Clinical features of post-neurosurgical bacterial meningitis in children / 中华儿科杂志

Objective: To understand the characteristics of bacterial meningitis after pediatric neurosurgical procedures. Methods: This was a retrospective observational study. From January 2016 to December 2022, 64 children diagnosed with post-neurosurgical bacterial meningitis based on positive cerebrospinal fluid (CSF) culture in Department of Neurosurgery of Shanghai Children's Medical Center were selected as the study population. The clinical characteristics, onset time, routine biochemical indexes of cerebrospinal fluid before anti infection treatment, bacteriology characteristics and sensitivity to antibiotics of bacteria cultured from cerebrospinal fluid were analyzed. Based on the CSF culture results, the patients were divided into the Gram-positive bacteria infection group and the Gram-negative bacteria infection group. The clinical characteristics of the two groups were compared using t-tests or Wilcoxon rank-sum tests, and chi-square tests. Results: There were 64 children,42 boys and 22 girls, with onset age of 0.83 (0.50, 1.75) years. Seventy cases of post-neurosurgical bacterial meningitis occurred in the 64 children, of which 15 cases (21%) in spring, 23 cases (33%) in summer, 19 cases (27%) in autumn, and 13 cases (19%) in winter. The time of onset was 3.5 (1.0, 10.0) months after surgery; 15 cases (21%) occurred within the first month after the surgery, and 55 cases (79%) occurred after the first month. There were 38 cases (59%) showing obvious abnormal clinical manifestations, fever 36 cases (56%), vomiting 11 cases (17%). Forty-eight cases (69%) were caused by Gram-positive bacteria, with Staphylococcus epidermidis 24 cases; 22 cases (31%) were caused by Gram-negative bacteria, with Acinetobacter baumannii the prominent pathogen 7 cases. The Gram-positive bacterial infection was more common in summer than the Gram-negative bacterial infection (20 cases (42%) vs. 3 cases (14%), χ2=5.37, P=0.020), while the Gram-negative bacterial infection was more in autumn and within the first month after surgery than the Gram-positive bacterial infection (11 cases (50%) vs. 8 cases (17%), 15 cases (67%) vs. 5 cases (33%), χ2=8.48, 9.02; P=0.004, 0.003). Gram-positive bacteria resistant to vancomycin and Acinetobacter baumannii resistant to polymyxin were not found. However, Acinetobacter baumannii showed only 45% (10/22) susceptibility to carbapenem antibiotics. Conclusions: The clinical presentation of post-neurosurgical bacterial meningitis in children is atypical. Gram-positive bacteria are the main pathogens causing post-neurosurgical bacterial meningitis; Gram-negative bacterial meningitis are more likely to occur in autumn and within the first month after surgery. Acinetobacter baumannii has a high resistance rate to carbapenem antibiotics, which should be taken seriously.

Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury / 中华医学杂志(英文版)

<p><b>Background</b>Compared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes of very preterm infants.</p><p><b>Methods</b>Totally 129 very preterm infants (gestational age ≤28 weeks) in neonatal intensive care unit of Hunan Children's Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS (weekly before discharge and monthly after discharge) was performed on the infants until 6 months or older. Magnetic resonance imaging (MRI) was performed on the infants at approximately the term-equivalent age. The mental developmental index (MDI) and psychomotor developmental index (PDI) were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed.</p><p><b>Results</b>The consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage (GMH) Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis (MDI: odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI: OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively). At the last cUS, gestational age, extensive cystic periventricular leukomalacia (c-PVL), and moderate and severe hydrocephaly are significantly correlated with MDI (OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively). Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI (OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively).</p><p><b>Conclusions</b>Very premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury.</p>

The association of sleep hygiene and sleep quality among school-age children / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the association between sleep hygiene and sleep duration and quality among school-age children, and to explore the risk factors related to poor sleep hygiene.</p><p><b>METHODS</b>Totally 2019 grade-five children were sampled by stratified cluster random sampling from 10 primary schools in Shanghai, during November and December 2009. Questionnaires were used to investigate children and their parents. Adolescent Sleep Hygiene Scale (ASHS) was used to inquiry sleep hygiene of children; Children Sleep Habits Questionnaire (CSHQ) was used to assess their sleep duration and quality; Family and Social Environment Questionnaire was used to collect demographic and socio-economic information. T-test, one-way ANOVA and multiple linear regression model were established to identify the risk factors for sleep hygiene.</p><p><b>RESULTS</b>The age of subjects was (10.81 ± 0.38) years old, 49.0% (989/2019) were boys. The ASHS total score was 125.43 ± 15.17, girls with better sleep hygiene than boys (127.05 ± 14.41 vs 123.74 ± 15.75, P < 0.05). The sleep duration was (9.47 ± 0.58)h/d, children slept less than 9 h/d had lower ASHS total score than those slept 9 - 10 h/d or over 10 h/d (121.69 ± 16.09 vs 126.17 ± 14.62 vs 126.50 ± 15.36, P < 0.05). Children with poor sleep quality had worse sleep hygiene than those with good sleep quality (121.00 ± 15.84 vs 128.36 ± 13.92, P < 0.05). Children with television set in bedroom had lower ASHS total score than the others (122.40 ± 15.76 vs 126.74 ± 14.66, P < 0.05). Children from single parent family had lower ASHS total score (117.90 ± 16.80 vs 125.94 ± 14.89, P < 0.05). Children whose father had irregular sleep or wake pattern had lower ASHS total score (122.65 ± 15.30 vs 125.89 ± 14.90 vs 127.79 ± 14.71, P < 0.05). The regression model confirmed that existence of television set in children's bedroom, single-parent family and father's irregular sleep pattern were the risk factors of poor sleep hygiene.</p><p><b>CONCLUSION</b>Sleep hygiene was closely associated with sleep duration and quality among school-age children. Children with television set in bedroom, male, from single parent family and whose father had irregular sleep or wake pattern had worse sleep quality.</p>

Comparative study of children's sleep evaluation methods / 中华儿科杂志

<p><b>OBJECTIVE</b>To compare the compliance of using Actiwatch, parent report of sleep diary and sleep questionnaire in school age children, and to further evaluate agreement rates between actigraphy, diary, and questionnaire for children's sleep patterns.</p><p><b>METHOD</b>Two primary schools in Luwan District were selected and first grade students without obvious physical and mental illnesses or sleep disorders were enrolled in the study. Each student was home-monitored with an Actiwatch for 7 days, meanwhile parents were asked to complete a detailed sleep diary during the Actiwatch monitoring days. Sleep questionnaires were distributed to their parents who were asked to fill in these on the last monitoring day.</p><p><b>RESULT</b>Forty-five children participated in the study, 36 children completed sleep assessments by all the three methods, and among them 20 were boys and 16 were girls. The mean age of those children was (7.26±0.42) years. The completion rate of questionnaire was 100%, of diary was 86.7% (39/45) and of Actiwatch was 93.3% (42/45). The completion rate between sleep diary and sleep questionnaire was significantly different (P<0.05). The satisfactory agreement between Actiwatch and sleep diary was reached with sleep diary overestimating weekday and weekend sleep duration by 26 minutes and 25 minutes respectively. The agreement rates between Actiwatch and questionnaire was insufficient for all variables with sleep questionnaire overestimating weekday and weekend sleep duration by 37 minutes and 38 minutes respectively.</p><p><b>CONCLUSION</b>Sleep questionnaire is an easy and high compliance method for evaluating children's sleep pattern while sleep diary showed high agreement with Actiwatch. Using either of these methods for evaluating children's sleep pattern should be judged by research aim and sample size, and limitation of those methods should be considered when they are used in practice.</p>

Follow-up study of school-age children's sleep quality in Shanghai / 中华儿科杂志

<p><b>OBJECTIVE</b>China has undergone massive socioeconomic change during the past several years, and its impact on children's sleep is still unrecognized. Shanghai, as one of typical economically fast-developing cities, was chosen as observational city in this study, which was designed to explore trends in sleep quality in Shanghai school-aged children and related high risk factors on sleep quality.</p><p><b>METHOD</b>Totally 884 fifth grade school-aged students were sampled by stratified cluster random sampling method from 10 primary schools of Shanghai in 2005, then four years later in 2009, 2161 same grade students were sampled from the same schools. Chinese version of Children's Sleep Habits Questionnaire (CSHQ) was used to evaluate 8 sleep quality parameters among those children, and high risk factors on school-aged children's sleep quality were investigated as well.</p><p><b>RESULT</b>The prevalence of poor sleep quality decreased from 29.2% in 2005 to 27.9% in 2009, and among 8 sleep quality parameters, bedtime resistance decreased from 33.1% to 28.7%, sleep anxiety from 50.6% to 39.8%, night waking from 25.2% to 21.5%, and parasomnia from 51.2% to 45.8%. The factors, such as heavier homework burden, longer daily computer use, bright light during sleep, cosleeping, existence of chronic disease and irregular sleep habits of parents, were associated with poor sleep quality of school-aged children after adjusting for children's age, gender, and family social-economic status.</p><p><b>CONCLUSION</b>Part of sleep quality parameters improved during the past 4 years, but current situation is still tough with more than 1/4 poor sleep quality children. Helping children to develop good sleep hygiene as well as educating parents how to shape children's regular sleep habits might be effective methods to improve children's sleep quality.</p>

Relationship between the grading of periventricular echodensities and periventricular white matter cystic lesions in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To understand the relationship of the grading of periventricular echodensities (PVE) with the morbidity and the occurrence time of periventricular white matter cystic lesions in preterm infants.</p><p><b>METHODS</b>A retrospective, single-centre cohort study of 120 preterm infants with PVE diagnosed by ultrasonography between February 2005 and May 2008 was performed. The infants had a median gestational age of 32 weeks and a median birth weight of 2 230 g.</p><p><b>RESULTS</b>Fifty-two infants (43%) were diagnosed as having PVE I, 42 infants (35%) having PVE II, and 26 infants (22%) having PVE III. The grading of PVE was closely related to birth weight, but not with gestational age. The total morbidity of periventricular white matter cystic lesions was 24% (29/120). The morbidity of the cystic lesions in PVE III patients (65%) was significantly higher than that in PVE II patients (21%) (<0.01). The PVE III patients developed the cystic lesions earlier than the PVE II patients.</p><p><b>CONCLUSIONS</b>The grading of PVE is closely related to the morbidity and the occurrence time of periventricular white matter cystic lesions in preterm infants.</p>

Ultrasonographic findings of intussusception complicated by intestinal necrosis in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>The information on the ultrasonographic features of pediatric intussusception complicated by intestinal necrosis is limited at present. This study aimed to investigate the ultrasonographic findings of this disorder in children in order to provide references for selecting a right means of reduction in clinical practice.</p><p><b>METHODS</b>The ultrasonographic findings of 48 children with intussusception complicated by intestinal necrosis and who underwent operative reduction between 2004 and 2006 were reviewed retrospectively.</p><p><b>RESULTS</b>The type of intussusception was closely correlated to the development of intestinal necrosis and the ileo-ileo-colonic intussusception was the most common one resulting in intestinal necrosis. The bowel wall of the invaginated segment was obviously thickened and the center of the invaginated segment was often accompanied with swollen lymph node and appendix caecalis. The intussusceptional fluidify, the expanding of distal segment accompanied with the thickened bowels wall, and weakening or disappearance of enterokinesia were the appearances of necrosis of most of bowel walls. The secondary intussusception was an important factor resulting in intestinal necrosis, and sound image of primary lesion was found in some patients. Seroperitoneum was a common manifestation in all of infants with intussusception complicated by intestinal necrosis.</p><p><b>CONCLUSIONS</b>There are some obvious sonographic characteristics of intussusception complicated by intestinal necrosis in children. The means of intussusception reduction may be selected according to ultrasonographic characteristics.</p>