Car transportation conditions of preschool children: use of children's car safety seats

The objective of this study was to evaluate children's car safety seat usage in a non-random study population of the Capital and surrounding area of Attica and a provincial region in Greece. One or both of the parents of 1556 children (aged 0–4 years) were interviewed. A questionnaire covering car safety seat usage by area of residence, age of parents, educational background, socioeconomic status and the number of siblings was completed. Optimal car safety seat restraint usage in the Attica region was 10.4% for infants 0–6 months old, 37.6% for infants 7–12 months old, 40.9% for children aged 1–2 years and 12% for children aged 3–4 years; the use of restraint systems in the provincial area was even lower at 4.9%, 15.2%, 24% and 6.6%, respectively. The mother's age, number of children and the socioeconomic status of the family seemed to influence the purchase and usage of the car safety seat. Such a high percentage of non-usage of car safety restraint seats has led to the Paediatric Society's initiative to create informative general public educational programmes and to urge governmental legislation regarding mandatory usage of children's car safety seats.     

Persistence of acute rheumatic fever in a tertiary children's hospital

Aim: To identify and describe all children admitted with acute rheumatic fever (ARF) to a tertiary paediatric hospital in Sydney over a 9‐year period and to describe their demographic and clinical characteristics, management and short‐term outcomes. Delays in diagnosis, recurrence of ARF and use of secondary prophylaxis were also documented. Methods: Retrospective review of medical records for children aged <15 years admitted to the Children's Hospital at Westmead, Sydney, with ARF (International Classification of Diseases (ICD)‐10 classification I0.0–I09.9) during 2000–2008. Only cases meeting the National Heart Foundation of Australia diagnostic criteria for ARF were included. Results: Twenty‐six children met the National Heart Foundation of Australia criteria for ARF. The median age was 11.5 years (range 5.8–14.6) and 15 (58%) were male. Ten (38%) identified as Pacific Islander, and 5 (19%) as Aboriginal and Torres Strait Islander (ATSI). Most (n= 20, 77%) lived in suburban Sydney, and 69% were classified in the two most disadvantaged quintiles on the Index of Relative Socioeconomic Disadvantage and Advantage. Four (15%) had Sydenham's chorea, and 81% had carditis (mitral and/or aortic regurgitation). Six (23%) children had previous ARF. Antibiotic prophylaxis to prevent recurrent ARF was prescribed in all cases, but 50% received oral penicillin, rather than by intramuscular injection. Barriers to timely diagnosis were identified in 81%, including delayed presentation and delayed referral. Conclusion: Most children presenting to the hospital with ARF lived in disadvantaged areas of Sydney. Pacific Islander and Aboriginal and Torres Strait Islander children were over‐represented. Mitigation of RHD requires early identification of ARF and appropriate delivery of secondary prophylaxis.     

Penetrating missile-type head injury from a defective badminton racquet

Injuries occurring during badminton are rarely serious and primarily involve the lower extremities. We report an instance wherein a patient suffered serious brain injury related to playing with a defective badminton racquet. The possibility of similar injuries following the separation of the racquet head and shaft from the handle needs to be disseminated.     

小儿急性肾损伤的流行病学

近年来国际肾脏病和急救医学界趋向于用急性肾损伤(acute kidney injury,AKI)来取代急性肾功能衰竭的概念.儿童AKI的病因日趋复杂,已由原发性肾脏疾病为主转变为多因素所致,且AKI不仅明显延长了PICU患儿的住院时间,也增加了PICU患儿的病死率.本文将对AKI的病因及流行病学作一简单的介绍,并对RIFLE及AKIN两个诊断标准进行分析.     

五年内儿童意外损伤住院情况调查

目的 了解儿童意外损伤发生的原因及危险因素,为意外损伤的防预提供依据.方法 对2005年1月1日至2009年8月31日在复旦大学附属儿科医院住院的4 116例意外损伤患儿的临床资料进行回顾性分析.结果 意外损伤患儿占同期住院总人数的4.35％ (4 116/94 579).男女之比为2.01∶1.意外损伤前3位病因分别是意外跌伤(30.73％,1 265/4 116)、交通事故(23.71％,976/4 116)和意外坠落( 11.59％,477/4116).意外跌伤主要见于1岁以上儿童,交通事故主要好发于4～7岁儿童,而意外坠落伤则主要见于l岁以内婴幼儿.其中病死率最高的前3位意外损伤原因分别是气道异物、溺水和中毒.意外损伤的好发部位为骨关节.结论 儿童意外损伤已严重威胁儿童的生命安全,应根据儿童各年龄段的特点,采取相应的防范措施.     

支气管镜在儿童呼吸系统疾病应用的安全性研究进展

随着支气管镜技术的不断发展和完善,支气管镜在儿科领域的应用日益广泛.同时,由于儿童自身的特殊性,支气管镜在儿科应用的安全性问题一直都备受关注.与儿童支气管镜诊疗安全性相关的研究及观察也逐渐成为热点.为了降低不良反应和并发症的发生率,术前应仔细评估并进行积极的心理护理.术中应选择适合的麻醉方式、持续给氧、熟练快捷地完成操作并应密切监护患者的生命体征.尤其是对于小年龄组患者更要引起高度重视.为了避免患者发生不必要的医源性感染,还应完善严格执行消毒隔离制度.同时也要保护好医护人员的安全.     

Management of minor closed head injury in children and adolescents

In order to develop a systematic, evidence-based approach to minor closed head injury (CHI) in the pediatric patient, case records were reviewed of all 2,533 children and adolescents admitted to Cooper Hospital/University Medical Center for minor CHI during the years 1986 to 1992. A survey was taken during a 6-month period of 734 consecutive pediatric patients dischanged from the Emergency Department for minimal CHI (out of a total of 10,276 children during the entire 7 years of the study). Categories of minor CHI derived from studies in adults were used to group data. For each category of minor CHI, the frequency of various complications such as skull fracture, intracranial lesions, and need for neurosurgical intervention was determined. Also reviewed were survival and neurological outcome 6 months following injury. Children with moderate CHI had a 37% incidence of intracranial lesions on computed tomography (CT) scan and 9% of them required intracranial surgery. The incidences of intracranial lesions and surgical intervention in the mild CHI group were 12% and 2.6%, respectively. Children with Glasgow Coma Scale scores of 13 belonged in the moderate rather than the mild CHI group, as evidenced by their higher risk. Skull fracture was not highly correlated with intracranial pathology or the need for surgery. Age had no significant impact on the incidence of lesions, rate of surgery, or outcome. Both intracranial lesions and surgery were extremely rare in the minimal CHI group. We propose three categories of minor CHI based upon relative severity (minimal, mild, and moderate) and offer a simple management scheme for each category. Based on our experience with this approach, we estimate that 80% of children with minor CHI can safely be dischanged from the Emergency Department. Cranial CT scanning will be required in only 7% of cases, but when indicated, will be extremely valuable in guiding further care.     

细胞自噬在急性肾损伤中的作用

急性肾损伤(acute kidney injury,AKI)是一种临床预后较差的常见疾病,肾小管上皮细胞的损伤及死亡是其主要的病理特征.近年来,大量的研究已经表明在急性肾损伤过程中,自噬在肾小管上皮细胞中被诱导发生.在多种药理干预或自噬相关基因敲除的急性肾损伤模型中,自噬能通过抑制炎症反应、清除损伤的细胞器等相关机制减少细胞凋亡,保护肾脏损伤.但是也有研究表明自噬在急性肾损伤中起损害作用.阐明自噬在急性肾损伤中的作用及相关调节机制能够为急性肾损伤的治疗及预后提供重要线索.     

急性肾损伤患儿的营养支持

急性肾损伤是危重患儿常见的多器官功能障碍之一,常发生在危重疾病的严重分解代谢期,代谢紊乱又使肾损伤进一步加重。营养支持对于改善预后至关重要。伴有急性肾损伤的危重患儿存在特殊的营养需求,需要提供肠内或肠外营养支持。应反复评估此类患儿营养需求的变化,以寻求个体化营养支持以及与肾脏替代治疗的精细整合。     

Blunt cerebrovascular injury in children

Blunt cerebrovascular injury in children is an uncommon occurrence that if missed and left untreated can result in devastating long-term neurologic consequences. Diagnosis can be readily obtained by a computed tomographic angiogram of the head and neck. If confirmed, treatment with antithrombotic therapy dramatically reduces the risk of a cerebrovascular accident. The difficulty lies in determining which child should be screened for such an injury. Several institutions have come up with criteria for screening. In this article, we review the nuances of the cerebrovascular system and its resulting injury. We present recent literature on the subject in an attempt to add clarity to this challenging situation.     

儿童急性肾损伤的诊断及早期标志物

近年来国际肾脏病和急救医学界应用急性肾损伤取代传统急性肾功能衰竭的概念,旨在早期诊断,以期达到早期干预、早期治疗、降低病死率的目的.单纯根据尿量及血肌酐值的变化不能早期及时诊断急性肾损伤,目前一些新的生物学标志物的出现为急性肾损伤的早期诊断和早期干预提供了可能.     

儿童创伤性胸主动脉假性动脉瘤一例报道及文献复习

目的 探讨创伤导致的儿童胸腹主动脉损伤的诊疗方法,以增加大家对这种临床罕见病的认识.方法 报道1例4岁女孩的创伤性胸主动脉瘤的诊断及治疗,并通过PubMed检索Medline数据库、检索Springer Link和Google Scholar等检索平台、及Embase、Ovid、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方和维普数据库,对儿童创伤性胸腹主动脉损伤的中英文文献进行系统性的综述.结果 一共43例年龄在14岁以下的创伤性胸腹主动脉损伤的患儿纳入本研究.交通伤26例是最常见的致伤机制.7例(16.3％)患儿伤后未及时诊断或初诊时漏诊.6例患儿随访中存在不同程度的后遗症.主动脉损伤以假性动脉瘤(20例)最常见,其次为内膜剥离(7例)及主动脉夹层(7例).27例患儿行开放主动脉修复术,7例行血管内治疗,7例患儿保守治疗,2例患儿行急诊手术,并在围手术期死亡.结论 血流动力学不稳或主动脉完全破裂的患儿需要急诊手术.而主动脉内膜环形剥离患儿发生并发症的可能性较高,需要限期手术.没有明显症状的内膜部分剥离或是迟发型假性动脉瘤的患儿可以保守治疗,但需要密切观察,如果假性动脉瘤进展,则需要手术.     

Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool

Background:  Though rare, allergic reactions occur as a result of administration of low osmolality nonionic iodinated contrast material to pediatric patients. Currently available resuscitation aids are inadequate in guiding radiologists’ initial management of such reactions. Objective:  To compare radiology resident competency with and without a computer-based interactive resuscitation tool in the management of life-threatening events in pediatric patients. Materials and methods:  The study was approved by the IRB. Radiology residents (n = 19; 14 male, 5 female; 19 certified in basic life support/advanced cardiac life support; 1 certified in pediatric advanced life support) were videotaped during two simulated 5-min anaphylaxis scenarios involving 18-month-old and 8-year-old mannequins (order randomized). No advance warning was given. In half of the scenarios, a computer-based interactive resuscitation tool with a response-driven decision tree was available to residents (order randomized). Competency measures included: calling a code, administering oxygen and epinephrine, and correctly dosing epinephrine. Results:  Residents performed significantly more essential interventions with the computer-based resuscitation tool than without (72/76 vs. 49/76, P < 0.001). Significantly more residents appropriately dosed epinephrine with the tool than without (17/19 vs. 1/19; P < 0.001). More residents called a code with the tool than without (17/19 vs. 14/19; P = 0.08). A learning effect was present: average times to call a code, request oxygen, and administer epinephrine were shorter in the second scenario (129 vs. 93 s, P = 0.24; 52 vs. 30 s, P < 0.001; 152 vs. 82 s, P = 0.025, respectively). All the trainees found the resuscitation tool helpful and potentially useful in a true pediatric emergency. Conclusion:  A computer-based interactive resuscitation tool significantly improved resident performance in managing pediatric emergencies in the radiology department.     

预防儿童乘客车内伤害的研究进展

汽车上的安全措施如安全带和气囊等都是依据成人设计的,因此儿童使用专为成人设计的安全设施只会增加受伤的可能.研究发现交通事故中坐在车内前排不使用任何约束装置的儿童受伤风险最高,坐在后排使用合适约束装置的儿童受伤风险最小.针对儿童家庭和家长的教育是实施立法和推广儿童约束装置使用的基础,但需要和其他方法或手段结合干预才可能有效.立法是预防儿童乘客伤害的一种最有力工具,但是如何在发展中国家一贯地实施和有力地执行这些法律更加重要.