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06 April 2011, Volume 26 Issue 04 Previous Issue    Next Issue

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Research into the application of asthma control test in children. WU Jin-zhun*,Yang Yun-gang，ZHANG Jian-min，LIN Rong-jun，WANG Ci-lin，CHENG Shi，BIN 2011, 26(04): 256.  Abstract ( )   ObjectiveTo compare several tools for assessing asthma control，which were used internationally and domestically，and to explore children’s asthma control tools complying with the domestic measurement ways. MethodsBy adopting prospective，multi-centre，double-blind and control test，239 patients （totally 700 cases） were studied in Xiamen，Nanning，Haikou，Qingdao，and Chengdu，and they were observed and evaluated for three months，and recorded the levels of asthma severities，lung function values （FEV1% and PEF），the Chinese version of children Asthma Control Test （C-ACT） scores，the Chinese version of the Pediatric Asthma Quality of Life Questionnaire （PAQLQ）. Results The reliability of the ACT survey，as determined by Cronbach’s α-coefficient，was 0.8546； the FEV1% values，PEF values and C-ACT scores had very significant differences in the four levels of asthma severity respectively（P < 0.01）. The more severe the asthma was，the lower the FEV1% values，PEF values or C-ACT scores were. The percent predicted FEV1% values，percent predicted PEF values and C-ACT scores had very significant differences in the three levels of asthma control respectively. C-ACT scores of well controlled，not well controlled and very poorly controlled asthma were respectively 24.46，21.85 and 15.37. Receive operating characteristic （ROC） curve analyses signified that asthma was very poorly controlled when the C-ACT scores were less than or equal to 19，it was not well controlled when the C-ACT scores were 20，21，or 22，and it was very well controlled when the C-ACT scores were greater than or equal to 23. ACT scores correlated significantly with the symptoms domain，the activity domain，and the emotional domain on the PAQLQ through multi-independent linear regression. Conclusion The Chinese version of the C-ACT is found to be a reliable and valid tool for measuring asthma control.

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Sleep-disordered breathing in obese children. XU Zhi-fei，AN Jia-qing，LI Yu-chuan，SHEN Kun-ling. 2011, 26(04): 260.  Abstract ( )   ObjectiveTo determine the prevalence of sleep disordered breathing in obese children，and to study the relationship between obesity and obstructive sleep apnea/hypopnea syndrome （OSAHS）．MethodsChildren with obesity were included into the study consecutively. Normal weight controls were recruited as well. Questionnaires and physical examination were carried out，standard lateral neck roentgengraphy，full blood count and polysomnography （PSG），including end tidal CO2 （ETCO2） were performed. ResultsTotally 203 obese children and 171 normal weight controls were recruited. A significantly higher AHI，lower sleep efficiency and MinSaO2 were found in obese patients than their normal weight controls （P < 0.01，P = 0.018 and P < 0.01 respectively）. Among children who were obese and didn’t have adenotonsillar hypertrophy ，50.8% （31/61） subjects had abnormal polysomnograms. Among children who were obese and had ATH，81.5% （116/142） were diagnosed as having OSAHS. Obesity，tonsillar hypertrophy，and adenoid hypertrophy were independent risk factors for OSAHS （obesity：OR =  0.4，P < 0.01； adenotonsillar hypertrophy：OR = 2.1，P = 0.03；adenoid hypertrophy：OR = 4.7，P < 0.01）. There was a positive correlation between the degree of obesity and the apnea/hypopnea index（r = 0.383，P < 0.01），and an inverse correlation between the degree of obesity and the MinSaO2（r = -0.312，P < 0.01）. ConclusionObese children have a higher risk for OSAHS，and the severity of obesity was positively related to the severity of OSAHS.

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Primary investigation of fractional concentration of exhaled nitric oxide in asthmatic children. SHA Li， CAO Ling， MA Yu， LI Shuo， LOU Xiao-shang， CHEN Yu-zhi. 2011, 26(04): 264.  Abstract ( )   Abstracts：ObjectiveTo investigate the level of exhaled nitric oxide in child asthma patients. MethodsA total of 358 asthmatic children in our asthma clinic observed from October 2007 to August 2009 were divided into different groups as asthma attack group and non-attack group ，and treatment group and non-treatment group. The therapy， attack symptoms and signs of them were recorded into clinical form. Tests of spiromety and FENO were performed at the same time. ResultsFENO in asthmatic children was 28.5（15.5～55.0）×10-9， there being no significant difference between male and female. FENO in asthmatic children older than 11 years was significantly higher than in normal children［36.0（20.0～65.0）×10-9，12.6（9.5～17.1）×10-9，Z = -11.352，P < 0.001］. FENO in asthmatic children was positively correlated with age （r =  0.206， P < 0.01），not related to asthma history course or FVC， but slightly negatively correlated with FEV1 and MMEF（r =  -0.164，P < 0.01，r =  -0.176，P < 0.01）. FENO in the group of asthma attack was significantly higher than the group of non-asthma attack ［ 38.4（16.7～59.1）×10-9，26.0（15.0～51.0）×10-9；Z = -2.327， 0.01 < P < 0.05］；in the group of treatment it was significantly lower than in the non-treatment group ［24.0（13.0～48.5）×10-9，31.0（16.7～57.2）×10-9，Z = -2.215，0.05 > P > 0.01］. By analysis with ROC in children older than 11 years， the cut-off point was 17.9×10-9， sensitivity was 0.802，specificity was 0.825. Seventy-seven out of the 96 asthmatic children with normal lung function showed higher FENO and 15 out of them had asthma attack. ConclusionIt is found that FENO in asthmatic children is significantly higher than in normal children. FENO is a useful method to identify non-specific inflammation in asthmatic children from the normal children. The patients who have asthma attack or non-treatment ones have a higher FENO. Higher FENO indicates bad control or even worse condition. Patients who have no symptoms but normal lung function still have abnormal FENO. The test of FENO can be used in asthma management and its control.

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Research of viral pathogens in hospitalized children with respiratory infection in Urumuqi in two consecutive epidemic seasons from 2006 to 2008 ZHI min，SUN he . 2011, 26(04): 269.  Abstract ( )   Abstract： ObjectiveTo explore the characteristics of viral pathogens in hospitalized children with respiratory infection in Urumchi. Methods479 nasopharyngeal secretion samples were collected from the hospitalized children with respiratory infection in the People’s General Hospital of Xinjiang Uygur Autonomous Region respectively from November 2006 to April 2007 and from November 2007 to April 2008.Direct immunofluorescence was done to detect seven common respiratory viruses，including respiratory syncytial virus （RSV），influenza virusA and B （ IFu A and IFu B），parainfluenza virus 1，2，3 （ Para 1，2，3） and adenovirus （ADV）. ResultsThe positive rate of Viral pathogens was 24.3% during the epidemic season from November 2006 to April 2007，while it was 41.8%. from November 2007 to April 2008. Respiratory syncytial virus all occupied the first place in two consecutive years.The positive rate was 20.1% and 32.3% respectively. ConclusionRSV was the most important virus in hospitalized children with respiratory infection in this hospital during winter and spring. ADV and Para Ⅲ took up the second and the third place，while the other viruses were seldom.

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Continuous veno-venous hemodialysis/filtration in the treatment of acute liver failure in children：clinical analysis of 5 cases. RONG Qun-fang，ZHANG Yu-cai，Zhu Yan，CUI Yun，XI Jia-ming 2011, 26(04): 272.  Abstract ( )   Abstract：ObjectiveTo investigate the efficacy of continuous veno-venous hemodialysis/filtration （CVVHDF） in children with acute liver failure. MethodsFive cases of acute liver failure in children were treated in Shanghai Jiao Tong University affiliated Children’s Hospital from May 2009 to May 2010. Two cases were male and 3 cases female， aged from 10 months to 5 years old. The duration of disease on admission was 3 d to 14 d. Three cases of acute liver failure were caused by medicine（paracetamol）， 1 case was caused by severe sepsis，and 1 case was caused by pylephlebitis. The hepatic encephalopathy class of the patients were： 1 case （grade 2）， two cases （grade 3）， two cases （grade 4）. Besides protecting liver function drugs，we used CVVHDF to treat the patients and closely monitored the vital sign， liver function and complications. ResultsThe time of CVVHDF initiated was 2 h to 24 h after admission. The total duration of CVVHDF was 24 h to 144 h. Three cases recovered， 1 case withdrew and 1 case died. Twelve hours after CVVHDF， ALT decreased from （3888.76±2373.60）U/L before CVVHDF to （3284.80±1974.80）U/L and continued to decrease （F = 3.58， P < 0.05）. Blood ammonia decreased from （209.00±53.61）μmol/L to （158.80±60.93）μmol/L （F = 3.75， P < 0.05）， and TBIL improved after 12 h～48 h，but there was no statistical difference compared with those at the beginning of CVVHDF （F＝0.23， P > 0.05）.The blood pressure was stable during the course of treatment. ConclusionCVVHDF treatment for acute liver failure can improve clinical symptom and abnormal biochemical indicator； it may be used as an effective method for treating acute liver failure in pediatric patients.

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Study on the safety of exchange transfusion for neonates with hyperbilirubinemia. ZHANG Hui*，LI Gui-nan，YUAN Yuan-hong，ZHOU Yong，YANG Hui，SUN Zheng-xiang. 2011, 26(04): 275.  Abstract ( )   Abstract：ObjectiveTo study the influence of exchange transfusion on serum interleukin （IL-1b， IL-6）， tumor necrosis factor α （TNF-α ） and cortisol （Cor） content in neonatal hyperbilirubinemia， and to identify whether the exchange transfusion will cause stress reaction of the neonates and influence the recovery of disease. MethodsIn the Department of Neonate in Hunan Children’s Hospital between August 2009 and December 2009，56 full-term neonates who were diagnosed with neonatal hyperbilirubinemia were treated with peripheral arteriovenous dual-channel synchronous exchange transfusion. Take the first tube of blood before exchange transfusion and 24 h and 168 h blood after exchange transfusion；detect serum IL-1b，IL-6，TNF-α and cortisol content. ResultsThe cortisol content was decreased obviously at 24 h after exchange transfusion compared with that before treatment， there being significant differences（P < 0.01）. The serum IL-1b，IL-6，TNF- α content before treatment had no obvious difference compared with that at 24 h after treatment（P > 0.05）. The concentrations of each cytokine in 24 h were of no obvious differences compared with that at 168 h after treatment（P > 0.05）. The concentrations of IL-6 AND TNF- α at 168 h after treatment were of no obvious differences compared with that before treatment（P > 0.05），but the concentrations of IL-1b was increased， there being significant differences（P < 0.05）； cortisol content was decreased， there being significant  ifferences（P < 0.01）. ConclusionAt present， exchange transfusion is a mature technology，it won’t cause serious stress reaction under normative operation， and it is a safe method to cure neonatal hyperbilirubinemia.

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Study on the internal environment of neonates with hyperbilirubinemia before and after blood exchange transfusion. ZHAO Hai-yan，CHEN Hong-wu，SHEN Wei. 2011, 26(04): 278.  Abstract ( )   Abstract：ObjectiveTo discuss the influence of blood exchange transfusions on blood environment of neonates with hyperbilirubinemian. MethodsBlood exchange transfusion was performed in 74 neonates in Nanfang Hospital，Southern Medical University from Jan.2008 to May 2010.Blood bilirubin，albumin，the ratio of indirect bilirubin and albumin，blood electrolyte and blood routine were measured before and after the transfusion. Results Blood bilirubin，albumin，the ratio of indirect bilirubin and albumin and blood electrolyte（Na+、K-、Cl-、 Mg2+） decreased obviously，but Ca2+ and P3+ increased significantly. ConclusionBlood exchange transfusion can influence blood bilirubin， albumin，the ratio of indirect bilirubin and albumin，blood electrolyte and blood routine. All of them should be monitoried before and after blood exchange transfusion， especially the ratio of indirect bilirubin and albumin.It can assess the risk of bilirubin toxicity index. The higher the ratio， the higher the risk， the more need for infusion of albumin.

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Clinical research of early individualized peripheral vein nutrition in very low birth weight premature infants. FAN Li-ying，LIU Yue-kun，ZOU Li-ping. 2011, 26(04): 281.  Abstract ( )   Abstract： ObjectiveTo investigate the feasibility and treatment effect of early individualized peripheral vein nutrition in very low birth weight （VLBW） premature infants. MethodsTotally 115 cases of the VLBW premature infants who cannot bear whole  astrointestinal alimentary tract in Liuyang Women and Child Health Hospital from Aug. 2005 to Jul. 2010 were randomly divided into two groups. A  total of 58 cases in experimental group were treated with the method of individualized vein infusion nutrition after 12 hours of the birth，while 57 cases in the control group were treated with the method of classic peripheral vein nutrition. The calories of supply per kilogram was calculated，the time of regaining  the birth weight and the body weight was observed everyday during the time of vein nutrition. The body weight during the time of vein nutrition and the time required for total gastroenteric nutrition were measured everyday，the body weight and the blood glucose was measured everyday， and the girth of the head and the length of the body was measured per week. The liver function，the kidney function，the blood lipid，the blood glucose，，the electrolyte，the blood routine and the ALP was also tested in the two groups during the time of hospitalization . The  omplications of vein nutrition were observed and the statistical analysis was done. ResultsThe calories of the experimental group were clearly higher than the control group at the same day age in a week. The difference was statistically significant （P < 0.05）. The time of regaining birth weight，and the time required for total gastroenteric nutrition at the experimental group were clearly shorter than the control group .The difference was statistically significant （P < 0.05）.The difference between the experimental group’s albumin after 14 days of hospitalization and the control groups’ 72 hours of hospitalization was statistically significant （P < 0.05）. The time to get to the weight of 2kg in the experimental group is clearly shorter than the comparative group. The difference was statistically significant （P < 0.05）. Both groups didn’t have a increase of the risk of metabolic acidosis，the PNAC，the Lipid Metabolism Disorder，the Hyperbilirubinemia or the kidney lesion. There were no clear differences between the ALP，but the difference between the VLBWIs’ ALP after 14 days and 72 hours of hospitalization was statistically significant （P < 0.05）. ConclusionThe early individualized peripheral vein nutrition showed well tolerated，the gaining of weight is faster，and required a shorter time to get total gastroenteric nutrition.There were no complications were increased.

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Congenital idiopathic chylopericardium—a case report and review of the literature. LI Min，SUN Zheng-yun，YU Yong-hui，YANG Bo，LIN Xia，WANG Yi. 2011, 26(04): 286.  Abstract ( )   Abstract：ObjectiveTo report a newborn case of congenital idiopathic chylopericardium associated with chylothorax about its clinical features，ancillary diagnostic tests，treatment and prognosis. MethodsA newborn case diagnosed with congenital idiopathic chylopericardium associated with chylothorax was admitted to the Pediatric Intensive Care Unit of Provincial Hospital Affiliated to Shandong University. Its clinical features，treatment and follow-up data were analyzed，and a brief review of the literature was presented. ResultsBulk chylopericardium associated with chylothorax was detected with ultrasonography in fetus during antepartum. The child presented no obvious symptoms after birth. Chest X-ray demonstrated enlargement of the cardiac silhouette （cardiac/chest ratio was 0.75）. Echocardiography revealed pericardial effusion. Computed tomography of the chest did not reveal any lesion obstructing the thoracic duct. The chylous nature of the fluid was confirmed by demonstration of chylomicrons and high levels of triglycerides at puncture pricardiocentesis. After pericardial drainage by pricardiocentesis for three times failed，a catheter was left in the pericardium for drainage. Two days later the patient was cured. At 1 week and 1 month after operation he was doing well and echocardiography did not reveal any signs of recurrence. Conclusion Primary idiopathic chylopericardium is a rare clinical entity with obscure etiology. In most cases chylopericardium is only confirmed by pericardiocentesis. Pericardiocentesis and pericardial drainage are effective conservative treatment options. Surgery should be considered for the patients with recurring chylopericardium.

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Effect of recombinant human growth hormone therapy on GHD patients and establishment of prediction model. WU Hua-hong，LI Hui，SUN Shu-ying 2011, 26(04): 289.  Abstract ( )   Abstract：ObjectivesTonalyze the effect and influencing factors of GH therapy on GHD patients，and to establish the growth prediction model for patients on GH therapy. MethodsGrowth velocity （GV） and delta in height SDS （ΔHTSDS） were used as outcome variables of growth responses to rhGH therapy. We used the new growth standard of Chinese children in 2009 to calculate the HtSDS and WtSDS of patients by the generally accepted method of LMS. Seventy patients diagnosed with GHD and MPHD who accepted rhGH therapy and regularly revisited were chosen as model group. Then retrospectively analyze the effect and influencing factors of their GH therapy. Based on the result of simple correlation analysis，we established prediction models on therapy effect in the first year by multiple liner regression. Meanwhile，15 patients with growth deficiency under therapy of rhGH were prospectively followed up for at least one year to validate our models. Results The height increment of patients receiving therapy was 10.56 cm （0.93 SDS） in the first year，during which the ΔHtSDS and GV during the first 3 months were all larger than those in 3～6 months，6～9 months and 9～12 months. The height increment was 7.99 cm （0.73 SDS） in the second year. According to the simple correlation analysis and multiple liner regression，we found that GV and ΔHTSDS in the first year were negatively correlated with patients’ age and differences between height SDS and middle parent height SDS at start of therapy，while positively correlated with their weight SDS and bone age retardation. Also，the growth responses in the first 3 months of therapy were found positively correlated with the response later，so we established a model on ΔHTSDS in the first year for this. All these 3 models were found to be significant at a level of P < 0.05，R2 ranging from 0.199～0.473. There were no significant differences between actual and predictive responses both in model and validation groups. ConclusionDuring therapy，we find the effect of earlier therapy is better than later， especially in the first 3 months. Our prediction models for children with GHD can be used to predict therapy response and provide guidance for clinical practice. We should pay more attention to the evaluation of effect in the first three months， which can be a good predictor of the therapeutic effect later.

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Relationship between genotype of hepatitis B virus and clinical classification in children with chronic hepatitis B. LEI Xiao-yan，SUN Yong-hong ，YANG Ju-lan，YUAN Hong. 2011, 26(04): 294.  Abstract ( )   Abstrct：ObjectiveTo study relationship between genotype of hepatitis B virus and clinical classification in chidren with chronic hepatitis B in Gansu province. MethodsTotally 124 HBV-DNA positive chidren with chronic hepatitis B were randomly enrolled，84 of whom were males and 40 were females. Among 124 patients，there were 65 cases of HBV carriers，chronic hepatitis （mild in 31 cases，18 cases of moderate and severe in 10 cases）. The genotypes of their serum HBV，liver function，preoperative blood coagulation and HBV-DNA load were detected. ResultsAmong the serum samples of 124 cases，C genotype existed in 62 cases（50.0％），B in 48 cases（38.7％），B/C in 9 cases（7.3％）， non B/C in 5 cases（4.0％）. In HBV carriers and mild group，the Bgenotype was 47.7% and 45.2% respectively，while in moderate and severe group，the C genotype was 72.2% and 80% respectively. As for B and C genotype distribution，there was significante difference between HBV carriers and mild group and moderate and severe group； DNA，ALT，AST and TBIL in C genotypes were higher than B. Compared with patients with genotype B，PT grolonged and PTA and FIB decreased in Cgenotype patients，the difference being significant. In genotype B and C，the ratio of mother to child transmission had no significant difference. ConclusionGenotype C and B HBV are mainly found in chidren with chronic hepatitis B in Gansu province，and genotype C is predominant. The liver pathological damage levels of genotype C in chidren with chronic hepatitis B is more serious ，and the viral load is higher than that of genotype B. Detection of Hepatitis B virus genotypes is of great importance in guiding therapy，assessment of prognosis and early prevention.

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Dynamic changes of DWI compared with conventional MRI in newborns with hypoglycemic brain damage. YAO Li， FU Jian-hua， XUE Xin-dong，WANG Xiao-ming， HUANG Wan-jie， GUO Jing. 2011, 26(04): 297.  Abstract ( )   Abstract：ObjectiveTo evaluate the dynamic changes of diffusion weighted imaging （DWI） and conventional MRI in neonatal hypoglycemic brain damage. MethodsTwenty neonates with hypoglycemic brain damage diagnosed by MRI from September 2005 to September 2008 were reviewed retrospectively. The clinical data were compared with the data from another 20 neonates with normal MRI findings after hypoglycemia（control subjects）. ResultsCompared with control subjects， the case subjects had lower mean lowest blood glucose level（P < 0.01）.Case subjects’ duration of hypoglycemia was longer than control subjects’（P < 0.01）. In case subjects， the first MRI scan was performed from 1 days to 11 days after hypoglycemia onset， the average being 3.8 days. The occipital and parietal cortex and white matter was involved most frequently，and occipital region was involved in 11 cases，parietooccipital region 8 cases， parietal region 1 case. All involved regions showed hyperintensive signals on DWI； normal signals on both T1WI and T2WI were seen in 12 cases； hypointensity on T1WI and hyperintensity on T2WI were seen in 6 cases. Eleven cases received second scan from 8 days to 15 days after first scan， the average being 11.4 days， 7 cases showed normal signals on DWI. While other 4 cases showed hypointensity. Hypointensity on T1WI and hyperintensity on T2WI were demonstrated in all 11 cases. Three cases was followed-up at 6 months of age，and MRI scan showed normal signals on DWI， hypointensity on T1WI and hyperintensity on T2WI. ConclusionThe sites which show hyperintensive signals on DWI at the early stage of disease are consistent with the foci which show hypointensity on T1WI and hyperintensity on T2WI in subsequent follow-up by conventional MRI. This consistency suggests that DWI seems to be a sensitive early diagnostic measure for disease.

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Influence of Ambroxol Hydrochloride and Clenbuterol Hydrochloride Oral Solution on airway function of children with capillary bronchitis. YU Jia-lu，DENG Li，LIU Ying，CHEN Chen. 2011, 26(04): 301.  Abstract ( )   Abstract：ObjectiveBy observing lung function changes of children with capillary bronchitis after the treatment of  Ambroxol Hydrochloride and Clenbuterol Hydrochloride Oral Solution，access its influence upon airway resistance of children. Methods93 children with capillary bronchitis were randomly divided into treatment group （with Ambroxol Hydrochloride and Clenbuterol Hydrochloride Oral Solution） and control group. Shape changes of TBFV and changes of main indexes of lung function were observed. ResultsThe TBFV of both groups showed narrowing down，abrupt ascending limb on breath curve，peak brought forward，and descending limb sunk like wave trough. After treatment，the shapes of TBFV of both groups were greatly improved. Comparing main parameters of two groups before treatment，there was no marked difference （P > 0.05）. After treatment，respiratory rate （RR），peak expiratory flow （PEF），respiratory system resistance （Rrs），and functional residual capacity per kilogram weight （FRC/kg） were all reduced， difference being marked （P＜0.05），while tidal volume per kilogram weight （VT/kg），inspiratory/expiratory （TI/TE），peak time of expiratory flow （TPTEF），time to peak ratio （TPTEF/TE），volume in peak time of expiratory flow （VPTEF），volume ratio in peak flow （PFV），MEFR with 75% tidal volume/peak expiratory flow （25/PF），tidal expiratory interim flow velocity/tidal inspiratory interim flow velocity （ME/MI） and compliance per kilogram weight （Crs/kg）were all increased， difference being marked （P＜0.05）. Compare treatment group with common group， obvious improvement was shown on airway obstruction main indexPFV，25/PF and ME/MI，and compliance of lung，Rrs of airway resistance，and FRC/kg were obviously improved， the difference also being meaningful. ConclusionAmbroxol Hydrochloride and Clenbuterol Hydrochloride Oral Solution shows marked clinical efficacy in improving airway resistance of children with capillary bronchitis.