Role of Pediatric Critical Illness Score in evaluating severity and prognosis of severe hand-foot-mouth disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the role of Pediatric Critical Illness Score (PCIS) in evaluating the prognosis and severity of severe hand-foot-mouth disease (HFMD).</p><p><b>METHODS</b>This study included 424 children with severe HFMD, consisting of 390 survivors and 34 deceased patients. Related physiological parameters and clinical data were collected for calculating PCIS scores. The area under receiver operating characteristic curve (AUC) was employed to assess the performance of PCIS in evaluating the complications and outcomes.</p><p><b>RESULTS</b>The median of PCIS scores for survivors was higher than that for deceased patients (P<0.01). Of the 424 children with severe HFMD, only 26 (6.1%) had critical illness according to the severity assessment using PCIS. The AUC (95%CI) of PCIS was 0.74 (0.66, 0.82) in predicting pulmonary edema, 0.82 (0.74, 0.90) in predicting pulmonary hemorrhage, and 0.83 (0.75, 0.92) in predicting death.</p><p><b>CONCLUSIONS</b>PCIS can predict the complications and prognosis in children with severe HFMD. However, the existing scoring system of PCIS cannot fully assess the severity of HFMD.</p>

Influencing factors on underweight and stunting among children aged 0-3 years in rural areas from ten provinces in China / 中华流行病学杂志

Objective To analysis the influencing factors on underweight and stunting among children aged 0-3 years in rural areas from ten provinces in China.Methods Children under study were identified by multi-stage stratified cluster from rural areas of ten provinces in China.The ascertainment methods mainly included questionnaire and anthropometric measurements.Results There were 58 926 children under investigation,with 50.91％ were boys.The overall rates on underweight and stunting were 5.05％ and 10.49％ respectively.The rate in the 6 month-olds (1.97％,3.79％ ) was the lowest,while the highest were in the 24 month-olds (7.80％) and the 36 month-olds (16.83％).Age,sex,birth weight,gestational weeks as well as maternal education and fathers' schooling were factors significantly related to childhood underweight and stunting (P＜0.0001).Conclusion The status of underweight and stunting among children aged 0-3 years in rural areas was impressive,with birth weight was the key factor influencing the growth of children.Perinatal health care should be improved to promote the growth of children.

Clinical and pathologic characteristics of pancreatic necrosis in critically ill children / 世界急诊医学杂志（英文）

@#BACKGROUND: Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis. METHODS: We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children's Hospital, China from 2003 to 2009, and died of multiple organ failure. The autopsy revealed pancreatic necrosis in 5 children, in whom sectional or gross autopsy was performed. RESULTS: The 5 children had acute onset and a fever. Two children had abdominal pain and 2 had abdominal bulging, flatulence and gastrointestinal bleeding. Four children had abnormal liver function, characterized by decreased albumin and 3 children had elevated level of C-reactive protein (CRP). B-ultrasonography revealed abnormal acoustic image of the pancreas in all children, and autopsy confirmed pancreatic necrosis, which may be associated with the damage of the adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other organs. Children 1 and 2 died of acute hemorrhagic necrotizing pancreatitis (AHNP);children 3-5 died of multiple organ dysfunction syndrome (MODS) due to pancreatic necrosis. CONCLUSION: Pancreatic damage or pancreatic necrosis in critically ill children is characterized by acute onset, severity, short course, multiple organ damage or failure. It may be asymptomatic in early stage, and easy to be ignored.

Analysis of 13 critically ill children complicated with pancreatic damages / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the pathological reports and clinical data of the cases with pancreatic damage in critically ill children, and summarize the clinical features and biological markers of critically ill children with pancreatic damage or pancreatic necrosis so as to provide the basis for early diagnosis and treatment in children complicated with pancreatic damage.</p><p><b>METHODS</b>The clinical data of 13 patients treated in our hospital from 2003 to 2009 whose autopsy confirmed pancreatic damage existed and the pathological results of all organs were collected and analyzed.</p><p><b>RESULTS</b>All the cases had acute onset; 7 cases had fever, 2 had abdominal pain, the other cases had abdominal distention, hepatosplenomegaly, hypoactive bowel sounds, ascites, intestinal obstruction and gastrointestinal bleeding, etc. All these cases had abnormal liver function, especially elevated ALT or AST level and significantly decreased albumin, 9 cases had abnormal blood glucose, 5 cases had elevated C-reactive protein (CRP). In abdominal B-mode ultrasonography, no case showed abnormal pancreas acoustic image. Autopsy confirmed that 7 cases had varying degrees of necrosis of the pancreas, other 6 cases showed edematous, hemorrhagic or inflammatory changes, which may be associated with adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other damage. All these children died within 36 hours after the patients' conditions worsened.</p><p><b>CONCLUSIONS</b>Pancreatic damage or necrosis in critically ill children had acute and ferocious onset, short course and were prone to multiple organ damage or failure to which all pediatric clinicians should have high alert.</p>

Clinical characteristics of children with acute pancreatitis / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of children with acute pancreatitis and provide the basis of early diagnosis and treatment.</p><p><b>METHODS</b>Totally 121 children with acute pancreatitis admitted to Hunan Children's Hospital between March 2003 and December 2009 were enrolled in this retrospective study. The data of clinical manifestations, biochemical examinations, imaging and prognosis were summarized and statistically analyzed.</p><p><b>RESULTS</b>Of the 121 cases, preschool and school-age children were the main groups, and the prevalent months were May and June. Abdominal pain (88.4%) and vomiting (61.2%) were the major initial symptoms of pancreatitis in children, but none of children under the age 1 year complained of abdominal pain; 70.2% had signs of abdominal tenderness, accompanied by abdominal rigidity, distension, hepatomegaly, jaundice, etc. Severe patients developed shock, convulsions, coma and so on. Serum amylase concentration increased to above the upper reference limit in 114 children (94.2%) when they admitted within 24 hours after admission. Urine amylase elevation was noted in 77 children (79.4%). The amylase concentration decreased after 3 days, but not all returned to normal 14 days afterward. Children with sustained serum amylase elevation or serum amylase level ≥ 3 times upper limit of normal range more likely to have fever, vomiting, abdominal distension, and pancreatic abnormalities at ultrasonography or CT which showed that the echo of pancreas decreased or enhanced, pancreas edema, pancreatic duct expanded, etc. Abdominal ultrasonography and CT showed that 75 cases (62.0%) had other organ damage besides pancreatitis, liver (25.3%) and intestinal (16.0%) damages were very common, while liver and myocardial damages were seen frequently in the laboratory examinations, which complicated with serum ALT/AST, total bilirubin, blood glucose elevation and myocardial enzyme abnormalities. Several gastroscopic examinations showed mucosal hyperemia and edema, sheet-like erosion, etc. Except for one case who underwent laparotomy, all the remaining children were treated with non-operative comprehensive treatment. Of them 119 were cured or improved, 2 died and 5 had recurred disease later.</p><p><b>CONCLUSIONS</b>Gastrointestinal symptoms were the main clinical manifestations of acute pancreatitis in children, often complicated with extrapancreatic damage. The younger the patient was, the less complaint of abdominal pain they had. This indicates that acute pancreatitis should be considered when children suffered from acute abdominal pain and vomiting which had no known cause or could not be explained. It is important to do take serial monitoring of serum amylase, and imaging procedures.</p>

Study on nonfatal injuries among home-stranded children in rural environment of Hubei province / 中华流行病学杂志

Objective To understand the characteristics of nonfatal injuries among home-stranded children in the rural environment of Hubei province,and to evaluate the effect on child iniury due to their parents going out for work.Methods Cross-sectional study and cluster sampling surveys were applied in September 2006 to survey students in six schools in Macheng city,Baiguo town and Songpu town.Results 3019 students were surveyed,1182 students were home-stranded children,constituting a rate to 39.15%.Male and female children accounted for 61.51% and 38.49%of students respectively.The rates of homestranded male and female students were 39.92%and 37.98%respectively.Home-stranded students who had both parents accounted for a 62.29%,and those who had one parent at home accounted for 37.71%.Among these students,the total injury rate was 179.1‰,while for home-stranded children it was 253.0‰.Male home-stranded children had the highest injury rate,higher than the rate for females.The three leading causes of injury were fall(84.6‰),mechanical(40.6‰)and animal related injures (36.4‰).The main injury sites were at home,school and on the street.The total length of stay in the hospital was 208 days,and the total cost was RMB 47 268 Yuan,and the average cost per person was RMB 201 Yuan.Conclusion There was a high proportion of home-stranded children in school of Macheng and two towns.Injuries were more serious than general students.It causes a high injury burden to these home-stranded children.It iS important to pay close attention to these children and to improve their safety.

Study on the perception of gender role and decision-making regarding family affairs among married women and its impact on the utilization of perinatal care / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the perception on roles of gender and decision-making regarding family affairs among married women and its impact on the utilization of perinatal care.</p><p><b>METHODS</b>Clustering sampling was conducted to select 1227 married women with at least a child aged from 0 to 7 years old, from Hebei, Hubei and Sichuan provinces. All women were interviewed using a uniform questionnaire during Nov.-Dec. 2004.</p><p><b>RESULTS</b>The overall proportion of women who had relatively poor perception of gender role was 65.1%. 59.3% of the women agreed that "husband's health is more important than wife's in the family" versus 39.7% of interviewed women agreed that "man is more suitable for leadership than woman". In 46.2% of the families, wife and husband shared the responsibility of decision making on family affairs. In 16.2% of the families women played a decisive role, while 67.1% of interviewed women had to get the approval of her husband when spending money on daily necessities. When there were different opinions between the couples, husband usually made the final decision in 20.5% of all the families versus 17.4% of families where wife made the final decision. In total,the proportion of women who had somehow rights on family affairs was 64.1%. The coverage rate of antenatal care was 91.0%, and 65.3% women who received antenatal care got the first antenatal visit during the first trimester and the proportion of women who had at least five antenatal visits was 39.7%. The institutional delivery was 59.3% among all the women. Perception of gender role was not a predictor for antenatal care utilization, but it was predictive of institutional delivery. Education was quite a significant predictor on perinatal care utilization.</p><p><b>CONCLUSION</b>Efforts should be strengthened to improve women's awareness and to increase their perception on gender role in the families so that more women could achieve quality perinatal care.</p>