Development and evaluation of a mortality risk prediction model for severe bacterial infections in children / 中华急诊医学杂志

Objective:To establish a mortality risk prediction model of severe bacterial infection in children and compare it with the pediatric early warning score (PEWS), pediatric critical illness score (PCIS) and pediatric risk of mortality score Ⅲ (PRISM Ⅲ).Methods:A total of 178 critically ill children were selected from the PICU of the Children's Hospital of Nanjing Medical University from May 2017 to June 2022. After obtaining the informed consent of the parents/guardians, basic information such as sex, age, height and weight, as well as indicators such as heart rate, systolic blood pressure and respiratory rate were collected from all children. A standard questionnaire was used to score the child 24 h after admission to the PICU. The children were divided into the survival and death groups according to their survival status at 28 d after admission. A mortality risk prediction model was constructed and nomogram was drawn. The value of the mortality risk prediction model, PEWS, PCIS and PRISM in predicting the risk of death was assessed and compared using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC).Results:Among the 178 critically ill children, 11 cases were excluded due to severe data deficiencies and hospitalization not exceeding 24 h. A total of 167 children were included in the analysis, including 134 in the survival group and 33 in the death group. A mortality risk prediction model for children with severe bacterial infection was constructed using pupillary changes, state of consciousness, skin color, mechanical ventilation, total cholesterol and prothrombin time. ROC curve analysis showed that the AUCs of mortality risk prediction model was 0.888 ( P<0.05). The AUCs of PEWS, PCIS and PRISM Ⅲ in predicting death in children with severe bacterial infection were 0.769 ( P< 0.05), 0.575 ( P< 0.05) and 0.759 ( P< 0.05), respectively. Hosmer-Lemeshow goodness-of-fit test showed the best agreement between risk of death and PEWS predicted morbidity and mortality and actual morbidity and mortality (χ 2 = 5.180, P = 0.738; χ 2 = 4.939, P = 0.764), and the PCIS and PRISM Ⅲ predicted mortality rates fitted reasonably well with actual mortality rates (χ 2= 9.110, P= 0333; χ 2 = 8.943, P= 0.347). Conclusions:The mortality risk prediction model for predicting the death risk has better prognostic value than PEWS, PCIS and PRISM Ⅲ for children with severe bacterial infection.

Pulmonary mechanical characteristics of children with acute respiratory distress syndrome / 中国小儿急救医学

The etiology and pathogenesis of acute respiratory distress syndrome (ARDS) are different.There are individual differences in the changes of pulmonary mechanics during the progress of the disease.The changes of compliance, pressure and volume are closely related to the etiology, severity and age.Correct use of lung protective ventilation strategy, reasonable adjustment of ventilator parameters and reduction of ventilator-associated lung injury are the key to improve the success rate of ARDS treatment.Therefore, we must pay more attention to the characteristics and changes of pulmonary mechanics in ARDS.

Influence of Resolvin D1 on the inflammatory response and expression of NLRP3 in mice with acute lung injury / 中华实用儿科临床杂志

Objective:To investigate the effects of Resolvin D1 (RvD1) on the inflammatory response and the expression of Nod-like receptor protein 3(NLRP3) inflammasomes in mice with acute lung injury.Methods:The 30 male BALB/c mice weighing 25-30 g were divided into 3 groups(each group with 10 mice). Mice in the normal control group were given normal saline by tail vein injection.Mice in the lipopolysaccharide (LPS) group were given the same volume of LPS (10 mg/kg) via tail vein injection.Mice in the RvD1 group were injected with RvD1 (5 μg/kg) through the tail vein 30 minutes prior to LPS administration.Mice were humanely sacrificed after 6 hours.Histopatholo-gical changes of lung tissue, the levels of pro-inflammatory cytokines interleukin(IL)-18 and IL-1β, and the expression of NLRP3 inflammasomes in lung tissue were measured.Results:After LPS administration, the lung of mice showed pathological damage.The levels of pro-inflammatory factors IL-18 and IL-1β as well as the expression of NLRP3, apoptosis-associated speck-like protein containing a card(ASC)and Caspase-1 in the LPS group were significantly higher than those in the normal control group (all P<0.05). After pretreatment with RvD1, the pathological damage of lung tissue was alleviated.The levels of pro-inflammatory factors IL-18 and IL-1β as well as the expression of NLRP3, ASC and Caspase-1 in the RvD1 group were significantly lower than those in the LPS group (all P<0.05). Conclusions:RvD1 can attenuate the pulmonary inflammation in acute lung injury and inhibit the release of pro-inflammatory factors, which is possibly related to the suppression of NLRP3.

Energy balance and prognosis of children with mechanical ventilation in pediatric intensive care unit / 中华临床营养杂志

Objective To investigate the influencing factors for energy balance and the relationship be-tween energy balance and clinical outcome in PICU mechanical ventilation children. Methods Children with mechanical ventilation who were hospitalized in PICU for more than 3 days from June 2015 to May 2016 were collected, resting energy expenditure was measured by resting energy metabolic detector, and the nutrition bal-ance was calculated, the influencing factors on energy balance was analyzed by regression analysis. Results A total of 104 mechanical ventilation children were included with the average energy consumption of ( 265. 4 ± 63. 2) kJ/kg in the first 3 days and the average energy supply of (219. 8±82. 9) kJ/kg, and failed to reach the target value ( P<0. 05) . As the time of hospitalization was prolonged, the supply of energy increased gradu-ally, the SAPS Ⅱ ( r=-0. 609, P=0. 000) , mechanical ventilation time ( r=-0. 456, P=0. 000) , ICU stay time ( r=-0. 646, P=0. 000) , the number of organ failure ( r=-0. 568, P=0. 000) , infection complications ( r=-0. 859, P=0. 000) were negatively correlated to energy supply balance; regression analysis showed that complications of nosocomial infection ( P = 0. 000 ) , number of organ failure ( P = 0. 000 ) , mechanical ventilation time ( P=0. 000) , ICU retention time ( P=0. 001) were predictors of energy supply balance. Con-clusion Insufficient supply of energy for the first three days of mechanical ventilation is high in the critically ill children. Factors affecting energy supply balance include patient's organ failure, infection complications, me-chanical ventilation time, and ICU retention time, which suggest that the strengthening of the nutritional man-agement of the critically ill children with mechanical ventilation will benefit to the clinical outcome.

Application value of continuous blood purification in pediatric intensive care unit: analysis of 203 cases / 中华危重病急救医学

Objective To explore the clinical application value of the continuous blood purification (CBP) technology in pediatric intensive care unit (ICU). Methods A retrospective study was conducted. All CBP patients admitted to pediatric ICU of Children's Hospital of Nanjing Medical University from 2015 to 2017 were enrolled. The disease diagnosis, CBP treatment mode, catheter placement, anticoagulation way, treatment time and adverse reactions were summarized and analyzed. Results ① A total of 203 children were included, male accounted for 59.1%; age 37 days to 14 years old, with an average of (4.52±3.60) years old; weight 3.3-68.0 kg, with an average of (21.38±13.77) kg.② There were a total of 660 CBP treatments, with an average of 3.25 times per person. The main treatment modes of CBP were plasma exchange (PE, 38.64%), and followed by continuous veno-venous hemodiafiltration (CVVHDF, 38.64%), hemoperfusion (HP, 16.51%) and continuous veno-venous hemofiltration (CVVH, 6.21%).③ Central venous catheterization was mainly placed in the right internal jugular vein (90.64%), followed by the right femoral vein (5.42%) and the left femoral vein (3.94%).④ Heparin sodium was the main anticoagulant in pipeline filters (84.73%), followed by low molecular weight heparin calcium (11.33%), sodium citrate and non-anticoagulant (both 1.97%). Mixed anticoagulants were used 21 children. ⑤ Primary diseases included poisoning (26.11%), liver failure (25.62%), sepsis (12.32%), shock after cardiopulmonary resuscitation (11.82%), acute respiratory distress syndrome (ARDS, 8.37%), central nervous system diseases (5.41%) and metabolic diseases (4.93%). The lowest efficacy of CBP was metabolic diseases, with mortality rate of 60.00%; followed by ARDS, shock after cardiopulmonary resuscitation, sepsis and liver failure, with mortality was 58.82%, 41.67%, 36.00% and 32.69%, respectively. The length of hospitalization stay of children with central nervous system diseases was (30.89±15.13) days.⑥ Adverse events of CBP treatment included uncontrollable restlessness (2.88%), hypotension (1.82%), allergic rash (1.21%), catheterization and pipeline coagulation (1.21%), filter coagulation (1.06%), decreased heart rate and oxygen saturation (0.76%); CBP was stopped in 8 children due to cardiac arrest during the treatment. Conclusion At present, the application of CBP technology in pediatric ICU is universal, and it is an important way to rescue critical illness.

Changes in serum adiponectin levels in children with severe sepsis and its clinical significance / 中华实用儿科临床杂志

Objective To study the changes in serum adiponectin level in children with severe sepsis,and to explore its clinical significance.Methods A prospective study was conducted,and 39 cases of critically ill children with severe sepsis and 47 cases of sepsis were enrolled into the Pediatric Intensive Care Unit(PICU),Children's Hospital of Nanjing Medical University from July 2012 to July 2014.Thirty cases of critically ill children without sepsis were enrolled as a control group.The plasma adiponectin,procalcitonin(PCT),and C-reactive protein(CRP)were determined with enzyme linked immunosorbent assay(ELISA)within 24 hours after PICU admission.The pediatric critical illness score(PCIS)was recorded.Results Among severe sepsis group,sepsis group and control group,there was no statistical significance in body temperature,heart rate,body mass index,PCIS,white blood cell count,platelet count,bilirubin,creatinine,pH value and activated partial thromboplastin time(APTT)(all P>0.05).Plasma adiponectin in the severe sepsis group[(0.102±0.041)mg/L] significantly decreased compared with that in the sepsis group[(0.125±0.046)mg/L] and the control group[(0.147±0.047)mg/L](F=8.456,P=0.000).The level of CRP in the severe sepsis group[(60.68±59.43)mg/L] significantly increased compared with that in the sepsis group[(52.76±26.67)mg/L] and the control group[(33.89±6.87)mg/L](F=17.416,P=0.000).There was a statistical significance in PCT level in the severe sepsis group,the sepsis group and the control group(x2=27.269,P=0.000).Further comparison showed that there was a significant difference in PCT level between the severe sepsis group and the sepsis group(Z=-4.679,P=0.000),which was also statistically significant between the severe sepsis group and the control group(Z=-4.244,P=0.000);there was no significant difference between the sepsis group and the control group(Z=-0.340,P=0.733).Negative correlation was found between plasma adiponectin and CRP(r=-0.219,P=0.042),PCT(r=-0.303,P=0.005).The correlation between plasma adiponectin and PCIS was positively correlated(r=0.332,P=0.002).Conclusions Plasma adiponectin decreased in severe sepsis children and was significantly associated with the severity of the disease.Detection of plasma adiponectin levels in children with sepsis has an important clinical significance in evaluating the severity of sepsis.Plasma adiponectin is negatively correlated with CRP and PCT,and plays a role in diagnosis of infection.

Application of prone position in acute respiratory distress syndrome of pediatrics / 中华实用儿科临床杂志

Acute respiratory distress syndrome (ARDS) is a common critical disease in department of pediatrics.Mechanical ventilation is one of the effective means for the treatment of ARDS.In the past,in order to comfort and care for patients,the supine or semi supine position were used often.Recently,many studies have showed that prone position could change the respiratory mechanics and reduce intrathoracic pressure,avoiding lung injury caused by over stretch and hyperinflation,which is significant in improving ARDS gas exchange.

Analysis on curative effect of the combined therapy of ReDuNing injection and acyclovir on children with infectious mononucleosis / 实用医学杂志

Objective To evaluate the efficacy of the combined therapy of ReDuNing injection and acyclo-vir on children with infectious mononueleosis(IM). Methods From October 2012 to July 2015 in the emergency ward of Children′s Hospital of Nanjing Medical University ,167 cases diagnosised with infectious mononucleosis were enrolled in this study. Ninety-five cases received acyclovir treatment were recruited in the conventional treat-ment group,72 cases received the combined thrapy of ReDuNing injection and acyclovir of children were recruited in the observation group. The clinical symptoms ,clinical manifestation and blood routine ,liver and kidney func-tion,myocardial enzymes,temperature recovery time,reduce lymph node,liver function recovery time and hospi-talization time of patients were recorded and compared between the two groups. Results No significant differences were observed in the clinical course and general fever,pharyngitis,lymphadenopathy,hepatosplenomegaly,rash and eyelid edema in children of the observation group (ReDuNing + Acyclovir) and routine treatment group (Acyclovir). No significant differences were found in blood routine ,blood biochemical indexes of liver ,kidney function and myocardial enzymes in patients of the two groups before and after treatment. The white blood cells , ALT and LDH were significantly reduced in patients of the two groups after treatment(P<0.05). However,LDH was still high in patients of the two groups before discharge ,with the level of(355.63 ± 116.89)U/L and(347.79 ± 106.74)U/L,respectively. The pyretolysis time(2.97 ± 2.56)d,lymph node reduced time(9.08 ± 1.54)d,liver function recovery time(8.67 ± 2.35)d,white blood cell recovery time(6.76 ± 2.96)d,hospitalization time (11.10 ± 3)d in the observation group were significantly shortened than those in the conventional treatment group ((4.38 ± 2.70)d,(10.48 ± 3.62)d,(11.50 ± 3.71)d,(9.15 ± 3.24)d,12.32 ± 3.62)d,respectively)(P<0.05, respectively). Conclusions The fever,lymphadenopathy,leukocytosis,liver damage and LDH were relieved and reduced at different degrees in patients of both the observation group and the routine treatment group after treat-ments. Reduning combined with acyclovir treatments lead to better clinical efficacy in children ,with shortening the duration of fever,Lymph node reduction time,and white blood cell recovery time. In particularly,the combined therapy can shorten the recovery time of patients with liver function damage ,which is a safe clinical application and can be used as one of the effective treatment measures for children with infectious mononucleosis.

Analysis on curative effect of the combined therapy of ReDuNing injection and acyclovir on children with infectious mononucleosis / 实用医学杂志

Objective To evaluate the efficacy of the combined therapy of ReDuNing injection and acyclo-vir on children with infectious mononueleosis(IM). Methods From October 2012 to July 2015 in the emergency ward of Children′s Hospital of Nanjing Medical University ,167 cases diagnosised with infectious mononucleosis were enrolled in this study. Ninety-five cases received acyclovir treatment were recruited in the conventional treat-ment group,72 cases received the combined thrapy of ReDuNing injection and acyclovir of children were recruited in the observation group. The clinical symptoms ,clinical manifestation and blood routine ,liver and kidney func-tion,myocardial enzymes,temperature recovery time,reduce lymph node,liver function recovery time and hospi-talization time of patients were recorded and compared between the two groups. Results No significant differences were observed in the clinical course and general fever,pharyngitis,lymphadenopathy,hepatosplenomegaly,rash and eyelid edema in children of the observation group (ReDuNing + Acyclovir) and routine treatment group (Acyclovir). No significant differences were found in blood routine ,blood biochemical indexes of liver ,kidney function and myocardial enzymes in patients of the two groups before and after treatment. The white blood cells , ALT and LDH were significantly reduced in patients of the two groups after treatment(P<0.05). However,LDH was still high in patients of the two groups before discharge ,with the level of(355.63 ± 116.89)U/L and(347.79 ± 106.74)U/L,respectively. The pyretolysis time(2.97 ± 2.56)d,lymph node reduced time(9.08 ± 1.54)d,liver function recovery time(8.67 ± 2.35)d,white blood cell recovery time(6.76 ± 2.96)d,hospitalization time (11.10 ± 3)d in the observation group were significantly shortened than those in the conventional treatment group ((4.38 ± 2.70)d,(10.48 ± 3.62)d,(11.50 ± 3.71)d,(9.15 ± 3.24)d,12.32 ± 3.62)d,respectively)(P<0.05, respectively). Conclusions The fever,lymphadenopathy,leukocytosis,liver damage and LDH were relieved and reduced at different degrees in patients of both the observation group and the routine treatment group after treat-ments. Reduning combined with acyclovir treatments lead to better clinical efficacy in children ,with shortening the duration of fever,Lymph node reduction time,and white blood cell recovery time. In particularly,the combined therapy can shorten the recovery time of patients with liver function damage ,which is a safe clinical application and can be used as one of the effective treatment measures for children with infectious mononucleosis.

Critically patient and position / 中国小儿急救医学

There is great role of position treta ment in critically paediatric patient.It can not only alleviate the ol cal skin contracture opprse sion,muscle joints,but can cause the redistribution of body fluids. Even changing body position plays a crucial role in a number of specific diseases and treatment modalities. Intensive care unit common position includes seated,semi-seated,supine,semi-supine,left lateral, right lateral op sition na d prone position,anti-trendelenburg position,continuous lateral rotation therapy.The following is a brief introduction to the application of various body positions in the intensive care unit.

A systematic review of intravenous immunoglobulin for critical hand-foot-mouth disease / 中华实用儿科临床杂志

Objective To evaluate the effectiveness of intravenous immunoglobulin (IVIG) in critical hand-foot-mouth disease (HFMD).Methods The data from PubMed, MEDLINE, EMBASE, EBSChost, Cochrane Library, Cochrane Central Register of Controlled Trials, Ovid, China Biology Medicine disc, Wanfang Data, China National Knowledge Infrastructure, Chinese Citation Database, and other references and grey literatures were retrieved, screening out all those related to clinical trials on treating critical HFMD by IVIG.Standard methods of the Cochrane Collaboration were employed to evaluate the methodological quality of the trials.Meta analysis was performed with Rev man 5.3 software.Results Eleven trials including 967 cases were investigated.The meta analysis showed that IVIG had significantly clinical efficacy (OR =6.84,95％ CI:3.74-12.52 ,P ＜ 0.05).IVIG could significantly decrease duration of fever (MD =-1.94,95％ CI:-3.07--0.81 ,P ＜0.05) ,hospitalization time (MD =-4.56,95％ CI:-8.95--0.17,P ＜0.05).There was no significant difference in duration of fever (MD =-0.28,95 ％ CI:-0.59-0.03, P ＞ 0.05), duration of herpes (MD =0.18,95％ CI:-0.22-0.59, P ＞ 0.05), hospitalization time (MD =-0.12,95％ CI:-0.47-0.23, P ＞ 0.05) when the dosage of injection was adjusted.Conclusions IVIG is recommended for treating critical HFMD because it is effective in decreasing the duration of fever and hospitalization.Well designed studies with more sample in multi-center are required in further study to explore the efficacy and safety of IVIG on critical HFMD.

Lung stem cell transplantation in acute respiratory distress syndrome / 中国小儿急救医学

There is a great progress in research related to the lung stem cell which is one kind of somatic stem cells in recent years.This article reviewed systematically the lung stem cell biological characteristics,the surface markers,migration,homing,and the clinical application in the treatment of acute respiratory distress syndrome.

Clinical observation of naloxone treatment in drowing children / 中国小儿急救医学

Objective To investigate the clinical effects and mechanism of naloxone treatment in drowing children.Methods A total of 97 drowing children were divided into treatment group(n=45)and control group(n=52)depending on whether the naloxone was administrated.General treatment was adopted in two groups.Treatment group Was given naloxone.The clinical effects were observed and the levels of betaendorphin(β-EP)in blood plasma were measured with radioimmunoassay(RIA)before and after treatment respectively.Results The total effective rate of treatment group(93.3%,42/45)Was significantly higher than that of control group(76.9%,40/52)(P＜0.05).As compared with that of control group(65.0%,26/40),nervous system disability rate in treatment group(33.3%,14/42)decreased significantly(P＜0.01).Continuous days of poor blood circulation,abnormal respiratory rhythm,convulsion and coma in treatment group were significantly shorter than those of control group respectively(P＜0.01).The level of β-EP was significantly lower in treatment group than that of control group(t=17.1,P＜0.01).Conclusion Clinical use of naloxone in the drowing children has curative result by reducing the level of blood plasma β-EP.

Step sequential therapy in rescuing infantile postrenal acute renal renal failure induced by melamine / 中华急诊医学杂志

Objective To investigate clinical characteristics and emergency managements of postrenal acute renal failure(ARV)induced by melamine in infant.Method Fluid therapy for urine alkalization and hydration,cistoscope drainage and peritoneal dialysis step by step were exerted in those who had both a history of certain milk intake and ARF according to the definition of pediatric ARF which developed by Pediatric Nephrology Assembly of Chinese Pediatric Association in 1994.Results Thirty-four postrenal ARF cases with anuria due to melamine in Nanjing Children's Hospital of Nanjing Medical University were involved in the study.Seventy cases(50%)re-ceived fluid therapy only.Nine cases(26.5%)received fluid thempy and eistoscope drainagemand 4 cases (11.8%)received fluid therapy and cistoscope drainage and peritoneal dialysis.Four cases(11.8%)received ur-gent peritoneal dialysis due to severe hyperkalemia.All cases(100%)survived.The urine pH at the first day.the second day,and after the second day in those who just pass away urine were 6.1±1.0、6.5±0.7.5.3±0.4,respectively(F=4.563,P=0.026).Conclusions Fluid therapy for urine alkalization and hydration and stop sequential thempy are effective in infant with postrenal ARF induced by melamine.

Effects of SDF-1 on the chemotaxis of cord blood AC133+ cells / 白血病·淋巴瘤

Objective To explore the effects of the stromal cell-derived factor on chemotaxis of cord blood ACl33+ cells.Methods The optimal SDF-1 concentration is detected in Transwell system.Migration was calculated from the number of cells found to have passed through an 8-um pore size polycarbonate membrane.Results The chemotactic rate of fresh cord blood AC133+ cells increases along with the concentration of SDF-1,however,it tends to be stable when the concentration of SDF-1 reaches 150 ng/ml.There is no difference in the chemotactic rate of cord blood AC133+ cells between the group with CXCR4-blocking antibody and the group without SDF-1.Conclusion Transwell Plate can simulate the phenomenon of cell crossing endothelium.The chemotactic rate of cord blood AC133+ cells increases progressively along with the concentration of SDF-1,however,the chemotactic rate tends to equability when SDF-1 reaches a certain concentration.The chemotactic rate does not have a marked change while continuing to increase the concentration of SDF-1.There is no difference in the chemotactic rate of cord blood AC133+ cells between the group using CXCR4-blocking antibody and the group without SDF-1.