The advance on the prenatal diagnosis and management of fetal long QT syndrome / 中华实用儿科临床杂志

Long QT syndrome(LQTS)is a rare and inherited cardiac channelopathy with high lethality,which is characterized by prolonged QTc interval and frequent malignant arrhythmia,the cause of the disease is that mutations of genes coding for cardiac ion channel subunit or channel associated proteins. Since some fetal LQTS may die in utero or neonatal period,thus,prenatal suspicion or diagnosis of fetal LQTS may improve their outcome and prognosis. There-fore,this review prepares to discuss around the prenatal diagnosis and management of fetal LQTS.

Clinical and etiological characteristics of secondary nosocomial bacterial infections associated with infectious mononucleosis in children / 中华实用儿科临床杂志

Objective To investigate the clinical manifestations and pathogenic characteristics of nosocomial bacterial infection in children with infectious mononucleosis (IM).Methods A retrospective analysis was performed for IM children from January to December 2015 in West China Second University Hospital.According to whether there was the process of secondary bacterial infection,the patients were divided into the secondary infection group and the non-infection group.The clinical manifestations and pathogenic bacteria were analyzed.Results Two hundred and sixteen children with IM were enrolled,of whom,177 cases (81.9％) were in the non-infection group,and 39 cases (18.1％) were in the secondary infection group.The patients in non-infection group were (4.7 ± 3.2) years old,and the patients in secondary infection group were (7.0 ± 3.8) years old,and the difference was statistically significant (t =3.066,P ＜ 0.05).The secondary infection group included bacterial tonsillitis in 17 cases,bronchial pneumonia in 11 cases,otitis media in 5 cases,cervical bacterial lymphadenitis in 3 cases,periorbital cellulitis in 2 cases,and sepsis in 1 case.Meanwhile,3 cases of concomitant thrush were observed in the secondary infection group.The rate of nosocomial bacterial infection in IM children [18.1％ (39/216 cases)] was significantly higher than the incidence of nosocomial infection [1.53％ (644/41 992 cases)] in the same period,and the difference was statistically significant (x2 =368.474,P ＜ 0.01).The patients with secondary bacterial infection were treated with antibiotics,and the pathogenic bacteria were mainly gram-negative bacteria,which was consistent with pharyngeal tonsil colonization bacteria on admission.In 212 cases (98.1％) with IM,variant lymphocytes increased,and there was no significant difference between 2 groups in the variation of lymphocyte composition (x2 =2.087,P ＞ 0.05).C-reactive protein (CRP) level of IM children on admission was (11.3 ± 17.4) mg/L,while the secondary infection group was (10.2 ±9.7) mg/L and the non-infection group was (11.5 ± 18.1) mg/L,and there was no significant difference between the 2 groups (t =1.309,P ＞ 0.05).CD3 +,CD4+,CD8 + lymphocytes in the secondary infection group were 0.877 6 ± 0.031 8,0.079 0 ± 0.032 5 and 0.682 1 ± 0.053 5,compared with the non-infection group,while CD3 + lymphocytes (t =12.652,P ＜ 0.01) and CD8 + lymphocytes (t =-9.723,P ＜ 0.01) increased significantly,but the proportion of CD4+ lymphocytes decreased significantly (t =18.341,P ＜0.01).Conclusions The IM children are susceptible to nosocomial bacterial infection,which is more obvious in school-age children.Secondary respiratory tract infections are the most common type,and pathogenic bacteria may be caused by the dissemination of colonization bacteria in the pharyngeal tonsils.The CRP and variant lymphocytes on admission could not be used as the marker for predicting noscoomial bacterial infection in IM.

Transcatheter occlusion of patent ductus arteriosus in a preterm infant and review of literatures / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of haemodynamically significant patent ductus arteriosus (hsPDA), and the indications of percutaneous transcatheter PDA occlusion.</p><p><b>METHOD</b>The data of a preterm infant admitted to West China Second Hospital in December. 2013, who finally underwent percutaneous transcatheter PDA occlusion were analyzed With the key words of"preterm"patent ductus arteriosus"transcatheter", Pubmed were searched and potentially relevant reports were retrieved and assessed by manual sorting from 2005 to 2015. Relevant reports in literature were reviewed.</p><p><b>RESULT</b>A preterm infnat at gestational age of 35 weeks with birth weight of 1 900 g was admitted to our department. Oral ibuprofen for closure of the patent ductus arteriosus failed, and the patient exhibited the features of"ventilator dependent"PDA of premature infants. On the 30th postnatal day, with the body weight of 1 950 g, under basal anesthesia, the infant underwent percutaneous transcatheter PDA occlusion, and the procedure successfully occluded the ductus with Amplatzer duct occluder (ADO). The ventilator was weaned 19 hours post procedure, and the child was discharged 7 days post operation with good recovery, and her growth and development was good. Follow-up for 13 months indicated that the intelligence and physical development evaluated by Bayley scales of infant development test were at the same level of normal age-matched infants. Fifty-two preterm infants treated with percutaneous transcatheter PDA occlusion in 8 reports were enrolled. The preterm infants were born at 23-35 gestational weeks, with PDA diameter of 1-4 mm. The occlusive device included coil, ADO, ADO Ⅱ, ADO Ⅱ AS, AVP Ⅱ and AVP Ⅳ respectively, with body weight of 870-2 610 g on operational days and age of 11-90 postnatal days. All those infants either failed or had contraindications to drug therapy, and exhibited as hsPDA cases. Percutaneous transcatheter PDA occlusions were performed successfully in all 52 cases, and there were no serious procedure-related complications.</p><p><b>CONCLUSION</b>Percutaneous transcatheter PDA occlusion in preterm infants is feasible and showed positive short-term and long-term effects, which provides an important alternative way for patients with the problem. The indications for transcatheter PDA occlusion include premature infants with hsPDA in whom drug therapy failed or is contraindicated.</p>

Clinical analysis of transcatheter closure treatment for the inaf nt wti h patent ductus arteriosus compli-cated with middle and severe pulmonary arterial hypertension / 中国小儿急救医学

Objective To evaluate the efficacy and safety of interventional occlsu ion operait no by analyizn g thes urgical data of 23 csa es of infants with patent ductusa rteriosus complicated with middle and severe pulmo an ry arterial hypertension.Methods Teh 23 cases of infants wiht patne t ductus arteriosus com-plicated with middlea nd severe pulmonary arterial hypertensionw ere collected in the hospital from January 2011 to December2014 .These infatn s rce eived transcateh ter occlusion with intravenuo s anesthesia after the preoperative examination.The operation procse s included:right ventriculography and pulmonary atr ery pressure tested,then lateral angiogar phy of descending aorta was performed to observe the type and size of patent ud ctus atr eriosus and measure ascending aorta,descending aortic pressure,and recorded the pressure re-spectively.1 ml blood sample of ascending aorta,pulmonary artery and inef rior vena vein respectively was used for gas analysis.All these data was used to calculate pulmonary vascular resistance.After tried to plug-ging effectiveyl we can release the occluder.In the postoperative 24 h,1 month,3 months,the infants should be measured with Doppler echocardiography,chest X ray and electrocardiogram examination.Results The clinical symptoms disappeared and the short-term follow-up was not associated with the complications of interventional therapy.Th e comparison of the pressure changes before and after the operation were performed as following, aortic per ssure decreased [ preoperation ( 68.3 ±17.5 )/( 21.4 ±3.7 ) mmHg, postoperation (52.4 ±8.7)/(15.6 ±3.5) mmHg,1 mmHg=0.133 kPa],ascending aorta pressure increased(preoperation (83.5 ±5.9)/(51.3 ±3.6) mmHg,postoperation(88.2 ±5.1)/(52.4 ±2.7) mmHg),and descending aorta pressure increased ( preoperation ( 81.4 ±3.3 )/( 48.2 ±2.7 ) mmHg, postoperation ( 86.5 ±4.7 )/(51.5 ±3.2) mmHg), the differences were statistically significant before and after surgery ( t =5.455/3.945 ,P<0.01;t=-2.696/-1.193 , P<0.05; t=-4.167/-3.745 , P<0.01 ) .Conclusion Under conditions of mastering the appropriate operation time and strengthening the management of the perioperative management,transcatheter measurement is safe and effective for infants with patent ductus arteriosus compli-cated with middle and severe pulmonary arterial hypertension.

Advances in fetal immune mediated atrioventricular block / 临床儿科杂志

Fetal atrioventricular block (AVB) is a type of fetal bradyarrhythmias. The reported incidence of fetal complete atrioventricular block (CAVB) and mortality of perinatal fetuses and neonates are signiifcantly higher in pregnancies of anti-SSA/Ro-positive mothers than that of anti-SSA/Ro-negative mothers. The auto-antibodies in maternal serum that can be transported into fetal circulation through placenta may damage fetal cardiac conductive system and eventually result in fetal AVB. There are evidences that early diagnosis and proper treatment can improve the prognosis and survival rate of affected fetuses. In this article, the pathogenesis, risk factors, prenatal diagnosis, treatment and prognosis of fetal immune mediated AVB is reviewed.

Prospective study on the isolated ventricular septal defect in fetus / 中华儿科杂志

<p><b>OBJECTIVE</b>Congenital heart defect is one of the most common birth defects. The isolated ventricular septal defect (VSD) has higher morbidity, and spontaneous closure may occur. Previously many studies about the prognosis of ventricular septal defect in childhood were conducted; in contrast, few studies on evolution and prognosis of ventricular septal defect from fetus to postnatal life have been available. This research aimed to determine the evolution of isolated ventricular septal defect during the period of fetus and postnatal life, and analyze the association between the diameter or location of VSD and the spontaneous closure of VSD.</p><p><b>METHOD</b>All pregnant women seen at the prenatal diagnosis center of the West China Second Hospital were recruited. From June 2011 to June 2014, these participants underwent the fetal 2-dimensional and color Doppler echocardiographic examinations, and the fetuses with isolated VSD were included in the study, and those with other malformations or abnormal chromosome were excluded. This study was a prospective and longitudinal research. These fetuses were followed-up until the VSD closed spontaneously, or were surgically repaired or percutaneously closed. Outcomes of all the cases were recorded.</p><p><b>RESULT</b>There were 234 fetuses with isolated VSD who were recruited in our research cohort. Twelve of 234 lost to follow-up, 5 of 234 were still in uterus. Totally 217 fetuses were followed up. One hundred eighty-nine of 217 (87.1%) cases were delivered. The pregnancies were terminated in 28 of 217 (12.9%) cases. Ten cases died after birth. Of the 179 delivered cases, the rate of VSD spontaneous closure was 45.2% (81/179), the VSD of 49 cases (27.4%, 49/179) spontaneously closed in uterus. The VSD of 17.9% (32/179) cases spontaneously closed after birth and those of 75% (24/32) cases closed in the first year of life. Furthermore, these participants were divided into 3 groups according to the diameter of VSD in fetus. There were 87 cases in ≤ 2.0 mm group, 51 spontaneously closed (59%, 51/87) and 30 of 84 spontaneously closed (36%, 30/84) in 2.1-5.0 mm group. There were no spontaneous closure in > 5.0 mm group. There was a significant difference in spontaneous closure rate between the 3 groups (χ(2) = 15.200, P = 0.001). Nevertheless, these participants were divided into 2 groups according to the location of VSD in fetus (perimembrane VSD (P-VSD) group and muscular VSD (M-VSD) group). There were 152 cases in P-VSD group, 69 spontaneously closed (45.4%, 69/152) and 12 of 27 spontaneously closed (44%, 12/27) in M-VSD group. There was no significant difference in spontaneous closure between P-VSD and M-VSD (χ(2) = 0.008, P = 0.950).</p><p><b>CONCLUSION</b>There was a high spontaneous closure rate of VSD in the period of late pregnancy. The most of postnatal VSD were spontaneously closed within one year of age. The spontaneous closure rates of fetal VSD with different diameter were different. The spontaneous closure rate of VSD with smaller diameter was higher.</p>

Visualized knowledge-mapping study in the subjects in pediatric clinical education based on multiple statistical and social network analysis / 中华医学教育探索杂志

Objective To study the subject domain knowledge of clinical education of pediatrics in our country with multivariate statistical analysis and social network study,research on the domain subject distribution and knowledge cluster,and then built visualized knowledge-mapping,so as to predict and guide the developmental trend in this field.Methods We searched the CNKI with MESH keywords (pediatrics OR children OR infants) AND clinical education OR bedside education OR interview of clinics in March,2013.679 articles were enrolled in and then imported into Bicomb.After core keywords had been identified by Bicomb,a word text matrix and co-occmrence matrix of words to articles were built.Systemic clustering of the co-occmrence matrix was finished by SPSS 20.0,leading the strategic plot to be built.Then draw visualized network in Ucinet 6.0.Results Totally 679 articles about pediatrics education were included.The number of core keywords was 66,and the lowest frequency of core keywords was 5.With multivariate statistical analysis and social network study,the visualized domain knowledge-mapping was successfully built,and it directly reflected the structure of subject knowledge-mapping of pediatric clinical education in our country,and then key clusters were formed,in which the clusters of participation model of clinical education and applications of clinical education had been well developed,and had been the dominant subject in pediatric clinical education.Whereas the unbalanced developed cluster of Exploration in refommtion of clinical education was now in rapid development with the introduction of new technology and innovative teaching model.At the same time,the nursing clinical education cluster has been separate cluster,but needed further and enhanced research.Conclusion The well developed subjects of participation model of clinical education applications of clinical education stood in the center of the subject do main knowledge-mapping,and with several clusters following.And the study of refomation of clinical education makes a great contribution to the progress of the subject.The nursing teaching needed balanced development.

Current ethical status and challenges in fetal cardiac intervention / 中华实用儿科临床杂志

With the development of fetal medical imaging and minimal invasive interventional therapy,fetal cardiac intervention has taken into clinical practice in few medical centers.Fetal cardiac therapy may alter the abnormal hemodynamics of fetal circulation,which can lead to recruit hypoplastic ventricle,to create a two-ventricle circulation after birth,to remodel the fetal pulmonary vascular bed whose outlet is obstructed,and to provide a better prognosis for the suffered children.However,according to the limitations and risks of this cutting edge technique,as well as the dilemmas to balance the interests among fetus,mother/parents and doctor/medical institution,ethical challenges never fade away ever since the first beginning in this rising field.Following the encouraging research results published,the risk of the technique has been partly taken control.So in current status,how to balance the interests among three participants and to establish optimal routine clinical practice are the most challenging problems.

Protective effect of dexamethasone on stress response induced by intrauterine balloon aortic valvuloplasty in a fetal lamb model / 临床儿科杂志

Objective To investigate the protective effect of dexamethasone on stress response induced by intraute-rine balloon aortic valvuloplasty (IUBAV) in a fetal lamb model. Methods Twenty-four near term twin pregnant goats were randomly assigned to control group (n=12) and dexamethasone group (intracardiac injection of dexamethasone) (n=12). Ultrasound guided IUBAV model was established. According to the combination of treatment and operation, 48 fetal lambs were divided into four groups. The following parameters were dynamically monitored by ultrasound, which were fetal and neonatal heart rate (HR), cardiac rhythm, aortic resistance index (RI) and pulsatility index (PI). On established IUBAV model, blood samples and liver tissue specimens were taken from fetal/neonatal goats for detection of blood glucose (Glu), lactate acid (LA), plasma epinephrine (E), norepinephrine (NE), cortisol (Cort), hepatic glycogen staining. Results IUBAV resulted in increased values of Glu, LA, E, NE and Cort levels, and decreased pH value, there were significant differences between pre-and 3h-post procedure (P<0.05), and significant differences were also existed in these values between pre-and 3d-post procedure (P<0.05). After administrating dexamethasone, the changes of Glu, LA, E, NE, Cort and pH levels were suppressed effectively. Fetal hepatic glycogen was consumed in large amounts due to IUBAV while recovered 3 days after IUBAV by glycogen staining. After administrating dexamethasone, hepatic glycogen consumption related to IUBAV was obviously inhibited. After IUBAV, fetal aortic RI was increased, and there was significant differences compared with pre-procedure (P<0.05). Up to 3d-post procedure, the values of RI recovered to some extent, but statistical difference was exist-ed compared with pre-procedure (P<0.05). After administrating of dexamethasone, increased aortic RI was effectively sup-pressed. Conclusions IUBAV could lead to reversible stress response and increased aortic RI in a fetal lamb model which could be alleviated by dexamethasone.