children with ordinary pneumonia aged from 3 months to 3 years old were also sampled with 16 male and 14 female(ordinary pneumonia group).The peripheral bloods of 2-3 mL of all children were taken.The BNP level were measured by enzyme-linked immunosorbent assay and the cTnI level was determined by micro-particle enzyme immunoluminescent.Left ventricular ejection fraction(LVEF) and left ventricular fractional shor-tening(LVFS)were detected by echocardiography.SPSS 11.0 software was used to analyze the data.Results The levels of cTnI [(0.389?0.030) ?g/L] and BNP [(0.572?0.090) ?g/L] of heart failure group increased significantly compared with healthy and ordinary pneumonia group,while their LVEF and LVFS decreased significantly(Pa