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06 January 2012, Volume 27 Issue 1 Previous Issue    Next Issue

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Clinical features of early preterm infants，late preterm infants and full term infants with respiratory distress syndrome. XU Fa-Lin, BAI Qiong-Dan, PENG Fang-Chi, DUAN Jia-Jia 2012, 27(1): 34-38.  Abstract ( )   Abstract： Objective　To investigate the different clinical characteristics of neonatal RDS with various gestational ages and to provide a new basis for clinical therapy. Methods　A total of 963 cases of RDS infants in the Third Affiliated Hospital of Zhengzhou University from Jan.2006 to Dec.2010 were divided into early preterm infants group （ < 34 weeks，679 cases），late preterm group （34 ～ < 37 weeks，204 cases），and full-term group （≥ 37 weeks，80 cases） according to gestational age respectively，and the general situation，risk factors，clinical condition，prognosis and complications in each group were analyzed. Results　There was an increasing tendency for the incidence of RDS，which predominantly happened in the early preterm infants. What’s more，the prevalence of RDS in late preterm infants and term infants was increased. The proportion of RDS in the male was higher than the female （P < 0.05），especially when the gestational ages and weight were greater. The antenatal use of glucocorticoid in full-term RDS infants was significantly lower than the preterm infants. The risk factors of preterm RDS were closely relevant to the rupture of membranes，placental abnormalities，women with pregnancy-induced hypertension，while those of the full-term newborns with RDS were frequently related to selective cesarean section. The time window of the diagnosis of the full-term RDS was later than that of the preterm RDS. The application of mechanical ventilation to full-term RDS infants was significantly more than to the preterm infants while the clinical cure rate was significantly higher（P < 0.05），but the mortality rate was not different，and more pulmonary infection and pneumothorax occured in full-term group consequently. Conclusion　The incidence of neonatal RDS is increasing yearly and the prevalence of RDS in late preterm infants and term infants increase. The different clinical characteristics between the preterm RDS and full-term RDS lie in the morbidity，sex ratio，risk factors，clinical characteristics，treatment response and complications etc. The gestational age factor should be considered to diagnose and treat RDS. The full-term RDS which are characterized by relatively late onset and complication of pneumothorax，has a close relation to elective cesarean section and infection，should be paid more attention to in the future.

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Risk factors for periventricular-intravenricular hemorrhage in very low birth weight infants. JIANG 　Gong, SONG Zhen-Feng, LI Xiang-Gong, LI Liang-Liang, LIU 　Yan, LIU Dong-Yun, SHU Zhi-Rong 2012, 27(1): 39-41.  Abstract ( )   Abstract： Objective　To investigate the high risk factors for periventricular-intraventricular hemorrhage （PVH-IVH） in very low birth weight infants（VLBWI）. Methods　From October 2009 to November 2010 in Hospital of Medical College，Qingdao University，39 VLBWI diagnosed with PVH-IVH were reviewed，and the control group consisted of 78 VLBWI without PVH-IVH，who were matched for gestational age and birth weight to each case of PVH-IVH. The data of 117 VLBWI were analyzed by 1 ∶ 2 conditional Logistic regression analysis of SAS 9.0. Results　Totally 39 of 130 VLBWI were found to have PVH-IVH，indicating an incidence of 30.00%. The 1 ∶ 2  conditional Logistic regression analysis showed that vaginal delivery（OR = 1461.699，CI 7.216～296094.700，P < 0.0001），intrauteral embarrassment（OR = 95.172，CI 2.213～4093.612，P = 0.0006），mechanical ventilation（OR = 65.124，CI 2.258～1878.432，P = 0.0228），patent ductus arteriosis （PDA） （OR = 42.051，CI 1.935～913.839，P = 0.0283），hyponatremia（OR = 33.415，CI 0.936～1192.593，P = 0.0475 and hypocalcemia（OR = 25.175，CI 1.328～477.243，P = 0.0325）were the main risk factors for PVH-IVH in VLBWI，and antenatal steroid treatment（OR = 0.061，CI 0.004～0.884，P = 0.0017）was the protective factor. Conclusion　Vaginal delivery，intrauteral embarrassment，mechanical ventilation，PDA and the electrolyte disturbances were the risk factors for PVH-IVH in VLBWI，and antenatal steroid treatment could protect the VLBWI from PVH-IVH，suggesting that PVH-IVH results from the reaction of many factors. These findings can be used to improve the quality of premature infants.

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Comparison of neonatal critical illness score with score for neonatal acute physiology，perinatal extension，Version II in predicting mortality risk in critically ill neonates.　 QIU Ru-Xin, YANG 　Chi 2012, 27(1): 42-44.  Abstract ( )   Abstract：Objective　To compare the advantages of critically ill neonates mortality risk prediction between neonatal critical illness score and score for neonatal acute physiology，perinatal extension，Version II （SNAPPE-II） and to research for the better neonatal disease severity scoring system feasible for use in our country. Methods　The 525 neonates，who were in neonatal intensive care unit（NICU） from Jan 2008 to Dec 2008 in the Zhongda Hospital affiliated to Southeast University，were scored by NCIS and SNAPPE-Ⅱ simultaneously.According to the scores the patients were divided into three groups （very critical group， critical group， non-critical group），and mortality rates were compared in each group.At the same time we drew the receiver operating characteristic curve （ROC） and counted out their areas under the ROC curves to observe the specificity and sensitivity of two scoring systems in predicting the risk of death in critically ill neonates. Results　The comparison between NCIS and SNAPPE-Ⅱscore：the differences were not statistically significant in mortality between the non-critical and the very critical subgroups（P > 0.05）； the difference between the two critical subgroups was statistically significant in mortality （P < 0.05）；the area under the ROC curve （AUC）：NCIS 0.934， SNAPPE-Ⅱ0.926. The differences were not statistically significant in AUC between NCIS and SNAPPE-Ⅱ. Conclusion　SNAPPE-Ⅱcan predict mortality risk in critically ill neonates earlier and more accurate and clinical application is easy.SNAPPE-Ⅱshould be used generally. NCIS's ability to distinguish critically ill newborns is better than SNAPPE-II， but cannot guide the clinical decision-making.

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Effects of dust mite allergen-specific immunotherapy on prevention and cure in children with asthma and allergic rhinitis and the reasons of symptom exacerbation during specific immunotherapy.　 TAN Yong-Jiang-1, BAO Yi-Xiao-2, CHEN 　Jin-1, XIE Gui-Yun-1, CHEN 　Liu-1 2012, 27(1): 45-48.  Abstract ( )   Objective　To evaluate the effects of dust mite allergen-specific immunotherapy combined with standardized management on prevention and cure in children with asthma and allergic rhinitis and analyze the reasons of the asthma and allergic rhinitis symptom exacerbation during specific immunotherapy. Methods　One hundred and two children with established diagnosis of allergic asthma and allergic rhinitis to dust mite were enrolled in this study from january 2006 to december 2010，of whom 78 children received the treatment with specific immunotherapy（SIT） combined with standardized management for 2 to 4 year（as the test group）and the other 24 served as the control group with inhaled corticosteroids according to Global Initiative for Asthma （GINA） and Allergic Rhinitis and its Impact on Asthma（ARIA） in the same time. At the beginning，6 months，1 year，2 years of the treament and 1 year after the treament，the clinical symptom and acute episode，pulmonery function（Peak Expiratory Flow，PEF） and Chinese children asthma control test （Ch-CACT） of the asthmatic children，symptem scores and Visual Analogue Scale（VAS） of allergic rhinitis were analyzed，while respiratory tract infection of all the patients were recorded at the second year and after 1 year of the treatment. The reasons of the asthma and allergic rhinitis symptom exacerbation during dust mite allergen-specific immunotherapy were analyzed. The data were analyzed by SPSS15.0. Results　Compared with control group，the frequency of acute episode，the frequency of respiratory tract infection in test group were significantly decreased at the 2 years of the treament and 1 year after the treament. The PEFof asthmasic children were obviously improved in the test group at the 2 years of the treament and 1 year after the treament and the Ch-CACT were more higher in the test group than the control group at 1 year after the treament. Compared with control group，the symptem scores and VAS of allergic rhinitis were significantly increased in test group at the 6 months，1 year，2 years of the treament and 1 year after the treament.The common reasons of the asthma and allergic rhinitis symptom exacerbation during specific immunotherapy were climatic factor，respiratory tract infection，nasosinusitis and improper room cleared，etc. Conclusion　The dust mite allergen-specific immunotherapy can enhance the PEF and Ch-CACT of the asthmasic children，can obviously improve the symptem scores and VAS of allergic rhinitis and it is a persistent and effective means on prevention and cure in children with allergic rhinitis and asthma . The climatic factor，respiratory tract infection，nasosinusitis are common reasons of the asthma and allergic rhinitis symptom exacerbation during specific immunotherapy.

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Application of gastroscopy to early diagnosis of Henoch-Schonlein purpura（HSP） in children.　 ZHANG Yan-Hui, SHU Chao-Min, HU Hua-Jian 2012, 27(1): 49-52.  Abstract ( )   Objective　To study the gastroscopical features and to evaluate the application value of gastroscopy to early diagnosis of Henoch-Schonlein purpura（HSP） in children. Methods　There were 79 children involved in a retrospective analysis，who underwent gastroscopy and had HSP as final diagnosis between January 2009 and May 2010 in Children’s Hospital of Chongqing Medical University. Results　Gastroscopic findings included diffused congestive edema，widespread erosions and ulcerations in gastroduodenal mucosa while the mucosal ecchymosis highlighted the pathological changes，which were similar to the purpura in skin. More distal the gastroscopy reached along upper gastrointestinal track，more severe the mucosal lesions manifested，as was especially significant in descending duodenum．To respond to clinical requirements，we pushed the gastroscope-tip to jejunum-input in one of all 79 cases. Conclusion　Typical endoscopic findings in gastroduodenal mucosa helps to make early diagnosis of HSP，especially HSP without purpura；gastroscopy can show the severity of gastrointestinal mucosal damages and be a guidance to clinical therapy. Finally，what we have to highlight is that it’s necessary to make the gastroscope-tip reach jejunum-input for higher detection rate during the gastroscopic operation in early diagnosis of HSP in children.

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Relationship between antral mast cell and electrogastrography in pediatric functional dyspepsia.　 QIN Zhao-Yuan-1, SU Ji-Ji-1, HE 　Zhen-2, XIE Hui-Xia- 2 2012, 27(1): 53-56.  Abstract ( )   Objective　To investigate the association of mast cells（MC）desity and their activation states with electrogastrography（EGG） in pediatric functional dyspepsia（FD）. Methods　From Jan.2007 to Jan.2010，40 consecutive patients from pediatric clinic in the First Affliatied Hospital of Sun Yat-sen University diagosed with FD according to Rome Ⅲ criteria were recruited in our study. After an antral biopsy was obtained for calculating the amount and degranulation index of MC，the EGG was recorded for all patients. Results　（1）With a mean of（65.7 ± 23.9）%，MC degranulation index was > 50% in 82.5% patients.（2）MC density increased in patients with abnormal EGG（P < 0.05），compared with the normal EGG.（3）The percentage of preprandial normal slow waves was decreased in patients with increasing mean MC density（P = 0.005） and in patients with increasing peak MC density（P = 0.01）. （4） MC degranulation index wasn't correlated with EGG；（5）Increasing mean MC density and increasing peak MC was associated with a decreased percentage of preprandial normal slow waves（P < 0.05）. Conclusion　There is a negative correlation between EGG abnormalities and elevated MC density in pediatric patients with FD. MC may mediate the generation and development of FD through influencing EGG.

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The treatment and prognosis of myoclonic atonic epilepsy. DENG 　Jie, ZHANG Ru-Hua, YANG Zhi-Xian, LIU Xiao-Yan, XIONG 　Hui, WANG 　Shuang, JIANG Yu-Wu, QIN 　Jiong, TUN Xi-Ru 2012, 27(1): 57-61.  Abstract ( )   Objectives　To summarize the treatment，EEG evolution and prognosis of myoclonic atomic epilepsy（MAE），and to provide a reference for selection of treatment program and evaluation of prognosis. Methods　MAE patients were diagnosed in Pediatric Department of Peking University First Hospital from November 2005 to December 2010. The treatment effects，EEG evolutions，and prognosis of MAE patients were followed up. Results　In 48 MAE patients，41 were male and 7 were female. The patients were followed up from 8 months to 5 years and 5 months. Seizures were controlled by antiepileptic drugs（AEDs）in 42 patients （87.5%）.The AEDs included valproate （38 cases），lamotrigine （25 cases），levetiracetam （10 cases），clonazepam （9 cases），and topiramate （8 cases）.The seizures of 2 patients were controlled by adrenocorticotropic hormone（ACTH）.In 44 seizure-free patients，the interictal generalized spike and wave discharges （GSWDs） disappeared in 36 patients in their course of 7 to 49 months，the EEG returned normal in 30 patients in their course of 7 to 44 months，θ rhythm existed in 6 cases. Cognitive decline were observed in 11 cases （22.9%）. Status epilepticus，tonic seizures，uncontrolled seizures，and continuous EEG discharges were associated with cognitive decline. Conclusion　Valproate and lamotrigine are more effective on MAE compared with other AEDs.After seizures have been controlled，the interictal GSWDs disappear first，and the background θ rhythm disappear later.The majority of MAE patients obtain a better prognosis by rational choice of AEDs for the treatment.

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Mevalonic aciduria： one case report and literature review. 2012, 27(1): 62-65.  Abstract ( )   Objective　To report one case of mevalonic aciduria（MVA） in China and its outcomes of long-term follow-up. Methods　The clinical features，treatment and follow-up data of a case diagnosed as MVA in Guangzhou Women and Children’s Medical Center was analyzed，and related literature was reviewed. Results　This 6-year and 6-month old boy presented with recurrent episodes of fever，lymphadenopathy，and hepatosplenomegaly. Laboratory tests revealed moderate elevation of erythrocyte sedimentation rate，C-reactive protein，leukocytes and serum IgA．Remarkable elevations of urinary mevalonic acid were confirmed by gas chromatography/ mass spectrometry （GC/MS） analysis. After intermittent maintenance therapy with Coenzyme Q10，Vitamin C and E for 4 years and 8 months，recurrence of fever gradually diminished over the years but still occurred 1～2 times/month accompanied by rash and painful joint. Conclusion　MVA should be suspected in patients with recurrent episodes of fever combined with lymphadenopathy，hepatosplenomegaly and nervous system symptoms. Urinary organic acid analysis with GC/MS is critical to the early diagnosis.