Objective To assess the prevalence of nocturnal enuresis (NE) in children and adolescents in China. Methods This was a cross-sectional study. Samples were selected from districts or counties having work relationships with the province, autonomous region and municipality where members of Chinese Cooperative Group for the Management of Pediatric Enuresis Affiliated to Pediatric Nephrology Committee of Chinese Medical Doctor Association come. The survey respondents were parents or other caregivers of students in the kindergarten, primary school, junior high school and senior high school. This survey was conducted through an online questionnaire. In this survey, people aged ≥ 5 years with bedwetting ≥ 1 time in 3 months were diagnosed as NE. The bedwetting was defined as urination in bed or pants during night sleep. This survey was conducted from April 20 to May 12, 2017 among children and adolescents aged from 5 to 18 years in China. The children and adolescents were divided into 4 groups: the kindergarten (5-6 years old), primary school (7-12 years old), junior high school (13-15 years old) and senior high school (16-18 years old) group. The sample size in each district or county was more than 3,073.A self-designed questionnaire was used. This article mainly analyzed basic demographic information and bedwetting events. Parents or caregivers of children or adolescents filled out questionnaires on mobile phones or other devices with WeChat. Results In this survey, 225 schools were selected from 34 counties or districts of 24 provinces, autonomous regions or municipalities including 82 kindergartens, 61 primary schools, 49 junior high schools and 33 senior high schools. A total of 129,952 people were sampled and 100,071 effective questionnaires (77.0%) were included into the analysis. Among them, 52,074 were from boys with the average age of 11.0±3.4 years; Han population accounted for 92.5% and the proportion of kindergarten, primary school, junior high school and senior high school group was about 1∶5∶2∶1. Based on this survey, the overall prevalence of NE among children and adolescents in China was 4.8%(4,821/100,071). The prevalence of NE in children or adolescents from kindergarten, primary school, junior high school and senior high school group was 12.1%, 5.1%, 1.1% and 1.4% respectively and the prevalence among boys was higher than that among girls in each age group. The prevalence of NE in the north，northeast, east, south central, southwest and northwest of China was 4.2%, 3.7%, 4.6%, 5.8%, 5.1% and 4.9% respectively after the standardization according to the proportion of four age groups. Among 4,821 patients with NE, mild, moderate and severe enuresis accounted for 81.4%, 13.5% and 5.1%, respectively and the rate of severe enuresis in kindergarten, primary school, junior high school and senior high school group was 6.9%, 3.7%, 5.3% and 10.0%, repectively. Conclusion In China, the prevalence of NE in students from kindergarten, primary school, junior high school and senior high school group was 12.1%, 5.1%, 1.1% and 1.4% respectively, and the overall prevalence of NE in children and adolescents was 4.8%. The proportion of severe enuresis was higher in the kindergarten and high school.
Objective To conduct a systematic review and meta-analysis of the literature on central line-associated bloodstream infections (CLABSI) in children based on a standardized central line bundle so as to provide the best evidence for the prevention and control of CLABSI in children. Methods Literature that met all of the following criteria was included: a. Populations were NICU and PICU patients younger than 18 years old; b. A standardized central line bundle was used as the intervention which referred to hand hygiene, maximal sterile barrier precautions, skin disinfectants of >0.5% chlorhexidine, iodine or iodophor, daily audits to assess whether each central line was still needed and ly removal of unnecessary central lines and the best insertion site (except femoral vein) based on individual patient characteristics and the first four of the above requirements about the bundle should be met at least; c. The outcome was the number of CLABSI events within 1,000 catheter days; d. The literature belonged to studies of interventions; e. There were no limits to the language of literature. Literature was searched in the database of Ovid-MEDLINE, Ovid-EMBASE, Web of science, Cochrane Library and China Biology Medicine (CBM), CNKI, VIP and Wanfang from January 1st, 2003 to December 31st, 2019. The risk of bias for eligible studies was assessed according to Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). Results A total of 9,708 literature was retrieved including 2 articles from other sources. Forty-one studies from 20 countries were included with 30 for NICU,10 for PICU and 1 for both, 18 of which were historical control studies from America with standardized central line bundles as the post-intervention and no limits to pre-interventions. There was a total of 952,584 catheter days, including 442,296 for pre-interventions and 510,288 for the post-interventions. Among 41 included literature, studies with low, moderate, serious risk of bias accounted for 27% (11 studies), 44% (18 studies) and 29%(12 studies) respectively. The standardized central line bundle could reduce the number of CLABSI events in both NICU and PICU patients［I 2=81%, random effect model, RR=0.40 (95% CI: 0.33-0.48), absolute effect value: 3 fewer per 1,000 catheter days (from 4 fewer to 3 fewer)］. For the intervention site of NICU, the number of CLABSI events in neonates can be reduced ［I 2=85%, random effect model, RR=0.36 (95% CI: 0.29-0.45), absolute effect value: 3 fewer per 1,000 catheter days (from 4 fewer to 3 fewer)］. For the intervention site of PICU, the number of CLABSI events in children can be reduced ［I 2=27%, fixed effect model, RR=0.54 (95% CI: 0.42-0.69), absolute effect value: 4 fewer per 1,000 catheter days (from 5 fewer to 3 fewer)］. Conclusion Standardized central line bundles (at least including hand hygiene, maximal sterile barrier precautions, skin disinfectants of >0.5% chlorhexidine, iodine or iodophor and daily audits and ly removal of unnecessary central lines) for pediatric patients could reduce 3 to 4 cases of CLABSI per 1,000 catheter days.
Objective To summarize the therapeutic effects of BCH-AML05 protocol on childhood acute myeloid leukemia (AML) and explore how to improve the event-free survival (EFS) rate. Methods The clinical characteristics and therapeutic effects of the patients who were newly diagnosed as AML and treated with BCH-AML05 protocol at Beijing Children's Hospitol from January 2005 to June 2014 were retrespectively studied. Survival rates were evaluated by Kaplan-Meier method with SPSS 19. Results A total of 185 patients were included in the study and divided into groups of LR (low risk, 47 cases), MR (moderate risk, 90 cases) and HR (high risk, 48 cases). The median follow-up time was 24 (0.5-129) months. Among the 185 patients, 106 (57.3%) achieved complete remission (CR) after one course treatment and 45 achieved CR after the second course treatment. The total CR rate was 81.6%. The 8-year overall survival (OS) rate was (66.2±4.2)% and the EFS rate was (54.1±5.5)%. The 8-year OS and EFS rates for LR, MR and HR patients were (65.7±10.4)% and (57.2±8.5)%, (70.3±5.2)% and (60.2±7.4)%, and (51.6±10.1)% and (31.3±14.5)%, respectively. The 8-year OS and EFS rates of 34 patients receiving hematopoietic stem cell transplantation (HSCT) were (73.5±9.5)% and (67.7±9.9)%, respectively. Relapse occurred in 36 patients (19.5%) with a median time of 10 months( 3.5-53 months). Fifty-two （28.1%) patients died, including 20 cases (10.8%) of chemotherapy related death, 11 cases (5.9%) of induced failure related death and 18 cases (9.7%) of relapse related death. The early mortality rate was 5.4%. Among them, 154 patients were tested for Flt3 gene mutation including 16 (10.4%) positive cases with 6 (37.5%) of CR after induced chemotherapy and 11 (68.8%) of death. Conclusion BCH-AML05 protocol was effective for childern with AML. Accurate stratification of risk level could increase the long-term survival rate. Children with high-risk AML should receive HSCT as soon as possible.
Objective To investigate the prognostic significance of BRAFV600E mutation in children with Langerhans cell histiocytosis (LCH), and to determine the prognostic factors of childhood LCH. Methods Children with newly diagnosed LCH were retrospectively included in this study who were enrolled in Beijing Children's Hospital affiliated to Capital Medical University between January 1, 2016 and December 31, 2017. BRAFV600E mutation in lesion tissues was detected by digital PCR method. Prognostic factors and the correlation of BRAFV600E mutation with clinical characteristics and prognosis were analyzed. Results A total of 140 patients with LCH were enrolled in this study, including 89 (63.6%) males and 51 females. The median age at diagnosis was 2.2 (0.1-15.7) years. For clinical classifications, there were 60 cases (42.9%) with single-system (SS) involvement, 47 cases (33.6%) with multi-system non-risk organ involvement (MS RO－), and 33 cases (23.6%) with risk organ involvement (MS RO+). The median follow-up time was 34.1 (0.9-50.7) months. During the follow-up, 70 patients (50.0%) developed progression or relapse; 12 patients (9.6%) had permanent sequelae; 3 patients (2.1%) died. The rate of 3-year progression free survival (PFS), event free survival (EFS) and overall survival (OS) was 48.9%±4.5%, 46.6%±4.4%, and 97.8%±1.2% respectively. BRAFV600E mutation was positive in 67.1% of 140 patients with LCH. There was a significant relationship between BRAFV600E mutation and clinical classifications. BRAFV600E was identified in 90.9% of patients with MS RO+ LCH, 53.2% of patients with MS RO－ LCH, and 65.0% of patients with SS LCH (P=0.001). Of patients with skin involvement, 77.8% was BRAFV600E positive, which was significantly higher than that of those without involvement (P=0.042). Of mutation positive patients, 57.4%had progression or relapse, which was significantly higher than that of negative patients (34.8%，P=0.019). However, there was no significant difference in the prognosis of patients with and without BRAFV600E mutation in the three clinical classifications. The multivariate analysis showed that only the RO+ was an independent prognostic factor of PFS in children with LCH (hazard ratio, HR=2.702, P=0.003), and pituitary involvement (HR=3.582，P<0.001), RO+ (HR=2.321, P=0.008) and ear involvement (HR=2.093, P=0.013) were independent prognostic factors of EFS. Conclusion BRAFV600E mutation was closely related to RO+ involvements in childhood LCH. The rate of progression/relapse of mutation-positive patients was significantly higher than that of mutation-negative patients, but BRAFV600E mutation was not an independent prognostic factor of childhood LCH.
Objective To investigate the physical growth level and its difference of infants with different feeding patterns. Methods Data on breastfeeding, complementary feeding and physical growth in infants aged 1-<12 months were collected through the fifth physical development survey of children under 7 years old in nine cities of China in 2015. Feeding patterns for infants aged 1-<6 months were classified into exclusive breastfeeding, partial breastfeeding and formula feeding, and for infants aged 6-<12 months into continued breastfeeding and formula feeding. Weight, length and head circumferences were assessed among different feeding groups using analysis of variance or t test. Results A total of 59,170 infants aged 1-<12 months were included in this study. For infants aged 1-<6 months, exclusive breastfeeding, partial breastfeeding and formula feeding accounted for 48.6%, 37.4% and 14.0% respectively and for infants aged 6-<12 months, continued breastfeeding and formula feeding accounted for 59.9% and 40.1% respectively. At the age of 1-<6 months, exclusively breastfed infants were a little heavier than partially breastfed infants with the difference from 0.06 to 0.20 kg, and also a little heavier than formula-fed infants with the difference from 0.09 to 0.22 kg. At the age of 6-<12 months, continuously breastfed infants were a little shorter than formula-fed infants with the difference from -0.3 to -0.1 cm. Weight at 6-<12 months, length at 1-<6 months, and head circumferences at 1-<12 months were almost not of statistical significance among different feeding groups. The growth of weight, length and head circumferences for infants with different feeding patterns generally conformed to child growth standards required by World Heath Organization, but the average growth levels of weight and length were slightly higher. Conclusion Infants with different feeding Methods presented similar growth patterns in infancy. The growth performance of exclusively breastfed infants was slightly higher than that of partially breastfed and formula-fed infants in the first half of the first year, but the growth performance of continuously breastfed infants was slightly lower than that of formula-fed infants in the second half.
Objective To analyze the characteristics of bone age development of children and adolescents with different nutritional status, and explore the association between overweight, obesity and emaciation and advanced or delayed bone age. Methods The sample included 7,062(3,310 boys and 3,752 girls) normal children and adolescents aged 4 to 18 years old from the Affiliated Children's Hospital Capital Institute of Pediatrics between January 2012 and February 2019. The bone ages were evaluated by CHN method on left hand radiographs. The body mass index z-value (BMIZ) was calculated by the child growth and nutrition assessment system. According to BMIZ, the subjects were classified into the group of emaciation (BMIZ<-2), excess weight (BMIZ>+1) and obesity(BMIZ>+2). The difference distributions between bone age and chronological age were compared among different genders and nutrition levels, and the risk of advanced bone age in overweight and obese children was analyzed. Results For overweight and obese children and adolescents, the bone age was advanced and for emaciated and normal ones, the bone age conformed to the chronological age. Overweight and obese girls were more advanced than boys (averagely, 1.10 and 1.36 years in advance in overweight boys and girls respectively P=0.000; 1.60 and 1.78 years in advance in obese boys and girls respectively P=0.000). Compared with boys and girls with normal weight, the risk of advanced bone age in overweight and obese boys and girls respectively increased by 2.358 times (95% CI:2.759-4.086) and 2.483 times (95% CI: 2.928-4.144) as well as by 5.820 times (95% CI: 5.066-9.181) and 7.537 times (95% CI: 6.319-11.534) and the risk of delayed bone age in emaciated boys and girls increased by 1.540 times (95% CI: 1.481-4.355) and 3.790 times (95% CI: 2.245-10.221) . Conclusion Excess weight and obesity increased the risk of advanced bone age in boys and girls respectively. In terms of advanced bone age, overweight boys and girls had similar risk, while obese girls had higher risk than boys. Emaciation increased the risk of delayed bone age.
Objective To investigate the clinical value of genetic screening for early diagnosis of neonatal PTPN11 gene-related Noonan syndrome. Methods We collected neonates with pathogenic variants related to Noonan syndrome in PTPN11 gene from patients of neonatal intensive care unit (NICU) of Children's Hospital of Fudan University enrolled in the Neonatal Genome Project from January 2016 to December 2017 and patients with PTPN11 gene-related Noonan syndrome with neonatal manifestation descriptions from Pubmed, CNKI and Wanfang databases. We summarized their clinical characteristics and gene variants, and compared them with other PTPN11 gene-related Noonan syndrome patients. Results In 5,280 neonates enrolled in the Neonatal Genome Project, there were 21 patients carrying pathogenic variants related to Noonan syndrome in PTPN11 gene, but they cannot fully meet the clinical diagnostic criteria of Noonan syndrome. Combined with 37 cases having neonatal feature descriptions of PTPN11 gene-related Noonan syndrome in published articles, we proposed specific genetic screening indications of neonatal PTPN11 gene-related Noonan syndrome: a. pulmonary stenosis/pulmonary valve stenosis and hypertrophic obstructive cardiomyopathy; b. lymphatic dysplasia-related chylothorax, pleural effusion, unexplained dyspnea; c. thrombocytopenia, leukocytosis, monocytosis; d. cryptorchidism or other genitourinary system abnormality. Conclusion Specific genetic screening indications and diagnosis criteria of neonatal PTPN11 gene-related Noonan syndrome should be established.
Objective To investigate the clinical characteristics of children infected by Streptococcus anginosus group. Methods From January 1, 2012 to December 31, 2019, cases positive for Streptococcus anginosus group in bacterial culture in Beijing Children's Hospital were collected retrospectively. Combined with their microbiology, radiology and clinical data, each isolated strain was evaluated in detail to exclude the positive cases caused by contamination and colonization strains. Age of onset, gender, clinical manifestations, laboratory tests, treatment, outcome and prognosis of the cases were analyzed and the bacterial identification and drug sensitivity test were conducted. According to the medical history, the patients were divided into two groups with or without underlying diseases. Underlying diseases referred to congenital heart disease, pyriform sinus fistula, dermal sinus, congenital esophageal fistula, congenital choledochal cyst and other congenital malformations, immunosuppression, paranasal sinusitis, cerebral palsy, esophageal foreign bodies, etc. Results A total of 119 cases were at the age of 33 days to 16 years, with a median age of 4 years. There were 56 (47.1%) in underlying disease group including 27 (48.2%) with head and neck infection, 11 (19.6%) with central nervous system (CNS) infection and 10 (17.9%) with bloodstream infection (BSI). Of head and neck infection, 70.4% (19/27) was pyriform sinus fistula; of BSI, 60.0% (6/10) was immunodepression; of CNS infection, 63.6% (7/11) was congenital heart disease. There were no significant differences in the average hospitalization days, average fever duration, WBC count, neutrophil percentage, CRP and ESR between the two groups. One hundred and four (93.7%) children infected by Streptococcus anginosus group had abscess with head and neck infection, abdominal infection, CNS infection, BSI accounting for 41.2%, 20.2%, 12.6% and 12.6% respectively. For strain identification, there were 44 cases of Streptococcus anginosus, 41 cases of Streptococcus constellatus and 34 cases of Streptococcus intermedius. The sensitivity to penicillin, ampicillin, cefotaxime, erythromycin, clindamycin and vancomycin was 87.4%, 93.2%, 94.2%, 20.2%, 21.8%, 100% and 100%, respectively. One case died and 2 cases gave up the treatment because of critical illness. Conclusion Streptococcus anginosus group infection could result in abscesses. Head and neck infection was the most common. There were no significant differences in the clinical characteristics of Streptococcus anginosus group infection in children with and without underlying diseases. Streptococcus intermedius was the main cause of brain abscess. Most of Streptococcus anginosus group strains were sensitive to penicillin antibiotics but resistant to macrolides.
Objective To explore the clinical characteristics of severe pneumonia in children caused by human adenovirus type 7 (HAdV7) and the application of metagenomic next-generation sequencing (mNGS) in etiological diagnosis. Methods The patients with severe pneumonia associated with HAdV7 infection were enrolled from Pediatric Department of Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2019 to November 2019. HAdV7 infection was identified by mNGS of blood or alveolar lavage fluid. The clinical data and results of mNGS of included patients were retrospectively analyzed. Results Twenty patients were included, and 17 of them were males. Twelve cases (60%) were aged from 6 months to 2 years, which was the most common age group. A total of 19 cases had high fever (>39 ℃). Fever duration of 16 cases was more than 10 days. There were 15 cases with both of cough and wheezing. Complications included toxic encephalopathy in 1 case, heart failure in 7 cases, respiratory failure in 5 cases and pleural effusion in 5 cases. On admission, WBC was (8.6±4.3)×109·L-1, and there were 6 cases with more than 10×109·L-1 and 2 cases with less than 4×109·L-1. The percentage of neutrophils was (55.9±131)%. The median of C-reactive protein was 10.9 (5.6, 23.7) mg·L-1, and there were 2 cases with more than 30 mg·L-1. As the disease aggravated such as hypoxemia or dyspnea, the median of WBC was 8.3 (3.1, 17.6) ×109·L-1, and there were 8 cases with more than 10×109·L-1 and 6 cases with less than 4×109·L-1; the percentage of neutrophils became (65.4±17.2)%, and there was an increase in 16 cases; the median of C-reactive protein became 26.5 (12.2, 65.9) mg·L-1, and there were 8 cases with more than 30 mg·L-1. Chest CT showed consolidation and air bronchogram in bilateral lungs were found in 17 cases respectively. Nineteen cases improved and 1 case died. The median of identified HAdV7 DNA sequences was 1,671.0 (892.0, 2 467.8) and the coverage rates were 98.9(89.8, 99.1)%. Of the 20 cases, 10 were performed mNGS of blood and 10 were performed mNGS of alveolar lavage fluid. The median of the identified reads of the two groups were 1,152.0 (347.8, 1,991.5) and 2,033.5 (1,263.2，2,901.8), and the coverage rates were 98.9(81.6, 99.1)% and 99.0(89.9, 99.2)%, respectively. Thirteen cases were affected by HAdV7 infection alone, and 7 cases were affected by mixed infection. Conclusion mNGS of blood or alveolar lavage fluid could identify HAdV7 infection accurately. Doctors should be aware of severe pneumonia and complications caused by HAdV7 infection and perform mNGS as soon as possible, when infants younger than 2 years old had persistent high fever, cough, wheezing, increased or decreased WBC focusing on neutrophils, high C-reactive protein and consolidation and air bronchogram in bilateral lungs shown by chest CT.
Objective To explore the reference value of serum Vitamin A (VA) of children aged 6 to 12 years in Chongqing, China. Methods In this study, a stratified cluster sampling method was adopted to randomly select two streets respectively in one urban district and one county in Chongqing, and classes of all primary schools in the street were sampled according to different grades. Blood samples of children were collected after the parents and children signed informed consents. High Performance Liquid Chromatography was used to detect serum VA. The Generalized Additive Model for Location, Scale and Shape (GAMLSS) was used to plot the P1, P5, P25, P50, P75, P95 and P99 percentile curves of serum VA by gender and age. Results Peripheral venous blood was collected from 1,110 healthy children in 36 grades of 6 primary schools in 2 streets of Jiulongpo District and 2 streets of Fengdu County in Chongqing and 1，077 healthy children were finally included in this study. The mean age of the participants was 9.52±163 years, including 570(52.9%) boys and 480(44.6%) urban children. The sample size of children from 6 to 12 years old were 62, 105, 92, 198,279, 257 and 84, respectively. GAMLSS results of overall, boys, girls indicated that VA conformed to Box-Cox-Cole-Green (BCCG) distribution, the theoretical percentile and the sample percentile almost lay on the same straight line, and the residuals were evenly distributed. The percentile curves of serum VA between boys and girls aged 6 to 12 years were crossed. In boys, the serum VA increased slowly with age, while the serum VA remained unchanged with age in girls. Conclusion This study established the percentile curve of serum VA of children aged 6 to 12 years in Chongqing. The trend of serum VA with age was disparate between boys and girls.
Objective To explore the clinical characteristics and prognosis of acute myeloid leukemia (AML) in children with -5/5q-abnormalities. Methods A retrospective analysis was performed for the data of acute myeloid leukemia diagnosed and treated in Department of Pediatrics of Peking University People's Hospital from January 1, 2007 to December 31, 2018, and the clinical manifestations, lab results, treatment and prognosis of children with -5/5q-AML were analyzed. Results Data of 584 children with non-recurrent AML were analyzed in this study. Among them, 12 children(2.05%) were detected with -5/5q-abnormalities, including 4 males, with a median age of 7.5 years and a median follow-up time of 28 months. Three(25%) of the 12 children with -5/5q-AML were transformed from MDS, which was significantly higher than that in children without-5/5q-AML(14/572, 2.4%, P=0.004). There was no significant difference between children with -5/5q-AML and children without -5/5q-AML in terms of gender composition, age at diagnosis, blood routine examination at diagnosis, extramedullary infiltration (hepatomegaly, splenomegaly and lymphnode enlargement), time of symptoms before diagnosis and time of release of myelosuppression after induction chemotherapy. Induction chemotherapy was performed with DAH or ADE regimen in the 12 children with -5/5q-AML. Seven children (58.3%) achieved complete remission; 2 children (16.7%) achieved partial remission; 3 children (25.0%) had no remission. During the follow-up time until July 1, 2019, 1 child lost follow-up; 6 children died ; 5 children survived. The survival time of children with -5/5q-AML (23.3±26.0 months) was significantly shorter than that of children without -5/5q-AML (63.0±10.5 months, P=0.023). The 1-year and 2-year accumulative survival rates of children with -5/5q-AML were 61.9% and 30.9% respectively, which were significantly lower than 81.6% and 77.0% of children without -5/5q-AML, respectively (P＜0.001). Conclusion The detection rate of -5/5q-abnormalities in children with AML was low and the prognosis was poor. The proportion of -5/5q-AML transformed from MDS was high.
Objective To observe the tolerance and safety of enteral nutrition (EN) and parenteral nutrition (PN) in neonates with critical illness supported with extracorporeal membrane oxygenation (ECMO). Methods Neonates admitted to Pediatric Intensive Care Unit (PICU) in Children's Hospital of Fudan University and receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) combined with EN and PN were retrospectively collected from August 10, 2015 to March 31, 2020. The newborns with complex and refractory congenital heart disease were excluded. Demographic data (gestational age, birth weight, sex, etc. ), nutrition-related laboratory data (biochemical and electrolytes tests), the initial time and daily doses of PN and EN, the vasoactive agents at the beginning of EN, the ventilation time，the morbidity and the prognosis were reviewed for each patient during hospitalization. Results A total of 11 neonates underwent ECMO. All of them were supported with PN, and 9 of them received EN. There was no necrotizing enterocolitis (NEC). Among 8 survivors, 7 patients' weight was >P10 at discharge according to the standard of World Health Organization. During the period of ECMO, all patients had experienced thrombocytopenia and hypophosphatemia, and cholestasis, hypocalcemia and hypomagnesemia were found in 6, 10 and 5 cases respectively. There was a statistically significant difference in serum concentration of direct bilirubin between ECMO with CRRT group and ECMO without CRRT group ［70.0(32.4,182.4) μmol·L-1 vs 13.7(11.2, 15.7) μmol·L-1，P =0.015］. Conclusion It is safe and feasible to treat critically ill neonates supported by ECMO with enteral and parenteral nutrition, but it is necessary to closely observe clinical situations and monitor laboratory indexes.
Objective To investigate the clinical features of Takayasu arteritis (TA) with heart failure in children. Methods TA patients complicated with heart failure admitted to Affiliated Children's Hospital of Capital Institute of Pediatrics from January 2013 to December 2019 were retrospectively analyzed. Results A total of 5 female patients were included and the age of onset was from 2 to 14 years old. Four patients started with the manifestations of heart failure including chest distress, palpitation, dizziness, fatigue and sweat. Vascular murmur, weak pulse or pulseless and hypertension were found in 5, 4 and 4 patients respectively. All 5 patients had valve involvement with 3 of multi-valve involvement. There were 4 cases of mitral valve regurgitation, 3 cases of aortic valve regurgitation with 2 of ascending aortic dilatation, 3 cases of tricuspid regurgitation and 3 cases of coronary artery dilatation. The clinical type of 5 patients was type Ⅲ. Four patients received treatment of glucocorticoid and/or immunosuppressive agents and 2 patients were treated with Infliximab injection. One patient was lost to follow-up and 4 patients were followed up for 6 to 48 months who had improved to varying degrees with normal inflammatory indicators and no new lesions, except for the irreversible heart injury. One case was complicated with intractable hypertension and prepared to receive surgical treatment. Conclusion To get early diagnosis of cardiac involvement and treatment in time, echocardiography should be performed regularly in children with TA. In addition to the primary heart disease, alert should be taken to the possibility of cardiac involvement of TA for patients starting with heart symptoms. TA patients with aortic and renal artery stenosis were always complicated with hypertension.
