Unintentional trazodone overdoses in children ≤6 years of age: data from poison center over a period of 16 years

Context: Trazodone is an atypical antidepressant with no established safety in children. Previous case reports showed no complications at doses 50–500?mg in children. Our study objective is to characterize the clinical effects, dose-related toxicity, and establish triage dose for acute trazodone ingestions in children ≤6 years of age.

Methods: Cases with acute trazodone ingestions in children ≤6 years of age between 2000 and 2015 were retrospectively reviewed. Data were analyzed for dose (mg/kg), clinical effects, management site, treatment, and outcome. Cases with coingestions, unknown outcome, or unknown dose were excluded.

Results: A total of 84 patients (mean age 26.7 months, 35 females, 49 males) were included. Of those, 52 (61.9%) had no clinical effects; 29 (34.5%) had minor effects (vomiting, dizziness, headache); and three (3.6%) had moderate effects (ataxia, slurred speech, priapism). No major effects or deaths were observed. Moderate effects were manifested at doses ≥6.9?mg/kg. Priapism occurred in a 2-year-old child at a dose of 6.9?mg/kg. Sixteen (19%) patients were managed at home and 68 (81%) patients were referred to a HCF. Among those referred to a HCF, three (4.4%) patients had moderate effects with ingested dose ≥6.9?mg/kg. However, 27 (39.7%) patients of those referred to a HCF had an ingested dose <6?mg/kg and none of them manifested symptoms beyond minor effects. All referred patients had uneventful recovery and no sequela.

Conclusions: Children should be referred for further evaluation in acute unintentional trazodone ingestions with doses ≥6?mg/kg.     

2011年浙江省绍兴市5岁以下流动儿童死亡监测结果分析

目的 了解浙江省绍兴市流动人口5岁以下儿童死亡情况,为制定流动人口儿童卫生保健政策提供参考依据。 方法 收集整理绍兴市2011年5岁以下儿童死亡监测资料,统计分析流动人口5岁以下儿童死亡率、死亡原因、死前保健服务情况,并与本地户籍死亡儿童进行比较。 结果 2011年绍兴市流动人口新生儿死亡率、婴儿死亡率、5岁以下儿童死亡率分别为5.40、7.69、9.85,均高于本地户籍儿童,差异有统计学意义(均P0.01);流动人口儿童死亡原因主要为出生窒息、早产和低出生体重、溺水、意外窒息和肺炎,感染性疾病死亡、伤害死亡和死亡未治疗比率明显高于户籍儿童,差异有统计学意义(均P0.01)。 结论 要降低流动儿童死亡率,应大力开展健康教育,提高流动孕产妇及儿童接受保健检查的意识,提高疾病识别和对伤害防范的能力。     

2011～2013年某医院5岁以下儿童死亡监测分析

目的了解某医院5岁以下儿童的死亡动态变化与主要死亡原因,寻找有效的干预措施。方法对2011~2013年某医院5岁以下儿童死亡监测资料汇总分析。结果 5岁以下儿童死亡率和新生儿死亡率逐年下降;婴儿死亡率2013年略有升高,1~4岁儿童死亡2011年和2012年为0,2013年仅报告3例,原因是该院新开展了大量肝移植手术。结论降低5岁以下儿童死亡率关键是减少移植术后的并发症,控制院内感染;其次加强新生儿免疫缺陷筛查和诊断技术,同时提高新生儿窒息复苏能力;预防意外伤害。     

Retrieval of DNA from the faces of children aged 0-5 years: a technical note

Approximately 21% of children suffer from some form of physical abuse. It is hypothesized that when an individual hits a child some of that person's DNA will be deposited onto the child's skin. As yet, no one has reported a method of sampling DNA from the skin of this vulnerable group of individuals. We have sampled DNA from several facial areas of 30 children aged 5 years of age and under. The results show that it is possible to swab the faces of this age group without distressing them or contaminating the samples. Additionally the results indicate that the DNA obtained is almost entirely that of the subject, with little nondonor DNA being observed.     

妥洛特罗贴剂治疗轻中度婴幼儿支气管哮喘临床观察

目的 观察妥洛特罗贴剂对轻中度婴幼儿支气管哮喘的治疗效果及其安全性.方法 将62例支气管哮喘患儿分为妥洛特罗贴剂组(32例)和对照组(30例),在丙酸氟替卡松气雾剂治疗基础上分别加用妥洛特罗贴刑和盐酸丙卡特罗片剂治疗2周.记录患儿的哮喘症状评分、喘鸣发作次数和短效β2受体激动剂的用量,并记录不良反应发生情况.结果 贴剂组治疗后哮喘日间症状评分[治疗1周后为(2.2±0.9)分/周、治疗2周后为(0.9 ±0.5)分/周]明显低于对照组[治疗1周后为(3.4 ±1.1)分/周、治疗2周后为(1.3±0.6)分/周],差异均有统计学意义(P均<0.05);贴剂组治疗1周后哮喘夜间症状评分[(1.8±0.7)分/周],明显低于对照组[(3.3 ±0.9)分/周],差异有统计学意义(P<0.05);贴荆组治疗期间喘鸣发作次数为(2.3±1.2)次,对照组为(3.6±1.3)次,2组比较差异有统计学意义(t=4.09,P<0.05);贴剂组的β2受体激动剂用量为(2.6 ±0.9)喷/周,对照组为(3.7 ±0.8)喷/周,差异有统计学意义(t=5.07,P<0.05);贴剂组不良反应发生率(3.12%)明显低于对照组(23.33%),2组比较差异有统计学意义(X2=3.89,P<0.05).结论 妥洛特罗贴剂是一种安全、有效的轻中度婴幼儿支气管哮喘治疗药物.     

阻断法气道阻力测定在2～5岁咳喘儿童中的应用

目的探讨阻断法气道阻力测定在2—5岁咳喘儿童中的临床应用价值。方法对55例反复喘息患儿、31例单纯咳嗽患儿、18例无呼吸道症状儿童进行吸入沙丁胺醇气雾剂前后的气道阻力测定。结果用药前气道阻力值及用药前后的气道阻力比值，喘息组与咳嗽组、对照组均有显著差异，而咳嗽组与对照组无明显差异；用药后三组数据间无明显差异。结论阻断法气道阻力测定可反应肺功能改变，在学龄前儿童哮喘诊断、疗效评估、随访等方面可作为临床可靠的常规检查手段。     

Airway obstruction in children aged less than 5 years: : The prehospital experience

Background

Treatment of choking in children has been well studied, but few data are available on the various causes of the choking episodes in the pediatric population.

Objectives

To assess frequency and to stratify etiologies of children less than 5 years of age who had a 911 advanced life support (ALS) ambulance response for airway obstruction.

Methods

A prehospital database was searched and information was collected defining type of obstruction, age of the child, parents' action, paramedic treatment, and incident outcome.

Results

There were 182 patients with airway obstruction under 5 years of age, of whom 99 (55%) were less than 1 year old. Liquid obstructions (i.e., formula, juices) were most common in the youngest children, whereas solid food and nonfood solid obstructions were most prevalent in children over 1 year old. One hundred seven (59%) of these obstructions resolved before paramedic arrival (69% of liquid obstructions, 72% of food, and 36% of nonfood solid objects). Interventions used by parents included bulb suction (3%), finger sweeps (6%), Heimlich maneuver (3%), and back blows (12%). Paramedics used ALS skills in only three cases. After paramedic evaluation, 47% of parents refused transport against medical advice (AMA).

Conclusions

Although most episodes of pediatric airway obstruction will have been resolved by the time of paramedic arrival, age-specific and item-specific treatment skills need to be reinforced with parents and prehospital providers.     

游戏结合言语训练在2~5岁语言发育迟缓高危儿童康复护理中的应用观察

目的探讨游戏结合言语训练在2~5岁语言发育迟缓高危儿童康复护理中的应用。方法采用便利抽样法,选取2016年1月—2018年12月泸州市人民医院190例2~5岁伴有语言发育迟缓的高危儿童为研究对象,采用随机数字表法分为观察组和对照组,每组各95例。对照组患儿接受常规言语训练,观察组患儿结合游戏进行言语训练,均干预6个月。比较两组患儿的康复训练效果,采用Gesell发育量表评定患儿的言语发育商。比较两组家长对康复的满意度。结果干预6个月后,观察组患儿的康复训练有效率为86.32%(82/95),对照组为73.68%(70/95),两组比较差异有统计学意义(P<0.05);观察组患儿Gesell发育量表评分(60.36±8.25)分,对照组(56.67±7.84)分,两组比较差异有统计学意义(P<0.05);观察组患儿家长对康复效果、服务态度、专业技能、人文关怀的满意率均高于对照组,两组比较差异有统计学意义(P<0.05)。结论在2~5岁伴有语言发育迟缓的高危儿童中,结合游戏进行言语训练可改善患儿言语发育商,更好地促进患儿康复。     

0～6岁健康儿童干血滤纸片中游离肉碱和酰基肉碱水平研究

目的通过对0~6岁健康儿童干血滤纸片中游离肉碱和酰基肉碱水平的检测,对儿童体内游离肉碱及酰基肉碱水平进行了统计分析,为脂肪酸代谢障碍性疾病和有机酸血症诊断提供生物参考区间。方法应用同位素稀释非衍生化串联质谱法对广州地区263例健康儿童的外周血干血滤纸片酰基肉碱进行检测。将所有儿童分成男、女两组;根据年龄分为分4个组:年龄0~28d,孕周≥37周;年龄0~12月;年龄0~3岁;年龄0~6岁。结果进行正态性检验后发现,儿童的游离肉碱和酰基肉碱水平呈正态分布。男性儿童组与女性儿童组的游离肉碱和各种酰基肉碱水平差异无统计学意义(t=0.5,P=0.619)。C4、C5、C6、C10、C12、C18各年龄组间方差齐(P0.05),可进行单因素方差分析;C0、C2、C3、C5-OH、C8、C14、C16方差不齐(P0.05),进行秩和检验。C0、C2、C3、C5-OH、C6、C8、C10、C12、C14、C16、C18不同年龄组水平差异有统计学意义,按不同年龄计算参考值范围。C4、C5差异无统计学意义可合并组计算参考值范围。结论根据年龄的不同建立儿童干血滤纸片游离肉碱和酰基肉碱含量参考值范围对于脂肪酸代谢障碍和有机酸血症疾病的诊断、治疗十分重要。     

北京市东城区221名1~12岁健康儿童肺炎链球菌携带状况研究

目的 了解1~12岁健康儿童鼻咽部肺炎链球菌携带情况,及该菌血清型、耐药情况,为制定防治策略提供参考依据。 方法 2010年10月至2011年6月,选取北京市东城区221名1~12岁健康儿童,每2个月采集鼻咽拭子标本1次,进行肺炎链球菌培养、血清分型及耐药性检测。 结果 1~12岁健康儿童肺炎链球菌累计携带率为57.47%;分离到32个血清型共220株肺炎链球菌,7价肺炎球菌结合疫苗的血清型覆盖率为36.82%,23价肺炎链球菌荚膜多糖疫苗的血清型覆盖率为64.55%;耐药菌株占3.64%。 结论 1~12岁健康儿童存在着较高肺炎链球菌疾病的风险,有必要建立科学的监测体系,研制出适合国情的肺炎链球菌疫苗。     

Validation of the Parents' Postoperative Pain Measure in Finnish children aged 1-6 years

The Canadian Parents' Postoperative Pain Measure (PPPM) is a behavioural pain measure for children. The purpose of this study was to test validity and reliability of this measure in 1-6-year-old Finnish children at home after minor day surgery. Children (n = 85) and their parents from four hospitals were included in the sample. The parents, mostly mothers (93%), filled in at home a questionnaire including PPPM during the day of operation, and the first and second postoperative days. Parents (n = 85) rated the presence or absence of behavioural changes from a checklist and also the child's worst pain during each day (using a Visual Analogue Scale, VAS). The response rate was 58. Principal component factor analysis, testing of correlation coefficient, cross-tabulations and Cronbach's alpha were used to test the instrument. The findings showed that construct validity of the measure was satisfactory. The PPPM was successful in discriminating between children who had no/low pain and children who had a clinically significant pain measured by VAS (convergence validity). Scores on the PPPM decreased from days 0 to 1 and from days 1 to 2 (predictive validity). Internal consistency of the measure and correlations with the pain scores on VAS were high on all days following surgery (equivalence). Sensitivity was satisfactory only when specificity was weaker. The findings of this study can be utilized in the development of children's postoperative pain assessment at home. However, further studies are needed to test the instrument in larger samples.     

北京市海淀区351名5岁儿童患龋状况调查分析

目的 了解海淀区351名5岁学龄前儿童患龋齿情况,为儿童龋病预防提供依据。方法 采用多阶段分层等容量随机整群抽样,按照第三次全国口腔流行病学调查方法,调查北京市海淀区351名5岁城乡常住儿童的乳牙患龋齿状况。结果 调查结果显示,351例受检者总患龋率为64.10%,其中男、女童患龋率分别为61.49%和66.67%,二者间差异无统计学意义(P0.05);龋齿充填率为31.54%,女童龋齿充填率高于男童龋齿充填率(P0.05)。结论 5岁学龄前儿童患龋情况严重,应当重视学龄前儿童口腔健康,家长应督促孩子做好口腔保健,养成良好的口腔卫生习惯,定期口腔检查,发现龋病及时治疗。     

小儿肺炎合剂的制备及临床应用

目的 建立小儿肺炎合剂的制备方法及质量控制标准,并初步观察其临床疗效。方法 对处方药物成分进行定性鉴别,并通过给药前后对照考察患儿197例。结果 临床总有效率为94．7％。结论 小儿肺炎合剂对小儿肺炎及急性呼吸道感染有显著疗效。     

5例山豆根中毒儿童的诊治报道及临床体会

目的 探讨儿童山豆根中毒的临床表现、诊治经过及转归,为儿童山豆根中毒的临床防治提供参考依据.方法 选取2017年1月至2019年12月空军军医大学西京医院儿科收治的5例山豆根中毒患儿的病例资料,回顾性分析患儿的临床表现、相关辅助检查、诊治方法 及转归情况,并总结临床救治体会.结果 5例山豆根中毒患儿均出现头晕、恶心、呕...     

上海崇明地区0～12岁儿童呼吸道病原体抗体检测分析

目的了解上海市崇明区0~12岁儿童8种常见呼吸道病原体特异性IgM的检测情况,指导临床治疗及合理用药。方法收集2015年4月至2018年11月上海交通大学附属新华医院崇明分院,因呼吸道感染的0~12岁患儿4272例血清标本,采用间接免疫荧光法同时检测呼吸道合胞病毒(RSV)、腺病毒(ADV)、嗜肺军团菌(LP)、肺炎衣原体(CP)、肺炎支原体(MP)、流感病毒A(IVA)、流感病毒B(IVB)、副流感病毒(PIV)8种呼吸道病原体的IgM抗体,比较不同季节和不同年龄段感染率。结果4272例样本中共检出IgM抗体阳性939例(21.98%),其中单一病原体感染773例,占82.32%(773/939),混合感染166例,占17.68%(166/939)。所调查样本中,阳性被检者中MP阳性率最高,占40.15%,其次为IVB、IVA、CP、PIV、LP、RSV、ADV,分别占35.68%、22.47%、10.44%、4.15%、2.24%、2.02%、1.60%。不同年龄段儿童,CP、MP、IVA、IVB、PIV感染率有显著性差异。其中学龄期组CP和MP阳性率最高,学龄前期组IVA和IVB阳性率最高,幼儿组IVB、MP和IVA阳性率最高。该地区不同季节的病原体感染率差异有统计学意义(P<0.05),主要表现为CP、IVA和IVB。CP感染率夏秋高于冬春季节,IVB冬春季节高于夏秋,IVA感染率秋冬季高于春夏。女童总体阳性率为25.98%(489/1882),高于男童18.83%(450/2390),差异有统计学意义(P<0.001)。结论掌握该地区0~12岁儿童呼吸道病原体感染的流行病学特点,有助于提高医生的诊断和治疗。     

0～13岁小儿感染性疾病与微量元素关系的探讨

目的探讨0~13岁小儿全血中微量元素镁、锌、铜、铁、钙与感染性疾病之间的关系。方法对1 183例感染性疾病的小儿采用原子吸收火焰光谱法进行全血微量元素的检测,其中感染组中男638例,女545例,根据感染的系统不同又分为呼吸系统感染828例,消化系统感染251例,其他系统感染104例。对照组采用同期到该院儿科门诊自愿进行体检的健康小儿160例,其中男96例,女64例。结果感染性疾病组与对照组比较,锌、铁和钙差异有统计学意义(P0.05),不同的感染系统间和不同年龄段间比较均有差异,感染性疾病患儿微量元素的缺乏以锌、铁、钙为主,分别占14.2%,10.3%,6.7%。镁和铜元素的缺乏比较少见。结论 0~13岁感染性疾病的小儿易出现微量元素锌、铁、钙的缺乏,患儿应有侧重的合理补充微量元素。     

Reference values for respiratory system impedance by using impulse oscillometry in children aged 2-11 years

The forced oscillation technique makes it possible to evaluate the mechanical properties of the respiratory system with a minimum of cooperation. The method is therefore especially useful in children. Impulse oscillometry (IOS) is a commercially available version of this technique. There is, as yet, limited information on reference values for IOS in children. The aim of this study was to extend the reference values for IOS variables and to study their correlation with height, weight and age in healthy children. A sample (n = 360) of children (age 2.1-11.1 years) was measured by using impulse oscillometry (IOS; Jaeger, Würzburg, Germany). The sample was based on children attending kindergarten in Finland and children attending primary school in Sweden. Measurements of respiratory resistance (Rrs) and reactance (Xrs) at 5, 10, 15 and 20 Hz, total respiratory impedance (Zrs) and the resonance frequency (Fr) were made. All variables were related to body height. Most of them were also weakly related to weight. Reference equations for children (height 90-160 cm) are presented.     

新疆地区5岁维吾尔族儿童龋病调查分析

目的了解新疆地区维吾尔族5岁维吾尔族儿童乳牙患龋情况,为有效开展儿童口腔保健工作提供依据。方法参照世界卫生组织《口腔健康调查基本方法》,以及第三次全国口腔健康流行病学调查方案,在新疆地区3个城市、3个农村随机抽样选取调查点,共调查782名5岁维吾尔族维吾尔族儿童的患龋情况,并将调查结果与第三次全国口腔健康流行病学西部抽样调查结果进行比较。结果新疆维吾尔族5岁维吾尔族儿童乳牙患龋率为65．35％,患儿中龋齿数最多为16个,龋均为3．30;乳牙患龋率和龋均在男性和女性、城市和农村维吾尔族儿童之间的差异均不具有统计学意义,而乳牙龋齿充填率则存在性别和地区间的差异。结论新疆地区维吾尔族5岁维吾尔族儿童乳牙龋齿患病率仍然较高,而龋齿充填率相对较低,今后维吾尔族儿童龋病防治工作应加强乳牙保健的口腔卫生宣传教育,提高保健人员和家长的口腔保健意识,培养幼儿良好的口腔卫生习惯,发现龋病及时治疗。