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??Objective To analyze the clinical characteristics and prognosis of pneumonia complicated with acute respiratory distress syndrome??ARDS?? in pediatric hematological patients in order to improve the clinical treatment level. Methods The data of clinical symptoms??laboratory result??treatment??prognosis and risk factors of 35 hematological children with pneumonia and ARDS admitted between March 2012 and January 2015 in Department of Pediatrics??Sun Yat-sen Memorial Hospital??Sun Yat-sen University were retrospectively analyzed. Results The 35 hematological children with pneumonia and ARDS had high fever??71.4%????cough??85.7%????shortness of breath??88.6%????cyanosis??74.3%????three concave sign positive??74.3%?? and lung rale??65.7%??. The level of PaO2/FiO2 decreased??chest X-ray showed patchy or patchy infiltrates??and diffuse exudation and large consolidation in severe cases. A total of 29 strains of pathogens were isolated??including 22 strains of gram-negative bacteria. In 35 ARDS children??23 cases died??65.7%????and the main cause of death was MODS??in 12 cases??52.2%??. The death cause was related to no remission in primary disease??MODS??shock??severe chest infiltration and the use of mechanical ventilation??P??0.05????but not to the way of mechanical ventilation??P??0.05??. Logistic regression analysis showed that MODS and shock were the independent risk factors of death??P??0.05??. Conclusion The hematological children with pneumonia and ARDS should get more attention for its high mortality. It can be diagnosed early according to the clinical symptoms and signs??the blood gas analysis and chest X-ray. MODS and shock are the independent risk factors of death.     

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??Objective To compare the etiologic factors??clinical features and prognosis in newborns with gastrointestinal perforation. Methods A retrospective study of the clinical data from 80 cases with diagnosis of gastrointestinal perforation collected from January 2004 to December 2015 was performed. Based on whether they were full-term??the cases were divided into two groups??then the clinical features??etiologic factors and prognosis were compared. Results Among the 80 neonates with gastrointestinal perforation??there were 62 preterm infants and 18 full-term infants. The main causes of gastrointestinal perforation for the two groups was necrotizing enterocolitis??with the most frequent clinical symptom of abdominal distension.cases. Compared with full-term infants??the incidence of preterm shock??dyspnea??DIC??and poor reaction was significantly higher in preterm infants??P??0.05??.The mean time period of perforation in preterm infants group was 9??1.75??20?? d??while it was 4.5??1??7.75?? d in full-term infants group.There were 62 cases that received surgical treatment??8 cases of which were gastric perforation and 54 cases were intestinal perforation. The exact site of perforation of the 18 cases who refused surgical treatment was not clear. Of all the cases??32 infants died with the overall mortality rate of 40%. For the preterm infants??the mortality was 41.9% ??26 cases????while it was 33.3% ??6 cases?? in the full-term infants group. Conclusion Neonatal gastrointestinal perforation is one of the serious diseases in neonatal period??which has a very high mortality rate. Early diagnosis??active treatment and timely surgical intervention can significantly improve survival rates and improve the prognosis.     

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??Establishing a regional pediatric transport network is crucial to treatment of critically ill children and implementation of hierarchical medical system. The transport mainly include s communication before transport??assessing and stabilizing patients in local hospital??life support during transport and high quality handoff communication between physicians in receiving hospitals. The transport team members should master the pediatric emergency skills??and the transport equipment and supplies must be in good condition. The transfer center should carry out quality control to improve the quality of transport??and train medical staff in the region and carry out scientific research to improve treatment for critically ill children.     

婴幼儿、学前期儿童上消化道疾病内镜诊治临床研究

为探讨婴幼儿和学前期儿童上消化道疾病内镜诊治价值以及成人内镜应用于儿童的可行性和安全性，选择近5年因摄入异物、黑便和上腹痛等儿童共71例，年龄为娩出后3小时－6岁，所用设备为成人内镜（外径9.8mm-9.0mm)、各种异物钳、内镜微波治疗仪、氧饱和度（SaO2)监视仪和幽门螺杆菌（H.pylori)检测试剂盒等。8例异物紧急内镜诊治，63例常规内镜诊治。结果显示8例异物均取出；1例胃溃疡和2例十二指肠溃疡中的1例伴有活动性出血，1例胃息肉和2例先天性不完全性胃窦幽前隔膜（congenital incomplete prepyloric antral septum,CIPAS)中的1例，共4例行内镜微波凝固治疗（endoscopic microwave coagulation therapy,EMCT)止血或切除，无并发症；57例为慢性胃炎伴或不伴有糜烂或胆汁反流。除8例取异物外，63例检测H.pylori,21例（33．33％）阳性。提示婴幼儿和学前期儿童上消化道疾病内镜诊治甚有价值，成人内镜在这些儿童中的应用是可行和安全的。     

Clinical,endoscopic, and histologic features of eosinophilic inflammation of the gastrointestinal tract in pediatric liver transplant patients

Immunosuppression during the post‐transplantation period has led to dramatic outcome improvements in PLTR patients. There have been reports describing the development of food allergies and an increased predilection for development of EGI in PLTR. We aimed to identify the clinical, endoscopic and histologic features of EGI in PLTR patients. In this retrospective case series we analyzed medical record of all PLTR who underwent EGD and/or colonoscopy at our institution from 2000 to 2006. From 2000 to 2006, 32 PLTR patients underwent endoscopic evaluation. Seventeen (53%) of 32 patients were diagnosed with EGI. Endoscopic abnormalities were seen in the esophagus, stomach, and small intestine in 11 (65%), 11 (65%), and four (24%) patients, respectively. Eosinophilic inflammation was seen in the esophagus, stomach, and small intestine in 13 (76%), 10 (59%), and five (29%) patients, respectively. Nine of 17 patients underwent colonoscopy and endoscopic abnormalities were seen in four (44%) patients. Five patients (56%) had eosinophilic inflammation. In conclusion, we have characterized the clinical, endoscopic, and histologic features of EGI. Histologic and endoscopic examination reveals that, when present, EGI is often found at multiple segments along the gastrointestinal tract.     

Rare causes of gastrointestinal hemorrhage in infancy

Gastrointestinal hemorrhage in children is a critical condition that demands quick and effective management. The differential diagnosis of gastrointestinal hemorrhage is wide. Heterotopic pancreas is a rare congenital anomaly and usually discovered incidentally. It is generally asymptomatic, but symptoms may occur when complicated by inflammation, bleeding, obstruction or malign transformation. Heterotopic pancreas may present throughout the gastrointestinal tract, but it is most commonly found in the stomach, duodenum and proximal jejunum. Juvenile polyps are common during childhood and present most often with painless rectal hemorrhage. They remain the most common colonic polyps in children. Colonoscopic polypectomy is the most effective procedure in the treatment of juvenile polyps. In this study, we describe rare causes of gastrointestinal system hemorrhage in infancy and discuss some diagnostic and therapeutic approaches.     

婴儿肠道菌群的形成及其与食物过敏的关系

目的　观察健康婴儿肠道菌群的定植过程及其在食物过敏症患儿的变化 ,分析肠道菌群形成与婴幼儿食物过敏的相互关系。方法　采用荧光定量PCR技术测定细菌 16SrRNA ,经与标准曲线对照计算细菌数量 ,对 71例健康无过敏症母乳喂养婴儿和 10 0例食物过敏婴儿粪便乳酸杆菌、双歧杆菌和大肠杆菌行定量检测。结果　婴儿肠道菌群处于动态定植过程 ,随生长发育 ,双歧杆菌和乳酸杆菌在肠道定植增加 ,大肠杆菌数量减少。食物过敏婴幼儿肠道乳酸杆菌、双歧杆菌数量较健康婴幼儿低 ,而大肠杆菌数量较健康婴幼儿高。结论　婴儿期肠道菌群仍处于动态演替过程。食物过敏婴儿肠道菌群与健康婴儿不同     

小儿下消化道出血的病因分析

目的分析小儿下消化道出血的临床特点与病因的联系，以提高对本病的诊治水平。方法对1996年6月-2006年6月我院小儿外科收治的551例下消化道出血患儿资料进行回顾性分析。结果551例下消化道出血患儿病因为结直肠息肉183例（33．2％），结、直肠炎132例（24．0％），肠套叠68例（12．3％），梅克尔憩室42例（7．6％），其次为肛裂、肠重复畸形、迟发性VitK缺乏症、内痔、直肠溃疡、应激性溃疡等；明确病因543例（98．5％）；急性发病患儿病因为梅克尔憩室（45．2％）、肠重复畸形（32．3％）、肠道息肉（13．3％）等，其中梅克尔憩室、肠重复畸形均伴有异位胃黏膜。结论小儿下消化道出血应根据不同年龄、不同出血部位选择有效的诊断方法，以提高病因诊断率、减少患儿痛苦及对生长发育的影响。     

婴儿肠道菌群形成与喂哺方式及食物过敏的关系

目的观察健康婴儿在不同喂养方式下肠道菌群的定植过程及其在食物过敏时的变化,分析肠道菌群形成与婴幼儿食物过敏的相互关系及母乳喂养的意义。方法采用荧光定量PCR技术测定细菌16SrRNA,对健康无过敏症131例(其中母乳喂养71例,人工喂养60例)及100例过敏症婴儿粪便中乳酸杆菌、双歧杆菌和大肠杆菌进行定量检测。结果婴儿肠道菌群处于动态定植过程。母乳喂养婴儿肠道乳酸杆菌、双歧杆菌数量较人工喂养婴儿高(P<0.05),而大肠杆菌数量较人工喂养婴儿低(P<0.05)。食物过敏婴幼儿肠道乳酸杆菌、双歧杆菌数量较健康婴幼儿低(P<0.05),而大肠杆菌数量较健康婴幼儿高(P<0.05)。结论婴儿期肠道菌群处于动态演替过程。不同的喂养方式对肠道菌群有影响,过敏性疾病婴儿肠道菌群与健康婴幼儿不同,应大力提倡母乳喂养。     

低出生体质量儿婴儿期食物过敏发生的危险因素

目的 探讨低出生体质量儿食物过敏发生的危险因素.方法 选择2007年1月1日至2011年12月31日在北京大学第三医院NICU住院治疗,出院后在食物过敏门诊就诊且符合食物过敏诊断标准的低出生体质量儿作为食物过敏组(49例),采用分层抽样的方法抽取同期在NICU住院治疗,出院后在儿童保健门诊建档随访但无食物过敏表现的低出生体质量儿作为对照组(49例).采用调查问卷的方法调查2组患儿性别、胎龄、产出方式、出院后喂养方式、父母饮酒、吸烟史、父母变应性疾病史及母孕期每日进食鸡蛋情况和婴儿期鸡蛋添加时间.同时查阅患儿住院期间的病历资料,分析患儿所患疾病、胃肠外营养、PS和呼吸机的应用情况.计数资料比较采用x2检验,计量资料比较采用t检验,多因素分析采用非条件Logistic回归分析.结果 2组患儿出生体质量、性别、产出方式、出院后喂养方式、父母烟酒暴露、母孕期每日进食鸡蛋情况、婴儿期鸡蛋添加时间及其住院期间所患的各系统疾病、胃肠外营养、PS和呼吸机应用情况比较差异均无统计学意义,而胎龄、父母变应性疾病史比较差异有统计学意义.食物过敏组中胎龄33～ 35周、36～37周患儿的比例高于对照组,胎龄29 ～32周患儿的比例低于对照组(x2=10.312,P =0.016;x2 =20.753,P =0.000).非条件Logistic回归分析显示,低出生体质量儿食物过敏的发生仅与父母一方或双方的变应性疾病史有相关性(OR=5.574,P=0.004;OR=14.487,P=0.000).结论 父母双方变应性疾病史与低出生体质量儿食物过敏的发病有关.     

Fish and shellfish allergy in children: Review of a persistent food allergy

The increased consumption of fish and shellfish has resulted in more frequent reports of adverse reactions to seafood, emphasizing the need for more specific diagnosis and treatment of this condition and exploring reasons for the persistence of this allergy. This review discusses interesting and new findings in the area of fish and shellfish allergy. New allergens and important potential cross‐reacting allergens have been identified within the fish family and between shellfish, arachnids, and insects. The diagnostic approach may require prick to‐prick tests using crude extracts of both raw and cooked forms of seafood for screening seafood sensitization before a food challenge or where food challenge is not feasible. Allergen‐specific immunotherapy can be important; mutated less allergenic seafood proteins have been developed for this purpose. The persistence of allergy because of seafood proteins’ resistance after rigorous treatment like cooking and extreme pH is well documented. Additionally, IgE antibodies from individuals with persistent allergy may be directed against different epitopes than those in patients with transient allergy. For a topic as important as this one, new areas of technological developments will likely have a significant impact, to provide more accurate methods of diagnosing useful information to patients about the likely course of their seafood allergy over the course of their childhood and beyond.