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1.
Chinese Journal of Contemporary Pediatrics ; (12): 566-571, 2023.
Article in Chinese | WPRIM | ID: wpr-981995

ABSTRACT

OBJECTIVES@#To study the role of plasma exchange combined with continuous blood purification in the treatment of refractory Kawasaki disease shock syndrome (KDSS).@*METHODS@#A total of 35 children with KDSS who were hospitalized in the Department of Pediatric Intensive Care Unit, Hunan Children's Hospital, from January 2019 to August 2022 were included as subjects. According to whether plasma exchange combined with continuous veno-venous hemofiltration dialysis was performed, they were divided into a purification group with 12 patients and a conventional group with 23 patients. The two groups were compared in terms of clinical data, laboratory markers, and prognosis.@*RESULTS@#Compared with the conventional group, the purification group had significantly shorter time to recovery from shock and length of hospital stay in the pediatric intensive care unit, as well as a significantly lower number of organs involved during the course of the disease (P<0.05). After treatment, the purification group had significant reductions in the levels of interleukin-6, tumor necrosis factor-α, heparin-binding protein, and brain natriuretic peptide (P<0.05), while the conventional group had significant increases in these indices after treatment (P<0.05). After treatment, the children in the purification group tended to have reductions in stroke volume variation, thoracic fluid content, and systemic vascular resistance and an increase in cardiac output over the time of treatment.@*CONCLUSIONS@#Plasma exchange combined with continuous veno-venous hemofiltration dialysis for the treatment of KDSS can alleviate inflammation, maintain fluid balance inside and outside blood vessels, and shorten the course of disease, the duration of shock and the length of hospital stay in the pediatric intensive care unit.


Subject(s)
Humans , Child , Plasma Exchange , Mucocutaneous Lymph Node Syndrome/therapy , Continuous Renal Replacement Therapy , Renal Dialysis , Plasmapheresis , Shock
2.
Chinese Journal of Contemporary Pediatrics ; (12): 284-288, 2023.
Article in Chinese | WPRIM | ID: wpr-971074

ABSTRACT

OBJECTIVES@#To study the application value of transport ventilator in the inter-hospital transport of critically ill children.@*METHODS@#The critically ill children in Hunan Children's Hospital who were transported with or without a transport ventilator were included as the observation group (from January 2019 to January 2020; n=122) and the control group (from January 2018 to January 2019; n=120), respectively. The two groups were compared in terms of general data, the changes in heart rate, respiratory rate, and blood oxygen saturation during transport, the incidence rates of adverse events, and outcomes.@*RESULTS@#There were no significant differences between the two groups in sex, age, oxygenation index, pediatric critical illness score, course of disease, primary disease, heart rate, respiratory rate, and transcutaneous oxygen saturation before transport (P>0.05). During transport, there were no significant differences between the two groups in the changes in heart rate, respiratory rate, and transcutaneous oxygen saturation (P>0.05). The incidence rates of tracheal catheter detachment, indwelling needle detachment, and sudden cardiac arrest in the observation group were lower than those in the control group during transport, but the difference was not statistically significant (P>0.05). Compared with the control group, the observation group had significantly shorter duration of mechanical ventilation and length of stay in the pediatric intensive care unit and significantly higher transport success rate and cure/improvement rate (P<0.05).@*CONCLUSIONS@#The application of transport ventilator in the inter-hospital transport can improve the success rate of inter-hospital transport and the prognosis in critically ill children, and therefore, it holds promise for clinical application in the inter-hospital transport of critically ill children.


Subject(s)
Child , Humans , Critical Illness , Respiration, Artificial/adverse effects , Intensive Care Units, Pediatric , Ventilators, Mechanical , Prognosis
3.
Chinese Journal of Contemporary Pediatrics ; (12): 249-254, 2022.
Article in English | WPRIM | ID: wpr-928595

ABSTRACT

OBJECTIVES@#To investigate the efficacy and application value of plasma exchange as an adjuvant therapy in children with hemophagocytic syndrome (HPS).@*METHODS@#A prospective randomized controlled trial was designed. Forty children with severe HPS were enrolled, who were treated in the pediatric intensive care unit (PICU) of Hunan Children's Hospital from October 2018 to October 2020. The children were randomly divided into a plasma exchange group and a conventional treatment group using a random number table, with 20 children in each group. The children in the conventional treatment group received etiological treatment and conventional symptomatic supportive treatment, and those in the plasma exchange group received plasma exchange in addition to the treatment in the conventional treatment group. The two groups were compared in terms of general information, clinical symptoms and signs before and after treatment, main laboratory markers, treatment outcome, and prognosis.@*RESULTS@#Before treatment, there were no significant differences between the two groups in gender, age, course of the disease before admission, etiological composition, pediatric critical illness score, involvement of organ or system functions, and laboratory markers (P>0.05). After 7 days of treatment, both groups had remission and improvement in clinical symptoms and signs. After treatment, the plasma exchange group had significantly lower levels of C-reactive protein, procalcitonin, and serum protein levels than the conventional treatment group (P<0.05). The plasma exchange group also had significantly lower levels of alanine aminotransferase and total bilirubin than the conventional treatment group (P<0.05). The length of stay in the PICU in the plasma exchange group was significantly shorter than that in the conventional treatment group (P<0.05). The plasma exchange group had a significantly higher treatment response rate than the conventional treatment group (P<0.05). There were no significant differences between the two groups in the total length of hospital stay and 3-month mortality rate (P>0.05).@*CONCLUSIONS@#Plasma exchange as an adjuvant therapy is effective for children with severe HPS. It can improve clinical symptoms and signs and some laboratory markers and shorten the length of stay in the PICU, and therefore, it may become an optional adjuvant therapy for children with severe HPS.


Subject(s)
Child , Humans , Intensive Care Units, Pediatric , Lymphohistiocytosis, Hemophagocytic/therapy , Plasma Exchange , Plasmapheresis , Prospective Studies
4.
Chinese Journal of Contemporary Pediatrics ; (12): 488-493, 2021.
Article in Chinese | WPRIM | ID: wpr-879882

ABSTRACT

OBJECTIVE@#To study the efficacy and safety of continuous renal replacement therapy (CRRT) in the treatment of neonates with inherited metabolic diseases and hyperammonemia.@*METHODS@#A retrospective analysis was performed on the medical records of neonates with inherited metabolic diseases and hyperammonemia who were hospitalized and underwent CRRT in the Department of Neonatology, Hunan Children's Hospital, from September 2016 to March 2020, including general conditions, clinical indices, laboratory markers, and adverse reactions.@*RESULTS@#A total of 11 neonates were enrolled, with 7 boys (64%) and 4 girls (36%). The neonates had a mean gestational age of (38.9±0.8) weeks, a mean body weight of (3 091±266) g on admission, and an age of (5.7±2.0) days at the time of CRRT. The main clinical manifestations were vomiting (100%), convulsions (100%), and coma (55%), and the main primary disease was urea cycle disorder (55%). The mean duration of CRRT was (44±14) hours, the medium duration of coma before CRRT was 2 hours, and the total duration of coma was 10 hours. The patients had a mean hospital stay of (18±10) days and a survival rate of 73%, and 2 survivors had epilepsy. After treatment, all patients had significant reductions in blood ammonia, lactic acid, and K@*CONCLUSIONS@#CRRT is safe and effective in the treatment of neonates with inherited metabolic diseases and hyperammonemia.


Subject(s)
Child , Female , Humans , Infant , Infant, Newborn , Male , Acute Kidney Injury , Continuous Renal Replacement Therapy , Hyperammonemia/therapy , Length of Stay , Metabolic Diseases/therapy , Retrospective Studies
5.
Chinese Journal of Contemporary Pediatrics ; (12): 180-185, 2021.
Article in Chinese | WPRIM | ID: wpr-879831

ABSTRACT

OBJECTIVE@#To study the efficacy and safety of double plasma molecular absorption system (DPMAS) in the treatment of pediatric acute liver failure (PALF).@*METHODS@#A prospective analysis was performed on the medical data of children with PALF who were hospitalized in the Intensive Care Unit (ICU), Hunan Children's Hospital, from March 2018 to June 2020. The children were randomly divided into two groups:plasma exchange group (PE group) and DPMAS group (@*RESULTS@#Compared with the PE group, the DPMAS group had a significantly lower number of times of artificial liver support therapy and a significantly shorter duration of ICU stay (@*CONCLUSIONS@#DPMAS is safe and effective in the treatment of PALF and can thus be used as an alternative to artificial liver support therapy.


Subject(s)
Child , Humans , Adsorption , Liver Failure, Acute/therapy , Plasma , Plasma Exchange , Prospective Studies
6.
Chinese Journal of Contemporary Pediatrics ; (12): 1233-1239, 2020.
Article in Chinese | WPRIM | ID: wpr-879782

ABSTRACT

OBJECTIVE@#To study the effect of mogroside VI (MVI) on acute liver injury induced by sepsis in mice and its possible mechanisms. Methods A total of 60 male C57BL/6 mice were randomly divided into five groups: sham-operation, model, low-dose MVI (25 mg/kg), high-dose MVI (100 mg/kg), peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) inhibitor (100 mg/kg MVI+30 mg/kg PGC-1α inhibitor SR-18292), with 12 mice in each group. Cecal ligation and puncture were performed to establish a mouse model of sepsis. The drugs were given by intraperitoneal injection after the model was established, once a day for 3 consecutive days. ELISA was used to measure the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Colorimetry was used to measure the levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) in liver tissue. Hematoxylin-eosin staining was used to observe liver histopathological changes. Liver mitochondrial respiratory function was measured, and mitochondrial respiratory control rate was calculated. RT-PCR was used to measure the copy number of mitochondrial DNA (mtDNA) in liver tissue and the mRNA expression levels of PGC-1α, nuclear respiratory factor-1 (NRF-1), and mitochondrial transcription factor A (TFAM) in liver tissue. Western blot was used to measure the protein expression levels of PGC-1α, NRF-1, and TFAM in liver tissue.@*RESULTS@#Compared with the sham-operation group, the model group had significant increases in the serum levels of ALT and AST and the content of MDA in liver tissue (P0.05). The PGC-1α inhibitor SR-18292 significantly inhibited the intervention effect of high-dose MVI (P<0.05).@*CONCLUSIONS@#MVI can effectively alleviate acute liver injury caused by sepsis in mice, possibly by enhancing mitochondrial biosynthesis mediated by PGC-1α.


Subject(s)
Animals , Male , Mice , Liver , Mice, Inbred C57BL , Sepsis/drug therapy , Triterpenes
7.
Chinese Journal of Contemporary Pediatrics ; (12): 429-434, 2020.
Article in Chinese | WPRIM | ID: wpr-828727

ABSTRACT

OBJECTIVE@#To study the clinical features of severe type 7 adenovirus pneumonia in children.@*METHODS@#A retrospective analysis was performed for the clinical data of children who were diagnosed with severe type 7 adenovirus pneumonia from February to June, 2019.@*RESULTS@#Among the 45 children, the male/female ratio was 3:2 and the median age was 14 months. All children had repeated fever, cough, and pulmonary moist rales, and the mean duration of fever was 14±4 days. The median time from fever to dyspnea was 8 days, and the time from fever to mechanical ventilation was 11.6±2.5 d. There was no significant increase in white blood cell count, with neutrophils as the main type. There were slight reductions in hemoglobin and albumin, while platelet and fibrinogen remained normal. There were increases in aspartate aminotransferase, lactate dehydrogenase, procalcitonin, and C-reaction protein. The detection rate of mixed pathogens was 84%. Effusion in both lungs was the major change on chest imaging (64%). Bronchoscopic manifestations were endobronchitis, tracheomalacia, and plastic bronchitis. The incidence rate of respiratory complications was 100%, and extrapulmonary complications mainly involved the circulatory system (47%), digestive system (36%), and nervous system (31%). Among the 45 children, 16 were administered with 400 mg/kg intravenous immunoglobulin (IVIG) daily for 5 days, with a mean duration of fever of 16±5 days, and 29 were administered with 1 g/kg IVIG daily for 2 days, with a mean duration of fever of 13±4 days; there was a significant difference in the mean duration of fever between the two groups (P=0.046). The overall mortality rate was 11%.@*CONCLUSIONS@#Severe type 7 adenovirus pneumonia in children has severe conditions, with a high incidence rate of complications and a high mortality rate, so it should be diagnosed and treated as early as possible.


Subject(s)
Female , Humans , Infant , Male , Adenoviridae , Bronchitis , Fever , Pneumonia, Viral , Retrospective Studies
8.
Chinese Journal of Contemporary Pediatrics ; (12): 522-527, 2019.
Article in Chinese | WPRIM | ID: wpr-774040

ABSTRACT

OBJECTIVE@#To study the clinical effect and safety of dexmedetomidine in children with agitation during ventilator weaning.@*METHODS@#A prospective open observational study was performed for children who were admitted to the intensive care unit and experienced mechanical ventilation between March 2017 and August 2018. They were given dexmedetomidine due to the failure in the spontaneous breathing test (SBT) caused by agitation. A sedation-agitation scale score of ≥5 was defined as agitation. The children were observed in terms of the sedation state at 0.5, 1, 2, 6, and 12 hours after the administration of dexmedetomidine, blood gas parameters before extubation and at 1, 24, and 48 hours after extubation, vital signs (heart rate, respiratory rate and mean arterial pressure) before SBT, before extubation, and at 10, 60, and 120 minutes and 24 hours after extubation, and incidence rates of adverse events related to the use of dexmedetomidine.@*RESULTS@#A total of 19 children were enrolled in this study. All the children were in a state of agitation at the time of enrollment. At 0.5, 1, 2, 6, and 12 hours after the administration of dexmedetomidine, 12, 17, 17, 18, and 18 children respectively reached the sedation state. There were no significant differences in the oxygenation index, arterial partial pressure of carbon dioxide, heart rate, respiratory rate, and mean arterial pressure at each time point before and after extubation (P>0.05). No adverse events were observed, such as severe hypotension and respiratory depression, and only one child experienced reversible bradycardia.@*CONCLUSIONS@#Dexmedetomidine is safe and effective in children with agitation during ventilator weaning, but prospective randomized controlled trials are needed for verification.


Subject(s)
Child , Humans , Dexmedetomidine , Hypnotics and Sedatives , Prospective Studies , Respiration, Artificial , Ventilator Weaning
9.
Chinese Journal of Contemporary Pediatrics ; (12): 998-1004, 2019.
Article in Chinese | WPRIM | ID: wpr-775067

ABSTRACT

OBJECTIVE@#To study the effect of different energy feeding patterns on the nutritional status, clinical course, and outcome of children with congenital heart disease (CHD) and severe pneumonia.@*METHODS@#A total of 43 malnourished infants, aged 0.05). At discharge and 1 and 3 months after surgery, the control group had significantly higher degree of malnutrition and level of nutritional risk than the observation group (P<0.05). The analysis of variance with repeated measures showed significant differences in body weight, upper arm circumference, weight-for-age Z-score, height-for-age Z-score, weight-for-height Z-score, and albumin level at different time points and between different groups, and there was an interaction between group factors and time factors (P<0.05). Compared with the control group, the observation group had a significantly lower average daily intake of fluid, a significantly higher average daily intake of energy, and a significantly lower incidence rate of insufficient feeding during hospitalization (P<0.05). Compared with the control group, the observation group had significantly shorter length of hospital stay, duration of mechanical ventilation, and duration of postoperative pyrexia, as well as significantly lower hospital costs (P<0.05). No significant adverse reactions were observed in either group.@*CONCLUSIONS@#An appropriate increase in postoperative energy supply for children with CHD can improve the status of malnutrition and clinical outcome.


Subject(s)
Humans , Infant , Energy Intake , Heart Septal Defects, Ventricular , Therapeutics , Nutritional Status , Pneumonia , Therapeutics
10.
Chinese Journal of Contemporary Pediatrics ; (12): 961-964, 2015.
Article in Chinese | WPRIM | ID: wpr-279016

ABSTRACT

<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>


Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Critical Illness , Hand, Foot and Mouth Disease , Diagnosis , Prognosis
11.
Chinese Journal of Contemporary Pediatrics ; (12): 194-197, 2014.
Article in Chinese | WPRIM | ID: wpr-269510

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the impact of continuous blood purification (CBP) on T-cell subsets and prognosis in children with severe sepsis.</p><p><b>METHODS</b>A total of 42 children with severe sepsis were randomly divided into a control group (n=22) and a CBP group (n=20). The patients in the control group received conventional treatment, while those in the CBP group underwent continuous veno-venous hemofiltration daily 12-24 hours for 3 days besides conventional treatment. Changes in clinical variables and in peripheral blood regulatory T cell subsets were assessed 3 and 7 days after treatment.</p><p><b>RESULTS</b>The pediatric intensive care unit length of stay and duration of mechanical ventilation were significantly shortened and the 28-day mortality rate was significantly lower in the CPB treatment group as compared with the control group (P<0.05). In the CBP treatment group, the percentage of CD3(+), CD4(+), CD8(+) T cell populations and PCIS scores were significantly higher at 3 and 7 days after treatment than before treatment (P<0.05). At 7 days after treatment, the percentage of CD3(+), CD4(+), CD8(+) T cell populations, CD4(+)/CD8(+) ratio and PCIS scores were significantly higher in the CBP group than in the control group (P<0.05).</p><p><b>CONCLUSIONS</b>The CBP treatment may counteract the suppression of immune function and thus improve prognosis in children with severe sepsis.</p>


Subject(s)
Child, Preschool , Female , Humans , Male , CD4-CD8 Ratio , Hemofiltration , Sepsis , Allergy and Immunology , Therapeutics , T-Lymphocyte Subsets , Allergy and Immunology
12.
Chinese Journal of Contemporary Pediatrics ; (12): 216-218, 2013.
Article in Chinese | WPRIM | ID: wpr-236835

ABSTRACT

<p><b>OBJECTIVE</b>To observe changes in T cell subsets in children with sepsis and their prognosis, and to investigate the clinical significance of these changes in the occurrence and development of sepsis.</p><p><b>METHODS</b>Fifty children with severe sepsis and 150 children with general sepsis were enrolled as subjects, and 50 age-matched healthy children were included as controls. The percentages of CD3(+), CD4(+) and CD8(+) T cells in peripheral blood and CD4(+)/CD8(+) ratio were measured by flow cytometry. The pediatric critical illness score (PCIS) was calculated within 24 hours of admission.</p><p><b>RESULTS</b>The children with severe sepsis showed significantly lower percentages of CD3(+), CD4(+) and CD8(+) T cells CD4(+)/CD8(+) ratio and PCIS than the controls and children with general sepsis (P<0.01). Among the 200 cases of sepsis, the percentages of CD3(+), CD4(+) and CD8(+) T cells, CD4(+)/CD8(+) ratio and PCIS were significantly lower in the cured group than in the deceased group.</p><p><b>CONCLUSIONS</b>Children with sepsis have different degrees of cellular immunosuppression, and the degree of cellular immunosuppression is significantly correlated with the severity of the disease. Detection of T cell subsets in peripheral blood is of great significance for evaluating immune function and judging disease severity in children with sepsis.</p>


Subject(s)
Child, Preschool , Female , Humans , Male , CD4-CD8 Ratio , Prognosis , Sepsis , Allergy and Immunology , T-Lymphocyte Subsets , Allergy and Immunology
13.
Journal of Applied Clinical Pediatrics ; (24)2006.
Article in Chinese | WPRIM | ID: wpr-639334

ABSTRACT

0.05);Compared to Gram-negative bacilli group of sputum culture,Gram-positive cocci group had significant diffe-rence in the incidence of gastrointestinal dysfunction and microcirculatory disorders(Pa

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