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??The incidence of malnutrition in critically ill children is always high??and parenteral nutrition??PN?? support is one of the important way to improve infants’nutrition status. The proper venous access and management is the fundamental assurance to infusion of PN. Properly venous access should be selected according to the concentration??osmotic pressure??pH and duration of parenteral nutrition. Venous accesses consist of peripheral venous access and central venous accesses??and central venous accesses consist of percutaneously inserted central catheter access?? peripherally inserted central catheter access and port. It will reduce complications effectively to choose suitable venous access??handle and manage inserted catheter well.     

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??The critically ill children often present nutritional and metabolic disorders??and have severe illness??which often leads to further deterioration of children’s nutritional status?? affecting the prognosis of the disease. The critically ill children have different nutritional status and have less muscle fat reserves??so they need to be given adequate calories and protein.But recent studies have found that the energy required for critically ill children under stress is not large??so how to choose the right calories and protein supply is our current concern which is worth exploring.     

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??Objective??To investigate the risk factors of purulent meningitis complicated with subdural effusion in infants and young children. Methods??The clinical data of the infants and young children who were diagnosed with purulent meningitis in PICU of Shengjing Hospital of China Medical University from January 2014 to December 2017 were analyzed retrospectively. All of them were divided into 2 groups according to whether there was complication of subdural effusion. The statistical data were analyzed by SPSS 20.0 software. Results??There were significant differences in hemoglobin??C reactive protein and protein in cerebrospinal fluid between control group and subdural effusion group??P??0.05??. Logistic regression analysis showed that hemoglobin??OR??0.940??95%CI??0.899—0.998????C reactive protein??OR??1.015??95%CI??1.004—1.028?? and protein in cerebrospinal fluid??OR??2.490??95%CI??1.151—6.315?? were independent risk factors for purulent meningitis complicated with subdural effusion??P??0.05??. Conclusion??Infants and young children diagnosed with purulent meningitis are with lower hemoglobin. Higher C reactive protein and higher protein in cerebrospinal fluid are likely to be complicated with subdural effusion.     

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??With the development of medical technology??survival rates have greatly improved in recent years in premature and critically ill newborns. However??these infants are at risk of long-term adverse neurobehavioral outcomes??including cognitive??motor and psychological problems and behavioral impairments. Neurodevelopmental disabilities and recurrent health problems take a toll in early childhood. Subsequently hidden disabilities??such as school difficulties and behavioural problems??become apparent and persist into adolescence. At present??the focus for early screening and interventions are to develop strategies to reduce long-term morbidity??especially to prevent brain injury and abnormal brain development. Due to the late start and weak foundation??the related researches in China is still in the early stages of development. To find abnormality is the first step to intervene??so it is particularly important to screen early. Thus??this review discusses key components of early evaluation??including commencing the evaluation as early as possible??preferably in the neonatal intensive care unit??and promoting developmental skills overtime in an appropriate enriched environment.     

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??Objective??To study clinical characteristics and risk factors for mortality of septic shock patients with hematological malignancies in pediatric intensive care unit??PICU??. Methods??A retrospective analysis of records of pediatric patients with hematological malignancy and septic shock was performed. In our study??43 cases admitted to PICU in Sun Yat-sen Memorial Hospital between March 2012 and September 2015 were included. Results??Among the 43 cases??16 died??while the other 27 survived. The percentage of mortality was 37.2%. Pulmonary infection ??74.4%?? and gastrointestinal tract infection??39.5%?? were the common causes of septic shock in these patients. Etiological examination revealed 43 kinds of pathogenic bacteria in 26 cases. The percentage of gram-positive bacteria??gram-negative bacteria and fungus was 11.6%??72.1% and 16.3%??respectively. Escherichia coli was found to be the main pathogen??6/43??14.0%??. Between the survival group and the mortality group??there were significant differences in the parameters of age??chemotherapy courses??time from infection to shock??time from neutropenia to shock??multiple organs dysfunction??pulmonary infection??hypocalcemia??oxygenation index and serum lactic acid concentration after 6 hours of fluid resuscitation??requirement of dopamine and mechanical ventilation ??P??0.05??. By logistic regression analysis??mortality was associated with the variables of serum lactic acid concentration after 6 hours of fluid resuscitation and requirement of mechanical ventilation. Conclusion??The risk factors for mortality of septic shock in pediatric patients with hematological malignancies are hyperlactacidemia after 6 hours of fluid resuscitation??hypocalcemia and requirement of mechanical ventilation.     

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??Helicobacter pylori??Hp?? is responsible for one of frequent chronic bacterial infections worldwide and most likely spread from person to person through fecal-oral or oral-oral routes. Children are at high risk of Hp infection. Hp infection in childhood is clustered in the family members??and associated closely with social economic status??personal hygiene and the feeding way. To promote health education??advocate breastfeeding??improve basic sanitation and family health behavior??pay attention to hand hygiene and correct poor diet living habitswould be critical to reducing the incidence rates of Hp infection in childhood.     

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??Hypertrophic cardiomyopathy??HCM?? is mainly hereditary heart disease caused by gene mutation encoding cardiac sarcomere protein. HCM is the main cause of sudden cardiac death in athletes and adolescents. The clinical manifestations of HCM in children are complex and varied??including being asymptomatic??exercise intolerance??syncope??and sudden death??etc. Labor dyspnea and chest pain are the most common symptoms in older children. The diagnosis of HCM in children is mainly based on imaging examination??which can be divided clinically into three types??obstructive??non-obstructive and occult obstructive. Risk factors were assessed according to the patient’s age??clinical symptoms??imaging findings and family history to guide further treatment??management and prognosis. Drug therapy mainly includes beta blockers??non-dihydropyridine calcium antagonists and other anti-arrhythmic drugs??as well as anticoagulants??diuretics and other applications. For those who are not satisfied with the effect of drug treatment??implantable cardioverter defibrillator??ICD?? or surgical treatment can be used. In recent years??with the development of gene detection??the diagnosis of HCM in children is more refined and the treatment is accurate.     

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目的研究与法洛四联症(TOF)一期根治手术早期死亡相关的危险因素。方法回顾1995年4月至2004年3月在复旦大学附属儿科医院心血管中心行一期根治术的TOF病例152例,术后早期死亡17例,对其术前、术中27个可能的危险因素指标与术后早期死亡的关系进行单因素和多因素分析。结果单因素分析结果显示与术后早期死亡有关的指标包括手术时体重、发生青紫年龄、动脉血氧饱和度、升主动脉与肺动脉干直径比AO/MPA、McGoon比值、Nakata指数、肺体循环血流量之比Qp/Qs、右向左分流量占体循环血流量比例(QseQp)/Qs、体肺侧支循环和跨瓣补片。多因素分析结果显示AO/MPA和McGoon比值与手术早期死亡有关。结论肺动脉的发育情况是TOF一期根治术后能否生存的关键。手术病例的选择需要综合考虑多种危险因素。     

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??Parenteral nutrition has become a mainstay in the treatment of critically ill children with intestinal or conditions that preclude enteral feeding. Accurate assessment of nutritional status and energy requirements in critically ill children will help to better implement the strategy of parenteral nutrition. The timing of the optimal parenteral nutrition has not been determined??and at present the supplementary parenteral nutrition tends to be started at a later stage. “All in one” is recommended for parenteral nutrition. Pharmacological nutrients have been recommended in critically ill adult patients with different levels??but more extensive research is still needed in critically ill children.     

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??Viral lower respiratory tract infections??LRTIs?? are common causes of critical illness in children. Recent advances in viral detection techniques over the past decade have demonstrated the rates of morbidity??mortality??and medical burden of LRTIs caused by viruses are comparable to those of bacterial community-acquired and nosocomial pneumonias. In the paper??it described the relationship between viral LRTIs and critical illness??and discuss relevant clinical features and management strategies of the more prevalent respiratory viral pathogens. Early diagnostic and treatment strategies are required to effectively treat these infections and prevent complications.     

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??Objective??By analyzing the cases of accidental injuries among critically ill children in our hospital in recent years??we put forward feasible preventive measures to effectively reduce the occurrence of accidental injuries. Methods??A retrospective analysis was performed on the clinical data of children who were admitted to the PICU in our hospital from May 1??2015 to April 30??2018??the types of children with accidental injuries were analyzed??and the male-to-female ratio of the results was analyzed. Seasonal characteristics??age??and the proportion of deaths were analyzed. Results ??It was found that the top three causes of accidents in critically ill children were falling injuries??246??39.87%????traffic accidents??156??25.28%????and poisoning??57??9.23%??. The incidence of accidental injuries for boys was significantly greater than that for girls??there were 375 boys and 242 girls??the ratio being 1.55??1??severe accident injuries peaked in early childhood??1??4 years old????there was no significant difference between urban and rural areas. Conclusion??The accidental injuries in critically ill children have undergone tremendous changes. We should adopt preventive measures to reduce accidental injuries.     

New approaches to parenteral nutrition in infants and children

Parenteral nutrition (PN) has become a mainstay in the treatment of children with intestinal failure or conditions that preclude enteral feeding. Estimated energy and protein requirements can usually be met, unless the patient is fluid volume restricted or glucose intolerant. Although PN is generally well tolerated, in some patients it is still associated with a significant morbidity. Complications include metabolic disturbances, venous access device infection or dysfunction, venous thrombosis and cholestatic liver disease. Patients need to be carefully monitored for evidence of micronutrient deficiencies or excesses. There is a close relationship between line sepsis and thrombosis. Strict aseptic technique is the key to preventing line infections. Recurrent sepsis and thrombosis may eventually lead to loss of venous access and may jeopardize the long-term delivery of PN. Chronic cholestatic liver disease is common in premature infants with gastrointestinal problems, recurrent sepsis and lack of enteral feeding. The aetiology is multifactorial. Early enteral feeding is the most effective strategy in preventing PN-associated liver disease. New specialized nutrient solutions and lipid emulsions promise improved clinical outcomes. However, long-term clinical data are not yet available in children. In recent years, nutrition support teams have improved clinical and economic outcomes by encouraging the appropriate use and monitoring of PN therapy. In patients with intestinal failure, parent-administered home PN has become an alternative to long-term hospitalization. Apart from a positive effect on the quality of life of patient and family, home PN is cost-effective and reduces the risk of nosocomial infections and catheter-related complications.     

危重症早期肠内营养的治疗进展

ICU患儿多处于严重应激状态,体内代谢变化异常复杂。肠内营养及早期肠内营养在维持营养代谢的同时,又维护、支持了肠黏膜屏障与消化功能,改善组织灌注,调节机体免疫,明显降低感染性疾病与多器官功能障碍综合征的发病率,减少感染并发症的发生,从而改善预后,因而有广阔的临床应用前景。本文对早期肠内营养进行综述,以期更好地为危重症患者的营养支持提供参考。     

纤维支气管镜在危重症患儿中的应用

纤维支气管镜术已在PICU中得到了广泛应用,成为了PICU呼吸系统疾病诊断及治疗的一项必备措施。本文着重结合实际工作介绍纤维支气管镜术在PICU的应用进展和注意事项。     

危重患儿胃肠外营养指征与方法

危重患儿的机体各系统在创伤和严重感染等应激状态下,迅速出现应激分解代谢,机体这一应激反应的目的在于通过改变代谢途径,为不同细胞、组织提供所需营养物质,其结果是耗氧量增加,血糖升高,肌肉、内脏蛋白质分解,最终导致血浆蛋白降低,抗体生成减少,特异性和非特异性免疫功能低