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??Objective To evaluate the risk factors for retinopathy of prematurity??ROP??for effective prevention.
Methods Studies were identified through literature search in Cochrane Library??PubMed??MEDLINE??Wanfang Periodicals Database??China Science Periodical Database and Chongqing VIP Science and Technology Journal Full-text Database up to October 2015. RavMan 5.3 provided by Cochrane was used for the meta-analysis. Results Ten studies were confirmed to be eligible. The meta-analysis showed as following?? low gestational age??WMD?? -1.76??95%CI?? -1.98—1.54?? P??0.01???? blood transfusion??OR??3.44??95%CI??2.41—4.90??P??0.01????sepsis??OR??2.37??95%CI??1.57—3.57??P??0.01????necrotizing enterocolitis ??OR?? 6.65??95%CI??3.46—12.78??P??0.01????patent ductus arteriosus??OR??2.39??95%CI??1.74—3.29??P??0.01????BPD??OR??4.75??95%CI??3.44—6.56??P??0.01????oxygen therapy??OR??2.72??95%CI??1.83—4.05??P??0.01????RDS??OR??2.53??95%CI??1.70—3.79??P??0.01????asphyxia??OR??2.99??95%CI??1.72—5.19??P??0.01????low birth weight??WMD??-238.19??95%CI??-320.93—155.44??P??0.01??. The differences were all significant statistically. Conclusion Low gestational age??blood transfusion??sepsis??necrotizing enterocolitis??BPD??patent ductus arteriosus??oxygen therapy??RDS??asphyxia??low birth weight are risk factors of ROP.     

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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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??Objective To evaluate the clinical therapeutic effect of livecapsules/powder combiningBifidobacterium??LactobacillusandEnterococcus in treating infantile rotavirus enteritis by meta-analysis. Methods Such databases as China Knowledge Resource Integrated Database?? Wanfang Database?? Vip Database?? Pubmed?? Embase and Web of Science were searched from establishingdatabase to December 2015 to collect all randomized controlled trials ??RCT?? and prospective non-randomized controlled trials??non-RCT?? on livecapsules/powder combiningBifidobacterium?? LactobacillusandEnterococcus in treating infantile rotavirus enteritis. The studies were selected according to the inclusion and exclusion criteria. The data were extracted?? the methodological quality of the included studies was assessed?? and the meta-analysis was performed with RevMan 5.2 in February 5??2016. Results A total of 23 prospective non-RCTs involving 3388 patients from 21 studies were included?? including 1804 patients from treatment group??livecapsules/powder combiningBifidobacterium??LactobacillusandEnterococcusplus conventional treatment?? and 1584 patients from control group??conventional treatment??. The total effective rate of the treatment group was superior to that of the control group??OR??4.59?? 95%CI 3.69??5.70?? P??0.01???? the diarrhearelieving time of the treatment group was shorter than that of the control group??MD??-1.39?? 95%CI -2.24 — -0.53?? P??0.001???? the total treatment time of the treatment group was shorter than that of the control group??MD??-1.32?? 95%CI -2.19 — -0.45??P??0.003??. Conclusion Livecapsules/powder combiningBifidobacterium??Lactobacillus and Enterococcus combined with conventional drugs can improve the total therapeutic effect on infantile rotavirus enteritis and shorten the diarrhea relieving time and total treatment time.     

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??Objective??To explore the clinical characteristics of hydrocephalus in children with purulent meningitis. Methods??The children??aged??14 years??treated for purulent meningitis at the Shengjing Hospital of China Medical University during the period from January 2010 to December 2016??were retrospectively enrolled in the study. The clinical data of every child who fulfilled the criteria were obtained and analyzed. Data were analyzed using the Statistical Package for Social Sciences??SPSS??13.0. Results??The morbidity of hydrocephalus in children with purulent meningitis was 9.36%??25/267??. In these cases with hydrocephalus??the ageofonset was mainly under 6 months old??and the period from onset to diagnosis of hydrocephalus was mainly 1-4 weeks. Fifteen cases of hydrocephalus had a confirmed bacterial etiology as follows??Escherichia coli??n??6????Streptococcus pneumoniae??n??2????staphylococcus??n??2????Group B beta-hemolytic streptococcus??n??2????acinetobacter??n??2??and Listeria monocytogenes??n??1??. The incidence of obstructive hydrocephalus was 48%??12/25??. About 56% patients received a previously treatment with antibiotics. The prognoses of these children were??survival in 12 cases??death in 1 case and loss of follow-up in 11 cases. The related factors of the development of hydrocephalus included??a rural living situation??OR??17.64??95%CI 1.23??252.86????altered level of consciousness??OR??7.59??95%CI 1.09??52.86????CSF protein??2.0 g/L??OR??177.02??95%CI 3.53??8866.51????C-reactive protein??100 mg/L??OR??52.29??95%CI 3.26??840.19????initial therapy with dual-agent antibiotic??OR??0.06??95%CI 0.01??0.62????dexamethasone use??OR??149.47??95%CI 2.56??8713.78?? and previous treatment with antibiotics??OR??36.28??95%CI 2.84??462.78??. Conclusion??Hydrocephalus is a serious complication of purulent meningitis. The severe clinical manifestations and significantly abnormal laboratory indexes represent the most important predictor of hydrocephalus in children with purulent meningitis.     

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??Objective??To explore the clinical characteristics of coinfections in children with pertussis. Methods??From February 2016 to September 2017??198 cases with pertussis-like symptom were tested for PCR??bacterial culture??respiratory virus antigen and serum mycoplasma pneumoniae antibody in Children’s Hospital of Soochow University. Results??Totally 198 patients were enrolled and 105 patients were B.Pertussis positive. Single infection was in 37 cases??35.2%??. Coinfections were observed in 68??64.8%?? children with pertussis??including co-infection with one pathogen in 51 cases??75.0%??. The most frequent co-infection pathogen was rhinovirus??50.9%??26 cases????followed by Mycoplasma pneumoniae??13.7%??7 cases?? and Streptococcus pneumoniae??11.8%??6 cases??. There was no statistical difference in the coinfection rate among different age groups??P = 0.08??. Pertussis coinfection with MP was increased with age. Coinfections patients were older than those with single infections???11.77±2.32?? months vs. ??6.74±8.07?? months??P = 0.017??. Fever??dyspnea??and positive signs of lung in chest imang were more common in children with mixed infections??0 vs. 10.3%??20.6% vs. 5.4%??76.5% vs. 36.4%??P??0.05??. Chest imaging showed pathy shadow in most cases. There was no significant difference in lab tests??such as white blood cell counts??neutrophil counts??C-reactive protein??CRP????course of disease prior to admission or hospital stay between patients with pertussis only and those with mixed-pathogen infections??P??0.05??. Patients older than 3 months??OR??3.0??95%CI 1.1-8.5??P??0.03?? and fever??OR??2.5??95%CI 1.1-6.7??P??0.03?? were the independent risk factors for mixed infections. Conclusion??There is a higher proportion of coinfection in hospitalized children with pertussis??most commonly co-infected with rhinovirus??followed by Mycoplasma pneumoniae and Streptococcus pneumoniae. Coinfections are found to aggravate pertussis. Fever and being older than 3 months are risk factors of mixed infection.     

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??Abstract: Objective To investigate the related factors?? clinical features and prognosis of septic shock in children with acute leukemia. Methods Analyse the clinical features??therapeutic measures??effect and death risk factors of eighteen children with acute leukemia and septic shock in our hospital from Jan.1??2005 to Jun.1??2012. Result Male children 15 cases ??83.3%???? with a mean onset age of 9.8 years?? the average strong chemotherapy treatment of 6.5 times. All children’s neutrophile granulocyte count was lower than 0.5 × 109 / L??hypoalbuminemia occurred in 13 cases ??13/15??86.7%???? cardiac dysfunction in 12 cases ??66.7%???? pneumonia in 13 cases ??72.2%???? MODS in 7 cases ??38.9%??. Bacterial culture was gram negative ??G -?? bacillus in 9 cases??including pseudomonas aeruginosa??3 cases????gram positive??G +?? bacteria in 2 cases?? both were hemolytic staphylococcus. Among the 18 cases?? 1 gave up treatment?? 6 cases died?? 11 cases were cured?? and the mortality rate was 35.3%. Single factor analysis results showed that the use of sensitive antibiotics within 24 hours during fever in the shock-correction group and the death group had statistical significances?? as well as the occurrence of MODS in the process of shock rescue ??P??0.05??.Shock merger pneumonia?? cardiac dysfunction?? and refractory-relapsed patients had no statistical significance. Conclusion The older boys?? agranulocytosis?? multiple chemotherapy and hypoalbuminemia are high risk factors of septic shock. Gram negative bacilli is more in bacterial culture?? especially pseudomonas aeruginosa.Staphylococcus heamolyticus can’t be ignored. Patients with cardiac dysfunction are common?? but CK - MB doesn't increase or increase obviously?? Not using sensitive antibiotics within 24 hours since fever occurs and MODS are the high-risk factors causing death. Using sensitive antibiotics as soon as possible and supportting the organ function actively are important measures to reduce the death of children with septic shock.     

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??Abstract??Objective??To study the clinical features of hand-foot-mouth disease ??HFMD?? caused by enterovirus 71 ??EV71?? infection. Methods Clinical data of hospitalized children with hand-foot-mouth disease caused by EV71 infection from May 2010 to August 2010 were analyzed retrospectively. The difference of clinical manifestation and results of auxiliary examination between intensive HFMD group and serious HFMD group were compared. Results??High fever and nontypical skin rash showed significant difference between intensive group and serious group??P = 0.002??P = 0.000??respectively???? 120 EV71-positived HFMD cases ??99.17%?? showed neurological impairments. The major neurological features included fatigue ??84.30%????frequent vomiting ??65.30%????limb tremble ??60.33%?? and sleep disorders ??53.72%??. The rate of abnormal knee reflex was 52.07% in physical examination. The incidence of vomiting??P = 0.001????unconsciousness ??P = 0.000????abnormal muscular tension??P = 0.000????abnormal heart rate ??P = 0.000????dysarteriotony ??P = 0.000????capillary refill time being more than 3 seconds ??CRT > 3 s?? ??P = 0.000????tachypnea or dyspnea ??P = 0.000?? and pulmonary exudative lesion in chest X-ray ??P = 0.000?? was morefrequent in serious group compared with intensive group??There were 51 cases ??42.15% ?? with a peripheral blood WBC count of more than 12 × 109/L or less than 4×109/L??52 cases ??42.98% ?? with blood glucose level of more than 6 mmol/L and cardiac troponin I elevated in 22 cases ??18.18%??. The above three indexes were significantly different between two groups ??P < 0.000??respectively??. Conclusion??HFMD caused by EV71 infection often shows neurological impairments. High fever??nontypical skin rash??frequent vomiting??unconsciousness??abnormal muscular tension??abnormal heart rate??dysarteriotony??CRT > 3s??tachypnea or dyspnea??and pulmonary exudative lesion are risk factors of serious HFMD. Early identification and correct treatment are the key to the rescue of serious HFMD.     

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??Expression and clinical significance of peripheral Th17 cell in children with acute leukemia.????WU Xiao-yan??JIN Run-ming??YU Hui??WANG Fang??XIA Yi. Pediatrics Department of Union Hospital??Tongji Medical School??Huazhong University of Science and Technology??Wuhan 430022??China
Abstract??Objective??To study the relationship between peripheral blood Th17 cells and the occurrence and status of disease of children with acute leukemia. Methods??From Aug. 2008 to Dec. 2009 in Pediatrics Department of Union Hospital??Tongji Medical School Huazhong University of Science and Technology?? 42 children with acute leukemia and 18 healthy children were divided into non-remission group ??Group A??n = 23????remission group ??Group B??n = 19?? and control group ??Group C??n = 18??. Concentration of IL-17 and IL-23 in the peripheral blood monocytes culture supernatant after stimulated with anti-CD3 and anti-CD28 mAb were determined with ELISA. Expression of CD4+ IL-17+ cells was determined with flow cytometry. Results??The concentrations of IL-17 and IL-23 in Group A and Group B were much lower than those in Group C??P < 0.05??. The level of IL-17 in Group A was lower than that in Group B??P < 0.05????while the difference of IL-23 concentration between Group A and Group B was not significant??P > 0.05??. The expression level of Th17 in Group A and Group B were much lower than those in Group C??P < 0.05????and the difference of Th17 expression level between Group A and Group B was significant??P < 0.05??. Conclusion??Th17 cells might play important role in the occurrence and development of children acute leukemia through secreting IL-17??and their function level can partly reflect the status of leukemia and evaluating the risks of infection in children with leukemia.