Objective To investigate the pattern of antibacterial consumption in five tertiary children′s hospitals from 2002 to 2006. To see if the Guidelines for antibacterial use in clinical practice have any impact on the use. Methods Five children′s hospitals including Beijing Children′s Hospital affiliated to Capital Medical University Beijing, Tianjin Children′s Hospital of Tianjin Medical University, Children′s Hospital of Fudan University, Chongqing Children′s Hospital affiliated to Chongqing Medical University, Shanghai Children′s Hospital affiliated to Shanghai Jiaotong University, Guangzhou Children′s Hospital Affiliated to Guangzhou Medical College were chosen. The Anatomical Therapeutical Chemical Classification/Defined Daily Doses (ATC/DDD) methodology was used. Aggregate data on antibiotic use (ATC code-J01) were expressed in numbers of DDD/100 patient-days for outpatients and DDD/100 bed-days for inpatients. Antibiotic data were collected for systemic drug in number of packages and doses retrospectively from each hospital computer database for the entire year from 2002 to 2006. In October 2004, national Guidelines for antibacterial use in clinical practice were issued, which divided antibiotics into non-restricted, restricted and special use grades. The trend of DDDs was investigated before and after national Guidelines for antibacterial use in clinical practice were issued. Results ①In outpatient departments of five children′s hospitals, the antibacterial consumption was different from each other. The overall antibiotic consumption decreased after the guideline was issued in some hospitals and the variation in antibiotic use between hospitals was also reduced. ②A significant decrease in non-restricted antibiotics use was observed in outpatient departments of the five hospitals. Also the use of restricted antibiotics was reduced in two hospitals. However, a decrease in the use of first-generation cephalosporins, and an increase in the use of third-generation cephalosporins as well as in the combination of penicillins and β-lactamase inhibitors were observed in outpatient departments. ③The overall use of antibiotic drugs of inpatients was 682, 584, 658, 656 and 499 DDD/100 bed-days for the years 2002 to 2006, respectively. While the overall antibiotic use in 2005 was not greatly changed compared with previous years, by 2006 antibiotic use was decreased by 22.6% and the variation in antibiotic use among hospitals was also reduced. ④The use of non-restricted grade antibacterials reduced one year after the guideline was issued and the use of restricted grade antibacterials remained stable. The antibiotic use may be improved because of the exchange in the top class from third-generation cephalosporins, Ceftriaxone and Cefoperazone to second-generation cephalosporins, Cefuroxime. Conclusions This multicentre survey on antibiotic use in five tertiary children′s hospitals showed that the DDDs were relatively high and considerable variation both in the pattern and amount of antibiotics use could be found in each hospital. The differences of DDDs were observed among five children′s hospitals. The decline in overall antibiotic use, especially in antibiotics of non-restricted grade, and variation in antibiotic use between hospitals may be attributed to the impact of national Guidelines for antibacterial use in clinical practice. The survey indicated that overuse of antibiotics might be reduced. To develop and implement guidelines is therefore crucial for rational use of antibiotics.
Objective To explore the developmental changes of 3-12 months old infants to 4 basic tastes and provide guides for the feeding. Methods Healthy infants through vaginal delivery or oxytocin induced vaginal delivery at Chengdu Maternity and Infants Health Hospital from September 2008 to September 2009 were included. The acceptability of sweet, salty, sour and bitter tastes was assessed in four groups of 3-, 6-, 9-, and 12-month-old infants by observing and scoring the facial responses after giving the four basic tastes solutions.The facial responses were analyzed by the Wilcoxon test. Results 480 infants including 122 in 3 months group(male 70, female 52), 122 in 6 months group(male 57, female 65), 119 in 9 months group(male 56, female 63), 117 in 12 months group(male 60, female 57) were given taste test. The analysis indicated that the intensities of the responses to the sweet（P=0.000 1），soul（P=0.016） and bitter（P=0.000 1） solutions of the 9 months old infants differed from the infants aged 6 months statistically. The infants aged 6 months had more sensitive response to the sweet taste but less sensitive response to soul and bitter tates compared with those aged 9 months. Compared with male infants, female infants showed more sensitive response to salty (P=0.02) and soul (P=0.000 1) tastes at age of 6 months, to sweet(P=0.001) and soul（P=0.000 1）taste at age of 9 months, and to bitter (P=0.000 1) and soul (P=0.000 1) tastes at age of 12 months. Conclusions The infants aged over 6 months more like sweet taste but dislike soul or bitter tastes. Female infants are more sensitive to the four basic tastes than male infants.
Objective To assess the effect of conventional primary therapy combined with corticosteroid on coronary artery aneurysm formation in Kawasaki disease. Methods Studies were identified by a systematic search in MEDLINE, EMBASE, Cochrane Library， WANFANG, CNKI and VIP Database from its establishment to June 2010. All clinical controlled trials comparing the addition of corticosteroids to conventional primary therapy for Kawasaki disease were eligible. Quality assessment was investigated according to the Kawasaki disease diagnosis, study design and blinding of outcome detection. The weighted mean difference (WMD) for duration of fever after initiation of therapy and pooled relative risk (RR) for coronary artery aneurysm, re-treatments with intravenous immunoglobulin (IVIG) and adverse events were compiled. Heterogeneity was evaluated by stratified analysis. Stata 11.0 software was used to perform the meta analysis. Results Two hundred and twenty two studies were identified from database search. Thirty studies were selected for further assessment through reading the title and abstract. Seven eligible studies (4 randomized controlled trials and 3 comparative studies) were enrolled in the meta-analysis according to the further assessment. Quality assessments results showed three sudies were scored 2, 3 were scored 6, 1 was scored 5, respectively. Meta-analysis showed the additional corticosteroids therapy to standard therapy was associated with a significant 66% risk reduction of coronary artery aneurysm formation (RR=0.34, 95% CI:0.13-0.89). The overall test for heterogeneity among studies was significant (P=0.06, I2=53.6%). The incidence rate of coronary artery aneurysm was not significantly different in RCT(RR=0.79，95％CI:0.43-1.43), large size samples(>100)(RR=0.73,95%CI:0.42-1.28). Corticosteroid therapy decreased the fever duration after initiation of therapy (WMD=-1.66 d, 95%CI:-2.58 to -0.73 d) and risk of re-treatments with IVIG (RR=0.43, 95%CI:0.31-0.61）but did not decrease the risk of adverse events (RR=0.87, 95%CI: 0.35-2.16). Conclusions The addition of corticosteroids to standard therapy did not decrease the incidence of coronary aneurysms, but could decrease the rates of re-treatment with IVIG and the fever duration after initiation of therapy.
Objective Kawasaki disease (KD) has become the most common cause of acquired cardiovascular disease in children. Children with severe coronary artery lesions (CALs) usually need further assessment and coronary artery bypass grafting. Methods Five cases were recruited, including 3 boys and 2 girls, aged from 12month to 10 years and 4 months. Intravenous gammaglobulin (IVIG) was given in all cases, and second dose IVIG in 3 cases. CALs were found by echocardiography (ECHO) from day 15 to day 21 of the course. All patients were followed up with ECHO and ECG regularly, moreover, multislice computed tomography (MSCT) was performed in 2 patients and 99Tcm-MIBI performed in 2 patients. Coronary artery angiography was performed 6 months to 65 months after diagnosis of KD, and all the five patients underwent coronary artery bypass grafting (CABG) and giant coronary aneurysm size-reducing repair. Results Among 5 patients, 1 had angina and 3 had heart failure, the remaining one with asymptomatic. One patient had documented myocardial infarction ECG and recovered to normal gradually, 2 patients had ST-T changes in ECG, and the other 2 patients had normal ECG. In addition to multiple coronary aneurysms, ECHO also showed enlargement of left atrium and left ventricle with low ejection fraction (LVEF) and shortening fraction (LVFS) in 3 patients, and ventricular wall movement disconcordance in 2 patients who also had multiple ischemic focuses in 99Tcm-MIBI. Coronary angiogram showed more than one coronary aneurysm formation and at least one giant aneurysm found in all patients, thrombogenesis and distal coronary artery blocked in all the 5 patients. MSCT findings were exactly the same as the angiogram. Four patients had satisfactory immediate results after coronary artery bypass grafting. However, the youngest patient (22-month-old) died during the operation. During follow-up, LVEF was gradually improved, but not reached normal. One boy recurred 18 months after operation, with no aggravation in coronary artery. Conclusions CALs should be followed up in patients with KD regularly. ECG, ECHO and 99Tcm-MIBI and even MSCT should be combined for examination in those severe cases if available. CABG should be considered when myocardial ischemia was detected, and coronary artery angiogram was necessary before CABG operation.
Objective To evaluate the diagnostic value of electrocardiography (ECG), echocardiography (2DE), muting-row detector computed tomography (MDCT) and selective coronary angiography (CAG) in the long-term management of Kawasaki patients with coronary artery complications. Methods The clinical data, therapeutic schedule and follow-up assessments of coronary lesions by using ECG, 2DE, MDCT and CAG in the total of 15 Kawasaki patients with severe coronary involvement from Children′s Hospital of Fudan University from July 2006 to September 2009 were retrospectively collected. Results The total of 15 patients, diagnosed as Kawasaki disease at mean age of 4 years and 9 months ±1 year and 1 month (range 5 months to 13 years and 6 months), were followed up at a mean period of (17.4±13.0) months (range 3 to 64 months ) after onset of the disease. During the convalescence phase, 2 patients complained of recurrent angina pectoris, other 2 patients presented with the symptoms of congestive heart failure, and the remaining 11 patients were asymptomatic. The abnormal deep Q wave with ST-T change was revealed by electrocardiography in 3 patients. With the further investigation by using the computed tomography and coronary angiography, the giant aneurysms in 1, 2 and 3 coronary vessels were identified in 5, 5 and 3 patients, respectively. Additional distal aneurysm was found in 6 patients, and the intraluminal thrombi without causing stenosis were found in 2 patients. The severe occlusive lesions were confirmed in 4 patients, including complete occlusion of RCA and LCX in one patient, severe stenosis of LAD and RCA in two and left circumflex obliteration in one. According to the risk-level categories of coronary lesions, there were 1, 10 and 4 patients in level Ⅲ, Ⅳ and Ⅴ, respectively. Compared with MDCT and CAG, the accuracy rate of 2DE was 46.7%（7/15）in this group. The distal aneurysms, severe occlusive lesions and intraluminal thrombus were not able to be visualized by 2DE in 6, 4 and 1 patients, respectively. Conclusions The computed tomography or invasive coronary angiography can provide more information about coronary anatomy for long-term follow-up and management while the significant coronary complications are detected by two dimensional echocardiography.
Objective To study the value of non-enhanced voluminal computed tomography (NEVCT) in diagnosis of pediatric acute abdomen with suspected appendicitis. Methods Children suspected of appendicitis were referred for abdominopelvic NEVCT examination from June 2008 to May 2009. All patients were sequentially undergone surgical operation. The VCT findings were analyzed and compared with the results of surgical pathology. Accuracy, sensitivity, specificity, and positive likehood ratio were calculated. The features of the VCT of the acute appendicitis and other acute abdomen were summarized. Results Two hundred and seventy of 284 patients with appendicitis were confirmed by surgery and pathology. In these patients, 243 cases were diagnosed by pre-operation NEVCT. The accuracy of VCT for detecting appendicitis was 90.0％（95%CI：87%-92%）, the sensitivity was 0.91（95%CI：0.87-0.94）and the specitivity was 0.89（95%CI：0.85-0.93）. According to the surgical pathology, the results showed the diagnostic accuracy of early appendicitis by VCT was 62.3%, the accuracy of the others (suppurative appendicitis, gangrenous appendicitis, perforating appendicitis) were all above 95%. The other 27 cases were misdiagnosed by VCT including early appendicitis (23 cases) and suppurative appendicitis (4 cases). In the latter, 3 cases were diagnosed by VCT as the right ovarian conditions and the other one as the right urinary calculus. In 284 patients, 14 children were not appendicitis confirmed by surgery, and 11 cases were accurately diagnosed by pre-operation NEVCT. However, the other 3 cases with mesenteric hiatual hernia, Meckel′s diverticulum were misdiagnosed by pre-operation NEVCT. VCT scan showed vague fat space around appendix, thick appendix 5-19 mm in diameter and thickened wall. Con clusionsPre-operation NEVCT scan is an essential method in pediatric acute abdomen with suspected appendicitis. It shows lower accuracy of VCT in diagnosis of early appendicitis; however, for the patients without typical CT findings of appendicitis, enhanced VCT can be used if necessary.
Objective To investigate the prognostic significance of early arterial blood lactate clearance rate in neonates with critical illness. Methods Infants with critical illness, gestational age over 28 weeks or birth weight more than 1 000 g and survival time more than 6 h were admitted into the newborn intensive care unit (NICU) in affiliated Zhong Da Hospital of Southeast University from June 2008 to December 2009. The neonatal critical illness score (NCIS) , arterial blood lactate and arterial blood gas analysis were measured before treatment and 6 hours after the treatment respectively, and then the 6 h arterial blood lactate acid clearance rate was calculated in all infants. The infants were divided into survival group and death group from hospital admission to the end of study, discharging or death of the patients. According to 6h arterial blood lactate clearance rate 10% limit, the infants were also divided into high lactic acid clearance(≥10%) group and low lactic acid clearance (<10%) group. Arterial blood lactate level, NCIS, pH, lactate clearance rate were compared between survival group and death group, high lactate clearance rate group and low lactate clearance rate group. Paired t-tests and group t-tests were performed for within-group and between-group comparisons.Chi-square tests were performed for proportion comparisions. Results One hundred twenty-six infants including 74 males and 52 females, with the average age（2.5±2.9）days, average gestational age (33.5±3.9) weeks and average birth weight (2 281±816) g, including 102 infants for survival group and 24 for dealth group; 96 in high lactate clearance rate group and 30 in low lactate clearance rate group. The 6 h lactate clearance rate of survival group (32.3%±12.2%) was significantly higher than that of death group (18.3%±1.9%) (P<0.05). Mortality of the high lactate clearance rate group(94%) was significantly lower than that of the low lactate clearance rate group(50.0%)(P<0.05). There were no statistical differences(P>0.05) in NCIS scoring, arterial blood lactate and pH before treatment between survival and death groups, high lactate clearance rate and low lactate clearance rate groups. After 6 h treatment, there was no statistical difference (P>0.05) in NCIS scoring but there was statistic difference (P<0.05) in the arterial blood lactate level between survival and death groups, high lactic acid clearance rate and low lactic acid clearance rate groups. Conclusions Early arterial blood lactate clearance rate could be a good index for predicting the prognosis of infants with critical illness.
Objective To review the clinical features of the patients disgnosed as MMA with renal dysfunction, in order to improve the prognosis. Methods Patients diagnosed as MMA with renal dysfunction as the main complaint from Beijing Children's Hospital affiliated to the Capitial University of Medical Sciences were included. The basic data, clinical features, laboratory examination, treatment and outcome of the patients were summarized and analyzed. Results Nine patients(5 male, 4 female) diagonsed as MMA by GC/MS from April 2008 to January 2010 were included. Eight of 9 MMA patients were diagnosed as hyperhomocysteinemia. The main features of renal impairment included proteinuria， haematuria， edema and hypertension. Two patients had acute renal injure. With auxiliary examination, 6 patients′ uric small protein was increased. Renal biopsy of one patinet was performed. Light microscopical evaluation of glomeruli showed proliferation of the intercapillary cells and substance. Some patients suffered from developmental retardation, coma and anemia. Nine patients were treated with vitamin B12 and calomide-Me by oral administration. MMA was decreased obviously after treatment，also the renal function of the patients was improved except 1 died due to MODS. The renal function and mental development of 8 patients were all normal by 1-6 months follow up. Conclusions MMA can be complicated with sereve renal impairment or renal dysfunction as the main symptom. Early diagnosis and treatment can effectively control the disease and improve the prognosis.
Objective To summarize the clinical manifestations, diagnostic methods and treatment of neonatal citrullinemia. Methods One case of neonatal citrullinemia was reported in clinical features, process of diagnosis, treatment and follow-up. The literatures were reviewed. Results The case was a male newborn with neonatal citrullinemia 2 days after birth and came to hospital because of hyperhidrosis for 6 hours. The patient was given the conventional therapy after admission, but his condition became worse gradually and showed feeding difficulties, apnea, seizures, coma, etc. The mechanical ventilation and symptomatic treatment were carried out. On day 3 blood ammonia was increased to 2 110 μmol·L-1. Citrullinemia was diagnosed on the basis of high blood values of citrulline (438.8 μmol·L-1) at age of 13 days. The patient was given limited protein intake and treated with arginine and sodium benzoate. The change of blood ammonia was detected and the ventilator was adjusted based on blood gas analysis, the patient got better and ventilator was withdrawn at age of 6 days, while blood ammonia reduced to 75 μmol·L-1. The newborn was fed a low-protein milk providing only 1.0 g·kg-1·d-1 of protein at age of 11 days, given oral arginine and sodium benzoate. The blood ammonia decreased to 34 μmol·L-1 and the patient was discharged in good condition on day 15. After discharge, the patient was continued to be fed a low-protein milk providing 1.0 g·kg-1·d-1 of protein, given oral arginine and sodium benzoate. MRI showed high signal intensity in white matter of brain at age of 33 days. The patient grew normal on day 45 (weight: 4.8 kg, length: 58 cm, head circumference: 38 cm). The patient would be continuously followed up. Through literature review, 20 cases were reported, of them 2 cases were domestic newborns, 18 cases came from Korea, Turkey, Netherlands, Japan, Spain, US, Germany, respectively. Among all the patients of literatures, 7 patients died in the neonatal period, 1 patient died in 8 months, 6 patients survived but with neurodevelopmental delay, 6 patients were alive with normal growth and development. Conclusions One case of neonatal citrullinemia was reported, who is healthy at present, MRI showed high signal intensity in the white matter of brain. The literatures reporting the cases of neonatal citrullinemia were reviewed. It is beneficial to clinical doctors to understand the disease of neonatal citrullinemia. Early diagnosis through expanded neonatal screening for genetic metabolic diseases and early intervention and treatment are the main methods to improve the survival rate and the prognosis of these patients.
