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Chinese Journal of Pediatrics ; (12): 197-202, 2022.
Article in Chinese | WPRIM | ID: wpr-935670


Objective: To investigate the prognostic factors of children with congenital heart disease (CHD) who had undergone cardiopulmonary resuscitation (CPR) in pediatric intensive care unit (PICU) in China. Methods: From November 2017 to October 2018, this retrospective multi-center study was conducted in 11 hospitals in China. It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group. The general condition, duration of CPR, epinephrine doses during resuscitation, recovery of spontaneous circulation (ROSC), discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared. According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not, children in CHD and non-CHD groups were divided into 2 subgroups: arrhythmia and non-arrhythmia, and the ROSC and survival rate to discharge were compared. Data in both groups were analyzed by t-test, chi-square analysis or ANOVA, and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest (CA). Results: The incidence of CA in PICU was 3.2% (372/11 588), and the implementation rate of CPR was 75.5% (281/372). There were 144 males and 137 females with median age of 32.8 (5.6, 42.7) months in all 281 CPA cases who received CPR. CHD group had 56 cases while non-CHD had 225 cases, with the percentage of 19.9% (56/281) and 80.1% (225/281) respectively. The proportion of female in CHD group was 60.7% (34/56) which was higher than that in non-CHD group (45.8%, 103/225) (χ2=4.00, P=0.045). There were no differences in ROSC and rate of survival to discharge between the two groups (P>0.05). The ROSC rate of children with arthythmid in CHD group was 70.0% (28/40), higher than 6/16 for non-arrhythmic children (χ2=5.06, P=0.024). At discharge, the pediatric cerebral performance category scores (1-3 scores) of CHD and non-CHD child were 50.9% (26/51) and 44.9% (92/205) respectively. Logistic regression analysis indicated that the independent prognostic factors of ROSC and survival to discharge in children with CHD were CPR duration (odds ratio (OR)=0.95, 0.97; 95%CI: 0.92~0.97, 0.95~0.99; both P<0.05) and epinephrine dosage (OR=0.87 and 0.79, 95%CI: 0.76-1.00 and 0.69-0.89, respectively; both P<0.05). Conclusions: There is no difference between CHD and non-CHD children in ROSC and survival rate of survival to discharge was low. The epinephrine dosage and the duration of CPR are related to the ROSC and survival to discharge of children with CHD.

Cardiopulmonary Resuscitation , Child , Child, Preschool , Female , Heart Arrest/therapy , Heart Defects, Congenital/therapy , Humans , Intensive Care Units, Pediatric , Male , Retrospective Studies
Article in Chinese | WPRIM | ID: wpr-879779


OBJECTIVE@#To study the incidence rate of non-thyroidal illness syndrome (NTIS) in critically ill children with or without sepsis and the association of NTIS with interleukin-6 (IL-6) and interleukin-10 (IL-10).@*METHODS@#A retrospective analysis was performed on the medical data of 97 children with sepsis (sepsis group) and 80 non-sepsis children with bacterial infection (non-sepsis group). The correlations of IL-6 and IL-10 with the thyroid function parameters triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH) were analyzed.@*RESULTS@#There were no significant differences in age and sex between the sepsis and non-sepsis groups (P>0.05). Compared with the non-sepsis group, the sepsis group had a significantly higher Sequential Organ Failure Assessment score, a significantly longer length of hospital stay, and a significantly higher rate of use of ventilator (P0.05), but the pooled analysis of the two groups showed that IL-6 level was negatively correlated with T3 and T4 levels (P<0.001).@*CONCLUSIONS@#Children with sepsis have a higher incidence rate of NTIS than those without sepsis. The high level of IL-6 may be associated with the development of NTIS.

Child , Critical Illness , Euthyroid Sick Syndromes , Humans , Interleukin-10/blood , Interleukin-6/blood , Retrospective Studies , Sepsis , Thyrotropin , Thyroxine
Article in Chinese | WPRIM | ID: wpr-279868


<p><b>OBJECTIVE</b>To investigate the effect of continuous veno-venous hemofiltration (CVVH) on inflammatory mediators in children with severe hand, foot and mouth disease (HFMD), and to investigate its clinical efficacy.</p><p><b>METHODS</b>A total of 36 children with stage IV HFMD were enrolled and randomly divided into conventional treatment group and CVVH group (n=18 each). The children in the CVVH group were given CVVH for 48 hours in addition to the conventional treatment. The levels of interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and lactic acid in peripheral venous blood, heart rate, blood pressure, and left ventricular ejection fraction were measured before treatment and after 24 and 48 hours of treatment.</p><p><b>RESULTS</b>After 24 hours of treatment, the conventional treatment group had a significantly reduced serum IL-2 level (P<0.01), and the CVVH treatment group had significantly reduced serum levels of IL-2, IL-6, IL-10, and TNF-α (P<0.05). After 48 hours of treatment, both groups had significantly reduced serum levels of IL-2, IL-6, IL-10, and TNF-α (P<0.01), and the CVVH group had significantly lower levels of these inflammatory factors than the conventional treatment group (P<0.01). After 48 hours of treatment, heart rate, systolic pressure, and blood lactic acid level were significantly reduced, and left ventricular ejection fraction was significantly increased in both groups, and the CVVH group had significantly greater changes in these indices except systolic pressure than the conventional treatment group (P<0.01).</p><p><b>CONCLUSIONS</b>CVVH can effectively eliminate inflammatory factors, reduce heart rate and venous blood lactic acid, and improve heart function in children with severe HFMD.</p>

Child, Preschool , Cytokines , Blood , Female , Hand, Foot and Mouth Disease , Allergy and Immunology , Therapeutics , Hemodynamics , Hemofiltration , Humans , Infant , Inflammation Mediators , Blood , Male , Ventricular Function, Left
Article in Chinese | WPRIM | ID: wpr-732971


Objective To explore the differences of biological markers level between upper urinary tract infection(UUTI) and lower urinary tract infection(LUTI) in children for providing help for localization diagnosis of urinary tract infection(UTI).Methods One hundred and nine children with UTI hospitalized in Children's Hospital of Tianjin from May 2010 to Jan.2012 were divided into UUTI group (18 cases) and LUTI group (91 cases).The clinical information (sex,age,onset symptoms),laboratory test including blood urea nitrogen and creatinine,biological markers including serum cystatin C(CysC),procalcitonin(PCT),β2-microglobulin (β2-MG),urine microalbumin(mAlb),transferrin (TF),α1-microglobulin (α1-MG),β2-MG and N-acetyl-β-D-glucosaminidase (NAG) were recorded.Then SPSS 17.0 software was used to analyze the data.Results UUTI children showed higher level of serum CysC,PCT,urine mAlb,TF,α1-MG,β2-MG and NAG than LUTI children did.The area under ROC curve of the 7 biological markers were all between 0.71 and 0.87.Logistic regression test was used to do multiple regression analysis and establish the multiple regression model.The standard of eliminating or screening variables was 0.05.CysC,PCT,NAG were identified as influence factors.Combining test result of CysC,PCT,NAG could improve diagnostic value so that the sensitivity could reach 90% and the specificity could reach 88.9%.Conclusions Both of serum CysC,PCT and urine mAlb,TF,α1-MG,β2-MG,NAG can be used for the positioning diagnosis of UTI,and the diagnostic value of joint test of serum change of CysC,PCT,urine NAG is higher than any single biological marker.