ObjectiveTo identify the neonatal death cause and mortality risk of large for gestational age infants(LGA). MethodsThis was a retrospective case-control study based on a Chinese multicenter neonatal death database including 39 tertiary hospitals. The database recruited all death cases with gestational age(GA) ≥24 weeks. Singleton LGA infants with GA of 34-41 weeks were compared with overall AGA or GA/gender/hospital-matched AGA. Mortality risk of LGA in whole population was estimated based on assumptive ratio of LGA∶AGA of 1∶8. Clinical characteristics, including maternal diseases, perinatal and neonatal factors were extracted from the database. The primary death causes were reclassified based on ICD-PM criteria issued by WHO. ResultsFrom July 2016 to June 2019, 126 LGA and 1,183 AGA met the inclusion criteria. Except maternal diabetes and birth weight, all other clinical characteristics were not significantly different between LGA and matched AGA. After adjustment of birth weight and maternal diabetes, multivariable logistic analyses demonstrated that LGA had 1.94 higher chance of dying in early neonatal period compared with matched AGA (OR=2.938，95%CI:1.346~6.416,P=0.007）. Congenital anomalies (29.4%), perinatal asphyxia (21.4%), respiratory and cardiovascular disease (14.3%), severe infection (11.9%) were four major death causes for LGA infants. The whole population estimation demonstrated that LGA shared similar overall mortality risk with matched AGA, but less mortality risk from severe infection (including sepsis, meningitis, pneumonia and virus infection; OR=0.541, 95%CI:0.320~0.912,P=0.019）. ConclusionIn tertiary Chinese hospitals, the spectrum of death cause was not significantly different between singleton LGA and AGA infants born at late preterm or term. For whole population, LGA seemed to have similar all-cause mortality risk, but less risk of dying from infection compared with AGA infants.
ObjectiveTo analyze the risk factors for 28-day mortality in immunocompromised pediatric patients admitted to PICU for sepsis. MethodsWe conducted a case-control study, and retrospectively collected the clinical data of patients who were admitted to the PICU of Children's Hospital of Fudan University for sepsis. Patients were divided into immunocompetent group and immunocompromised group based on immune status and 28-day mortality was the primary outcome. ResultsFrom December 1st, 2015 to December 31st, 2018, 385 consecutive cases were diagnosed as sepsis at discharge, of which 251 fitted the eligibility criteria, and others were excluded due to ICU-acquired sepsis or being discharged within 24 h. We identified the immunocompetent group (n=141) and immunocompromised group (n=110). The 28-day mortality was 69.1% in immunocompromised patients. Compared with the immunocompetent patients, they showed a larger portion of in-patients, less age disparity and higher PRISM Ⅲ score, and they were more dependent on life support therapies (vasoactive agents, ventilation) and less likely to localize infection sites, the RRT treatment survive rate was 17.4% and none of the 5 ECMO receivers survived. Univariate analysis of 28-day mortality within two groups identified several common factors including septic shock, invasive-ventilation, CRRT, PRISM Ⅲ score, PICU length of stay, hospital stay,PICU-free time, therapy limitation within 24 h and overall therapy limitation, with "other comorbidities" unique to the immunocompetent patients and "vasoactive agents" unique to immunocompromised patients. Multivariate Cox regression revealed that PRISM Ⅲ score, invasive-ventilation and serum lactate above 2 mmol·L-1 were shared risk factors in both groups, and septic shock was also a predictor in the immunocompromised group. Conclusion28-day mortality in pediatric patients admitted to PICU for sepsis remained high, with the immunocompromised status more likely to succumb to death. PRISM Ⅲ score, invasive ventilation and serum lactate above 2 mmol·L-1 were strong predictors for short-term mortality, hence early recognition and effective management might improve patients clinical outcome.
ObjectiveTo analyze the clinical and renal pathology of children with Henoch-Schonlein purpura nephritis (HSPN). MethodsThe clinical and pathological data of children with HSPN treated in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine (our hospital) from January 1st, 2016 to December 31st, 2018,with biopsy pathology report and age at diagnosis ≤18 years, was retrospectively analyzed. ResultsA total of 371 HSPN children were included. Among them, 85.4% had abnormal urine test within one month after skin purpura, and skin purpura with digestive and joint symptoms accounted for 37.4%, with joint and muscle symptoms for 21.6%, and with digestive symptoms for 20.2%. Hematuria plus proteinuria accounted for 78.4%, nephrotic syndrome (NS) for 15.1%, and simple proteinuria and simple hematuria for 3.2%. Compared with hematuria plus proteinuria (3.8%, 11/291), NS (12.5%, 7/56) had a higher proportion of gross hematuria, χ2 =28.4, P < 0.01. The proportion of proteinuria in patients with gastrointestinal symptoms (45.8%, 98/214) was higher than those without gastrointestinal symptoms (40.1%, 63/157), χ2= 15.6, P < 0.001. Optical microscope grading with level Ⅲ was the most (74.9%), and type Ⅲa and Ⅲb all accounted for 46.6% and 28.3%, followed by type Ⅱ (21.3%). Clinical classification and optical microscopy classification (r=0.264, P<0.001) or renal tubular pathological grade（r=0.246，P＜0.001）, optical microscopy classification and renal tubular pathological grade (r=0.366, P＜0.001), proportion of crescent and 24 h urine protein (F=3.980, P=0.001) were related.There is certain correlation between Clinical features and pathological features, gastrointestinal symptoms and massive proteinuria, NS and gross hematuria, renal tubular lesions and pathological type, crescent proportion and 24 h urine protein level. ConclusionHematuria and proteinuria is the most common clinical type in children with HSPN, while Grade Ⅱ and Ⅲ are the most common pathological types.
ObjectiveEvaluate the value of Xpert MTB/RIF in the diagnosis of pulmonary tuberculosis (TB) in children using bronchoalveolar lavage fluid (BALF). MethodsChildren were enrolled if (i) they had suspected symptoms of TB; (ii) they had the indications to undergo fiberoptic bronchoscopy; and (iii) informed consent had been provided to undergo fiberoptic bronchoscopy. With the golden standard of bacteriologically and clinical evidence, the diagnostic value of Xpert MTB/RIF was evaluated in children with bacteriologically confirmed and clinically diagnosed TB using BALF. The MTB load of the samples were reported as semiquantitative readouts based on the Ct. Rifampicin (RIF). The sensitivity testing were detected through the RIF-resistance-determining region of rpoB gene. ResultsFinally, 351 children suspected with pulmonary TB ［(5.9±3.9) years old, 198 boys and 153 girls ］ were included in the study. 125 children were finally diagnosed as having pulmonary TB, including 43 (34.4%) cases with bacteriologically confirmed TB and 82 (65.6%) cases classified as clinically diagnosed TB. Among them, 51（40.8%）children were accompanied by tracheobronchial tuberculosis (TBTB). 226 children were finally diagnosed with respiratory tract infection, including 187(82.7%) cases with Mycoplasma pnuemoniae pneumonia and 39(17.3%) cases with bacterial pneumonia. The sensitivity of Xpert MTB/RIF were 79%(95%CI: 64-89), 51%(95%CI: 40-62), 80%（66%~90%) and 47%(36%~59%) respectively in children with bacteriologically confirmed TB, clinically diagnosed TB, pulmonary TB accompanied by TBTB and pulmonary TB. The specificity of Xpert MTB/RIF were 100% (95% CI:97.9%~100%) in the above four subgroups. The sensitivity of Xpert MTB/RIF in bacteriologically confirmed TB children was significantly higher than that of the test in children with clinically diagnosed TB (χ2=9.18，P=0.002). The sensitivity was significantly higher in children accompanied by TBTB, when compared with those who were not accompanied by TBTB (χ2=13.88，P<0.001). The load of MTB nucleic acid detected in bronchoalveolar lavage was higher in bacteriologically confirmed cases than that in clinically diagnosed cases (χ2=7.37，P=0.025). Among the 76 children with positive Xpert MTB/RIF results, two cases (2.6%) were detected to be infected with rifampicin resistant MTB. ConclusionXpert MTB/RIF using bronchoalveolar lavage fluid had good sensitivity and added clinical value by assisting the rapid and accurate diagnosis of pulmonary TB in children with negative bacteriological results.
ObjectiveTo systematically evaluate the risk factors of failure of continuous positive pressure ventilation (CPAP) for premature infants and its effect on the outcome of premature infants. MethodsPubMed, EMBASE, The Cochrane library, CBM, CNKI, Wanfang and VIP were selected to search the analysis of the causes of failure of CPAP treatment for premature infants and the influence of failure of CPAP treatment on the outcome of premature infants from initiation establishment of database to April 1st 2019. The quality of the included studies were assessed. Statistical analysis was performed employing Rev Man 5.3. Effects were expressed by odds ratio (OR), standardized mean difference (SMD) and 95%CI for categorical variables. ResultsOnly 10 trials with 13,075 cases were included. The risk factors (gestational age, birth weight, antenatal steroids, plurality, men, PEEP, FiO2, RDS ) of the OR/SMD and 95% CI were distributed as follows: -0.83（-1.10,-0.55）, -0.97（-1.39，-0.55）, 0.83（0.76,0.90）, 0.88（0.79,0.98）, 1.29（1.19,1.40）, 0.96（0.54,1.38）, 7.6（3.93,11.26）, 5.94（3.55，9.94）and P<0.05. The difference of other risk factors had no statistically significance. The outcomes of the OR/SMD and 95%CI were distributed as follows: 5.07(3.66, 7.01), 3.99(3.50, 4.55), 11.32（1.74,73.69）, 2.25（1.54,3.27）, 2.42（1.78,3.29）, 3.64（2.58,5.15）and P<0.05. ConclusionThe low gestational age, low birth weight, plurality, men, PEEP, FiO2, RDS are risk factors for CPAP failure, and antenatal steroids is a protective factor for it. Failure of CPAP treatment will lead to the increase of premature infant mortality, BPD, pneumothorax, ROP, NEC and IVH.
ObjectiveTo analyze the clinical presentation and treatment of a case of glycogen storage disease (GSD) type Ⅰb with severe hypertriglyceridemia due to SLC37A4 gene mutation. MethodsThe clinical manifestations, laboratory examination, imaging examination, gene mutation characteristics and treatment of an infant with GSD type Ⅰb were concluded. And the related literature was reviewed. ResultsAn eight-month-old female infant was hospitalized for reduced eating for 2 months and fever for 1 week who presented with severe hypertriglyceridemia (triglycerides were 79.97 mmol·L-1), refractory hypoglycemia, hyperlacticemia, and hepatomegaly. After twice plasmapheresis, triglyceride dropped markedly. After pumped skimmed milk via nasogastric tube and fed with uncooked cornstarch to maintain normoglycemia, the infant's vital signs became stable. The diagnosis of GSD type Ⅰb was confirmed by molecular genetic testing. Mutation of c.1063G>T (p.E355*) and c.343G>A (p.G115R) were detected in SLC37A4 gene in this infant, which were separately inherited from her mother and father. ConclusionGlycogen storage disease should be highly suspected in patients with severe hypertriglyceridemia, recurrent hypoglycemia, hepatomegaly. Gene analysis can help to clarify a diagnosis. Plasmapheresis is an effective therapeutic tool to rapidly reduce triglycerides levels in patients with severe hypertriglyceridemia. As for these patients, diet therapy is also demanded such as skimmed milk and uncooked cornstarch.
ObjectiveTo study the clinical and laboratory characteristics, treatment and follow-up results of chronic active Epstein-Barr virus infection（CAEBV）in children and to provide a basis for the diagnosis and treatment of CAEBV. MethodsThe clinical data of 18 children with CAEBV from Jan 1st, 2010 to Dec 31st, 2017 was analyzed retrospectively, including onset, clinical manifestation, EBV DNA, EBV antibodies, cytokines, treatment and follow-up results. ResultsThe onset of the disease was EBV recurrent infection at the time of first hospitalization in 13 cases, and EBV-hematophagous lymphocyte hyperplasia (HLH) in 5 cases. The common clinical manifestations were fever, hepatosplenomegaly, and lymphadenopathy. Laboratory tests showed that elevated transaminase and cytopenia were common. The anti-EB VCA-IgG antibodies were positive, while the IgM antibodies were negative in 18 cases. EBV DNA in peripheral blood(18/18), bone marrow(14/14) and biopsy sample(live: 1/4, lymphonodus: 2/3) was positive. Plasma levels of several cytokines, including IL-4,IL-10 and IFN-γ,elevated in different degrees in persons with CAEBV, while the ratio of B cells, total T cells, CD8+T cells, and NK cells in peripheral blood decreased. The patients had mainly received antiviral drugs, intravenous immune globulin, immunosuppressive agents, multi-drug chemotherapy, rituximab, and HSCT. Among 17 CAEBV patients followed up,14 cases died. The patients with EBV-associated HLH had significantly shorter survival time. ConclusionThe children with CAEBV infection had poor prognosis and high mortality due to the variety of onset, clinical manifestation and treatment. The specific changes of EBV DNA, antibody profiles, cytokines and lymphocyte subsets may be helpful in the early diagnosis and targeted therapy of CAEBV.
ObjectiveTo study the characteristics of the molecular, drug resistance and virulence in community acquired methicillin-resistant staphylococcus aureus from neonates with skin and soft tissue infections. MethodsCA-MRSA isolates were prospectively collected from Beijing Children's Hospital. All the isolates were characterized by staphylococcal chromosomal cassette (SCCmec) type, staphylococcal protein A (spa) type and multilocus sequence type (MLST). Superantigen toxin gene, sasX gene, antimicrobial susceptibility were also detected. ResultsCellulitis of umbilicus was the most common case, and the most common CA-MRSA clones were ST59-SCCmecIVa-t437. The sasX gene was not detected. Four isolates were oxacillin-susceptible. ConclusionCellulitis of umbilicus was the most common case in neonates with skin and soft tissue infections, and ST59-SCCmecIVa-t437 was the most common clones. OS-MRSA was reported for the first time.
ObjectiveTo investigate the sleep status of preschool children in Shanghai, and analyze the common sleep problems of preschool children with different characteristics. MethodsAccording to the principle of universal mobilization and voluntary participation, kindergartens in Songjiang district of Shanghai were chosen as the scene of questionnaire survey, and the questionnaire of children's family social environment and sleep health was used as a survey tool. Analysis was by age and stratified gender. Sleep problems include sleep deficiency，sleep delay，and the occurrence of sleep disorder more than twice a week during sleep like fear of going to bed, snoring, excessive daytime sleepiness, molars, night terrors, nightmare, difficulty falling asleep and sleepwalking. First of all, the kindergarten health care teachers received the centralized and unified training, and then the kindergarten health care teachers trained the class teachers. The questionnaire was filled in by the father or mother of the child, or the relatives who raised the child and lived with the child for nearly one year. The class teachers sent out questionnaires, which filled in and collected on the spot. ResultsFrom May to June 2018, 22 kindergartens participated in the questionnaire survey, 8,624 questionnaires were sent to parents and 8,586 valid questionnaires include 4 595 boys(53.5%) and 3 991 girls(46.5) with 17.8% in the 3-year-old group, 34.1% in the 4-year-old group, 32.0% in the 5-year-old group and 16.1% in the 6-year-old group. The average time of going to bed at night was 21∶43, and the average time of waking up in the morning was 7∶01. The total sleep time, daytime sleep time and nighttime sleep time decreased with the growing age, and the average time of going to bed at night was delayed, and the average time of waking up in the morning was advanced. The difference was statistically significant (P<0.01). There were no significant differences in the daytime sleep time, nighttime sleep time, total sleep time and bedtime in preschool children of different genders (P>0.05). The incidence of sleep deprivation was 12.2%, and the incidence of sleep delay was 75.7%. The incidence of sleep deprivation and sleep delay were decreasing with the growing age, and the difference was statistically significant (P<0.01). The incidence of fear of going to bed was 72.4%, snoring was 62.5%, excessive daytime sleepiness was 51.2%, molars was 50.4%, night terrors was 49.2%, nightmare was 41.2%, difficulty falling asleep was 33.4% and sleepwalking was 4.4%. The incidence of snoring and molars in boys was significantly higher than that in girls (P＜0.05), while the incidence of night terrors, nightmares, difficulty of falling asleep and sleepwalking in girls was significantly higher than that in boys (P＜0.05). ConclusionThe incidence of sleep deficiencies, sleep delay and sleep problems are higher of preschool children in Songjiang district of Shanghai, which should be paid attention to by the society and parents.
ObjectiveTo explore the predictive value of clearance of blood lactate and serum procalcitonin for prognosis at 28 d of septic shock in children. MethodsA retrospective analysis was done in 50 cases of children with septic shock from February 1st 2017 to February 1st 2019. They were divided into survival group and dead group. The predictive value of Sequential Organ Failure (SOFA) Score, clearance of blood lactate and clerance of serum procalcitonin for prognosis at 28 d of septic shock in children was evaluated by receiver operator characteristic curve. ResultsFifty cases of children with septic shock were analyzed, including survival group (n=33) and dead group (n=17). ①Compared with the survival group, SOFA Score, CPR and N-terminal pro-B-type natriuretic peptide were higher (P＜0.001, =0.041，=0.017,respectively), and platelet count was lower（P=0.010）in dead group. The cases of celiac infection in survival group was higher than that in dead group (P=0.040). ② Blood lactate level at initial stage and after 6 h, serum procalcitonin level at 120 h in dead group were higher than those in survival group (P =0.043, <0.01, =0.044, respectively). Lactate clearance rate and the PCT clearance rate on 24 h,48 h,72 h and 120 h were obviously lower in the dead group(P<0.00,<0.001,=0.009,=0.033,=0.006, respectively). ③The predictive value for prognosis in children with septic shock: Yoden index of serum PCT clearance rate at 120 h was the highest（F=3.631，P =0.015）. The area under the AUC curve of combined index (SOFA score>11.5, lactate clearance rate on 6 h<15.8% and the PCT clearance rate on 120 h<70.8%) was 0.986, Yoden index was 0.892, the sensitivity was 96.9%, the specificity was 92.3%. ConclusionThe SOFA score, serum lactic acid clearance rate at 6 h and serum PCT clearance rate at 120 h had a good evaluation value for the prognosis of children with septic shock. The combined application of the three indexes can improve the forecasting efficiency.
Objective To analyze the risk factors of infantile aspiration pneumonia Methods We reviewed hospital patients with pneumonia who completed the salivagram in the clinic or after hospital ization in Children's Hospital of Fudan University in January 2016 to December 2018. The patients were classified into 2 groups according to the test results: case group (aspiration pneumonia group) and control group (non-aspiration pneumonia). The clinical features of the two groups were collected and compared to analyze the risk factors of infantile aspiration pneumonia. Results A total of 484 cases were included in this study, including 151 cases in the case group and 333 cases in the control group, with a positive rate of 31.2%. Previous history of pneumonia, milk choking, positive pathogen test, accompanied by neurological disease, upper airway disease, lower airway structural abnormality and genetic syndrome showed significant differences between the 2 groups.Logistic regression analysis showed that positive pathogen test (OR=2.033, 95%CI: 1.261-3.279), accompanied by neurological disease (OR=2.210, 95%CI: 1.318-3.707), upper airway disease (OR=2.408, 95%CI: 1.556-3.727), and genetic syndrome (OR=2.909, 95%CI: 1.265-6.692) were independent risk factors for aspiration pneumonia in infants. Conclusion The risk factors of aspiration pneumonia in infants included positive pathogen test, accompanied by neurological disease, upper airway disease and genetic syndrome.
Objective To explore the diagnostic value of C-reactive protein (CRP) on urinary tract infections (UTI) in infants. Methods According to the level of CRP, the clinical data of outpatient infants with fever, who were first visited in our hospital from January, 2015 to December, 2017 were studied retrospectively. They were diagnosed clearly and divided into five groups including A（CRP<25 mg·L-1）、B（25≤CRP<50 mg·L-1）、C（50≤CRP<75 mg·L-1）、D（75≤CRP<100 mg·L-1）and E（CRP≥100 mg·L-1）, respectively. Results 713 cases of infants with fever were included finally in the study, and group A, B, C, D and E consist of 320, 216, 84, 58 and 35, respectively. With the level of CRP increasing, the percent of UTI also increased. When CRP≥50 mg·L-1, ≥75 mg·L-1 and ≥100 mg·L-1, the percent of UTI was 62.1% (110/177), 87.1% (81/93) and 91.4% (32/35), respectively. When CRP ≥50 mg·L-1, Youden index was the most with 93.2% sensitivity(95%CI: 86.6%-96.8%) and 88.7% specificity（95%CI: 85.9%-91.1%） Conclusion Routine urianalysis must be down in order to exclude or identify the diagnosis of UTI in infants with unknown fever and obviously increased CRP (≥50 mg·L-1).
Objective Aplastic anemia (AA) is considered as an immune-mediated bone marrow failure syndrome with abnormal immune cells and cytokines. In clinic, immunosuppressive therapy (IST) is the first choice for the treatment of severe or very severe aplastic anemia (SAA/VSAA) without suitable hematopoietic stem cell donors. So we aimed to investigate the impact of IST on expression of cytokines in children with acquired SAA. Methods From October 2017 to December 2018, 25 cases of newly diagnosed children with SAA/VSAA was selected in our department, and 37 children for moderate aplastic anemia (MAA). Flow cytometry was used to measure the levels of IFN-γ, TNF-α, IL-2, IL-4, IL-6 and IL-10 in peripheral blood from all, and the changes in the expression of the above cytokines after IST in children with SAA/VSAA in order to evaluate the abnormal immunity in AA indirectly. Results Compared with MAA, children with newly diagnosed acquired SAA/VSAA showed higher levels of IFN-γ (0.84 pg·mL-1 vs 0.37 pg·mL-1, P=0.009 7) and IL-6 (47.26 pg·mL-1 vs 13.54 pg·mL-1, P=0.046 8). After IST, total 25 cases of complete remission and partial remission were obtained, and the effective rate of IST was 100%. And six months after IST, the expressions of IFN-γ (0.02 pg·mL-1 vs 0.56 pg·mL-1), TNF-α (0.88 pg·mL-1 vs 11.51 pg·mL-1) and IL-6 (9.60 pg·mL-1 vs 71.44 pg·mL-1) were decreased significantly in children with SAA/VSAA (P<0.05). One year after IST, the concentrations of above cytokines were decreased to some extent. Conclusion Children with newly diagnosed acquired SAA/VSAA showed abnormal levels of cytokines in serum. However, IST could significantly improve the expression of these negative hematopoietic regulatory factors.
