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Objective Through retrospective data analysis,we tried to further understand the epide-miological characteristics,clinical feature and death factors of infant and young children with severe pneumo-nia. Methods The study objects were inpatients( age between≥28 days and≤3 years) who were diagnosed severe pneumonia from 1 January,2011 to 31 December,2013 of the Chengdu Women′s and Children′s Cen-tral Hospital. We used retrospective case study to understand the epidemiology,clinical feature,death factors of infant and young children with severe pneumonia. And we used chi-square test and Logistic multivariate regression analysis to analyze the death factors of infants and young children with severe pneumonia. Results (1) Among 1 411 cases of severe pneumonia,the ratio of male and female was 1. 8∶1,and the ratio of urban and rural areas was 1∶3. 62. The proportion of less than 3 months old infant was 46. 00%. And 62. 93% infant and young children with severe pneumonia occurred in the spring and winter. (2) Average hospitalization time was (9. 99 ± 6. 27 ) days, longer than the hospitalization time of mild pneumonia patients. ( 3 ) A total of 64. 21% of infant and young children with severe pneumonia had basic diseases. (4)A total of 91. 99% of the infant and young children with severe pneumonia had complications. (5) The most common etiology of infant and young children with severe pneumonia was bacteria,the second was virus. (6) In all cases,there were 44 cases died. The mortality of infant and young children with severe pneumonia was 3. 12%. And 72. 73% of the death cases were infants less than 3 months old. (7) The results of Logistic multiple regression analysis showed that there were significant differences in age, congenital heart diseases, repeating infection history, multiple drug-resistant strains infection, surgical history, multiple organ dysfunction, internal environment disorder. Conclusion Infant and young children with severe pneumonia have the following characteristics:most of them occurred in the winter and spring, and come from rural more than from the city. The smaller the age, the incidence of a disease is higher,and the mortality is higher. Most of infant and young children with severe pneu-monia have basic diseases. Most of the infant and young children with severe pneumonia have complications. If having one of the following high-risk factors:less than 3 months old,congenital heart diseases,repeating infec-tion history,multiple drug-resistant strains infection,surgical history,multiple organ dysfunction,internal envi-ronment disorder,the infant with severe pneumonia should be intensively monitored and actively treated.
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Objective To investigate pathogen bacteria distribution and clinical analysis of ventilator-associated pneumonia in infants and young children with congenital heart disease after surgery for guiding the rational clinical use of antimicrobial drugs.Methods The clinical data of ventilator-associated pneumonia in infants and young children with congenital heart disease after surgery were retrospectively analyzed for microbiologically documented infection.Bacterial identification was performed in an automatic VITEK2Jr expression system and antimicrobial susceptibility testing by Kirby2Bauer method.The results of antimicrobial susceptibility testing were performed in WHONET 5.0 system software.Results There were 16 strains of pathogenic bacteria in 2010,Gram-negative bacteria 9 stains (Klebsiella pneumoniae 18.75％,Acinetobacter baummannii 12.5％),gram positive coccus 6strains (Streptococcus 18.75％),Fungi 1 strain.There were 32 strains of pathogenic bacteria in 2011,Gram-negative bacteria 24 stains (Acinetobacter baummannii 31.25％,Klebsiella pneumoniae 25％,Pseudomonas aeruginosa 6.25％),gram positive coccus 8 strains (Enterococcus 12.5％,Streptococcus 6.25％).There were 42 strains of pathogenic bacteria in 2012,Gram-negative bacteria 38 stains (Acinetobacter baummannii 26.19％,Klebsiella pneumoniae33.33％,Pseudomonas aeruginosa 21.42％),gram positive coccus 4 strains (Enterococcus 4.76％).Acinetobacter baummannii remained highly sensitive to Amikacin and Levofloxacin,highly resistant to Meropenem,Imipenem,Klebsiella pneumonia remained highly sensitive to Amikacin and Levofloxacin,highly resistant to Cefoperazone/Sulbactam,Meropenem,Imipenem,trimethoprim-sulfamethoxazole,Ciprofloxacin.Pseudomonas aeruginosa only remained sensitive to Levofloxacin and Piperacillin/Tazobactam.Gram-positive cooci proportion in pathogenic bacteria decreased year by year,Streptococcus and Enterococcus had major proportion in Gram-positive cooci,Staphylococci decreased,There was no Staphylococcus,Enterococcus and Staphylococci resistant to vancomycin.Conclusions Gram-negative bacteria was the major pathogenic bacteria in ventilator-associated pneumonia with congenital heart disease postoperative infants and young children,Acinetobacter baummannii Klebsiella pneumoniaeand Pseudomonas aeruginosa had major proportion in gram-negative bacteria and drug resistance increased.Rational use of antibacterials was very important to reduce drug resistant strains.
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Objectives To evaluate the values of notched on R wave in inferior leads of electrocardiogram in infant with secundum atrial septal defect. Methods To observe and compare the prevalence of notch on R wave in inferior leads combined with incomplete right bundle branch block (IRBBB) in 162 cases with secundum atrial septal defect (group I) and 162 cases without heart disease (group II). Results The prevalence of notch on R wave in all the three inferior leads, in at least one inferior lead with IRBBB and in all the three inferior leads with IRBBB were 27.16%, 14.20%and 10.49%respec-tively in group I, and were 3.09%, 1.85%and 0.62%in group II respectively, and the differences between two groups were statistically significant (P<0.005). The specificities of notch on R wave in diagnosis of atrial septal defect were 96.91%, 98.15% and 99.38% respectively. Conclusions Notch on R wave in inferior leads is an independent electrocardiographic sign of secundum atrial septal defect in infants, and thus can be used as a diagnostic parameter.
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Objective To examine the kinetics of plasma S100A12 and soluble receptor for advanced glycation end products (sRAGE) in infants and young children undergoing cardiopulmonary bypass ( CPB),and to investigate whether they could protective the occurrence of noninfectious pulmonary complication (NPC) after cardiac surgery.Methods This was a case-control study.The subjects included all children aged ＜3 years old who underwent cardiac surgery with CPB during the period from June 1st to July 31st 2011.The patient who showed pulmonary inflammation or had abnormal liver or renal function before surgery was excluded.The remain patients were divided into 2 groups according to whether they had developed NPC postoperatively.Twenty patients were grouped into NPC because they developed the complications of pleural effusion,chylothorax,partial lung collapse,pulmonary hypertensive crisis,airway disorders,pneumothorax,pneumomediastinum,or phrenic nerve palsy.Forty patients were categorized into the no-NPC group.Plasma concentrations of S100A12 and sRAGE were measured using ELISA at baseline,before CPB,immediately after CPB,1 h,12 h and 24 h after operation.Differences concentrations between two groups were analyzed with t test.A stepwise logistic regression analysis was used to indentify the independent risk factor for NPC.A P value ＜0.05 was considered statistically significant.Results Plasma levels of S100A12 and sRAGE dramatically increased immediately after CPB ( P ＜ 0.01 ).The levels of sRAGE dropped to lower than baseline level (P ＜0.05),while S100A12 was still at high level 24h after operation (P ＜0.01 ).Levels of S100A12 and sRAGE immediately after CPB in NPC group were significantly higher than the no-NPC group (P ＜ 0.05).Twenty-four hours after operation,levels of S100A12 were still higher in NPC group than no-NPC (P ＜ 0.01 ),while levels of sRAGE were similar in the two groups ( P ＞ 0.05 ).In the stepwise logistic regression analysis,plasma S100A12 level immediately after CPB remained as a independently predictor for postoperative NPC (OR =1.042,95％ CI:1.010 ～ 1.076,P =0.011 ).Levels of S100A12 immediately after CPB were positively associated with mechanical ventilation time ( r =0.47,P ＜ 0.01 ),duration of surgical Intensive Care Unit ( r =0.407,P =0.002) and hospital stay ( r =0.421,P =0.01 ).Conclusions Plasma levels of S100A12 and sRAGE were significantly increased immediately after CPB and the elevated plasma S100A12 immediately after CPB served as an early reliable biomarker of the occurrence and the prognosis of NPC after CPB in infants and young children.
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This study was conducted to evaluated the nutrition quality of the commercial supplementary foods for infants and young children and to seek a solution to the establishment of standards of nutrient requirements for supplementary foods in Korea. Information on food ingredients, nutrient contents, claims about usefulness of food components and instructions for feeding preparation were obtained from the labels of 33 commercial supplementary foods manufactured by 4 different domestic companies. According to the standard of supplementary foods for infants and young children described in the Korean Food Code, the commercial supplementary foods were categorized into two different types, weaning food and baby food. All the commercial weaning foods were in powder form and mainly composed of cereals, whereas all the baby foods were mainly composed of fruits in the form of canned juice. The weaning foods contained more nutrients than the baby foods did, and the nutrient levels of the weaning foods expressed as nutrient density on energy basis were higher than the RDA for infants aged 5 to 11 months, suggesting that the commercial weaning foods provide adequate amounts of nutrients. If one followed the instructions for feeding preparation appearing on the label, however, recommended amounts of intake of the weaning foods would provide too much energy as well as nutrients. There were many differences in nutrient standards of weaning foods between the Korean Food Code and Codex international food standard. In conclusion, the establishment of standards for nutrient requirements for the supplementary foods requires significant scientific studies on what nutrients are the most inadequate in Korean infants and young children feeds and what levels of nutrients should be added to the foods in order to supplement their nutrition. In addition, it is very important to have a strong scientific basis to support our standard when discrepancies exist between our standard and the international standard.