Establishment of a risk model for severe adenovirus pneumonia and prospective study of the timing of intravenous immunoglobulin therapy in children / 中国当代儿科杂志

OBJECTIVES@#To develop a risk prediction model for severe adenovirus pneumonia (AVP) in children, and to explore the appropriate timing for intravenous immunoglobulin (IVIG) therapy for severe AVP.@*METHODS@#Medical data of 1 046 children with AVP were retrospectively analyzed, and a risk prediction model for severe AVP was established using multivariate logistic regression. The model was validated with 102 children with AVP. Then, 75 children aged ≤14 years who were considered at risk of developing severe AVP by the model were prospectively enrolled and divided into three groups (A, B and C) in order of visit, with 25 children in each group. Group A received symptomatic supportive therapy only. With the exception of symptomatic supportive therapy, group B received IVIG treatment at a dose of 1g/(kg·d) for 2 consecutive days, before progressing to severe AVP. With the exception of symptomatic supportive therapy, group C received IVIG treatment at a dose of 1 g/(kg·d) for 2 consecutive days after progressing to severe AVP. Efficacy and related laboratory indicators were compared among the three groups after treatment.@*RESULTS@#Age<18.5 months, underlying diseases, fever duration >6.5 days, hemoglobin level <84.5 g/L, alanine transaminase level >113.5 U/L, and co-infection with bacteria were the six variables that entered into the risk prediction model for severe AVP. The model had an area under the receiver operating characteristic curve of 0.862, sensitivity of 0.878, and specificity of 0.848. The Hosmer-Lemeshow test showed good consistency between the predicted values and the actual observations (P>0.05). After treatment, group B had the shortest fever duration and hospital stay, the lowest hospitalization costs, the highest effective rate of treatment, the lowest incidence of complications, the lowest white blood cell count and interleukin (IL)-1, IL-2, IL-6, IL-8, IL-10 levels, and the highest level of tumor necrosis factor alpha (P<0.05).@*CONCLUSIONS@#The risk model for severe AVP established in this study has good value in predicting the development of severe AVP. IVIG therapy before progression to severe AVP is more effective in treating AVP in children.

Application of blood purification in children with severe adenoviral disease / 中国小儿急救医学

Severe hypoxia respiratory failure or acute respiratory distress syndrome, acute renal injury, liver function disorder, and multiple organ dysfunction syndrome caused by severe adenoviral disease have high mortality.Blood purification have become more widely available for acute renal injury, fluid overload, hyperlactacidemia, inflammatory reaction, coagulopathy and so on.The methods include renal replacement therapy(RRT) and therapeutic plasma exchange, usually combined with extracorporeal membrane oxygenation (ECMO). The appropriate blood purification strategy has not been available.Based on experience of RRT in acute renal injury, liver dysfunction, currently continuous renal replacement therapy/RRT technologies are reasonable used by personalized decision-making.

Application of blood purification in children with severe adenoviral disease / 中国小儿急救医学

Severe hypoxia respiratory failure or acute respiratory distress syndrome,acute renal inju﹣ry,liver function disorder,and multiple organ dysfunction syndrome caused by severe adenoviral disease have high mortality. Blood purification have become more widely available for acute renal injury,fluid overload, hyperlactacidemia,inflammatory reaction, coagulopathy and so on. The methods include renal replacement therapy(RRT) and therapeutic plasma exchange,usually combined with extracorporeal membrane oxygena﹣tion (ECMO). The appropriate blood purification strategy has not been available. Based on experience of RRT in acute renal injury,liver dysfunction,currently continuous renal replacement therapy/RRT technologies are reasonable used by personalized decision﹣making.

Analysis of Imaging and Clinical Findings of Severe Adenoviral Pneumonia in Children / 实用放射学杂志

Objective To investigate imaging and clinical findings of severe adenoviral pneumonia in children.Methods The imaging and clinical findings of severe adenoviral pneumonia in three children were retrospectively analyzed. All cases underwent radiography and CT examinations of chest. Results Two patiens showed fairly homogeneous opacity with air bronchograms in segmental or lobar distribution in left lung,in company with volume decreased in one case. There was interstitial change in 1 case,pleural effusion in one case and heart shadow enlarged in 3 cases. All of patients had cough and fever (range,38.4℃～40.3℃). Physical examinations showed decreased breathing sound and crackles in all cases. Laboratory findings included abnormally elevated aspartate aminotransferase,lactic dehydrogenase, hydroxybutyric dehydrogenase and creatine kinase and positive adenovirus examination in all cases. Conclusion Lobar pneumonia in company with liver and heart dysfunction should be suspected as the severe adenoviral pneumonia in children.