Objective: To report the design of the physical growth and development survey for Chinese newborns by different gestational ages and the technical process and methods of establishing the growth standards for Chinese newborns. Methods: From June 2015 to November 2018, nine cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou and Kunming were selected to investigate newborn infants with gestational age of 24 to 42 weeks. Four cities including Tianjin, Shenyang, Changsha and Shenzhen were recruited to collect preterm babies with gestational age of 32 weeks and below. Naturally conceived singleton live births with gestational age of 24 to 42 weeks were included, and those infants who were not healthy or whose mothers had high health risk were excluded. Gestational age was jointly determined based on the mother's last menstrual period and the results of ultrasound examination in the first three months of pregnancy. Sample size was comprehensively estimated according to the statistical accuracy requirement of establishing growth standards and the actual number of newborn infants at different gestational ages. Full-term babies were sampled by cluster sampling, and the sample size was evenly distributed to each quarter, and the babies were randomly selected in each quarter. All eligible preterm babies within selected hospitals were included in this survey. Before establishing growth standards, sensitivity analysis, normality test, skewness and kurtosis analysis, sample weighting analysis and distribution transformation analysis were assessed for birth weight, length and head circumference for male and female newborn infants. The Generalized Additive Model for Location, Scale and Shape (GAMLSS) was employed to establish percentile and standard deviation score reference values and growth curves of birth weight, length and head circumference for male and female newborn infants with gestational age of 24 to 42 weeks. Results: A total of 24,375 singleton live births with gestational age of 24 to 42 weeks were investigated in 69 hospitals in 13 cities, including 12,264 preterm neonates and 12,111 full-term neonates. In the majority of gestational age groups, birth weight, length and head circumference showed significant non-normal distribution. Birth weight presented right skewness and leptokurtosis, and birth length and head circumference presented left skewness and leptokurtosis. Birth weight used the GAMLSS model with BCT distribution transformation and cubic spline smoothing function and birth length and head circumference used the GAMLSS model with BCPE distribution transformation and cubic spline smoothing function. All the GAMLSS models for birth weight, length and head circumference did not have to be weighted. The growth reference values and growth curves of birth weight, body length and head circumference were obtained for male and female newborn infants with gestational age of 24 to 42 weeks. Conclusion: Based on a large sample of cross-sectional data from a well-designed national survey, standardized reference values and growth curves of birth weight, length and head circumference were established for male and female newborn infants with gestational ages of 24 to 42 weeks, which was useful for growth and nutrition evaluation of newborn infants at birth and early growth monitoring of preterm infants.
Objective:To systematically evaluate the risk factors of central line-associated bloodstream infections (CLABSI) caused by pediatric central venous access devices (CVAD). Methods: A systematic search of literature on CLABSI by pediatric CVADs was carried out in databases of Ovid-Medline, Ovid-Embase, JSTOR, Cochrane Library, CNKI, China Biomedical Medicine, Wanfang and VIP from January 2000 to June 2020. The stratified analysis was performed in terms of PICU, NICU, department of hematology and oncology, and pediatric populations. Results: A total of 16 case reports and cohort studies were included, with 34,478 CVADs and 1,585,358 catheter days. The combined OR (95% CI) of risk factors for CLABSI in PICU, NICU, department of hematology and oncology, and pediatric populations was: a. PICU: 2.72 (1.89 to 3.92) for body weight <8 kg, 1.75 (1.26 to 2.01) for heart disease(congenital heart diseases, chronic low cardiac output, heart failure, and cardiac arrest), 4.95 (3.65 to 6.72) for infusion of blood products (red blood cells or platelets) through central venous lines, 5.83 (3.50 to 9.70) for the use of ECMO, 2.56 (1.80 to 3.65) for mechanical ventilation, 2.89 (2.05 to 4.08) for vasoactive agent, 10.60 (6.44 to 17.47) for parenteral nutrition, 2.72 (1.43 to 5.16) for gastrointestinal diseases (gastrointestinal bleeding, acute and chronic liver failure, gastroesophageal reflux and esophageal diseases), 2.13（1.43 to 3.10） for after gastrostomy, 2.32 (1.84 to 2.94) for catheters in femoral vein, 4.93 (3.60 to 6.76) for two or more catheters placed at the same time and 2.15 (1.68 to 2.75) for long-term catheters; b. NICU: 2.60 (1.25 to 5.41) for parenteral nutrition, 1.71 (1.08 to 2.70)for catheters in femoral vein and 1.39 (1.21 to 1.61) for over 21 days of catheter placement; c. department of hematology and oncology: 4.95 (2.73 to 8.96) for malignant tumors, 8.1 (2.5 to 25.7) for the stage of intensive chemotherapy, and 6.77 (2.18 to 21.04) and 7.09 (2.64 to 19.05) for infusion of red blood cells and platelets through central venous lines one week before respectively, 2.92 (1.37 to 6.24) for more than 1 lumen and 3.36 (1.41 to 7.97）for tunneled catheter; d. pediatric populations: 2.22 (1.58 to 3.10) for bloodstream infection history, 3.95 (2.98 to 5.24) for catheters in upper limb vein and 2.03 (1.94 to 3.04) for catheters in lower limb vein. Conclusion: The risk factors were unique for CLABSI caused by CVADs in PICU, NICU, department of hematology and oncology, and pediatric populations. Treatment and catheters had a greater impact on CLABSI caused by CVADs.
Objective:The influence of music on the sleep cycle and brain electrical activity of preterm infants is still inconclusive. This article aims to observe the changes in the quiet sleep cycle(QSC) and EEG characteristics of preterm infants after music intervention. Methods: This study was a single-center randomized controlled trial. Preterm infants admitted to the Neonatal Department of Children's Hospital of Fudan University at 32 weeks ≤ gestational age <36 weeks were divided into a musical intervention group (intervention group) and a control group in the ratio of 1∶1 using a randomized numerical table. The intervention group was given Brahms lullabies at an average volume of 40-50 dB, played once every 24 h for 6 h. The intervention period was 1 week. The control group was given no musical intervention, and the nursing measures were the same as the intervention group. EEG monitoring was carried out for 6 h within 48 h after completion of the intervention in rhe two groups. The primary observation was the characteristics of the quiet sleep cycle, including mean QSC time, total QSC time, QSC frequency, QSC interruption frequency, and mean QSC interval. The secondary observation was the comfort score (COMFORTneo scale) and the amplitude integrated EEG outcome score (Burdjalov's method). Results: A total of 112 subjects completed enrollment from June 1, 2018 to June 30, 2019, with 56 in the intervention and 56 in the control group. The differences in baseline data between the two groups were not statistically significant. In terms of QSC characteristics, the mean QSC duration in the intervention group increased by 0.17 h (P=0.015), the total time of QSC occurrence during EEG monitoring increased by 0.52 h (P=0.033), and the number of QSC interruptions was three times fewer than that in the control group (P=0.003). For comfort score, the total scale score in the intervention group was 1.9 points higher (P=0.031) and the alertness score was 0.8 points higher (P=0.042) than those in the control group. For aEEG score, the sleep-wake cycle score was 0.7 points higher (P=0.043), the spectral bandwidth score was 07 points higher (P=0.019), and the overall score was 1.4 points higher (P=0.047) in the intervention group than those in the control group. Mean QSC time, total QSC time, total comfort score, and total aEEG score all increased with gestational age. There were positive correlations between gestational age and mean QSC time, total QSC time, comfort scores, and aEEG scores. Conclusion: Music intervention can affect the quiet sleep cycle and EEG activity of preterm infants, including increasing the time of single QSC, total QSC time, reducing the number of QSC interruptions, and actively improving the comfort score and EEG characteristics of preterm infants.
Objective:To investigate the value of early brain MR combined with cerebrospinal fluid (CSF) parameters in predicting the outcomes of full-term neonatal bacterial meningitis. Methods: A retrospective cohort study analyzed hospitalized full-term infants with bacterial meningitis, using the discharge outcomes as the cohort endpoint (good prognosis group and poor prognosis group), and early brain MR semi-quantitative scoring system and/or CSF examination (CSF white blood cells, CSF protein, CSF glucose) as predictive indicators, to evaluate the value of different methods in predicting the outcomes of full-term neonatal bacterial meningitis. Results: One hundred and eighty-nine full-term infants with bacterial meningitis who met the inclusion and exclusion criteria of this study were included in our analysis. Among them, 108 (57.1%) were male; the gestational age ranged from 37 to 42.3 weeks; the birth weight was 2,100~5,000 g; 132 (69.8%) were delivered vaginally; the age of onset was from 1 to 28 d; the hospitalization stay was 4~129 d. There were 162 (85.7%) and 27 (14.3%) cases in the good and poor prognosis groups respectively and there were no statistically significant differences in gestational age, birth weight, gender, delivery method, age of onset and brain MR examination time between the two groups. The area under curve (AUC) of the combination of brain MR scores and CSF protein, brain MR scores, CSF protein, CSF white blood cells, CSF glucose was 0.902, 0.875, 0.788, 0.728, 0.248, respectively. The cut-off value of brain MR scores was 17 points, and that of CSF protein was 2,316 mg·L-1. There was no statistically significant difference in AUC between the brain MR scores and CSF protein, and the difference between the combination indicator and CSF protein was statistically significant, but there was no statistically significant difference between the combination indicator and brain MR scores. Sensitivity and specificity of the combination indicator with brain MR scores were 88.9% (95%CI: 84.4%~93.4%) vs 77.8% (95%CI: 71.9%~83.7%), 80.9% (95%CI: 75.3%~86.5%) vs 82.7% (95%CI:77.3%~88.1%), respectively. Conclusion: The combination of early brain MR scores and CSF protein improved the accuracy of predicting the prognosis outcomes of full-term neonatal bacterial meningitis.
Objective:To analyze the clinical and imaging characteristics of invasive fungal disease (IFD) in high-risk children, and to evaluate the clinical value of serum (1,3)-β-D-glucan and galactomannan detection in children with IFD. Methods: Retrospective analysis was performed on children admitted to Children’s Hospital of Chongqing Medical University from June 2015 to June 2019, who were suspected of fungal infection and completed G test, GM test and fungal culture. According to invasive fungal disease diagnostic criteria, the study subjects were divided into IFD group and non-IFD group. The clinical characteristics of children with IFD were analyzed, and the sensitivity and specificity of the G test and the GM test for the diagnosis of IFD were calculated. Results: There were 64 patients in the IFD group with 24 of proven IFD and 40 of probable IFD. There were 100 cases in non-IFD group. Pulmonary patchy, nodules, and pleural effusions were common in the lung imaging findings in the IFD group, but there were relatively fewer cavitation and halo sign. Children with Aspergillus infection had higher incidence of halo sign and air crescent sign than those with Candida infection. In children with non-Aspergillus infection, the CT appearance of the lung was mainly patchy and nodular, with few signs of cavitation and halo sign. Sixty-four pathogenic fungi were detected in 64 children with IFD, among which Candida albicans had the highest detection rate of 42.2%, and Aspergillus was detected in 10 children (15.6%). The sensitivity and specificity of G test was 68.8% and 87.0% respectively and the sensitivity and specificity of GM test was 80.0% and 95.0% respectively. The area under the ROC curve for G test and GM test was 0.79 (95% CI：0.72~0.87) and 0.92 (95% CI：0.82~1.00), respectively. Conclusion: The clinical and imaging manifestations of IFD in children are not typical, and the typical cavitation and halo signs in lung imaging are relatively few. Patches, nodules, and pleural effusions are common. The (1,3)-β-D-glucan has a moderate value for the diagnosis of non-Aspergillus IFD in children, while the GM test has a high diagnostic value for Aspergillus IFD in children.
Objective: To evaluate the effectiveness and safety of generic nebulized salbutamol in children with acute wheezing. Methods: This was a non-randomized controlled trial. Patients younger than 18 years old with acute wheezing episodes were divided into the original drug group ［5 mg·(2 mL)-1 albuterol inhalation solution, produced by GSK company］ and the generic drug group ［2.5 mg·（2.5 mL)-1 albuterol sulfate nebulized inhalation solution, produced by Shanghai Xinyi Jinzhu Pharmaceutical Co., Ltd.］ according to the actual clinical prescriptions. The dose and administration were the following: a. 2.5 mg each time for those with weight≤20 kg or 5.0 mg each time for those with weight >20 kg; b. compatible with normal saline or other nebulized drugs (according to actual clinical needs) to 4 mL liquid, driven by oxygen flow 6 to 8 L·min-1 or air compression pump, twice a day for 3 days. Each participant recorded a log every day. The primary outcome was the difference in clinical symptom severity (ΔCS) each day, and the secondary outcome was the adverse event such as arrhythmia, muscle tremor or diarrhea. Results: A total of 841 outpatients consulting in Children's Hospital of Fudan University from February 2018 to June 2019 with acute wheezing were included, 438 cases in the original group and 403 cases in the generic group. All patients completed the follow-up period. The baseline items (gender, age, main diagnosis, compatibility of nebulized medications and combined systemic medication) with statistically significant differences between the two groups were treated as a covariate of the propensity score. According to 1∶1 matching and the matching tolerance set as 0.1, there were 299 cases left in each group. ΔCS each day in both groups decreased over time ［（-0.38±0.48）vs(-0.43±0.49)vs(-0.58±0.49）for 3 days in the original group, (-0.47±0.50)vs(-0.50±0.50)vs(-0.59±0.49) for 3 days in generic group］. There were statistically significant differences in ΔCS among 3 days in both groups. The ΔCS on day 3 was significantly lower than that on day 1 and day 2 in both groups. There was a statistically significant difference in the ΔCS scores between the two groups on the first day, and there was no significant difference in the ΔCS scores on the second or the third day. Among the 841 children with acute wheezing, there were no cases withdrawing from observation because of serious adverse reactions. Proportion of tremors was 2.5% (11/438) in original group and 4.5% (18/403) in the generic drug , and that of diarrhea was 0.7% (3/438) in the original group and 1.5% (6/403) in the generic drug group. The differences were not statistically significant. Conclusion: Generic salbutamol is not less effective than the original drug in relieving children's acute wheezing, and they have similar frequency of adverse events.
Objective: To compare the physical development of obese and normal boys aged from 0 to 5 years old to provide a basis for early identification and prevention of obesity. Methods: The diagnosis of childhood obesity was made using the WHO BMI standard of 2006 for children aged from 5 to 19 years old that BMI of xˉ+SD, xˉ+2SD, xˉ-2SD were defined as excess weight, obesity and malnutrition respectively. The children included in the analysis should meet the following three criteria at the same time: a. a 5-year-old boy who came to the Child Healthy Department of Chongqing Health Center for Women and Children for physical measurements from January 2008 to January 2020; b. taking physical measurements at all of the time points of 6, 12, 18, 24, 36, 48 and 60 months; c. those meeting the diagnostic criteria at the age of 5 without secondary obesity caused by endocrine diseases, drugs and tumors. The calculation formula of Z-score = (children observation value - mean of children of the same age and same sex)/standard deviation (SD). Results: There were 104 obese boys and 864 normal boys meeting the first inclusion criterion. Among them, 58 obese boys and 303 normal boys who met all of the three criteria were included in the analysis. The mean WAZ and BMIZ of the obese group were higher than that of the normal group from the age of 6 months, and the difference was statistically significant after the age of 18 months. The mean HAZ of the obese group continued to be higher than that of the normal group after the age of 18 months, and the difference was statistically significant after the age of 36 months. The mean ΔWt of the obese boys was consistently higher than that of the normal boys, and there was a statistically significant difference in the rate of weight gain after the age of 12 to 18 months. The mean of ΔHt in obese boys continued to be higher than that of normal boys after the age of 12 to 18 months, and there was a statistically significant difference in height increase between the age of 12 to 18 months and 36 to 48 months. Absolute mean value of ΔBMI of the obese boys from 6 to 12 months to 24 to 36 months were consistently lower than that of the normal boys, while those in the 36 to 48 months and 48 to 60 months were higher than that of the normal boy group. The difference of ΔBMI after 18 to 24 months was statistically significant. Conclusion: The prevention of childhood obesity should be before the age of 2 years and the age of 12 to 18 months was the first critical period. Obese children showed higher height and faster height growth in a short period of time, but there was no advantage in height growth after the age of 48 months.
Objective: To explore the clinical features, surgical treatment and prognosis of neonates with diaphragmatic eventration. Methods: Twenty-two neonates with diaphragmatic eventration admitted from June 1st, 2016 to May 31st, 2020 were recruited in the study. Clinical data was analyzed including gender, gestational age, weight, sides, being congenital or acquired, degree of diaphragmatic eventration, combined congenital diseases, treatment, preoperative/postoperative respiratory support, prognosis, et al. Clinical characteristics of surgical cases and survived cases without surgery were compared as well. Results: The median gestational age and birth weight of 22 neonates, including 12 males and 8 preterm infants, were 38 (33, 39) weeks and 2,730 (1,940, 3,110) g respectively. All cases were unilateral, with 20 cases on the right side. Twenty cases were congenital while 2 cases were secondary to birth injury. The median elevation of diaphragmatic eventration was 1.75 (1.50, 2.00) cm. Nine cases had operation. The lowest weight of operated cases was 2.3 kg at the time of operation. The main indications for surgery were failure to maintain normal breathing (8 cases), and repeated cyanosis (1 case). Compared with non-surgical survival, the diaphragm elevation ［2.0 (1.65, 2.4) vs 1.60 (1.0, 1.80) cm, P=0.015］, and the proportion of respiratory symptoms as the chief complaint for admission (100% vs 50%, P=0.029) were higher in surgical cases. Co-existing congenital diseases in recruited cases were common, including congenital hypotonia, congenital heart disease, airway anomalies, cryptorchidism, et al. All 5 deaths were combined with other congenital abnormalities, including 4 cases of congenital hypotonia and 1 case of complicated congenital heart disease. Conclusion: The main indication for operation in neonatal diaphragmatic eventration cases was failure to maintain normal breathing. The poor prognosis was mainly determined by combined critical congenital anomalies, such as congenital neuromuscular disease.
Objective: To analyze the clinical characteristics of antineutrophil cytoplasmic antibody （ANCA） associated vasculitis（AAV） in children and to improve its recognition. Methods: A retrospective analysis was performed for the clinical data of children with AAV who were hospitalized between March 1st,2010 and December 31st, 2019 in the Children's Hospital of Zhejiang University School of Medicine. Results: Among 10 AAV patients, there were 4 cases of granulomatosis with polyangiitis (GPA),4 cases of microscopic polyangiitis (MPA),and 2 cases of eosinophilic granulomatosis with polyangiitis (EGPA). Seven cases started from respiratory symptoms, 2 cases from renal lesions and 1 case from anemia. Cough, sputumdyspnea, hemoptysis, chest tightness or thoracalgia were the most common respiratory symptoms.The chest CT showed ground glass shadow in bilateral lungs, consolidation nodular opacities, honeycomb, bronchiectasis and cavity, pleural effusion, pleural thickening, emphysema and other manifestation. MPO or PR3 was positive in 8 cases and erythrocyte sedimentation rate elevated in all patients. Ten cases were treated with corticosteroid and 8 cases were combined with immunosuppressive agents. Clinical status improved in 9 cases and one children died. Conclusion: Respiratory involvement is the primary manifestation in children with AAV. The lung may be the only organ affected in the early stage of AAV. The respiratory manifestation is lack of specificity, which is easy to be misdiagnosed or missed. When the treatment of antibiotics is less effective in pneumonia patients with damage in multiple organs, it is suggested that further examination of ANCA and pathological biopsy should be conducted for early diagnosis.
Objective: To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) in infants after cardiac surgery and evaluate its effect. Methods: The infants who had undergone ECMO support after surgery for congenital heart disease in Henan Provincial People’s Hospital from June 1st, 2018 to December 31st, 2019 were included.The general information and clinical data of them were retrospectively analyzed. Results: There were 17 cases including 8 males and 9 females who underwent ECMO after congenital cardiac surgery. Their age and weight ranged respectively from 13 days to 11 months and from 2.8 to 6.9 kg (average, 4.7±1.2 kg). Four cases underwent ECMO due to postoperative low cardiac output and cardiac arrest, and other 13 cases were transferred to ECMO due to poor cardiac function and failure to stop cardiopulmonary bypass. ECMO support time was 13 hours to 26 days. As a result, 11 infants (64.7%) were successfully weaned from ECMO and 8 infants (47.1%) were discharged from hospital. Nine cases died or gave up the treatment. Seven cases （41.2%）underwent secondary thoracotomy for hemostasis.Three infants (17.6%) due to renal insufficiency underwent membrane replacement. Six infants (35.3%) underwent perytoneal dialysis. Pulmonary infection occurred in 5 cases (23.5%), including 1 case (5.9%) with severe systemic infection and positive blood culture (Acinetobacter baumannii). Three cases (17.6%) had multiple organ dysfunction and 3 cases (17.6%) had gastrointestinal hemorrhage. All the 4 cases who underwent ECMO in ICU died. Conclusion: ECMO is an important life support method for infants with heart failure after heart surgery. The key to successful treatment is to grasp the indications, shorten the operation time and prevent the related complications.
Objective: To analyze the etiology and clinical characteristics of children with bloody pleural effusion(BPE). Methods: Retrospective collection of BPE children admitted to Shenzhen Children’s Hospital was performed from June 1st, 2009 to June 30th, 2019. The clinical manifestations, imaging examination (B-ultrasonography, chest CT), fiberoptic bronchoscopy, bone marrow cytology, routine biochemistry of pleural fluid, etiological examination, treatment and outcome of the cases were collected. Results: During the study period, there were a total of 1,416 children with pleural effusion in our hospital, among whom 26 BPE children (1.8%) were included in our study. They were aged from 3 months to 13 years and 11 months, and all had a history of BCG vaccination. The course of disease ranged from 4 h to 25 d. Among them, 18 cases were caused by infection and 11 cases were identified as mycoplasma infection (4 cases), pseudomonas aeruginosa (2 cases), streptococcus pneumoniae (1 case), aspergillus fumigatus (1 case), tuberculosis bacillus (1 case), cytomegalovirus (1 case) and EB virus(1 case). There were 7 cases with unknown pathogens, 7 cases with tumors and 1 case with unknown etiology. The onset was mainly featured by fever (16 cases), cough (11 cases), shortness of breath (8 cases), dyspnea and chest pain (3 cases each). Chest B-ultrasound showed medium volume pleural effusion in 13 cases, massive volume pleural effusion in 11 cases and enveloping effusion in 2 cases. Chest CT showed bilateral pleural effusion in 10 cases, unilateral pleural effusion in 16 cases, combined with pneumothorax in 3 cases, necrotic pneumonia in 2 cases and pericardial effusion in 2 cases. Fiberbronchoscopy was performed in 8 patients, and pathogen of alveolar lavage fluid was positive in 5 patients with 3 cases of mycoplasma DNA, 1 case of aspergillus fumigatus, 1 case of pseudomonas aeruginosa. Bone marrow cytology was performed in 5 cases, including 1 patient with dysplastic bone marrow (acute myelogenous leukemia) and 1 patient with haemophilic cells. Blood culture and/or sputum culture were conducted in 22 cases, including 3 positive cases, 1 case of Pseudomonas aeruginosa (blood culture), 1 case of Pseudomonas aeruginosa (blood and sputum culture) and 1 case of Streptococcus pneumoniae (sputum culture). The etiology of pleural fluid was examined in all cases and 7 cases were positive (mycoplasma PCR positive in 3 cases, EBV DNA positive in 1 case, Pseudomonas aeruginosa in 2 cases, Streptococcus pneumoniae in 1 case). Two patients (1 with combined immunodeficiency and 1 with T-lymphoblastic lymphoma) died and other patients were discharged with improved condition after anti-infection or chemotherapy treatments. Conclusion: Most cases of BPE were caused by infection in children, followed by malignant tumors that large or medium quantities of pleural effusion were predominant.
