Risk factors for the development of acute respiratory distress syndrome in children with measles / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the risk factors for the development of acute respiratory distress syndrome (ARDS) in children with measles.</p><p><b>METHODS</b>The clinical data of 55 children with measles were retrospectively studied. Of the 55 children, 11 were complicated by ARDS. The risk factors for the development of ARDS were investigated by univariate analysis and multivariate non-conditional logistic regression analysis.</p><p><b>RESULTS</b>The univariate analysis showed that there were significant differences in the oxygen inhalation mode (nasal catheter/mask), the rate of sepsis, blood C-reactive protein (CRP) levels and lymphocyte counts at admission between the ARDS and non-ARDS groups (P<0.05). The presence of sepsis and higher blood CRP levels were identified as the major risk factors for the development of ARDS by the multivariate logistic regression analysis (OR=116.444, 1.050 respectively; P<0.05).</p><p><b>CONCLUSIONS</b>The children with measles who have sepsis and higher blood CRP levels are at risk of ARDS.</p>

Short-term prognostic factors in children with acute liver failure / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the factors that influence the short-term (6 months) prognosis in children with acute liver failure.</p><p><b>METHODS</b>The clinical information of 53 children with acute liver failure treated between June 2008 and September 2013 was retrospectively analyzed. The patients were divided into survival group (n=21) and death group (n=32) according to their outcomes. The liver function parameters and incidence of complications were compared between the two groups, and multivariate logistic regression analysis was used to identify major factors affecting the short-term prognosis in these patients.</p><p><b>RESULTS</b>There were significant differences between the death and survival groups in the indices of international normalized ratio (INR), blood ammonia and serum albumin (Alb), and complications such as hepatic encephalopathy, gastrointestinal hemorrhage, and multiple organ failure (P<0.05). Multivariate logistic regression analysis demonstrated that serum Alb, INR, and hepatic encephalopathy were the major factors affecting the short-term prognosis of acute liver failure (OR=0.616, 75.493 and 1210.727 respectively; P<0.05).</p><p><b>CONCLUSIONS</b>INR, hepatic encephalopathy and serum Alb are the major factors that influence the short-term prognosis in children with acute liver failure.</p>

Clinical characteristics and drug resistance in children infected with Pseudomonas aeruginosa in the pediatric intensive care unit / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics of Pseudomonas aeruginosa (PA)-positive children in the pediatric intensive care unit, and to provide a basis for early diagnosis and reasonable treatment of PA infection.</p><p><b>METHODS</b>The clinical data of 62 children infected with PA in the pediatric intensive care unit were retrospectively reviewed,including age, affected organs, fever duration, hospital stay duration, mechanical ventilation duration, prognosis, underlying diseases, mortality, culture results and drug sensitivity test results.</p><p><b>RESULTS</b>Of the 62 PA-positive children, 25 (40%) were aged under 6 months and 47 (76%) under 2 years, with a median age of 28.8 months. Twenty-seven showed one positive result for sputum culture or endotracheal tube aspirates culture, 3 showed one positive result for blood culture, and 32 showed more than two positive results for blood, sputum or endotracheal tube aspirates cultures. On average, 2.8 organs were affected in each patient, with the respiratory system involved most frequently (58 patients, 94%). The mean fever duration was 7.3 days and the mean hospital stay duration was 34.2 days. In the 62 patients, 35 (57%) were cured and 17 (27%) died. Mechanical ventilation was administered to 51 patients (82%) for a mean duration of 13.4 days. Fifty-one patients (82%) had underlying diseases. The 17 (27%) children who died had a mean age of 17.4 months and a mean CRP level of 52.6 mg/L; 14 of them had increased or normal white blood cell count, and 3 had a decreased white blood cell count.The antibiotic sensitivity of PA was 72.6% for cefoperazone/sulbactam, 70.8% for meropenem, 49.1% for imipenem, 65.1% for ceftazidime, and 44.3% for piperacillin/tazobactam. There was complete resistance to cephazolin, cefuroxime and cefotaxime.</p><p><b>CONCLUSIONS</b>The children under 2 years are prone to PA infection. Respiratory system involvements are common. Most of children infected with PA suffer from underlying diseases.The sensitivity of PA to common antibiotics is not high.</p>

Characteristics of circulatory disturbance and the treatment of severe hand-foot-and-mouth disease / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of circulatory disturbance and treatment of severe hand-foot-and-mouth disease (HFMD).</p><p><b>METHOD</b>The clinical characteristics, laboratory findings, therapy and outcome of 22 severe HFMD patients were retrospectively analyzed.</p><p><b>RESULT</b>All the 22 severe HFMD patients came from the countryside. All these patients had encephalitis. Fifteen cases had myocardial injury. All had symptoms of sympathetic excitation and 17 cases had hypertension [(128 ± 16)/(81 ± 14) mm Hg (1 mm Hg = 0.133 kPa)]. Fourteen cases had exacerbation with rapid decline of blood pressure [(61 ± 12)/(33 ± 12) mm Hg]. In cardiorespiratory failure stage, 13 patients had neurogenic pulmonary edema accompanied by circulatory failure and 12 cases had a lower glasgow scores (less than 7). Myocardial injury and ECG change were found in some cases. Inotropic and pressor drugs were given in patients with circulatory collapse. Five cases received fluid resuscitation due to refractoriness to inotropic drugs. Nine patients received blood purification. Seventeen survived and 5 cases died due to circulatory failure.</p><p><b>CONCLUSION</b>Circulation failure of severe HFMD is the main cause of death. Early and appropriate circulation support is very important to reduce mortality.</p>

Changes of drug-resistance of Pseudomonas aeruginosa in pediatric intensive care unit / 中华儿科杂志

<p><b>OBJECTIVE</b>Pseudomonas aeruginosa is an important cause of nosocomial infection, severe sepsis and death which associated with a trends of rising rates of resistance to a broad array of antimicrobial agents. To explore a feasible treatment protocol for such patients, we analyzed the susceptibility patterns of Pseudomonas aeruginosa in pediatric intensive care unit (PICU).</p><p><b>METHOD</b>The age distribution, outcome of patients, sources of strains and susceptibility patterns of Pseudomonas aeruginosa in PICU from Jan 1, 2007 to Dec 31, 2011 were analyzed. Susceptibility to amikacin, piperacillin/tazobactam, aztreonam, ampicillin, ciprofloxacin, imipenem, meropenem, cefepime, cefoperazone, cefotaxime, ceftriaxone, ceftazidime, cefoperazone/sulbactam, cephazolin, cefuroxime, and polymyxin were determined by the disk-diffusion technique (K-B test method) and broth microdilution. P. aeruginosa ATCC 27853 was used as reference strain.</p><p><b>RESULT</b>Seventy-five patients were Pseudomonas aeruginosa positive. 26(34.7%) were < 6 m, 49 (65.4%) were < 2 y. The percentages of cases who were Pseudomonas aeruginosa positive in different age groups in the same time was basically similar; 18 (24.0%) cases died. Pseudomonas aeruginosa accounted for 10.9% of G(-) germs, 6.5% of all pathogens in 2010 - 2011. Of the 126 strains, 83 (65.9%) were from sputum sample, 31 (24.6%) were from catheter sample of tracheal cannula, 10 (7.9%) were from blood sample and 2 (1.6%) were from secretion sample. The sensitivity to antibiotics of Pseudomonas aeruginosa in pediatric common treatments was 72.4% to cefoperazone/sulbactam, 71.5% to meropenem, 48.4% to imipenem, 66.7% to ceftazidime, 49.2% to piperacillin/tazobactam. Absolute resistance to ampicillin, cephazolin, cefuroxime and cefotaxime. Multiple-drug resistance was still severe, but a decreasing tendency was observed, 90.5% in 2007, 81.3% in 2008, 51.1% in 2009, 53.8% in 2010, 33.3% in 2011. Pan-drug resistance in different years was similar, 12.5% in 2008, 2.2% in 2009, 7.7% in 2010, 6.7% in 2011.</p><p><b>CONCLUSION</b>The condition of drug resistance of Pseudomonas aeruginosa was still rigorous, we should conduct surveillance and prevent abusing antibiotics in order to avoid exacerbating drug resistance. We should improve testing technique, early and appropriate empirical antibiotics therapy is crucial according to clinical experience and antibiotic sensitivity. The effective treatment of P. aeruginosa is paramount to prevent multidrug resistance. The use of combination therapies for P. aeruginosa infection has been a long-advocated practice. To prevent hospital acquired cross infection, health care workers must pay close attention to hand sanitation and sterile operation strictly.</p>