儿童重症监护病房铜绿假单胞菌感染临床特征与耐药分析

目的 探讨儿童重症监护病房(PICU)患儿中铜绿假单胞菌(pseudomonas aeruginosa,PA)感染的临床特点及耐药情况.方法 分析我院PICU 2007年1月至2009年12月收治危重患儿中PA感染的临床情况.结果 (1) 临床特征:同期全院监测共获PA 232株,在58例PICU患儿中,共获得PA菌株112株(48.3%).社区获得性感染12例,医院获得性感染46例.死亡12例,病死率为20.7%,社区获得性感染和医院获得性感染病死率分别为41.6%(5例)和15.2%(7例),两组差异有统计学意义(P<0.05).社区获得性感染患儿主要表现为急性起病,肠道感染(5例)和败血症(5例)为主要疾病,迅速发展为休克及多器官功能障碍综合征;血白细胞不增高(7/12例)或降低(5/12例),血液C-反应蛋白和内毒素升高.医院获得性感染患儿以呼吸道感染为主要表现(38例),造成原发疾病加重,存活者住院时间延长.(2) 耐药性分析:112株PA中,头孢他丁耐药占69.8%;亚胺培南耐药率达72.8%.结论 社区获得性PA感染与医院获得性PA感染临床特征有明显差别,前者多为原发性感染,病死率高.PA为医院获得性感染重要病原之一.长时间使用广谱抗生素及侵入性医疗操作可致PA感染增多.

Abstract：

Objective To explore the clinical characteristics of critically ill children infected with pseudomonas aeruginosa(PA) and PA antibiotics resistance in pediatric intensive care unit (PICU).Methods Case records of children with PA infection admitted to PICU in children′s hospital affiliated to Shanghai Jiaotong University from Jan 2007 to Dec 2009 were reviewed for clinical characteristics,case fatality rate,prognosis and drug resistance.Results (1) Clinical features:12 cases were community-acquired infection and 46 cases were hospital-acquired infections in 58 cases.On the same period,hospital-wide surveillance obtained PA 232 strains,PICU obtained PA 112,the ratio was 48.3%.Twelve cases died and total mortality was 20.7%.The mortality was significantly difference between community-acquired infections (5 cases,41.6%)and hospital-acquired infections (7 cases,15.2%)(P<0.05).The main symptom of children with community-acquired infections were intestinal infection (5 cases) and sepsis (5 cases).The children had acute onset and developed to shock and multiple organ dysfunction syndrome rapidly.Laboratory examination revealed the white blood cell normal (7/12) and decreased in 5 cases (5/12).The value of C-reactive protein was increased significantly,and the concentration of blood endotoxin were also increased.In the hospital-acquired PA infection cases,the main symptom was respiratory abnormal (38 cases),worsen primary disease,extended staying days in PICU.(2)Drug resistance analysis:112 PA,69.8% of ceftazidime-resistant,72.8% of the imipenem-resistant.Conclusion There is significant difference of the clinical features between PA community-acquired infection and hospital-acquired infection.The former is mostly primary infections with high fatality rate.PA hospital-acquired infection has become an important pathogen of nosocomial infection in PICU.And it is important to prevent PA infection caused by a long term broad-spectrum antibiotics application and invasive medical procedures.     

胆道闭锁患儿肝移植术后的监护与治疗

目的 回顾分析22例胆道闭锁患儿(23例次,其中1例行再次肝移植)肝移植术后的重症监护管理经验,探讨并发症的发生率以及病原菌与患儿并发症预后之间的联系.方法 统计分析22例平均体重＜8.8 kg的婴幼儿在ICU的相关临床资料,包括药物的使用情况(肾上腺素能激动剂、抗高血压药、利尿剂、镇静止痛药)及主要并发症(排异反应11例,外科并发症16例,感染18例)的诊断、评估及治疗,其中抗生素的选用主要根据药敏试验结果决定.结果 最常见的术后并发症包括感染(18例)、消化道出血(3例)、血管并发症(4例).1例死于原发性无功能肝,11例出现排异反应.最常见的病原微生物包括表皮葡萄球菌(7例),不动杆菌属(6例),铜绿假单胞菌(7例).ICU平均住院时间为10 d,机械通气平均时间37.6 h.多巴酚丁胺、前列腺素E1、多巴胺的平均使用时间分别为3.3 d,7.5 d,8.8 d.术后胃肠外营养的平均起始时间为12 h,进食起始时间平均72 h.结论 术后监护是保证婴幼儿肝移植成功的关键之一.

Abstract：

Objective To summarize experience of pediatric intensive care and explore the incidence of complications, the involved pathogens among liver recipients to determine the effective strategies for preventing complications. Methods Between June 2006 and July 2009, 35 children under the age of 14 yr received 35 liver transplantations (LTs) performed at the center. A retrospective review of 22 infants weighing 8. 8 kg or less underwent 23 transplants was conducted. Indication for transplantation was biliary atresia. Central venous pressure and arterial blood pressure were monitored continuously and fluid monitoring was performed every 2 hours in the first postoperative week. Blood loss, ascites, and intraoperative transudate loss were primarily replaced with 5% albumin and crystalloids to maintain a central venous pressure between 4 and 6 cm H2O. Oral food intake was allowed as soon as possible. To identify vascular or biliary complications, liver doppler ultrasound was performed intraoperatively immediately after reperfusion and after closure of the abdominal wall and postoperatively, twice daily during the first week after surgery.Immunosuppression was initially cyclosporine based, in combination with steroids. Cyclosporine was begun one day prior to transplantation at a dose of 10 mg/( kg · d) divided into two doses, except for cases with hepatic encephalopathy and severe infection. The subsequent doses were adjusted on the basis ofrecommended trough blood concentrations at different stages. Steroids were eventually discontinued at a time point exceeding 6 months after transplantation. The diagnosis of rejection was confirmed by histology on needle biopsy specimens. Acute graft rejection episodes were treated with a 3-day scheme of Ⅳ methylprednisolone 10 mg/( kg · d) followed by recycling doses during the following 3 days (7.5, 5 and 2. 5mg/(kg · d). Results The most common postoperative complications were infections (18 cases),gastrointestinal bleeding (3 cases), and vascular complications (4 cases). Rejection occurred in 25% of patients. There was one perioperative death from primary graft non-function. The most common isolated bacteria of the pathogen spectrum were Staphylococcus epidermidis. The median length of stay (LOS) in the PICU for 22 patients (23 transplants) was 10 days ( range 5-21 ) and the mean length of stay in the hospital was ( 18.5 ± 116) days ( range, 11-48 days). Mean requirement for artificial ventilation was 37.6 h. Mean use of dobutamine, prostaglandin E1 and dopamine was 3.3, 7.5 and 8.8 days, respectively.Preoperatively, 3 children had gastrointestinal bleeding, 18 had ascites, 2 had encephalopathy, 22 had jaundice, and 16 had coagulopathy. There were multiple early operative complications in these infants,including one graft with primary non-function (4. 5% ). Two patients (9. 1% ) returned for a total of three times for gastrointestinal bleeding or intra-abdominal hematoma. Three patients (13.6%) had early postoperative intestinal perforations related to adhesions or enterotomy, one was associated with a bowel obstruction. There were 26 episodes of bacterial or fungal infections in 18 (81.8%) patients in the early postoperative period, and infection was the direct/contributing cause of death in one infant. These infections included pneumonia, intra-abdominal abscess or sepsis. All of the bacterial and fungal infections were successfully treated with the appropriate antibacterial and antifungal agents, except for one patient who developed overwhelming sepsis after small bowel perforation. Four (18.2%) patients developed five episodes of acute allograft rejection during the first 15 days after LT. Three of the four patients who developed rejection were transplanted before 2007. All episodes of rejection were treated successfully with intravenous steroid pulse and optimization of cyclosporine levels or FK506 conversion. Of the 20 survivors beyond the perioperative period, two cases ( 10% ) had hypertension requiring therapy. Conclusions Liver transplantation in infants with biliary atresia appears technically demanding but acceptable. There should be essentially no age or size restriction for infants and transplantation can be performed with good outcome,although the frequency of complications is much higher than that seen in older children. The improvement in medical and nursing expertise in this group of very sick infants is based on judicious preoperative donor and recipient selection, meticulous surgical technique (vascular reconstruction and abdominal closure ),immediate detection and prompt intervention of complications, and keen postoperative surveillance, which reflect a learning curve for both the technical aspects of liver transplantation and post-operative care of these very small patients in our institution. Liver transplantation for infants can be technically challenging.     

福建省福州地区儿童慢性咳嗽病因分析

目的 探讨福建省福州地区儿童慢性咳嗽的病因.方法 根据中华医学会儿科学分会呼吸学组与<中华儿科杂志>编辑委员会2008年制定的<儿童慢性咳嗽诊断与治疗指南>的标准,对福建省福州儿童医院哮喘专科门诊诊断的364例慢性咳嗽患儿,按照指南的诊断流程询问病史,进行体检、辅助检查,初步确定病因后,并针对病因进行特异性治疗,分别在初诊后半个月、1个月、3个月对患儿进行随访,根据辅助检查及疗效判定病因诊断,进而分析病因构成比.结果 364例慢性咳嗽患儿病因依次为:咳嗽变异性哮喘171例(47.0%),上气道咳嗽综合征104例(28.6%),呼吸道感染和感染后咳嗽58例(15.9%),胃食管反流17例(4.7%),支气管异物3例(0.8%);引起慢性咳嗽只有单一病因的299例(82.1%),同时有2种病因的56例(15.4%),同时有3种病因的9例(2.5%).结论 福建省福州地区儿童慢性咳嗽的病因依次为咳嗽变异性哮喘、上气道咳嗽综合征、呼吸道感染和感染后咳嗽、胃食管反流、支气管异物;不同年龄组儿童慢性咳嗽病因构成比不同;部分患儿合并有2或3种病因,表明儿童慢性咳嗽病因呈多因素.

Abstract：

Objective Chronic cough in children is a common pediatric symptom with complex causes and its diagnosis is difficult; chronic cough affects the life of children in both physical and mental health and also learning. Therefore this study aimed to investigate the causes of chronic cough in children in Fuzhou area of Fujian province. Method Data were collected from 364 children with chronic cough who visited the asthma specialist clinic of Children's Hospital of Fuzhou, Fujian Province from March 2009 to April 2010. The diagnosis was made according to Guideline for Diagnosis and Treatment of Chronic Cough in Pediatrics published in 2008. Among the patients, 241 were boys and 123 girls. The patients were divided into 3 age groups: group 1, 1 to 3 years old ( infants and young children group, n =75); group 2, 4 to 6years old (pre-school group, n =215 ); and group 3, over 7 years (school-age group, n = 74), the mean age was (4.8 ± 1.1) years (3 months to 14 years), course of the illness was (4.5 ± 1.8) months (4 weeks to 38 months ). Mycoplasma pneumoniae was detected by Enzyme-linked immunosorbent assay (ELISA). Result The causes of chronic cough were as follows: 171 cases (46. 98% ) had cough variant asthma; 104 cases ( 28.57% ) had upper airway cough syndrome; 58 cases ( 15.93% ) had respiratory infections; 17 cases (4.67% ) had gastroesophageal reflux; 3 cases (0.82% ) had foreign bodies. Totally 9 cases (2.47% ) had chronic cough associated with 3 causes; 56 cases ( 15.38% ) had 2 causes and 299cases ( 82.14% ) had single cause. The main causes of cough in the group of pre-school children were cough variant asthma and upper airway cough syndrome. The proportion of the upper airway cough syndrome in school-age children group was the highest among the 3 age groups, which is flowed by cough variant asthma.Conclusion The causes of chronic cough in children were cough variant asthma, upper airway cough syndrome, respiratory infections, cough after infection, gastroesophageal reflux and foreign bodies in Fuzhou area of Fujian province. Children with chronic cough in different age groups had different etiology, in about 18% of the children the etiology of chronic cough was associated with 3 or 2 causes, indicating that the causes of chronic cough in children are multifactorial.     

手足口病病原体流行特征分析及临床意义

Objective To investigate the epidemic characteristics of etiological agents in children with hand, foot and mouth disease (HFMD) and analyze the differences between the severe and mild cases with HFMD seen from 2008 to 2009 in the Children's Hospital Methods A total of 154 patients with HFMD were enrolled from May 2008 to September 2008 and from May 2009 to September 2009, including 28 severe HFMD patients. Data from 80 cases with suspected herpangina were collected as control. Enterovirus universal type, enterovirus type 71 (EV71) and coxsackie virus group A 16 (CA16) were detected by realtime RT-PCR respoctively. Results The positive rate of enterovirus universal type in the 154 patients with HFMD was 81.82% (126/154). EV71 positive rate in these 126 patients with enterovirus universal type infection was 57.14% (72/126). The positive rate of enterovirus universal type in the 80 cases with suspected herpangina was 68.75% (55/80). There was no EV71 infection in these 80 cases with suspected herpangina. EV71 infection was mainly popular in 2008. Both EV71 and CA16 were prevalent in 2009. The epidemic characteristics of enterovirus infection with HFMD between 2008 and 2009 had significant differences (X2 = 23.50, P = 0.000) ( P ＜ O.01 ). The epidemic characteristics of enterovirus infection between severe and mild HFMD patients also had significant differences (X2 = 29.85, P ＜ O. 01). There were 28 cases with severe HFMD, in whom the EV71 positive rate was 92.86% (26/28). EV71 positive rate in the mild HFMD was 36.51% (46/126) (X2 =29.22, P ＜0.01). There was no significant difference in the gender ( X2 = 0.135, P = 0.714) and virus load (t = 0.141, P = 0.889) between the mild and severe HFMD cases. But the age of mild and severe HFMD showed a significant difference ( t = 2.926, P =O.009). Patients who were less than 2 years of age had a proportion of 88.89% (8/9) with severe HFMD.The mean age of mild HFMD patients was 3.19 years. Conclusion HFMD showed different epidemic characteristics at different times of enterovirus infection. There was no significant difference in the gender and virus load between the mild and severe cases with HFMD. Children under 3 years of age with EV71 infection were at high risk for severe HFMD.     

手足口病病原体流行特征分析及临床意义

Objective To investigate the epidemic characteristics of etiological agents in children with hand, foot and mouth disease (HFMD) and analyze the differences between the severe and mild cases with HFMD seen from 2008 to 2009 in the Children's Hospital Methods A total of 154 patients with HFMD were enrolled from May 2008 to September 2008 and from May 2009 to September 2009, including 28 severe HFMD patients. Data from 80 cases with suspected herpangina were collected as control. Enterovirus universal type, enterovirus type 71 (EV71) and coxsackie virus group A 16 (CA16) were detected by realtime RT-PCR respoctively. Results The positive rate of enterovirus universal type in the 154 patients with HFMD was 81.82% (126/154). EV71 positive rate in these 126 patients with enterovirus universal type infection was 57.14% (72/126). The positive rate of enterovirus universal type in the 80 cases with suspected herpangina was 68.75% (55/80). There was no EV71 infection in these 80 cases with suspected herpangina. EV71 infection was mainly popular in 2008. Both EV71 and CA16 were prevalent in 2009. The epidemic characteristics of enterovirus infection with HFMD between 2008 and 2009 had significant differences (X2 = 23.50, P = 0.000) ( P ＜ O.01 ). The epidemic characteristics of enterovirus infection between severe and mild HFMD patients also had significant differences (X2 = 29.85, P ＜ O. 01). There were 28 cases with severe HFMD, in whom the EV71 positive rate was 92.86% (26/28). EV71 positive rate in the mild HFMD was 36.51% (46/126) (X2 =29.22, P ＜0.01). There was no significant difference in the gender ( X2 = 0.135, P = 0.714) and virus load (t = 0.141, P = 0.889) between the mild and severe HFMD cases. But the age of mild and severe HFMD showed a significant difference ( t = 2.926, P =O.009). Patients who were less than 2 years of age had a proportion of 88.89% (8/9) with severe HFMD.The mean age of mild HFMD patients was 3.19 years. Conclusion HFMD showed different epidemic characteristics at different times of enterovirus infection. There was no significant difference in the gender and virus load between the mild and severe cases with HFMD. Children under 3 years of age with EV71 infection were at high risk for severe HFMD.     

Investigation on epidemiology of nosocomial sepsis of premature infants with gestational age less than 34 weeks in Shaanxi province北大核心CSCD

Objective To investigate the epidemiological data of nosocomial sepsis of premature infants with gestational age less than 34 weeks and the distribution characteristics of pathogenic bacteria in Shaanxi province. Methods A retrospective analysis of clinical data of premature infants born with gestational age < 34 weeks born between January 1 and December 30,2018 in Neonatal Intensive Care Units(NICU) in 4 Grade A Class Three hospitals in Shaanxi province was performed. The high risk factors and pathogenic bacteria were analyzed by using chi - square test and t test for statistical analysis. Results Totally 823 infants were included in this study,among whom,73 patients developed nosocomial sepsis,and the incidence was 8. 9%. The mean gestational age of the 73 patients with nosocomial sepsis was (30. 6 ±2.2) weeks and mean birth weight was (1 320. 3 ± 450. 5) g. The rate of invasive ventilator was 23.4% (52/222 cases).The rate of peripherally inserted central catheter (PICC) was 20. 1% (61/303 cases). The rate of early antibiotic use was 8. 1 % (39/481 cases) and breast feeding rate was 9. 3% (63/675 cases). The rate of PICC and ventilator use were statistically different between the non-infection group and the infection group (all P < 0.05). There were 31 strains of pathogenic bacteria, among which gram-negative bacilli was the most common (22 strains,70. 9%), which mainly were klebsiella pneumoniae strains (15 strains,48. 4%), and 6 strains(19. 4%) of Fungus was detected. Conclusions The incidence of nosocomial sepsis in NICU in Shaanxi province is higher,gram -negative bacilli was the most common pathogenic bacteria, among which, klebsiella pneumoniae was main, it is necessary to strengthen the regular monitoring and analysis of nosocomial infection in NICU in order to reduce the incidence of nosocomial infection and sepsis. © 2019 Authors. All rights reserved.     

儿童特发性膜性肾病临床病理特点及治疗探讨

目的 了解儿童特发性膜性肾病(IMN)的临床病理特点,探讨其治疗方案.方法 回顾性分析25例病理确诊的IMN患儿的临床病理特点,总结其不同治疗方法 的疗效.结果 儿童IMN占同期所有肾穿刺活检(简称肾穿)患儿的3.81%.25例IMN中男9例,女16例;起病年龄2～14岁,平均(9.4±3.4)岁;肾穿时病程0.4～11.0个月,中位数2.5个月.临床表现为肾病综合征肾炎型21例(84%),肾小球肾炎4例(16%).全部患儿均伴血尿,其中肉眼血尿7例,高血压4例,并发血栓2例,肾功能不全1例.病理分期IMNⅡ期21例(84%).伴中重度小管间质损害者6例,伴局灶节段硬化2例.22例肾病综合征及肾病水平蛋白尿患儿中,21例首选糖皮质激素治疗,其中20例符合评价激素疗效标准:激素敏感1例(复发后转为激素耐药),19例为激素耐药(95%).后续治疗包括继续单纯激素减量隔日治疗8例,其中完全缓解5例,部分缓解3例;激素联合免疫抑制剂治疗12例,该12例连同首选联合免疫抑制剂治疗1例、激素治疗5周联合免疫抑制剂治疗1例,共14例.结论 本组患儿IMN临床表现以肾病综合征为主,均伴有不同程度血尿.绝大多数初治激素耐药,但部分病例减量隔日治疗过程中获缓解,联合免疫抑制剂治疗及疗效尚需进一步临床验证.

Abstract：

Objective To investigate the clinicopathological feature and treatment of idiopathic membranous nephropathy(IMN)in children.Method A retrospective analysis of 25 cases of biopsyproven IMN seen between January 2004 and December 2009.Result The incidence of IMN was 3.81% in all the children patients who underwent renal biopsy.Of 25 patients with IMN,nine were boys and sixteen were girls.The mean age at onset was(9.4±3.4)years with a range of 2-14 years.Renal biopsies were performed at a median 2.5 months(range 0.4-11 months)after onset.The clinical manifestations included nephrotic syndrome(NS)nephritic type in 21 cases(84%)and glomerulonephritis in 4 cases.All patients presented with hematuria,and 7 had macroscopic hematuria.Hypertension was noted in 4 patients.Two patients were complicated with thrombosis.One patient was in a chronic renal insufficiency(CRI)state.According to the MN staging criteria,21 cases were in stage Ⅱ IMN(84%).Six patients showed moderate or severe tubulointerstitial lesion.Focal segmental glomerulosclerosis(FSGS)was found in two patients.Of the 22 patients with NS and nephrotic proteinuria,21 cases were treated with prednisone initially and in 20 of them the efficacy of corticosteroid therapy was evaluated:one of them was steroid sensitive(became steroidresistant after relapse)and all the others were steroid-resistant(95%).The subsequent treatment:eight of them were treated with prednisone followed by a taper to alternate-day therapy.Five of them had complete remission and three partial remission.Twelve cases were treated with combined therapy of prednisone and immunosuppressive agents. Of these 12 cases together with one case who received initially combined treatment with prednisone and immunosuppressive agent and one case treated with prednisone initially for five weeks then with combined therapy contained another immunosuppressive agent,totally 14 cases,5 had complete remission,2 partial remission,3 did not achieve remission,and 3 had unknown response.Conclusion Of the patient cohort,the predominant presenting feature was nephrotic syndrome,and with different degree hematuria.Almost all of them were steroid resistant,but followed by a taper to alternate-day therapy,some could achieve remission.The effect of a combination of prednisone and immunosuppressive agent is needed to be further proven in children.     

小儿致密物沉积病的临床与病理分析

Objective To analysis the clinical and pathological characteristics of children with dense deposit disease (DDD). Methods 12 Children diagnosed as DDD by electron microscope were enrolled in this study. The clinical and pathological data were analyzed. Results Of the 12 cases, 7 were males and 5 females, mean age 9.1±3.9(5-13) years at onset, the duration from onset to renal biopsy was 1 month to 5 years and the follow-up period was 1-9 years. All cases had heavy proteinuria >50 mg/(kg·d), and persistent microscopic hematuria with recurrent gross hematuria during the course. Seven cases had hypertension (≥140/100 mm Hg, 1 mm Hg=0.133 kPa), 5 cases had transient or recurrent abnormal renal function, and mild to severe anemia were observed in 8 cases respectively. All the cases had lower serum C3(0.15-0.55 g/L). Clinically, 10 cases were diagnosed as nephritic syndrome (one case had partial lipodystrophy at the sa me time), and 2 cases were diagnosed as acute nephritic syndrome. Immunofluorescence study showed intense deposition of C3 along GBM, TBM and the wall of Bowman's capsule in a ribbon-like pattern and in the mesangial regions as coarse granules in all the cases. Under light microscopy, 9 cases showed the feature of membrane proliferative glomerulonephritis (MPGN), 1 case with focal segmental glomeruloselerosis (FSGS), 1 case with endocapillary proliferative glomerulonephritis (EnPGN) and 1 case with proliferative sclerosis (PSGN). Crescents were seen in 3 cases. Under electron microscopy, ribbon-like or linear electron-dense intramembranous deposits were identified in the lamina dense of GBM, and often along TBM and the wall of Bowman's capsule. All patients showed steroid resistance. After methylprednisone treatment, some patients showed transient remission. During the followup stage of 1-9 years, 3 cases showed normal urinalysis, 5 cases showed partial remission, 2 cases progressed to end stage renal disease (ESRD) and 2 cases were lost. Conclusion DDD is an in dependentiy rare disease with pathological-clinical rarities. Children with DDD presented with persistently lower C3, heavy proteinuria, recurrent gross hematuria and anemia. The characteristic immunopathologic finding is intense deposition of C3 along the GBM. Under electron microscopy, ribbon-like or linear electron-dense deposits in the lamina dense of the GBM, TBM and the wall of Bowman's capsule. Electron microscopic examination to demonstrate the intramembranous dense deposits is definitive diagnosis, regardless of the finding of light microscopy. All of them showed steroid resistant. Patients with steroid and CTX treatment showed some clinical improvement of their urinalysis.     

Clinical and laboratory results of 270 children with infectious mononucleosis北大核心CSCD

Objective To summarize the clinical and laboratory characteristics of infectious mononucleosis (I M) in children. Methods Clinical features and laboratory results of 270 cases with IM admitted to the Department of Pediatrics in Strategic Support Force Medical Center of People's Liberation Army from January 2012 to December 2020 were retrospectively analyzed. χ2 test was used for comparison between groups. Results IM mainly occurred in children aged 5 months to 18 years old in autumn and spring. The highest incidence rate (105 cases, 38.9 %) was 3 - <6 years old (preschoolers). There were 253 cases (93.7%) with fever, 266 cases (98.5 %) with adenopharyngitis, 196 cases (72.6%) with tonsil pseudomembrane or exudation, 248 cases (91.9%) with cervical lymphadenopathy, 92 cases (34.1%) with eyelid edema, 202 cases (74.8%) with nasal obstruction, 124 cases (45.9%) with nasal obstruction and snoring, 24 cases (8. 9 %) with rash, and 112 cases (41.5%) with splenomegaly. A total of 225 cases (83.3%) presented with typical triplets of IM (fever, adenopharyngitis and cervical lymphadenopathy). Sixty - two IM patients were complicated with pulmonary infections and 3 cases with diarrhea. The main co - infection pathogens in children with IM were Mycoplasma pneumonia (M P) (79 cases, 29.3%), influenza A or B virus (34 cases, 12.6%), Streptococcus pneumonia (S P) (18 cases, 6.7%), adenovirus (22 cases, 8.1%) and cytomegalovirus (3 cases, 1.11%). A total of 46 cases (17.0%) had multiple infections. Laboratory test results suggested that absolute lymphocyte count 5. 0 x 109/L was found in 199 cases (73.7%), and abnormal lymphocyte ratio > 0.10 was found in 225 cases (83.3%). Some children had elevated transaminase levels. Epstein - Barr virus capsid antigen - immunoglobulin M (EBV - VCA - IgM) was positive in 249 cases (92.2%), Epstein - Barr virus capsid antigen - immunoglobulin G (EBV - VCA - IgG) was positive in 238 cases (88.1%), and Epstein - Barr virus nuclear antigen - immunoglobulin G (EBV - NA - IgG) was negative in all cases. EBV - VCA - IgG showed low affinity in all cases (< 40%). EBV DNA tests of peripheral blood plasma were carried in 153 cases, of which 118 cases (77.1%) were positive. Conclusions EBV related IM mainly attacks preschoolers. Most patients are presented with typical triplets of IM. Eyelid edema, nasal obstruction, snoring, splenomegaly and elevated transaminase levels are prevalent in IM children. Most cases have a favorable prognosis. © 2022 ＣｈｉｎＪＡｐｐｌＣｌｉｎＰｅｄｉａｔ. All rights reserved.     

Two approaches for newborns with critical congenital heart disease: a comparative study

Background Prenatal diagnosis and planned peripartum care is an unexplored concept in China.This study aimed to evaluate the effects of the“prenatal diagnosis and postnatal treatment integrated model”for newborns with critical congenital heart disease.Methods The medical records of neonates(≤28 days)admitted to Fuwai Hospital were reviewed retrospectively from January 2019 to December 2020.The patients were divided into“prenatal diagnosis and postnatal treatment integrated group”(n=47)and“non-integrated group”(n=69).Results The age of admission to the hospital and the age at surgery were earlier in the integrated group than in the non-integrated group(5.2±7.2 days vs.11.8±8.0 days,P<0.001;11.9±7.0 days vs.16.5±7.7 days,P=0.001,respectively).The weight at surgery also was lower in the integrated group than in the non-integrated group(3.3±0.4 kg vs.3.6±0.6 kg,P=0.010).Longer postoperative recovery time was needed in the integrated group,with a median mechanical ventilation time of 97 h(interquartile range 51–259 h)vs.69 h(29–168 h)(P=0.030)and with intensive care unit time of 13.0 days(8.0–21.0 days)vs.9.0 days(4.5–16.0 days)(P=0.048).No significant difference was observed in the all-cause mortality(2.1 vs.8.7%,P=0.238),but it was significantly lower in the integrated group for transposition of the great arteries(0 vs.18.8%,log rank P=0.032).Conclusions The prenatal diagnosis and postnatal treatment integrated model could significantly shorten the diagnosis and hospitalization interval of newborns,and surgical intervention could be performed with a lower risk of death,especially for transposition of the great arteries.     

新生儿医院感染的调查分析

目的 通过对新生儿医院感染病例进行流行病学调查,探讨其危险因素,分析病原学,为预防和控制医院感染提供依据.方法 对我院新生儿病房2007年1月至2009年12月,医院感染病例的流行病学资料、临床特点、病原学、细菌耐药资料进行回顾性分析和调查.结果 研究期间住院总人数为6347例,发生医院感染433例,感染例次数513例,医院感染率为6.82％,例次感染率8.0％;总住院日73 663 d,日医院感染率6.96‰;呼吸机相关性肺炎发病率为28.7‰;导管相关性血流感染发病率3.5‰.经多元logistic回归分析,结果 显示发生医院感染的主要危险因素是胎龄(OR=1.049)、机械通气(OR=1.810)、脐静脉置管(OR=1.106)、住院时间(OR=1.081)、胎膜早破(OR=1.433).在医院感染疾病构成中,以肺炎最多见,共197例次(38.4％);其中呼吸机相关性肺炎129例次,占肺炎的65.5％,占呼吸机使用人数的24.4％;其次为败血症124例次(24.2％)和腹泻病65例次(12.7％).病原以革兰阴性菌最多见(54.4％),主要为肺炎克雷伯菌(19.6％)、鲍曼不动杆菌(8.1％)、铜绿假单胞菌(7.2％)、嗜麦芽窄食单胞菌(4.8％)和大肠埃希菌(4.8％).肺炎克雷伯菌和大肠埃希菌的产超广谱β-内酰胺酶( ESBLs)率分别达91.4％和75.0％,对头孢菌素普遍耐药;肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌对亚胺培南的耐药率分别为1.5％、11.1％和41.7％.耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为28.6％和95.5％.结论 充分了解新生儿医院感染的危险因素,缩短机械通气和住院时间,尽早拔除中心静脉置管可降低医院感染发病率;革兰阴性菌是最主要的医院感染病原,其中肠杆菌和非发酵菌的多重耐药现象已相当严重.     

儿童产超广谱β-内酰胺酶菌株感染危险因素分析

目的：研究儿童产超广谱β-内酰胺酶（ESBLs）菌株感染的危险因素。方法：回顾性分析2009年2月至2011年1月242例下呼吸道感染住院患儿的临床资料,应用单因素分析和非条件logistic回归分析进行产ESBLs菌株感染的危险因素调查。结果：单因素分析显示6个因素与产ESBLs菌株感染有关：反复口鼻腔吸痰（OR=2.279,P<0.01）、气管插管（OR=3.101,P<0.01）、应用第三代头孢菌素大于3 d（OR=3.628,P<0.01）、入住儿科重症监护病房（PICU）（OR=2.378,P<0.01）、留置鼻饲管（OR=2.460,P<0.01）、预防应用抗生素（OR=1.747,P<0.05）。非条件logistic多元回归分析显示,应用第三代头孢菌素大于3 d（OR=5.672,P<0.01）、反复口鼻腔吸痰（OR=3.917,P<0.01）、气管插管（OR=3.717,P<0.01）、留置鼻饲管（OR=2.961,P<0.01）、入住PICU（OR=3.237,P<0.01）为产ESBLs感染菌的独立危险因素。结论：产ESBLs菌株感染为多因素所致,其中主要与第三代头孢菌素的使用、侵袭性操作、入住PICU密切相关。     

儿童医院获得性肺炎的病原学及流行特征

目的 总结儿童医院获得性肺炎(HAP)的病原学及流行特征.方法 回顾性分析2005年1月至2008年12月本院52639例住院患儿的医院感染资料.结果 共诊断HAP 698例,发病率为1.33%,其中早发HAP为108例(占15.47%);晚发HAP 590例(占84.53%).男503例,女195例,年龄3 d～15岁,其中1岁以下占51.4%.原发病以巨细胞病毒肝炎、先天性心脏病、恶性肿瘤、粒细胞减少或缺乏、早产和低体重儿为多见.以ICU发病率最高,其次为感染科、血液科和消化科.有355例患儿进行痰液病原学检测,共检出病原体231株,以革兰阴性菌最多见(67.5%),其次为革兰阳性菌(13.0%)、呼吸道病毒(12.6%)、真菌(6.5%)及支原体(0.4%).居前5位的革兰阴性菌分别为肺炎克雷伯菌、嗜麦芽假单胞菌、洋葱伯克霍尔德菌、大肠埃希菌及鲍曼不动杆菌,其中肺炎克雷伯菌和大肠埃希菌的产超广谱β-内酰胺酶(ESBLs)率分别为94.8%和85.7%,对头孢菌素普遍耐药.早发HAP病原以呼吸道合胞病毒、缓症链球菌、肺炎链球菌、流感嗜血杆菌及肺炎克雷伯菌为多见.而晚发HAP则以ESBLs阳性的肺炎克雷伯菌、嗜麦芽假单胞菌、洋葱伯克霍尔德菌、大肠埃希菌及鲍曼不动杆菌为主.结论 HAP好发于1岁以下及有基础疾病的患儿,病原以革兰阴性菌最多见,呼吸道病毒亦是重要病原;早发和晚发HAP的病原构成小同.本研究结果 有助于儿童HAP的防控,可指导合理应用抗菌药物.     

儿童重症监护病房侵袭性真菌感染38例临床分析

目的：探讨儿童重症监护病房（PICU）侵袭性真菌感染（IFI）的临床特征,为其有效防治提供依据。方法：回顾性分析38例IFI患儿的临床特征及治疗转归情况。结果：38例患儿中,以呼吸道感染最多见（89%）;感染前均有较严重的基础疾病,且使用过多种抗生素,其中碳青霉烯类抗生素使用率高达95%;47%患儿曾全身激素治疗;所有患儿均有侵入性操作史,其中47%患儿接受过气管插管及机械通气治疗;所有患儿临床症状及体征不典型,影像学检查无特异性。真菌培养共检出致病真菌56株,以白色念珠菌为主（41%）,其次为曲霉菌（25%）和毛霉菌（20%）;所有患儿及时予以高效抗真菌药物治疗,治愈15例,好转16例,有效率为82%,不良反应发生率为16%。结论：呼吸道为最常见IFI感染部位;白色念珠菌为主要病原;多数患儿有严重基础疾病、广谱抗生素及糖皮质激素的使用史和侵入性操作史;早期诊断、及时使用高效抗真菌药物可改善预后。     

小胎龄早产儿支气管肺发育不良发生率和危险因素分析

目的探讨小胎龄早产儿支气管肺发育不良(BPD)的发生率和高危因素。方法回顾性分析2008年5月至2011年12月我院新生儿科收治、胎龄≤32周、且存活28天以上的早产儿临床资料,发生BPD的早产儿为BPD组,按1∶2的比例随机选取未发生BPD的早产儿为对照组。结果共纳入197例早产儿,BPD组28例,BPD发生率14.2%,早产儿随胎龄和出生体重降低BPD发生率明显增加,各胎龄段和体重组差异均有统计学意义(χ2=32.269,30.244,P=0.000)。通过对23个单因素的分析发现,BPD组和对照组胎龄、出生体重、吸氧时间、最高吸入氧浓度、住院时间、气管插管机械通气、应用肺表面活性物质治疗、贫血、使用美罗培南、第10天体重/出生体重比值、氧合指数<300和生后第1次血气评分值12个单因素差异有统计学意义(P均<0.05);多因素Logistic回归分析发现,出生体重低(OR=0.996)、吸氧浓度高(OR=0.898)、第10天体重/出生体重比值小(OR=1.069)为发生BPD的高危因素(P均<0.05)。中重度BPD组与轻度BPD组相比,窒息和使用利尿剂比例高、吸氧时间长、生后第1次血气评分低,差异有统计学意义(P均<0.05)。结论出生体重低、吸入高浓度氧、第10天体重/出生体重比值低为小胎龄早产儿发生BPD的高危因素。     

早产儿经鼻高流量氧疗安全性和有效性的系统评价和Meta分析

目的评价经鼻高流量氧疗(HFNC)用于早产儿的安全性和有效性。方法计算机检索中国知网、中国生物医学文献数据库、维普数据库、万方数据库、Medline、Embase、Web of Sience和the Cochrane Library,收集早产儿应用HFNC(HFNC组)和经鼻持续气道正压通气(NCPAP组)的RCT,检索时间为建库至2017年3月31日。主要结局指标:住院病死率和治疗失败需有创机械通气(气管插管)率;次要结局指标:支气管肺发育不良(BPD)、气漏、肺部感染和鼻部损伤的发生率,肺表面活性物质的应用率。结果 8篇文献1 604例患儿进入本文Meta分析,HFNC组799例,NCPAP组805例。8篇均报告了计算机随机序列产生,7篇采用分配隐藏,8篇文献均无失访、数据完整性好、研究结果无选择性报告,其他偏倚不清楚。两组病死率和气管插管率差异均无统计学意义。病死率行亚组分析,差异仍无统计学意义。气管插管率行亚组分析显示,体重均数≥1 500 g(OR=1.58,95%CI:1.11~2.26,P=0.01)和胎龄≥28周(OR=1.58,95%CI:1.13~2.22,P=0.008),NCPAP组气管插管率低于HFNC组。BPD、气漏、肺部感染发生率和肺表面活性物质应用率,两组差异无统计学意义。HFNC组鼻部损伤发生率低于NCPAP组(OR=-0.14,95%CI:-0.19~-0.09,P0.0001)。结论 HFNC应用于早产儿的疗效和安全性有待进一步证实,其鼻部损伤发生率低于NCPAP。     

Risk factors for ventilator-associated pneumonia in the neonatal intensive care unit: a meta-analysis of observational studies

Ventilator-associated pneumonia (VAP) is a common and serious problem among mechanically ventilated patients in intensive care units (ICU), especially for the newborn. However, limited literatures have been reviewed to synthesize the finding of previous papers to investigate the risk factors for VAP although it has been a serious complication of mechanical ventilation (MV) with a high morbidity and mortality in the newborn. We performed this meta-analysis to extend previous knowledge for developing VAP prevention strategies by identifying the potential risk factors related to VAP in the neonatal intensive care unit (NICU). The relevant literatures published up to July 2013 were searched in the databases of PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science. Three reviewers screened those literatures and extracted data according to the inclusion and exclusion criteria independently. A total of eight studies including 370 cases and 1,071 controls were identified. Ten risk factors were found to be related to neonatal VAP which were listed as follows in order by odds ratios (ORs): length of stay in NICU (OR 23.45), reintubation (OR 9.18), enteral feeding (OR 5.59), mechanical ventilation (OR 4.04), transfusion (OR 3.32), low birth weight (OR 3.16), premature infants (OR 2.66), parenteral nutrition (OR 2.30), bronchopulmonary dysplasia (OR 2.21), and tracheal intubation (OR 1.12). Conclusion: We identified ten variables as independent risk factors for the development of VAP: length of stay in NICU, reintubation, enteral feeding, mechanical ventilation, transfusion, low birth weight, premature infants, parenteral nutrition, bronchopulmonary dysplasia, and tracheal intubation. Due to several limitations in the present study, further large and well-designed studies are needed to confirm the conclusion.     

肠道病毒71型感染首发肺水肿与肺出血三例报告

目的 了解肠道病毒71型首发肺水肿或肺出血的暴发性致死性的临床特征.方法 回顾分析3例的临床表现,化验检查,诊断,治疗转归等.结果 此3例均死亡,病初仅有发热、呕吐等非特异性症状,均无手足口臀部皮疹,发病后1～2 d病情迅速恶化,突发口唇发绀,呼吸急促.3例均误诊,因考虑感染性休克而扩容.均未能早期认识肺出血,直至出现口鼻吐血性液、全身发绀等才行气管插管,气管内均见大量血性泡沫液.3例血糖显著升高和肌张力降低,2例心动过速,1例高血压.3例胸片双侧或单侧渗出性病变,心影不大,3例外周血白细胞均升高,3例咽拭子、气管分泌液和1例脑脊液样本均检测到肠道病毒71型.结论 婴幼儿首发肺水肿或肺出血患儿,符合肠道病毒71型感染特点,发生神经源性肺水肿或肺出血,急诊医生对该类疾病认识和处理不足.婴幼儿病初仅发热伴呕吐,数天后突发口唇发绀,呼吸急促,心动过速,高血压或低血压,肌张力低下,应高度怀疑该病,警惕肺水肿、肺出血.及时告知预后不良,扩容将迅速加剧病情恶化,应严格控制液体,早期气管插管正压通气,积极心功能支持.     

新生儿社区和院内获得性肺炎的病原学特点及药敏分析

目的探讨新生儿社区获得性肺炎(CAP)和院内获得性肺炎(HAP)的病原分布和药敏情况。方法回顾性分析2010年1月—2014年12月因新生儿肺炎住院且痰培养阳性新生儿的临床资料。结果在3 564例CAP新生儿中共检出病原微生物4 383株,其中细菌3 584株、病毒771、真菌7株及非典型病原体21株。细菌以革兰阴性菌为主,3 045株(85.0%),细菌中排名前三的为肺炎克雷伯菌、大肠埃希菌及金黄色葡萄球菌;病毒以呼吸道合胞病毒为主,693株(89.9%)。在344例HAP新生儿中共检出病原微生物424株,其中细菌402株,真菌17株,呼吸道合胞病毒5株。细菌均为革兰阴性菌,未发现革兰阳性菌,排名前三的为肺炎克雷伯菌、大肠埃希菌及鲍曼不动杆菌。CAP与HAP新生儿中革兰阴性菌产ESBLs菌分别为26.9%、46.8%,差异有统计学意义(P?0.05)。CAP、HAP的肺炎克雷伯菌和大肠埃希菌均对阿米卡星、碳青霉烯类高度敏感。HAP的肺炎克雷伯菌对常用抗菌药物(除阿米卡星、喹诺酮类外)的敏感性普遍低于CAP,差异有统计学意义(P?0.05);HAP的大肠埃希菌对常用抗菌药物(除阿米卡星、喹诺酮类及碳青霉烯类外)的敏感性普遍低于CAP,差异有统计学意义(P?0.05)。此外,还发现耐碳青霉烯类的肠杆菌。结论新生儿肺炎病原菌以革兰阴性菌为主,其中CAP以肺炎克雷伯菌、大肠埃希菌及金黄色葡萄球菌为主,HAP以肺炎克雷伯菌、大肠埃希菌及鲍曼不动杆菌为主。HAP致病菌的产酶率和耐药性均普遍高于CAP,且有多重耐药趋势。     

Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial

OBJECTIVE: We studied the efficacy and safety of electively providing surfactant to preterm infants with mild to moderate respiratory distress syndrome (RDS) not requiring mechanical ventilation. STUDY DESIGN: A 5-center, randomized clinical trial was performed on 132 infants with RDS, birth weight >or=1250 grams, gestational age or=40% for >or=1 hour, and no immediate need for intubation. Infants were randomly assigned to intubation, surfactant (Survanta, Ross Laboratories, Columbus, Ohio) administration, and expedited extubation (n=65) or expectant management (n=67) with subsequent intubation and surfactant treatment as clinically indicated. The primary outcome was duration of mechanical ventilation. RESULTS: Infants in the surfactant group had a median duration of mechanical ventilation of 2.2 hours compared with 0.0 hours for control infants, since only 29 of 67 control infants required mechanical ventilation (P=.001). Surfactant-treated infants were less likely to require subsequent mechanical ventilation for worsening respiratory disease (26% vs 43%, relative risk=0.60; 95% CI, 0.37, 0.99). There were no differences in secondary outcomes (duration of nasal continuous positive airway pressure, oxygen therapy, hospital stay, or adverse outcomes). CONCLUSIONS: Routine elective intubation for administration of surfactant to preterm infants >or=1250 grams with mild to moderate RDS is not recommended.